Page 2097 - Cote clinical veterinary advisor dogs and cats 4th

1048 Whipworm Infection

Acute General Treatment ○ IER is calculated by multiplying RER by • Rarely, protein-losing enteropathies cause
Increase caloric intake: an illness factor (1.2-1.4 for dogs; 1.1-1.2 weight loss without diarrhea. Large-intestinal
VetBooks.ir ○ Increase palatability. Drug Interactions look for comorbidities or diffuse intestinal
disease does not cause weight loss by itself;
for cats).
• Dietary management
disease in a patient with weight loss and
○ Increase caloric density.
○ Administer nutrition by feeding tube.
large-intestinal diarrhea.
○ Rarely, partial or total parenteral nutrition • Metoclopramide is contraindicated in • Record body condition score (BCS of 1-9;
patients with a physical obstruction of the
(PPN or TPN) GI tract or GI bleeding. 5 is ideal) and muscle condition score (1-3;
• Pharmacologic management • Serotonin syndrome can result when any of 3 is ideal) with every exam.
○ Antinausea medications: maropitant, the following are used in combination: mir- • Appetite stimulants are often ineffective in
metoclopramide, ondansetron, pheno- tazapine, tramadol, trazodone, ondansetron/ the presence of nausea or severe illness.
thiazines. These medications may be dolasetron, monoamine oxidase inhibitors
contraindicated in some diseases. (MAOIs) (e.g., selegiline), selective serotonin Technician Tips
○ Appetite stimulants: mirtazapine (dogs and reuptake inhibitors (SSRIs) (e.g., fluoxetine) • With hospitalized patients, use the same scale
cats), cyproheptadine (cats), capromorelin (p. 1281). daily to keep an accurate trend of BW.
(dogs and cats), cannabis derivatives (data • Mirtazapine and tramadol may be less • When feeding by esophagostomy tube, if the
lacking currently) effective if used in combination with patient begins to swallow, you are feeding
○ Gastric acid reducers: proton pump cyproheptadine. too quickly.
inhibitors (omeprazole, pantoprazole,
esomeprazole) are more effective than Possible Complications Client Education
H2-receptor antagonists (famotidine, • Refeeding syndrome if anorexia is chronic Weight loss is caused by a wide array of diseases;
ranitidine) at increasing gastric pH. and/or severe many are treatable, but obtaining a diagnosis
• Aspiration pneumonia in patients that are might require extensive testing.
Nutrition/Diet regurgitating, vomiting, or being force-
• Enteral nutrition is preferred in animals that fed SUGGESTED READING
have a functioning GI tract. • Hepatic encephalopathy if there is hepatocel- Baldwin K, et al: Special Report: 2010 AAHA Nutri-
• Feeding through a nasoesophageal, esopha- lular dysfunction tional Assessment Guidelines for Dogs and Cats. J
gostomy, gastrostomy, or jejunostomy tube Am Anim Hosp Assoc 46:285-296, 2010. https://
may be required (pp. 1106, 1107, and 1109). PROGNOSIS & OUTCOME www.aaha.org/public_documents/professional/
• Parenteral nutrition may be necessary in guidelines/nutritionalassessmentguidelines.pdf
animals that cannot tolerate enteral feeding Depends on underlying disease process AUTHOR: Bradley A. Green, DVM, DACVIM
or if enteral feeding alone cannot meet caloric EDITOR: Leah A. Cohn, DVM, PhD, DACVIM
requirements (p. 1148). PEARLS & CONSIDERATIONS
• Caloric requirements (p. 1077) are estimated
by calculating resting energy requirements Comments
(RER) and illness energy requirements (IER): • Other clinical signs (e.g., vomiting, fever,
○ RER (in kcal) can be calculated as: cough) can provide more specific clues to
70 × (BW [in kg]) 0.75 the diagnosis than weight loss alone.
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Whipworm Infection Client Education
Sheet

BASIC INFORMATION CONTAGION AND ZOONOSIS HISTORY, CHIEF COMPLAINT
Humans are rare aberrant hosts. • None (incidental finding on fecal flotation)
Definition • Clinical signs of large-bowel diarrhea: tenes-
Infection of the cecum and possibly ileum and GEOGRAPHY AND SEASONALITY mus; frequent, urgent defecation of loose
colon with Trichuris vulpis (dogs) or Trichuris • Common in the eastern and southern United or watery feces, possibly containing mucus
campanula or Trichuris serrata (cats) States or fresh blood (hematochezia); flatulence
• Ova are extremely resistant in the environ- possible
Synonym ment, surviving 4-5 years and demonstrating • Occasionally associated with weight loss and
Trichuriasis no seasonality. protein-losing enteropathy
• In dogs with hypoadrenocorticism-like illness,
Epidemiology Clinical Presentation lethargy, vomiting, or severe diarrhea may
SPECIES, AGE, SEX DISEASE FORMS/SUBTYPES be present.
Primarily adult dogs; rare in cats • Subclinical (common)
• Persistent or intermittent large-bowel diarrhea PHYSICAL EXAM FINDINGS
RISK FACTORS (mucoid stool, hematochezia, tenesmus) with • Usually, animals with mild whipworm
• Roaming various degrees of severity infections have a normal physical exam.
• Exposure to feces or contaminated environ- • Hypoadrenocorticism-like syndrome: hypo- • Vague signs of mid-abdominal pain/tenderness,
ment natremia, hyperkalemia, azotemia, metabolic often characterized by flank licking, have
• Poor health maintenance program, especially acidosis been associated with granulomatous typhlitis.
those lacking proper heartworm or intestinal • Rarely, physical signs of systemic disease
parasite prevention (weight loss/cachexia) are present with

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