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SA Gastroenterology (Spring 2015) > L10: Chronic Dz of the Small and Large Intestine > Flashcards

L10: Chronic Dz of the Small and Large Intestine Flashcards

1
Q

chars. of Crohn’s disease

A
  • usually extends through all layers of intestine in humans

- ileal, ileocolic, and colonic are 3 most common locations

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2
Q

chars. of ulcerative colitis

A
  • only affects colon

- causes ulcers and superficial inflamm.

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3
Q

Irritable Bowel Syndrome

A
  • NOT IBD (no inflamm. present)

- functional dz

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4
Q

chars. of Inflammatory Bowel Disease (IBD)

A
  • collective term for disorder of the SI char. by persistent or recurrent GI signs and histologic evidence of intestinal inflammation
  • idiopathic
  • SI, LI, or combination
  • infiltration of lamina propria by lymphocytes, plasma cells**, eos, neuts, macs
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5
Q

path. of IBD

A
  • combo of epithelial, immune, environmental, and microbial stressors
  • CS attributable to mucosal cell infiltrates and inflammatory mediators
  • release of complement, prostanoids, leukotrienes, pro-inflammatory cytokines, leukocyte proteases, NO, free rads
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6
Q

Clinical presentation of IBD

A
  • middle to older animals

- GSDs, irish setters, etc.

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7
Q

Clinical presentation of IBD in cats

A
  • vomiting most frequent sign***
  • intermittent or continuous
  • acute or chronic
  • CS: lethargy, change in appetite, loss of weight and condition, hairball accumulation, weight loss, NO edema, thickened intestine, mesenteric lymphadenopathy
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8
Q

Clinical presentation of IBD in dogs

A

-diarrhea most frequent sign***
-small, large bowel, or both
+/- vomiting
-diarrhea usually chronic
-CS: borborygmus, flatus, halitosis, abd pain, pica, polyphagia, weight loss, edema/ascites, thickened intestine, mesenteric lymphadenopathy

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9
Q

key to dx of IBD

A

biopsy

  • MUST EXCLUDE OTHER CAUSES OF INFLAMMATION
  • can biopsy obvious lesions or do a systemic biopsy of stomach, duodenum, jejunum and ileum
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10
Q

endoscopic findings with IBD

A

50% normal, or:

  • erythema (redness)
  • inc. granularity
  • friability
  • erosions
  • lymphangiectasia (dilation of lymph vessels)
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11
Q

interpretation of biopsy report for IBD

A
  • classified as mild, mod, or severe
  • look for description of cell type (lymphocytes, plasma cells, eos, neuts
  • interpret mucosal atrophy, villous atrophy/fusion, fibrosis, epithelial erosion, crypt abscesses, lymphangiectasia, bacteria
  • need for re-biopsy?**
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12
Q

Tx of IBD - SI

A
  • diet and abx trials

- steroids (= main therapy): prednis(ol)one, dexamethason, budesonide

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13
Q

how do steroids tx IBD?

A
  • dec. neut migration
  • dec. mac function
  • dec. lymphocyte numbers
  • dec. cytokine production
  • redistribute circulating lymphocytes
  • inhibit arachidonic acid pathways
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14
Q

chars. of budesonide

A

-less systemic effects than other steroids (has very high first pass effect in liver)

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15
Q

CIBDAI

A

Canine IBD Activity Index
-scores attitude/activity, appetite, vomiting, stool consistency/frequency, weight loss (higher the number, more severe, 0 = normal)

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16
Q

CCECAI

A

Chronic Enteropathy Activity Index)

17
Q

How to tx IBD - SI patients that show improvement

A
  • slowly taper drugs (25% reduction q2-4wks) to lowest effective dose
  • adjunctive therapy: plasma or albumin transfusion, multivitamin therapy (cobalamin), TPN, pancreastic enzymes
18
Q

Tx of IBD - LI

A

Mild: hypoallergenic/high fiber diet, metronidazole

Mod-Severe: sulfasalazine, pred

19
Q

Histiocytic ulcerative colitis

A
  • aka Boxer Colitis
  • LI dz causing hematochezia, tenesmus
  • PAS-positive macs
20
Q

Tx of Histiocytic ulcerative colitis

A

abx: enrofloxacin, bayril

NO STEROIDS!

21
Q

Food Responsive Disease tx

A
  • hypoallergenic diet (hydrolyzed or novel protein)
  • highly digestible diet
  • some respond to high fiber diet
22
Q

slide 44

A

:)

23
Q

Abx Responsive Disease

A
  • possibly results from inc. bacteria or abnormal host response
  • common in GSDs
  • Abx: tylosin, amoxicillin, metronidazole/enrofloxacin
  • probiotics, fecal transplant
24
Q

PLE

A
  • heterogenous group of diseases in which plasma proteins are lost into the GI lumen
  • mechs: lymphatic obstruction or rupture, inc. mucosal permeability, mechanical causes (ulcers)
25
Q

Diseases that –> PLE

A

inflammatory enteropathies
infectious diseases
neoplasia (LSA)
lymphangiectasia (1ary or 2ary to other dz process)

26
Q

CS of lymphangiectasia

A
  • subclinical or:
  • weight loss, d, edema, ascites, and/or pleural effusion
  • Yorkies most common
  • fluid has no protein in it
27
Q

clin path of lymphangiectasia

A
  • hypoproteinemia (often pan, but can be hypoalbuminemia) due to loss of protein rich lymph
  • hypoCa/Mg/cholesterolemia
  • lymphopenia
28
Q

Dx of lymphangiectasia

A

intestinal biopsy

29
Q

Tx of lymphangiectasia

A
  • tx underlying disease
  • low fat diets
  • anti-inflammatories
30
Q

4 main causes of infectious colitis

A

clostridium
pythium
prototheca
histoplasma

31
Q

pythium

A
  • GIT or cutaneous version
  • present w/ LI signs
  • sx + anti-fungal therapy
32
Q

prototheca

A
  • dogs w/ access to stagnant water
  • usually involves large bowel
  • tx: anti-fungals (usually unsuccessful)
33
Q

histoplasma

A
  • rare in FL

- usually requires long-term therapy

SA Gastroenterology (Spring 2015) (9 decks)

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