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Gastrointestinal > Gastric Ulcer Disease > Flashcards

Gastric Ulcer Disease Flashcards

1
Q

T/F: Adult equine ulcers frequently bleed

A

False; they rarely bleed

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2
Q

T/F: Perforating ulcers are very common in horses

A

False; they are very uncommon

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3
Q

T/F: EGUS is potentially fatal in foals

A

True

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4
Q

Squamous mucosal lesions result from increased ___

A

Acid (HCl, bile acids, organic acids such as VFAs)

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5
Q

Glandular mucosal lesions result from ___

A

Impaired mucosal protection and blood flow (may be related to NSAIDs)

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6
Q

80% of equine ulcers are in the ___ region, while 20% are in the ___ region

A

Squamous

Glandular

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7
Q

How does intensive exercise lead to increased risk of ulceration?

A

Reduced gastric mucosal blood flow
Increased gastric acidity?
Altered eating behavior?

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8
Q

T/F: Exercise increases intra-abdominal pressure and causes gastric compression, leading to displacement of acidic contents into the proximal stomach

A

True

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9
Q

Feeding management

A

Low prevalence of ulcers in horses at pasture
Decreased acid when roughage available
Increased serum gastrin when fed concentrates (grain)
Intermittent feed deprivation = gastric ulcers
Stall confinement = gastric ulcers
Feeding alfalfa hay may help

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10
Q

What are the four organic acids (VFAs or SCFAs) found in high concentrate diets?

A

Acetic
Butyric
Propionic
Valeric

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11
Q

How are the organic acids formed and what do they do?

A

Byproducts of carbohydrate fermentation in the stomach
Synergistic with HCl
May lead to non-glandular ulcers
Lactic acid may be important (isolation of Lactobacillus from stomach, ferment grain and lead to acid damage)

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12
Q

CS of gastric ulcer in adult horses (6)

A 
Poor appetite
Poor body condition
Attitude changes
Decrease in performance
Mild to moderate colic
Dry, poor haircoat
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13
Q

CS in foals (7)

A 
Poor appetite or intermittent nursing
Colic
Poor body condition
Frequently lies on back*
Bruxism*
Excessive salivation (ptyalism)*
Diarrhea*
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14
Q

Dx of EGUS

A 
CS are suggestive
Response to Tx
Gastric endoscopy is best tool
Clin path (not commonly observed)
- Mild anemia, hypoproteinemia
- Increased serum pepsinogen?
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15
Q

Two types of medical management

A

Control gastric acid

Mucosal protectants

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16
Q

Traditional Management

A 
Reduce level of training
Limit fasting
Increase roughage
- pasture turnout
- Free choice hay
- Alfalfa hay - dietary antacid**
Reduce grain/concentrates
Limit stress (trailering, overcrowding, long-term stall confinement)
17
Q

Medical therapy

A

Antacid therapy
- Neutralizing agents: antacids (MgOH, AlOH) - approx 2hr effect
Antisecretory agents: Histamine H2 receptor antagonists (Ranitidine), prostaglandin analog (Misoprostol), Acid pump inhibitors (Omeprazole)

18
Q

Ulcer treatment actions

A

H2 antagonists act on H2 receptors
Gastrogard works on the acid pump
Sucralfate works on the mucus/bicarbonate barrier
Antacids work on the stomach lumen

19
Q

Gastrogard

A 
Proton pump inhibitor
Substituted benzimidazole
Inhibits H-K ATPase parietal cell
4mg/kg PO Q24h
Treatment and prevention of recurrence
Can maintain training program
FDA approved for use in horses
20
Q

Ulcergard

A

Prevention of ulcers
Non-prescription strength of gastrogard
Sold through veterinarians

21
Q

T/F: Compounded and generic omeprazole are acceptable for treatment of gastric ulcers

A

False; they do not have the enteric coating of Gastrogard

22
Q

Helicobacter spp.

A

Isolated from horse stomachs

  • 2 horses with squamous erosions
  • 1 horse with glandular erosions
23
Q

Antimicrobial Tx

A

Amoxicillin, metronidazole, clarithromycin, bismuth compounds (NOT azithromycin)
Primarily used in humans with H. pylori (not associated with EGUS)
Antimicrobials may be used in horses with resistant EGUS

24
Q

Neutriceuticals

A 
NeighLox antacid and coating agents
- Aluminum Phosphate, calcium carbonate
- Dihydroxy-Aluminum sodium carbonate
Labeled for prevention of heartburn
No studies in horses to prove or disprove
Probably does not cause any harm
GUT nutrient buffer
25
Q

T/F: EGUS is common in performance horses

26
Q

Duodenal Ulcer/Stricture CS and Dx

A

Part of EGUS (more common in foals)
Similar path and CS
Delayed gastric emptying associated with esophageal ulcers
Dx from CS, duodenoscopy, rads (barium swallow)

27
Q

Duodenal Ulcer/Stricture Tx

A

Omeprazole 4mg/kg PO Q24h for 28d
Omeprazole 1mg/kg IV q24h
Ranitidine 6.6mg/kg POQ8h
Sx - gastrojejunostomy (foals only?)

28
Q

Ulcers in the Critically Ill Neonate

A

Perforation of a duodenal ulcer in a foal was described in 1972, several cases followed
Usually foals <14d
Prophylaxis started in NICUs (H2 antagonist and mucosal protectant), incidence decreased
Don’t need prophylaxis anymore

Gastrointestinal (12 decks)

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