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Equine Final Year > Diarrhoea in Horses > Flashcards

Diarrhoea in Horses Flashcards

1
Q

What are some differential diagnoses for diarrhoea in foals?

A

–Foal heat diarrhoea

–Necrotising enterocolitis

–Neonatal sepsis (variety of organisms e.g. Actinobacillus, E coli, Strep. spp.)

–Viral diarrhoea (Rotavirus)

–Bacterial causes (e.g. Clostridia)

–Parasitic causes – S. westeri

–(Cryptosporidium – mild and self-limiting except if immunocompromised

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2
Q

What are clinical signs of foal heat diarrhoea?

A

–5-14 days

–mild, self-limiting

–foal remains bright and sucking

–normothermic (remember foals always normally 0.6C hotter than adults)

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3
Q

What is the pathogenesis of foal heat diarrhoea?

A

Likely a change in gastro-intestinal function (or with dietary changes)

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4
Q

What is the diagnosis and treatment for foal heat diarrhoea?

A
  • Dx – hx and clinical signs
  • Tx – none required
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5
Q

Which foals are most at risk of rotavirus?

A

–all foals esp those housed in large groups with their dams

–common cause and highly infectious

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6
Q

What is the pathogenesis of rotavirus in foals?

A

–Invade epithelial cells lining the intestinal villi

–Cell death and blunting of villi

  • Maldigestion through loss of intestinal enzymes
  • Malabsorption through loss of surface area
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7
Q

What are the clinical signs of rotavirus in foals?

A

–Anorexia, depression, profuse watery diarrhoea

–Hypovolaemia and electrolyte derangements (low Na and Cl)

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8
Q

How old are foals usually when infected with rotavirus?

A
  • 7 - 28 days of age (occasionally younger)
  • May be secondary pathogen too
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9
Q

What is the diagnosis of rotavirus in foals?

A

•Diagnosis – faeces – PCR, EM, ELISA (practice kits) – all low sensitivity

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10
Q

What is the management and treatment for rotavirus in foals?

A

•Management

–Isolation policy needs to be implemented

•Treatment

–Vaccination of mares – suggested efficacy

–Supportive therapy – IV (occasionally only oral) fluids, PPN, sucralfate, vaseline to prevent skin abrasion, young foals may benefit from plasma & AB’s

–Prevention -colostrum

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11
Q

What age of foals is bacterial diarrhoea most common in?

What should you always do?

What are the most common organisms?

A
  • In foals <7dd, always rule out sepsis w blood culture if possible
  • C.perfringens and C. difficile
  • Individual cases and outbreaks (dam source)
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12
Q

What are the clinical signs of bacterial diarrhoea in foals?

A

Colic, hypovolaemia, profuse watery diarrhoea (smells bad!!), sometimes red-tinged and haemorrhagic (poorer px)

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13
Q

What is the diagnosis for bacterial diarrhoea in foals?

A

–Faecal ELISA for toxin

–US

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14
Q

What is the treatment for bacterial diarrhoea in foals?

A

Usually sick – a minimum of IV fluids and broad spectrum parenteral antibiotics, oral metronidazole and often need more support with hospitalisation, vaseline, occ whole blood transfusions or plasma required

NB – about 50% of sick foals presenting with D++ will be bacteraemic

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15
Q
A
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16
Q

What is S. westeri?

How is it transmitted to foals?

Clinical signs?

Treatment?

A

Causes parasitic diarrhoea

•S. westeri

–Transmammary transmission

–8-12 days

–Mild diarrhoea

–Self-limiting

–Responds to deworming with BZ or avermectins

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17
Q

What are some differential diagnoses for diarrhoea in weanlings?

A
  • Lawsonia intracellularis
  • Rhodococcus equi
  • Strongylus vulgaris
  • (Also diseases of the adult)
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18
Q

What is Lawsonia intracellularis?

What age of foal does it affect?

A

Proliferative enteropathy

  • Affects horses at 2-8 months of age – usually weaned
  • Common in some areas and never reported in others
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19
Q

What are the clinical signs of Lawsonia intracellularis?

A

•Clinical signs

  • Depression, rapid and significant weight loss, subcutaneous oedema, diarrhoea and colic. Often poor hair coat and pot-bellied
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20
Q

What is the clinical pathology and pathophysiology of Lawsonia intracellularis?

A

•Clinical pathology

–SEVERE hypoalbuminaemia, inc WBC, anaemia (of chronic dx)

•Pathophysiology

–Intracellular bacteria, spread by faeco-oral transmission - proliferative enteropathy of small intestine

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21
Q

What is the diagnosis for Lawsonia intracellularis?

A

–Difficult to get definitive dx

–Clinical signs, low albumin, ruling out other causes

–Abdominal ultrasound

•Marked SI thickening

–Faecal PCR - insensitive

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22
Q

What do you see on abdominal ultrasound with Lawsonia intracellularis?

A

Marked SI thickening

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23
Q

What is the treatment for Lawsonia intracellularis?

A

–Oxytetracycline IV BID or doxycycline PO BID

–Eyrthromycin, clarithromycin or azithromycin PO with or without rifampin

–Colloidal support

•Plasma

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24
Q

What age is Strongylus vulgaris usually seen?

What are clinical signs seen with?

A
  • 6 months onwards
  • Now a rare condition in the UK due to widespread use of avermectins
  • See clinical signs with L4 migration through arterioles of caecum and descending colon
  • Colic and SIRS
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25
Q

What is the diagnosis for Strongylus vulgaris?

A

Clinical exam, hx, clinicopathology, REMEMBER pre-patent disease so WEC a good rule-in but not rule-out!!

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26
Q

What is the treatment for Strongylus vulgaris?

A

Avermectins

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27
Q

Where is Rhodococcus equi secreted from?

What age of foal does it usually affect?

A
  • R equi - excreted in dams’ faeces, builds up on pasture in warm, dry (or wet) conditions, ingested, colonizes white blood cells, abscessation
  • Usually 2 to 4 month old foals
28
Q

What clinical signs do you see with Rhodococcus equi?

A

•Enteric infection

–persistent diarrhoea, fever

•Intra-abdominal abscess

–fever, colic

•Rare cf respiratory forms

29
Q

What is the treatment for Rhodococcus equi?

Any side effects?

A

–Rifampin, 7.5 mg/kg q12h, po

–Erythromycin estolate 25 mg/kg q8h, po

  • Azithromycin, 10mg/kg q24h, po
  • Clarithromycin 7.5mg/kg q12h, po

–Side-effects: hyperthermia, diarrhoea in dam

30
Q

What are some more common causes of acute diarrhoea in adult horses (> 9 months)?

A

•Causes

–Larval cyathostomosis

–Clostridial diarrhoea

–Right dorsal colitis secondary to NSAIDs

–Grain overload

–Idiopathic

–Dietary changes

31
Q

What are some rare causes of acute diarrhoea in adult horses (> 9 months)?

A

•Rare causes (but important)

–Salmonellosis

–Antibiotic-induced

•Rare causes

–Peritonitis

–Sand colic

–Strongylosis

–Duodenitis-prox jejunitis

–Congestive heart failure

–Liver disease - esp hyperlipaemia

32
Q

What is currently THE most important equine parasitic disease in terms of prevalence and severity of clinical signs seen?

A

Cyathostomosis

33
Q

What does Cyathostomosis cause?

A

Severe acute diarrhoea and colic; chronic diarrhoea

34
Q

What is the life cycle of Cyathostomes?

A
  • Adults adhere to mucosa of caecum and colon - <10% total population – tip of iceberg
  • Direct, non-migratory life cycles
  • Pre-patent period 6 - 14 weeks (no hypobiosis_
  • Arrested larval development occurs in the large intestinal mucosa - larvae are encysted and can persist for 2 - 3 years
  • THIS IS A PRE-PATENT DISEASE – so WEC allows a rule-in, but not a rule-out
35
Q

What is this?

A

Cyathostomosis

36
Q

What anthelmintic works against encysted, hypobiotic cyathostomes larvae?

A

•Encysted, hypobiotic larvae unaffected by any anthelmintic

37
Q

What percentage of cyathostomes are hypobiotic?

When doe IL3 emerge?

A
  • This hypobiotic population makes up 50% of the larval population, which is 90% of the total population (10% adults)
  • For various reasons, IL3 emerge in Spring, often many many at once – one is a reduction of adults in the lumen!!
38
Q

What is the epidemiology of Cyathostomes?

A
  • All ages affected – more common in young or unexposed horses
  • Egg shedding highest in Spring and due to rapid cycle will get re-infection in June and all the way to Sept/Oct if not too dry
  • Larvae at maximum number in horse in Autumn
39
Q

What is the diagnosis for cyathostomes?

A
  • Very difficult as PPP disease
  • History and clinical signs – young animals, poor worming history or sudden change
  • May see larvae in faeces or on glove after rectal examination in animals with acute larval cyathostomiasis
  • Clinical pathology (non-specific)
  • neutrophilia
  • hypoalbuminaemia
  • hyperglobulinaemia
40
Q

What are the clinical signs of Cyathostomes?

A
  • First syndrome – seen in SPRING
  • ACUTE LARVAL CYATHOSTOMIASIS
  • Due to mucosal damage caused by emergence of the LL3

–Colic

–Weight loss

–Ventral oedema – often before D++

–May or may not be pyrexic – some are bacteraemic

–Diarrhoea – acute and chronic

–Wasting and death either acutely or chronically

•Autumn syndrome – when larvae entering intestinal wall – less common than that seen in the Spring

–Colic

–Diarrhoea due to inflammation

41
Q

What is the treatment for Cyathostomiasis?

A

•Intensive care required for animals with acute larval cyathostomiasis

–IV fluids

–Parenteral antibiotics

–Colloidal support – plasma

–Foot supports (?ice)

–Polymixin B

–Circulatory support – inc GI blood flow – dobutamine infusion

–NSAIDS – no such thing as anti-endotoxic doses of flunixin

–Other analgesia – many v painful - ischaemic

–Pre-treat with steroids and anthelmintics effective early larvae – moxidectin and 5-day fenbendazole (probably) are larvicidal (LL4)

42
Q

What is the prevention and management for Cyathostomiasis?

A
  • Treat with above drugs during Spring to Autumn
  • Pick up faeces
  • Keep different ages of horses separate
  • Avoid overgrazing and rotate pastures
  • Harrowing helps as parasite sensitive to sunlight
43
Q

What is the prognosis for Larval cyathostomosis?

A
  • Guarded - around 30 - 40% survive with treatment as described above
  • May take many months to re-gain weight
44
Q

What is clostridiosis?

A
  • Important cause of acute diarrhoea in the UK in adults and foals
  • C. perfringens (esp A) and C. difficile
  • Also common cause secondary to antibiotic use
  • C. perfringens is occ associated with haemorrhagic D++ (foals, but also adults)
  • Are normal flora in low numbers, but in this role don’t produce toxins
45
Q

What are the clinical signs of clostridiosis?

A
  • Fetid smelling D++, anorexia, depression, SIRS, +/- pyrexia and eventually ventral oedema
  • Occ colic first sign
  • Can cause peracute colitis and death, but rare
  • Clinicopathological signs – non-specific

–Neutrophilia, hypoproteinaemia, inc PCV, inc lactate, inc creatinine, inc liver damage indicators, low Na, low K, low Cl, metabolic acidosis

46
Q

What is the diagnosis and treatment for clostridiosis?

A

•Diagnosis

–Faecal ELISA for toxin

–PCR for faecal toxins

•Treatment

–As for cyathostomiasis (not dewormer)

–I use parenteral antibiotics to cover for systemic bacteraemia

–‘Poo-soup’ also on day 3 ish

–Will use steroids if no improvement in D++

–Lots of TLC

47
Q

What is the prognosis for clostridiosis?

A

–As for acute larval cyathostomiasis – 30-50%

–Loss often due to severe and ultimately fatal laminitis…..doesn’t even become evident usually until horse is producing normal faeces

48
Q

What is antibiotic induced diarrhoea?

Which ones can cause it?

A
  • Actually very uncommon
  • Penicillin, Ceftiofur, Trimethoprim sulpha, Doxycycline & Oxytetracycline all implicated

–Can be any antibiotic that targets gram negative or anaerobic bacteria

•Erythromycin in mares - a specific syndrome in the dams of foals receiving erythromycin has been described

–relates to ingestion of drug from foals faeces

•Despite common concerns over certain antibiotics (oxytetracylcine in UK, trimethoprim sulpha in USA), there is no real evidence that any one antibiotic is worse than others

49
Q

What are the clinical signs, diagnosis and treatment for antibiotic induced diarrhoea?

A

•Clinical signs – very variable

–Mild transient diarrhoea with no systemic effects

–Severe, fulminant enterocolitis

•Diagnosis

–History

–Faecal ELISA or PCR for Clostridial perfringens enterotoxin and C. difficile toxins A and B

•Treatment

–Stop antibiotics

–Transfaunation (Poo-soup)

–??Metronidazole

–If severe – as for Clostridiosis

50
Q

What is grain (carbohydrate) overload and how can it cause diarrhoea?

A
  • History of horse gaining access to large quantity of hard feed (feed room left open,rats eating through bins)
  • SI digestion overwhelmed and soluble CHO enters LI
  • Rapid fermentation by lactic acid producing bacteria lowers pH
  • Gram negative enterobacteriaceae die, other bacteria overgrow, gut wall compromised and bacteria enter the circulation
51
Q

What can grain overload lead ot?

A

–SIRS

–Osmotic diarrhoea due to lactic acid being poorly absorbed

–Severe, oftern-fatal laminitis

52
Q

What is the diagnosis and treatment for grain overload?

A
  • Diagnosis is usually based on clinical history
  • Treatment (as for Clostridiosis)

–IV fluids

–Analgesia

•Often very painful

–BS parenteral antibiotics

–Oral laxatives

•Liquid paraffin

–Antiendotoxic agents

•Polymixin b

–Laminitis prevention

•Frog supports, ice?

–PPN

–Surgery to decominate GIT

53
Q

What is right dorsal colitis often secondary to?

Which horses more susceptible?

A
  • Secondary to NSAID use
  • In adults MUCH more common than causing gastric ulceration
  • Ponies more susceptible than horses
  • Changes GI blood flow and this affects protective mechanisms
  • Often in horses receiving high-than-licensed doses, but doesn’t have to be and not administered for long periods
54
Q

What are the clinical signs of right dorsal colitis?

What are the clinicopathological changes?

A
  • Anorexia, lethargy/depression and colic
  • Also D++, fever and SIRS
  • If chronic,

–Weight loss, intermittent colic, depression, anorexia and ventral oedema with soft or less formed faeces

•Clinicopathological changes

–Hypoproteinaemia

–Certain cases

  • Hypovolaemia
  • Electrolyte abnormalities
  • Neutropenia
  • Occ anaemia
  • Inc creatinine
55
Q

What is the diagnosis for right dorsal colitis?

A

Diagnosis

–Presumptive based on history

–More common with oral phenylbutazone (and suxibuzone) use and ?? Less with more COX-2 selective drugs (meloxicam and firocoxib) – BUT used much less

–Transabdominal ultrasound

56
Q

What is the treatment for right dorsal colitis?

A

–As for cyathostomiasis

–MAY use PGE2 analogue, misoprostol to help increase GI blood flow and protective factors, but has some unwanted SE

57
Q

What are some potential causes of idiopathic diarrhoea?

A
  • Horses have persistent D++, but remain normovolaemic usually and are bright
  • Very frustrating and q common
  • Can over time become hypoproteinaemic
  • ?Dietary intolerance

–haylage

  • Start with Hx, WEC, faecal culture (ideally 3 over a week) and toxin ELISA
  • Then exclusion diet for 4-6 weeks
  • Codeine phosphate – oral BID
58
Q

How common is salmonellosis?

What are the syndromes?

A
  • Important, but rare cause of diarrhoea in the UK. Very common in other parts of the world
  • Many syndromes

–Acute fuminant diarrhoea – are neutropenic rather than neutrophilic as with many other causes of D++ in adults

–Sepsis in foals

–Depression, fever, anorexia without diarrhoea

–Small colon impaction

–Likely a latent or carrier state – unlikely to be common in UK

59
Q

What is the diagnosis for salmonellosis?

How can you prevent spread?

A

•Diagnosis

–Bacterial Culture

  • Intermittently shed
  • 3 negative cultures to rule out Salmonellosis
  • 5 negative cultures to declare no longer infected after a positive culture
  • Prevention of spread

–ISOLATION – personnel, equipment

–Phenolics, fumigation – tricky to kill

60
Q

What is the treatment for salmonellosis?

A

–As for cyathostomiasis

–I use antibiotics for management of bacteraemia not to try and kill the Salmonella

61
Q

If a horse has diarrhoea, when should you isolate?

A

•Two of three

–Pyrexia

–Neutropenia

–Diarrhoea

–Only exception is 24-48hrs following sx for a LCV

•Horses with neurologic disease that have dec tail tone and HL paresis

–(Neutrologic EHV-1)

•Suspected Strangles (Strep equi var equi)

62
Q

What are the aims of the diagnostic approach with regards to diarrhoea?

A
  • Determine likely cause of D++
  • Determine need for specific therapy
  • Determine need for supportive therapy
  • Determine risk to in-contact horses and personnel
63
Q

How can you determine likely cause of diarrhoea and thus need for specific therapy?

A
  • HISTORY
  • PHYSICAL EXAMINATION!!!
  • FINDINGS ON HAEMATOLOGY AND BIOCHEMISTRY
  • WEC done properly!
  • FAECAL PCR/ ELISA
  • FAECAL CULTURE AND SENSITIVITY
64
Q

How can you determine the need for supportive therapy in horses with diarrhoea?

A

•MAJOR BODY SYSTEM ASSESSMENT

–MM, CRT, jugular fill, HR, GI borborygmi

•BASIC BLOOD WORK

–PCV, TS – are issues with interpretation of these values in D++ cases

–Problems overcome with lactate concentration – also provides prognostic information

–Blood gas (and electrolyte analysis)

–(Clotting profiles)

65
Q

What are some examples of supportive therapy in horses with diarrhoea?

A
  • IV fluids – Hartmann’s or Lactated Ringers
  • Plasma
  • Haemodynamic support – dobutamine infusions
  • Analgesia (anti-inflammatory)

–No such thing as anti-endoendotoxic doses of flunixin

  • Lidocaine infusions
  • Polymixin B – binds endotoxin – only truly anti-endotoxic drug
  • ANTIBIOTICS

–Use is controversial

  • Treatment of possible bacteraemia secondary to increased intestinal permeability
  • Treatment of primary bacterial pathogen NOT recommended
  • Foot supports /?ice – these cases are prone to very severe laminitis that is often the reason for euthanasia
  • Monitor jugular veins regularly as prone to developing thrombophlebitis
  • Feed them whatever they want to eat or consider PPN after 48hrs of anorexia – check TG concentration regularly
  • Steroids - controversial
  • Transfaunation - ‘Poo-soup’
66
Q

If diarrhoea is severe or a horse has SIRS - what should you consider?

A

consider referral or hospitalisation

Equine Final Year (102 decks)

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