Case Conversations Flashcards
Bright, good appetite, one horse is really dyspnoeic, 2 or 3 depressed and inappetant
*Mucopurulent nasal discharge. Enlarged submandibular LNs– some have ruptured
Most likely???
E. Streptococcus equi equi- Strangles
Unlikely to be viral because of big LNs
B- farm workers (fomites)
C- Soil-maybe
D- Asymptomatic carrier
E- vet maybe
F- neighboring horse maybe
Strangles
Isolating horses– 3 groups– really contagious, incubation period of a few weeks.
D- definitely
Treating with antibiotics difficult to penetrate abscesses… so organisms left in the core of the abscess so those animals often have a relapse
** do not recommend to vaccinate– type III hypersensitivity
Strangles
D- absolutely not!!
What do you do?
A. CBC, biochem, urinalysis
B. Biopsy tongue ulcers
C. Biopsy hind limb
D. Blood cultures
E. Nasal swab for viral culture
F. PCR samples for viruses
A. CBC, biochem, urinalysis
A B C D
Not C and not H
Primary diagnosis?
Vasculitis and cellulitis secondary to:
- drug or vaccine reaction
b. severe cat bites
c. post dental bacteraemia
d. virulent systemic disease (VSD)
e. something else
D. Virulent systemic disease
3 yo TB racehorse
* 4am found rolling
Trainer gave 2 ml ACP IV
No change at 10 minutes
Trainer gave 10 ml flunixin
What do you do first?
Give detomidine for analgesia and to get physical exam done
History– don’t do first– horse is painful
* physical exam- HR, RR, temp, g/s, MMs– dangerous at this time
How you interpret?
a. Not surgical: r/v 3 hours
b. Impaction- MM
c. Early sxl lesion
d. Don’t have enough info to decide
Duration of colic short and pretty painful
Elevation in HR is minimal
Can’t make a call it is not surgical yet, too early
* Impaction- hasn’t passed manure but don’t know that is the primary lesion yet
Mgt of impaction– enteral fluids– but if SI obstruction would distend SI more… so wouldn’t want to do too much
Could be early surgical
DON’t have enough info!!!
Soo… rectal and U/S.. transverse of the SI.
Definitely small intestinal because the U/S picture is not normal
** Not likely AE because there was no reflux– AE causes functional obstruction of the proximal SI so reflux is often present a short time after onset. The horse was not febrile though this doesn’t always occur with AE and he had said NSAIDs which could decrease temp slightly and give a false reading: despite 38C is well within normal range
* The level of pain may also be more than expected with AE though this is unreliable. I would expect some motility in the U/S picture with AE but stasis with a physical obstruction. AE is less common than a physical obstruction though a racehorse is fed a large amount of concentrates which is a risk factor for AE
A. NGT/ rectal: 2-3 hours
* Reflux may or may not be present at this time: it depends on the site of obstruction. Passing a NGT is an important part of any colic work up or reassessment but absence of reflux does not rule out SI obstruction in the early stages of colic
Repeating the rectal exam is an important part of re-evaluation of a colic and SI distension may not be palpable: if present it is most often in the midline as stacked fluid filled tubes travelling transversely across the abdomen but the mesentery is long so dilated loops can be anywhere. Tension on the medial band of the caecum or pain when it is palpated occurs if the caecum is being pulled out of place due a lesion involving the ileum though this is not a particularly sensitive or specific finding.
Which is most appropriate COA?
A. Fecal culture
B. rumen pH
C. Abdominocentesis
D. Exploratory laparotomy
E. Wither pinch test
B. Rumen pH
Lactic acidosis
What if it was 5.5? We would need to go back to clinical exam
When would abdominocentesis be helpful? If it is chronic
Exploratory lap?
Wither pinch test? Peritonitis
JD- culture takes weeks because slow growing.. culture used as the definitive test
Salmonellosis- yes; fetid diarrhoea, pyrexic– 95% confident in diagnosis. Sensitivity of culture… revolting salmonella faeces… does not survive transport to the lab very well. 80% with Salmonella would come back with Salmonella. (cost of C&S- $10)
E. coli scours- no
Mycotic rumenitis
Grain overload- no
A
Give oxytet for 5 days IF the cow is showing systemic signs– this cow had a temp of 39, not normal in Warnabol in winter
* In general the enterobacteria that get into the blood are not sensitive to Penicillin
* Baytril- by law do not use in food producing animals in Australia– can’t use it against the label
* Tolfenamic acid- NSAID- 2 day duration of action in cattle, cheaper than Meloxicam
* Low pH and want to correct that.. so either Sodium bicarb or Mg carbonate or both.
* 2 liters of hypertonic fluids followed by 20 L of water orally– appropriate fluid therapy– but this cow doesn’t need it, she is standing up
4 stages of acidosis
Cow is down- antibiotics and fluids
low rumen pH need to buffer
Compromise of gut wall if systemica effects
A. 5 liters of Hartmann’s IV quickly
B. 15 L of Hartmanns quickly IV
C. 2 L of hypertonic fluids IV and 20 L of electrolyte solution
D. 2 liters of hypertonic fluids and 20 L of water orally
E. 2 liters of hypertonic fluids and 20 L of water with 200g NaHCO3
blood volume of a cow? 40 L in 500 kg cow (8%)
Is she down because she is dehydrated?
She is down because she is acidotic and she is in shock, therefore circulatory collapse therefore not enough volume of fluid to fill capillaries….
Hartmann’s doesn’t treat acidosis well in cattle
* Animals that are dehydrated– extracellular space is dehydrated–idea of hypertonic solution is to draw fluid from the EC space to the IV space… where there is no fluid in the EC it can make them worse… however in cases of shock, hypertonic fluids are very useful… so hypertonic would be OK.
* So D or E??
- Use sodium bicarb because we want to fix the acidosis too.
A. 5 liters of Hartmann’s IV quickly
B. 15 L of Hartmanns quickly IV
C. 2 L of hypertonic fluids IV and 20 L of electrolyte solution
D. 2 liters of hypertonic fluids and 20 L of water orally
E. 2 liters of hypertonic fluids and 20 L of water with 200g NaHCO3
5 liters of Hartmann’s combined with flunixin.
5 liters to 40 L enough of a circulatory boost to get them going again. Don’t give too much end up with haemolysis.
** 2 L of hypertonic with electrolytes… reason for electrolytes… when you give hypertonic fluids IV and then oral fluids into the rumen… want to make easy path of fluid for fluids to get into the blood stream… putting electrolytes in will potentially slow that down
* use electrolytes in a dehydrated cow but not hypertonic solution for a dehydrated cow.
Diarrhoea last week, eating OK, not depressed, no straining or blood, normal temp, green poo, no grain, watery, sub mandibular oedema
A. Salmonella
B. Liver Fluke
C. JD
D. Simple indigestion
E. E. coli scours
F. BVD
Diet? Can always be change in diet of an individual cow because the cow before her didn’t eat and she got a double ration
* milk? dropping off
* JD?
* Parasitic tx? No.
Salmonella– unlikely– faeces would stink, depressed, first clinical sign is the cow goes off her feed, in herds with outbreaks– 20-40 cases… cows come into bail, if above 39C and not eating- treat
Liver fluke– could be, a bit old
JD- likely diagnosis, 7 is classic age, no other signs, sub mandibular oedema… Johne’s ELISA… Finding fluke eggs would not rule out Johne’s.
NOT Simple indigestion, E. coli scours, BVD– if you suspected could do ELISA on milk vat to check for antibodies but unlikely in this cow
A, B, C (within 1 week of suspicion so wait for the test)… can send the cow to knackery that has a positive ELISA but clinically normal
JD cause problems in humans?? Current thinking– people in both camps.
Incidence in WA CD, incidence in farmers is no different to the normal population
b. 12 DSE/ha
based on classes of animals have on the land
How can you tell farm is appropriately stocked? Based on French equation– below
** a bit on the lower side with stocking rate
What is a high total worm count in a lactating Merino ewe?
10-20,000 or more is a high total worm count
Age related immunity… ewes may not be the best indicator.. wethers also would have developed immunity. Not lambs with low WEC– wouldn’t get enough sensitivity, so not very representative. Lambs with high WEC >1000epg– selective tx. If drenches do work… would see a change.
E. random lambs- if their avg. WEC > 200 epg
August and taking into account all we have learned
E. Mainly Teladorsagia and Trichostrongylus
** often occur in mixed infections
Haemonchus isn’t such a problem in August– mainly at warmer times of year (in this region that is!)
Outbreaks in warmer regions depending on how much rainfall
Good exam question!!!
Larry
- 12 yo Warmblood gelding
- 2 week history of mild intermittent colic
- Unwilling to work/poor performance
- Occasional urine dribbling
- Frank blood in urine sometimes seen after work
- Physical exam findings
–Bright and alert
–Normal TPR
–Some blood-stained urine on hindlimbs
–No other abnormalities
•What is your problem list?
–Mild intermittent colic
–Unwillingness to work
–Urine dribbling
–Haematuria (frank blood) after work
–Blood-stained urine on hindlimbs
Larry
•What is your diagnostic plan?
–Urinalysis
–CBC/chemistry
–Palpation per rectum
–Transrectal ultrasound
–Cystoscopy
–Renal ultrasound
What are your treatment options?
A.Monitor and wait for it to resolve
B.Surgical excision under general anaesthesia
C.Break the urolith up endoscopically and wait for the pieces to pass through the urethra
D.Dietary management
Increased urea
