Exam 5 Flashcards

Question

Diarrhea

Answer 1

1. Foal heat diarrhea Etiology -Hormonal changes in mare? -Changes in intestinal flora or diet C/S -2-5 days -Age 5-15 days old -Soft feces + NORMAL foal -Keep nursing -Monitor and prevent scalding 2. Lactose intolerance -Osmotic diarrhea due to undigested lactose -Primary: rare -Secondary: separation, overfeeding, artificial milk, change in diet. -Tx: modify milk supply, help digestion (Lactaid) 3. Viral diarrhea -Rotavirus: breeding centers, A&B rotavirus. Very contagious. Age 5-35 days to 6mts. Shedding 3 days past clinical signs. Fecal-oral, environment, fomites, inapparent shedders. Risk factors: foals born unvaccinated mare, inadequate IgG colostrum, inadequate biosecurity. Decreased absorption (villous atrophy), increased secretion (lactase deficiency). Complications: dehydration, lactose intolerance, fever may occur. Dx: ELISA, RT-PCR. VP6 protein **Watery to cow-pile feces** Tx: Symptomatic (hydration), plasma, Sucralfate. Prevention: biosecurity, vaccinate mare (8,9,10). Disinfectants: accelerated hydrogen peroxides, bleach, phenolic. -Corona virus -Adeno virus -Parvo virus 4. Bacterial diarrhea -Actinobacillus -Bacteremia, septicemia -Clostridiosis: C. perfringes, A&B toxin. A biotype severe. Sporadic or farm issue. C/S: hemorrhagic diarrhea, colic, hypovolemic/septic shock, often rapidly fatal. Dx: culture, PCR, ELISA for C. perfringes and difficile. Abdominal ultrasound, thickened bowel, gas in wall. Tx: metronidazole PO, rectal. Supportive care, penicillin -Salmonellosis: ZOONOTIC, shedding from healthy horses. Foals <1 mts. Diarrhea, depression, SEPSIS. CBC, PCR, culture. -Rhodococcosis -Actinobacillus -Eschericia coli: most frequent cause of sepsis in the neonate 5. Parasitic diarrhea -Parascaris equorum, Cryptosporidium sp., Giardia. Others: -Hypoxic diarrhea at birth. Colic, reflux, abdominal distension. Tx: nursing, parenteral nutrition, AB -Ulcers Sand irritants 6. Treatment -Treat agent -Hydration, electrolytes, plasma -Mucosal and gastric protectants: Kaolin & Pectate, Activated charcoal, Smectite -Adsorbent -Nutrition: enteral-parenteral -Fluid therapy: Colloids, plasma, dextrose containing, HES.

Answer 2

Neonate -Mecomium impactions: 6-24 hrs post partum. Depression, stop nursing, straining, recumbency, abdominal distension. Dx: digital palpation, ultrasound (distension, ileus), radiographs contrast. Tx: enema, warm soapy water, retention enema acetylcystein. No food, mineral oil, fluids, pain medication (Diazepam, butorphanol) -Ulcers: glandular/non-glandular. C/S: intermittent, rupture, no appetite, colic, ptyalism, eructation, colic, asymptomatic, perforative, pyloric or duodenal stricture. Dx: Diarrhea, teeth grinding, fever, colic, Fecal occult blood, imaging: gastroscopy, ultrasound, radiographs. Tx: Ranitidine combo with Omeprazole. -Enteritis -Hernia 2-5 days -Ruptured bladder -Ulcers -Enteritis -Atresia coli Older foal -Ulcers -Enteritis -Volvulus SI -Intessusception -Gastric outflow obstruction

Answer 3

Previously covered

Answer 4

-HYPP -PSSM1 -HERDA Overo lethal white syndrome Overo = white coat (APH, AQH, others) -Autosomal recessive -Abnormal endothelia receptor B/altered neural crest migration: melanocytes and intestinal ganglia -Born white -C/S: Foal blue eyes, white coat, colic develops. -Always fetal if homozygous, intestines are different Severe Combined Immune Deficiency Disorder. -Arabian -Autosomal recessive -No functional T & B cells -Lethal primary immunodeficiency -C/S: normal at birth, 1-3mts susceptible to infection (Pneumocystis crania) -Dx: Genetic testing, CBC lymphopenia, no IgM pre suckle -Tx: none, test parents to prevent Lavender Foal Syndrome -Recessive genetic disorder -Arabian horses (Egyptian) -C/S: Unique color dilution, difficult delivery, problems to stand up, episodes of rigid limb extension + head, neck. -Dx: genetic testing -Tx: fatal Hereditary Equine Regional Dermal Asthenia -Autosomal recessive, mutation in PPIB gene -Defective collagen -C/S: cuts, wounds, sloughing, problem when training under saddle, slow healing injuries -Dx: genetic testing -Tx: none, unsuitable to ride, pasture pet AQHA -5 panel test: HYPP, PSSM, MH, GBED, HERDA -Hereditary equine regional Asthenia -Hyperkalemic Periodic Paralysis -Myosin-Heavy chain Myopathy -Malignant hyperthermia -Polysaccharide Storage Myopathy -Glycogen Branching Enzyme Deficiency Junctional Epidermolysis Bullosa -Belgian, French draft horses and American Saddlebreds -Red foot disease, hairless foal syndrome, epitheliogenesis imperfect. -C/S: normal at birth, 4-5 days ulcers, erosions at pressure points. Secondary infections and pain, hooves may detach, oral ulcers -Tx: none, most euthanized -Dx: genetic testing

Answer 5

Purpose of PPE -Determine the CURRENT health status of the horse NOT to -Pass or fail, we can't say a horse is perfectly sound, we can only tell what we found or did not found -Can not predict the future soundness -Can not determine suitability, if the horse is dangerous, it needs to be in the record -Can not determine the horse's price, it should be determined before PPE and maybe negotiate after Components **Use standardized form** 1. Detailed patient information, client information, who was present for the exam 2. Pictures of the horse with markings visible and written in report 3. Identification -Microchip: left side of neck 1/2 way down -Tattor: under lip in racehorses -Freeze brand: under mane, on hip 4. Detailed history from seller -Document if unable to talk to seller or agent -What is the horse's current workload -Any known medical/lameness issues 5. Get through the body systems individually -Cardiac: listen to arrhythmias, murmurs before and after exercise -Respiratory: lungs, noise during exercise -Neurological: document what tests were performed -GI: passing normal manure, gut sounds -Oral exam: age, dental abnormalities -Reproductive: stallion, gelding, cryptorchid? BSE -Integumentary: look for skin masses, surgical scars -Lymphatic: enlarged LNs -Ophthalmic: cataracts, cysts, corneal scars **Last musculoskeletal** palpate limbs, back, joints, hoof testers, lameness exam, flexions

Answer 6

**Most important part** ** No diagnostic nerve blocks** -Evaluate conformation, shoeing -Palpate limbs -Hoof testers -Motion +/- Ridden exam -Flexion test

Answer 7

**Communicate that finding with the buyer** -Some buyers will end the PPE there -Other clients will continue and want further diagnostics: radiographs, ultrasound, becomes very difficult **Localizing lameness is the seller's responsibility** buyer should not pay for lameness exam on a horse that they don't own -Document what tests were declined as well -Radiographs, ultrasound, endoscopy, nuclear scintigraphy, bloodwork, drug screen Imaging -Ultrasound, MRI, Nuclear Scintigraphy: interpretation can be very challenging -Endoscopy for race horses URT -Standard views: Front feet, hocks +/- stifles -Expensive horses: front feet, all 4 fetlocks, hocks, stifles, back, neck Bloodwork -Drug screen: often take blood and hold it, up to 6 months frozen serum -CBC/chemistry -Coggins: Equine infectious anemia, need for traveling out of state -PPID test in older horses? -Make sure you take enough blood during exam so you don't have to go back!

Answer 8

Thoroughbred (or other breed) Auction -Repository film sets -May have endoscopy at sale as well Breeding stock: BSE International sales: communication barriers, different levels of practice

Answer 9

The buyer, they are paying for the exam If seller wants the information, the buyer must give permission to release the records

Answer 10

Communication -Ideally buyer is present or trainer/agent -Seller watches from distance **Make sure buyer understands what you are telling them** -Make sure you ask if they have any requests BEFORE starting the exam -Train staff to ask questions: what does the buyer want radiographs? endoscopy? BSE? Conflict of Interest -Avoid doing a PPE for a horse that is in your regular care and seller is the client. Seller should fully disclose any medical issues and release records -Do not base your fees on the value of the horse -Make the exam fee high: they can take hours and paperwork is intense! -Determining stakeholders is not that simple Protect yourself -Horse may not be broke enough to do a PPE -Carry malpractice insurance (lots) -Waivers: reduce your liability -Get in writing if seller refuses to disclose medical history -Never give any guarantees: Horse assessment condition for TODAY -Document EVERYTHING There is no perfect horse -If you look, you will always find "stuff" -Need to help your client decide how much "stuff" they can live with -Lame horses: if the horse never gets more sound that they are today, does it still work for you?

Answer 11

Why? -No PPE performed -No history of surgery

Answer 12

-Subtle lameness that seller and buyer can't see is very common -Seller lies about history -Lies about medications administration -Seller makes excuses for the horse -Scratches actually suspensory ligament injury! -Veterinarian did not mentioned 5 year locking stifle lameness, sued and settle out of court -Veterinarian sued, but trainer had switched horses for PPE -Buyer wanted radiographs first, but then arrhythmia found last, expensive exam and no purchase, buyer upset **Eyes, heart, lungs, teeth first** Tips -Be honest, people will respect you -Document everything -Use systematic approach -Use standardized form -No perfect horse -PPE's take time -Take good quality radiographs -You will make someone mad at some point

Answer 13

Standing Procedure Sedation 1. Ophthalmic exam -Sedation: xylazine for quick, detomidine if longer -Local block: auriculopalpebral -Other: xylazine, butorphanol or detomidine +/- LA block 2. Penile exam or sheath cleaning -Detomidine -Acepromazine to drop the penis -Acepromazine + xylazine 3. Green colt castration (to lay down in the field) -NO ACEPROMAZINE -Start with xylazine (50mg per 100 lbs) -Xylazine + butorphanol IV 4. Dental float -Oral detomidine: last 3 hrs, use prior to farrier visit. Follow manufacturer's recommendations -Detomidine IV for longer procedures -Detomidine + butorphanol -Romifidine IV + butorphanol 5. Standing surgery (wound repair, perineum surgery, etc.) -Detomidine to start or CRI if long procedure -Detomidine and local block 6. Joint Injections -Detomidine + butorphanol IV, top off as needed -Detomidine + physical restraint Opioids for standing sedation **Do not use opioids by themselves = excitement risk** -Morphine: 0.1-0.2 mg/kg IVsynergistic with alpha-2 agonist -Ketamine stun: 0.1 mg/kg IV sub anesthetic dose, another 15 minutes profound sedation

Answer 14

Premedication -Alpha-2 agonist +/- butorphanol IV -IM premed for skittish horses -Dose of alpha-2 agonist > when patient is going to be induced for general anesthesia compared to standing sedation -IM alpha-2 agonist dose is doubled than IV Induction -Ketamine: can be used alone or with muscle relaxant (midazolam) ~ 10ml -Midazolam or diazepam ~ 6-8 ml -Both can be mixed and given as bolus. -Do not titrate to effect, the horses needs it all Maintenance -Ketamine + xylazine -15-20 minutes after induction give 1/3 of the previous dose of ketamine + xylazine for additional time -Triple Drip only for 1 hour, too much muscle relaxation = rough recovery Post op analgesia -NSAID -Local anesthesia -Cryotherapy -Hydrotherapy -Opioids -Confinement/exercise: castration 24 hrs confined. Hydrotherapy, 15 minutes exercise.

Answer 15

Duration Romidifine >> detomidine >> dexmedetomidine >> xylazine -Butorphanol + alpha-2 agonist = less CRI. Loading dose 0.02 mg/kg IV then 0.024 mg/kg CRI, analgesic + sedative **no behavioral changes** -Crystalloid fluids isotonic CRI xylazine 0.65 mg/kg/hr 500 ml fluid bag 10 drops/ml 450 kg horse =1 drop/sec (10 drops/ml set) = 0.8mg/ml = 80 minutes of infusion

Answer 16

Premedication -Alpha-2 agonist +/- butorphanol IV -IM premed for skittish horses -Dose of alpha-2 agonist > when patient is going to be induced for general anesthesia compared to standing sedation -IM alpha-2 agonist dose is doubled than IV Induction -Ketamine: can be used alone or with muscle relaxant (midazolam) ~ 10ml -Midazolam or diazepam ~ 6-8 ml -Both can be mixed and given as bolus. -Do not titrate to effect, the horses needs it all Maintenance -Ketamine + xylazine -15-20 minutes after induction give 1/3 of the previous dose of ketamine + xylazine for additional time -Triple Drip only for 1 hour, too much muscle relaxation = rough recovery Post op analgesia -NSAID -Local anesthesia -Cryotherapy -Hydrotherapy -Opioids -Confinement/exercise: castration 24 hrs confined. Hydrotherapy, 15 minutes exercise.

Answer 17

General Considerations -Adequate padding -Equipment, personnel -Fasting requirements (1-4 hr) -Must flush oral cavity prior to intubation -Removal of shoes -Have additional drugs available Anticipated complications -Hypotension, hypoventilation, hypoxemia, hypothermia -Dysphoria -Prolonged recovery -Nasal edema -Myopathy or neuropathy from lack of adequate padding **Ideally <3 hrs** Anesthetic Risk -CHARIOT article

Answer 18

Pre-med -Alpha-2 agonist IV unless needs IM for placement of IVC +/- Opioid +/- Acepromazine Induction -Ketamine + Benzodiazepine Maintenance -Isoflurane Post op -Small dose of alpha-2 agonist IV for transitioning, safety of personnel -NSAID given prior to premedication -Other analgesia (e.g., lidocaine CRI post colic operation) Opioids -Never give alone -Butorphanol most commonly used -Hydromorphone IV least likelihood of post op colic, decreased motility -Morphine, fentanyl, have also been studied -Buprenorphine

Answer 19

-Hypotension and post-anesthetic myopathy -Hypotension incidence decreases with use of TIVA or PIVA **MAP >70mmHg** normal recovery -Neonatal foals lower BP, MAP 40-60 mmHg Treatment -Lighten anesthetic depth -Administer positive inotrope (Dobutamine to effect or epinephrine) -Change to PIVA Environment -Quiet dark room -Maintain safe position -IPPV until spontaneous ventilation resumes -Remove deflated ETT when patient swallows and remove mouth gag Time for Recovery -Varies -If not up after 1 hours, sternal recumbency encourage Post op Myopathy Prevention -Padding -Prompt treatment of hypotension -IVF, analgesics, anti-inflammatory drugs, sedatives if needed, vasodilators. Rehab therapy if needed Neuropathy -Peripheral nerves: radial, femoral, peroneal, facial -May return to normal within a few days or be permanent -Young breed heavy horses rarely myelomalcia "dog sitting" Prolonged Recovery -Can something be reversed -IVF warm, dextrose added Hypoxemia causes 1. Hypoventilation 2. V/Q mismatch 3. Decreased FiO2 4. Right to left shunt 5. Diffusion impairment -Recurrent laryngeal neuropathy: use smaller size ETT -Airway obstruction: placed 16-18 mm nasal tube if nasal edema. Phenylephrine Determining oxygenation and ventilation status -Arterial blood gas Recurrent airway obstruction -Tx: Albuterol, if severe V/Q mismatch increase minute ventilation -IPPV 1:2 ratio HYPP -Signs: muscle fasciculations, weakness, prolapse of nictitating membrane, sweating and stressful events -Tx: decrease stress (even fasting and diet changes can trigger an attack). Avoid drugs with potential to exacerbate HYPP (depolarizing neuromuscular blockers, K-pen, potassium sparing diuretics) -Avoid NSIADs, ketamine, halothane, isoflurane, IVF containing potassium -Oral acetazolaminde for 2 days prior to elective procedure

Answer 20

See handnotes

Answer 21

-Donkeys are stoic (can endure hardship) -Mules are difficult to handle -Anatomically: narrower nasal passages, use smaller ETT, thicker skin over jugular furrow -Drugs metabolized faster, use higher doses, except for Carprofen -Donkeys have higher GGT values -Hematocrit does not increased until >30% dehydration -Higher blood pressure can lead to more bleeding -Recovery is generally smooth **Higher end of dose for mules, lower for donkeys**

Answer 22

Important/common toxicants vary greatly -Geographic location -Husbandry Diagnosis -Based on clinical signs and history -Laboratory confirmation occasionally available Treatment is often limited to symptomatic and supportive care -Few antidotes or specific treatment -Decontamination is more difficult Species variation -Horses are more sensitive than other herbivores to many toxicants **Prevention is critical in most cases**

Answer 23

**Rotten round hay bales** -Clostridium botulinum -Toxins type B, and C most sensitive -Rotten vegetation, hay or feed contaminated with carcasses -Less common: wounds, foals, adults with necrotic ulcers C/S -Progressive flaccid paralysis -Acetylcholine release into neuromuscular junction inhibited. Muscle nerves can't fires -"Dog sitting" -Loss of tongue and tail tone -Difficulty pretending and swallowing food -Peracute paralysis and death -Death due to respiratory paralysis Tx -Supportive care: nutrition, hydration, preventing crush injuries, choke, etc. -Prolong -Antitoxin not always available Dx -Suspect source material test -Feces testing not sensitive enough Prevention -Vaccination -Only effective against Toxin B -Recommended in endemic areas -Feed clean and dry forage -Prevent/remove rotting hay/vegetation from horse's reach

Answer 24

"Moldy corn poisoning" C/S -Acute onset of neurological signs -Recumbent -Dyspneic with nasal discharge -"Thrashing around" Fumosisins -Mycotoxins: fungal metabolite Fusarium sp. -B1 toxin most common in corn Mechanism and C/S -Inhibition of sphingolipid metabolism -Disruption of endothelial cell wall -Edema, necrosis -Horses: ELEM -Pigs: Porcine pulmonary edema -Humans: carcinogen Necropsy findings -White matter degeneration -Grey matter hemorrhages -No inflammation History -Eastern Kentucky -Commercial feed -Pond water Report suspected food/feed contamination -FDA -AAFCO -FDA Vet-LIRN responds to potential food/feed contamination -Safety reporting portal -Call state/regional agents -Can file a report even in only suspicion

Answer 25

C/S -Siff, "stilted" gait -Hyperesthesia/exaggerated menace -Third eyelid prolapse -Extended neck -Arched back -Raised tailhead -Lock jaw -Grimace face -Recumbency and death due to paralysis of respiratory muscles History -Unknown vaccination history common Tx -Prognosis is grave -Antitoxin: not consistently available. Side effects include Theiler's disease -Expensive -Only binds circulating toxin, can't help reverse signs -Supportive care, mechanical ventilation Prevention -Vaccination -Booster when treating even minor wounds