L22: Therapy Of Chronic Diarrhea (Gallagher)

Question 1

Types of hypoallergenic diets

Answer 1

1) Hydrolyzed protein (prevents Ag cross-bridging required to activate immune cells since proteins are so small)
- if doesn’t work, doesn’t necessarily mean there isn’t food allergy
2) Novel protein
- beware of cross-contamination

Question 2

Highly digestible diets

Answer 2

• leaves less material in the GIT
• usually turkey, chicken, or rice-based
• ie: i/d, EN

Question 3

High fiber diets

Answer 3

Hill’s w/d
Purina OM
Pumpkin, metamucil additives

Question 4

SIBO

Answer 4

• should be called Intestinal dysbiosis
• dx with folate/vit. B12
• results from alteration and/or increased bacteria with abnormal host response
• common in GSDs

Question 5

Antiobiotic Responsive Disease

Answer 5

• no good test for it but responds to abx therapy with tylosin, amoxicillin, metronidazole/enrofloxacin
• “resets” the microbiota in the GIT
• tx time variable
• probiotics may or may not work
• fecal transplantation becoming more popular

Question 6

Forms of IBD

Answer 6

(Idiopathic inflammation)
LPE
EGE
LPC
Histiocytic ulcerative colitis (HUC)

Question 7

Tx of lymphoplasmacytic enteritis form of IBD

Answer 7

• corticosteroids (main line tx for immunosuppression)
• use prednisone or dexamethasone, then taper dose 25% every 3-4 weeks and monitor for recurrence
• can also use other immunosuppressives (Atopica, Azathioprine, Chloramphenicol in cats)
• Cyclosporine may be better for PLE that aren’t responding to glucocorticoids

Question 8

Dexamethasone is how many times more potent than pred?

Answer 8

7-10x

Question 9

What tests to run if can’t differentiate between IBD and small cell lymphoma?

Answer 9

PARR
IHC

-will probably still tx both with chloramphenicol and pred

Question 10

Weaning off meds in patients with IBD

Answer 10

• decrease drugs with greatest adverse effects first (usually the steroid) by 25% q2-4 wks
• decrease Azathioprine to EOD
• decrease Chlorambucil to twice a week unless have small cell lymphoma

Question 11

Tx of lymphoplasmacytic colitis form of IBD

Answer 11

CATS: similar tx as with LPE

DOGS: corticosteroids, sulfasalazine (aspirin for the gut)

Question 12

Cats usually have LPC and LPE simultaneously, whereas dogs usually have one or the other

Answer 12

:)

Question 13

Histiocytic ulcerative colitis (HUC) form of IBD

Answer 13

• common in Boxers, Frenchies
• will present w/ wt. loss, progressive large bowel signs, nasty bloody diarrhea, loss of appetite
• caused by adherent and intracellular E. Coli in the GIT
• poorly responsive to immunosuppression
• tx with enrofloxacin +/- amoxicillin/metronidazole
• some need months or longer of therapy
• Cornell does “FISH” to dx

Question 14

Intestinal Lymphangiectasia

Answer 14

• can be primary (congenital) or 2ary to something that causes obstruction (ie. IBD, lymphoma, fungal dz)
• tx: fix underlying dz, feed low fat diet to minimize protein loss, anti-inflammatories

Question 15

Tx of EPI

Answer 15

• Pancreatic enzyme therapy
• Diet change
• Cobalamin supplement (esp. If only slowly improving with enzyme therapy)
• Abx responsive diarrhea is common, so may need to tx with abx initially

Question 16

Cobalamin deficiency

Answer 16

• common in cats
• think about it poorly responding patients
• give via parenteral supplementation
• may require lifelong therapy

Question 17

Drug of choice for treating tritrichomonas

Answer 17

Ronidazole

-neuro adverse effects seen at recommended dosage

Question 18

Diet trials can be both:

Answer 18

Diagnostic and therapeutic

• require careful eval of diet hx
• need 2-6 wk tx period to know if working