Gastrointestinal disease Flashcards by Thomas Conway

Scenario: A 10-year-old Quarter Horse gelding presents with a history of quidding and weight loss. On oral examination, you identify a prominent, sharp enamel point on the buccal aspect of the right maxillary 110.

Lead-in: Which of the following is the most likely cause of this finding?

Options:

a) Excessive wear on the opposing mandibular tooth
b) Lack of wear on the corresponding maxillary tooth
c) Malalignment of the opposing mandibular arcade
d) Asymmetrical eruption rate of the right maxillary 110
e) Normal anisognathic anatomy of the equine jaw

Answer: c) Malalignment of the opposing mandibular arcade

Explanation: Sharp enamel points form on the buccal aspect of maxillary teeth and the lingual aspect of mandibular teeth due to the anisognathic nature of the equine jaw. However, a prominent enamel point suggests a more significant issue with the opposing tooth or arcade, such as malalignment or missing teeth, leading to a lack of wear.

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Scenario: A 5-year-old Thoroughbred mare is presented for a routine dental examination. You identify a diastema between the left maxillary 208 and 209.

Lead-in: Which radiographic view would be most appropriate to further investigate this finding?

Options:

a) Latero-lateral view of the cheek teeth
b) Dorso-ventral view of the cheek teeth
c) Lateral 30° dorsal-lateroventral oblique view of the left maxillary cheek teeth
d) Lateral 45° ventral-laterodorsal oblique view of the left mandibular cheek teeth
e) Rostro 35° lateral 50° ventral-caudodorsal oblique view of the temporomandibular joint

Answer: c) Lateral 30° dorsal-lateroventral oblique view of the left maxillary cheek teeth

Explanation: A 30° dorsal-lateroventral oblique view best highlights the apexes of the maxillary cheek teeth closest to the plate, making it ideal for examining the diastema between 208 and 209. The other views are less suitable for visualizing this specific interdental space.

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Scenario: An owner reports that their 15-year-old Irish Draught gelding has been dropping food from his mouth while eating and has lost weight. Clinical examination reveals sharp enamel points on the buccal aspect of the upper cheek teeth and lingual aspect of the lower cheek teeth, as well as a malaligned 311. No other abnormalities are detected on oral examination.

Lead-in: Which of the following is the most likely cause of the horse’s clinical signs?

Options:

a) Sharp enamel points
b) Equine odontoclastic tooth resorption and hypercementosis (EOTRH)
c) Malalignment of 311 causing secondary cheek teeth issues
d) Retained deciduous teeth “caps”
e) Diastemata

Answer: a) Sharp Enamal Points

In this scenario, the clinical signs of food dropping from the mouth while eating and weight loss are indicative of dental issues, most likely associated with sharp enamel points. These are commonly found in horses due to the natural grinding action during chewing, which causes the buccal aspect of the upper cheek teeth and the lingual aspect of the lower cheek teeth to develop sharp edges. These sharp points can cause pain or discomfort while eating, resulting in quidding (dropping food from the mouth) and subsequent weight loss.

In this case, the clinical examination reveals both sharp enamel points and a malaligned 311 (a tooth misalignment), which could contribute to uneven wear and the formation of these points. Since no other abnormalities are detected on oral examination, the primary cause of the horse’s clinical signs is most likely the sharp enamel points that are interfering with normal eating.

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Scenario: You are performing a dental examination on a 4-year-old Warmblood gelding. You note that the occlusal surface of the 106 appears abnormally worn compared to the 206.

Lead-in: Which of the following would be the most appropriate next step?

Options:

a) Removal of the 106
b) Radiographic examination of the 106
c) No action required, continue with routine dental rasping
d) Repeat the dental examination in 6 months
e) Prescribe antibiotics to prevent potential infection

Answer: b) Radiographic examination of the 106

Explanation: Abnormal wear of a single tooth in a young horse warrants further investigation. Radiography can help identify potential underlying issues such as tooth fracture, periapical infection, or developmental abnormalities. Simply removing the tooth without identifying the cause could lead to further complications

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Scenario: A 20-year-old Arab mare presents with loose incisors and hyperplastic gum margins. You suspect equine odontoclastic tooth resorption and hypercementosis (EOTRH).

Lead-in: Which of the following treatment options would be the most appropriate for this case?

Options:

a) Administration of bisphosphonates to reduce bone resorption
b) Surgical removal of the affected incisors
c) Dental scaling and polishing to remove plaque and calculus
d) No treatment necessary, as EOTRH is a normal aging process
e) Regular flushing of the affected areas with chlorhexidine

Answer: b) Surgical removal of the affected incisors

Explanation: The only effective treatment for EOTRH is the extraction of the affected teeth. This provides pain relief and improves the horse’s quality of life. The other options are not indicated for the treatment of EOTRH.

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Scenario: You are called to examine a 6-month-old foal that is not nursing properly. The owner reports that the foal seems to be in pain when it tries to suckle. On oral examination, you find that deciduous incisor 101 has erupted.

Lead-in: What is the most likely cause of the foal’s difficulty suckling?

Options:

a) The eruption of deciduous incisor 101 is causing discomfort
b) The foal has a retained deciduous incisor
c) The foal has a fractured incisor
d) The foal has a diastema between the incisors
e) The foal has an impacted wolf tooth

Answer: a) The eruption of deciduous incisor 101 is causing discomfort

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Scenario: An 8-year-old pony gelding presents with a firm swelling on the mandible. You suspect a dental-related issue and take a radiograph of the area.

Lead-in: Which radiographic finding would be most consistent with a diagnosis of neoplasia?

Options:

a) A well-defined radiolucent area within the mandible
b) Diffuse osteolysis and bone remodelling
c) A sclerotic bone lesion with a smooth margin
d) Widening of the periodontal space around a single tooth
e) Displacement of a tooth with no evidence of fracture

Answer: b) Diffuse osteolysis and bone remodelling

Explanation: Neoplasia often causes irregular bone destruction and remodelling, appearing as a poorly defined area of radiolucency on radiographs. The other options are less characteristic of neoplastic changes

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Scenario: A 10-year-old Arabian mare presents with a history of intermittent quidding and resistance to the bit. You suspect a dental issue and take a radiograph of the cheek teeth.

Lead-in: Based on the radiographic findings, what is the most likely diagnosis?

a) Dental fracture
b) Tooth root abscess
c) Diastemata with secondary food impaction
d) Retained deciduous tooth “cap”
e) Equine odontoclastic tooth resorption and hypercementosis (EOTRH)

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Scenario: An owner presents their 18-year-old Shetland pony mare for a dental examination. They report that she has been reluctant to eat hard feed and has had some mild nasal discharge. You note halitosis and hyperplastic gum margins on oral examination. You take a radiograph of the incisors to investigate further.

Lead-in: Based on the radiographic findings, what is the most likely diagnosis?

Options:

a) Dental fracture
b) Tooth root abscess
c) Diastemata with secondary food impaction
d) Retained deciduous tooth “cap”
e) Equine odontoclastic tooth resorption and hypercementosis (EOTRH)

Answer: e) Equine odontoclastic tooth resorption and hypercementosis (EOTRH)

Explanation: The radiograph shows characteristic signs of EOTRH, including radiolucent areas around the roots of the incisors, indicating resorption. These findings, combined with the pony’s age and clinical signs, strongly support this diagnosis.

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Scenario: A 10-year-old Thoroughbred gelding is presented for evaluation of weight loss. The owner reports that the horse has been losing weight for the past 6 months despite having a good appetite and no history of diarrhea.

Lead-in: Which of the following diagnostic tests would be LEAST helpful in the initial workup of this horse’s weight loss?

Options:

a) Complete blood count and biochemistry profile
b) Faecal egg count
c) Oral glucose absorption test
d) Dental examination
e) Rectal palpation

Answer: c) Oral glucose absorption test

Explanation: An oral glucose absorption test is used to assess intestinal function but is not a first-line test in the initial weight loss workup. The other options are essential components of the initial evaluation of a horse with weight loss.

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Scenario: An 8-year-old Warmblood mare presents with a history of chronic weight loss and intermittent diarrhea. Abdominal ultrasound reveals mild thickening of the right dorsal colon wall.

Lead-in: Which of the following is the most likely cause of these findings?

Options:

a) Sand enteropathy
b) Right dorsal colitis
c) Granulomatous enteritis
d) Proliferative enteropathy
e) Lymphocytic-plasmacytic enterocolitis

Answer: b) Right dorsal colitis

Explanation: Thickening of the right dorsal colon wall on abdominal ultrasound is a common finding in right dorsal colitis. While the other options could potentially cause weight loss and diarrhoea, they are less likely to specifically cause thickening of the right dorsal colon wall.

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Scenario: A 5-year-old Quarter Horse gelding is presented for evaluation of weight loss and hypoalbuminemia. You suspect protein-losing enteropathy (PLE).

Lead-in: Which of the following diagnostic tests would be most helpful in confirming PLE?

Options:

a) Faecal egg count
b) Rectal biopsy
c) Oral glucose absorption test
d) Measurement of serum vitamin E levels
e) Liver biopsy

Answer: b) Rectal biopsy

Explanation: A rectal biopsy can help identify intestinal lesions associated with PLE, such as granulomatous enteritis or lymphocytic-plasmacytic enterocolitis. While the other options may be part of the overall diagnostic workup, they are less specific for confirming PLE.

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SBA 4

Scenario: A 12-year-old Arabian mare presents with a history of weight loss, lethargy, and icterus. Blood work reveals elevated liver enzymes and bile acids.

Lead-in: Which of the following is the most common cause of hepatic disease in horses that can lead to these clinical signs?

Options:

a) Cholelithiasis
b) Theiler’s disease
c) Cholangiohepatitis
d) Pyrrolizidine alkaloid toxicosis
e) Equine parvovirus-hepatitis virus infection

Answer: d) Pyrrolizidine alkaloid toxicosis

Explanation: Pyrrolizidine alkaloid toxicosis, often caused by ragwort ingestion, is the most common cause of hepatic disease in horses. It can lead to weight loss, lethargy, icterus, and elevated liver enzymes. While the other options can also cause liver disease, they are less common.

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Scenario: A 6-month-old foal presents with a history of weight loss, anorexia, and depression. The foal is housed with its dam on a pasture with access to a variety of plants.

Lead-in: Which of the following diagnostic tests would be most helpful in determining if the foal’s clinical signs are related to liver disease?

Options:

a) Measurement of serum vitamin E levels
b) Faecal egg count
c) Oral glucose absorption test
d) Liver biopsy
e) Measurement of serum bile acids

Answer: d) Liver biopsy

Explanation: A liver biopsy is the most definitive diagnostic test for evaluating liver disease in foals. It can help identify specific causes of liver disease, such as pyrrolizidine alkaloid toxicosis or viral hepatitis. While the other options may be part of the overall diagnostic workup, they are less specific for evaluating liver disease.

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Scenario: A 4-year-old Standardbred gelding presents with a history of weight loss, intermittent colic, and low-grade fever. You suspect inflammatory bowel disease (IBD).

Lead-in: Which of the following treatment options would be most appropriate for the initial management of this horse?

Options:

a) Intravenous oxytetracycline
b) Oral prednisolone
c) Surgical resection and anastomosis
d) Misoprostol
e) Psyllium and magnesium sulfate

Answer: b) Oral prednisolone

Explanation: Oral prednisolone is a corticosteroid commonly used in the initial management of IBD in horses. It helps reduce inflammation and improve nutrient absorption. The other options are less appropriate for the initial management of IBD.

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Scenario: A 7-year-old Warmblood mare presents with a history of weight loss and poor performance. She is housed on a sandy paddock with limited access to good quality forage.

Lead-in: Which of the following would be the most important initial management step for this horse?

Options:

a) Deworming with a broad-spectrum anthelmintic
b) Increasing the horse’s caloric intake
c) Administering corticosteroids
d) Performing a liver biopsy
e) Performing an oral glucose absorption test

Answer: b) Increasing the horse’s caloric intake

Explanation: The most important initial management step for this horse is to address the underlying cause of weight loss, which is likely inadequate nutrition. Increasing the horse’s caloric intake by providing access to good quality forage and/or supplementing with concentrates is crucial. While the other options may be considered later in the diagnostic or treatment process, they are not the most important initial step.

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Scenario: A 15-year-old Irish Draught gelding is diagnosed with chronic liver disease secondary to ragwort poisoning.

Lead-in: Which of the following treatment options would be most likely to improve the horse’s long-term prognosis?

Options:

a) Intravenous oxytetracycline
b) Oral prednisolone
c) Oral colchicine
d) Intravenous DMSO
e) Surgical removal of choleliths

Answer: c) Oral colchicine

Explanation: Colchicine is an antifibrotic agent that can help slow the progression of liver fibrosis in horses with chronic liver disease. While the other options may be used in the management of liver disease, they are less likely to improve the long-term prognosis.

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Scenario: A 12-year-old pony mare is presented for evaluation of weight loss and ventral edema. Blood work reveals elevated liver enzymes and hypoalbuminemia.

Lead-in: Which of the following clinical signs would be LEAST likely to be associated with liver disease in this horse?

Options:

a) Icterus
b) Photosensitization
c) Hepatic encephalopathy
d) Diarrhea
e) Colic

Answer: d) Diarrhea

Explanation: While diarrhea can be associated with some gastrointestinal diseases that may also cause weight loss, it is not a typical clinical sign of liver disease in horses. The other options are more commonly associated with liver disease.

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Scenario: A horse presents with signs of colic. You are preparing to perform a rectal examination.

Lead-in: Which of the following is the most important safety precaution to take when performing a rectal examination on a horse with colic?

Options:

a) Wear a hard hat and safety glasses.
b) Sedate the horse with xylazine.
c) Ensure the horse is adequately restrained or sedated.
d) Perform the examination in a well-lit area.
e) Have the owner hold the horse’s tail.

Answer: c) Ensure the horse is adequately restrained or sedated.

Explanation: Restraint or sedation is crucial to minimize the risk of sudden movement during the rectal examination, protecting both the veterinarian and the horse. While the other options may be helpful, they are not the most critical safety precaution.

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Scenario: You are performing a rectal examination on a horse with colic. The horse begins to strain excessively.

Lead-in: Which of the following is the most appropriate immediate action to take?

Options:

a) Continue the examination quickly.
b) Remove your hand from the rectum immediately.
c) Administer 2% lidocaine per rectum.
d) Apply pressure to the horse’s flank.
e) Shout loudly to startle the horse.

Answer: c) Administer 2% lidocaine per rectum.

Explanation: Administering lidocaine per rectum can help reduce straining and allow you to complete the examination safely. 1 The other options are not appropriate or effective in this situation.

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Scenario: You have just finished performing a rectal examination on a horse with colic and notice blood on your glove.

Lead-in: Which of the following is the most appropriate next step?

Options:

a) Ignore the blood, as it is a common finding.
b) Inform the owner that a rectal tear has occurred.
c) Apply a pressure bandage to the rectum.
d) Administer antibiotics to prevent infection.
e) Flush the rectum with saline solution

Answer: b) Inform the owner that a rectal tear has occurred.

Explanation: It is essential to inform the owner immediately if you suspect a rectal tear, as further assessment and potential referral may be necessary.

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Scenario: You are passing a nasogastric tube in a horse with colic.

Lead-in: Which of the following confirms correct placement of the tube in the esophagus?

Options:

a) The horse coughs during tube placement.
b) The tube is visualized in the esophagus on the left side of the neck.
c) The horse swallows during tube placement.
d) No resistance is felt during tube passage.
e) The tube is easily advanced to the stomach

Answer: b) The tube is visualized in the esophagus on the left side of the neck.

Explanation: Visualizing the tube in the oesophagus is the most reliable way to confirm correct placement. The other options may be suggestive but are not definitive.

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Scenario: You are preparing to administer medication through a nasogastric tube.

Lead-in: Which of the following is NOT a suitable lubricant for nasogastric intubation?

Options:

a) Water
b) Liquid paraffin
c) KY Jelly
d) Surgex
e) Petroleum jelly

Answer: b) Liquid paraffin

Explanation: Liquid paraffin is not recommended for nasogastric intubation due to the risk of aspiration and potential complications.

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Scenario: A horse presents with colic and a heart rate of 80 bpm.

Lead-in: How would you classify the severity of this horse’s colic based on the heart rate alone?

Options:

a) Mild
b) Moderate
c) Severe
d) Critical
e) Cannot be determined from heart rate alone

Answer: b) Moderate

Moderate = 60-80bpm

Severe = >80bpm

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Scenario: A horse with colic has purple mucous membranes and a capillary refill time (CRT) of 3 seconds. Lead-in: What do these findings suggest? Options: a) Mild dehydration b) Normal hydration c) Poor peripheral perfusion d) Respiratory distress e) Hypertension

Answer: c) Poor peripheral perfusion Explanation: Purple mucous membranes and a prolonged CRT indicate poor circulation and possible endotoxemia.

Scenario: You are ausculting the abdomen of a horse with colic and hear no gut sounds in any of the four quadrants. Lead-in: What does this finding suggest? Options: a) Normal intestinal motility b) Hypermotility of the intestines c) Hypomotility of the intestines d) Complete intestinal stasis e) Spasmodic colic

Answer: d) Complete intestinal stasis Explanation: The absence of gut sounds in all quadrants indicates a lack of intestinal motility, which is a serious concern.

Scenario: A horse with colic has a rectal temperature of 39.5°C. Lead-in: What is the most likely cause of this elevated temperature? Options: a) Pain b) Dehydration c) Shock d) Infectious process e) Stress

Answer: d) Infectious process Explanation: While pain and stress can cause a mild elevation in temperature, a temperature of 39.5°C is more suggestive of an infectious or inflammatory condition.

Scenario: A horse with colic has a distended small intestine palpable on rectal examination and visible on ultrasound. Lead-in: Which of the following is the most likely cause of this finding? Options: a) Spasmodic colic b) Large colon impaction c) Small intestinal obstruction d) Gastric ulceration e) Colitis

Answer: c) Small intestinal obstruction Explanation: Distension of the small intestine indicates a blockage preventing the passage of ingesta, gas, or fluid.

Scenario: You are performing abdominocentesis on a horse with colic. The peritoneal fluid is serosanguinous with an elevated lactate concentration. Lead-in: What does this finding suggest? Options: a) Normal peritoneal fluid b) Mild intestinal inflammation c) Strangulating lesion d) Peritonitis e) Recent abdominal surgery

Answer: c) Strangulating lesion Explanation: Serosanguinous fluid with elevated lactate is indicative of intestinal ischemia and potential necrosis, consistent with a strangulating lesion.

Scenario: A horse with colic requires referral to a surgical facility. Lead-in: Which of the following is the most important factor to consider when preparing the horse for transport? Options: a) Administering a long-acting sedative b) Providing food and water c) Bandaging the horse's legs d) Applying a fly mask e) Clipping the horse's hair coat

Answer: a) Administering a long-acting sedative Explanation: Ensuring adequate sedation and analgesia for the duration of the journey is crucial for the horse's welfare during transport.

Scenario: A horse with a history of chronic laminitis presents with mild colic signs. Lead-in: Which of the following diagnostic approaches would be most appropriate in this case? Options: a) Treat the horse with analgesics and observe. b) Perform a rectal examination and nasogastric intubation. c) Refer the horse for immediate surgery. d) Consider non-intestinal causes of colic and investigate further. e) Euthanize the horse due to the poor prognosis associated with chronic laminitis.

Answer: d) Consider non-intestinal causes of colic and investigate further. Explanation: In horses with a history of chronic laminitis, it is essential to consider atypical causes of colic, such as peritonitis or renal disease, and perform a thorough diagnostic workup.

Scenario: A horse presents with severe colic signs that do not improve with analgesia. Lead-in: Which of the following is the most important immediate action to take? Options: a) Repeat the analgesic administration. b) Perform a rectal examination. c) Pass a nasogastric tube. d) Refer the horse to a surgical facility. e) Euthanize the horse.

Answer: d) Refer the horse to a surgical facility. Explanation: Severe, unrelenting pain despite analgesia is a critical sign that warrants immediate referral for further diagnostics and potential surgical intervention. Sources and related content

Scenario: A 3-year-old Thoroughbred filly presents with acute, severe colic. On examination, she is thrashing, her heart rate is 90 bpm, and her mucous membranes are injected. Rectal examination reveals a distended small intestine. Nasogastric intubation yields 10L of reflux. Lead-in: Which of the following is the most likely cause of this filly's colic, considering the need for rapid intervention? Options: a) Ileal impaction b) Small intestinal volvulus c) Pelvic flexure impaction d) Right dorsal colitis e) Enterolithiasis

Answer: b) Small intestinal volvulus Explanation: The severity of signs, distended small intestine, and large volume of reflux point towards a strangulating lesion like a volvulus. Volvulus requires immediate surgical intervention. Ileal impactions and pelvic flexure impactions are less likely to cause such acute, severe signs. Right dorsal colitis typically presents with thickening of the right dorsal colon wall, not small intestinal distension. Enterolithiasis is more common in older horses and may not produce this volume of reflux.

Scenario: A 15-year-old Quarter Horse gelding presents with a history of recurrent colic episodes. He is currently comfortable but has a heart rate of 60 bpm and abdominal distension. You perform abdominal auscultation. Lead-in: Which pattern of gut sounds would raise the most suspicion for a chronic intestinal adhesion? Options: a) Normal gut sounds in all quadrants b) Increased gut sounds in all quadrants c) Reduced gut sounds in all quadrants d) Absent gut sounds in the left dorsal and ventral quadrants e) Variable gut sounds with periods of hypermotility and hypomotility in the same location

Answer: e) Variable gut sounds with periods of hypermotility and hypomotility in the same location Explanation: Chronic adhesions can cause intermittent obstructions, leading to variable gut sounds depending on the degree of blockage. The other patterns are less specific for adhesions.

Scenario: A 5-year-old Warmblood mare presents with colic and is diagnosed with a nephrosplenic entrapment. The owner is concerned about the prognosis and asks for your advice. Lead-in: Which of the following factors would have the LEAST impact on the prognosis of this mare's condition? Options: a) Duration of entrapment before correction b) Presence of concurrent medical conditions c) Severity of pain before treatment d) Breed of the horse e) Experience of the surgeon performing the correction

Answer: d) Breed of the horse Explanation: While the other options can significantly influence the outcome of nephrosplenic entrapment, the breed of the horse has minimal impact on the prognosis.

Scenario: You are called to examine a horse with colic at a remote stable with limited facilities. The horse is in severe pain and has a heart rate of 85 bpm. You suspect a surgical lesion. Lead-in: In this situation, which of the following is the most appropriate course of action? Options: a) Perform emergency surgery in the field. b) Administer analgesics and refer the horse to a surgical facility. c) Attempt to correct the suspected lesion with medical management. d) Euthanize the horse due to the lack of available facilities. e) Leave the horse and return the next day with additional equipment.

Answer: b) Administer analgesics and refer the horse to a surgical facility. Explanation: Given the horse's condition and the limited facilities, the most appropriate action is to provide pain relief and refer the horse for appropriate surgical care.

Scenario: A horse presents with colic and is diagnosed with a large colon torsion. During surgery, a section of the colon is found to be non-viable. Lead-in: Which of the following intraoperative findings would be most indicative of non-viable bowel? Options: a) Pink/red color of the affected bowel b) Strong pulse in the mesenteric arteries c) Serosal surface is shiny d) Affected bowel is motile e) Green/black discoloration of the affected bowel

Answer: e) Green/black discoloration of the affected bowel Explanation: A green/black discoloration indicates severe ischemia and necrosis, confirming non-viable bowel. The other options describe characteristics of viable bowel.

Scenario: A horse undergoes successful colic surgery for a small intestinal strangulation. Lead-in: Which of the following post-operative complications is most likely to occur in this horse? Options: a) Incisional infection b) Post-operative ileus c) Laminitis d) Colic recurrence e) Pneumonia

Answer: b) Post-operative ileus Explanation: Post-operative ileus is a common complication following small intestinal surgery and requires careful monitoring and management. While the other complications are possible, they are less common than ileus. Sources and related content

Scenario: A 12-year-old Warmblood gelding presents with moderate colic signs. He is pawing, occasionally rolling, and has a heart rate of 65 bpm. Rectal examination reveals a large, doughy mass palpable in the pelvic flexure. No other abnormalities are detected. Lead-in: Based on these rectal findings, what is the most likely diagnosis? Options: a) Enterolith b) Nephrosplenic entrapment c) Pelvic flexure impaction d) Small intestinal volvulus e) Caecal impaction

Answer: c) Pelvic flexure impaction Explanation: A doughy mass in the pelvic flexure is characteristic of an impaction of the left colon at this site. Enteroliths are typically harder and more mineralized. Nephrosplenic entrapment would not be palpable in the pelvic flexure. Small intestinal volvulus is characterized by distension of the small intestine, not a focal impaction. Caecal impactions are usually located in the right paralumbar fossa.

Scenario: A 6-year-old Thoroughbred mare presents with acute, severe colic. She is rolling and thrashing, with a heart rate of 90 bpm. Rectal examination is difficult due to the mare's discomfort, but you feel a tense, distended structure in the left dorsal quadrant. Lead-in: Which of the following is the most likely cause of these findings, considering the clinical presentation? Options: a) Left dorsal displacement of the large colon b) Large colon volvulus c) Small intestinal obstruction d) Caecal torsion e) Sand impaction

Answer: b) Large colon volvulus The tense, distended structure in the left dorsal quadrant, combined with the acute, severe colic signs, suggests a large colon volvulus. Left dorsal displacement of the large colon would typically present with less severe signs. Small intestinal obstruction is characterized by distension of the small intestine, not the large colon. Caecal torsion is less common and may present with right-sided distension. Sand impaction would likely be palpable as a firm mass in the ventral colon.

Scenario: An 8-year-old pony mare presents with mild colic signs. She is restless and has reduced gut sounds. Rectal examination reveals a distended, gas-filled viscus that feels like a "bicycle inner tube." Lead-in: Based on these findings, what is the most likely diagnosis? Options: a) Small intestinal obstruction b) Large colon impaction c) Caecal tympany d) Uterine torsion e) Peritonitis

Answer: a) Small intestinal obstruction Explanation: The description of the distended, gas-filled viscus as feeling like a "bicycle inner tube" is characteristic of a small intestinal obstruction. Large colon impaction would typically present with a firmer, doughy mass. Caecal tympany would be localized to the right paralumbar fossa. Uterine torsion would not be gas-filled. Peritonitis does not usually cause distension of a single viscus. Sources and related content

Scenario: A 20-year-old Arab mare presents with a history of weight loss and intermittent colic. Rectal examination reveals a hard, rounded mass in the right dorsal colon. Lead-in: Based on these findings, what is the most likely diagnosis? Options: a) Sand impaction b) Enterolith c) Caecal impaction d) Right dorsal colitis e) Intussusception

Answer: b) Enterolith Explanation: A hard, rounded mass in the right dorsal colon of an older horse is highly suggestive of an enterolith. While sand impaction can also occur in the colon, it typically feels more like a diffuse accumulation rather than a discrete mass. The other options are less likely to produce this specific rectal finding.

Scenario: A 10-year-old Thoroughbred gelding presents with acute colic and marked abdominal distension. Rectal examination reveals a large, gas-distended structure in the right flank. Lead-in: Which of the following is the most likely cause of these findings? Options: a) Large colon volvulus b) Caecal torsion c) Small intestinal obstruction d) Nephrosplenic entrapment e) Right dorsal colitis

Answer: b) Caecal torsion Explanation: A large, gas-distended structure in the right flank is indicative of caecal torsion. Large colon volvulus typically presents with distension in the left dorsal quadrant. Small intestinal obstruction would involve distension of smaller diameter structures. Nephrosplenic entrapment does not cause right-sided distension. Right dorsal colitis usually presents with thickening of the colon wall, not marked gas distension.

Scenario: A 5-year-old Warmblood mare presents with mild colic signs. Rectal examination reveals a firm, painful band palpable in the left dorsal quadrant. Lead-in: Which of the following is the most likely cause of these findings? Options: a) Large colon impaction b) Small intestinal adhesion c) Mesenteric rent d) Inguinal hernia e) Omental lipoma

Answer: b) Small intestinal adhesion Explanation: A firm, painful band in the left dorsal quadrant is suggestive of a small intestinal adhesion. Adhesions can cause pain and partial obstruction. Large colon impaction would typically present as a doughy mass. Mesenteric rents, inguinal hernias, and omental lipomas are less likely to be palpable as a distinct band.

Scenario: A 14-year-old pony gelding presents with recurrent colic episodes. Rectal examination reveals a thickened, corrugated small intestine. Options: a) Inflammatory bowel disease b) Sand enteropathy c) Parascaris equorum infection d) Gastric ulceration e) Anterior enteritis

Answer: a) Inflammatory bowel disease Explanation: Thickening and corrugation of the small intestine are characteristic findings in inflammatory bowel disease (IBD). Sand enteropathy typically affects the colon. Parascaris equorum infection is more common in foals. Gastric ulceration and anterior enteritis do not usually cause these specific changes in the small intestine.

Scenario: A 7-year-old Standardbred mare presents with acute colic. Rectal examination reveals a distended small intestine and a large amount of free fluid in the abdomen. Lead-in: Which of the following is the most likely cause of these findings? Options: a) Simple intestinal obstruction b) Strangulating small intestinal lesion c) Large colon displacement d) Peritonitis e) Haemorrhage

Answer: b) Strangulating small intestinal lesion Explanation: The combination of distended small intestine and a large amount of free abdominal fluid suggests a strangulating lesion, such as a volvulus or incarceration. Simple obstruction would not typically cause this much free fluid. Large colon displacement does not usually involve the small intestine. Peritonitis can cause free fluid but not usually distension of the small intestine. Haemorrhage would cause free fluid but not distension unless there was concurrent intestinal compromise.

Scenario: A 10-year-old Quarter Horse gelding presents with acute onset colic. He is rolling and kicking at his abdomen. Heart rate is 70 bpm, and mucous membranes are pink with a CRT of 2 seconds. No reflux is obtained on nasogastric intubation. Rectal examination reveals a distended, gas-filled large colon. Lead-in: Based on these findings, what is the most likely diagnosis? Options: a) Large colon volvulus b) Large colon impaction c) Caecal torsion d) Small intestinal obstruction e) Nephrosplenic entrapment

Answer: a) Large colon volvulus Explanation: The presentation of acute colic with a distended, gas-filled large colon is most consistent with a large colon volvulus. Large colon impactions typically present with a doughy, rather than gas-filled, colon. Caecal torsion, small intestinal obstruction, and nephrosplenic entrapment are less likely to cause marked distension of the large colon.

Scenario: A 5-year-old Thoroughbred mare presents with a history of poor performance and intermittent colic. Gastroscopy reveals grade 2 squamous ulceration in the non-glandular region of the stomach. Lead-in: Which of the following treatment options is the most appropriate first-line therapy for this mare? Options: a) Omeprazole 4 mg/kg PO once daily b) Sucralfate 10-40 mg/kg PO three times daily c) Misoprostol 5 mcg/kg PO three times daily d) Prednisolone 1 mg/kg PO once daily e) Dexamethasone 0.05 mg/kg IV once daily

Answer: a) Omeprazole 4 mg/kg PO once daily Explanation: Omeprazole is the most appropriate first-line treatment for squamous ulceration in horses. It is a proton pump inhibitor that effectively reduces gastric acid secretion. Sucralfate and misoprostol can be used as adjunctive therapies but are not the primary treatment of choice. Corticosteroids are not indicated for the treatment of gastric ulcers.

Scenario: A 12-year-old Warmblood gelding presents with mild colic and a rectal temperature of 39°C. Abdominocentesis reveals a total nucleated cell count (TNCC) of 8 x 10^9 cells/L and a lactate concentration of 1.5 mmol/L. Lead-in: Which of the following is the most likely diagnosis? Options: a) Normal findings b) Mild colic with incidental pyrexia c) Peritonitis d) Colitis e) Pleuropneumonia

Answer: c) Peritonitis Explanation: The elevated rectal temperature, increased TNCC in the abdominal fluid, and mild colic signs are indicative of peritonitis. While colitis can also cause colic and pyrexia, it is less likely to result in a significantly elevated TNCC in the abdominal fluid. Pleuropneumonia would primarily cause respiratory signs

Scenario: A 7-year-old Thoroughbred mare presents with acute onset colic. She is sweating and has a heart rate of 80 bpm. Rectal examination reveals a distended small intestine and a large amount of free fluid in the abdomen. Lead-in: Which of the following is the most important immediate treatment for this mare? Options: a) Administer flunixin meglumine 1.1 mg/kg IV. b) Pass a nasogastric tube. c) Refer for surgical exploration. d) Administer oral fluids. e) Perform abdominocentesis.

Answer: c) Refer for surgical exploration. Explanation: The clinical signs and rectal findings suggest a strangulating small intestinal lesion, which requires immediate surgical intervention. While analgesia (flunixin meglumine) and decompression via nasogastric tube may be part of the initial management, referral for surgery is the priority. Oral fluids are contraindicated in horses with significant reflux or ileus. Abdominocentesis can be performed to further assess the abdominal fluid, but it should not delay referral.

Scenario: A 4-year-old Warmblood gelding presents with signs of choke. He has been fed a diet of mainly concentrates with limited access to forage. Lead-in: Which of the following diagnostic tests is most helpful in confirming the diagnosis and location of the esophageal obstruction? Options: a) Endoscopy b) Radiography with contrast c) Ultrasound d) Hematology and biochemistry e) Urinalysis

Answer: b) Radiography with contrast Explanation: Radiography with contrast (barium) is the most reliable method for confirming esophageal obstruction and identifying the location of the blockage. 1 Endoscopy can be helpful in some cases but may not be able to visualize the obstruction if it is located in the distal esophagus

Scenario: A 15-year-old pony mare is presented for chronic weight loss, inappetence, and difficulty prehending food. Clinical examination reveals ptosis, muscle fasciculations, and decreased borborygmi. Lead-in: Which of the following diagnostic tests would be most helpful in confirming the most likely diagnosis? Options: a) Rectal biopsy b) Gastroscopy c) Abdominal ultrasound d) Phenylephrine eye test e) Oral glucose absorption test

Answer: a) Rectal biopsy Explanation: The clinical signs are suggestive of equine grass sickness, a dysautonomia primarily affecting the gastrointestinal tract. A rectal biopsy is a useful diagnostic test for confirming grass sickness, as it can reveal characteristic histopathological changes in the enteric nervous system.

Scenario: A horse with colic is being treated with intravenous fluids. Blood work reveals hypokalemia and hypomagnesemia. Lead-in: Which of the following is the most likely cause of these electrolyte abnormalities? Options: a) The horse has been receiving Hartmann's solution. b) The horse has been receiving hypertonic saline. c) The horse has been receiving oral fluids. d) The horse has been receiving potassium penicillin. e) The horse has been receiving magnesium sulfate.

Answer: a) The horse has been receiving Hartmann's solution. Explanation: Hartmann's solution is a balanced electrolyte solution, but it does not contain potassium or magnesium. In horses that are not eating, these electrolytes can become depleted, especially with ongoing fluid therapy.

Scenario: A horse recovering from colic surgery develops jugular vein thrombophlebitis. Lead-in: Which of the following treatment options would be the most appropriate first-line therapy for this complication? Options: a) Intravenous heparin b) Oral aspirin c) Topical DMSO d) Surgical removal of the thrombus e) No treatment necessary

Answer: a) Intravenous heparin Explanation: Heparin is an anticoagulant that can help prevent further clot formation and promote resolution of the existing thrombus. Aspirin and DMSO can be used as adjunctive therapies, but heparin is the most effective first-line treatment. Surgical removal of the thrombus is rarely performed.

Scenario: A critically ill horse with colitis is showing signs of systemic inflammatory response syndrome (SIRS). Lead-in: Which of the following clinical signs is NOT typically associated with SIRS in horses? Options: a) Tachycardia b) Hyperthermia c) Bradycardia d) Tachypnea e) Leukopenia

Answer: c) Bradycardia Explanation: SIRS is characterized by an inflammatory response that often leads to tachycardia, hyperthermia, tachypnea, and leukopenia. Bradycardia is not a typical feature of SIRS.

Scenario: A horse with a history of choke is presented for evaluation of recurrent esophageal obstruction. Lead-in: Which of the following is the most likely complication of choke that can lead to recurrent obstruction? Options: a) Esophageal stricture b) Aspiration pneumonia c) Esophageal rupture d) Megaesophagus e) Diverticula

Answer: a) Esophageal stricture Explanation: Esophageal stricture, or narrowing of the esophagus, is a common complication of choke that can predispose the horse to recurrent episodes of obstruction. While the other options are also potential complications of choke, they are less likely to directly cause recurrent obstruction.

Scenario: A horse is diagnosed with peritonitis secondary to a ruptured small intestine. Lead-in: Which of the following antimicrobial choices is the most appropriate for treating this condition? Options: a) Penicillin and gentamicin b) Ceftiofur c) Trimethoprim sulfadiazine d) Oxytetracycline e) Metronidazole

Answer: a) Penicillin and gentamicin Explanation: Penicillin and gentamicin provide broad-spectrum coverage against the bacteria commonly involved in gastrointestinal infections, including those associated with peritonitis.

Scenario: A horse with severe colic is being treated with high doses of flunixin meglumine. Lead-in: Which of the following side effects is most likely to occur with long-term or high-dose flunixin administration? Options: a) Renal papillary necrosis b) Hepatotoxicity c) Gastric ulceration d) Coagulopathies e) Hypotension

Answer: a) Renal papillary necrosis Explanation: Flunixin meglumine is a non-narcotic analgesic with potential side effects, including renal papillary necrosis and gastric ulceration, especially with prolonged or high-dose use. Sources and related content

Scenario: A 5-year-old Warmblood mare presents with acute onset, profuse watery diarrhea. She is tachycardic and tachypneic, with injected mucous membranes and a prolonged capillary refill time. Lead-in: Which of the following clinicopathological findings would be most consistent with this mare's presentation? a) Normal packed cell volume (PCV), normal total protein (TPP), and normal lactate b) Increased PCV, increased TPP, and increased lactate c) Decreased PCV, decreased TPP, and increased lactate d) Increased PCV, decreased TPP, and increased lactate e) Decreased PCV, increased TPP, and normal lactate

Answer: b) Increased PCV, increased TPP, and increased lactate Explanation: This mare is showing signs of hypovolemic shock due to the severe, acute diarrhea. This typically results in hemoconcentration (increased PCV and TPP) and poor tissue perfusion (increased lactate).

Scenario: A 10-year-old Thoroughbred gelding presents with chronic diarrhea and weight loss. He has a history of being treated with high doses of phenylbutazone for several months. Lead-in: Which of the following diagnostic tests would be most helpful in confirming the most likely cause of this gelding's diarrhea? Options: a) Faecal egg count b) Faecal PCR for Salmonella c) Abdominal ultrasound d) Rectal biopsy e) Oral glucose absorption test

Answer: c) Abdominal ultrasound Explanation: The history of high-dose phenylbutazone suggests right dorsal colitis (RDC) as the most likely cause of this gelding's diarrhea. Abdominal ultrasound is the most useful diagnostic test for RDC, as it can reveal characteristic thickening of the right dorsal colon wall.

Scenario: A 3-year-old Quarter Horse gelding presents with acute colic and diarrhea. He is housed on a sandy pasture and has a history of being fed on the ground. Lead-in: Which of the following is the most likely cause of this gelding's clinical signs? Options: a) Sand enteropathy b) Cyathostomiasis c) Coronavirus infection d) Antimicrobial-associated diarrhea e) Grain overload

Answer: a) Sand enteropathy Explanation: The signalment, clinical signs, and history of being housed on a sandy pasture and fed on the ground are highly suggestive of sand enteropathy.

Scenario: A 2-year-old cob gelding presents with acute onset, watery diarrhea. He is pyrexic and has a heart rate of 70 bpm. Lead-in: Which of the following is the most likely cause of this gelding's diarrhea? Options: a) Salmonella infection b) Clostridium difficile infection c) Cyathostomiasis d) Right dorsal colitis e) Sand enteropathy

Answer: a) Salmonella infection Explanation: Salmonella infection is a common cause of acute, febrile diarrhea in young horses. The other options are less likely to cause pyrexia.

Scenario: A foal is diagnosed with Clostridium perfringens type C enteritis. Lead-in: Which of the following clinical signs would be most consistent with this diagnosis? Options: a) Mild, self-limiting diarrhea b) Hemorrhagic diarrhea c) Chronic weight loss d) Respiratory distress e) Neurological signs

Answer: b) Hemorrhagic diarrhea Explanation: Clostridium perfringens type C produces toxins that can cause severe intestinal damage and hemorrhagic diarrhea in foals.

Scenario: A 15-year-old Arabian mare presents with chronic diarrhea and ventral edema. Abdominal ultrasound reveals thickening of the small intestinal wall. Lead-in: Which of the following is the most likely cause of these findings? Options: a) Granulomatous enteritis b) Sand enteropathy c) Lawsonia intracellularis infection d) Cyathostomiasis e) Right dorsal colitis

Answer: a) Granulomatous enteritis Explanation: Granulomatous enteritis, a form of inflammatory bowel disease (IBD), can cause chronic diarrhea, ventral edema, and thickening of the small intestinal wall. The other options are less likely to cause these specific findings.

Scenario: A foal is diagnosed with Rhodococcus equi diarrhea. Lead-in: Which of the following antimicrobial choices is the most appropriate for treating this condition? Options: a) Erythromycin b) Penicillin c) Gentamicin d) Metronidazole e) Oxytetracycline

Answer: a) Erythromycin Explanation: Erythromycin is a macrolide antibiotic that is effective against Rhodococcus equi.

Scenario: A 10-year-old Warmblood gelding presents with acute onset colic and diarrhea. He has a history of being treated with high doses of phenylbutazone for several months. Lead-in: Which of the following treatment options would be contraindicated in this case? Options: a) Intravenous fluid therapy b) Flunixin meglumine 1.1 mg/kg IV c) Oral psyllium d) Misoprostol e) Doxycycline

Answer: b) Flunixin meglumine 1.1 mg/kg IV Explanation: Flunixin meglumine is an NSAID, and its use would be contraindicated in this case as NSAIDs are a potential cause of right dorsal colitis, which is the most likely diagnosis given the horse's history and clinical signs.

Scenario: A 5-year-old Thoroughbred mare presents with chronic diarrhea and weight loss. Rectal biopsy reveals granulomatous inflammation in the intestinal mucosa. Lead-in: Which of the following treatment options is the most appropriate for this mare? Options: a) Oral prednisolone b) Intravenous prednisolone c) Intramuscular prednisolone d) Oral methylprednisolone e) Oral Flunixin

Answer: a) Oral prednisolone Explanation: Oral prednisolone is a corticosteroid commonly used in the management of inflammatory bowel disease (IBD) in horses.

Scenario: A 3-month-old foal presents with diarrhea and is diagnosed with Lawsonia intracellularis infection. Lead-in: Which of the following treatment options is the most appropriate for this foal? Options: a) Oral doxycycline b) Intravenous gentamicin c) Oral metronidazole d) Moxidectin e) Psyllium

Answer: a) Oral doxycycline Explanation: Doxycycline is a tetracycline antibiotic that is effective against Lawsonia intracellularis.

Scenario: A 12-year-old pony mare presents with chronic diarrhea and weight loss. Abdominal radiographs reveal a large amount of sand in the colon. Lead-in: Which of the following treatment options is the most appropriate for this mare? Options: a) Oral psyllium and magnesium sulfate b) Intravenous fluid therapy c) Oral prednisolone d) Moxidectin e) Misoprostol

Answer: a) Oral psyllium and magnesium sulfate Explanation: Oral psyllium and magnesium sulfate are commonly used to treat sand enteropathy in horses.

Scenario: A 7-year-old Warmblood gelding presents with acute onset colic and diarrhea. He is housed on a pasture with lush green grass. Lead-in: Which of the following is the most likely cause of this gelding's clinical signs? Options: a) Grain overload b) Cyathostomiasis c) Coronavirus infection d) Antimicrobial-associated diarrhea e) Dietary imbalance

Answer: e) Dietary imbalance Explanation: The sudden introduction of lush green grass can disrupt the normal balance of the intestinal microflora and lead to colic and diarrhea in horses.

Scenario: A 6-month-old foal presents with a 1-week history of watery diarrhea, weight loss, and ventral edema. The foal is bright and alert but has a poor appetite. Blood work reveals hypoalbuminemia and hypoglobulinemia. Abdominal ultrasound shows thickening of the small intestinal wall. Lead-in: Which of the following is the most likely cause of this foal's diarrhea? Options: a) Lawsonia intracellularis infection b) Rotavirus infection c) Foal heat diarrhea d) Sand enteropathy e) Meconium impaction

Answer: a) Lawsonia intracellularis infection Explanation: Lawsonia intracellularis is a common cause of chronic diarrhea in foals, typically between 2 and 8 months of age. The clinical signs, blood work, and ultrasound findings are all consistent with this diagnosis. Rotavirus and foal heat diarrhea are more common in younger foals. Sand enteropathy is less likely in a foal that has not been grazing for an extended period. Meconium impaction typically causes diarrhea in the first few days of life.

Scenario: An 8-year-old Standardbred gelding presents with acute onset, profuse diarrhea. He is febrile (39.5°C) and has a heart rate of 75 bpm. He shows signs of colic. Lead-in: Which of the following diagnostic findings would be LEAST suggestive of an infectious cause for this gelding's diarrhea? Options: a) Leukopenia on a complete blood count b) Elevated serum amyloid A (SAA) concentration c) Thickening of the right dorsal colon on abdominal ultrasound d) Positive faecal PCR for Salmonella e) Elevated lactate concentration

Answer: c) Thickening of the right dorsal colon on abdominal ultrasound Explanation: Thickening of the right dorsal colon is a classic finding in right dorsal colitis, which is often caused by non-steroidal anti-inflammatory drug (NSAID) toxicity. The other findings are more suggestive of an infectious process.