Lecture 14: Diarrhea II Flashcards
1
Q
What are the 3 selective barriers to GIT
A
- Mucus- physical barrier to bacteria, IgA binds antigen and neutralizes lumen
- Enterocytes: tight junctions, antigen presentation
- GALT
2
Q
t or f: most GI luminal antigens are harmless- commensals, nutrients
A
true
3
Q
__response if GALT is presented a harmless antigen
A
anti-inflammatory
4
Q
__ response if GALT is presented a pathogenic antigen
A
pro-inflammatory
5
Q
define microbiome
A
bacteria, fungi, viruses, living in GI
6
Q
Bacteria number and diversity increase as you move __in GIT
A
distally
7
Q
microbiome compete for __ and __bad bacteria
A
nutrients, crowd out
8
Q
products of bacterial metabolism promote __
A
GI health
9
Q
What is the metabolome composed of
A
SCFA and secondary bile acids
10
Q
where are bile acids mainly absorbed
A
ileum
11
Q
what is the result of ileal disease in relation to bile acids
A
decreased bile acid reabsorption—> increase BA’s in colonic lumen
12
Q
microbial __required for bile acid reabsorption
A
deconjugation
13
Q
what microbe in host alters primary bile acids into secondary bile acids
A
peptacetobacter hiranois
14
Q
secondary bile acids interact with __ and __
A
GI enterocytes and immune ells
15
Q
secondary bile acids inhibit growth of __
A
bad bacteria (E. Coli, C. Diff, C. Perfringes)
16
Q
microbial CHO metabolism—-> ___
A
short chain fatty acids
17
Q
what are the 3 main SCFA
A
acetate, butyrate, proprionate
18
Q
what are the functions of SCFA (4)
A
- Promote production of tight junction proteins
- Increase mucosa anti-inflammatory cytokines
- Decrease mucosa pro-inflammatory cytokines
- Acidify lumen—> alters bacterial growth
19
Q
SCFA acidifying the lumen reduces what bacteria
A
E. Coli and clostridia genii
20
Q
SCFA acidifying the lumen prevents enteropathogen ___ and __
A
virulence factor expression and colonization
21
Q
Tolerance may be turned off appropriate in presence of __
A
enteropathogen
22
Q
tolerance may fail inappropriate if __ or __malfunction
A
physical barriers or regulatory immune cells
23
Q
define chronic inflammatory enteropathy
A
non-infectious GI inflammation lasting >3 weeks
24
Q
why type of bowel diarrhea is CIE
A
small, large or mixed
25
what does AUS show for CIE
GI intestinal wall thickening +/- lymphadenomegaly
26
what does GI blood work panel for CIE show
1. Low cobalamin
2. Low folate
27
CIE may cause secondary __, __ and __
secondary Lymphangiectasia, mucosal ulceration and PLE
28
how do you dx CIE
1. Biopsy
2. Treatment trials
29
identify 1-5 and is this normal or abnormal intestine
1. Serosa
2. Muscularis
3. Submucosa
4. Mucosa
5. Lumen
Normal
30
identify 1-4 and is this normal or abnormal SI
1. Serosa
2. Muscularis
3. Submucosa
4. Lumen
Abnormal: Muscularis thickened
31
what does a low cobalamin indicate
ileal malabsorption
32
what does a decreased folate indicate
duodenal malabsorption
33
what does an increased folate indicate
bacterial overgrowth
34
what does increased trypsin like immunoreactivity
nonspecific marker for pancreatitis
35
what does decreased trypsin like immunoreactivity indicate
diagnostic for EPI
36
what does increase cPL or fPL indicate
acute pancreatitis
37
t or f: serum and skin allergy tests are realizable for CIE
false
38
antigenic dietary protein sources can lead to __ in CIE
mucosal inflammation
39
alterations in fat digestion/absorption can lead to __ and __ in CIE
lymphatic leakage, osmotic diarrhea
40
alterations in microbial fermentation productions lead to ___ in CIE
mucosal permeability
41
__% of dogs with CIE will respond to therapeutic diets
60%
42
what diet is good for CIE
Hypoallergenic
43
what are some examples of hypoallergenic diets
1. Novel protein (immune system won’t react)
2. Hydrolyzed protein (protein molecules too small to have recognizable antigen sequence)
3. Limited antigen diets (single protein and carb diet)
44
What are the levels of fat and fiber in an easily digestible diet
low
45
what are some indications for a hypoallergenic and easily digestible diet
Adverse food reactions +/-
1. CIE
2. Pancreatitis
3. Chronic vomiting
4. EPI
5. PLE
46
what is dietary fiber
plant carbohydrates that can’t be digested by mammalian enzymes
47
what 3 things are important to evaluate about fiber
1. Solubility
2. Viscosity
3. Fermentability
48
Soluble or insoluble fiber: decrease fecal bulk
soluble
49
soluble or insoluble fiber: increases large intestinal motility, increases fecal bulk
insoluble
50
viscous fiber reduces serum __
cholesterol
51
how does viscous fiber affect GI
1. Slows nutrient absorption—> improved glycemic index
2. Ileal brake: slows gastric emptying and intestinal transit time
52
fermentable fiber increases fecal ___content
SCFA
53
what is included in the guaranteed analysis for nutrient reporting in pet food
1. Minimum crude protein
2. Minimum crude fat
3. Maximum crude fiber
4. Maximum moisture
54
t or f: guaranteed analysis can be used to compare diets
false
55
What do you use to compare diets
typical dry matter analysis
56
what fibers are reported vs not reported on pet foods
Reported: Maximum crude fiber
Not reported: insoluble vs soluble fiber, fermentable, viscous
57
what is a common fiber supplement
psyllium husk power
58
what type of fiber is psyllium: soluble or insoluble, viscous or not, fermentable or not
soluble, viscous, non-fermenting
59
how does psyllium assist with hard stool/constipation
1. softens by incorporating more water into fecal bulk
2. Improves peristaltic contractions
3. Soft, easy to pass, more frequent bowel movements
60
how does psyllium assist in soft stool
1. Viscous gel forms slowing transit time
2. Improves fecal consistency
3. Reduces bowel movement frequency
61
How slow should you transition to new diet
1-2 weeks
62
for CIE new diet feed exclusively for __ weeks
2-4 weeks
63
to compare these foods: calculate protein, fat, and crude fiber
Protein: 7.40 g/100kcal
Fat: 4.11 g/100kcal
Fiber: 1.37 g/100kcal
64
Define dysbiosis
imbalance in types of microorganisms in microbiome
65
what are some causes of dysbiosis
1.EPI
2. Liver disease
3. Kidney disease
4. Pancreatitis
5. Enteropathogen
66
what are some iatrogenic causes of dysbiosis
1. Acid suppressants
2. Abx
67
what are some tx for dysbiosis
1. Prebiotics
2. Probiotics
3. Postbiotics
4. Symbiotic
5. Fiber
5. FMT
68
what is a prebiotic
substances that feed good bacteria
69
what are probiotics
live beneficial bacteria
70
what are postbiotics
beneficial bacterial productions
71
what are the theoretical benefit is of probiotics
1. Displacement of intestinal pathogens
2. Production of antimicrobial substances
3. Increase expression of enterocyte tight junction proteins
4. Regulation of immune responses
5. Upregulation of cellular defense mechanisms
72
what is visbiome
probiotic
73
visbiome has been shown to reduce __ and increase __
mucosal inflammatory cells, biomarkers for GI tolerance
74
slab61 combination probiotic improved histopath scores in dogs with
chronic inflammatory colitis
75
what probiotic shortened duration of diarrhea after lincomycin in dogs
saccharomyces boulardii
76
what probiotic improved fecal scores in cats who received amox-clav for 7 days
fortiflora
77
what antibiotics are typically used to tx dysbiosis
metronidazole, tylosin
78
metro and tylosin: activity against aerobes or anaerobes
anaerobes
79
before trying antibiotics for dysbiosis try __, __ and rule out __
diet modulation, pre/probiotics, rule out parasites
80
what steroids are used in tx of CIE
1. Prednisone
2. Budenoside
81
what is the advantage to budenoside
high 1st pass metabolism- fewer systemic side effects
82
what are the risks of putting patients on steroids without definitive CIE dx
1. Worsening of even fatality if infectious cause
2. Masking steroid responsive neoplasia
3. Dx addisons much harder
83
how do you definitively dx CIE
bippsy
84
what are the pros and cons of surgical biopsy for CIE
Pros:
1. Access jejunum
2. Full thickness biopsies
3. Evaluate and biopsy other organs and LN
Cons:
1. One sample from part of GIT
2. Post-op recovery
3. Risk of dehiscence and septic abdomen
4. Colonic biopsies risky
85
what are the pros and cons of endoscopic GI biopsy for CIE
Pros:
1. Biopsies from multiple parts of GIT
2. No post-op recovery
3. No risk of dehiscence or septic abdomen
4. Safe colonic biopsies
5. Greater total mucosa sampled
Cons
1. Biopsies are small and only mucosa
2. Can’t access jejunum
3. Can’t access other organs/ LN
4. Distal ileum and colon access requires prep
86
what secondary immunosuppressive agents can we give for CIE if lack of response to steroids
1. Cyclosporine
2. Chlorambucil (especially cats)
87
what is triaditis in cats
IBD, cholangitis, pancreatitis
88
what is cause of triaditis in cats
bile and pancreatic ducts combine and empty into duodenum
89
what are some signs of triaditis in cats
anorexia, weight loss, diarrhea, icterus, dehydration
90
what does minimum database show for cats with triaditis
1. Inflammatory leukogram
2. Increased ALT, ALP, total bilirubin
91
What breed specific inflammatory enteropathies do basenjis get and prognosis
severe hereditary PLE
Poor prognosis
92
what breed specific inflammatory enteropathy do soft coated wheaten terriers get and prognosis
concurrent PLE/PLN
Poor prognosis
93
what breed specific inflammatory enteropathy do Norwegian lundehund get
PLE
94
what breed specific inflammatory enteropathy do boxers, English and French bulldogs get
granulomatous colitis
95
what breed specific inflammatory enteropathy do yorkies get
primary Lymphangiectasia
96
How can you dx lymphangiectasia
1. AUS- 70% sensitive
2. Endoscopy
3. Biopsy
97
what does this endoscopy show
lymphangiectasia
98
ultrasound of SI- what wrong
lymphangiectasia
99
large or small bowel diarrhea with lymphangiectasia
small
100
With lymphangiectasia small bowel diarrhea, __ and __ are common
weight loss, PLE
101
what blood work findings support lymphangiectasia
1. Hypoalbunimeia—> ascites, pleural effusion, SQ edema
2. Hypocholesterolemia
3. Lymphopenia
102
how do you tx lymphangiectasia
1. Fat restriction
2. Anti-inflammatory pred, budenoside, cyclosporine
103
what is prognosis for lymphangiectasia
guarded
104
what are signs of gluten insensitivity
poor weight gain, chronic intermittent diarrhea after weaning
105
what breed is gluten sensitivity genetic in
Irish setters
106
how do you dx gluten sensitivity
1. Signs
2. Biopsy- inflammation, villus atrophy
3. Gluten free diet trial
107
does granulomatous colitis cause large or small bowel diarrhea
large bowel
108
what are some signs of granulomatous colitis
large bowel diarrhea, hematochezia, progresses to severe weight loss, shock and death
109
What is pathophysiology of granulomatous colitis
1. Adherent/invasive E. Coli invade mucosa
2. Replicate in macrophages
3. Granulomas
110
how do you dx granulomatous colitis
1. Biopsy- granulomatous inflammation
2. Fluorescent stains can ID E. Coli
111
what is tx for granulomatous colitis
enrofloxacin
112
what is tritrichomonas blagburni
flagellate protozoan
113
tritrichomonas blagburni colonizes __ of cats resulting in chronic __ bowel diarrhea
LI, large bowel
114
how do you dx tritrichomonas blagburni
PCR
115
what is tx for tritrichomonas blagburni
ronidazole
116
what is adverse effect of ronidazole
neurologic effects
117
IBS causes chronic intermittent __bowel diarrhea
large
118
t or f: no histopath changes with IBS
true
119
IBS is likely disorder of __ and __, with __ component suspected
GI motility and ENS, anxiety/stress component
120
what is most common intestinal neoplasia in cats
lymphoma
121
what is most common intestinal neoplasia of dogs
adenocarcinoma
122
what is a common intestinal neoplasia in the LI of dogs
benign adenomatous polyps
123
what are some signs of intestinal neoplasia
1. Small or large bowel diarrhea
2. Weight loss
3. Ulceration—> melena/hematochezia
124
how do you dx intestinal neoplasia
biopsy
125
what is prognosis for adenocarcinoma with resection and chemo
6-10 months
126
what is MST for leiomyosarcoma, gastrointestinal stromal tumors
>1 year
127
what is most common intestinal lymphoma in cats
small cell T cell lymphocyte
128
what are signs of small cell T lymphocyte
vomiting, diarrhea, weight loss
129
what is found on AUS for small cell T cell lymphoma in cats
GI wall thickening, loss of layering of Muscularis
Mesenteric lymphadenomegaly
130
how do you dx small cell T lymphocyte lymphoma in cats
full thickness biopsy
131
how do you differentiate between small cell T lymphocyte cell vs IBD
IHC, PARR
132
what is tx and MST for small cell T cell lymphoma in cats
tx: prednisolone or budenoside +/- chlorambucil
MST:1-3 years
133
what is tx for large B and T cell lymphomas
tx: chemo
MST: 17 days (T cell) or 7-10 months ( B cell) with chemo
134
what is MST and tx for alimentary lymphoma in dogs
MST: few months
Tx: CHOP
135
what is prognosis for solitary alimentary lymphoma in dogs
good prognosis with tumor resection
136
what is prognosis with colorectal lymphoma in cats
MST >3yrs with chemo
137
what are some signs if protein losing enteropathy (PLE)
1. Small or mixed bowel diarrhea
2. Weight loss
3. Ascites, pleural effusion, SQ edema
138
what does minimum database show with PLE
1. Panhypoproteinemia
2. Hypocholesterolemia
3. Hypocalcemia
139
what are some causes of PLE
1. Mucosa injury (IBD, infection, neoplasia, ulcerative, addisons, crypt diseases)
2. Parasites
3. Lymphatic disease (primary or secondary)
140
how do you manage PLE
1. High protein, low fat diet
2. Immunomodulation: pred and chlorambucil +/- budenoside
3. Antithrombin II: heparin, clopidogrel, aspirin
141
PLE dogs with __restriction responsive have good prognosis
fat
142
What are some negative prognostic indicators for PLE
1. Low BW, ascites, vomiting
2. Increased or decreased BUN, monocytosis, low albumin
3. No increase in albumin after 50 days
4. Villus atrophy and lacteal dilation
143
what are some common differentials for chronic small bowel diarrhea
1. CIE
2. Triaditis
3. Giardia
4. Lymphangiectasia
5. Neoplasia
144
what are some common differentials for chronic large bowel diarrhea
1. CIE
2. Neoplasia
145
what are some common differentials for extra-GI causes of chronic diarrhea
1. Chronic liver disease
2. Chronic biliary disease
3. Hyperthyroidism
4. Cushings
5. EPI
6. Chronic pancreatitis
7. Pancreatitis neoplasia
