Difference between revisions of "Inflammatory Bowel Disease"

From WikiVet English
Jump to navigation Jump to search
 
(104 intermediate revisions by 5 users not shown)
Line 1: Line 1:
−
{{unfinished}}
+
{{OpenPagesTop}}
−
 
+
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==
 
==Signalment==
 +
Affects the cat, dog and horse. No sex or breed or age predispositions exist.
  
 +
==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===
 +
<u>'''Haematology''':</u>
  
−
==Description==
+
A [[Neutrophilia|Neutrophilia]] ± a mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]].  
−
'''Inflammatory bowel disease'''(IBD) is an idiopathic group of disorders characterised by inflammatory changes without a known inciting cause. IBD can affect any part of the intestines and it is classified according to the predominant cellular inflammatory infiltration.  Three types have been recognised, they are:
+
An [[Eosinophilia|Eosinophilia]] is not always present in [[Enteritis, Eosinophilic|EE]].
−
*Lymphoplasmacellular enteritis(most common)
 
−
*Eosinophilic enteritis
 
−
*Ulcerative colitis (rare disorder found in Boxers)
 
−
 
 
−
The underlying cause of IBD is currently unknown.  It is speculated to have been caused by an exaggerated or inappropriate response by the immune system to dietary and/or bacterial antigens.
 
  
−
====Pathogenesis====
+
<u>'''Biochemistry''':</u>
  
−
* Is idiopathic, but appears to be immune mediated.
+
On biochemistry there is often a Panhypoproteinaemia, Hypocholesterolaemia and mildly elevated liver enzymes, secondary to intestinal inflammation.
−
** Possibly food allergy. 
 
−
*** Change of diet is a potential treatment.
 
−
**** Disease is often due to something present in the diet for some time, rather than something suddenly introduced. 
 
−
** Hypersensitivity to inhaled or ingested environmental allergens is another possible cause.
 
  
−
* Lymphocytic - plasmacytic enteritis is seen most commonly in the '''dog'''.
+
<u>'''Other Tests''':</u>
−
** Is the most common inflammatory colonic disease of dogs.
 
−
** Sometimes seen in the cat and horse.
 
−
* Affects the [[Small Intestine - Anatomy & Physiology|small intestine]], sometimes quite extensively.
 
−
** Produces chronic diarrhoea with lymphocytic or plasma cell (rather than macrophage) infiltration of the lamina propria.
 
−
** Produces a severe [[Intestines Protein-Losing Diseases - Pathology#Protein-Losing Enteropathy (PLE)|protein losing enteropathy]].
 
−
* Sometimes eosinophil infiltration is quite marked.
 
−
* Has a hereditary basis in the Basenji
 
−
==Diagnosis==
 
−
===Clinical Signs===
 
  
 +
'''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.
  
−
===Laboratory Tests===
+
===Diagnostic Imaging===
−
====Haematology====
+
<u>'''Radiography''':</u>
 +
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 may reveal mesenteric lymphadenopathy and thickening of the intestinal wall.
  
−
====Biochemistry====
+
===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.
 +
 +
==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 - Introduction|hypersensitivity]].
 +
Folate and cobalamin supplementation may be required if the levels are subnormal.
  
−
====Other Tests====
+
===Antimicrobials===
 +
[[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.
  
−
===Diagnostic Imaging===
+
==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''.
  
−
==Treatment==
+
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''.
  
  
−
==Prognosis==
+
{{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''.
 

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
VetstreamVetlexicon advert button.png
Vetstream
To reach the Vetstream content, please select 		Canis, Felis, Lapis or Equis
CABICABI logo.jpg
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.


This article has been peer reviewed but is awaiting expert review. If you would like to help with this, please see more information about expert reviewing.



Error in widget FBRecommend: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6750a97039e256_97637346
Error in widget google+: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6750a970a495d4_85700521
Error in widget TwitterTweet: unable to write file /var/www/wikivet.net/extensions/Widgets/compiled_templates/wrt6750a9710d66f9_51483592
WikiVet® Introduction - Help WikiVet - Report a Problem
Retrieved from "https://en.wikivet.net/index.php?title=Inflammatory_Bowel_Disease&oldid=181089"