SI Flashcards
What are the functions of the SIT?
Digestion of ingesta/food Secretion of water and mucous
Digestive enzyme: peptidases, nucleases, disaccharidases Bile acids
Pancreatic enzymes
*** Absorption of nutrients ***
Barrier to infection
Complex immunologic organprotects body against threats
VILLI
Mucosal immune system Lamina propria Enterocytes
Turnover in 3 days from base of crypts
Microvilli membrane / brush border – nutrients absorbed Digestive enzymes and carrier proteins, goblet cells Crypt cells
Secretory capacity
Make undifferentiated epithelial cells – most of these are enterocytes which migrate from crypt up to tip of villi
ENTEROCYTES
Enterocytes main energy requirement is glutamine If absent
Decline in villi structure
Loss of epithelial integrity Decreased immune function Decreased absorptive function
In GI disease – NUTRITIONAL SUPPORT IS VITAL !!!!!!!!!
What kind of stools are common with SI bowl disease?
steorrhea
ACUTE ENTEROPATHY
Dietary Indiscretion Diet change Infection Medications
Stress (boarding, car ride, apt at your office) Secondary to pancreatitis
CHRONIC ENTEROPATHY
Food allergy or hypersensitivity Inflammatory Bowel Disease Lymphangiectasia
Infections including SIBO, parasites Neoplasia
Secondary to EPI
HGE VS. AHDS
Hemorrhagic gastroenteritis IS NOW … Acute hemorrhagic diarrhea syndrome
Small breed dogs over-presented
Marked hemoconcentration
Marked fluids shifts
Typically requires hospitalization
Hypovolemic shock before clinical evidence of dehydration
Clinical signs including: Hematemesis and hematochezia Etiology
Viral or
Hypersensitivity reaction or Clostridium perfringens **
PCV > 60% and TS not as high as expected (GI loss)
What’s the treatment/prognosis for AHDS?
Treatment IVFs
Antibiotics (Unasyn or Metro) Gastroprotectants Antiemetics
Nutrition
Prognosis is good with aggressive supportive care Unless severe hypoproteinemia
OR signs of sepsis
What do you treat tapeworms with?
Praziquantel
5 mg/kg PO once
Fenbendazole 50 mg/kg PO SID 3 days
Toxacara
Ingestion of eggs or maternal transmission
Adults mature in small intestine
Young pup & kittens most affected
Can be fatal
High worm burdens Pulmonary involvement
Small intestinal obstructions possible/rare
Clinical Signs
• Vomiting of live worms • Unthrifty
• Diarrhea
What is common with protozoa? and who does it affect?
Single Celled Organisms
Found worldwide in most habitats
Infections range from asymptomatic to life threatening
Species, strain, the resistance of the host
Young and immunocompromised
GIARDIA DUODENALIS
How do you check it?
Dogs and Cats Species specific strains
Transmission between humans & pets = RARE Re-infection can occur
DIRECT SMEAR PROTOCOL
Checking for TROPHOZOITES in diarrheic stools 1. Small, FRESH, unrefrigerated feces
- Mix sample into two to three drops of saline (not water) on a glass slide
- Add coverslip
- A Lugol’s iodine stain may be added to aid in identification
Subclinical infections common GOAL
Stop diarrhea
Elimination of infection = DIFFICULT
Apparently well animals do not need treatment more than 1x RX:
Fenbendazole x 5 days +/- Metronidazole x 5 days Bathing on last day
COCCIDIA
Cystoisospora a.k.a. Isospora species Species specific
Fecal oral OR predation transmission Sporozoites infect enterocytes
CLINICAL SIGNS
Weight loss, dehydration, +/- hemorrhage Adults – can be self-limiting
Young, immunocompromised can be quite sick Anorexia, vomiting, dehydration
Diagnosis Direct smear
Fecal float Treatment
Sulfadimethoxine (ALBON)
50-60 mg/kg daily for 5-20 days (D,C)
Others (i.e. Ponazuril) Supportive care
Prognosis
Good in adults and mild symptoms Guarded in systemically ill patients
CRYPTOSPORIDIUM
Cryptosporidium parvum ‘Coccidia-like”
Species specific BUT zoonosis possible
Transmission
Fecal oral
Contaminated food, water
CLINICAL SIGNS
Self limiting small bowel diarrhea
Severe life-threatening in immunocompromised Can extend into large intestine and other organs
DIAGNOSIS
Direct smear & Fecal float
Difficult to find ELISA
PCR
+/- Biopsy
TREATMENT
Paromomycin
150 mg/kg SID for 5 days (D,C) Tylosin
10 to 15 mg/kg TID for 14 to 21 days (C)
TOXOPLASMA GONDII
ZOONOTIC
Oocysts require 1-5 days to become infectious after passed
Clean litter boxes daily
Disease seen in immunocompromised, immunosuppressed, fetus, elderly CATS > DOGS
Transmission
Predation – bradyzoites/muscle Fecal contamination
Significant clinical disease often from extra-intestinal effects
Unlikely to shed oocysts at the time significantly ill
DIAGNOSIS Fecal Float
Capc.org
Limited use
Oocyst shedding occurs briefly after infection AND not always
associated with clinical disease
Antibody Titers
_ IgG & IgM * useful when associated with sick pet
Positive titers does not = oocyst shedding or clinical disease_
What’s the treatment for Toxo?
Clindamycin
10 to 12 mg/kg orally twice daily for 4 weeks
Trimethoprim-sulphonamide
15 mg/kg orally every 12 hours for 4 weeks.
Other meds (see CAPC) Supportive care
PYTHIUM INSIPIOSUM
Aquatic oomycete
Fungus-like & resembles algae
Feeds on rotting material or living plants by absorbing nutrients through fine threads
Occasional mammal host
Tropical, subtropical, temperate climates
Mostly Gulf Coast States
Also documented NJ,VA,NC,CA, IN,IL, KY,OK,MI,KS
Exposure to free standing waterpenetration of skin or mucosa by motile zoospores
DOGS; rare = cat, sheep, exotics, cow, human Zoonosis not been documented
Gastrointestinal distress Vomiting
Weight loss Diarrhea Hematochezia Abdominal pain
Dermatologic disease Non healing skin lesions
What are the PE findings of Pythium?
GI
Palpable abdominal mass
Dehydration
Poor body condition
Cutaneous
DOG: Lesions base of the tail, extremities,
ventral neck, perineum
CAT: Cervica, inguinal, truncal Ulcerative nodules
Draining tracts
+/- LN involved
Skin and GI do not occur together!
What is the main diagnostic for pythium?
CBC: eosinophilia, anemia
CHEM: hypoalbuminemia, hyperglobulinemia
UA: NSF
* Pythium ELISA – antibody detection; also used for response to therapy – titers fall with therapy
Culture – difficult
FNA of lesions – nonspecific for organism
* Biopsy of lesions
SEVERE transmural segmental thickening (esophagus colon +/- dissemination into other abdominal organs) Pyogranulomatous and eosinophilic inflammation on biopsy
GMS stain on histopath to ID organisms
What will you see on US for pythium? Treatment/ prognosis?
ULTRASOUND
Segmental thickening of GI
Thickened gastric outflow tract possible Enlarged LNs
TREATMENT:
SURGERY
Removal (3-4 cm margins) of limb or GI segment
MEDICATIONS
At least 2 -3 months
Itraconazole: 10 mg/kg P) SID Terbinafine: 5-10 mg/kg PO SID
+/- Immunotherapy (pred 1 mg/kg/day) in non-resectable cases Medications aloneless than 20% chance of survival
Prognosis:
Monitor ELISA
IF COMPLETE RESECTION and NO RECURRENCE
ELISA usually drops by 50% or more within 3 months Can d/c oral meds
Poor with disseminated disease, non-resection
Less than 20-25% respond to medial management alone
HISTOPLASMOSIS
Dimorphic fungus
Occurs worldwide
USA: Mississippi and Ohio River valleys
DOG & CAT- cats have more respiratory signs
TRANSMISSION
Aerosols into lungs & thoracic LN
Gastrointestinal tract (D > C)
3milliondogs.com
Organisms enters bloodstream from primary site and can cause wide spread disease
What are the most common CS/PE findings for Histo?
Diarrhea (LARGE > SMALL)
Weight loss to emaciation
Chronic cough
Fever
Anemia
Hepatomegaly, splenomegaly, lymphadenopathy
Nasopharyngeal and GI ulceration
Lameness
Respiratory difficulty
Nodules & thoracic LNs
Skin lesions Cats
Same as dog EXCEPT GI signs
DX, treatmetn, and prognosis for histo
DIAGNOSIS
Non-specific CBC, CHEM, UA
Chest Rads: nodules, enlarged LNs
U/S:
Spleen, liver, LN enlargement
Thickened LI and/or SI wall
Fine needle aspirates of abnormal tissue+fluid- peritoneal effusion
Biopsy of abnormal tissues
Culture
ELISA antigen test Urine, serum, and CSF
vetfolio.com
Cross-reactivity occurs with blastomycosis
TREATMENT & PROGNOSIS
MEDICATION *** PROLONGED THERAPY Itraconazole
10 mg/kg/day
ALT: Fluconazole or Ketoconazole (mild cases) SEVERE
Amphotericin B
PROGNOSIS
Acute histoplasmosis may be fatal after 2–5 weeks
Poor condition & multisystem involvement = guarded to poor One organ involved = better
CANDIDIASIS
Normal inhabitant of nasopharynx, GI tract, genitalia
_OPPORTUNISTIC INFECTIONS CAN BE SEEN
Associated with disruption of MUCOSAL INTEGRITY ! _Immunosuppresive medications
Antibiotic administration
IV or urinary catheters
CATS
Oral and upper respiratory disease, pyothorax, ocular lesions, intestinal disease, and cystitis
DOGS
Peritonitis & Fungemia documented
Perforating intestinal lesions after surgery
Mucosal and cutaneous candidiasis has been noted in immunosuppressed dogs
SALMONELLA
Gram -, facultative anaerobic Low prevalence in normal pets
Normal flora in up to 30% dogs & 18% cats
Culture positive and clinical signs
= likely association
Young, parasitized, immunocompromised, or stressed kenneled dogs Raw and/or contaminated food
ZOONOTIC
Destroyes Intestinal Villi
Ileum Cecum Colon
CLINICAL SIGNS
Acute, transient illness (diarrhea)
Supportive care
Septic, shock, hospitalized from illness
DIAGNOSIS
- Culture
- Blood in septicemia • Feces
• PCR lacks validation
How do you treat SALMONELLA?
TREATMENT
None for primary infection & when transient
No evidence it is effective and no need if pet’s signs resolve
Need to treat for bacterial translocation in very ill animals
TYPICALLY WHEN WE SEE THEM & TEST THEM
IV antibiotics like fluroquinolones, amoxicillin, TMS, chloramphenicol
PROGNOSIS
Good unless septic (fair-guarded)
ESCHERICHIA COLI
Mammalian flora naturally contains E. coli Gram-negative, anaerobic, rod-shaped bacterium
Most non-pathogenic RARE to cause disease
Dogs & Cats Acute disease
Puppy – unclean, crowded breeding environments Immunocompromised – with Parvovirus
Food & water contamination including raw food
CLINICAL SIGNS
- Diarrhea
- Vomiting
- Dehydration
- Lethargy
- DIAGNOSIS
- Culture
- Blood in septicemia
• Feces
E. COLI
TREATMENT IN HOSPITAL
IV supportive care
Antibiotics like fluroquinolones, unasyn, others
PROGNOSIS
Good unless septic (fair-guarded)
SALMON POISONING DISEASE
DOG
SALMON
FLUKE
Nanophyetus salmincola
BACTERIA
Neorickettsia helminthoeca & elokominica
Pacific Northwest ACUTE DISEASE (as little as 7 days after fish meal)
Parasitology.cvm.ncsu.edu
High fever
Hematemesis
Diarrhea Nonhemorrhagic enteritis +/- Hematochezia
Vomiting
Lethargy
Anorexia
Nasal and ocular discharge Enlarged lymph nodes
DIAGNOSIS
Fluke eggs in feces
History of of ingested fish
Inclusion bodies in macrophages in lymph node PCR
Serology
Chem, UA: non-specific
CBC: Thrombocytopenia (94%)
Where can you find neorickesttsa for Salmon poisoning disease?
within lymphocytes
What’s the treatment and prognosis for SPD?
TREATMENT
Hospitalized support
Antibiotics Oxytetracycline
(7 mg/kg IV TID) 7 day Doxycycline
(10 mg/kg BID) 7 day Praziquantel for fluke
PROGNOSIS
Fair to good with
aggressive supportive care
Death in up to 90% of untreated animals with SPD
Elokomin fluke fever (EFF)
Milder form
10% death in untreated animals
A client brings you a sick cat with neuro and ocular signs. On labwork, you determine the cat to be positive for Toxo. The owner is concerned about parasite shedding and contracting toxo. What do you advise?
Treat the patient. Scoop the litter box daily. Risk of oocyst( the contagious bit) shedding is unlikely
What is the prognosis of canine parvo?
If survive the first 3-4 days then likely to make a full recovery.
What can you use diagnosis feline panleukopenia?
canine parvo snap test
INTESTINAL NEOPLASIA
FELINE
Lymphoma
Adenocarcinoma
Mast cell
Canine intestinal neoplasia
Lymphoma
Adenocarcinoma
Smooth muscle tumors – leiomyoma, leiomyosarcoma, GIST (gastrointestinal stromal tumor)
SMALL CELL LYMPHOMA
INFILTRATIVE Diffuse disease
+/- Thickening of SI on AUS Biopsy diagnosis
Treatment: Chlorambucil
Prednisone
Prognosis:
Survival up to 3 years reported
INTUSSUSCEPTION
Most common cause of Extraluminal obstruction
where does it commonly happen
1 site = Ileocolic Junction
What is the most common intestinal hernia CS?
INTESTINAL HERNIA
Small intestinal loops slip outside abdominal cavity into SQ tissues Can lead to strangulation and necrosis of intestines
Intermittent GI signs
Exocrine Pancreatic Insufficiency
Insufficient secretion & production of pancreatic enzymes
MALDIGESTION
Acinar Atrophy – genetic or immune mediated
Chronic Pancreatitis
Aplasia or Hypoplasia – congenital
Usually multiple enzymes
One report of Canine Lipase Deficiency alone causing signs
Breed: German Shepard, Rough Coat Collie, Eurasians
What the main CS for EPI?
#1 = Weight loss
Can occur as only sign in the cat
Loose stools steatorrhea
Excess presence of fat in the feces Pale, oily appearance, foul smelling
Ravenous appetite Poor hair coat Borborygmi Flatulence
Can be subclinical
How do you diagnose EPI?
CBC, CHEM, UA
Rule out other causes
TLI level
Species specific
Measures trypsin, trypsin bound to proteinase inhibitors, & trypsinogen
B12
OFTEN LOW IN EPI and needs supplementation
TREATMENT
EXOGENOUS PANCREATIC ENZYME
Dried Pancreatic Extract powder (pork, beef) DOG: 1 tsp/10 kg Pancrelipase
CAT: 1 tsp/meal Pancrelipase
MANY FORMULAS AVAILABLE
MIX IN FOOD 20 mins before feeding
SE: Gingival bleeding & irritation
FRESH PANCREAS
30 - 90 g = 1 tsp of the dried extract Can freezemaintains activity
B12 SUPPLEMENTATION
Pancreatic Tablets & Capsules Typically less effective
HYDROLYZED DIETS
Split proteins to such a small size that immune system cannot recognize them as foreign
IDEAL = 1 KD = too bitter MOST are 7-10 KD
Some can still mount antigenic response Cannot cross link IgE for TYPE 1
TYPE 4 still possible
IDIOPATHIC ANTIBIOTIC RESPONSIVE DIARRHEA
Small Intestinal Bacterial OvergrowthARD
No reliable test
MECHANISMS Host-bacterial interactions
Bacterial overgrowth – difficult to quantify
SECONDARY
Defects in mucosa
Aberrant mucosal immune response Qualitative change in enteric flora (dysbiosis)
ARD TREATMENT
DIAGNOSIS
• Biopsy can be normal or concurrent disease
• Treatment trial 4 - 6 weeks Abs
Metronidazole Tylosin Oxytetracycline
10-15 mg/kg PO BID 20 mg/kg PO BID 10-20 mg/kg TID
Can need to be repeated or long-term treatment in some Diet
Variable response but positive outcomes seen in some with high quality +/- low fat
What are bx diagnosis diseases?
Inflammatory Bowel Disease
Several types
Lymphangectasia
Lymphoma
INFLAMMATORY BOWEL DISEASE
WHAT IS IT ?
- Disease of dogs and cats with chronic GI signs for which no other causes is documented
- Affected animals who fail to respond to parasiticides, antibiotics, and diet
- On histopath, mucosal changes include inflammatory infiltrate - Extent varies from focal to diffuse disease
- Inflammatory infiltrates include lymphocytes, plasma cells, eosinophils, neutrophils, macrophages or some combo thereof, in numbers more than consistent with the normal immune defense
- Can involve stomach AND/OR small intestine AND/OR the large intestine
Why do they get IBD?
Multifactorial cause likely
1. Disruption of the physiologic interaction of innate and adaptive immune response
- Defective mucosal barrier influx of food antigens and microbes into Lamina Propria where they trigger proinflammatory cytokines from T cells
- Can include inappropriate reaction to commensal bacteria, food antigen, idiopathic/ primary abnormality of the innate immune system
Pattern Recognition Receptors = PRR
HEALTH: maintain hyporesponsiveness to luminal contents, diet, and protects the mucosa EXAMPLES
Toll-Like Receptors – TLR
NOD2- Nucleotide oligomerization domain
Most common IBD
MOST COMMON Lymphoplasmacytic infitrate
What are the type of IBD?
Minimal Change Granulomatous or Neutrophilic Lymphoplasmacytic Eosinophilic
Lymphangectasia
MINIMAL CHANGE ENTEROPATHY
Characteristics and treatment
CHARACTERISTICS
• Low clinical disease score
- Albumin > 2.0 (rr: 3.0-4.2 g/dL)
- Normal B12
- Normal to minimal inflammation on histopathology
TREATMENT Deworm
Fenbendazole
5 days at 50 mg/kg PO SID Diet Trial
Antibiotic trial
Petmed.com
If good response, trial to probiotics
Chronic therapy with tylosin 5 mg/kg PO SID may be necessary in some pets
What do you want to do first?
Deworming, Diet Trial, and Antibiotic Trial
GRANULOMATOUS OR NEUTROPHILIC ENTEROPATHY
Characteristics
CHACTERISTIC Infrequent diagnosis
Macrophages/Histiocytic and/or Neutrophilic Infiltrate PROMPTS you to look for INFECTIOUS DISEASE
NEXT STEPS
Image chest and abdomen to look for other evidence of infectious disease Bacterial, fungal, parasitic testing
FISH (fluorescence in situ hybridization to look for invasive bacteria) Culture of mucosal biopsy, LN, other organs
Special stains on histopathology (GMS, PAS)
What’s the treatment/ prognosis for GNE?
TREATMENT
Treat underlying infectious disease
Umich.edu
Antibiotic trial (E coli, Stept, Campylobacter, Yersina, Mycobacteria) Immunosuppressive medications IF infectious disease excluded
Slow taper after see clinical response PROGNOSIS
Can be guarded to poor if underlying etiologic agent not identified
LYMPHOPLASMACYTIC ENTEROPATHY
characterisitics
CHARACTERITIC
Lymphocyte and Plasma Cell infiltrate
Variable clinical disease presentation Mild
PLE
• 67% with normal albumin • 33% with low albumin
Systemically ill
Diet has shown 60 – 88 % response rates
TREATMENT
• Hydrolyzed or novel antigen diet
- Responders tend to be younger dogs w/ normal albumin
- Antibiotics trial
- Immunosuppressants when no response to above When clinical signs resolve, consider slow taper
- Anti-clot medications with hypoalbuminemia • Clopidogrel
- Low Dose Aspirin
WITH CLINICALLY ADVANCED DISEASE
MAY START ALL THERAPY SIMULTANEOUSLY
EOSINOPHILIC ENTEROPATHY
CHARACTERISTIC
• Eosinophilic predominant infiltrate
• Reaction to parasites or diet or fungal organisms possible
PROGNOSIS
Good in dogs Guarded to poor in cats
LYMPHANGESTASIA
Exudation of protein-rich lymph into intestine
Severe malabsorption of fat and other nutrients leading to PLE & clinical signs
Weight loss Ascites Vomiting
Wikivet.net
ENDOSCOPY
White granules/blebs on mucosal surface
Abnormal distension of lymphatic vessels within mucosa
Surgery = potential dehiscence in advanced disease
treatment of lymphagestesia
DIET
• Hydrolyzed and LOW FAT
ANTIBIOTICS
Metronidazole or tylosin to reduce risk of bacterial translocation
IMMUNOSUPPRESANTS
• Prednisolone 1-2 mg/kg PO BIDtaper to LED
- May need parenteral administration
- Cyclosporine or other immune modulating medications in advanced disease
ANTI-CLOT MEDICATIONS
Low dose aspirin or clopidogrel
DIURETICS
For ascites
PROGNOSIS
Fair to guarded pending response to treatment and severity of clinical sign at presentation
What kind of feeding tube is her favorite?
esopahgostomy tube- requires GA
