Inflammatory Bowel Disease in a 6-year-old Dachshund Presented By: Matan Paradis Advisors: Dr. Gerald Duhamel and Dr. Jennifer Prieto Senior Seminar August 29th, 2018 Signalment & Chief Complaint ▶ 6-year-old Female Spayed Dachshund ▶ Chief Complaint ▶ 2 wk history of gastrointestinal upset & declining appetite History Initially presented to primary care veterinarian with 3 day history of vomiting ▶ CBC, chemistry panel, pancreatic lipase, urinalysis unremarkable ▶ Treated with supportive care including subcutaneous fluids, anti-nausea medication, bland diet ▶ Vomiting stopped, appetite initially improved, but subsequently declined ▶ Chemistry panel unremarkable ▶ Abdominal radiographs WNL ▶ No improvement with supportive care CUHA Presentation Vital Parameters ▶ Temperature 102.8F ▶ Remaining WNL Physical Exam ▶ 5 % dehydrated ▶ Good body condition, no blood or melena on rectal exam Point of care blood work: Unremarkable Abdominal radiographs: No mechanical obstruction Diagnostics ▶ Complete Blood Count – No Significant Findings ▶ Urinalysis – No significant Findings ▶ ACTH Stimulation Test – Normal ▶ Chemistry Panel 7/13/18 7/15/18 Reference Range Albumin 3.6 g/dL 3.6 g/dL 3.2 – 4.1 Cholesterol 126 mEq/L 124 mEq/L 136-392 Diagnostics Abdominal Ultrasound – Normal GI Architecture Problem List Anorexia ▶ DDX – Secondary Anorexia ▶ Systemic Disease: Renal, Hepatic, Pancreatic ▶ Primary GI: Inflammatory bowel disease, lymphangiectasia, infectious, parasitic, foreign body ▶ Endocrine: Hypoadrenocorticism ▶ Neoplasia ▶ Neurological disease ▶ ileus ▶ Behavioral ▶ DDX – Primary Anorexia ▶ Focal brain lesion Problem List Acute Vomiting ▶ DDX ▶ General: Dietary indiscretion, toxin exposure ▶ Systemic: Pancreatitis, renal disease, hepatic disease ▶ Endocrine: hypoadrenocorticism ▶ Primary Gastrointestinal: Neoplasia, inflammatory bowel disease, lymphangiectasia, parasitic, viral, Foreign body, intussusception ▶ Neurologic Problem List Hypocholesterolemia ▶ DDX ▶ General: Starvation ▶ Systemic: hypoadrenocorticism, synthetic liver failure/compromise ▶ Primary Gastrointestinal: Neoplasia, inflammatory bowel disease, lymphangiectasia Gastrointestinal Endoscopy Duodenal villi mildly edematous & blunted   Gastrointestinal Endoscopic Mucosal Pinch Biopsies - Histopathology ▶ Stomach (6 sections) ▶ Mild chronic lymphocytic gastritis ▶ Duodenum (7 sections) ▶ Moderate chronic lymphoplasmacytic enteritis ▶ Colon (4 sections) Inflammed Small Intestine ▶ Mild chronic plasmacytic colitis Inflammatory Bowel Disease Histopathology Normal Small Intestine Inflammed Small Intestine Etiology of Inflammatory Bowel Disease Pathophysiology ▶ Dysregulated host immune response to food and/or microbial component antigens (loss of tolerance) Genetic Predisposition ▶ German Shephard, Basenji, Lunderhund, Yorkshire terrier, Rottweiler, Soft-coated Wheaton terriers, Sharpei Diagnosis of Inflammatory Bowel Disease 4 Diagnostic Criteria 1) Clinical Signs 2) Histopathology (required for diagnosis) 3) Inability to document separate cause for clinical signs 4) Clinical response to immunomodulatory anti-biotics or immunosuppressive agents Treatment Modalities For Inflammatory Bowel Disease ❖ Diet Modification - Novel protein or hydrolyzed diet ❖ Immunomodulatory antibiotics ❖ Immunosuppressive medications ❖ 15-40% of IBD patients are non-responsive Patient Outcome 1. Novel Protein Diet 2. Immunomodulatory Antibiotic 3. Immunosuppressant 4. Supportive Care ▶ Anti-nausea medications ▶ Gastroprotectants ▶ Esophageal Feeding tube Current Status And Prognosis ▶ Current treatment protocol ▶ Patient eating well, not showing further clinical signs of gastrointestinal disease ▶ Based on mild histopathologic abnormalities ▶ Future attempt to taper off immunosuppressant medications and maintain on diet ▶ Patient prognosis – Good Negative Prognostic Indicators ▶ Negative prognostic Indicators ▶ Hypoalbumenemia (6-12 months) ▶ Non-responsive to therapies ▶ Severe histological abnormalities Hospital, Diagnostics and Treatment Costs Total Cost = $4,078 ▶ Major costs included: ▶ 5 day hospitalization - 796$ ▶ Abdominal ultrasound - 575$ ▶ Repeated bloodwork - 382$ ▶ Endoscopy under anesthesia -687$ ▶ Biopsy collection and histopathology -270$ ▶ All medications - 362$ References ▶ Dandrieux JR. 2016. Inflammatory bowel disease versus chronic enteropathy in dogs: are they one and the same? J Small Anim Pract 57:589–599. ▶ Maeda S, Tsuboi M, Sakai K, Ohno K, Fukushima K, Kanemoto H, Hiyoshi-Kanemoto S,  Goto-Koshino Y, Chambers J.K, Yonezawa T,Uchida K, and N. Matsuki. 2017. Endoscopic Cytology for the Diagnosis of Chronic Enteritis and Intestinal Lymphoma in Dogs. Veterinary Pathology Vol 54, Issue 4, pp 595-604 ▶ Simpson KW, Jergens AE. 2011. Pitfalls and progress in the diagnosis and management of canine inflammatory bowel disease. Veterinary Clinics of North America: Small Animal Practice 41(2): 381-398. ▶ Washabau, R. 2010. Endoscopic, biopsy, and histopathologic guidelines for the evaluation of gastrointestinal inflammation in companion animals. J Vet Intern Med 24:10–26.