Chronic d+

Question 1

List the major differentials for chronic diarrhoea

Answer 1

Food responsive enteropathy (FRE)
Dysbiosis
Steroid responsive enteropathy
Non-responsive enteropathy
PLE – e.g. lymphangiectasia
EPI
Neoplasia
(Non-GI causes)

Question 2

T/F you can have an enteropathy without diarrhoea

Answer 2

True

Question 3

List 6 factors that can influence the development of chronic enteropathies

Answer 3

diet
genetics
gut flora (microbiome)
environment
immune response
comorbidities

Question 4

Name the 2 categories of adverse food reactions

Answer 4

food allergy
food intolerance reactions

Question 5

How does Food responsive enteropathy generally present

Answer 5

Usually chronic small bowel diarrhoea
+/- vomiting
+/- pruritus

Question 6

how long does a food trial need to last

Answer 6

For GI disease should be no longer than 3 weeks
Signs of improvement noted very quickly compared with skin
+ symptomatic treatment

Question 7

describe how to diagnose food responsive enteropathy

Answer 7

by response to food trial

Question 8

what is dysbiosis

Answer 8

an imbalance between the types of organism present in a person’s natural microflora
is common in many conditions

Question 9

what do you tend to see with dysbiosis

Answer 9

chronic d+ SI
weight loss failure to thrive
V+/ borborygmus/ appetite changes

Question 10

where is folate and B12 absorbed

Answer 10

folate - proximal SI
B12- distal SI

Question 11

Describe how to treat dysbiosis

Answer 11

cobalamin (B12) supplementation
treat primary cause
probiotics

Question 12

another name for steroid responsive enteropathy

Answer 12

inflammatory bowel disease

Question 13

describe how to diagnose SRE/IBD

Answer 13

History + CS
physical exam
rule out other differentials
biopsy

Question 14

what is feline triaditis complex

Answer 14

a condition in cats in which they are simultaneously affected with three separate diseases:
pancreatitis
cholangiohepatitis
inflammatory bowel disease (IBD)

Question 15

describe how to diagnose feline triaditis complex

Answer 15

exclude other diseases
biopsy all 3 organs involved

Question 16

describe how to treat SRE/IBD

Answer 16

dietary manipulation
pre and probiotics
anti-parasitic agents - to make sure no comorbidities
vitamins- B12
May need immunosuppressive therapies (preds)
May need Abs (metrinidazole)

Question 17

what is Protein-losing enteropathy

Answer 17

This is a form of chronic enteropathy characterised by the loss of protein through the GIT
both albumin and globulins are low

Question 18

How does the microbiome of the CE patient differ from normal?

Answer 18

Reduced diversity and richness
More volatile and unstable

Question 19

How do you diagnose adverse food reactions?

Answer 19

response to food trial

Question 20

How long should you wait before you can confirm that the diet is not a cause of CE?

Answer 20

around one week

Question 21

What is the most common/major cause of chronic enteropathy?

Answer 21

dysbiosis

Question 22

When is dysbiosis likely to occur?

Answer 22

Decreased gastric acid production
Increased small intestine substrates
Obstructions
Motility disease
Hypothyroidism

Question 23

What breed of dog is most commonly affected by dysbiosis?

Answer 23

GSD

Question 24

How can dysbiosis be diagnosed?

Answer 24

Faecal microbiome analysis
History
Breath hydrogen testing
Serum folate (cobalamin)

Question 25

How is dysbiosis managed?

Answer 25

Highly digestible diet Low fat Pre and probiotics

Question 26

What supplement is vital in dysbiosis cases?

Answer 26

cobalamin (same as B12)

Question 27

Should antibiotics be used in cases of dysbiosis?

Answer 27

No

Question 28

Where is folate absorbed?

Answer 28

Proximal SI

Question 29

Where is B12 absorbed?

Answer 29

Distal SI Ileum

Question 30

List the clinical signs of IBD

Answer 30

Weight loss Appetite variable Abdominal discomfort Chronic diarrhoea

Question 31

What are the more severe signs of eosinophilic enteritis?

Answer 31

GI haemorrhage Bowel perforation Focal mass lesions

Question 32

What percentage of dogs with chronic enteritis will show no response to treatment?

Answer 32

15-40%

Question 33

If there is no response to therapy of CE, what would you now consider is the cause of clinical signs?

Answer 33

Neoplasia Dysbiosis Vitamin D deficiency Bile acid diarrhoea

Question 34

What protein is low with PLN?

Answer 34

albumin

Question 35

What are the differentials for PLE?

Answer 35

severe IBD Lymphangiectasia neoplasia (lymphoma most commonly)

Question 36

What is lymphangiectasia?

Answer 36

Abnormal dilation of intestinal lymphatics- secondary to lots of things

Question 37

How does lymphangiectasia lead to PLE?

Answer 37

LP oedema Loss of lymph into the gut lumen

Question 38

What are the CS of lymphangiectasia?

Answer 38

PLE Weight loss Protein-rich ascites

Question 39

How can lymphangiectasia be diagnosed?

Answer 39

Low albumin Low globulin Low cholesterol Lymphopenia Low Ca/Mg

Question 40

On endscope, what would you see with lymphangiectasia?

Answer 40

White spots on villus tips White nodules or plaques White fluid

Question 41

How is lymphangiectasia treated?

Answer 41

Treat primary cause Ultra-low fat diet Albumin/colloid due to hypoproteinaemia Diuretic for severe effusion

Question 42

What does EPI stand for?

Answer 42

Exocrine pancreatic insufficiency

Question 43

What are the CS of EPI?

Answer 43

Polyphagia Weight loss D+- lots of it, yella, greasy

Question 44

What is EPI caused by?

Answer 44

Acinar cell loss

Question 45

What condition is EPI commonly associated with

Answer 45

chronic pancreatitis

Question 46

T/F EPI is more common in cats than dogs

Answer 46

false more common in dogs

Question 47

What breeds are predisposed to EPI?

Answer 47

GSD Rough Collie Chows

Question 48

How can EPI be diagnosed?

Answer 48

Low TLI Low cPLI Low cobalamin

Question 49

What does TLI stand for?

Answer 49

Trypsin-like immunoreactivity

Question 50

What is cPLI?

Answer 50

Pancreatic lipase concentrations

Question 51

How is EPI managed?

Answer 51

Pancreatic enzyme supplementation- pig/cow pancreas dietary management vit supplementation (cobalamin)

Question 52

What is the prognosis of EPI?

Answer 52

good

Question 53

What are common intestinal tumours?

Answer 53

Lymphoma Adenocarcinoma Leiomyoma/sarcoma (smooth muscle) Mast cell tumour Fibrosarcoma Haemangiosarcoma

Question 54

Diagnosis of intestinal tumours

Answer 54

US radiographs biopsy- endo or laparotomy

Question 55

Define chronic D+

Answer 55

if it has been ongoing for over 3 weeks

Question 56

What are the 2 most common forms of IBD

Answer 56

lymphoplasmacytic IBD eosionophilic IBd

Question 57

what do you need to do if the enteropathy has not responded to diet trial, antibiotics or steroids

Answer 57

consider non-GI disease, neoplasia or other disorders

Question 58

Management of intestinal tumours

Answer 58

chemo preds surgical resection combo of multiple treatments