FASAVA 筆記分享 part2

講師是UC Davis的教授，是我這次整個congress聽到覺得最棒的講者。當初給這位教授的教室很小，很多醫生最後都站著聽講

主題： the latest on infectious GI disease

🔺Giardia
1. most common sign is “asymptomatic”
2. associated with small intestinal diarrhea
3. most strains are non-zoonotic
4. diarrhea is often self-limiting

If test positive -> ignore or treat with single dose only, if recur don’t treat again

ELISA (snap) test for giardia: only to be used for initial dx, NEVER use it to check efficacy of tx (coz it can remain positive for up to 4 wks after elimination)

Tx:
metronidazole, Fenbendazole(highest efficacy), Ronidazole, Frontal plus, Secnidazole

🔺Campylobacter can be non-pathogenic commensial
🔺Raw diet animal : 60-70% +ve on Salmonella, healthy animal but zoonotic risk

‼️Take home message:
-Isolation of bacterial ,viral or parasitic enteropathogen doesn’t denote a cause-and effect phenomenon
-bacterial, viral and parasitic enteropathogens are commonly isolated from healthy asymptomatic dogs and cats

🔺Granulomatous colitis (boxer and French Bulldog)
Cause: Adherent and invasive E. coli
Tx: fluoroquinolones 6-8 wks, up to 17% resistance
DO NOT use steroid, as will make worse

🔺AHDS Acute Hemorrhagic Diarrhea Syndrome (to replace previously known HGE)
-acute onset of vomiting and hemorrhagic diarrhea
-frequently associated with hemoconcetration
-can be associated with infectious and non-infectious causes

🔺If see hemoconcentration with normal protein-> think about Clostridium perfringens

🔺Antimicrobial therapy is controversial for management of C. Perfringens
Study shows same outcome between AB and placebo groups

🔺Need to assess the patient 2-4 times/day, if see increased temp, WBC (toxic left shift), and systemic signs: then give ABs

‼️‼️非常重要‼️‼️
Rational use of ABs in diarrhea patient
1. Hemorrhagic diarrhea with signs of sepsis
2. Prevention of bacterial translocation
3. Severely immunocompromised patient
4. Management of AB responsive diarrhea
5. Management of a specific bacterial enteropathogen eg E. Coli in Boxers with granulomatous colitis

#看了就餓了
#有緣待續

鑑於太久沒有分享知識性的文，於是今天分享9月底在FASAVA 上課的部分重點筆記

Topic: Chronic Diarrhea

🔺Causes of chronic enteropathy
Food responsive >>AB responsive > steroid responsive > neoplasia > infectious > miscellaneous

🔺Large bowel diarreah DDx
1. Food responsive
2. AB responsive
3. Steroid responsive
4. Colonic neoplasia
5. Granulomatous colitis (boxer, French bulldog)
6. Whipworms

🔺Food responsive enteropathy 50-60% of cases
-> expect to see resolution in 10-14 days with food elimination trial Vs 8 weeks for skin
-> large bowel signs more common than mixed large & small bowel Vs protein losing enteropathy is exclusively small bowel

🔺AB responsive enteropathy:
-dog phenomenon
-young to middle age
-small bowel and large bowel
Tx: tylosin 20mg/kg q12-24h

🔺Cats IBD
Prednisolone, don’t use prednisone coz low bioavailability
Course: 5mg BID for 2 weeks -> 5mg am 2.5mg pm for 2 weeks ->2.5mg BID 2 weeks -> SID -> EOD

🔺pred use never exceed 30mg BID per dog even in big dogs (max 60mg/day)

🔺Vit B12 supp 1mg tab ->safe and cheap
1-10kg 1/4tab
10-20kg 1/2tab
>20kg 1tab
course PO: SID for 2 months then EOD
Or
SC injection 250 microgram : once/week for 6 weeks then q2-3wks

🔺Management of lymphocyte and plasma cell IBD
1. dietary therapy: novel protein, hydrolysed
2. AB therapy: tylosin, metronidazole
3. Immunomodulatory therapy: pred, azathioprine, chlorambucil, cyclosporin

❗️傳統上腸道用抗生素首選metronidazole，但近年開始看到resistance，現在腸道疾病若需要使用抗生素會更建議用Tylosin

#有緣下集待續😂
#好吃的炸牛排

加護病房查房日誌20190326
好久沒有遇到small vessel vasculitis，以前有時候會遇到病人被診斷為microscopic polyangiitis(MPA)或Churg-Strauss syndrome，而且這些疾病其實不好鑑別診斷。這些都和antineutrophil cytoplasmic antibodies(ANCAs)有關，也都有a paucity of immune deposits的特徵。(迷之音:講到這邊，有同學已經頭昏了)

Vasculitis是血管壁發炎可能導致壞死或出血，MPA的特徵是pauci-immune，壞死的小血管炎，但臨床和病理上沒有granulomatous發炎的證據。
發生率和Churg-Strauss syndrome都一樣超低，每年每一百萬人才3.6個案例，所以用台灣的兩千萬人估計，全台灣每年可能只有72例。(真的很少!!)

MPA主要會侵犯腎臟和肺臟(我們來看一張x-ray)。
Lab方面:白血球會高，貧血，ESR高，腎臟方面:BUN/Scr會上升，有蛋白尿和血尿，另外ANCA(+)，pANCA(60%)，cANCA(40%)，C3,C4正常。
治療是以oral prednisone和cyclophosphamide為主。

老師想知道各位同學有沒有遇過MPA or Churg-Strauss syndrome?
有遇過或聽過的+1，沒有的+2。
也歡迎分享經驗再底下留言。
#MPA
#ANCAs