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Acute diarrhea is usually ___________, except in specific cases when...
self-limiting; a specific etiology is known (parasites) [deworming is never wrong, give fluids if necessary]
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What should you not do with an animal with diarrhea?
do not withhold food (unless intractable vomiting)
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What is a recommendation that vets have historically made for animals with acute diarrhea that is no longer recommended?
giving rice and chicken instead of dog food
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What are specific bacterial or protozoal enteropathogens for which antibiotics are indicated? (3)
Clostridium, Giardia, E. coli
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Antibiotic- responsive diarrhea is aka _____________; effects that antibiotics are thought to have in these cases include...
intestinal dysbiosis; immunomodulatory effects, specific alteration of gut flora.
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What are the most commonly used antibiotics with acute diarrhea? (2)
Metronidazole, Tylosin
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What findings on the GI panel are associate with intestinal dysbiosis?
low cobalamin, high folate
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When are antibiotics NOT indicated? Why?
uncomplicated, non-infectious diarrhea; may adversely affect normal GI flora, may promote antibiotic resistance
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What are options for diet trials? (4)
novel ingredient, hydrolyzed, highly digestible, home-cooked
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Describe what "hydrolyzed diet" means.
- reduced protein size--> reduced allergenicity (gut can't recognize it as an antigen anymore)
- the carbohydrates are intact
- typically highly digestible
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The highly digestible diets generally have low _________, so this can lead to...
fiber (and fat); animal's small bowel signs improve, but they start have large bowel signs (b/c the fiber is so low)--> add metamucil
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Describe typical "highly digestible" diets.
~90% digestible, low-to-moderate in fat, NOT novel ingredient or hydrolyzed
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When are "low fat diets" useful?
in dogs with fat intolerance, certain PLEs
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What are Dr. Parker's opinions on home-cooked diets?
no inherent benefit, most recipes do not provide complete and balance nutrition (get a vet nutritionist on board), can formulate a novel ingredient diet, typically excellent digestibility
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Fiber is a component of ____________ but it is unique because...
dietary carbohydrate; resists enzymatic digestion in the SI.
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Fiber can benefit animals with...
diarrhea AND constipation.
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What are 2 characteristics of fiber that can be quantified?
solubility and fermentability
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Sources of soluble and insoluble fiber.
- Soluble: oatbran, barley, nuts, seeds, beans, lentils, fruits, veggies
- Insoluble: whole wheat, whole grain, veggies, wheat bran
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Describe the mechanism and consequences of soluble fiber.
binds excess water in intestine, reducing water content in stool, increasing viscosity, slowing GI transit time
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What are the results of fermentation in the intestines?
short-chain fatty acids,which benefit colonocyte health and reduce colonic pH, impeding pathogen growth
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What happens when you have too many short-chain fatty acids?
osmotic diarrhea (too much soluble fiber)
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Describe the mechanisms of insoluble fiber.
bulking agent, stretching of intestinal wall, stimulating peristalsis
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What can cause low cobalamin?
chronic enteropathies and EPI
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How does cobalamin deficiency contribute to intestinal disease? (2)
villous atrophy, mucosal inflammation
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Cobalamin is supplemented by what means?
parenterally, orally (brand new product)
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What are criteria for efficiency of probiotics? (2)
live microorganisms, adequate amounts
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What are the purported benefits of probiotics? (3)
establish healthy intestinal microflora, compete with pathogenic bacteria to colonize intestinal mucosa, support immune system
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What is a prebiotic?
non-digestible dietary substances that get fermented and enhance good flora (like fiber....)
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What are criteria for classification as a prebiotic? (3)
resistance to digestion in GI tract, fermentable, selective for stimulation of "good" flora
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What drugs decrease GI motility?
- opioids (loperamide), anticholinergics (atropine)
- NOT INDICATED IN THE MAJORITY OF CASES, atropine may cause ileus
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List immunosuppressive agents.(5)
- corticosteroids (Pred, Budesonide)
- Azathioprine
- Cyclosporine
- Chlorambucil
- Mycophenelate mofetil
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Side effects of corticosteroid use. (4)
PU/PD, polyphagia, muscle atrophy, insulin resistance (with chronic use)
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Describe the unique characteristics of Budesonide.
steroid with high topical activity and low systemic activity, rapidly metabolized in liver, well-tolerated, used for GI and respiratory disease
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What is the most common second line drug for immunosuppression with IBD?
cyclosporine
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What are side effects of azathioprine? (3)
hepatotoxicity, BM suppression (don't use in cats!!!), GI upset
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What is Chlorambucil?
alkylating chemotherapy agent, adjunctive therapy for refractory IBD and GI lymphoma, monitor CBC (BM suppressant)
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What are mycophenelate side effects?
transient GI upset, generally well-tolerated immunosuppressant
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