Difference between revisions of "Inflammatory Bowel Disease"

Revision as of 16:04, 12 August 2009

Signalment

No sex predisposition
More common in middle-aged dogs and cats

Description

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:

Lymphocytic - Plasmacytic Enteritis (most common)
Eosinophilic Enteritis

The underlying cause of IBD is currently unknown. It may reflect an exaggerated or inappropriate response by the immune system to dietary, bacterial or self-antigens.

Diagnosis

Clinical Signs

Vomiting (most common sign in cat)
Diarrhoea; small or large intestinal
Haematoemesis or haematochezia (more severe cases)
Weight loss
Abdominal discomfort or pain
Excessive borborygmi
Variable appetite; incrased or decreased
Hypoproteinaemia or ascites
Thicked intestinal loop

Laboratory Tests

Haematology

Neutrophilia ± mild left shift in LPE
Eosinophilia
- Not always present in EGE

Biochemistry

Panhypoproteinaemia
Hypocholesterolaemia
Mild increased in liver enzymes, secondary to intestinal inflammation

Other Tests

Faecal analysis should be carried out to rule out parasitic causes such as hookworms, whipworms and Giardia
Serum folate level decreases with proximal small intestitnal inflammation
Serum cobalamin level decreases with distal small intestinal inflammation

Diagnostic Imaging

Plain radiography is used for evaluate for anatomic abnormalities.
Contrast study is only of value if there is a severe mucosal disease.
Ultrasonography may reveal thickening of intestinal wall and mesenteric lymphadenopathy.

Histopathology

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

Treatment

Dietary modification
- An elimination diet should be instigated. The patient should be fed strictly a protein source that the patient was never exposed to. Clinical signs should resolve within 1-2 weeks.
- Folate and cobalamin supplementation may be required if the levels are subnormal.
Antimicrobials such as Metronidazole at 10-15 mg/kg BID for 3-4 weeks may be given to mild to moderate cases, and especially in cats
- The mucosal damage caused by IBD may decrease the animal's ability to manage to intestinal flora and secondary ARD has been reported.
Immunosuppressive therapy
- This should be considered if antimicrobial therapy alone is inadequate.
- Prednisolone at 2.2mg/kg/day PO for 10 days. Then gradually taper to EOD.
- Azathioprine or Cyclosporine can be given alternatively if non-responsive or poor tolerance to steroid.

Prognosis

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.

@@ Line 1: / Line 1: @@
-{{OpenPagesTop}}
+{{unfinished}}
-Also known as: '''''IBD
+{{dog}}
+{{cat}}
-==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 [[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==
-Affects the cat, dog and horse. No sex or breed or age predispositions exist.
+*No sex predisposition
+*More common in middle-aged dogs and cats
-==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.
-===Laboratory Tests===
+==Description==
-<u>'''Haematology''':</u>
+'''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:
+*[[Lymphocytic - Plasmacytic Enteritis - WikiClinical|Lymphocytic - Plasmacytic Enteritis]] (most common)
+*[[Eosinophilic Enteritis - WikiClinical|Eosinophilic Enteritis]]
-A [[Neutrophilia|Neutrophilia]] ± a mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]].
+The underlying cause of IBD is currently unknown.  It may reflect an exaggerated or inappropriate response by the immune system to dietary, bacterial or self-antigens.
-An [[Eosinophilia|Eosinophilia]] is not always present in [[Enteritis, Eosinophilic|EE]].
-<u>'''Biochemistry''':</u>
+==Diagnosis==
+===Clinical Signs===
+*'''Vomiting''' (most common sign in cat)
+*'''Diarrhoea'''; small or large intestinal
+*Haematoemesis or haematochezia (more severe cases)
+*Weight loss
+*Abdominal discomfort or pain
+*Excessive borborygmi
+*Variable appetite; incrased or decreased
+*Hypoproteinaemia or ascites
+*Thicked intestinal loop
-On biochemistry there is often a Panhypoproteinaemia, Hypocholesterolaemia and mildly elevated liver enzymes, secondary to intestinal inflammation.
-<u>'''Other Tests''':</u>
+===Laboratory Tests===
+====Haematology====
+*Neutrophilia ± mild left shift in LPE
+*Eosinophilia
+**Not always present in EGE
-'''Faecal analysis''' should be carried out to rule out parasitic causes such as [[Trichuris vulpis|whipworms]], [[Uncinaria stenocephala|hookworms]] and [[Giardia|''Giardia'']].
+====Biochemistry====
+*Panhypoproteinaemia
+*Hypocholesterolaemia
+*Mild increased in liver enzymes, secondary to intestinal inflammation
-'''Serum folate''' level decreases with proximal small intestinal inflammation and serum cobalamin level decreases with distal small intestinal inflammation.
+====Other Tests====
+*Faecal analysis should be carried out to rule out parasitic causes such as hookworms, whipworms and ''Giardia''
+*Serum folate level decreases with proximal small intestitnal inflammation
+*Serum cobalamin level decreases with distal small intestinal inflammation
 ===Diagnostic Imaging===
-<u>'''Radiography''':</u>
+*Plain radiography is used for evaluate for anatomic abnormalities.
-Plain radiography is used to evaluate for anatomic abnormalities.  Contrast study is only valuable if there is a severe mucosal disease.
+*Contrast study is only of value if there is a severe mucosal disease.
+*Ultrasonography may reveal thickening of intestinal wall and mesenteric lymphadenopathy.
-<u>'''Ultrasonography''':</u>
-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]] are 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 by this limits where the samples can be taken from as the jejunum and ileum in not easily accessible.  Exploratory laparotomy and full thickness may sometimes be preferred.
-==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===
+*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 - Introduction|hypersensitivity]].
+**An elimination diet should be instigated.  The patient should be fed strictly a protein source that the patient was never exposed to.  Clinical signs should resolve within 1-2 weeks.
-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 such as Metronidazole at 10-15 mg/kg BID for 3-4 weeks may be given to mild to moderate cases, and especially in cats
+**The mucosal damage caused by IBD may decrease the animal's ability to manage to intestinal flora and secondary ARD has been reported.
+*Immunosuppressive therapy
+**This should be considered if antimicrobial therapy alone is inadequate.
+**Prednisolone at 2.2mg/kg/day PO for 10 days.  Then gradually taper to EOD.
+**Azathioprine or Cyclosporine can be given alternatively if non-responsive or poor tolerance to steroid.
-===Antimicrobials===
+==Prognosis==
-[[Nitroimidazoles|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 |antibiotic responsive diarrhoea]] (ARD) has been reported.
-===Immunosuppressive===
-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.
-==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''.
+*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''
-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''.
-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]]
-[[Category:Alimentary Diseases - Horse]]
-[[Category:Expert_Review]]
-[[Category:Allergic Alimentary Diseases]]