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Fecal Transplant 1105

on history and physical exam; attendant risks worsening respiratory and/or cardiovascular • The DH view helps differentiate pericardial
compromise.
and pleural effusion.
must be considered (e.g., lung laceration). • Change the depth and focus at each location • The number of B-lines correlates to the
VetBooks.ir for pneumothorax detection but involves of the emergency ultrasound scan after the • Practice improves skill.
• Computed tomography scan: gold standard
severity of AIS.
organs of interest are identified; helps identify
anesthesia/heavy sedation and is not as widely
available; cannot be performed cageside.
smaller accumulations of fluid and improves
image quality. SUGGESTED READING
Pearls • TFAST is best evaluated when the patient Boysen SR, et al: The use of ultrasound for dogs and
• Not all patients produce pathology that is takes a deep breath. cats in the emergency room: AFAST and TFAST.
detectable on emergency ultrasound scans. • Keep your hand, the patient, and the Vet Clin Small Anim 43:773-797, 2013.
• FAST scans omit large areas of the abdomen ultrasound probe still when assessing the AUTHORS: Serge Chalhoub, DVM, DACVIM; Søren R.
and thorax and do not reliably exclude local- glide sign to avoid a false-positive glide sign. Boysen, DVM, DACVECC
ized organ injury. • Increase the depth to view the entire heart EDITORS: Leah A. Cohn, DVM, PhD, DACVIM; Mark S.
Procedures and Techniques
• Dorsal positioning of patients should when differentiating pericardial from pleural Thompson, DVM, DABVP
be avoided because of a higher risk of effusion.

Fecal Transplant

Difficulty level: ♦ Materials: • At a minimum, perform direct and flotation
• Gloves fecal parasite exam on donor stool within a
Synonyms • Blender, or container and disposable spoon week of use.
Fecal microbiota transplant (FMT), stool to mix feces • Ideally, test donor stool for multiple GI
transplant • Fresh stool from healthy, screened donor pathogens (e.g., IDEXX Diarrhea RealPCR
• Measuring device or gram scale Panel, Antech Canine or Feline GI PCR
Overview and Goal • Milk (alternative: sterile saline or water) Panel, fecal culture) within a week of use.
• The overall goal of fecal transplant is to • Sieve strainer device or gauze/cheese cloth Patient preparation:
alter the patient’s gastrointestinal (GI) • Syringes with tip appropriate for tubing or • Fast the patient overnight before the
microbiome, thereby improving GI health. with adaptor to connect syringe to enema procedure.
• Stool from a healthy, screened donor is tubing • Allow patient to defecate before beginning
introduced into the GI tract of a patient ○ Number and size depends on volume of the procedure.
with GI signs (usually chronic diarrhea) transplant infusion • Ideally, avoid administering the transplant
believed to be due to intestinal dysbiosis. • Enema tubing: size depends on patient size while the patient is receiving antimicrobials.
The transplant can be given by retention but adequate in length to reach at least the
enema (most common), delivered to the transverse colon Possible Complications and
ileum by colonoscopy, delivered orally or ○ For cats or small dogs, 8 to 12 Fr red Common Errors to Avoid
by stomach tube, or through a combination rubber catheter appropriate • Not having donor stool at the time of
of these routes. ○ For larger dogs, larger-bore tubing procedure: have the donor spend the day
• There is very sparse published data regarding appropriate at the clinic, and do not allow them access/
optimal transplant procedures, safety, or • Lubricant opportunity to defecate the morning of the
efficacy of fecal transplant in dogs or cats, • ± Canned, enticing food procedure.
but the technique has gained in popularity • Early evacuation of enema by recipient:
due to anecdotal success stories. Anticipated Time consider sedation; avoid excessive volume
60-90 minutes, including the transplant or overly rapid infusion of enema; do not
Indications preparation and enema retention time allow access to litter box (cat) or outdoors
Dogs or cats with chronic diarrhea that have for at least 45 minutes after procedure.
failed to respond to the standard therapy, Preparation: Important Checkpoints • Iatrogenic transmission of pathogens: use
including food trials, probiotics, or antibiotics Donor selection criteria are not well established, only healthy donor with normal stool, and
but suggest screen for parasites ± other pathogens within
Contraindications • Clinically healthy pet of same species a week of transplant.
• Recognized cause of GI signs for which there ○ Ideally, pet from same household as is • Ineffective transplant: use fresh stool from
is a known, effective treatment patient donor that has not recently received antimi-
• Good response to food trials, probiotics, or ○ Avoid using donors from institutional crobial drugs; avoid exposure of transplant
antibiotics housing (e.g., clinic animals). liquid (“fecal shake”) to bacteriostatic materi-
• Known or suspected intestinal ulceration • Between 1 and 7 years of age als; avoid excessive exposure of fecal shake
• Immunocompromise is a relative contrain- • Normal, well-formed stools absent of blood to air/oxygen because many of the normal
dication. or excessive mucus microbes are anaerobic
• No systemic antimicrobial exposure during
Equipment, Anesthesia the past 6 months Procedure
Can be performed with or without sedation; • Diet that does not include raw meat or • Wear gloves while handling stool and during
sedation may encourage enema retention (goal animal-based treats preparation and administration of the fecal
≥ 45 minutes). • Regular use of endoparasite prevention shake.

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