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Inflammatory Bowel Disease (view source)
Revision as of 21:42, 9 September 2015
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Also known as: '''''IBD
==Description==
==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, which are: [[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, 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.
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.
===Laboratory Tests===
===Laboratory Tests===
<u>'''Haematology''':</u>
A [[Neutrophilia|Neutrophilia]] ± mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]]
A [[Neutrophilia|Neutrophilia]] ± a mild left shift will be present in [[Enteritis, Lymphocytic - Plasmacytic |LPE]].
An [[Eosinophilia|Eosinophilia]] is not always present in [[Enteritis, Eosinophilic|EE]].
An [[Eosinophilia|Eosinophilia]] is 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.
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]] and serum cobalamin level decreases with distal small intestinal [[Inflammation - Pathology|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'']].
'''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>
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 may reveal mesenteric [[Lymph Nodes - Pathology|lymphadenopathy]] and thickening of the 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. 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]] 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==
==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 - WikiBlood|hypersensitivity]].
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.
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, 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.
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===
===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]] first and azathioprine or Cyclosporine can be given 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==
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''.
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[[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]]
[[Category:Intestine_-_Inflammatory_Pathology]][[Category:Dog]]
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[[Category:To_Do_-_Caz]]