Small intestinal disorders Flashcards
Difference between canine and feline bile and pancreatic ducts.
Canine bile duct opens separately from the pancreatic duct into the duodenum at the major duodenal papilla.
Dogs generally have two pancreatic ducts, the Accessory pancreatic duct which opens at the minor duodenal papilla & the plain Pancreatic duct which joins the bile duct before entering the major duodenal papilla. The accessory pancreatic duct is the dominant duct in most dogs.
In cats, The common bile duct is shorter than in dogs and always joins with the pancreatic duct before entering the duodenum and empties at the major duodenal papilla.
This is why cats tend to get triaditis. Liver-pancreas-small intestine are connected in cats.
Duodenum percentage of small intestine is…
Ileum is…
10% of small intestine.
ileum can be up to 30 cm dependent on animal
the rest is jejunum.
The gut-brain axis (GBA) is
the bidirectional communication system between the gastrointestinal (GI) tract and the central nervous system (CNS). It involves neural, hormonal, and immune pathways and plays a key role in digestion, mood, and overall health.
- tryptophan is a major player
Clinical signs of small intestinal dz: (8)
DIARRHEA!
Vomiting
Weight loss
Anorexia
Polyphagia
Coprophagia
Abdominal pain
Dehydration
Volume in small intestinal diarrhea vs large intestinal.
increased volume in small intestinal
normal or only very slight increase in large intestinal
Frequency in small intesinal diarrhea vs large intestinal.
2-3 x in small intestinal
over 3 x is found in large intestinal diarrhea
Weight loss in small intestinal diarrhea vs large intestinal.
yes, in small intestinal
not in large intestinal
Diarrhea extra-GI disease ddx. (5)
✓ Pancreas (EPI)
✓ Liver (portal hypertension)
✓ Endocrine system (hypoadrenocortisism, diabetes
mellitus, hyperthyroidism)
✓ Renal insufficiency
✓ Heart (right-sided insufficiency)
Diarrhea GI disease ddx. (5)
✓ Infections (bacteria, parasite, fungi)
✓ Foreign bodies
✓ IBD (diet, AB, immunosuppressants)
✓ Tumors
✓ Intussusception
Diagnostics steps for SI diarrhea. (5)
“Step-wise”
- blood sample
- fecal sample
- X-Ray
- ultrasound
- endoscopy
Chronic enteropathy clinical
activity index is…
The Chronic Enteropathy Clinical Activity Index (CCEAI) is a scoring system used to assess the severity of chronic enteropathy (CE) in dogs.
This index is commonly used in veterinary practice to guide treatment decisions and evaluate response to therapy, particularly for inflammatory bowel disease (IBD) and protein-losing enteropathy (PLE).
There’s one of these for cats too.
Total Score Interpretation
0–5: Normal/mild CE
6–8: Moderate CE
≥9: Severe CE
Any increase in liver enzymes in cats is remarkable, why?
the half-life of liver enzymes is so much shorter in cats so any increase is infact abnormal.
(triaditis in cats due to anatomy)
bottom right: raindrops are typical to linear foreign body which can also cause intussusception
Describe Acute haemorrhagic diarrhoea syndrome (AHDS)
Very acute onset
Necrotising/neutrofilic enterocolitis, no stomach involvement.
Cl.perfringens toxins, toxin producing NetF gene
Different severity (hypovolemic shock, bacteremia,
hypoproteinemia)
Treatment: IV fluids, antiemetics, pain medication, synbiotics (pre+probiotics), kaolin pectin, AB are NOT part of first-line tx (but yes, if fever and bacterial toxin signs).
Recovery 24-72 h
Prognosis: rarely reoccurs, ca 30% develop chronic
enteritis
postbiotics are not live but can be a piece of a microbe and have probiotic effects e.g. protexin
most common types of Chronic gastroenteropathies (CE)?
food responsive are most common
AB responsive is no longer, so now its microbiota-related modulation responsive are next most common
less common are immunosuppressant responsive enteropathies like IBD
least common are completely non-responsive ones
Chronic inflammatory enteropathies (CIE) are
syndromes with chronic GI symptoms.
Exclude inf.diseases first.
Risk factors: genetics, environment, intestinal microbiome, abnormal immune response.
Histology: diffuse or multiple cell infiltrations
(LP: lymphoplasmacytic, E: eosinophilic, N: neutrophilic)
FRE - food-responsive enteropathies
ARE - antibiotic responsive enteropathies which is no longer recognized, instead its microbiome modulation responsive
IRE: immunossupressants/immunomodulatory responsive (idiopathic IBD)
NRE: non-responsive
➢ PLE - protein-losing enteropathies
➢ Tumors - neoplastic disease, lymphoma
NB animals can move from one group to another!
Why pay attention to the type of Enterococcus faecium a probiotic product contains?
Mind the strain of the bacterium!
Only some are probiotic ((SF68) strain) and then some are facultatively pathogenic!
Canius is good and can be used long-term.
If the product doesn’t mention the strain then don’t use it!
Describe FRE - food-responsive enteropathies. (6)
- Inflammation triggered by food antigens (animal protein or proteins in carbohydrate)
- Usually affects younger animals and they may even grow out of it making prognosis good for the young.
- Colitis, anorexia, diarrhea, vomiting
- Hydrolyzed diets don’t always work since its not IgE mediated. Often need to try 2-4 diff types before finding one that works. You may also need a novel protein source.
- Give synbiotics continuously.
- Response usually seen in 1-4 days, up to 14 days (another diet, owner compliance?).
- Challenge with new protein sources to identify trigger proteins.
diff diets have protein of diff dalton size! must be checked
Certain SCFA (proprionic, isovaleric etc) could be good non-invasive indicators for intestinal inflammation, especially for FRE !
fecal transplantation used to tx which type of enteropathy?
microbiome modulation / microbiota-related modulation responsive enteropathies
How might owners notice diabetes in their cat?
sweet smelling urine
You need to immunosuppress a cat but its already predisposed to diabetes. What drug do you choose?
cyclosporine instead of the usual prednisolone
Cyclosporine takes 4-8 weeks to reach full efficacy.
Describe ARE - microbiome modulation responsive.
- Chronic diarrhea which responds to AB (tylosin, metronidazole)
Several terms:
- Previously Antibiotic-responsive diarrhea (outdated)
- Tylosin-responsive diarrhea 25mg/kg SID 7 days, 5 mg/kg SID 1-3 weeks, increase in LAB+Enetrococci
- Small intestinal bacterial overgrowth (SIBO)
- Intestinal dysbiosis
Consider Responsible use of AB!
* Metronidazole 10-15 mg/kg q8-12 h or 50mg/kg/day (old tx for Giardia, reconsider it nowadays)
Whenever giving AB also give synbiotics.
giardia tx for cats: fenbendazole + fiber!
Describe IRE - immunoresponsive enteropathies.
- Etiology unknown
- Histology-based diagnosis
Risk factors:
* Genetics
* Food antigens
* Microbial antigens
* Environmental factors – stress
Diet – no effect.
Rule out first:
* FRE by elimination diet
* Parasites
* EPI
* Addison’s
Studies have found a High frequency of anti-RBC antibodies + erythroid regeneration in dogs with IRE. So Possible subclinical chronic immune-mediated hemolysis, which can cause anemia in IRE dogs.
IRE Therapy:
Diet alone not effective! Hydrolyzed or novel
protein!
Anti-inflammatory / Immunosuppressive medication:
➢ Prednisolone 1-2 mg/kg BID or 2-4 mg/kg SID
Chlorambucil: bone marrow suppression, leukopenia
Azathioprine: bone marrow suppression! Not for cats!
Cyclosporine: 5 -10 mg/kg q 24 h
➢ Budesonide (human, corticosteroid) option
- Pro- and prebiotics ?
- Cobalamine supplement if needed
Studies have found a High frequency of anti-RBC antibodies + erythroid regeneration in dogs with IRE. So Possible subclinical chronic immune-mediated hemolysis, which can cause anemia in IRE dogs.
Cobalamin (Vit B12) supplementation:
➢ Injectable SC
Fel: 250 µg/Fel
Can: 250-1000 µg/per dog, according to kg,
example 4 kg 250 ug; 20 kg 600 µg etc.
Schedule: 1x 6 weeks, 1x/month, re-test after 30 days.
➢ Tablets – same effect! Usually daily!
12 weeks, re-test 1 week after finishing course.
Dose: 250 µg in cats and 250-1000 µg in dogs
Folate supplementation?
Hypofolatemia is rare and due to malabsorption.
Supplementation PO SID for 4 weeks in dogs:
- less 20 kg BW: 200 mcg/day
- over 20 kg BW: 400 mcg/day
Indication for duodeno-jejunoscopy
Hyperfolatemia will be due to small intestinal bacterial dysbiosis (intestinal microbiota synthesizes folate) or EPI.
Antidiarrheal treatment (7)
Elimination diet /novel protein source
Probiotics + prebiotics = synbiotics
Antiparasitics
Adsorbents: Kaolin pectin (2h after food as it coats mucosa!), carbo medicinalis (active carbon)
Antibiotics only in cases of true inflammation and/or sepsis. (ARE – anitbiotic responsive enteropathy)
Immunosuppressants for IRE – immuno-suppressive responsive enteropathy.
Fecal transplantation (should be sedated, admin. rectally, 1 time not enough (usually takes 4-5 transplantations), 2nd admin. in 3 weeks)
Protein-losing enteropathies (PLE) include 3 diseases:
- Severe IBD
- Lymphangiectasia
- Lymphoma
Lymphangiectasia can be categorized as (2)
Primary: congenital, w & w/o clinical symptoms. E.g.
Yorkshire, Maltese, Lundehund.
Secondary: dilatation due to intestinal obstructions.
histological changes are diffuse in congenital and found in specific areas when secondary.
Lymphangiectasia
Clinical symptoms: (4)
Bloodwork changes: (2)
- weight loss
- diarrhea +/-
- polyphagia
- steatorrhea
Blood samples:
- Lymphopenia
- Hypocalcemia +/-
Mucus in the feces is not
normal.
Diagnosing primary lymphangectasia.
- blood sample
- ultrasound
- endoscopy (whitish rice looking spots on scoping)
- diagn. laparotomy
mucosal biopsies needed for histology, NOT full thickness you won’t be able to suture it up
Lymphangiectasia tx.
- Cure primary disease in secondary! Its lofelong in congenital.
- Fluid therapy to due to loss of proteins and edema.
- diuretics if ascites
- Ultra low fat Diet
- Immunosuppressants:
Corticosteroids
Azathioprine
Cyclosporine
Cyclosporine is more likely to cause gingival hypperplasia in medium- large breed dogs.
boiled chicken and rice for a maximum of
3 days if owner wants to feed this.
