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Equine Med > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Endotoxemia (SIRS); Pathophysiology & Symptoms

A

Pathophysiology
• LPS from dead bacteria in LI -> LI damaged -> bacteria thru mucosa -> systemic inflammatory response -> systemic vasodilation-> severe hypotension-> organ failure

Presenting Sign
• Ds

Symptoms (2 or > in adult, 3 or > foal)
• Hyper/hypothermic
• Tachycardia (>52)
• Tachypnea (>20)
• Lukocytosis/penia
• Immature neutrophils

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2
Q

Endotoxemia (SIRS); Management

A

Block LPS Absorption
• Di-tri-octahedral smectite (decrease Ds, binds LPS???)

Bind LPS already in circulation
• Polymyxin B (nephrotoxic & costly)
• Hyperimmune plasma (conflicting data)

NSAIDs
• Flunixin meglumine

Lidocaine CRI
Corticosteroids (low dose)
Soft bedding (laminitis)
Cryotherapy (laminitis)

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3
Q

Hyperdynamic State of Endotoxemia

A

1st stage
o High HR and RR
o Hyperemia
o Fever

o Anorexia
o Lethargy
o Sweating
o Yawning
o Colic – ileus

o Muscle fasciculations
o Recumbency

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4
Q

Hypodynamic State of Endotoxemia

A

o Lethargy (worse)
o Anorexia

o Diarrhea

o Poor perfusion
o Thrombosis – increased bleeding

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5
Q

First thing to fail in endotoxemia

A

o Laminitis
o Kidney (obv can’t see)

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6
Q

Polycythemia; Most common symptom, causes

A

Symptom
o hyperemic MMs

Relative (common)
o splenic contraction
o dehydration

Absolute (rare)
o hypoxia
o paraneoplastic
o bone marrow over production

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7
Q

Anemia Types & Causes

A

Regenerative
• Hemorrhage
• hemolysis

Non Regenerative
• Anemia of chronic dz
• Bone marrow
• Iron deficiency
• CKD

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8
Q

Anemia; Symptoms

A

• Pale MMs
• Exercise intolerance
• Tachypnea
• Tachycardia
• Systolic murmur
• Not visible scleral vessels

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9
Q

Internal Hemorrhage; Diagnosis & Treatment

A

Diagnosis
• Check PCV
• ultrasound

Treatment
• Stop bleed (difficult in horse)
• Replace volume
• Maintain O2 carrying capacity

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10
Q

What’s different about horse bood?

A

• Rouleaux
• No reticulocytes
• Unstable PCV (due to stress)
• Yellow plasma due to chlorophyll in food
• Howell-Jolly bodies (nuclear remnants)

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11
Q

Immune Mediated Hemolysis; Causes, Diagnosis

A

Causes
• Drugs (penicillin)
• Neoplasia
• Bacterial infection
• primary

Diagnosis
• Autoagglutination
• Coombs test

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12
Q

Hemolysis; Intra Vs Extravascular

A

Intravascular
• Hemoglobinemia
• Hemoglobinuria
• Increased unconjugated billirubin

Extravascular
• Increased unconjugated billirubin

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13
Q

Immune Mediated Hemolysis; Causes, Diagnosis, Treatment

A

Cause
• Drugs (penicillin)
• Neoplasia
• Bacterial
• autoimmune

Diagnosis
• Autoagglutination
• Coombs test

Treatment
• Discontinue current medications
• Treat underlying problems
• Corticosteroids
• Blood transfusion
• Diurese (intravascular hemolysis)

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14
Q

Oxidative Hemolysis; Causes, Diagnosis, Treatment

A

Cause
• maple leaf toxicity
• pistacia leaves

Diagnosis
• Presence of Heinz bodies
• Blood methemoglobin levels high

Treatment
• Maintain oxygenation of tissues (monitor resp rate, peripheral perfusion)
• Protect kidneys
• Prevent further toxin absorption

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15
Q

Equine Infectious Anemia; cause, clinical finding, diagnosis, epi

A

Cause
• Retrovirus in lentivirus family
• Carried by horseflies

Clinical Finding
• Hemolytic anemia

Diagnosis
• Coggins test
• ELISA assays

Epi
• Infected for life
• Inapparent carriers
• No Vx available
• (+) horses can’t move interstate

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16
Q

Equine Piroplasmosis; cause,s clinical finding, diagnosis, treatment

A

Causes
• Babesia caballi
• Theileria equi
• Carried by Ixodid tick

Clinical Finding
• Hemolytic anemia
• Fever
• icterus

Diagnosis
• organism in RBCs

Treatment
• Imidocarb

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17
Q

Anemia of Chronic Dz; Pathophysiology, Clin Path, Treatment

A

Pathophysiology
• sequestration of iron by chronic dz

Clin Path
• normocytic normochromic nonregenerative
• PCV usually not below 20%

Treatment
• Treat underlying dz

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18
Q

Clin Path of Chronic Infection

A

• neutrophilia
• monocytosis
• thrombocytosis
• hyperfibrinogenemia
• hyperglobulinemia
• normocytic normochromic nonregenerative anemia

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19
Q

Immune Mediated Thrombocytopenia; What is it? Types, Diagnosis, Treatment

A

Increased Platelet Destruction

Types
• Primary (autoimmune)
• Secondary due to infection, drugs, toxins, neoplasia

Diagnosis
• Flow cytometry

Treatment
• Treat underlying cause

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20
Q

Equine Anaplasmosis; What is it? Cause, Carrier, & Symptoms

A

Increased Platelet Destruction

Cause
• Anaplasma phagocytophilum

Carrier
• Ixodes tick

Symptoms
• Fever, icterus, ataxia, ventral edema, epistaxis
• Thrombocytopenia, anemia, leukopenia

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21
Q

Equine Anaplasmosis; Diagnosis, Treatment

A

Diagnosis
• Morulae in granulocytes
• PCR (early/late stages)
• Indirect fluorescent Ab test

Treatment
• Oxytetracycline 5-7d
• Self-limiting
• Supportive care

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22
Q

DIC; What is it? Causes, Pathophysiology

A

Increased Platelet Utilization

Causes
• SIRS/endotoxemia (main)
• Retained placenta or fetus
• basically any sever dz

Pathophysiology
• Activation of coagulative & fibrinolytic systems

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23
Q

DIC; Symptoms, Treatment

A

Symptoms
• Thrombosis after venipuncture
• Petechial, echymoses, epistaxis
• Organ dysfunction; renal or laminitis

Treatment
• Treat underlying cause
• Supportive care

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24
Q

Where to collect bone marrow sample in horses

A

• sternum
• tuber coxi

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25
Q

Lymphosarcoma Epi, Clin Path

A

Epi
• One of the most common internal neoplasms of horses
• Common in YOUNG and middle-aged horses


Clin Path
• Anemia 

• Increased fibrinogen 

• Immune-mediated anemia /
thrombocytopenia 

• Hyperglobulinemia
• Increased liver enzyme 
activities 

• Hypercalcemia - uncommon 

• IgM deficiency - uncommon 

• Lymphocytic leukemia – rare 

• Serum thymidine kinase (sTK) activity

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26
Q

Lymphosarcoma; Symptoms, Diagnosis, Treatment

A

Symptoms
• Depression 

• Anorexia, weight loss 

• Lymphadenopathy (rare)
• Ventral 
edema 

• Fever 

• Respiratory distress 

• Colic, diarrhea 

• Pallor 

• Mass on rectal exam 


Diagnosis (difficult)
• Biopsy of affected tissues

• Serum thymidine kinase (sTK) activity?

Treatment
• Usually not economically feasible

• Some chemotherapy regimens
• transiently responsive to steroids

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27
Q

Whats different about cutaneous lymphoma?

A

• Often slowly progressive, may 
wax and wane 

• May show improvement when 
mares become pregnant
• At least one case resolved after surgical removal of a 
granulosa thecal cell tumor 


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28
Q

Pigeon Fever; Cause, Types, Transmission

A

Cause
• Cornybacterium pseudotuberculosis

Types
• Lymphangitis
• Classic (abcess usually on chest/midline)
• Internal Abscessation

Transmission
• Organisms in soil gain entrance through breaks in skin
• Possible insect vectors 

• Possible relationship to midline 
dermatitis 

• Higher incidence in dry areas, late summer 


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29
Q

Pigeon Fever; Symptoms, Diagnosis, Treatment

A

Symptoms
• Edema, abscess (pectoral, inguinal, internal) 

• Lameness 

• Fever, anorexia, weight 
loss 

• chronic inflammation blood panel

Diagnosis
• culture of aspirate
• serology

Treatment
• Drain the abscess if possible 

• NSAIDs 

• Antibiotics for internal 
abscesses

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30
Q

3 Phases of Fluid Therapy

A

Initial
• Resuscitation

• Treats hypovolemia (7-8%)
• 4-6ml/kg Hypertonic saline bolus
• follow w/ crystalloids

Second
• Rehydration

• Treats dehydration

Third
• Ongoing losses
• Maintenance Fluids – crystalloids low Na/Cl & high K/Mg/Ca

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31
Q

Levels of Dehydration & Signs

A

5%-7%
• tacky MMs
• slightly tachycardic

8-10%
• pronlonged refill time
• etc

> 10%
• prune
• severe

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32
Q

Calculate Fluids Needed

A

o Deficit = BW (kg) x estimated % dehydrated
o Shock dose = 20ml/kg in 1st hour
o Ongosing losses = total volume of deficit given over 24hr
o Maintenance = 40-60 ml/kg/day (often 25L/day or 1L/hr)

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33
Q

Reasons for Low Ca, symptoms, and how to Supplement in Fluids

A

Reasons for Low (Ca
• Anorexia, exercise, cantharidin toxicity, etc.

Symptoms
• Ileus, tremors, muscle fasciculations, etc.

Treat
• Ca gluconate in crystalloids
• ionized Ca

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34
Q

Non-Infectious Causes of Ds

A

NSAIDs
• R dorsal colitis or colitis
• Due to decrease pf prostaglandins

ANY antibiotics
• Especially Clindamycin, macrolides

Sand

Etc, etc, etc

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35
Q

Causes of Infectious Ds

A

• Salmonella enterica
• Clostridium difficile
• Neorickettsia risticii (Potomic Horse Fever)
• Equine Corona Virus

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36
Q

Salmonella enterica; Bacteria, Epi, Diagnosis, Treatment

A

gram (-)

Epi
• Fecal-oral
• Zoonotic
• Healthy shedders

Diagnosis
• signs +
• culture x5 OR
• PCR x 3

Treatment
• Supportive care

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37
Q

Clostridium difficile; Bacteria, Epi, Diagnosis

A

gram (+)

Epi
• caused by Antibiotic use or stress
• Healthy carriers
• Not contagious

Diagnosis
• Evidence of Toxin A & B

38
Q

Neorickettsia risticii (Potomic horse fever); Bacteria, Epi, Common Symptoms besides Ds, Diagnosis, Treatment

A

gram (-)

Epi
• Horse eats infected water bug when grazing wet areas

Symptoms
• neutrophilia
• laminitis

Diagnosis
• PCR of feces
• PCR of whole blood

Treatment
• Oxytetracycline IV 3-5d
• Supportive care

39
Q

Equine Corona Virus; Epi, Common Symptoms besides Ds, Diagnosis, Treatment

A

Epi
• RNA virus
• Fecal-oral

Symptoms
• fever
• anorexia
• lethargy

Diagnosis
• Fecal PCR

Treatment
• Supportive Care

40
Q

Colic; Where, What else presents like colic?

A

o GI
o Liver
o Reproductive tract

Colic like
• Rhabdomyolysis
• Laminitis
• Pleuropneumonia
• Nero dz

41
Q

How many colics resolve or continue after Tx?

A

o 85-90% resove
o 10-15% need additional dx or surgery

42
Q

First things to do when a colic comes in

A

Transrectal palpation (1st if not painful)
• Use restraint
• Sedate w/ Xylazine & butorphanol IV or Detomidine IV
• Buscopan relaxes rectum
• Should feel cecum on R, and colon on R
• Should not feel SI

Place nasogastric tube (1st if painful or HR > 60bpm)
• Since horses can’t vomit
• Sedate to help swallow
• Check for reflux
• Use fluids

43
Q

Expected Values for Abdomenocentesis

A

• Protein <2.5g/dL
• WBC <5000/uL
• Lactate <2mmol/L (shows eschemia if high)

44
Q

L Dorsal Displacement; basics, treatment

A

o Often felt on transrectal palpation btwn spleen & kidney

Treatment
• Phenylephrine IV + trotting
• Surgery last resort

45
Q

R Dorsal Displacement; basics, treatment

A

o Left colon moves to the R
o Transrectal palpation

Tx
• Give enteral fluids
• Surgery

46
Q

Enteroliths; reasons for & Treatment

A

o Horse in CA or SW US
o Eating alfalfa
o Need sx

47
Q

Sand/gravel colic; symptoms, diagnosis, treatment

A

o Sounds like ocean waves
o +/- Ds
o SIRS

Diagnosis
• Abdominal rads

Treatment
• Surgery

48
Q

Prognosis for Surgical Colics

A

o Large colon displacement or impaction: 95%
o Small colon Good if no mucosa compromise
o Abdominal hernia worse prognosis
o All need 3 mo rest/recovery

49
Q

Small Colon Impaction; causes, secondary issues, treatment

A

Causes
o usually fecalith or enterolith

Secondary Issues
o large colon distension
o pressure necrosis

Treatment
o +/- surgery
o Transrectal fluid therapy

50
Q

Transrectal Fluid Therapy

A

o Stallion urinary catheter
o Same CRI setting as nasogastric tube
o Hard to keep in place

o Max 2L/h

o Plain water ONLY

51
Q

Reasons for Distended Small Intestine

A

West coast
• usually strangulating lesion like lipoma

East coast
• could be strangulating OR
• anterior enteritis (inflammation)

52
Q

Signs of Anterior Enteritis Vs Strangulating Lesion

A

Anterior Enteritis
o Large amounts of orange reflux
o Colic improves post reflux
o SIRS
o Febrile
o Dilate +/- thickened small intestine
o Abdomenocentesis w/ Protein >5 and high WBCs

Strangulating
o Small amount black/fetid reflux
o Colic doesn’t resolve post reflux

53
Q

Treatment for Small Intestine Strangulating Lesion Post Surgery

A

o Gentamicin – gram (-) aerobic
o Penicillin – gram (+) anaerobic
o Fix hypovolemia
o Feed VERY slowly
o Anti-inflammatory dose of steroids if VERY painful
o 6/10 horses go home

54
Q

Was Severely painful -> No longer painful but high HR/RR; What is it? Diagnosis

A

o Abrasions on body and head USUALLY = strangulating lesion
o No more pain due to rupture from strangulating lesion
o Must euthanize

Diagnose rupture
• Abdomenocentesis – will see neutrophils/cells on cytology
• Exploratory laparotomy to take a look

55
Q

Peritonitis; Diagnosis, Treatment, Secondary Issues

A

Abdomenocentesis shows
• High protein
• Very high WBCs
• +/- Degenerative neutrophils

Treatment
• Gentamicin – gram (-) aerobic
• Penicillin – gram (+) anaerobic
• Metronidazole – for the anaerobe bacteroides
• NSAIDs

Secondary Issues
• Adhesions
• ileus

56
Q

Common Causes of Colic

A

LC
o Impactions
o Displacements
o Sand – enterolith
o volvulus

SC
o Impactions (enteroliths, fecalith)
o strangulation
o anterior enteritis

57
Q

Squamous Ulcer Symptoms, Pathophysiology, Predisposing Factors

A

Symptoms
o Often asymptomatic
o Colic quickly post eating
o Poor appetite
o Weightloss
o Common in performance horses

Pathophysiology
o Squamous fundus not protected from acid

Predisposing Factors
o Fasting
o Intermitting feeding
o High grain diet
o Exercise

58
Q

Glandular Ulcers Predisposing Factors

A

o Foals > adults
o Decreased blood flow to gut
o Decreased mucus & HCO3
o Use of NSAIDs -> decrease PgE2
o Stress (corticosteroids) -> decrease prostaglandins

59
Q

Diagnose Gastric Ulcers

A

o Gastroscopy (expensive)
o Fast ~18hrs
o Withhold water ~4hrs
o Sedate

60
Q

Treatment of Squamous Ulcers

A

Omeprazole (Gastrogard ONLY)
• PO 30 min before feed Q24 for 28d
• Takes ~3ds to start working
• Decrease dose gradually

Sucralfate to coat ulcers
• Q 6-8hrs for first few days

61
Q

Treatment of Glandular Ulcers

A

Misoprostol (PgE1 analog)
• PO Q8h for 28d

Sucralfate to coat ulcers
• Q 6-8hrs for first few days

62
Q

Symptoms of Gastric Ulcers in Foals

A

o Bruxism
o Foaming

o Poor growth
o Dull haircoat
o Colic

63
Q

3 Potential Phases of Dysphagia

A

pre-pharyngeal
• show quidding (blobs of chewed food coming out of mouth)
• increased salivation
• problems w/ prehension

pharyngeal or esophageal
• cough
• food/water from nostrils
• gagging
• anxious
• neck extension
• out of the nose

64
Q

Neurologic Dysphagia

A

Sensory loss

Forebrain dz (yellow star thistle, viral encephalitis etc)

Peripheral Damage - Cranial nerves
• VII – prehension
• V – mastication
• XII – bring to back of throat

65
Q

Diagnosis of Pre-pharyngeal Dysphagia

A

o Oral exam
o Upper airway endoscopy
o Serum selenium (for white muscle dz)
o Equine protozoal myeloencephalitis (EPM) serology
o Radiographs (metallic foreign body)
o Ultrasound (masses & lymph nodes)

66
Q

Treat Esophageal Dysphagia (choke)

A

SEDATE 1st
• Detomidine IV
• +/- Butorphanol
• relaxation & analgesia
• head down

oxytocin or Buscopan to relax smooth muscle in lower esophagus

Nasogastric tube
• Assess distance
• Flush carefully to dislodge

Assume they have aspiration pneumonia

67
Q

No luck Unchoking?

A

• IV fluids
• Sedate w/ 1ml detomidine IM
• Flunixin meglumine after rehydration
• NPO
• No bedding

68
Q

Treat Aspiration Pneumonia During Choke

A

Broad spectrum antibiotics
• Metronidazole per rectum (2x dose) AND
• Ceftiofur IV OR
• K-penicillin + gentamicin IV (nephrotoxic & expensive)

Thoracic ultrasound & bloodwork

69
Q

Post Choke

A

o Re-scope to assess mucosa damage
o Don’t feed at first
o Soup -> pellets -> slow feeder
o NSAIDs
o Sucralfate

70
Q

Reasons for Ptyalism

A

o Pain 

o Foreign body 

o Mucosal ulceration 
(Vesicular stomatitis, Awns)
o Slaframine

71
Q

Why do Fresians choke?

A

look for megaesophagus!

72
Q

Manage Weightloss

A

• Feed alone
• Feed in a bowl (so they’re not eating dirt)
• Give pelleted feed (senior feed not carbs)
• supplement fat (oil or calorie powder)

73
Q

Causes of Weightloss

A

o Teeth
o Diet
o Parasites (often small stongyles)

74
Q

Lawsonia intracellularis Basics & Clinical Signs

A

o Equine proliferative enteropathy
o G- intracellular obligate
o Fall and winter

o Fecal - oral
o Weanlings (< 1y)

o Can be deadly
o Slow to grow

Clinical Signs
• Fever
• Anorexia
• Low albumin (edema)
• +/- Ds
• neutrophilia or penia
• weight loss

75
Q

Lawsonia intracellularis Diagnosis & Treatment

A

Diagnosis
• Fecal PCR

Treatment
• Oxytetracycline IV
• Oncotic support (plasma or hetastarch IV)
• Supportive care

76
Q

Normal TPR Horses

A

Temp
• 99-101

HR
• 28-44

RR
• 8-20

77
Q

Symptoms of Liver Dz

A

o General signs
o weightloss
o Photosensitization
o Hemolysis
o Edema
o PU/PD
o Hepatic encephalopathy
o Icterus

78
Q

Hepatocyte Enzymes Vs Biliary Enzymes

A

Hepatocyte Enzymes
o ALT
o AST
o LDH
o SDH (MOST specific in horses for hepatic Dz)

Biliary Enzymes
o ALP (growing horse, GI dz)
o GGT (MOST specific in horses for biliary Dz)

79
Q

Tests for Hepatic Function

A

o Increased Bile acids
o Increased Bilirubin conjugated
o BUN (down) / ammonia (up)
o increased PT PTT
o Hyperglobulinemia

80
Q

Reasons for Elevation of Unconjugated Vs Conjugated Bilirubin

A

Unconjugated
• Hemolysis
• Anorexia (most common)
• Drugs
• Acute hepatocellular dz

Conjugated
• More reliable indicator of hepatic dz
• Detectable in urine

81
Q

Balance of BUN & Ammonia

A

o Ammonia from protein digestion is converted to urea by the liver 

o liver dysfunction -> Decreased BUN
+ Increased ammonia
o No correlation between blood ammonia and severity 

o Increased ammonia not specific for liver disease 
(can increase in colonic dz)

82
Q

What can be seen on Hepatic Ultrasound

A

o Tissue homogeneity
o Masses
o Bile duct abnormalities
o L side you can see liver & spleen together

83
Q

Liver Biopsy

A

o MOST specific diagnostic for liver dz
o Can be done blind or through US

84
Q

Poor Prognostic Indicators for Liver Dz

A

Liver Biopsy
o Sever fibrosis
o Severe biliary hyperplasia

o hepatoencephalopathy
o intravascular hemolysis
o coagulopathy

o marked weight loss
o decreased albumin + increased globulins

85
Q

Stages of Heptoencephalopathy

A

o Mild confusion, decreased attention, irritability ->
o Drowsiness, lethargy, disorientation 
->
o Somnolent but rousable, occasional aggressive uncontrolled behavior ->
o Coma 


86
Q

Treatment of Hepatoencephalopathy

A

Decrease absorption of toxic metabolites
• Mineral oil
• Activated charcoal
• Lactulose or neomycin as LAST resort

Low protein/high carb diet
• Best to keep them eating BUT
• BCAAs
• Beet pulp
• Sorghum
• Oat or grass hay

Support
• IV fluids w/ B vits
• Avoid drugs that require hepatic metabolism/excretion
• NSAIDs
• Vit K (coag issues)
• Avoid sunlight

87
Q

Cholelithiasis Treatment, Prognosis

A

Treatment
• Long-term antimicrobials (gram -)
• Pain management (NSAIDs)
• DMSO to dissolve Ca bilirubinate stone?
• Surgery if common bile duct is occluded

Prognosis
• Dependent on hepatic fibrosis, clinical signs, number of choleliths
• 77-85% survive w/ treatment

88
Q

Pyrrolizidine Toxicity Presenting Signs

A

• Acute hepatic necrosis, signs rapidly progressive
• Liver dz
• Megalocytosis & fibrosis of liver

89
Q

Theiler’s Dz Presenting Signs, Cause

A

Presenting Signs
• Acute hepatic necrosis, signs rapidly progressive
• Usually adult horses 

• Most affected horses die 


Cause
• Equine-origin biological 4-10 weeks prior to 
onset 

• Usually tetanus anti-toxin
• Associated w/ equine parvovirus hepatitis

90
Q

Hyperlipemia Basics, Predisposing Factors, Clinical Signs

A

o Ponies & minis
o Relative insulin insensitivity
o Usually young

Predisposing Factors
• Pregnancy
• Dz
• Parasitism
• Pituitary dz

Clinical Signs
• Icterus
• Anorexia, weakness
• Severe depression

• Ataxia

• Diarrhea, mild colic
• Fever
• Dependent edema

91
Q

Hyperlipemia Diagnosis, Treatment, Prognosis

A

Diagnosis
• Stressed pony or Miniature horse

• Hyperlipidemia – TG <500 mg/dl

• Hyperlipemia – TG >500 mg/dl
• Opalescent plasma

• Increased liver enzyme activity
• Check serum creatinine, electrolytes

Treatment
• Treat hepatic disease
• Improve energy intake and balance

• Eliminate stress or concurrent disease
• Inhibit fat mobilization from adipose tissue w/ insulin
• Increase triglyceride uptake by tissues w/ heparin

Prognosis
• Mortality in 60-100% 

• Death often results from underlying disease 

• Most Minis w/ triglyceride <1200 mg/dl survive

Equine Med (3 decks)

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