Comparison of endoscopic and full-thickness biopsy specimens for diagnosis of inflammatory bowel disease and alimentary tract lymphoma in cats

OBJECTIVE: To evaluate the accuracy of endoscopic biopsy (EB) specimens for diagnosis of alimentary tract lymphosarcoma in cats. DESIGN: Prospective study. ANIMALS: 22 cats with inflammatory bowel disease (IBD) or alimentary tract lymphosarcoma. PROCEDURES: Endoscopic biopsy specimens were obtained during endoscopy of the stomach and duodenum immediately prior to laparotomy or laparoscopic surgery, during which full-thickness biopsy (FTB) specimens were obtained. Accuracy of histopathologic diagnoses was compared between EB and FTB specimens. RESULTS: Lymphosarcoma was diagnosed in 10 cats on the basis of FTB specimens. Lymphosarcoma was detected in the jejunum and ileum in all 10 cats, in the duodenum in 9 cats, and in the stomach in 4 cats. In the same 10 cats, EB findings indicated a diagnosis of lymphosarcoma in 3 cats and were suggestive but inconclusive for lymphosarcoma in 3 cats. Lymphosarcoma was correctly diagnosed via gastric EB specimens in 3 of the 4 cats with gastric lymphosarcoma but evaluation of EB specimens led to an incorrect diagnosis of IBD in 4 cats with small intestinal lymphosarcoma. CONCLUSIONS AND CLINICAL RELEVANCE: EB specimens were useful for diagnosis of gastric lymphosarcoma but were not adequate for differentiating between IBD and lymphosarcoma in the small intestine. Because the most common sites of alimentary tract lymphosarcoma in cats are the jejunum and ileum, FTB specimens of those sites should be obtained via laparotomy or laparoscopy for accurate diagnosis. Laparoscopy may be a minimally invasive alternative to endoscopy and laparotomy for obtaining diagnostic biopsy specimens.     

Possible causal association of idiopathic inflammatory bowel disease with thrombocytopenia in the dog

Extraintestinal manifestations of inflammatory bowel disease (IBD) are commonly observed in humans but are poorly documented in companion animals. Thrombocytopenia is an uncommon but well-documented extraintestinal hematological abnormality in humans; however, there are no previous reports of IBD and concurrent thrombocytopenia in the veterinary literature. Seven dogs having idiopathic IBD and concurrent thrombocytopenia were identified and evaluated retrospectively (this represents an incidence of 2.5% in the authors' IBD population). Obvious known causes for thrombocytopenia were eliminated by diagnostic testing as deemed appropriate by the clinician of record. Thrombocytopenia resolved with treatment for the IBD in some but not all patients. This is similar to reports in humans. Thrombocytopenia typically appears to be subclinical, and the severity does not correlate with the degree of intestinal inflammation defined histopathologically. However, quantitative platelet counts should be monitored during IBD therapy, as additional immunosuppression may be required to treat thrombocytopenia, despite resolution of gastrointestinal signs. It is speculated that thrombocytopenia may be causally associated with canine IBD, possibly secondary to immune stimulation from lumenal bacterial antigens, altered immunological regulation, or both.     

Two cases of severe iron-deficiency anaemia due to inflammatory bowel disease in the dog

Two dogs were referred for investigation of lethargy and anaemia. Preliminary examinations by the referring veterinary surgeons had revealed severe anaemia, which was poorly regenerative. In one case, the anaemia was microcytic and, in the other, it was hypochromic. These findings were suggestive of chronic blood loss anaemia. Neither dog had external signs of gastrointestinal disease, although one had vomited on a single occasion during the two weeks preceding referral. Although both dogs were producing grossly normal faeces, further investigations detected faecal occult blood. Multiple full thickness gastrointestinal biopsies were taken at laparotomy. These showed segmental eosinophilic enteritis of the duodenum and proximal jejunum in one case, and marked chronic lymphocytic gastritis in the other. Both cases illustrate the fact that severe systemic disease can result from gastrointestinal pathology in the absence of clinical signs of gastrointestinal disease.     

Clinical assessment of disease activity for canine inflammatory bowel disease

Clinical indices, consisting of gastrointestinal signs and laboratory parameters, are widely used for assessing disease activity in human inflammatory bowel disease (IBD). The development of a standardized scoring index for use in dogs with IBD would be useful in the management of clinical cases, both at diagnosis and in response to medical therapy. This review provides a synopsis of current strategies used to assess IBD activity in humans and companion animals. The clinical application of a simple scoring index (e.g., canine IBD activity index [CIBDAI]) for measurement of canine IBD activity is also reviewed.     

A scoring index for disease activity in canine inflammatory bowel disease

The clinical course of inflammatory bowel disease (IBD) in dogs is characterized by spontaneous exacerbations and remissions, which makes assessment of disease burden difficult. The objectives of this study were to develop a scoring system for evaluation of canine IBD activity and to validate this scoring method by correlating it to objective laboratory and histologic indices of intestinal inflammation. Fifty-eight dogs with IBD were evaluated prospectively and compared to 9 disease-free control dogs. Clinical disease activity was quantified by a simple scoring system, the canine IBD activity index (CIBDAI), and compared to serum concentrations of C-reactive protein (CRP), haptoglobin (HAP), alpha-acid glycoprotein (AGP), and serum amyloid A (SAA), as well as histology scores derived from endoscopic biopsy specimens. Forty-six dogs were available for a reevaluation of the CIBDAI, CRP HAP, and AGP, and 34 dogs had repeat analysis of SAA performed after medical therapy. Serum concentrations of CRP were significantly (P < .02) increased in dogs with CIBDAI scores > or = 5 (mild disease activity or greater) compared to controls. Among IBD dogs, the CIBDAI showed good correlation (r = 0.82, P < .0001) to both histology and HAP scores, but CRP also was a strong co-correlate of disease activity. The IBD dogs showed significantly (P < .0001) decreased CIBDAI and CRP values but significantly (P < .0001) increased HAP concentrations after medical therapy compared to pretreatment values. We conclude that the CIBDAI is a reliable measure of inflammatory activity in canine IBD and that CRP is suitable for laboratory evaluation of the effect of therapy in these patients.     

Usefulness of MRI compared with CT for diagnosis of mesenteric lymphoma in a dog

We evaluated the usefulness of MRI and compared it with CT for diagnosis of mesenteric lymphoma in a dog. The results in the plain CT, dynamic CT and plain MR (T1WI and T2WI) images suggested that the mass was a large single nodular lesion with abundant blood perfusion. On enhanced MRI(T1WI) , the mass was depicted as a tumor with adhesion to the gut wall. Exploratory laparotomy confirmed the mass was consistent with the findings on enhanced MRI. We think that MRI might be a useful imaging tool for diagnosis of canine mesenteric lymphoma.     

Multisystemic inflammatory disease in a borzoi dog

A six-week-old female borzoi puppy from a brother-sister mating developed a generalised illness characterised by anorexia, temporary intention tremor, episodic pyrexia, tachypnoea, conjunctivitis, otitis and neck pain. Haematological abnormalities included an inflammatory leukogram and regenerative anaemia. Blood cultures remained sterile; clinical chemistry values were unremarkable. The puppy had recurrent seizures and was euthanased when 18 weeks old. Post mortem examination revealed a multisystemic inflammatory disease involving thyroids, lymph nodes, spleen, pancreas, bladder and lung, but no lesions to account for the neurological signs. The cause of this generalised disease was not recognised. The histological features are unusual and resemble those described in other dogs of this breed.     

Bacterial endocarditis and inflammatory joint disease in the dog

The main clinical features of 12 cases of bacterial endocarditis were lameness, pyrexia, lethargy, anorexia and systolic cardiac murmurs. The lameness varied from generalised stiffness to an inability to stand and walk. Multiple joint involvement was typical. Two types of joint pathology were identified. A marked synovitis with granulation tissue sometimes covering the articular cartilage was present in some joints associated with the presence of bacterial organisms. Other joints proved sterile and showed a milder synovial pathology. In many dogs both an infective arthritis and a non-infective arthritis co-existed. Bilaterally symmetrical joint involvement was typical of the non-infective arthritis. The pathogenesis of the latter was likely to involve the deposition of circulating immune complexes (bacterial antigens, antibody and complement) in the synovium. The infective arthritis was presumed to be secondary to embolic disease, ie, the spread of infected emboli from the heart valve to the joints. Treatment was unsuccessful in all cases.     

Feline inflammatory bowel disease: a review

Inflammatory bowel disease (IBD), while a popular diagnosis, may not occur as commonly as it is diagnosed. It is a diagnosis of exclusion, meaning that it is important to eliminate diseases that mimick it. Dietary intolerance or allergy in particular, can have the same clinical and histologic appearance as IBD. Likewise, well-differentiated alimentary lymphosarcoma can also be confused with it. Intestinal biopsies are useful, but must be taken carefully and then evaluated by someone with interest and expertise in alimentary tract pathology. Therefore, it behoves the clinician to carefully consider the diagnosis instead of starting multiple drug therapy in a cavalier fashion. Well constructed dietary therapy can often be beneficial for both dietary problems and IBD.     

The clinical diagnosis of renal disease in the dog

A review has been made of the presenting clinical signs and of the laboratory analyses and investigative procedures which aid in the diagnosis of renal disease in the dog. Résumé. On passe en revue les signes cliniques qui se présentent, les analyses de laboratoire et les sondages et recherches qui facilitent le diagnostic des maladies rénales chez le chien. Zusammenfassung. Es wird eine Übersicht uber die sich darbietenden klinischen Zeichen, die Laboratoriumsanalysen und die Untersuchgsverfahren gegeben, welche zur Diagnose von Nierenerkrankungen des Hundes beitragen.