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to the intact compounds.10 Finally, many medications, especially OTC medications, may contain unwanted/ hidden proteins.11 These should, therefore, be taken into consideration in performing an elimination diet.
Antibiotic responsive diarrhoea is hypothesised to be a result of the following factors or a combination of them: defects in the mucosal barrier, altered mucosal immune response, and dysbiosis.12 Choices of antibiotics that may be trialled include oxytetracycline, metronidazole and tylosin. Concurrent cobalamin deficiency should be managed with parenteral or oral cobalamin.
V) Biopsy
There are three means of obtaining representative tissue samples for histology: flexible endoscopy, laparoscopy, and surgery. Current recommendations are to perform upper and lower GI endoscopy as the preferred method of sampling.5 Acquisition of 6–7 adequate or 10–15 marginal tissue samples is advised for histopathological evaluation.5
Advantages of endoscopy include visualisation and biopsy of mucosal changes that cannot be seen by
a serosal approach during surgery; the collection
of multiple tissue biopsies per site; minimal risk of perforation and septic peritonitis, compared to surgical biopsy; and decreased morbidity to the patient. Disadvantages include limited access to the entire GI tract and the inadequacy of tissue samples that may not permit diagnosis. Recent studies have highlighted the importance of concurrent ileal biopsies in providing valuable information not always found in duodenal or colonic biopsies.13
Monitoring Management
The canine IBD activity index (CIBDAI) and the canine chronic enteropathy clinical activity index (CCECAI) help assess response to therapy. The latter consists of both objective and subjective measures. A CCECAI of >12 has been associated with negative outcomes, along with hypocobalaminemia, hypoalbuminemia and duodenal endoscopic abnormalities.14
1. Volkmann M, Steiner JM, Fosgate GT, Zentek J, Hartmann S, and Kohn B. Chronic Diarrhea in Dogs – Retrospective Study in 136 Cases. J Vet Intern Med. 2017; 31:1043–1055.
2. Leib MS, Larson MM, Grant DC, Monroe WE, Troy GC, Panciera DL, Rossmeisi JH, Werre SR. Diagnostic Utility of Abdominal Ultrasonography in Dogs with Chronic Diarrhea. J Vet Intern Med. 2012; 26:1288–1294.
3. Francis M, Lane AE, Lenard ZM. Sonographic features of gastrointestinal lymphoma in 15 dogs. J Small Anim Pract. 2013; 54: 468-474.
4. Hoey S, Drees R, Hetzel S. Evaluation of the gastrointestinal tract in dogs using computed tomography. Vet Radiol Ultrasound. 2013; 54:25-30. doi: 10.1111/j.1740- 8261.2012.01969.x.
5. Washabau RJ, Day MJ, Willard MD, Hall EJ, Jergens AE, Mansell J, Minami T, Bilzer TW. Endoscopic, Biopsy, and Histopathologic Guidelines for the Evaluation of Gastrointestinal Inflammation in Companion Animals. J Vet Intern Med 2010;24:10–26.
6. Gaschen FP, Merchant SR. Adverse Food Reactions in Dogs and Cats. Vet Clin Small Anim. 2011; 41: 361–379.
7. Haroun-Díaz E, Blanca-López N, Vázquez de la Torre M, Ruano FJ, Somoza Álvarez ML, Labrador Horrillo M, Bartolomé B, Blanca M, Canto Díez G. Severe anaphylaxis due to crocodile-meat allergy exhibiting wide cross-reactivity with fish allergens. J Allergy Clin Immunol Pract. 2018; 6: 669-670.
8. Ballardini N, Nopp A, Hamsten C, Vetander M, Melén E, Nilsson C, Ollert M, Flohr C, Kuehn A, van Hage M. Anaphylactic Reactions to Novel Foods: Case Report of a Child With Severe Crocodile Meat Allergy. Pediatrics. 2017;139(4). pii: e20161404. doi: 10.1542/peds.2016-1404.
9. Mandigers PJJ, Biourge V, van den Ingh TSGAM, Ankringa N, and German AJ. A Randomized, Open-Label, Positively-Controlled Field Trial of a Hydrolyzed Protein Diet in Dogs with Chronic Small Bowel Enteropathy. J Vet Intern Med 2010;24:1350–1357.
10. Olivry T, Bizikova P. A systematic review of the evidence of reduced allergenicity and clinical benefit of food hydrolysates in dogs with cutaneous adverse food reactions. Vet Dermatol 2010; 21: 32–41.
11. Jackson HA, Hammerberg B. The clinical and immunological reaction to
a flavored monthly oral heartworm prophylactic in 12 dogs with spontaneous food allergy. North American Veterinary Dermatology Forum. New Orleans (LA): American College of Veterinary Dermatology; 2002. p. 60.
12. Hall EJ. Antibiotic-Responsive Diarrhea in Small Animals. Vet Clin Small Anim. 2011: 41; 273–286.
13. Procoli F, Mõtsküla PF, Keyte SV, Priestnall S, Allenspach K. Comparison of Histopathologic Findings in Duodenal and Ileal Endoscopic Biopsies in Dogs with Chronic Small Intestinal Enteropathies. J Vet Intern Med 2013;27:268–274.
14. Allenspach K, Wieland B, Gröne A, Gaschen F. Chronic Enteropathies in Dogs: Evaluation of Risk Factors for Negative Outcome. J Vet Intern Med 2007;21:700– 708.
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