Gastrointestinal Flashcards
Equine Choke
obstruction in oesophagus - usual internal but can be external constriction
not an emergency - can tolerate for 48 hours
equine choke - predisposing factors
eating too quickly - greedy horse, irregular feeding
poor dentition
abnormal oesophageal anatomy
dry feeds
failure to soak sugar beet
inadequate water
weird shaped or large food pieces
equine choke - signs
food from nostrils
hypersalivation
retching
inappetance
colic
dullness
coughing
head down, extended neck
equine choke - treatment
sedation - detomidine/romifidine + butorphanol
NSAIDs
IV Buscopan
ACP
lower head to prevent aspiration of impacted feed
most cases resolve spontaneously
if above not working + repeated gentle lavage to soften impaction (if become distressed stop and resume in 6 hours)
if still not working - refer - endoscopy/gastroscopy, may need foreign body removal
soaked or sloppy feeds for 24 hours after resolution
equine choke - complications
aspiration penumonia - uncommon - mix of broad spectrum antibiotics and tracheal wash for c&s
ulcerated mucosa - stricture formation, repeated chokes, can form fistules
megaoesophagus - assess with radiograph, no treatment, feed balls from a height
poorer prognosis if full thickness ulceration and strictures
equine choke - prevention
adequate water provision
dampened food
cut up food small
large stones or salt blocks into feed bins for greedy horses to slow them up
Acute Equine peritonitis - signs
depression
colic
inappetence
pyrexia
reluctance to move
boarded abdomen - don’t like palpation
congested mm
tachypnoea and tachycardia
reduced gut sounds - inflammation –> ileus
reduced fecal output
diarrhoea
chronic equine peritonitis - signs
depression
chronic intermittent colic
anorexia
weight loss
ventral oedema
reduced exercise tolerance
intermittent pyrexia
equine peritonitis - common causes
colic - ischemia –> leakage into body cavity
spread of infection from other areas - liver, kidney, internal abscess
urogenital injury
internal parasite migration
iatrogenic - abdominal surgery
penetrating trauma
viral (rare)
equine peritonitis - pathophysiology
bacterial contamination
inflammation in peritoneal cavity
accumulation of peritoneal fluids
fibrin deposition on peritoneal surface
increased peritoneal permeability
toxins and bacteria in
impaired organ function and other sickness
equine peritonitis - DDX
Colic/GI disease
pleuropneumonia
post op pain
chronic inflammatory bowel disease
abdominal abcessation
abdominal neoplasia
laminitis
hemoperitoneum
uterine perforation
myopathies
pyelonephritis
equine peritonitis - hematology
acute - marked neutropenia, rebounds to increased WBCs with left shift. Increased PCV
chronic - decreased PCV (bone marrow suppression)
equine peritonitis - biochemistry
low albumin
increased blood lactate
chronic - sometimes high protein, fibrinogen
equine peritonitis - peritoneal fluid analysis
increased opacity
brown-orangey colour
smell
high total nucleated cell count
high protein
may have decreased glucose relative to blood levels
may have elevated lactate
equine peritonitis - ultrasound
guide abdominocentesis
show increased volume of fluid
may be useful in identifying underlying cause
equine peritonitis - treatment
treat underlying cause
eliminate infection - broad spectrum - penicillin, gentamycin and metronidazole - up to 6 weeks
reverse hypovolemic and endotoxic shock
correct fluid and electrloyte abnormalities - fluids
NSAIDs - flunixin meglumine
nasogastric tube - analgesia via decompression of ileus
correct dehydration and pypoproteinemia - fluids (colloids/plasma if hypoproteinemia)
nutritional support
cyathostomiasis - signs
varying severity
rapid weight loss
diarrhoea
ventral oedema
abdominal pain
endotoxemia signs
colic signs
rapid death
cyathostomiasis - pathogenesis
mass emergence L3
lymphocyte infiltration
oedema, haemorrhage, ulceration
inflamed mucosa
increased permeability and protein loss to intestinal lumen
altered motility –> diarrhoea and abdominal pain
cyathostomiasis - risk factors
large numbers of encysted larvae
most common in late winter/early spring
young horse
poor pasture management
ineffective anthelmintic treatment
ivermectin in horses with heavy encysted burdens
anthelmintic resistance
cyathostomiasis - diagnosis
neutrophilia
hypoalbuminemia
FEC - not so useful
small red worm ELISA - can’t confirm but can rule it out
cyathostomiasis - treatment
supportive - for fluid and protein loss
anti inflammatories
prednisolone - immune system suppression
anthelmintics
antibiotics if infection
cyathostomiasis - prevention
poo picking
pasture management
monitoring and treatment
changing anthelmintics used
fecal egg count reduction tests to monitor drug efficacy
signs of neonatal diarrhoea in foals
wet tail and diarrhoea on hindlimbs
hair loss around rear
dullness
reduced nursing
abdominal distention
colic
bruxism
pyrexia to hypothermia
hypovolemia/hypotension/bacteremia
tachycardia
weak pulses
tachypnoea
cool extremities - if really dehydrated
recumbant
death
viral causes of neonatal diarrhoea in foals
rotavirus
coronavirus
rotavirus in foals
more severe in younger foals
most commonly detected infectious agent in foals
tips of villi destroyed - can’t digest milk
continue having diarrhoea after resolved - develop degree of lactose intolerance
highly contagious
bacterial causes of neonatal diarrhoea in foals
clostridia
e coli
salmonella
lawsonia intracellularis
clostridia in foals
difficile and perfringens
toxin producing strains
risk factors - previous antibiotic use, stress
can cause severe haemorrhagic enterocolitis in foals - rapid progression and high mortality - more common in younger foals
zoonotic
salmonella in foals
diarhoea and septicemia
pyrexia and inappetence
monitor for sepsis and bacteremia
joint ill, uveitis, naval ill, osteomyelitis - spread to other body systems - generalised sepsis
all neonates with salmonellosis should be treated with antibiotics
zoonotic
lawsonia intracellularis in foals
weaning age foals
wildlife reservoir - rodents etc
shed for 1-3 weeks, can live in environment for a few weeks
quick loss of condition after weaning
rapid protein loss
peripheral oedema
can use pig vaccine rectally in horses for prevention
rhodococcus equi in foals
primarily respiratory - ‘rattles’
rarely - enterocolitis, abscess, peritonitis, and hepatitis
GI parasites in foals
uncommon
strongylus westeri
cryptosporidium parvum
septicemia in foals
only common in really young foals - 0-14 days
non infectious causes of diarrhoea in foals
foal heat diarhoea
perinatal asphyxiation syndrome
necrotising enteritis
nutrition/luminal irritants
gastric ulceration
foal heat diarrhoea
really common
not really a problem
occurs around same time mare returns to oestrus
self-limiting
loose feces but bright and still suckling
0-14 days
perinatal asphyxiation syndrome in foals
risk factors - dystocia, inadequate oxygen during delivery
enterocytes prone to problems with reduced oxygen
diarrhoea
intolerance of milk
0-14 days
necrotising enterocolitis in foals
complex interaction of immature GI mucosa, bacterial infiltration
don’t like being fed
poor prognosis - usually die soon after birth
0-14 days
nutritional/luminal irritant causes of foal diarrhoea
ingestion of abnormal materials
incorrect formulation of milk replacers
from after 2 weeks
gastric ulceration in foals
diarrhoea
foals over 2 months
diagnosis of foal diarrhoea
clinical exam and history - age important, how hydrated, are they suckling
h&b -
PCV and TP - hydration
inflammatory markers - infection
renal enzymes - dehydration –> renal injury
proteins
IgG testing - maternal antibody transfer
fecal testing -
tests based on most likely infectious agents based on age
looking for toxins, not particular bacteria
abdominal ultrasound -
intestinal wall thickening
umbilical structures - key centre for infection
treatment foal diarrhoea
fluids - enteral in mild cases with no reflux, systemic if hypovolemic
NB - not tolerant of high sodium levels -start with lactated ringers
monitor electrolyte imbalances and acid base disturbances
antibiotics -
always if under 2 weeks
check kidneys first
salmonella - ampicillin
clostridia - metronidazole
lawsonia - oxytetracycline, macrolides
analgesia -
NSAIDs
butorphanol
buscopan
gastric ulcer therapy - sucrealfate
nutritional support -
come off milk for 24 hours (with fluids)
intestinal binding agenst - bind clostridial toxins
lactase - replace loss in rotavirus
probiotics - not recommended in foals
nursing care
infectious causes of diarrhoea in calves
salmonella
enterotoxic e coli
rotavirus
BVD
Coronavirus
parasitic causes of diarrhoea in calves
coccidia - eimeria
cryptosporidium
salmonella in calves
dublin
more dairy than suckler
2-6 weeks
high morbidity and mortality
dullness, anorexia, off food
grey, pasty feces with blood and mucous, foul smelling
can also get penumonia or meningitis as primary presenting sign
surviving calves often grow poorly
zoonotic
treatment - fluids, electrolytes, antibiotics
vaccine
enterotoxic e coli in calves
k99 antigen
toxin draws fluid into the gut
first few days of life
yellow white diarrhoea
quickly dehydrated and recumbent
vaccine - cover e coli, rotavirus and coronavirus
rotavirus in calves
high mortality
just over a week old
watery green/yellow feces
concurrent infection makes it worse - usually crypto
collapse, dehydration, sunken eyes, skin tent
prevention - colostrum and pen management
zoonotic
BVD in calves
can develop into mucosal disease
coccidia in calves
eimeria spp
villous atrophy - failure to absorb
diarrhoea with mucous and fresh blood
straining - discomfort –> rectal prolapse
normal temp
can become chronic
sporulated oocysts retained in environment
cryptosporidium in calves
crypto parvum
only a few oocysts needed
retained in environment
4-6 weeks to 6 months (older calves)
associated with intensive stocking and poor hygiene
increased risk in mixed age groups
treatment - halofuginone
prevention - regular moving feed and water troughs, bedding management, cleaning and disinfection of all buildings with product that kills oocysts
severe summer scour in calves
recent observation
don’t know cause
rapid BCS loss
diarrhoea
3-12 months
during summer
salmonella in pigs
typhmurium
may be subclinical
weaners (4 weeks) and growers
zoonotic
acute - high temp and yellow to bloody diarrhoea
can become carriers
necrotic ear tips
can lead to rectal stricture –> euthanasia
resists drying in feces in the environment - exist for years in dust
prevention - hygiene, isolation, rodents, birds, pasteurised feed, cull chronically infected
carried on tonsils and in caecum
foodborne infection to people in pork
ELISA on pork juice at abattoir
infectious causes of diarrhoea in sheep
e coli - watery mouth
salmonella
clostridium perfringens B - lamb dystentery
coccidia - eimeria
cryptosporidium
various parasitic worms
rotavirus
dental nerve blocks
infraorbital - into infraorbital foramen, between gum and lip - anaesthetises from maxillary 3rd premolar to incisors
mental (rostral mandibular) - into mental foramen, inside lip under root of 1st mandibular premolar - anaesthetises mandibular front teeth
caudal maxillary - under zygomatic arch, perpendicular to palate behind second maxillary premolar - caudal maxilla to first incisor including palatal bone
ideally mepivicaine
care with lidocaine in cats - not IV, toxic
non hepatic causes of raised liver enzymes
diabetes mellitus
hyperthyroidism
pancreatitis
IBD
systemic infections (eg dental disease)
liver enzymes
ALT - liver only - liver cell damage
ALP - liver (cholestatic/billiary) and bones - liver specific in cats - billary or cholangic disease
billirubin - RBC breakdown - liver or bile duct
Bile acid stimulation test - liver function
Ddx - elevated ALT in cats
liver disease
toxins
pancreatitis
diabetes
hyperthyroidism
systemic infection
lymphoma
malnutrition
causes of diarrhoea in adult small animals
dietary indiscretion
parasites
endocrine
allergy
obstruction
IBD
lymphoma
food allergy diarrhoea in small animals
symptomatic management
usually chronic diarrhoea
exclusion diet - diagnosis and treatment
single novel protein
no treats, flavoured medications, or toothpaste
rapid response - 2-3 days - quicker than skin allergy response
12 weeks before rechallenging
infectious diarrhoea small animal adults
parasites
protozoa - giardia, cryptosporidium
viruses - parvo, distemper, enteric coronavirus
bacteria - clostridium perfringens, salmonella, toxoplasmosis, tritrichomonas, clostridium jejuni
fecal culture - not useful
pathogen panels - different depending on species
treatment depending on cause - fenbendazole - giardia or mic worms, most endoparasites, not isospora
mild bacterial - supportive care only
bacteremia, acute diarrhoea - amoxyclav
campylobacter - erythromycin
clostridium - metronidazole
avoid broad spectrum
viral - fluids, antiemetics if vomiting, antibiotic if secondary infection or septicemia
FIV, FeLV, parvo - virbagen omega (recombinant feline interferon)
supportive care - fluid, nutritional support, probiotics
IBD - adult diarrhoea - small animals
persistent GI signs
histological evidence of intestinal inflammation
no response to diet trial
immunosuppression treatment - preds
ongoing treatment
ciclosporin if not reactive to preds
highly digestible diet
folate and cobalain supplementation
pre- pro- and post-biotics - manage dysbiosis
metronidazole in severe cases
lymphangiectasia - diarrhoea - small animals
ddx for protein losing enteropathy
causes - congenital, obstructive neoplasia, secondary to hypertension
lymph build up in vessels, leaks across enteric mucosa
poor prognosis
management - low fat high protein diet, supplementation ADEK vitamins, preds, metronidazole if secondary infection
granulomatous colitis - adult diarrhoea - small animals
in predisposed breed <2 years old
inflammation and invasive e coli
baytril (fluoroquinolone) - 4-8 weeks
confirm before antibiosis
antibiotic responsive diarrhoea - adult small animals
metronidazole or tylosin - 4-6 weeks
not common
diagnosis of exclusion
dietary support - highly digestible, low fat, high fibre
supplements - pre-, pro– and post-biotics
fecal microbial transplantation - probably won’t ever actually do this
neoplasia - adult diarrhoea - small animal
lymphoma most common
adenocarcinoma and mast cell also reported
signs -
chronic progressive diarrhoea
palpable mass
hypoalbuminemia
weight loss
ultrasound - loss of layering
treatment -
focal masses, no mets - mass resection and end to end anastomoses
diffuse masses - chemo
complete remission possible with t cell lymphosarcoma
palliative care - preds, nutritional support, anti emetics, appetite stimulants
extraintestinal causes adult diarrhoa
pancreatitis
triaditis
endocrine - addisons, hyperthryroidusm
hepatic
renal
cardiac
exocrine pancreatic insufficiency
drug induced
exocrine pancreatic insufficiency
not producing pancreatic digestive enzymes
idiopathic or from chronic pancreatitis
lack of enzymes –> maldigestion
diagnosis - TLI - trypsin like immunoreactivity
treatment - enzyme replacement, highly digestible diet, cobalamin/B12 supplementation
drug induced adult diarrhoea
NSAIDs - prostglandin inhibition leading to loss of protective covering
antibiotics - disruption of biome
antifungals and chemo - cytotoxic
short bowel syndrome - cause of diarrhoea
secondary to surgery
fat restricted diet
supplementation - vitamins and minerals
metronidazole for intestinal bacterial overgrowth
root causes diarrhoea - adult horse
disruption of mucosal barrier
altered motility
hypersecretion of fluid
infectious causes of acute diarrhoea - horse
salomella
clostridia
cyathostomins - usually more chronic
equine coronavirus
potomac horse fever
non-infectious causes of acute diarrhoea - horse
drug related - NSAIDs, antibiotics - usually more chronic
toxins - acorns
carbohydrate overload
dietary change
salmonellosis - adult diarrhoea - horse
opportunisitic infection
healthy horses still shed a bit of salmonella
severe, acute enterocolitis
pyrexia
pronounced neutropenia - main thing
zoonotic
risk factors - recent colic, recent GA, antibiotic therapy, stress, concurrent infection, immunosuppression
most horses not badly affected
clostridia - adult diarrhoea - horse
normal intestinal flora
c. difficile - toxigenic
range from moderate diarrhoea to rapidly fatal peracute colitis
zoonotic - significant cause of diarrhoea in humans
coronavirus - adult diarrhoea, horse
common in foals
can see encephalitis signs (mentation changes) - secondary to hyperammonemia
blood testing - adult diarrhoea - horse
hydration, electrolyte, acid base disturbances - low electrolytes, metabolic acidosis
PCV/TP - hydration - PCV <45% associated with decreased survival
initial leukopenia
pre renal or renal azotemia - from dehydration
elevated blood lactate - dehydration or endotoxemia
decreased TP or albumin - can be masked by dehydration
fecal analysis - adult diarrhoea - horse
PCR for specific pathogens - salmonella intermediate shedding so needs multiple samples
culture - not reliable
toxin ELISA - clostridia
abdominal US - wall thickness, distension, fluid
abdominal radiography - sand enteropathy, obstruction
treatment - acute adult diarrhoea - horse
flunixin meglumine - anti inflammatory
fluid therapy - dehydration, assess proteins, low proteins may have been being masked by dehydration
laminitis prophylaxis - ice boots
anti endotoxemix medications - intestinal binding agents, polymixin B
anti microbials - usually now, clostridia can use metronidazole, use if evidence of sepsis or in potomac
chronic adult diarrhoea - horse
minimum 7-14 days
persistent or intermittent
signs -
weight loss
oedema
pyrexia
colic
inappetence
depression
reduced gut sounds
causes of chronic adult diarrhoea - horse
cyathostomins/parasites
lawsonia
chronic salmonella
peritonitis
idiopathic
dietary
IBD
sand enteropathy
NSAID toxicity - mucosal ulceration and right colon oedema
neoplasia
secondary to other chronic disease - hepatic, renal, CHF, hyperlipemia
diagnosis - chronic adult diarrhoea - horse
history - age, worming, NSAIDs, soil type
bloods -
PCV - anemia
WBC
hypoproteinemia
electrolyte imbalance
signs of other systemic disease - liver, kidney etc
fecal -
fibre length - mastication
FWEC
PCR - salmonella, lawsonia
dental - mastication
US - wall thickness and fluid
rectal - lymph nodes, thickening
abdominocentesis -
increased WBC - inflammation
increased protein - peritonitis
radiograph - sand enteropathy
Biopsy - IBD/neoplasia
treatment - chronic adult diarrhoea - horse
depending on underlying cause
codeine phosphate - decreases fecal water content
diet change
antimicrobials - only for lawsonia and peritonitis
cilium - sand enteropathy, pushes sand through bowel
stop any drugs causing adverse effects (eg NSAIDs)
sub acute ruminal acidosis
–> metabolic acidosis
economic costs - reduced production, decreased efficiency production, premature culling, increased fatalities
common sequelae - rumenitis, metabolic acidosis, reduced dry matter intake, abomasal displacement, ulcers, laminitis, bloating, reduced fertility
risk factors - early lactation with high energy rations introduced too quickly, mid lactation with high feed intake
signs -
bright yellow sour smelling feces
foamy diarrhoea with gas bubbles and undigested fibre
can be intermittent
acute acidosis
sudden overload of carbohydrates
signs -
colic signs - restlessness
distended abdomen - bloat
weakness
ataxia
teeth grinding
anorexia
increased resp rate - due to metabolic acidosis
profuse watery diarrhoea - after 24 hours
high fatality
treatment -
fluids
antibiotics
IV vitamins
surgery - probably won’t bother
salmonellosis - adult diarrhoea - farm animals
salmonella dublin
more common in dairy
signs -
abortion - late pregnancy
diarrhoea
milk drop
acute or chronic
recovered animals become carriers and shed intermittently
can survive up to 6 years in dry feces
zoonotic
vaccine
bulk milk testing
on farm hygiene and biosec important
johne’s disease - adult diarrhoea - farm animal
mycobacterium avium paratuberculosis
chronic
can shed before clinical signs
4 stages - silent, subclinical, clinical, advanced (diarrhoea at advanced stage)
chronic granulomatous enteritis - bacteria infects macrophages of peyers patches
inflammatory cell infiltration into intestinal wall –> thickening and destruction of villi
earlier infection - worse subsequent lesions
in utero infection possible
decreased yield, mastitis, infertility - may be culled for these without realised it’s johnes
BVD - adult diarrhoea - farm
diarrhoea, respiratory, reproductive, mucosal disease
immunosuppression
drop in production
abortion and persistently infected calves
infection in utero -
1 month - early abortion
2-4 months - persistent infection
5-9 months - abortion, congenital abnormalities
persistently infected - main source of infection for rest of herd, continual shedding, poor growth, prone to other infections, often die, eventually get mucosal disease
mucosal disease - only in persistenyl infected, tongue ulcerations
vaccine
remove persistently infected - testing optional, but culling compulsory once identified
malignant catharral fever - adult diarrhoea - farm
ovine herpes virus
depression
anorexia
pyrexia
photophobia
oral stomatitis
corneal opacity
usually sporadic
fatal at 7-10 days
ddx - mucosal disease, bluetongue
winter dysentery - adult diarrhoea - farm
bovine coronavirus
watery diarrhoea with dark blood
winter housing season
anorexia and severe milk drop
usually recover in a few days, can give supportive treatment
ovine johnes - adult diarrhoea - farm
chronic weight loss
often culled as barren ewes due to infertility without knowing they have it
dirrhoea in late stages
hypoalbuminemia
ELISA
vaccine available
uneaten cecotrophs - non traditional companion animals
frequently confused with diarrhoea
causes -
inappropriate diet - low fibre, high carb, too much protein
obesity
dental disease
MSK disease - not wanting to bend to eat them
upper resp tract disease - can’t smell them
urinary tract disease
enterotoxemia - non traditional companion animals
clostridia or e coli
enterotoxins –> enteritis
severe watery diarrhoea
quiet
GI pain
dehydration
peracute - collapse and death
risk factors -
low fibre, high carb, excessive protein predisposes
after antibiotics - predispose to bacterial overgrowth
diagnosis -
fecal gram stain
signs and history (antibiotics)
post mortem
ddx -
infectious enteritis
mucoid enteropathy
megacolon
treatment -
supportive care - fluid (care in rabbits, can cause pleural oedema), termperature control, nutritional support, probiotics, high fibre supplement
pain relief - opioid
spasmolytics
metronidazole - clostridia
cholestyramine - binds toxins
prevention -
care with antibiotic selection
supplements
appropriate diet
ddx diarrhoea in small mammals - non traditional companion animals
infectious enteritis - all species
mucoid enteropathy - rabbits
megacolon - rabbits
heavy metal toxicity - all species
beak trimming - birds
only indicated if overgrowth or malformed - not routine maintenance
correct overgrowth with husbandry
malformation can be congenital or acquired
causes of acquired malformation -
trauma
liver disease
kidney disease
regurgitation - birds
behavioural regurg - normal mating behaviour in psittacines - can end up doing if try to pair bond with owner
treatment -
avoid sexual behaviour - fully body stroking, feeding from mouth
reqard only non sexual behaviours
increased enrichment
increase interactions with other people
reduce environmental stimulus - decreased day length, lower calorie diet
sour crop - birds
common
disruption of normal crop flora
candida overgrowth
risk factors -
inappropriate diet
antibiotics
GI stasis (delaying crop emptying)
diagnosis -
clinical signs
abundant yeast on crop cytology
treatment -
crop emptying and flushing
treat underlying conditions
oral anti fungals
supportive care - probiotics, GI stimulants, metaclopramide
crop impaction - birds
ingestion of long grass, hay or string
GI hypomotility
treatment -
flushing - not too useful, risk of aspiration
ingluviotomy
green urates - birds
biliverdinuria
liver disease –> increased biliverdin –> green urates
can look like diarrhoea
hematology and biochem for liver dysfunction, WBC changes, globulin changes
treatment - depends on cause - heavy metal poisoning, chlamydia causing hepatitis
undigested food in feces - birds
usually lower GI disease
differentiate from seed spilled on feces
due to malabsorption
diagnosis -
history
fecal exam - cytology, parasites, c&s (mycobacterium), imaging (US difficult because of air sacs), specific disease testing
post hibernation anorexia - tortoises
poor hibernation practice
insufficient temperature control - run down glucose waking up repeatedly
excessive length of hibernation - leukopenia on waking (Red plastron) - don’t make WBCs during hibernation
hematology - low WBC
biochem - high uric acid
treatment -
correct dehydration - feeding before urinate can cause refeeding syndrome - 2 maintenance until urine then 1x
antibiotics - injectable
supportive feeding - o tube
prevention -
health check before hibernation
prepration temperature
close monitoring
temperature control during hibernation
limit hibernation length - max 3 months, start 2 weeks with juveniles and increase by one week per year
constipation in reptiles
infrequent defacation common but only normal in species that don’t eat often
causes -
inappropriate diet
inappropriate substrate
not enough exercise
low calcium due to UVB provision
lack of fibre
parasites
systemic disease
hypercalcemia (metabolic bone disease)
treatment -
KY enema and water
bathing
fluid therapy
treat underlying disease
prevention -
husbandry
maintain hydration
IBD types - horses
Lymphocytic plasmocytic enteritis
Eosinophilic
Granulomatous
Multicentric eosinophilic
Lymphosarcoma
Undifferentiated
treatment IBD - horses
corticosteroids
anthelmintics
environmental changes
dietary changes - high protein, highly digestible, balanced feeds, corn oil, grass hay, pasture grasses
treatment cyathostomins - horses
supportive therapy - fluids, flunixin meglumine
polymixin B
biosponge
moxidectin
antibiotics - if specific pathogens
ice boots - if laminitis
treat other horses in shared environment - anthelmintics
clinical signs - gastric ulceration - equine
negative reaction to girth
colic signs around feeding
loss of appetite
loss of condition
poor performance
dorsal recumbency for long periods
teeth grinding or cribbing
salivation
gastric ulceration treatment - horses
pretty much same whether in squamous or glandular part of stomach
changing acid levels to ptoect lining
H2 receptor agonists
omeprozole
protectants - don’t use with omeprazole, will stop it being absorbed
prostaglandin E analogues
antacids
gastric motility agents
supportive therapy
management changes -
constant roughage availability
limited concentrates
spread food through the day
minimise stress
consistent routine
give breaks
consistent companions
increased fibre
minimise infection
parasite control
low dose omeprazole as a preventative (Expensive)
avoid NSAIDs in at risk horses
causes of vomiting
GI -
dietary change
dietary indiscretion
food intolerance/allergy
obstruction
IBD
volvulus
other abdominal -
pancreatitis
renal
pyo
metabolic/endocrine -
diabetic ketoacidosis
hypoadrenocorticism
infectious -
parvo
feline panleukopenia
giardia
helminths
vestibular disease
toxins
drugs
vomiting - when to test
mild acute vomiting, unremarkable history and exam - just wait and see, maybe symptomatic treatment
severe acute vomiting, concerning history - most likely further tests
chronic vomiting - further tests
hypoadrenocorticism - vomiting
often waxing/waning signs
could have concurrent renal
azotemia with isothenuria - can cause a pre renal azotemia, easily confused with renal disease
interventions - common causes of vomiting
supportive care
prokinetics - only if rules out obstruction
antiemetics - maropitant
NSAIDs - often contraindicated
bland diet
short period of not feeding
gastroprotectants
omeprazole
antimicrobials - not indicated unless specific diagnosis that needs tham (parvo - due to neutropenia)
causes of abdominal pain
pancreatitis
urinary - lower UT obstruction, renoliths, cystitis
ischemia
gaseous distension
obstruction - foreign body, intussuception
injury - muscular, trauma
mass lesion
volvulus
peritonitis
treatment - pancreatitis
IVFT
analgesia - opioids, paracetamol, gaba, CRI lidocaine and ketamine (not NSAIDs)
antiemetics - maropitant
feeding - tube
antimicrobials - not indicated
surgical intervention for abdominal pain
critical, immediate -
GDV
intestinal volvulus
diagphragmatic hernia
acute peritonitis
linear foreign body
complete high foreign body obstruction
ischemic bowel
complete UT obtruction
critical, surgery once stable -
gastic dilation without volvulus
gastric obstruction
partial or distal intestinal obstruction
partial or distal intestinal obstruction
intussuception
pyo
pancreatic mass/abscess
diagnostics - biopsies
LDA risk factors
winter and early spring - housed, most opportunity for diet to go wrong
high yield dairy cows
first month after calving
concurrent disease - hypocalcemia, retained foetal membranes, twinning, endometritis, enotoxemia
high concentrate , low fibre rations
high or low BCS
multiparous dams
hosteins - big abdomen
low dry matter intake
LDA pathophysiology
gravid uterus pushes rumen forwards
reduced dry matter intake
more space after calving
rumen falls to fill new space as uterus shrinks
omentum attached to abomasum stretched so able to move more
abomasum moves to left dorsal
acute LDA
very recently calved
toxic metritis
pyrexia
depression
toxemia
anorexia
dramatically reduced milk yield
recent milk fever episode
profuse diarrhoea
drawn up abdomen and sunken flanks
prominent rubs
moderate dehydration
chronic LDA
more mild
over 10 days in milk
chronic endometritis
secondary ketosis
history of poor yield rather than sudden decline
reduced appetite
chronic weight loss
slow and dull mentation
usually normal temperature
constipation/stiff feces
LDA diagnosis
percussion - ping at 11-13th rib if gas fluid interface
push with balled fist (succusion) - sloshing sound
urine dipstick - metabolic acidosis
confirmation by surgery or paracentesis of displaced abomasum contents (pH2 and no protozoa)
ultrasound
ddx LDA
rumen void syndrome
rumen gas cap
vagal indigestion
oneumoperitoneum
physometra
LDA treatment
roll the cow - cheap but <40% effective, needs time, floorspace and 3 people
laparotomy - very successful
treat other conditions - ketosis, dehydration, endotoxemia, fix dietary insufficiencies
toggle - roll on back and pull abomasum over and suture it to right side - risky
euthanasia
supportive therapy
prevention LDA
prompt identification
oral fluid therapy
balanced diet
transition nutrition
prevent over fatness
yard management
monitor rumen fill
monitor energy
monitor post partum disease levels
RDA risk factors
dairy cow
atony due to concentrate feed –> gas –> floats upward
RDA exam
dehydration
elevated HR
reduced feces in rectum
bad smelling diarrhoea with blood in
high pitched ping on right side
pain - colic behaviours, lifting leg, stamping, flank watching, rolling
RDA treatment
medical -
buscopan - spasmolytic
calcium - improved contractility of abomasum
oral coffee - contractility
surgery - recommended due to risk of torsion if not done
euthanasia - poorer prognosis than LDA
RDA with torsion signs
more acute
very fast deterioration
toxemia
pale mm
ping
empty rectum
RDA with torsion treatment
euthanasia or no surgery - no other options
prognosis bad
RDA with torsion ddx
vagal indigestion
pyloric obstruction
caecal torsion
perforated ulcer
