Gastric disease

Question 1

What are the 2 halves of the equine stomach

Answer 1

top half: squamous/non-glandular
bottom half: glandular

separated by the margo pilcatus

Question 2

List the clinical signs of gastric disease

Answer 2

Colic signs (particularly after eating)
Weight loss
Bucking/rearing under saddle
Resentment of girthing and leg aid
Poor performance
Changes in temperament

Varies between individuals

Question 3

List 5 risk factors for gastric disease

Answer 3

Lack of access to forage
Lack of access to water
High carbohydrate diets
High stress environments/individuals
Other focuses of pain?

Question 4

Why can a high carbohydrate diets cause gastric disease

Answer 4

acidifying effect on gastric juices

Question 5

describe how to prep patient for gastroscopy

Answer 5

Horses must have food withheld for at least 12 hours
Water removed ~4 hours before?
Grazing muzzle for horses which eat bedding

Question 6

List the 2 ways we restrain a horse for gastroscopy

Answer 6

chemical restraint
physical restraint:
- at least 3 personnel
- nose twitching

Question 7

describe how er sedate horse for gastroscopy

Answer 7

alpha 2 agonist and a opiate
detomidine and butorphanol

Question 8

Describe how we should give an IV injection to a horse

Answer 8

inject into proximal 1/3 of jugular vein
insert needle all the way in (no syringe attached) - ensure you have a slow drip of blood (if v fast then in artery)
attach syringe, raise vein, draw back to confirm placement and then inject

Question 9

how long should we give a horse after sedation with Dom and tor before we start doing gastroscopy

Answer 9

5 mins ish

Question 10

if, when we go into the nasal cavity, we end up being a Y shaped fissure - what does this mean?

Answer 10

ended up in the middle meatus, don’t want to be here because if we advance gastroscope then we will hit the ethmoid turbinates (and cause epistaxis)

Question 11

which meatus do we want to be in when doing gastroscopy?

Answer 11

ventral

Question 12

when going down the oesophagus with the gastroscope, what can help us get into it?

Answer 12

if horse swallows (can encourage them to do this by passing bits of water and air down the scope)

Question 13

What are the colours of the different sections of stomach

Answer 13

light pink= non-glandular mucosa
dark pink= glandular mucosa

Question 14

Describe how we grade squamous ulcerations

Answer 14

from 0- IV
0= no ulceration, no hyperkeratosis
IV= extensive lesions with areas of apparent deep ulceration

Question 15

where are you most likely to see galndular disease

Answer 15

near the pylorus

Question 16

where are you most likely to see squamous disease

Answer 16

lesser curvature

Question 17

Describe how to grade glandular disease

Answer 17

use descriptions:
- mild/moderate/severe
- focal/multifocal/diffuse
- raised/flat/depressed
- colour: hyperaemic/haemorrhagic/fibrinosupprative

More subjective

Question 18

Describe how we treat squamous ulceration

Answer 18

Oral omeprazole +/- oral sucralfate

Question 19

Describe how to treat glandular disease

Answer 19

Oral misoprostol +/- oral sucralfate

harder to treat than squamous ulceration

Question 20

Describe how we treat a horse for both glandular disease and squamous ulceration

Answer 20

long acting injectable omeprazole +/- oral sucralfate

Question 21

we may need a second line treatment for ……

Answer 21

glandular disease

Question 22

If glandular disease isn’t responding to the oral misoprostol, list the options are avaliable

Answer 22

1. Continue on current therapy if see signs of healing
2. switch to long acting injectable omeprazole
3. do further diagnostics e.g. transendoscopic mucosal biopsies- not very helpful
4. if this does point towards diffuse inflammation then switch to corticosteroids - dex or pred

Question 23

how should we manage and maintain a horse with glandular disease (once they’ve had one bout - they are at risk of it happening again)

Answer 23

Husbandry and management changes
feed supplements
medication

Question 24

list some husbandry management changes for horses with glandular disease

Answer 24

feed roughage ad lib
reduce stress
eliminate carbohydrates from diet

Question 25

T/F omeprazole can be used long term in horses prone to glandular disease

Answer 25

True- can be targeted to high risk periods