25 Sept 2017
Graham Lewis
Job Title
Parenteral fluid therapy should be considered when assessing patients with GI disorders. Image © stockdevil / Fotolia
With a study finding inappetence, weight loss, vomiting and diarrhoea are in the top 10 presenting complaints to small animal first opinion practice – making up just below 25% of the total combined (Robinson et al, 2015) – it is, perhaps, not surprising such a vast range of treatment options are available for gastrointestinal (GI) disorders.
Diagnosis of GI disorders can be challenging, with Differential Diagnosis in Small Animal Medicine dedicating more than 11 pages to differentials for vomiting and diarrhoea.
As such, localising the problem is beneficial, as is determining its severity. A thorough history is essential for this to determine if the clinical signs are due to a primary GI problem or are secondary to an extra-GI condition.
Non-specific signs (Table 1) can point towards extra-GI disease; however, some can be due to primary GI disease and can help point towards further investigations required. Specific GI signs can help localise the problem in certain areas of the GI tract, but these can also be due to some extra-GI conditions.
| Table 1. Clinical signs and gastrointestinal conditions | |
|---|---|
| Specific gastrointestinal clinical signs | Non-specific clinical signs |
| • Vomiting • Haematemesis • Diarrhoea • Melaena • Haematochezia • Abdominal pain • Bloat • Borborygmi • Flatulence • Dyschezia • Tenesmus |
• Anorexia • Polyphagia • Weight loss • Fever • Depression • Polydipsia • Ascites • Ptyalism • Halitosis • Dehydration |
An environmental and dietary history are key to help rule out acute dietary problems, such as dietary indiscretion, infectious gastroenteritis or toxin/medication ingestion. Asking about other animals or owners affected can be important, and finding out the medical history, including worming status, helps rule in/out some simple definitive diagnoses.
Anatomical localisation can be helpful and asking detailed information about the nature, frequency and progression of the disease can help. Owners can struggle to differentiate between vomiting and regurgitation, so careful questioning can uncover oesophageal disease. Diarrhoea can be due to diffuse disease throughout the GI tract, but some signs point towards small intestinal diarrhoea over large intestinal diarrhoea (Table 2).
| Table 2. Clinical signs associated with small and large intestinal diarrhoea | |
|---|---|
| Small intestinal diarrhoea | Large intestinal diarrhoea |
| • No increase in frequency • Large volume • Melaena • Steatorrhoea • Weight loss, if chronic |
• Increased frequency • Urgency • Haematochezia • Tenesmus • Mucous |
The time frame of the condition should be noted, as chronic disease will need a different approach to acute onset conditions.
The clinical examination should also help localise the condition, as well as establishing severity and hydration status. To check for dehydration or hypovolaemia a thorough examination should take place – not just focusing on the GI tract.
A focused GI tract examination should include oral examination to check for halitosis, mucous membranes, capillary refill time and ulceration. Abdominal palpation can help identify pain, foreign bodies, neoplasia or intussusceptions. Rectal palpation can help identify melaena, haematochezia or prostatic problems that may cause tenesmus.
Hopefully, by this point the clinician will have established if the clinical signs are likely to be severe and life-threatening, if the condition is acute or chronic and have some idea if it is likely to be a primary GI condition or an extra-GI condition. This information should be used to decide whether further investigation is required and what tests may be helpful to try to determine a definitive diagnosis. It can also help in deciding on possible supportive treatments for GI conditions.
Hopefully, a run through some of the main treatments used will help clinicians pick what to use on a case-by-case basis.
Every animal and GI disorder requires different treatments and management and, unfortunately, no set formula exists for dealing with patients with GI signs and conditions. Hopefully, this brief review will help clinicians wade through the range of products and find what they think is appropriate for the case in front of them.
