Digestion & Metabolism 2: Medical Dz of Equine Colon Flashcards
ENDOTOXEMIA…
this is a typical sign for WHAT disease process?
= what causes clinical signs?
what 2 ways can it occur?
what IS the endotoxin?
5 clinical signs?
typical sign for horse with COLITIS
= clinical signs caused by INFLAMMATORY RESPONSE TO CIRCULATING ENDOTOXIN
2 ways?
1. GRAM-NEGATIVE BACTERIAL INFECTION in ANY TISSUE
2. GRAM NEGATIVE ENTERIC BACTERIA through COMPROMISED MUCOSAL BARRIER
LPS = THE ENDOTOXIN
5 clinical signs?
1. FEVER
2. TACHYPNEA
3. TACHYCARDIA
4. ACUTE D+/COLIC
5. PALE, HYPEREMIC, TOXIC LINE on MMs
INTESTINAL HYPERAMMONEMIA…
caused in ___ cases of COLITIS
= what is it?
caused by SEVERE ____ ____, 3 examples?
clinical signs tend to be ____, including 6 examples
caused in ACUTE cases of COLITIS
= INCREASED PRODUCTION/ABSORPTION of AMMONIA from GI tract due to COLITIS, so much that EVEN LIVER CANNOT CLEAR IT ALL
caused by SEVERE GI DZ, such as…
1. ENTERITIS
2. COLITIS
3. COLONIC TORSION
clinical signs tend to be NEUROLOGIC, including…
1. ATAXIA
2. DEPRESSION
3. DYSPHAGIA
4. CENTRAL BLINDNESS
5. NYSTAGMUS
6. SEIZURES
what diagnostic value CONFIRMS INTESTINAL HYPERAMMONEMIA?
this value DOES/DOES NOT correlate with SEVERITY OF ___ SIGNS
AMMONIA > 60 umol/L
this value DOES NOT correlate with SEVERITY OF NEUROLOGICAL SIGNS
TREATMENT for INTESTINAL HYPERAMMONEMIA? (4)
- TREAT UNDERLYING DZ (colitis)
- LACTULOSE to DECREASE ABSORPTION/PRODUCTION OF AMMONIA DIRECTLY in GI TRACT
- SEDATIVES to control neurologic signs
- SAFETY –> PADDED STALL, IV EXTENSION SETS OUTSIDE STALL
in ADULT HORSES with ACUTE D+, what are the BIG FOUR infectious causes?
what are 5 other causes?
BIG FOUR infectious causes?
1. SALMONELLOSIS
2. CLOSTRIDIUM PERFRINGENS/DIFF
3. POTOMAC HORSE FEVER
4. CORONAVIRUS
other causes?
1. ANTIBIOTIC-CAUSED
2. RIGHT DORSAL COLITIS/NSAID TOXICOSIS
3. CANTHARIDIN TOXICITY (blister beetles)
4. SAND
5. PARASITISM
SALMONELLA…
2 descriptors?
3 ways that disease can manifest? (4 subs for last one)
how long does the virus shed?
diagnosis? (2, one is a +/-)
treatment? (mainly one, antimicrobials?)
2 descriptors?
1. GRAM NEGATIVE
2. ENTEROBACTERIACAE
3 ways?
1. SUBCLINICAL CARRIERS where SALMONELLA SHED IN FECES
2. MILD clinical dz (mild fever, off-food)
3. ACUTE SEVERE DZ…
–> SEVERE D+
–> SEVERE COLIC
–> COAGULATION ABNORMALITIES
–> SIRS/SEPSIS
how long does the virus shed?
–> usually DAYS TO WEEKS, occasionally MONTHS
diagnosis?
1. SALMONELLA FECAL PCR IS MOST SENSITIVE
2. +/- CULTURE to determine TYPE of SALMONELLA for tx
treatment?
1. MAINLY SUPPORTIVE
2. NO DIRECT ANTIMICROBIAL TREATMENT unless SEPTIC or AT RISK FOR SEPSIS
why do we NOT want to use antimicrobials for SALMONELLA?
we DON’T WANT TO KILL OFF GOOD GI BACTERIA THAT COULD HELP GET RID OF SALMONELLA
CLOSTRIDIUM PERFRINGENS/DIFFICILE
2 descriptors?
can be associated with use of WHAT?
diagnosis? (2, + one that we NEVER do)
2 clinical signs?
treatment?
descriptors?
1. GRAM POSITIVE
2. ANAEROBES
can be associated with ANTIMICROBIAL USE
diagnosis?
1. FECAL TOXIN ELISA
2. FECAL PCR
–> we DO NOT DO CULTURE because CLOSTRIDIUM IS A PART OF NORMAL FLORA, just want to determine if STRAINS ARE PATHOGENIC
2 clinical signs?
1. COLIC
2. D+ (can be HEMORRHAGIC, has unique smell)
treatment = METRONIDAZOLE
POTOMAC HORSE FEVER…
caused by WHAT kinds of pathogens?
3 descriptor words?
infects what 4 types of cells?
how do horses get this? (2)
2 most IMPORTANT/COMMON clinical signs?
3 other clinical signs?
caused by RICKETTSIAL pathogens!
3 descriptors = OBLIGATE INTRACELLULAR PARASITE
infects…
1. MACROPHAGES
2. MONOCYTES
3. INTESTINAL EPITHELIAL CELLS
4. COLONIC MAST CELLS
how do horses get this? = horses INGEST ADULT AQUATIC HOSTS DIRECTLY
2 most imporant clinical signs?
1. SEASONALITY = MID-LATE SUMMER OR FALL
2. LAMINITIS
3 other signs?
1. FEVER
2. D+
3. SEPSIS/ENDOTOXEMIA
POTOMAC HORSE FEVER…
diagnosis?
treatment? when can we give it?
vaccination?
prevention? (2)
diagnosis? = PCR on WHOLE BLOOD & FECES
treatment? = OXYTETRACYCLINE, we can even give it BEFORE culture to HELP PREVENT LAMINITIS
vaccination OFTEN NOT EFFECTIVE because SO MANY STRAINS OF THIS DZ
prevention?
1. BARN LIGHTS OFF TO STOP ATTRACTING AQUATIC INSECTS/FLIES
2. AVOID WATER FROM NATURAL SOURCES
CORONAVIRUS in horses…
what TYPE of virus is this?
transmission?
what AGE of horse is likely?
what SEASON is this more likely?
4 clinical signs?
diagnosis?
treatment? (2, one main and one we don’t do)
how LONG can this virus shed?
RNA VIRUS
can occur in ANY AGE HORSE
occurs more in the WINTER
4 clinical signs?
1. HIGH FEVER
2. ABDOMINAL DISTENTION
3. COLIC
4. D+
treatment?
1. SUPPORTIVE
2. NO ANTIMICROBIALS
virus can shed for 3 WEEKS
ANTIBIOTIC-INDUCED COLITIS…
usually caused by WHAT organism? what else can cause it?
what is the PATHOPHYSIOLOGIC term for the thing that causes this?
3 commonly associated antibiotics that cause this?
what OTHER use of antibiotics can cause this?
treatment? (2)
usually CLOSTRIDIUM DIFFICILE, but can also be from SALMONELLA
caused by DYSBIOSIS
3 antibiotics?
1. ERYTHROMYCIN
2. TMS
3. CEFTIOFUR
MULTIPLE SWITCHES OF ANTIBIOTICS can also cause this
treatment?
1. METRONIDAZOLE if C DIFF
2. FECAL/CECAL TRANSFAUNATION if we need to reset intestinal microflora
____ can cause FATAL ANTIBIOTIC-INDUCED COLITIS
MACROLIDES
RIGHT DORSAL COLITIS…
can be caused by WHAT? 2 examples?
4 clinical signs?
3 lab findings? what can sometimes be the FIRST sign seen?
diagnosis? what do we see?
can be caused by PROLONGED or EXCESSIVE NSAID ADMINISTRATION, such as…
1. PHENYLBUTAZONE
2. FLUNIXIN MEGLUMINE
4 clinical signs?
1. D+
2. COLIC
3. TACHYCARDIA
4. VENTRAL/SHEATH EDEMA
3 lab findings?
1. HYPOPROTEINEMIA = this can be the FIRST SIGN
2. HYPOCALCEMIA
3. HYPERLACTATEMIA
diagnosis on US to see THICKENED RIGHT DORSAL COLON
what part of the colon is MORE SUSCEPTIBLE FOR ISCHEMIA and has a SLOWER TRANSIT TIME?
RIGHT DORSAL COLON
TREATMENT of RIGHT DORSAL COLITIS…
medications? (2)
diet? (2)
fluids? (2)
medications?
1. MISOPROSTOL (PG analogue) to INCREASE MUCOSAL BLOOD FLOW & REPAIR RIGHT DORSAL COLON
2. SUCRALFATE = protects ulcers
DIETARY CHANGES RECOMMENDED
1. LOW BULK DIET TO REDUCE COLONIC LOAD
2. COMPLETE PELLETED FEED & LITTLE TO NO HAY
be CAREFUL with the USE OF FLUIDS bc…
1. HYPOPROTEINEMIA
2. can get VENTRAL EDEMA from LOW ONCOTIC PRESSURE
CANTHARIDIN TOXICITY (blister beetles)
blister beetles feed on WHAT?
the concentration of cantharidin per beetle?
causes WHAT 1 MAIN CLINICAL SIGN? what 3 other things occur?
4 CBC findings?
what 2 diseases can occur SECONDARILY?
blister beetles feed on FLOWERS of ALFALFA HAY
concentration of CANTHARIDIN PER BEETLE VARIES!!
1 main clinical sign = ULCERATION THROUGHOUT GI TRACT
1. SEVERE D+
2. SWEATING
3. FEVER
4. THUMPS
4 CBC findings?
1. HYPOCALCEMIA
2. HYPOMAGNESIA
3. AZOTEMIA
4. HYPOPROTEINEMIA
2 diseases?
1. NEPHROSIS/RENAL DZ
2. MYOCARDITIS
what is THUMPS?
what clinical finding is this usually
what DISEASE is it usually associated with?
THUMPS = SYNCHRONOUS DIAPHRAGMATIC FLUTTER
–> “FLUTTER” in the FLANK AREA associated with PHRENIC NERVE being STIMULATED as ATRIA DEPOLARIZE, causing a “THUMPING NOISE”
usually associated with HYPOCALCEMIA
usually associated with CANTHARIDIN TOXICITY (blister beetles)
CANTHARIDIN TOXICITY (blister beetles)
diagnosis? (3)
treatment? (3)
mineral oil/charcoal?
diagnosis?
1. based on CLINICAL SIGNS
2. horse is ON ALFALFA/BLISTER BEETLES FOUND IN HAY
3. can measure CANTHARIDIN CONCENTRATION in GASTRIC/INTESTINAL contents or URINE
treatment?
1. FLUID THERAPY & ELECTROLYTE CORRECTION
2. mostly SUPPORTIVE CARE
3. ANALGESIA
MINERAL OIL/CHARCOAL = prevents ABSORPTION of the toxin
CHRONIC D+ DDxs…
(3 main, 2 subs for first)
- INFILTRATIVE BOWEL DZ
–> IBD
–> NEOPLASIA (lymphoma) - SAND ENTEROPATHY
- IDIOPATHIC
INFILTRATIVE BOWEL DZ…
2 main diseases? 4 subs for first
typically presents with ?? signs, including 3 specific
2 main diseases?
1. INFLAMMATORY BOWEL DZ
–> GRANULOMATOUS
–> EOSINOPHILIC
–> LYMPHOCYTIC/PLASMACYTIC
–> MULTISYSTEMIC EOSINOPHILIC EPITHELIOTROPHIC ENTERCOLITIS (MEED)
- NEOPLASIA (LYMPHOMA IS THE MOST COMMON FOR GI NEOPLASIAS)
typically presents with CHRONIC signs, including 3 specific…
1. WEIGHT LOSS
2. D+
3. ANEMIA
4 options for DIAGNOSIS of INFILTRATIVE BOWEL DZ?
- ABDOMINAL US
- INTESTINAL BIOPSY
- ORAL GLUCOSE ABSORPTION TEST
- PERITONEAL FLUID CYTOLOGY
TREATMENT for INFLAMMATORY BOWEL DZ?
5 options, first and last one has 2 subs
hints: food, steroids, parasites
PROGNOSIS?
- CORTICOSTEROIDS tapered to MINIMAL EFFECTIVE DOSE
–> DEXAMETHOSONE (better IV/IM if MALABSORPTIVE DZ)
–> PREDNISONE - ANTIHELMINTICS
–> MOXIDECTIN - ANABOLIC STEROIDS to BOOST APPETITE
- DIETARY MODIFICATION
–> LOW BULK DIETS for diseased LI
–> EASILY-DIGESTED PELLETED FEEDS for diseased SI
prognosis is VARIABLE bc hard to reach root cause
LYMPHOMA IN HORSES…
3 types? what’s the MOST COMMON?
in the MOST COMMON TYPE…
what age horses?
where does it tend to occur?
4 clinical signs?
3 types?
1. MULTICENTRIC
2. CUTANEOUS
3. INTESTINAL TYPE = MOST COMMON INTESTINAL NEOPLASM IN HORSES
in INTESTINAL TYPE…
age = in YOUNG horses
location = SI > LI, but can occur in both
clinical signs?
1.CHRONIC D+
2. WEIGHT LOSS
3. PLE
4. COLIC/INTESTINAL OBSTRUCTION
TREATMENT (2) & PROGNOSIS for INTESTINAL LYMPHOMA in HORSES?
treatment?
1. CORTICOSTEROIDS
- can do RESECTION if ONLY ONE SMALL AREA AFFECTED
prognosis?
–> survive DAYS TO YEARS depending on LOCATION, AMOUNT OF GI AFFECTED & HOW LATE IN DZ we’ve diagnosed
SAND ENTEROPATHY…
what 2 states is it most common in?
what 3 clinical signs are most common?
2 PE findings?
diagnostics? (3)
found in CA and NJ where there’s A LOT OF SANDY SOIL
3 clinical signs = NON-SPECIFIC
1. COLIC
2. FEVER
3. D+
2 PE findings?
1. upon VENTRAL ABDOMEN AUSCULTATION, hear “WAVES OVER SAND, SHOOSH” sounds
2. HEAVY over VENTRAL MIDLINE
diagnostics?
1. ABDOMINAL RADS
2. US
3. FECAL SAND SEDIMENTATION
for IDIOPATHIC diarrhea/colitis, what 4 things should we rule out?
- IBD
- NEOPLASIA
- INFECTIOUS CAUSES
- FUNGAL
diagnostics for chronic D+? (7)
- ABDOMINAL US
- ABDOMINAL RADS
- GASTROSCOPY
- DUODENAL BIOPSIES
- INTESTINAL BIOPSIES
- ABDOMINOCENTESIS
- GLUCOSE ABSORPTION TEST
are antibiotics usually used for COLITIS in ADULT HORSES?
EXCEPTIONS? (4)
NOT USUALLY USED, unless..
- < 6 months of age bc MORE PRONE TO GET SEPSIS from COLITIS
- CLOSTRIDIAL COLITIS SUSPECTED or DIAGNOSED –> METRONIDAZOLE
- POTOMAC HORSE FEVER SUSPECTED or DIAGNOSED –> OXYTETRACYCLINE
- SEVERE NEUTROPENIA (<1000 ug/mL) or SEVERE DEGENERATIVE LS so HIGH RISK OF SEPSIS
3 steps for ENDOTOXEMIA treatment?
- REMOVE CAUSE/TRIGGER of COLITIS
- NEUTRALIZE CIRCULATING ENDOTOXIN
- INHIBIT ENDOTOXIN-INDUCED INFLAMMATION
how can we NEUTRALIZE circulating endotoxin? (2)
- HYPERIMMUNE PLASMA = horses with immunity against endotoxin can provide their plasma with HELPFUL FACTORS
- POLYMIXIN B = broad-spectrum CYCLIC PEPTIDE ANTIBIOTIC with POTENT ENDOTOXIN-BINDING ACTIVITY
2 ways to inhibit ENDOTOXIN-INDUCED INFLAMMATION?
- NSAIDs at a QUARTER OF REGULAR DOSE (flunixin meglumine)
- PENTOXIFYLLINE
ANTICOAGULANT THERAPY can be used for WHAT disease?
ENDOTOXEMIA
ANTIOXIDANTS & DMSO can be used for…..
in WHAT disease?
can be used to SCAVENGE REACTIVE OXYGEN SPECIES that may be present in ENDOTOXEMIA
GASTROPROTECTANT DRUGS (4)
- SUCRALFATE (protective for GI mucosa/ulcers)
- MISOPROSTOL (PG analog)
- PSYLLIUM
- SACCROMYCES BOULARDII (yeast probiotic)
what is CRYOTHERAPY used for in horses?
HOW does it work? (2)
contraindicated if…
used to MAINTAIN HOOF TEMPERATURE LOWER THAN 10 C to REDUCE EFFECT OF ENDOTOXEMIA ON FEET & PREVENT LAMINITIS
HOW does it work?
1. helps cause VASOCONSTRICTION to LIMIT DELIVERY FOR TRIGGERS FOR LAMINITIS
2. DECREASES tissue METABOLIC RATE to REDUCE PRODUCTION and ACTIVATION OF MMPs
contraindicated if UNDERLYING PROBLEMS WITH LEGS OR SKIN
