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61 Cards in this Set
- Front
- Back
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Between IBD and IBS - which is the inflammatory disorder and which is the motility disorder?
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IBD - inflammatory disease
IBS - motility disorder |
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True or false: IBS is highly overdiagnosed in veterinary patients
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False - IBD is
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True idiopathic inflammatory bowel disease is a diagnosis of _______
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exclusion
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What are the 5 main types of IBD?
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Lymphocytic-plasmacytic****
eosinophilic granulomatous/pyogranulomatous neutrophilic just lymphocytic |
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which of the 5 types of IBD is most common (85%)
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lymphocytic-plasmacytic
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is hair in the stomach normal for a cat?
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yes
So long as motility is good, hair not a problem |
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Chronic gastritis is distinguished from acute gastritis based on what?
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history and duration (>7 days of vomiting, vomiting >2/wk for 3 weeks)
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>80% of hair ball vomiting cats have what disorder?
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chronic gastritis
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What are the clinical signs of chronic gastritis?
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vomiting, inappetence, weight loss, melena, hematemesis
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What aged animals are more likely to get chronic gastritis?
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older
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Whill treating a chronic gastritis like a relapsing acute gastritis work?
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NO!!!
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What are some differentials for chronic gastritis?
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renal failure
hepatic disease, hepatic encephalopathy endocrine gastric outflow obstruction (PYLORIC HYPERTROPHY => projectile vomiting) chronic foreign body, chronic intussusception gastric neoplasia and paraneoplastic disease (GASTRINOMA commonly causes gastric vomiting) chronic pancreatitis constipation pythium insidiosum in SW of USA |
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What diagnostics do we perform for chronic gastritis?
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extensive!
minimum database: CBC/chem UA/SG endocrinology: thyroid panel PLI Abd imaging; rads, U/S +/- endoscropy adn biopsy, FB retrieval +/- explaratory laparotomy and full thickness biopsies |
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True or false: chronic gastritis is typically part of an overall syndrome
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true
Cholangitis, cholangiohepatitis, hepatitis, pancreatitis, chronic enteritis |
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How do we treat chronic Gastritis?
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identify adn treat a cause if you can
DIET often a MAJOR contributor **food responsive dz needs to be ruled out before its considered idiopathic Novel protein source, restricted antigen diet |
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How long should you give the elimination diet for chronic gastritis?
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at least 2 weeks
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If the food diet works when treating chronic gastritis, what should we call teh condition?
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food intolerance (NOT IBD)
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If the diet trial does not lead to improvement for chronic gastritis, what shoudl be done?
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prednisolone 1-2 mg/kg, follwed by taper
AVOID NSAIDs |
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True or false: severe LP gastritis should be treated with steroids only for initial symptomatic relief
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FALSE - treat with steroids AS WELL as diet change
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Should you taper the steroids while still on the new diet, or change the diet prior to tapering the steroids when managing chronic gastritis?
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taper steroids while mainting the diet
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What drug should we ALWAYS avoid giving to cats when considering chronic gastritis management?
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AZOTHIOPRINE
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If the diet and steroids do not work to relieve the chronic gastritis, what is the next step?
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reconsider the diagnosis - get biopsies for neoplasia and consider more porten immunosuppression
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What immunosuppresive drugs can be used for chronic gastritis in a dog? In a cat?
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dog: azothioprine
cat: chlorambucil |
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What are the presenting signs of IBD?
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vomiting - bile, hair, grass eating dogs
diarrhea - SI or LI signs weight loss appetite alterations - increased or decreased borborygmus in the cat: voluminous stools with steatorrhea (looks like EPI) |
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what are some potential causes of chronic SI inflammation?
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Food allergies or intolerance***
Inflammation secondary to other primary diseases - lymphosarcoma, lymphangectasia Idiopathic*** - lymphocytic-plasmacytic enteritis, eosinophili gastroenterocolitis chronic infections - thing regionally and treat appropriately |
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What are some tings noted on clnical exam of IBD
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often unremarkable
thickened bowel loops may be palpable - hose pipe sensation ascites if severe disease - poor prognositc signs (PLE as primary disease?) weight loss, poor hair coat condition - "Greasy" in cats w/cobalamin deficiency |
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What are the ideas for pathology of IBD?
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many theories, all short on facts!
loss of immune tolerance to luminal antigens (food derived or bacterial antigens) Genetic factors? - breed dispositions seen german shepherd, basenji, sharpei, pure bred cats unknown pathogen? - secondary invasion of e. coli |
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What is the common diagnostic approach to IBD?
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minimum database: CBC/chem and UA
Serum TLI, cobalamin and folate concentrations fecal float and smears fecal a1PI if low/low normal TP imaging |
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What levels of cobalamina dn folate would you expect to see in a mucosal infiltrative disease?
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low and low
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what levels of cobalamin and folate would you expect to see if consistent with SIBO?
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low cobalamina dn high folate
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Cats often have ____ serum TLI concentrations with IBD
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high - loss of ileal brake mechanism
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What sort of imaging do we do to diagnose IBD?
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abdominal ultrasound - either very useful, or not at all
plain rads - often unrewarding endoscopy, biopsy and histo ex-lap, biopsy and histo |
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Can you rule out IBD with imaging techniques?
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NO
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what sort of details can you discern with U/S for IBD?
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wall thickness, layering architecture, masses
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What sort of changes can be seen with an endoscope on an IBD patient?
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significant inflammation or tumors
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what are the age, breed, and sex predisposition sofr chronic colitis?
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there are none
in boxers, consider granulomatous colitis instead |
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What type of diarrhea is seen with chronic colitis?
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LI, or small and large, but large dominant
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What disease do you need to differentiate chronic colitis from via a lack of response to diet change
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fiber-responsive colitis
try giving fiber and if its not better, can rule out this disorder |
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What is the diagnostic approach for chronic colitis?
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minimum database: CBC/chem adn UA
fecal float and smears fecal a1 PI if low/low normal TP |
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what diseases are we looking for on the fecal float of a chornic colitis cat? chronic colitis dog?
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CAT: tritrichomonas foetus ELISA or PCR**
Dogs; pentatrichomonas is emerging pathogen (PCR) |
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What are the five F's when discussing diagnosing chronic colitis?
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Fiber
Food Finger (rectal palpation) Fenbendazoole Flagyl - bacteria or parasite |
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If all 5 of the F's fail, what diagnostic step should you take?
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colonoscopy
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Where do the infiltrates of chronic colitis typically go?
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infiltrates at teh crypt or submucosal level, endoscopic biopsies do not relieably sample this area
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_____ is the natural state of the GIT
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inflammation
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True or false: there is a standardized method of assessing and scoring pathological inflammation in gut biopsies
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FALSE - there is no standard
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True or false: it is often very hard to definitely separate severe IBD from lymphoma for the two may merge
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true
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What should be the first step to mgmt of IBD?
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empirical parasiticide therapy (fenbendazole)
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Dietary modification trials should be used to try to manage IBD. What sort of novel protin sources can be used?
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turkey, fish, venison, duck, ostrich, emu
HA (purina), A/D or a/D ultra |
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Should diets used for mgmt of IBD be lower or higher in fat?
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lower - helps get diarrhea under control
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Do the majority of cats with clinical signs and histories consistent with IBD show response to diet modification?
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yes - 60%
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How long should yo uuse novel antigen diet when managing IBD?
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at least 2 weeks, preferably 4-6
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If you do a food trial with novel proteins, then reintroduce the old food adn signs reappear, what can we diagnose?
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Food intolerance, NOT IBD
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If clinical signs of IBD are not improving after 4 weeks of a food trial, what type of therapies should you move onto?
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anti-inflammatory or immune suppressive
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True or false: Immune suppression is teh main therapy for iodiopathic IBD, but shouldn't be started until other diagnosis are ruled out and other therapies are tried
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TRUE
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What type of immune suppression therapy is used in dogs and cats with idiopathic IBD?
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prednisone/prednisolone 1-2 mg/kg PO BID for 14 days then taper
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What should the rate of tapering a dose be for prednisone in an IBD dog?
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taper 25% dose every 14 days
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for fractious cats, you should depot prednisone injection 1 mg/kg q4-6 weeks. These levels are completely safe and there are no complications noted
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no - iatrogenic hyperadrenocorticism is common at these doses and we should warn the owner
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If the glucocorticoids are not working for idiopathic IBD, what drugs should you try in dogs? in cats?
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Dogs: Azathioprine 2mg/kg PO SID or cyclosporin, mycophenalate
Cats: chlorambucil 2-6 mg/m2 then taper or cyclosporin, mycophenalate |
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What is a sacrificial diet?
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novel protein when immune suppressed, when off the prednisone (example), switch to another longer term novel protein - hasn't been tested effective yet
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What are some potential supplemental therapies to use with idiopathic IBD
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probiotics and prebiotics - lactobacillus GG
Omega-3 fatty acid supplements - alters arachidonic acid metabolism cobalamin supplementation of serum cobalamin <300 pg/L |
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can decrased cobalamin lead to GI signs?
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yes!
all cells, including enterocytes need cobalamin and the gut is less able to heal and permeability remains abnormal if deficient |
