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9- SA- Gastrointestinal and Hepatic Disease > Chronic d+ > Flashcards

Chronic d+ Flashcards

1
Q

List the major differentials for chronic diarrhoea

A

Food responsive enteropathy (FRE)
Dysbiosis
Steroid responsive enteropathy
Non-responsive enteropathy
PLE – e.g. lymphangiectasia
EPI
Neoplasia
(Non-GI causes)

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2
Q

T/F you can have an enteropathy without diarrhoea

A

True

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3
Q

List 6 factors that can influence the development of chronic enteropathies

A

diet
genetics
gut flora (microbiome)
environment
immune response
comorbidities

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4
Q

Name the 2 categories of adverse food reactions

A

food allergy
food intolerance reactions

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5
Q

How does Food responsive enteropathy generally present

A

Usually chronic small bowel diarrhoea
+/- vomiting
+/- pruritus

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6
Q

how long does a food trial need to last

A

For GI disease should be no longer than 3 weeks
Signs of improvement noted very quickly compared with skin
+ symptomatic treatment

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7
Q

describe how to diagnose food responsive enteropathy

A

by response to food trial

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8
Q

what is dysbiosis

A

an imbalance between the types of organism present in a person’s natural microflora
is common in many conditions

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9
Q

what do you tend to see with dysbiosis

A

chronic d+ SI
weight loss failure to thrive
V+/ borborygmus/ appetite changes

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10
Q

where is folate and B12 absorbed

A

folate - proximal SI
B12- distal SI

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11
Q

Describe how to treat dysbiosis

A

cobalamin (B12) supplementation
treat primary cause
probiotics

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12
Q

another name for steroid responsive enteropathy

A

inflammatory bowel disease

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13
Q

describe how to diagnose SRE/IBD

A

History + CS
physical exam
rule out other differentials
biopsy

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14
Q

what is feline triaditis complex

A

a condition in cats in which they are simultaneously affected with three separate diseases:
pancreatitis
cholangiohepatitis
inflammatory bowel disease (IBD)

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15
Q

describe how to diagnose feline triaditis complex

A

exclude other diseases
biopsy all 3 organs involved

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16
Q

describe how to treat SRE/IBD

A

dietary manipulation
pre and probiotics
anti-parasitic agents - to make sure no comorbidities
vitamins- B12
May need immunosuppressive therapies (preds)
May need Abs (metrinidazole)

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17
Q

what is Protein-losing enteropathy

A

This is a form of chronic enteropathy characterised by the loss of protein through the GIT
both albumin and globulins are low

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18
Q

How does the microbiome of the CE patient differ from normal?

A

Reduced diversity and richness
More volatile and unstable

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19
Q

How do you diagnose adverse food reactions?

A

response to food trial

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20
Q

How long should you wait before you can confirm that the diet is not a cause of CE?

A

around one week

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21
Q

What is the most common/major cause of chronic enteropathy?

A

dysbiosis

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22
Q

When is dysbiosis likely to occur?

A

Decreased gastric acid production
Increased small intestine substrates
Obstructions
Motility disease
Hypothyroidism

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23
Q

What breed of dog is most commonly affected by dysbiosis?

A

GSD

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24
Q

How can dysbiosis be diagnosed?

A

Faecal microbiome analysis
History
Breath hydrogen testing
Serum folate (cobalamin)

25
Q

How is dysbiosis managed?

A

Highly digestible diet
Low fat
Pre and probiotics

26
Q

What supplement is vital in dysbiosis cases?

A

cobalamin
(same as B12)

27
Q

Should antibiotics be used in cases of dysbiosis?

A

No

28
Q

Where is folate absorbed?

A

Proximal SI

29
Q

Where is B12 absorbed?

A

Distal SI
Ileum

30
Q

List the clinical signs of IBD

A

Weight loss
Appetite variable
Abdominal discomfort
Chronic diarrhoea

31
Q

What are the more severe signs of eosinophilic enteritis?

A

GI haemorrhage
Bowel perforation
Focal mass lesions

32
Q

What percentage of dogs with chronic enteritis will show no response to treatment?

A

15-40%

33
Q

If there is no response to therapy of CE, what would you now consider is the cause of clinical signs?

A

Neoplasia
Dysbiosis
Vitamin D deficiency
Bile acid diarrhoea

34
Q

What protein is low with PLN?

A

albumin

35
Q

What are the differentials for PLE?

A

severe IBD
Lymphangiectasia
neoplasia (lymphoma most commonly)

36
Q

What is lymphangiectasia?

A

Abnormal dilation of intestinal lymphatics- secondary to lots of things

37
Q

How does lymphangiectasia lead to PLE?

A

LP oedema
Loss of lymph into the gut lumen

38
Q

What are the CS of lymphangiectasia?

A

PLE
Weight loss
Protein-rich ascites

39
Q

How can lymphangiectasia be diagnosed?

A

Low albumin
Low globulin
Low cholesterol
Lymphopenia
Low Ca/Mg

40
Q

On endscope, what would you see with lymphangiectasia?

A

White spots on villus tips
White nodules or plaques
White fluid

41
Q

How is lymphangiectasia treated?

A

Treat primary cause
Ultra-low fat diet
Albumin/colloid due to hypoproteinaemia
Diuretic for severe effusion

42
Q

What does EPI stand for?

A

Exocrine pancreatic insufficiency

43
Q

What are the CS of EPI?

A

Polyphagia
Weight loss
D+- lots of it, yella, greasy

44
Q

What is EPI caused by?

A

Acinar cell loss

45
Q

What condition is EPI commonly associated with

A

chronic pancreatitis

46
Q

T/F EPI is more common in cats than dogs

A

false more common in dogs

47
Q

What breeds are predisposed to EPI?

A

GSD

Rough Collie

Chows

48
Q

How can EPI be diagnosed?

A

Low TLI
Low cPLI
Low cobalamin

49
Q

What does TLI stand for?

A

Trypsin-like immunoreactivity

50
Q

What is cPLI?

A

Pancreatic lipase concentrations

51
Q

How is EPI managed?

A

Pancreatic enzyme supplementation- pig/cow pancreas
dietary management
vit supplementation (cobalamin)

52
Q

What is the prognosis of EPI?

A

good

53
Q

What are common intestinal tumours?

A

Lymphoma
Adenocarcinoma
Leiomyoma/sarcoma (smooth muscle)
Mast cell tumour
Fibrosarcoma
Haemangiosarcoma

54
Q

Diagnosis of intestinal tumours

A

US
radiographs
biopsy- endo or laparotomy

55
Q

Define chronic D+

A

if it has been ongoing for over 3 weeks

56
Q

What are the 2 most common forms of IBD

A

lymphoplasmacytic IBD
eosionophilic IBd

57
Q

what do you need to do if the enteropathy has not responded to diet trial, antibiotics or steroids

A

consider non-GI disease, neoplasia or other disorders

58
Q

Management of intestinal tumours

A

chemo
preds
surgical resection
combo of multiple treatments

9- SA- Gastrointestinal and Hepatic Disease (14 decks)

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