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Inflammatory Bowel Disease - Coggle Diagram
Inflammatory Bowel Disease
definition
group of disorders
persistent or recurrent GI signs
histological evidence of gastric/intestinal inflammation
unknown origin
breakdown of immune tolerance to lumina Ags?
environmental factors?
microbiome disturbance?
genetics?
CS
weight loss
appetite changes
decreased
polyphagia
eating grass
vomiting
diarrhea
small and/or large bowel
abdominal pain
excess flatulence/borborygmi
all signs may vary
usually chronic and intermittent
:cat:
50:50 upper GI:lower
:dog:
85:15 upper GI:lower GI
diagnosis
rule out other causes of vomiting/diarrhea
:first_place_medal: histopathology
canine IBD activity index
tier 1
CBC
may be normal
neutrophilia
eosinophilia
anemia
fecal
:cat: T4
baseline cortisol
+/- abdominal rads
chem
may be normal
:arrow_down:
albumin
globulins
cholesterol
reactive hepatopathy
UA
tier 2
abdominal US
mucoal and submucosal thickening
wall layering
enlarged LNs
might be normal
GI panel
B12
absorbed in distal SI
if low
disease in distal SI
EPI
must be fasted
light protected
folate
absorbed in proximal SI
high
bacterial overgrowth
low
proximal SI
must be fasted
light protected
TLI
PLI
contrast upper GI
specific differentials
bile acids
ACTH stimulation
tier 3
CT
biopsy
ways to get one
endoscopy
biopsy mucosal layer
cannot get to jejenum
less invasive
colonoscopy
abdominal explore
:warning: avoid if low albumin
allows for full-thickness biopsies of multiple organs
interpretation
type of infiltrate
area affected
severity of inflammation
mucosal thickness
topography
architectural changes
types
lymphoplasmacytic
most common
severe form hard to differentiate fr/ lymphoma
eosinophilic
2nd most common
can be confused with dietary sensitivity
granulomatous
rare
granuloma formation
mixed
treatment
food responsive
strict diet trial
novel protein/hydrolyzed
low fat, esp. in lymphangiectasia
highly digestable
+/- new microbiome diet
abx responsive
tylan vs. metronidazole
cannot
be longterm
use folate to guide abx trial
steroid responsive
do not exceed 40mg/dog/day
use lowest effective dose
:dog: prednisone
immunosuppression
:cat: prednisolone
alternative: budesonide
more active locally
fewer side effects
secondary immunosuppressants when steroids not adequately controlling disease
cyclosporine
azathioprine
mycophenolate
chlorambucil
B12 supplement
if low on GI panel
oral or onjectable