Small Ani. Med 2- Intestinal Dz's

wilsbach's version from 2016-02-27 19:31


Question Answer
if its IBD in sm int, called what? large int? both?SMALL: IBD. LARGE: IBD, Chronic Colitis, ulcerative colitis. BOTH: IBD
in order to dx IBD you need to see what two things?Chronic persistent or chronic recurrent GI signs AND histologic inflammation of lamina propria
how do you dx IBD?exclusion of other ddx, endoscopy & histopath (so need to do CBC/Chem/UA, then fecal exam AND diagnostic tx, GI panel (PLI, TLI, Cobalamin, folate, ACTH Stim), test TT4, FeLV, FIV, do Abdominal ultrasound, try a dietary trial (some improvement after 2 wk) abx trial (tylosin, OTC, metronodazole--> do endoscopy
what causes IBD?Probably loss of tolerance to microbiome (Genes + immune dysregulation + decreased complexity of microbiome)
ok.....TLI vs PLI, what are these tests telling us(1) TLI= Trypsin-Like Immunoreactivity. This tests for EPI. Trypsinogen/trypsin (trypsin only activated from trypsinogen in serum if pancreas inflammation) so is synthesized exclusively by the acinar cells pancreas, and measurement of this zymogen by assay of TLI provides an excellent indirect index of pancreatic function. So if TLI low, EPI. (1) PLI: pancreatic lipase immunoreactivity. if high levels of PLI in blood, there is inflammation in the panc
IBD: so you do CBC/Chem,Urinalysis,Fecal analysis (flotation/protozoa/rectal scraping…), PLI, TLI, Cobalamin, folate, ACTH Stim, TT4, FeLV, FIV, Abdominal ultrasound....and you get nothing. THEN you do a dietary trial and it is successful. What do you have?Food responsive diarrhea= FRD
IBD: so you do CBC/Chem,Urinalysis,Fecal analysis (flotation/protozoa/rectal scraping…), PLI, TLI, Cobalamin, folate, ACTH Stim, TT4, FeLV, FIV, Abdominal ultrasound....and you get nothing. THEN you do a dietary trial ...and you get nothing. Then you do a Abx trial and you get success...what do you have?Antibiotic responsive diarrhea= ARD
IBD: so you do CBC/Chem,Urinalysis,Fecal analysis (flotation/protozoa/rectal scraping…), PLI, TLI, Cobalamin, folate, ACTH Stim, TT4, FeLV, FIV, Abdominal ultrasound....and you get nothing. THEN you do a dietary trial ...and you get nothing. Then you do a Abx trial get nothing. Your next step is endoscopy, with possible dx being? (Which is most common)Lymphocytic-plasmacytic= most. Eosinophilic= some. Granulomatous= rare (AKA histiocytic= histiocytic ulcerative colitis)
histiocytic is akagranulomatous (histiocyte is a kind of macrophage)
IBD: so you do CBC/Chem,Urinalysis,Fecal analysis (flotation/protozoa/rectal scraping…), PLI, TLI, Cobalamin, folate, ACTH Stim, TT4, FeLV, FIV, Abdominal ultrasound....So you do this basic min. database and you get nothing, but your animal is hypoalbuminemic, unstable, or has worsening clinical signs. what should you do next?USUALLY you would do diet trial, then abx trial, THEN endoscopy. but because they are unstable, go right to endoscopy.
what is the tx for IBD? how can it vary between cat and dog?Prednisolone for both! DOG: Cyclosporine. CAT: pred + chlorambucil
how can you do a canine follow-up on your tx of their IBD? CRP (C-reactive protein- a type of nutritional assay), CIBDAI (canine IBD activity index) & biopsies (cat is just clinical and bx)
CIBDAI= canine IBD activity index. Explain thisa way to rate the severity of the IBD

PLE/ case/ cat stuff

Question Answer
PLE means you will have low albumin. what other dzs cause low albumin that you will have to exclude? Renal loss (UPC=urine protein creatinine ratio) (in renal, low albumin but globulins still normal), Third space loss (pleural effusion, ascites), Skin burns, Liver failure (no production)-- ALT/ALP, bile acids pp & fasted, us, biopsy
*how can you tell renal protein loss from GI protein loss?in RENAL, ONLY ALBUMIN WILL BE LOW. IN GI, ALBUMIN AND GLOBULINS ARE LOW
in lymphangiectasia, the main protein you lose is..albumin
what are the four primary causes of protein losing enteropathy?(1) lymphangiectasia / crypt disease (York,Rottw.) (2) IBD (3) breed associated forms (basenji, maltese, soft coated wheaten terrier, lundehund) (4) hemorrhage (histoplasma, parvo, hookworms, giardia, lymphoma, neoplasia…)
clinical signs of PLE (what is the MAJOR one?)WEIGHT LOSS!!!, +/- Diarrhea, +/- vomiting, +/- inappetence, EDEMA, pleural effusion, abdominal effusion ( in smaller print she also had: deficiency of fat soluble vitamins (ADEK), thromboembolism from AT deficiency, hypocalcemia -> tetany/seizures, hypomagnesemia, possible bleeding from Vitamin K deficiency)
what are the 4 major lab findings you will see with PLE?(1) Panhypoproteinemia (aka both albumin and globulin. PAN is with intestinal dz, if only low albumin prolly liver or kidney dz). (2) Hypocholesterolemia (not absorbing fats correctly either) (3) Hypocalcemia (4) Lymphopenia (if lymph vessels damaged, prolly dumping some lymphocytes into the intestines etc)
how do you dx PLE? biopsies (surgery > endoscopy) (some clinicians administer corn oil 3-4h pre-biopsy to dilate lactaceals)
what dietary therapies can you implement to tx PLE?highly digest. protein, ultra low fat, high carb, PPN / TPN, soluble fibre (FOS)
read case susiy
Antibiotic responsive diarrhea / Bacteriel overgrowth is a prob or small or large int.?small
if you see systemic dz, are you thinking small or large bowel?small
which 3 parasites can be large bowel dairrhea?giardia, whip, tritrichomonas
Tritrichomonas foetus is a ddx for what two things?Ddx for giardia, large bowel diarrhea
who is most affected by Tritrichomonas foetus? (sp, age)CATS, <2yo
what is the tx for Tritrichomonas foetus, and what is the problem with this?Ronidazole only proven effective drug...however there is dose dependant neurotoxicity (lethargy, inappetance, ataxia, seizures)..... Rule out asymptomatic carriers (PCR on faeces)
Giardia spp- what part of GI is affected? what are the CSs?SMALL AND LARGE bowel diarrhea-- there will be abdominal pain and lots of borborygmi. (in small print on slide it says most dogs get the C type of giardia, and most cats get F)
how do you treat giardia? what is important to know about treatment method?TX: Fenbendazole, some ppl add some metronidazole too. YOU ALSO NEED TO TX THE ENVIRONEMENT-- Shampoo the patient during fenbendazole treatment and do Cleaning (steam & quarternary ammonium compounds)
if a cat has a cobalamin deficiency, what are your tx options? Substitution of Cobalamin, New diet: hydrolyzed protein, OR Trial therapy metronidazole (tx 2 wk beyond clinical cure) (unusual use for this abx!!)
case cat with low cobalamine-- didnt really respond to cobalamine and diet changes, but DID respond well to abx= antibiotic responsive therapy. Why do you think the abx worked?more important than abx effect might be the immune modulation
case cat: if they didn't respond to the cobalamin, the diet changes, OR the abx, what do you think it might be?Lymphoma :(
*where is the most common site of feline lymphoma? what is the low grade and high grade like?MOST COMMON LOCATION IS GI- LOW grade: lymphocytic (mostly T cells). intermediate grade.... then HIGH grade: lymphoblastic, large granular)
who is most prone to feline intestinal lymphoma? (breed, age) Clinical signs?DSH, 6-13 yrs. Mostly see weight loss and anorexia, maybe some diarrhea and vomiting. MAJORITY of low grade lymphoma has LOW COBALAMIN
how do you treat feline intestinal lympoma?LOW GRADE (lympocytic mostly T cells)= prednisolone and chlorambucil. HIGH GRADE: response 25-50%, MST 2-9mo (doxorubicin and multiagent protocols)
two prognostic factors to consider with feline intestinal lymphoma?(1) low grade (lympocytic) is better outcome than high grade (lymphoblastic, large granular) (2) initial response to chemo
what's a stress leukogram again?neuts and monos up, lymps and eos down
breed problem with bernese mountain dogs?they get lots of tumors
test if prob is liver with?alt, alp, bile acids
test if prob is kidney with?BUN, creat, USG
check if prob with adrenals with?Na/K levels, LACK of stress leukogram, ACTH stim
check if prob with uterus with?rads, us, leukocytes
check if prob is prostate with?US, urine
check if prob is with pancreas with?PLI/TLI
check if prob is with peritoneum/spleen with?rads, us
check if prob is with LNs with?FNA
check if prob is endocrine with?chem, CBC
remember if you wanna do a giardia snap, that...test for 3 days! intermittent shedding
what might lab results be like if there was an UPPER DUODENAL FB? (any change if a cat?)see elevated bilirubin (bile duct blocked), pancreatitis (pancreatic duct blocked), in CATS, low cobalamin if >2wk (bc IF from panc in cats)

Flatulance/ bloating

Question Answer
is flatulace more a dog or cat prob?Dog
flatulance can be normal, or it can be a result of dz from what 3 places?stomach, small int, colon
what is flatulance?Excessive formation of gas in stomach or intestines
PE sign of flatus might beborborygmi
abdominal distension can lead to borboygmi--> flatus or alsobelching
Gastric dilatation / volvulus: explain how the stomach flips usually turns clockwise (when viewed from ventrally)
if you open up a GDV, which side do you want to grab, and which way do you want to pull?so grab from L side and turn it back to right side when it is all rotated
Re-occurrence of bloating from GDV: … after surgery, what can we do ? First, exclude other disorders. How do you do this?Try some drugs like Metoclopramide (inc gastric emptying), Cisapride (inc GI movement), Ranitidine (dec stomach acid) -- so if the stomach was just angry, maybe it distended for that reason
if there is reoccurring bloating, and you eliminate out other motility diseases and irritation, what might be your next step in trying to figure it out?perhaps try to eliminate amount of gas being produced which might lead to the bloating-- Erythromycin (Also has prokinetic effects) and Simethicone (anti-gas agent)
if you have tried your first step of trying to elim other causes (metaclopramide, cisapride, ranitidine) which might lead to dysmotility, that doesnt work, so then you try to eliminate possible gas formation problems (erythromycin inc motility), and that doesnt work....then what can you try as your 3rd and last effort?teach owner to pass a tube , 2nd surgery
Re-occurrence of bloating --> Metoclopramide where does it work? who do you not give it to?METOCLOPRAMIDE. works on smooth muscle upper gi tract & dopamine receptors CNS. do not give to seizure-patients .... can give PO, SC, IV
Cisapride--> how does this work, when should you dec dose?Stimulation of the serotonin receptors increases acetylcholine release--> prokinetic agent. decrease dose if pain/cramping
Ranitidine--> how does this work?H2 receptor antagonist.... questionable effect on gi kinetics
bloating right after surgery... what are some possibilities for this to happen?(1) is the Gastropexy in the right place? If it isnt, might be causing outflow obstruction. (2) Is there an underlying disorder? Consider: (a) primary motility disorder (b) cancer
how can you check for a primary motility disorder?Barium contrast studies-- 10-12h max for gastric emptying!

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