Management of severe ascites in a case of inflammatory bowel disease
An eight year old female spayed Rottweiler mixed breed dog presented to the Cornell University Hospital for Animals (CUHA) Internal Medicine Service for evaluation of a previously diagnosed case of inflammatory bowel disease. The diagnosis was the result of full thickness biopsies taken of the small intestine during a previous exploratory laparotomy. They had made a histologic diagnosis of lymphoplasmacytic and eosinophilic enteritis with granulomatous regions consistent with inflammatory bowel disease. Immunosuppressive therapy was undergone at the time (Prednisone and Azathioprine). At the time of presentation at Cornell (3/15/11), the patient was exhibiting severe ascites, edematous hind limbs with severe pitting edema in the right hind, muscle wasting, and labored breathing with shortened breaths. Other clinical signs included intermittent diarrhea and anorexia, lethargy, and the inability to rise on her own due to the severe ascites. The results of numerous diagnostic tests indicated that the patient was exhibiting protein loss due to a severe protein losing enteropathy. Re-cuts of the previously taken biopsies (evaluated at Cornell) also showed a lymphoplasmacytic and eosinophilic enteritis as well as lymphangiectasia and lymphangitis. Medical therapy was altered and a treatment protocol was begun that included immunosuppressive drugs, antibiotics, diuretics, and vitamin supplements. Nutritional recommendations were to start a home-cooked, novel protein, highly digestible, low fat diet. This diet would help lower the antigen load to decrease inflammatory response as well as decrease the dilatation of lymphatic vessels due to its fat restriction. Within two weeks following treatment, the patient had responded with decreased peritoneal fluid, resolution of edema, the ability to rise and ambulate normally, as well as regaining a normal appetite with a decrease of clinical signs. The prognosis remains variable based on the response to treatment, which will continue to be monitored closely.
Senior seminar paperSeminar SF610.1 2011
Dogs -- Diseases -- Case studies