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Equine Medicine > Unit 2 - Diarrhea > Flashcards

Unit 2 - Diarrhea Flashcards

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1
Q

What is diarrhea?

A

Passage of feces with increased water content

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2
Q

What is colitis?

A

inflammation of the large bowel

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3
Q

What is the duration of acute diarrhea?

A

1-2 weeks

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4
Q

What is the duration of chronic diarrhea?

A

greater than 1 month

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5
Q

What are the infectious etiologies of acute diarrhea in a horse?

A

Salmonella, Neorickettsia, Clostridium, and Cyanthostomiasis

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6
Q

What else can cause acute diarrhea?

A

antimicrobial induced and toxin induced

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7
Q

What is one of the most common causes of severe infectious diarrhea in horses?

A

Salmonella

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8
Q

What is the most commonly isolated Salmonella species?

A

Salmonella typhimurium (most common), S. agona, S. anatum, S. krefeld

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9
Q

What percentage of the horse population are non-systomatic carriers of Salmonella?

A

3-5%

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10
Q

How is Salmonella spread?

A

It is contagious - spread by direct contact and fomite transmission

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11
Q

What predisposing factors may induce Salmonella diarrhea?

A

Stress, general anesthesia, systemic illness, prolonged transportation, administration of antimicrobials, or exposure to a horse with acute Salmonella-induced colitis

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12
Q

What is severity of Salmonella induced diarrhea related to?

A

The Salmonella species involved, age, and health status of the animal

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13
Q

What are the four clinical presentations of Salmonella?

A
  1. Asymptomatic carriers
  2. Fever, depression, neutropenia, anorexia, without evidence of diarrhea
  3. Severe, profuse diarrhea with dehydration, neutropenia, and endotoxemia
  4. Chronic diarrhea
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14
Q

What clinical signs are associated with Salmonella diarrhea?

A

Acute severe and profuse diarrhea, dehydration, +/- abdominal pain, tachycardia, tachypnea, fever, depression, and anorexia

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15
Q

What clinical pathology abnormalities are associated with Salmonella induced diarrhea?

A

Leukopenia, neutropenia, left shift, hemoconcentrationn, electrolyte derangements, azotemia, hypoproteinemia, and metabolic acidosis

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16
Q

How is Salmonella induced diarrhea diagnosed?

A

Clinical signs and/or history of exposure, serial cultures of feces (at least 3 negative), PCR of feces

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17
Q

How is Salmonella induced diarrhea treated?

A

Overall treatment for acute diarrhea and supportive care

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18
Q

What does Neorickettsia risticii cause?

A

Potomac Horse Fever

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19
Q

What does Neorickettsia risticii infect?

A

the equine macrophage

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20
Q

What cells does Neorickettsia risticii have tropism for?

A

cells of the cecum and large colon

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21
Q

Where does Neorickettsia risticii survive?

A

In cell-derived vacuoles

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22
Q

How is Neorickettsia risticii transmitted?

A

It is not completely understood, but there is some associated between disease and proximity to freshwater streams and rivers

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23
Q

When does Neorickettsia risticii transmission typically occur?

A

during spring/summer months in northern climates

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24
Q

What clinical signs are associated with Neorickettsia risticii induced diarrhea?

A

Soft stool to profuse diarrhea, dehydration, +/- abdominal pain, tachycardia, tachypnea, fever, depression, diarrhea, laminitis

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25
What clinical pathology changes are associated with Neorickettsia risticii infection?
Electrolyte deficiencies, metabolic acidosis, hypopriteinemia, azotemia, leukopenia, and neutropenia with a left shift (toxic changes)
26
How is Neorickettsia risticii diagnosed?
PCR tests (feces and blood) or paired blood samples for antibody titers
27
How is Neorickettsia risticii treated?
Supportive therapy and oxytetracycline
28
What is the prognosis for Neorickettsia risticii infection?
Fair to good; mortality rate is 5-30%
29
How is Neorickettsia risticii prevented?
vaccination (efficacy debatable); natural infection protects for 1-2 years
30
What type of bacteria is Clostridium?
Obligate gram + anaerobe
31
What Clostridium species are the most commonly implicated in causing acute diarrhea?
Clostridium difficile and Clostridium perfringens
32
What toxins does C. difficile produce?
Toxin A and Toxin B
33
What effects does Toxin A have?
Intestinal secretory and cytotoxic effects, increases intestinal permeability, and activates inflammatory cells
34
What effects does Toxin B have?
Enterotoxigenic and secretory effects
35
What toxins does C. perfringens create?
Toxin A and C
36
What unique clinical sign does Clostridium cause that other acute diarrhea agents dont?
Gas distention
37
How is acute diarrhea caused by Clostridium diagnosed?
ELISA toxin assay or culture of feces
38
How is Clostridium diarrhea treated?
Supportive care and Metronidazole
39
How do Cyathostomes cause diarrhea?
The emergence of large numbers of L4 stage larvae from the mucosa of the cecum and colon damages the submucosa/mucosa and provokes a severe granulomatous reaction
40
When does Cyathostome caused diarrhea typically occur?
Late winter and spring
41
What intestinal 'disease' is associated with Cyathostomes?
Hemorrhagic or fibrinous typhlitis (cecum-itis) and colitis
42
What are the distinguishing featurse of Cyathostome induced diarrhea?
Profound hypoalbuminemia, larvae found on scrape or biopsy, and chronic changes (weight loss, ill thrift, ventral edema, intermittent fever, and intermittent colic)
43
How is Cyathostome induced diarrhea treated?
Fenbendazole, Moxidectin, and supportive care
44
How can antimicrobials cause acute diarrhea?
They cause changes in the normal GI flora leading to the diarrhea
45
What is the prognosis for antimicrobial induced acute diarrhea?
Poor - it is often fatal
46
What drugs can cause antimicrobial induced acute diarrhea?
Trimethoprim suflas, erythromycin, tetracyclines, ceftiofur, and potassium penicillin
47
What NSAIDs can cause toxin induced acute diarrhea?
Phenylbutazone and flunixin meglumine
48
What disease processes can NSAID toxicity cause?
right dorsal colitis or gastric ulceration
49
What clinical signs are associated with right dorsal colitis?
Intermittent colic, diarrhea, lethargy, +/- fever, hypoproteinemia, ventral edema, and history of NSAID use
50
What will you find on ultrasound in patients with right dorsal colitis?
Thick or edematous colon wall
51
How is right dorsal colitis treated?
Discontinue use of NSAIDs, low bulk feed, sucrulfate, Misoprostol, and Psyllium
52
Why can overfeeding/grain overload cause diarrhea?
It overwhelms the small intestinal digestive capacity - excess CHO enter colon, rapidly fermented by lactic acid producing bacteria, decreases the pH and kills gram negative bacteria, endotoxemia
53
How is diarrhea caused by overfeeding/grain overload treated?
Lavage and remove gastric contents, anti-endotoxin therapy, fluid therapy, Cathartics, activated charcoal, laminitis treatment/prevention, possibly surgical removal
54
What diagnostics should be performed in all cases of acute diarrhea?
CBC, serum chemistry, venous blood gas (acid/base), and fecal samples
55
What supportive care should be considered/given in all cases of adult equine diarrhea?
IV fluid therapy, oral fluids + electrolytes, anti-inflammatories, medications to modulate endotoxemia, nutritional support, prevention of laminitis, colloids, and correction of acidosis
56
What is the maintenance rate for IV fluids for adults?
50 ml/kg/day
57
What medications can be given to modulate endotoxemia?
Flunixin meglumine, hyper immunized plasma, polymyxin B, and pentoxifylline
58
What probiotic can be given to treat adult equine diarrhea?
Saccharomyces boulardii
59
What nutritional support can be given in cases of adult equine diarrhea?
Ground up pellets via NG tube, IV dextrose, partial parenteral nutrition, and total parenteral nutrition
60
What preventative measures can be attempted to prevent laminitis in patients with diarrhea?
Ice boots, NSAIDs, mechanical support, Acepromazine, and Aspirin
61
Why would you want to give colloids in a patient with diarrhea?
To maintain vascular oncotic pressure and prevent edema
62
How do you correct metabolic acidosis in patients with diarrhea?
Correct with NaHCO3
63
What are the potential causes of chronic diarrhea?
Diet, inflammatory bowel disease, primary disorders of other body systems, intestinal parasites, infectious causes, sand enterocolitis, and miscellaneous
64
How could diet cause chronic diarrhea?
Excess amounts of CHO, oil, supplements, fresh green grass, and toxic plants
65
What inflammatory cells could cause IBD which could cause chronic diarrhea?
granulomatous, eosinophilic, and lymphocytic-plasmacytic
66
What clinical signs are associated with inflammatory bowel disease?
Colic, weight loss, hypoproteinemia, and abnormal glucose absorption
67
How do you do a glucose absorption test?
Fast overnight, give 1g/kg of dextrose in water. Measure BG every 30 minutes for 4 hours. Peak BG should be 2x the baseline at 60-120minutes
68
How do you diagnose IBD?
rectal biopsy, clinical signs, and clin path abnormalities
69
How do you treat IBD?
corticosteroids
70
What primary disorders of other body systems cause chronic diarrhea?
Liver disease/cirrhosis and congestive heart failure
71
What intestinal parasites can cause chronic diarrhea?
Large or small strongyle species
72
What infectious causes can cause chronic diarrhea?
Chronic Salmonella infections
73
How does sand cause chronic diarrhea?
It irritates the ventral colon and causes inflammation of the mucosa leading to subsequent diahhrea
74
What miscellaneous things can cause chronic diarrhea?
peritonitis, abdominal abscess, and lymphosarcoma of the GI tract
75
What diagnostics should be considered for patients with chronic diarrhea?
rectal palpation, abdominocentesis, CBC and chemistry profile, fecal analysis, rectal biopsy, intestinal absorption test, abdominal radiography, abdominal ultrasonography, investigate medications/supplements received, diet
76
How is chronic diarrhea treated?
treat the underlying cause, corticosteroids, and diet
77
What is the prognosis for chronic diarrhea?
poor

Equine Medicine (27 decks)

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