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Equine Year 4 > GI > Flashcards

GI Flashcards

1
Q

ddx of recurrent colic

A 
colon displacement 
impaction 
adhesions
gastric ulceration 
chronic grass sickness
IBD
INtra-abdominal abscess
Cholelithiasis
ileal hypertrophy 
uterine torsion 
neoplasia
tapeworm
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2
Q

ddx weight loss in horses

A
  • Dental disorders
  • Parasitism
  • Inadequate diet
  • PPID
  • Liver disease
  • Malabsorption and protein losing enteropathy
  • Chronic diarrhoea
  • Abdominal abscess
  • Renal disease
  • Cardiac disease
  • Chronic thoracic disease
  • Non GI neoplasia
  • Equine grass sickness
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3
Q

definition of chronic colic

A

colic signs are visible for over 48 hours

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4
Q

definition of recurrent colic

A

shorter period of colic pain which recur at variable intervals

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5
Q

what would the following blood results suggest about GI disease

  • hypoalbuminaemia
  • hypoglobulinaemia
  • hypergloninaemia
  • hyperfibrinogenaemia
  • serum amyloid A
  • total protein
A

Total protein- decrease could be masked by concurrent dehydration
Hypoalbuminaemia- GI loss, effusions, liver disease (rarely a cause)
Hypoglobulinaemia- GI loss
Hyperglobulinaemia- chornic inflammarory diease
Hyperfibrinogenaemia- infection, inflammation, neoplasia
Serum amyloid A- acute phase protein, acute marker

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6
Q

Oral Glucose Absorption Test

  • how is it conducted
  • what does it show
A

1) fast overnight 2)1mg/kg in 20% solution via nasogastric tube 3)take glucose concentration in blood after 2 hours

>85% = normal 
15-85%  = partial, SI, LI disease or normal intestine 
<15%= complete, SI disease
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7
Q

what pathology does inflammatory infiltrative bowel disease cause?
is the aetiology known?
treatments?

A

granulomatous enteritis, lymphocytic-plasmacytic enteritis, eosinophilic enterisi
»>presence of inflammatory cells in intestinal wall&raquo_space;> malabsopriton and protein loss

unknown aet

non specific :give steroids in am as work better: prednisolone, dexamethasone, anthelmintcs
- variable effectiveness

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8
Q

what are the clinical signs of equine lymphoma and how would you treat

A

fever
weight loss
peritonitis
pleural effusion
abdominal distension
intra-abdominal mass palpable per rectum
hypercalceamia/haemolyiss/ cachexia of malignancy

Tx: steroids- treats asscociated inflammafion

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9
Q

how is Equine Gastric Ulcer Syndrome divided?

clinical signs?

A

EGUS a) unknown risk factors b) related to acid injury (squamous portion of stomach damaged)

Subtle: weight-loss, poor performance, selective appetite, slow eating, roughage preference to grain, bad behaviour, girthy? Overt colic signs unlikely

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10
Q

Equine Gastric Ulcer Syndrome

  • diagnosis
  • treatment
A

Diagnsis: gastroscopy 3m endoscope

Grading squamous ulceration.
1- inflammation, 2- ulcer present 3- crater, grade 4- haemorrhagic

Tx: omeprazole (proton pump inhibitor) 2mg/kg for 3-4 weeks, reduce exposure to risk factors

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11
Q

Clinical signs of hepatobiliary disease in horses

A

o Jaundice – retention of bilirubin
o Weight loss
o Depression/ CNS signs
o Photosensitation – phylloerythrin accumulation
o Haemorrhae
o Colic
o Oedema- rarely due to hypoalbuminaemia
o Diarrhoea
o Dyspnoea- usually ragwort or laryngeal paralysis
o Anorexia

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12
Q

Ddx hepatobiliary disease in horses

A

Ragwort poisoning

Cholangioheptatitis

Hepatitis: acute and chronic

Hyperlipidaemia

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13
Q

what blood tests can be done to assess hepatobiliary function in horses

A

Liver enzymes
GGT- liver and pancreas specific, also hepatocellular dx, sustained levels over month
AST- not organ specific, also from muscle
SDH- hepatocellular, acute enzyme
ALK
GLDH

Bilirubin and bile acids
Hyperbilirubinaemia is difficult to interpret. Increase conjugated portion. likely hepatocellular or cholestasis
Bile acids: good liver function test. Secreted continuously so no need to fast. Correlates with severity

Other
Ammonia: failure of gut detoxoification
Clotting times
Triglycerides

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14
Q

what test gives the best prognosis of liver disease in horses?

A

liver biopsy

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15
Q

which plant is Senecio jacobaea and how does it affect horses?

A

Ragwort: Worse if dried in hay.
Pyrrolizidine alkaloid toxicity

Clinical signs
phase 1: weight loss, inappetence et,
phase 2: neurological/ behaviours change(aggression) + anorexia dominant

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16
Q

how could you diagnose and treat ragwort poisoning in horses?

A

From history and clinical signs. GGT levels indicative.
- Alkaloid measurement should be available soon to test.

Tx: supportive reduce hepatic encephalopathy: neomycin, metronidazole

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17
Q

Cholangiohepatitis and cholelithiasis

cause, clinical signs, dx and tx

A

ascending bile duct infection form GIT–> bile duct inflammation

fever, jaundice and colic

ultrasound: can see calculi, elevated GTT, biopsy and histo useful for culture.

antibiotics, good prognosis

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18
Q

give causes and clinical signs of

  • chronic active hepatitis
  • acute hepatitis
A

chronic: Aet: any progressive inflammatory hepatitis, low grade, low level inappetence etc
Diag: biopsy: may indicated plasmicytic-lymphocytic immune mediated condition
Tx: corticosteroids +/- other immunosppressibve medications eg azathioprine

active: theilers diease (viral infection), parvovirus, hepacivirus, alfatoxins, liver fluke
CS: mild to severe CNS, jaundice and discoloured urine

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19
Q

what are risk factors for hyperlipidaemia?

A 
Ponies
Obese
Female
Lactation
Starvation

Age
Underlying disease
Transport stress
Lactation 
Insulin sensitivity
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20
Q

How does hyperlipidaemia occur and how can it be diagnosed/treated

A

negative energy balance> fatty deposits mobilised> fatty acids/ triglycerides accumulates in liver

dx: cloudy serum: Hyperlipidaemia= TG’s<5 but>1.5

  • IMPORTANT TO DIFFERENTIATE
    hyperlipaemia= TG>5mmol/l

Tx: positive energy balance, correct dehydration, normalise lipid metabolism

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21
Q

Give risk factors for the following types of colics

Pedunculated lipoma

Large colon volvulus

Large colon impaction

Epiploic foramen entrapment

A

P. lipoma: Older horses and ponies , Ponies» horses, Geldings» mares , SI most common site

LC volvulus: Mares post foaling, Larger horses, Increased stabling, Dental disease, Feed changes

LC impaction: Autumn winter cold weather, Box rest, Straw bedding- eat it Good prognosis

EFE: Seasonal Dev, Jan, feb, Crib biting/ wind sucking behaviour

22
Q

Equine Grass Sickness (equine dysautonomia)

A

Aet: Clostridium botulinum type C

Path: polyneuropathy, neurologically degeneration

Clin signs:
o Acute: colic, reflux, tachycardia, SI distension, sweating, salivation, dysphagia, ptosis
o Chronic: weight loss, dysphagia, tachycardia, patchy sweating, muscle fasiculation, rhinitis sicca, elephant on a barrel stance

Diagnosis: clinical signs and histology: ileal biopsy, PME

Treatment: possible vaccine :

Epidemiology:
Spring, April/may. Previous infections increases risk of reinfection. Young horses 2-7 yrs. Also peak in autumn. Horses at pasture.

23
Q

Indications for medical treatment of colic

A 
Mild-moderate pain	
Good response to analgesia 
HR<50bpm
GI motility continuing/ improving
No net reflux
Resolving/ no abdominal distension
Normal peritoneal fluid
Normal PCV/ TP and systemic lactate
24
Q

When should you never use flunixin meglumine in colic cases?

A

in acute/ mod cases where cause is unknown-

could mask more serious issue as v strong pain killer.

can also mask increase in HR associated with SIRS

25
List 3 NSAIDs you may use to treat medical colic
Metimazole= the NSAID component of buscopan Phenylbutazone= equipalazone, - Moderate potency, good first line analgesic Hetoprofen: - moderate to strong potency flunixin- if cause known and just relieving pain whilst other action is being planned.
26
when may alpha 2 agonists be useful in managing medical colic name 3 used
Xylazine: Quick onset and short acting up to 30 mins, very potent. Good for use in examination. Romifidine - Around 2-4 hours analgesia, usually combined with butorphanol - IM ,useful in colic cases showing moderate- severe pain, can use in combination with phenylbutazone Detomidine - 2-4 hours. Combined with butorphanol
27
which opiate can be used to treat medical colic, and is often used with on its own or with alpa 2 agonist
Butorphanol
28
Which drug may be indicated for mild- moderate spasmodic colic
Buscopan a) Butylscopolamine: smooth muscle relaxant b) metamizole: NSAID for additional analgesic. It is used to treat spasmodic colic in horses and can reduce the risk of a rectal tear.
29
Treatment for pelvic flexure impaction (Ingesta collects at narrowing at pelvic flexure+ reabsorption of water in colon pain of contracting colon and ingesta wont move)
Oral fluid therapy until faeces passed, +/- Epsom salts. - No evidence of liquid paraffin is of use. - IV fluid not as useful Surgery
30
Treatment for Nephrosplenic entrapment Left Colon Lodged between spleen and left kidney. Warmblood/ large horse
Medical: CV parameters are normal, not severe pain, marked gaseous distention of large colon is absent - Analgesia PBZ/ alpha 2 agonist - Phenylephrine: administered of 15 mins (to reduce size of spleen), horse lunged for 10 mins see if LC has repositioned. *RISK OF HAEMORRHAGE IN TEENAGE+ HORSES* Diagnosis: ultrasound – gas filled intestine seen where should see spleen and kidney
31
Treatment for large colon distention/ other displacements
Medical therapy indicated initially+ light exercise can be helpful Surgery if severe and worsen pain, deteriorating CV parameters
32
Treatment for sand colic Ingesting sand from soil/ sandstone areas Path: irritates colon and can twist and cause a torsion. Can thicken mucosa. Sand impaction. Cs: mild to moderate abdominal pain, weight loss, sand in faeces
Diag: can see sand on radiograph Mild case: remove source of sand, provide forage, psyliium into feed Medical Tx: magnesium sulphate and psyllium, Surgical: removal of sand at enterotomy if causing impaction/ colon torsion
33
Meconium retention in neonatal foals
Soapy water/ commercial phosphate or acetylcysteine retention enema- foley catheter Sedate foal and keep HQ elevated for 30 mins
34
what should the owner do after the vet has medically treated a colic?
Remove feed and leave water with the horse Ask owner for update within 2hours, sooner if deteriorates If horse responds to treatment: offer small amounts of food until back to normal over 24 hour
35
Colic- euthanasia indications
Uncontrollable pain despite analgesia Severe CV compromise o HR> 90bpm o PCV>60% o Purple mucous membranes Gastrointestinal rupture o Brown/ red ingesta contaminated peritoneal fluid o Profuse sweating, sudden reduction in pain Note: insurance company may not cover cost of horse if euthanasia chosen instead of surgery
36
Indicators for surgical management of colic
``` o Severe, unrelenting pain o Recurrence of pain despite moderate – potent analgesia o HR >60bpm o Net reflux >2L o Deteriorating CV parameters o Reduced intestinal motility o Increased abdominal distension o Deteriorating peritoneal fluid values ```
37
common surgical colics
Pedunculated lipoma Epiploic foramen entrapment Large colon displacements Large colon torsion
38
Most colic surgery is done via midline laparotomy in dorsal recumbency - which structures cannot be exteriorised in this position?
Stomach Duodenum Base caecum / terminal part of ileum Parts of right ventral and dorsal colons Transverse colon Very proximal and distal parts of small colon Rectum
39
Post colic surgery care
Place into a stable Place a belly bandage Colic checks (usually q.4h) o Observation: attitude/ signs of pain, defacation/ urination o Clin exam: TPR, GIT sounds, digital pulses, PCV/TP, incision checked, catheters site checked o Pain scoring Confirm medication  Antimicrobials: depends on procedure, penicillin/ gentamicin 72 hours  Analgesia: flunicin meglumine most commonly used: NOTE IF PAIN CONTINUING OR INCREASING RELAPAROTOMY SHOULD BE CONCSIDERED  Other medications e.g. lidocaine infusion / other prokinetics Oral or IV fluids  Crystalloids +/- colloids, plasma for CV support Nasogastric intubation Walks to grass (if can eat) Nutrition: initial
40
Name some colic surgery complications
Gastric rupture: gastric lavage/ decompression may be required Post Operative Reflux (POR): Risk factors: increased HR/ PCV, SI lesions, intestinal ischaemia, intestinal resection Post operative colic (POC) – most episodes respond to medical therapy. Aet unknown. More common in RDD,LDD, EFE colic types. Surgical site infection Reperfusion injury Anastomoses
41
Choke in horses
Oesophageal obstruction: compacted food in oesophagus - Sugar beet nuts can swell once ingested and enter mouth, cause blockage CS: coughing, ptyalism, dysphagia, repeated flexion and extension of neck. Distressing. Food evidence at mouth and nostrils Tx: most episodes will clear spontaneous. Take food and water away. If no improvement within 30 mins, needs further invegstigation. If does resolve, give water but withhold food for 1-2 hours and start with sloppy feeds/ grass. Important to resolve any underlying dental issues. Sedate: alpha 2 agonist +/- butorophanol, +/- butylscopalmine- helps keep horse calm and lower the head. Helps reduce amount inspirated . +/- oxyctocin. Pass a nasogastric tube – lavage with warm water, repeat lavage until obstructed material all removed and stomach tube cn be passed into the stomach Aftercare: antibiotics for inhalation pneumonia? Reintroduce feed over 24- 28 hours . monitor for nasal discharge/ coughing/ dullness Endoscopic evaluation should be performed if 2 or more episodes of choke occur or if obstruction can not be cleared +/- oesophageal surgery. Should be avoided if poss.
42
Carbohydrate overload
ingestion of large amount of grain/ concentrate feed intestinal bacteria fermentation and absorption of endotoxins>colic and severe abdominal distension> SIRS, laminitis, diarrhoea +/- death tx: early: lavage contents, activated charcoal, flunixin, cryotherapy to prevent laminitis once SIRS: referral, poor PGx
43
List some causes of dysphagia in horses
Pain: abscess, strangles, dental issue, foreign body, masseter myositis, atipical myopathy Neurogenic: head trauma, guttual pouch disease, pharyngeal paralysisi, lead posioning, botulism, Obstructive: FB or neoplasia
44
how would you diagnose neurological dysphagia in horse
determine phase, neurological assessment- cranial nerves, +/- intra-oral examination - Oral phase - Pharyngeal phase - Oesophageal phase Imaging, haematology,
45
what causes rectal prolapse and how might they be treated?
Aet: diarrhoea, colic, parasite (heavy burden) proctitis/ mass in the rectum, repeated straining eg retained fetal membranes Uncommon Graded I, II, III= reduced prolapsed tissue, address underlying cause Grade IV= surgical management
46
Ddx of haemoabdomen
secondary to abdominal trauma, splenic rupture/ tear, uterine tear, following partiurition- rupture of middle uterine artery
47
Causes/ types of hernias in horses?
Body wall hernias: can result in colic if intestine entrapped Incisional hernias: uncommon, following colic surgery (laparotomy). Prolonged box rest, hernia belt. Surgical repair 4-6 months after surgery – prosthetic mesh placement Thoracic wall injury
48
Which parasites most likely to affect foals
Parascaris equorum/ univalens - Most common cause of parasitic colic in foals. Larvae also cause respiratory disease - Develop immunity Strongyles - Autumn winter moxidectin treatment Tapeworm: A. perfoliata
49
Which parasites most likely to affect young stock (1-3,5 years)
Most at risk of larval cyathosominosis V important to keep pasture clear in this age group. - Risk in autumn winter - Autumn: Moxidectin and praziquantel given to treat cyathostomes Tapeworm: A. perfoliata
50
Which parasites most likely to affect adult horses
Lowest risk of disease due to equine parasites as developed immunity. Test and treat only is ideal. Tapeworm: A. perfoliata
51
list anthelmintics used in horses
Fenbendazole Pyrantel Ivermectin Moxidectin

Equine Year 4 (10 decks)

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