Lecture Equine GI 3-4 Flashcards
(56 cards)
1
Q
Inflammatory GI conditions
A
- Small intestine
- Duodenitis/proximal jejunitis
- mescellaneous inflammatory
- proliferative enteropathy
- Colon
- Acute diarrhea
- chronic diarrhea
- Peritonitis
2
Q
Dudenitis-Proximal Jejunitis
(DPJ)
A
- inflammation and stasis of proximal segments of small intestine
- cause
- salmonella
- clostridium (esp Canada, UK)
- fungal toxins
- relatively uncommon
3
Q
DPJ
CS
A
- moderate pain
- low-grade fever
- rectal: dilated SI
- U/S: dilated +/- thick SI
- Ab tap: inc TS
4
Q
DPJ vs. Strangulation
A
- DPJ
- low grade fever 101.5-103.0 R
- Pain, HR dec with gastric decompression
- peritoneal fluid inc protein +/- WBC, normal RBC
- Strangulation
- normothermic
- Pain, HR not related to reflux
- peritoneal fluid typically serosanguinous
5
Q
DPJ
TX
A
- Gastric decompression
- Anti-inflammatories
- NSAIDS
- Lidocaine (systemic)
- IV fluids
- Don’t usually need antibiotics
6
Q
DPJ
Prognosis/Complications
A
- adequate supportive care and resources = good
- may require sx: prognosis still good
- complications: Endotoxemia
- laminitis
- peritonitis
- adhesions
- cholangiohepatitis
7
Q
Inflammatory bowel disease
A
- granulomatous enterocolitis
- lymphocytic-plasmacytic enterocolitis
- eosinophilic, basophilic enterocolitis
- multisystemic eosinophilic epitheliotropic disease
- lymphoma/lymphosarcoma
8
Q
Inflammatory bowel disease
CS
A
- weight loss
- recurrent colic
- severe colic - eosinophilic enteritis
- edema
9
Q
Inflammatory bowel disease
Pathophisiology
TX
A
- Pathophysiology
- likely related to interaction of multiple immune functions
- TX
- corticosteroids
- immune suppressants
- SX for EE with obstruction
10
Q
Acute diarrhea
Infectious causes
A
- salmonella species
- Neorickettsia risticii (Potomac horse fever)
- Clostridium difficile
- Clostridium perfringens
- Larval cyathostomosis
- Coronavirus
- Other viral (foals)
11
Q
Acute diarrhea
Non-infectious causes
A
- diet changes (composition, quantity)
- antibiotics (routine, ionophore)
- NSAIDS (right dorsal colitis-RDC)
- Cantharidin (blister beetle)
- hoary alyssum
- heavy metals
12
Q
Colitis
CS
A
- Endotoxemia
- fever
- inc HR, RR
- Toxic MM
- Dehydration
- Diarrhea
- volume, consistency variable
- Hemorrhagic (rare)
- Colic (+/-) - can precede diarrhea
- ventral edema (+/-)
- Borborygmi: can inc; may dec initially
- Rectal
- fluid filled colon +/- cecum; variable distention
- indicated if colicky
13
Q
Colitis
Lab data
A
- CBC is important
- neutropenia w/ toxicity and left shift
- metabolic or lactic acidosis
- Dec Na, Cl, K, Ca
- Azotemia (often pre-renal)
- Decreased TP
- may be relative if hemoconcentrated
- Inc liver enzymes (AST, GGT, SDH)
14
Q
Colitis
Diagnostics
A
- Whole blood
- N. risticii - PCR
- Feces
- salmonella (culture, PCR?)
- clostridium toxin (ELISA)
- Parasites (direct/flotation)
- sand sedimentation
- coronavirus (PCR)
- U/S
- Rads
15
Q
Colitis
Basic TX
A
- Volume replacement, maintenance
- crystalloids
- Colloids
- Oral fluid replacement
- less severe cases
- Bind intestinal free toxin
- biosponge
16
Q
Colitis
endotoxin related TX
A
- NSAIDS
- analgesic, COX-inhibition
- flunixin meglumine
- Polymixin B
- binds circulating free endotoxin
- Digital hypothermia
- preventative for laminitis
17
Q
Colitis TX
Supportive care
A
- ISOLATION
- catheter maintenance
- Tail wrap
- Heavy bedding
- Perineal care
18
Q
Colitis TX
Antibiotics
A
- avoid in adults horses
- exceptions
- PHF
- Clostridiosis
- Substantial leukopenia
- Peritonitis
- Significant risk factor for diarrhea
- No significant effect on outcome
19
Q
Colitis
Potential sequelae
A
- Laminitis
- Renal failure
- Thrombophlebitis
- Peritonitis
- Fungal pneumonia
20
Q
Salmonellosis
A
- intermittent shedding
- detection influenced by
- inc diarrhea
- method (fecal culture vs PCR)
- time of year (inc summer and fall)
- no specific therapy for acute cases
21
Q
Salmonellosis
Risk factors
A
- change in microbiota
- transportation
- antimicrobial tx
- change in diet
- sx
- nasogastric tubes
- wet, dark conditions
- GI dz
22
Q
Salmonellosis
Prognosis/Shedding
A
- good with early therapy; dec w/ complications
- horses may shed sig number organisms 1-2 months
23
Q
Neorickettsia risticii
A
- Potomac horse fever (PHF)
- Infectious, not contagious
- Seasonal (may-Oct)
- geographic variability
- transmission through fresh water snails, insects
24
Q
N. Risticii
CS
A
- Incubation 9-11 days
- Biphasic clinical signs
- lethargy, anorexia, fever
- +/- colic, diarrhea
- may progress rapidly
- Not a cause of chronic diarrhea
- Lethargic and Febrile
25
N. risticii
DX
* **Whole blood PCR**
* response to treatment
* Can remain PCR positive up to 30 d post infection
26
N. risticii
Therapy
Prevention
* Tetracyclines: resp w/in 12-24 hours
* Vaccination
* questionable efficacy
* may reduce severity
* Prognosis
* good with early therapy
* **Laminitis common complication**
27
Clostridial infection
spp
* Clostridium difficile
* commonly assoc w/ antimicrobial-associated diarrhea
* adults
* Clostridium perfringens
* foals
28
Clostridiosis
Risk factors
* **Antimicrobial use**
* ****Big problem in CA
* individual
* mares of foals treated with macrolides, azolides
* management
* tubes, hands
* hospitalization
* age
* geography
29
Clostridiosis
DX
* **Fecal toxin tests**
* enterotoxin (C. perfringens)
* **ELISA (A +/- B C. difficile)**
* PCR (C. difficile)
* Fecal gram stain
30
Clostridiosis
TX
* Metronidazole
* **BioSponge**
* DTO-smectitie
* synthetic clay
* shown to bind clostridial toxin
31
Coronavirus
CS
* **Fever**
* Anorexia
* lethargy
* +/- diarrhea
* frequent in colder months
* usually lasts 1-4 days
32
Coronavirus
Transmission
DX
TX
Prognosis
* Fecal-oral transmission
* often occurs in outbreaks
* DX: fecal PCR
* TX: supportive
* no vaccine
* Prognosis pretty good
33
Cantharidin toxicosis
CS
* Inc temp, HR, RR
* DIarrhea
* lethargy
* colic
* Sudden death
34
Cantharidin toxicosis
Lab findings
Diagnosis
* Lab findings
* decreased Ca, Mg, TP
* DX
* toxin detectedin serum, urine: 500 mL
* gastric contents 200 g
35
Chronic diarrhea
* Diarrhea of longer than 1 month duration
* variablel weight loss
* no major clinical exam findings
* no major abnormal lab findings: no evid protein loss
36
Inflammatory causes chronic diarrhea
Infectious
* Salmonellosis
* Parasites
* giardia
* strongyles
37
Inflammatory causes chronic diarrhea
non-Infectious
* inflammatory bowel disease
* neoplasia
* sand
* right dorsal colitis
38
chronic diahrrea
Diagnostic tests
* CBC, Chem
* Abdominocentesis
* helps identify IBD, neoplasia
* Rectal exam
* check for masses
* check for lymphadenopathy
* Rectal biopsy
* inflammatory bowel disease
* salmonellosis
39
Chronic diarrhea
Fecal diagnostics
* Gross examination for parasites
* Flotation/McMaster's quantification
* Direct smear
* Culture
* Sand sedimentation
* Gram stain
40
Chronic diarrhea
TX
* Supportive therapy
* fluid therapy
* NSAIDS
* Antibiotics ?????
* salmonellosis
* Larvicidal deworming
* **Withdrawel meds**
41
Chronic diarrhea
Other TX
* Diet mod
* BioSponge
* Probiotics not helpful
* contraindicated in foals
* Transfaunation
* Acid suppression first
42
Sand enteropathy
TX
Prevention
* Diarrhea usually mild
* May be accompanied by recurrent colic
* TX
* environmental
* psyllium mucilloid
* Prevention
* feed over mat
43
Right Dorsal Colitis
NSAID use
Risk factors
CS
* NSAID use
* non-selective COX inhibitors
* Does not have to be abuse
* can occur within one weak
* Risk factors poorly identified
* CS
* albumin drop may precede clinical signs
* **Ventral edema often first CS**
* colic
* diarrhea
* weight loss
* inappetence
* icterus
44
Right Dorsal Colitis
DX
* HX
* Hypoalbuminemia
* U/S: thickened R. Dorsal colon
45
Right Dorsal Colitis
TX
* avoid NSAIDS
* Complete pelleted diet
* small, frequent meals
* **decrease bulk**
* Psyllium mucilloid
46
Peritonitis
Causes
* GI perforation
* Abscess
* Iatrogenic
* Rectal tear
* Castration
* Trauma
* post-foaling
* Post-op
* Actinobacillus equuli: assoc with primary peritonitis
* good prognosis
47
Peritonitis
Foals
* GI perforation
* Omphalitis
* Uroperitoneum
* Abscess
* Sepsis
48
Peritonitis
DX
* Ab tap
* \> 10,000 cells/microL
* Culture
* Intracellular bacteria
* High lactate, low glucose (bact in periton. eat it)
* **U/S**
* **inc free peritoneal fluid**
49
Peritonitis
TX
* Exploratory
* Antibiotics
* Lavage
* NSAIDS
* Analgesics
50
Peritonitis Prognosis
GI rupture
Uterine tear
A. equuli
Post-op
* GI rupture
* Grave
* Uterine tear
* fair to good
* A. equuli
* good
* Post-op
* moderate
51
Determining factor for infectious colitis
* Number of animals affected
52
Colitis
Signalment and history
* Number affected
* Recent therapy
* NSAIDS
* antimicrobials
* Feeding plan and recent changes
53
Endotoxemia causes
Founder
54
Fever + Diarrhea =
**ISOLATION**
55
Hallmark blister beetle signs
* Horses on alfalfa
* Low serum Ca
56
Common complication of peritonitis
adhesions
