Difference between revisions of "Inflammatory Bowel Disease"

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==Signalment==
Also known as: '''''IBD
+
*No sex predisposition
 +
*There are contradictions with regard to age predisposition
  
==Introduction==
+
==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, including [[Enteritis, Lymphocytic - Plasmacytic |Lymphocytic - Plasmacytic Enteritis]] (LPE) and [[Enteritis, Eosinophilic |Eosinophilic Enteritis]] (EE).
+
'''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:
 +
*[[Enteritis, Lymphocytic - Plasmacytic |Lymphocytic - Plasmacytic Enteritis]] (LPE)
 +
*[[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.
 
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==
 
==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.
+
*'''[[Vomiting|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.
+
*'''[[Diarrhoea|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.
+
*'''Weight loss'''; nearly all cases of chronic small intestinal disease
Hypoproteinaemia or ascites may also be evident.
+
*Variable appetite; increased or decreased which relates to severity
 +
*Lethargy; common in severe cases
 +
*Anorexia; common in severe cases
 +
*[[Antibiotic Responsive Diarrhoea|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>
+
====Haematology====
 
+
*[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Neutrophilia|Neutrophilia]] ± mild left shift in [[Enteritis, Lymphocytic - Plasmacytic |LPE]]  
A [[Neutrophilia|Neutrophilia]] ± a mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]].
+
*[[Changes in Inflammatory Cells Circulating in Blood - Pathology#Eosinophilia|Eosinophilia]]
An [[Eosinophilia|Eosinophilia]] is not always present in [[Enteritis, Eosinophilic|EE]].
+
**Not always present in [[Enteritis, Eosinophilic|EE]]
 
 
<u>'''Biochemistry''':</u>
 
 
 
On biochemistry there is often a Panhypoproteinaemia, Hypocholesterolaemia and mildly elevated liver enzymes, secondary to intestinal inflammation.
 
 
 
<u>'''Other Tests''':</u>
 
  
'''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 - Pathology|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 [[Trichuris vulpis|whipworms]], [[Uncinaria stenocephala|hookworms]] 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]].
  
 
===Diagnostic Imaging===
 
===Diagnostic Imaging===
<u>'''Radiography''':</u>
+
====Radiography====
 
Plain radiography is used to evaluate for anatomic abnormalities.  Contrast study is only valuable if there is a severe mucosal disease.
 
Plain radiography is used to evaluate for anatomic abnormalities.  Contrast study is only valuable if there is a severe mucosal disease.
  
<u>'''Ultrasonography''':</u>
+
====Ultrasonography====
Ultrasonography may reveal mesenteric lymphadenopathy and thickening of the intestinal wall.
+
Ultrasonography may reveal mesenteric [[Lymph Nodes - Pathology|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===
 
===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 - WikiBlood|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===
 
===Antimicrobials===
[[Nitroimidazoles|Metronidazole]] can be given for 3-4 weeks, this may be suitable for mild to moderate cases, and especially in cats.
+
*[[Nitroimidazoles|metronidazole]] can be given for 3-4 weeks
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.
+
*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===
 
===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.
+
*This should be used if other treatments are inadequate.
 +
*[[Steroids|Prednisolone]]  
 +
*Azathioprine or Cyclosporine can be given alternatively if the patient is non-responsive or unable to tolerate steroid.
  
 
==Prognosis==
 
==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==
+
=Pathology=
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''.
+
===Introduction===
 +
 
 +
* Inflammatory bowel disease will result in malabsorption and in many cases, chronic diarrhoea.
 +
* The small and/or [[Large Intestine - Anatomy & Physiology|large intestine]]s are affected.
 +
** The site determines whether diarrhoea is present.
 +
* Additionally, can get extraintestinal abnormalities
 +
** Cholangiohepatitis
 +
** Nephritis
 +
** Pancreatitis
 +
** Polyarthropathy
 +
** Thrombocytopenia (uncommon)
 +
*** Extent of thrombocytopenia not related to duration of IBD or  to its resolution.
 +
* The term "inflammatory bowel disease" covers several conditions characterised by the major inflammatory cell(s) present.
 +
** All have some common features:
 +
*** Thickening of the mucosa.
 +
*** Villus atrophy in advanced disease.
 +
*** Significant inflammatory infiltrate in the mucosa and sometimes deeper layers.
 +
 
 +
 
 +
==Granulomatous enteritis==
 +
 
 +
* Seen mainly in the dog.
 +
** Also in the cat and horse
 +
* Idiopathic.
 +
* Granulomatous inflammation
 +
** Macrophages and giant cells, but also [[Neutrophils|neutrophils]], eosinophils, lymphocytes and plasma cells.
 +
 
 +
==Idiopathic colitis==
  
Hall, E.J, Simpson, J.W. and Williams, D.A. (2005) '''BSAVA Manual of Canine and Feline Gastroenterology (2nd Edition)''' ''BSAVA''
+
* Affects the dog.
  
Nelson, R.W. and Couto, C.G. (2009) '''Small Animal Internal Medicine (Fourth Edition)''' ''Mosby Elsevier''.
+
==Histiocytic Ulcerative Colitis==
  
 +
* Occurs in the dog and cat .
 +
** In the dog, animals less than two years old are most likely to be affected.
 +
*** Particularly the boxer and French bulldog.
 +
* Produces soft faeces containing mucous and blood.
  
{{review}}
+
===Pathology===
  
{{OpenPages}}
+
* Produces raised ulcerative nodules in the colon.
 +
** Due to an macrophage infiltration of the mucosa and submucosa
 +
*** Macrophages are filled with PAS positive material.
 +
*** Electron microscopy demonstrates macrophages to be filled with [[Escherichia coli|''E.coli'']] antigen.
 +
* Accompanying lymphadenopathy.
  
[[Category:Intestine_-_Inflammatory_Pathology]][[Category:Intestinal Diseases - Dog]][[Category:Immunological Diseases - Dog]]
 
[[Category:Intestinal Diseases - Cat]][[Category:Immunological Diseases - Cat]]
 
  
[[Category:Alimentary Diseases - Horse]]
+
=References=
[[Category:Expert_Review]]
+
*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:Allergic Alimentary Diseases]]
+
*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''.
 +
[[Category:Intestine_-_Inflammatory_Pathology]][[Category:Dog]]
 +
[[Category:Cat]]
 +
[[Category:To_Do_-_Clinical]]
 +
[[Category:Alimentary_Disorders_-_Horse]]

Revision as of 12:00, 29 July 2010

Signalment

  • No sex predisposition
  • There are contradictions 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 whipworms, hookworms and Giardia.
  • Serum folate level decreases with proximal small intestinal inflammation.
  • 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 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

  • 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 to intestinal flora, resulting in secondary ARD has been reported.

Immunosuppressive

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

Prognosis

Pathology

Introduction

  • Inflammatory bowel disease will result in malabsorption and in many cases, chronic diarrhoea.
  • The small and/or large intestines are affected.
    • The site determines whether diarrhoea is present.
  • Additionally, can get extraintestinal abnormalities
    • Cholangiohepatitis
    • Nephritis
    • Pancreatitis
    • Polyarthropathy
    • Thrombocytopenia (uncommon)
      • Extent of thrombocytopenia not related to duration of IBD or to its resolution.
  • The term "inflammatory bowel disease" covers several conditions characterised by the major inflammatory cell(s) present.
    • All have some common features:
      • Thickening of the mucosa.
      • Villus atrophy in advanced disease.
      • Significant inflammatory infiltrate in the mucosa and sometimes deeper layers.


Granulomatous enteritis

  • Seen mainly in the dog.
    • Also in the cat and horse
  • Idiopathic.
  • Granulomatous inflammation
    • Macrophages and giant cells, but also neutrophils, eosinophils, lymphocytes and plasma cells.

Idiopathic colitis

  • Affects the dog.

Histiocytic Ulcerative Colitis

  • Occurs in the dog and cat .
    • In the dog, animals less than two years old are most likely to be affected.
      • Particularly the boxer and French bulldog.
  • Produces soft faeces containing mucous and blood.

Pathology

  • Produces raised ulcerative nodules in the colon.
    • Due to an macrophage infiltration of the mucosa and submucosa
      • Macrophages are filled with PAS positive material.
      • Electron microscopy demonstrates macrophages to be filled with E.coli antigen.
  • Accompanying lymphadenopathy.


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.