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B. Anthony Nanton BSc. DVM. Diplomate ABVP (Feline Practice)
Brookhaven Cat Hospital
20-F Middle Country Rd.
Coram, NY. 11727
Inflammatory Bowel Disease
Inflammatory bowel disease ( IBD) may be described as a disease of exclusion. The term is often preceded by the word Idiopathic which indicates that it is disease for which no cause is precisely known. Idiopathic IBD is found primarily in cats between the ages of 6 to 8 years, although it can occur in younger cats. Clinically it is seen as chronic vomiting and diarrhea in various degrees of severity and often with a waxing and waning course with acute flare-ups. The diarrhea may be large bowel in origin with blood and mucus or small bowel in origin. Abdominal pain especially in the anterior abdomen may indicate associated pancreatitis and liver disease. The association between IBD of the small intestine, pancreatitis and liver disease (cholangiohepatitis) is due to the fact that the pancreatic duct and the bile duct from the gall bladder enter the small intestine jointly at the major duodenal papilla. Bacteria may ascend from the intestines through the common papilla into the pancreas and liver. Other clinical signs may include lethargy, weight loss, inappropriate eliminations with defecation outside of the litter box, and jaundice. It is believed that there is an initial insult to the intestinal tract which results in a breakdown of its immunological defences. This allows movement of antigens from the contents of the intestines into the wall of the intestines, setting up an inflammatory process which becomes amplified with the release of chemicals and the attraction of more inflammatory cells. The degree of clinical signs depend on the severity of the inflammatory process. With chronicity comes structural deformity of the intestinal wall and altered function, further complicating the issue. Determination of the cause of the initial insult and efforts to eliminate it form the crux of the diagnostic process. Because it is a diagnosis of exclusion, one has to eliminate the other causes of gastro-intestinal upsets before one can definitively claim to have diagnosed Idiopathic IBD.
Testing should include a Complete Blood Count (CBC) Chemistry profile, Fecal examinations and cultures, Radiographs, Feline Leukemia and Feline Immunodeficiency testing, Heartworm test, thyroid levels and abdominal ultrasound. Full thickness biopsy of the intestines may be necessary to characterize the inflammatory process and to distinguish if from Lymphosarcoma which often has the same clinical presentation as Idiopathic IBD. Treatment of Idiopathic IBD involves the reduction of the antigen load presented to the intestines in the food, and the use of anti-inflammatories to reduce the severity of the inflammatory process. Reduction of the antigen load involves the provision of a novel hypoallergenic diet or one that contains ingredients to which the cat in unaccustomed. There are a number of these products available and may contain duck or venison as the protein source, or may contain low molecular weight protein hydrosylates. Medications to reduce the severity of the inflammation may include metronidazole, prednisolone, chlorambucil, azothiaprine and sulfasalazine. Some of these medications should be used only after a confirmatory biopsy Idiopathic IBD is a challenge to diagnose, and its treatment can be frustrating, involving therapeutic trials, and varied responses, and requires client compliance and patient co-operation.
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INDICAZIONI GENERALI PER LA LA GESTIONE DELLA CRISI EPILETTICA PROLUNGATA Documento redatto con il supporto tecnico degli specialisti dell’Ospedale dei Bambini di Brescia e dei rappresentanti dei pediatri di famiglia 1. MANIFESTAZIONI DELLA CRISI EPILETTICA La maggior parte delle crisi in persone con epilessia nota non rappresenta una emergenza medica e termina, senza dan