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Diarrhoea and Treatment Flashcards

1
Q

Give 4 differential diagnoses for an adult horse with acute diarrhoea

A

Salmonella spp.
Clostridium difficile
Clostridium perfringens
Coronavirus
Cyathostomiasis
Antimicrobial associated
Right Dorsal Colitis
Grain overload
Dietary

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2
Q

Give 4 clinical signs/conditions which may accompany diarrhoea in the adult horse

A

Quiet to depressed
Colic
Pyrexia
Hypovolaemia
SIRS
Laminitis
Secondary infections

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3
Q

What is the most important thing to inform the clients about a Salmonella spp. infection in their horse?

A

Some serovars are zoonotic

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4
Q

What are the limitations of PCR testing for Salmonella in faeces?

A

Can be intermittently spread, so a negative result doesn’t always mean the horse is clear

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5
Q

True or False?
Coronaviruses are part of the normal flora in all ages of horse

A

False - clostridiosis is part of the normal flora

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6
Q

How do clostridia cause disease?

A

Toxins produced cause disease - low numbers don’t produce toxins

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7
Q

True or False?
Coronavirus has only recently been found as an enteric pathogen

A

True
Can be associated with outbreaks
Risk factors not fully understood

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8
Q

What is the most important equine parasitic disease?

A

Cyathostomiasis
Can have severe clinical signs
Pre-patent disease
Most commonly seen in spring with a sudden mass emergence

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9
Q

Describe the pathogenesis of antibiotics causing colitis

A
  1. Disruption of GI flora
  2. Lack of competition for nutrient
  3. Pathogenic bacteria able to proliferate
    Obligate anaerobe population of the flora is most important, so antibiotics affecting these are more likely to cause diarrhoea
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10
Q

What causes Right Dorsal Colitis?

A

NSAID toxicity

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11
Q

Describe how grain overload can result in diarrhoea

A
  1. Small intestine is overwhelmed and soluble CHO enters the large intestine
  2. Rapid fermentation by lactic acid-producing bacteria lowers the pH
  3. Gram negative bacteria die and endotoxins released
  4. Other bacteria overgrow = gut compromised
  5. Bacteria and toxins enter the circulation
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12
Q

Other than gastrointestinal disease and antimicrobials, what are the risk factors for diarrhoea in an adult horse?

A

Immunosuppression
General anaesthesia
Recent abdominal surgery
Hospitalisation
Other horses with diarrhoea
Dietary changes

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13
Q

Which 4 causes of acute diarrhoea can also cause chronic diarrhoea in the adult horse?

A

Salmonella spp.
Cyathostomiasis
Diet
Right Dorsal Colitis

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14
Q

Name 3 causes of chronic diarrhoea in the adult horse

A

Salmonella spp.
Cyathostomiasis
Right Dorsal Colitis
Sand enteropathy
Inflammatory Bowel Disease
Dietary

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15
Q

Is ventral oedema more likely to be seen in chronic or acute diarrhoea in the adult horse?

A

Chronic diarrhoea

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16
Q

What might you see on blood testing an adult horse with chronic diarrhoea?

A

Electrolytes imbalances
Often normovolaemic

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17
Q

How does sand cause chronic diarrhoea in adult horses?

A

Accumulates in the large intesting and irritates the mucosa
Often associates with acute intestinal obstruction (colic)

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18
Q

What are 3 risk factors for chronic diarrhoea caused by sand in adult horses?

A

Pasture access on sandy soil
Overgrazed pastures
Fed on the ground

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19
Q

What are the 4 causes of inflammatory bowel disease in adult horses?

A

Multisystemic Eosinophilic Epitheliotropic Disease (MEED)
Granulomatous enteritis
Lymphocytic plasmocytic enteritis/colitis
Lymphosarcoma

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20
Q

What is the most frequently found serovar of Salmonella causing diarrhoea in adult horses?

A

Typhimurium
Common to have a large volume of watery diarrhoea - bacteraemia
Intermittent shedding

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21
Q

What are 4 risk factors for Salmonellosis in adult horses?

A

Recent abdominal surgery
General anaesthesia
GI disease (small colon impaction)
High ambient temperatures
Prolonged hospital stay
Immunosuppression
Antimicrobials
Horses actively shedding or carriers

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22
Q

What are the most common reasons for clostridiosis in adult horses?

A

Antimicrobial-associated
Nosocomial (picked up in a hospital)
Part of the normal flora in all ages
Colostridium difficile and Colostridium perfringens

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23
Q

Which types of Clostridium perfringens are most commonly found in adult horses?

A

Types A and C
Produce toxins which cause disease

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24
Q

Is Clostridium perfringens or Clostridium difficile more likely to be seen in neonates?

A

Clostridium perfringens

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25
Which Clostridium disease is more likely if the horse has haemorrhagic diarrhoea?
Clostridia perfringens
26
Which Clostridium disease is most often associated with antimicrobial associated colitis?
Clostridium difficile Can be zoonotic
27
Name 3 risk factors for Clostridiosis in adult horses
Dietary changes Hospitalisation Antimicrobials Gastrointestinal disease
28
In hot climates, when is Cyathostomiasis most commonly seen?
In Autumn - Spring in cooler climates
29
How long is the pre-patent period of Cyathostomins?
6-14 weeks Can remain encysted from weeks to 2 years
30
What stage of the Cyathostomin lifestyle is unaffected by most anthelmintics?
Encysted, hypobiotic larvae
31
What pathology do Cyathostomins cause in the GIT in an outbreak?
Mucosal injury Ulceration Inflammation
32
What are the risk factors for Cyathostomiasis in adult horses?
Age Season Time since last anthelmintic Altered host immunity Stress Dietary changes Unknown factors
33
True or False? Anthelmintic toxicity can cause medullary crest necrosis
False - NSAID toxicity can cause this
34
What cause of diarrhoea can lead to SIRS, osmotic diarrhoea due to poorly absorbed lactic acid and severe laminitis?
Grain (carbohydrate) overload Laminitis is often fatal
35
What age range is a young horse in?
6 weeks to 9 months
36
What diseases which cause diarrhoea in adult horses also cause diarrhoea in young horses?
Salmonella spp. Clostridium difficile Clostridium perfringens Coronavirus Cyathostomiasis Antimicrobial associated Grain overload Dietary
37
Name 2 causes of diarrhoea most commonly seen in young horses
Equine proliferative enteropathy (Lawsonia intracellularis) Rhodococcus equi (causes serious pneumonia)
38
What age group is Lawsonia intracellularis infection (Equine Proliferative Enteropathy) most commonly seen?
2-8 months Proliferative enteropathy of the small intestine
39
What are the 2 main effects of Equine Proliferative Enteropathy other than diarrhoea?
Severe hypoalbuminaemia Severe weight loss
40
Which antibiotics are appropriate for treating Equine Proliferative Enteropathy in young horses?
Antibiotics with good intracellular penetration, e.g. oxytetracycline, chloramphenicol or macrolides
41
What is Rhodococcus equi, a cause of diarrhoea in young horses, most often associated with?
Foal pneumonia - normally causes respiratory disease
42
Which of the following isn't a common cause of chronic diarrhoea in young horses? 1. Cyathostomiasis 2. Inflammatory Bowel Disease 3. Lawsonia intracellularis 4. Fasciola hepatica 5. Rhodococcus equi
Fasciola hepatica Other causes of chronic diarrhoea in young horses include Salmonella spp., Right Dorsal Colitis, Sand Enteropathy and Diet
43
How many period is the neonatal period commonly divided into? What are they?
2 periods: - 0-10 days - 10 days-6 weeks
44
At what age do foals normally start ingesting roughage?
Towards 6 weeks of age Weaning is normally around 6 months old
45
True or False? Diarrhoea in neonates can indicate large intestinal disease only, whereas in juveniles/adults small intestinal pathology must be present for diarrhoea to occur
False Neonatal diarrhoea can indicate just small intestinal disease Juveniles and adults need large intestinal disease for diarrhoea to occu
46
Name the 2 main viral causes of diarrhoea in foals aged 0-10 days
Rotavirus Coronavirus (usually in immunocompromised foals)
47
True or False? Candida or Mucor spp. fungal infections are rare causes of diarrhoea in immunocompromised foals
False - most commonly seen in immunocompromised foals
48
What is the main protozoal cause of diarrhoea in foals aged 0-10 days?
Cryptosporidium
49
Which of the following is a Gram positive bacteria which causes diarrhoea in foals aged 0-10 days? 1. Clostridium spp. 2. E. coli spp. 3. Salmonella spp. 4. Actinobacillus spp.
Clostridium spp. E. coli, Salmonella and Actinobacillus are Gram negative bacteria which cause diarrhoea
50
You are investigating a case of diarrhoea in a 7 day old foal. The foal is systemically well an you have ruled out infectious causes of the diarrhoea. What non-infectious causes might be on your differentials list?
Foal heat diarrhoea Diarrhoea secondary to meconium impaction Errors in concentration or volume of milk fed, especially in orphaned foals Gastroduodenal ulceration Sand enterocolitis Congenital lactose intolerance
51
You are called out to visit a 3 day old foal. The foal has diarrhoea and is systemically unwell on clinical examination. What are your top 2 differentials?
Perinatal asphyxia syndrome/Neonatal maladjustment syndrome (dummy foals from lack of oxygen in parturition) Sepsis
52
What 4 infectious causes of diarrhoea are seen in foals 10 days-6 weeks, but not in foals <10 days old?
Rhodococcus equi (Gram +ve bacteria, generally >6 weeks old) Strongyloides Westerii - passed through milk Parascaris equorum - on grass Strongylus vulgaris - on grass
53
Can foal heat diarrhoea be a differential for diarrhoea in a 2 week old foal?
Yes - can be seen up to 2 weeks of age
54
True or False? All the causes of non-infectious diarrhoea in 0-10 day old foals can also cause diarrhoea in foals 10 days-6 weeks
In general yes - post enteritis lactose intolerance more commonly seen in older foals than congenital lactose intolerance Older foals less likely to have diarrhoea due to Perinatal Asphyxia Syndrome or sepsis
55
What is the main risk factor for diarrhoea in neonatal foals?
Failure of passive transfer Also pre-existing disease, poor hygiene, high stocking density, antimicrobial administration and incorrect milk replacer feeding
56
How can you treat the consequences of diarrhoea in neonatal foals?
Fluid/Electrolyte loss - IV fluids and (oral) electrolytes Bacterial translocation from damaged gut into systemic circulation - systemic antibiotics Albumin loss - plasma or colloid therapy Nutrition - enteral nutrition via NG tube if needed
57
When should you get worried about a foal?
If you can catch it easily or it's not drinking
58
You are investigating the cause of diarrhoea in a 12 year old pony gelding. NAD on clinical exam other than the diarrhoea (cow-pat consistency). FWEC was 50 epg 12 weeks ago. What diagnostic tests would you like to do and what for? What is your top differential?
Faecal worm egg count to look for cyathostominosis. Faecal PCR to look for Salmonella or Clostridia spp. Haematology and biochemistry PCV, SAA and blood lactate Top differential is cyathostominosis, as Salmonella normally originates from hospitals
59
A 2 year old cob gelding presents with watery faeces in the last 24 hours. Wormed with fenbendazole 8 weeks ago. HR 66bpm, increased watery gut sounds, dark MM CRT 3 secs and cold extremities. What diagnostic tests would you do? What is your top differential diagnoses?
PCV, SAA and blood lactate Faecal PCR for Salmonella and Clostridia spp. Haematology and biochemistry Cyathostominosis Faecal worm egg count - cyathostominosis
60
What are the 4 main aims of doing diagnostic tests for diarrhoea?
Determine the underlying cause Decide if supportive therapy needed Determine need for specific therapy Determine risk to in-contact horses and personnel
61
How many litres of fluid does a 500kg horse need for maintenance per day?
25L/day
62
A horse has mild to moderate diarrhoea. How will you ensure they maintain hydration?
Voluntary drinking +/- NGT If moderate to severe diarrhoea then IVFT with Hartmann's - may need KCl, NaHCO3 and Na supplements; think about oncotic pressure decline
63
How could you avoid the negative effects of NSAIDs when treating diarrhoea in horses?
Use a COX-2 selective NSAID to avoid Right Dorsal Colitis
64
What temporary analgesia can be used in young and adult horses with diarrhoea, other than NSAIDs?
Xylazine, detomidine +/- butorphanol
65
What analgesia can you use for constant rate infusion in young and adult horses?
Butorphanol, lidocaine +/- ketamine
66
When should you give antimicrobials to a horse with diarrhoea?
If neutropaenic or signs of sepsis Give penicillin IM and gentamicin IV Debatable as risk of antimicrobial-associated colitis
67
Which antibiotics could you use for severe cases of clostridiosis?
Metronidazole PO
68
Use of faecal transfaunation (probiotics) to treat diarrhoea in horses is debatable. What should you take into account when choosing a horse to donate faeces for this?
Mustn't have had recent antimicrobials No risk of additional infection Complications and risks associated with faecal transfaunation
69
Name an adsorbent which is useful in treating diarrhoea in young and adult horses
Di-Tri Octahedral Smectite (Biosponge) Better to give SID-BID via NGT
70
What dietary recommendations would you give for a young or adult horse with diarrhoea?
Ideally give a complete pelleted diet with no grain and no hay If anorexic then give good quality grass hay or anything Can add corn oil for added calories
71
Other than general treatment for diarrhoea, what specific treatment can be useful for Right Dorsal Colitis?
Misoprostol may be useful - mucous barrier Psyllium may be useful - absorbs liquid in the intestines, swells and forms a bulky stool
72
Which anthelmintic will you give to a horse with cyathostomiasis?
Moxidectin (macrocyclic lactone like ivermectin) Pre-treatment with dexamethasone or prednisolone
73
Psyllium can be useful to treat Right Dorsal Colitis and what other cause of diarrhoea?
Sand enteropathy
74
Which antibiotic should you use for Lawsonia intracellularis infections?
Doxycycline
75
Dobutamine is sometimes used to treat sepsis in acute diarrhoea. What is it's mechanism of action?
Inotrope which increases blood pressure and cardiac output
76
Would you give a horse with sepsis and diarrhoea Flunixin meglumine? If so, why?
Yes - analgesia and may help block parts of the sepsis cascade Lower dose may be needed
77
How can you reduce the risk of laminitis in horses with sepsis and colitis?
Cryotherapy - using ice to cool the feet (critical) Important to maintain a constant low hoof temperature - often means replacing ice every 2 hours for 24 hours a day
78
Why is plasma therapy so expensive when managing horses with sepsis and acute diarrhoea?
Need lots to make a difference to the protein levels 7-10L for a 500kg horse 1-2L for a 500kg horse may help with toxin neutralisation (debatable)
79
What is the mechanism of action of pentoxyfyline in the treatment of sepsis?
Not sure how but suppresses proinflammatory cytokines Increases RBC deformability Currently no published controlled clinical trials supporting its use
80
Which drug is used in cases of sepsis to prevent initiation of the proinflammatory cascade?
Polymixin B Debatable efficacy
81
How should you treat a neonate with diarrhoea?
Consider referral IVFT, but care with Na and acid base Antimicrobials - mostly sepsis-related (FPT) GI rest 24-48 hours so partial (glucose in IV) or total parenteral nutrition Supportive care Don't forget about secondary infections
82
When should you isolate a horse with diarrhoea?
If 2 of the following apply: - Pyrexia - Neutropenia - Diarrhoea Or if diarrhoea has been progressing for 24-48 hours

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