Equine Diseases- Stomach and Small Intestine Flashcards
What is the most common stomach disease in horses?
gastric ulcers
Describe the etiology of squamous gastric ulcers in horses
-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
Etiology of gastric ulcers in glandular stomach
breakdown of the normal defense mechanism (esp in the pylorus)
What are the clinical signs of gastric ulcers in foals and adults?
foal: moderate colic, bruxism
adults: low grade recurrent colic, bruxism, decreased appetite, poor performance, spends more time down
How do you diagnose gastric ulcers?
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
Describe a treatment plan for a gastric ulcer patient
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
How do I advice a client on how to prevent gastric ulcers?
-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)
What are clinical signs of a gastric impaction?
-decreased appetite (bc stomach full of feed)
-acute and reoccurant colic
-relapse of colic after reintroduction of food
What is the etiology of a gastric impaction
-poor dentation
-poor stomach motility
-outflow obstruction
How do I diagnose a gastric impaction?
-gastroscopy: stomach will be full after 12-16 hrs of fasting
-Ultrasound: shows stomach distention
What is treatment for a gastric impaction
-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
How do you manage a chronic gastric impaction patient?
-address dental abnormalities
-low bulk diet
-bethanechol
-we don’t want a stomach rupture!
What is the most common cause of Gastric neoplasia in horses?
squamous cell carcinoma
What are clinical signs of gastric neoplasia in horses? How do I diagnose it?
weight loss, colic, reflux
DX: gastroscopy and biopsy
Prognosis: poor
What are clinical signs of Proximal Enteritis?
colic, depression, LARGE amount of reflux, small intestinal distention
pain seems to decrease after gastric lavage
+/-: fever, may be systemically sick
Describe the etiology of proximal enteritis
unknown
C. difficile toxins
salmonella
C. Perfringens
What are systemic signs of endotoxemia?
elevated HR, RR, red mucous membranes
If i have a patient that I suspect has proximal enteritis, how do i diagnose it?
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
What are some differentials of Proximal Enteritis?
simple and strangulating SI obstruction
How do I treat a patient with Proximal Enteritis?
-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
Why is providing prokinetics as a part of my proximal enteritis patients tx helpful?
antiinflammatory
mild pain relief
ex. metoclopramide
What are Clinical signs of IBD in horses?
-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
How do i diagnose IBD i horses?
-Clin Path: hypoproteinemia, hypoalbuminemia, anemia, malabsorption of glucose and D-xylose
-Ultrasound: thickened SI loops
-biopsy:
What is treatment for IBD?
-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
What age group is commonly affected by ascarid impactions?
mostly weanlings: 4months - 2 years
What history would be indicative of an ascarid impaction?
horses with a high parasite burden that are then dewormed with effective product
animal shows colic signs 1-5 days post deworming
What are clinical signs of an ascarid impaction
mimic that of SI obstruction so colic and reflux
How do I diagnose Ascarid impaction
signalment, history of recent deworming, signs of SI obstruction and US (hyperechoic)
What is the treatment for an ascarid impaction
medical- frequent stomach decompression and supportive care
usually sx to manual evacuate into the cecum or enterotomy
What are risk factors for ileal impactions?
geographical location (SE US)
feeding bermuda hay
lack of deworming for tapeworms
How do I diagnose an ileal impaction
SI distention on US and rectal, normal abdominal fluid, might be able to palpate rectally
What is the treatment for an ileal impaction
stomach decompression, pain management and IV fluids if there is no evidence of intestinal compromise
SX
Clinical Signs of small intestinal strangulating obstruction
-marked pain, depression, trembling, sweating, elevated vitals, injected MM, self-trauma, reflux
-poor response to NSAIDs, burn through sedation
What diagnostics diagnose a small intestinal strangulating lipoma
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
WHat is the treatment for a Small Intestinal strangulating obstruction ?
IV fluids, tx for shock, NSAIDs, analgesics
SX
What is an Intussception? What is the signalment?
one segment of intestine passes inside an adjacent segment
-young foals, yearlings
How do I diagnose an intussception? What is the treatment?
NGT- reflux
Rectal- SI distention d/t obstruction
US: SI distention and may see target lesion
ABD fluid: variable
TX: surgery
WHat is the most common site for an intussusception
ileocecal
How do I differentiate proximal enteritis from a simple and strangulating obstruction?
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
