Acute Diarrhea
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ACUTE DIARRHEA
Patients with diarrhea are best classified into those with acute (<2 to 3 weeks) versus those with chronic (>2 to 3 weeks) diarrhea. Acute diarrhea (Table 9-4 ) is usually self-limiting, although some conditions may be severe and cause mortality, such as acute hemorrhagic gastroenteritis, parvoviral disease, parasites (e.g., hookworms), or intoxication. History should explore the possibility of recent dietary change or exposure to infectious agents. Diet, bacteria, viruses, and parasites are the major identifiable causes of acute diarrhea in dogs and cats. Because intestinal parasites may contribute to any diarrheic state, multiple fecal examinations (direct and flotation) are warranted in all diarrheic patients. Giardiasis may be particularly occult and require special diagnostic techniques (see Fecal Giardia Detection).
TABLE 9-4
Major Categories of Causes of Acute Diarrhea in Dogs and Cats
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Feeding with bland or hypoallergenic diets may be diagnostic and therapeutic. Depressed, weak, and dehydrated patients should undergo electrolyte and acid-base evaluations to aid in selecting fluid replacement therapy. All patients less than 12 to 14 weeks of age and those that are emaciated or weighing less than 5 pounds should undergo blood glucose monitoring to detect secondary hypoglycemia. Febrile or depressed patients should undergo CBC analysis so that sepsis or transmural inflammation can be detected. To identify the cause of acute diarrhea that is not the result of diet or parasites (such as that occurring in kennels, pet stores, shelters, and households where more than one member has diarrhea), fecal cultures for Salmonella spp.,Campylobacter jejuni, Yersinia enterocolitica, verotoxin-positive Escherichia coli, and other pathogens plus viral identification methods (i.e., ELISA, electron microscopy) or toxin identification methods (i.e., ELISA for Clostridium perfringen s or Clostridium difficile toxins) or both may be used.
Not all patients with canine parvoviral diarrhea are severely ill, have identifiable leukopenia, have diarrhea, or have a fever. Leukopenia may persist as briefly as 24 to 36 hours and can easily be missed if a CBC is not performed during that period. Other diseases causing severe sepsis (i.e., perforating linear foreign body with peritonitis or overwhelming salmonellosis) can cause leukopenia indistinguishable from that of canine parvoviral diarrhea. Routinely used vaccination schedules do not necessarily guarantee protection against canine parvovirus. Finally, fecal shedding of viral particles may not occur for 1-3 days after signs begin and decreases rapidly with time. In-house ELISA tests for parvovirus are performed on the feces and appear to be accurate in identifying the parvoviral antigen, but testing may be negative if done too early or too late. The test result should be strongly positive within 3 days of the onset of clinical signs and remain positive for several days. A recent vaccination may result in a weakly positive fecal ELISA.
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Reference:
Published online 2009 May 15. doi: 10.1016/B0-72-168903-5/50014-8
Gastrointestinal, Pancreatic, and Hepatic Disorders
Michael D. Willard and David C. Twedt