Equine

Question 1

Where do most esophageal obstructions occur?

Answer 1

Proximal esophagus

Question 2

What are the clinical signs of esophageal obstruction?

Answer 2

Nasal discharge (feed, saliva, or milk in young animals)
Salivation
Distress, head extension, lethargy, dehydration
May have abnormal lung sounds

Question 3

How is esophageal obstruction diagnosed?

Answer 3

By esophageal palpation and the inability to pass a nasogastric tube
Endoscopy or radiography may be used

Question 4

What is the first step in treating esophageal obstruction?

Answer 4

Sedate the horse!

Can use alpha-2 agonists (xylazine, detomidine) or butorphanol

Question 5

Which drug is favored for esophageal relaxation? What other drugs can be used?

Answer 5

Buscopan

Can use oxytocin or lidocaine

Question 6

What else should be done in the management of esophageal obstruction?

Answer 6

NSAIDs for analgesia
Antibiotics to prevent pneumonia
Slowly return to normal diet
Exclude underlying causes (do dental exam, endoscopy)

Question 7

What are some potential complications of esophageal obstruction?

Answer 7

Laryngeal paralysis, esophageal rupture, strictures

May develop pneumonia if foreign material is aspirated

Question 8

What is the most common type of esophageal neoplasia in horses?

Answer 8

Squamous cell carcinoma

Question 9

What are the general reasons a horse may have GI pain?

Answer 9

Distention, traction on the mesentery, ischemia, inflammation

Question 10

What questions need to be answered when evaluating a horse with colic?

Answer 10

Can the pain be controlled?
Is it small or large intestine?
Is it strangulating or non-strangulating?
Does it need surgery?
What is the prognosis? (i.e. is euthanasia necessary?)

Question 11

What is the most common type of colic?

Answer 11

Large intestinal non-strangulating, either gas/spasmodic or large colon impaction

Question 12

What are the subtle signs of colic?

Answer 12

Anorexia
Lying down more than usual
Decreased fecal production (normally passed every other hour)

Question 13

What signs might a horse with moderate pain due to colic show?

Answer 13

Pawing, stretching
Flank watching
Abdominal distention

Question 14

What signs might a horse with severe pain due to colic show?

Answer 14

Rolling, thrashing

Facial abrasions

Question 15

If a horse showing severe pain suddenly becomes depressed, what is your major concern?

Answer 15

Rupture

Question 16

If you suspect colic, which vital sign is extremely important?

Answer 16

Heart rate

Question 17

What characteristics of the mucous membranes should be evaluated in a colic workup?

Answer 17

Color, moisture, CRT, toxic line

Question 18

True or false: When listening to gut sounds, even minor changes can be significant.

Answer 18

False. Look for big changes, like complete absence of gut sounds.

Question 19

What should be done in cases of moderate and severe colic?

Answer 19

Pass a nasogastric tube!

Question 20

What amount of net reflux from the stomach is considered significant?

Answer 20

Greater than 2-3 L

Question 21

When is abdominocentesis typically used?

Answer 21

To differentiate small intestinal strangulating versus non-strangulating colic.

Question 22

What are the characteristics of normal peritoneal fluid?

Answer 22

Clear with yellowish tinge, no blood
5,000-10,000 WBC/microliter
Less than 2g/dL of protein
Lactate not significantly elevated compared to plasma

Question 23

What should be done as initial therapy in colic cases?

Answer 23

Analgesia (gastric decompression and drugs)

Fluid therapy

Question 24

What are some drugs appropriate for analgesia in colic cases?

Answer 24

NSAIDs, alpha-2 agonists, opioids, Buscopan

Question 25

What is the maintenance rate for fluid therapy in horses?

Answer 25

40-50 mL/kg/day

Question 26

What are some possible abnormalities that can be noted in the peritoneal fluid?

Answer 26

Serosanguinis fluid, elevated WBC count, elevated protein concentration, plasma greater than twice the concentration of plasma

Question 27

When should IV fluids be given over enteral fluids?

Answer 27

In cases of significant gastric reflux (more than 2-3 L) Severe pain Substantial dehydration

Question 28

What are the clinical signs of equine gastric ulcer syndrome in adult horses?

Answer 28

Non-specific, may include anorexia, chronic/intermittent colic, decreased performance, poor quality coat, etc.

Question 29

How is equine gastric ulcer syndrome diagnosed?

Answer 29

Based on clinical signs and response to treatment | Endoscopy

Question 30

True or false: the severity of ulceration found on endoscopy is well correlated to the severity of the clinical signs.

Answer 30

False. Horses with EGUS diagnosed by endoscopy may be clinically normal.

Question 31

Which clinical sign of equine gastric ulcer syndrome may be seen in foals but not adults?

Answer 31

Diarrhea

Question 32

What are some potential risk factors for the development of equine gastric ulcer syndrome?

Answer 32

Any type of exercise, NSAID administration | Management (diet, feeding patterns, environment)

Question 33

What drugs can be used to treat equine gastric ulcer syndrome? Which one is FDA approved?

Answer 33

FDA approved: Omeprazole (proton pump inhibitor) | Others: H2 antagonists, sucralfate

Question 34

Which particular group of horses develop gastroduodenal ulcer disease?

Answer 34

Suckling and early weaning foals under 6 months old

Question 35

What are the clinical signs of gastroduodenal ulcer disease?

Answer 35

Resembles equine gastric ulcer syndrome

Question 36

What characterizes gastroduodenal ulcer syndrome?

Answer 36

Lesions in the proximal duodenum as well as the stomach, decreased gastric emptying, gastroesophageal reflux

Question 37

When is surgical intervention in gastroduodenal ulcer syndrome needed?

Answer 37

If strictures develop in the duodenum and create a gastric outflow obstruction

Question 38

What are the risk factors in developing ileal impaction? Which is more common?

Answer 38

Feeding coastal Bermuda grass- more common | Tapeworms

Question 39

What are the physical exam findings in a case of ileal impaction?

Answer 39

Moderate to severe pain Distended small intestine May or may not have gastric reflux

Question 40

True or false: peritoneal fluid from a case of ileal impaction is often normal.

Answer 40

True. In some cases, there may be an increase in total protein.

Question 41

How is ileal impaction treated?

Answer 41

Gastric decompression, withdraw food and water Analgesics and IV fluid therapy Surgery if not improved in 24-36 hours or abnormal peritoneal fluid Deworm if caused by tapeworms

Question 42

What are the clinical findings in the case of a cecal impaction?

Answer 42

Varying degrees of pain Usually no reflux Distended cecum (with feed or fluid)

Question 43

What are the risk factors for developing cecal impaction?

Answer 43

Mares near parturition, general anesthesia

Question 44

How is cecal impaction treated?

Answer 44

Identify early! Withdraw feed IV fluids plus enteral laxatives Usually needs surgery- rupture common

Question 45

Large colon impactions often happen at which site?

Answer 45

The pelvic flexure

Question 46

In Florida, what material can cause impactions besides feed?

Answer 46

Sand