L10: Chronic Dz of the Small and Large Intestine Flashcards
chars. of Crohn’s disease
- usually extends through all layers of intestine in humans
- ileal, ileocolic, and colonic are 3 most common locations
chars. of ulcerative colitis
- only affects colon
- causes ulcers and superficial inflamm.
Irritable Bowel Syndrome
- NOT IBD (no inflamm. present)
- functional dz
chars. of Inflammatory Bowel Disease (IBD)
- 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
path. of IBD
- 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
Clinical presentation of IBD
- middle to older animals
- GSDs, irish setters, etc.
Clinical presentation of IBD in cats
- 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
Clinical presentation of IBD in dogs
-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
key to dx of IBD
biopsy
- MUST EXCLUDE OTHER CAUSES OF INFLAMMATION
- can biopsy obvious lesions or do a systemic biopsy of stomach, duodenum, jejunum and ileum
endoscopic findings with IBD
50% normal, or:
- erythema (redness)
- inc. granularity
- friability
- erosions
- lymphangiectasia (dilation of lymph vessels)
interpretation of biopsy report for IBD
- 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?**
Tx of IBD - SI
- diet and abx trials
- steroids (= main therapy): prednis(ol)one, dexamethason, budesonide
how do steroids tx IBD?
- dec. neut migration
- dec. mac function
- dec. lymphocyte numbers
- dec. cytokine production
- redistribute circulating lymphocytes
- inhibit arachidonic acid pathways
chars. of budesonide
-less systemic effects than other steroids (has very high first pass effect in liver)
CIBDAI
Canine IBD Activity Index
-scores attitude/activity, appetite, vomiting, stool consistency/frequency, weight loss (higher the number, more severe, 0 = normal)
CCECAI
Chronic Enteropathy Activity Index)
How to tx IBD - SI patients that show improvement
- slowly taper drugs (25% reduction q2-4wks) to lowest effective dose
- adjunctive therapy: plasma or albumin transfusion, multivitamin therapy (cobalamin), TPN, pancreastic enzymes
Tx of IBD - LI
Mild: hypoallergenic/high fiber diet, metronidazole
Mod-Severe: sulfasalazine, pred
Histiocytic ulcerative colitis
- aka Boxer Colitis
- LI dz causing hematochezia, tenesmus
- PAS-positive macs
Tx of Histiocytic ulcerative colitis
abx: enrofloxacin, bayril
NO STEROIDS!
Food Responsive Disease tx
- hypoallergenic diet (hydrolyzed or novel protein)
- highly digestible diet
- some respond to high fiber diet
slide 44
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Abx Responsive Disease
- possibly results from inc. bacteria or abnormal host response
- common in GSDs
- Abx: tylosin, amoxicillin, metronidazole/enrofloxacin
- probiotics, fecal transplant
PLE
- 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)
Diseases that –> PLE
inflammatory enteropathies
infectious diseases
neoplasia (LSA)
lymphangiectasia (1ary or 2ary to other dz process)
CS of lymphangiectasia
- subclinical or:
- weight loss, d, edema, ascites, and/or pleural effusion
- Yorkies most common
- fluid has no protein in it
clin path of lymphangiectasia
- hypoproteinemia (often pan, but can be hypoalbuminemia) due to loss of protein rich lymph
- hypoCa/Mg/cholesterolemia
- lymphopenia
Dx of lymphangiectasia
intestinal biopsy
Tx of lymphangiectasia
- tx underlying disease
- low fat diets
- anti-inflammatories
4 main causes of infectious colitis
clostridium
pythium
prototheca
histoplasma
pythium
- GIT or cutaneous version
- present w/ LI signs
- sx + anti-fungal therapy
prototheca
- dogs w/ access to stagnant water
- usually involves large bowel
- tx: anti-fungals (usually unsuccessful)
histoplasma
- rare in FL
- usually requires long-term therapy
