Difference between revisions of "Inflammatory Bowel Disease"

Latest revision as of 21:42, 9 September 2015

Also known as: IBD

Introduction

Inflammatory bowel disease (IBD) is an idiopathic group of disorders characterised by intestinal inflammatory changes, associated with persistent or recurrent gastrointestinal signs. IBD can affect any part of the intestines and is classified according to the predominant cellular inflammatory infiltration. Several histological types have been recognised, including Lymphocytic - Plasmacytic Enteritis (LPE) and Eosinophilic Enteritis (EE).

There is no underlying cause of IBD in 75% of cases. They are thought to reflect an exaggerated or inappropriate response by the immune system to dietary, bacterial or self-antigens. IBD is a diagnosis of exclusion. Other differential diagnoses have to be investigated and ruled out before a diagnosis of IBD can be made.

Signalment

Affects the cat, dog and horse. No sex or breed or age predispositions exist.

Diagnosis

Clinical Signs

Vomiting is a very common sign in the cat, more common than diarrhoea. Where as in the dog Diarrhoea is more common and usually small intestinal. Nearly all cases of chronic small intestinal disease present with weight loss and a variable appetite. Animals often display abdominal discomfort or pain and excessive borborygmi. Lethargy, anorexia, haematemesis or haematochezia are present in more severe cases. Hypoproteinaemia or ascites may also be evident.

Laboratory Tests

Haematology:

A Neutrophilia ± a mild left shift will be present in LPE. An Eosinophilia is not always present in EE.

Biochemistry:

On biochemistry there is often a Panhypoproteinaemia, Hypocholesterolaemia and mildly elevated liver enzymes, secondary to intestinal inflammation.

Other Tests:

Faecal analysis should be carried out to rule out parasitic causes such as whipworms, hookworms and Giardia.

Serum folate level decreases with proximal small intestinal inflammation and serum cobalamin level decreases with distal small intestinal inflammation.

Diagnostic Imaging

Radiography: Plain radiography is used to evaluate for anatomic abnormalities. Contrast study is only valuable if there is a severe mucosal disease.

Ultrasonography: Ultrasonography may reveal mesenteric lymphadenopathy and thickening of the intestinal wall.

Histopathology

A biopsy of the intestine is required for a definitive diagnosis of IBD. A non-invasive biopsy may be taken via endoscopy. However, this limits where the samples can be taken from as the jejunum and ileum are not easily accessible. Exploratory laparotomy and full thickness biopsy may be preferred at times.

Pathology

The term inflammatory bowel disease covers several conditions characterised by the major inflammatory cells present. Increased numbers of plasma cells, lymphocytes, eosinophils, and neutrophils in the lamina propria can be present. All conditions have some common features and these include thickening of the mucosa, villus atrophy in advanced disease and significant inflammatory infiltrate in the mucosa and sometimes deeper layers.

Treatment

Dietary modification

An elimination diet should be instigated. The patient should be fed strictly on a novel protein source which they have not previously been exposed to. Clinical signs should resolve within 1-2 weeks. The patient should ideally be rechallenged to demonstrate a true dietary hypersensitivity. Folate and cobalamin supplementation may be required if the levels are subnormal.

Antimicrobials

Metronidazole can be given for 3-4 weeks, this may be suitable for mild to moderate cases, and especially in cats. The mucosal damage caused by IBD may decrease the animal's ability to manage intestinal flora, resulting in secondary antibiotic responsive diarrhoea (ARD) has been reported.

Immunosuppressive

This should be used if other treatments are inadequate. Prednisolone first and azathioprine or Cyclosporine can be given if the patient is non-responsive or unable to tolerate steroid.

Prognosis

Variable

Inflammatory Bowel Disease Learning Resources
Vetstream To reach the Vetstream content, please select	Canis, Felis, Lapis or Equis
Literature Search Search for recent publications via CAB Abstract (CABI log in required)	Inflammatory Bowel Disease publications

References

Ettinger, S.J. and Feldman, E. C. (2000) Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2 (Fifth Edition) W.B. Saunders Company.

Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition) BSAVA

Nelson, R.W. and Couto, C.G. (2009) Small Animal Internal Medicine (Fourth Edition) Mosby Elsevier.

Error in widget FBRecommend: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6737b6996c28e3_47401234

Error in widget google+: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6737b699713444_85906211

Error in widget TwitterTweet: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6737b699756221_94819700

WikiVet^® Introduction - Help WikiVet - Report a Problem

@@ Line 1: / Line 1: @@
-{{unfinished}}
+{{OpenPagesTop}}
+Also known as: '''''IBD
-{{dog}}
+==Introduction==
-{{cat}}
+'''Inflammatory bowel disease (IBD)''' is an idiopathic group of disorders characterised by intestinal inflammatory changes, associated with persistent or recurrent gastrointestinal signs.  IBD can affect any part of the intestines and is classified according to the predominant cellular inflammatory infiltration.  Several histological types have been recognised, including [[Enteritis, Lymphocytic - Plasmacytic |Lymphocytic - Plasmacytic Enteritis]] (LPE) and [[Enteritis, Eosinophilic |Eosinophilic Enteritis]] (EE).
+There is no underlying cause of IBD in 75% of cases.  They are thought to reflect an exaggerated or inappropriate response by the immune system to dietary, bacterial or self-antigens.  IBD is a diagnosis of exclusion.  Other differential diagnoses have to be investigated and ruled out before a diagnosis of IBD can be made.
 ==Signalment==
-*No sex predisposition
+Affects the cat, dog and horse. No sex or breed or age predispositions exist.
-*There are contraditions with regard to age predisposition
+==Diagnosis==
+===Clinical Signs===
+[[Vomiting|Vomiting]] is a very common sign in the cat, more common than diarrhoea. Where as in the dog [[Diarrhoea|Diarrhoea]] is more common and usually small intestinal.
+Nearly all cases of chronic small intestinal disease present with weight loss and a variable appetite.
+Animals often display abdominal discomfort or pain and excessive borborygmi. Lethargy, anorexia, haematemesis or haematochezia are present in more severe cases.
+Hypoproteinaemia or ascites may also be evident.
-==Description==
+===Laboratory Tests===
-'''Inflammatory bowel disease (IBD)''' is an idiopathic group of disorders characterised by intestinal inflammatory changes, associated with persistent or recurrent gastrointestinal signs.  IBD can affect any part of the intestines and is classified according to the predominant cellular inflammatory infiltration.  Several histological types have been recognised, which are:
+<u>'''Haematology''':</u>
-*[[Lymphocytic - Plasmacytic Enteritis - WikiClinical|Lymphocytic - Plasmacytic Enteritis]] (LPE)
-*[[Eosinophilic Enteritis - WikiClinical|Eosinophilic Enteritis]] (EE)
-There is no underlying cause of IBD in 75% of cases.  They are thought to reflect an exaggerated or inappropriate response by the immune system to dietary, bacterial or self-antigens.  IBD is a diagnosis of exclusion.  Other differential diagnoses have to be investigated and ruled out before a diagnosis of IBD can be made.
+A [[Neutrophilia|Neutrophilia]] ± a mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]].
+An [[Eosinophilia|Eosinophilia]] is not always present in [[Enteritis, Eosinophilic|EE]].
+<u>'''Biochemistry''':</u>
-==Diagnosis==
+On biochemistry there is often a Panhypoproteinaemia, Hypocholesterolaemia and mildly elevated liver enzymes, secondary to intestinal inflammation.
-===Clinical Signs===
-*'''[[Stomach and Abomasum Consequences of Gastric Disease - Pathology|Vomiting]]'''; very common in cat, more common than diarrhoea
-*'''[[Intestine Diarrhoea - Pathology|Diarrhoea]]'''; very common in dog, more common than vomiting, usually small intestinal
-*'''Weight loss'''; nearly all cases of chronic small intestinal disease
-*Variable appetite; increased or decreased which relates to severity
-*Lethargy; common in severe cases
-*Anorexia; common in severe cases
-*[[Small Intestinal Bacterial Overgrowth and Antibiotic Responsive Diarrhoea - WikiClinical|Antibiotic responsive diarrhoea]]
-*Abdominal discomfort or pain
-*Excessive borborygmi
-*Haematemesis or haematochezia (more severe cases)
-*Hypoproteinaemia or ascites
-*Thickened intestinal loop
+<u>'''Other Tests''':</u>
-===Laboratory Tests===
+'''Faecal analysis''' should be carried out to rule out parasitic causes such as [[Trichuris vulpis|whipworms]], [[Uncinaria stenocephala|hookworms]] and [[Giardia|''Giardia'']].
-====Haematology====
-*[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] ± mild left shift in [[Lymphocytic - Plasmacytic Enteritis - WikiClinical|LPE]]
-*[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Eosinophilia|Eosinophilia]]
-**Not always present in [[Eosinophilic Enteritis - WikiClinical|EE]]
-====Biochemistry====
-*Panhypoproteinaemia
-*Hypocholesterolaemia
-*Mild increased in liver enzymes, secondary to intestinal [[Inflammation - Pathology|inflammation]]
-====Other Tests====
-*Faecal analysis should be carried out to rule out parasitic causes such as [[Small Animals #Nematodes of Dogs - the HOOKWORMS |hookworms]], [[Small Animals # Nematodes of Dogs - the WHIPWORM| whipworms]] and [[Giardia|''Giardia'']].
-*Serum folate level decreases with proximal small intestinal [[Inflammation - Pathology|inflammation]].
-*Serum cobalamin level decreases with distal small intestinal [[Inflammation - Pathology|inflammation]].
+'''Serum folate''' level decreases with proximal small intestinal inflammation and serum cobalamin level decreases with distal small intestinal inflammation.
 ===Diagnostic Imaging===
-====Radiography====
+<u>'''Radiography''':</u>
 Plain radiography is used to evaluate for anatomic abnormalities.  Contrast study is only valuable if there is a severe mucosal disease.
-====Ultrasonography====
+<u>'''Ultrasonography''':</u>
-Ultrasonography may reveal mesenteric [[Lymph Nodes - Pathology|lymphadenopathy]] and thickening of the intestinal wall.
+Ultrasonography may reveal mesenteric lymphadenopathy and thickening of the intestinal wall.
 ===Histopathology===
-A biopsy of the intestine is required for a definitive diagnosis of IBD.  A non-invasive biopsy may be taken via endoscopy.  However, this limits where the samples can be taken from as the [[Jejunum - Anatomy & Physiology|jejunum]] and [[Ileum - Anatomy & Physiology|ileum]] is not easily accessible.  Exploratory laparotomy and full thickness biopsy may be preferred at times.
+A biopsy of the intestine is required for a definitive diagnosis of IBD.  A non-invasive biopsy may be taken via endoscopy.  However, this limits where the samples can be taken from as the [[Jejunum - Anatomy & Physiology|jejunum]] and [[Ileum - Anatomy & Physiology|ileum]] are not easily accessible.  Exploratory laparotomy and full thickness biopsy may be preferred at times.
+==Pathology==
+The term inflammatory bowel disease covers several conditions characterised by the major inflammatory cells present. Increased numbers of plasma cells, lymphocytes, eosinophils, and neutrophils in the lamina propria can be present. All conditions have some common features and these include thickening of the mucosa, villus atrophy in advanced disease and significant inflammatory infiltrate in the mucosa and sometimes deeper layers.
 ==Treatment==
 ===Dietary modification===
-*An elimination diet should be instigated.  The patient should be fed strictly on a novel protein source that had not previously been exposed to.  Clinical signs should resolve within 1-2 weeks.  The patient should ideally be rechallenged to demonstrate a true dietary [[Hypersensitivity - WikiBlood|hypersensitivity]].
+An elimination diet should be instigated.  The patient should be fed strictly on a novel protein source which they have not previously been exposed to.  Clinical signs should resolve within 1-2 weeks.  The patient should ideally be rechallenged to demonstrate a true dietary [[Hypersensitivity - Introduction|hypersensitivity]].
-*Folate and cobalamin supplementation may be required if the levels are subnormal.
+Folate and cobalamin supplementation may be required if the levels are subnormal.
 ===Antimicrobials===
-*{Nitroimidazoles|metronidazole]] can be given for 3-4 weeks
+[[Nitroimidazoles|Metronidazole]] can be given for 3-4 weeks, this may be suitable for mild to moderate cases, and especially in cats.
-*This may be suitable for mild to moderate cases, and especially in cats.
+The mucosal damage caused by IBD may decrease the animal's ability to manage intestinal flora, resulting in secondary [[Antibiotic Responsive Diarrhoea |antibiotic responsive diarrhoea]] (ARD) has been reported.
-*The mucosal damage caused by IBD may decrease the animal's ability to manage to intestinal flora, resulting in secondary ARD has been reported.
 ===Immunosuppressive===
-**This should be used if other treatments are inadequate.
+This should be used if other treatments are inadequate. [[Steroids|Prednisolone]] first and azathioprine or Cyclosporine can be given if the patient is non-responsive or unable to tolerate steroid.
-**[[Steroids|Prednisolone]]
-**Azathioprine or Cyclosporine can be given alternatively if the patient is non-responsive or unable to tolerate steroid.
+==Prognosis==
+Variable
+{{Learning
+|Vetstream = [https://www.vetstream.com/canis/Content/Freeform/fre60004.asp,Canine inflammatory bowel disease]
+|literature search = [http://www.cabdirect.org/search.html?it=any&q1=%22Inflammatory+Bowel+Disease%22&calendarInput=yyyy-mm-dd&occuring1=ab&show=all&rowId=1&rowId=2&rowId=3&options1=AND&options2=AND&options3=AND&occuring3=freetext&occuring2=freetext&publishedend=yyyy&la=any&publishedstart=yyyy&y=10&x=57 Inflammatory Bowel Disease publications]
+}}
+==References==
+Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.
+Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
-==Prognosis==
+Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
+{{review}}
+{{OpenPages}}
+[[Category:Intestine_-_Inflammatory_Pathology]][[Category:Intestinal Diseases - Dog]][[Category:Immunological Diseases - Dog]]
+[[Category:Intestinal Diseases - Cat]][[Category:Immunological Diseases - Cat]]
-==References==
+[[Category:Alimentary Diseases - Horse]]
-*Ettinger, S.J. and Feldman, E. C. (2000) '''Textbook of Veterinary Internal Medicine Diseases of the Dog and Cat Volume 2''' (Fifth Edition) ''W.B. Saunders Company''.
+[[Category:Expert_Review]]
-*Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
+[[Category:Allergic Alimentary Diseases]]
-*Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.