Day 7 - GI 4 Flashcards
Proliferative and inflammatory bowel diseases (6)
- Infiltrative enteropathies with predominantly unknown aetiology and pathogenesis
- Granulomatous enteritis
- Multisystemic eosinophilic epitheliotropic disease (MEED)
- Lymphocytic-plasmacytic enteritis
- Proliferative enteropathy
- Alimentary lymphosarcoma
Proliferative and inflammatory bowel diseases - laboratory findings (4)
- No typical clinicopathological abnormalities
- Anaemia (normocytic, normochromic)
- Neutrophilia
- Hypoproteinaemia, hypoalbuminaemia
- Abdomino centesis (often not diagnostic)
Proliferative and inflammatory bowel diseases - US
- Thickened intestinal walls
- Dilated intestines
- Tissue mass
- Could help to distinguish between small/large intestinal involvement
- Abdominal fluid; quantity and quality
Proliferative and inflammatory bowel diseases - Functional intestinal tests
- Limited to carbohydrates
- Oral glucose tolerance test (normal >85% at 120 min)
- D-xylose absorption test (normal: 20-25 mg/dl btw 60 and 90 min)
Granulomatous enteritis
(Obs Tx)
- Granulomatous hypersensitivity reaction
- Immune-mediated process (antigens: feed, parasite, bacterium)
- genetic predisposition
- Aluminium
CS: Malabsorption, enlarg. mesenteric ln, anaemia, dia, WBC, decr TP/albumin, Incr, ALKP, normal GGT
Tx: Corticosteroides, surgery in localized cases
Multisystemic Eosinophilic Epitheliotropic Disease (MEED)
Young horses
(Obs Tx)
- Eosinophilic infiltration: gastrointestinal tract, liver, pancreas, lymph nodes, skin
- Eosinophilic gastroenteritis
- Eosinophilic granulomatosis
- Eosinophilic dermatitis
CS: Dia, gastric hyperkeratosis, SI lesions, skin lesions, granulomatous lesions
Dx: absorption tests (delayed peak)
Biochemistry: hypoalbuminaemia, ALKP, GGT ↑
Tx: Corticosteroides, AB, antiparasitic
Eosinophilic enterocolitis
- Different from the other conditions
- Idiopathic
- Not multisystemic
- Malabsorption is not typical
- Signs of colic
- Often diagnosed during colic surgery
- Segmental lesions in intestinal wall
- Prognosis is better
Lymphocytic-plasmacytic enteritis
- Rare
- Dominated by inflammatory cell infiltration
- No specific signs
- Rectal biopsy could be valuable
- Treatment is ineffective
- Prognosis: guarded
Proliferative enteropathy
Weanlings. Lawsonia IC.
CS: lethargy, fever, ventral oedema, colic, dia
Dx: US (thickened SI),
* Leukocytosis, Hypalbuminaemia, hypoproteinaemia, Hyperfibrinogenaemia
* Faecal PCR, serology
Tx: AB:
* Erythromycin, Azithromycin,
* Oxytetracycline, doxycycline, Metronidazole
Supportive therapy: Fluids, NSAIDS (if fever)
Alimentary lymphosarcoma
Most common. 5-10yrs
Similar CS as all alim. d.
Dx: Rectal biopsy, abdominocentesis, laparotomy
Tx:
* Immunosuppressive medications, chemo
* Cytosine arabinosid
* Cyclophosphamide
* Vincristine
* Doxorubicin
* Dexamethasone !
* Prednisolone !
Specific indicators of liver disease
- SDH, GGT, Bile acids, Arginase, GLDH
-Direct bilirubin, urin bilirubin, Ammonia, Branched-chain amino acid to aromatic amino acid ratio ↓
Non-specific indicators of liver disease
- Total/indirect bilirubin (for icterus 3)
- LDH-3, AST, (ALT), ALP
- Blood urea nitrogen ↓
- Globulins, triglycerides
- Albumin ↓, Glucose ↓
- PTT, APTT
- WBC
Photosensitization
Dermal accumulation og phylloerythrin
Signs of endotoxaemia
Decreased hepatix clearance of endotoxin
Hepatoencephalopathy
- Depression
- Yawning
- Ataxia, paresis
- Circling
- Forward walking
- Dementia/confusion
Treatment of equine liver disease (10)
- Diet (low protein, high branched-chain – low aromatic amino acid ratio)
- Fluid, electrolyte, acid/base requirements
- Intravenous glucose and branched-chain amino acids
- Parenteral antibiotics (septic cholangiohepatitis)
- Vitamins
- Mineral oil
- Oral antibiotics (neomycin) to decrease NH3 production
- Sedatives if maniacal (α2-agonists)
- Surgery (displaced large colon) (Acute)
- Protection from sunlight
