- 12 year old mn German Shepherd with BCS=3/9, perianal fistula, 30lb weight loss over 1 year despite good appetite, chronic diarrhea
- Chemistry profile shows ALB=2.3. CBC was not done
- RDVM began treatment with cephalexin and cyclosporine/ketoconazole-ALB improved slightly but continued weight loss persists
- 12 year old mn German Shepherd with BCS=3/9, perianal fistula, 30lb weight loss over 1 year despite good appetite, chronic diarrhea
- Chemistry profile shows ALB=2.3. CBC was not done
- RDVM began treatment with cephalexin and cyclosporine/ketoconazole-ALB improved slightly but continued weight loss persists
- Abdominal US shows a few small (<1.0cm) hypoechoic nodules in the spleen with maintence of normal parenchymal architecture and normal capsule border. There is normal to increased intestinal motility and preservation of intestinal wall layering with minor loss of detail in some segments
- Intestinal biopsies were recommended but the owner will not likely pursue this due to cost constraints. I have also recommended fecal parasite, TLI and cobalamin testing.
- My rule out list for chronic diarrhea and severe weight loss includes IBD (LPE), lymphoma, EPI, GI parasites.
- For empiral tx, I am recommending a prescription diet (low fat), metronidazole, tylosin, fenbendazole trial, pancreatic enzyme supplementation, and cobalamin injections if the dog is deficient. Any thoughts on the use of prednisone in this dog without a definitive diagnosis?
- Please see US pictures below:
Comments
The submucosal intestinal
The submucosal intestinal layer is a little thick and ragged which suggests IBD and chronicity but studies still need to support this and of course intraoperative US and bx would be my choice here to get the best sample and rule out lsa, but no detail loss so cancer less likely. If its a money case and your current protocol at the end of the thread isnt working then cobalamine supplementation regardless of serum values….and pred are things to try as long as chest is clean and there are no subtle CNS signs that may suggest emerging CNS neoplasia. Sometimes you just have to treat the treatable if the pocketbook isn’t there for the patient.
The submucosal intestinal
The submucosal intestinal layer is a little thick and ragged which suggests IBD and chronicity but studies still need to support this and of course intraoperative US and bx would be my choice here to get the best sample and rule out lsa, but no detail loss so cancer less likely. If its a money case and your current protocol at the end of the thread isnt working then cobalamine supplementation regardless of serum values….and pred are things to try as long as chest is clean and there are no subtle CNS signs that may suggest emerging CNS neoplasia. Sometimes you just have to treat the treatable if the pocketbook isn’t there for the patient.
Your rule out list is spot
Your rule out list is spot on, although lymphoma unlikely. I would only add prednisone after the other therapy as you are trying to determine what has worked in this patient
Your rule out list is spot
Your rule out list is spot on, although lymphoma unlikely. I would only add prednisone after the other therapy as you are trying to determine what has worked in this patient
Thanks Eric and Remo. Why is
Thanks Eric and Remo. Why is lymphoma unlikely? Is it because of the US appearance of the intestines? The chronicity of the disease? Because the dog is still polyphagic?
Thanks Eric and Remo. Why is
Thanks Eric and Remo. Why is lymphoma unlikely? Is it because of the US appearance of the intestines? The chronicity of the disease? Because the dog is still polyphagic?
No loss of intestinal
No loss of intestinal layering and the chronicity.
No loss of intestinal
No loss of intestinal layering and the chronicity.