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Equine Medicine > Diseases of the Large Intestine, Pt. 2 > Flashcards

Diseases of the Large Intestine, Pt. 2 Flashcards

1
Q

How do SI and LI obstructions most commonly present? What are the 3 most common reasons to refer?

A

SI = reflux due to an accumulation of fluid in the stomach
LI = gassy abdominal distension - bloat

  1. high heart rate (dehydration and shock)
  2. reflux upon stomach tube placement
  3. serosanguinous abdominal fluid (dead bowel)
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2
Q

Why is acute diarrhea considered a snowball effect? What complications are associated?

A

it starts as a small incident but if it remains chronic, it leads to dehydration, electrolyte disturbances, and impaired cardiovascular function

sepsis, endotoxemia, immune compromise, superinfection, infarction, thrombosis, laminitis, coagulopathy, inflammation

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3
Q

What bacterial cause of acute diarrhea requires a culture along with PCR for diagnosis?

A

Salmonella

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4
Q

Where does equine coronavirus (ECoV) typically start? What signs are most common?

A

begins in the SI, causing necrosis and sloughing

anorexia, lethargy, fever > diarrhea, colic

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5
Q

What are 2 signs on bloodwork indicative of equine coronavirus (ECoV) infection? How is it diagnosed?

A
  1. leukopenia
  2. hyperammonemic encephalopathy

fecal PCR

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6
Q

What is the most frequence species of Salmonella to cause diarrhea in horses? What are 3 risk factors?

A

S. enterica serovar typhimurium

  1. stress - surgery, broodmare status
  2. carriers
  3. antibiotics
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7
Q

Why are salmonella infections especially important to prevent/maintain?

A

zoonotic and virulence potential

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8
Q

What is the most common sign of Salmonellosis in horses? What else is seen?

A

acute colitis - profuse, initially hemorrhagic diarrhea, occasional abdominal pain before the diarrhea breaks (not recommended to walk for relief!)

  • fever, depression, dehydration
  • tachycardia
  • sepsis, endotoxemia: dark line over teeth
  • CV shock
  • vascular leak syndrome, coagulopathy
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9
Q

How is Salmonellosis diagnosed?

A
  • culture: 3-5 fecal samples 12-24 hr apart with 5-10 g of feces on selective media or mucosal biopsy culture
  • PCR screening
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10
Q

How is Salmonellosis treated? Prevented? What is indicative of a poor prognosis?

A
  • fluid therapy with colloids or plasma
  • Flunixine meglumine
  • antimicrobials: Penicillin, Gentamycin, Enrofloxacin
  • anticoagulants

> 10 days of diarrhea

biosecurity - cleaning, disinfection, isolation

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11
Q

What causes Potomac Horse Fever? When is infection most common?

A

Equine Monocytic Ehrlichiosis - Neorickettsia risticii infecting trematodes or aquatic insects (mayflies, caddisflies) ingested by horses (accidental host)

June-November in areas within 5 miles of river/water

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12
Q

What cells are infected with Potomac Horse Fever? How are horses in stables infected?

A

monocytes, macrophages, intestinal epithelium

aquatic insects (mayflies, caddisflies) find their way into horses’ water source

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13
Q

What are the 2 stages of PHF? What are the most common signs?

A

1st fever = 1-3 days following ingestion, typically unnoticed
2nd fever = 5-7 days later when organism moves from blood to colon

  • diarrhea
  • colic
  • fever, anorexia, depression
  • abortions
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14
Q

What is commonly the only sign of PHF in 30% of horses? How is it diagnosed?

A

laminitis

  • fecal AND blood PCR (infection monocytes and macrophages!)
  • serology (IFA): not considered diagnostic, indicates exposure
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15
Q

What 2 antimicrobials are recommended for treating PHF? What are 3 additional treatment strategies?

A
  1. oxytetracycline - q12h for 4 days, fever should resolve in 48h, diarrhea should resolve in 24-72h
  2. doxycycline - q12-24h, less effective due to decreased absorption
  • fluids, plasma, colloids
  • Flunixine meglumine
  • vaccination in early Spring to mid Summer to decrease incidence - has unreliable efficacy due to multiple strains of N. risticii
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16
Q

What are the 2 main etiologies of Clostridial diarrhea?

A
  1. C. difficile - colitis in adults, Toxin A enterotoxin and Toxin B cytotoxin, risk increased with antimicrobial administration or hospitalization
  2. C. perfringens - occasional cause of colitis, types A-E based on exotoxin, risk based on age and environmental persistence
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17
Q

What are the major clinical signs of Clostridial diarrhea in foals and adults?

A

FOALS - hemorrhagic diarrhea, sepsis, gas/fluid-filled small intestine (intramural)

ADULTS - diarrhea, abdominal discomfort, fever, severe toxemic colitis

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18
Q

What are 4 diagnostics used for C. difficile diarrhea?

A
  1. culture with selective media - further testing needed to determine if isolates ar toxigenic
  2. antigen ELISA - initial
  3. Toxin A/B ELISA
  4. PCR for TcdA and TcdB - quick!
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19
Q

What are 4 diagnostics used for C. perfringens diarrhea?

A
  1. culture - shedding common in healthy horses!
  2. culture + PCR (toxin genes)
  3. toxin ELISA - enterotoxin only
  4. PCR
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20
Q

What are 4 treatments for Clostridial diarrhea?

A
  1. antimicrobials - Penicillin, Metronidazole, Vancomycin for resistance
  2. Saccharomyces boulardii (yeast) or probiotics to normalize flora
  3. GI protectants - di-tri-octahedral smectite powder (Biosponge)
  4. transfaunation with feces from a healthy or recently deceased horse through an NG tube
21
Q

What is the most common cause of Cyathostomiasis? What is the most common sign? When is this most common?

A

(small Strongyles) - young horses with poor deworming history

poor body condition, usually no fever

October to April

22
Q

What 3 conditions are seen with colitis-x? What are 3 possible causes?

A

acute colitis + endotoxemia + anaphylaxis

  1. anaphylaxis
  2. clostridiosis
  3. enteric bacteria
23
Q

What is a common copathogen seen with Salmonella also found in clinically healthy horses?

A

Aeromonas

24
Q

How can NSAIDs affect the GIT? What 3 are the most common causes?

A

right dorsal colitis

  1. Phenylbutazone
  2. Flunixin meglumine
  3. Firocoxib
25
Q

What are the 3 most common clinical signs seen with NSAID toxicity? How is it diagnosed?

A
  1. hypoproteinemia (hypoalbuminemia)
  2. diarrhea
  3. colitis

U/S can reveal edema of the right distal colon +/- SUCCEED fecal blood test

26
Q

What are the 3 most common side effects of NSAIDs? What conditions in horses are typically treated with heavy NSAID doses?

A
  1. stomach ulcers
  2. right dorsal colitis
  3. kidney failure

laminitis and recurrent keratitis

27
Q

When are oral fluids indicated for horses with acute diarrhea? What is commonly used?

A

if there is no reflux or pain

water + electrolyes (50% glucose, baking soda, KCl)

(make sure regular water is still available!)

28
Q

What 3 IV fluids are used in horses with acute diarrhea?

A
  1. hypertonic saline - 2-4 mL/kg bolus followed by 10 L of crystalloids per L of hypertonic
  2. crystalloids - Plasma-Lyte, Normosol, LR + KCl
  3. colloids - plasma, hydroxyethyl starch (hetastarch, pentastarch)
29
Q

What are 6 aspects to general therapy for acute diarrhea?

A
  1. treat endotoxemia with hyperimmune plasma, Flunixin megulmine (if no RDC), polymyxin, and pentoxyfylline
  2. prevent founder
  3. prevent thrombophlebitis
  4. slow IV vit B
  5. intestinal protectants
  6. nutrition
30
Q

What specific treatment is recommended for Salmonellosis and Potomac Horse Fever?

A

antibiotics based on clinical signs and culture

oxytetracycline - the earlier the better, nephrotoxic in dehydrated horses

31
Q

What specific treatment is recommended for antibiotic-associated C. difficile diarrhea? What else can be used?

A

Metronidazole

  • di-tri-octahedral smectite (BioSponge)
  • commercial plasma with Ab against C. diff
  • transfaunation
32
Q

What specific treatments are recommended for NSAID toxicity?

A
  • plasma
  • hetastarch
  • sucralfate
  • misoprostol (not used in pregnant mares)
33
Q

What specific treatment is recommended for cyathostomiasis?

A

Moxidectin once with Dexamethasone

(Fenbendazole)

34
Q

How does inflammation cause chronic diarrhea? What are 6 infectious causes?

A

morphological changes in the intestinal wall

  1. chronic salmonellosis
  2. chronic parasitism
  3. abscesses
  4. EPE
  5. R. equi
  6. Rotavirus
35
Q

What are 3 non-infectious causes of chronic inflammatory diarrhea?

A
  1. cellular infiltrative disorders
  2. weanling foals - gastric ulceration or emptying dz
  3. NSAIDs
36
Q

What is a non-inflammatory cause of chronic diarrhea? How long must diarrhea be occurring to be considered chronic?

A

abnormal fermentation of cellulose

> 1 month —> frustrating diagnosis, often remains undetermined despite extensive workup

37
Q

Causes of chronic diarrhea in horses:

A
38
Q

What is recommended for diagnosing chronic diarrhea?

A
  • Hx, PE
  • blood work: CBC, hypoproteinemia, hypoalbuminemia, biochemistry
  • peritoneal fluid
  • fecal tests
  • absorption tests
  • rectal mucosal biopsy
  • U/S
  • exploratory laparotomy
39
Q

What treatments are recommended for chronic diarrhea? What is specifically recommended for cellulose maldigestion?

A
  • hydration and nutrition
  • inflammation
  • antihelminthics + steroids
  • GI protectants
  • sulfasalazine
  • tranfaunation
  • cultured yogurt, brewers yeast, probiotics

iodochlorhydroxyquin

40
Q

When should colic be referred?

A
  • uncontrolled or recurring severe pain
  • HR > 60
  • abnormal rectal exam (not an impaction)
  • reflux on nasogastric tube
  • dehydration
  • toxemia
  • abnormal abdominal fluid
41
Q

What pain management is recommended while a horse is being transported to a referral hospital?

A

<30 mins away = Xylazine IV

1-2 hr away = Detomidine IV

+ indwelling NG tube and IV fluids

42
Q

Small intestinal issues:

A
43
Q

Which of the following are common locations for impaction?

a. cecum
b. pelvic flexure
c. right dorsal colon
d. small colon

A

A, B, D

pelvic flexure - sudden housing change, lack of water

cecum - hospitalization, treatment

small colon - lack of water, infection

44
Q

Which of the following is a typical site for colitis related to NSAIDs?

a. cecum
b. pelvic flexure
c. right dorsal colon
d. small colon

A

C

treatment with Phenylbutazone, Flunixin meglumine, or Firocoxib

U/S - edema of the right distal colon

45
Q

A 16 y/o Warmblood gelding presents with…

  • injected MM
  • CRT of 3 seconds
  • 68 bpm HR
  • 20 bpm RR
  • 100.5 F rectal temp
  • increased gut sounds in all 4 quadrants

What is the % of dehydration? What amount of fluid is needed to correct it? What rate is recommended over 30 minutes?

A

8%

(assume 500 kg)
500kg x 0.08 = 40 L

10-20 mL/kg over 30 mins
500kg x (10mL/kg) = 5 L

46
Q

What volume of IV fluids is required for most horses (500 kg) for maintenance?

A

40-60 mL/kg/day

500kg x (40-60 mL/kg/day) = 20-30 L/day

47
Q

Each liter of hypertonic saline must be followed by at least how many liters of crystalloids?

a. 1 L
b. 5 L
c. 10 L
d. 20 L

A

D

48
Q

What drugs are commonly used to prevent endotoxemia?

A
  • Banamine
  • Polymyxin
  • Pentoxyfylline

Equine Medicine (33 decks)

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