Page 609 - Clinical Small Animal Internal Medicine

53 Motility Disorders of the Alimentary Tract 577

parts of the SI. LI contrast studies should also not be (1–2 mg/kg SID to BID) or budesonide (0.05–1 mg/kg/
VetBooks.ir done two hours after a cleansing enema, 6–12 hours day with the total dose not exceeding 3 mg q8h).
Alternatively, sulfasalazine (15–30 mg/kg BID to TID,
after colonoscopy and 3–4 days after full‐thickness
colonic biopsies. Ultrasound has so far not been investi-
trolling idiopathic colitis in some dogs. However, this is
gated to evaluate LI motility. maximum 6 g/day) has been particularly useful in con-
usually done on an empirical basis, and the decision
Measurement of Gastrointestinal Transit Times regarding which dogs can or need to be treated with
Different ways to assess LI motility or whole‐intestinal either of those antiinflammatory compounds is often
transit have been employed, but are so far limited to arbitrary.
research purposes or require special equipment. The When CILBD is suspected (and all other causes of coli-
simplest way to assess oroanal transit time is to feed plas- tis have been ruled out), treatment should start with
tic markers of different colors and recover them from the dietary modifications (fiber supplementation; see ear-
feces. Different radiopaque markers have been used in lier). The remainder of treatment depends on the nature
healthy dogs as well. Similar to assessment of gastric of clinical signs (intermittent, alternation between con-
emptying (see earlier), radioscintigraphy has also been stipation and diarrhea, abdominal pain/cramping) and
used to determine LI motility (e.g., with 111 In). Recently, their suspected inciting cause. Different types of bulking
total GI transit times and LI transit times were measured agents (psyllium, kaolin, pectin) can help in times of
with a wireless motility capsule system in dogs. Other diarrhea. Alternatively, motility modifiers or antispas-
tests used in human medicine, such as colonic manom- modics may be tried (Table 53.3). Antispasmodic drugs
etry or MRI, have so far only been used in experimental might relieve some pain and sedatives reduce stress
dogs to assess LI motility and are not useful for routine effects. Most dogs only require treatment for a day to
diagnostics. two weeks, with some requiring long‐term treatment.
Stressors should be avoided and behavioral therapy can
be considered. Drugs modifying behavior, including ami-
Treatment of Large Intestinal Dysmotility
triptyline, can be tried in refractory cases of CILBD (see
Treatment of Idiopathic Colitis and CILBD Table 53.3). The prognosis of CILBD is good, particularly
Treatment of LI dysmotility secondary to infectious or for dogs that respond to fiber supplementation.
inflammatory colitis, neoplasia or mechanical impair-
ment is directed towards the underlying cause. Treatment of Constipation
Treatments for IBD with LI involvement, food hypersen- Management of constipation depends on the severity
sitivity, fiber‐responsive colitis and CILBD overlap and the underlying cause, which should be addressed
frequently, as all involve some form of dietary modifica- first (mechanical obstruction, pelvic fracture, neurologic
tion (see later). This also explains why definitive diagno- disorder, etc.). If possible, drugs that may cause constipa-
sis and accurate separation of these disease entities can tion (opioids, diuretics, antispasmodics, anticonvulsants,
be difficult. sucralfate, NSAIDs) should be minimized or discontin-
Dietary modifications often include the change to a ued. In overweight animals, weight loss should be
novel protein (and possibly carbohydrate) source or a encouraged and their activity increased. Cat litter boxes
hydrolyzed protein diet. Alternatively, increasing the should always be kept clean, to encourage defecation,
amount of dietary fiber or adding bulk‐forming agents and water intake should be increased (availability of
(e.g., a commercial high‐fiber diet or the addition of water bowls, addition of water to food).
psyllium 1–3 tbsp/day or unprocessed wheat bran 1–5 In addition, or as sole treatment in mild cases, dietary
tbsp/day) to the food also frequently leads to clinical modification is recommended. This can again consist of
improvement. bulk‐forming agents (high‐fiber diet, added psyllium or
Antibiotics usually have no place in treating “idio- bran) or the administration of lactulose or other laxatives
pathic” colitis. However, the authors have noticed that (see Table 53.3). A single enema or rectal suppository on
some dogs improve with the administration of metroni- an outpatient basis can also be considered.
dazole or tylosin, similar to antibiotic‐responsive chronic In more severe or refractory cases, manual removal of
enteropathy/IBD, even if constipation or LI diarrhea are impacted feces and several warm water enemas (in many
the only presenting complaints. cases requiring general anesthesia) are necessary.
Antiinflammatories can aid in controlling LI symp- Adequate amounts of intravenous fluids need to be
toms in some dogs. As in small intestinal forms of IBD, administered to correct dehydration and possible elec-
this might include the administration of steroids (if all trolyte abnormalities and to prevent worsening of obsti-
other causes of clinical signs, especially infectious dis- pation. Constipation is most commonly a recurring
eases, have been excluded), for example prednisolone problem and long‐term prophylactic measures (dietary