Introduction
Diarrhea is defined as the passage of feces containing an excess amount of water and is generally considered to be chronic or intermittent when it lasts for 2 or 3 weeks, at which time it is recommended that the problem be more thoroughly evaluated using specific diagnostic tests and in some cases therapeutic trials.
Many clinicians rank the definitive diagnosis and management of chronic intermittent or chronic persistent diarrhea as one of the most challenging and frustrating aspects of their medical practice. There are no universally accepted recommendations on how to work up patients with chronic or intermittent diarrhea. Prevalences of different disorders vary in different countries, making it difficult to develop a common workup protocol for use throughout the world. However, general principles apply and should be used as a guideline for a systematic approach to patients with chronic diarrhea. As an example, the workup protocol used at the Faculty of Veterinary Medicine, University of Helsinki is represented in Figure 2.3. In patients with chronic diarrhea, every effort should be made to achieve a specific diagnosis in order to allow for specific therapy. Unfortunately, this can not always be achieved, in which case empirical therapeutic trials are employed. There are conflicting opinions on how long empirical therapy should be attempted. We recommend 10 days if dogs have chronic diarrhea or if the intervals between intermittent diarrheal episodes are only a few days. If signs of diarrhea disappear or are relieved during the empirical treatment period, the latter should be continued for at least 2-6 weeks. If the intervals between episodes in patients with intermittent diarrhea are long, for example more than one week, the length of the empirical treatment period should be prolonged.The workup protocol for patients with chronic or intermittent diarrhea is applicable to most veterinary practices. Also, it is useful regardless of the presence of clinical signs that are typical for large- or small-intestinal disease. There is a high prevalence of diseases that can simultaneously affect the small and large intestines. Isolated colitis, which is a common condition in human beings, is uncommon in cats and rare in dogs.
2.3.2