GI med 3 Flashcards
what is IBD?
collective term of disorders of the GIT characterized by persistent or recurring GI signs and histologic evidence of inflammation
chronic, immune-mediated enteropathy of middle-aged or older cats/dogs
loss of self tolerance and lack of protection, dysregulated inflammatory response –> leads to malabsorption, maldigestion, clinical signs
extremely complex interaction b/t environment and immune system of host
wayyyyy over diagnosed!!
IBD is a loss of _______ and lack of _____, dysregulated _______. leading to…?
need to know this
self-tolerance, protection, inflammatory response
leads to malabsorption, maldigestion, C/S
what are the C/S of IBD?
progressive, GI urgency markers, failed therapy
- chronic V+
- chronic d+
- borborygmi, flatulence
- weight loss
- altered appetite
- abd discomfort
tell me the general steps of the IBD workup
- hx
- lab work
- GI panel
- medical imaging
- targeted therapy or GI biopsies (ideally biopsy)
what lab work do you need to get done during the IBD workup?
CBC, chem, UA, baseline cortisol
what is included in the GI panel?
folate, cobalamin, TLI, PLI
what changes do you expect in the GI panel with IBD?
increase folate, decrease cobalamin (may be supplementation)
what are you looking for in medical imaging during the IBD workup?
GI thickening, layering changes
true or false: you do a GI biopsy and it comes back as mildly inflammated. you are most likely dealing with IBD
false! mild inflammation is likely not IBD
the most common IBD disease is ______. another one is _____; for this one, consider deworming.
lymphoplasmacytic
eosinophilic
describe the first line treatment for IBD
- hypoallergenic or novel protein diet
- prednisone
- consider cobalamin, probiotics, tylosin
describe second line treatment for IBD
add another agent (cyclosporine, azathioprine, etc)
new diet?
describe third line treatment for IBD
other immunosuppressant agent, injectables? fecal transplant? (no strong evidence thus far)
what are the other names for cobalamin
cyanocobalamin
vit B-12
what is the px for IBD?
good to guarded (relapse common when meds tapered)
treament success not guaranteed (cats have better outcome than dogs)
severe IBD can lead to ____.
PLE (protein-losing enteropathies)
what is the most common cause of PLE?
lymphangiectasia
what is lymphangiectasia and why does it cause PLE?
marked dilation and dysfunction of intestinal lymphatics (lacteals)
leakage of protein-rich lymph into intestinal lumen
what are the C/S of lymphangiectasia?
d+ (SI and LI), weight loss, ascites, hyporexia
how do you dx lymphangiectasia?
panhypoproteinemia (albumin>globulin), hypocholestrolemia, lymphopenia
US: protein poor transudate, rule out PLN, other losses of protein
GI biopsy
how do you tx lymphangiectasia?
- marked fat restriction (most important tx!!!)
- immunosuppressive therapy (prednisone)
- cobalamin suplement
what is the px of lymphangiectasia
good to poor (depends on response, worse than IBD alone, relapse
what breed gets familial PLE?
Soft-coated Wheaten terriers
what breed + age is predisposed for histiocytic ulcerative colitis? why?
young boxers
E. coli in macrophages
what is the typical hx and C/S of histiocytic ulcerative colitis?
young boxer (<2yo), severe and chronic large bowel diarrhea, weight loss, hematochezia
how do you dx histiocytic ulcerative colitis?
colonic biopsies by endoscopy, submission for fluorescent in situ hybridization (FISH)
how do you tx histiocytic ulcerative colitis?
enrofloxacin
true or false: constipation in SA is common
false.
rare in dogs, ± common in cats
what are the causes of constipation in SA?
pelvic fx/canal stenosis, neuro abnormalities, recent diet change, dehydration, CKD, idiopathic megacolon in cats
what are the C/S of idiopathic megacolon in cats?
males >females, DSH, middle aged
reduced or absent poopies
painful poopy, dry stool
dehydration, weight loss, decreased appetite, vocalization, hiding
how do you dx megacolon
PE, rads
what is the acute tx for megacolon in cats?
enema if mild constipation
severe: deobstipation under anesthesia, or oral osmotic agents given by NG tube
what is the chronic tx for megacolon in cats?
- weight loss of overweight
- chronic laxative therapy, once deobstipated
- diet: low fat and low residue
- prokinetics
- sx (severe cases)
what is the pathophys of Tritrichomonas fetus?
young kitten disease
chronic large or small bowel D+ in cats
risk factors: youth, exposure to catteries or shelters, immune compromise, pure breeds
how do you dx Tritrichomonas fetus?
fresh feces
PCR
how do you tx Tritrichomonas fetus?
ronidazole
true or false: you should suture close anal gland abscesses after draining and flushing
false
list the rectoanal diseases we have to know
- anal gland impaction
- anal gland abscess
- perineal hernias
- perianal fistulas
what is the pathogenesis of perineal hernias?
unknown, or chronic straining or IBD
what are the C/S of perineal hernias?
nothing, or perianal swelling, straining, tenesmus, painful defecation
how do you dx and tx perineal hernias?
dx: rectal exam
tx: surgery
what are perianal fistulas and what is the pathogenesis?
chronic, progressive immune disease of perineal region of older GSD
pathogenesis: immune dysfunction
what are the ddx for perianal fistulas?
neoplasia, anal gland disease
how do you diagnose perianal fistulas?
typical signs, biopsies
what is the treatment for perianal fistulas? what is the px?
tx: cyclosporine
px: good
