Approach to Constipation In Companion Animals PDF

APPROACH TO… C O N S T I PAT I O N I N C O M PA N I O N ANIMALS PRIYA SHARP LEARNING OBJECTIVES Construct a differential diagnosis list based on constipation as a clinical presentation and choose appropriate diagnostics. Determine appropriate medical and surgical...

APPROACH TO… C O N S T I PAT I O N I N C O M PA N I O N ANIMALS PRIYA SHARP LEARNING OBJECTIVES Construct a differential diagnosis list based on constipation as a clinical presentation and choose appropriate diagnostics. Determine appropriate medical and surgical interventions in the management and treatment of diseases characterized by constipation. Determine appropriate prognosis, and the welfare implications of treatment options. Determine control measures appropriate for disease prevention. 2 DEFINITION Constipation – infrequent or difficulty defecation associated with retention of faeces within the colon and rectum Obstipation – Chronic form of constipation and drier faeces that becomes impacted Megacolon – Chronic, recurrent constipation and obstipation which leads to increased bowel diameter Tenesmus – Straining to defecate (or urinate) Dyschezia – Painful expelling of faeces. 3 C L I N I C A L S I G N S - C O N S T I PAT I O N Tenesmus Behaviour changes – reluctant to be touched, hiding Intermittent diarrhoea (sometimes) Vomiting – Why? Not using litter tray Licking behind Vocalizing Inappetance 4 C A U S E S - C O N S T I PAT I O N Associated with: Difficulty to defecate – pain? Unable to squat? Inability to defecate – faecal factors like dehydration? faecal bulk? Poor peristalsis? Physical obstruction – Mass? Trauma? Localisation: Luminal Mural Extra-mural Extra-intestinal 5  C A U S E S - C O N S T I PAT I O N Category Cause Dietary factors Ingestion of foreign material Inadequate water intake Psychological/ Dirty litter tray Environmental factors Inactivity Change in habitat/routine Competition with others Painful conditions Anal sac disorders (infection, abscess, myiasis) Perianal disorders (cellulitis, abscess, atrophy) Arthritis Colonic/Anorectal obstruction Extramural/ intramural intraluminal Pelvic fractures or malunion Perianal tumour Rectal prolapse Perineal hernia Neuromuscular dysfunction Lumbosacral spinal cord disease (trauma, degeneration, infection etc) Idiopathic megacolon Bilateral pelvic nerve injury Hypothyroidism Fluid and electrolyte abnormalities Dehydration Hypokalemia Hypercalcemia Conditions causing electrolyte imbalances eg CKD 6 I N V E S T I G AT I O N - C O N S T I PAT I O N History taking Onset? Duration? Persistent? Feed and feeding? Water intake – Location? (cats) Toileting behaviour – where? Changes with age? Litter tray (numbers, locations etc) Accidents? Environmental changes – new animal? Visual access? 7 D I A G N O S T I C P L A N - C O N S T I PAT I O N Physical examination Abdominal palpation – hard structures felt Neurological examination – including proprioception, reflexes, gait analysis MSK assessment Rectal examination (lots of lube!!) – consider sedation if too painful. Haematology and Biochemistry – electrolyte profile, extraintestinal conditions eg CKD Radiography Abdominal MSK US – to assess intramural lesions Biopsy – to investigate intramural/extramural cause 8 C O N S T I PAT I O N Primary or Secondary Dysautonomia Feline = Key-Gaskell Megacolon (feline) A B A:B 1.48=megacolon 9 P R I N C I P L E S O F M A N A G E M E N T O F C O N S T I PAT I O N Ensure removal of obstructing faeces Ensure colonic motility and smooth passage of faeces Reduce faecal bulk Ensure adequate hydration Manage underlying problems 10 T R E AT M E N T – I N W E L L H Y D R AT E D, OT H E R W I S E H EA LT H Y A N I M A L Laxatives Lubricant - mineral oil Hyperosmotic – Lactulose, Micralax Emollient - Dioctyl sodium sulfosuccinate Stimulant – Bisacodyl Bulk laxatives – High fiber diet, supplement like psyllium Prokinetics agent (No Obstruction!) – Cisapride Manage underlying problem Pain management? 11 T R E AT M E N T - C O N S T I PAT I O N Manual removal of impacted faeces. Sedation? Surgical correction Sub-total colectomy (megacolon). Studies find better results when ileo-caecal junction intact. Fracture repair Treatment of extra intestinal conditions – dehydration, electrolytes, pain management, wound management (abscess) Long term dietary management? Water intake? Pain management? Manage underlying problem 12 PROGNOSIS & WELFARE Prognosis in uncomplicated cases is good. Prognosis with underlying condition is dependent on management of condition (good to poor) Consider welfare of cases with poor prognosis. Consider long term management in episodic cases and prevention will improve prognosis and welfare. Prognosis following subtotal colectomy is generally good if managed well. Client education very important for the welfare of the animal Pain management for long term conditions also very important 13 PREVENTIVE AND LONG-TERM MANAGEMENT 14