Page 256 - WSAVA2018
P. 256

 25-28 September, 2018 | Singapore
WSV18-0203
TIPS FROM THE EXPERTS FOR THE MANAGEMENT OF...
CHRONIC DIARRHEA IN DOGS
N. Prakash1
1Mount Pleasant Veterinary Centre, Small Animal Medicine, Singapore, Singapore
TIPS FROM THE EXPERTS FOR THE APPROACH AND MANAGEMENT OF
CHRONIC DIARRHOEA IN DOGS
Nathalee Prakash BSc BVMS (Hons) FANZCVS (Canine Medicine)
Mount Pleasant Veterinary Centre samedicine@mountpleasant.com.sg Definition
Chronic diarrhoea is used in dogs with diarrhoea lasting for longer than a three-week duration. It is a clinical sign that may result from primary gastrointestinal or extra- gastrointestinal diseases but is usually associated with chronic enteropathies.
Causes
In a recent publication by Volkman et al., primary gastrointestinal disease was found in 90% of the 136 dogs with chronic diarrhoea.1Of these, inflammatory diseases were the most prevalent (71%; FRD 66% dietary responsive, 23% SRD, 11% ARD), with infectious and neoplastic diseases less frequently characterised.1 10% of cases had metabolic aetiologies, including exocrine pancreatic insufficiency, endocrine, hepatic, renal and cardiac disease.
Approach
I) History and Clinical Examination
Useful information includes establishing the nature of diarrhoea, the demeanour of patient, the presence of weight loss, the presence of vomiting and associated frequency, appetite, and presence of puritis. Dietary history should include treats, access to table scraps, and previous diet trials.
Physical examination is often unremarkable, but attention should be paid to assess for pale mucous membranes, lymphadenopathy, oedema, and joint effusion. Also thickened loops of intestine, masses or a fluid wave
on abdominal palpation. The examination should also include a digital rectal exam to assess for intra- or extraluminal masses, mucosal abnormalities or blood.
II) Laboratory
Routine haematology, serum biochemistry and urinalysis are often normal but may reveal evidence
of hypoalbuminemia or panhypoproteinemia, hypocholesterolemia, increased urea, anaemia or the absence of a stress leukogram. A faecal examination is recommended to screen for parasites.
Serum trypsin-like immunoreactivity and an ACTH stimulation test may be used to investigate exocrine pancreatic insufficiency and hypoadrenocorticism respectively. Determination of serum cobalamin levels may be beneficial in patient management.
III) Imaging
Abdominal ultrasound is often performed as part of the investigation in chronic diarrhoea. The overall diagnostic utility, however, was found to be low in a study, with ultrasound not making a difference in 66% of cases, providing additional benefit in only 17%.2 Sonography
was shown to be most useful when abnormalities were already identified on physical examination (abdominal and rectal masses).2 Even with gastrointestinal lymphoma, 26.7% of dogs had normal sonographic findings, highlighting limitations of the modality.3
Alternatively, evaluation of the GI tract via computed tomography has also been described. Helical acquisition of 2-5 mm slices in anaesthetised dogs allowed assessment of intestinal diameter and wall thickenss.4
IV) Dietary and Antibiotic trials
Although histopathology is perceived to be important, it cannot distinguish inflammatory bowel disease
from food- and antibiotic-responsive diseases. Significant weight loss, poor body condition, anorexia, hypoalbuminemia or panhypoproteinemia, or sonographic evidence of significant infiltrative disease would indicate that endoscopy is appropriate earlier rather than proceeding with a therapeutic trial.5
Options for a dietary elimination trial include home- prepared or commercial novel protein diets, as well
as hydrolysed diets. Food trials should be conducted for at least two weeks. Controversy exists between these choices as some dogs can tolerate home- prepared, single protein diets but not their commercially prepared versions. However, home-cooked diets can be unbalanced and inadequate. Choosing a novel protein may also be difficult depending on patient dietary history, and cross-reactivity between food antigens.6-8 Hydrolysed diets were found to be superior to highly digestible ones in the management of chronic enteropathy, with significantly more dogs remaining
in remission at three years.9 However, concerns have been raised regarding hydrolysate diet being tolerated by most, but not all, of the dogs, sensitized
43RD WORLD SMALL ANIMAL VETERINARY ASSOCIATION CONGRESS AND 9TH FASAVA CONGRESS
    254

































































   254   255   256   257   258