GI3- SA Intestinal Diseases

  1. What are the etiologies of EPI? (2)
    • pancreatic acinar atrophy- young adult GSDs
    • chronic pancreatitis- small dogs and cats
  2. What are the clinical signs of EPI? (5)
    • weight loss despite polyphagia,┬álarge volumes of diarrhea with increased frequency, flatulence, borborygmus
  3. How is EPI diagnosed? (2)
    species-specific TLI assay, hypocolbalaminemia [min database usually normal, not a PLE!]
  4. Describe the management of EPI? (3)
    • pancreatic enzyme supplementation (Viokase-V), cobalamin supplementation, +/- antibiotics
    • [usually no special diet needed]
  5. What is the prognosis of EPI?
    good with lifelong therapy
  6. How can you monitor response to treatment for EPI? How can you not measure it? Why?
    • assess by patient gaining weight, no more diarrhea, diminished clinical signs
    • cannot monitor patient's TLI to assess efficacy (it will always be low! supplements don't cross react with assay)
  7. What are the types of IBD? (4)
    food-responsive, antibiotic-responsive, steroid-responsive, multi-modal
  8. What types of inflammation may accompany IBD? (3)
    lymphoplasmacytic, eosinophilic, granulomatous
  9. What are the proposed etiologies of IBD? (5)
    genetic, dietary, infectious, immunologic, idiopathic
  10. What breed gets gluten enteropathy IBD?
    Irish setters
  11. What breed is prone to getting PLE and PLN?
    Soft-coated wheaten terrier
  12. What are clinical signs of IBD? (5)
    middle-aged animals with chronic enteropathy, vomiting, diarrhea, weight loss, anorexia [variable]
  13. How is IBD diagnosed? (6)
    diagnosis of exclusion, rule out EPI, rule out parasites, rule out food allergy, rule out addison's, rule out neoplasia
  14. What diagnostics yield indirect support of IBD? (3)
    decreased cobalamin and folate, abdominal US shows thickened intestinal loops with normal wall layering
  15. How is IBD managed? (4)
    [trial and error] diet changes, antibiotics, probiotics, +/- immunosuppressive medications (avoid if possible- corticosteroids, chlorambucil)
  16. Why is the diet changed with management of IBD? (3)
    may reduce antigen delivery to intestine, may affect intestinal flora, may improve digestibility
  17. What nutrients can influence digestibility/ intestinal disease? (3)
    specific ingredients, fat conc, fiber conc
  18. What are a few key differences b/w abdominal effusions caused by intestinal disease and liver disease?
    • Intestinal dz: hypoalbuminemia, panhypoproteinemia, hypocholesterolemia, mucosal striations; ascites from decreased oncotic pressure
    • Hepatic dz: hypoalbuminemia, hypocholesterolemia; ascites from decreased oncotic pressure +/- portal hypertension
  19. With severe hypoalbuminemia, animals are at greater risk for ______________.
  20. Define lymphangectasia.
    a form of PLE, in which there is pathologic dilation of lacteals (lymph vessels)
  21. Breeds predisposed to lymphangectasia include... (3)
    Yorkies, soft-coated wheaten terriers, norwegian lundehunds
  22. What are common underlying diseases for PLE? (3)
    inflammatory bowel disease, lymphangectasia, infection [typically NOT EPI]
  23. With PLE, decreased oncotic pressure leads to __(3)__; another consequence is __________.
    edema, ascites, pleural effusion; hypercoagulability/TE
  24. Describe the pathophysiology of lymphangectasia.
    lymph doesn't drain normally due to obstruction by inflammatory infiltrates or neoplastic cells--> increased venous pressure at thoracic duct--> dilated lacteals--> lymph/chylous exudate goes into the lumen of the GI--> fluid and protein loss through GI
  25. What are etiologies of lymphangectasia?
    • may be primary
    • secondary- inflammatory or neoplastic intestinal disease, leading to increased venous pressure at thoracic duct; R-CHF, pericardial effusion, neoplasia
  26. What are the classic pathologic processes involved with (and seen on Chem profile) lymphangectasia? (5)
    panhypoproteinemia, hypocholesterolemia, hypocalcemia (total and ionized), hypomagnesemia, lymphopenia
  27. How is lymphangectasia diagnosed? (4)
    • CBC/Chem: panhypoproteinemia, hypocholesterolemia, hypocalcemia (total and ionized), hypomagnesemia, lymphopenia
    • Abdominal US: hyperechoic mucosal striations
    • Endoscopy: white-tipped villi (plaques)
    • Intestinal biopsy: endoscopic (prob not full-thickness b/c low alb)
  28. What is the gold standard for diagnosis of lymphangectasia?
    intestinal biopsy
  29. Describe the management of lymphangectasia. (2)
    • dietary management: ultra low fat diet
    • medical therapy: cobalamin supplementation, immunosuppressive pred, maybe antibiotics
  30. What are differentials for an anal sac mass? (3)
    anal sac adenocarcinoma, abscess, impacted anal sac
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GI3- SA Intestinal Diseases
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