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Principles of Science BVetMed 4 > CS - difficult cases in gastroenterology > Flashcards

CS - difficult cases in gastroenterology Flashcards

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Biology 101 flashcards
1
Q

Ddx - monoclonal gammopathies

A

o Lymphoreticular tumours (lymphoma, EMP, chronic and acute lymphocytic leukaemia)
o Chronic infections (e.g. ehrlichiosis, leishmaniasis, FIP)
o MGUS (monoclonal gammopathy of unknown significance)

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2
Q

T/F: you see BM plasmactyosis in myeloma and lymphoma

A

True

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3
Q

If you believe a dz is undistributed in bone. what do you do?

A

multiple samples

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4
Q

How commonly is extramedullary plasma cell tumour (EMP) associated with paraneoplastic disease?

A

rarely

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5
Q

What is Pythium insidiosum?

A
  • an oomycete = an algae

- sort of like a fungus

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6
Q

Species - Pythium insidiosum

A

horses, dogs, cats

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7
Q

Typical signalment - animals suffering from Pythium insidiosum

A
  • algae freshwater infection therefore hunting/working dogs.
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8
Q

Forms - Pythium insidiosum

A
  • cutaneous
  • vascular
  • ocular
  • GIT
  • systemic (typically too late to respond to tx)
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9
Q

CS - Pythium insidiosum

A
  • vague
  • vomiting
  • wt loss
  • anorexia
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10
Q

Lab findings - Pythium insidiosum

A

• Eosinophilic and granulomatous inflammation
• Mesenteric lymphadenopathy
• Stomach, duodenum and ileocolic junction (possible any part of GIT)
• Not associated with immunosuppression like other fungal dz
++++

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11
Q

Dx - Pythium insidiosum

A

3 ways:
o Wet mount exam in 10% KOH followed by culturing
o Detect anti-P Abs using serological assays
o Detection of DNA of the infectious agent in the infected tissue by PCR/ se-quencing

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12
Q

Tx - Pythium insidiosum

A
  • SURGICAL EXCISION (best, poor px if excision not possible, sx debridement of skin lesions popular but high recurrence rate)
  • MEDICAL: 20% success rate, anti-fungals have reduced efficacy as not true fungus, steroids may decrease inflammation, immunotherapy tx available but low efficacy
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13
Q

Differentiate atypical addison’s from secodary addisons

A

> Atypical addisons = primary hypoadrenocorticism, normal serum electrolytes (MC levels not affected as doesn’t affect zona glomerulosa)

> Secondary addisons = pituitary gland doesn’t secrete ACTH. Serum electrolytes are also still normal because aldosterone preserved. D/t destruction poutiitary (neoplasia, inflammation, head trauma) or chronic exogenous GCs  negative feedback to pituitary.

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14
Q

CS - atypical addisons

A
  • normal serum electrolytes
  • decreased post ACTH cortisol
  • normal post-ACTH aldosteroine
  • increased endogenous ACTH
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15
Q

Lab findings - atypical addisons

A
  • Hypoglycaemia (GCs stimulate glucose production)
  • Mild, normocytic, normochromic non-regenerative anaemia
  • Absence of stress leukogram
  • Hypocholestrolaemia (decreased GIT absorption)
  • Hypoalbuminaemia (d/t gut issues)
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16
Q

Dx - atypical addisons

A

• 1st ACTH stimulation test – confirms hypoadrenocorticism but doesn’t differentiate primary/secondary hypoadrenocorticism
• Dz d/t atypical or secondary hypoadrenocorticism via lack of electrolyte imbalance
• Ddx atypical vs secondary = periodic +++
• ULTRASOUND
• ECG
++++++++++++++++++++++

17
Q

Tx - atypical addisons - what dose of prednisolone?

A

o Immunosuppressive dose is 2-4mg/kg BID (other dz)
o Anti-inflammatory dose is 0.5-1mg/kg BID (other dz)
o Physiological dose – this case as replacing body’s GC – 0.1mg/kg/BID. More is usually given to owner so that if they anticipate a stressful event  can give 5mg in a day to reduce chance of  Addisonian crisis.

18
Q

What to monitor with atypical addison’s?

A

electrolyte changes regularly as some atypical addison’s can  primary hypoadre-nocorticism (begin to lack MCs)  need MC and GC supplementation

19
Q

What lab findings suggest EMP?

A
  • cytopathology of BM aspirate (in EMP, plasma cell infiltration doesn’t exceed 5% of all nucleated cells. In MM, >20% plasma cells are present)
  • Histopath (gastric tumour) : plasma cell neoplasm and primary amyloidosis
  • Biochemistry: high TP –> serum electrophoresis –> monoclonal spike in globulin.
  • Haematology: check PCV, PLT and WBC to check no BM involvement
  • Radiograph: skeletal lytic (‘punched out’) lesions
20
Q

Features of EMP staging

A
  • Skeletal radiography
  • BM aspiration
  • Serum protein electrophoresis
21
Q

Dx - multiple myeloma (MM)

A

MM requires 2 of the 4 following signs: radiographic lytic ‘punched out’ lesions, Bence-Jones proteinuria (Ig light chains in urine, not part of standard UA panel), monoclonal gammopathy and >20% plasma cells on BM aspirates.

22
Q

What method allows categorisation of the immunoglobulin class involved in a monoclonal/polyclonal spike?

A

Immunoelectrophoresis

23
Q

Tx - EMP

A
  • establish staging before tx (often metastasises)
  • GIT protectants (sucralfate and kaolin)
  • prednisolone (lyses plasma cells)
  • if non-resectable, use chemo or radiotherapy (depends on location)
  • chemo: melphalan and cyclophosphamide protocol or melphalan/ prednisolone protocol/
24
Q

What is good about melphalan/prednisolone protocol?

A

give orally, at home, less hassle, less invasive. Although px for MM not great, many owners adopt this protocol as ‘nicer’.

25
Q

Prognosis - EMP

A

o Soft tissue form better px than SBP = solitary bone plasmacytoma
o Non-cutaneous, non-oral sites carry worse prognoses
o SOP may  MM

26
Q

Contrast MM in dogs versus cats

A

Both fairly similar in presentation signs.
DOG – 8-9 yo, IgG and IgG equally common, radiographs more likely visible bone disease, 30% thrombocytopaenic, hyperCa can occur but also in cats, enlarged liver and spleen, bone (latter two are CS specific to dogs)
CATS – less common, 12-14, possible male predisposition, no evidence that FeLV, FIV or FIP related, 80% IgG and 20% IgA, more likely to have heart murmur/ cardiomegaly, skeletal lesions rare, 50% thrombocytopaenic, dogs respond better (cat MST 137 d). Tend to get Bence Jones proteinuria more commonly than dogs. Only about 30 cases have ever been reported though. Main CS anaemia.

27
Q

What is the biggest immunoglobulin? Clinical significance?

A
  • IgM
  • . If this is present more serious glomerular disease as  nephritis (d/t size of globulin – a macroglobulin). Syndrome = ‘Wadestroms macroglobinuria’.
28
Q

Give an overview of Histoplasma capsulatum

A
  • worldwide
  • Endemic - US (Mississippi, Ohio River Valleys)
  • Fungus found in soil containing bird and bat manure
  • Oval or round (2-4 micrometers diameter within macrophages)
  • Basophilic centre surrounded by clear area caused by shrinkage from fixation
29
Q

Transmission - Histoplasma capsulatum

A
  • Aerosol contamination of respiratory tract (commonly)

* Primary site of infection: lungs, thoracic LNs, or GIT

30
Q

Presentation - Histoplasma capsulatum

A

• CS vary and are non-specific (many different organs involved)
• Chronic GI signs, especially large intestinal diarrhoea, usually most obvious in dog, often progress to small intestinal diarrhoea
• Many dogs have a protracted course of weight loss to emaciation, chronic cough, poor coat, persistent diarrhoea, fever, anaemia, hepatomegaly/splenomegaly, lymphadenopathy, nasopharyngeal and GI
ulceration
• Fever (non-respondant to antibiotics)
• Acute histoplasmosis may be fatal after 2-5 weeks

31
Q

CBC - histoplasma

A

• Normocytic, normochromic non-regenerative anaemia
(blood loss, inflammation, marrow infiltration)
• Thrombocytopenia (Platelets sequestered in spleen or liver
• Neutrophilia or neutropaenia
• Eosinophilia or eosinopaenia
• Monocytosis
• Chronic cats may show no blood abnormalities!

32
Q

UA - histoplasma

A

usually normal

33
Q

Biochem - histoplasma

A
  • Hypoalbuminemia common in cats and dogs (blood loss, decreased synthesis due to inflammation, protein losing enteropathy)
  • Hyperglobulinemia in cats and dogs (inflammation)
  • Increased ALT, ALP and bilirubin (hepatic involvement)
34
Q

Why is a fungal culture not recommended to dx Histoplasma?

A

risk to staff

35
Q

Serology - histoplasma

A
  • Test for Abs but many false negatives/positives
  • Testing for Ag: Quantitative antigen ELISA is used in humans on urine, serum, and CSF but - limited research into canine and feline use thus far
36
Q

Treatment - histoplasma

A
  • Itraconazole 10 mg/kg/day for 60-130 days is the treatment of choice for disseminated histoplasmosis in dogs and cats. Oral suspension or IV if oral impossible
  • Ketoconazole, 10–15 mg/kg, bid for 4–6 mo, may be effective in early or mild cases in dogs.
  • Consider corticosteroids (pred 2mg/kg every 12-24 hours) if significant airway obstruc-tion from enlarged lymph nodes or lung inflammation

Principles of Science BVetMed 4 (6 decks)

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