Gastroenterology, Pt. 7 (case 6) Flashcards
feline chronic colitis causes
¡ Inflammatory bowel disease
¡ Dietary responsive enteropathy
¡ Lymphoma
¡ Hyperthyroidism
¡ Infectious
infectious causes of feline chronic colitis
¡ Campylobacteriosis
¡ FeLV/FIV-associated infection, dysbiosis
¡ Giardia
¡ Tritrichomonas foetus (TTF)
¡ Cryptosporidium parvum
canine chronic colitis causes
¡ Inflammatory bowel disease
¡ Dietary responsive enteropathy
¡ Lymphoma
¡ Hyperthyroidism
¡ Infectious
> as in cats. In canines, differentials also include:
* Histoplasmosis
* Pythiosis
* Protothecosis (concurrent uveitis)
* Heterobilharzia
* E. coli histiocytic ulcerative colitis in Boxers & French Bulldogs
E. coli histiocytic ulcerative colitis in Boxers & French Bulldogs
- how can we confirm this diagnosis?
Confirm by fluorescein in-situ hybridization (FISH), Cornell
chronic colitis general presentation
Problem: Chronic large bowel diarrhea ± small intestinal component
diagnostics for LI diarrhea
¡ CBC, chemistry
¡ FeLV/FIV test
¡ Abdominal ultrasound
¡ Fecal smears & float
¡ Giardia ELISA
¡ Tritrichomonas culture and PCR
¡ Fecal culture for pathogens
¡ IDEXX PCR panel
¡ Similar options as chronic enteropathy
¡ Surgery for colonic biopsy not recommended ¡ Colonoscopy
¡ Capsule endoscopy
what may we see on ultrasound in a case of LI diarrhea
colon mildly thickened
how to prepare colonoscopy for LI diarrhea
- Fast 48 hr (dogs)
- Colonic lavage solutions (Peg-Lyte)
- Enemas
- Flexible, or rigid (comparatively inexpensive)
chronic colitis treatment
¡ IBD – Colitis
> Usually easier to control than enteritis
> Dietary trial
¡ Anti-inflammatory drugs as per enteritis
¡ Antibiotics?
¡ Fecal transplantation
¡ Antiparasitic drugs
¡ Anticancer therapy
diet for chronic colitis
¡ High fiber can be beneficial in colitis patients
¡ Otherwise hydrolyzed protein vs novel protein dietary trial
what parasite can cause acute recurrent and chronic colitis in adult dogs? treatment?
Whipworms
* Fenbendazole (repeat in 3 months)
types of anticancer therapy that can help in cases of colitis of this origin
¡ Surgery for solid tumors
¡ Chemotherapy for lymphoma
what is tritrichomonas foetus? what is the general signalment of infected animals?
¡ Flagellate protozoan in cats
¡ Similar to giardia, but only exists in the trophozoite form
¡ Signalment: Most frequent in young cats (<1 year of age), pedigree cats, crowded catteries, multi-cat households
clinical signs of tritrichomonas foetus
¡ Chronic colitis; waxing and waning large bowel diarrhea, mucous, blood
¡ Anal irritation, fecal incontinence
¡ Persistent infection most typical
¡ Signs may resolve, although may become latent and recrudescence may occur when stressed
tritrichomonas foetus diagnosis? considerations for methods?
- Colonic biopsy
- Wet mount examination
- Culture
- PCR of feces*
tritrichomonas foetus diagnosis
- colonic biopsy; what can cause false negative?
¡ Antibiotic usage in past 7 days may result in false negatives
tritrichomonas foetus diagnosis
- wet mount examination; what type of sample requirred? look for what? when do we get false negatives and what is Sn / Sp?
Wet mount examination
¡ Need fresh fecal sample kept warm and immediately examined
¡ Characteristic forwardly progressive, jerky motion, undulating membrane, 3 anterior flagella
¡ False negative results more likely if formed feces examined
¡ Sensitivity of 14% reported, specificity can be low if misdiagnosed with Giardia
tritrichomonas foetus culture - when do we consider negative?
More sensitive than direct smear, although laborious and considered negative only when no growth after 12 days
is fecal PCR a good diagnostic method for tritrichomonas foetus? details?
¡ Quick, most sensitive
¡ Fresh feces should be tested
¡ Quantitative PCR can be utilized to monitor response to treatment
TRITRICHOMONAS VS GIARDIA appearance
Tritrichmonas:
¡Spindle shaped
¡Undulated membrane
¡Move in irregular, jerky fashion
Giardia:
¡Binucleated
¡Pear shaped
¡‘Face like’ appearance
tritrichomonas treatment
¡ Ronidazole 30-50mg/kg PO q12-24 x 2 weeks (only therapy shown to be effective)
¡ Neurologic signs can occur (particularly when given q12)
> Typically disappear following discontinuation of therapy
¡ Clean litterbox daily
¡ Untreated and treated cats should be separated
¡ Relapses common
another name for granulomatous colitis? what causes it?
histiocytic ulcerative colitis
- Adherent and invasive E. coli, located
intramucosally and within macrophages
granulomatous colitis signalment
¡ Signalment: Boxers, french bull dogs, collies
> Young dogs <4 years of age
granulomatous colitis clinical signs?
Severe large intestinal diarrhea, weight loss, inappetence
GRANULOMATOUS COLITIS: DIAGNOSIS
- Colonoscopy: Hyperemia of mucosa, thickened mucosa, mucosal ulcerations, increased friability
- Histopathology:
> mucosal infiltration with large numbers of
PAS positive macrophages
> mucosal ulceration - FISH: Gram negative coccobacilli within macrophages and clusters of invasive bacteria within the mucosa
- Colonic tissue culture: Isolate E. coli and ensure appropriate antibiotic selection
> Increasing evidence of antibiotic resistance is present
granulomatous colitis treatment
- Enrofloxacin
- In resistant cases, consider: Chloramphenicol, TMS (penetrate
intracellularly) - Antibiotics choice should be chosen based on results of culture and sensitivity testing
- Histologic improvement tends to lag behind clinical improvement
- Post treatment colonoscopy and biopsy advised to demonstrate remission and successful eradication of E. coli
Causes of constipation
¡ Pelvic fractures
¡ Painful anorectal disorders
¡ Prostatomegaly
¡ Too high-in-fiber diets in cats
¡ Chronic kidney disease in cats (dehydration)
¡ Idiopathic
CONSTIPATION AND MEGACOLON treatment
¡ Correct primary disorder
¡ Enemas (saline, castille soap, Microlax)
¡ Laxatives
> Examples include: lactulose, bisacodyl (stimulant & irritant laxative), PEG (Miralax)
¡ Cisapride
> Stimulates feline colonic smooth muscle
¡ Individualize low residue vs. high fibre diet
Idiopathic megacolon in cats - what is it?
Obstipation without any of the known causes
Idiopathic megacolon in cats treatment
- Surgical treatment: subtotal colectomy
- Medical treatment:
- Rehydrate with IV fluids
- Slow - nasoesophageal tube - trickle in colonic lavage solution over days
- Rapid – anesthesia, enema, manual degragmentation and disimpaction with sponge forceps
- Rarely fatal sepsis presumed secondary to translocation of colonic bacteria
- Follow with chronic therapy for constipation
Normal cytology of anal glands
Cholesterol crystals, some epithelial cells, extra-cellular bacteria
anal glands normally empty when?
during defacation
are anal gland disorders more common in dogs or cats?
dogs > > cats
signs of anal sac impaction, and what will cytology look like?
¡ Scooting, biting at tail end, tail quivering, head of tail sensitivity, odour
¡ Normal cytology
causes of anal sac impaction?
- Gastrointestinal disorders (e.g. IBD, dysbiosis)
- Dermatologic disorder (e.g. food allergy)
treatment of anal sac impaction
- Treat any underlying condition
- Regular expression
- Increase fibre in diet?
Anal sacculitis (chronic) signs? cytology
- Same signs as impaction:
> Scooting, biting at tail end, tail quivering, head of tail sensitivity, odour
¡ Cytology shows neutrophils and bacteria in neutrophils
causes of anal sacculitis
- Gastrointestinal disorders (e.g. IBD, dysbiosis)
- Dermatologic disorder (e.g. food allergy)
treatment of anal saccultis
- Treat any underlying disorder
- Regular expression
- Increase fibre in diet?
- Instill topical antibiotic (ophthalmic)
- Systemic antibiotics rarely used – culture first
Acute anal sacculitis & abscess - what it looks like grossly and on cytology
¡ May have had chronic impaction/sacculitis
¡ Acute painful swelling and redness
¡ Cytology shows neutrophils and bacteria in neutrophils
Acute anal sacculitis & abscess treatment
- Systemic antibiotics
> consider culture - Warm compresses
- Consider lancing if not ruptured
- Consider flushing if ruptured
- Consider removing if recurrent
Anal sac adenocarcinoma
- common in females or males? associated with what other disorder?
¡ Females >? males
¡ Hypercalcemia
Anal sac adenocarcinoma diagnosis and treatment
¡ Diagnosis: fine needle aspirate
¡ Stage the disease (see Oncology lectures)
¡ Surgical excision ± chemotherapy
perianal adenoma is in dogs or cats? what type of animals is it most common in?
dogs only
¡ Intact males»_space; neutered males > females
perianal adenoma Dx? treatment?
¡ Dx – fine needle biopsy
¡ Neutering – 95% regression
* Finasteride if neutering not an option
* Do not use estrogen unless no other
choice
> Bone marrow suppression risk
¡ Surgical excision (histology)
¡ R/O perianal adenocarcinoma if does not regress
what is a perianal fistula? causes?
¡ Ulceration and fistulous tracts in the anal/perianal area
¡ Multifactorial immune mediated mechanism suspected
¡ Other causes: chronic anal sac abscessation, neoplasia, trauma
perianal fistulas more common in what dog breed?
german shepherd
what condition is commonly concurrent with perianal fistula?
50% have concurrent colitis
perianal fistula diagnosis
Usually clinical diagnosis (can biopsy)
PERIANAL FISTULA TREATMENT
- Neither medical nor surgical therapy usually proves to be curative
- Medical treatment usually treatment of choice
> Perianal clipped and cleaned with mild
disinfectant (dilute chlorhexidine)
> Novel protein/hydrolyzed dietary trial
> Antibiotics; To treat secondary infections
Medical treatment usually treatment of choice:
- Cyclosporine* (treatment of choice)
> Immunosuppression can be gradually tapered upon resolution of lesions to lowest effective dose
- Topical tacrolimus
> To treat mild lesions or as long term management after resolution of more severe lesions
Long term immunosuppressive therapy usually necessary
¡ Stool softeners to reduce pain during defecation
¡ Surgery if no response
* Anal sac removal if involved
* Various aggressive surgeries rarely used
Identify the true statement
A) Capsule endoscopy is a recommended treatment approach for colitis in cats
B) Whipworms may cause acute and recurrent colitis in dogs
C) Chronic colitis (IBD) is typically harder to control than chronic enteritis (IBD)
D) Surgically obtained biopsies are recommended for patients with chronic colitis
B) Whipworms may cause acute and recurrent colitis in dogs
Which of the following is true regarding perianal fistulas?
A) Surgical treatment is the typical treatment of choice
B) Long term immunosuppression is often indicated
C) Cyclosporine is contraindicated in patients with perianal fistulas
D) All of the above
B) Long term immunosuppression is often indicated
