ENTERITIS ENTEROPATHY MALABSORPTION SYNDROME n n n Definition

ENTERITIS (ENTEROPATHY, MALABSORPTION SYNDROME) n n n Definition: Inflammation of the intestinal mucosa resulting in diarrhea and sometimes dysentery, abdominal pain, varying degree of dehydration and acidbase imbalance depending on the cause, severity and location. In many cases, gastritis is associated, leading to gastroenteritis. 1

Etiology I- predisposing factors 1. Factors lower the animal immunity, thus increasing the pathogenicity of the causative agent to induce enteritis: 2. The newly born calves deficient in immunoglobulins are more susceptible than adults. 3. Stress of transportation. 4. Stress of deprivation of food and water. 5. Stress of weaning. 6. Prolonged use of antibacterial agents orally may alter the intestinal microflora and permit the development of superinfection by organisms which would not normally cause disease. 2

II- Etiological factors A-Infectious causes I- Bacteria Etiological agent Age & class of animal affected Major clinical findings 1 - Enterotoxigenic E. Coli - Newborn calves (3 -5 d old). 2 - Salmonella spp. - All ages, outbreak occurs, stress-induced. - Young well-nourished calves. - Mature cattle, sporadic, single animal affected. - Acute profuse watery diarrhea, dehydration and acidosis. - Acute diarrhea, fever, dysentery, high mortality - Severe hemorrhagic enterotoxemia, rapid death. - Chronic diarrhea with loss of weight, long course, no response to therapy. - Chronic to subacute diarrhea, progressive weight loss, no response to treatment. 3 - Clostridium perfringens (type B and C). 4 - mycobacterium paratuberculosis 5 - Proteus and pseudomonas Spp. - Calves treated for diarrhea with prolonged course of antibiotics 3

II- Viruses 1 - Rota and corona virus. - Newborn calves, 5 -21 d old, explosive outbreak. 2 - Winter Dysentery (Coronavirus). - Mature housed cows, explosive outbreak. 4 - Rinderpest - Highly contagious, occur in plague form. 5 - Bovine malignant catarrh. - Usually mature cattle, sporadic but small outbreaks occur - Acute profuse watery diarrhea, virus can be demonstrated in feces. - Acute epizootic transient diarrhea and dysentery lasting for 24 h. 3 - Bovine viral diarrhea - Young cattle (8 -24 - Erosive gastroenteritis and (mucosal disease). month old). Sporadic, but Stomatitis, usually fatal. outbreak may occur. - Erosive gastroenteritis and Stomatitis, high morbidity and mortality. - Erosive gastroenteritis, nasal and ocular discharge 4

III- Parasites Ostertagia Haemonchus, and Trichostrongylus, Oesophagostomum - Young cattle in pasture - Acute or chronic diarrhea, dehydration, hypoproteinaemia, fecal examination. IV- Protozoa 1 - Eimeria 2 - Cryptosporidium - Calves over 3 weeks old up to 12 month of age. Outbreaks common. - Calves 5 -35 days of age - Dysentery, tenesmus, bloody feces, fecal examination is diagnostic. - Young calves following prolonged use of antibacterials. - Chronic diarrhea, no response to treatment. - Acute diarrhea V- Mycotic Candida spp. 5

B- Chemical factors: Arsenic, copper, mercury, molybdenum, poisonous plants, nitrates - all ages affected, history of access to the substance, outbreaks occurs - all severities of diarrhea, dysentery, abdominal pain, dehydration, toxemia, nervous signs may occur Nutritional deficiency. Copper deficiency, conditioned by excess molybdenum Usually mature cattle in Subacute and chronic pasture with high levels diarrhea, osteodystrophy, no of molybdenum systemic effect, hair color changes. Dietary: 1 - Overfeeding. 2 - Simple indigestion. - Young calves overfed on milk. - Change in ration of mature cows (hay to silage or grain) of feedlot cattle. - Mild diarrhea, feces pale and yellow - subacute diarrhea, normal in 24 hour 6

Pathogenesis Etiological factors Inflammation Necrosis MM bacteria and virus multiply in the brush border cells decreased carrier-protein function Secretion-absorption defect colibacillosis the intestinal secretion is increased beyond the absorptive capacity Osmotic disturbance overfeeding and indigestible feeds malabsorbed nutrients exert strong intraluminal osmotic effects movement of excessive increase in the cyclic adenosine monophosphate amount of fluid into the lumen of intestine Loss of Na, cl, HCO 3 and Decrease transport of nutrients watery feces and diarrhea Into circulation decreased mucosal absorptive surface area Metabolic acidosis dehydration 7

Clinical findings n A- Diarrhea n n n Severe watery diarrhea, sometimes dysentery, and often tenesmus in acute enteritis. The feces is watery and profuse in case of lesions of small intestine. Small volume and soft feces with excess quantity of mucus occur in case of lesions of large intestine. The presence of blood or fibrinous cast, indicate severe inflammatory lesion of intestine. The feces is voluminous, soft and odoriferous in case of dietary diarrhea. 8

n B- Dehydration is usually marked in acute diarrhea (10 -12 hr after onset of diarrhea). n Signs of dehydration include dry muzzle, sunken eye, shrunk skin and oliguria. n Dehydration can be assessed by tinting of the skin. n 9

n n C- Weight loss Chronic weight loss associated with chronic diarrhea may indicate John’s disease. Moderate weight loss, profuse diarrhea with normal hydration and depigmentation of hair and indicate copper deficiency conditioned by excess molybdenum in diet. Weight loss with profuse diarrhea occurs also in intestinal heminthiasis. 10

n n D-Systemic reaction Septicemia, toxemia and fever occur mostly in infectious enteritis, such as salmonellosis and colibacillosis 11

n n E- Peripheral circulatory collapse Lack of perfusion of liver, kidney, and peripheral tissues due to dehydration lead to uremia, enhance anaerobic oxidation and produce lactic acidosis. 12

n n n F- Acid-base and electrolyte imbalance Loss of bicarbonate leads to metabolic acidosis manifested by hyperventilation. Hyponatremia leads to muscle weakness 13

n n G- Abnormalities in heart rate Tachycardia or bradycardia and cardiac arrhythmia may occur depending on the degree of acidosis and electrolyte imbalance. 14

n n n F- Abdominal pain in calves with enteric colibacillosis is manifested as intermittent bouts of stretching and kicking at the abdomen. In adults, abdominal pain is associated with salmonellosis, lead and arsenic poisoning. 15

Diarrhea and tenesmus due to Coccidia infection in a buffalo calf 16

Bacterial enteritis in a calf (soiling of perineum and hindquarters) 17

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Soiling of perineum and hindquarters 19

Soiling of perineum (calf diarrhea) 20

Diagnosis History Clinical signs Lab. Diagnosis: n n Fecal examination: to determine the presence of causative parasite, fungi, bacteria, virus … etc. 21

n Blood analysis: n Haemoconcentration (elevated PCV %). n Hypochloremia, hyponatremia and reduction of bicarbonate (metabolic acidosis). n Hyperkalemia is possible in severe metabolic acidosis. n Increased blood urea nitrogen (BUN) due to inadequate perfusion of kidney associated with dehydration leading to renal insufficiency. 22

Treatment Five goals of treatment should be fulfilled: n Temporary withdrawal of the diet if necessary. n Removal of the causative agent (Anthelmentics against parasitic enteritis antibacterial against bacterial enteritis, non-specific symptomatic treatment for viral enteritis…. . etc n Replacement of lost fluids and electrolytes. n Intestinal protectants and adsorbents. n Use of anti-diarrheal drugs e. g. drugs inhibit secretion and control intestinal hypermotility if necessary. 23

n n A) Temporary withdrawal of the diet: If the diarrhea is dietary in origin, the feed should be removed until the animal is fully recovered. . 24

n (B) Antibacterials: n n n The use of antibacterials either orally or parenterally, or by both routes simultaneously. Parenteral preparations are indicated in animals with acute diarrhea, toxemia and fever (many antibacterials when given parenterally are excreted by the liver into lumen of the intestine). Oral preparations may be sufficient in cases of subacute diarrhea with minimal systemic effects. N. B: -Oral antibacterial preparations should not be used for more than 3 days to avoid superinfection. 25

n n (C) Fluids and electrolytes: To correct the 3 major abnormalities of dehydration, acidosis and electrolyte deficit. -When severe acidosis is suspected, a 5% hypertonic soln. of bicarbonate is given IV at a rate of 5 -7 ml/kg B. W at a speed of 100 ml/ minute. -Administration of electrolyte solution in quantities necessary to correct the dehydration. : n n (a) In severe dehydration (equivalent 10% of B. W), large amount of fluids are necessary at rate of 100150 ml/kg B. W per 24 hours I/V and I gm of Kcl must be added for each litre of fluid to overcome hypokalemia. (b) In animals, which are not severely dehydrated, oral route can also be used successfully to correct dehydration 26

n n D- Intestinal protectants and adsorbants : Kaolin and pectin mixtures are used widely to coat the intestinal mucosa, n inhibit secretions and n increase the bulk of faeces in horses with enteritis n 27

n n E- Antidiarrheal drugs : Antisecretory drugs for treatment of diarrhea due to hypersecretory activity. For example: atropine sulphate, n chlorpromazine Hcl and n prostaglandin inhibitors. n 28

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