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BVetMed3 Alimentary > Equine Diarrhoea > Flashcards

Equine Diarrhoea Flashcards

1
Q

How is the approach to equine diarrhoea different to that of small animals?

A

DON’T think of small vs large bowel.

Apart from foals - think of as a big dog!

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2
Q

What usually causes diarrhoea in horses?

A

usually GIT (occasionally other e.g. liver)

ADULT = LARGE INTESTINE
foal = small or large
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3
Q

What is the function of the colon in horses?

A

Water reabsorption

Microbial digestion of carbohydrate and protein/non-protein nitrogen —— VFA production

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4
Q

How can you narrow down the differentials for equine diarrhoea?

A

Age of animal
Duration of clinical signs
History - presence of risk factors

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5
Q

What are the ddx for neonatal foals with diarrhoea?

A

Foal heat diarrhoea
Viral - especially rotavirus
Salmonella
Clostridium

Less likely:
Necrotising enterocolitis 
Sepsis 
Nutritional diarrhoea 
Parasitic diarrhoea - strongyloides westeri 
Gastroduodenal ulceration
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6
Q

How likely is it that a foal will get rotavirus?

A

DEPENDS ON AGE

Likely in young foals, less likely in older foals up to 10-12 months

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7
Q

What are the ddx for older foals (up to 10-12 months) with diarrhoea ?

A

Parasitic diarrhoea - Strongylus vulgaris, cyathostomins
Proliferation enteropathy - Lawsonia intracellularis
Salmonella
Clostridia

Less likely:
Cryptosporidiosis, Rhodococcus equi, Viral, Sepsis, Nutritional, Gastroduodenal ulcer, Parasitic diarrhoea - strongyloides westeri

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8
Q

What are the ddx for a horse with diarrhoea?

A

Salmonellosis
Clostridiosis
Idiopathic acute colitis

Less likely:
Parasitism - cyathostominosis, strongylosis 
Antimicrobial associated
NSAID toxicity (right dorsal colitis)
Sand enteropathy
Carb overload, IBD, Dietary, Neoplasia.
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9
Q

What is the typical treatment approach to diarrhoea in horses?

A

Treat symptomatically

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10
Q

Why is it important to differentiate between acute and chronic diarrhoea?

A

Acute = EMERGENCY in adult horse

Chronic can go on for months

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11
Q

How does acute diarrhoea present?

A

Acute onset febrile (with fever) diarrhoea

Clinical signs of hypovolaemia and endotoxaemia

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12
Q

How would you define chronic diarrhoea?

A

Diarrhoea of more than two weeks duration

Otherwise healthy animal

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13
Q

What can cause both acute and chronic diarrhoea in adult horses?

A

Salmonellosis
Parasitism - Strongylus vulgaris, larval Cyathastominosis
Sand enteropathy
NSAID toxicity (right dorsal colitis)

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14
Q

What can only cause acute diarrhoea in adult horses?

A

Clostridiosis
Antimicrobial associated diarrhoea
Carbohydrate overload

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15
Q

What can only cause chronic diarrhoea in adult horses?

A

Inflammatory or infiltrative disorders e.g. IBD
Dietary - abnormal fermentation
Neoplasia - Lymphoma
Peritonitis, abdominal abscessation

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16
Q

What risk factors should be considered to narrow down the ddx list?

A

Treatment with NSAIDS
Anthelmintic history
Antibiotic treatment
Contact with other horses/foals with diarrhoea

17
Q

Why should you try to make a definitive diagnosis?

A

To make sure it isn’t contagious or a zoonosis

Some conditions need specific treatments e.g. Psyllium for sand colitis

18
Q

What are the three key principles of therapy in horses with diarrhoea?

A

Address fluid loss
Address inflammation and endotoxaemia
Address specific cause

19
Q

If you can see a skin tent on a horse, what is its percentage dehydration?

A

At least 5%

Could be more if there are more clinical signs

20
Q

What is the maintenance volume of fluid for a horse?

A

2-4 ml per kg per hour (about 48L)

21
Q

How do you calculate the amount of fluid required?

A

Deficits - e.g. 5% dehydrated - need to add 5% back

Maintenance - 2-4 ml /kg / hr

Ongoing losses- diarrhoea quantity

22
Q

What is endotoxin?

A

LPS molecule part of the outer cell wall of gram negative bacteria

Systemic response to endotoxin causes pathology

SIRS-MODS-Death

23
Q

What do sirs and mods stand for?

A

Systemic inflammatory response syndrome

Multiple organ dysfunction syndrome

24
Q

How does endotoxin enter the horse’s blood?

A

Horse gut normally has large number of G-ve bacteria in lumen (for fermentation and digestion)

Normal mucosal barrier prevents access to circulation - if this barrier is broken down = ENDOTOXAEMIA

25
Q

Once endotoxin is in the circulation, how does it progress?

A

Endotoxin interacts with cells e..g macrophages and inflammatory mediators released (e.g. IL-1,6, TNF)

Initiates SIRS

Clinical signs of endotoxaemia

CV and GI dysfunction, shock, MODS, DIC, DEATH

26
Q

What are the clinical signs associated with endotoxaemia?

A 
Depression, 
Tachycardia, 
Tachypnoea, 
Fever - endotoxin = pyrogen
Colic
Diarrhoea 
Hyperaemic ‘toxic’ mucous membranes
27
Q

Why is tachypnoea associated with endotoxaemia?

A

Vasoconstriction results in decreased absorption of oxygen

Therefore resp rate increases

28
Q

What cellular changes would you expect to see with endotoxaemia?

A

Low white cell count
Low neutrophil count
Immature ‘band’ neutrophils

29
Q

Why is neutropenia associated with endotoxaemia?

A

Neutrophil margination

30
Q

What are the treatment approaches for endotoxaemia ?

A
  1. Prevent movement of endotoxin into the circulation
  2. Neutralise endotoxin before it interacts with inflammatory cells
  3. Prevent synthesis, release or action of inflammatory mediators
  4. Prevent endotoxin-induced cellular activation
31
Q

How can you prevent access of endotoxin into the circulation?

A

Surgically remove necrotic tissue in colicing horse

32
Q

How can you neutralise endotoxin before it interacts with inflammatory cells?

A

Polymixin B - binds LPS

Hyper immune plasma - has antibodies against LPS

33
Q

How can you prevent inflammatory cell activation?

A

Pentoxifylline

34
Q

How can you inhibit SIRS?

A

Flunixin

35
Q

What is a key difference between endotoxaemia in horses and foals?

A

In foals, usually associated with bacteraemia / sepsis

  • treatment - concern with nephrotoxicity therefore no polymixin B or flunixin
  • Treat with plasma and antibiotics
36
Q

Why are horses likely to be hospitalised with ACUTE diarrhoea?

A

To keep up with fluid requirements

Chronic doesn’t need as much fluid

37
Q

How is fluid managed in foals?

A

Volumes not as large as adult horses

Can give intermittent, frequent boluses, or separate mare and foal for continuous fluid

38
Q

What management consideration needs to be made when hospitalising a foal?

A

BRING MOTHER

39
Q

How could you assess whether a horse needs to be referred based on fluids?

A

In horse/foal can keep up with fluid requirements by drinking then probably can be treated at home

BE CAREFUL WITH FOALS - can deteriorate very rapidly

BVetMed3 Alimentary (16 decks)

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