Chronic Enteritis, Alimentary Lymphoma Flashcards
Prolif and inflamm bowel diseases
Infiltrative enteropathies- usually unknown aetiology and pathogenesis
Granulomatous enteritis
MEED: multisystemic eosinophilic epitheliotropic disease
Lymphocytic-plasmacytic enteritis
Prolif enteropathy
Alimentary lymphosarcoma
Prolif and inflamm bowel diseases: tests and plan of action
History
Phys exam
Blood haem and biochem
Urinalysis
Faecal: worms and culture
Abd (thoracic) US
Abdominocentesis: cyto and bacto
Oral glucose tolerance test
Biopsy: rectal, intestinal, liver, kidney
Laparoscopy, laparotomy
Prolif and inflamm bowel diseases Phys exam:
Malabs and maldigestion: this is why we do oral glucose
Chronic weight loss
Parameters may be normal (apart from BCS)
Chronic Dx
Ventral edema (because of protein loss)
Tissue mass in rectum (tumours in the abd?)
SI abnormalities could impact LI function
Prolif and inflamm bowel diseases lab tests
No typical abnormalities to be looking out for!!
Anaemia- normocytic and normochromic (caused by chronic inflamm in this case)
Neutrophilia
Hypoproteinaemia
Hypoalbuminaemia
Abdominocentesis: usually not diagnostic!! in case of abd tumout only a 50-60% chance the sample will contain tumour cells
Prolif and inflamm bowel diseases: US
Thickened walls or segments of walls
Dilation
Tissue mass
Could help localize btw small and large
Abd fluid: quantity and quality
Prolif and inflamm bowel diseases: rectal biopsy
Simple- biopsy forceps but results could be contradicting!!
Diagnosis in only 50%
Laparoscopy/laparotomy could be more useful
Prolif and inflamm bowel diseases: functional intestinal tests
Only for carbs
Oral glucose tolerance tests
Gives info on SI abs!!
- fast for 12-16 hrs
- 1g/kg glucose in 20% soln(via NG tube)
- Measure blood prior to glucose admin and every 30 mins until 180 mins
- NB times are 90 mins and 180 mins: peaks
- Normal: >85% elevation until 120 mins
- Partial malabs: 15-95% elevation
- Total:<15% elevation
Sometimes results contradicting e.g if delayed abs or delayed gastric emptying
D-xylose absorption test
V. similar to glucose but less impacted by hormones therefore more reliable!!
Granulomatous enteritis
young,2-3 yrs
Standardbreds
Mycobact avium?? Aluminium?
Granulomatous sensitivity reaction- where the antigen could be feed, parasite or bacteria
Granulomatous enteritis clinical signs
Malabs
Enlarged mesenteric ln’s- rectal palp
Normal or decr TP, hypoalbuminaemia
WBCs may increase or decr slightly
Sometimes, increased biliary enzymes (ALKP and GGT)
rarely Dx
Anaemia
**Rectal biopsy!
Granulomatous enteritis Therapy
Corticosteroids- improves the clinical signs but doesn’t impact long term prognosis
Surgery in localised lesions
MEED- multisystemic eosinophilic epitheliotropic disease
aetiology unknown- hypersensitivity, parasite??
Eo infiltration of: GIT, liver, pancreas, ln’s and skin
Eosinophilic: gastroenteritis, granulmatosis, dermatitis
BUT systemic eosinophilia is rare!! i.e rarelt in the blood, therefore must take biopsy for diagnosis
More common than granulomatous enteritis
Young standard and thoroughbreds
MEED- multisystemic eosinophilic epitheliotropic disease: Clinical signs
Dx
Hyperkeratosis of stomach
Lesions in SI: prox duo try and take biopsy with scope, dist ileum can only take biopsy via surgery
Granulomatous lesions and ulcers
Fibrosis of Colon
Skin: exudative derm and ulcerative coronitis
Abs tests: DELAYED peak conc
Biochem: Hypoalbumin, incr bile enzymes as before with granulomatous enteritis
MEED- multisystemic eosinophilic epitheliotropic disease: diagnosis and treatment
Biopsy: rectum, skin, liver, lymph nodes- if Eo infiltration in all of them then poor prognosis
Therapy: Corticosteroids, AB’s, larvicides
Guarded prognosis
Eosinophilic enterocolitis
Differs from the other conditions! don’t confuse with gastroenteritis
Idiopathic
Not multisystemic
Usually no malabs therefore normal BCS
Often diagnosed during colic surgery
Bight red, v inflammed segmental lesions in the int wall- may be able to perform resection, treat with corticosteroids after surgery. if not, treat with NSAID’s
Fair prognosis
Lymphocytic-plasmacytic enteritis
Rare
Inflamm cell infiltration
No specific signs
Rectal biopsy
Treatment is ineffective
Guarded prognosis
Sidenote:
It is NB to change diet with all of these diseases
Hay/grass ad lib
More freq and smaller feeds
Oil- can provide E
Proliferative Enteropathy
This is the only one where there is a known cause!!
Weanlings 3-8mnths (because weaning is stressful)
Predisp: prev AB therapy, overcrowding
LAWSONIA IC!!
- Obligate IC
- in crypts of ep of jejunum and ileum- causes tissue prolif!
Proliferative Enteropathy: Clinical Signs
Lethargy, fever
Sudden weight loss
VENTRAL EDEMA: because loss of protein
Colic signs
Dx in 50%
Dull, rough haircoat
These signs may not always be present
Proliferative Enteropathy: Diagnosis
Abd US: V thickened small intestinal walls- almost no lumen!!
History, age and clinical signs
Severe hypoalbuminaemia
Faecal PCR
Serology: IMPA
Proliferative Enteropathy: lab findings
Leucocytosis
Hypoalbuminaemia and proteinaemia
Hyperfibrinogenaemia
Maybe: hyponatraemia, kalaemia, chloraemia
elevated CK
Proliferative Enteropathy: treatment
AB’s for 2-4 weeks
- Erythomycin and rifampin
- Azithro, clarithro
- Oxytet, Doxy
- Metronidazole
- Chloramphenicol
Supportive therapy:
Fluids, electrolytes, colloids, plasma
NSAIDS if fever (give also Ranitidine in younger or omeprazole)
Good prognosis!
Alimentary Lymphosarcoma
Lymphoma= most common neoplastic condition of haemolymphatic system!!
4 anatomical forms: General, intestinal, mediastinal and dermal
Lymphocytic leukemia is rare
Typically btw 5-10 yrs (alimentary 2-4 yrs)
Unknown aetiology
Often chronic and progressive but could manifest acute signs
Lymphocytosis is rare
Alimentary lymphosarcoma: clinical signs
Malabs
Weight loss
Enlarged mesenteric lymph nodes: rectal exam
US: thickened intestinal walls
Anaemia
Neutropenia or neutrophilia
Thrombocytopenia
Normal/elevated TP
Hypoalbuminaemia or hyperglobinaemia– losing albumin BUT incr globulins! therefore TP stays the same
Alimentary lymphosarcoma: Diagnosis
Rectal biopsy, abdominocentesis (38-50%)
Diagnostic laparotomy, biopsy
Alimentary lymphosarcoma: treatment
Immunosupp drugs or chemo
