Hello Jacquie, There is
Hello Jacquie, There is hyperperistalsis and subjectively hypertrophied mucosae and some speckling. The muscularis/mucosal ratio is increased in favor of the mucosae. This is an area of research right now as opposed to direct wall thickness. Traditionally speckling can be present in inflammatory states as opposed to striations which would suggest lymphangectasia and if albumin is dropping then i would be concerned for PLE as the striation scenario is not 100%. This does not seem to be the case here. From my perspective these are irritated bowels for whatever reason and therefore hypersecretory and hence the mucosae will hypertrophy. The sm, m and s layers are fine so it looks to be a mucosal issue. I would look for or tx for parasites, dysbiosis, diet intollerance and such. Beautiful images and video:)

Jacquie I added an image of
Jacquie I added an image of mucosal striations from the SonoPath pathology CD to evidence the difference between mucosal speckling and mucosal striations. You may already be familiar with this but this may serve for other forum participants.
Best regards,
Eric

Thanks Eric – we have decided
Thanks Eric – we have decided to place the pet on tylosin, B12, a probiotic and limited antigen diet and see what happens. She has already undergone a deworming.

I guess we should take the “textbook” measurements for SI wall with a grain of salt.

Thanks for the image of the mucosal striations!
Jacquie

Jacquie,

I generally look
Jacquie,

I generally look at the measurements based on the books but also very important in my mind is the proportion of mucosa to the submucosa, muscularis and serosa. I look for the thickness of the mucosa to be equal to or slightly larger than the other 3 combined. In other words, if the submucosa + muscularis + serosa measured 2mm, I expect the mucosa to measure ~2-2.5mm. BTW, I don’t measure them separately, but just want to make the point clear. I assess cats in the same way.

Your dog has significantly increased mucosal layer thickness. I agree with Eric’s comments and would suggest exactly the treatment plan you’ve lined out above. I suspect this is food allergy or IBD driven and hopefully you’ll see improvement with a food trial. If that fails, consider low-dose steroids.

Let us know how he does!
Marty

Intestinal ultrasound is one
Intestinal ultrasound is one of those sectors that will defined and redefined in the next 10 years or so in my opinion. those of us that see a ton of it are less content with the research that is out there in trying to put it in categories as there are so many mixed bags of presentations, its a long organ, and what is happening downstream isnt necessarily happening upstream… sectorial disease thing. Plus its a shock organ and changes presentation based on hydration status and systemic disease. Penninck and others have done great work so far but its just the platform that will be defined over time…. so maybe a pile of salt instead of a grain… but its still salt:) I think your approach is fine clinically just watch the albumin down the line. good informative post I think

Here is an update on this
Here is an update on this case. So far this pet’s stool has normalized – now firm and no diarrhea. She is still ravenous. She has been staying at our hospital and we noticed that she was having urine accidents in her kennel so we did a U/A and culture (collected via cystocentesis) Cultured a proteus infection sensitive to enrofloxacin.

She is still on tylosin, probiotic (Purina Forti-flora), weekly B12 injections and she is on Royal Canine Gastro diet – we tried her on Hills Z/D but this brought on diarrhea.

She is still losing weight! Looks like a skeleton. She has just finished her enrofloxacin so I am now ready to reach for the pred. She is happy with lots of pep.

Any thoughts?

I would maybe repeat a
I would maybe repeat a maldigestion panel first as things may have changed since you first ran it. Good that the D has stopped. That is the first step. If maldigestion is normal then sounds like a nutritional consultation is in order. Here is a boarding nutritionist I know that I go to a lot and have had good results.
Mark Taylor

If happy and no Gi signs and only has weight loss i would hold on the pred for now. You can also kick up the food quantities now that the D has stopped and feed for a dog that is 30% heavier… treat him quantity for a body score 4-5 for his breed. When cases are complex I try to go back to basics and do the simplest thing….diet adjustment in this case.

A final update on this case –
A final update on this case – the rescue organization pulled the funding and opted to euthanize this pet (no foster home and not a good candidate for adoption). They declined a pred trial even after the “better pred than dead” talk.

I performed a PM and sent some samples for histopath under professional interest. SI came back as mild-moderate diffuse chronic lymphoplasmacytic and eosinophilic enteritis with hyperplastic mucosa and mild villous atrophy; reactive jejunal LN and normal pancreas.

Bad outcome but good
Bad outcome but good information. Thx for providing it Jacquie.