scott@vtx-cpd.com

Replying to Emma Holt 23/03/2023 - 13:07

Hey Emma.

Thanks for your questions! Lovely to see you in person this week!

Scott 🙂

Replying to Vigre B. 24/03/2023 - 10:36

Hello Vigre.

Interesting case! You could indeed be dealing with an inherited cobalamin disorder!

Selective cobalamin malabsorption is a rare congenital disease. The first report about selective cobalamin malabsorption in dogs describes 2 related Giant Schnauzers that lacked the expression of the cobalamin-IF-receptor complex in the apical brush border of the ileal and renal epithelium. Classical clinical signs of IGS such as intermittent diarrhea, inappetence, poor body condition, and failure to grow typically manifest within the first year of age.

Several case reports and case series have described a selective cobalamin malabsorption in the Border Collie breed. Clinical manifestations in some cases are mild and the onset of clinical signs can be delayed into early adulthood compared to other breeds with selective cobalamin malabsorption. Also, juvenile cobalamin deficiency might not be routinely associated with hematologic changes in the Border Collie breed.

About 40% of healthy Border Collies have increased urine MMA levels, but none of the normocobalaminemic dogs in that study had increased plasma HCY concentrations compared to the Border Collies with cobalamin deficiency. It has been hypothesized that these dogs have a primary methylmalonic aciduria. Of note, hypocobalaminemia is also associated with an increased prevalence of EPI in Border Collies.

Would you be able to share the bloods? What was the cobalamin level? Did you check TLI and basal cortisol?

Interesting case!

Scott 🙂

Replying to Neus E. 22/03/2023 - 17:58

Thanks Neus.

This is a really interesting paper. We are chatting lots about omeprazole and the possible increase in bacterial load when dogs on omeprazole have an aspiration even due to the change in gastric pH and alteration to what swallowed bacteria survive!

I am sure you will not be surprised to hear there is omeprazole chat going on!

I will share this paper with the GI lot now!

Scott 🙂

Hello Ornella.

Great to hear from you as always. Thank you for the brilliant questions:

1. I think there could indeed be a justification for omeprazole and maropitant pre-GA in brachycephalic dogs. I would probably give it the night before and the morning of the surgery. I am not sure there is a justification for the days after when the dog has recovered. The main event we are trying to protect against is GA-related reflux oesophagitis. Some brachycephalic dogs will also need steroids, but I would not give this routinely in every case.

2- Yes, in persistent cases of haematemesis and melena, it is appropriate to prescribe a PPI while you are investigating the underlying problem. I would not prescribe a PPI immediately in more acute cases. If you fully investigated a case and would no lesions on endoscopy but there was persistent melena, there would still be an indication for a PPI. Some lesions are not detected during standard endoscopic examination:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6766531/pdf/JVIM-33-1964.pdf

3- I would often use maropitant alongside oral and injectable TXA. I would indeed use it in IMTP cases at the start of their treatment while we get the disease under control. Mainly because they are at risk of spontaneous hemorrhage. Maybe for the first 3-4 days? I would use it in the more severe cases of GI hemorrhage overall. I would not use routine with every case I am giving omeprazole.

Hope that helps.

Scott 🙂

Replying to Ornella R. 20/03/2023 - 13:54

Hello.

Really interesting question! Hope you are well.

1. The decision-making when they are on NSAIDs is always really challenging. I am not sure the is a definitive right answer here! If there was an episode of haematemesis, I would stop the NSAID. I would probably not give the omeprazole if it was a one-off. However, I do not think you did the wrong thing here at all! If there was any persistence with clinical signs I would give omeprazole.

2. There is no direct link between hypoalbuminemia and ileus, but there will be many dogs that have ileus due to GI disease and PLE.

Hope that helps.

Scott 🙂