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Equine Med Final (Old Material) > EGUS > Flashcards

EGUS Flashcards

1
Q

Frequent clinical signs of horses with EGUS

A
  • Not performing well
  • Not finishing feed
  • Variable and often vague
  • Can have completely normal physical exams
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2
Q

Glandular and non-glandular stomach

A
  • Orad 1/3 lined with stratified squamous epithelium (non-glandular)
  • Ends at margo plicatus
  • Glandular portion is the aborad 2/3 (compound columnar)
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3
Q

What stimulates acid and histamine?

A
  • Histamine stimulates acid

- Gastrin stimulates histamine

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4
Q

pH of the region near the pylorus?

A

1-2

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5
Q

pH of the region near the glandular fundus

A
  • Medium density mat

- pH 4-5

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6
Q

pH of the region near the margo plicatus

A
  • Low density mat

- pH 5-7

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7
Q

How long should liquid contents take to go through the stomach vs solid contents?

A
  • Liquid contents take ~30 min

- Solid contents take ~1-5 hours

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8
Q

What cells are in the oxyntic portion of the glandular mucosa?

A
  • Acid secreting parietal cells
  • Pepsinogen secreting chief cells
  • Histamine secreting cells
  • Somatostatin secreting cells
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9
Q

What cells are in the antral region of the stomach?

A
  • Mucus and mucin secreting cells
  • Endocrine cells
  • Gastrin secreting G cells
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10
Q

What are the three types of EGUS?

A
  1. ) Primary squamous ulceration
  2. ) Primary glandular ulceration
  3. ) Secondary squamous ulceration
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11
Q

Primary squamous ulceration

A
  • Increased acid exposure

- Alteration in gastric pH gradient and content stratification

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12
Q

Primary glandular ulceration

A
  • Acid exposure occurs

- FAILURE of mucosal defenses

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13
Q

Secondary squamous ulceration

A
  • Delayed gastric emptying (pyloric disease)
  • Increases residual gastric fluid volume
  • Dorsal movement of acid
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14
Q

Factors that impact primary squamous ulcer formation

A
  • Horses on pasture and light exercises (low prevalence of ulcers)
  • Starvation produces prolonged high gastric acidity (pH<2) - horses fed fewer times a day have an increased risk of ulceration
  • Consistent fresh water important (will increase risk factor of EGUS by 3)
  • Fermentation of soluble carbohydrates with stomach produce VFA that can penetrate the squamous epithelium and cause cell damage
  • High starch diet increases risk factors
  • Exercise (increased intrabdominal pressure combined with lowered intragastric pH)
  • Duration of acid exposure related to duration and intensity of exercise
  • Stress
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15
Q

Do NSAIDs cause gastric ulcers?

A
  • No
  • If at normal dose of NSAIDs and they eat, it won’t cause ulceration
  • They can lead to ulceration of the right dorsal colon
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16
Q

Glandular ulcer causes

A
  • Unknown pathogenesis
  • Acid can exacerbate tissue injury
  • Ulceration may reduce diversity and lead to colonization of opportunistic bacteria
17
Q

Clinical pathologic abnormalities of horses with colic

A
  • No consistent clinical pathologic abnormalities

- Sometimes slight anemia and lowered hemoglobin

18
Q

Is colic associated with EGUS?

A
  • Not as much

- Reduced appetite and decreased performance is more likely

19
Q

Diagnosis of EGUS?

A
  • History
  • PE
  • Confirm with gastroscopy (GOLD STANDARD) - MUCH better than the fecal occult blood test for specificity and sensitivity
20
Q

Prevalence of ulcers

A
  • varies with breed and level of training

- Most racehorses in full training have ulcers

21
Q

Prevalence of gastric squamous ulcers and glandular ulcers

A
  • Similar prevalence
  • No association between presence and severity
  • No correlation between squamous and glandular ulcers
22
Q

Healing time of squamous vs glandular ulcers

A
  • Squamous ulcers heal faster
  • Glandular ulcers can take 3-6 months
  • Squamous ulcers can heal within 21 days
23
Q

How to confirm healing after treatment of ulcers?

A
  • Gastroscopy
24
Q

What therapy might glandular ulcers need?

A
  • Antimicrobial therapy (dysregulation of microbiota)

- Misoprostal

25
Q

Is there a magic “fix” for EGUS management?

A
  • No; must cater to the individual animal
26
Q

What diet change will have the most significant change on gastric ulcer formation?

A
  • Addition of chopped fiber is more important than differences between concentrates
27
Q

Other dietary strategies to reduce gastric ulcer formation

A
  • Constant access to water
  • Consistent feeding
  • Small meals before exercise
28
Q

What dietary addition may help glandular ulcers by increasing prostaglandin production?

A
  • Supplementation with corn or rapeseed oil
29
Q

What ideal pH are we looking to have for ulcer healing?

A
  • Prolonged pH >4
30
Q

What is the best acid suppressant for gastric ulcer treatment?

A
  • Gastroguard
  • Proton pump inhibitor
  • Once a day thing
  • Give 30 minutes prior to feeding to increase bioavailabiltiy
  • $$$$
31
Q

H2 blockers

A
  • Block HCl production
  • Less support to show healing
  • Need to be on them for longer
  • At least 40 days of treatment may be needed along with reduced exercise and increased forage access
32
Q

Sucralfate

A
  • Mucosal protectant
  • May speed mucosal ulcer healing by binding to the ulcer bed
  • Increases blood flow by stimualting prostaglandin
33
Q

Antacids

A
  • Don’t use
34
Q

Misoprostal

A
  • Prostaglandin
  • Will decrease gastric acid secretion by action on parietal cells and stimulate increased secretion of protective mucus that lines the intestinal tract
35
Q

Antibiotics

A
  • TMS may work for mucosal ulcers
  • Doxycycline maybe
  • Squamous healing promoted with live culture of Lactobacillus and Streptococcus
36
Q

Overall summary of ulcer treatment

A
  • Life style changes
  • Proton pump inhibitor
  • Mucosal protectants
  • For glandular ulcers specifically add
  • Rapeseed oil to diet (stimulates prostaglandin)
  • Also mucosal protectant
  • Antimicrobials
  • Misoprostol

Equine Med Final (Old Material) (11 decks)

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