Equine Alimentary Diseases Flashcards
(227 cards)
1
Q
what is colic?
A
abdominal pain in the horse - a sign not a diagnosis
2
Q
what are the clinical signs of colic?
A
rolling pawing flank watching lip curling rolling and throwing themselves around if severe
3
Q
when may a horse show signs of colic that are not related to abdominal issues?
A
if there is pain elsewhere in the body
4
Q
what do the signs of colic depend on?
A
severity of case
5
Q
what is the key question that must be answered when examining colic cases?
A
will this horse require emergency surgery now or not?
6
Q
how should all colic cases be treated until proven otherwise?
A
that they are surgical unless absolutely certain they are not
7
Q
what is the most important body system to examine when checking a colic case?
A
cardiovascular system
8
Q
what parameters (including blood tests) are used to assess cardiovascular function in colic patients?
A
HR and rhythm RR temp PCV TP lactate
9
Q
why must cardiovascular status be carefully monitored in colic patients?
A
very important
will have huge influence on decision making
acute conditions of the GI tract can lead to endotoxaemia, dehydration, shock and coagulation disorders - all detected through CVS parameters
10
Q
what can acute conditions of the GI tract lead to?
A
endotoxaemia, dehydration, shock and coagulation disorders
11
Q
what should be done before administering any analgesia or sedation to a patient?
A
attempt to get HR reading
12
Q
following cardiovascular exam what is the next area that should be assessed in colic patients?
A
abdomen
13
Q
is auscultation of the gut useful in colic cases?
A
variable - hugely increased sounds or silence may indicate issue but otherwise not very useful and definitely not in isolation.
14
Q
what would increased gut sounds in colic patient potentially indicate?
A
spasmodic colic
15
Q
what would decreased gut sounds in colic patient potentially indicate?
A
stasis
strangulation
16
Q
how should the abdomen be auscultated?
A
in 4 quadrants (upper and lower on left and right)
17
Q
what should you look for when examining the abdomen?
A
distention
18
Q
what does obvious abdominal distention indicate?
A
emergency in horses
19
Q
what pathology does obvious abdominal distention in horses indicate?
A
large colon torsion
20
Q
what is the most useful part of an initial exam when diagnosing colic?
A
rectal exam
21
Q
what can be felt during a rectal exam?
A
only part of the abdomen
can detect displacement, impaction and distension of LI
some SI distension
22
Q
what is the main risk associated with rectal exam?
A
risk of tear
23
Q
what equipment is needed for a rectal exam?
A
rectal sleeve lube sedation LA buscopan
24
Q
what is buscopan used for?
A
stops contraction of gut temporarily
25
what is stomach tubing used for?
administration of fluid
medication
relief of gastric overfilling
26
what is the role of stomach tubing in emergency?
empty the stomach to prevent rupture
27
how may gastric overfilling occur?
stomach continually secretes fluid
if there is a blockage in the GI tract this fluid will back up into the stomach and fill it
if pressure is not relieved the stomach will rupture as horses cannot vomit
28
what can be avoided by placing a stomach tube in a horse with gastric overfilling?
death and rupture of stomach
29
what is the main risk associated with stomach tubing?
epistaxis - very common
30
what equipment is needed for stomach tubing?
```
stomach tube
2 buckets (1 with water)
funnel
jug
twitch
sedation
lube
```
31
what are the methods of ultrasound that may be used to diagnose colic?
```
rectal
transabdominal (more common)
```
32
what equipment is needed for ultrasound?
machine
clippers
spirit
gel
33
what is abdominoparacentesis?
belly tap
34
what can be shown by abdominoparacentesis?
```
intestinal damage
haemoperitoneum
rupture of stomach (food content)
inflammation
neoplastic cells
```
35
what is the risk associated with abdominoparacentesis?
low risk
care with diagnosis of gastric rupture (and then euthanasia) due to food matter in sample as this may be due to needle passing into gut
36
what signs would you expect to see with gastric rupture?
tachycardia
groaning
sweating profusely
37
what are the 2 techniques that can be used for abdominoparacentesis?
using 23G 2 inch needle or teat cannula and 15 blade
38
is abdominoparacentesis useful for every case?
no
39
how can abdominoparacentesis show intestinal damage?
blood
WBC
protein
40
when may abdominoparacentesis be useful?
can show presence of obstruction before stomach fills and evidence is seen on stomach tubing
41
what equipment is needed fro abdominoparacentesis?
```
clippers
scrub
sterile gloves
plain tube
EDTA tube
either: 23G 2 inch needle or teat cannula, 15 blade and 2ml of LA
```
42
is an oral exam required for colic patients?
no
43
what equipment is needed for oral exams?
```
sedation
gag
torch
head stand
flush mouth
```
44
what can gastroscopy be used for?
diagnosis of ulceration, outflow obstruction and impaction
assessment of choke before and after treatment
biopsy
45
how long should patients be starved before planned gastroscopy?
at least 12 hours
46
what equipment is needed for gastroscopy?
```
sedation
gag / short stomach tube
gastroscope (long endoscope)
air
water
```
47
when is radiography useful in abdominal assessment of horses?
foals
| adults to see if there is sand build up
48
why can sand cause GI issues?
taken in if grazing on sandy soil or having hay in arena turnout. Irritates LI wall
49
what tests can be performed on blood samples to diagnose GI issues?
```
PCV
TP
lactate
haematology
biochemistry
fibrinogen
serum amyloid A
```
50
what tests can be performed on peritoneal fluid samples to diagnose GI issues?
gross appearance
cytology
protein
51
what should peritoneal fluid look like?
yellow
straw coloured
clear
52
what tests can be performed on faecal samples to diagnose GI issues?
egg count
| culture
53
why may a glucose absorption test be performed in horses?
suspected SI malabsorption
54
what techniques may be used for invasive investigations or biopsies?
laparoscopy
| laparotomy
55
what dental diseases can horses suffer from?
```
eruption disorders
dental decay
periodontal disease
fractured tooth
diastema
```
56
what can be done with teeth that are causing issues?
filling
widening of diastema to prevent impaction of food
removal
57
what are the issues with the removal of horses teeth?
hypsodont - if removed the opposite one will have nothing to grind against and will overgrow
58
how often do horses teeth need to be rasped?
at least once a year
59
why do horses need to have regular teeth rasping?
teeth continuously erupt and if natural grinding on other teeth isn't even hooks can develop at the front and back as well as sharp edges
60
what is the risk associated with not regularly rasping horses teeth?
dysphagia
| impaction in LI from not chewing properl
61
describe how to examine a horses mouth for dental disease?
```
watch horse eat
palpate mouth
sedate and place mouth gag
wash out mouth
use torch and mirror to look at all surfaces of teeth
```
62
what is an emergency condition seen in the oesophagus?
oesophageal obstruction / choke
63
what are the usual primary causes of choke?
bad luck
eating too fast
dry concentrate
poor dentition
64
what are the more rare secondary causes of choke?
```
oesophageal damage (usually from previous choke)
mass
```
65
what are the immediate clinical signs of choke?
neck extended
food/discharge from nose
cough
gagging
66
what are the signs of chronic choke?
dehydration
acid-base imbalance (due to saliva loss)
weightloss
67
what are the risks associated with choke?
aspiration pneumonia
rupture
stricture or diverticulum long term
68
how is choke diagnosed?
```
auscultation
cardiovascular parameters
gastroscopy
stomach tube
(bloods, ultrasound, plain and contrast radiography more rare)
```
69
what is the goal of choke treatment?
relieve obstruction without causing damage or aspiration
70
how can a stomach tube diagnose choke?
will stop at blockage before it enters stomach
71
how is choke treated?
sedate to lower head
place stomach tube and lavage obstruction through tube
tube is not used to push blockage
72
why is a lowered head during choke treatment desirable?
reduce aspiration risk
73
what can be done in desperation if choke won't shift?
GA and use cuffed ET tube
74
what drugs may be given to hep with choke?
buscopan / oxytocin to relax smooth muscle
75
what can be done if horse is becoming fed up with tubing during treatment for choke?
leave sedated and muzzled on IVFT and try again in an hour
76
what should be done once choke is cleared?
use gastroscope to check definite clearance, mucosa isn't damaged
check trachea with endoscope for aspiration (TW if choke has been ongoing)
check for underlying issues
rest from feeding
77
what drugs may be needed following choke?
antibiotics and antiinflammatories
78
what equipment is needed for treating choke?
```
endoscope / gastroscope
sedation
twitch
stomach tube
2 buckets (1 with water)
funnel and jug
overalls
```
79
what are the 2 areas of the horses stomach?
glandular and non-glandular
80
where may stomach ulcers form?
in either glandular or non-glandular area
81
what can stomach ulcers cause?
inflammation
erosion
ulceration
perforation
82
how may ulcers be graded?
0 (none) to 4 (actively bleeding)
83
how prevalent are ulcers in horses?
10-100% depending on literature and whether grade I is considered relevant
84
in how many foals is gastroduodenal ulceration seen?
25-57%
85
what causes ulcers?
imbalance between inciting and protective factors
86
why may foals show higher prevalence of glandular ulcers?
reduced mucosal blood flow anyway
when sick this further reduces
NSAIDs will increase problem
87
what are the inciting factors of gastroduodenal ulcers?
HCl
bile acids
pepsin
88
what are the protective factors that will prevent gastroduodenal ulcers?
```
mucus bi-carbonate layer
mucosal blood flow
mucosal prostaglandin E
epidermal growth factor production
gastroduodenal motility
```
89
what are the risk factors for gastroduodenal ulcers?
```
empty stomach
exercise
diet (high concentrates)
NSAIDs
hospitalisation
```
90
what increases the risk of squamous ulcers?
exercise on an empty stomach
91
what increases the risk of glandular ulcers?
NSAIDs
92
what are the clinical signs of gastroduodenal ulceration?
varies from nothing to poor appetite, recurrent colic, tooth grinding, dog sitting, diarrhoea, poor performance
93
what is the aim of dog sitting in gastroduodenal ulcer patients?
movement of acid away from sore, sensitive non glandular area
94
how is gastroduodenal ulceration diagnosed?
gastroscopy
| assumption
95
is the presence of GD ulcers always significant?
no - they may be incidental and not the cause of presenting issue
96
what does treatment of GD ulcers depend on?
cause
| age of horse (adult or foal)
97
how are adult horses treated for GD ulceration?
omeprazole
| misoprostal - increases blood flow to gastric wall
98
what are the issues with misoprostal?
off licence
| is abortive in humans
99
how are foals with GD ulcers treated?
sucralfate
100
why are foals not given any NSAIDs in hospital?
contraindicated due to reduction in blood flow to stomach already seen in foals
101
what are the risks of giving omeprazole (any drug that raises pH) to foals?
may make the sick which increases likelihood of GI ulcers
102
what are the main causes of gastric dilation and rupture?
primary
secondary
idopathic
103
what are the primary causes of gastric dilation and rupture?
gastric impaction
grain engorgement
other
104
what happens during gastric impaction?
stomach stops contracting and amptying
105
what are the signs of gastric impaction?
acute or chronic colic
106
what is the cause of gastric impaction?
unknown
107
when is gastric impaction often discovered?
PM
108
why does gastric dilation lead to rupture?
horses are unable to vomit
109
what are the secondary causes of gastric dilation and rupture?
small and large intestinal obstruction
| ileus (secondary to EGS)
110
what is the most common cause of gastric dilation and rupture?
small or large intestinal obstruction
111
what are the signs of gastric dilation and rupture?
```
overfilling of stomach (loads of fluid when tube passed)
acute colic
tachycardia
fluid from nose
dehydration
```
112
why does gastric dilation and rupture lead to dehydration?
fluid produced in stomach is not being absorbed from LI
113
what is a sign that a horses stomach is about to rupture?
fluid from nose - pass stomach tube immediately!!
114
how is gastric dilation and rupture diagnosed?
clinical signs and history
reflux (lots of fluid in stomach tube)
colic work up
gastroscopy
115
how is gastric dilation and rupture treated?
```
stomach tube ASAP
treat underlying cause
IV fluids
IV nutrition (if gut stasis - only short term)
electrolytes
NPO
```
116
when can gastric dilation and rupture patients be fed?
when stomach tube is not producing fluid
117
is anterior enteritis common in the UK?
no
118
what is anterior enteritis also known as?
duodenitits-proximal jejunitis
119
what is anterior enteritis?
inflammatory condition affecting proximal small intestine
120
what is the cause of anterior enteritis?
in most cases unknown
| may be bacterial involvement in some (can be cultured from reflux)
121
what bacteria may be involved with anterior enteritis?
Salmonella
| Clostridia
122
where can bacteria causing anterior enteritis be sampled from?
gastric reflux
123
what is a high risk factor for anterior enteritis?
recent diet change to high concentrate
124
what are the main clinical signs of anterior enteritis?
distended SI and stomach
signs relating to gastric dilation
pyrexia
125
why does anterior enteritis cause distention of the SI and stomach?
hypersecretion in the proximal SI and functional ileus due to inflammation leads to build up of fluid as it is no longer propelled into LI
126
how is anterior enteritis diagnosed?
may be suspected SI obstruction and only surgery will determine difference
colic investigation
reflux
127
what are the findings in peritoneal fluid of a patient with anterior enteritis?
raised protein but not serosanguinous
128
what will be performed on the reflux of a patient with suspected anterior enteritis?
culture
129
what is usually needed to diagnose anterior enteritis?
ex lap as is hard to differentiate from SI
130
how is anterior enteritis treated?
```
repeated gastric decompression (q2h)
antibiotics
IVFT
electrolytes
nutritional support NPO
analgesia
ex lap with decompression of SI
```
131
what antibiotics are often used for anterior enteritis?
penicillin
gentamicin
metronidazole
132
what is the prognosis of anterior enteritis?
25-94% depending on the case
133
is malabsorption and maldigestion often seen in horses?
no - fairly rare
134
what happens during malabsorption and maldigestion?
animal is unable to absorb nutrients from food
135
what can cause malabsorption and maldigestion?
inflammatory type diseases
| lymphosarcoma
136
what are the clinical signs of malabsorption and maldigestion?
weight loss
137
how is malabsorption and maldigestion diagnosed?
abdominoparacentesis
ultrasound
oral glucose tolerance test
laparoscopic / laparotomy biopsy
138
what can been seen on the ultrasound of a patient with malabsorption and maldigestion?
thickened SI wall
| inflammation
139
what is the role of a glucose tolerance test in the diagnosis of malabsorption and maldigestion?
confirms lack of absorption
140
how is malabsorption and maldigestion treated?
method depends on diagnosis
resection
corticosteroids
no treatment
141
what is the prognosis of malabsorption and maldigestion?
depends on diagnosis and response to treatment
142
what are the main types of SI obstruction?
simple
| strangulating
143
describe a simple SI obstruction
obstruction of the lumen without direct obstruction of vascular flow
144
what can simple SI obstruction be caused by?
course food material
ileal hypertrophy
ascarid impaction
adhesions
145
what is ileal hypertrophy?
thickening of the area between the ileum and the caecum leading to eventual blockage by food
146
what can ileal hypertrophy be caused by?
secondary to tapeworm and muscular hypertrophy associated with increased gut effort due to worms
147
why does ascarid impaction cause simple SI obstruction?
worms physically block lumen
148
describe a strangulating SI obstruction
simultaneous occlusion of intestinal lumen and its blood supply
149
what are the main causes of strangulating SI obstruction?
```
pedunculated lipoma
epiploic foramen entrapment
SI volvulus
mesenteric rent
inguinal or diaphragmatic hernia
intussusception
```
150
what is a pedunculated lipoma?
benign fatty lump attached to the mysentery by a long stalk that can wrap around and strangulate SI
151
what does SI obstruction result in?
gastric overfilling as nothing can pass into LI through SI
deterioration of intestinal mucosa
intestine will die (increased length and severity with time)
sepsis
endotoxaemia
152
with what type of SI obstruction does deterioration of gastric mucosa happen faster?
strangulating lesion
153
what are the clinical signs of SI obstruction?
```
colic
reflux
tachycardia
hypovolaemia
distended SI on rectal exam
serosanguinous peritoneal fluid with high protein and lactate
```
154
what will colic be like in a patient with an SI obstruction?
severe as the gut dies, will ease when the gut is dead
155
what can be detected by peritoneal fluid?
early strangulation
156
how is SI obstruction treated?
surgery
euthanasia
ileal impaction will very rarely clear alone (and this is by chance)
157
what is the prognosis for short term survival following SI obstruction surgery?
80%
158
what is the prognosis for long term survival following SI obstruction surgery?
60-70%
159
how much rest is needed following SI obstruction surgery?
3-4 months
160
what is involved in a simple cecal obstruction?
impaction, becomes blocked with food
161
what are the 2 main types of simple obstruction of the caecum?
primary
| secodary
162
what is the reason for primary caecal impaction?
underlying motility disorder
163
what is the reason for secondary caecal impaction?
usually young horses following painful (e.g. orthopedic) procedures but not well understood
164
what are the clinical signs of caecal impaction?
```
colic (although not always)
depressed
not eating
reduced faecal output
may just rupture leading to severe shock and death
```
165
what must be monitored after any surgery to protect against caecal impaction?
faecal output
appetite
pain
166
what should be assumed if horse is inappetant, depressed and has low faecal output?
may be caecal impaction until proven otherwise
167
how is caecal impaction diagnosed?
clinical signs and history
rectal exam as can often palpate
abdominoparacentesis
168
how is caecal impaction treated preferably?
medically
169
when may surgical treatment of caecal impaction be needed?
if there is intestinal damage / endotoxaemia
170
what is involved in medial treatment of caecal impaction?
oral and IV fluids
171
what is involved in the surgical treatment of caecal impaction?
typhlotomy - open ceacum
| caecal bypass if necessary
172
what is the prognosis of caecal impaction?
90% success due to close monitoring and prevalence in hospital
173
what are the 2 main types of caecal intussusception?
ileo-caecal
| caeco-caecal
174
when is caecal intussusception often seen?
young horses
| those with a high tapeworm burden
175
what are the clinical signs of caecal intussusception?
colic of varying severity
| chronic colic if happening repeatedly and then correcting on it's own
176
how is caecal intussusception diagnosed?
rectal
ultrasound
peritoneal fluid (although care as may suggest more extensive damage than is actually present)
177
how is caecal intussusception treated?
surgery
| treatment for tapeworm
178
what is the prognosis for caecal intussusception?
as for colic surgery
179
what are the 2 main types of LI obstruction?
simple
| strangulating
180
what is simple LI obstruction due to?
impaction
| displacement
181
what is strangulating LI obstruction due to?
torsion
182
where is impaction LI obstruction usually located?
pelvic flexure
183
why is impaction LI obstruction usually seen at the pelvic flexure?
narrows and there is a change in innervation
184
what can cause impaction LI obstruction?
```
food material
poor teeth
long fibre
motility disorder so reduced movement
recent box rest
sand
```
185
what are the clinical signs of LI obstruction due to impaction?
```
mild colic (may be chronic)
reduced faecal output or none
```
186
how is LI impaction diagnosed?
```
rectal exam (key)
abdominoparacentesis
```
187
how is LI impaction treated?
```
oral fluids (repeated through stomach tube)
cathartics
analgesia (care with type)
paraffin may help to move obstruction
IVFT
eventual surgery
```
188
what are cathartic drugs?
draw water into the gut
189
why should horses not be given pro-motility drugs?
can cause gastric / intestinal rupture
190
what is the prognosis for LI impaction?
excellent
| fair if surgery required
191
what are the main types of LI displacement?
right dorsal
left dorsal
nephroplenic entrapment
192
what is nephrosplenic entrapment?
large intestine becomes trapped on the left side between the kidney and the spleen over the nephrosplenic ligament
193
what can happen with LI displacement?
may correct itself or with medical treatment
may remain displaced until gut becomes compromised and surgery is required
torsion - emergancy surgery
194
how is LI displacement diagnosed?
rectal exam
ultrasound
abdominoparacentesis to decide if surgical
195
what type of LI displacement is shown on ultrasound
nephrosplenic entrapment (NSE)
196
how is LI displacement treated if no evidence of gut damage and not too painful?
medically - fluids (oral and IV), analgesia
197
when will surgery be required to treat LI displacement?
if painful
evidence of gut damage
if persistant
198
how can NSE LI displacement be treated?
phenylepherine and lunging (shake it around!!)
199
what does Phenylepherine do?
shrinks spleen
200
when does LI torsion occur?
follows displacement
| spontaneous
201
what is LI torsion?
strangulating lesion of LI
202
what are the clinical signs of LI torsion?
extreme, violent pain
distended abdomen
respiratory compromise
203
how is LI torsion diagnosed?
rectal exam - very difficult due to gas and LI
204
how is LI torsion treated?
immediate surgery with potential LI resection (although difficult)
205
what is the prognosis of LI torsion?
depends on damage to LI
| risk of recurrance
206
what are the 4 types of diarrhoea?
acute
chronic
infectious
non-infectious
207
should diarrhoea cases be isolated?
if fever or until proven non-infectious
208
what are the 2 types of acute diarrhoea?
inflammatory
| non-inflammatory
209
what are the causes of acute inflammatory diarrhoea?
```
Salmonellosis
Clostridiosis
Colitis (NSAIDs)
Ehrlichia risticii
parasites
neoplasia
```
210
what are the causes of acute non-inflammatory diarrhoea?
```
excitement
management change
food hypersensitivity
toxicity
iatrogenic purges
```
211
what are the 2 types of chronic diarrhoea?
disruption of normal physiology
| inflammatory / infiltrative disease
212
what causes chronic diarrhoea due to disruption of normal physiology?
dietary sensitivity
dental disease
antibiotic induced
213
what causes chronic diarrhoea due to inflammatory / infiltrative disease?
parasites
IBDs
neoplasia
214
how is diarrhoea assessed and cause diagnosed?
```
CVS parameters
rectal exam
ultrasound
abdominoparacentesis
rectal biopsy
FEC
faecal cultures
```
215
why are CVS parameters assessed in the diarrhoea patient?
assess how sick they are
216
what cardiovascular parameters will be assessed in the diarrhoea patient?
```
sepsis
endotoxaemia
dehydration
WBC
electrolytes
```
217
how is diarrhoea treated?
```
hydration
electrolytes
anti-endotoxic
laminitis prevention (e.g. ice boots)
treat underlying cause
antibiotics
plasma
feeding through
```
218
what is the most crucial element of care for the diarrhoea patient?
nursing!
| hand feed, clean and grooming
219
is small colon impaction common?
no
220
what is small colon impaction caused by?
```
foreign body (plastic bag)
Salmonella
```
221
how is small colon impaction diagnosed?
difficult
| guessed from history of intermittent diarrhoea and colic
222
how is small colon impaction treated?
medical treatment
| many require surgery
223
what is peritonitis?
infection / inflammation of the peritoneum or peritoneal fluid
224
what is the difference between primary and secondary peritonitis?
primary is idiopathic
| secondary follows surgery
225
what are the signs of peritonitis?
pyrexia
| mild colic
226
how is peritonitis diagnosed?
abdominoparacentesis
227
how is peritonitis treated?
antibiotics
| persistent or recurrent may need laparoscopy or laparotomy
