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IP 11 Equine Medicine > exam 3 - the stomach > Flashcards

exam 3 - the stomach Flashcards

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1
Q

what is the basic structure and function of the equine stomach?

A

single chambered, compound stomach with 2 types of tissues lining it

fxn as a reservoir - relatively small compared to the rest of the GIT

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2
Q

what 2 types of tissue line the equine stomach?

what is the demarcation btwn them?

A

squamous epithelial tissue and glandular epithelial lining

margo plicatus btwn the 2 regions

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3
Q

what types of digestion occur in the stomach?

A

mechanical and enzymatic digestion

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4
Q

t/f

HCl is produced intermittently in the equine stomach, during feeding times

A

false

HCl is produced constantly

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5
Q

what important functions does HCl have in the stomach?

A
  • disinfection

- microbial digestion

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6
Q

what is the function of Ghrelin?

and Leptin?

A

opposing action

Ghrelin: stimulates eating in the brain
Leptin: suppresses appetite

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7
Q

t/f

there is a pH gradient/stratification w/in the equine stomach

A

true

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8
Q

what is the relative pH of the top versus the bottom of the stomach?

A 
top = less acidic [squamous epithelial lining]
bottom  = more acidic
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9
Q

where is HCl secreted from?

by what mechanism of action?

A

sec from parietal cells

via proton pump action

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10
Q

what is the proton pump that secretes HCl stimulated by?

A
  • histamine
  • gastrin
  • acetylcholine
  • prostaglandins
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11
Q

what effect does gastrin have on histamine?

what causes elevation of gastrin?

A

gastrin stimulates histamine release

gastrin is elevated by cortisol

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12
Q

what is the main inhibitor of HCl prduction?

A

somatostatin

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13
Q

what is EGUS?

what % of adult horses are affected?

A

equine gastric ulcer syndrome

common: 60-90% of adult horses

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14
Q

what populations of horses have a higher predisposition of EGUS?

A
  • race and show training horses
  • common in hospitalized horses
  • common in horses affected with colic
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15
Q

t/f

EGUS is a common primary cause of colic

A

false

umcommon primary cause of colic

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16
Q

what are common consequences of colic?

A

being held NPO
stress
drugs

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17
Q

what are 3 types of EGUS?

A
  • 1* squamous ulceration [MC]
  • 1* glandular ‘ulceration’ [2nd MC]
  • 2* squamous ulceration
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18
Q

what causes 1* squamous ulceration?

A
  • excessive exposure to HCl corrodes the lining => bile acids may play a facilitatory role
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19
Q

what causes 1* glandular ulceration?

A

breakdown of bicarbonate-rich mucus layer

may be a role of bacT also

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20
Q

what causes 2* squamous ulceration?

A

pyloric outflow obstruction => excessive exposure to HCl

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21
Q

what is ESGD?

EGGD?

A

equine squamous gastric dz

equine glandular gastric dz

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22
Q

t/f

horses often have both ESGD and EGGD as a part of EGUS

A

false

most horses have 1 or the other - NOT both

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23
Q

what are the mechanisms that lead to squamous epithelial injury?

A

minimally protected

HCl exposure from the fundus

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24
Q

what risk factors contribute to the development of squamous epithelial injury?

A
  • VFAs produced in the stomach of horses assoc with inc ulcer severity
  • pepsin maybe
  • bile salts maybe
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25
what effects might bile have on the squamous cell epithelium?
- detergent action can 'enable' H+ to gain access to intercellular squamous epithelial cellular attachments - bile may enter stomach during fasting => enterogastric reflux
26
what are the components of the glandular epithelial protection apparatus?
- bicarbonate rich layer of mucus - growth factors [epidermal growth factor] - epithelial restitution [stimulated replication] - blood flow (NO) - PGe2 - peristalsis - saliva production [buffer to acids]
27
what is the pH in the bicarbonate rich layer of mucus near the glandular epithelium?
7
28
risk factors for EGUS?
``` low forage ration intense/inc exercise high concentration ration regular / prolonged transport intermittent fasting [being fed BID] mgmt / housing change water deprivaiton weaning protracted stable accommodation stress ```
29
approximately what % of horses at pasture have EGUS? why?
11% b/c continuous flow of saliva -> bicarbonate -> growth factors
30
what effects does stabiling a horse have on chances for developing EGUS?
INCREASED chances of EGUS d/t stress and acid mobility [altered eating habits]
31
what effect does NPO for 24 hours have on horse GIT?
gastric pH drops to less than 2 squamous ulceration occurs w/in 96 hours
32
BID feeding gives horse ___% chance of developing EGUS TID feeding gives a horse ___%
BID = 75% TID = 58%
33
unavailability of water inc chances of EGUS by ___ times
3
34
why do rations with low roughage content contribute to EGUS?
- VFAs play a role [high NSC (non structural carbohydrate) rations] - low dietary fiber [cellulose]
35
what effect does high intensity exercise have on EGUS?
- dec pH to less than 4 - inc intra abdominal pressure - pushes acidic fluid onto squamous epithelium
36
t/f NSAIDs are commonly linked to EGUS
false ulcers NOT commonly linked to routine NSAID asministration
37
t/f uremia d/t kidney dz can inc risk of developing EGUS
true
38
c/s of EGUS?
- may be sub clin and NO signs - behavioral signs - poor performance - wt loss - poor haircoat - bruxism [grinding teeth]
39
what behavioral changes may occur with EGUS?
- abnormal / dec appetite ** - slow eating ** - girthing pain or stretching - abnormal attitude / personality - uncharacteristic protracted recumbency
40
dx of EGUS based on:
Hx c/s gastric endoscopy trial Tx and response
41
complications commonly assoc w EGUS?
``` aspiration pneumonia reflux esophagitis peritonitis blood loss hypoproteinemia cholangiohepatitis gastrorrhexis ```
42
when does EGUS and reflux esophagitis occur? 2* to what? c/s? prognosis?
- 2* to gastric outflow obstruction: severe acid reflux erosive ulceration - c/s: dysphagia, ptyalism, wt loss, inappetence, lethargy - more severe ulceration at gastric aspect - unfavorable prognosis - indicator of severe dz
43
what abnormalities may be seen on blood work for EGUS?
presence of inflammation
44
t/f a fecal occult blood test is helpful in Dx of EGUS?
false is unhelpful
45
what is the typical protocol for gastro-esophageal endoscopy?
- NPO at least 15 hours - restraint - twitch, stocks, experienced assistants, tranquilization - pass line NG tube - gastruc infufflation and deflation
46
EGUS Tx and Px?
risk reduction and pharmaceuticals
47
prognosis of EGUS?
- squamous ulceration tends to heal better than glandular ulcers - extensive squamous ulcers heal better than deeper focal ulcers
48
what is essential to follow up of EGUS treatment?
ENDOSCOPY
49
how to reduce risks of EGUS?
- mirrors in stables and during transport - horse feels less lonely - dec stress - provide plenty of water - promotes salivary flow - use haying nets to promote smaller feedings and foraging behavior - dec risk factors for stereotypical behavior - alfalfa for forage - offer small forage feeding 30 mins prior to exercise
50
why is alfalfa a good feed for an EGUS animal?
has high Ca - neutralizing effect on gastric acid
51
what is the drug of choice for EGUS? Tx dose? Px dose?
Omeprazole gastro gard to Tx: 4 mg/kg PO SID ulcer gard to Px: 1 mg/kg PO SID 4 wk duration
52
what is mechanism of omeprazole?
must be absorbed into circulation from duodenum / SI - circulates back and works systemically on gastric mucosa
53
what is the mechanism of action of Ranitidine for Tx of EGUS?
histamine inhibitor
54
how does sucralfate work?
promotes PGe2 production most helpful in glaudular ulcers
55
t/f antacids are effective Tx for EGUS
false right idea but you would need very large amounts to be effective
56
how commonly is Sx a Tx option for EGUS?
rarely
57
what role do oils have in Tx of EGUS?
corn oil or rapeseed oil promote PGe2 prod help gastric glanduular dz
58
EGGD is easier or more difficult to resolve than ESGD? why?
more difficult b/c does not respond as well to fast and simple Tx with omeprazole needs longer term Tx
59
how common is gastric neoplasia in horses?
RARE
60
what types of neoplasia occur in equine stomach?
gastric squamous cell carcinoma lymphosarcoma leiomyoma
61
common presentation for gastric squamous cell carcinoma?
- old horse - wretched halitosis - weight loss and inappetance d/t pain upon eating - colic: post prandial - episodes of choke
62
dx of gastric squamous cell carcinoma?
enodscopy u/s of cavities analysis of peritoneal fluid
63
what is behavior typical of gastric squamous cell carcinoma?
- may only involve the stomach - may spread to involve abdominal vescera and ascites - may spread to invade chest
64
why might a horse with gastric squamous cell carcinoma experience inc respiratory rate and effort?
if tumor has metastasized to the chest puts pressure on diaphragm
65
what causes a 1* gastric distension disorder to occur?
ingestion of fermentable food => food impaction [simple grain ingestion]
66
what causes a 2* gastric distension disorder to occur?
small intestinal obstruction
67
what might cause a gastric / pyloric outflow obstruction?
ulceration | neoplasia
68
what is a phytobezoar? clinical significance?
hair ball horses will eat whole persimmons and get a large mass of "persimmon-bezoar" in their stomach
69
in the event of a gastric distension disorder, what MUST be done? if this is not done, the patient will die.
STOMACH TUBE | necessary to relieve fluid accumulation
70
what occurs if a horse consumes too many persimmons?
foreign body mass in stomach outflow obstruction and colic spontaneous reflux common consider location and time of year for Dx / case presentation
71
dx persimmon problem?
geographic location and season first endoscopy exploratory coeliotomy
72
tx for persimmon-boezer?
Sx anecdotal - coca cola - questionable
73
t/f gastric impaction may be primary OR 2* d/t hepatic dz
true
74
what is gastric impaction?
- outflow obstruction | - risk of rupture
75
predisposing factors to gastric impaction?
dental gastritis ulceration
76
dx of gastric impaction?
difficulty passing NG tube x ray evidence
77
what is gastrorrhexis? caused by?
gastric rupture may be spontaneous or idiopathic 2* to weakness in wall or to distension potentially but invariably fatal

IP 11 Equine Medicine (10 decks)

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