Horse Flashcards
(20 cards)
COLIC BY SIGNALMENT # AGE # REPRO STATUS # GEOGRAPHY # FEBRILE COLIC
# AGE Young - meconium impaction - atresia coli - Enteritis - Ascarid impaction, intussusception
Old
- Benign: lipoma
- Malignant: lymphoma, adenocarcinoma
- Poor dentition causing impaction
REPRO STATUS
Stallion
- Testicular torsion
- Herniation
Broodmare
- > Pregnant
- foal movement - mild colic
- foaling / abortion - vaginal discharg/open cervix
- uterine torsion - DGx rectal - Tx surg (standing flank lap / midline coeliotomy) or rolling under GA
- > Recently foaled
- uterine artery rupture - CSx mod-sev colic, CV compr - Tx sed, nsaid, tranexamic acid, blood transfusion
- dmg to uterus (tear/fluid) -> peritonitis CSx mild colic, febrile - DGx abdotap - Tx surg drainage & lavage
- dmg to GIT -> peritonitis w endotoxaemia - Tx euth
- (3 MONTHS) LARGE COLON VOLVULUS - CSx mod-sev colic, CV compr, abd distension - Tx surg emergency
GEOGRAPHY
Sand impaction - WA/SA
* DGx sea washing over sand on ausc, sand in manure
* Tx feed off ground, drench w psylium
Enterolith - WA/QLD/NSW
- obstr in LI
- Tx surg removal
HENDRA VIRUS - QLD/NSW
- Flying fox -> horse 100% death but x horse to horse -> people via blood & mucus
- CSx resp depression, ataxia, colic
- Tx vacc status, PPE
Swim colic
- severe colic within 30m of swimming
- Tx nsaids + sed + NGT OR surg
# FEBRILE COLIC Bacterial * Colitis - Clostridial / salmonella * Anterior Enteritis - Clostridial * Peritonitis (A equuli) w GI catastrophe (mixed)
Viral - Hendra
ACUTE COLITIS # Adult horses
Disruption of mucosa & normal flora -> malabsorption, hypersecretory, inflammatory
# ADULT HORSES DDx * Salmonella * Clostridial difficile / perfringens * Antimicrobials assoc * Grain overload -> diarrhoea, SIRS, laminitis * Peritonitis - GI perforation / septic / A equuli - DGx US, Abdotap * Nsaid toxicity at RDC * Mass emergence of cyathostomes
Complications
- SIRS dt endotoxaemia
- Laminits
- Thrombophlebitis
- Hypertriglyceridaemia
- Rectal prolapse
Treatment
- Isolation
- Supportive - IV fluids
- anti-inflam
- Tx laminitis - ice boots, impression material
- Anti-diarrhoea - di-tri-octahedral smectite
- Analgesia - lidocaine / butorphanol / Nsaids (except RDC)
- Anti- endotoxic - plasma, polymixinB, pentoxyfyllline, flunixine (not RDC)
Preventative
- Isolation
- Avoid mixing w cattle
- Feed roughage
- Avoid antimicrobial
ACUTE COLITIS # FOALS
# FOALS - get bacteriaemia !
DGx
- CBC & Biochem
- USx
- Faecal - salm, clos, rota, crypto, rhodo
DDx
- Salm
- Clos
- Rotavirus
- TMx carrier, foals, fomites
- malabsp + hypers -> 2ndary lactase def -> watery, yellowish/green diarrhea w/o smell
- DGx virus isolation / EM of tissue / faecal, ELISA
- Tx supp + lactase
- Crypto
- ZOONOSIS
- DGx acid fast stain of faeces
- Tx supp (self-limiting)
- Nutritional usu orphan foals - feeding Mx
- Foal heat diarrhea (first week)
- Sepsis, NE - Tx primary prob, supp
- > Older foals (6weeks - 6 months)
- Rhodococcus
- pulmonary abscess, ulcerative colitis
- DGx TTW, RG/US, faecal culture & PCR
- Tx rifampin+ macrolide, supp
- PVx hyperimmune plasma, minimise dust, separate
- Intestinal parasite
Tx
-Isolation
-IV crystalloids fluids
-Plasma
-Broadspec AM - ceph 2/3 gen, peni + aminogly + metronidazole if Clost
Gastroprotectants - omeprazole
-Anti-diarrhoea - Di-tri-octahedral smectitie, bismuth salicyalte
PVx: adequate colostrum, hygiene & biosecurity
CHRONIC DIARRHOEA
CSx
- chronic diarrhoea w wt loss
- ventral oedema
DDx
- RDC dt NSAID
- Sand enteropathy
- Cyathostomiasis
- IBD
- Alimentary lymphosarcoma
- Equine proliferative enteropathy (Lawsonia intracellularis)
CHRONIC DIARRHOEA
DDx
RDC
- Nsaid toxicity -> cox 1 inhibitor -> ulcerative colitis (RDC, stomach) & renal dz
- DGx CBC, USx
- Tx
- avoid nsaid
- fluids
- misoprostal, omeprazole, sucralfate
- low roughage
- PVx
- monitor TP
Sand enteropathy
- feed on bare ground w minimal veg -> sand accum causing inflam
- DGx ausc, sand test, RGR
- Tx
- feed off ground
- psyllium
- enterotomy
Cyathostomiasis
- DGx hypoproteinaemia, FEC
- Tx FBZ or moxi
- PVx good deworming protocol
IBD
- DGx glucose absorption test, US, biopsy, Abdotap
- Tx corts
ALS
- CSx enlarged mesenteric LN
- DGx & Tx = IBD
EPE
- dt lawsonia intracellularis in weanling foals
- DGx faecal PCR, serology, US
- Tx
- supp
- oxytet
- macrolide + rifampin
Parasitic
CSx poor hair coat, body condition, diarrhoea, ventral oedema -> colic, wt loss, failure to thrive or vague (PP)
DDx?
DDx
- large strongyles
- small strongyles
- ascarids
- cestodes
- gasterophilus / bots
- strongyloides westeri
- oxyuris equi
DGx
* Hx - what dewormer? when? FEC?
Parasite
DDx
Large strongyles / strongylus sp
- adult & larvae pathogenic
- Tx FBZ, moxidectin, ivermectin kill migrating larvae
Small strongyles / cyathostomes sp
- adult non-pathogenic but mass emergence of EL3
- Tx FBZ & moxidectin (EL3!!)
Ascarids / Parascaris equorum - YOUNG
- migratory larvae affect liver & lung + SI impaction, colic, rupture
- Tx FBZ, ML
Strongyloides westeri
- L3 in milk -> diarrhoea in foals
- Tx deworming mares
Oxyuris equi / pinworms
- eggs in anus -> irritation, rubbing
- Dx sticky tape
- Tx Broadspec anthelmintics
Dictyocaulus arnfieldi / lungworm
- ingested L2 -> lungs -> coughing
- Tx ML, avoid donkeys (carriers)
Cestodes / Anoplocephala perfoliata
- at ileocaecal valve
- DGx faecal float w saturated sugar, proglottids
- Tx praziquantel, pyrantel
Gasterophilus intestinalis / nasalis / bots
- Tx ivermectin, moxidectin, fly control
Mx of anthelmintics resistance
- Goal: Control disease, prevent resistance & pasture contamination
- FEC at ERP + 4 weeks
- Diff natural immunity -> low / mod / high contaminators
- Save refugia by deworming high shedder (>500epg) & x removing all encysted larvae
- Drug choice:
- FBZ, OxiFBZ, OxFBZ, Pyrantel - adults
- Ivermectin - unencysted larvae
=> Prevent pasture contamination - Dosing interval - Do FEC -> deworm -> FEC in 2 weeks -> should reduced by >90%
- Use effective drugs or avermectins only
- Seasonal deworming
- Reduce larval numbers by pick up manure every 3-5 days
- Education
Kidney Disease
CSx:
- PUPD / oliguria / anuria
- inapp, lethargy
AKI
- Dt ATN from toxic insult or ischaemia
- Drugs eg aminoglycosides or nsaids
- Pigment nephropathy eg Hb, Myoglobin
- Oxytet
- DGx CBC, Ux
- Tx fluids, monitor
- PVx monitor if nephrotoxic drugs, slow w fluids avoid consc days oxytet
CRD
- reduced GFR dt chronic interstitial nephritis, proliferative glomerulonephritis, pyelonephritis
- DGx CBC, Ux, US, biopsy, cystoscopy & C&S
- Tx
- fluids + salt
- diet - low protein
- pyelonephritis - prolonged ABs or nephrectomy
Haematuria
Idiopathic
- DGx by exclusion, cystoscopy, US
- Tx supp
Neoplasia
- Renal - adenocarcinoma
- Bladder - TCC, SCC
Cystic calculi
- haematuria after exercise
- DGx rectal palp, US, cystoscopy - single large spiculated CaO
- Tx - fragmentation & surg removal
- PVx - grass hay diet, urinary acidification w ammonium chloride, water + salt
Urethral haemorrahge
- haematuria at end of urination / ejaculation, haemospermia
- DGx cystoscopy
- Tx resolve, partial urethrostomy
URINARY INCONTINENCE
DDx
Cystic calculi
Sabulous urolithiasis
- dt bladder paralysis
- DGx rectal palp, US, cystoscopy
- Tx catherisation & lavage
UTI
- predisp by bladder stasis -> dysuria / stranguria / pollakiuria / incontinence
- DGx Ux C&S
- Tx ABs
Neuro
- LMN lesions dt EHV1 myelitis, cauda equina neuritis
- UMN lesions
ANAEMIA
DGx approach?
DDx for internal / external haemorrhage?
Urogenital haemorrhage - CSx? Dgx? Tx?
Haemorrhagic anaemia
- Acute blood loss - DDx? CSx? Tx?
- Chronic blood loss - DDx?
Haemolytic anaemia
- > Extravascular haemolysis
- IMHA - Cause? DGx? Tx?
- NI - Cause? DGx? Tx?
- > Intravascular haemolysis
- Heinz bodies anaemia - Cause? CSx? DGx? Tx
- Bacterial infections -> haemolysins eg Staph aureus
Inadq rbc production
-> Anaemia of chronic Dz
Urogenital haemorrhage
- Tx
- IVFT
- ABs
- NSAIDs
- Antifibrinolytic (formaline / tranexamic acid / aminocaproic acid)
- Blood transfusion - reason for & against? max volume? Formula?
JAUNDICE / HYPERBILIRUBINAEMIA
DDx
Liver Dz
# Pyrrolizidine toxicity
- cause? csx? dgx? tx?
NI
- Cause? DGx? Tx? Pvx?
- Fasting animals
- Pre / hepatic / Post
- Intravascular vs extravascular
NI
CSx Hyperbilirubinaemia, Hbaemia/uria, Inflammatory leukogram
APPROACH TO COLIC
How to manage rectal tear during rectal palp
MEDICAL COLIC
- Hypermotility
- Hypomotility -> large colon impaction
- GI ulceration
Referral
SURGICAL COLIC
- differentiate strangulation vs non-strangulation & SI vs LI -> DDx
CSx Approach Mild Moderate Severe
Rectal tear - mucosa only or + underlying structure
Hypermotility
- spasmodic colic but otherwise well
- Tx buscopan + NSAIDs
Hypomotility -> large colon impaction * CSx - reduced manure, rectal palp * DGx * Aetx diet (high carbs, low fibres), poor fluid intake, poor dentition / fibrous feed * Tx - nsaids - enteral fluid by NGT - Na bicarbs/KCl, oils, epsom salt - IV fluids - address RF -- dietary (70 fibres / 30 carbs & gradual introduction & avoid sudden change) -- intensive / no exercise -- parasitism -- lack turnover -- stress DDx: caecal impaction * CSx - sudden chg in mx, hospitalised for ortho * DGx * Tx surg
GI ulceration -> colic or PP
- CSx
- Aetx - high carbs -> acidification -> ulceration
- DGx - gastroscopy, respond to Tx
- Tx
- proton pump inhibitor - omeprazole
- H2 antagonist - ranitidine
- sucralfate - protective layer
- increase roughage/turnout
- NSAIDs induced ulceration
- by reducing blood flow to stomach & RDC
- CSx seen w GI ulceration
- Tx adequate / no nsaids, low roughage diet
Referral
- sedation & analgesia
- truck > float
- alternative, euth
SURGICAL COLIC Strangulating vs non-strangulating - CV, Abdotap SI vs LI - NGT, US, rectal => DDx * RDD vs LDD - rectal vs US (NSE) - RDD - surg - LDD - phenylbenzamine, lunging, rolling UGA
- strangulating SI vs AE
- CSx reflux (pain relief after reflux), dull, febrile, abdotap inflam
- hypomotility assoc w Clostridial, high carbs
- Tx intensive mx
- reflux to decompress
- NPO
- iv fluids
- nsaids + metronidazole
Surgical Mx
- non-strangulating
- repositioning, decompression (needle suction for gas or pelvic flexure enterotomy for evacuation)
- strangulating
- untwist & reposition, decompress check viability, resection & anastomosis
Post op Mx
IVFT, electrolytes, broadspec ABs, analgesia, gradual refeeding, hospitalise for 1 week
Complications & Tx:
* ileus - reflux, IVFT
* endotoxaemia + laminitis - IVFT, hyperimmune plasma, polymixinB, iceboots
* inflam/adhesion/stricture - good surgical technique
Discharge
* 6 weeks box 6 weeks yard -> 12 weeks for linea alba regain full strength
* complication - incisional infection - Tx drainage, ABs & C&S, nsaids
Px - RECURRENCE
LI displacement > SI R&A > LI volvulus
NEONATES
Neonatal sepsis
Neonatal encephalopathy
Uroabdomen
Neonatal sepsis
CSx
Aetx infection -> SIRS (proinflam + compensatory CARS = MARS) -> MODS
- acquired from resp, GI, omphalitis, in utero -> risk septic arthritis & osteomyelitis
Tx
* IVFT
* Intra-nasal O2
* Abs - pen/gen/amikacin
* Nutrition / Enteral feeding / plasma transfusion
* Nursing & supp care
Neonatal encephalopathy
CSx - within 72hrs - poorly coordinated suck reflex & loss affinity for mare
Aetx period of hypoxia dt dystocia / C-section / in-utero infection -> affect GI, kidney, lung
Tx
* Prevent sepsis - broadspec & FPT
* Tx seizure - diazepam / midazolam, phenobarb
* Hypothermia (32-34) to protect nerves
* NSAIDs - flunixin
* IVFT
* Intra-nasal O2
* Nutrition / enteral feeding
* Nursing & supp care & careful monitoring of GI & renal function
Uroabdomen CSx DGx * Post-renal azotaemia * USx * fluid analysis - peritoneal fluid [creatinine] > 2 x plasma [creatinine] Tx * Tx hyperkalaemia - Ca gluconate, insulin + dextrose, sodium bicarbs * Peritonael drainage * IVFT * Surgery repair -> indwelling cathere * Nursing & supp care
FOAL COLIC
CSx
# 6-24 hours * Congenital atresia
- Meconium impaction
- dt in utero infection
DGx contrast RG, USx
Tx - sed + buscopan + enema / acetylcystein + water
- fluids + analgesia
- Lethal white syndrome
DGx genetic test for frame gene in overo (white face/ blue eyes)
2-5 days
FOAL COLIC
CSx
# 6-24 hours * Congenital atresia
- Meconium impaction
- dt in utero infection
DGx contrast RG, USx
Tx - fluids + analgesia
- sed + buscopan + enema / acetylcystein + water
- Lethal white syndrome
DGx genetic test for frame gene in overo (white face/ blue eyes)
2-5 days
* SI obstruction
CSx severe colic, bruxism, refluex from nares
DGx USx
- Ascarid impaction (3-5months + just dewormed)
- risk ileus & adhesions
DGx USx
Tx - medical: IVFT, nsaids, decompression via NGT, enteral fluids / oil
- surgery
- Intussusception
DGx USx target lesions - Herniation
- inguinal - manual reduction or surgery
- Umbilical - resolve or surgery (elastrator, surg closure)
- Gastroduodenal ulceration
CSx low grade colic, bruxism, pytalism - imp dt bowel strictures during healing
- Aetx stress, starvation dt illness, nsaids, sepsis/NE
- DGx USx (stomach enlarged), gastroscopy, contrast RG (delay barium flow)
- Tx IVFT, gastric decompression, anti-ulcer med OR ELSE surgical bypass
HORSES THAT EAT TOO MUCH EMS CSx Aetx DGx Tx
HORSES THAT EAT TOO LITTLE
Hepatic lipidosis
EMS
CSx high BCS, cresty neck, regional adiposity, laminitis
Aetx genetic + env (high carbs, overfeeding, reduce exercise) -> obesity -> insulin resistance -> chronic inflam + laminitis
DGx
- BCS, cresty neck score, circum around midneck / withers / umbilicus
- in feed glucose tolerance test
- fasting insulin test
Tx
- Dietary - mild (remove grain, reduce pasture access eg small paddock, short turnout, grazing muzzle, graze at night/early morning (low sugar)) or severe (remove from paddock, soak & reduce hay portion)
- exercise
- Tx PPID w pergolide
- metformin
HEPATIC LIPIDOSIS Aetx period of anorexia -> neg E balance -> rapid mobilisation of fat -> fat deposition into liver + other organs (kidney, adrenal, heart, muscle) DGx - plasma triglycerides conc - liver enzymes: GGT, SDH, bile acid, bilirubin, ammonia - USx Tx -
HORSES THAT EAT TOO MUCH
EMS
HORSES THAT EAT TOO LITTLE
Hepatic lipidosis
Refeeding syndromes
EMS
CSx high BCS, cresty neck, regional adiposity, laminitis
Aetx genetic + env (high carbs, overfeeding, reduce exercise) -> obesity -> insulin resistance -> chronic inflam + laminitis
DGx
- BCS, cresty neck score, circum around midneck / withers / umbilicus
- in feed glucose tolerance test
- fasting insulin test
Tx
- Dietary - mild (remove grain, reduce pasture access eg small paddock, short turnout, grazing muzzle, graze at night/early morning (low sugar)) or severe (remove from paddock, soak & reduce hay portion)
- exercise
- Tx PPID w pergolide
- metformin
HEPATIC LIPIDOSIS Aetx period of anorexia -> neg E balance -> rapid mobilisation of fat -> fat deposition into liver + other organs (kidney, adrenal, heart, muscle) DGx - plasma triglycerides conc - liver enzymes: GGT, SDH, bile acid, bilirubin, ammonia - USx Tx - enteral feeding / glucose in IV fluids - insulin
REFEEDING SYNDROMES
Aetx poor BCS dt inadq nutrition, poor dentition, severe parasitism -> refeeding stimulates anabolism -> deplete cofactors eg P, Mg) -> cardiac & neuromuscular dysfunction
Tx
- gradual introduction of lucerne hay (high protein, P & Mg)
- teeth & hoof trimming
- FEC & deworming
CARDIAC CAUSES OF PP
DGx
MURMUR
G (1-6) holo/pan systolic/diastolic at PMI
=> Valvular insufficiency
- Left sided murmur
- Right sided murmur
=> LRT
- EIPH
- IAD
=> Arrhythmias
- Normal arrhythmia
- AFIB
- APC
- VPC
=> Myocardial disease
* Ionophore toxicosis
=> Valvular insufficiency
- L sided
- P - diastolic, systolic if relative stenosis 2ndary to VSD
- A - diastolic heart base - risk Afib, VPC
- M - systolic heart apex - risk Afib
- R sided
- T - systolic heart apex -
- VSD - systolic dt L->R shunt + relative pulmonic stenosis (L systolic murmur)
DGx Echo, Exercise ECG + holter if risk Afib/VPC
=> LRT * EIPH DGx - epistaxis via endoscopy - BAL - haemosiderophages Tx - furosemide (X GIVE ON RACE DAY)
- IAD
DGx - BAL (neutrophils, mast cells, eosinophil)
Tx - env - house outdoors»_space; indoors (well ventilated, low dust bedding, wet hay / hay cubes)
- corts - dexamethasone, pred
- inhaled fluticasone
=> Arrhythmias
Normal: SA block, sinus arrhythmia, 2nd AV block (low-normal HR, regular irregularly rhythm - abnormal if P:QRS >2:1)
DGx: Echo, exercising ECG, CTn1, electrolytes & blood gas
* AFIB Tx - quinidine gluconate - quinidine sulfate Mx HR, ECG, plasma quinidine lv, toxicity signs - electrocardioversion
- APC
No Tx - VPC
Tx - underlying cardiac dz
- VTach Mg sulfate, lidocaine
=> Myocardial disease - Ionophore toxicosis * contaminated feed -> impair NaK transport -> hypercontractility / arrhythmia + skeletal m (myoglobinuria, increase CK & AST) DGx - feed analysis - CTn1 CK AST Myoglobinuria - ECG PMx -pale w haemorrhage & necrosis Tx - supp + activated charcoal
