7.1.2: Gastric disease - diagnosis, treatment and management Flashcards
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Dorsal squamous fundus
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Greater curvature
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Margo plicatus
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Lesser curvature
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Cardia
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Ventral glandular fundus
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Antrum
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Pylorus
Risk factors for gastric disease
- Lack of access to forage
- Lack of access to water
- High carbohydrate diets -> these have acidifying effects on gastric juices
- High stress environments/individuals
- Other focuses of pain (sometimes can’t resolve gastric disease until pain from elsewhere in the body is controlled)
Clinical signs of gastric disease
- Colic signs (particularly after eating)
- Weight loss
- Bucking/rearing under saddle
- Resentment of girthing and leg aid
- Poor performance
- Changes in temperament
Preparation of a patient for gastroscopy
- Withhold food for at least 12hrs; some centres say longer (need empty stomach to properly assess)
- Water should be removed ~4hrs before
- Use a grazing muzzle for horses liable to eat their own bedding/faeces in order to prevent this happening
What would you use to sedate a horse for gastroscopy?
Detomidine + butorphanol
How do you grade squamous ulceration visualised on gastroscopy?
- Grade 0 - epithelium intact, no appearance of hyperkeratosis
- Grade I - the mucosa is intact but there are areas of hyperkeratotis
- Grade II - small single or multifocal lesions
- Grade III - large single or extensive superficial lesions
- Grade IV - extensive lesions with areas of apparent deep ulceration
Which grade of squamous ulceration is shown here?
Grade 0
Which grade of squamous ulceration is shown here?
Grade IV
How do we describe glandular disease lesions?
- Mild/moderate/severe
- Focal/multifocal/diffuse
- Raised/flat/depressed
- Hyperaemic/haemorrhagic/fibrinosuppurative
Any combination is possible. Some centres also use diagrams to note the appearance of lesions.
Numerical grading systems are no longer used for glandular disease.
First line treatment of gastric disease
- Oral omeprazole -> for squamous ulceration. Licensed and effective. Better bioavailability if horse starved beforehand.
- Misoprostol -> for glandular disease
- Not uncommon to see combination therapy
- ± oral sucralfate as an adjunct to the above
Which of the following is considered easier to treat?
a) glandular disease
b) squamous ulceration
b) squamous ulceration - typically takes 3 weeks to treat compared to 3 months for glandular disease
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How does oral sucralfate help with the treatment of gastric disease?
Oral sucralfate coats the stomach and helps to bolster the mucus barroer while we are treating the lesions with other drugs.
How often should you endoscope a horse with gastric disease to monitor treatment progress?
Every 4 weeks
True/false: once a horse has had one episode of glandular disease, they should forever be managed accordingly as they are at a high risk of recurrence.
True
These horses are like laminitic ponies - highly predisposed to recurrence.
Husbandry changes you would implement for long-term management of gastric diseases
- Feed roughage al lib throughout the day
- Reducing stressful stimuli where at all possible
- Elimination of carbohydrates from the horse’s diet; replace with oils if calories needed
- Feed supplements: there is evidence for pectin and lecithin to bolster the mucus barrier
- Can use oral omeprazole long-term at 1 mg/kg^ daily; ideally target this to high risk periods e.g. moving yards, competitions -> check competition rules to check if this is allowed
(^this is 1/4 of the therapeutic dose)
