Large intestinal and exocrine pancreatic disease Flashcards
Clinical signs of large intestinal disease. (5)
- increased defecation frequency
- tenesmus
- mucus
- fresh blood (hematochezia)
- small portions
intestinal microbial fermentation produces
gases
short chain fatty acids
energy
B12 vitamin produced
Describe the dog and cat appendix.
psyche! dogs and cats dont have an appendix like humans do.
Ddx for large intestinal disease. (8)
- small intestinal IBD
- intestinal perforation
- LI intussusception very rare compared to SI
- foreign body (but if its already in the LI then it may exit completely on its own)
- neuropathy
- hind legs paresis
- pelvic fracture
- perineal hernia
Diagnostics for large intestinal disease. (6)
- Blood sample
- Fecal sample
- X-Ray
- Ultrasound (may be hard to see cause of gas in the LI)
- Colonoscopy
- CT
Main 6 disease types of affect the large intestine.
- inflammation
- constipation
- infectious diseases
- obstruction (intussusception)
- motility disorders (constipation)
- tumors
Describe colitis + its tx.
Acute colitis vs chronic
Chronic can be: IBD, HUC (histocytic ulcerative), GC (granulomatous colitis).
Think age, breed, sex predispositions.
Treatment:
- diet + fiber (beet root, psyllium, fructo-oligosaccharides)
- glucocorticosteroids
- pre- & probiotics
- AB (only in case of uclerative colitis for e.coli with enro)
fiber responsive large intestinal diarrhea in dogs is a thing
Infectious diseases ddx for large intestinal diarrhea.
Parasites:
- Trichuris spp. (T.vulpis – koer)
Protozoa:
- Tritrichomonas foetus (kass)
Fungi
Bacteria
- Campylobacter
- Cl.spp
- EHEC/EPEC
- Salmonella
-Yersinia
Viruses:
- Coronavirus (Fel)
Giardia is NOT large intestinal, its in the small intestine.
Chronic inflammatory colitis.
Dogs: can have plain colitis
Cats: usually have diffuse changes all over
Tx:
* Diet (hydrolyzed)
* Anti-inflammatory drugs (metronidazole,
enrofloxacin – Histocytic Ulcerative Colitis)
* Immunosuppressants
Breeds predisposed to granulomatous colitis and histocytic ulcerative. (5)
Boxer
Alaskan malamute
French bulldog
English bulldog
Border collie
Clinical signs of HUC - histocytic ulcerative colitis. (6)
Hematochezia
Tenesmus
Frequent defecation
Mucus
Weight loss/anorexia +/-
Rectal palpation: blood+mucus
Etiology and ddx of HUC - histocytic ulcerative colitis.
Etiology: E.coli (aberrantly living in the mucosa, macrophages)
Analogous to Crohn’s disease in humans.
DDx:
Idiopathic IBD
Parasites, virus, bacteria
Polyps
Tumors
Intussusception
Strictures
Diagnosing HUC - histocytic ulcerative colitis. (4)
Plus tx.
Blood sample
Fecal sample
Ultrasound (thick mucosa typical)
Colonoscopy for biopsies and to visualize ulcers.
Treatment: Enrofloxacin 8 weeks against E.coli living in the mucosal layer on the colon.
Fiber-responsive large bowel diarrheal syndrome in dogs.
Typically middle-aged animals.
Symptoms: hematochezia, mucus, tenesmus. Stress-induced.
Treatment:
Diet (easily digestable)
Soluble fibre (psyllium) – increases fecal mass.
Constipation is a dysmotility disorder.
Causes? (6)
- mechanical
- inflammation
- neurologic diseases
- metabolic/endocrine diseases
- medications
- environment
Constipation in cats: see table.
Always check K+ in constipated cats.
Signs of Megacolon. (4)
Hypertrophy vs megacolon, they are different. Megacolon is not reversible. Hypertrophy wil look the same as megacolon on xray but the wall of the LI will be really thick. Hypertrophy can be reversed.
Clinical symptoms:
- constipation
- recurrent diarrhea (blood)
- weight loss
- dehydration
Constipated cats can get what looks like neuro signs (tremors, aggression).
Tx of megacolon. (6)
- super high fiber diet (change to new diet over 5-7 days)
- enemas under GA (can take up to 5h!)
- laxatives
- prokinetics
- colectomy (as long as you retain the ileocolic junction, cats can survive without their colon)
- pelvic osteotomy
Hypertrophy vs megacolon, they are different. Megacolon is not reversible. Hypertrophy wil look the same as megacolon on xray but the wall of the LI will be really thick. Hypertrophy can be reversed.
Prevalence of large intestinal tumors in small animals.
Can 36-60%, Fel 10-15%
Age, breed contribute.
Metastases occur
Canine: adenocarcinoma, lymphosarcoma, stromal
tumors (GISTs), adenoma, polyps, plasmacytoma, mast cell tumor
Fel: adenocarcinoma, lymphoma (total GI tract),
lymphosarcoma, mast cell tumor, stromal tumors
(GISTs), plasmacytoma
Signs of LI tumors. (5)
Tenesmus
Diarrhea
Melena, mucosa
Vomiting +/-
Weakness
Describe perianal fistula.
Affects DOGS.
Symptoms:
- licking
- discharge
- constipation
- painful defecation
- anorexia
- behaviour
Tx:
- AB
- Perineal cleansing
- prednisolone/cyclosporine
- analgesia
- surgery
Describe anal sacculitis tx:
- manual emptying
- flush with saline
- AB + steroids
- several weeks emptying
- warm compresses for 5 d
- surgery
Characterize pancreatitis.
Acute Pancreatitis (oedema, necrosis, significant morbidity & mortality)
vs
chronic (atrophy, fibrosis)
Acute vs chronic is techincally a histology based diganosis.
Most cases idiopathic!
Pathogenesis not well understood.
Factors to predispose to pancreatitis.
Any breed, age, sex can get it.
Predisposing factors:
- obesity
- endocrinopathies (hyperadrenocortisism, hypothyroidism, diabetes mellitus)
- drugs (KBr, phenobarbital, azathioprine)
- hypertriglyceridemia (S-trig over 9.7 mmol/l), adz of its own, seen in miniature-schnauzers.
- diet
Ingestion of unusual food: 6.1x more likely to develop it.
Table scraps: 2.2x more likely
Getting into trash (doesn’t even need to be high sugar or fat trash): 13.2x more likely
Could even get it as a complication of surgery.
Cats can develop CIE (Chronic Inflammatory Enteropathy) from: (4)
Cholangitis
Trauma
Hypercalcaemia
Ischemia (anesthesia, hypotension)
Clinical signs of pancreatitis in dogs.
- anorexia
- weakness
- vomiting
- diarrhea
- pain
- fever/hypothermia
- PU/PD
- shock
“praying position”
Subclinical cases as well!
Clinical signs of pancreatitis in cats.
- hyporexia, anorexia
- lethargy
- vomiting, weight loss
- diarrhea
- icterus (due to triaditis)
- hypothermia
- abd pain only in 20%
TRIADITIS = pancreatitis, CIE (Chronic Inflammatory Enteropathy), cholangitis
Subclinical cases as well!
Feline TRIADITIS =
pancreatitis,
CIE (Chronic Inflammatory Enteropathy), cholangitis
Diagnostics for pancreatitis. (5)
Fast 12 hours for these.
Blood sample for Hematology / Biochemistry, plus:
Pancreatic specific lipase (pancreas, liver, stomach), TRIG + CHOL (in classic pancreatitis all 3 area elevated)
Amylase (stomach, liver, pancreas) (but 50% of dogs with elevation had no pancreatitis on histology!)
Trypsin + trypsinogen (pancreas) (but TLI may be normal!)
SNAP cPLI/fPLI – positive test must always be confirmed with quantitative assay!
Specific cPLI/fPLI in referral lab.
Needs biopsy to confirm.
- X-Ray – 24%? not specific
- Ultrasound, hypoechogenic spots or hyperechogenic outer tissue in pancreas – 68%, better sensitivity but still possible there are no discernible changes.
- Laparoscopy
- Diagnostic laparotomy
- HISTOLOGIC ANALYSIS!
trypsin like immunoreactivity
normal values in cats and dogs
EPI values in cats and dogs
pancreatic lipase immunoreactivity
normal values in cats and dogs
pancreatitis values in cats and dogs
What can cause pancreatic lipase to be in the grey zone (200-400 ug/L)?
* all small intestinal diseases due to anatomical connection
* very fatty food diet (despite fasting)
* diabetes espech in cats
* hyperthyroidism
* liver andbiliary tract diseases
Pancreatitis Treatment. (8)
- Diet: low fat diet for dogs + omega 3 fatty acids // cats: feeding regular diet. If DM: high protein, low carb
- Fluid therapy (Ringer / colloids) / fresh frozen plasma.
- Pain treatment, dogs: buprenorphine, morphine, methadone, fentanyl patches.
Cats: butorphanol, buprenorphine. - Antiemetics: maropitant
- Antibiotics: not first choice! Only if its acute necrotizing pancreatitis! Very bad condition. If septic: enro+ampicillin.
- Appetite stimulants – mirtazapine, cyproheptadine, capromorelin.
- Ca-gluconate (Fel) if needed!
Necrotizing pancreas is always large and contains hypoechogenic areas.
Pancreatitis Complications.
abscess,
pseudocyst,
necrotizing masses,
extrahepatic bile duct obstruction
Pancreatitis pain treatment from mild- very severe.
Describe EPI
exocrine pancreatic insufficiency: Inadequate production of digestive enzymes resulting in Maldigestion, malnutrition.
Causes signs when 90% secretory ability destroyed!
Potentially Caused by:
* Pancreatic acinar atrophy (PAA), partially Immune-mediated (GSD, Collie)
* Chronic pancreatitis
* Neoplasia (rare)
Predisposing factors – all breeds!
Clinical signs of EPI. (6)
- weight loss
- normal/increase appetite
- increased fecal masses
- coprophagia
- dull hair coat
- behavioural changes due to abdominal discomfort
Ddx for weight loss with polyphagia. (5)
Exocrine Pancreatic Insufficiency (EPI)
Diabetes mellitus
Intestinal malabsorption:
- severe CIE (chronic inflammatory enteropathy)
- lymphangiectasia
- intestinal neoplasia
Hyperthyroidism
Severe intestinal parasitism
Do cats get EPI?
Uncommon in cats (make up 2.4% of fTLI submissions to Texas A&M lab).
Secondary to chronic pancreatitis
Loss of exocrine & endocrine pancreatic function
The Cats are usually diabetic.
Polyuria/polydipsia
DDx: CIE (Chronic Inflammatory Enteropathy)
Hyperthyroidism
Intestinal neoplasia
Clinical symptoms of EPI in cats. (6)
- weight loss (91%)
- increased appetite (42%)
- anorexia (42%)
- diarrhea (62%)
- vomiting (19%)
- dull hair coat (50%)
- only 32 % of cats presented with classic presentation of weight loss, polyphagia, and diarrhea!
What can cause dogs to be in the grey zone for TLI? (2)
grey zone: 2.5- 5.7 microg/L
beginning stages of EPI can cause it
also subclinical EPI
In some animals, you MUST fast for 16-18 hours even! In order to get reliable TLI results.
Describe TLI.
Trypsinogen-like Immunoreactivity
High specificity and sensitivity for EPI
Once EPI is diagnosed, it is not necessary to recheck it at any point. TLI will enver increase again once gone.
12-hour fast recommended
Pancreatic enzyme supplementation does NOT
affect TLI result.
Causes for elevated TLI:
- severe renal disease
- malnourishment
- pancreatitis
EPI tx:
Tx is lifelong.
- enzymes (powder/tablets/raw pancreas) – non
enteric coated products better!
Individual variations: change product or dose, powder best for cats! Give WITH food, otherwise the supplement will digest the oral mucosa.
- Cobalamin supplementation if needed.
- pro & prebiotics sure, at least at beginning to correct dysbiosis.
- Diet: balanced, complete (low fibre, moderate fat)
Acute pancreatitis can be
life-threatening.
Pancreatitis can lead to EPI.
