Difference between revisions of "Inflammatory Bowel Disease"

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Also known as: '''''IBD
 
  
==Introduction==
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{{dog}}
'''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).
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{{cat}}
  
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==
 
==Signalment==
Affects the cat, dog and horse. No sex or breed or age predispositions exist.  
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*No sex predisposition
 +
*There are contraditions with regard to age predisposition
 +
 
 +
==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 - 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.
  
 
==Diagnosis==
 
==Diagnosis==
 
===Clinical Signs===
 
===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.
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*'''Vomiting'''; very common in cat, more common than diarrhoea
Nearly all cases of chronic small intestinal disease present with weight loss and a variable appetite.
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*'''Diarrhoea'''; very common in dog, more common than vomiting, usually small intestinal
Animals often display abdominal discomfort or pain and excessive borborygmi. Lethargy, anorexia, haematemesis or haematochezia are present in more severe cases.
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*'''Weight loss'''; nearly all cases of chronic small intestinal disease
Hypoproteinaemia or ascites may also be evident.
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*Variable appetite; increased or decreased which relates to severity
 +
*Lethargy; common in severe cases
 +
*Anorexia; common in severe cases
 +
*Antibiotic responsive diarrhoea
 +
*Abdominal discomfort or pain
 +
*Excessive borborygmi
 +
*Haematemesis or haematochezia (more severe cases)
 +
*Hypoproteinaemia or ascites
 +
*Thickened intestinal loop
 +
 
  
 
===Laboratory Tests===
 
===Laboratory Tests===
<u>'''Haematology''':</u>
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====Haematology====
 
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*[[General Pathology - Changes in Inflammatory Cells Circulating in Blood #Neutrophilia|Neutrophilia]] ± mild left shift in LPE
A [[Neutrophilia|Neutrophilia]] ± a mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]].
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*[[General Pathology - Changes in Inflammatory Cells Circulating in Blood #Eosinophilia|Eosinophilia]]
An [[Eosinophilia|Eosinophilia]] is not always present in [[Enteritis, Eosinophilic|EE]].
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**Not always present in EE
  
<u>'''Biochemistry''':</u>
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====Biochemistry====
 +
*Panhypoproteinaemia
 +
*Hypocholesterolaemia
 +
*Mild increased in liver enzymes, secondary to intestinal inflammation
  
On biochemistry there is often a Panhypoproteinaemia, Hypocholesterolaemia and mildly elevated liver enzymes, secondary to intestinal inflammation.
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====Other Tests====
 
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*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'']].
<u>'''Other Tests''':</u>
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*Serum folate level decreases with proximal small intestinal inflammation.
 
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*Serum cobalamin level decreases with distal small intestinal inflammation.
'''Faecal analysis''' should be carried out to rule out parasitic causes such as [[Trichuris vulpis|whipworms]], [[Uncinaria stenocephala|hookworms]] and [[Giardia|''Giardia'']].
 
 
 
'''Serum folate''' level decreases with proximal small intestinal inflammation and serum cobalamin level decreases with distal small intestinal inflammation.
 
  
 
===Diagnostic Imaging===
 
===Diagnostic Imaging===
<u>'''Radiography''':</u>
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*Plain radiography is used to 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.
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*Contrast study is only valuable if there is a severe mucosal disease.
 +
*Ultrasonography may reveal mesenteric lymphadenopathy and thickening of the intestinal wall.
  
<u>'''Ultrasonography''':</u>
 
Ultrasonography may reveal mesenteric lymphadenopathy and thickening of the intestinal wall.
 
  
 
===Histopathology===
 
===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.  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.
 
==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==
 
==Treatment==
===Dietary modification===
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*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 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.
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 [[Nitroimidazoles|metronidazole]] at 10-15 mg/kg BID 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 to intestinal flora, resulting in secondary ARD has been reported.
 +
*Immunosuppressive therapy
 +
**This should be used if other treatments are inadequate.
 +
**[[Steroids|Prednisolone]] at 2.2mg/kg/day PO for 10 days.  Then gradually taper to EOD.
 +
**Azathioprine or Cyclosporine can be given alternatively if the patient is non-responsive or unable to tolerate steroid.
  
===Antimicrobials===
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==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==
 
==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]]
 

Revision as of 12:57, 13 August 2009



Category:WikiClinical CanineCow
Category:WikiClinical FelineCow


Signalment

  • No sex predisposition
  • There are contraditions with regard to age predisposition

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:

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.

Diagnosis

Clinical Signs

  • Vomiting; very common in cat, more common than diarrhoea
  • 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
  • Antibiotic responsive diarrhoea
  • Abdominal discomfort or pain
  • Excessive borborygmi
  • Haematemesis or haematochezia (more severe cases)
  • Hypoproteinaemia or ascites
  • Thickened intestinal loop


Laboratory Tests

Haematology

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 intestinal inflammation.
  • Serum cobalamin level decreases with distal small intestinal inflammation.

Diagnostic Imaging

  • Plain radiography is used to evaluate for anatomic abnormalities.
  • Contrast study is only valuable if there is a severe mucosal disease.
  • 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 is not easily accessible. Exploratory laparotomy and full thickness biopsy may be preferred at times.

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.
    • 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
    • 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 to intestinal flora, resulting in secondary ARD has been reported.
  • Immunosuppressive therapy
    • This should be used if other treatments are inadequate.
    • Prednisolone at 2.2mg/kg/day PO for 10 days. Then gradually taper to EOD.
    • Azathioprine or Cyclosporine can be given alternatively if the patient is non-responsive or unable to tolerate 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.