15. Non-infective diseases of the small intestines in dogs and cats. Protein loosing enteropathies Flashcards
(11 cards)
Acute Haemorrhagic diarrhoea syndrome?
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
Chronic small intestinal disorders?
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
Food Responsive Enteropathy(FRE)?
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
Antibiotic responsive enteropathy?
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
Immunosuppresant responsive enteropathy?
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
Non- responsive enteropathy?
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
Intestinal Neoplasia?
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
Protein- Losing Enteropathies?
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
General Clinical signs?
GENERAL CLINICAL SIGNS
§ Chronic diarrhoea
§ Intestinal protein loss
Ascites
Oedema
Cachexia
Lymphangiectasia?
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
Generic treatment of Gastrointestinal diseases?
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
