Equine entero-typhylo-colitis pt 2 Flashcards
Sepsis - Endotoxemia
criteria for diagnosis of SIRS in horses
- atleration in body temp
- alteration in the leukogram
- tachycardia, tachypnea
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Systemic inflammatory response syndrome
endotoxemia signs
- Lethargy
- Pyrexia
- Tachycardia
- Tachypnea
- Hyperemic mucus membranes
- Prolonged CRT
Thrombophlebitis
- what does it feel like?
- can we ‘milk’ it out?
- signs?
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- how to stop it
- Painful
- Hot
- Thickened
- Cannot be milked out
- Head edema
<><> - Remove catheter!
- Cold/warm packing
- Don’t continue injecting in that vein.
Laminitis Clinical signs
- Increased digital pulses
- Warm hooves
- Coronary sinking
- Pain
Laminitis treatment
- Fluid therapy to dilute toxins
- NSAIDs
- Cryotherapy
- Pain control (lidocaine, butorphanol, feet blocks)
Dehydration clinical assessment
4-6%
7-9%
>9%
- skin tent
- mucous membrane moisture
- CRT
- PCV
- TP
4-6%
- Skin tent: 2-3s
- Mucous membrane moisture: fair
- CRT: 1-2s
- PCV: 40-50%
- TP: 6.5-7.5
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7-9%
- Skin tent: 3-5s
- Mucous membrane moisture: sticky
- CRT: 2-4s
- PCV: 50-65%
- TP: 7.5-8.5
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>9%
- Skin tent: >5s
- Mucous membrane moisture: dry
- CRT: >4s
- PCV: >65%
- TP: >8.5
what factors may affect PCV and TP readings when trying to assess dehydration?
splenic contraction and hypoproteinemia
dehydration treatment
- what are the losses?
- formula?
- Replacement of fluid and electrolyte losses
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Maintenance + Dehydration + Losses
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50-60ml/kg/day + 5% dehydration + ?
Crystalloids
- volume to give
- capillary leakage
- Large volume
- Leaks out of abnormal capillaries
hypertonic fluids
- effect on intravascular volume
- purpose / use
- must be followed with?
- ↑ intravascular volume
- Initial rehydration in severe cases
- Has to be followed with crystalloids
Colloids
- volume to give
- properties / purpose
- side effect
- max dose
- price
- possible disadvantage in endotoxemia?
- Small volume
- Large molecules that stay in IV space
and attract fluid to IV space - Coagulopathy – side effect
- Maximum dose 10ml/kg/day
- Expensive
> controversial: we have leaky vessels, molecules can end up in subQ and attract fluid there
dehydration - what are common electrolyte imbalances? how do we correct?
- Hyponatremia & hypokalemia is common
- Oral supplementation
- Salt block
ileus can be caused by what electrolyte imbalance?
hypocalcemia
issues with fluids in a case of severe hyponatremia
- brain edema > seizure
<><> - concentration of sodium in our fluids is higher than in the body > creates osmotic pressure
- rise in plasma sodium provokes osmotic water movement out of the cell > brain shrinkage
Control of inflammation and pain
- issues with NSAIDs in dehydrated patients
- good alternative? another risk?
- NSAIDs (side effects – nephrotoxicity)
> blocks vasodilator PGs via COX-2 inhibition
> reduced GFR
<><> - lidocaine is a good alternative
> with hypoproteinemia we have a greater risk of lidocaine toxicity
ways to reduce fluid secretion
- possible drawback with one of these?
- Bismuth subcylicate
- Di-tri-octahedral smectite (Biosponge)
> impactions* - Activated charcoal
methods to control endotoxemia
- Plasma transfusion
- Systemic antibiotic therapy
- Polymyxin B > binds to toxins
<><> - Pentoxifylline
- DMSO
> these scavenge reactive oxygen species, not used often
methods: Control of sepsis
- watch out for what?
- Systemic antibiotic therapy
> Can cause further disruption of GI flora! - Indicated in severe cases, especially if neutropenia is present
how do we re-establish normal gut flora in a diarrhea / endotoxemia case?
> All of these are Disappointing in studies :(
* Fecal transfaunation (give oral anti-acids first)
* Probiotics
* Feed supplements containing live organisms that exert a benefit beyond inherent basic nutrition
what we need to do to treat a diarrhea / endotoxemia case (6 steps) - summary
- Replacement of fluid and electrolyte losses
- Control of inflammation and pain
- Reduction of fluid secretion
- Control endotoxemia
- Control of sepsis
- Reestablishment of normal flora
salmonella
- bacterial properties
- virulence properties
- Enterobacteriacea
- Gram-negative
- Kauffman-White taxonomy
> O = somatic
> H = flagella
<><><><> - Name: place of isolation
- i.e. Dublin, Montevideo, etc.
Clinical syndromes associated with salmonella
- Inapparent infection
<><> - Acute colitis
* Profuse diarrhea
* Abdominal pain
* Sepsis
<><> - Fever and leukopenia
<><> - Proximal enteritis
* Gastric reflux
Salmonellosis
- where is it found?
- prevalence?
> with lameness
> with GI
> ICU
Dont really need to know numbers
- Ubiquitous in the environment
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Prevalence:
Overall: <1% - Culture (1-5%)
- PCR
> 17% lameness
> 60% GI disorders - ICU: 5-6.3%
- GI disease: 5-13%
- Increase to 4% during hospitalization
Salmonellosis – risk factors
- Transportation,
- Gastrointestinal tract disorders
- Change in or withholding of feed
- Abdominal surgery
- High ambient temperature
- Antimicrobial therapy
