Gastric Disease in Horses Flashcards

Question

What is EGGD thought to be caused by?

Answer 1

•We need to determine what underlying cause is – we literally have no idea! –Thought maybe to be immune-mediated (may relate to diet) or infectious (become less likely now though)

Answer 2

•Biopsies are problematic and difficult! –Transendoscopic not representative of full thickness –Disease only manifests at pyloric antrum, but often whole glandular region affected

Answer 3

* Changes in temperament including nervousness and aggression * Cutaneous sensitivity manifested as biting of the flanks and resentment of girthing, grooming, leg aids or rugging * Changes in rideability including reduced willingness to work and reluctance to go forward * Unexplained weight loss * Reduced appetite or altered eating patterns * Colic (mild and possibly recurrent)

Answer 4

Different risk factors to squamous disease –Undertaking more exercise per days of the week –Less common in those performing at a higher level – less stressed and different management –Less likely to be lame, calmer, more likely to have weigh loss secondary to reduce appetite –Increased number of carers…different management?/stress? –If they work more than 5 days a week, the risk starts to increase –Horses that have multiple keepers – increased risk

Answer 5

Gastroscopy

Answer 6

•Treatment –Omeprazole monotherapy is NOT appropriate – only 20% get better! –Three options: * Oral omeprazole and sucralfate – increases mucosal blood flow (not for its ‘ulcer-lining’ effects – only 20% get better with oral therapy! * Misoprostol – 60-75% get better – increases PGE2 * Injectable omeprazole – NEW KID ON THE BLOCK, ONCE A WEEK IM, data for this at the moment – injectable does seem to be more effective than oral, might suggest it does have a role to play and this might be about acid suppression, might be about something else * NO evidence for antimicrobials * Steroids for refractory cases – in those horses where nothing else works! INHIBIT COX AND LOX, REDUCE GASTRIC BLOOD FLOW AND INCREASE CORTISOL – WHICH IS WHAT STRESS DOES- SO WHY DOES IT WORK?! NO IDEA – BUT DOES SEEM TO WORK IN SOME CASES * Omeprazole reduces acid secretion, but by itself orally doesn’t work very well. Sucralfate – crap bandage, but increases PGE and mucosal blood flow – certainly seems to increase usefulness with omeprazole

Answer 7

* Provide a minimum of 2 rest days from work per week * Turn-out where possible provided the horse does not become stressed by turn-out. Some horses that are not accustomed to turn-out may be less stressed in a stable environment * Minimise changes in equine companions and human carers * Minimise management changes and other potential stressors * Feed 2 litres of chaff or an equivalent volume of forage 30 mins prior to exercise * Feed 250g sugar beet twice daily or pectin-lethicin supplements * Add corn oil to diet

Answer 8

Gastric disease in foals - glandular disease ## Footnote * Very serious issue – life threatening disease! * Often of concern in sick, septic, Perinatal Asphyxia Syndrome, stressed and hospitalised foals * Present with moderate to severe colic signs in young foals * Bruxism and ptyalism older foals (preweaning) * Gastric disease leads to oesophageal (reflux) and pyloric/ duodenal strictures and gastric rupture (older foals) –Increased risk of strictures •Ischaemic damage and reduction in mucosal blood flow and not of acid damage - may ultimately contribute –Therefore omeprazole is NOT an appropriate treatment for these guys!

Answer 9

•Acid in the stomach is there for a reason –Acid helps to reduce live bacterial load entering the intestines from food and environment –If we use acid suppressants - increases risk of D+ - so we want to increase blood flow rather than suppressing acid! * Reduction in gastric acid predisposes foals particularly to developing severely secondary bacterial infections caused by Clostridial disease esp C. difficile * As the acid is a secondary problem, the focus should be on returning gastric blood flow to normal rather than suppressing acid

Answer 10

Gastroscopy, Faecal occult blood, contrast radiography, abdominal ultrasound, peritoneocentesis

Answer 11

•Treatment: VERY controversial – two camps – become less controversial, still older vets that want to give omeprazole to every foal but more have move to treatment with sucralfate –Omeprazole (or ranitidine) OR –\*\*Sucralfate\*\* –If concurrent oesophageal ulceration – sucralfate always •Prognosis: Much less favourable than either ESGD or EGGD in adults

Answer 12

* Common condition growing pigs (up to 60% at slaughter) and then in sows (5% prevalence) – often around cardia * Clinical signs incl –Anorexia –Vomiting –Signs associated with anaemia –Teeth grinding –Black faeces –Dead (due to haemorrhage) –Weight loss in growers with a chronic form

Answer 13

* As in horses multifactorial * Various nutritional factors have been identified –low protein, low fibre, high energy, high wheat, vitamin E, selenium or Zn def, high levels of iron, copper or calcium, high unsaturated fats, whey and skimmed milk based diets •Physical aspects of the feed –More ground worse; pelleted diets better •Management issues –Irregular feeding patterns and shortage of feeder space, increased stocking densities, stress, transportation, excessive aggression between animals, poor stockmanship, fluctuating environmental temperatures •Other disease –Link between pneumonia and sepsis; Helicobacter •Breed

Answer 14

* Diagnosis – clinical signs and post mortem examination; faecal occult blood test * Main DDx –Eperythrozoonosis –Hyostrongylus rubidus (gastric worm) –Porcine enteropathy

Answer 15

–Secondary to small intestinal strangulating lesions – very specific way of presenting: •Often have been painful and then become pain free –Because of decreased pressure –Then they: –Horses quickly progress to septic shock because of peritonitis * Reluctant to move * HR\>100BPM * Purple MM * No GI borborygmi –Diagnosis – peritoneal tap

Answer 16

–As in adults, but rarer –Secondary to perforating gastric ulcers •Most likely secondary to necrotising enterocolitis (bacterial infection)

Answer 17

* Acute or chronic * Usually associated with anorexia, weight loss if chronic to colic signs if acute * Primary or secondary motility disorder * Rarely associated with poor quality forage, foreign objects or improper mastication * Can see secondary to dental disease, gorging(primarily sugar beet they get hold of) or inadequate water consumption and DEHYDRATION (e.g. endurance horses, but usually rare in other horses)

Answer 18

Diagnosis – Idea when pass a nasogastric tube – hitches and gets stuck and often don’t get fluid back; gastroscopy (convincing diagnosis is still being full after 24 hrs of food being witheld); abdominal ultrasound, (abdominal radiographs in ponies and sm horses), surgery

Answer 19

•Treatment –The longer the stomach is distended, the less likely its functions will return –Aggressive gastric lavage – Coke (I recommend caffeine free – send them wild!!) – coke has stable bubbles and carbonic acid stabilised in these bubbles has a big positive impact on breaking down the fibre mat –Pro-motility agents –erythromycin and metaclopormide –(Surgery to empty)

Answer 20

Cause summer sores around the mucosa, sometimes around the eyes, usually mucosa of mouth – fly related disease – eggs get laid, larvae hatch and larve go burrowing and get themselves into oesophagus and into stomach and GIT – develop and end up with worms

Answer 21

* Usually of little consequence * Q common in terms of causing summer sores * Penetrates and migrates to the stomach * Usually of little consequence * Susceptible to avermectins administered q 4 weeks for 3 doses * Can cause pyloric outflow obstruction rarely * Present with mild, recurrent colic * Intermittent tachycardia and NG reflux * DX: Gastroscopy and biopsy * DDX: SCC, EGGD

Answer 22

Left – normal Right – horse that was confirmed to have habronemiasis

Answer 23

* Adult flies are active in middle of day in warm months * Lay their white/yellow sticky eggs on the legs of horses. Flies 1-1.5cm in length-look like small bumblebees * Eggs hatch spontaneously or when stimulated by the horse’s saliva whilst grooming * L3 attaches to squamous gastric mucosa along the margo pliacatus (Gastrophilus intestinalis) or to the dorsoproximal part of the duodenum (Gasterophilus nasalis) * Larvae then survive here for 10-12 months before passed out to pupate in faeces

Answer 24

•Totally unimportant in terms of clinical disease –IF in vvvv high numbers could block duodenum – this form v rare in UK •IS a condition that needs client management –Get very upset when pupae are passed in faeces * Often see a few in horses * Very responsive to avermectins * NOT a cause of poor performance –

Answer 25

* Most common tumour of the stomach, but RARE – 3 cases in referral practice in 14 years * Present with weight loss, recurrent, chronic, mild colic, anorexia and depression * Can metastasise to local LN and lungs * No treatment – resection not possible, not really responsive to any treatment we have available to us * Dx: Gastroscopy (cant always see) and abdominal ultrasound

Answer 26

Gastric squamous cell carcinoma Looks like very deep ulcer, but doesn’t have other changes to mucosa you would expect to disease