Equine.GI. PLE, chronic diarrhea, disorders of peritoneum,EPE

Question 1

causative agent of equine proliferative enteropathy

Answer 1

Lawsonia intracellularis

Question 2

diagnosis of EPE is dependent on:

Answer 2

hypoproteinemia from hypoalbuminemia
thickening of segments of SI wall on abdom U/S
positive serologic findings
molecular detection of L intracellularis in feces

Question 3

on pig farms, what are important reservoirs of L. intracellularis?

Answer 3

mice and rats

Question 4

L. intracellularis in pathogenesis of EPE

Answer 4

invasion of proliferating crypt cells in ileum causing excessive mitotic division and sever hyperplasia–> leads to limited brush boarder development, decreased absorptive capacity = weight loss and hypoproteinemia

Question 5

What is a ddx in EPE for lawsonia intracellularis?

Answer 5

R. equi– can also cause ulceration in areas of Peyers patches throughout SI, cecum and colon

Question 6

Why is it important to perform molecular & serologic diagnostic testing b/c

Answer 6

• high specificity
  -variable sensitivity
  – dep on situtation

Question 7

negative serologic results can be expected in what stage of disease with Lawsonia intracellularis

Answer 7

** in early stage of disease

Question 8

In what are of the Small intestine are lesions of L. intracellularis?

Answer 8

distal jejunum and ileum
** although diffuse thickening of Si may occur

Question 9

What stain is used to visualize L. intracellularis in sections of S.I.?

Answer 9

Silver staining with Warthin-Starry stain
– elongated, curved bacilli in apical zone of crypt epithelial cells

Question 10

What is the survival rate for L. intracellularis in foals?

Answer 10

93% of treated foals survive the disease

Question 11

Extrapulmonary R. equi disorders of Gastrointestinal system

Answer 11

enterocolitis
typhlitis
intraabdominal abscesses
abdominal lymphadenitis
septic peritonitis

Question 12

the ability for R. equi to cause disease is based on the presence of:

Answer 12

virulence factors
virulence associated protein A

Question 13

What is the most common small intestinal lesion in R. equi GI disease?

Answer 13

multifocal ulcerative enteritis in the area of the Peyer patches of the ileum

Question 14

What are complications of R. equi enteritis?

Answer 14

septic peritonitis
intestinal adhesions

Question 15

What are frequent cause of severely pruritic cutaneous granulomas in horses along the Gulf coast and southern United States?

Answer 15

Pythium spp: conidiobolus and Basidiobolus pp

Question 16

Pythium suspected pathophysiology

Answer 16

transmitted via contact with contaminated water
–> organisms penetrate intestinal mucosa through existing lesion
( can penetrate normal mucosa)

Question 17

Gross examination of pythium lesions

Answer 17

caseous with discrete yellow foci (“kunkers”)
intestinal wall is thickened b/c pyogranulomatous inflammation

Question 18

Microscopic exam of pythium lesions

Answer 18

diffuse, mixed inflammatory infiltrate
granulation tissue
–> submucosa, tunica muscularis & mesenteric attachemnts

Question 19

Diagnosis of Pythium lesions

Answer 19

culture– difficult
indirect immunoperoxidase technique– stain for Puthium positive hyphae (some labs)

Question 20

What can be used in the treatment of pythium?

Answer 20

antifungals– ineffective
organic iodides
vaccine– can shrink cutaneous lesions

Question 21

Examples of inflammatory bowel diseases?

Answer 21

granulomatous enteritis
multisystemic eosinophilic epitheliotropic enterocolitis
eosinophilic enterocolitis
lymphocytic-plasmocytic enteritis
basophilic enterocolitis

Question 22

Idiopathic focal eosinophilic enteritis (IFEE) involves

Answer 22

focal areas of eosinophilic inflammatory infiltrates w/in the small intestine

Question 23

Idiopathic focal eosinophilic enteritis lesions

Answer 23

intramural masses or circumferential mural bands
– eosinophils w/ or w/o lymphs infiltrating all layers of intestine with varying degrees of fibrosis

Question 24

Are hypoproteinemia and malabsorption are characteristic of idiopathic focal eosinophilic enteritis? True/False

Answer 24

False

Question 25

Some Treatments of IBD

Answer 25

corticosteroids
anthelmintics
surgical resection

Question 26

What is the most common form of neoplasia of the GIT in horses?

Answer 26

alimentary lymphoma
** usu msall intestine

Question 27

Other neoplasms affecting the sm intestine are unusual but typically include

Answer 27

adenocarcinoma
leiomyosarcoma
neurofibroma

Question 28

Paraneoplastic syndromes of horses may be the first C/S seen, such as

Answer 28

pemphigus
hypoglycemia
hypercalcemia
erythrocytosis
neuropathies

Question 29

Small intestinal fibrosis suggested pathogenesis

Answer 29

–clusters of cases missouri & colorado
-unknown pathophysiologic origin of fibosis
– ingestion of toxins: COnvolvulus arvensis or common bind week
– inhibitors of 11 beta-hydroxysteroid dehydrogenase
– compounds of mineralocorticoid activity

Question 30

lymphangiectasia definition

Answer 30

dilation of the lymphatic channels of small & large intestine
**usu abscess or neoplasia

Question 31

reports of chyloabdomen result from

Answer 31

congenital lymphatic defect in neonatal foals
intraabdominal abscess in a foal
abdominal adhesions in a mini horse

Question 32

Ulcerative duodenitis lesions primary occur where?

Answer 32

duodenum

Question 33

The ulcerative duodenitis disorder pathogenesis is considered:

Answer 33

peptic disase– damage ot duodenal mucosa results from excessive exposure to HCL and pepsin

Question 34

The origin of ulcerative duodenitis in foals is usually caused by

Answer 34

multifactorial:
- breakdown of duodenal mucosal defenses
- interaction of GI peptides
- possible pathogenic agents

Question 35

Complications of ulcerative duodenitis include:

Answer 35

duodenal perforation with peritonitis or adhesions
duodenal stricture with complete or partial obstruction
ascending cholangitis & hepatitis
ascending pancreatitis

Question 36

ulcerative duodenitis peritoneal fluid analysis

Answer 36

Signs of inflammation
infection
hemorrhage
com of dep on severity of dz

Question 37

treatment of objectives of ulcerative duodenitis

Answer 37

decreased duodenal inflammation
treat secondary gastric & esophageal ulceration
promote gastric emptying
treat related problems such as peritonitis

Question 38

Medications described in the treatment of ulcerative Duodenitis?

Answer 38

H2 antagonists (cimetidine, ranitidine)
proton pump inhibitors (pantoprazole, omeprazole)
bethanechol
misoprostol
sucralfate
parenteral administration

Question 39

DPJ/anterior enteritis lesions

Answer 39

serositis: bright red to dk red petechial & ecchymotic hemorrhages on serosal surfaces

Question 40

DPJ causes increases in volume of duodenogastric reflux by

Answer 40

50 to 100 ml/min

Question 41

In anterior enteritis, what is the mechanisms of intestinal fluid secretion

Answer 41

passive transmucosal exudationsconary to mucosal & submucosal inflammation & characterized by protein rich fluid secretion
active fluid secretion– caused by INC cyclic nucleotides & characterized by fluid with high elyte content & low protien content

Question 42

What is the most common etx agent that causes anterior enteritis?

Answer 42

Clostridium difficile

others include: C. perf, salmonella, etc.

Question 43

What are the criteria used to discriminate between DPJ & obstructive lesions

Answer 43

degree of pain after reflux
presence of fever
changes in hematologic parameters & abdominal fluid