SI and LI Diseases

Question 1

What are the clinical signs of a dog with IBD?

Answer 1

• Signalment = middle aged to older animals
• Breed predilections = GSD, Basenjis, Lundehunds, soft coated Wheaten terries, Irish setters
• C/S = diarrhea (small/large bowel or both), vomiting may be present, diarrhea usually chronic, borborygmus and flatus, halitosis, abdominal pain, pica, polyphagia; will see edema/ascites on PE

Question 2

What are the clinical signs of a cat with IBD?

Answer 2

• Vomiting = most freq sign
• clear fluid, foam or bile, may contain food, unrelated to eating, hematemesis rare
• Lethargy
• change in appetite
• loss of wt and condition
• hairball accumulation

Question 3

How do you diagnose IBD?

Answer 3

• Biopsy = key to dx (via endoscopy, laparotomy), but consider therapeutic trials first!
• Biopsy findings:
  
  • mucosal atrophy
  • villus atrophy or fusion
  • fibrosis
  • epithelial erosion
  • crypt abscesses
  • lymphangiectasia
  • bacteria

Question 4

How do you treat IBD?

Answer 4

• ALWAYS deworm, diet and antibiotic/probiotic trials, steroids (main stay of tx)
• adjunctive tx - plasma or albumin transfusion, multivitamin tx (cobalamin), TPN, pancreatic enzymes, injectables

Question 5

What are your differentials for IBD?

Answer 5

• Food responsive dz, fiber response colitis, antibiotic responsive dz, histiocytic ulcerative colitis, protein losing enteropathy, EPI, parasites, intestinal tumors, lymphangiectasia, fungal infection, drugs

Question 6

What is the pathogenesis for lymphangiectasia?

Answer 6

Obstruction to lymphatic drainage causes lacteals and villi to become distended

• primary - congenital malformation of lymphatic
• secondary - usually d/t infiltrative dz, causes PLE, seen in Yorkies

Question 7

What is the clinical presentation of lymphangiectasia?

Answer 7

Hypoproteinemia (often pan-), hypocalcemia, hypomagnesemia, hypocholesterolemia, lymphopenia

Question 8

How do you diagnose lymphangiectasia?

Answer 8

Intestinal biopsy

Question 9

How do you treat lymphangiectasia?

Answer 9

• Treat the underlying dz!
• low fat diets
• anti-inflammatories

Question 10

What is the pathogenesis of histiocytic ulcerative colitis? How does this differ from other forms of IBD?

Answer 10

Adherent and Invasive E. Coli (AIEC) - an intracellular organism

Question 11

How do you treat histiocytic ulcerative colitis? How does this differ from other forms of IBD?

Answer 11

treat with antibiotics (enrofloxacin), +/- amoxicillin/metro, NOT steroids!!

• steriods will immunosuppress patient, which could be detrimental

Question 12

Describe the treatment of lymphoplasmacytic colitis in dogs and cats

Answer 12

• mild - diet (hypoallergenic, high fiber), metronidazole,
• moderate to severe - sulfasalazine, pred

Question 13

How does inflammatory bowel disease differ from irritable bowel syndrome?

Answer 13

IBD: ulcerative colitis (colon only), ulcers and superficial inflammation

IBS: no inflammation present, functional dz

Question 14

In IBD, what cells make up the infiltrate and in what layer of the intestines does this infiltrate occur?

Answer 14

Lymphocytes/plasma cells, eosinophils, neutrophils, macrophages; occurs primarily in the lamina propria

Question 15

What is histiocytic ulcerative colitis?

Answer 15

• Better known as ‘Boxer colitis’
• Seen in Boxers, Bostons, and Frenchies
• LI Signs: tenesmus, hematochezia
• PAS-positive macrophages