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IP 11 Equine Medicine > exam 3 - Small Intestine > Flashcards

exam 3 - Small Intestine Flashcards

1
Q

what is the MC sign of SI dz?

A

obstruction ===> pain and colic

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2
Q

pain in SI may occur d/t:

A

acute inflammation
simple obstruction
strangulating obstruction

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3
Q

what is a simple versus strangulating obstruction?

A

simple: obstructs flow w/in the lumen, NOT blood flow so NO devitalization occurs
strangulating: effected with loss of blood supply AND blocks the lumen

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4
Q

how common is neoplasia of the bowel?

A

UNCOMMON

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5
Q

signs of chronic inflammation or neoplasia?

A

poor performance
wt loss
recurrent episodes of colic

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6
Q

why does subcutaneous edema occur in many SI dzz?

A

protein losing enteropathy (PLE)

inflammation in bowel -> inc permeability -> leak albumin -> hypoalbuminemia -> loss of plasama oncotic pressure -> subQ edema if severe

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7
Q

t//f

SI dz does NOT usually cause diarrhea in adult horses

A

true

SI dz may cause diarrhea in foals - rotavirus enteritis and Lawsonia intracellularis

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8
Q

what pathogen may cause diarrhea in both foals and adult horses?

A

equine coronavirus

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9
Q

what is a great biomarker in the blood for tissue perfusion?

also is a good prognostic indicator.

A

lactate

high lactate => poor prognosis

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10
Q

diagnostic tests for SI dz?

A
  • routine CBC, plasma biochemistry
  • rectal palpation
  • check for reflux
  • u/s
  • abdominocentesis
  • etiological tests on feces
  • laparoscopy
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11
Q

what are c/s of complete SI obstruction?

A
  • severe pain, possibly refractory to analgesia
  • high HR
  • cardiovascular deterioration and endotoxemia
  • reflux positive
  • rectal palpation -> distended loops of small intestine
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12
Q

dx of complete SI obstruction?

A
  • u/s evidence

- abdominocentesis: serosanguineous peritoneal fluid

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13
Q

what is the best method to detect SI distension?

A

u/s

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14
Q

hyperemia of gums and a toxic line along the tooth/gum interface suggests what illness?

A

endotoxemia - SIRS - cardiovascular compromise

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15
Q

dry digesta in the large intestine suggests what?

A

an obstruction in the SI

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16
Q

if SI obstruction is suspected, what is the FIRST STEP for initiating immediate Tx?

A

pass stomach tube - check for reflux

note: must create a siphon to help get the tube going

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17
Q

what does a serosanguineous tap suggest?

A

devitalized intestine

iatrogenic

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18
Q

t/f

SI obstruction is considered an emergency and often warrants referral to hospital

A

true

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19
Q

what treatments are instituted immediately for SI colic?

A
  • analgesia
  • decompress stomach - NG intubation
  • fluid therapy
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20
Q

what is a common cause of acute inflammation that leads to SI obstruction?

A

proximal enteritis

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21
Q

what are 2 common causes of simple obstruction that leads to SI obstruction?

A

ileal impaction

ascarid impaction

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22
Q

what are 2 common causes of strangulating obstruction (StO)

A 
lipoma
anatomical excursions (mis adventures)
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23
Q

what is proximal enteritis?

A
  • acute inflammation
  • edema
  • hemorrhage
  • necrosis
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24
Q

what are common names for proximal enteritis?

A

duodenitis / proximal jejunitis

“anterior enteritis”

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25
Q

what does inflammation of a segment of the intestine lead to?

A
  • dysperistalsis: paralytic ileus, functional obstruction

- inc fluid secretion, dec fluid absorption

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26
Q

proximal enteritis often effects what types of horses?

A

well managed horses - dz of luxury
higher grain diet
confined

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27
Q

etiologic agent of proximal enteritis?

A

unknown

maybe:
Clostridium perfringens / difficile
salmonella

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28
Q

c/s of proximal enteritis:

A

colic
lots of reflux
lethargy
fever s/t

CBC - inflammation, hemoconcentration
PBP: azotemia, elevated lactate, hyperproteinemia

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29
Q

classic presentation for what dz:

animal painful w colic, you place stomach tube, drain stomach so pain goes away then animal becomes profoundly depressed / lethargic

A

proximal enteritis

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30
Q

CBC and PBP in proximal enteritis?

A

CBC: inflammation and hemoconcentration

PBP: azotemia, elevated lactate, hyperproteinemia

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31
Q

dx of prox enteritis?

A
  • compressible loops of SI on palpation
  • thickened loops of SI on U/s
  • yellow / orange peritoneal fluid
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32
Q

t/f

protein levels in peritoneal fluid suggests prognosis of animal

A

true

higher protein => poorer prognosis

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33
Q

prox enteritis vs Strangulation:

bowel loop distension

A

loops of distended SI are less tight in PE

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34
Q

what does a bloody reflux duriing prox enteritis suggest?

A

assoc w less favorable outcome

inc risk of laminitis

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35
Q

prox enteritis vs Strangulation:

blood work?

A

CBC inflammatory in PE

stress changes in StO

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36
Q

prox enteritis vs Strangulation:

after draining, what c/s about animal’s attitude is most noteworthy ?

A

lethargy MOST noteworthy in PE

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37
Q

prox enteritis vs Strangulation:

quantity of refulx?

A

higher quantity - substantial - during PE

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38
Q

prox enteritis vs Strangulation:

peritoneal fluids

A

yellow orange in PE
also fluid protein is high w normal TNCC

serosanguineous in StO
often elevated protein and TNCC

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39
Q

prox enteritis vs Strangulation:

GGT levels

A

GGT elevated in StO

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40
Q

prox enteritis vs Strangulation:

response to medical tx?

A

PE responds well to medical Tx typically

w/o Sx, StO condition will deteriorate

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41
Q

PE tx:

A 
gastric decompression - stomach tube***
hold NPO
fluids
anti endotoxemia tx
abx [controversial]
prokinetic drugs
celiotomy
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42
Q

prognosis of PE?

A

survival = 66-87%
68% developed gastric ulcers w/in 24 hours
risk aspiration pneumonia and phlebitis
risk of laminitis high: 7.5-28.4% and higher if reflux is bloody

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43
Q

where does ileal impaction commonly occur?

A

at the ileum - where the ileum joins the LgI

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44
Q

MC geographic loc of ileal impaction?

A

SE USA

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45
Q

what type of obstruction occurs in ileal impaction?

A

simple luminal obstruction

46
Q

1* ileal impaction occurs d/t:

A

coarse ingesta - poor quality forage

47
Q

2* ileal impaction occurs d/t:

A

ileocecal jxn dysfxn
ileal hypertrophy
damage / occlusion by tapeworms

48
Q

what type of tapeworms often cause ileal impaction in horses?

A

anoplocephala perfoliata

49
Q

older animals may acquire ileal impaction 2* to what idiopathic muscular condition?

A

idiopathic thickening of muscularis layer of the ileum ==> dec luminal diameter at the end orad to the ileocecal junction

50
Q

c/s of ileal impaction?

A

moderate pain - tachycardia, diminished borborygmi

later stages:
positive reflux
SI distension

51
Q

rectal palpation of ileal impaction?

A

early = doughy to solid tubular mass extending proximad from ileocecal jxn

later = extensive SI distension

52
Q

early case of ileal impaction Tx:

A
  • hold NPO
  • analgesia
  • drain stomach
  • laxative [mineral oil or DSS]
  • fluid therapy
53
Q

late case of ileal impaction Tx:

A

surgical reduction

jejunocecostomy

54
Q

px of ileal impaction?

A

deworm for tapeworms - praziquantel

do not feed course roughage

55
Q

MC ascarid to cause impaction in equine?

A

parascaris equorum

56
Q

t/f

parascaris equorum is ubiquitous in the horse environment

A

true

57
Q

route of infection of ascarids and life cycle / pathogenesis?

A

fecal oral transmission

all young exposed

parasite larvae migrate out of gut and into liver -> milk spots on liver -> migrate to lungs -> respiratory signs -> couging and discarge -> re swallow -> adults enter SI

58
Q

t/f

equine often develop a self cure from ascarid infection

A

true

develop natural immunity

59
Q

ascarid parasitism issues MC seen in what age animals?

A

young foals

60
Q

why should foals with a high ascarid load NOT be given high doses of de worming agents?

be cautious during what age range

A

worms become stunned and die -> form physical foreign body obstruction -> often occurs near duodenum and jejunum

foals 3-12 mos old

61
Q

c/s of ascarid impaction:

A 
colic signs after de worming
severe SI obstruction
abdominal distension
positive reflux
may see worms in reflux and/or feces
62
Q

dx ascarid impaction?

A

circumstances, c/s
PE
u/s

63
Q

how to manage an incomplete ascarid impaction:

A

relieve pain
decompress stomach
laxative
fluids

64
Q

how to manage a complete obstruction?

A

decompression surgery

resection / anastomosis surgery

65
Q

how to px ascarid impaction:

A

use benzimidazole de wormers

worms are resistant to macrocyclic lactones [ivermectin] and pyrimidine derivatives

66
Q

what 2 intestinal issues may complicate ascarid impaction patients?

A

jejunal intussusception or perforation

67
Q

what is SI strangulation?

A

obstruction accompanied and complicated by loss of blood supply to affected segment

68
Q

Tx of SI strangulation:

A

SURGERY

resection and anastomosis
remove strangulated segment
remove part of pre stenotic segment

69
Q

prognosis of SI strangulation?

A

guarded

post op ileus likely, peritonitis and adhesions, anastomotic site dysfunction

70
Q

in SI strangulation, why is the pre stenotic segment removed?

A

b/c it is damaged d/t distension

71
Q

what does high lactate in the peritoneal fluid suggest?

A

intestinal de vitalization

72
Q

t/f

lactate conc in peritoneal fluid may be elevated to a greater extent than that of the blood

A

true

73
Q

some types of SI strangulation?

A

pedunculated mesenteric lipoma
herniation
volvulus
intussusception

74
Q

in SI strangulation d/t hernia, what 2 locations commonly herinate?

A

epiploic foramen

gastro splenic lig

75
Q

MC strangulation type in MO?

A

pedunculated mesenteric lipoma

76
Q

common presentation of horse with mesenteric lipoma:

A

mature or older horse - often over 15 yo

obesity is a risk factor

MC cause of critical SI colic in MO *****

77
Q

how do mesenteric lipomas cause colic?

what region of intestines?

A

as a result of their mass impingement on the intestinal lumen [mild]

MC SI but can affect descending colon

78
Q

dx of mesenteric lipoma?

A

at surgery

79
Q

how do hernias cause colic?

A

section of intestine is obstructed after moving through an aperture => strangulation is a common sequela

80
Q

what is the anatomy of the epiploic foramen?

A

a slit, 4-6 cm wide

dorsal: Cd love of liver, Cd vena cava
ventral: R lobe of pancreas, gastro splenic fold, hepatic portal vein

81
Q

risk factors of epiploic foramen entrapment?

A

thoroughbred breed
winter months
cribbing and wind sucking - d/t altered / abnormal abdominal pressures

82
Q

what configuration of epiploic forament entrapment is most common?

A

Left to Right

83
Q

c/s of epiploic foramen entrapment?

A
  • abdominal pain
  • SI obstruction [MC jejunum and ileum, rare colon]
  • rectal palpation findings equivocal in early stages
  • reflux - later stages
  • abnormal peritoneal fluid
84
Q

dx epiploic foramen entrapment?

A

u/s obstructed SI - R Cr abdomen

85
Q

what type of hernia should be considered especially when a stallion presents with colic?

A

inguinal hernia

86
Q

how to check for inguinal hernia during PE?

A

palpate scrotum
rectal palpation
u/s

87
Q

what age is commonly found to have inguinal hernias?

common management?

A

neonates

reducible scrotal swelling
managed by repeated manual reduction - wait for tissue to becomes stronger as animal grows/develops

obstruction and strangulation are still a risk

88
Q

what is volvulus?

A

twisting of intestine about its mesenteric axis?

89
Q

a volvulus of the root of the mesentery can affect ___ % of the SI

A

80%

90
Q

what age group MC gets volvulus?

A

foals and young adults

91
Q

1* volvulus:

A

consequence of abnormal motility - dysperistalsis

92
Q

2* volvulus:

A

abnormal motility consequent to entrapment or other obstruction [herniated jejunum, for example]

93
Q

what region MC for volvulus in equine?

A

SI

94
Q

c/s volvulus?

A

severe SI obstruction and strangulation

95
Q

tx volvulus?

A

resection and anastomosis

jejunocecostomy

96
Q

prognosis of volvulus?

A

only 58% survival - high inter operative attrition

80% survival if survives anesthesisa

48% post operative complication rate

97
Q

partial obstruction d/t intussusception typically presents as :

A

chronic recurrent colic

dec feces and appetite
fever
wt loss
post prandial colic
failure to thrive
98
Q

risk factors for intussusception:

A

MC in foals and horses less than 3 yo
enteritis [dysmotility]
parasites

abrupt diet change
prior anastomosis
presence of focal mass along intestinal wall [granuloma, neoplasia]

99
Q

what is the pathognomonic sign on u/s for intussusception?

A

target sign

100
Q

what is ileo cecal intussusception?

A

ileum into cecum thru ileocecal jxn

intussusceptum = ileum
intussuscipiens = cecum
101
Q

clinical presentation of ileo cecal intussusception?

risk factor?

A

young horse, intermittent colic responds to Tx

risk: Anoplocephala perfoliata parasitism

102
Q

what is Meckel’s diverticulum?

A

remnant of primitive yolk sac

incomplete atrophy of the embryonic vitellointestinal duct

103
Q

where is Meckel’s diverticulum loc?

A

loc at anti mesenteric border

distal jejunum
ileum

may be connected to umbilicus via mesenteric band

104
Q

what issues arise at Meckel’s diverticulum?

A
  • bacT overgrowth -> risk of acute intestinal inflammation
  • distends w ingesta: painful -> necrosis and possible rupture
  • facilitates volvulus and intussusception
  • can loop around and strangulate adjacent gut like pedunculated lipoma
105
Q

SI adhesions predispose animal to what issues?

A

obstruction
herniatioin
volvulus

106
Q

what is the nature of chronic infiltrative SI dz?

A

chronic inflammation

granulomatous enteritis
lymphocytic plasmacytic enteritis
eosinophilic enteritis

107
Q

what kind of neoplasia my manifest as chronic infiltrative SI dz?

A

alimentary LSA

108
Q

clin presentation of chronic infiltration dz?

A

wt loss and ill thrift
hypoalbuminemia / ventral subQ edema
recurrent colic

109
Q

Dx of chronic infiltration dz?

Tx?
Prognosis?

A

oral glucose absorption study
biopsy

tx - corticosteroid?
prog - unfavorable

110
Q

what is etiologic agent of proliferative enteropathy (EPE)?

proliferative ileitis

A

Lawsonia intracellularis infection

111
Q

MC presentation and sings of EPE?

A

young horse MC than mature horse

hemorrhagic diarrhea and colic => hypoalbuminemia

112
Q

dx EPE?

Tx?

A

dx: PCR of feces, Aby titer

Tx: abx
erythromycin
chloramphenicol
tetracycline

IP 11 Equine Medicine (10 decks)

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