scott@vtx-cpd.com
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Replying to Vigre B. 31/03/2023 - 11:31
Hello Vigre.
I hope you are well. Thank you for the update!
How weird regrading the ALT?! I think I would try a hydrolysed diet in this case. I think Hills ZD would be a good choice.
Feel free to email me the results and I can upload:
Scott 🙂
Replying to Magda Upton 19/03/2023 - 05:43
Hey Magda!
I am pleased you enjoyed the session! Thank you for your brilliant questions!
I think fecal occult blood is a reasonable test to perform when you are suspicious of GI bleeding. I will often use it in patients who are anemic (with no other obvious cause) and do not have obvious melena. I think it is a helpful test! Capsule endoscopy is an interesting one! I must admit I have never used it clinically. However, I have always been lucky to have access to endoscopy. Some studies have demonstrated that it might pick up bleeding GI lesions with the reach of endoscopy. The big issue is that there is no option to take biopsies:
https://pubmed.ncbi.nlm.nih.gov/33993552/
https://pubmed.ncbi.nlm.nih.gov/31381197/regarding biopsies. Most of the time for chronic enteropathies I will use endoscopic biopsies. I am more likely to do full-thickness biopsies in cats because we are often wanting to biopsy other organs too (liver and pancreas). I am not aware that it is possible to do GI biopsies laparoscopically. If full-thickness surgical biopsies are the only option, I think that is reasonable.
cPLI! It is a great question!!!! I agree! We will cover it more in another session. I often use it as a rule out, if it is normal, probably not pancreatitis. The US is considered helpful, but can also be ‘normal’ in the face of pancreatitis. So not a perfect test!
Hope that helps.
Scott
Replying to Hayley O. 21/03/2023 - 14:16
Hello Hayley!
Sorry for my delayed reply! I hope you are well. I am really glad you are enjoying the course!
Insect based!!!! I am clearly out of date from a diet point of view!
I think metoclopramide could be a consideration here, although I would be more inclined to try cisapride. I think cisapride would be a good option for this case.
Sucralfate might be an option too, but I think that is less likely to be effective. I suppose that the benefit of sucralfate is that it is not likely to do any harm! The liquid is harder to come by, you could consider crushing the tablets.
Hope that helps.
Scott
Replying to Ornella R. 21/03/2023 - 15:48
Omeprazole is one of my favourite topics!
Scott 🙂
Replying to Ornella R. 27/03/2023 - 12:42
Thank you!
Let me know if you have any other questions!
Scott 🙂
Replying to Magdalena M. 26/03/2023 - 17:54
Hello Magdalena.
I hope you are safe and well. Thank you somuch for your question.
Glucocorticoids are prescribed frequently in small animal practice and over a wide dose range depending on the desired clinical effect. Glucocorticoids have been associated with gastroduodenal ulceration mainly as a result of studies published into the use of high-dose (eg: 30mg/kg methylprednisolone) glucocorticoids in patients with known spinal compression, but more recently, a prospective double-blinded study has indicated that prednisolone used at 2mg/kg once a day is associated with a four-times increased risk of developing endoscopically visible gastric erosions compared to dogs treated with a placebo, so the incidence of glucocorticoid-induced gastroduodenal ulceration may be underestimated. However, none of the dogs in this study developed clinical signs of gastric ulceration or of GI hemorrhage, so again, the true clinical relevance of this study raises two main questions; are we missing something in patients that we treat with immunosuppressive doses of glucocorticoids and should we be doing something about this or not? Currently, there is no convincing evidence that gastroprotectant medications are beneficial in patients we treat with glucocorticoids, but further work in this area is required. This recent paper is interesting:
https://pubmed.ncbi.nlm.nih.gov/10668814/
In short, I do not use omeprazole when I give high doses of steroids.
Hope that helps.
Scott
Replying to Gisela T. 26/03/2023 - 16:37
Gisela.
I hope you are safe and well. Sorry for the delay in getting back to you.
Metoclopramide is definitely up for debate regarding how effective it is. I agree, cisapride is probably more effective in cats. Metoclopramide probably does still have some action in cats, so I would still consider using it in cats:
https://pubmed.ncbi.nlm.nih.gov/32515089/
I suppose the main benefit is it is injectable and we do not have injectable cisapride.
Hope that helps.
Scott
Replying to Gosia Scherchen 28/03/2023 - 21:59
Hello Gosia.
Thank you so much for the great feedback!
I am so glad you enjoyed the course.
Scott 🙂
Replying to Samanta A. 29/03/2023 - 11:16
No problem!
Let me know if I can be of any more help!
Speak soon.
Scott 🙂
Replying to Ornella R. 27/03/2023 - 16:06
I have nothing to contribute clinically here…
But I can confirm that Barcelona is my favorite place in the world (apart from Scotland obviously).
Honestly, I love it.
Scott 🙂
Replying to Magda Upton 23/03/2023 - 09:38
Hello Magda!
Lovely to hear from you. Great questions!!!! Generally, the use of enteric-coated human preparations is more unpredictable in cats and dogs as there are differences in the anatomy of the GI tract and pH between species. Having said that, most the dog studies use enteric-coated human tablets and they are demonstrated to be effective.
In human studies, the desired benefit of the drug therapy was not obtained because the tablet was crushed. Omeprazole is formulated as an enteric-coated tablet to avoid the inactivation of the drug by gastric acid. Crushing the tablet compromised the protective coating, which resulted in the loss of efficacy.
So generally I would not crush/remove the coating. But if there was no other option then I would!
Another thought might be the liquid omeprazole Bova re-formulate. We may even have an injectable form soon:
https://pubmed.ncbi.nlm.nih.gov/35546514/
I will check with BOVA where they are up to with that!
Hope that helps.
Scott 🙂
This is a brilliant question, Emma!
I look forward to hearing from the others… who will know much more about this than me!!!
Scott 🙂
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 Felipe M. 23/03/2023 - 14:16
Hello Felipe.
Thank you so much for your answer. Really interesting!
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 🙂
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