Colitis

By | 2011-08-22

1. What is the typical signahnent for acute colitis?

• German shepherds and golden retrievers are the most commonly affected breeds.

• 1-4 years old is the most common age.

• Males are more commonly affected than females (3:2).

2. What are the common clinical signs of acute colitis?

• Diarrhea or soft stool (watery, mucus, fresh blood, frequent small amounts)

• Tenesmus

• Normal appetite with little or no weight loss

• Vomiting (30%)

• Abdominal pain

3. What is the typical scenario for a nosocomial clostridial infection?

Acute, bloody diarrhea beginning 1-3 days after exposure to a veterinary hospital.

4. What are the possible causes of acute colitis?

The cause of acute colitis is usually unknown, but the following possibilities should be considered:

1. Mucosal injury by a foreign body or trauma

2. Infection

• Parasitic (whipworms[Trichuris sp.])

• Bacterial (Salmonella, Campylobacter, Clostridium spp.)

• Fungal (histoplasmosis)

3. Systemic disease (especially uremia)

5. What differential diagnoses should be considered in patients suspected of acute colitis?

1. Other gastrointestinal problems

• Chronic colitis

• Neoplasia (adenocarcinoma, lymphoma, leiomyosarcoma, polyp)

• Ileocolic intussusception

• Cecal inversion

• Irritable colon (diagnosis by exclusion)

• Rectal stricture

• Perianal fistula

• Uremic ulcers

2. Painful abdomen

• Hemorrhagic gastroenteritis (HGE)

• Viral enteritis

• GI foreign bodies

• Bowel ischemia due to thrombi

• Intestinal volvulus

• Pancreatitis

• Hepatobiliary problems

• Urologic disorder (renal calculi, pyelonephritis, urinary tract infection)

Peritonitis (ruptured abdominal organ, sepsis)

• Splenic torsion

• Genital problems (uterine torsion or rupture, testicular torsion, prostatic abscess)

3. Thoracolumbar pain

6. Which diagnoses are most commonly confused with acute colitis?

• Neoplasia (adenocarcinoma, lymphoma, leiomyosarcoma, polyps)

• Rectal stricture

7. What are the most common physical findings?

1. Physical examination is usually normal.

2. Deep palpation may or may not produce abdominal pain.

3. Rectal examination may be painful and show fresh blood and mucus.

8. How do you approach the diagnosis of acute colitis?

• Rectal examination

• Fecal flotation for ova or parasites

• Direct and stained fecal smears

• Fecal culture

• Routine laboratory evaluation (complete blood count, biochemical profile, urinalysis)

• Abdominal radiographs and barium enema

• Colonoscopy

• Mucosal biopsy via colonoscopy

9. Describe the appropriate symptomatic treatment.

1. Withhold food for 24-48 hours or until diarrhea resolves. If lymphocytic-plasmocytic enteritis is suspected, withholding food will not resolve the problem.

2. Give crystalloid fluids with potassium chloride.

3. Give medication to decrease fecal water and increase colonic motility (loperamide).

10. What cause-specific treatments may be used for acute colitis?

• Correction of underlying cause if known (e.g., foreign body removal)

• Reduction of clostridial overgrowth (tylosin preferred; also metronidazole)

• Treatment of inflammatory bowel disease (i.e., chronic colitis) with tylosin, mesalazine, sulfasalazine (oral, enema, or foam), or prednisone (antiinflammatory doses)

• High-fiber diet (often supplemented with Metamucil)