Chronic d+ Flashcards
List the major differentials for chronic diarrhoea
Food responsive enteropathy (FRE)
Dysbiosis
Steroid responsive enteropathy
Non-responsive enteropathy
PLE – e.g. lymphangiectasia
EPI
Neoplasia
(Non-GI causes)
T/F you can have an enteropathy without diarrhoea
True
List 6 factors that can influence the development of chronic enteropathies
diet
genetics
gut flora (microbiome)
environment
immune response
comorbidities
Name the 2 categories of adverse food reactions
food allergy
food intolerance reactions
How does Food responsive enteropathy generally present
Usually chronic small bowel diarrhoea
+/- vomiting
+/- pruritus
how long does a food trial need to last
For GI disease should be no longer than 3 weeks
Signs of improvement noted very quickly compared with skin
+ symptomatic treatment
describe how to diagnose food responsive enteropathy
by response to food trial
what is dysbiosis
an imbalance between the types of organism present in a person’s natural microflora
is common in many conditions
what do you tend to see with dysbiosis
chronic d+ SI
weight loss failure to thrive
V+/ borborygmus/ appetite changes
where is folate and B12 absorbed
folate - proximal SI
B12- distal SI
Describe how to treat dysbiosis
cobalamin (B12) supplementation
treat primary cause
probiotics
another name for steroid responsive enteropathy
inflammatory bowel disease
describe how to diagnose SRE/IBD
History + CS
physical exam
rule out other differentials
biopsy
what is feline triaditis complex
a condition in cats in which they are simultaneously affected with three separate diseases:
pancreatitis
cholangiohepatitis
inflammatory bowel disease (IBD)
describe how to diagnose feline triaditis complex
exclude other diseases
biopsy all 3 organs involved
describe how to treat SRE/IBD
dietary manipulation
pre and probiotics
anti-parasitic agents - to make sure no comorbidities
vitamins- B12
May need immunosuppressive therapies (preds)
May need Abs (metrinidazole)
what is Protein-losing enteropathy
This is a form of chronic enteropathy characterised by the loss of protein through the GIT
both albumin and globulins are low
How does the microbiome of the CE patient differ from normal?
Reduced diversity and richness
More volatile and unstable
How do you diagnose adverse food reactions?
response to food trial
How long should you wait before you can confirm that the diet is not a cause of CE?
around one week
What is the most common/major cause of chronic enteropathy?
dysbiosis
When is dysbiosis likely to occur?
Decreased gastric acid production
Increased small intestine substrates
Obstructions
Motility disease
Hypothyroidism
What breed of dog is most commonly affected by dysbiosis?
GSD
How can dysbiosis be diagnosed?
Faecal microbiome analysis
History
Breath hydrogen testing
Serum folate (cobalamin)
How is dysbiosis managed?
Highly digestible diet
Low fat
Pre and probiotics
What supplement is vital in dysbiosis cases?
cobalamin
(same as B12)
Should antibiotics be used in cases of dysbiosis?
No
Where is folate absorbed?
Proximal SI
Where is B12 absorbed?
Distal SI
Ileum
List the clinical signs of IBD
Weight loss
Appetite variable
Abdominal discomfort
Chronic diarrhoea
What are the more severe signs of eosinophilic enteritis?
GI haemorrhage
Bowel perforation
Focal mass lesions
What percentage of dogs with chronic enteritis will show no response to treatment?
15-40%
If there is no response to therapy of CE, what would you now consider is the cause of clinical signs?
Neoplasia
Dysbiosis
Vitamin D deficiency
Bile acid diarrhoea
What protein is low with PLN?
albumin
What are the differentials for PLE?
severe IBD
Lymphangiectasia
neoplasia (lymphoma most commonly)
What is lymphangiectasia?
Abnormal dilation of intestinal lymphatics- secondary to lots of things
How does lymphangiectasia lead to PLE?
LP oedema
Loss of lymph into the gut lumen
What are the CS of lymphangiectasia?
PLE
Weight loss
Protein-rich ascites
How can lymphangiectasia be diagnosed?
Low albumin
Low globulin
Low cholesterol
Lymphopenia
Low Ca/Mg
On endscope, what would you see with lymphangiectasia?
White spots on villus tips
White nodules or plaques
White fluid
How is lymphangiectasia treated?
Treat primary cause
Ultra-low fat diet
Albumin/colloid due to hypoproteinaemia
Diuretic for severe effusion
What does EPI stand for?
Exocrine pancreatic insufficiency
What are the CS of EPI?
Polyphagia
Weight loss
D+- lots of it, yella, greasy
What is EPI caused by?
Acinar cell loss
What condition is EPI commonly associated with
chronic pancreatitis
T/F EPI is more common in cats than dogs
false more common in dogs
What breeds are predisposed to EPI?
GSD
Rough Collie
Chows
How can EPI be diagnosed?
Low TLI
Low cPLI
Low cobalamin
What does TLI stand for?
Trypsin-like immunoreactivity
What is cPLI?
Pancreatic lipase concentrations
How is EPI managed?
Pancreatic enzyme supplementation- pig/cow pancreas
dietary management
vit supplementation (cobalamin)
What is the prognosis of EPI?
good
What are common intestinal tumours?
Lymphoma
Adenocarcinoma
Leiomyoma/sarcoma (smooth muscle)
Mast cell tumour
Fibrosarcoma
Haemangiosarcoma
Diagnosis of intestinal tumours
US
radiographs
biopsy- endo or laparotomy
Define chronic D+
if it has been ongoing for over 3 weeks
What are the 2 most common forms of IBD
lymphoplasmacytic IBD
eosionophilic IBd
what do you need to do if the enteropathy has not responded to diet trial, antibiotics or steroids
consider non-GI disease, neoplasia or other disorders
Management of intestinal tumours
chemo
preds
surgical resection
combo of multiple treatments
