Difference between revisions of "Inflammatory Bowel Disease"
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==Description== | ==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: | + | '''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]] ( | + | *[[Lymphocytic - Plasmacytic Enteritis - WikiClinical|Lymphocytic - Plasmacytic Enteritis]] (LPE) |
| − | *[[Eosinophilic Enteritis - WikiClinical|Eosinophilic Enteritis]] | + | *[[Eosinophilic Enteritis - WikiClinical|Eosinophilic Enteritis]] (EE) |
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. | 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. | ||
| Line 22: | Line 22: | ||
*'''Vomiting''' (most common sign in cat) | *'''Vomiting''' (most common sign in cat) | ||
*'''Diarrhoea'''; small or large intestinal | *'''Diarrhoea'''; small or large intestinal | ||
| − | * | + | *Haematemesis or haematochezia (more severe cases) |
*Weight loss | *Weight loss | ||
*Abdominal discomfort or pain | *Abdominal discomfort or pain | ||
*Excessive borborygmi | *Excessive borborygmi | ||
| − | *Variable appetite; | + | *Variable appetite; increased or decreased |
*Hypoproteinaemia or ascites | *Hypoproteinaemia or ascites | ||
| − | * | + | *Thickened intestinal loop |
| Line 35: | Line 35: | ||
*Neutrophilia ± mild left shift in LPE | *Neutrophilia ± mild left shift in LPE | ||
*Eosinophilia | *Eosinophilia | ||
| − | **Not always present in | + | **Not always present in EE |
====Biochemistry==== | ====Biochemistry==== | ||
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====Other Tests==== | ====Other Tests==== | ||
| − | *Faecal analysis should be carried out to rule out parasitic causes such as hookworms, whipworms and ''Giardia'' | + | *Faecal analysis should be carried out to rule out parasitic causes such as hookworms, whipworms and ''Giardia''. |
| − | *Serum folate level decreases with proximal small | + | *Serum folate level decreases with proximal small intestinal inflammation. |
| − | *Serum cobalamin level decreases with distal small intestinal inflammation | + | *Serum cobalamin level decreases with distal small intestinal inflammation. |
===Diagnostic Imaging=== | ===Diagnostic Imaging=== | ||
| − | *Plain radiography is used | + | *Plain radiography is used to evaluate for anatomic abnormalities. |
| − | *Contrast study is only | + | *Contrast study is only valuable if there is a severe mucosal disease. |
| − | *Ultrasonography may reveal thickening of intestinal wall | + | *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 | + | 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== | ==Treatment== | ||
*Dietary modification | *Dietary modification | ||
| − | **An elimination diet should be instigated. The patient should be fed strictly a protein source that | + | **An elimination diet should be instigated. The patient should be fed strictly on a protein source that had not previously been 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 | + | *Antimicrobials such as metronidazole at 10-15 mg/kg BID for 3-4 weeks |
| − | **The mucosal damage caused by IBD may decrease the animal's ability to manage to intestinal flora | + | **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 | *Immunosuppressive therapy | ||
| − | **This should be used if other | + | **This should be used if other treatments are inadequate. |
**Prednisolone at 2.2mg/kg/day PO for 10 days. Then gradually taper to EOD. | **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 | + | **Azathioprine or Cyclosporine can be given alternatively if the patient is non-responsive or unable to tolerate steroid. |
==Prognosis== | ==Prognosis== | ||
Revision as of 08:25, 13 August 2009
 |
This article is still under construction. |
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:
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
- Haematemesis or haematochezia (more severe cases)
- Weight loss
- Abdominal discomfort or pain
- Excessive borborygmi
- Variable appetite; increased or decreased
- Hypoproteinaemia or ascites
- Thickened intestinal loop
Laboratory Tests
Haematology
- Neutrophilia ± mild left shift in LPE
- Eosinophilia
- Not always present in EE
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 protein source that had not previously been 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
- 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.