Diarrhea, Chronic

Diarrhea, Chronic



Basic Information image



Definition


Persistent or intermittent diarrhea of at least 1-month duration



Clinical Presentation



History, Chief Complaint




• Persistent or intermittent diarrhea for longer than 1 month


• Variable appetite


• Variable signs of abdominal pain; diarrhea often occurs in the absence of colic or inappetence


• ± Weight loss



Physical Exam Findings




• Poor body condition is often noted.


• Other findings are quite variable. No abnormalities other than diarrhea may be present, or clinical signs of dehydration and toxemia, as for acute colitis (see “Colitis/Diarrhea, Acute” in this section), may be noted.


• Rectal examination:


• Often within normal limits.

• Thickened rectal or colonic mucosa may be noted.

• Rarely, mural or intraluminal intestinal masses are palpated.


Etiology and Pathophysiology


A variety of distinct etiologies can manifest with chronic diarrhea via a variety of mechanisms, including:



• Partial large colonic obstruction, such as an enterolith or mural intestinal neoplasia. This may irritate the colonic mucosa or intermittently partially obstruct the colonic lumen, only allowing passage of softer fecal material around the obstruction.


• Sand enteropathy: sand irritates and inflames the colonic mucosa.


• Infectious causes, such as parasitism or salmonellosis, or rotavirus in foals. These also result in damage to and chronic inflammation of the colonic mucosa.


• Primary infiltrative or inflammatory intestinal disease impairs the normal absorptive capacity of the colonic mucosa.


• Colonic fibrosis secondary to previous severe acute colitis. This also impairs the normal absorptive capacity of the colonic mucosa.


• Gastroduodenal ulcer disease in foals is presumed to alter the absorptive function of the small intestine, which may overwhelm the colonic absorptive capacity in the less mature colon of a foal.


• Maldigestion or abnormal fermentative function of colonic flora may be caused by slight alterations in the nonpathogenic colonic flora population, resulting in altered volatile fatty acid synthesis or absorption, which may impair colonic water and electrolyte absorption.


• Other systemic disease, such as hepatic disease and congestive heart failure may cause portal hypertension, altering fluid dynamics in the colonic vasculature and impairing water absorption.



Diagnosis image



Differential Diagnosis




• Partial large colonic obstruction (enterolith or mural intestinal neoplasia)


• Sand enteropathy


• Infectious causes: parasitism, salmonellosis


• Colonic fibrosis secondary to previous severe acute colitis


• Primary infiltrative or inflammatory intestinal disease


• Abnormal fermentative function of colonic flora (altered volatile fatty acid synthesis or absorption)


• Gastroduodenal ulcer disease in foals


• Rotavirus in foals


• Hepatic disease


• Congestive heart failure

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Diarrhea, Chronic

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