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SA DX & TX II > Exam 1 - Weight Loss Due To Malassimilation > Flashcards

Exam 1 - Weight Loss Due To Malassimilation Flashcards

1
Q

what are the 3 main causes of weight loss in small animals?

A

decreased caloric intake

malassimilation

hypermetabolic state

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2
Q

how can you differentiate protein losing enteropathy from other causes of severe hypoalbuminemia?

A

start with cbc/chemistry, fecal, urinalysis, gi panel, & baseline cortisol

must rule out other diseases that cause hypoalbuminemia

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3
Q

what is malassimilation?

A

decreased ability of the gi tract to incorporate nutrients into the body

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4
Q

what 2 components make up malassimilation?

A

maldigestion & malabsorption

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5
Q

what is maldigestion? what is a common example of this?

A

failure of adequate degradation of dietary constituents within the gi tract

EPI

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6
Q

what is malabsorption?

A

failure of passage of nutrients from the intestinal lumen into the bloodstream

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7
Q

what is protein losing enteropathy?

A

loss of protein from the intestines due to intestinal disease - strictly any disease causing intestinal protein loss is a PLE

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8
Q

T/F: in order to cause protein loss, there has to be a mucosal injury or lymphatic obstruction in the intestines

A

true

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9
Q

what is the most common cause of PLE in dogs?

A

intestinal lymphangiectasia

followed by inflammatory bowel disease

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10
Q

how is intestinal lymphangiectasia characterized?

A

dilation of the intestinal lymph vessels resulting in the leakage of protein rich fluids into the intestines

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11
Q

what dog breeds are predisposed to primary intestinal lymphangiectasia?

A

yorkies, maltese, rottweilers, & norwegian lundehunds

can lead to secondary inflammation

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12
Q

what causes secondary intestinal lymphangiectasia?

A

obstruction of the lymphatic vessels from either inflammation or increased venous pressure

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13
Q

T/F: in practice, it is often impossible to differentiate between primary & secondary intestinal lymphangiectasia

A

true

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14
Q

what are the most common causes of PLE in dogs?

A

intestinal lymphangiectasia

IBD

others: neoplasia (lymphoma), fungal, intussusception, & gi parasites

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15
Q

when trying to diagnose inflammatory bowel disease, what other causes of inflammation should you rule out first?

A

food responsive enteropathy

antibiotic responsive enteropathy

parasites

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16
Q

inflammatory bowel disease is characterized by ______ _________ ___ _____ ______ ____

A

chronic inflammation of the gi tract from things such as dietary antigens, their intestinal microbiome, & host-immune response

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17
Q

what are the most common inflammatory cell types seen in IBD dogs?

A

lymphocytes & plasma cells

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18
Q

how is IBD classified?

A

according to the predominant cell type

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19
Q

T/F: in order to cause protein loss, the IBD must be severe

A

true

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20
Q

what are the major consequences of PLE?

A

decreased oncotic pressure - leading to edema, ascites, & loss of fluid from the dog’s circulation

malnutrition

increased risk of thromboembolism

hypomagnesemia/hypocalcemia

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21
Q

what dog breeds are at risk for developing IBD?

A

yorkies, soft-coated wheaten terrier, norwegian lundehund, basenji, & rotties

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22
Q

T/F: some dogs with IBD have no clinical signs

A

true

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23
Q

what clinical signs are commonly seen in dogs with IBD?

A

usually small bowel diarrhea, vomiting, weight loss, abdominal distension due to ascites, limb & ventral swelling due to edema, & respiratory distress due to thromboembolism

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24
Q

T/F: PLE is a syndrome & NOT a disease

A

true - once the dog is diagnosed with PLE, important to try and identify the underlying cause usually by collecting intestinal biopsies

25
Q

if you suspect PLN in a dog that presents with a serum albumin <2.0 g/dL, what diagnostic test should be done next to investigate? what do you expect the the serum globulin concentration to look like?

A

urine protein to urine creatinine ratio - suspicious if > 2.0

normal to high

26
Q

if you suspect hepatic insufficiency in a dog that presents with a serum albumin <2.0 g/dL, what diagnostic test should be done next to investigate? what do you expect the the serum globulin concentration to look like?

A

serum bile acids - would expect to be very elevated

normal to high

27
Q

if you suspect PLE in a dog that presents with a serum albumin <2.0 g/dL, what diagnostic test should be done next to investigate? what do you expect the the serum globulin concentration to look like?

A

rule out other causes/fecal alpha 1 proteinase inhibitor

can be decreased, normal, or high

28
Q

T/F: hypoadrenocorticism is an important differential diagnosis for a dog that presents with serum albumin levels < 2.0 g/dL

A

true

29
Q

if you have a dog with IBD, and you do an ultrasound to investigate further and see this upon imaging, what do you suspect? why?

A

lymphangiectasia

hyperechoic mucosal striations are present which is characteristic of lacteal dilation in dogs

healthy dogs can have them after a fatty meal

30
Q

why do an intestinal biopsy for dogs with IBD? what criteria is used to evaluate the specimens?

A

it allows for a histomorphological diagnosis to be made - doesn’t always give the etiology

WSAVA criteria

31
Q

what should be provided in a sample submission for pathology for an intestinal biopsy for a dog with IBD?

A

detailed but succinct history

signalment, history, lab test results, diagnostic imaging findings, & any questions that need to be answered

32
Q

what is the mainstay of treatment for intestinal lymphangiectasia in dogs? why? what drug is used?

A

feed an ultra low diet that is easy to digest, palatable, has a high energy density, & low in fiber

the diets reduce the amount of fat that needs to be transported in the lacteals

immunomodulatory drugs - prednisone at 2mg/kg/day with cyclosporine as an alternative or add-on drug at 5mg/kg/day

33
Q

why is a diet change sometimes not enough of a therapy for dogs with intestinal lymphangiectasia causing IBD?

A

the lymphangiectasia may be secondary to inflammation - even if it isn’t the case, the drugs may help prevent lipogranuloma formation

34
Q

T/F: some dogs with intestinal lymphangiectasia may need a diet lower in fat that anything on the market indicating the need for a home cooked diet such as boiled fat free turkey, low fat cottage cheese, & egg whites

A

true - vitamins, minerals, & acids may need to be added in the longterm

35
Q

T/F: some critically ill patients with intestinal lymphangiectasia may benefit initially being fed an elemental diet which is low in fat & easy for them to digest

A

true

36
Q

why do a baseline cortisol in a patient you suspect PLE in?

A

rule out addison’s disease!!

37
Q

what meds can you add on for a dog that has PLE & has a decreased appetite? what therapeutic procedure can you do?

A

maropitant & ondansetron

place a feeding tube

38
Q

how is cobalamin supplemented for patients with serum cobalamin concentrations <400 ng/L?

A

cyanocobalamin given SQ weekly for 6 weeks & then once monthly

39
Q

T/F: cyanocobalamin can be used as an appetite stimulant

A

true

40
Q

what are some ways you can reduce the risk of thrombosis in PLE patients?

A

avoid placing unnecessary iv catheters

check catheter sites daily for inflammation

encourage patients to get up & move from time to time

prophylactic treatment with aspirin (0.5-2mg/kg every 24 hours) or clopidogrel (1-3mg/kg every 24 hours)

41
Q

if you have a PLE dog that has low serum calcium levels on their biochemistry panel, what diagnostic test should you run?

A

ionized calcium - can see the correct calcium serum concentration

42
Q

if you have a PLE patient that is severely hypocalcemic or symptomatic for hypocalcemia, what medications can you treat it with?

A

calcitriol (vitamin D - 30 to 60ng/kg/day) or tums dual action which is 320 mg calcium/65 mg magnesium (1/4 to 1 tablet every 12 hours)

43
Q

you have a 1 year old female spayed border collie that presents with a history of chronic diarrhea that is voluminous, light tan in color, & no increase in frequency, weight loss (15% of body weight) over 2 months, & a good appetite - what diagnostics/treatment may you pursue?

A

fecal float

prescribe metronidazole, loperamide, fenbendazole, & switch diet to hill’s i/d

44
Q

you have a 1 year old female spayed border collie that presents with a history of chronic diarrhea that is voluminous, light tan in color, & no increase in frequency, weight loss (15% of body weight) over 2 months, & a good appetite - her fecal float was negative, & you prescribe metronidazole, loperamide, fenbendazole, & a switch diet to hill’s i/d

she has a slight improvement to this, but as soon as the metronidazole is stopped, there is a complete recurrence of the diarrhea

what is your problem list/differentials?

A

small bowel diarrhea & severe weight loss despite a good appetite

ddx - EPI, antibiotic-responsive enteropathy, dietary intolerance/allergy, & IBD

45
Q

you run a CBC/chem, urinalysis, fecal float & direct smear, giardia IFA, baseline cortisol, & gi panel on the 1 year old female spayed border collie with chronic small bowel diarrhea & severe weight loss despite a good appetite

abnormal values on CBC - mild leukopenia, mild thrombocytopenia, mild neutropenia, & mild monocytopenia

abnormal values on serum chemistry - mildly decreased lactate, moderate hypocholesteremia, & mildly elevated ALT

fecal float & direct smear & giardia IFA - negative
urinalysis - WNL
baseline cortisol - 3.3 ug/dL (reference range is 1-6)

cobalamin - decreased
folate - normal
cPLI - normal
cTLI - severely decreased

what is your diagnosis?

A

EPI with secondary hypocobalaminemia

46
Q

for the 1 year old female spayed border collie you diagnosed with EPI with secondary hypocobalaminemia, what do you treat her with?

A

pancreatic enzyme powder - 2.5 teaspoons with each meal

tylosin - 400mg every 12 hours

cyanocobalamin - 800 ug SQ once weekly for 6 weeks & then once monthly

47
Q

a 5 year old male neutered rottweiler presents with a 3 month history of chronic small bowel diarrhea & weight loss with a normal appetite - there has been no response to purina EN food or metronidazole

TPR is WNL, BCS is 3/9, patient is BAR

he has a fluid wave upon abdominal palpation & subcutaneous pitting edema of the distal hind limbs

what diagnostics should you run?

A

cbc/chemistry

urinalysis

fecal float & direct examination

gi panel

48
Q

for the 5 year old male neutered rottweiler presenting with a 3 month history of chronic small bowel diarrhea & weight loss with a normal appetite - with no response to purina EN food or metronidazole

you ran a CBC/chem, urinalysis, fecal float and direct smear, & a gi panel with these results

CBC - total solids moderately decreased, mild neutrophilia, severe lymphopenia

chemistry - mild hypocholesteremia, decreased total protein, hypoalbuminemia

urinalysis - USG was 1.028 & UPC <0.4

fecal float & direct smear was negative

cobalamin - decreased
folate - decreased
cTLI - normal
cPLI - normal

what diagnostics should you do next?

A

ultrasound

49
Q

this is seen upon abdominal imaging of the 5 year old male neutered rottweiler presenting with a 3 month history of chronic small bowel diarrhea & weight loss with a normal appetite - with no response to purina EN food or metronidazole

what is this?

A

intestinal thickening & peritoneal effusion

50
Q

after seeing the intestinal thickening & peritoneal effusion on the 5 year old male neutered rottweiler presenting with a 3 month history of chronic small bowel diarrhea & weight loss with a normal appetite - with no response to purina EN food or metronidazole - you decide to do endoscopy to get biopsies of the stomach, duodenum, ileum, & colon

you receive this back - what do you see? what is this indicative of?

A

dilation of the central lacteals

suspected primary intestinal lymphangiectasia resulting in PLE

51
Q

after seeing the intestinal thickening & peritoneal effusion on the 5 year old male neutered rottweiler presenting with a 3 month history of chronic small bowel diarrhea & weight loss with a normal appetite - with no response to purina EN food or metronidazole

what is your major problem & differentials for it?

A

PLE with secondary peritoneal effusion

ddx - lymphangiectasia, IBD, neoplasia, & histoplasmosis/another infectious disease

52
Q

how do you treat the 5 year old male neutered rottweiler presenting with a 3 month history of chronic small bowel diarrhea you’ve diagnosed with primary intestinal lymphangiectasia?

A

cobalamin - 1,500 ug SQ once weekly for 6 weeks

ultra low fat highly digestible diet

tylosin - 800mg every 12 hours for 6 weeks

53
Q

T/F: dogs with PLE may not have clinical signs consistent with gi disease

A

true

54
Q

T/F: PLE is usually diagnosed by ruling out other causes of severe hypoalbuminemia

A

true

55
Q

you see this on abdominal ultrasound of a patient with PLE - what are you suspicious of?

A

intestinal lymphangiectasia - hyperechoic mucosal striations are characteristic of lacteal dilation in dogs

56
Q

what is the purpose of using a fecal alpha-1 proteinase inhibitor test for a dog with PLE?

A

increased fecal alpha(1)-PI concentration may signal the need to obtain gastrointestinal biopsies for a final diagnosis of PLE

fecal alpha(1)-PI concentration may be a useful test for early detection of protein-losing enteropathy before decreases in serum albumin concentration can be detected

57
Q

what are 3 common causes of a dog having a serum albumin concentration <2.0?

A

PLN

hepatic insufficiency

PLE

use diagnostic tests!!!

for PLN - urinalysis & UPC ratio
for hepatic insufficiency - bile acids
for PLE - rule out other causes/fecal alpha-1 proteinase inhibitor test

58
Q

why is the importance of fecal alpha-1proteinase inhibitor?

A

it is synthesized by the liver & it inhibits a variety of proteins - it is similar in size to albumin

so if gi disease is severe enough for albumin to be lost, fecal alpha-1 proteinase inhibitor will be lost as well, but unlike albumin, it IS NOT hydrolyzed by digestive & bacterial proteinases, so it can be used as an estimate of gi protein loss

59
Q

what are the indications for running a fecal alpha-1 proteinase inhibitor test?

A

should be measured in dogs and cats with hypoalbuminemia that do not have clinical signs of gastrointestinal disease and where an extra-gastrointestinal source of protein loss cannot be identified

also dogs belonging to a breed that is associated with a high prevalence of protein-losing enteropathy (e.g., Norwegian Lundehund, Soft Coated Wheaten Terrier, Yorkshire Terrier) that don’t have any clinical signs of gastrointestinal disease, but are intended for breeding

SA DX & TX II (62 decks)

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