Changes

==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]] (most common)

*[[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.

*'''Vomiting''' (most common sign in cat)

*'''Vomiting''' (most common sign in cat)

*'''Diarrhoea'''; small or large intestinal

*'''Diarrhoea'''; small or large intestinal

*Haematoemesis or haematochezia (more severe cases)

*Haematemesis or haematochezia (more severe cases)

*Weight loss

*Weight loss

*Abdominal discomfort or pain

*Abdominal discomfort or pain

*Excessive borborygmi

*Excessive borborygmi

*Variable appetite; incrased or decreased  

*Variable appetite; increased or decreased  

*Hypoproteinaemia or ascites

*Hypoproteinaemia or ascites

*Thicked intestinal loop

*Thickened intestinal loop

*Neutrophilia ± mild left shift in LPE

*Neutrophilia ± mild left shift in LPE

*Eosinophilia

*Eosinophilia

**Not always present in EGE

**Not always present in EE

====Biochemistry====

====Biochemistry====

====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 intestitnal inflammation

*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 for evaluate for anatomic abnormalities.

*Plain radiography is used to evaluate for anatomic abnormalities.

*Contrast study is only of value if there is a severe mucosal disease.

*Contrast study is only valuable if there is a severe mucosal disease.

*Ultrasonography may reveal thickening of intestinal wall and mesenteric lymphadenopathy.

*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 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.

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 the patient was never exposed to.  Clinical signs should resolve within 1-2 weeks.

**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 Metronidazole at 10-15 mg/kg BID for 3-4 weeks may be given to mild to moderate cases, and especially in cats  

*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 and secondary 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 therapy

*Immunosuppressive therapy

**This should be used if other treatment is inadequate.

**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 poor tolerance to steroid.

**Azathioprine or Cyclosporine can be given alternatively if the patient is non-responsive or unable to tolerate steroid.

==Prognosis==

==Prognosis==