Page 1025 - Small Animal Clinical Nutrition 5th Edition

Chapter
57

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Inflammatory Bowel Disease

Deborah J. Davenport
Albert E. Jergens
Rebecca L. Remillard

“With good digestion all can be turned to health.”
George Herbert

CLINICAL IMPORTANCE PATIENT ASSESSMENT
The term inflammatory bowel disease (IBD) refers to a group History and Physical Examination
of chronic, idiopathic gastrointestinal (GI) disorders character- The most common clinical signs in dogs and cats with IBD are
ized by histopathologic lesions of mucosal inflammation. Each chronic vomiting, diarrhea and weight loss. The predominant
IBD variant is named by the predominant cellular infiltrate GI sign varies with the portion or portions of bowel affected.
within the lamina propria. Currently, IBD is considered the Vomiting tends to be the predominant clinical sign when the
most common cause of chronic diarrhea and vomiting in dogs stomach and proximal duodenum are affected. Loose, fluid or
and cats (Guilford, 1996; Jergens, 1999). The generic term, steatorrheic stools are most common when the small intestine
IBD, encompasses lymphoplasmacytic enteritis, lymphocytic is involved. Diarrhea marked by tenesmus, mucus and small
gastroenterocolitis, eosinophilic gastroenterocolitis, segmental scanty stools is noted with colonic lesions. Clinical signs may be
granulomatous enterocolitis (regional enteritis), suppurative intermittent or persistent. Clinical signs tend to increase in fre-
enterocolitis and histiocytic colitis. The lymphoplasmacytic quency and intensity as IBD progresses temporally. The pres-
form is probably the most common type of IBD (Leib, 1997; ence of systemic signs is also variable. Some animals present
Craven et al, 2004; Hall, 2005, Hall and German, 2005). with a history of depression, malaise and inappetence. Others
The severity of IBD varies from relatively mild clinical signs are alert and active at the time they are examined.
to life-threatening protein-losing enteropathies. In particular, The frequency and character of the vomitus and stools are
the Basenji and Ludenhund breeds may present with a very important features. At times, vomiting will be temporally relat-
severe variant that has been termed immunoproliferative small ed to food intake and the vomitus will contain food particles. In
intestinal disease (Breitschwerdt, 1992; Flesja and Yri, 1977; other cases, animals may vomit only fluid or froth. Owners
Williams, 1997). should be questioned closely about the appearance of the vom-
Inflammatory infiltrates may involve the stomach, small ited material. Dark black or coffee grounds material may indi-
bowel and colon. In cats, the stomach and small bowel are cate gastric ulceration or erosions.The diarrhea may be small or
affected most often. In dogs, IBD is common in both the small large bowel in origin.The color of the stools should be assessed
and large intestines. In many cases, multiple segments of the to determine the presence of GI bleeding.
bowel are involved and clinical signs may be mixed, reflecting Physical examination findings in dogs and cats with IBD are
the broad distribution of mucosal lesions. variable. Many patients have no abnormalities. Others present