Equine Diseases- Stomach and Small Intestine

Question 1

What is the most common stomach disease in horses?

Answer 1

gastric ulcers

Question 2

Describe the etiology of squamous gastric ulcers in horses

Answer 2

-squamous mucosa is exposed to 24 hour gastric secretion and it has protection against acid
-high grain meals creates more volatile fatty acids which are corrosive to the squam. epithelium
-increased abdominal pressure (ex. high intensity exercise)
-can be secondary to delayed gastric outflow

Question 3

Etiology of gastric ulcers in glandular stomach

Answer 3

breakdown of the normal defense mechanism (esp in the pylorus)

Question 4

What are the clinical signs of gastric ulcers in foals and adults?

Answer 4

foal: moderate colic, bruxism
adults: low grade recurrent colic, bruxism, decreased appetite, poor performance, spends more time down

Question 5

How do you diagnose gastric ulcers?

Answer 5

gastroscopy after 12-16 hours of fasting is the only way to definitively diagnose gastric ulcers

less desirable options: Fecal occult blood test (most ulcers patients won’t have hematechezia) , SUCCEED equine blood test bc it is hard to interpret, sucrose absorption (research): if ulcers are present sucrose won’t be absorbed

Question 6

Describe a treatment plan for a gastric ulcer patient

Answer 6

PPI- omeprazole (GastroGard PO x 24h x 28 d
Dose: 4mg/kg; give on empty stomach
GI protectant-Sucralfate
H2 blockers- ranitidine not as effective as PPIs
Antacid: (Maalox)
Misoprostol (glandular ulcerations only) PGE1

Question 7

How do I advice a client on how to prevent gastric ulcers?

Answer 7

-increase grazing time to help buffer acid
-free access to hay (ideally 24/7)
-Decrease grain
-Feed alfalfa (bc it is high in calcium)
-prev dose of omeprezole (1mg/kg)

Question 8

What are clinical signs of a gastric impaction?

Answer 8

-decreased appetite (bc stomach full of feed)
-acute and reoccurant colic
-relapse of colic after reintroduction of food

Question 9

What is the etiology of a gastric impaction

Answer 9

-poor dentation
-poor stomach motility
-outflow obstruction

Question 10

How do I diagnose a gastric impaction?

Answer 10

-gastroscopy: stomach will be full after 12-16 hrs of fasting
-Ultrasound: shows stomach distention

Question 11

What is treatment for a gastric impaction

Answer 11

-fasting
-stomach lavage. (add caffeine free and diet cola to break up impaction and then lavage out later)
-consider bethanechol (a prokinetic) if you suspect d/t a motility disorder
-consider gastrotomy
After tx: always recheck w/ ultrasound or gastroscopy to ensure resolution of the impaction

Question 12

How do you manage a chronic gastric impaction patient?

Answer 12

-address dental abnormalities
-low bulk diet
-bethanechol
-we don’t want a stomach rupture!

Question 13

What is the most common cause of Gastric neoplasia in horses?

Answer 13

squamous cell carcinoma

Question 14

What are clinical signs of gastric neoplasia in horses? How do I diagnose it?

Answer 14

weight loss, colic, reflux
DX: gastroscopy and biopsy
Prognosis: poor

Question 15

What are clinical signs of Proximal Enteritis?

Answer 15

colic, depression, LARGE amount of reflux, small intestinal distention
pain seems to decrease after gastric lavage
+/-: fever, may be systemically sick

Question 16

Describe the etiology of proximal enteritis

Answer 16

unknown
C. difficile toxins
salmonella
C. Perfringens

Question 17

What are systemic signs of endotoxemia?

Answer 17

elevated HR, RR, red mucous membranes

Question 18

If i have a patient that I suspect has proximal enteritis, how do i diagnose it?

Answer 18

NGT: large volumes of reflux (50-80L /day), may be brown or bloody
-Rectal Exam: diffuse distention of the small intestinal loops
-Ultrasound: generalized SI distention, wall of SI may be thickened
Abdominocentesis: yellow fluid with elevated TP and mildly increased WBC
Clin Path: over 50% of p will have elevated liver enzymes, electrolyte loss (Na, K, Cl, Ca, Mg), inflammation

Question 19

What are some differentials of Proximal Enteritis?

Answer 19

simple and strangulating SI obstruction

Question 20

How do I treat a patient with Proximal Enteritis?

Answer 20

-gastric decompression as often as needed (usually no more than q 1hr)
-IV fluids
Promote acid-base balance and electrolyte balance
-Lidocaine CRO +/- prokinetics
-laminitis protection
-parenteal nutritional support

Question 21

Why is providing prokinetics as a part of my proximal enteritis patients tx helpful?

Answer 21

antiinflammatory
mild pain relief
ex. metoclopramide

Question 22

What are Clinical signs of IBD in horses?

Answer 22

-weight loss even though p has a good appetite
-intermittent abdominal discomfort
-peripheral edema (hypoproteinemia)
-diarrhea may be present
-dermatitis if MEED (multisystemic epitheliotrophic entercolitis) - MUST involve skin
-acute colic (idiopathic focal eosinophilic enteritis IFEE) mural bands act as an obstruction

Question 23

How do i diagnose IBD i horses?

Answer 23

-Clin Path: hypoproteinemia, hypoalbuminemia, anemia, malabsorption of glucose and D-xylose
-Ultrasound: thickened SI loops
-biopsy:

Question 24

What is treatment for IBD?

Answer 24

-Steroids - Dexmethasone injectable, low dose for 3 months and may be continued forever
-Dietary changes
-Larvacidal deworming- encysted larvae- fenbendazole
IF IFEE: surgery to remove mural bands
Prognosis: variable

Question 25

What age group is commonly affected by ascarid impactions?

Answer 25

mostly weanlings: 4months - 2 years

Question 26

What history would be indicative of an ascarid impaction?

Answer 26

horses with a high parasite burden that are then dewormed with effective product
animal shows colic signs 1-5 days post deworming

Question 27

What are clinical signs of an ascarid impaction

Answer 27

mimic that of SI obstruction so colic and reflux

Question 28

How do I diagnose Ascarid impaction

Answer 28

signalment, history of recent deworming, signs of SI obstruction and US (hyperechoic)

Question 29

What is the treatment for an ascarid impaction

Answer 29

medical- frequent stomach decompression and supportive care
usually sx to manual evacuate into the cecum or enterotomy

Question 30

What are risk factors for ileal impactions?

Answer 30

geographical location (SE US)
feeding bermuda hay
lack of deworming for tapeworms

Question 31

How do I diagnose an ileal impaction

Answer 31

SI distention on US and rectal, normal abdominal fluid, might be able to palpate rectally

Question 32

What is the treatment for an ileal impaction

Answer 32

stomach decompression, pain management and IV fluids if there is no evidence of intestinal compromise
SX

Question 33

Clinical Signs of small intestinal strangulating obstruction

Answer 33

-marked pain, depression, trembling, sweating, elevated vitals, injected MM, self-trauma, reflux
-poor response to NSAIDs, burn through sedation

Question 34

What diagnostics diagnose a small intestinal strangulating lipoma

Answer 34

rectal: taunt + distended SI loops
NGT: reflux eventually
US: distended, amotile SI USUALLY 2 POPULATIONS ( one distended and one normal)
Abdominal fluid: serosanguinous, elevated TP and cell count, abdominal lactate 2x higher than systemic

Question 35

WHat is the treatment for a Small Intestinal strangulating obstruction ?

Answer 35

IV fluids, tx for shock, NSAIDs, analgesics
SX

Question 36

What is an Intussception? What is the signalment?

Answer 36

one segment of intestine passes inside an adjacent segment
-young foals, yearlings

Question 37

How do I diagnose an intussception? What is the treatment?

Answer 37

NGT- reflux
Rectal- SI distention d/t obstruction
US: SI distention and may see target lesion
ABD fluid: variable

TX: surgery

Question 38

WHat is the most common site for an intussusception

Answer 38

ileocecal

Question 39

How do I differentiate proximal enteritis from a simple and strangulating obstruction?

Answer 39

Proximal Enteritis: INSANE amount of reflux whereas the other two will
Strangulating Lesion: US will have 2 populations of intestine
Belly tap will be: serosanginous with elevated TP and abdominal lactate that is 2x higher than systemic lactate