Chronic Weight Loss and Enteropathies in the Horse Flashcards
what are potential causes of weight loss in the horse (7)
- insufficient food intake (may not always be apparent to owner if turned out)
- dental disease or mouth pain
- parasitism (increased loss of nutrients)
- decreased absorption of nutrients: inflammatory or infiltrative bowel disease
- intestinal disorders causing diarrhea, such as right dorsal colitis, acute colitis, protein losing enteropathies
- decreased assimilation of nutrients: severe hepatic disease or metabolic disease
- protein losing nephropathy
what is the definition of chronic colic
subacute abdominal pain extending over a period of days
what might be a symptom with chronic colic
weight loss with both chronic and recurrent colics
what are the most common types of chronic colic in the UK (3)
- colonic impaction (31%)
- peritonitis (16%)
- lymphoma (4%)
how do you prevent colic (management) (14)
- establish set daily routine (exercise, turnout, minimize changes in diet)
- 2-3%DM of body weight in forage in diet
- daily access to grass
- avoid excessive grain
- divide concentrate feed in >2 small meals
- don’t feed from ground if sandy
- access to clean water
- parasite control effective
- 6 month dental exam
- avoid meds unless prescribed by vet
- count droppings passed overnight (fluctuation?)
- particular attention with transporting
- keep diary of all colics
- record changes in feed/management/exercise/weather
what are causes of chronic and recurrent colics in the stomach (4)
- gastric ulceration (most common)
- gastric dilation
- pyloric outflow problem
- neoplasia (squamous cell carcinoma)
what are causes of chronic and recurrent colic in the small intestine (6)
- ascarid impaction
- idiopathic focal eosinophilic enteritis
- mild non-strangulating infarction (S. vulgaris)
- inflammatory bowel disease
- ileum hypertrophy
- adhesions
what are causes of chronic and recurrent colic in the large colon (7)
- impaction
- sand impaction
- enterolith
- mild non strangulating infarction
- right dorsal colitis
- granulomatous enteritis
- chronic salmonellosis
what are the presenting signs of sand enteropathy (5)
- colic
- diarrhea
- borborygmi often decreased
- fever
- neutrophilia
how is sand enteropathy diagnosed
radiography superior to ultrasonography for diagnosis
how are sand enteropathies diagnosed
- daily mineral oil and psyllium by NG tube
- IV fluids
- NSAIDs as required
what are causes for chronic and recurrent colics in the cecum (4)
- impaction/atony
- sand
- intussusception
- enterolith
what are causes of chronic and recurrent colic in the small colon/rectum (5)
- impaction
- fecolith/foreign body
- mesocolon tear
- enterolith
- peri rectal abscess
what are non GIT associated causes of chronic and recurrent colic (4)
- peritoneum
- liver
- urinary system
- (pleuritis)
what are peritoneum causes of chronic and recurrent colic (7)
- adhesions
- chronic peritonitis
- abdominal abscess
- neoplasia
- lymphoma
- squamous cell carcinoma
- other (mesothelioma)
what are liver causes of chronic and recurrent colic (3)
- cholelithiasis
- chronic active hepatitis
- echinococcosis
what are urinary system causes of chronic and recurrent colic (4)
- urolithiasis
- cystitis
- pylenephritis
- renal hemorrhage
if you have a horse presenting with weight loss +/- chronic colic what should be included in your first assessment (4)
- history
- clinical exam, rectal palpation, dental
- clinical chemistry
- abdominocentesis + cytology
what further diagnostics can be done at referral/later if you have a horse presenting with weight loss +/- chronic colic (5)
- gastroscopy +/- biopsy
- abdominal ultrasound
- abdominal radiographs
- tests of GI motility
- laparotomy +/- biopsies
describe the general horse gastric physiology and acid production and grazing habits
horses voluntarily graze 14-16 hours per day
trickle consumption of grass/forage
small stomach with limited stretch
continuous production of HCl from parietal cells of glandular mucosa, under stimulation of histamine and gastrin
buffered by salivary bicarb, forage itself
retrograde movement of bile into the stomach is normal
how does lack of dietary forage contribute to EGUS
gastric pH continues to fall, allowing breach of gastric mucosa
again compounded by decreased forage intake and decreased saliva production
how does consumption of large concentrate feeds increase the risk of EGUS1
fermentation of high starch feeds within the stomach results in production of additional VFAs that potentiate mucosal damage –> propionic acid plus hydrochloric acid
decreased saliva production compounds the increase in acidity
how does exercise on an empty stomach increase the risk of EGUS
increased intra abdominal pressure during exercise
gastric acid more likely to coat the squamous mucosa
how does high intesity exercise increase the risk of EGUS
prolonged canter/gallop work results in reduced mucosal bloodflow
decreased capacity for pre existing ulceration to heal
how does crib biting increase the risk of EGUS
increased intra abdominal pressure during activity
decreased time spent grazing/foraging
may be raised cortisol in some
what are the early signs of EGUS (6)
- may be none
- reduced rate of eating
- decreased interest in concentrates
- discomfort on girthing
- reduced coat quality
- subtle changes in performance
what are the later signs of EGUS (8)
- loss of performance
- refusal to move forward under saddle
- labouring at exercise
- poor appetite
- pain after eating
- reduced body condition
- dullness, weight loss, lethargy
- chronic colic
what do cases of inflammatory bowel disease present with (4)
- weight loss
- low protein
- +/- colic
- +/- thickened small intestine on ultrasound
- usually no diarrhea
what is the least invasive route to take intestinal biopsies when diagnosing inflammatory bowel disease
gastroscope
rectal biopsies
what is the more invasive route to take intestinal biopsies when diagnosing inflammatory bowel disease
hand assissted laparoscopic
laparotomy
what are potential causes of inflammatory bowel disease (4)
- eosinophilic enteritis
- Multisystemic Eosinophilic Epitheliotropic Disease
- lymphocytic-plasmacytic enteritis
- lymphoma
how is inflammatory bowel disease treated (3)
- immunosuppressive
predisolone 1-2 mg q 12 until protein loss stops and then decreasing maintenance dose at 24 h intervals
- increase nutrient and protein content to diet
- chemotherapy if lymphoma
