IBD

Question 1

what are the 6 diagnostics criteria for idiopathic IBD?

Answer 1

1) GI signs are chronic (ie. >3weeks) and persistent or recurrent
2) Histopathologic evidence of mucosal inflammation is present
3) No evidence exists of other causes of GI inflammation such as parasites, bacteria, fungi and neoplasia (ie. lymphoma)
4) Other causes of similar clinical signs are ruled out, such as hypoadrenocorticism, exocrine pancreatic insufficiency, pancreatitis, etc.
5) Response to dietary, antibiotic, and anthelmintic therapies is inadequate
6) Positive clinical response occurs to anti-inflammatory or immunosuppressive agents

Question 2

US findings consistent with IBD

Answer 2

• lesions may be diffuse or multifocal
• abnormalities may include; thickening of the intestinal wall with preservation of wall layering and mesenteric lymphadenopathy, hypertrophy of the muscularis with increased mucosal echogenicity is considered a sensitive indicator of IBD
• increased intestinal wall thickness is not sensitive or specific or IBD and can also occur with intestinal lymphoma
• neoplastic infiltration may be more focal and cause more severe thickening and loss of layering

Question 3

what are the predominant inflammatory cell types in IBD?

Answer 3

• lymphoplasmacytic
• eosinophilic
• granulomatous
• neutrophilic

Question 4

how can CRP be used to monitor IBD?

Answer 4

• CRP is a positive, acute phase protein that is a sensitive marker of inflammation
• CRP correlates well with chronic enteropathy activity indices scores in some studies and can decrease significantly after successful treatment
• CRP may be more useful for monitoring response to therapy than as biomarker of IBD and histologic severity

Question 5

what is Canine A1PI?

Answer 5

Faecal alpha1-proteinase inhibitor - is synthesized in the liver and has a molecular weight similar to albumin. Increased faecal concentrations of A1PI correlates with GI protein loss and histologic lesions consistent with PLE in dogs

Question 6

typical signalment for IBD

Answer 6

• predisposed breeds; german shep, basenjis, soft-coated wheaten terrier, shar pei
• middled-aged (ave. 6yrs)
• no sex predisposition

Question 7

what is faecal calprotectin?

Answer 7

• a nonspecific biomarker of GI inflammation; faecal calprotectin levels may increased with IBD and decrease in response to therapy
• faecal and serum calprotectin can be measured by in-house immunoassays, however, results are mixed and do no significantly correlate with clinical severity or histopathologic changes

Question 8

what is Calgranulin-C?

Answer 8

• biomarker of GI inflammation that can be measured by enzyme-linked immunosorbent assay
• faecal calgranulin-C correlates with severity of CS and endoscopic lesions but not histopathologic changes
• Calgranulin-C is unaffected by corticosteroid therapy

Question 9

typical time to response with diet trials

Answer 9

within 1-2 weeks; rechallenge with original diet is needed to demonstrate intolerance

Question 10

difference between response to hydrolyzed vs. novel protein diets?

Answer 10

• fewer relapses with hydrolyzed diets compared to novel protein

Question 11

initial drug of choice for immunosuppressive therapy?

Answer 11

• prednisolone started at 1-2mg/kg PO q12-24h. Response usually seen within 1-2 weeks. Taper after 2-4weeks increments to lowest effect dose.

Question 12

negative prognostic factors associated with IBD

Answer 12

• hypoalbuminaemia
• dogs with elevated Spec-cPL
• serum cobalamin <200ng/L