Lecture 37 5/1/25 Flashcards by Danika Boltz

What are the characteristics of gastric ulcer presentation?

-seen in all ages, including neonates, weanlings, and adults
-now more common in adult horses
-likely multifactorial in cause

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What are possible mechanisms of gastric ulceration?

-increase in serum gastrin
-increase in acid secretion
-ischemia
-splash effect
-stress
-high concentrate diets

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Why is continuous access to pasture beneficial in preventing gastric ulcers?

withholding feed was shown to lead to a decreased gastric pH

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What are the characteristics of NSAIDs as a cause of gastric ulcers?

-known to cause gastric ulcers
-not a factor in most cases in horses
-are a factor in right dorsal colon ulcers

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What are the possible sites of gastric ulcers?

-squamous
-glandular
-margo plicatus

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What are the characteristics of squamous and glandular ulcers?

-currently thought that they are different
-umbrella term is equine gastric ulcer
-individual syndromes are equine squamous gastric dz and equine glandular gastric dz

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What are the characteristics of gastric acid secretion?

-acid is secreted by parietal cells in glandular stomach
-H+-K+-ATPase is the acid pump

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What stimulates gastric acid secretion?

-acetylcholine (neuroendocrine)
-gastrin (endocrine)
-histamine (paracrine)

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What inhibits gastric acid secretion?

-prostaglandins E1 and E2
-somatostatin
-secretin

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Which substances are aggressors in gastric ulcer formation?

-acid
-pepsin
-bile salts

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Which substances are protective against gastric ulcer formation?

-mucus
-bicarbonate
-prostaglandin E
-mucosal blood flow and epithelial repair

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What is the prevalence of gastric ulcers?

-high prevalence in foals, weanlings, and adults
-20 to 95% prevalence in adult horses
-prevalence and severity increase with time in training

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What are the clinical signs of gastric ulcers in foals?

-decreased suckling
-colic
-dorsal recumbency
-bruxism
-salivation
-ill thrift

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What are the clinical signs of gastric ulcers in adults?

-inappetence
-colic
-diarrhea
-bruxism
-salivation
-poor body condition
-lethargy/changes in attitude
-poor performance

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How are gastric ulcers diagnosed?

-clinical signs are suggestive
-endoscopy

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What is the grading scale for squamous ulcers?

Grade 0: stomach lining is intact; no reddening
Grade 1: stomach lining is intact; areas of reddening
Grade 2: stomach has small single or multiple ulcers
Grade 3: stomach has large single or multiple ulcers
Grade 4: stomach has extensive ulcers; often merged to give areas of deep ulceration

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What causes esophagitis?

acid reflux

What is the significance of gastric ulcer findings?

-can be hard to determine
-signs do not always correlate with severity

What are the characteristics of diagnostics for ultrasound besides endoscopy?

-no consistent clinicopathologic abnormalities
-fecal occult blood is highly unreliable
-severe cases may have peritonitis from leakage
-response to treatment may be used

What are the steps to gastric ulcer management?

*increase pasture turnout when possible
*if stalled:
-free choice hay
-decrease concentrate
-feed hay before concentrate
*multiple small feedings
*decrease level of training

Which medications are used to treat gastric ulcers?

-antacids like Neigh Lox
-proton pump inhibitors like omeprazole
-histamine receptor antagonists like ranitidine
-sucralfate
-misoprostol/synthetic PGE1

What are the characteristics of sucralfate?

-enhances mucus-bicarbonate layer
-increases protective prostaglandins
-coats/sticks to wound

What are the current medication recommendations for squamous and glandular/pyloric ulcers?

*squamous ulcers:
-omeprazole
*glandular/pyloric ulcers:
-omeprazole plus sucralfate OR
-misoprostol

How can gastric ulcers be prevented?

-appropriate management
-low dose omeprazole
-Neigh Lox
-smart-gut ultra
-relyne
-other products; limited data

What are the characteristics of the equine hindgut?

-fermentation "vat" with 25 to 30 gallon capacity -important for assimilation of many dietary components -less than optimal fermentation with stasis, inflammation, and ulceration

What are the characteristics of hindgut disorders?

-can be difficult to diagnosed -"hind gut ulcers" often used non-specifically -pathogenesis of true hind gut ulcers is not fully understood

What are the theories behind right dorsal colitis/right dorsal colon ulceration?

-changes in blood flow -protective changes -NSAID use

What are possible risks for right dorsal colitis?

-NSAID use -stress -individual microbes/dysbiosis

What are the signs of right dorsal colitis?

-colic; generally mild and recurrent -soft feces -hypoproteinemia; esp. albumin -possible increased protein in abdominal fluid

What are the characteristics of right dorsal colitis diagnosis?

-ultrasound not highly sensitive -exploratory surgery done if repeatedly colicky

How can right dorsal colitis be treated?

-avoid NSAIDs -dietary management with pelleted rations, oils, and psyllium -sucralfate -misoprostol or metronidazole -surgery

What are the clinical signs of duodenitis/proximal jejunitis?

-inflammatory syndrome -acute onset of abdominal pain -tachycardia -fever -ileus -gastric reflux -dilated small intestine

What clin path findings are seen in duodenitis/proximal jejunitis?

*blood work: -increased PCV/TP *abdominocentesis: -increased TP -normal or increased cell count

How can duodenitis/proximal jejunitis be distinguished from obstruction?

-rectal temp. is increased in D/PJ -depression is worse in D/PJ -peritoneal fluid analysis is better in D/PJ -gastric reflux volume is larger with D/PJ

What are the histopath. findings in duodenitis/proximal jejunitis?

-hemorrhagiconecrotic enteritis -most severe proximally

What are predisposing factors for duodenitis/proximal jejunitis?

-diet change -high grain -stress -change in intestinal flora/bacterial overgrowth -C. difficile

What is the therapy for duodenitis/proximal jejunitis?

-gastric decompression -fluid therapy -possibly antibiotics -treatment of endotoxemia -analgesics -prokinetics

What is the prognosis for duodenitis/proximal jejunitis?

-fair to good -around 90% survival -complications include laminitis and thrombophlebitis

What are the characteristics of peritonitis?

*primary: -idiopathic -60 to 70% respond to treatment *secondary: -occurs due to colic, surgery, perforation, etc. -generally worse prognosis *can be acute or chronic

How is peritonitis diagnosed?

-ultrasound -peritoneal fluid analysis -palpation -exploratory laparoscopy

What is the treatment for peritonitis?

-correct primary problem -antibiotics -drainage/lavage -supportive care

What are potential complications of peritonitis?

-development of adhesions -chronic colic