What's Plan B: For the Patient with Chronic or Recurrent Diarrhoea

Assuming there are no criteria for concern (e.g. anorexia, abnormal abdominal palpation, severe pain or hypoalbuminaemia) a common approach to a patient with chronic diarrhoea is first to treat it with antiparasitic drugs and then to perform a diet trial. Whilst often successful, if the patient fails to respond or relapses, then reinfection or resistance to treatment is possible, or the diet trial may have been compromised. However, it is possible that a systemic illness was missed, abdominal palpation was insensitive or that there is another complicating factor. Plan B is to start again from the beginning, rule out systemic disease, especially hypoadrenocorticism and pancreatic insufficiency in dogs, and hyperthyroidism in cats, and then investigate further with testing serum cobalamin. Hypocobalaminaemia is common in chronic enteropathies and supplementation is required for an optimal response to any other treatment. Finally imaging and intestinal biopsy should be performed.

Plan B

Presented by Edward Hall, MA VetMB PhD DipECVIM-CA FRCVS
Emeritus Professor of Small Animal Medicine at Langford Vets

Sponsored by AnimalCare

Presented at the London Vet Show 2019
RVC Clinical Theatre 3
Thursday, November 14 at 4:50 PM