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Y4 EQ - Gastrointestinal tract > Equine Weight Loss and Chronic Colic > Flashcards

Equine Weight Loss and Chronic Colic Flashcards

1
Q

What are the 4 mechanisms of weight loss?

A
  • Reduced intake
  • Reduced digestion, absorption or assimilation of nutrients
  • Increased losses
  • Increased requirements
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2
Q

How does reduced intake occur?

A

Inappropriate feeding
Unable to obtain feed
Competition for feed
Dental disorders
Dysphagia,

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3
Q

How does weight loss occur due to increased losses?

A

Protein losing enteropathy (nephropathy, sequestration to body cavity = peritonitis or pleuritis)

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4
Q

Which increased requirements lead to weight loss

A

Pregnancy
Lactation
Sepsis
Neoplasia
Systemic disease

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5
Q

List some common causes of weight loss

A

Dental disease
Parasites
Inadequate diet
PPID
Liver disease
Malabsorption and protein losing enteropathy

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6
Q

What are the daily feed requirements for a horse?

A

2-2.5% BW

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7
Q

What is the daily requirement of a racehorse?

A

1.5% BW

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8
Q

List some less common causes of weight loss in horses

A

Chronic diarrhoea
Abdominal abscess
Renal disease
Cardiac disease
Chronic thoracic disease
Non-GI neoplasia
Grass sickness

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9
Q

Define chronic colic

A

Colic of variable intensity that last longer than 48hrs

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10
Q

Define recurrent colic

A

Shorter periods of colic pain which recur at variable intervals

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11
Q

List 4 GIT related causes of recurrent colic

A

Intermittent partial/complete obstruction
Inflammation
Motility disorder
Mesenteric traction

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12
Q

Define colic

A

Behaviour manifestation of visceral pain

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13
Q

Colic normally refers to which 4 types of intestinal pain?

A

Stretch
Inflammation
Ischaemia
Muscle spasm

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14
Q

What information needs to be gathered on the history of recurrent colic cases?

A
  • Number/ nature of previous colics / abdominal sx
  • Faecal output / diarrhoea / wgt. loss /medical conditions
  • Diet esp. recent changes
  • Worming
  • Dental problems, quidding?
  • Crib biting/windsucking?
  • Sand pastures?
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15
Q

Describe the clinical exam for recurrent colic cases

A
  • Exam as for acute colic:
  • Clinical examination
  • Nasogastric intubation (usually only during an acute episode)
  • Rectal examination
    Also observe for concurrent/associated signs:
  • Weight loss
  • Diarrhoea
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16
Q

Describe the history and initial clinical exam for chronic GIT disease

A
  • Rule out obvious simple causes e.g. recent diet change, dental disorders etc
  • Assess exposure to infectious causes e.g. worming history, environment, drug history
  • Determine if in “ACUTE” or “CHRONIC” categories
  • Diarrhoea?
  • Rule out other causes - pregnancy , heart disease, PPID, others
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17
Q

Why would you want to perform a preliminary clinical pathology for chronic GIT disease?

A

Will help to rule in or out:
- Specific organ disease: enzymes, bile acids etc.
- Inflammatory processes: WCC, fibrinogen, globulins
- Protein loss: esp. albumin into the lumen of the bowel
- Occasionally indicators of malignancy e.g hypercalcaemia
- Faecal egg count: for mature parasites

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18
Q

Why must you be cautious when interpreting clinical pathology?

A

If the first set of bloods don’t give you a diagnosis, repeating the same tests more than once more rarely will
Reference ranges are calculated to include 95% of the normal population -i.e. in any give horse, 1 in 20 results will be “abnormal”
Solution: chose specific tests and avoid extensive and expensive panels

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19
Q

Decreases in total protein may be masked by?

A

Concurrent dehydration

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20
Q

How should you interpret hypoalbuminaemia

A

GI loss more common than renal
Effusions: peritoneal/pleural
Liver disease (rare)

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21
Q

How should you interpret hypoglobinaemia

A

GI loss

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22
Q

How should you interpret hyperglobinaemia

A

Chronic inflammatory disease (including cyathostomiosis)

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23
Q

How should you interpret hyperfibrinogenaemia?

A

Infection
Inflammation
Neoplasia

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24
Q

Verminous arteritis is caused by?

A

Strongylus vulgaris - migrating to the mesenteric artery cause loss of blood supply to certain areas of the colon

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25
Q

Following clinical pathology tests, what is the next step in diagnosing chronic GIT disease?

A

Monitor temperature several times a day over several days - consider abscess and neoplasia if intermittently febrile
Perform peritoneal fluid analysis

26
Q

How should normal peritoneal fluid appear

A

Clear and light yellow

27
Q

Cloudy peritoneal fluid = …?

A

Increased protein and WBCs

28
Q

Red peritoneal fluid = … ?

A

RBCs - may indicate a strangulating colic

29
Q

Name the 3 types of ultrasound that can be used to diagnosed chronic GIT disease

A

Transabdominal
Transrectal
Intestinal

30
Q

What does an increased in intestinal wall thickness on US indicate?

A

Inflammation

31
Q

What does an increase in intestinal lumen diameter indicate on US?

A

Obstruction

32
Q

What are the visible structures on the right side of a horse?

A

Liver
Duodenum
Caecum
RDC

33
Q

What are the visible structures on the left side of a horse?

A

Stomach
Spleen
Left ventral colon
Pelvic flexure
Small colon
Small intestine

34
Q

Where does the stomach lie in the horse

A

8th - 13th ICS
Medial to spleen
Visible over ≥ 5 rib spaces = distension

35
Q

Describe nephrosplenic entrapment

A

Colon migrates through the body wall of the spleen – hooks into the space between the kidney and the spleen

36
Q

Which 3 tests are used when there is weight loss

A

Oral glucose absorption test
Rectal Biopsy
Duodenal biopsy

37
Q

What is the oral glucose absorption test?

A

Absorption test vs. tolerance
Small intestinal only
Fast overnight
1 gm/kg in a 20% solution administered by nasogastric tube
Keep horse calm (do not sedate with alpha 2’s)

38
Q

Describe a normal result following a normal oral glucose absorption test

A

NORMAL: >85% increase in blood glucose concentration at two hours

39
Q

Describe the two abnormal results following a normal oral glucose absorption test

A

PARTIAL: 15 - 85% increase in blood glucose concentration at two hours
COMPLETE: < 15% increase in blood glucose concentration at two hours
= small intestinal disease

40
Q

Describe how to perform a rectal biopsy

A
  • Easy to perform
  • 20 - 30 cm inside rectum
  • Small piece of mucosa from floor at around 4 or 8 o’clock
  • Submit for histology (in formalin) and culture
  • Antibiotics and tetanus prophylaxis
41
Q

Name 3 inflammatory/infiltrative bowel diseases

A
  • Granulomatous enteritis
  • Lymphocytic-plasmacytic enteritis
  • Eosinophilic enteritis
    -> Presence of inflammatory cells in intestinal wall leading to malabsorption and protein-loss
42
Q

List the DDx of inflammatory bowel disease

A

Cyathostomosis
Mixed strongyle infection
Idiopathic
Infiltrative bowel diseases
Neoplasia
Lawsonia (foals 3- 11 months)

43
Q

Multisystemic eosinophilic epitheliotropic disease often involves which parts of the body?

A

GIT, skin, particularly around coronary bands, pancreas, liver

44
Q

How is Multisystemic eosinophilic epitheliotropic disease treated?

A

Dexamethasone

45
Q

What are the clinical clues/signs that indicate lymphoma or other forms of disseminated neoplasia

A

Fever
Weight loss
Peritonitis
Pleural effusion
Abdominal distension
Intra-abdominal mass palpable per rectum
Hypercalcaemia/haemolysis/cachexia of malignancy

46
Q

Other than lymphoma, name 4 other intestinal neoplasias

A

Leiomyoma
Myxosarcoma
Gastric or Adenocarcinoma
Melanoma

47
Q

Describe how to treat inflammatory bowel disease

A

Non-specific
Prednisolone
Dexamethosone
Anthelmintics

48
Q

Name 2 common causes of chronic GIT bacterial infections

A

S.equi
R.equi

49
Q

How are chronic bacterial infections diagnosed?

A

Inflammatory haemogram - Neutrophillia, hyperfibrinogenaemia, anaemia

50
Q

What are the two main GIT consequences of large strongyles?

A
  • Verminous arteritis
  • Thromboembolic colic
51
Q

What is the main GIT consequences of small Strongyles?

A

Submucosal infection

52
Q

Describe the haematological changes for parasitism in horses

A

Neutrophilia, hypoalbuminaemia, and hyperglobulinaemia, NOT eosinophillia

53
Q

Describe equine gastric ulcer syndrome

A
  • Common and widespread problem in horses in training (70%)
  • Potential cause of poor athletic performance
54
Q

Equine gastric ulcer syndrome is divided into which 2 conditions?

A

Equine glandular gastric disease
Equine squamous gastric disease

55
Q

What are the important implications for risk factors and treatment in the two conditions of equine gastric ulcer syndrome?

A

Equine glandular gastric disease: risk factors not well known - possibly stress, NSAIDS
Equine squamous gastric disease: risk factors related to acid injury

56
Q

What are the clinical signs of equine gastric ulcer syndrome?

A

Vague e.g. weight loss, poor performance
Selective appetite, slow eating, eat roughage in preference for grain
Bad/cranky behaviour

57
Q

Why are horses so susceptible to equine gastric ulcer syndrome?

A

Horses are herbivores evolved to:
- Digest fibre,
- Graze continuously and maintain a full stomach
Stomach anatomy
- Poor mixing
- Grain portion rapidly fermentable
- Production of acids

58
Q

Which portion of the stomach is prime to acid injury?

A

Squamous portion - pH 5.4

59
Q

List the predisposing factors for acid injury in horses

A
  • Intermittent feeding vs trickle feeding over 18+ hours
  • High concentrate diets: VFAs, low fibre concs -> reduced saliva production (buffer)
  • Exercise: gastrin production
  • Stress: transport, confinement, stabling
60
Q

How is equine gastric ulcer syndrome diagnosed?

A

Gastroscopy: ≥3 m endoscope
Faecal occult blood is not reliable

61
Q

How is equine gastric ulcer syndrome treated?

A
  • Proton pump inhibitor omeprazole
  • ESGD more responsive clinically at lower doses e.g. 2 mg/kg daily for 3 – 4 weeks
  • EGGD less responsive and requires higher doses e.g. 4 mg/kg daily for 4 – 6 weeks
  • Reduce exposure to risk factors: diet, exercise, stress (modern management)
  • Long term dietary supplements may help

Y4 EQ - Gastrointestinal tract (9 decks)

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