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year 1/2 > Defense & Barriers 2: Equine Immunodeficiencies > Flashcards

Defense & Barriers 2: Equine Immunodeficiencies Flashcards

1
Q

identify this disease

A

EQUINE METABOLIC SYNDROME

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2
Q

equine metabolic syndrome is also referred to as “____ ____”

why? (2)

A

PERIPHERAL CUSHING’S

resembles Cushing’s in APPEARANCE or can have it CONCURRENTLY

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3
Q

equine metabolic syndrome…
4 clinical signs?
3 contributing factors?
what 2 labs are used for diagnostics? (+ which is most common?)

A

clinical signs
1. OBESITY (fat deposits)
2. CHRONIC LAMINITIS
3. INSULIN DYSREGULATION
4. POSSIBLY infertility issues

contributing factors?
1. chronic overfeeding
2. limited physical activity = clinical signs might KEEP them from doing physical activity
3. enhanced metabolic efficiency

labs?
1. oral sugar test (MOST COMMON)
2. basal insulin

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4
Q

4 most common places for FAT DEPOSITS in EQUINE METABOLIC SYNDROME

A
  1. gluteal
  2. sheath
  3. shoulders
  4. CRESTY NECK (beneath mane)
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5
Q

in equine metabolic syndrome, fat acts as both…. (2)

A

A STORAGE AND ENDOCRINE ORGAN

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6
Q

pathophysiology of equine metabolic syndrome… (3)
horses with this syndrome will maintain chronic HIGH levels of ____

A
  1. in obese animals, an excess amount of adipocytes will produce EXCESS GLUCOCORTICOIDS
  2. EXCESS GLUCOCORTICOIDS = INHIBIT the action of insulin at CENTRAL (hepatic) and PERIPHERAL (muscle) tissues
  3. If INSULIN INHIBITED = glucose INTOLERANCE develops

high levels of INSULIN

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7
Q

2 hypotheses for reasons for LAMINITIS in EQUINE METABOLIC SYNDROME?

A

(1) HYPERINSULINEMIA causes…

–> inappropriate stimulation of INSULIN-LIKE GROWTH FACTOR 1 RECEPTORS on LAMINAR EPIDERMAL CELLS

–> ELONGATION/DEFORMITY of these epidermal cells

–> laminitis

(2) INSULIN RESISTANCE…

–> BLOCKS NITRIC-OXIDE mediated VASODILATION and GLUT4 transolocation

–> results VASOCONSTRICTION OF THE FEET

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8
Q

physical exam findings that support equine metabolic syndrome? (3)

A
  1. Regional adiposity
  2. HIGH BODY CONDITION SCORE (out of 9) = in horses, 5/9 is ideal
  3. Cresty neck score greater than or equal to 3
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9
Q

basal insulin test…
what DISEASE does this test for?
dietary restrictions? (2)
parameters? (3, including what to do if SUSPECT)

A

what DISEASE?
EQUINE METABOLIC SYNDROME

dietary restrictions?
1. Perform NON-FASTING (hay or pasture only)
2. No grain within 4 hours

parameters?
1. Positive for INSULIN RESISTANCE = >50 microiU/mL
2. NON-diagnostic (cannot confirm) = <20 microiU/mL
3. 20-50 microiU/mL ID suspect = SHOULD GO TO ORAL SUGAR TEST IF WITHIN THIS RANGE

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10
Q

adiponectin test…
what does it do?
what does it mean if it’s LOW? (2)

what does it mean when a LEPTIN test is high?

triglyceride test…
what does it measure?
what does it mean when it’s HIGH?
what 3 species is this usually measured in?

A

adiponectin?
= looks at RECEPTORS on ADIPOSE TISSUE
1. if LOW = METABOLIC DERANGEMENT in adipose tissue
2. increased risk of LAMINITIS

if LEPTIN is high = THE HORSE IS OVERCONDITIONED

triglyceride?
= measures NEGATIVE ENERGY BALANCE
if HIGH, then HIGH RISK FOR LAMINITIS
3 species = donkeys, ponies, miniature horses

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11
Q

treatment for equine metabolic syndrome in OVERWEIGHT horses…
what kind of food should they get?
how should it be prepared?
3 additional points about DIET
what other thing should we try and do? + stipulations
** additional supplement that can help if added to feed?
weight loss goal?

A

DIET
–> feed LOW GLYCEMIC INDEX FOODS (make <10-12% non-structural carbohydrates)
–> can SOAK hay for 1 HOUR to avoid freezing/molding
1. ** NO GRAINS!!
2. make sure to supplement with VITAMINS/MINERALS
3. put in either DRY LOT or LIMITED TURNOUT to reduce high-calorie pasture

other main thing = EXERCISE!
needs to be TAILORED if previously laminitic, and DO NOT DO IF ACTIVELY LAMINITIC

additional supplement = ANTI-OXIDANTS, LIKE VITAMIN E

weight loss goal? = 1% BM per WEEK lost

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12
Q

exercise regime for OBESE EQUINE METABOLIC SYNDROME PATIENTS, specifically…
NON-laminitic patients? (2)
PREVIOUSLY laminitic patients? (include something about environment and a warning about the horse)

A

NON-laminitic patients…
1. CANTER to FAST CANTER for >30 minutes >5 times per week (HR 130-170 bpm)
2. Trot for 15 minutes 5 times per week

PREVIOUSLY laminitic patients…
1. FAST TROT to CANTER on a soft surface >30 minutes >3 times per week (110-150 bpm)
2. MAKE SURE HORSE IS SOUND

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13
Q

diet plan for THINNER equine metabolic syndrome patients? (2)

A
  1. Give commercial-grade, NSC feeds that are BEET PULP or SOY BASED
  2. Try to give MULTIPLE SMALL MEALS so that they DON’T HAVE INSULIN SPIKES AFTER MEALS
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14
Q

what are portagrazers?
what are they good for? (2)

A

= these are SLOW FEEDERS for horses

what are they good for?
can help both provide a place to SOAK HAY and SLOW HORSES DOWN WHILE EATING FOR WEIGHT LOSS

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15
Q

levothyroxine sodium
what disease is this used for?
what does it do? (2)
dosage? for what size horse? (+ how often to really give it)
when STOPPING this medication…

A

used for EQUINE METABOLIC SYNDROME

what does it do?
1. helps induce WEIGHT LOSS
2. helps INCREASE INSULIN SENSITIVITY

dosage?
48 mg/DAY PO 3-6 months for horses that are >360 kg, TRY TO GIVE FOR SHORTEST DURATION

when stopping medication, WEAN OVER THE COURSE OF A MONTH

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16
Q

all MEDICATIONS for EQUINE METABOLIC SYNDROME should be paired with ___ & ____

A

DIET & EXERCISE

17
Q

metformin…
used in WHAT disease?
chemical makeup & main function?
what 3 things does it do?

A

EQUINE METABOLIC SYNDROME

chemical makeup/fxn?
BIGUANIDE anti-hyperglycemic agent that helps to INCREASE INSULIN SENSITIVITY at the POST-RECEPTOR level

what 3 things does it do?
1. DECREASES glucose PRODUCTION in the LIVER
2. CONTROLS postprandial insulin spikes
–> Make sure to give it BEFORE they go out on pasture/meal/hay
3. DECREASES carbohydrate load in the GUT

18
Q

sodium-glucose co-transporter 2 (SGLT2) inhibitors…
what disease is this used for?
main function?
what does this then cause?
cons? (2)

A

EQUINE METABOLIC SYNDROME

main function?
inhibits REUPTAKE OF GLUCOSE from GLOMERULAR FILTRATE to cause glucose to be lost in the urine

what does this then cause?
DECREASED GLUCOSE = DECREASED INSULIN

cons? (2)
1. EXPENSIVE
2. needs to be on LONG-TERM for INSULINEMIC horses

19
Q

pioglitazone…
what disease is this used for?
chemical makeup?
what does it do?
pro? (1, when compared to another drug)
cons? (2)

A

EQUINE METABOLIC SYNDROME

chemical makeup?
= SYNTHETIC LIGANDS for peroxisome proliferator-activated receptors (PPARs)

what does it do?
1. Helps to INCREASE glucose uptake and utilization
2. DECREASES GLUCONEOGENESIS by the LIVER

pros?
= LESS EXPENSIVE than SGLT-2 inhibitor

cons?
1. MUST BE GIVEN OFTEN
2. might have longer-term effects & can INCREASE ADIPONECTIN (increases risk of LAMINITIS)

20
Q

identify the DISEASE & clinical sign

** frequency?

A

PARS PITUITARY INTERMEDIA DYSFUNCTION

this is HIRSUITISM (excess hairiness)

MOST FREQUENT CLINICAL SIGN IN PPID

21
Q

pars pituitary intermedia dysfunction 9 CLINICAL SIGNS
for 2 of them include SUBHEADINGS
Locations for one

A
  1. Chronic laminitis
  2. Chronic infections that manifest as solar (foot) abscesses
  3. Poor wound healing/indolent wounds
  4. Muscle wasting
  5. Weight loss
  6. ABNORMAL FAT DISTRIBUTION
    –> NOT ALWAYS FAT!
    –> Peripheral fat deposits (cresty neck, gluteal muscles, etc)
  7. Hyperhidrosis = EXCESSIVE SWEATING
    –> Due to heavy hair coat and androgen response
  8. PU/PD
  9. RARELY causes seizures/blindness
22
Q

identify GLAND, condition and DISEASE

A

gland = ADRENAL GLAND

condition = HYPERPLASIA/HYPERTROPHY

disease = PITUITARY PARS INTERMEDIA DYSFUNCTION

23
Q

pathogenesis of pituitary pars intermedia dysfunction…
4 main steps, first one has 3 subheadings

A
  1. NORMALLY, the pars intermedia is under control of dopamine, but LOSS OF HYPOTHALAMIC DOPAMINERGIC INHIBITION, due to…

(1) Adrenal glands are making corticosteroids, which should cause negative feedback, but THE FEEDBACK DOESN’T WORK
(2) Dopaminergic neurons degenerate
(3) Oxidative stress causes protein misfolding

  1. Lack of dopaminergic inhibition results in PITUITARY HYPERPLASIA, HYPERTROPHY & MICRO/MACROADENOMA FORMATION
  2. This then causes EXCESSIVE production of ACTH and POMC-derived peptides, causing ADRENAL HYPERPLASIA
  3. Adrenal glands are INSENSITIVE to glucocorticoid feedback
24
Q

in PPID, ___ ___ causes a ___-fold increase in size, and a ____ ____ causes a ___-fold increase in size

A

ADRENAL HYPERPLASIA, 4, PITUITARY ADENOMA, 5

25
Q

an ENLARGED pituitary adenoma…
causes COMPRESSION of what 3 structures?
related to what disease?

A

compression?
1. hypothalamus
2. Posterior pituitary lobe
3. Optic chiasm

disease = PITUITARY PARS INTERMEDIA DYSFUNCTION

26
Q

etiology of specific CLINICAL SIGNS of… (what disease?)
1. chronic laminitis?
2. increased infection?
3. hyperhidrosis
4. PU/PD
5. muscle wasting/weight loss?
6. seizures/blindness?

A

PITUITARY PARS INTERMEDIA DYSFUNCTION

  1. Chronic laminitis/solar abscesses = glucocorticoids?
  2. Increased infection = increased cortisol
  3. Hyperhidrosis = pituitary compression of hypothalamus which then causes dysregulation of thermoregulation
  4. PU/PD
    (1) COMPRESSION OF POSTERIOR PITUITARY –> DECREASED ADH
    (2) HYPERGLYCEMIA –> OSMOTIC DIURESIS
    (3) Increased cortisol –> INCREASES GFR
  5. Muscle wasting/weight loss = PROTEIN CATABOLISM
  6. Seizures/blindness = masses in the pituitary pressing on OPTIC CHIASM/CEREBRUM
27
Q

hematologic changes in PPID? (5)

A
  1. HYPERGLYCEMIA/HYPERINSULINEMIA
  2. Elevated endogenous ACTH
    –> We use ACTH to determine if there’s ALSO a decrease in cortisol
  3. Anemia, neutrophilia, lymphopenia = RARE
  4. Hypertriglyceridemia
  5. HIGH FECAL EGG COUNTS bc disease INTERFERES WITH ANTI-PARASITIC ACTIVITY
28
Q

fill out table!

A
29
Q

3 things to consider for DIAGNOSIS of PPID?
when is it the best time to measure ACTH via swim?

A
  1. NO OPTIMAL TEST, but there are many tests to choose from!
    –> Tend to use ACTH stim or TRH stim
  2. Poor sensitivity & poor specificity
  3. TIME OF YEAR CHANGES RESULTS

best time?
Values for ACTH will increase in fall, so BEST TIME TO DO BASAL ACTH IS IN THE FALL

30
Q

ACTH stim test in HORSES…
can test for WHAT disease?
when is the BASAL level recommended to be done?
definition/expectations of “endocrine spring/fall?”
false elevations? (2)
what happens if we KEEP GETTING NEGATIVE TESTS but suspect disease?

A

for PITUITARY PARS INTERMEDIA DYSFUNCTION

BASAL levels = recommended for the FALL, when VALUES TEND TO BE HIGHER (between MID-JULY to MID-NOVEMBER)

“endocrine spring” = MID-NOVEMBER –> MID-JULY, ACTH values are LOWER

“endocrine fall” = MID-JULY –> MID-NOVEMBER, ACTH values are HIGHER

can have FALSE ELEVATIONS if STRESSED/IN PAIN

if we keep getting NEGATIVE TESTS but SUSPECT DISEASE, then perform TRH test!

31
Q

TRH stim test…
= definition
what DISEASE is this used for?
best SEASON to perform it/why?
WHY would we do this after ACTH stim?
procedure? (preparation, administration range, when positive, 4 normal clinical signs?)

A

= THYROTROPIN-RELEASING HORMONE stim test

used for PITUITARY PARS INTERMEDIA DYSFUNCTION

best done in SPRING to have RELIABLE VALUES FOR FALL ACTH TESTING

if ACTH stim keeps coming back NEGATIVE but SUSPECT PPID, then DO THIS!

procedure?
1. NO GRAIN for 12 hours prior
2. Administer 0.5 mg (<250 kg) or 1.0mg (>250 kg) TRH IV
3. Wait 10 minutes post ACTH-levels, and STICK AROUND
4. POSITIVE FOR PPID = >200 pg/mL
5. Can see the following transient clinical signs
–> Yawning
–> Flehmen
–> Twitching
–> Coughing
** All of these should STOP after 10 minutes are up

32
Q

about 30% of all horses with ____ ALSO have _____ ____
when should we test for the latter disease?
what does it mean to have both?

A

PPID, INSULIN RESISTANCE

we should ALWAYS test for IR when SUSPICIOUS OF PPID

if PPID + IR = HIGH RISK OF LAMINITIS

33
Q

overall procedure of diagnostics for PPID (3, depends on NATURE OF HTE SIGNS & 1 clinical sign)

A
  1. If only MILD signs = TRH stim as first diagnostic, and test for INSULIN STATUS
  2. If SEVERE signs/DURING THE FALL TIME = BASAL ACTH
  3. HIRSUTISM IS A GOOD INDICATOR FOR MEDICATION!!!
34
Q

PERGOLIDE…
what DISEASE is this used to treat?
what classification?
formulation of drug?
starting dose?
follow-up procedure?

A

treats PITUITARY PARS INTERMEDIA DYSFUNCTION

= DOPAMINE agonist

formulation?
Often compounded

starting dose? = 1/mg per 500 kg horse

follow-up? = RECHECK BASAL ACTH at 1 MONTH

35
Q

CABERGOLINE
what DISEASE is this used to treat?
what classification?
what kind of patients are best suited for it?
a con?
follow-up procedure?

A

treats PITUITARY PARS INTERMEDIA DYSFUNCTION

= DOPAMINE agonist

what patients?
–> good for REFRACTORY cases (patients that do not respond to high doses of pergolide)

con? = MORE EXPENSIVE

follow-up? = RECHECK ACTH after 3 MONTHS

36
Q

what 3 things are associated with SURVIVAL in PPID?

A
  1. Being a PONY
  2. Higher BCS
  3. Pergolide treatment
37
Q

prognosis for PPID? (2)

A
  1. LIFELONG CONDIITON (no cure)
  2. Usually effective treatment with medication & management changes allows for increased QUALITY of life, not necessarily longevity

year 1/2 (139 decks)

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