SI (still bc FML) Flashcards
Canine Parvoviral Enteritis is caused by Type 2 Canine Parvovirus, how is it transmitted?
Fecal oral
T/F Canine Parvoviral Enteritis is not contagious.
False. It’s contagious af.
How long do dogs shed canine parvoviral enteritis (let’s call it CPV bc mama can’t type it out all day long)?
Affected dogs shed virus and up to 8-10 days after acute illness.
Why is CPV so difficult to manage?
Because it remains infectious in the environment for months.
CPV likes what kind of cells?
Rapidly dividing cells: GIT, bone marrow, LNs
What is the presentation for pups presenting with CPV?
Ill within 4-7d after infection. Young pups up to 6 months. Can be seen in older, unvax dogs.
CS aren’t particularly thrilling? V, D, depression, anorexia, hypothermia
What is seen in the CBC of 65% of cases of CPV?
Leukopenia- up to 65% of cases
What is present on the chemistry for CPV?
HYPOglycemia and HYPOproteinemia
What massive aspect of supportive care is needed if want CPV patients to live?
Fluids!
Blue box: what are some complications with CPV?
Sepsis, intussusception, pneumonia, DIC
Patients with CPV desperately need supportive care. What are some examples of these?
Fluids, electrolytes, dextrose, antacids, antiemetics, pain mgmt, antibiotics to decrease risk of sepsis, colloids (Vetstarch, plasma, blood)
What is the prognosis for CPV?
If survive first 3-4 days then likely to make full recovery.
68%- 92% survival w supportive care.
Feline Panleukopenia: similar af to CPV. Blue box! What diagnostic method can we use?!
Can use canine snap test to diagnose!!
What’s the prognosis for Feline Panleukopenia ?
50-90% fatal without aggressive support.
What is a major clinical sign of Feline Panleukopenia?
Cerebellar hypoplasia: associated w perinatal infection
What disease can feline enteric coronavirus mutate to look like?
Feline Infectious Peritonitis
Blue Box: For intestinal neoplasia: Neoplasias can be mass lesion or infiltrative which may NOT show up as changes on US. So what diagnostic methods do we need?
Need FNA and biopsy!!
Small cell lymphoma is over represented in what species?
Cats
Small cell lymphoma is an infiltrative dz. How are we gonna tx it?
Chlorambucil or PrednisOLONE (it’s a pussy dz, remember?)
Telescoping of one bowel loop into the adjacent segment is known as what?
Intussusception
What diseases are intussusceptions associated with?
Parvovirus
Masses
Any lesion causing diffuse ileus (arrest of intestinal peristalsis)
Intussusceptions are the most common cause of what?
Most common cause of extraluminal obstruction #1 site: ileocolic jxn
The follow are predisposed to developing what?
Young animals w severe gastroenteritis
Neoplasia in older animals
Postparturient bitches
Predisposed to developing intussusception
What are some characteristic findings that we’ll see when diagnosing intussusception?
Palpate tube like mass
US: double walled structure!! Characteristic bullseye!
T/F Intestinal volvulus has a good prognosis.
Nah, it’s often fatal.
When performing sx on patient with intestinal volvulus, what will we find?
Bowel is most often diffusely necrotic.
What kind of GI signs will we see with intestinal hernias?
INTERMITTENT Gi signs
SI loops slip outside ab cavity into SQ tissues
Can lead to strangulation and necrosis of intestines
Exocrine Pancreatic Insufficiency (EPI) leads to insufficient secretion an production of pancreatic enzymes which then leads to what?
MALDIGESTION (blue letters!)
Insufficient secretion and production of pancreatic enzymes leads to . . .
Acinar atrophy (genetic or immune mediated)
Chronic Pancreatitis
Apalasia or Hypoplasia- congenital
What breeds are predisposed to EPI?
GS, Rough coat collie, Eurasians
***Important AF!! What is the major major major clinical sign seen in EPI?
Weight loss DESPITE eating a ton!!! #1 sign! Often the ONLY sign seen in cats.
ALSO!!! Loose stools –> steatorrhea (blue letters!); excess presence of fat in the feces; pale, oily appearance; foul smelling!
Ravenous appetite
Poor hair coat
Flatulence
What do we do to dx EPI?
TLI level! It is species specific and checks measurement of pancreatic enzymes. Measures trypsin, trypsin bound to proteinase inhibitors & trypsinogen
Also, B12!! OFTEN LOW IN EPI! and needs supplementation
What is the bizarre way in which we tx EPI?
By giving dried pancreatic extract powder (pork, beef) or by giving fresh pancreas
We also give B12 supplementation: Blue box: teach clients to give these injections at home`
Clicker question: T/F The canine parvovirus snap test can be used to DI cats w panleukopenia.
True!
What is our prognosis for EPI?
Super good! They must stay on supplement !
Primary enteropathies are inflammatory diseases of the _______ and _________.
Mucosa and submucosa
Wheaton terriers are predisposed to what 2 diseases?
Protein Losing Enteropathy (PLE) and PLN
Irish setters are Hipster-esque in that they’re sensitive to what?
Gluten! They have a predisposition to Gluten-sensitive enteropathy
German Shepherd’s are prone to what type of enteropathy?
Antibiotic sensitive enteropathy
Wow, didn’t realize there were so many breeds with predispositions to enteropathy shit sooo if you wanna know more what slide should you look at?
SI slide 110
Blue Boxes: When and why do we biopsy?!
To prioritize and optimize therapy
When empiric therapy fails or patient status dictates definitive answer
If you have a stable patient with chronic diarrhea then what therapy should be considered?
Empiric therapy: deworming, diet change, antibiotic trial, +/- probiotics
Blue Box: Failure to respond to empiric therapy or worsening disease=
Biopsy time!!!
At what point do we know that a food allergy or hypersensitivity was the root of the problem?
When GI signs resolve w diet change
What’s the MOA of food allergies/hypersensitivity?
Type I, II & IV hypersensitivity rxns
Our options for a diet change are hydrolyzed diets or novel diets. What is the interesting aspect regarding novel diets?
Novel diets are ONLY ONE PROTEIN
When does HP lady use a novel diet vs hydrolyzed diet?
She starts with novel protein in less severe cases vs. hydrolyzed in more severe cases
Clinical response in 2 weeks expected
Try at least 2 different diets before medication trial
How do hydrolyzed diets work?
Split proteins to such small size that immune system cannot recognize them as foreign
Ideal = 1 KD = too bitter so most are 7-10 KD . . . type 4 sensitivity rxn can still occur
Small intestinal bacterial overgrowth –> ARD. What does ARD stand for?
Antibiotic Responsive Diarrhea
What test do we use for ARD?
NO reliable test!!
Blue box: What are the 4 things that happen in ARD?
- competition for nutrients
- mucosal border damage
- malabsorption
- diarrhea
What breed and age group is commonly seen with ARD?
YOUNG dogs and large breed dogs like GERMAN SHEPHERDS
The following clinical signs are associated with what?
Small bowel diarrhea Stunted growth Flatulence Appetite change V
ARD
What is the main way we tx ARD?
TREATMENT TRIAL: 4-6 weeks Abs: Metronidazole, Tylosin, Oxytetracycline
What are the 3 most common biopsy diagnosed diseases?
- Inflammatory Bowel Dz- several types
- Lymphangectasia
- Lymphoma
When performing an endoscopic biopsy, which one do you use for upper GI (esophagus, stomach, proximal duodenum)?
Gastroduodenoscopy
When performing an endoscopic biopsy, which one do you use for lower GI (anus, rectum, colon +/- ileum)?
Colonoscopy
When would we have concerns about upper and lower GI?
Concurrent concerns for colitis
Concerns for lower SI dz i.e. low B-12 bc absorbed in ileum
Concerns for neoplasia
When should a surgical biopsy be performed?
When concern for disease predominantly NOT in MUCOSAL layer
Other organs affected
Obstructive lesions requiring removal
What are the pros and cons of endoscopy?
Pros:
Minimally invasive
Home same day if general anesthesia recovery well
Many regions biopsied
Cons:
Deeper layers missed
NO jejunal biopsy
No other abdominal organs sampled
Regarding biopsy eval, idk if this is important but what does Fish Analysis dx?
Diagnosis of AIEC on colonic biopsy
AIEC= adherent invasive E. coli
What disease do all of the following things describe?
Dz of dogs and cats with chronic GI signs for which no other cause is documented
Affected animals who fail to respond to parasiticides, antibiotics, diet
On histopath, mucosal changes include inflammatory infiltrate so some combo of lymphocytes, plasma cells, eosinophils, neutrophils, macrophages and there are more there than with the normal immune defense
Can involve stomach AND/OR SI AND/OR LI
Inflammatory Bowel Dz (IBD)
Why do they get IBD?
Multifactorial cause
- 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 rigger pro inflammatory cytokines from T cells
- Can include inappropriate rxn to commensal bacteria, food antigen, idiopathic/primary abnormality of the innate immune system
What is the most common IBD?
Lymphoplasmacytic infiltrate
What is the pathogenicity of Lymphoplasmacytic infiltrate?
Loss of normal villous structure
Goblet cell changes: associated with more severe disease
Crypt abscesses and cysts encountered with advanced disease and lymphangestasia
Moderate to severe infiltrates often associated with protein losing dz
What characteristics are associated with minimal change enteropathy?
Low clinical disease score
Albumin >2.0 (regular: 3.0-4.2 g/dL)
Normal B12
Normal to minimal inflammation on hisopathology
How do we tx minimal change enteropathy (MCE)?
Deworm (Fenbendazole)
Diet trial
Antibiotic trial (if good response, trial to probiotics); chronic therapy w tyrosine may be necessary in some pets
Blue box: It is not infrequent that biopsies are acquired BEFORE deworming, diet trial and antibiotic trial has been pursued. Why?
- Client insistence
2. Lack of understanding of dz
What characteristics are seen with granulomatous or neutrophilic enteropathy (GNE)?
Infrequent diagnosis
Macrophages/ histiocytic and/or neutrophilic infiltrate
BLUE ARROW: PROMPTS YOU TO LOOK FOR INFECTIOUS DZ IF SEE ABOVE THINGS
If we see macrophages/histiocytic and/or neutrophilic infiltrate then what are our next steps?! Important!
Image chest andn 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 are our tx options for GNE?
Tx underlying infectious dz
Antibiotic trial
Immunosuppressive meds IF infectious dz excluded
Prognosis: guarded to poor if underlying etiologic agent not ID’d
What are the characteristics of lymphoplasmacytic enteropathy (LPE)?
Lymphocytes and plasma cell infiltrate
Variable clinical disease presentation (mild; PLE= 67% with normal Alb and 33% with low Alb; systemically ill)
Diet has shown 60-88% response rates
How do we tx LPE?
Hydrolyzed or novel antigen diet–> responders tend to be younger dogs w normal albumin
Antibiotic trial
Immunosuppressants when no response to above (when clinical signs resolve, consider slow taper)
Anti clot meds w HYPOalbuminemia: Clopidogrel or low dose aspirin
Blue box: With clinically advanced LPE, what is our tx strategy?
Might start all therapy simultaneously
What characteristics are seen in eosinophilic enteropathy (EE)?
Eosinophilic predominant infiltrate
Rxn to parasites or diet or fungal organisms possible
Good prognosis in dogs
Guarded to poor in cats
How do we tx EE?
Deworm
Diet
Immunosuppressant
Dilated lymphatics and inflammation is the definition of?
Lymphangiectasia
What characteristics can be seen in lymphangiectasia and crypt cysts?
Inflammation blocks lymphatic flow
Local or generalized lymphatic dz
Rarely associated with increased portal pressure seen with right sided HF, portal hypertensia, canal obstruction
COMMON CAUSE OF PLE!
What breeds are predisposed to lymphangiectasia?
SCWT (Soft Coated White Terrier - I think?), Yorkie and Lunehunds
Especially Yorkies!
Blue Box: These are important aspects to know about lymphangiectasia. Tell me dem.
Exudation of protein rich lymph into intestine
Severe malabsorption of fat and other nutrients leading to PLE & clinical signs
Weight loss
V & D
Ascites
Decreased appetite
What can be seen on endoscopy of lymphangectasia?
WHITE GRANULES/BLEBS on mucosal surface
Abnormal dissension of lymphatic vessels within mucosa
What 5 ways do we tx lymphangiectasia?
- Diet: hydrolyzed and LOW FAT
- Abs: Metronidazole or tylosin
- Immunosuppressants: Prednisolone; Cyclosporine
- Anti clot meds: low dose aspirin or Clopidogrel
- Diuretics
Prognosis: fair to guarded
Inflammatory dz, lymphangiectasia, neoplasia, infectious (Parvo, Histoplasma, Pythium), endoparaites, intussusception etc can all cause Protein Losing Enteropathy (PLE). How do we tx it?
Tx underlying dz
Diuretics as needed
Abdominocentesis: DO NOT REMOVE ALL FLUID!!; remove 1/3-1/2 at most
What are some negative indicators regarding the prognosis of PLE?
Lower Alb
Low B12
Neoplasia
HP lady’s favorite tube is the esophagostomy tube.
T/F They can stay in for weeks or months, can be used in dogs and cats, and can be put in while animal under sedation.
FALSE. They CAN stay in for weeks or months, used in both dogs and cats but they have to be put in while animal is under anesthesia.
Clicker question: T/F In a mildly symptomatic patient, SI biopsy should be performed before deworming, diet trial and antibiotic trial.
False!
