15. Non-infective diseases of the small intestines in dogs and cats. Protein loosing enteropathies Flashcards

1
Q

Acute Haemorrhagic diarrhoea syndrome?

A

ACUTE HAEMORRHAGIC DIARRHOEA SYNDROME

(AHDS)

Formerly known as haemorrhagic gastroenteritis

Aetiology & pathogenesis is unclear

Young-middle aged; Small & toy breeds; In winter months

May be acute; peracute; severe

Possible causes

§ Dietary indiscretion § Toxins

§ Immune-mediated § Pancreatitis

§ Hyperreactivity § Stress

§ Intestinal bacteria § Anxiety

§ Intestinal parasites § Trauma

§ Intestinal ulcer § Infection

§ Foreign body § GI tumour

§ Coagulation disorder § Gastric ulcer

Toxigenic Clostridium perfringens

Intestinal biopsies of dogs with AHDS have been taken, and 80% of

those tested with IHC/culture had C. perfringens testing positive.

Therefore, AHDS may be associated with Costridial overgrowth.

Pathophysiology: Not considered contagious; ↑ Intestinal

permeability → Leakage of fluid, plasma proteins and RBCs into the

intestinal lumen

Clinical Signs

§ Acute onset vomiting

§ Profuse haemorrhagic diarrhoea → Hypovolaemia (shock)

§ Anorexia

§ Lethargy

§ Abdominal pain

§ Fever

Diagnosis

§ History; CSx

§ Lab. D:

↑ PCV;

Neutrophilic leucocytosis (left shift);

Normal/↓ TP; Possible panhypoproteinaemia;

Hypoglycaemia; Electrolyte abnormalities

Treatment

§ Aggressive IVFT

§ Parenteral abx

§ Symptomatic treatment: Antiemetic; Analgesia

§ Intestinal diet

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2
Q

Chronic small intestinal disorders?

A

Chronic Small Intestinal Disorders

“Chronic inflammatory enteropathy (CIE)/ chronic enteropathy

(CE)”

Gastrointestinal diseases present for 3 weeks or longer (at this point,

extraintestinal diseases e.g. parasites & neoplasia are ruled out).

Subtypes

§ Food-responsive enteropathy

§ Antibiotic-responsive enteropathy

§ Immunosuppressant-responsive enteropathy/Steroidresponsive enteropathy

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3
Q

Food Responsive Enteropathy(FRE)?

A

FOOD RESPONSIVE ENTEROPATHY (FRE)

Enteropathy that improves by alteration of the diet

Food allergy (immune related)

§ Food may be the source of antigens “oral intolerance”

§ Cause: Genetics; ↑ Intestinal mucosa permeability;

Previous infections; Prolonged intestinal flora damage

Food intolerance (non-immune related)

§ E.g. Lactose intolerance in cats

Most common allergens: Proteins

§ Dog: Beef; Chicken; Wheat; Milk

§ Cat: Beef; Chicken; Wheat; Fish; Corn

Clinical signs: Pruritis; Recurrent chronic diarrhoea

Diagnosis & treatment work together:

§ Diagnosis by exclusion

§ Prescription diet: Hypoallergenic/hydrolysed mono diet

§ Homemade diet

§ Avoid hidden allergens: Drugs; Other pets; “Grandma

treats”

§ Successful diet: Provocation with the suspected protein

How long to trial diets

§ Pruritis: Trial the diet for 8-12 weeks → Evaluate

§ Diarrhoea: Trial the diet for 3 weeks → Evaluate

§ Trial diets: No more than one therapeutic change every 2-

3 weeks

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4
Q

Antibiotic responsive enteropathy?

A

ANTIBITOIC RESPONSIVE ENTEROPATHY (ARE)

Enteropathy that improves by administration of antibiotics

§ Primary: Loss of tolerance by the local immune system

(predisposed: G. Shepherd)

§ Secondary: Damage of microbiome; Dysbiosis

Consequences

§ Endotoxin secretion

§ Brush border enzymes become damaged

§ Competition for nutrients (e.g by Cobalamine)

Clinical signs

§ Chronic s. intestinal diarrhoea

§ Gas production

§ Fat malabsorption

§ Weight loss

§ Vomiting

Diagnosis

Ø Specific tests

Intestinal microbiotia: Mostly unculturable; Molecular techniques;

Antigen diversity

Microbiota dysbiosis index is used as a scoring system

Treatment
Aim is to ↓ the microbiome & ↓ dysbiosis
§ Antibiotics: Metronidazole; It is important to withdraw
these if there is any relapse
§ Intestinal diet

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5
Q

Immunosuppresant responsive enteropathy?

A

IMMUNOSUPPRESANT RESPONSIVE ENTEROPATHY

(IRE)

Enteropathy that improves with immunosuppressive treatment

In human medicine, this is known as irritable bowel syndrome (IBS)

Middle aged animals

Predisposed: German Shepherd; Terriers; Sharpei

Histopathological types

§ LPE (Lymphocytic-plasmocytic enteritis) (most common)

§ EGE (Eosinophilic gastroenteritis)

§ Neutrophilic gastroenteritis

§ Granulomatous gastroenteritis

Pathophysiology: Diffuse cellular infiltration; Mucosal

inflammation & oedema

Clinical signs

§ Chronic diarrhoea § Weight loss

§ Abdominal discomfort § Inappetence

§ Flatulence § Vomiting

In cases of severe IBD, protein-losing enteropathy may occur →

Ascites; Subcutaneous oedema (see later)

Diagnosis

Non-specific: Hypoproteinaemia; Leucocytosis (LPE);

Eosinophilia (EGE)

Specific

Intestinal biopsy → Histology; Sample collection by:

Endoscopy

Exploratory laparotomy

Treatment

Immunosuppressive drugs used for chronic enteritis

§ Prednisolone (use gastroprotectants)

§ Azathioprine (Ø In cats)

§ Budesonide

§ Cyclosporine

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6
Q

Non- responsive enteropathy?

A

NON-RESPONSIVE ENTEROPATHY (NRE)

Enteropathy that doesn’t respond to any treatment; Idiopathic

At this stage, perhaps reconsider the diagnosis

Possible choices of treatment

§ Pre- & Probiotics

§ Faecal transplantation

§ Mesenchymal stem cell treatment

§ Intestinal biopsy → Histology

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7
Q

Intestinal Neoplasia?

A

Intestinal Neoplasia

Middle /older-aged animals

Types

§ Alimentary lymphoma (cat)

§ Lymphosarcoma

§ Intestinal adenosarcoma

§ Intestinal leiomyoma/Leiomyosarcoma

Clinical signs

§ Chronic diarrhoea § Anorexia

§ Excess weight loss § Melaena

§ Haematemesis § Vomiting

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8
Q

Protein- Losing Enteropathies?

A

Protein-Losing Enteropathies

Any GI condition resulting in a net loss of protein from the body

CAUSES

§ Lymphangiectasia (most common)

§ IBD

§ Intestinal neoplasia/lymphoma

§ GI haemorrhage

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9
Q

General Clinical signs?

A

GENERAL CLINICAL SIGNS

§ Chronic diarrhoea

§ Intestinal protein loss

Ascites

Oedema

Cachexia

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10
Q

Lymphangiectasia?

A

LYMPHANGIECTASIA

Abnormal dilation & dysfunction of lymphatic vessels

Predisposed: Yorkshire terrier; Rottweiler

Classification

§ Primary: Lymphatic abnormality

§ Secondary

Intestinal: IBD; Neoplasia

Systemic: RS-HF; Hepatic failure

Clinical signs

§ Prolonged protein loss → ↓ Oncotic pressure → Ascites;

Hydrothorax; Oedema

§ Fat malabsorption & protein loss → Weight loss

§ Chronic diarrhoea

§ Thromboembolism (rare complication)

Diagnosis

§ Specific: Intestinal biopsy → Histology

§ Lab. D: Hypoproteinaemia; Hypocholesterolaemia;

Lymphopenia; Hypocalcaemia; Hypomagnesaemia

§ Endoscopy: Mucosal oedema; “Rice grain” nodules;

distended lacteals

§ Abdominal US: Mucosal thickening; Streaks in

submucosa; Distended lacteals (absorbing lymphatic

vessels)

Treatment

Protein loss: Ultra low-fat (ULF) diet with high

Bioavailability – Highly digestible; Chicken & rice;

If IBD ✓ → Hypoallergenic diet

Inflammation: Glucocorticoids; Cyclosporine

If IBD ✓ → Immunomodulation

Oedema/Ascites:

Diuretics: Spironolactone; Furosemide

IVFT

Plasma: Supply of antithrombin-III

Weekly monitoring of albumin

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11
Q

Generic treatment of Gastrointestinal diseases?

A

Generic Treatment of Gastrointestinal Diseases

These are better described as treatments of specific diseases (see

these diseases in topics 14 & 15)

§ Deworming – Anthelmintic therapy: Fenbendazole

§ Dietary management

§ Antibiotics

§ Anti-inflammatories

§ Immunosuppressants

§ Adsorbents; Intestinal protectants

§ Secretion & motility modifiers

§ Antiemetics & gastroprotectants

§ Vit. B12 supplement

§ Pro- & pre-biotics

Critically ill patients

§ IVFT

§ Colloid treatment (PLE/IBD)

§ Feeding tube

§ Parenteral Abx

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