Esophagus-->small colon

Question 1

Anatomy of the esophagus in the horse (skeletal vs. smooth muscle location)

Answer 1

first 2/3–skeletal

last 1/3–smooth

Question 2

Why is it difficult to perform surgery on the esophagus

Answer 2

lacks a serosa which is important for closure

Question 3

most common equine esophageal disease?

Answer 3

intraluminal feed impaction (choke)

Question 4

2 most common locations for choke to occur

Answer 4

just distal to pharynx

thoracic inlet

Question 5

What should be used when lavaging an esophageal impaction?

Answer 5

Water only!!

*NEVER mineral oil due to risk of aspiration

Question 6

Most common complication associated with choke?

Answer 6

aspiration!

Question 7

3 hormones/molecules that can stimulate parietal cells to produce H+

Answer 7

1) ACh
2) Gastrin (G-cells)
3) Histamine (ECL-cells)

Question 8

Reflux is most commonly an indication of disease in which part of the GI tract?

Answer 8

Small intestine (stomach fills secondarily)

Question 9

Which stomach disease is associated with aged, male horses?

Answer 9

Gastric SCC

Question 10

3 forms of gastric ulcer disease in horses

Answer 10

1) primary squamous gastric ulcer disease
2) secondary squamous gastric ulcer disease
3) glandular gastric ulcer disease

Question 11

Which form of EGUD is common to thoroughbreds in race training (and other performance horses)

Answer 11

Primary equine squamous gastric ulcer disease

Question 12

Concerning NEONATAL foals with gastric ulcers

1) a common clinical sign
2) at a high risk for?

Answer 12

1) diarrhea

2) higher risk for perforation

Question 13

Concerning WEANLING foals with EGUD:

1) more likely to get?
2) a common clinical sign

Answer 13

1) duodenal ulceration and stricture formation

2) diarrhea

Question 14

3 goals of treating EGUD

Answer 14

reduce acid
promote healing
prevent recurrence

Question 15

4 categories of drugs indicated in the Tx of EGUD

Answer 15

1) H2 antagonists
2) proton pump inhibitors
3) sucralfate
4) antacids

Question 16

What type of diet modification should take place to prevent EGUD?

Answer 16

low carb diet, high fiber
small, frequent meals

*don’t let the stomach sit empty!!

Question 17

4 COMMON clinical signs in horses with liver disease

Answer 17

weight loss
colic (mild)
fever
icterus

Question 18

Top 4 differentials for a horse that presents with fever & colic

Answer 18

1) colitis
2) enteritis (anterior)
3) peritonitis
4) hepatitis

Question 19

Most common reason horses become icteric/have high bilirubin?
Describe the pathophysiology

Answer 19

Anorexia

uptake protein for bilirubin, LIGANDIN, becomes downregulated so the liver cannot take up as much UNCONJUGATED bilirubin as normal

Question 20

Two less common clinical signs of liver disease

Answer 20

Photosensitization

Hepatic encephalopathy

Question 21

Photosensitzation occurs when the liver loses it’s ability to clear which substance?

Answer 21

Phylloerythrin (formed from chlorophyll by intestinal bacteria)

Question 22

How can you differentiate hepatic encephalopathy from another neurological disease?

Answer 22

look for elevated GGT on bloodwork

Question 23

Which two liver enzymes are liver-specific and can be considered sensitive indicators of disease

Answer 23

SDH (leakage)

GGT (inducible)

Question 24

An increase in ____bilirubin of more than ___% can be considered specific for liver disease

Answer 24

DIRECT bilirubin (conjugated portion)

increase of 25% (or more)

Question 25

What type of diet is indicated for hepatic insufficiency treatment?

Answer 25

low protein, high branch-chain AA, high carbohydrate

Question 26

Cholangiohepatitis in horses is often secondary to?

Answer 26

a primary GI disease (anterior enteritis or ileus) that causes bile to sit in the intestine and be refluxed back into the common bile duct (taking bacteria with it)

Question 27

3 differentials for icetrus in foals

Answer 27

1) sepsis 2) neonatal isoerytholysis 3) primary liver disease

Question 28

Most common cause of liver disease in foals? Causative agent?

Answer 28

Tyzzer's disease Clostridium piliformis

Question 29

3 common clinical signs of small intestinal colic in horses

Answer 29

1) SI distension (on US) 2) reflux 3) ileus

Question 30

concerning anterior enteritis: 1) pain level 2) 2 PE findings 3) reflux present? 4) rectal findings

Answer 30

1) moderate-->become DEPRESSED when gastric pressure is relieved 2) fever, tachycardia 3) Yes; LARGE amount 4) distended, compressible SI

Question 31

Most common complication associated with endotoxemia?

Answer 31

Laminits

Question 32

Adhesions typically form within ______ following surgery (time frame)

Answer 32

3 months

Question 33

Concerning endotoxemia: 1) which part of the bacterial wall is responsible 2) 2 ways/meds to neutralize the toxin

Answer 33

1) Lipid A moiety 2) hyperimmune plasma; polymixin B * Polymixin B binds lipid A

Question 34

A foal that fails to pass it's meconium and colics in the first 24-48hrs of life may have? (name 2 things)

Answer 34

Intestinal agangliosis | Meconium impaction

Question 35

Disease where the enteric nervous system fails to develop

Answer 35

intestinal agangliosis

Question 36

Two etiologies commonly associated with ILEAL impaction

Answer 36

1) coast/bermuda hay (fine stemmed feed) | 2) tapeworms

Question 37

When viewing with US, how would an ileal impaction look different from anterior enteritis?

Answer 37

SI will be distended in both but with ileal impaction, the walls will NOT be thickened

Question 38

Why is buscopan commonly used in treatment? (i.e. what's is MOA)

Answer 38

it's a muscarinic antagonist--stops spasming

Question 39

Concerning inguinal/scrotal hernias: 1) which form is most common 2) differentiate where the intestine ends up with direct vs. indirect

Answer 39

1) indirect most common 2) indirect--ends up in vaginal tunic with the testicle direct--ends up in SQ tissue of scrotum

Question 40

Contrast acquired indirect inguinal hernias and congenital indirect inguinal hernias

Answer 40

Acquired: Adults, short nonreducible segment, strangulating Congenital: foals, long reducible segment, NEVER strangulating (no colic)

Question 41

For which 3 types of inguinal hernias is surgery required

Answer 41

1) adult-indirect 2) foals-direct 3) foals--ruptured indirect

Question 42

4 boundaries of epiploic foramen

Answer 42

1) gastropancreatic fold 2) caudate lobe of liver 3) portal vein 4) caudal vena cava

Question 43

An expected rectal finding with epiploic foramen entrapment

Answer 43

SI distension in RIGHT CRANIAL abdomen

Question 44

Common signalment for mesenteric rents in the following locations: 1) duodenal/jejunal mesentery 2) gastrosplenic ligament

Answer 44

1) periparturient, multiparous mares | 2) middle aged, QH geldings

Question 45

Which segment of bowel is typically involved with pedunculated lipomas

Answer 45

jejunum

Question 46

3 most common types of intussusception

Answer 46

1) ileocecal 2) jejunojejunal 3) jejunoileal

Question 47

Concerning adhesions: 1) acute, clinical adhesions lead to? 2) chronic, subclinical adhesions lead to?

Answer 47

1) ileus (get reflux and SI distention); need Sx | 2) mild to moderate recurrent colic; medical tx

Question 48

Differentiate the types of pain associated with: 1) anterior enteritis 2) non-strangulating obstructions (i.e. ileal impaction) 3) strangulating obstructions

Answer 48

1) moderate/severe; become DULL after decompression 2) mild/moderate; INTERMITTENT 3) mod/severe; PERSISTENT

Question 49

Which of the following would produce the most abnormal abdominocentesis: 1) anterior enteritis 2) non-strangulating obstructions (i.e. ileal impaction) 3) strangulating obstructions

Answer 49

3--strangulating obstruction

Question 50

Most commonly reported colic in horses?

Answer 50

Large colon tympany (functional--spasmodic colic)

Question 51

A common historical fact and clinical finding that would cause you to suspect right dorsal colitis

Answer 51

history of NSAID administration hypoproteinemia/hypoalbuminemia

Question 52

Concerning large colon impaction: 1) most common thing causing the impaction 2) 3 common sites for it to occur

Answer 52

1) dry/coarse ingesta | 2) pelvic flexure, RDC, transverse colon

Question 53

A common rectal finding with large colon impaction

Answer 53

doughy, indentible ingesta

Question 54

Where is the incisions made for a large colon enterotomy?

Answer 54

pelvic flexure

Question 55

Best method for detecting sand in the large colon?

Answer 55

radiographs

Question 56

Common signalment for enterolithiasis | breed, diet, location

Answer 56

arabians, on alfala diet, in florida or Cal

Question 57

With right dorsal displacement: 1) where is the colon 2) how is it oriented 3) where is the pelvic flexure

Answer 57

1) btwn cecum and body wall 2) oriented transversely 3) near diaphragm

Question 58

Absence of pelvic flexure, taut transverse bands, and an slightly elevated GGT would be indicative of?

Answer 58

Right dorsal displacement *GGT gets elevated bc RDC can kink off near major duodenal papillae

Question 59

Exception for when you would do trocarization for decompression before surgery?

Answer 59

Large colon volvulus

Question 60

Where is the colon located with left dorsal displacement?

Answer 60

nephrosplenic space (btwn kidney and spleen)

Question 61

A disease where Phenylephrine is indicated and why

Answer 61

Left dorsal displacement it's an alpha-1 agonist that can be used to shrink the spleen (give more room for colon to get unstuck)

Question 62

Concerning large colon volvulus: 1) most common site 2) direction of rotation

Answer 62

1) cecocolic fold | 2) dorsal colon will rotate dorsomedial

Question 63

A broodmare who recently gave birth presents for severe, uncontrollable colic; abdominocentesis reveals increased PCV but LOW TS...top ddx?

Answer 63

Large colon volvulus

Question 64

2 most important taenia of the cecum? Which taenia is palpable on rectal?

Answer 64

ileocecal fold (dorsal) & cecocolic fold (lateral) are most important Ventral band is palpated on rectal

Question 65

Most common disease of the cecum

Answer 65

cecal impaction

Question 66

Differentiate: 1) Type 1 cecal impaction 2) type 2 cecal impaction

Answer 66

1) true impaction--feed filled | 2) motility disorder--fluid

Question 67

3 common risk factors associated with impactions

Answer 67

1) decreased water intake 2) decrease in exercise or stall rest due to injury (pain) 3) NSAID administration

Question 68

A horse presents to you with reduced fecal output and on rectal palpation you feel firm, doughy ingesta in the right caudal abdomen. You learn the horse has been on stall rest due to an injury and is also currently on an NSAID. What is your top ddx?

Answer 68

cecal impaction

Question 69

A mare who recently gave birth presents with a dull mentation and you note abrasions around the face, her MM are hyperemic on rectal, your arm feels like it's floating & the rectum is vacuum-packed to your arm; Abdominocentesis contains plant material and intracellular bacteria... top ddx?

Answer 69

Cecal perforation/rupture

Question 70

The most common disorder of the small colon

Answer 70

small colon impaction

Question 71

Usual signalment (breed & time frame) and most common clinical sign of small colon impaction

Answer 71

miniature horses in fall and winter small volume diarrhea

Question 72

Primary concern in horses with small colon impaction?

Answer 72

Salmonella! (50% of cases shed the bacteria)

Question 73

2 common sites of small colon obstruction

Answer 73

small colon | transverse colon

Question 74

Most common cause of colic in neonates?

Answer 74

Meconium impaction

Question 75

Which method of treatment is NOT indicated for meconium impaction

Answer 75

Surgery--foals will die if you go to surgery