Horse GI Lecture 2

Question 1

Where are the 2 places you will see ulcers in a horse due to NSAIDs?

Answer 1

1) Stomach and 2) Right Dorsal Colon

Question 2

What do NSAIDs inhibit and as a result, cause ulcers?

Answer 2

PGE2, a constitutive/COX1 prostaglandin responsible for regulating blood flow

Question 3

Are ulcers common in horses?

Answer 3

YES! They are far more common than we ever used to think.

Question 4

Glandular ulcers around the pylorus are most likely due to ______.

Answer 4

NSAIDs

Question 5

Squamous epithelial ulcers are due to ______.

Answer 5

Long periods of restricted feed

Question 6

When and where would you see ulcers in FOALS?

Answer 6

25%-50% of sick foals in the SQUAMOUS epithelium

Question 7

When and where would you see ulcers in ADULTS?

Answer 7

90% of Race horses; Horses in training; mostly in the squamous epithelium

Question 8

Are squamous lesions predictive of glandular lesions?

Answer 8

NO.

Question 9

Do ulcers cause diarrhea in adults?

Answer 9

NO

Question 10

Do ulcers cause diarrhea in foals?

Answer 10

YES, they can

Question 11

How do you diagnose ulcers in the horse?

Answer 11

GASTROSCOPY!

Fecal occult blood (only potentially works for dx in foals) and gastric mucosa permeability test (time) have their limitations

Question 12

Grossly, what distinguishes acute from chronic ulcers?

Answer 12

Chronic lesions have yellow plaque-like lesions surrounding them.

Question 13

What medications could you treat ulcers with?

Answer 13

1) Omeprazole (treat 28 days and re-check)
2) H2 blockers (multiple treatments throughout the day)
3) Sucralfate (probably not effective in treating squamous)

Question 14

When would you use sucralfate to treat an ulcer?

Answer 14

In the GLANDULAR region. It promotes PGE2 synthesis and coats.

Question 15

How could you treat ulcers by management?

Answer 15

1) Lifestyle: Turnout on pasture

2) ∆ Feed: Inc. Roughage and/or continuous feeding

Question 16

Is inflammation in the stomach an emergency?

Answer 16

YES

Question 17

Is inflammation in the upper GI tract an emergency?

Answer 17

YES

Question 18

What are the causes of GASTRITIS?

Answer 18

1 Over-eating!!

2) Abrupt diet ∆
3) Gastric impaction
4) Delayed gastric emptying
5) 2˚ to SI Dz

Question 19

What are the causes of ULCERS?

Answer 19

#1 Prolonged periods off feed
#2 NSAIDs
3) weaning, dz in general
4) training, breeding, showing
5) high carb diet

Question 20

What’s a major concern of grain overload?

Answer 20

Endotoxemic shock leading to laminitis and eventual Founder.

Question 21

What does gastritis look like in a horse?

Answer 21

VERY PAINFUL and VERY TOXIC. Some horses are stoic but do PE and look for toxic line!!

Question 22

What major therapy/diagnostic do you use in horses after PE?

Answer 22

NG Tube looking for Reflux!

Question 23

How do you treat gastritis?

Answer 23

NG Tube - relieve pressure, reflux and leave in place.
CHECK FOR REFLUX every 2-3 hr or when PAINFUL.
Banamine
Laminitis prevention
NO FEED 12-24 HOURS
Re-feed

Question 24

How quickly do you change diets in horses?

Answer 24

7-10 days

Question 25

How quickly can you change to pasture?

Answer 25

2-3 weeks; be cautious of LUSH pasture

Question 26

What are causes of GASTRIC IMPACTION?

Answer 26

#1 Fibrous hay/feed 2) Dry pelleted feed 3) Foreign Bodies 4) Limited access to water 5) Anatomic obstruction 6) Poor dentistry

Question 27

How do you treat a gastric impaction?

Answer 27

Similar to grain overload. No feed to impaction is resolved, reflux, fluids, fiber diet. Identify initial cause and remove.

Question 28

What would a delayed gastric emptying look like?

Answer 28

6-8 month old FOALS. Got sick then better on milk, then weaning. Due to ulcer in duodenum or pylorus when very young and eventual stricture formation.

Question 29

Prognosis of delayed gastric emptying foals?

Answer 29

POOR

Question 30

Causes of enteritis/dpj?

Answer 30

Infectious, Dietary indiscretion, ambient heat/exercise

Question 31

What do you feel rectally for enteritis/dpj?

Answer 31

Distended SI with thickened walls

Question 32

What is key differentials between enteritis/dpj and strangulating lipoma?

Answer 32

Enteritis has a FEVER, moderately distended and some motility. Strangulation has no fever, very dilated and NO MOTILITY.

Question 33

What would abdominocentesis show on enteritis?

Answer 33

Protein elevated

Question 34

What would abdominocentesis show on strangulating lipoma?

Answer 34

Protein AND CELLS elevated.

Question 35

How do you treat enteritis/dpj?

Answer 35

Relieve pressure, empty fluid. Will feel better and show it. Fluids, NSAIDs, gastroprotectants, prophylactic abx, laminitis prevention.

Question 36

How do you treat strangulating lipoma?

Answer 36

Relieve pressure, empty fluid. | They WILL NOT feel better ---> SURGERY.

Question 37

What are main causes of peritonitis in horses?

Answer 37

TRAUMA, usually some form of penetration or disruption to the gut and TRANSLOCATION. Others: ascarid migration, neonates damaged or ruptured bladder; bacterial abscesses, iatrogenic, neoplasia

Question 38

How would peritonitis present?

Answer 38

Fever, anorexic, colic mild to moderate.

Question 39

What does peritonitis feel like in horse?

Answer 39

Fibrin tags/ADHESIONS form very quickly on SEROSAL SURFACES.

Question 40

What does US show for peritonitis in horse?

Answer 40

lots of fluid in the abdomen

Question 41

What does abdominocentesis reveal for peritonitis?

Answer 41

protein, cells, +/- bacteria

Question 42

Prognosis of Peritonitis?

Answer 42

Guarded to POOR

Question 43

Treatment of severe peritonitis?

Answer 43

None recommended, very poor Px.

Question 44

Treatment of non-severe peritonitis?

Answer 44

Stabilize, identify inciting cause, remove it. Broad Spec. Abx Minimize inflammation and fibrin, treat endotoxemia. Laminitis prevention. Peritoneal LAVAGE - top to bottom drain technique