SA Med, MT, IV
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what breeds have a genetic susceptibility for IBD?
- shar pei
- irish setter
what are clinical signs associated with IBD?
variable GI signs that can presist or wax/wane over time
what form of IBD is more common in cats? small or large bowel?
- Lymphocytic Plasmacytic Enteritis - IBD
- small bowel diarrhea and vomiting
- appetite is variable; wt loss, lethargy
how does LP-IBD enteritis compare to LP-IBD colitis...which causes vomiting; what about wt loss?
- vomiting can occur in both, more common in cats with enteritis or with megacolon
- weight loss typically a feature of enteritis not colitis
what vitamin malabsorption can be a complicating factor of IBD?
- vit K deficiency (cats)
what are the components of triaditis in cats, which can be a complicating factor of IBD?
what intestinal neoplasia is associated with IBD?
what are some preliminary diagnostic tests when approaching a possible IBD case?
- infectious diseases like protozoa, bacteria,etc
phase 2: imaging (rads, US)
phase 3: endoscopic biopsy
If you want to test the patients response to treatment for suspected IBD, what would you try? what tx requires a biopsy confirmation first/
- novel-protein diet trial (if healthy enough)
- antibiotic trial/probiotics
- environment enrichment (cat)
- cobalamine therapy
biopsy before steroids/immunosuppressives
what are prominent lab findings with MDB of IBD patient?
no abnormalities in most cases!
what are some advanced diagnostics that can be used on biopsy sample to distinguish IBD from lymphoma?
- flow cytometry
- lymphocyte clonal assay
where in the intestine is cobalamin absorbed? what enzyme is required for absorption?
- pancreatic intrinsic factor needed
where in the intestine is folate absorbed?
- absorbed in proximal small intestine
- and produced by bacterial microflora
what are 3 main causes of decreased cobalamin?
- EPI (74%)
- malabsorption in ileum
- antibiotic responsive diarrhea
what are folate and cobalamin levels like with antibiotic responsive diarrhea?
incr. folate and decr. cobalamin
how do you treat cobalamin deficiency due to ARD?
- give SQ cobalamin/B12 (not oral - can't absorb; and not B-complex)
- ok to supplement even if you havent tested values
are dogs or cats more likely to present with protein losing enteropathy? what breeds have genetic susceptibility?
- lundehound (lymphangiectasia)
- wheaton terrier
- *yorkie* (lymphangiectasia)
what are rule outs for PLE?
- young dog w/hookworms; intussusception
how low does albumin have to be before oncotic pressure low enough to result in effusions?
what is most common etiology of lymphangiectasia?
also due to lymphatic obstruction, pericarditis, infiltrative disease
what are important clinical features of lymphangiectasia?
- weight loss with effusions/edema
- small bowel diarrhea (may be ABSENT or intermittent)
how is cholesterol, Ca+ and Mg+ affected by lymphangiectasia?
how are lymphocytes affected with lymphangiectasia?
what are some US findings suggestive of lymphangiectasia? how is diagnosis confirmed?
- hyperechoic mucosal striations
- diffuse thickening of mucosa
- peritoneal effusion
- definitive w/biopsy - histo shows dilation of lacteals
how is lymphangiectasia treated?
- ultra low fat diet
- other treatment as used w/IBD
Is stress (fiber responsive) diarrhea from large or small bowel? acute or chronic?
dogs - acute onset large bowel diarrhea (colitis)
how is stress colitis diagnosed? treatment?
- diagnosis of exclusion
- tx: fiber, Abs
what are 4 neoplasias of the small intestine? which are associated w/hypoglycemia?
- leiomyoma (hypoglycemia)
- leiomyosarcoma (hypoglycemia)
What is clinical name for boxer colitis? what are important clinical features?
- chronic histiocytic ulcerative colitis
- wt loss + large bowel diarrhea
what are biopsy findings with boxer colitis?
- histiocytic inflammation/ulcers
- lots of macrophages
- adherent invasive E.coli (fluorescent in situ hybridization)
what is treatment for bower colitis?
enrofloxacin for 3 weeks
it is important to get a biopsy sample if you suspect adenocarcinoma in the rectum to rule out what similar looking condition?
rectal polyps (not malignant)
what perianal disease is associated with hypercalcemia?
anal sac adenocarcinoma
what is most common etiology for megacolon? how is it diagnosed?
- idiopathic (likely myopathic)
- radiographs and rule out other causes
what is treatment for megacolon? usually surgical or medical case?
- usually responds well to medical management
- -stool softeners
- -prokinetics like cisapride
what is MOA of cisapride?
- incr. Ach release for myenteric plexus
- 5-HT4-serotonergic agonist
- (no CNS or antiemetic effects; won't cross BBB)
What is the first stage of deobstipation? is sedation or GA required?
- rehydrate the patient!
- GA + ET tube + manual extraction
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