Exam 1 Flashcards

Question

Lecture 3 Esophagus & Stomach

Answer 1

1. Examination 2. Definition -Choke: most frequent esophageal problem 3. Etiology -Ravenous eaters -Geriatric horses -Sedated or exhausted horses -Grain, hay, beet pulp, carrots, chewing issues, size of feed -Remove all the food after a horse has been sedated due to increased risk for choke 4. Epidemiology 5. C/S -Horse anxious -Extended neck -Nasal discharge -Coughing -Ptyalsims -Dysphagia -Distended esophagus 6. Pathophysiology 7. Dx -Clinical signs -Naso gastric tube (stops at obstruction site) -Endoscopy: not always necessary. Examine Trachea (aspiration signs) and esophagus for lesions, withdrawing scope and inflating esophagus. -Ultraound -Radiographs 8. Tx a. Remove all feed and water b. Make patient comfortable & let esophagus relax -Sedate: low head carriage to avoid aspiration c. Pass tube: up to obstruction, lavage gently (head down), track water and outflow. Gentle push Tx - variations -Wait give drugs and check back in 2-4 hrs -Sedation (alpha agonist + butorphanol) -Oxytocin -N-butylscopolammonium bromide -Tubes sizes vary -Correct dehydration -General anesthesia Aftercare -Restriction of food 48hrs -Progressive re-feed -Endoscopy of trachea and esophagus -NSAIDs and antimicrobials -Monitor for fever and other signs 9. Prognosis/complications -Excellent if no complications -Ulceration -Aspiration pneumonia -Metabolic alkalosis -Stricture -Perforation -Stomach rupture **Follow up exam**

Answer 2

1. Examination 2. Definition 3. Etiology 4. Epidemiology 5. C/S 6. Pathophysiology 7. Dx 8. Tx 9. Prognosis

Answer 3

1. Examination -40-90% exercise induced stress overexercised -Endoscopic view -Ultrasound -Nasogastric tube 2. Definition 3. Etiology ESGUS: squamous -Acidic conditions -Exercise intensity -Training, fasting, transport, stabling, time at work -NSAIDs -Dietary: grain vs. pasture Prevention -High % heals with Omeprazole -4 weeks -Add H2 receptor antagonist -Change management practices -Supplements EGGUS: Glandular -Acidic conditions -NSAIDs -Helicobacter? -Gender, trainer, no grass turn out, no roughage -Unprocessed grain, exercise **No impact of time in work** Prevention -Low % heals with Omeprazole -6 weeks tx -Doxycycline, Sulcralfate, Pectin-lecithin, Misoprostol -Supplements -Gastric hyperplasia-biopsy 4. Epidemiology 5. C/S -Colic -Poor appetite -Weight loss -Pain on tightening of girth -May or may not show clinical signs 6. Pathophysiology 7. Dx **Endoscopy** -Withhold food for 16 hours -Withhold water for 1 hour -Fecal occult blood? -Sucrose marker? 8. Tx -Proton pump inhibitors: Omeprazole for 28days -Histamine receptor antagonists: Cimetidine, Ranitidine, Famotidine Mucosal Protection -Sucralfate -Misoprostol Antiacids -Magnesium hydroxide -Aluminum hydroxide -Lidocaine if severe colic Prokinetics -Bethanecol -Metoclopramide -Erythrmycin -Cisapride **Omeprazole as prophylaxis** Gastrogard: Treats ulcers, prescription tube Ulcergard: Prevent ulcers, OTC tube 9. Prognosis

Answer 4

1. Examination 2. Definition 3. Etiology 4. Epidemiology 5. C/S -Depend on severity -Red-purple MMs -Tachycardia -Tachypnea -Colic -Abdominal distention -Severe lameness -Trembling -Sweating -Diarrhea -No intestinal sounds **Endotoxemia, Colic:gas, motility, Lameness, laminitis, flounder** 6. Pathophysiology 7. Dx -Hx -C/S -Polycythemia -Neutropenia with left shift and toxic changes -Gastric reflux -Tight bands on rectal exam 8. Tx Asymptomatic -Prevent absorption -Lavage stomach -If no reflux: 1 lb Epsom salts or 1 lb activated charcoal -Mineral oil, biosponge -Prevent endotoxemia and sequelae -1mg/kg Flunixin meglumine then 0.3 mg/kg q8hrs -Antihistamine: Diphenhydramine, Doxylamine -Remove all feed for 24hrs -Cryoprophylaxis for laminitis 9. Prognosis -Excellent if tx before C/S Symptomatic grain overload -IV fluid: hypertonic saline -Follow by polyionic -Plasma fluid -1mg/kg flunixin meglumine then 0.3mg/kg q8hr -Lidocaine (motility, analgesia, neutrophil margination) -Leave NG tube in place: receives gas, if no reflux 1/2 lb Mg sulfate, 1/2 charcoal, 1/2 gallon warm water **Polymyxin to bind endotoxin (if normal renal function)** -Pentoxyfylline -Laminitis prevention Prognosis: depends on complication present

Answer 5

1. Examination 2. Definition 3. Etiology -Primary: impaction, grain overload, water intake, air -Secondary: ileus obstruction 4. Epidemiology 5. C/S -Acute colic -Reflux -Hemoconcentration -Hypokalemia -Hypochloremia -Rupture: septic shock, pain that suddenly stops -Tachypnea, tachycardia, wearing, muscle fasciculations 6. Pathophysiology 7. Dx -NG tube -Ultrasound -Abdominocentesis -Rectal palpation 8. Tx -NG-rube -Pain medication -Euthanasia 9. Prognosis -Poor

Answer 6

1. Examination 2. Definition 3. Etiology -Unknown -Poor dental care -Grain overload -Ingestion of persimmons -Severe hepatic disease -SCC 4. Epidemiology 5. C/S -Inappetence -Acute and recurrent colic -Improves when food withheld -Worsens if refed 6. Pathophysiology 7. Dx -Gastroscopy -Ultrasound 8. Tx Type 1 -Accumulation of food, normal size stomach -Enteral fluids 1L/100kg isotonic electrolytes q2h Type 2 -Accumulation of food, increased stomach size -Add IV fluids -Prokinetics: Bethanecol, Erythromyin Type 3 -Phytobezoar (persimmon seeds) -Diet coke (>< laminitis, caffein toxicosis) -1L/hr for 1-3 days -700 ml/12 hrs Surgery 9. Prognosis

Answer 7

1. Duodenitis proximal jejunitis 2. Equine proliferative enteropathy 3. Inflammatory bowel disease -Simple obstruction

Answer 8

1. Medical -DPJ -EPE -IBD Thickening -EPE -IBD Obstruction -Ascarid -Ileal 2. Mixed issues -Ileal impactions -Ascarids 3. Surgical -Volvulus strangulation -Herniation Entrapment -Intussusception

Answer 9

Etiology -Unknown -Possible Clostridium difficile, Perfringes, Salmonella -Feeding practices Pathophysiology -Inflammation -Edema -Hemorrhage C/S -Serositis (petechia & ecchymosis) -Increased secretion -Decreased motility -Pancreas, liver involvement -Possible infection -Fever not always present -Dehydration eventually -Acute colic, depression -Tachycardia -Tachypnea **Pain wanes after NG decompression** -Depression remains Dx -Lots of reflux -NG-tube orange-brown, fetid reflux -Dehydration -Electrolyte, acid base, liver enzymes tests -Rectal palpation: multiple loops distended SI -Ultrasound: distended SI, decreased motility -Abdominocentesis: yellow - turbid (to serosanguinous) -Increased TP -Normal WBC -Acidosis -Elevated liver enzymes Tx -Reflux: NG-tube q 12hr -Fluid: correct imbalances -Combat endotoxemia + inflammation and sequelae -Benamine -Polymyxin -DMSO -Laminitis prevention -Penicillin, Metronidazole per rectum -Add gentamicin if low WBC -Prokinetic agents: Lidocaine, Metoclopramide, erythromycin lactobionate, Cisapride Response -Improves Nutrition -Avoid oral food for several days -Consider parenteral nutrition Surgery -If they are painful, costly Prognosis/Complications -Resolves if aggressive Tx -Peritonitis -Infarction -Aspiration pneumonia -Adhesions -Laminitis

Answer 10

-Weanlings -Foals -N. America: August-February Etiology -Lawsonia intracellularis Epidemiology -Disease of pigs (subclinical) -Rodent reservoir -Often no obvious exposure to pigs -Transmission: oro-fecal -Risk factor: stress Pathophysiology -Distal jejunum and Ileum -Invasion of proliferating crypts in Ileum -Excessive mitosis, hyperplasia -Thick corrugated mucosa -Decreased absorption capacity C/S -Lethargy -Anorexia -Colic, diarrhea -Concurrent disease -Peripheral edema -Protein loss Dx -Hx -PE -Hypoproteinemia <5g/dL -Hypoalbuminemia <2g/dL -Ultrasound: thickened SI, excessive abdominal fluid **PCR and Serology combine to be definitive** -PCR fecal sample or rectal swab definitive diagnosis -Serology: IFAT, ELISA, IPMA (immune peroxidase monolayer assay) -Silver stain of biopsy -Test herd mates Tx -Antimicrobials 2-3 weeks -Young: Macrolides (Azithromycin, Clarithromycin) -Older: OTC IV, then oral Doxycycline -Others: Rifampin, Chloramphenicol, Mino -Supportive colloids -Parenteral nutrition -Antiulcer -Continue until issues resolve Prognosis -Good with early therapy Prevention -Separate foals -Regular PE, TP, serological status -Pest control -Extra-label vaccine (pig vax intra-rectally)

Answer 11

**Adult horses** a. Granulomatous enteritis (GE) b. Multisystemic eosinophilic epitheliotropic enterocolitis (MEED) c. Eosinophilic/lymphocytic-plasmocytic/basophylic enterocolitis d. Idiopathic focal eosinophilic enteritis (IFEE) Pathophysiology -Intestinal thickening -Protein losing enteropathy C/S -Progressive weight loss -Intermittent abdominal discomfort -Edema Dx -Anemia -Hypoproteinemia -Umtrasound -Absorption test -Biopsy Tx -Steroids -Surgical (IFEE)

Answer 12

1. Ascarids: young horses Etiology/Risk factors -Heavy infestation Parascaris equorum -Weanling foals -Poor deworming history C/S -Untrhiftyness -Poor hair coat -Colic 1-5 days Dx -NG-reflux: may contain dead worms -Ultrasound and rectal exam: Distended SI Tx -Medical: intestinal lubricants, IV fluids, pain control. Slow onset antihelmintics (Fenbendazole - Panacur) -Surgery may be needed 2. Ileal: adults Etiology/Risk factors -Adult horses -South Eastern USA -Coastal bermuda grass hay -Tapeworms (Anoplocephala perfoliata) -Ileal hypertrophy -IBD C/S -Colic -Progressive abdominal distension -Decreased gut sounds -Rectal exam & Ultrasound Distended SI -NG reflux -Abdominocentesis normal Tx -Medical: reflux, pain control, IV fluids -Surgical: pain, changed abdominal fluid Prognosis -Good

Answer 13

Surgical Structures Not exteriorized -Stomach -Duodenum -Transverse colon -Rectum

Answer 14

-Ileal impaction (thicker, gateway to cecum, bermuda grass hay contributor) -Ascarid impaction -Duodenitis-proximal jejunitis -Foal inguinal herniation (congenital) -Intestinal hypertrophy

Answer 15

-More common in older horses >20 years old 3x more likely -Strangulating lipoma: Arabians, QH, Saddlebreds, ponies C/S -Painful -Depressed -Dead gut = doesn't hurt -Decreased GI sounds -Trauma to face due to severe pain, rolling -Dehydration -Endotoxic, MMs injected -Evidence of trauma Dx -C/S -Rectal exam: tubes 8-10 cm , distended SI, shrink wrapped colon -NG tube: reflux!! but may not show right away bc intestine is long and takes a while to get full. Blood work -Dehydration -Increased PCV/TP -Leukopenia if early endotoxemia -Increased lactate >2mmol/L -Ultrasound: >4cm diameter >4mm thick wall Abdominocentesis -Serosanguinous -Lactate >2mmol/L -TP>2g/dL Prognosis -Mid-jejunum best -Proximal ileum not best -Towards duodenum or end of helium = worst -Endotoxemia = bad -Longer affected area = worse Tx -Surgery: resection and anastomosis

Answer 16

-Space between caudate lobe of the liver, portal vein and gastropancreatic fold -Risks: cribbing -Often involves ileum = bad -Careful not to rip the portal vein, bleed out on the table

Answer 17

Congenital or acquired (trauma) -Large Intestine: interfere with respiration. Entire large colon can herniate -Small intestine: more likely to herniate -Challenging diagnosis and treatment -Radiographs -Ultrasound -Exploratory surgery: ventral tears: suture or mesh -Later laparoscopic repair if dorsal

Answer 18

-No breed or age predisposition -No need to repair rent -Enlarge it at surgery so nothing else can get trapped there

Answer 19

-Medium size (two fingers) -Strangulating intestine: painful, swollen, heat, non-reducible -Ultrasonography

Answer 20

-Foals, Racehorses, endurance horses C/S -Twisting of intestine and mesentery Tx -Resection

Answer 21

Intessusception -Ileo-cecal or jejuno-jejunal -Abnormal motility: TAPEWORMS -Surgery: resection

Answer 22

-Stallion -Tennessee walkers, Saddlebreds, Standard breeds -Unilateral -Indirect: through vaginal ring -Rectal and external palpation -ultrasonography -Surgery: resection, hemi-castration, external inguinal ring closure

Answer 23

-Enterotomy -Resection and anastomosis: jejunojejunostomy, jejunoileuostomy, jejunocecostomy. -Hand sewn end to end: Single or double layer. Member vs. Cushing Common complications -Ileus: everything backs up till the stomach, NG-tube helps relieve. Reflux -Adhesions: when excessive inflammation -Endotoxemia: laminitis **Motility affected by surgery** -SI detention: shortening of villi = increased inflammation -Loss of mesothelial cells -Neutrophil infiltration -Edema -Decreased perfusion -Ischemia and reperfusion injury: free oxygen radical formation, inflammation, motility affected -Devitalized intestine: bacterial translocation

Answer 24

-Prevalence 10-55% -Mortality 13-86% Risk factors -Increased PVC at admission -Surgery/anesthesia length -Length of resection Tx -Supportive care -Reflux regular every 2-4 hours -IV fluids, replace + maintenance -NSAIDs -Time -Prokinetics The Lidocaine Debate -Dose must be precise -CRI -Anti-inflammatory -Prokinetic? mixed reviews

Answer 25

-25% of cases -Foals at higher risk -Fibrin over damaged areas -Inadequate fibrinolysis Causes -Post-op ileus -Ischemia -Foreign material -Serosal abrasion NO DRY GAUZE -Excessive tissue handling -Large suture Tx -Re-laparotamy -Mild-manage intermitent colic -Prevention: Carboxymethycellulose, good tissue handling

Answer 26

-Lipopolysaccharide in the blood -Equidae: sensitive compare to other species -Toxic dose 2 ug/kg C/S -Mild colic -Decreased borborygmi -Restlessness -Sweating -Anorexia -yawing -Depression -Pale MMs, later brick red, purple +/- toxic line with prolonged CRT -Increased HR, RR, Temp, later decreased temp, venous filing, and pulse strength +/- Lose manure -Scleral reddening -Profound depression Systemic Inflammatory Response Syndrome -Endotoxemia is one of the triggers for SIRS -Profound neutropenia with a left shift -Hyperglycemia -Hypovolemia -Azotemia -Increased cardiac troponin -Lactic acidosis Tx -Remove the source -Prevent LPS and host infection **Polymyxin B binds and neutralizes endotoxin** -Endoserum/hyperimmunized J5 plasma - Antitoxin antibodies -Decrease inflammatory response: NSAIDs, DMSO?? -Supportive fluid therapy to prevent shock & laminitis

Answer 27

-Not completely understood why -LPS administration does not cause laminitis -Endothelial damage and direct platelet activation -Coagulopathy

Answer 28

Non-strangulating -80-90% good Intra-op -Mid jejunum 75% -Ileum <5% -Duodenum <10%

Answer 29

Large Intestine Medical

Answer 30

Impactions Diarrhea Inflammation -SI obstruction leads to reflux -LI obstruction lead to bloat, usually -High HR, dehydration, and shock = refer -Always pass a stomach tube. Reflux suggests a SI lesion. Refer -Serosanguinous abdominal fluid often indicates dead bowel. Refer -Rectals can be dangerous to both horse and veterinarian. Only do if safe and necessary. Palpate changes may include distention (gas or impaction) or displacement (spleen, guts) Review anatomy -Cecum can be auscultated in the upper right abdominal quadrant. It sound like a drain is opened or a flushing

Answer 31

1. Sand -Ventral diaphragmatic/sternal flexure 2. Pelvic flexure -Straw/hay/boredom -Lack of water 3. Cecum -Hospitalization -Typical risk factors -Tapeworms **Note: Small intestine: Ileum = Coastal bermuda hay, Ascarid: poor deworming**

Answer 32

Predisposing factors -Poor ability to chew -Coarse roughage -Decrease water intake -Decrease motility -Excessive fluid loss Clinical signs -Pain: slow onset, mild, intermittent, severe -Anorexia, abdominal distension, decreased fecal output -Heart rate varies with level of pain Typical case -Horse moved from pasture to stall -Eats excessive straw/hay -Water supply broken in winter Dx -Hx, C/S -NG-tube: no reflux -Rectal exam impaction -Abdominocentesis: normal Tx -Do not feed -Allow water if no reflux -Pain management -Fluid/laxatives: oral, water, mineral (controversial), magnesium sulfate, DSS -IV if impaction is severe 4-5 L/hr Prognosis -Good

Answer 33

Predisposing factors -Access to sandy soil -Feeding hay or grain on sandy ground -Lack or roughage -Mineral content C/S -Pain: acute, intermittent, severe or chronic -Anorexia, abdominal distension -Decreased fecal output -HR varies with level of pain -Diarrhea if chronic Dx -Auscultation sound of waves -May not find sand in feces, glove test -Rectal palpation -Ultrasound -Radiographs -Bowel necrosis possible under the weight of the sand Tx -Pain management -Fluids and laxatives -Psyllium hydrophilic mucilloid (Metamucil) 400g/500kg q6hr until resolves, then SID x7d -Water, other laxatives -Psyllium and probiotics -Limit feed -Surgical Prevention -Prevent overgrazing -Do not feed off the ground -Prophylactic psyllium (7 days q 4-12 mts) Prognosis -Good for mild to moderate -Unless intestinal wall debilatized

Answer 34

Diagnostic Approach -Hx and PE -Fecal exam -Blood and serum -Other tests -Response to treatment Infectious -Bacteria -Parasites -Viruses Non-infectious -Toxicity -IBD -Sand impaction Complications -Sepsis -Endotoxemia -Immune compromise -Superinfection -Infarction -Thrombosis -Laminitis -Coagulopathy -Inflammation -Sepsis -Impared CV function -Colitis, typhlocolitis, isolation

Answer 35

-Enveloped, ++RNA virus -Beta coronavirus 1 linked to enteric fever and diarrhea -Infection starts in SI (necrosis, sloughing villi) -Anorexia, lethargy, fever >> diarrhea, colic -Leukopenia -Hyperammonemic encephalopathy

Answer 36

2500 serotypes -S. enterica serovar typhimurium = most frequent -Risk factors: stress, carriers, surgery, broodmares, antibiotics -Zoonosis -Virulence -Spread C/S -Acute colitis -Profuse diarrhea, occasional pain or colic -Fever, tachycardia, depression, dehydration -Sepsis, shock, endotoxemia, CV shock -Vascular leak syndrome -Coagulopathy -Culture: 3-5 fecal samples 12-24 hrs apart -5-10g of feces -Mucosal biopsy -PCR screening, quatitative Tx -Fluid therapy, plasma or colloids -Flunixine meglumine -Total/partial parenteral nutritional support -Antimicrobials -Anticoagulants? Prognosis -If >10d diarrhea and sepsis = poor prognosis Prevention -Biosecurity measure -Cleaning, disinfection, isolation

Answer 37

a.k.a Equine Monocytic Ehrlichiosis -Neorickettsia risticii (obligate intracellular bacterium) -Infected trematodes -Mayflies and caddisflies -Horse ingest infected fluke larvae -Oral or water transmission -Snail 1st, Insect 2nd -June-november -Area close to river -Pasture or stable -80% of horses will nor develop clinical signs -20% will develop C/S C/S **Biphasic fever** -Diarrhea, colic, fever, anorexia, depression -Leukopenia, toxemia, hypoproteinemia -Laminitis: 30% of affected horses: may be the only clinical sign -Abortions Dx -Neorickettsia risticii PCR on fecal or blood -PCR on buffy coat of blood -Serology Tx -Antimicrobials -Oxytetracycline IV, followed by oral -Several days treatment -Fluid, plasma, colloids -Vaccination available but many different strains. Early spring and early summer

Answer 38

C. difficile -Colitis in adults -Toxin A (enterotoxin) -Toxin B (cytotoxin) -Risk: antimicrobial administration, hospitalization C. perfringes -Occasional cause of colitis -Hemorrhagic diarrhea -Sepsis -5 types (A-E) based on exotoxin -Age, environmental persistence C/S Foals -Hemorrhagic diarrhea -Sepsis -Gas and fluid filled SI Adults -Diarrhea -Abdominal discomfort -Fever -Colitis -Severe Toxic colitis -Moderate illness Dx -Culture isolation -ELISA antigen test -Extra testing required to determine if isolates are toxigenic -PCR -Toxin A/B II ELISA **Culture + PCR, Toxin-ELISA** Tx -Supportive care -Antimicrobials: Penicillin, Metronidazole, Vancomycine if resistance -Saccharomyces boulardii (yeast), probiatics -Gastro-intestinal protectants: Di-tri octahedral smectite powder (Biosponge) -Transfaunation

Answer 39

-Phenylbutazone, Flunixine meglumine C/S -Hypopotreinemia -Hypoalbuminemia -Right dorsal colitis, diarrhea, colic Dx -Ultrasound: edema RDC -Succeed fecal blood test -Rule out

Answer 40

Oral fluids -Water -Electrolytes: 30 ml of 50% dextrose, 12 g Baking soda, 10 g KCl Intravenous -Hypertonic saline: 2-4 ml/kg bolus -Follow with crystalloids (10L for each L of hypertonic) -Crystalloids: plasma-lyte, Normosol, Lactated Ringe. KCl 20-40 mEq added per L (0.5 mEq/kg/hr) -Colloids: plasma, hydroxyethyl starch (hetastarch, Penastarch) Endotoxemia -Plasma 2L -Flunixin meglumine -Polymyxin for laminitis -Pentoxifylline -Prevent founder -Prevent thrombophlebitis -Slow IV B-vitamins -Intestinal protectants -Nutrition

Answer 41

Type 1: mechanical obstruction, fecal material Type 2: dysfunctional motility Etiology -Poor dentition -Poor quality hay -Lack of access to water -Post anesthesia/hospitalization -Tapeworms -NSAIDs -Lack of exercise C/S -Reduced fecal output -Mild pain -Reduced borborygmi -Decreased cecal emptying Dx -Rectal palpation -Cecum is attached to the dorsal body wall, can not pass your hand over the cecum, helps differentiate from Left colon Tx -Some respond to medical, others need surgery **Monitor carefully for 24-36 hours if not improving with medical management, then recommend surgery** Medical Tx -Laxatives: Magnesium sulfate, mineral oil, NG-tube -IV fluids -Analgesics: NSAIDs **Be careful with Alpha2 agonists = decreased motility, may delay surgery -Prokinetic? **Neostigmine can cause too much contraction and lead to rupture** Surgical Tx -Typhlotomy "dump the cecum" -Jejunocolostomy or ileocolostomy -Can't remove the cecum, complete cecal bypass

Answer 42

a.k.a "Left dorsal displacement" -Space between the left kidney and spleen Risk -TBs, WBs, anything round barreled -Yearlings **Not seen in foals, ponies, nor minis** Dx -Mild to severe colic -Ultrasound: spleen pushed ventral, can't see left kidney -Rectal exam: feel something coursing up to the left -Can be hard with short arms Tx 1. IV phenylephrine (in saline IV slowly) and exercise 2. Fluid therapy 3. +/- Rolling (under GA) 4. Surgery: correct displacement Surgical Tx -Ventral midline laparotomy initial correction -Hand assisted laparoscopic nephrosplenic ablation -Recurrence 8%

Answer 43

Etiology -Generally associated with impaction -Risk: none specific -Recurrence more common than with other types of displacement C/S -Mild to moderate pain -Severe pain if >/= 180 degree torsion -PE paramenters WNL -Blood work: dehydration, elevated GGT (stasis in liver) Dx -Rectal palpation -Taenia palpable in the wrong direction +- impaction -Ultrasound +/- Reflux Tx -Pain management: NSAIDs, alpha-2, butophanol -Fluid therapy, enteral, IV or combination -Trocharization if surgery not an option -Aseptic prep, 14g catheter, antibiotics Sx -Pain -Deterioration of condition -Colic >24hrs -Replace colon into proper anatomic position +/- pelvic flexure enterotomy "dump" the colon empty -Lots of lavage during sx, change gloves. Two layers closure: simple continuous + Cushing

Answer 44

-Sometimes need surgery -Sand impaction, feed material, Enteroliths (always need surgery) -Pelvic flexure enterotomy Colon Torsion -The most painful colic -Rapid referral -Common in post parturient mares -Typically at the base of the cecum Dx -Hx, C/S -Elevated HR, dehydration, very painful, abdominal distension -Rectal: severe gas distension -Bloodwork: dehydration, elevated lactate -May show signs of endotoxemia Tx -Surgical -Untwist colon +/- enterotomy, +/- colon resection -Difficult anesthesia management: arterial blood pressure low, endotoxemia when un-flip colon Post-Op -Look terrible for the first 24 hrs -NSAIDs -Antimicrobial - Broad spectrum -Colloids: hetastarch, plasma -Anti-endotoxic medications, Polymyxin B, Hyperimmunized plasma, Endoserum -Lidocaine -Ice boots for laminitis Prognosis -Impactions/displacements: Good >95% -Torsions: 50/50 Post op management -Antibiotics: penicillin K (IV), or procaine (IM). -Gentamicin +/- Metronidazole -IV fluids 2x maintenance -If refluxing, need to replace that loss too -Supplementation: Calcium gluconate (23%), KCl -Colloids if TP<4 g/dL, Albumin <2g/dL -Equine plasma, Hetastarch (10ml/kg increases oncotic pressure) Monitoring -Fecal output -Pain -Feed/water intake -Watch for laminitis, diarrhea, colic signs -Reflux q2hrs -PCV/TP, CBC, Chemistry, Electrolytes -Feeding: LI = water first, grass or hay 12-18hrs later. Slow SI= water 24 hrs, feed 48 hrs, small particles, alfalfa leaves, grass best. -Exercise: Day 60-90 turn out with no forced exercise, after 90 days training if no other problems Complications -Incision dehiscence: rare. Heavy horses, older >1 yo. -Hernia: 8-10% of cases -Edema: common, drainage -Infection: 8-30% cases -Diarrhea -Peritonitis -Post operative elius (POI) -Adhesions 8-26% -Laminitis: 2-9% -Phlebitis: 3-18%

Answer 45

-Take a long time to form -Risks: alfalfa, Arabias, region -Right dorsal colon, small colon (transverse colon) C/S -Variable -Gas distension -Mild-moderate pain Dx -Often surprise at surgery -Radiographs -Continue to be painful despite medical colic treatment = referral Fecalith -Very similar to enteroliths -Can break them apart **Common in minis & ponies with colic** -May resolve medically: IV, enteral fluids, pain management -surgery: enterotomy or manual break up

Answer 46

Risk -Altered motility -Coarse feed -Poor dentition -Fall/winter not drinking **Salmonellosis** C/S -Usually diarrhea -Mild pain, then worse -Decreased manure production: 10x more likely to have diarrhea than LC impaction Dx -Tubular small colon -"wall" of manure -Blood on the sleeve, mucosal irritation -Leukopenia with left shift Tx -Medical: fluid therapy IV and oral. Laxatives, flunixin meglumine. Antibiotics if severe leukopenia, septicemia -Surgery: enterotomy or enema passing a garden hose Prognosis -Tend to develop endotoxemia, reduces prognosis

Answer 47

Intra-abdominal Abscesses -Relatively rare Etiology -Bastard strangles =Streptococcus equi -Pigeon fever = Corynebacterium pseudobtuberculosis -GI perforation -Wound -Foaling complication -Unknown causes C/S -Low grade persistent fever -Low grade chronic colic -Weight loss and decreased appetite Tx -Long term antimicrobial therapy -Drainage?? not first choice

Answer 48

Primary -Actinobacillus equuli, Strep zooepidemicus -Only one type of bacteria present Internal abscess -Strep equi subsp equi, R. equi, C. pseudotuberculosis GI perforation -Foreign body -Impaction -Multiple types of bacteria present Wound Castration -Aseptic peritonitis - inflammation Post-Op colic surgery -Increased risk with resection and anastomosis or enterotomy Neoplasia Hemoabdomen Dx -Hx of chronic low-grade colic, inappetence, depression, weight loss chronic -PE: fever, decreased motility, dehydration -CBC: chronic inflammatory leukogram -Serum chemistry: Increased SAA, chronic hyperglobulinemia -Rectal exam: may be unremarkable -Abdominal ultrasound: increased fluid, flocculent: mixed echogenicity **Fibrin "tags"** Abdominocentesis -Culture and sensitivity -Red top tube: does not have anything = culture and sensitivity -Purple top: EDTA = Cytology -Total nucleated cell count Normal <5000/uL Acute septic peritonitis: 100,000/uL After colic surgery: 150,000-200,000/uL -pH: Decrease with septic peritonitis -Glucose: decrease (consumed by bacteria) **Definitibe diagnosis and cause = surgery** Tx -Surgery? -Antibiotics -Abdominal drainage -Abdominal lavage: LRS, normal saline. Instill 10L - walk horse 20-30 minutes - open drain Prognosis -Depends on the cause -Actinobacillus equuli - favorable -Higher mortality if post op complication 56% fatal

Answer 49

GI perforation -Sick but can sometimes survive -Endotoxemia -Depends on how big of a leak (bacteria) and for how long Tx -May be able to resect leaky bowel GI rupture Stomach > Cecum > LC -Rapid onset of septic shock -Elevated HR >70, dark red/brown/purple MMs -Prolonged CRT -Hypothermic -Sweating -Shivering -Severe depression: not colicky -Rectal: free gas -Ab tap: Plant material **Euthanize ASAP**

Answer 50

Etiology -Trauma horse kick -Post-op colic: resection and anastomosis - slipped ligature -Chemical peritonitis -Increased risk of adhesion formation: mild colic, decreased PCV = pale MMs Dx and Tx as for other types of peritonitis +/- treat blood loss

Answer 51

Etiology -Palpation per rectum -Foaling trauma/dystocia -Idiopathic, tend to be transversely oriented -Risk factors: Arabians, Minis: max size 7 glove palpation. -Risk >9 yo more often Legalities -Malpractice, bad luck -Protect yourself: sedation, restraint, Buscopan or lidocaine Grades and Tx Grade 1 & 2 **Mucosa or muscular tear** -Do not rectal for 2-4 weeks -Systemic antibiotics? Trimethoprim-sulfadiazine, Ceftiofur -Laxative diet, fresh grass, pellets, bran mashes, mineral oil Grade 3 **Mucosa, submucosa, and muscularis** -Refer -Prior to referral: epidural and pack rectum -May develop endotoxemia -NSAIDs -Broad spectrum antibiotics: Penicillin, Gentamicin, Metronidazole -Suture? -Repeatedly evacuate rectum? -Surgery and pelvic flexure enterotomy -Low bulk feed and laxative diet Grade 4 -Laparotomy -Loop or end colostomy: by-pass procedures -Rectal liner: suture in a sleeve via laparotomy Prognosis -Grade 1 & 2 = excellent 93% -Grade 3 = poor -Grade 4 = Grave

Answer 52

Relatively rare Type 1 -Mucosa and submucosa: diarrhea, parasitism, rectal tumor Type 2 -Full thickness to rectal ampulla Type 3 -Rectum with small colon intussception Type 4 -Entire rectum and small colon: Foaling

Answer 53

Methods -Overdose of pentobarbital: most common -Dose 1ml/10 lbs Others -KCl: only if horse is anesthetized -Gun shot -Captive bolt -Intrathecal lidocaine (only is anesthetized) Pentobarbital 1. Premed Xylazine + Ketamine induction 2. 1ml/10lbs 3. Jugular vein catheter preferable 4. Horse falls down before entire amount is given, don't stop give the rest 5. Check for heart beat and corneal reflex. -It can take a while, be patient and let owners know

Answer 54

History and C/S -Not evident until >60-80% parenchyma non-functional -Often Acute onset Acute -Hepatic encephalopathy -Abnormal behavior -Depressed, aggressive, bizarre -Icterus -Jaundice -Unsafe to handle horse Chronic -Weight loss -Intermittent fever -Intermittent colic -Diarrhea -Ascites -Pruritus -Photosensitization

Answer 55

-Hepatic dysfunction or porto-systemic shunt -Does not differentiate acute vs. chronic failure -Behavioral changes: yawning, stridor, aimless wondering, incoordination, depression, sudden neurological behavior , blindness Pathophysiology -Neurotoxins (ammonia) -False neurotransmitters (serotonin) -Imbalance nero-transmission (GABA, glutamate)

Answer 56

Cholestatis induction Problem: biliary hyperplasia & cholestasis. High in young animals (colostrum), RACEHORSES, right colonic displacement, proximal enteritis -GGT: liver -ALP: Kidney & pancreas Cytosol leakage Problem: Acute insult, short life, not stable. Inflammation, infection, metabolic disease, toxins, neoplasia -IDH (SDH) -AST -LDH **Bilirubin direct & indirect. Bile acids, triglycerides, clotting factors, ammonia** Ultrasound -Size, location, vessel diameter, texture -Abscess, cholelithiasis, neoplasia, fibrosis -Right last rib to 10th intercostal space Liver Biopsy **Check clotting time first ** -Diagnosis and etiology (use for culture and prognosis) -Right 14th ICS (tuber coax - point of shoulder) -Ultrasound guided when possible

Answer 57

Equine parvovirus hepatitis (EqPV-H) -Acute disease -Strong association with Theiler's disease Nonprimate equine Hepacivirus (EqHV) -Not associated with Theiler's disease -Acute and chronic **USDA requires donor horses to be tested for viral hepatic diseases before products can be use/donated**

Answer 58

1. Theiler's disease -Common acute failure -Adult horses -Post-vaccinal Hepatitis -Idiopathic acute hepatic disease -Most likely EqPV-H -Transmission is unclear: product recipient -No known contact Risks: biologic product administration (TAT, other). Brood mares, recently castrated males. Season spring/summer C/S -Acute hepatic failure 2-3 months after biologic product -Anorexia -Hepatoencephalopathy -Icterus -Pica (persistent eating) -Yawning, fever, dermatitis -Weight loss, edema, icterus, ARDS -50-60% acute mortality Dx -Increased AST >1000 IU/L, LDH, SDH -Increased GGT >100IU/L, ALP -Increased total and unconjugated bilirubin, bile acids -Decreased BUN -Hyperammonemia -Increased PT, APTT -Decreased Albumin -PCR -Biopsy: hepatocyte necrosis Tx -Focus on controlling Hepaticenphalopathy -Supportive care -Dextrose, balanced electrolytes -Decrease diet protein, increase carbohydrates, sorghum, milo, beet pulp -Antioxidant and anti-inflammatory -Systemic antimicrobials -Neomycin, luctalose, mineral oil (decreases risk of HE) -Sedation -Corticosteroids -Prognosis: guarded 2. Tyzzer's disease **Foals** Etiology -Clostridium piliforme: spore forming intracellular anaerobe. Multiple strains in environment -Transmission: fecal-oral. Colonization GI tract, liver -Risks: time of the year, Spain mare on lush pasture. Resident status -Foal ingests mare's feces -Bacteria absorbed by portal circulation - liver C/S **Acute 7-42 days old foals** -Liver, intestine, heart -Septic shock and liver failure -Seizures, coma, sudden death -Leukopenia, hemoconcentration, hyperfibrinemia -Hypoglycemia -Severe acidosis -Increased IDH, AST, LDH, GGT, ALP Dx -Post mortem -Acute multifocal hepatitis, lytic hepatic necrosis, enteritis -Culture: difficult -PCR **Intrahepatocellular filamentous bacteria in silver stain Tx -Supportive care -High dose Penicillin, Gen, Metronidazole. -Septic shock parenteral nutrition Prognosis -Highly fatal

Answer 59

1. Choalongiohepatitis -Bacteremia -Ascending infection -Jaundice -Fever -Occasional colic -Anorexia Cholelithiasis -Recurrent episodes with colic and weight loss -Biliary obstructions -Liver disease **Middle aged horses** -Stasis Labwork -Increased highly GGT, ALP -Increased bilirubin, and bile acids -Inflammatory profile Ultrasound -Hepatomegaly -Bile duct dilation -Increased echogenicity -Choleliths crania-ventral part of the liver 6-8th ICS Biopsy: culture, histopath Endoscopy Tx -Long-term antibiotics -Penicillin gen 3 -Cephalosporin, TMS -Enrofloxacin + Metronidazole -DMSO 3-5 days to dissolve stones -Fluids dextrose included -NSAIDs -Bile salts -Choleithotomy, choleitoripsy -Prognosis: fibrosis, clinical signs, location 2. Pyrrolizidine toxicosis -Chronic progressive, often delayed intoxication -USA: Senecio, Crotalaria -Only eaten if sparse food or in hay, pellets -Cumulative dose -Delayed signs Pathophysiology -Pyrrolizidine alkaloid activated to Pyrrols in liver -Absorption into portal circulation then liver -Pyrrols cross-link DNA in dose dependent manner **Antimitotic, megalocytic effect** -Damage specific to prevent division of hepatocytes -Liver failure -Veno-occlusive disease -Portal hypertension C/S -Photosensitization -Liver failure -Weight loss -Icterus -Abnormal behavior -Diarrhea -Stridor Dx -Increased GGT, ALP, bile acids, bilirubin -Ultrasound: increased echogenicity -Biopsy: chronic hepatitis **fibrosis, bile duct proliferation, megalocytosis** -Run a clotting profile before doing biopsy Tx -May improve and relapse possible -supportive therapy -Pentoxifylline, SAMe Prognosis -Poor

Answer 60

-Hepatic lipidosis -Life threatening -Fatty liver and serum cloudy with lipids -High caloric need but low intake Risk -Well-conditioned, middle aged -Ponies, donkeys -Early lactation, late pregnancy Pathophysiology -Negative energy balance -Fat mobilization -Triglycerides synthesis -Secretion Very low density lipids -Fat accumulation and deposition C/S -Anorexia -Depression -Weakness -Incoordination -Diarrhea -Colitis Dx -Opaque plasma -Increased bilirubin -TG>500 mg/dL -Azotemia -Fatty liver infiltration Tx -Emergency -Treat primary disease -IV fluids -Nutritional support: enteral nutrition critical care meals MD's choice -Heparin? -Insulin - hyperglycemia

Exam 1 Flashcards

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