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EQUINE > 7.1.4: Causes of diarrhoea > Flashcards

7.1.4: Causes of diarrhoea Flashcards

1
Q

What are some differentials for acute diarrhoea in the adult horse?

A
  • Salmonella spp.
  • Clostridium difficile
  • Clostridium perfringens
  • Coronavirus
  • Cyathostomiasis
  • Antimicrobial-associated
  • Right Dorsal Colitis
  • Grain overload
  • Dietary
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2
Q

What are some differentials for chronic diarrhoea in the adult horse?

A
  • Salmonella spp.
  • Cyathostomiasis
  • Right Dorsal Colitis
  • Sand enteropathy
  • Inflammatory Bowel Disease
  • Dietary
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3
Q

What clinical signs and complications might you see in a young or adult horse with acute diarrhoea?

A
  • Cow pat to high volume hosepipe diarrhoea
  • Quiet to depressed demeanour
  • Colic
  • Fever
  • Hypovolaemia
  • Might also see: SIRS, laminitis, secondary infections

These cases have a significant risk of deteriorating rapidly.

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4
Q

What clinical signs and complications might you see in an adult horse with chronic diarrhoea?

A
  • Cowpat to high volume hosepipe diarrhoea
  • Bright to depressed demeanour
  • Colic
  • Fever
  • Ventral oedema
  • Weight loss
  • Electrolyte imbalances
  • These horses are often normovolaemic
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5
Q

Describe the pathogenesis of antimicrobial-associated colitis

A
  • Disruption of GI flora -> lack of competition for nutrients
  • This allows pathogenic bacteria to proliferate
  • The obligate anaerobe population of the flora is most important -> antibiotics affecting these have a higher incidence of causing diarrhoea
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6
Q

True/false: cyathostomiasis can cause prepatent disease.

A

True

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7
Q

When is cyathostomiasis most commonly seen?

A

In spring due to sudden mass emergence which produces clinical disease

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8
Q

What is the cause of right dorsal colitis?

A
  • NSAID toxicity
  • This is often in horses receiving higher than licensed doses, but can still occur with normal doses over a short time
  • This can occur in the normovolaemic horse
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9
Q

Describe how grain overload leads to diarrhoea in the adult horse

A
  • Horses gain access to large quantity of hard feed
  • Small intestinal digestion is overwhelmed and soluble carbohydrates enter the large intestine
  • Rapid fermentation occurs by lactic acid-producing bacteria. This lowers the pH and kills off gram negative bacteria.
  • Endotoxin is released when bacteria die
  • Other bacteria overgrow and the gut wall becomes compromised
  • –> bacteria and toxins enter circulation
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10
Q

Describe how clostridiosis causes diarrhoea in the adult horse

A
  • Clostridiosis is most commonly antimicrobial-associated and nosocomial
  • Clostridia are part of the normal flora in all ages, and are present at low numbers without producing toxins
  • When these bacteria produce toxins, disease is seen
  • Most commonly: Clostridium difficule, Clostridium perfringens
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11
Q

True/false: all Salmonella serovars are zoonotic and affected animals shed constantly.

A

False
* Not all serovars are zoonotic but some are so need to be aware of this.
* There is intermittent shedding by infected animals.

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12
Q

What clinical signs might you associated with Salmonella infection in adult horses?

A
  • Large volume watery diarrhoea
  • Lethargy
  • Pyrexia

May see bacteraemia.

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13
Q

True/false: coronavirus can be associated with outbreaks of diarrhoea in adult horses.

A

True

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14
Q

What are risk factors for sand enteropathy?

A
  • Pasture access on sandy soil
  • Overgrazed pastures
  • Fed on the ground
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15
Q

Sand ingestion is commonly associated with acute intestinal obstruction, but can also cause…

A

abnormal accumulation of sand in the large intestine (–> chronic diarrhoea)

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16
Q

What are some risk factors for salmonellosis in adult horses?

A
  • Recent abdominal surgery
  • GI disease e.g. small colon impaction
  • Immunosuppression
  • Antibiotics
  • General anaesthesia
  • High ambient temperatures
  • Prolonged hospital stay
  • Horses actively shedding or carriers
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25
Q

What types of inflammatory bowel disease are there?

A
  • Multisystemic eosinophilic epitheliotropic disease (MEED) / Eosinophilic enteritis (EE)
  • Granulomatous enteritis (GE)
  • Lymphocytic-plasmocytic enteritis (LPE) or colitis
  • Lymphosarcoma
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26
Q

Pathogenesis of Clostridiosis in horses

A
  • Most commonly antimicrobial-associated and nosocomial
  • Clostridia are part of the normal flora in all ages; usually exist at low numbers and do not produce toxins
  • When toxins are produced there is disease
  • Clostridium difficile, Clostridium perfringens
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27
Q

Differentiate between the types of Clostridia that cause diarrhoea in horses

A

C. difficile = more common
* Often associated with antimicrobial-associated colitis
* Could be a reservoir for human Clostridium difficile infection

C. perfringens
* Type A and C are most common
* Toxins produced lead to disease
* Seen with haemorrhagic disease, mainly neonates but can be adults too

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28
Q

Risk factors for Clostridiosis

A
  • Dietary changes
  • Hospitalisation
  • Antimicrobials
  • GI disease
  • (Not fully understood)
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29
Q

Characteristics and risk factors of coronavirus

A
  • Recently emerged as an enteric pathogen in horses
  • Can be associated with outbreaks
  • Risk factors not fully understood
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30
Q

Epidemiology of cyathostomiasis

A
  • Most important equine parasitic disease: high prevalence and can have severe clinical signs
  • Causes pre-patent disease
  • Most commonly in spring; in hotter climates, mostly seen in autumn
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31
Q

What is the difference between Cyathostomins and small strongyles?

A

They are the same thing

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36
Q

The life cycle of which parasite is shown here?

A

Cyathostomins (small strongyles)

37
Q

How do cyathostomins cause disease?

A
  • Sudden mass emergence leads to clinical disease
  • There is mucosal injury, ulceration, and inflammation
38
Q

Risk factors for cyathostomiasis

A
  • Age
  • Season
  • Period since last anthelmintic
  • Altered host immunity
  • Stress
  • Dietary change
  • (Some factors unknown)
39
Q

What is antimicrobial-associated diarrhoea and how does it develop?

A
  • Occurs as a side effect of antimicrobial administration: there is disruption of GI flora, lack of competition for nutrients, and pathogenic bacteria / those normally found in low numbers can proliferate
  • Obligate anaerobe population of the flora is most important in preventing this from happening (antibiotics affecting these have a higher incidence of causing diarrhoea)
  • Consider if patient really needs antibiotics before prescribing and follow PROTECT ME guidelines
40
Q

Which are more susceptible to Right Dorsal Colitis: horses or ponies?

A

Ponies are more susceptible to NSAID toxicity and right dorsal colitis

41
Q

Pathogenesis of Right Dorsal Colitis

A
  • Toxicity from NSAID administration
  • NSAIDs interfere with prostaglandins needed for colon health -> interfere with GI blood flow and protective mechanisms e.g. mucus production
42
Q

As well as Right Dorsal Colitis, what other side effect(s) can NSAIDs cause in adult horses?

A

Medullary crest necrosis

43
Q

Risk factors for Right Dorsal Colitis

A

NSAID use
* Can occur with normal dose, but often seen if higher than licensed doses are used
* Does not need to be long term use
* Can happen in normovolaemic horses at normal doses!
* More common with oral phenylbutazone, less common with COX-2 selective drugs

44
Q

Pathogenesis of grain overload

A
  • History of horses gaining access to large quantity of hard feed
  • Small intestinal digestion is overwhelmed and soluble carbohydrates enter large intestine
  • Rapid fermentation of carbohydrates by lactic acid-producing bacteria lowers pH
  • Gram negative bacteria die and large quantities of endotoxin are released
  • Other bacteria overgrow and gut wall becomes compromised
  • Bacteria and toxins enter circulation
45
Q

Clinical signs of grain overload

A
  • SIRS
  • Osmotic diarrhoea due to lactic acid being poorly absorbed
  • Severe (often fatal) laminitis
46
Q

Risk factors for grain overload

A
  • Access to large quantity of grain

Amount needed to cause diarrhoea varies but horses fed diets high in soluble carbohydrates are more resistant

47
Q

General risk factors for infectious GI disease

A
  • Existing GI disease
  • Immunosuppression
  • General anaesthesia
  • Recent abdominal surgery
  • Antimicrobials
  • Hospitalisation
  • Other horses
  • Dietary changes
48
Q

Differentials for acute diarrhoea in young (6 weeks-9 months) horses

A
  • Salmonella spp.
  • Clostridium difficile
  • Clostridium perfringens
  • Coronavirus
  • Cyathostomiasis
  • Antimicrobial-associated
  • Right Dorsal Colitis
  • Grain overload / dietary
  • Equine Proliferative Enteropathy
  • Rhodococcus equi
49
Q

Causative agent, signalment and pathogenesis of Equine Proliferative Enteropathy

A

Causative agent: Lawsonia intracellularis
Signalment: 2-8 months old
Pathogenesis: proliferative enteropathy of small intestine leading to severe hypoalbuminaemia and weight loss +++

50
Q

Characteristics of Rhodococcus equi

A
  • Usually see respiratory disease
  • Diarrhoea is an uncommon manifestation
51
Q

Risk factors for Lawsonia intracellularis and Rhodococcus equi

A
  • Often geographical: farms with a history of disease often see annual reoccurence in the given age group
52
Q

Differentials for chronic diarrhoea in the young horse

A
  • Salmonella spp.
  • Cyathostomiasis
  • Right Dorsal Colitis
  • Sand enteropathy
  • Inflammatory Bowel Disease
  • Dietary causes
  • Lawsonia intracellularis
  • Rhodococcus equi
53
Q

Which anatomical regions are implicated in neonatal diarrhoea compared to juvenile and adult horses?

A
  • Neonatal diarrhoea - small intestinal pathology only (neonate starts really ingesting roughage around 6 weeks of age)
  • In juvenile / adult horses - large intestinal pathology required (± small intestinal pathology) in order to result in diarrhoea
54
Q

How old is a neonate and how is the neonatal period divided?

A

Neonate: 0 days - 6 weeks
First period: 0-10 days
Second period: 10 days-6 weeks

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Risk factors for development of diarrhoea in neonatal foals

A
  • Failure of passive transfer
  • Pre-existing disease
  • Poor hygiene in the peripartum period
  • High stocking density
  • Antimicrobial administration
  • Milk replacer therapy
78
Q

Diagnostics and treatment for diarrhoea in neonatal foals

A

Diagnostics
* History and physical exam
* Haematology and biochemistry
* Further diagnostics: ultrasound, faecal cultures, PCR

Treatment
* Treat the underlying cause
* Treat the consequences of diarrhoea: fluid/ electrolyte loss, bacterial translocation, albumin loss, nutrition

EQUINE (59 decks)

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