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Equine Med > Exam 1 > Flashcards

Exam 1 Flashcards

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1
Q

Endotoxemia (SIRS); Pathophysiology & Symptoms

A

Pathophysiology
• LPS from dead bacteria in LI -> LI damaged -> bacteria thru mucosa -> systemic inflammatory response -> systemic vasodilation-> severe hypotension-> organ failure

Presenting Sign
• Ds

Symptoms (2 or > in adult, 3 or > foal)
• Hyper/hypothermic
• Tachycardia (>52)
• Tachypnea (>20)
• Lukocytosis/penia
• Immature neutrophils

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2
Q

Endotoxemia (SIRS); Management

A

Block LPS Absorption
• Di-tri-octahedral smectite (decrease Ds, binds LPS???)

Bind LPS already in circulation
• Polymyxin B (nephrotoxic & costly)
• Hyperimmune plasma (conflicting data)

NSAIDs
• Flunixin meglumine

Lidocaine CRI
Corticosteroids (low dose)
Soft bedding (laminitis)
Cryotherapy (laminitis)

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3
Q

Hyperdynamic State of Endotoxemia

A

1st stage
o High HR and RR
o Hyperemia
o Fever

o Anorexia
o Lethargy
o Sweating
o Yawning
o Colic – ileus

o Muscle fasciculations
o Recumbency

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4
Q

Hypodynamic State of Endotoxemia

A

o Lethargy (worse)
o Anorexia

o Diarrhea

o Poor perfusion
o Thrombosis – increased bleeding

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5
Q

First thing to fail in endotoxemia

A

o Laminitis
o Kidney (obv can’t see)

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6
Q

Polycythemia; Most common symptom, causes

A

Symptom
o hyperemic MMs

Relative (common)
o splenic contraction
o dehydration

Absolute (rare)
o hypoxia
o paraneoplastic
o bone marrow over production

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7
Q

Anemia Types & Causes

A

Regenerative
• Hemorrhage
• hemolysis

Non Regenerative
• Anemia of chronic dz
• Bone marrow
• Iron deficiency
• CKD

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8
Q

Anemia; Symptoms

A

• Pale MMs
• Exercise intolerance
• Tachypnea
• Tachycardia
• Systolic murmur
• Not visible scleral vessels

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9
Q

Internal Hemorrhage; Diagnosis & Treatment

A

Diagnosis
• Check PCV
• ultrasound

Treatment
• Stop bleed (difficult in horse)
• Replace volume
• Maintain O2 carrying capacity

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10
Q

What’s different about horse bood?

A

• Rouleaux
• No reticulocytes
• Unstable PCV (due to stress)
• Yellow plasma due to chlorophyll in food
• Howell-Jolly bodies (nuclear remnants)

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11
Q

Immune Mediated Hemolysis; Causes, Diagnosis

A

Causes
• Drugs (penicillin)
• Neoplasia
• Bacterial infection
• primary

Diagnosis
• Autoagglutination
• Coombs test

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12
Q

Hemolysis; Intra Vs Extravascular

A

Intravascular
• Hemoglobinemia
• Hemoglobinuria
• Increased unconjugated billirubin

Extravascular
• Increased unconjugated billirubin

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13
Q

Immune Mediated Hemolysis; Causes, Diagnosis, Treatment

A

Cause
• Drugs (penicillin)
• Neoplasia
• Bacterial
• autoimmune

Diagnosis
• Autoagglutination
• Coombs test

Treatment
• Discontinue current medications
• Treat underlying problems
• Corticosteroids
• Blood transfusion
• Diurese (intravascular hemolysis)

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14
Q

Oxidative Hemolysis; Causes, Diagnosis, Treatment

A

Cause
• maple leaf toxicity
• pistacia leaves

Diagnosis
• Presence of Heinz bodies
• Blood methemoglobin levels high

Treatment
• Maintain oxygenation of tissues (monitor resp rate, peripheral perfusion)
• Protect kidneys
• Prevent further toxin absorption

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15
Q

Equine Infectious Anemia; cause, clinical finding, diagnosis, epi

A

Cause
• Retrovirus in lentivirus family
• Carried by horseflies

Clinical Finding
• Hemolytic anemia

Diagnosis
• Coggins test
• ELISA assays

Epi
• Infected for life
• Inapparent carriers
• No Vx available
• (+) horses can’t move interstate

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16
Q

Equine Piroplasmosis; cause,s clinical finding, diagnosis, treatment

A

Causes
• Babesia caballi
• Theileria equi
• Carried by Ixodid tick

Clinical Finding
• Hemolytic anemia
• Fever
• icterus

Diagnosis
• organism in RBCs

Treatment
• Imidocarb

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17
Q

Anemia of Chronic Dz; Pathophysiology, Clin Path, Treatment

A

Pathophysiology
• sequestration of iron by chronic dz

Clin Path
• normocytic normochromic nonregenerative
• PCV usually not below 20%

Treatment
• Treat underlying dz

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18
Q

Clin Path of Chronic Infection

A

• neutrophilia
• monocytosis
• thrombocytosis
• hyperfibrinogenemia
• hyperglobulinemia
• normocytic normochromic nonregenerative anemia

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19
Q

Immune Mediated Thrombocytopenia; What is it? Types, Diagnosis, Treatment

A

Increased Platelet Destruction

Types
• Primary (autoimmune)
• Secondary due to infection, drugs, toxins, neoplasia

Diagnosis
• Flow cytometry

Treatment
• Treat underlying cause

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20
Q

Equine Anaplasmosis; What is it? Cause, Carrier, & Symptoms

A

Increased Platelet Destruction

Cause
• Anaplasma phagocytophilum

Carrier
• Ixodes tick

Symptoms
• Fever, icterus, ataxia, ventral edema, epistaxis
• Thrombocytopenia, anemia, leukopenia

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21
Q

Equine Anaplasmosis; Diagnosis, Treatment

A

Diagnosis
• Morulae in granulocytes
• PCR (early/late stages)
• Indirect fluorescent Ab test

Treatment
• Oxytetracycline 5-7d
• Self-limiting
• Supportive care

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22
Q

DIC; What is it? Causes, Pathophysiology

A

Increased Platelet Utilization

Causes
• SIRS/endotoxemia (main)
• Retained placenta or fetus
• basically any sever dz

Pathophysiology
• Activation of coagulative & fibrinolytic systems

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23
Q

DIC; Symptoms, Treatment

A

Symptoms
• Thrombosis after venipuncture
• Petechial, echymoses, epistaxis
• Organ dysfunction; renal or laminitis

Treatment
• Treat underlying cause
• Supportive care

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24
Q

Where to collect bone marrow sample in horses

A

• sternum
• tuber coxi

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25
Lymphosarcoma Epi, Clin Path
Epi • One of the most common internal neoplasms of horses • Common in YOUNG and middle-aged horses
 Clin Path • Anemia 
 • Increased fibrinogen 
 • Immune-mediated anemia /
thrombocytopenia 
 • Hyperglobulinemia • Increased liver enzyme 
activities 
 • Hypercalcemia - uncommon 
 • IgM deficiency - uncommon 
 • Lymphocytic leukemia – rare 
 • Serum thymidine kinase (sTK) activity
26
Lymphosarcoma; Symptoms, Diagnosis, Treatment
Symptoms • Depression 
 • Anorexia, weight loss 
 • Lymphadenopathy (rare) • Ventral 
edema 
 • Fever 
 • Respiratory distress 
 • Colic, diarrhea 
 • Pallor 
 • Mass on rectal exam 
 Diagnosis (difficult) • Biopsy of affected tissues
 • Serum thymidine kinase (sTK) activity? Treatment • Usually not economically feasible
 • Some chemotherapy regimens • transiently responsive to steroids
27
Whats different about cutaneous lymphoma?
• Often slowly progressive, may 
wax and wane 
 • May show improvement when 
mares become pregnant • At least one case resolved after surgical removal of a 
granulosa thecal cell tumor 

28
Pigeon Fever; Cause, Types, Transmission
Cause • Cornybacterium pseudotuberculosis Types • Lymphangitis • Classic (abcess usually on chest/midline) • Internal Abscessation Transmission • Organisms in soil gain entrance through breaks in skin • Possible insect vectors 
 • Possible relationship to midline 
dermatitis 
 • Higher incidence in dry areas, late summer 

29
Pigeon Fever; Symptoms, Diagnosis, Treatment
Symptoms • Edema, abscess (pectoral, inguinal, internal) 
 • Lameness 
 • Fever, anorexia, weight 
loss 
 • chronic inflammation blood panel Diagnosis • culture of aspirate • serology Treatment • Drain the abscess if possible 
 • NSAIDs 
 • Antibiotics for internal 
abscesses
30
3 Phases of Fluid Therapy
Initial • Resuscitation
 • Treats hypovolemia (7-8%) • 4-6ml/kg Hypertonic saline bolus • follow w/ crystalloids Second • Rehydration
 • Treats dehydration Third • Ongoing losses • Maintenance Fluids – crystalloids low Na/Cl & high K/Mg/Ca
31
Levels of Dehydration & Signs
5%-7% • tacky MMs • slightly tachycardic 8-10% • pronlonged refill time • etc >10% • prune • severe
32
Calculate Fluids Needed
o Deficit = BW (kg) x estimated % dehydrated o Shock dose = 20ml/kg in 1st hour o Ongosing losses = total volume of deficit given over 24hr o Maintenance = 40-60 ml/kg/day (often 25L/day or 1L/hr)
33
Reasons for Low Ca, symptoms, and how to Supplement in Fluids
Reasons for Low (Ca • Anorexia, exercise, cantharidin toxicity, etc. Symptoms • Ileus, tremors, muscle fasciculations, etc. Treat • Ca gluconate in crystalloids • ionized Ca
34
Non-Infectious Causes of Ds
NSAIDs • R dorsal colitis or colitis • Due to decrease pf prostaglandins ANY antibiotics • Especially Clindamycin, macrolides Sand Etc, etc, etc
35
Causes of Infectious Ds
• Salmonella enterica • Clostridium difficile • Neorickettsia risticii (Potomic Horse Fever) • Equine Corona Virus
36
Salmonella enterica; Bacteria, Epi, Diagnosis, Treatment
gram (-) Epi • Fecal-oral • Zoonotic • Healthy shedders Diagnosis • signs + • culture x5 OR • PCR x 3 Treatment • Supportive care
37
Clostridium difficile; Bacteria, Epi, Diagnosis
gram (+) Epi • caused by Antibiotic use or stress • Healthy carriers • Not contagious Diagnosis • Evidence of Toxin A & B
38
Neorickettsia risticii (Potomic horse fever); Bacteria, Epi, Common Symptoms besides Ds, Diagnosis, Treatment
gram (-) Epi • Horse eats infected water bug when grazing wet areas Symptoms • neutrophilia • laminitis Diagnosis • PCR of feces • PCR of whole blood Treatment • Oxytetracycline IV 3-5d • Supportive care
39
Equine Corona Virus; Epi, Common Symptoms besides Ds, Diagnosis, Treatment
Epi • RNA virus • Fecal-oral Symptoms • fever • anorexia • lethargy Diagnosis • Fecal PCR Treatment • Supportive Care
40
Colic; Where, What else presents like colic?
o GI o Liver o Reproductive tract Colic like • Rhabdomyolysis • Laminitis • Pleuropneumonia • Nero dz
41
How many colics resolve or continue after Tx?
o 85-90% resove o 10-15% need additional dx or surgery
42
First things to do when a colic comes in
Transrectal palpation (1st if not painful) • Use restraint • Sedate w/ Xylazine & butorphanol IV or Detomidine IV • Buscopan relaxes rectum • Should feel cecum on R, and colon on R • Should not feel SI Place nasogastric tube (1st if painful or HR > 60bpm) • Since horses can’t vomit • Sedate to help swallow • Check for reflux • Use fluids
43
Expected Values for Abdomenocentesis
• Protein <2.5g/dL • WBC <5000/uL • Lactate <2mmol/L (shows eschemia if high)
44
L Dorsal Displacement; basics, treatment
o Often felt on transrectal palpation btwn spleen & kidney Treatment • Phenylephrine IV + trotting • Surgery last resort
45
R Dorsal Displacement; basics, treatment
o Left colon moves to the R o Transrectal palpation Tx • Give enteral fluids • Surgery
46
Enteroliths; reasons for & Treatment
o Horse in CA or SW US o Eating alfalfa o Need sx
47
Sand/gravel colic; symptoms, diagnosis, treatment
o Sounds like ocean waves o +/- Ds o SIRS Diagnosis • Abdominal rads Treatment • Surgery
48
Prognosis for Surgical Colics
o Large colon displacement or impaction: 95% o Small colon Good if no mucosa compromise o Abdominal hernia worse prognosis o All need 3 mo rest/recovery
49
Small Colon Impaction; causes, secondary issues, treatment
Causes o usually fecalith or enterolith Secondary Issues o large colon distension o pressure necrosis Treatment o +/- surgery o Transrectal fluid therapy
50
Transrectal Fluid Therapy
o Stallion urinary catheter o Same CRI setting as nasogastric tube o Hard to keep in place
 o Max 2L/h
 o Plain water ONLY
51
Reasons for Distended Small Intestine
West coast • usually strangulating lesion like lipoma East coast • could be strangulating OR • anterior enteritis (inflammation)
52
Signs of Anterior Enteritis Vs Strangulating Lesion
Anterior Enteritis o Large amounts of orange reflux o Colic improves post reflux o SIRS o Febrile o Dilate +/- thickened small intestine o Abdomenocentesis w/ Protein >5 and high WBCs Strangulating o Small amount black/fetid reflux o Colic doesn’t resolve post reflux
53
Treatment for Small Intestine Strangulating Lesion Post Surgery
o Gentamicin – gram (-) aerobic o Penicillin – gram (+) anaerobic o Fix hypovolemia o Feed VERY slowly o Anti-inflammatory dose of steroids if VERY painful o 6/10 horses go home
54
Was Severely painful -> No longer painful but high HR/RR; What is it? Diagnosis
o Abrasions on body and head USUALLY = strangulating lesion o No more pain due to rupture from strangulating lesion o Must euthanize Diagnose rupture • Abdomenocentesis – will see neutrophils/cells on cytology • Exploratory laparotomy to take a look
55
Peritonitis; Diagnosis, Treatment, Secondary Issues
Abdomenocentesis shows • High protein • Very high WBCs • +/- Degenerative neutrophils Treatment • Gentamicin – gram (-) aerobic • Penicillin – gram (+) anaerobic • Metronidazole – for the anaerobe bacteroides • NSAIDs Secondary Issues • Adhesions • ileus
56
Common Causes of Colic
LC o Impactions o Displacements o Sand – enterolith o volvulus SC o Impactions (enteroliths, fecalith) o strangulation o anterior enteritis
57
Squamous Ulcer Symptoms, Pathophysiology, Predisposing Factors
Symptoms o Often asymptomatic o Colic quickly post eating o Poor appetite o Weightloss o Common in performance horses Pathophysiology o Squamous fundus not protected from acid Predisposing Factors o Fasting o Intermitting feeding o High grain diet o Exercise
58
Glandular Ulcers Predisposing Factors
o Foals > adults o Decreased blood flow to gut o Decreased mucus & HCO3 o Use of NSAIDs -> decrease PgE2 o Stress (corticosteroids) -> decrease prostaglandins
59
Diagnose Gastric Ulcers
o Gastroscopy (expensive) o Fast ~18hrs o Withhold water ~4hrs o Sedate
60
Treatment of Squamous Ulcers
Omeprazole (Gastrogard ONLY) • PO 30 min before feed Q24 for 28d • Takes ~3ds to start working • Decrease dose gradually Sucralfate to coat ulcers • Q 6-8hrs for first few days
61
Treatment of Glandular Ulcers
Misoprostol (PgE1 analog) • PO Q8h for 28d Sucralfate to coat ulcers • Q 6-8hrs for first few days
62
Symptoms of Gastric Ulcers in Foals
o Bruxism o Foaming
 o Poor growth o Dull haircoat o Colic
63
3 Potential Phases of Dysphagia
pre-pharyngeal • show quidding (blobs of chewed food coming out of mouth) • increased salivation • problems w/ prehension pharyngeal or esophageal • cough • food/water from nostrils • gagging • anxious • neck extension • out of the nose
64
Neurologic Dysphagia
Sensory loss Forebrain dz (yellow star thistle, viral encephalitis etc) Peripheral Damage - Cranial nerves • VII – prehension • V – mastication • XII – bring to back of throat
65
Diagnosis of Pre-pharyngeal Dysphagia
o Oral exam o Upper airway endoscopy o Serum selenium (for white muscle dz) o Equine protozoal myeloencephalitis (EPM) serology o Radiographs (metallic foreign body) o Ultrasound (masses & lymph nodes)
66
Treat Esophageal Dysphagia (choke)
SEDATE 1st • Detomidine IV • +/- Butorphanol • relaxation & analgesia • head down oxytocin or Buscopan to relax smooth muscle in lower esophagus Nasogastric tube • Assess distance • Flush carefully to dislodge Assume they have aspiration pneumonia
67
No luck Unchoking?
• IV fluids • Sedate w/ 1ml detomidine IM • Flunixin meglumine after rehydration • NPO • No bedding
68
Treat Aspiration Pneumonia During Choke
Broad spectrum antibiotics • Metronidazole per rectum (2x dose) AND • Ceftiofur IV OR • K-penicillin + gentamicin IV (nephrotoxic & expensive) Thoracic ultrasound & bloodwork
69
Post Choke
o Re-scope to assess mucosa damage o Don’t feed at first o Soup -> pellets -> slow feeder o NSAIDs o Sucralfate
70
Reasons for Ptyalism
o Pain 
 o Foreign body 
 o Mucosal ulceration 
(Vesicular stomatitis, Awns) o Slaframine
71
Why do Fresians choke?
look for megaesophagus!
72
Manage Weightloss
• Feed alone • Feed in a bowl (so they’re not eating dirt) • Give pelleted feed (senior feed not carbs) • supplement fat (oil or calorie powder)
73
Causes of Weightloss
o Teeth o Diet o Parasites (often small stongyles)
74
Lawsonia intracellularis Basics & Clinical Signs
o Equine proliferative enteropathy o G- intracellular obligate o Fall and winter
 o Fecal - oral o Weanlings (< 1y)
 o Can be deadly o Slow to grow Clinical Signs • Fever • Anorexia • Low albumin (edema) • +/- Ds • neutrophilia or penia • weight loss
75
Lawsonia intracellularis Diagnosis & Treatment
Diagnosis • Fecal PCR Treatment • Oxytetracycline IV • Oncotic support (plasma or hetastarch IV) • Supportive care
76
Normal TPR Horses
Temp • 99-101 HR • 28-44 RR • 8-20
77
Symptoms of Liver Dz
o General signs o weightloss o Photosensitization o Hemolysis o Edema o PU/PD o Hepatic encephalopathy o Icterus
78
Hepatocyte Enzymes Vs Biliary Enzymes
Hepatocyte Enzymes o ALT o AST o LDH o SDH (MOST specific in horses for hepatic Dz) Biliary Enzymes o ALP (growing horse, GI dz) o GGT (MOST specific in horses for biliary Dz)
79
Tests for Hepatic Function
o Increased Bile acids o Increased Bilirubin conjugated o BUN (down) / ammonia (up) o increased PT PTT o Hyperglobulinemia
80
Reasons for Elevation of Unconjugated Vs Conjugated Bilirubin
Unconjugated • Hemolysis • Anorexia (most common) • Drugs • Acute hepatocellular dz Conjugated • More reliable indicator of hepatic dz • Detectable in urine
81
Balance of BUN & Ammonia
o Ammonia from protein digestion is converted to urea by the liver 
 o liver dysfunction -> Decreased BUN
+ Increased ammonia o No correlation between blood ammonia and severity 
 o Increased ammonia not specific for liver disease 
(can increase in colonic dz)
82
What can be seen on Hepatic Ultrasound
o Tissue homogeneity o Masses o Bile duct abnormalities o L side you can see liver & spleen together
83
Liver Biopsy
o MOST specific diagnostic for liver dz o Can be done blind or through US
84
Poor Prognostic Indicators for Liver Dz
Liver Biopsy o Sever fibrosis o Severe biliary hyperplasia o hepatoencephalopathy o intravascular hemolysis o coagulopathy
 o marked weight loss o decreased albumin + increased globulins
85
Stages of Heptoencephalopathy
o Mild confusion, decreased attention, irritability -> o Drowsiness, lethargy, disorientation 
-> o Somnolent but rousable, occasional aggressive uncontrolled behavior -> o Coma 

86
Treatment of Hepatoencephalopathy
Decrease absorption of toxic metabolites • Mineral oil • Activated charcoal • Lactulose or neomycin as LAST resort Low protein/high carb diet • Best to keep them eating BUT • BCAAs • Beet pulp • Sorghum • Oat or grass hay Support • IV fluids w/ B vits • Avoid drugs that require hepatic metabolism/excretion • NSAIDs • Vit K (coag issues) • Avoid sunlight
87
Cholelithiasis Treatment, Prognosis
Treatment • Long-term antimicrobials (gram -) • Pain management (NSAIDs) • DMSO to dissolve Ca bilirubinate stone? • Surgery if common bile duct is occluded Prognosis • Dependent on hepatic fibrosis, clinical signs, number of choleliths • 77-85% survive w/ treatment
88
Pyrrolizidine Toxicity Presenting Signs
• Acute hepatic necrosis, signs rapidly progressive • Liver dz • Megalocytosis & fibrosis of liver
89
Theiler's Dz Presenting Signs, Cause
Presenting Signs • Acute hepatic necrosis, signs rapidly progressive • Usually adult horses 
 • Most affected horses die 
 Cause • Equine-origin biological 4-10 weeks prior to 
onset 
 • Usually tetanus anti-toxin • Associated w/ equine parvovirus hepatitis
90
Hyperlipemia Basics, Predisposing Factors, Clinical Signs
o Ponies & minis o Relative insulin insensitivity o Usually young Predisposing Factors • Pregnancy • Dz • Parasitism • Pituitary dz Clinical Signs • Icterus • Anorexia, weakness • Severe depression
 • Ataxia
 • Diarrhea, mild colic • Fever • Dependent edema
91
Hyperlipemia Diagnosis, Treatment, Prognosis
Diagnosis • Stressed pony or Miniature horse
 • Hyperlipidemia – TG <500 mg/dl
 • Hyperlipemia – TG >500 mg/dl • Opalescent plasma
 • Increased liver enzyme activity • Check serum creatinine, electrolytes Treatment • Treat hepatic disease • Improve energy intake and balance
 • Eliminate stress or concurrent disease • Inhibit fat mobilization from adipose tissue w/ insulin • Increase triglyceride uptake by tissues w/ heparin Prognosis • Mortality in 60-100% 
 • Death often results from underlying disease 
 • Most Minis w/ triglyceride <1200 mg/dl survive

Equine Med (3 decks)

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