Final Flashcards
True/False: Inflammation (Ex. Enteritis) leading to Colic will Typically present as Strangulating Disease
True
How to Diagnose Choke
NG Intubation- Inability to Enter Stomach
*Endoscopy- Used to Asses Presence and Extent of Damage to Esophagus but not necessary for Diagnosis
Diagnostic Test used to Confirm Cases of Diaphragmatic Hernias
Ultrasound
Medical Managment that can be used in Patients with Equine Metabolic Syndrome in Horses not responding to Exercise and Diet Strategies
Levothyroxine Sodium
How would Non-Strangulating Small Intestinal Disease Differ from Strangulating Small Intestinal Disease?
Less Cardiovascular Compromise
Variable/Less Reflux
Less Tightly Distended Loops on Rectal Palpation
Typical Clinical Sign in Horses with Dsyuria/Stranguria
Urine Scalding of Hind Limbs
Treatment for Left Dorsal Displacement (LDD) of Large Colon
Medical: IV Phenylephrine -Causes Contraction of the Spleen and Release of Large Colon
Surgery: Ventral Celiotomy- If Phenylephrine does NOT work
*When Done with Phenylephrine Drip, Jog the Horse around for 15 Mintues and then Re-Rectal the Horse
Three Most Useful Indicators of Liver Disease
SHD
GGT
Serum Bile Acids
*In the Face of Significant Liver Disease, at least one of the three will be Elevated
After Gastric Decompression the Horse is in Less Pain. 100 mg Xylazine is Administered. The Mare stays relatively Pain Free for 30 Min. Pain Increases Again and another 9.5 L of Reflux is Obtained. The Mare is Administered another 100 mg of Xylazine which keeps her Comfortable for longer. It is 1 Hour later that she is Refluxed again, 10L reflux Obtained. The Mare is Progressively Depressed. Analysis of the Peritoneal Fluid is Obtained by Abdominocentesis reveals Serosanguinous TP = 4.5 g/dL, WBC = 11,600
What Features of the Case helped Make the Decision for this Diagnosis (Duodenitis Proximal Jejunitis)?
The Rectal Palpation- Moderately Distended Loops
The Abdominocentesis- TP Increased
The Volume of Reflux- Copious Amounts of NG Reflux
The Response to Reflux- Pain Subsides or abates after Decompression, most Horses Remain very Depressed
The Temperature- Rectal Temperature > 101 F
The CRT- Prolonged CRT (> 3 seconds)
Renal Toxicity Described Below:
Most common Cause of Tubular Nephrosis in Horses
Risk of Acute Renal Failure- Increased if concurrent use of NSAIDs, Dehydration, Endotoxemia, Prolonged Administration (> 10 Days)
Clinical Signs- Typically Polyuric, Depression and Anorexia
Aminoglycoside Nephrotoxicity
Free-Flow
*Free-Flow most commonly used- Put new Bedding in Stall
What Drug should be AVOIDED when Treating Liver Disease
Diazepam
*Enhances Effects of GABA on Inhibitory Neurons
*AVOID Diazepam in Horses with Liver Disease
1. The Rectal Palpation- Empty Caudal Abdomen/Reduced Palpable Loops
2. The Abdominocentesis
7. The Progression- Recurrence/Episodic Colic
*Most Diaphragmatic Hernias in the Horse are going to be Large- More than just the Small Intestine will be herniated through the Diaphragm into the Thorax. Will not Feel normal Structures on Rectal Palpation because they are all pushed Forward (Empty)
Three Risk Factors of PRIMARY Non-Strangulating Large Colon Impaction
Teeth- Dental Abnormalities
Winter Season
Water Restriction
*Most Notably will see Primary Non-Strangulating Large Colon Impactions Develop in Winter Months
If horses have Poor Dentition they are going to be Chewing their hay less well and therefore will have larger Fiber Components in their colon which will predispose them to impactions
______ Mechanisms likely MAJOR underlying Cause of Ileus regardless of Initial insult
Inflammatory
*Late stage POI is mainly associated with Inflammatory Mechanisms irregardless of what the underlying cause is
Differential for Small Intestinal Strangulating Disease where the Animal gets Progressively Depressed
DPJ (Anterior Enteritis)
Three Most Common Etiologies leading to Cresty Necked Horses
Hypothyroid
Pituitary Adenoma
Equine Metabolic Syndrome
B, C, D, E
*High Levels of Glucose in the Blood leading to Glucosuria
Pathophysiology of which Cause of Colitis:
Obligate Intracellular Parasite which Infects Trematode
Trematode then Infects Snails and many Aquatic Insects
Focus on Fresh Water Snails and Fluke
Inadvertent Ingestion of Aquatic Insects and Snails
Potomac Horse Fever
*Accidental Ingestion of the Infected Trematode Vector- How the Horse Develops Disease- Be Careful with Feed and Water Sources
Most Diagnostic Serum Abnormality in Patients with Hyperlipemia
Serum Triglyceride Levels in Excess of 500mg/dL
NG Reflux: None
Rectal: Very Firm Slightly Indentable Structure in Left Ventral Quadrant. Filled Structure coming across Pelvic Inlet
Abdominocentesis: TP
What is the Likely Diagnosis in this Case?
Large Colon Impaction
*Non-Strangulating Large Intestine
*Normal Abdominocentesis- Common with Non-Strangulating Lesions
Colitis- Inflammatory Disease of the Large Colon that looks STRANGULATING
Large Colon Volvulus = Strangulating
Cecal Impaction- Would be Located in the Right DORSAL Quadrant
On Rectal Palpation, if Kidney is Larger, Softer and Painful it is ____Disease
Acute
_____ Dorsal Displacement of the Large Colon is also known as Nephrosplenic Entrapment
Left Dorsal Displacement (LDD)
*Large Colon becomes Distended and Filled with Gas. The Colon Migrates up along the Body Wall and hooks into the Nephrosplenic Ligament. Large Colon becomes stuck in the Space because there is a Ledge on the Spleen
*Main Therapy for Left Dorsal Displacement of the Large Colon targets the SPLEEN. Contraction of the Spleen will Minimize the Ledge and the Large Colon will no longer be Entraped
Albuminocytologic Dissociation
*VERY Elevated Protein in the Abscence of Increased WBC
Treatment for Ruptured Bladder in Foals
Stabilize First- Correct Electrolyte Imbalance
NaCl Fluids
*MEDICAL EMERGENCY (not a Surgical Emergency)
Ileal Impaction associated with Bermuda Grass Hay
*Non-Strangulating Small Intestine
Review Card: Comparison of DPJ to Strangulating Obstruction
*Patients with DPJ are Depressed and Painful while Patients with Strangulating Obstruction are just Painful. In Patients with DPJ the Depression Increases as the Pain decreases (Decompression). In Patients with Strangulating Obstructions the Pain never Decreases
After Nasogastric Intubation, Patients with DPJ will become Depressed and Quiet as Decompression relieves the Pain, while Patients with Strangulating Lesions will have No Pain Relief
Rectal Temperature- Patients with DPJ will have a Rectal Temperature between 101.5-102.5 (Infection) while Patients with Strangulating Obstrufctions will have a Rectal Temperature
Abdominocentesis- Patients wtih DPJ will have WBC less than 5,000/uL while patients with Strangulating Obstructions will have WBC between 3,000-20,000/uL
Normal Urine Specific Gravity in a Horse
1.020-1.050
Differential for Small Intestinal Strangulating Disease where the Animal is Febrile
DPJ (Anterior Enteritis)
*Fever Typically > 101 F
What will you find on Abdominocentesis in a Foal with Ruptured Bladder
Creatinine Greater than That of Serum
Three Electrolyte Abnormalities seen in Foals with Bladder Rupture
Hyponatremia
Hypochloremia
Hyperkalemia
The Abdominocentesis- Peritoneal Fluid Changes may not Reflect the Degree of Intestinal Necrosis because “Dead” Bowel is essentially isolated from the Peritoneal Cavity
The Progression- Acute Colic Followed by Intermittent Colic
*The More Gut that Telescopes into the next segment, the more compromise you’re going to have to that Internal Segment
*There is a HUGE Lag in seeing Abnormalities on the Abdominocentsis in these Horses
Three Causes of SECONDARY Non-Strangulating Large Colon Impaction
Sand Enteropathy
Enterolithiasis
Colonic Displacements
*Secondary Non-Strangulating LI Disease is MORE Likely to Progress to Strangulating Disease
Review Card: C1 and C2
*Be abe to Recognize C2 and C6 on a Radiograph
Arrows = Skijumps: On the Ventral Aspect of the Vertebrae in an Abnormal Vertebrae they are going to get Remodeling Ventrally such that it makes a Scoop. At the end of the Vertebrae they will have Caudal Epiphyseal Flare. A Scoop and Flare Together looks like a Skijump
Three Cervical Vertibra on a Radiograph that Look Identical- C3, C4, C5
Only Specific Antemortem Test used to Diagnose Rabies
IFA of Tactile Hair
*Immunoflouresence = IFA
Patients with Blister Beetle Toxicosis Frequently Develop Severe ______
Hypocalcemia
*Blister Beetle Toxicosis- High Degree of Hypocalcemia
In Horses with Icterus, Ratio of Direct (Conjugated) Bilirubin to Total Bilirubin in Excess of 25-30% is associated with _______
Cholestatic Disease
Typical Protocol used to Manage Pain in Horses with Spasmodic/Simple Colic
1. Flunixin Meglumine- Every one of these Horses should be given a dose of Flunixin Meglumine. Flunixin not only helps to control the pain but it is also part of the therapy for Endotoxemia
2. Xylazine (Alpha 2 Agonist)
*There is NO Better group of Drugs addressing Gastrointestinal Pain associated with Colic than Alpha 2 Agonists: The Best drugs to use to address the Pain in a Colic Horse
Protocol: First Administer Flunixin Meglumine. If it Doesn’t really work then Dose with Xylazine. After a Couple Doses of Xylzaine, if it is Not working then add in Butorphanol. If you are Administering Xylazine and Butorphanol and its not really Holding off the Pain and you need to ship the Horse then you could potentially give Detomidine
Treatment for Acute Renal Failure
Fluid Therapy- Correct Volume Deficits and Electrolyte, Acid-Base Abnormalities
Furosemide- Every 1-2 Hours
*Stop Nephrotoxic Drugs
Review Card: Colic in Foals
In the First Few Days of life we have two Major Differentials- Meconium Impaction, Ruptured Bladder
Which Small Intestinal Strangulating Disease tend to have Recurrent Colic Episodes?
Strangulating Lipomas
Diaphragmatic Hernias
One of the Number one Treatments that we use in Colic Patients on a Routine Basis is _____ Infusions, to Prevent Post-Op Ileus
Lidocaine
*Prevents Post-Op Ileus in Colic Patients- The vast majority of Surgical Colic Cases are going to routinely be placed on Lidocaine
Diagnosis based on this Myelography of the Equine Neck
Equine Wobblers (Cervial Stenotic Myelpathy)
*Definitive Diagnosis- 50% or Greater Decrease in Diameter of Dorsal and Ventral Dye Column at Diametrically Opposed Sites
Risk Factors for which Brain Stem Disease:
Head Shakers
Eating Hard Feeds (Corn)
Loud Vocalization
Yawing
Otitis Media Interna
*Fusion of the Temporal Bone and as Forces are Repurrcused through the bone structures they will end up Fractoring
How to Diagnose Clostridial Colitis
Identify Toxins in Feces (ELISA)
*Clostridial Organisms are Ubiquitous in the Environment- Horse Normally have Clostridum in their Intestinal Tract
Six Syndromes of Equine ______ Infection:
Fever with Leukopenia
Colic with Diarrhea
Colic Without Diarrhea
Proximal Enteritis/Jejunitis
Septicemia
Asymptomatic Carriers
Salmonellosis
*Classic Case- Colic with Diarrhea
How to Monitor for NSAID (Phenylbutazone) Nephrotoxicity in Horses
Specific Gravity
*Loss of Concentrating Ability is the EARLIEST sign of NSAID Toxicity
Is this the Right or Left Ureter?
Right
*You are coming from Behind the Horse
Infectious Etiology of Colitis Described Below:
Most Frequently Diagnosed Infectious Cause of Diarrhea in Horses
Highly Contagious and Potentially Zoonotic
Risk Factors: STRESS Induced Disease
Asymptomatic Carriers under stress can shed the Organism
Salmonellosis
*STRESS INDUCED- Ex. Long Distance Shipping, Competing a Lot
The Patients that are Brining in the Salmonella are NOT Sick- Asymptomatic Carriers
Risk Factors/Predisposing Factors associated with _____:
Feed Associated Problems- Hay Cubes, Pellets, Beet Pulp (Expansible Feeds)
Horse Associated Problems- Dental Abnormalities, Esophageal Abnormalities
Managment Associated Problems- Competition, “Bolting”
Choke
*VERY COMMON Cause of Choke- Dental Abnormalities
Post-Operative Ileus Describe Below:
Uncomplicated Post-Op Ileus
*Post-Op Ileus is Common in the Horse- 20% of Post Op Colic Cases deveop Ileus
Uncomplicated Post-Op Ileus is expected after Abdominal Surgeries- Motility should Return within a Couple of hours after Surgery in Uncomplicated Cases. When performing Abdominal surgery, Gut Manipulation activates Mechanoreceptors which inhibits Motility
*If the Horse has Post Op Ileus more than 5 Hours after surgery that is considered ABNORMAL
Important Risk Factors for which Cause of Colitis:
Cyathostomiasis
*Season- Mainly seen in Winter
*DEWORMED within Two Weeks- Recent Deworming History
Most commonly Affected Nerves with Brainstem Disease
Facial Nerve
Vestibular Nerve
_*V, VII, and VIII_
Horses with Wobblers, will be _____ the 52% and 56% Cutoff for Intravertebral Sagittal Ratio Along the ENTIRE Cervical Spine
BELOW
*Wobblers- Narrowed Canal Throughout
What would NOT be Included in the Treatment of this Horse?
NSAIDs
DMSO
Thiamine
Vitamin E
Antiparasitic Agent
All would be Included
*Since we don’t have a Diagnosis we Treat the Treatable
Deworming Agent- Classically Fenbendazole (Gets into the CNS)
How to Diagnose Equine Herpes Myeloencephalopathy
PCR: Blood, Nasopharyngeal Swabs
Most Horses with West Nile Virus devlop Mild or Subclinical Disease. However, about 10% of the Population develops ______ when the Virus enters the CNS
Encephalomyelitis
*Horse would develop Neurologic Signs within 8 DAYS of Infection
Common Finding on Physical Exam in Horses with Equine Wobblers (Cervical Stenotic Myelopathy)
Small Focal Area of Atrophy on Neck
*Very Specifically Located and ONLY one small focal area on the neck
Test used to Make Postmortem Diagnosis of Rabies
IFA of Brain
True/False: In the Face of Liver Disease, Horses are RARELY Hypoalbuminemic
True
*Only 5-20% of Horses with Liver Disease will be Hypoalbuminemic
Clinical Signs of _____:
Profuse Bilateral Nasal Discharge
Often Feed Tinged
Retching- Gagging, Neck Stretching
Neck Extension
Anxious
Profuse Salivation
Choke
*# 1 Clinical Signs- Feed Tinged Nasal Discharge
Treatment of Spasmodic/Simple Colic
NO Feed- Until passes Substatial Amounts of Manure
Walking- Promotes Motility
Manage Pain
Nasogastric Intubation-Mineral Oil (1 Gallon)
*Manage the Pain- if we don’t then we will be Perpetuating the Decrease in Motility
Neurologic Exam- When Circling you notice he Swinging his Hind Legs out too Far (Circumduction) and its Swinging in the Air prior to Stepping Down
Is this Upper or Lower Motor Neuron Disease?
Upper Motor Neuron
*# 1 Criteria to Differentiate UMN vs. LMN: Muscle Atrophy. There is No Evidence of Muscle Atrophy in this animal therefore it is UMN
Surgical Procedure that is used in Patients with Wobblers, where the Best Result Possible is a Two Grade Improvement
Ventral Stabilization
*Will NOT get any better than a Two Grade Improvment
Ex. In a Horse with Grade IV, they will AT BEST become a Grade II
Vectors for Rabies Virus
Bats
Raccoons
Skunks
Fox
Important Risk Factor for Large Colon Volvulus/Torsion
Broodmare 1 Month Pre - 1 Month Post Partum
*Particular Group of Horses that are Predispoed to Large Colon Torsion- Most commonly in Broodmares 1 Month Post Partum that have Just Foaled. After giving Birth they have a Sudden Emptyness of their Abdomen leading to Torsion of the Large Colon
Colic in Foals Described Below:
Impaction of Normal Foal Feces
Meconium Impaction
*Meconium is Sticky, which is why it Impacts
Treatment for Otitis Media Interna
General Therapy- Acute Fracture/Trauma Therapy
Blood From the Ear (Open Fracture)- Antimicrobials
Three A’s (Clinical Signs) that we look for in Horses with Equine Protozoal Myelitis (EPM)
Asymmetric Ataxia with Atrophy
After Gastric Decompression the Horse is in Less Pain. 100 mg Xylazine is Administered. The Mare stays relatively Pain Free for 30 Min. Pain Increases Again and another 9.5 L of Reflux is Obtained. The Mare is Administered another 100 mg of Xylazine which keeps her Comfortable for longer. It is 1 Hour later that she is Refluxed again, 10L reflux Obtained. The Mare is Progressively Depressed. Analysis of the Peritoneal Fluid is Obtained by Abdominocentesis reveals Serosanguinous TP = 4.5 g/dL, WBC = 11,600
Which of the Following is the Likely Diagnosis in this Case?
Duodenitis Proximal Jejunitis (DPJ)
*Classify Colic as Small Intestinal Strangulating Lesion. Colitis is Immediately taken off the List
*This Case is absolutely and Inflammatory Strangulating Small Intestinal Disease. No Mechanical Obstruction but DPJ Cases look Strangulating because of Gut Wall Compromise
Main Manifestations of Duodenitis Proximal Jejunitis- Extensive Reflux and ileus
Etiology of Colitis Described Below:
Small Strongyles (Red Worms)
Emergence of Encysted Larvae “En Masse” leading to Acute Inflammation of Large Colon Mucosa
Cyathostomiasis
*Diagnosis- Small Strongyles (Red Worms) in Feces
Risk Factors for Development of Blister Beetle Toxicosis
Diet of Alfalfa Hay
Hay Harvested after First Cutting (Second or Later)
CUTTING and Bailing at SAME TIME- Traps Beetles in Hay
Pars Intermedia Pituitary Dysfunction is most Commonly associated with Advancing _____
Advanced Age
*Average Age of Onset- 20 Years
Incidence Increases in Horses greater than 20 years old and significant increases from “old” to “very old” horses
Clinical Presentation of Liver Disease Described Below:
Clinical Syndrome Characterized by Abnormal Mental Status that occurs Secondary to Hepatic Insufficiency
Seen in 80% of Liver Disease/Dysfunction Cases
Mechanism of Action- Decrease in Branched Chained Amino Acids and Increase in Aromatic Amino Acids
Hepatic Encephalopathy
*Imbalance of Brached Chain Amino Acids and Aromatic Amino Acids. Leads to Imbalance between Excitatory and Inhibitory Neurotransmitters
Treatment for Pars Intermedia Pituitary Dysfunction (PIPD)
Excellent Managment: Dental Care, Routine Vaccinations, Exercise, Good Quality Feed (MOST IMPORTANT)
Peroglide Mesylate (Treatment of Choice)- Decrease POMC Level
*Excellent Managment is the Most important Treatment Factor. Once you start Medically treating the Horse you will have to treat FOR LIFE so some clients would prefer just to manage these horses- Delay the amount of time the Horse will have to be on Medication via Ideal Managment
If you get to the point where you need Medical Therapy, Peroglide Mesylate is the Treatment of Choice
Important Clinical Signs associated with_____:
Hypersensitivity
Hyperesthesia- Excessive Physical Sensitivity/Pain
Muzzle Faciculations
Twitching/Muscle Tremors
Rabies
*These are Clinical signs that Heighten our Index of Suscpision for Rabies
Most Common Clinical Sign of Cystic Calculi
Hematuria AFTER Exercise
Majority of the Sand Enteropathies that you see will present as _______ Large Colon Colics/Impactions
Non-Strangulating
Gold Standard for Diagnoses of Pars Intermedia Pituitary Dysfunction (PIPD)
Overnight Dexamethasone Suppression Test
*Excellent Screening Test- Considered the Gold Standard
*DON’T want to use this Screening Test in Laminitic Horses- use Diurnal Cortisol instead
Two Signficiant Causes of Acute Renal Failure
Vasomotor- Dehydration, Endotoxemia, Septic Shock, Severe Hemorrahge
Toxic- NSAIDs, Aminoglycosides
Four Pathophysiologic Categories for Small Intestinal Strangulating Disease
True Strangulating Obstruction
Inflammatory
Thromboembolic
Progressed Non-Strangulating
*Very Unlikely to have a Non-Strangulating that Progressed
Diagnosis based on this Endoscopic Image
Bladder Stone
Treatment for Blister Beetle Toxicosis
No Specific Therapy
Supportive Care
Characteristics of which Small Intestinal True Strangulating Obstruction:
Diaphragmatic Hernia
*Empty Abdomen Feel on Palpation, Recurrent/Episodic Colic
MAIN RISK FACTOR- History of Trauma (Strong Blunt Trauma to the Abdomen)
*Possible Clinical Findings- Silent Abdomen/Absence of GI Sounds in Abdomen but can hear them in Thorax
Cecal Impactions are Mainly ______ Large Intestinal Obstructions
Non-Strangulating
True/False: Horses with Equine Metabolic Syndrome should have a NORMAL Dexamenthasone Suppression Test
True
*Horses with EMS have Normal Dex Suppression Test and Normal TSH Stimulation Tests- How to Distinguish from PIPD
Triad of Clinical Syndromes that when Appear Together should suspect Liver Disease
Coagulation
Nervous System Involvement
Cutaneous Involvement
Review Card: Normal CSF Values
Differential for Small Intestinal Strangulating Disease where Abdominocentesis is NOT as expected
Intussusception
Diaphragmatic Hernia
Epiploic Foramen Entrapment
*Dead/Compromised Segment not Contiguous with Peritoneum
*Expected Abdominocentesis in SI Strangulating Lesions- Increase in RBC, WBC, and Total Protein all to the same degree at the same time
Treatment for PRIMARY Non-Strangulating Large Colon Impaction
Fluids- Per Os (Nasogastric Intubation)
Pain Control- Alpha 2 Agonist (Xylazine)
No Feeding
Walking
*These Horses have a Large Colon Impaction and we are trying to move that Impaction- Need to Improve Motility and Soften the Content so that it is more Easily Moved (Per Os Fluids). The horse will be More Painful now because there will be more pull on the mesentary with all the Fluids administered- Horse will get more Painful before it gets better (Expect this)
Review Card: Liver Enzymes
Acute Hepatocellular Disease- High SDH
Chronic Hepatocellular Disease- High AST
C6
How to Differentiate Equine Protozoal Myelitis (EPM) vs. Verminous Encephalomyelitis
CSF Cell Type
EPM- Increase in White Cells and Increase in Proteins with Large Mononuclears
Verminous- Eosinophils
Prognosis in cases of Hyperlipemia
Mortality Rate: 40-50%
*Poor Prognosis usually correlated to RENAL DYSFUNCTION rather than Hepatic Dysfunction
Treatment for Cervical Stenotic Myelopathy (Wobblers)
Foals < 1 Year: PACE Diet
Adults- Symptomatic Therapy
*PACE: Low Carb, Low Protein
Post-Operative Ileus Describe Below:
Late Stage Post Op Ileus
*These Horses are going to have Significant Compromise to the GI Motility- Some of these horses are going to have Compromise in GI Motility up to 7 Days or More (Big Problem in Equine Patient)
*Ileus that is associated with Inflammatory Changes in the Gut Wall- Infiltration of Neutrophils/Leukocytes into the Intestinal wall resulting in Total Shut down of Motility. These horses will be Refluxing for Days
Clinical Signs of which SECONDARY Non-Strangulating Large Colon Colic:
Impacted Large Colon
Diarrhea
Weight Loss
Sand Enteropathy
*Animal may present for Fluctuating Fecal Consitencies- Diarrhea
If Urine Disocoloration from the Horse is Red (Red-Orange), what are the Likely Causes?
Hemoglobin
RBC
Rifampin- Is the Horse being Treated with Rifampin?
*Urine is going to change to Orange if the Horse is being Treated with Rifampin
List the Differences between Type I and Type II Cecal Impaction
Type I Cecal Impaction:
Primary Cecal Impaction
Dryer/Firm Impaction of Ingesta (Dehydrated Type)
Diets High in Corncobs, Kernel Corn and Coarse Hay
Type II Cecal Impaction:
Secondary Cecal Dysfunction
MOST COMMON type of Cecal Impaction
Fluid Ingesta Filled Cecum
Cecal Impaction rapidly followed by Rupture
Clinical Signs assocaited with which Etiology of Colitis:
Very HIGH FEVER (104-106) for 2-3 Days before Onset of Clinical Signs
High Incidence of Laminitis- At Onset of Fever or Concurrent with Onset of Diarrhea
Diarrhea and Colitis
Potomac Horse Fever
*High Fever, Laminitis, then Diarrhea- VERY Suspicious for Potomac Horse Fever
In Horses with West Nile Disease, Early in the Course you have Predominately _____ on CSF
Neutrophils
Endocrine Disease shown below:
“Happy, Hungry, Hairy Horses”
Pituitary Pars Intermedia Dysfunction (Pituitary Adenoma)
Treatment for Meconium Impaction
Enamas: Soapy Water
Predominant CSF Cell Type seen in Horses with Rabies
Mostly Neutrophils
*Increased WBC, Increased Protein and Predominately see Neutrophils
Pathophysiology of which Brain Stem Disease:
Petrous Temporal Fracture
Otitis Media Interna
Any Acute Neurologic Disease Less than 10 days Duration consider ______
Rabies
*Any Acute Neurologic Disease less than 10 days duration should be considered Rabies until proven otherwise
The Rectal Palpation
The Auscultation of GI Sounds
*The Rectal Palpation- On Rectal Palpation, There will be a GRITTY Feel. Gritty Feel will be within the Small Colon. The Manuer with sand is moving through
Auscultation of GI- The Horse who Colics and Presents to you for a Sand Impaction is likely going to have Reduced Motility. On Ventral Midline you will hear “Waves on the Beach” sounds
*The Gross appearance of the Feces is probably not going to be abnormal unless the animal ate a tremendous amount of sand. Normally, you are not going to see the sand in the feces
Four Pathophysiologic Categories of Colic
TRUE Obstructions- Simple or Strangulating
Thromboembolic- Ex. Strongylus Vulgaris (Classic Example)
Ulcerations- NSAID Toxicity
Inflammatory- Ex. Enteritis/Colitis (Mainly Bacterial Infections)
*Colic = Abdominal Pain
Treatment for Cystic Calculi (Urolithiasis)
Males- Ventral Midline Abdonimal Approach for Urethrostomy or Celiotomy
Females- Manually Remove from Bladder by Hand or Retrival with Instrument
Post Surgery Antiobiotics- Trimethoprim Sulfa
Foal Colic Described Below:
Colic occurs witihin FIRST 24 HOURS of Life
Signs of Colic by about 12 Hours
Meconium Impaction
How do we Diagnose Salmonellosis?
Fecal Cultures (Gold Standard)
*Need to run at least 3-5 Fecal Cultures- Going to start being Positive as Feces Firm Up
History of Cribbing in the Affected Horse- Higher Incidence of Epiploic Foramen Entrapments in Horses that are Cribbing. Horse is Cribbing with an Acutely Developed Strangulating Small Intestine = Epiploic Foramen Entrapment
Reduced Number of Palpable Loops of Small Intestine on Rectal- ONLY for Epiploic Forament Entrapment. Epiploic Foramen is on the Dorsum and Cranial by the Liver. T_he Small Intestine will be Pulled Cranially leading to Few Palpable Loops_
Presence of Serosanguinous Abdominocentesis- Seen in BOTH Strangulating Lipoma and Epiploic Foramen Entrapment
Older Horses- More Commonly have Strangulating Lipomas. Epiploic Foramen Entrapment can be seen in any age horse, not distinct to Older Horses
True/False: EEE, WEE, and VEE are ALL Reportable Diseases
True
Treatment for Clostridial Colitis
Metronidazole
Supportive Treatment
In Horses with a PRIMARY Non-Strangulating Large Intestinal Impaction, what would you Expect on Abdominocentesis?
Should Be Normal (Non-Strangulating)
*If the Impaction is severe then you may start seeing changes in the Abdominocentesis
Large Colon Displacement Mainly Presents as ______ Secondary Large Intestinal Disease
Non-Strangulating
Treatment for Duodenitis Proximal Jejunitis (DPJ)
Gastric Decompression- Every 1-2 Hours
Fluid Administration
*Mainstay of Therapy is the Fluid Therapy and Decompression
Most Common Finding on Blood Tests in Horses with Equine Metabolic Syndrome
Hyperinsulinemia (> 30-40ul/mL Fasted)
*The Majority of Horses with Equine Metabolic Syndrome will be Hyperinsuliniemic
Gold Standard for Diagnosing Otitis Media Interna
Radiography
*Straight DV/VD Shots
In Horses, If Fractional Excretion of Sodium is >_____% , the Function of Renal Tubular Cells are Inadequate
> 1%
*If Fractional Excretion of Sodium is > 1%, the Horse is Eliminating too much Sodium = Tubular Dysfunction
Review Card: Strangulating vs. Non Strangulating Colic
Non Strangulating Abdominocentesis:
- No Change Initially
- Increase in TP
- Increase in WBC
- Increase in RBC
Strangulating Abdominocentesis:
Increase in TP, WBC, and RBC at the Same Time to the Same Degree
For Which NON-Strangulating Small Intestinal Lesions can you palpate the LESION ITSELF on Rectal Palpation
Ileal Impaction
*Might be able to specifically palpate the lesion itself on Rectal Palpation- Only can Palpate Early in the Disease
Clinical Signs of which Etiology of Colitis:
Colic
Development of Diarrhea- Malodorous, Profuse Watery
Dependent on Syndrome
Salmonellosis
*Classic Manifestation- Depression, Fever, Fluid Sequestration, Colic and Diarrhea (Particular Odor)
Main Risk Factor for the Development of Potomac Horse Fever
Stagnant Fresh Water Pools (Ponds)
*NO Horse to Horse Transmission
Foal Colic Described Below:
Clinical Signs typically between 24-72 Hours of Age
HYPERKALEMIA
Hyponatremia, Hypochloremia
Ruptured Bladder
Physical Exam
Neurologic Exam
CSF Cytology
LS CSF Tap
Cervical Spine Radiography
*We do NOT do AO CSF Tap because we have spinal disease and therefore we need to be Downstream from the Lesion, which means you are running Lumbosacral Taps
*We will run a CSF Cytology and LS CSF Tap on all of these Horse- Routine Evaluation
The only thing you can Radiograph is an Equine patient is the Cervical Spine
Nasogastric Intubation: Malodorous Fluid Volume 15L, pH 7.6
Heart Rate: 110 bpm
RR: 48/min
Temp = 99.2 F
MM Congested with CRT of 3.5 sec
What is the Top Differential in this Case?
NON-Strangulating Ascarid Impaction
*Generally seen in Young Horses (6 Months-1 Year) with Recent Deworming with Effective Medication- All the Ascarids get killed at the Same Time and they plug up the Small Intestine
*Why do these Horses look Strangulating? Dead Parasites generally cause Immense amount of Reaction and Necrosis
Horses with West Nile Encephalitis that Develop Ataxia will commonly Display _____ Limb Weakness
Hind
Main Way to Diagnose West Nile Virus
Capture ELISA WNV (IgM)
*ELISA will Detect within 8-10 Days
*You will NOT see a Positive Result on this Test because of Vaccinates- Good Test to Determine if you are dealing with a Vaccination Serology Titer or a True Infection
Saggital Ratio associated with C4-C6 as well as C7
C4-C6 = 52%
C7 = 56%
*C3, C4, C5, and C6 will be 52% as your Low Cutoff
C7 will be 56% as your Low Cutoff
*If you have a Number below that that means there is a Narrowing at that Location.
True/False: West Nile Virus is a REPORTABLE Disease
True
Protein Pattern seen on Biochemistry in Patients with Acute Colitis
Hypoproteinemia
*Huge surface area of Damaged Mucosa- These Patients loose Protein like crazy- HYPOPROTEINEMIA
For which Equine Viral Encephalitides does the Horse act as a Multiplier (Amplifier)?
VEE (Venazualen Equine Encephalitis)
VEE- Circulating Virus levels High enough that can act as Ampifier of Disease
*The Horse is NOT a Multiplier to WEE and EEE- Do NOT Transmit Disease
In Cases of West Nile Virus, Prognosis can be Related to Temperature in Febrile Horses. Horses with a Temperature Greater than ______ usually did NOT survive
>103
Best way to Accurately assess the Thyroid in the Horse
Thyroid Response Function (TSH Stimulation Test)
True/False: Spasmodic/Simple Colic Cases are typically Associated with Copious amounts of Reflux
False
*In Patients with Spasmodic/Simple Colic we DO NOT expect Reflux since the Small Intestine is not Involved
When Referring Cases of Colic, ALWAYS Refer them with a ______
Nasogastric Tube
*Regardless of whether the Patient has Reflux you should ALWAYS refer them with a NG Tube. The Patient could start Refluxing during the time that they are being referred- Transport TIme. In that time if the patient doesn’t have a NG Tube we could loose them to a Gastric Rupture
*Make sure that you send a Record of everything that you have administered
How do you Diagnose Sand Enteropathy?
Rectal Exam- Gritty Feeling Impaction
Auscultation- If you are Hearing Sand on the Ausculation of Ventral Abdomen then there is a Clinically Significant Quantity of Sand. “Waves on the Beach”
Sedimentation of Feces-Use Glove to bring Fecal Material out of Colon on Rectal Palpation. Pull Sleeve Inside out. Fill Sleeve with Water. All the sand wil sediment out into the Fingers of the Glove/Sleeve
Differential for Small Intestinal Strangulating Disease where you Palpate a Few Tight Sausage Bandless Loops (Only 3-4)
Diaphragmatic Hernia
Epiploic Foramen Entrapment
Gastrosplenic Ligament Entrapment
*Very Proximal Lesion or Hiding Somewhere/Out of Reach
Most Common Type of Simple Obstruction Colics
Spasmodic Colic
*Functional Obstruction
Based on what Criteria or Parameters do we Recommend Surgical Correction/Exploration in Cases of Colic
Determination of Strangulating Colic
*If it Looks like Strangulating Disease- Generally what we are using to make the decision of Surgical Intervention
A. The Horse would show Signficant Weakness
*Equine Herpes Myeloencephalopathy is characterized by ATAXIA and PARESIS (WEAKNESS)
*Two Differentials for Significant Weakness- Herpes and Botulism
At Risk Population for which Endocrine Disease:
Ponies
Miniature Horses
Miniature Donkeys
Hyperlipemia
For CSF Analysis where do we take the Sample?
Closest to the Site of the Lesion and DOWNSTREAM of CSF Flow
Ex. If you have a Horse with a C1 Lesion, where are you taking your Sample for CSF Analysis? Lumbosacral Space
Neurological Disease Described Below:
Acute to Peracute Onset
Rapid Progressive Development of Ataxia for first 24-36 Hours Followed by Stabilization of Deficits and occasionally Signs of Improvement
Characterized by ATAXIA and PARESIS (Weakness)
Urine Dribbling commonly Seen
Occasionally Lingual Paresis (Tongue Sticking Out)
Equine Herpes Virus
*WEAKNESS
Where do we most typically see Uroliths in the Equine Patient?
Bladder (Cystic Calculi)
How to Diagnose Potomac Horse Fever
PCR (Most Common)
Isolation/Culture Blood or Feces (Ideal but Uncommon)
#1 Complication in Patients with Choke (Esophageal Obstruction)
Aspiration Pneumonia
How to make Definitive Diagnosis of Meconium Impaction
Radiographs
*Visualize Impacted Material and Location
Neurologic Disease that produces a POSITIVE CSF Western Blot Analysis
Equine Protozoal Myelitis (EPM)
*If the Western Blot is Negative, then Most likely not EPM
*Positive CSF Westernblot with Increased IgG Index = EPM
Urinary Condition Described Below:
Problem in Males (Stallions and Geldings)
Pelvic Urethral Lesions and Tears at Ischial Arch
Blood at END of Urination and Possible Blood Clots at Beginning of Urination
Urethritis
When Treating Patients with Equine Metabolic Syndrome, Feed Hay at _____% of Ideal BWT
1-1.5%
*Want to feed at NO LESS than 0.75% of Normal BWT
Four Criteria used to Determine Surgery/Referral in Cases of Colic
PAIN
Looks Strangulating
Definitive Rectal Abnormalities
Large Amount of Reflux where Pains Persist despite Gastric Decompression
NG Intubation- Little/No Reflux
Severely Distended Abdomen- Obvious External Flank Distention
Rectal Examination- Only get into Rectum to your Mid-Forearm, very Tight Distended Balloon, Tight Bands
1 HOUR LATER: HR = 90, T = 99F, RR = 40, CRT = 3 Seconds
Mucous Membranes- Toxic Line and Congested
What is the Likely Diagnosis in this Case?
Large Colon Volvulus/Torsion
*Strangulating Large Intestine
*Horses with Large Colon Volvulus- VERY Painful, VERY Rapidly and they will have a lag in term of Cardiovascular Compromise
*Inconsistency- Severly Painful Animal with Minimal/No Cardiovascular Compromise. Why don’t they Match? Most Likely the Colic was Very Early and the Cardiovascular Compromise had yet to Manifest. 1 Hour later, the Cardiovascular Compromise has Manifested
Treatment for Hyperlipemia
Get the Animal to EAT (Most Important)- Various Feeds
Insulin- Blocks Mobilization of Adipose Tissue
Treatment of Late Stage Post-op Ileus
Address Primary Problem- Relief of Pain/Treat Shock ect.
Motility Enhancers- Lidocaine
*With the Exception of Lidocaine, motility enhancers in the equine patient are considered the second level of intervention
Three Main Infectious Causes of Duodenitis Proximal Jejunitis (DPJ)
Salmonella
C. Perfringens
C. Difficile (Most Common)
*Clostridium Difficile accounts for over 50% of DPJ Cases
Symmetric
Hindlimbs > Forelimbs (Hindlimbs are More Effected)
*Symmetrically affected animal with the Hindlimbs more effected than the Forelimbs- The MOST COMMON Presentation for Spinal Ataxia in the Equine Patient
*Symmetry refers to Right vs. Left Limbs
Common Clinical Signs seen which which Form of Equine Encephalitis:
Head Pressing
Circling,Blindness
Hyperexcitability
Progressive Ataxia
Eastern Equine Encephalitis (EEE)
*VEE has Similar Clinical Signs, except commonly have GI Signs as well- Colic, Diarrhea, Consitpation
Etiology of Colitis Described Below:
EXTREMELY PAINFUL
Toxin Component- Cantharidin (Extremely Caustic)
Beetles Found in Alfalfa Hay
Blister Beetle Toxicosis
*Cantharidin- Erosions and Ulcers throughout the GI Tract
Four Liver Enzymes that are used to Evaluate Liver Function
SDH- Liver Specific
ALK PHOS- Not Liver Specific
AST- Not Liver Specific
GGT- Fairly Liver Specific
On Rectal Palpation, if Kidney is Smaller, Firmer and Non-Painful it is ______ Disease
Chronic
True/False: We do NOT make a Recommendation for Surgery based on Abdominocentesis Alone or Rectal Palpation Alone in Cases of Colic
True
Main Indication for Use of Antibiotics (Antimicrobial Therapy) in Cases of Acute Colitis
Horses with Low WBC Counts
*Immunocompromised Horses
Four Pathophysiologies leading to Small Intestinal Strangulating True Obstructions
Volvulus
Strangulating Lipoma
Herniation
Intussusception
*Bandless, Tubular/Sausage like Structure Tightly Distended on Rectal Palpation- Small Intestine
Strangulating Lipoma- Significant Cause of a Strangulaing Lesion in the Small Intestine
Which Small Intestinal Strangulating Disease may Progress from Chronic Non-Strangulating to Strangulating?
Intussusception
Where does the Majority of the Pain come from in a Duodenitis Proximal Jejunitis (Anterior Enteritis)
Stomach Distension
Potential Complications that can be seen in Cases of Hyperlipemia due to Fatty Infiltration
Liver Failure/Disease
Kidney Failure/Disease
*Deposition of Lipids into the Liver and Kidney
*Renal Fatty Infiltration is associated with a Poor Prognosis in the Horse
Typical Clinical Signs of which Endocrine Disease:
PU/PD
Coat Abnormalities (85%)- DELAYED SHEDDING (Hirsutism)
Type II Diabetes Mellitus (38%)
REDISTRIBUTION of Fat- Accumulation in Neck (Cresty Neck)
Chronic/Recurrent Low Grade Laminitis (33-52%)
Muscle Wasting
Pars Intermedia Pituitary Dysfunction (PIPD)
*PU/PD- Caused by Destruction of Pars Nervosa
*Cases of Chronic Recurrent Low Grade Laminitis- Top of your List should be PIPD
All of the Above can cause Colitis in the Horse
Risk Factors for _____:
Regional: California (CA)
Undigestible Materials- Sand, Stones, Rubber Fencing, Bailing Twine
Feeding Alfalfa Hay
Breed: Arabian
Enterolithiasis
(Secondary Non Strangulating Large Colon Impaction)
*Enteroliths are Mineral Concretions made in the Large Colon
Tend to see Enterolithiasis in Horses that have Lived in California for some time
Three Viruses that ALL Horses should be Vaccinated against
EEE
WEE
West Nile Virus
Tetanus
True/False: Vast Majority of Colics will be Non-Strangulating Simple Obstructions
True
*70-80% of Colics will be Simple/Non Strangulating that will resolve with Medical Therapy
Triad of Histologic Findings that are Diagnostic of Pyrrolizidine Alkaloid Toxicity
Fibrosis
Bile Duct Proliferation
Megalocytosis
*Pyrrolizidine Alkaloid Toxicity- Chronic Progresseive Intoxication resulting from Consumption of Plants containing Pyrrolizidine Alkaloids
Potential Clinical Signs in Horses with _____:
Colic- Common
Frequent Yawning
Behavior Changes- Aggression/ Unruly, Depression, Incoordination
Aimless Wandering, Head Pressing
Liver Disease
*Behavoir Changes secondary to Hepatic Encephalopathy
*Ascites in the Horse is Very RARE
Characteristics of which Small Intestinal True Strangulating Obstruction:
Risk Factors:
Parasitic (Esp. Tapeworms)
Rapid Changes in Fecal Consistency (Normal Feces to Acute Diarrheas and vice versa)
Intussusception
*Intussusception- Longitudinal Displacement of one Section of Bowel into another (Jejuno-Jejunal, Jejuno-Ileal, Ileocecal)
In General, the Secondary Non-Strangulating Large Colon Impactions don’t show anything different than Primary Non-Strangulating Large Colon Impactions
*If there is anything, it would be the PROGRESSION. Secondary Non-Strangulating Large Colon Impactions are going to progress to Strangulating Presentations in most cases
*Enterolith- Stone in the Intestinal Tract
Clinical SIgns associated with which Liver Disease:
Abdominal Pain (Colic)
Febrile (Fever)
Icterus
Cholelithiasis
*Colic Horse that is Febrile with Icterus = Cholelithiasis
Cholelithiasis- Gall Stones in Bile Ducts
CSF: Protein 50 mg/dL; WBC 5, diff. WNL
What Differentials can we REMOVE from the List?
Wobblers
*What Factor Dicated your Choice to Remove this Differential? Analysis of the Plaine Standing Cervical Films
*C3, C4, C5, and C6 will be 52% as your Low Cutoff
C7 will be 56% as your Low Cutoff
*If you have a Number below that that means there is a Narrowing at that Location. In a Wobbler we normally see a Narrow Canal Throughout
Prevention Protocol for West Nile Virus
VACCINATION
Vector Control (Mosquito Control)
Clinical Presentation of Liver Disease Described Below:
Abnormal Reactivity of Skin to Light in Response to Photosensitizing Agents
Typically only WHITE Areas Affected- Eyrthema, Edematous Infiltration, Full Thickness Damage, Skin Becomes Dry
Photosensitization
Common CSF Changes in Horses with Equine Encephalitis
Increase in Lymphocytes/Plasma Cells
*Common CSF Findings in Horses with EEE,WEE, and VEE
True/False: Thromboembolisms leading to Colic will Typically present as Strangulating Disease
True
Characteristics of which Small Intestinal True Strangulating Obstruction:
Twist on the Long Axis of the Mesentery at least 180 Degrees
Any Age Horse/Any Signalment
Volvulus
West Nile Viremia is Short Duration and Low Magnitude, so Horse is ____ to be an Amplifier or WNF
Unlikely
*Horses are Not Likely to be an Amplifier of WNV, however they can Be Sentiles for WNV to indicate the Viral Load in the Environment
Preferred Screening Test for Pars Intermedia Pituitary Dysfunction (PIPD) in an animal that has Laminitis
Diurnal Cortisol
*Preferred Procedure especially if Laminitic
*Affected Horses have LESS than 30% Variation between Two Samples
Due to Contagious/Infectious Nature of the Disease, if you believe that a Horse has ______, you should be Isolating and Quarantining that Facility
Equine Herpes Myeloencephalopathy
Most common Problem with NSAID Induced Nephrotoxicity
Renal Crest Necrosis
*NSAID Toxicity = Renal Crest Necrosis in Equines
General Treatment of Liver Disease
Correct Abormal Behavoir- Xylazine, Correct Acid-Base Distrubance, Supplment Branched Chain Amino Acids
Decrease Hepatic Workload- Constant 5-20% Dextrose Drip
Dietary Managment- Low Protein Diet (Beet Pulp and Cracked Corn)
In Horses with Basilar Fractures, the Odds of Death are 18 times more Likely if Recumbancy persists Greater than ___ Hours after Initial Evaluaation
4
*Prognosis for Head Trauma cases in the Horse- Gaurded to Grave
Clinical Features of Which Etiology of Colitis:
Synchronous Diaphragmatic Flutter (SDF)
HYPOCALCEMIA
Hypokalemia
Metabolic Acidosis
Blister Beetle Toxicosis
Description of which Endocrine Disease in Horses:
Increased Adiposity Generally (Obesity)
Insulin Resistance
Predisposition to Laminitis
Equine Metabolic Syndrome
Etiology of Colitis Described below:
Mostly Indistinguishable from Salmonella
Agent: Neorickettsia Risticii
Life Cycle: Flukes, Fresh Water Snails, Aquatic Insects Consumed by Birds and Bats
Potomac Horse Fever
How to Diagnose Urolithiasis (Cystic Calculi) in Horses)
Confirmed by Rectal Palpation
Confirmed by Rectal Ultrasound- Leave Bladder Full
Confirmed by Endoscopy (Preferred)
Ideal way to Monitor Nephrotoxicity with Aminoglycosides
Trough and Peak Levels
*Monitor Plasma Trough Levels of Aminoglycosides
*Most Clinics do NOT have the ability to Monitor Trough Levels, therefore we just Monitor for Casts in Urine
Treatment for Choke (Esophageal Obstructions)
1. HEAVY Sedation Initially- Xylazine (Large Dose)
2. NG Intubation and Flush- Plain Water
3. If Step 1 and 2 did NOT Resolve Issue- Add Carbocaine
4. If Step 1,2, and 3 did NOT work- Use Intratracheal Tube in Esophagus (Cuff Filled) to Increase Pressure on Flush
Surgical Procedures (Last Resort)- Esophagotomy
*Once you have Diagnosed Choke, First step should be to Sedate with Xylazine. Wait 15-20 Minutes and Nasogastric Intubation and Flush with Plain Water and the choke will likely Resolve on its own
Treatment for Enterolithiasis
Surgical Removal (Midline Celiotomy)
*Tend to Obstruct most Notably at the Transverse Colon
Impairment of Normal Propulsive Bowel Motility
Ileus
*Ex. Drugs- Atropine is VERY likely to Result in Ileus in Horses
Most Consistent and Characteristic Clinical Sign of Duodenitis Proximal Jejunitis (DPJ)
Pain Subsides or Abates after NG Decompression, but Horse will remain Very Depressed (Response to Refluxing)
Neurological Disease Described Below:
Many Breeds
Dietary Vitamin E Deficiency in Genetically Predisposed Animals
Clinical Signs start at 6 Months of Age
UMN Disease
HYPOREFLEXIA OF Cutaneous Trunci
Symmetric Ataxia, Weakness, Spasticity of all 4 Limbs (Typically Worse Hindlimbs)
Equine Degenerative Myeloencephalopathy (EDM)
*HYPOREFLEXIA of Cutaneous Trunci- Run a Pen down the Spine and the Cutaneous Trunci Muscle does not Respond
*Degenerative Disease associated with Vitamin E Deficiency- These Horses have a Lower Vitamin E Status
Secondary Hyperlipemia is most common, namely the presence of any concurrent Disease or Physiologic State which will put Increased demands when associated with Decreased Intake, most commonly _______
Pregnancy
*Lactation and Pregnangy in a Pony, Miniature Horse, or Miniature Donkey is an Associated Risk Factor for developing Hyperlipemia
If Urine Disocoloration from the Horse is Dark Red-Brown, what are the Likely Causes?
Myoglobin (Typing Up Disease)
Common Clinical Signs seen with Which Virus:
West Nile Virus
*If they have Ataxia they are most likely going to be affected in their Hind Limbs
*Most common Causes of Muscle Tremors- Botulism, Rabies and WNV
Review Card: Neurology
In Horses with a PRIMARY Non-Strangulating Large Intestinal Impaction, what would you Expect on Rectal Palpation?
Large Colon will Displace Caudally and towards Right
Ability to Depress Contents (Indentable)- Firmness of Impaction
*The Pelvic Flecture is in the Left Ventral Quadrant. The More filled it is, the more it is going to come across the Pelvic Inlet towards the Right Side and the More Easily Palpable it will be
Three Phases of Acute Renal Failure
Induction- Loss of Concentrating Ability (60% Damage)
Maintenance- Significant Azotemia with 65-75% Damage
Recovery- Return to Normal SG, Resolving Azotemia
*You will Likely have Resolution in Acute Renal Failure Cases in Equines because most injury will NOT be affecting Basement Tubular Cells
How do we Most Commonly Monitor for Nephrotoxicity with Aminoglycosides?
Casts in Urine
Acute Peripheral Vestibular Disease from Temporohyoid Osteoarthropathy
Otitis Media/Interna
*In Horses Otitis is commonly Subclinical that is normally a Chronic Inflammatory Process. They get DJD in the Temporohyoid area and they are basically fusing the joint. When forces are Repercussed through the Area it results in a Fracture
*Mainly what you are seeing in these Horses is a Petrous Temporal Fracture leading to Injury of Cranial Nerves VIII and VII
Neurologic Exam- When Circling you notice he Swinging his Hind Legs out too Far (Circumduction) and its Swinging in the Air prior to Stepping Down
What Type of Disease are you Dealing with?
Focal Disease
*You can explain all the Abnormalities in this animal with a Lesion in One Location- Focal Disease
Treatment for Equine Metabolic Syndrome
EXERCISE (Most Important)
Diet Changes- Eliminate Grains, Reduce Food Intake
*Exercise is a Huge Component to getting these Horses back to a normal Endocrine Status
The Cervical Spine Radiographs
The Intravertebral Saggital Ratios
*Wobblers = Cervical Stenotic Myelopathy
Three Causes of STRANGULATING Large Colon Disease
True Strangulating Obstruction- Large Colon Torsion/Volvulus
Colitis (Inflammatory)
Thromboembolic
Idiopathic Acue Hepatic Disease (IAHD), also known as “Theilers Disease”, is mainly associated with the use of any Equine Serum Product, most frequently _______
Tetanus Antitoxin (TAT)
Three most common Differentials in Terms of Prevalence
EPM (Equine Protozoal Myelitis)
EHV (Equine Herpes Myeloencephalopathy)
WNV (West Nile Virus)
For Which Equine Viral Encephalitides do we Vaccinate?
EEE
WEE
*Trivalent Vaccine Increases Specific Antibody to all Viruses
Clinical Presenation of Liver Disease Described Below:
Yellow Discoloration to Mucous Membranes associated with the Retention of Bilirubin
Seen Mostly in ACUTE Liver Disease
Frequently associated with Fasting Hyperbilirubinemia (Anorexia)
Icterus
*Normal Bilirubin Value in Horse: 0.5-2.0
*In the Face of being Signficantly off feed (Fasting) the Horse is going to Develop and Indirect (Unconjugated) Hyperbilirubinemia - There is NO Liver Dysfunction or Disease associated with this
*We can have Horses that have Diseases of other Natures (Ex. Fasting) unrelated to any Liver Disease that will lead to Elevated Unconjugated Bilirubin
Treatment for Potomac Horse Fever
Oxytetracycline
Supportive Therapy
Treatment for Cecal Impactions
Medically:
Nasogastric Intubation with DSS (Dioxal Sodium Succinate)
Surgically:
Cecal Impaction Type II- Generally Recommend Surgery
Findings on Transrectal Palpation in a Patient with Left Dorsal Displacement (LDD) of the Large Colon
Bands running in a Verticle Direction on the Left Side of the Abdomen
Feel Colon in Space of the Nephrosplenic Ligament
Find Colon in Dorsal Left Abdomen and Cannot Displace it
Most Reliable Prognosticator in Cases of Spasmodic/Simple Colic
Heart Rate
How we assess Narrowing in the Spinal Canal
Intravertebral Saggital Ratio
True/False: Ulcerations leading to Colic will Typically present as Strangulating Disease
False
*Typically, Ulcerations are going to present as NON-Strangulating Disease
Treatment for Hypothyroidism in Horses
Thyroxine Supplementation
Pathogenesis of which Neurologic Disease:
“OUTBREAKS” Of Acute Neurologic Disease (Ex. 30-40 Horses Affected at one Time)
Equine Herpes Myeloencephalopathy
*Ex. 30-40 Horses on a Farm may be Affected at one time
Review Card: Neurology
We Recommend ____ Vaccinations for Rabies Virus
Yearly
*Vaccination Recommended Annually
B.
Normal Appearance of Horse Urine- Cloudy/Turbid due to Mucus and Crytals (Calcium Carbonate)
*Horse urine is usually NEVER Clear- Too Dilute
Treatment for Rabies
No Treatment- Euthanize
What would be the Top Differential in this Case?
Mesenteric Rent
*This Horse just had Abdominal Surgery- Most likely the Reason why the Abdominocentesis looks like that. Abdominocentesis probably has nothing to do with the Strangulating Small Intestinal Disease
Mesenteric Rent is most Commonly Iatrogenic and most commonly occuring in Young Horses. Young Horses have much more Friable Mesentary, so while you are running the SI during surgery, you can create Tears in the Mesentary. You put a Tear in the Mesentary and then a piece of Small Intestine finds its way in
Name the Common Motility Enhancers used to Treat Ileus
Proximal GIT- Lidocaine, Metaclopramide
Large Intestine- Neostigmine, Cisapride
General- Erythromycin, Lidocaine
*Neostigmine- Inhibits Small Intestinal Motility
By far and away the Lidocaine is the most commonly used!
Most Common Location of Choke
Thoracic Inlet
_____ Causes Simply an Esophageal Obstruction, where Repercussion to the Trachea from Local Compression is Extremely Rare
Choke
*Respiratory Complications are Rare
Two Clinical Signs typical of Foals with Colic that Differ from Adults
Straining
Dorsal Recumbancy
How can we Diagnose Cholelithiasis
Ultrasonography- Distended Biliary Tracts, Increase Echogenicity Focal Circular Patches
Which of the Following is the Most Likely Diagnosis?
Strangulating Lipoma
*Main Reason to Suspect Strangulating Lipoma- Age of the Horse (17 years Old). Strangulating Lipomas occur most typically in Older Horses. The older the Horse gets, the more likely that a Strangulating Lesion is going to be a Strangulating Lipoma
*In Horses over 20 years old, Strangulating Lipomas account for 50% of Strangulating Lesions in Small intestinal Disease
*Duodenitis Proximal Jejunitis- Inflammatory Disease. This animal has none of the Classic Characteristics that we would expect to see in an Inflammatory Disease
Treatment for Urethritis
Urethrostomy
*Creating “Urethral Rest”
*Repeated Antimicrobial Protocols and Anti-Inflammatory Use often leads to Resolution of Clinical Signs only to have them recur when Treatment ceases
Chemistry Exam Described Below:
Good Screen of Liver Failure: Sensitive Indicator
Increases within 24-48 Hours of Liver Disease
Serum Bile Acids
Only Factor which is ever used Alone to Determine Referral for Surgery in Cases of Colic
PAIN
*The one and only Criteria that you may ever use alone is Pain that is Uncontrollable and Unresponsive to Therapy
Risk Factor leading to Type II Cecal Impaction
Very PAINFUL Chronic Musculoskeletal Problem
*Typical Scenario with Type II Cecal Impaction- Horse comes into Practice for Musculoskeletal Problem that is going to be corrected surgically. Horse goes to Surgery. 24-36 Hours Following Surgery the Horse is Acutely Colicky with Cecal Impaction
*Virtually all of these Horses have a Rupture at the Base of the Cecum that is associated with a Weakness in the Cecum wall
A BUN below _____ Indicates Liver Dysfunction
*BUN
Pathophysiology of which Endocrine Disease:
Secretion of POMC from Melanotropes under Inhibitory Regulation by Dopamine
Loss of Dopaminergic Control in Pars Intermedia
Large amounts of MSH and Beta-Endorphins Produced
Pituitary Pars Intermedia Dysfunction (Pituitary Adenoma)
*Destruction of Dopaminergic Function and these cells are then Overproducing MSH and Beta Endorphins
*Inhibition of the Inhibitory Effects of Dopamine
Etiology of Colitis Described Below:
HEMORRHAGIC Diarrhea
Clostridial Colitis (Clostridium Perfringens)
*Major Cause of Colitis in the Horse- Horses with Clostridial Infections do not do well
*Hemorrhagic Diarrhea in Adult Horse (Rare)- Top Differential is Clostridial Colitis
Meconium Impactions and Ruptured Bladder in Foals present as _____ Colics
Non-Strangulating
Therapy in Confirmed Equine Herpes Virus
Corticosteroids
Antiviral Agents: Acyclovir
Treatment for Equine Protozoal Myelitis (EPM)
Pyrimethamine Sulfa
*Specific Treatment for EPM
Most Common NSAID Associated with Nephrotoxicity
Phenylbutazone
Pathophysiology of which Neurological Disease:
Chronic Spinal Ataxia (Undiagnosed Lameness)
Multifocal Disease
Obscured Lameness Progressing to Ataxia, Spasticity and Incoordination
Equine Protozoal Myelitis (EPM)
*Frequent Complaint- Obscure Lameness Progressing to Ataxia, Spasticity and Incoordination
Endoscopy can be used to Diagnose Otitis Media Interna. You scope the _____ and the Stylohyoid Bone will be Enlarged and Remodeled
Gutteral Pouch
*If the Stylohyoid Bone is Remodeled/Enlarged in Conjunction with a Cranial Nerve VIII associated Vestibular Disease = Otitis Media Interna
Brainstem Diseases are Mainly indicated by the Presence of ____ Signs
Cranial Nerve
*Cranial Nerve Signs- Easiest way to Localize Lesion to the Brainstem
Dietary Managment in Horses with Liver Disease
Frequent Small Feedings
Beet Pulp and Cracked Corn mixed with Molasses
Vitamin B1, Folic Acid and Vitamin K1 should be Supplemented
Which Two Equine Viral Encephalitides Cause the Highest Mortality
EEE (Eastern Equin Encephalitis)
VEE (Venezualen Equine Encephalitis)
*Both have High Mortality Ranges
Findings on Ultrasound in Patients with Left Dorsal Displacement of the Large Colon
Cannot Visualize Left Kidney
See Intestine between Spleen and Kidney
Treatment for Basilar Fractures
Prevent/Diminish Edema- Glucocorticoids (Dexamethasone)
DMSO- Rapidly Reduces Edema in CNS
Pathophysiology of which Neurologic Disease:
Viral Endotheliotropism and Results in Vasculitis and Thrombosis in the Central Nervous System with Resultant Ischemia and Myelomalacia
Equine Herpes Virus
What Species is the Principle Natural Host for West Nile Encephalitis and what is the Vector?
Birds- Principle Natural Host
Mosquitoes- Vector
*Transmitted by Mosquitoes feeding on Viremic Birds
WBC Pattern that is Commonly Found on Biochemistry in Patients with Acute Colitis
Neutropenic Leukopenia
*The Patients has an acute Severe Colitis- These Patients also have SEVERE Endotoxemia and by virtue of the Endotoxemia they are going to have a drop in their WBC count
*Vast Majority of Acute Severe Colitis Cases are likely going to present with a Neutropenic Leukopenia
Main Risk Factor for Ileal Impactions
Bermuda Grass Hay
*Bermuda Grass Hay turns into very Fine Fiber Material
Treatment for Sand Enteropathy/Impaction
Medically- Large Volumes of Psyllium and Mineral Oil via Nasogastric Intubation
Surgery-I_f Larger Pebbles, Stones, Gravel_
Production of > 20-25 Liters of Urine that may be Dilute
Polyuria
*May be due to Increased Water Intake and Electrolyte Intake- Overhydration, Excess Electrolytes
Define Premature and Dsymature Foals
Premature- Gestation Less than 320 Days
Dysmature- Gestation Over 320 Days with Clinical Signs of Prematurity
*Normal Gestation- 335-340
A. TB = 6.0 mg/dL, Direct = 0.2 mg/dL, Indirect = 5.8 mg/dL
*Fasting Hyperbilirubinemia- Our Direct Bilirubin should be within Normal Range, our Total Bilirubin should be High and our Indirect Bilirubin should be Elevated
Cystic Calculi are Typically _____in Composition
Calcium Carbonate
Description of _____ Colic:
Mild-Moderate
Little to No Abnormal Findings- NG, Rectal
Feces- Dry, Mucus on Surface
GI Motility- Hypermotility with Gassy and Fluidy Sounds
Spasmodic/Simple Colic
*Motility, Especially in Cases of Spasmodic Colic, is likely going to be Hypermotile
Less than ___% of Horses with Hypoalbuminemia have Liver Disease
*If you see Hypoalbuminemia in Horses, Usually NOT Liver Disease
Hypoalbuminemia is NOT Related to Liver Disease in the Equine Patient
Most Likely Cause of Hypoalbuminemia in Equines? GI Tract
Which Two Equine Viral Encephalitides are used as Sentinels for the Human Population
WEE (Western Equine Encephalitis)
EEE (Eastern Equine Encephalitis)
*As Incidence begins to rise in the horse we start worry about Incidence Increasing in the Human Population
Endocrine Disease Described below:
Severe Imbalance between Energy Intake and Demand in a specific population of Susceptible animals. Increase Demand due to Stress of disease associated with Decreased Intake (Consumption) results in Mobilization of Peripheral Adipose Tissue
Hyperlipemia
Treatment for Hepatic Encephalopathy
Supplement with Branch-Chained Amino Acids- Ex. Beet Pulp
Low Protein Diet
Most Helpful Diagnostic Procedure for Left Dorsal Displacement (LDD) of the Large Colon
Rectal Exam
Risk Factor leading to Cystic Calculi
High Alfalfa Intake
Neurologic Exam- When Circling you notice he Swinging his Hind Legs out too Far (Circumduction) and its Swinging in the Air prior to Stepping Down
Characterize the Neurologic Disease
Symmetric Tetraparesis and Ataxia with Hindlimb > Forelimbs
Circumduction- When Circuling the Animal you see him Circumduct his Hind Limbs- Grade 1 Spinal Ataxia
Specific Syndrome of Horses Described Below:
Horses 8-18 Years Old
Anormal Fat Deposition: Neck (Cresty Neck)
Overweight to Obese
Recurrent Low Grade Laminitis
Cresty Necked Horse
Which Virus is an Incidental Infection in Both Horses and Humans?
West Nile Virus (Flavivirus)
True/False: Spasmodic/Simple Obstructions are most commonly Large Intestinal Lesions
True
*Small Intestinal Lesions are usually Strangulating, therefore in patients with Simple Obstructions its probably NOT going to be involving the Small Intestine
*In Patients with Spasmodic/Simple Colic we DO NOT expect Reflux since the Small Intestine is not Involved
Cresty Neck Score Greater than ____ is common in Equine Metabolic Syndrome Affected Animals
3
Head Trauma in the Horse Described Below:
Occurs when Horse Flips Over Backwards and Impacts the Poll
Commonly Training to Lead Accidents (Trying to Get Young Horse to Learn how to Walk on Lead Rope)
Basilar Fractures
*Because of the Thickness of the Skull in that location, the Forces are reprocussed through the Skull and blow out at the point of least resistance- Basilar Bones
*Leads to Trauma at the base of the Brain
