15, 16)non infective enteritis, protein loosing enteropathy, perineal diseases diseases of the large intestine Flashcards
acute haemorrhagic diarrhea syndrome
a. Formerly HGE
b. Toxigenic Cl. perfringens
c. Young, middle-age, small-breed; winter
d. Acute/peracute, severe
e. Vomiting → haemorrhagic diarrhea, hypovolaemia
f. PCV usually increases; neutrophilic left-shift
g. Agressive iv. fluid therapy → good prognosis
h. +- parent. ab. (if septic or non-responder to fluid)
i. Symptomatic treatment: antiemetic medic., analgesia
j. Intestinal diet
acute small intestinal disorders
unknown cause diet related ahds infectious alimentary tract parasites ileus
chronic small intestinal disorders
food responsive
ARE
IRE/IBD
lymphangiectasia
neoplasms of SI
parasites, fungi, bacteria
infectious diarrhea
a. Viral
i. Canine parvoviral enteritis (CPV)
ii. Feline parvoviral enteritis (FPV)
iii. Canine coronaviral enteritis (CCoV; CPCoV)
iv. Other viral enteropathies of cats (FCoV/FECV, FIP; FIV; FeLV)
b. Bacterial
i. Campylobacteriosis
ii. Salmonellosis
iii. Miscellaneous bacterial enteritis
c. Fungal
i. Histoplasmosis
WHY USE THE TERM “CHRONIC ENTEROPATHY” RATHER THAN “INFLAMMATORY BOWEL DISEASE” IN DOGS?
Because of the differences between dogs and human in regards to treatment and the need for surgery to control clinical signs, it can be misleading to use the term “inflammatory bowel disease” in dogs. In effect, most dogs with this disease will not need immunosuppressant treatment. For this reason, chronic enteropathy is often used instead to describe dogs with chronic gastrointestinal signs. The advantages of using this term are:
- It can be used for animals in which intestinal inflammation is suspected but has not been documented (i.e. no biopsies have been taken).
- It does not infer which treatment will be needed to control clinical signs.
pathogenesis of chronic enteropathy
food -> intestinal microbiota -> intestinal immune systemic
loss of tolerance -> intraluminal allergens -> pathology immune response - mucosal inflammation
genetic!
Food Responsive Enteropathy (FRE)
o Food allergy – immune system involved
• Food = potential antigen → „oral tolerance”
• Causes of loss of tolerance: genetic predispose. +
• Permeability of intestinal mucosa increases
• Earlier bacterial, viral or parasitic infections
• Prolonged damage of intestinal flora
o Food tolerance – immune system NOT involved
• eg lactose intolerance in cats
→ most common allergens = PROTEINS
▪ Dogs: beef, chicken, milk, wheat
▪ Cat: beef wheat corn, fish, chicken
o Clinical signs
• PRURITUS
• recurrent chronic diarrhea
o Diagnosis, therapy
• Length of diet: pruritus = diarrhea→ evaluate
▪ DIARRHEA improve→ continue for all together 12 weeks
• Essence of diet
▪ One, NOVEL protein, (CH), high bioavailability
▪ Prescription diet: hypoallergenic/ hydrolysed or
▪ Home made
▪ Avoid „hidden” allergens
• ! Drugs; contamination in food?
• Companion pet, neighbour, grandma
Antibiotic Responsive Enteropathy (ARE)
o First named SIBO = small intestinal bacterial overgrowth
o BUT: NO real overgrowth in many cases
→ renamed: SIBO → ARE
o Primary ‒ loss of tolerance, breed predisp.: Germ. Shep.
o Secondary ‒ damage of intestinal microbiota, dysbiosis
• Consequences
o Secretion of enterotoxins
o Direct harmful effect on brush border enzymes
o Competition for nutrients (e.g. cobalamine)
• Clinical signs: CHRONIC SI DIARRHEA
o Gas production, fat malabsorption
o Weight loss (+-polyphagia/anorexia)
o Vomiting (sometimes)
• Diagnosis: NO specific test
o Most intestinal microbiota NOT culturable
o (cobalamine INCREASE, folate DECREASE)
• Aim of therapy: number of microbiota DECREASE + normal balance
o Antibiotics
▪ Metronidazole (IMMUNOMODULATING), tilozin, (OTC)
▪ Long-term, min. 4 weeks
▪ Withdrawal → relapse
• Intestinal diet
Immunosuppressant Responsive Enteropathy (IRE) → IBD
o When the term inflammatory bowel disease (IBD) is used for dogs, it typically implies that treatment trials with diet (FRE) and subsequently antibiotics (ARE) have failed, inflammation has been demonstrated and an immunosuppressant will be needed = IRE! Histopathological types: o LPE (lymphocytic-plasmacytic enteritis) – most common o EGE (eosinophilic gastroenteritis) o Neutrophilic gastroenteritis o Granulomatous gastroenteritis Clinical findings: o Middle age o Predisposed breeds: German shep., terriers, sharpei o Chronic diarrhea • Recurrent, even for months o +/- weight loss, vomiting o Inappatence o Abd. discomfort, flatus o Ascites, subcutan oedema o Severe IBD → PLE!!! Diagnosis: o NOT specific • Blood tests ▪ Hypoproteinaemia ▪ Leukocytosis (LPE) ▪ Eosinophilia (EGE) ▪ Cobalamine decrease; folate increase • Abdominal ultrasonography ▪ Thickened SI loops, lymphadenopathy (EGE) o SPECIFIC • Endoscopic findings • Diagnostic laparotomy Treatment: o Immunosuppressant drugs used for CE include • Prednisolone (use gastroprotectors) • Azathioprine (NOT in cats) • Budesonide • Cyclosporine o Only cortices for 4 weeks o Cortices + cyclosporine for 2 weeks o In case of critically-ill patient: • Fluid therapy – fluid-, electrolyte-, acid-base homeostasis o Colloid – PLE IBD – treatment o Feeding tube (Noe/ cat) – anorexia, malnutrition o Parent ab – risk of bacterial translocation a. Eg. metronidazole + enrofloxacin b. Eg. amoxicillin-clavulanate • VitB12 supplementation – long-term • Probiotic – long-term, but if risk of bacteria translocation don’t!
Non-Responsive Enteropathy (NRE)
o Reconsider the diagnosis
o The microbiome has been shown to play a central role in several diseases and treatment to alter its constituents, using pre- and probiotics appears promising
o Another promising technique to alter the intestinal flora is faecal transplantation
o mesenchymal stem cells for the treatment of inflammatory conditions such as CE
LYMPHANGIECTASIA
o Predisposed breeds • Yorkshire terrier, • Rottweiler o Classification • Primary ▪ Lymphatic abnormality • Secondary ▪ Intestinal disorders • Inflammatory disease (IBD) • Intestinal neoplasia ▪ Systemic disorders • Right-sided cardiac failure • Hepatic failure o Clinical signs • Prolong protein-loss Increase → ascites, hydrothorax, oedema • Fat malabsorption and protein loss→ weight loss • +-! Chronic Chronic diarrhea diarrhea • Thromboembolia (rarely) → severe complication (loss of atithrombin III) o Diagnosis • Laboratory findings ▪ HYPOPROTEINAEMIA (TP decr, Alb decre ) ▪ Hypocholesterolaemia (TotChol derease) ▪ Lymphopenia (lymphocyte decrease) ▪ Hypocalcaemia (Ca DEcrease), hypomagnesaemia (Mg INcrease) • Endoscopic findings ▪ Mucosal edema ▪ “rice-grain” nodules • Abdominal US ▪ Mucosal thickening ▪ Streaks in submucosa o Specific diagnosis • Intestinal biopsy → histology o Treatment • Ultra! low-fat (ULF) diet; high bioavailability • Immunomodulation (see IBD) • Antimicrobial therapy (see ARE) • Diuretics ascites • Fluid therapy: colloids oncotic p. increase • Plasma: suppl. of antitrombin III (microthrombosis premedication & treatment)
Neoplasm
o Types • Alimentary lymphoma in CAT • Lymphosarcoma • Intestinal adenocarcinoma • Intestinal leiomyoma / leiomyosarcoma o Clinical signs • Middle-aged, older animals • Chronic diarrhea, excess weight loss, anorexia, melena, vomiting, hematemesis
PROTEIN LOSING ENTEROPATHY
o Collective term • Lymphangiectasia (most frequent) • IBD • Intestinal neoplasia/lymphoma • GI haemorrhage o Clinical findings • Chronic Chronic diarrhea diarrhea • Intestinal Intestinal protein protein loss • Ascites • Edema, cachexia
INTUSSUSCEPTION
o Invagination (telescoping) of one part of the intestine into another
o Most often in young dogs and puppies
o Ileocolicus (mostly) or jejunojejunal (often in cats)
o Idiopathic or secondary to diseases causing dysmotility (viral, parasitic enteritis, infiltrative diseases in older cats)
o Hematochesia, vomiting, abdominal pain, palpable elongated thickened intestinal loop
o Abdominal US: multiple concentric rings
o Surgery
o Treatment of ileus:
o Medical pre-operative management:
• fluid therapy (crystalloid with K+)
• antibiotic (parenterally, wide spectrum)
o Surgical management: ASAP
• Laparotomy and enterotomy
• + Resection of devitalized intestine
• Sterile lavage of peritoneal cavity
o Post-operative care:
• fluid therapy as needed
• analgesia
• early post-op enteral feeding (ASAP - no risk of aspiration, 25% of RER, low fat, highly digestible, orally via syringe feed or feeding tube)
• prokinetic drug in paralytic ileus
diseases of the large intestine in cats and dogs
Anatomy of the COLON o Segments: ▪ Ascendens ▪ Transverse ▪ descendens o Ileocolic orifice (prevent oral movement) o Layers: → NO villi!! ▪ Mucosa ▪ Submucosa ▪ Muscularis ▪ Serosa o Crypt: ▪ columnar epithel cells ▪ goblet cells (mucous secreting) ▪ endocrine cell, intraepithelial ly o a. / v. mesenterica (cran / caud) – v. portae o Parasympathicus: vagus (prox colon); n. pelvini (dist. colon) o Sympathicus: paravertebralis gl. – n. splanchnicus Physiology of the large intestine o Conservation of water, Na, Cl ▪ Absorption of fluid~ Na, SCFA ▪ Secretion: HCO3, K (colon descendens: absorption/secretion) o Storage of waste products ▪ Segmentation (mixing) ▪ Propulsive (peristaltic, reverse and mass peristaltic) o microbial population 10 to the power of 11/gr feces ▪ Fermentation Fermentation: dietary fibre, poorly digest. CHO→ SCFA • ↑H2O absorption,7-10% energy, peristaltic, colonocyts proliferation ▪ primary BA→ secondary BA o Mucous production ▪ Physiological barrier o Immune balance History, clinical signs (CS) o Large bowel diarrhoea (LBD) o Tenesmus: ▪ Straining to defecate (remains postured for extended period or repeated attempts) o Dyschezia: ▪ Difficult, painful defecation o Fresh blood: haematochezia o Generally alert, active o Physical examination: normal ▪ Rectal digital palpation! RDP → CS: SBD or LBD?
