Gastrointestinal Disease of the Horse Part II

Question 1

what percent of dehydration is clinically detectable?

Answer 1

only 5% and above

Question 2

what can you use to evaluate hypoperfusion in laboratory tests?

Answer 2

lactate
creatinine
PCV/TS
urine specific gravity
cardiac filling pressure
blood pressure

Question 3

what is elevated lactate?

Answer 3

> 2 mmol/L

Question 4

what can cause marked hyperlactatemia (>4mmol/L)?

Answer 4

hypoperfusion
severe hypoxemia
severe anemia
can happen in absence of tissue hypoxia

Question 5

in whom is PCV/TS potentially a poor indicator of circulatory status?

Answer 5

foals

Question 6

what is the range of urine specific gravity in adult horses?

Answer 6

1.020-1.050

Question 7

what can cause spurious hypercreatinemia?

Answer 7

placental dysfunction
perinatal asphyxia

Question 8

what is perinatal asphyxia?

Answer 8

swallowing of fetal fluids
happens if under fetal distress

Question 9

in whom is central venous or cardiac filling pressure useful for?

Answer 9

most for neonates
need a central line

Question 10

a central venous pressure < ___________ may indicate a need for increased fluid therapy

Answer 10

2 cmH2O

Question 11

what is the goal for central venous pressure of resuscitation?

Answer 11

8-12 cmH2O

Question 12

what fluid rate is used for adults after resuscitation?

Answer 12

50-75 ml/kg/day

Question 13

when are oral fluids better than intravenous fluids?

Answer 13

treatment of large colon disease
following water deprivation

Question 14

does glucose and temperature of gastrointestinal fluid absorption matter?

Answer 14

minimal effect

Question 15

are chronic colics commonly cardiovascularly stable?

Answer 15

yes

Question 16

how common is equine gastric ulcer syndrome in adults?

Answer 16

80-90% active racehorses
up to 60% other performance horses

Question 17

how long should you fast a horse before gastroscopy?

Answer 17

12-18 hours

Question 18

what might a gastroscopy for equine gastric ulcer syndrome underestimate?

Answer 18

extent of gastric ulcers
severity or depth of squamous ulcers
may miss glandular or duodenal gastric ulcers

Question 19

how does sucralfate work?

Answer 19

reacts with HCl: acid buffer
binds to proteins: protective barrier
absorbs bile acids
increases prostaglandin E

Question 20

why are fresians thought to present with progressive dilation of the stomach?

Answer 20

primary neurological or structural dysfunction suspected

Question 21

how can stomach impaction be diagnosed?

Answer 21

ultrasound
endoscopy
surgery potentially

Question 22

what can be found on physical exam with peritonitis?

Answer 22

fever

Question 23

what are the causes of peritonitis?

Answer 23

diagnostic complications
surgical complications
primary gastrointestinal disorders

Question 24

how can you treat peritonitis?

Answer 24

eliminate cause
antimicrobials
analgesia
supportive care

Question 25

what indicates moderate/8-10% dehydration?

Answer 25

weak pulses, CRT>3s poor jugular distention moderately increased heart rate

Question 26

what can cause increased lactate in the absence of tissue hypoxia?

Answer 26

increased primary lactate production cytokine inhibition of pyruvate dehydrogenase relative thiamine deficiency decreased utilization/clearance of lactate by liver

Question 27

what should you put PCV/TS into context with?

Answer 27

urine output and USG

Question 28

what is normal USG in foals?

Answer 28

first 2 samples postpartum: 1.035-1.025 within 24 hours: <1.008

Question 29

what can cause elevated creatinine?

Answer 29

hypovolemia/dehydration renal disease reduced renal clearance in premature foals spurious hypercreatinemia

Question 30

how much can you bolus?

Answer 30

20 ml/kg over 30-60 mins

Question 31

what fluid rate is used for post-resuscitation in adults?

Answer 31

50-75 ml/kg/day

Question 32

what are the endpoints to resuscitation?

Answer 32

CVP 8-12 cmH2O blood lactate <2mmol/L normal acid-base urine output >0.5-1 ml/kg/hr improvement of clinical variables

Question 33

what has significant effects on GI fluid absorption?

Answer 33

tonicity: hypertonic slow

Question 34

where can ulceration occur?

Answer 34

terminal esophagus proximal/squamous stomach distal/glandular stomach proximal duodenum

Question 35

what are the signs of ulcers in adults?

Answer 35

poor appetite, recurrent colic, poor BCS change in attitude, dullness, poor performance, stiffness asymptomatic

Question 36

what blood test can you use for ulcers?

Answer 36

succeed equine fecal blood test

Question 37

what parts of the stomach should you examine in gastroscopy?

Answer 37

squamous margo plicatus glandular pyloric antrum

Question 38

what is a grade IV for equine gastric ulcer syndrome?

Answer 38

extensive lesions with areas of deep ulceration

Question 39

what is the mucosal protection like in the squamous and glandular portions of the stomach?

Answer 39

squamous: minimal intrinsic resistance to peptic injury glandular: mucous/bicarbonate layer, prostaglandins, nitric oxide regulates mucosal blood flow

Question 40

how can you treat equine gastric ulcer syndrome?

Answer 40

proton pump inhibitors: omeprazole histamine type-2 receptor antagonists antacids protectants

Question 41

what are the risk factors for stomach impactions?

Answer 41

excessive dry, fibrous ingesta feeds that tend to swell after ingestion dental disease friesian breed

Question 42

what are the clinical signs with stomach impaction?

Answer 42

acute and severe to chronic and mild anorexia uncontrollable colic unresponsive to therapy

Question 43

where can you image the greater curvature of the stomach with ultrasound?

Answer 43

left side 9-12th ICS

Question 44

what is abdominocentesis like with peritonitis?

Answer 44

elevated WBC elevated protein elevated lactate