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SA DX & TX II > Exam 1 - Colonic Disease > Flashcards

Exam 1 - Colonic Disease Flashcards

1
Q

what is the function of the colon?

A

secretion & absorption of water & electrolytes - helps firm up feces

production of mucus

motility - segmentation, peristalsis, & mass transmit

immune surveillance & immune tolerance

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2
Q

why is the ileocolic valve important?

A

stops back up from colon into ileum - could cause dysbiosis problem

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3
Q

what is the longest part of the colon?

A

descending colon

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4
Q

why does it take longer to see diarrhea from small bowel causes when compared to large bowel disease?

A

the large bowel compensates for the small bowel, but in large bowel disease, fairly mild disease can cause diarrhea very quickly

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5
Q

what is the role of the colonic microbiome?

A

development of mucosal immune system

energy metabolism of epithelial cells - butyrate, need fermentation of butyrate for energy!!

vitamin synthesis (folate, vitamin K, & biotin)

absorption of complex macromolecules

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6
Q

what are some common helminths that cause large bowel disease?

A

trichuris vulpis & heterobilharzia americanum

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7
Q

what are some common protozoal causes of large bowel diarrhea in cats?

A

tritrichomonas fetus

giardia intestinalis (small bowel in dogs & large bowel in cats)

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8
Q

what cats are commonly affected by t. fetus?

A

common in pure bred cats & shelter cats - typically young cats

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9
Q

T/F: some cats infected with t. fetus can be apparently healthy with no clinical signs

A

true

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10
Q

how is t. fetus diagnosed?

A

fecal direct smear - lacks sensitivity

in-house culture - sensitivity around ~55%

fecal PCR - most sensitive, gold standard!!

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11
Q

what is the gold standard test for diagnosing t. fetus infection in cats?

A

fecal PCR

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12
Q

T/F: t. fetus is resistant to metronidazole

A

true

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13
Q

what is the treatment used for t. fetus infections causing large bowel diarrhea in cats?

A

ronidazole - 30mg/kg every 24 hours for 2 weeks

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14
Q

what are the adverse effects associated with ronidazole?

A

neurotoxicity!!

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15
Q

an owner brings in their bengal cat they recently adopted with large bowel diarrhea, this is seen on the fecal - what is it? how do you treat it?

A

tritrichomonas fetus

ronidazole

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16
Q

what are some fungal/mold causes of large bowel diarrhea?

A

histoplasma capsulatum, phythium insidiosum, & prototheca zopffi

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17
Q

what bacterial causes commonly cause large bowel diarrhea?

A

campylobacter, clostridium perfringens, & clostridium difficile

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18
Q

what are the 3 main treatments used for chronic enteropathies of the colon listed in order?

A

diet trial - if they respond, fiber-responsive colitis

tylosin trial - antibiotic responsive colitis

biopsy then immunosuppressant trial (IBD)

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19
Q

what are your main options for diet trials?

A

intestinal diets - moderately restricted fat content, omega-3 fatty acid supplementation, & high digestibility

exclusion diets - novel protein sources & hydrolyzed antigen

fiber supplementation - psyllium husk, fructooligosacchararides, & canned pumpkin

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20
Q

what is a more practical term to use instead of dysbiosis?

A

antibiotic responsive diarrhea

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21
Q

what is dysbiosis?

A

imbalance in the intestinal microbiota that may be a primary problem or can be secondary to another disease

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22
Q

T/F: not every dog with antibiotic responsive diarrhea has dysbiosis & not every dog with dysbiosis has antibiotic responsive diarrhea but there is overlap

A

true

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23
Q

what are the proposed mechanisms in which dysbiosis/antibiotic responsive diarrhea can lead to diarrhea & malabsorption?

A

competition for nutrients is increased

production of secretory stimulants (think e. coli)

decreased brush border enzyme activity

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24
Q

what is the treatment recommended for dysbiosis?

A

abx - tylosin at 20mg/kg every 12 hours for 4-6 weeks, metro, but know that signs often relapse as soon as meds are stopped

prebiotics - fiber!!!

may try probiotics or potentially a fecal microbiota transplant

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25
Q

T/F: IBD can affect any part of the intestinal tract

A

true

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26
Q

T/F: it is unusual for IBD to just affect the colon in dogs

A

true

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27
Q

what is the most common age of onset of IBD? what is the most common clinical sign?

A

6 years in dogs & cats

diarrhea

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28
Q

what clinical signs are seen in boxers with e. coli associated granulomatous colitis?

A

large bowel diarrhea +/- weight loss

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29
Q

T/F: in e. coli associated granulomatous colitis, most dogs develop clinical signs prior to 2 years of age

A

true

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30
Q

what is the treatment for large bowel signs in IBD?

A

intestinal or elimination diet +/- prebiotics

anti-inflammatory/immunosuppressive drugs with prednisone/prednisolone being your top choice

chlorambucil - add on agent in cats

cyclosporine - add on agent in dogs

sulfasalazine - for large bowel disease in dogs only!!!

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31
Q

what breed of dog is commonly affected by e. coli associated granulomatous colitis?

A

boxer dogs

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32
Q

what is granulomatous colitis?

A

granulomatous inflammation with PAS positive macrophages & intralesional bacteria that is caused by e. coli

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33
Q

how is e. coli associated granulomatous colitis diagnosed?

A

fluorescence in situ hybridization (FISH) & culture

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34
Q

how is e. coli associated granulomatous colitis treated?

A

enrofloxacin at 10mg/kg every 24 hours for at least 6 weeks

35
Q

why does enrofloxacin need to be prescribed for at least 6 weeks in dogs with e. coli associated granulomatous colitis?

A

if the medication is stopped, signs of e. coli associated granulomatous colitis will come back

36
Q

this biopsy shows a lesion that is caused by e. coli in the colon - what is it?

A

granulomatous colitis of boxers

37
Q

neoplasia in the colon is associated with what clinical signs? what finding is commonly detected during a physical exam?

A

tenesmus & dyschezia, large bowel diarrhea, hematochezia, obstruction, weight loss, & vomiting if the disease is diffus

mass detected on rectal exam or abdominal palpation

38
Q

what are the most common tumor types seen in the colon of dogs?

A

adenocarcinoma, lymphoma, gi stromal tumors, & benign adenomas/polyps/leiomyomas (less common)

39
Q

T/F: large intestinal tumors are more common than gastric & small intestinal tumors

A

true

40
Q

what are the most common tumor types seen in the colon of cats? what is the general risk of metastasis?

A

adenocarcinoma, lymphoma, & mast cell tumors

high rates of metastasis

41
Q

____________ intussusception accounts for 2/3 of intussusceptions in dogs & cats, & of these, _________ is the most common

A

enterocolic

ileocolic

42
Q

what clinical signs are associated with intussusception?

A

vomiting, inappetence, diarrhea, +/- abdominal pain - can occur as a complication of acute gi disease

43
Q

what is seen on physical examination of a patient with an intussusception?

A

may feel a cylindrical mass in the abdomen, may protrude through the rectum

44
Q

how do you differentiate an intussusception from a rectal prolapse?

A

use a thermometer - if prolapsed rectum, you can’t pass it between the prolapse and the anus

in patients with intussusception you can pass it

45
Q

how is an intussusception diagnosed?

A

physical exam, target lesion on ultrasound, & surgical exploration

46
Q

what is the treatment for an intussusception?

A

surgery - reduce it or R&A

47
Q

what lesion is seen on this ultrasound image?

A

ileocolic intussusception

48
Q

how are some ways in which signalment helps you when creating your differential list for a patient with colonic disease?

A

patient age - neoplasia is less likely in young animals

young animals are more likely to have infections & dietary intolerance/allergy

breed predispositions - think boxers & the granulomatous colitis

49
Q

what are the main clinical signs associated with large bowel disease?

A

diarrhea & constipation

50
Q

how do you differentiate small & large bowel diarrhea?

A

small bowel - large volumes of watery diarrhea, normal to mildly increased frequency, no tenesmus or urgency, no mucus, may have melena, & weight loss

large bowel - normal to mildly increased volumes, markedly increased frequency, tenesmus & urgency usually present, mucus frequently present, fresh blood can be present, & weight loss is uncommon

51
Q

T/F: a sick patient should have a stress leukogram, so the absence of one suggests addison’s disease

A

true

52
Q

what diagnostic tests should be done for a patient with large bowel disease?

A

cbc - look for stress leukogram

chemistry - evaluate patient for systemic disease that can cause diarrhea & also evaluate for consequences of gi disease

ua

53
Q

what is a zinc sulfate fecal centrifugation useful for? how can you increase its sensitivity?

A

detecting helminths & other parasites

pool 3 days worth of feces

54
Q

when is a direct fecal smear useful?

A

detecting protozoal trophozoites

55
Q

why is it difficult to interpret a positive bacterial culture for salmonella or campylobacter?

A

healthy dogs & cats can be colonized by these organisms!!! are they just there or are they actually causing an issue

56
Q

what is the best testing used for detecting giardia?

A

IFA antigen testing

57
Q

why is it hard to establish a causal relationship of clostridium & large bowel diarrhea?

A

enterotoxin producing strains of clostridium have been found in healthy dogs

58
Q

what clostridium species have been associated with large bowel diarrhea in dogs?

A

clostridium perfringens & clostridium difficile - both produce enterotoxins

59
Q

what aspect of clostridium actually causes the diarrhea?

A

the enterotoxins cause the diarrhea

60
Q

what diagnostic test is used for diagnosing phythium?

A

elisa tests

61
Q

what diagnostic tests are used for diagnosing heterobilharzia?

A

fecal sedimentation & fecal PCR

62
Q

what diagnostic tests are used for diagnosing histoplasmosis as a cause of large bowel diarrhea?

A

cytology & EIA for antigen in serum or urine

63
Q

when are survey abdominal rads most useful for patients with gi problems?

A

better used when the patient has vomiting as well as diarrhea

64
Q

when is rectal scraping especially useful as a diagnostic tool for animals with large bowel disease?

A

may be used to detect infectious agents such as histoplasmosis/prothecosis

performed on conscious/mildly sedated dogs

65
Q

what is the stage 1 in approaching chronic large bowel diarrhea?

A

rule out parasitism using a fecal float/sedimentation & deworm with fenbendazole (50mg/kg by mouth every 24 hours for 3 days)

do a diet trial with a highly digestible diet

66
Q

what is the stage 2a in approaching chronic large bowel diarrhea?

A

rule out systemic disease - not often seen with large bowel diarrhea - CBC, chem, UA, FeLV/FIV snap test in cats

67
Q

what is the stage 2b in approaching chronic large bowel diarrhea?

A

further fecal testing - look for t. fetus in cats, giardia antigen testing in cats, & may test for heterobilharzia

may do diagnostic imaging - rads/ultrasound

68
Q

what is the stage 3 in approaching chronic large bowel diarrhea?

A

therapeutic trials - novel protein or hydrolyzed antigen diet, add soluble fiber to the diet, antibiotic trial with tylosin

+/- probiotics & fecal transplant

69
Q

what is the stage 4 in approaching chronic large bowel diarrhea?

A

abdominal ultrasound +/- rads if they haven’t been done yet

intestinal biopsy for upper & lower gi tract or surgical biopsy (not commonly done on the colon)

70
Q

what is the stage 4 in approaching chronic large bowel diarrhea?

A

abdominal ultrasound +/- rads if they haven’t been done yet

intestinal biopsy for upper & lower gi tract or surgical biopsy (not commonly done on the colon)

71
Q

what is constipation?

A

infrequent or difficult evacuation of feces

72
Q

what is obstipation?

A

intractable constipation that is refractory to treatment

73
Q

what is megacolon?

A

abnormal dilation of the colon resulting from constipation or obstipation

74
Q

what is dilated megacolon?

A

end stage disease due to the loss of motility

75
Q

what is hypertrophic megacolon?

A

megacolon due to obstruction that is potentially reversible

76
Q

what are some obstructional causes of constipation?

A

luminal mass, mural mass, extra-mural issue

77
Q

T/F: painful defecation can be a cause of constipation

A

true - anal fistulas

78
Q

what are the 2 categories of neuromuscular causes of constipation?

A

primary & secondary

79
Q

what is the most common cause of constipation in cats?

A

idiopathic megacolon

80
Q

what is the general approach that should be taken for an animal that presents with constipation?

A

rule out drugs that reduce gi motility

rule out metabolic disease - CBC, chem, urinalysis, & TT4

rule out obstruction - abdominal rads, +/- u/s, biopsies

81
Q

what medications are used for treatment for constipated patients?

A

hyperosmotic laxatives - lactulose or miralax

colonic prokinetics - cisapride (need to have it compounded!!)

82
Q

what therapies are used for patients that are constipated?

A

removal of impacted feces - rectal suppositories, enemas, & manual extraction

surgery

83
Q

what patients are colectomies reserved for?

A

cats that are refractory to medical management - try to preserve the ileocolic valve

SA DX & TX II (62 decks)

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