Inflammatory bowel disease

Question 1

What is inflammatory bowel disease?

Answer 1

A collective term used to describe persistent or recurrent GI signs characterised by histological evidence of intestinal inflammation. Loss of immunological tolerance to the normal intestinal flora

Question 2

How is IBD diagnosed?

Answer 2

Clinical examination 
Haematology
Faecal exam
Radiography
Ultrasound
Intestinal biopsy 
Trial diets first to exclude food intolerance
Rule out known causes of intestinal inflammation
Suspected from clinical signs
intestinal biopsy
• rule out anatomical disease

Question 3

Clinical signs associated with IBD

Answer 3

Vomiting, 
abdominal pain,
 weight loss, 
lack of appetite, 
SI diarrhoea (large volume watery, melena) 
LI diarrhoea(small volume, mucous, increased frequency)  
Haemtaemeisis 
Excessive gurgling
Hypoproteinaemia (ascities)

Question 4

Aetiology of IBD

Answer 4

Loss of immunological tolerance to the intestinal Flora
Inflammatory response
Genetic predisposition

Question 5

Name the three types of IBD

Answer 5

Lymphocytic plasmacytic enteritis (colitis)
Esoinophillic enteritis
Granulomatous enteritis

Question 6

Treatment IBD

Answer 6

Dietary manipulation (highly digestible restricted fat)
Probiotics
Antibiotics
Vitamin B12
Corticosteroids-prednisalone (do not use dexmethasone)
Novel steroids- Budesonide(enteric coated version)
Azathioprine-immunosuppressive agent, takes several weeks to be fully effective not recommended for cats! Use chlorambucil
Cyclosporine-
Varible success
5-aminosalicyic acid derivatives-
For isolated chronic colitis free 5ASA is an anti inflammatory dry eye major side effect

Question 7

What may haematology and biochemistry investigations show for IBD?

Answer 7

Anaemia (chronic inflammation and blood loss)
Neutrophillia
Eosinophilia

ALT and ALP increased 
Decreased cholesterol 
Decreased total protein
Decreased albumin
Low folate and cobalamin

Question 8

What are the causes of bowel inflammation?

Answer 8

idiopathic
 food allergy
 chronic infection
 associated with other diseases
• lymphoma (? low grade lymphoma not IBD)

Question 9

What anatomical locations are affected by IBD?

Answer 9

gastritis
• enteritis
• colitis
• gastro-enteritis
• entero-colitis
• gastro-entero-colitis

Question 10

List the characteristics of the two types of D+

Answer 10

SI-type diarrhoea
• large volume
• watery
• melaena
LI-type diarrhoea
• small volume
• mucus
• haematochezia

Question 11

List the haemotology clinical signs

Answer 11

Haematology - variable
 ± anaemia
• chronic inflammation
• chronic blood loss (microcytic)
 ± neutrophilia / left shift in LPE
 ± eosinophilia in EGE (NB. parasites)

Question 12

List the possible faecal parasitology that may arise from investigations of IBD and how they are treated

Answer 12

Faecal parasitology
 hookworms (Ancylostoma, Uncinaria)
 whipworms (Trichuris)
 Giardia
Empirical treatment with fenbendazole
(50 mg/kg PO SID for 3 days)

Question 13

How is folate and cobalimin associated with IBD?

Answer 13

Folate & cobalamin
 folate = proximal disease
 cobalamin = distal disease
 folate &  cobalamin = diffuse disease
Low cobalimin indicates the need fro treatment

Question 14

What should be included in a diet during a diet trial?

Answer 14

highly digestible
 fibre
 vitamins
 micro-nutrients
 optimum n3:n6 FA ratio
 prebiotics ?
 ‘hypoallergenic’ or exclusion diet

Question 15

What is an exclusion diet?

What types can you get?

Answer 15

Use of a single protein and carbohydrate source fro 3 weeks to see if symptoms improve
Home made (labour intensive poor compliance) 
Hydrolysed diets (commercial, greater compliance reduced size of proteins used in diet must be above

Question 16

What should be done before drug therapy is started?

Answer 16

Exclusion diet