GI Flashcards
What are the most commonly used NSAID in post-operative colic patient ?
And what are the 3 most important factors to consider for NSAID discontinuation ?
Flunixin and phenylbutazone
Important factor to consider when deciding the timepoint for NSAID discontinuation following colic surgery : absence of active colic sign, pain score evaluation and absence of fever.
A survey of non-steroidal anti-inflammatory drug use in the post-operative period following equine colic surgery
eve 2023
What is the Leaky Gut Syndrome (LGS) ?
What are the risk factors for developing LPS ?
Leaky gut syndrome (LGS) is an idiopathic disorder characterised by weakening of tight junction proteins (such as zonulin) in the gastrointestinal epithelium. The resulting hyperpermeability of the GI tract can trigger aberrant systemic inflammatory responses.
Combined transport and exercise increases gastrointestinal permeability and systemic SAA and LPS.
The combination of trailer transport and exercise increases gastrointestinal permeability and markers of systemic inflammation in horses
EVJ 2023
Which of the following statements best summarizes the findings and clinical implications of the study on ischaemic postconditioning (IPoC) in equine jejunal ischaemia?
A) Ischaemic postconditioning significantly reduced epithelial denudation and paracellular permeability after reperfusion, but had no effect on intestinal microperfusion or tight junction protein levels.
B) Ischaemic postconditioning reduced epithelial denudation, lowered paracellular permeability, and prevented the reduction of tight junction proteins like claudin-1, claudin-2, and occludin, showing potential protective effects against ischaemia-reperfusion injury.
C) Ischaemic postconditioning led to increased intestinal microperfusion and oxygen saturation during reperfusion, resulting in a higher rate of tissue recovery and greater expression of tight junction proteins.
D) The study concluded that ischaemic postconditioning had no significant effect on reducing ischaemia-reperfusion injury, as it failed to improve histomorphology, permeability, or tight junction protein levels compared to the control group.
Correct Answer:
B) Ischaemic postconditioning reduced epithelial denudation, lowered paracellular permeability, and prevented the reduction of tight junction proteins like claudin-1, claudin-2, and occludin, showing potential protective effects against ischaemia-reperfusion injury.
Justifications:
A) is incorrect because IPoC did reduce intestinal microperfusion during clamping cycles, and it also prevented the reduction in tight junction protein levels during reperfusion, indicating protective effects on the intestinal barrier.
B) is correct. This statement accurately summarizes the key findings: IPoC reduced epithelial denudation, lowered paracellular permeability, and prevented the reduction of important tight junction proteins, showing potential protective effects during reperfusion.
C) is incorrect. While IPoC did reduce epithelial damage and permeability, it did not increase microperfusion or oxygen saturation during the reperfusion phase; in fact, saturation was only affected during the first clamping cycle.
D) is incorrect because the study did find significant benefits of IPoC, particularly in reducing villus denudation, decreasing permeability, and maintaining tight junction proteins, suggesting it has protective potential against ischaemia-reperfusion injury.
The effect of ischaemic postconditioning on mucosal integrity and function in equine jejunal ischaemia.
2021 EVJ
Which of the following best summarizes the findings and clinical implications of the study on the inflammatory response in horses undergoing colic surgery using quantitative real-time PCR?
A) The study found that inflammatory genes such as IL-1β, IL-6, TNF, and CCL2 were significantly upregulated in both the mucosa and muscularis externa in colic cases compared to controls, with higher TNF expression linked to the development of post-operative reflux (POR).
B) Horses undergoing colic surgery had reduced gene expression of IL-1β, IL-6, and TNF in both the mucosa and muscularis externa, indicating a lack of inflammatory response.
C) Inflammatory gene expression was consistent between colic cases and controls, with no significant difference in the presence of post-operative reflux (POR).
D) Horses that developed post-operative reflux (POR) had significantly lower TNF expression in the mucosa, suggesting that lower levels of inflammation protect against this complication.
Correct Answer:
A) The study found that inflammatory genes such as IL-1β, IL-6, TNF, and CCL2 were significantly upregulated in both the mucosa and muscularis externa in colic cases compared to controls, with higher TNF expression linked to the development of post-operative reflux (POR).
Justifications:
A) is correct. This option accurately captures the study’s main findings: key inflammatory markers such as IL-1β, IL-6, TNF, and CCL2 were upregulated, and higher TNF expression in the mucosa was associated with the development of post-operative reflux (POR), a complication linked to POI.
B) is incorrect because the study found increased expression of inflammatory genes, not reduced, in horses undergoing colic surgery, indicating a significant inflammatory response.
C) is incorrect because there was a significant difference in inflammatory gene expression between colic cases and controls, particularly in horses with POR.
D) is incorrect because horses with POR actually had higher TNF expression, indicating more inflammation, not less.
Use of quantitative real-time PCR to determine the local inflammatory response in the intestinal mucosa and muscularis of horses undergoing small intestinal resection.
EVJ. Lisowski1 et al. 2021
Which of the following best summarizes the findings of the study on Equine Omega Complete (EOC) supplementation in preventing gastric ulcers and increasing alpha-tocopherol concentrations in horses?
A) EOC supplementation effectively prevented gastric ulcer formation, similar to omeprazole, and significantly increased alpha-tocopherol levels compared to the control group.
B) EOC supplementation did not prevent gastric ulcer formation, and although it increased alpha-tocopherol concentrations, the increase was not significantly different from the control group.
C) Omeprazole had no effect on gastric ulcer prevention, while EOC effectively reduced ulcer formation and improved alpha-tocopherol concentrations.
D) EOC and omeprazole both failed to prevent gastric ulcer formation, and neither treatment had an effect on alpha-tocopherol concentrations.
Correct Answer:
B) EOC supplementation did not prevent gastric ulcer formation, and although it increased alpha-tocopherol concentrations, the increase was not significantly different from the control group.
Justifications:
A) is incorrect because EOC did not prevent ulcer formation, and the increase in alpha-tocopherol was not significantly different from the control group.
B) is correct. The study found that EOC did not prevent ulcers, and while it increased alpha-tocopherol, the change was not significant.
C) is incorrect because omeprazole was effective in preventing ulcers, while EOC was not.
D) is incorrect because omeprazole did successfully prevent gastric ulcer formation.
Efficacy of the oral supplement, Equine Omega Complete, for the prevention of gastric ulcers and alpha-tocopherol supplementation in horses
2023 JVIM
What are the clinical effects of transportation on gastric pH and gastric ulceration in mares ?
Transportation is associated with increased gastric squamous ulceration and with increased pH of gastric fluid.
These findings may be a csq of impaired gastric emptying and reflux of alkaline small intestinal content, with factors such as duodenal bile salts and short-chain fatty acids mediating mucosal injury.
Effects of transportation on gastric pH and gastric ulceration in mares
jvim 2020
Is Serum Amyloid A elevated in horses with equine gastric ulcer syndrome?
No association was found between SAA concentrations and the presence or degree of squamous or glandular EGUS.
Is Serum Amyloid A elevated in horses with equine gastric ulcer syndrome?
eve 2020
What are the effects of PBZ on gastric ulcers, intestinal permeability and fecal microbiota in horses ?
A- PBZ induces impaired barrier function and increased gastric ulceration score, but does not induce specific changes in the microbiota
B- PBZ induces impaired barrier function, increased gastric ulceration score, and induced specific changes in the microbiota
C- PBZ induces increased gastric ulceration score, but does not alter barrier function and specific changes in the microbiota.
D- PBZ induces increased gastric ulceration score and specific changes in the microbiota, but does not alter barrier function.
B- PBZ induces impaired barrier function, increased gastric ulceration score, and induced specific changes in the microbiota.
Collectively, these findings suggest that phenylbutazone induces GI injury, including impaired barrier function, and that nutritional treatment could attenuate these changes.
Effects of phenylbutazone alone or in combination with a nutritional therapeutic on gastric ulcers, intestinal permeability, and fecal microbiota in horses
jvim 2021
Can omeprazole be use to prevent PBZ-induced EGUS ?
Administration of omeprazole ameliorated PBZ-induced EGGD, but was associated with an increase in intestinal complications. Caution should be exercised when co-prescribing NSAIDs and omeprazole in horses, particularly in association with change in management.
Impact of concurrent treatment with omeprazole on phenylbutazone-induced equine gastric ulcer syndrome (EGUS)
evj 2021
Which fatty acid to choose to prevent the most severe gastric ulcers?
Long-chain polyunsaturated fatty acid supplementation (omega 3, omega 6) was associated positively with prevention or resolution of severe squamous gastric ulceration.
Long-chain polyunsaturated fatty acid supplementation increases levels in red blood cells and reduces the prevalence and severity of squamous gastric ulcers in exercised Thoroughbreds
javma 2022
Are gastric ulcers a pathology reserved for sport and race horses?
An abattoir study found EGGD in 30% of feral horses demonstrating that these do not only occur in domesticated equids.
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
What is the pathophysiology of ESGD and the associated risk factors ? (4 points)
Squamous ulceration is caused by exposure of the gastric mucosa to acid, mainly hydrochloric acid (HCl), volatile fatty acids (VFA’s) and bile acids.
Risk factors:
- High starch intake, probably because starch leads to increased production of VFA’s that reduce mucosal integrity → increased serum gastrin concentrations
- Periods of forage deprivation >6 h
- Stress → Cribbing and other stereotypies are associated with ESGD and considered to be coping mechanisms, suggesting a link with stress
- Intensity of exercise → During exercise intra-abdominal pressure increased, pushing the acidic gastric contents up against the squamous mucosa (racehorses, high distance of endurance horses).
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
What is the pathophysiology of EGGD and the associated risk factors ? (3 points)
EGGD is thought to be related to compromise of mucosal defence mechanisms. Histological examination of glandular gastric lesions showed a lack of ulcerative pathology, but rather of inflammation.
Risk factors :
- NSAID at inappropriate doses, mediated mainly by effects on mucosal blood flow, caused by prostaglandin inhibition. Normal use of NSAIDs does not appear to cause EGGD under field conditions and preventive use of omeprazole is not considered necessary. Reminder: caution should be exercised when co-prescribing NSAIDs and omeprazole in horses
- Stress → Both trainer and the number of caretakers were shown to increase the prevalence of EGGD in riding horses.
- Frequency of exercise → Exercising during 5 or more days per week also considerably increased the risk of horses developing EGGD and may be related to altered gastric blood flow or (physiological) stress.
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
What is the correlation between endoscopic findings and histology for EGUS ?
When results of endoscopy, necropsy and histology were compared it became obvious that endoscopy may underestimate ulcer number and severity.
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
What is the clinical relevance of sucrose permeability testing in the diagnosis of EGUS ?
Sucrose permeability testing is based on the fact that sucrose cannot cross the healthy gastrointestinal mucosa, but when the epithelium is injured.
Blood sucrose testing had a high sensitivity for the detection of gastric ulcers in weanling foals but the specificity was low.
And it was found to be neither sensitive nor specific in adult horses with EGUS.
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
What is the clinical relevance of fecal occult blood test in the diagosis of EGUS ?
The fecal occult blood test also has a low sensitivity for detecting EGUS.
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
What is the reliability of EGUC ordinal grading system (0-4) for EGGD in horses ?
Inter- and intra-observer reliability were substantial for glandular mucosa using the EGUC scale.
Current recommendations are to use descriptive terminology for EGGD (Consensus 2015), but further refinement seems desirable.
Equine gastric ulcer syndrome in adult horses (Review)
Vet J 2022
Interobserver and intraobserver reliability for 2 grading systems for gastric ulcer syndrome in horses
jvim 2021
Which prophylactic treatment for EGUS is preferable between omeprazole (1 mg/kg q24h) and sucralfate (20 mg/kg q8h) in horses exposed to a combined feed-fast and NSAID administration ?
Omeprazole was superior to sucralfate for mitigating gastric lesion severity in healthy horses exposed to a feed-fast/NSAID model.
Effect of omeprazole and sucralfate on gastrointestinal injury in a fasting/NSAID model
evj 2022
Does curcumin extract or Harpagophytum species result in gastric ulceration ?
Supplements containing turmeric (Curcuma longa) and devil’s claw (Harpagophytum species) did not cause or worsen gastric ulcers or alter health parameters after 28 days of feeding.
Effect of an oral supplement containing curcumin extract (Longvida) on lameness due to osteoarthritis and gastric ulcer scores
eve 2022
Effects of supplements containing turmeric and devil’s claw on equine gastric ulcer scores and gastric juice pH
eve 2022
What is the clinical efficacy and safety of a long-acting IM omeprazole in EGUS ?
5 mg/kg bwt intramuscular injection of LAO-USA once a week for four doses
Both ESGD and EGGD improved within 28 days, but injection reactions included oedema, heat and pain at the injection site. The number of injection site reactions increased following each dose.
Clinical efficacy, safety and pharmacokinetics of a novel long-acting intramuscular omeprazole in performance horses with gastric ulcers
eve 2022
What is the potential clinical efficacy of porcine hydrolysed collagen (PHC) on gastric ulcer scores, gastric juice pH, and gastrin concentration in horses ?
The PHC fed to horses enhanced the effects of omeprazole on increased gastric juice pH, inhibited gastrin secretion after feeding and resulted in fewer nonglandular ulcers after long-term feeding (56 days) in stall-confined horses undergoing intermittent feeding.
EGGD ?
The effect of porcine hydrolysed collagen on gastric ulcer scores, gastric juice pH, gastrin and amino acid concentrations in horses
eve 2022
What is the clinical impact of partial substitution of concentrates by dehydrated alfalfa ?
Feeding pelleted dehydrated alfalfa could help to reduce the incidence and severity of EGGD.
Effect of diet composition on glandular gastric disease in horses
jvim 2023
Is it important to use tapering protocols of omeprazole in horses ? And why ?
- Serum gastrin concentrations increased in response to omeprazole treatment but returned to baseline within 2 to 4 days after the last dose of omeprazole.
- No effect of treatment or discontinuation was seen in serum chromogranin A concentrations.
- Rebound gastric hyperacidity seems unlikely in horses and our results do not support the use of tapering protocols in horses.
Evaluation of the effects of medium-term (57-day) omeprazole administration and of omeprazole discontinuation on serum gastrin and serum chromogranin A concentrations in the horse
jvim 2023
What is the best dosing intervals of extended-release injectable omeprazole in the treatment of ESGD and EGGD ?
- The proportions of horses with EGGD healing in association with ERIO used at 5-day intervals were higher than associated with treatment at 7-day intervals.
- For ESGD, there was no significant difference between the 2 protocols.
- The use of ERIO at 5-day intervals might be more appropriate than the 7-day interval that is used currently.
- Prevalence of injection-site reaction → 1%
Five- versus seven-day dosing intervals of extended-release injectable omeprazole in the treatment of equine squamous and glandular gastric disease
evj 2024
Is oral esomeprazole more protent than omeprazole in horses ?
Oral-buffered esomeprazole was a more effective treatment for ESGD (and concurrent EGGD) than oral-buffered omeprazole.
Comparison of oral esomeprazole and oral omeprazole in the treatment of equine squamous gastric disease
evj 2024
In horses diagnosed with gastric impactions, which of the following is true regarding the prognosis and management of lone gastric impactions (LGI)?
A) LGI are less likely to require long-term dietary management compared to CGI.
B) LGI resolves more quickly compared to CGI, with shorter hospital stays.
C) LGI horses are more likely to experience gastric rupture and require long-term dietary changes.
D) LGI horses show more acute clinical signs compared to CGI.
Answer: C
Justifications:
A): Incorrect. Horses with LGI were significantly more likely to require long-term dietary management (72.7%) compared to CGI (25%).
B): Incorrect. LGI resolves more quickly (median 2 days) compared to CGI (median 4 days), but there is no significant difference in hospital stay.
C): Correct. LGI horses were more likely to experience gastric rupture (29.6%) and required long-term dietary management more often.
D): Incorrect. LGI horses had longer-lasting clinical signs, while CGI cases showed more acute onset.
Clinical presentation and outcome of gastric impactions with or without concurrent intestinal lesions in horses. 2023
In the study on plasma concentrations of serum amyloid A (SAA) and lipopolysaccharide-binding protein (LBP) in horses with laminitis caused by hindgut acidosis (HGA), which of the following statements are clinically accurate?
A. Horses fed a high-forage diet (70:30 forage-to-concentrate ratio) showed significant increases in laminitis severity, LBP, and SAA levels by Day 20.
B. Horses fed a high-concentrate diet (30:70 forage-to-concentrate ratio) showed significant increases in plasma LBP and SAA concentrations, along with laminitis severity scores, particularly by Day 20.
C. The study suggests that LBP may be a more sensitive marker than SAA for the early identification of HGA and laminitis in horses on high-carbohydrate diets.
D. Cecal pH and volatile fatty acids (VFA) levels remained stable across both diet groups, with no significant changes due to diet composition.
E. The increase in LBP observed in horses with HGA may be due to endotoxins released from gram-negative bacteria as a result of decreased cecal pH.
Correct answer: 2. B, C, E
Explanation:
A is incorrect: Horses on the high-concentrate (30:70) diet, not the high-forage (70:30) diet, exhibited significant increases in laminitis severity, LBP, and SAA levels.
B is correct: Horses on the 30:70 diet showed notable increases in plasma LBP, SAA concentrations, and laminitis severity, especially by Day 20.
“On day 20, a significant increase in the concentration of SAA was observed in horses fed a high-concentrate diet, in contrast to the initial stage of the study.
LBP levels in the plasma were significantly elevated on days 10 and 20 in horses fed a high-concentrate diet.
Based on our findings, it is recommended that the evaluation of plasma LBP concentrations is more effective than SAA for the early identification of HGA in horses fed a high-grain diet.”
C is correct: The study suggests that LBP could be a more sensitive marker than SAA for early detection of HGA and laminitis in horses on high-carbohydrate diets.
D is incorrect: Cecal pH and VFA levels showed significant changes, particularly in horses on the high-concentrate diet.
E is correct: The increase in LBP is likely due to endotoxins from gram-negative bacteria as a result of decreased cecal pH, consistent with the study’s findings.
Plasma concentration of serum amyloid A and lipopolysaccharide binding protein in horses with laminitis resulted from hindgut acidosis 2024
In a study on the effects of intravenous ascorbic acid (AA) on oxidative stress in healthy adult horses, which of the following statements accurately summarize the findings?
A. All doses of AA (25, 50, and 100 mg/kg) significantly reduced plasma dROM levels at 2 and 6 hours post-administration.
B. Only the 100 mg/kg dose of AA significantly reduced dROM levels at 2 hours, with levels returning to baseline by 6 hours.
C. Plasma antioxidant capacity (PAC) and reactive oxygen species (ROS) levels in neutrophils and erythrocytes were unaffected by AA at any dose.
D. Plasma AA concentrations increased in a dose-dependent manner and remained elevated at 6 hours.
E. The study recommends 50 mg/kg AA for reducing oxidative stress due to its effects on ROS in neutrophils.
Correct Answer: 2. B, C, D
Explanation:
B is correct: Only the 100 mg/kg dose reduced dROM levels, and effects were temporary (baseline levels by 6 hours).
C is correct: PAC and ROS in neutrophils and erythrocytes were unaffected by any AA dose.
D is correct: Plasma AA concentrations rose in a dose-dependent manner and remained elevated at 6 hours.
A is incorrect because not all doses impacted dROM.
E is incorrect as the study did not recommend the 50 mg/kg dose for reducing oxidative stress.
2023 Effects of intravenous administration of ascorbic acid (vitamin C) on oxidative status in healthy adult horses
In a 12-year-old Quarter Horse gelding with chronic colic and weight loss due to lymphocytic myenteric ganglionitis (MG) associated with equine herpesvirus infection, which of the following statements is TRUE regarding diagnosis and management?
A. Myenteric ganglionitis can be reliably diagnosed in horses through partial-thickness intestinal biopsies.
B. Treatment options for Chronic Intestinal Pseudo-Obstruction (CIPO) in horses are generally successful, with long-term survival expected.
C. Full-thickness biopsies provide greater diagnostic value in cases of suspected myenteric ganglionitis in horses.
D. Neuronal degeneration in CIPO cases is primarily managed with surgical removal of affected intestinal sections in horses, with successful long-term outcomes.
Correct Answer: C. Full-thickness biopsies provide greater diagnostic value in cases of suspected myenteric ganglionitis in horses.
Explanation:
Option A: False. Partial-thickness biopsies are often limited in diagnosing myenteric ganglionitis effectively, as shown in equine cases where full-thickness biopsies are recommended to better capture enteric neuropathy characteristics.
Option B: False. The prognosis for CIPO in horses is typically poor, as even with prokinetics, dietary management, and corticosteroids, recurrence of symptoms and complications such as intestinal rupture often lead to euthanasia. (fair to moderate -> 65% survive 3y -> paper valentina IBD
Option C: True. Full-thickness biopsies are indeed more reliable for identifying myenteric ganglionitis, especially in cases involving recurrent intestinal impactions.
Option D: False. Surgical interventions in horses with CIPO, including resection, have not shown successful long-term outcomes due to the disease’s complex and recurrent nature.
2023 Lymphocytic myenteric ganglionitis associated with equine herpesvirus infection: A cause of chronic intestinal pseudo-obstruction and recurrent colic in an adult horse
Based on the study’s findings, which of the following diets is most likely to result in spontaneous healing of severe Equine Gastric Ulcer Syndrome (EGUS) in horses?
A. Whole oat grains at 2 g starch/kg body weight per meal with hay ad libitum (OS2)
B. Pasture turnout (PST)
C. Whole oat grains at 1 g starch/kg body weight per meal with hay ad libitum (OS1)
D. Hay fed ad libitum (HAY)
Correct Answer: B. Pasture turnout (PST)
Justification:
Option A (OS2): Horses fed 2 g starch/kg body weight per meal had an increased risk of ulceration and a higher likelihood of acute gastritis.
Option B (PST) is correct: The study showed that pasture turnout provided the best outcomes, with spontaneous healing of severe EGUS, particularly in the squamous mucosa.
Option C (OS1): This low-starch diet still posed some risk for EGUS, with increased ulceration in the antrum.
Option D (HAY): Ad libitum hay showed positive results but was less effective than pasture turnout for spontaneous healing of severe EGUS.
Equine gastric ulcer syndrome in horses fed hay, hay plus different amounts of oats or with pasture turnout
A 10-year-old gelding used in a university teaching program undergoes monthly gastroscopies as part of a study. The horse shows mild girthing pain but no other clinical signs. Based on the findings of this study, which of the following statements is most likely to be true?
A) The horse’s ESGD and EGGD lesions will remain stable over the three-month period without treatment.
B) If the horse has ESGD, it will definitely worsen without acid suppressive treatment.
C) The horse’s ESGD or EGGD lesions may improve or deteriorate within a month without treatment.
D) Girthing pain is a definitive indicator of severe EGUS in teaching horses.
Correct answer: C) The horse’s ESGD or EGGD lesions may improve or deteriorate within a month without treatment.
Justification:
The study found that “Both ESGD and EGGD lesions can improve or deteriorate in a month’s time, without acid suppressive treatment.”
The researchers observed that ESGD grades changed in 5/13 horses between the first and second gastroscopies, and in 4/13 horses between the second and third gastroscopies, without any treatment.
EGGD classifications also changed in 5/12 horses between the first and second gastroscopies, and in 2/13 horses between the second and third gastroscopies.
The study suggests that management factors and stress from handling by multiple people during teaching may contribute to EGUS development, which could explain the fluctuations in lesion severity.
A 3 month longitudinal evaluation of the prevalence of ESGD and EGGD in a group of teaching horses
According to the study, which of the following is TRUE regarding the treatment of Equine Glandular Gastric Disease (EGGD) in horses with concurrent Inflammatory Bowel Disease (IBD)?
A. Horses with IBD showed significant improvement in EGGD lesion scores when treated with intramuscular omeprazole (IMOM).
B. The presence of IBD tends to reduce the effectiveness of EGGD treatment, and some horses with IBD had worsened EGGD scores after IMOM treatment.
C. Oral omeprazole alone is equally effective for EGGD in horses with or without IBD.
D. Intramuscular omeprazole is not recommended for EGGD treatment due to its lack of efficacy across all cases.
Correct Answer: B. The presence of IBD tends to reduce the effectiveness of EGGD treatment, and some horses with IBD had worsened EGGD scores after IMOM treatment.
Justification:
Option A is incorrect: Horses with concurrent IBD did not show significant improvement in EGGD lesion scores with IMOM; in fact, some cases worsened.
Option B is correct: The study found that IBD may negatively impact the treatment outcome for EGGD, with some horses experiencing worsened scores post-IMOM.
Option C is incorrect: Oral omeprazole alone was less effective for EGGD, particularly in horses with IBD (difference with injectable omeprazole that is effective for both EGUS)
Option D is incorrect: Intramuscular omeprazole is generally effective for EGGD but may be less so in cases with concurrent IBD.
Retrospective comparison of different treatments of EGUS and the inflluence of IBD
In a study comparing the fecal microbiota of healthy horses to horses with colitis, which of the following findings was observed regarding horses with colitis and their survival outcomes?
A. The microbiota composition was identical between surviving and non-surviving colitis horses.
B. Non-surviving colitis horses showed an enrichment of Enterobacteriaceae, Pseudomonas, Streptococcus, and Enterococcus.
C. Colitis horses that developed laminitis showed no enrichment of specific bacterial groups compared to healthy horses.
D. Differences in the fecal microbiota were more pronounced between laminitis and non-laminitis colitis horses than between survivors and non-survivors.
Correct Answer: B. Non-surviving colitis horses showed an enrichment of Enterobacteriaceae, Pseudomonas, Streptococcus, and Enterococcus.
A is incorrect: The study found that non-surviving colitis horses had distinct microbiota, particularly with an enrichment of certain bacterial groups.
B is correct: Non-surviving colitis horses had significant enrichment of Enterobacteriaceae, Pseudomonas, Streptococcus, and Enterococcus.
C is incorrect: Horses with laminitis were also enriched in specific bacterial groups, such as Enterobacteriaceae, Streptococcus, and Lactobacillus, though the overall microbiota composition was not significantly different from non-laminitis horses.
D is incorrect: Microbiota differences were more prominent between healthy and colitis horses than between laminitis and non-laminitis or survivor and non-survivor subgroups.
Fecal microbiota of horses with colitis and its association with laminitis and survival during hospitalization 2022
A 5-day-old Franches-Montagnes filly is presented with apathy, reluctance to nurse, fever, abdominal distension, and diarrhea. Blood work reveals severe hypertriglyceridemia (35 mmol/L) and elevated lipase activity (150 U/L). Which of the following is the most likely diagnosis?
A) Neonatal septicemia
B) Hypertriglyceridemia-induced pancreatitis
C) Rotavirus infection
D) Congenital heart defect
E) Meconium impaction
The correct answer is B) Hypertriglyceridemia-induced pancreatitis.
Explanation:
The clinical presentation and laboratory findings strongly suggest hypertriglyceridemia-induced pancreatitis. This diagnosis is supported by:
- The age and breed of the foal match the case series description.
- The clinical signs (apathy, reluctance to nurse, fever, abdominal distension, and diarrhea) are consistent with those reported in the study.
- Severe hypertriglyceridemia (35 mmol/L) is a key feature, far exceeding the reference interval (0.16–0.73 mmol/L).
- Elevated lipase activity (150 U/L) is also observed, above the reference interval (9–21 U/L).
While other conditions like neonatal septicemia or rotavirus infection might present with similar clinical signs, the extreme hypertriglyceridemia and elevated lipase activity strongly point towards pancreatitis as the primary issue. The study emphasizes that pancreatitis should be considered in the differential diagnosis of sick foals with these symptoms, especially when high triglyceride levels are present.
A candidate variant in the LMF1 gene for hypertriglyceridemia has been identified.
CLINICAL RELEVANCE
Pancreatitis should be considered in the differential diagnosis of sick foals with diarrhea, colic, and possibly neurologic signs, especially those
with high triglyceride levels. Since a genetic predisposition seems to be associated with hypertriglyceridemia and pancreatitis, genetic testing
and strict avoidance of carrier x carrier matings should be implemented to prevent this fatal condition in the future.
ECEIM CONGRESS 2024
A 10-year-old Thoroughbred gelding is presented to your equine hospital with signs of acute colic. On initial examination, the horse shows marked abdominal pain, has a rectal temperature of 38.5°C, and small intestinal distention is palpated on rectal examination. Blood glucose concentration is 8.2 mmol/L. Peritoneal fluid analysis reveals serosanguineous fluid with an L-lactate concentration of 6.5 mmol/L, while the blood L-lactate concentration is 3.2 mmol/L.
Based on the study by Long et al., which of the following statements is most accurate regarding the prediction of intestinal strangulating obstruction (SO) in this case?
A) The peritoneal fluid L-lactate concentration alone is the best predictor of SO.
B) The ratio of peritoneal:blood L-lactate concentration is the most reliable indicator of SO.
C) A multivariable model including clinical and laboratory variables would provide the best prediction of SO.
D) Blood L-lactate concentration is the most important single factor in predicting SO.
E) Rectal temperature is the most significant variable in determining the likelihood of SO.
The correct answer is C) A multivariable model including clinical and laboratory variables would provide the best prediction of SO.
Explanation:
The study by Long et al. demonstrated that multivariable models incorporating multiple admission variables performed better in predicting intestinal strangulating obstruction (SO) than individual variables or simple ratios.
The study developed two models for predicting SO, with the second model (including peritoneal fluid analysis) showing outstanding discrimination (AUC ROC: 0.91).
This model included marked abdominal pain, rectal temperature, serosanguineous peritoneal fluid, peritoneal-blood L-lactate, and peritoneal:blood L-lactate ratio.
The study concluded that blood and peritoneal fluid L-lactate concentrations should be interpreted in conjunction with other clinical variables, rather than alone or as a simple ratio.
The multivariable approach achieved higher sensitivity (85%), specificity (80%), and accuracy (82%) compared to individual variables.
Use of multiple admission variables better predicts intestinal strangulation in horses with colic than peritoneal or the ratio of peritoneal:blood L-lactate concentration 2023
A 12-year-old Warmblood gelding is presented to your equine hospital in late January with a 2-day history of fever (40.1°C), anorexia, and mild colic. On physical examination, the horse has slightly dry mucous membranes, a heart rate of 52 bpm, and few feces in the rectum. Initial bloodwork reveals a white blood cell count of 2.8 x 10^9/L (reference range: 5.0-11.6 x 10^9/L) with a neutrophil count of 1.1 x 10^9/L (reference range: 2.6-6.8 x 10^9/L) and a lymphocyte count of 1.4 x 10^9/L (reference range: 1.6-5.8 x 10^9/L). Serum biochemistry shows mild hypoproteinemia and hyperglycemia. Which of the following is the most appropriate next step in management?
A) Immediately start broad-spectrum antibiotics and perform nasogastric intubation
B) Collect a fecal sample for Salmonella culture only
C) Administer flunixin meglumine and monitor for 24 hours before further diagnostics
D) Perform abdominal ultrasound and collect fecal samples for both Salmonella culture and equine coronavirus (ECoV) PCR
E) Isolate the horse and wait for development of diarrhea before further testing
The correct answer is D) Perform abdominal ultrasound and collect fecal samples for both Salmonella culture and equine coronavirus (ECoV) PCR.
Explanation:
Seasonality: ECoV is more prevalent in colder months (January in this case).
Clinical signs: Fever, anorexia, and mild colic are consistent with both ECoV and Salmonella infections.
Hematological findings: Leukopenia with neutropenia is observed in both ECoV and Salmonella infections.
Biochemical changes: Hypoproteinemia and hyperglycemia are reported in ECoV cases.
Fecal consistency: Absence of diarrhea does not rule out enteric infections.
2020- Evaluation of safety, humoral immune response and faecal shedding in horses inoculated with a modified-live bovine coronavirus vaccination
2022 Serosurveillance of equine coronavirus infection amongThoroughbreds in Japan
A 5-year-old Thoroughbred gelding presents with recurrent mild colic, poor body condition, and slow eating. Gastroscopy reveals grade 4 squamous ulceration and a narrowed pyloric region with reduced motility. Which of the following statements best describes the relationship between equine squamous gastric disease (ESGD) and delayed gastric emptying in this horse?
A) Primary ESGD is caused by delayed gastric emptying and results in secondary gastric distention and acid exposure.
B) Secondary ESGD results from delayed gastric emptying, leading to increased acid exposure and gastric distention.
C) ESGD is unrelated to gastric emptying rates and primarily results from dietary factors.
D) Delayed gastric emptying is a direct consequence of primary ESGD due to increased acid production.
E) Gastric distention due to delayed emptying has no impact on ESGD development.
The correct answer is B) Secondary ESGD results from delayed gastric emptying, leading to increased acid exposure and gastric distention.
Explanation:
Secondary ESGD occurs when delayed gastric emptying causes gastric distention, which increases acid exposure to the squamous mucosa.
The paper emphasizes that secondary ESGD is less common than primary ESGD but can occur as a direct consequence of delayed gastric emptying.
The condition involves chronic exposure of the squamous mucosa to acid due to prolonged retention of stomach contents.
Primary ESGD is typically associated with factors related to domestication and management practices, not directly with delayed gastric emptying.
Equine squamous gastric disease and delayed gastric emptying – the chicken or the egg? 2022
A 3-year-old Warmblood gelding is presented with a 4-month history of poor body condition, slow eating, and recurrent mild colic episodes. Physical examination reveals no significant abnormalities. Blood work shows mild hypoalbuminemia (27 g/L). Abdominal ultrasound reveals the stomach extending to the 15th left intercostal space. Gastroscopy shows grade 4 squamous ulceration and a depressed fibrinosuppurative pyloric lesion with absent pyloric motility.
Which of the following statements is most accurate regarding the diagnosis and prognosis of this case?
A) The clinical presentation is atypical for chronic severe pyloric lesions, and further diagnostics should focus on ruling out other causes of weight loss and colic.
B) The gastroscopic findings are consistent with chronic severe pyloric lesions, but the prognosis is excellent with medical management alone.
C) Surgical intervention with gastrojejunostomy is the only viable treatment option and has been shown to have excellent long-term outcomes in horses under 3 years of age.
D) The clinical and diagnostic findings are consistent with chronic severe pyloric lesions, and the horse has a guarded prognosis due to its young age at diagnosis.
E) Transendoscopic biopsy of the pyloric lesion is essential for definitive diagnosis and should be performed before initiating any treatment.
The correct answer is D) The clinical and diagnostic findings are consistent with chronic severe pyloric lesions, and the horse has a guarded prognosis due to its young age at diagnosis.
The clinical presentation (poor body condition, slow eating, recurrent colic) is consistent with chronic severe pyloric lesions.
The gastroscopic findings of severe squamous ulceration and a fibrinosuppurative pyloric lesion with absent motility are typical of the condition.
Ultrasonographic evidence of gastric distension (stomach extending to the 15th intercostal space) supports delayed gastric emptying.
The study found that horses diagnosed at 3 years of age or younger were significantly less likely to survive long-term compared to older horses.
While various treatments were attempted in the study, no single approach showed consistently superior outcomes, especially in younger horses.
Equine squamous gastric disease and delayed gastric emptying – the chicken or the egg? 2022
Which factor was NOT associated with decreased survival in horses with acute diarrhoea?
A) High creatinine levels
B) High L-lactate levels
C) Presence of systemic inflammatory response syndrome (SIRS)
D) Geographic location
Correct Answer: D) Geographic location
2023 Survival Rates and Factors Associated with Survival and Laminitis of Horses with Acute Diarrhoea
What pathogen was associated with a higher likelihood of developing laminitis in horses with acute diarrhoea?
A) Salmonella spp.
B) Neorickettsia risticii
C) Clostridioides difficile
D) Equine Coronavirus
Correct Answer: B) Neorickettsia risticii
- C. difficile-positive horses had higher odds of non-survival (OR: 2.69).
- N. risticii-positive horses had higher odds of developing laminitis (OR: 2.76).
2023 Diagnostic Approaches, Aetiological Agents, and Their Associations with Short-term Survival and Laminitis in Horses with Acute Diarrhoea
A 10-year-old Thoroughbred gelding is admitted to your hospital with acute diarrhea. On presentation, the horse has a heart rate of 60 bpm, respiratory rate of 24 rpm, temperature of 39°C, and WBC count of 4,500 cells/μL. Blood work reveals a creatinine of 180 μmol/L and L-lactate of 3.2 mmol/L. Based on the findings of this study, what is this horse’s approximate survival probability?
A) 85%
B) 75%
C) 60%
D) 50%
Correct answer: C) 60%
Explanation: The horse meets SIRS criteria (2 or more of: HR>40, RR>20, T>38.5°C, WBC < 5300). It also has elevated creatinine (>159 μmol/L) and L-lactate (>2.8 mmol/L) The study found that horses with SIRS and elevated L-lactate had a 59% survival rate, which is closest to the 60% option.
2023 Survival rates and factors associated with survival and laminitis of horses with acute diarrhoea admitted to referral institutions
A 12-year-old Warmblood gelding presents with weight loss, intermittent fever, and peripheral lymphadenopathy. You suspect lymphoma and run a serum thymidine kinase 1 (TK1) assay. The result comes back as 3.5 U/L. Based on the findings of this study, which of the following statements is most accurate?
A) The TK1 result confirms the diagnosis of lymphoma
B) The TK1 result rules out lymphoma
C) The TK1 result is not reliable for diagnosing lymphoma in horses
D) The TK1 result indicates the horse has inflammatory disease
E) The TK1 result suggests the need for immediate chemotherapy
C) The serum TK1 result is not reliable for diagnosing lymphoma in horses
This question tests understanding of the study’s main finding that TK1 was not predictive of lymphoma in horses, contrary to previous assumptions.
Clinical performance of a commercially available thymidine
kinase 1 assay for diagnosis of lymphoma in 42 hospitalized
horses (2017-2020)
Which of the following statements about postoperative monitoring in equine colic patients is correct?
A) Physical examinations should be performed every 2-3 hours throughout the entire postoperative period.
B) Tachycardia (60-70 bpm) is expected for the first 72 hours after surgery.
C) Fecal output typically returns to normal within 24 hours postoperatively.
D) Fluid administration rates should be checked at least hourly to ensure accuracy.
E) Pain assessment using numerical scales is not recommended in the postoperative period.
**Answer: D) Fluid administration rates should be checked at least hourly to ensure accuracy.
Explanation: The other options are incorrect:
A) Physical examinations are initially performed every 4-6 hours, not 2-3 hours then spaced them.
B) Tachycardia is expected for the first 24-40 hours, not 72 hours.
C) Reduced fecal output is expected for several days postoperatively. (1st feces within 8h)
E) Pain assessment using numerical scales (e.g., Composite Pain Score, Equine Acute Abdominal Pain Score) is considered valuable.
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
Which of the following statements about laboratory tests in postoperative equine colic patients is correct?
A) Complete blood counts (CBCs) should be performed every 6 hours in all postoperative colic patients.
B) Blood L-lactate concentration should be greater than 1 mmol/L in horses receiving IV fluids.
C) Packed cell volume and total solids (PCV/TS) should be monitored every 6 hours in horses with reflux, diarrhea, or evidence of systemic inflammatory response syndrome (SIRS).
D) Serum biochemistry profiles should always be repeated daily in all postoperative colic patients.
E) Persistent leukocytosis on serial blood leukocyte count is a negative prognostic indicator for survival following colic surgery.
Answer: C) Packed cell volume and total solids (PCV/TS) should be monitored every 6 hours in horses with reflux, diarrhea, or evidence of systemic inflammatory response syndrome (SIRS).
Explanation: This statement is correct according to the information provided in the paragraph. The other options are incorrect:
A) CBCs are recommended every 24 to 48 hours, not every 6 hours.
B) Blood L-lactate concentration should be less than 1 mmol/L in horses receiving IV fluids.
D) The frequency of serum biochemistry profiles depends on the patient’s condition and can be as infrequent as every 72 hours in stable patients.
E) Persistent leukopenia, not leukocytosis, is mentioned as a negative prognostic indicator.
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
One day (24h later) after a colic surgery, you measure the TG that are 300mg/dl, do you think it’s normal or abnormal?
Yes often seen until 36h.
In one study of horses undergoing exploratory celiotomy, 58% of horses experienced a mild hypertriglyceridemia (50–250 mg/dL) and 38% experienced moderate hypertriglyceridemia (250–500 mg/dL) in the first 24 to 36 hours postoperatively.
However, persistent and severe hypertriglyceridemia (ie, >500 mg/dL) will result in lethargy and inappetence
In horses with mild-to-moderate hypertriglyceridemia (100–500 mg/
dL), supplementation with oral Karo syrup (0.15 mL/kg by mouth every 8 hours) may be sufficient, as long as enteral nutrition is also being provided. Horses with plasma triglyceride greater than 500 mg/dL will likely need nutritional support such as IV dextrose supplementation with or without insulin therapy
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
Which of the following statements about ancillary tests in postoperative colic patients is correct?
A) Routine abdominal ultrasound should be performed on all postoperative patients
B) Nasogastric intubation is recommended for any horse with a heart rate above 60 beats/minute
C) Transabdominal sonography can reliably differentiate between functional ileus and mechanical obstruction
D) Leaving a nasogastric tube in place for extended periods may lead to sinusitis
Answer: D) Leaving a nasogastric tube in place for extended periods may lead to sinusitis
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
Regarding biosecurity monitoring in equine colic patients, which of the following is true?
A) Colic surgery is not considered a risk factor for Salmonella shedding
B) Salmonella testing is typically performed only when clinical signs of infection are present
C) Routine Salmonella culture or PCR following colic surgery is standard practice in many hospitals
D) Salmonella shedding always occurs after the development of clinical signs such as diarrhea or pyrexia
Answer: C) Routine Salmonella culture or PCR following colic surgery is standard practice in many hospitals
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
Which of the following statements about antimicrobial use in equine colic surgery is correct?
A) A single dose of preoperative antimicrobials is always sufficient for prophylaxis
B) Extended prophylaxis beyond a single postoperative dose is uncommon
C) Potassium penicillin and gentamicin are commonly used in routine colic surgery
D) Longer duration of antimicrobial administration decreases the risk of surgical site infections
Answer: C) Potassium penicillin and gentamicin are commonly used in routine colic surgery
Justification:
3 days vs 5 days of treatments no benefits in preventing surgical site infection.
! resistance 92% of organisms isolated from SSIs after colic surgery were penicillin-resistant, whereas 18% were gentamicin resistant.
Escherichia coli, a normal commensal organism in the gastrointestinal
tract of most mammals, is one of the most commonly isolated organisms from infected
incisions after colic surgery
the most common antimicrobials used in colic surgery are potassium penicillin (22,000 IU/kg IV every 6 hours) and gentamicin (6.6 mg/kg IV every 24 hours) although duration of use varies between surgeons.
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
Which of the following statements about postoperative feeding in colic patients is correct?
A) Feeding should be delayed until normal borborygmi and fecal production return
B) Early refeeding may help prevent postoperative large colon impactions and displacements
C) Fecal production typically returns to normal within 24 hours postoperatively
D) Concentrate feeds are preferred over roughage for initial refeeding
Answer: B) Early refeeding may help prevent postoperative large colon impactions and displacements
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
Which of the following is recommended for horses with signs of endotoxemia due to the risk of laminitis?
A) Polymyxin-B
B) Hyperimmune plasma
C) Continuous digital cryotherapy
D) Enteral adsorbents
Answer: C) Continuous digital cryotherapy
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
What percentage of horses that survive to discharge after colic surgery typically return to their previous athletic potential?
A) 40-60%
B) 63-85%
C) 90-95%
D) 98-100%
Answer: B) 63-85%
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
What percentage of organisms isolated from surgical site infections (SSIs) after colic surgery were penicillin-resistant?
A) 72%
B) 82%
C) 92%
D) 98%
Answer: C) 92%
Justification: The text mentions “In one study, 92% of organisms isolated from SSIs after colic surgery were penicillin-resistant, whereas 18% were gentamicin-resistant.
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
What percentage of horses presenting for treatment of acute abdominal disease are hyperglycemic on admission?
A) 25-30%
B) 35-40%
C) 45-50.2%
D) 60-65%
Answer: C) 45-50.2%
severe >195mg/dl at admission -> poor prognosis
Basic Postoperative Care of the Equine Colic Patient. 2023 VETCLINIC
What is the specificity and sensitivity of sonographic identification of distended small intestine for small intestinal strangulation?
A) 63-65%
B) 73-76%
C) 85-90%
D) 100%
Answer: B) 73-76%
Abdominal-Sonographic-Evaluation_2023
What is the specificity of sonography in detecting sand accumulations in horses?
A) 67.5%
B) 77.5%
C) 87.5%
D) 97.5%
Answer: C) 87.5%
Abdominal-Sonographic-Evaluation_2023
Which of the following statements about transabdominal large intestinal trocarization in horses with colic is correct?
A) The procedure is associated with a high risk of fatal complications
B) It should only be performed if consent for surgery has not been obtained
C) Multiple trocarization procedures are associated with improved survival
D) 73% of horses that underwent the procedure survived to hospital discharge
Answer: D) 73% of horses that underwent the procedure survived to hospital discharge
228 equids that underwent large intestinal trocarization, 167 (73%) survived to hospital discharge.
A) is incorrect because the study found that none of the equids died or were euthanized due to complications from the trocarization procedure itself.
B) is incorrect because the study did not restrict the procedure only to cases without surgical consent. In fact, some horses underwent both trocarization and surgery.
C) is incorrect because the study found that performing multiple trocarization procedures was actually associated with increased odds of non-survival, likely due to more severe underlying conditions rather than the procedure itself.
2020 transabdominal large intestinal trocarization
How is the prognosis for a mare and her foal undergoing surgery?
LCV surgery:
91.1% were bred after surgery **81.7% of bred mares had
at least one foal after surgery. **
Uterine torsion:
no difference of fertility after
90.5% of mares and 82.3% of foals survived to hospital discharge as well as to foaling.
93.5% became pregnant
When uterine torsion occurred before 320 days gestation, both mare and foal outcomes were more favourable
2020 Clinical insights: Update on colic
Risk factors for intermittent colic
- previous abdominal surgery,
- consuming coastal grass hay,
- being more than 8 years of age,
- being of the Arabian breed,
- being a gelding,
- having a recent change in diet,
- dental disease,
- cribbing/wind-sucking and
- weaving behaviour
- living in an environment with a high density of horses
reducing risk w/ increasing time at pasture
Recurrent Colic vet clinic
How the frequency of colic could help you in your ddx and suspected outcome?
very frequent (3 colic/month) bouts of recurrent colic are likely to have more serious diseases and a higher mortality (50 %) rate (eg:lymphoma, intussusception etc.)
less frequent bouts (3 or + / year) of transient colic, which are more likely to have recurrent non-specific, “spasmodic” colic (4 % mortality)
Horses with recurrent bouts of prolonged colic ((3 or + / year but prolonged) are more likely to have motility issues (resulting in repeated colonic impactions for example) or partial intestinal obstruction. (30 % mortality)
2023 Recurrent Colic
What do we know about cajal cells and myenteric ganglionitis ?
Dysfunctional ICCs (interstitial cells of Cajal) primarily cause motility disorders due to their pacemaker role, whereas myenteric ganglionitis causes motility issues through inflammation and disruption of neural pathways.
ICC dysfunction is often a result of cellular loss or damage, while myenteric ganglionitis involves immune-mediated inflammation targeting nerve cells.
Neurotropic viruses, such as equine herpesvirus, were suspected in most cases of **myenteric ganglionitis **and confirmed in some of them.
The importance of full-thickness biopsies for comprehensive diagnosis in non-responsive cases
2024 The subtle link between myenteric ganglionitis and inflammatory bowel disease
Which breed has been reported to be at increased risk for recurrent colic?
A) Thoroughbred
B) Quarter Horse
C) Arabian
D) Warmblood
Correct answer: C) Arabian
Recurrent Colic vet clinic
Which of the following is NOT mentioned as a common clinical sign of recurrent colic?
A) Weight loss despite good appetite
B) Mild, recurrent abdominal pain
C) Chronic or intermittent diarrhoea
D) Persistent fever
Correct answer: D) Persistent fever
Recurrent Colic vet clinic
Which diagnostic test is described as potentially useful for assessing small intestinal absorptive function in horses with suspected inflammatory bowel disease (IBD)?
A) Complete blood count
B) Rectal biopsy
C) Glucose absorption test
D) Abdominal radiography
Correct answer: C) Glucose absorption test
Recurrent Colic vet clinic
According to recent studies, what percentage of horses with inflammatory bowel disease (IBD) survive at least 3 years?
A) 25%
B) 45%
C) 65%
D) 85%
Correct answer: C) 65%
Recurrent Colic vet clinic
What is described as the treatment of choice for horses diagnosed with inflammatory bowel disease (IBD)?
A) Antibiotics
B) Corticosteroids
C) Probiotics
D) Surgery
Correct answer: B) Corticosteroids
Recurrent Colic vet clinic
A) Geriatric horses had a better survival rate and lower inflammatory markers compared to young adult horses
B) There was no significant difference in survival rates between age groups, and inflammatory cytokine levels were similar
C) Geriatric horses had significantly higher mortality, higher IL-6 and TNF-α levels, and longer hospitalization compared to young adults
D) Age had no impact on survival, but geriatric horses showed lower inflammatory markers
Correct answer: C) Geriatric horses had significantly higher mortality, higher IL-6 and TNF-α levels, and longer hospitalization compared to young adults
2021 - Sage - Assessment of the impact of age and of blood‐derived inflammatory markers in horses
Suspicion of Strongylus infarction, CS and hematobiochemistry?
1. dull demeanor
2. mild colic
3. pyrexia
4. increased SAA, leukopenia
5. peritonitis (90%)
vetclinic 2023 colic
foal of <7days colic: ddx
congenital: atresia colic/ani, lethal white
* meconium impaction,
* bladder rupture,
* prematurity/dysmaturity
* trauma (rib fracture)
* infectious enterocolitis
* ulcerations
* ileus (elctrolytes)
* peritonitis
* chyloabdo
* hernias
* voluvus/displacement
* intussusception
foal 6-10weeks of age, ddx colic
intraabdo mass Rhodo
infectious enterocolitis
foal 1-6weeks of age, colic ddx
congenital
bladder rupture
trauma
infectious enterocolitis
lactose intolerance
antibiotic induced diarrhea
ulceration
duodenal sttricture
strang obstruction
non strang obstruction = ascaris, feed impaction, foreign body
complicated hernias
less frqt: white muscle disease, fecaliths, adhesions (post sx or enteritis)
what are the risk factor for POI?
ADMISSION:
TC
>8L reflux
Sx: SI resection/anastomosis
2023 colic vetclinic
What about fillies and hernias and congenital colic disorder?
more prone to umbilical hernias + atresia ani
foal with meconium impaction : more frqt in female or male?
Male
foal with** bladder rupture**: more frequent in female or male ?
Male
foal with atresia ani: more frqt in male or female
female
foal with umbilical hernia: more frqt in male or female?
female
bladder rupture : when do you go to Sx?
If Na > 123mmol/L
K < 5mmol/L
Suspicion of uterine torsion: left ligament is horizontal and dorsal and right ligament is vertical -> where the uterus is turned?
clockwise to the right
season and colic: when and which specific type?
LCV/displacement : spring + autumn
LC impaction + epiploic foramen : winter
risk factors for Epiploic foramen
cribbing
colic last 12m
icnreased stabling prior 28d
increased height
increased carers
winter
risk factors for pedunculated lipoma
increased age
arab
QH
saddlebred
pony
risk factors for ileal impaction
a perfoliata
coastal bermuda hay
no pyrantel last 9m
risk factors for idiopathic focal eosinophilic enteritis
young
geo location
july and november
risk factors for LCV
icnreased height
colic episode last 12m
mare
mare that foaled
quidding
medication other than antihelminthic in last 7d
increase hours stbaling last 2w
greater number of horses on premises
3 or more carers
feeding hay
feeding sugar beet
chge pasture last previou s28d
alteration amount hay last 7d
Risk factors for simple colonic obstruction/distension
cribbing
increased hours stabled
reduction exercise
transport last 24h
absence ivermec/moxi last 12m
resident on premise <6m
previous colic
reduced frcy dental prophylaxis
Risk factors for colonic impaction in donkeys
increased age
extra feed
previous colic hisory
paper bedding
concentrates
limite pasture
increased numbers of carers
recent weight loss
recent vaccin
dental abnormalities
Risk factors for enterolithiasis
alfalfa hay, > or = of the diet as alfalfa hay, feeding <50% oat/grass hay
lack of daily pasture
< or = 50% outdoor
arabian or x arabs
miniature
morgan
american saddlebred
donkeys
dry climate
magnesium/P in diet
What is the transabdominal ultrasonographic diagnosis of gastric impaction ? Which breed seems to be predisposed ?
Caudal extension of the stomach as evidence of gastric distension may be present on transabdominal ultrasonography if the wall of the greater curvature can be visualized at or beyond the left 14th intercostal space.
The Friesian breed was significantly overrepresented in a study.
In a study, what was the consequence of a single large volume (> 8L) of enteral fluid given to patients with concurrent gastric impaction ?
Giusto and colleagues reported development of colonic volvulus in 4 horses following treatment with a single large volume (≧ 8 L) of enteral fluid given to patients with concurrent gastric impaction that were not identified until celiotomy.
Thus, frequent enteral administration of smaller volumes of water or crystalloids (4 to 10 mL/kg) through gravity flow was recommended.
What is the overall survival rate of gastric impaction cases ? What is the difference of outcome between primary and secondary gastric impaction ?
The overall survival rate on data comprising 238 cases from 2 recent reports was approximately 60%.
There was no difference in survival to discharge for horses with primary (58%) and secondary (62%) disease.
The complication rate with primary disease may be higher with reports of recurrence and a greater likelihood to progress to gastric rupture.
Which of the following factors is most commonly associated with an increased risk of Equine Gastric Glandular Disease (EGGD) in horses?
A) Intensity of exercise
B) Use of nonsteroidal anti-inflammatory drugs (NSAIDs)
C) Increased cortisol response to stress
D) Type of diet
Explanation:
An increased cortisol response to stress has been associated with a higher prevalence of EGGD in horses. While other factors like exercise intensity and diet are relevant in other gastric conditions (e.g., ESGD), cortisol sensitivity is a key risk factor for EGGD.
Exercising for more than 4 or 5 days per week has been shown to be a risk factor in racehorses and sports horses, whereas intensity of exercise was not.
In thoroughbred racehorses, the trainer was identified as a risk independent of other management factors.
No association has been documented for involvement of infectious agents, nonsteroidal anti-inflammatory drug use in clinical cases, diet, or lameness with EGGD.
Which of the following horse types has been shown to be at an increased risk of developing Equine Gastric Glandular Disease (EGGD)?
A) Arabian horses
B) Warmblood horses
C) Draft horses
D) Shetland ponies
Explanation:
Warmblood horses are at an increased risk of developing EGGD compared to other horse types. This risk is associated with various factors, including management practices and exercise regimens specific to this breed.
Which of the following is a characteristic feature of lesions associated with Equine Gastric Glandular Disease (EGGD)?
A) Ulcerative lesions with necrosis
B) Erosive and inflammatory lesions with a mixed inflammatory cell population
C) Non-inflammatory lesions with minimal cellular infiltration
D) Lesions confined to the squamous mucosa
Explanation:
Lesions associated with EGGD are typically erosive and inflammatory, involving a mixed inflammatory population, including lymphocytes, plasmacytes, and neutrophils. These lesions are best described as glandular gastritis, rather than being ulcerative in nature.
The proposed pathophysiology of these lesions includes changes in blood flow.
Why grading system is not recommended for EGGD ?
It is now widely accepted that the grading system for EGGD does not reflect the severity of disease. Until a better system is developed, describing lesions based on the ECEIM-ACVIM consensus statement is recommended.
These descriptors include the following:
- focal, multifocal, and diffuse;
- mild, moderate, and severe;
- nodular, raised, flat, or depressed;
- erythematous, hemorrhagic, or fibrinosuppurative.
Which of the following treatment combinations is recommended in a recent consensus statement for managing Equine Gastric Glandular Disease (EGGD)?
A) Oral omeprazole combined with misoprostol
B) Oral misoprostol with sucralfate
C) Oral ranitidine combined with sucralfate
D) Long-acting intramuscular omeprazole combined with sucralfate
E) Intravenous corticosteroids with misoprostol
Explanation:
The consensus statement for managing EGGD recommends several treatment combinations, including:
- oral omeprazole (4 mg/kg every 24 hours) combined with sucralfate (12 mg/kg every 12 hours),
- oral misoprostol (5 mg/kg every 12 hours) with or without sucralfate,
- Long-acting intramuscular omeprazole is also used in some regions.
There may be some rationale for administration of glucocorticoids, which have anecdotally been reported to be efficacious.
Although mucosal restitution can occur within 3 to 5 weeks, EGGD may take several months to completely resolve, especially where raised areas or nodules are visible.
Which of the following statements about the prevention of Equine Gastric Glandular Disease (EGGD) is TRUE?
A) Corn oil supplementation is beneficial in preventing EGGD because it increases gastric acid output and decreases PGE production.
B) Magnesium sulphate is recommended as a supplement for preventing EGGD due to its ability to enhance gastric mucosal protection.
C) A consistent routine with minimal stress, including 2 rest days per week and maximizing turnout, is advised to reduce the risk of EGGD.
D) Pectin-lecithin supplementation has been proven to be highly effective as a treatment for EGGD but has no role in prevention.
Explanation:
The correct answer is C).
Preventing EGGD involves strategies like minimizing stress (through a calm environment, few caregivers, and familiar companions), ensuring 2 rest days per week, and maximizing turnout.
Corn oil (150–250 mL/d/500 kg) may be helpful for preventing EGGD by decreasing gastric acid output and increasing PGE production, while pectin-lecithin may act as a mucosal protectant (though it’s not effective as a treatment). Magnesium sulphate should be avoided due to its irritating properties.
There is no evidence for administration of antibiotics, ranitidine, aloe vera, pectin-lecithin complexes, polysaccharides, kaolin, bismuth subsalicylate, sea buckthorn, acupuncture, or homeopathy for the treatment of EGGD.
What is the likely etiology of IBD in horses ? What are the most frequent clinical signs ?
IBD is likely driven by an inappropriate immune response to bacteria, viruses, parasites, and dietary allergens.
Extrapolating knowledge from others species, particularly humans and dogs, it can be assumed that there is a complex relationship between genetics, the environment, bacteria, viruses and parasites, and cereal and meat proteins. There is one study suggesting that gluten may play a role in IBD in the horse, but further studies are required to ascertain if this is the case.
IBD is associated with clinical signs of weight loss, diarrhea, and/or recurrent colic. Clinical signs are likely due to changes in absorption of nutrients and water and effects on gastrointestinal motility.
How to diagnose IBD in horses ?
Diagnosis of IBD is achieved using a variety of techniques, including:
- abnormal oral glucose or xylose absorption tests,
- increased intestinal wall thickness on transabdominal ultrasonographic evaluation (40% to 50% of cases),
- partial-thickness rectal and transendoscopic duodenal biopsies,
- or full-thickness intestinal biopsies.
The previous reported poor prognosis was recently challenged in another, larger prospective publication, whereby initial response to therapy was 75% with 3-year survival reported to be 65%.
What are the 5 subtypes of IBD in horses ?
Five types of IBD are described in the horse that can affect the small and large intestine:
- lymphocytic-plasmocytic enterocolitis (LPE),
- granulomatous enteritis (GE),
- diffuse eosinophilic enterocolitis,
- idiopathic focal eosinophilic enterocolitis,
- multisystemic eosinophilic epitheliotropic disease (MEED).
MEED and GE are the only subtypes of IBD with disease in tissues beyond the intestinal tract. In MEED, changes in the skin and other organs are commonly reported, and in GE, changes in the skin and lymph nodes can be seen.
GE and MEED have most commonly been reported in horses less than 4 years of age with an increased prevalence in standardbreds. The breed predilection may suggest that there is a genetic component.
What is the treatment of IBD in horses ?
Recommendations for treatment in horses include parasiticides, corticosteroids, and azathioprine (3–5 mg/kg once daily). Horses that did not respond to corticosteroids and required the addition of azathioprine had a poorer outcome.
Simplifying treatment and treating IBD like it is a short-term condition that will resolve with corticosteroids are likely to be ineffective. In fact, one needs to appreciate the multifactorial nature and attempt to address the inciting cause and attempt to simplify the dietary management:
- change the fiber source,
- reduce the carbohydrate content,
- simplify to 1 or 2 cereal sources,
- supplement with corn oil and vitamin D.
There is currently limited evidence in the literature for consistent benefits of prebiotics and probiotics.
Fecal transplantation may allow manipulation of the microbiota, in the short and medium term. Efficacy ?
Surgery to undertake resection and anastomosis may be curative for focal idiopathic eosinophilic enterocolitis.
Which are the potential predisposing causes of colon displacement ?
The exact cause of colon displacement is not known and is likely multifactorial.
Diet (particularly those higher in fermentable carbohydrates), changes in diet and exercise, changes in fecal microbiota, and colon impaction are listed as potential predisposing causes.
What are the pros and cons of flank standing surgery?
This approach may offer a cost-effective option when a ventral midline approach cannot be performed, paying special
attention to case selection based on presumptive diagnosis as well as the patient’s signs of discomfort and compliance.
Expense associated with the treatment of the surviving cases was approximately half of the lower end of the estimate for an uncomplicated ventral midline celiotomy within the same hospital.
No horse with strangulation or infarction of the large or small intestine survived to discharge.
Overall survival to discharge was 54%. In this population of horses, the most common complication was surgical site infection in 20% of cases.
Long-term survival (>9 months) was 41% with all surviving equids returning to their intended use.
Which of the following conclusions can be drawn from the study by Stockle and colleagues regarding antimicrobial prophylaxis in equine colic surgery?
A) A 5-day antimicrobial regimen was significantly more effective in reducing postoperative infections than a single-shot regimen.
B) The study found no significant difference in postoperative complications or clinico-pathological data between the single-shot and 5-day antimicrobial regimens.
C) A 23% postoperative infection rate in the single-shot group suggests the need for prolonged antimicrobial prophylaxis for all colic surgeries.
D) The study strongly supports the use of long-term antimicrobial therapy due to the associated reduction in postoperative infections.
Explanation:
The correct answer is B) The study found no significant difference in postoperative complications or clinico-pathological data between the single-shot and 5-day antimicrobial regimens.
Although there was a difference in incisional infection rates 30 days after surgery (23% for the single-shot group vs. 5% for the 5-day group), the study did not find significant differences in postoperative overall complications or clinico-pathological data.
The small sample size and other limitations in the study design make it difficult to draw firm conclusions about the optimal duration of antimicrobial prophylaxis.
Which of the following findings was MOST commonly observed in horses with nonstrangulating intestinal infarction secondary to Strongylus vulgaris in the retrospective study by Pihl and colleagues?
A) Severe acute colic, abdominal distention, and rapid deterioration
B) Mild colic for longer than 24 hours, dull demeanor, mild pyrexia, and leukopenia
C) Immediate post-surgical survival with minimal complications
D) High incidence of necrotic tissue in the small intestine due to cranial mesenteric artery infarction
Explanation:
The correct answer is B) Mild colic for longer than 24 hours, dull demeanor, mild pyrexia, and leukopenia.
Horses with nonstrangulating intestinal infarction secondary to Strongylus vulgaris in the study presented with mild colic lasting over 24 hours, dull demeanor, mild pyrexia, leukopenia, high serum amyloid A concentrations, and peritonitis. The diagnosis was further supported by the analysis of peritoneal fluid, showing increased protein and nucleated cell count, which helped guide the identification of intestinal infarction.
Infarctions were present within the viscera supplied by the cranial mesenteric artery, most commonly the left dorsal colon/pelvic flexure or the cecum.
0% short-term survival in horses managed medically
14% short-term survival in horses that underwent laparotomy
Which of the following conclusions can be drawn from the study by Lawless and colleagues regarding the prognosis and surgical management of duodenojejunal mesenteric rents in Thoroughbred broodmares?
A) The mesenteric rents were primarily caused by inflammatory bowel disease and had a poor prognosis with only 40% survival to 12 months.
B) Mares with duodenojejunal mesenteric rents (caudal to the root of the mesentery) had a better prognosis than previous report of mesenteric rents and higher survival rates following surgical intervention.
C) A higher percentage of mares requiring a jejunojejunostomy had better long-term survival compared to those undergoing simpler rent closure.
D) Mesenteric rents in broodmares were rarely associated with parturition and were generally not repaired during surgery.
Explanation:
The correct answer is B) Mares with duodenojejunal mesenteric rents (caudal to the root of the mesentery) had a better prognosis than previous report of mesenteric rents and higher survival rates following surgical intervention.
The study found that mesenteric rents involving the mesoduodenum caudal to the root of the mesentery were likely associated with parturition and had a better prognosis compared to previous reports. The overall survival to hospital discharge was 76%, and 74% of mares survived for at least 12 months post-surgery, which is a higher outcome than prior reports.
Recurrent colic was more common in mares where the rent was not repaired, reinforcing the importance of closing the rent during the initial surgery.
Which of the following factors was NOT associated with an increased risk of surgical site infections (SSIs) after ventral midline celiotomy, according to the retrospective study by Scharner and colleagues?
A) Age of 20 years or older
B) Not suturing the peritoneum
C) Postoperative fever
D) Use of a stent bandage
Explanation:
The correct answer is D) Use of a stent bandage.
The study by Scharner and colleagues identified several risk factors for SSIs, including older age (20 years or older), not suturing the peritoneum, and postoperative fever. In contrast, the use of a stent bandage was not discussed as a risk factor for SSIs in this study, though it has been suggested as a protective factor in other studies reviewed by Shearer and colleagues.
Which of the following statements best summarizes the findings of Boorman and colleagues regarding the impact of age on prognosis and survival in horses undergoing surgery for small intestinal strangulating obstructions?
A) Geriatric horses (≥16 years) had significantly worse survival outcomes, both short-term and long-term, compared to mature horses (<16 years).
B) Age was not associated with a higher volume of postoperative reflux (POR) or increased mortality, suggesting that age alone is not a determining factor for surgical prognosis in small intestinal strangulating obstructions.
C) Geriatric horses had higher volume of POR, but the short-term prognosis was similar than that of younger horses, regardless of surgical intervention.
D) Horses that underwent jejunojejunostomy or jejunocecostomy had a significantly better long-term survival compared to those that had no resection.
Explanation:
The correct answer is B) Age was not associated with a higher volume of postoperative reflux (POR) or increased mortality, suggesting that age alone is not a determining factor for surgical prognosis in small intestinal strangulating obstructions.
The study by Boorman and colleagues found that age (≧ 16 yo) was not associated with increased postoperative complications or a higher risk of mortality. While geriatric horses had a shorter median long-term survival, this was largely due to the fact that they had fewer years remaining in their natural life span. The study also highlighted that early referral and surgical intervention are crucial to optimizing outcomes, with better long-term survival rates for horses managed without resection.
Which of the following conclusions is best supported by the findings of Arndt and colleagues regarding the prognosis and diagnostic challenges of peritonitis in horses?
A) Secondary peritonitis, particularly when associated with trauma, consistently had a better prognosis than idiopathic peritonitis, with similar survival rates to horses without peritonitis.
B) Peritoneal fluid abnormalities were frequently detected on ultrasound, and all horses with peritonitis had grossly abnormal peritoneal fluid, which is a highly reliable diagnostic indicator of peritonitis.
C) The presence of a significant volume of peritoneal fluid was only observed in a small proportion of horses (29% in point-of-care ultrasound and 24% in complete ultrasound exams), indicating that peritoneal fluid volume is not a sensitive diagnostic marker for peritonitis in horses.
D) Treatment with antimicrobials alone without surgical intervention resulted in a survival rate of 82%, supporting the notion that surgical management is not necessary for the successful treatment of peritonitis in all cases.
Explanation:
The correct answer is C) The presence of a significant volume of peritoneal fluid was only observed in a small proportion of horses (29% in point-of-care ultrasound and 24% in complete ultrasound exams), indicating that peritoneal fluid volume is not a sensitive diagnostic marker for peritonitis in horses.
Arndt and colleagues highlighted that, despite the grossly abnormal appearance of peritoneal fluid in all cases, a significant volume of fluid was found in only a small proportion of horses when examined using ultrasound. This suggests that peritoneal fluid volume is not a reliable marker for diagnosing peritonitis in horses. They also noted that horses with secondary peritonitis (e.g., from trauma) had a poorer prognosis (25% mortality) than those with idiopathic peritonitis (4% mortality).
Which of the following statements about equine celiotomy and its complications is correct?
A) Ultrasonography is primarily used for the diagnosis of surgical site infection (SSI), as it can identify fluid accumulation before incisional drainage appears.
B) Incisional hernias are typically diagnosed immediately postoperatively using routine clinical examination and ultrasonography.
C) The primary risk factor for incisional hernia formation following celiotomy is the surgical procedure itself, not the development of surgical site infection (SSI).
D) No objective data exists regarding the efficacy of specific therapies for surgical site infections following celiotomy, but general treatment principles include drainage, antimicrobial therapy, and extended rest to avoid hernia formation.
Explanation:
The correct answer is D) No objective data exists regarding the efficacy of specific therapies for surgical site infections following celiotomy, but general treatment principles include drainage, antimicrobial therapy, and extended rest to avoid hernia formation.
This statement is supported by the review, which highlights that there is no objective evidence evaluating the specific therapies for surgical site infections (SSIs) after celiotomy. However, standard treatment principles include drainage, bandaging, antimicrobial therapy (guided by culture and sensitivity), and extended rest to prevent complications such as incisional hernias or dehiscence.
A) A presumptive diagnosis of surgical site infection is made based on the presence of fever and incisional swelling, pain, and discharge. Ultrasonography can be used to identify areas of fluid accumulation prior to the appearance of incisional drainage.
B) Incisional hernia is diagnosed by palpation of the incision, usually 30–60 days after surgery. Ultrasound of the incision may aid in early diagnosis of incisional hernia if gaps along the incision in the linea alba are apparent.
C) Infection is the most important risk factor for incisional hernia formation.
Incisional infections associated with ventral midline celiotomy in horses
J Vet Emerg Crit Care 20
True or false
The prevalence of incisional morbidities is higher in pregnant mares compared to control mares undergoing colic surgery.
False
The prevalence of incisional morbidities did not differ between pregnant and control mares undergoing colic surgery, with incisional swelling the most common reported complication in both groups.
Nonsurvival was higher in pregnant mares (13%) compared to control mares (5%).
Several factors were associated with incisional morbidities, including the duration of surgery and anesthesia, anesthetic variables (hypercapnia), abdominal bandage use, previous ventral abdominal incision, and longer
duration of hospitalization.
A multicenter retrospective case–cohort study on the prevalence of incisional morbidities in late pregnant mares following exploratory celiotomy (2014–2019): 579 cases
J Vet Emerg Crit Care 23
In the retrospective case series describing acute abdominal dehiscence (AAD) following ventral midline laparotomy in horses, which of the following statements is true based on the study’s findings?
A) Surgical site infection (SSI) was identified in 100% of horses prior to the development of AAD.
B) Broodmares accounted for approximately 25% of the AAD cases.
C) Surgical repair of AAD led to a higher survival rate than conservative management.
D) Peritoneal fluid leakage was identified in 50% of horses prior to the onset of AAD.
Explanation:
The correct answer is B) Broodmares accounted for approximately 25% of the AAD cases.
According to the study, broodmares accounted for 25% of the cases of acute abdominal dehiscence (n = 16), with pregnant or early post-partum mares may be important risk factors for AAD.
A is incorrect because surgical site infection (SSI) was noted in 44% of horses before AAD developed, not 100%.
C is incorrect because 90% of horses managed conservatively survived to discharge, while only 56% of those who had surgical repair survived.
D is incorrect because only 5% of horses had peritoneal fluid leakage before AAD was identified.
Acute abdominal dehiscence following laparotomy: A multicentre, international retrospective study
evj 22
Based on the study investigating epiploic foramen (EF) length in horses, which of the following conclusions can be drawn?
A) Certain breeds seem predisposed to EFE, linked to a higher EF lenght.
B) The study found a strong correlation between epiploic foramen length and various physical variables, such as age, breed, and gender.
C) Increased intra-abdominal pressure is considered the most important factor in predisposing horses to the recurrence of epiploic foramen entrapment (EFE).
D) Age is directly correlated with epiploic foramen length, and older horses are at a higher risk for EFE.
The correct answer is C) Increased intra-abdominal pressure is considered the most important factor in predisposing horses to the recurrence of epiploic foramen entrapment (EFE).
- The study concluded that there is no association between EF length and physical variables such as height, weight, breed, gender, and age, as reflected in the regression analysis.
-
A is incorrect because the study does not support correlation between EF length and the categorical variables gender, breed or age. We suggest that the positive correlation between Thoroughbreds and EFE reported in previous studies might be due to the high prevalence of cribbing in this breed, since cribbing increases
intra-abdominal pressure in horses. - B is incorrect because the study did not find a correlation between EF length and physical variables.
- D is incorrect because age was found to have no correlation with EF length, contrary to what the question suggests.
Correlation of epiploic foramen length to height, weight, breed, gender and age in horses
eve 20
What is the clinical significance of procalcitonin concentration in peritoneal fluid, according to the study’s findings?
- A) Procalcitonin concentration in plasma is the most reliable marker for detecting strangulating lesions in horses.
- B) Peritoneal fluid procalcitonin concentration is a sensitive indicator of intestinal ischemia and can help identify horses that need surgery for strangulating lesions.
- C) Procalcitonin concentration in both plasma and peritoneal fluid is equally useful for diagnosing strangulating lesions.
- D) Procalcitonin concentration in peritoneal fluid has no diagnostic value for identifying strangulating intestinal lesions.
Answer:
B) Peritoneal fluid procalcitonin concentration is a sensitive indicator of intestinal ischemia and can help identify horses that need surgery for strangulating lesions.
Results suggested that peritoneal fluid procalcitonin concentration, when evaluated in conjunction with other clinicopathologic results, might be a sensitive indicator of intestinal ischemia and facilitate early identification of horses that require surgery to address a strangulating lesion.
Diagnostic value of plasma and peritoneal fluid procalcitonin concentrations in horses with strangulating intestinal lesions
javma 20
How long after surgery can tachycardia be observed?
It is expected for postoperative colic patients to be tachycardic (60–70 bpm) for the first 24 hours after surgery, which is unlikely to be caused by anesthesia alone.
It can take up to 40 hours for mean heart rate to decrease to normal in most horses following large intestinal procedures.
What are the common causes of postoperative fever ?
- Systemic (endotoxemia)
- Lungs (aspiration pneumonia)
- Abdominal cavity (peritonitis)
- Small intestines (enteritis)
- Large intestines (colitis, Salmonellosis)
- Catheter site (thrombophlebitis)
- Surgical site (incisional infection)
What is the median time to first defecation after celiotomy ?
Passage of first feces after colic surgery can vary widely from 1 to 4 hours at the earliest. In one study, median time to first defecation was 8 hours following celiotomy in horses that did not develop postoperative ileus.
Clinicians should not expect normal fecal production in the postoperative colic patient for many days following surgery.
What is the main complication of type II (functional) cecal impaction ?
Cases of type II (functional) cecal impactions have a high risk of reoccurrence and should be monitored closely.
What is the clinical significance of severe hyperglycemia at the time of admission ?
Severe hyperglycemia (>195 mg/dL) at the time of admission is associated with poor prognosis.
What are the estimated daily maintenance fluid requirement of postoperative colic horses ?
What are the consequences of overhydration ?
The daily maintenance fluid requirement in adult horses is around 60 mL/kg when on an all-hay diet.
In one study, water needs were reduced to 16% in horses having feed withheld compared with fed horses. Much less water will be required for normal digestive function in horses that are anorexic or on a restricted diet, as is standard in the immediate postoperative period.
Over hydration can lead to tissue edema and impaired intestinal motility, possibly to the point of exacerbating the postoperative reflux.
What are the risks associated with the prolonged use of IV fluids ?
Prolonged use of IV replacement fluids (ie, Normosol-R) will put horses at risk for complications such as hypernatremia and hypokalemia, unless switched to preparations intended for use as maintenance fluids.
Supplementation of standard replacement fluids with K+ and Ca2+ may be required until horse is back on full-feed. Supplementation with K+, Ca++, and Mg++ is often required in horses with postoperative reflux.
Early transition to free-choice oral fluids over IV replacement fluids is ideal and has the added benefit of decreased expense.
When water and feed can be reintroduced after a colic surgery ?
In horses with large intestinal or small intestinal nonstrangulating lesions :
- Water can be offered as early as 3 hours following recovery from anesthesia.
- Feed can be reintroduced within 6 to 12 hours after recovery from anesthesia.
In horses with small intestinal strangulating lesions :
- Reintroduction of water may be delayed until 12 to 24 hours following recovery from anesthesia.
- Feeding recommendations are more variable. It is reasonable to start slowly refeeding anywhere from 12 to 24 hours following recovery from anesthesia, as long as the horse is comfortable and not refluxing.
- Horse can initially be offered small sips of tap water and then free choice water within the first 24 hours.
- Horses recovering from a large intestinal strangulation probably should not be refed until signs of SIRS have resolved sufficiently to indicate that colonic mucosa can tolerate refeeding.
- In horses with small colon disorders, it is also recommended to administer mineral oil via nasogastric tube postoperatively to help soften fecal material.
Most postoperative colic patients could be started on one handful of hay, or 2 minutes grazing, offered every 4 to 6 hours for the first 24 hours after the start of feeding. If tolerated, feed should gradually be increased during the next 4 to 5 days until back to what is considered “full feed” for that individual.
Based on the study investigating the protective effects of dexmedetomidine on small intestinal ischaemia-reperfusion injury in horses, which of the following statements is TRUE?
A) The study found that dexmedetomidine administered after ischaemia had no effect on epithelial injury scores or villus surface area denudation.
B) Both preconditioning and post-conditioning with dexmedetomidine led to lower epithelial injury scores and less villus surface area denudation compared to the control group.
C) The control group showed no significant increase in epithelial injury or villus surface area denudation following ischaemia-reperfusion injury.
D) Preconditioning with dexmedetomidine showed significantly higher epithelial injury scores compared to the control group.
Answer:
B) Both preconditioning and post-conditioning with dexmedetomidine led to lower epithelial injury scores and less villus surface area denudation compared to the control group.
There was no difference from baseline-1 at any time point for the preconditioning group.
Dexmedetomidine was protective for small intestinal ischaemia-reperfusion injury in the horse when administered before or during ischaemia.
Preconditioning has limited application in the clinical setting with naturally occurring strangulating small intestinal lesions.
Protective effects of dexmedetomidine on small intestinal ischaemia-reperfusion injury in horses
evj 21
What is the clinical efficacy of preconditioning with lidocaine or xylazine ?
Preconditioning with lidocaine did not have any effect on the tested variables.
The lower cell counts of caspase- and calprotectin-positive cells in group preconditioned with Xylazine may indicate a beneficial effect of xylazine on ischaemia/reperfusion injury. Due to the absence of a concurrent reduction of histomorphological injury, the clinical significance remains uncertain.
Preconditioning with lidocaine and xylazine in experimental equine jejunal ischaemia
evj 21
According to the study on duodenal contractility as a predictor of post-operative reflux and survival to discharge in horses following colic surgery, which of the following conclusions is supported?
A) Duodenal contractility on Day 1 post-operatively was significantly lower in horses that did not experience reflux compared to those that did.
B) Duodenal contractility on Day 1 post-operatively had no significant difference between survivors and nonsurvivors.
C) Horses that experienced reflux post-operatively showed significantly increased duodenal contractility compared to those that did not reflux.
D) There was a significant correlation between duodenal contractility on Day 1 and survival to discharge, with increased contractions being associated with higher survival rates.
Answer:
D) There was a significant correlation between duodenal contractility on Day 1 and survival to discharge, with increased contractions being associated with higher survival rates.
This preliminary study indicates that Day 1 (6–36 h post-operatively) duodenal contractions may predict reflux (>5 L/24 h beyond 24 h) and that increased duodenal contractions are associated with survival. However, there was no clear distinction or cut-off between groups.
Equine duodenal motility, assessed by ultrasonography, as a predictor of re ux and survival following colic surgery
eve 21
What was a key finding regarding the use of standing flank laparotomy in horses with colic?
A) Standing flank laparotomy was associated with a survival rate of 100%.
B) Horses that underwent standing flank laparotomy had a higher survival rate when compared to those that underwent ventral midline laparotomy.
C) The survival rate following standing flank laparotomy was 54%, with some animals requiring immediate euthanasia due to severe lesions.
D) Intolerance to abdominopelvic exploration during standing flank laparotomy had no effect on the outcome.
Correct Answer: C)
The survival rate following standing flank laparotomy was 54%, with some animals requiring immediate euthanasia due to severe lesions.
Explanation:
-
Answer C is correct: The study reports that the survival rate was 54%, and some animals required immediate euthanasia due to severe or extensive lesions discovered during the procedure.
The overall short-term survival rate of the present study (54%) was lower than the pooled survival rate (65%) of 10 large case series of equine colic managed with ventral midline laparotomy published since 2002. - Answer D is incorrect: The study mentions that intolerance to abdominopelvic exploration can negatively affect the outcome, making it an important factor to consider.
Median total bill was 52% of the cost estimated for an uncomplicated colic surgery under general anaesthesia for survivors and 40% for non-survivors.
Standing flank laparotomy for colic: 37 cases
evj 22
Experimental jejunal ischaemia was induced for 90 min in horses under general anaesthesia. In the control group, the jejunum was reperfused without further intervention. In the postconditioning group (IPoC), reocclusion was implemented following release of ischaemia by clamping the mesenteric vessels in three cycles of 30 seconds.
What was the primary outcome of the study investigating the effect of ischaemic postconditioning (IPoC) on equine small intestinal ischaemia-reperfusion injury?
A) IPoC had no effect on the intestinal mucosa or paracellular permeability.
B) IPoC significantly increased intestinal microperfusion during all clamping cycles.
C) IPoC reduced mucosal villus denudation and paracellular permeability compared to the control group.
D) IPoC showed no significant differences in mucosal histomorphology compared to the control group.
Correct Answer: C)
IPoC reduced mucosal villus denudation and paracellular permeability compared to the control group.
Explanation:
- Answer C is correct: The study found that IPoC significantly reduced mucosal villus denudation and paracellular permeability compared to the control group, indicating a protective effect of IPoC on ischaemia-reperfusion injury.
- Answer A is incorrect: The study demonstrated that IPoC did indeed have a positive effect on the intestinal mucosa and paracellular permeability, showing a protective effect.
- Answer B is incorrect: While IPoC reduced intestinal microperfusion during the clamping cycles, it did not increase microperfusion. It actually reduced microperfusion during the clamping cycles but showed improvement in reperfusion.
- Answer D is incorrect: The study showed significant differences in mucosal histomorphology between the IPoC group and the control group, with IPoC being beneficial.
The effect of ischaemic postconditioning on mucosal integrity and function in equine jejunal ischaemia
evj 22
What is the clinical significance of persistent colonic edema after a LCV correction ?
Detection of persistent edema within the colonic wall following correction of an LCV is associated with increased morbidity.
What is the clinical significance of a venous lactate of greater than 5 mmol/L after correction of the LCV ?
A horse with a venous lactate of greater than 5 mmol/L after correction of the LCV had 27 times higher odds of dying in the postoperative period than those with blood lactate less than 5 mmol/L.
Additionally, horses with arterial lactate values of greater than 5 mmol/L in recovery had a 2.25 times greater relative risk to develop postoperative complications, and those with recovery lactate greater than 7 mmol/L had a 10.5 times higher relative risk of death.
What is the primary acid base derangement seen in the colic patient ?
Metabolic acidosis is the primary derangement seen in the colic patient, which is often a result of hyperlactatemia secondary to hypoperfusion or hypoxemia (type A). Bicarbonate administration in lactic acidosis is generally contraindicated.
Hypochloremic metabolic alkalosis can also be observed when large volume gastric reflux is present.
Hyperlactatemia can also occur in horses with sepsis in the presence of normal tissue oxygenation because leukocytes produce a large amount of lactate when activated (type B).
Which patients are more suspectible to severe metabolic acidosis ?
In cases of severe metabolic acidosis with a pH of 7 or less in a volume-resuscitated patient, bicarbonate therapy
may be beneficial. This may be most commonly observed in horses and foals with persistent and voluminous diarrhea.
The bicarbonate deficit in mEq = base deficit x 0.3 x BW.
The first half of the deficit can be administered over 1 hour, and the remainder during the following 12 to 24 hours, with frequent reassessments to guide therapy.
Why rapid intravascular volume expansion is controversial ?
Rapid fluid bolus administration is associated with adverse effects on the microcirculation and the endothelial surface layer (ESL), which contains a structural scaffold called the endothelial glycocalyx. The ESL is the protective barrier that regulates transvascular fluid movement, vasomotor tone, coagulation, and inflammation.
Thinning or shedding of this critically important layer through rapid intravascular volume expansion may promote interstitial edema, inflammation, and promote microcirculatory dysfunction.
When should repeat celiotomy be performed ?
The authors’ approach for POR that persists for the first 24 hours after it starts is to discuss the possible need for repeat celiotomy with the owner.
If POR decreases in volume during the first 24 to 48 hours, continued medical treatment is justified; however, persistence to 48 hours and beyond should invoke a stronger consideration for repeat celiotomy.
Signs of POC, especially if difficult to control, can force an earlier decision than POR.
Which of the following statements about small intestinal (SI) intussusception, not involving the caecum, in horses is correct?
A. The condition is most frequently diagnosed in horses older than 10 years.
B. Horses with higher lactate levels and reflux before admission had a poorer prognosis.
C. The study found a low postoperative complication rate.
D. Long-term survival after hospital discharge was reported to be low.
Correct Answer:
B. Horses with higher lactate levels and reflux before admission had a poorer prognosis.
Explanation:
- A is incorrect because the median age of affected horses was 9 months, with a range including younger horses.
- B is correct, as the study found poorer prognosis associated with higher lactate levels and reflux before admission (p = 0.024), and when the involved segment was longer.
- C is incorrect because the postoperative complication rate was high at 47% and included ileus, diarrhoea and colic.
- D is incorrect because the long-term survival rate after hospital discharge was high (92%).
Ccl° : Small intestinal intussusception was diagnosed in horses of a variety of breeds and ages. Alterations of motility can predispose to intussusception, not only due to
hypermotility (diarrhoea), but also due to hypomotility (anaesthesia).
Prognosis for hospital discharge was fair (53%); however, following hospital discharge, the long-term survival rate is high and complications are rare.
Small intestinal intussusception in horses: Multicentre retrospective report on 26 cases (2009-2020)
eve 22
Which of the following factors was identified as having the greatest impact on long-term survival in horses after small intestinal surgery for strangulating diseases?
A. The type of anesthesia used during surgery.
B. The age of the horse at the time of surgery.
C. The use of Kaplan-Meier statistics for survival analysis.
D. The length of the recovery period after surgery.
Correct Answer:
B. The age of the horse at the time of surgery.
Explanation:
- A is incorrect because anesthesia was not discussed as a significant factor.
- B is correct, as the study concluded that the remaining lifespan of older horses at the time of surgery had the greatest effect on survival.
- C is incorrect because Kaplan-Meier statistics were used as a method for analysis, not a factor influencing survival.
- D is incorrect because the recovery period length was not mentioned as a major determinant of long-term survival.
The remaining lifespan of older horses at the time of surgery had the greatest effect on survival. Age could influence long-term survival studies after colic surgery, and therefore needs to be considered for survival analyses.
Effects of age, disease and anastomosis on short- and long- term survival after surgical correction of small intestinal strangulating diseases in 89 horses
evj 22
Which of the following surgical outcomes was associated with the longest median survival time in horses?
A. Horses that underwent jejunocecostomy.
B. Horses that required resection and anastomosis.
C. Horses with miscellaneous diseases without resection.
D. Horses diagnosed with strangulating lipoma.
Correct Answer:
C. Horses with miscellaneous diseases without resection.
Explanation:
- A is incorrect because horses that underwent jejunocecostomy had shorter median survival times.
- B is incorrect because resection and anastomosis were associated with shorter survival times compared to horses without resection.
- C is correct, as the study reported significantly longer median survival times for horses with miscellaneous diseases and no resection, compared with strangulating lipoma.
- D is incorrect because horses with strangulating lipoma had shorter median survival times.
Ccl° : Horses that did not require resection and anastomosis had favourable outcomes, underscoring the potential importance of early intervention to reduce the need for resection.
Effects of age, disease and anastomosis on short- and long- term survival after surgical correction of small intestinal strangulating diseases in 89 horses
evj 22
What was the main conclusion of the study on exploratory laparoscopy in horses with chronic abdominal pain?
A. Exploratory laparoscopy has low sensitivity but high specificity for diagnosing chronic abdominal pain.
B. Exploratory laparoscopy is a valuable diagnostic tool due to its high sensitivity and low complication rate.
C. Exploratory laparoscopy frequently causes severe postoperative complications in standing horses.
D. Exploratory laparoscopy should only be performed under general anesthesia for accurate results.
Correct Answer:
B. Exploratory laparoscopy is a valuable diagnostic tool due to its high sensitivity and low complication rate.
Explanation:
The study concluded that exploratory laparoscopy in standing horses has high sensitivity (88%), but low specificity (15%) and a low complication rate, making it a useful tool for diagnosing chronic abdominal pain.
Use of flank laparoscopy in the standing horse as a diagnostic aid in horses with chronic abdominal pain
eve 24
Which horses seem predisposed to fecalith obstruction ?
Miniature horses and ponies were overrepresented and equids ≤ 1 year of age were overrepresented in the fecalith population compared to the colic population. However, full-sized breeds were also affected.
Surgical treatment had an excellent short-term prognosis. Severe colic signs, tachycardia, hyperlipemia, postoperative colic, and surgical complications negatively affected short-term survival.
Ponies, miniatures, and younger equids are at higher risk of fecalith obstruction compared to a general colic population
javma 24
What are the different categories of rectal tears and treatment associated ?
Rectal tears are classified by severity.
- Tears of the mucosa or mucosa and submucosa are defined as grade 1 tears. These generally heal without surgical treatment.
-
Grade 2 rectal tears involve the muscle layer only and can lead to a diverticulum where the mucosa and submucosa prolapse through the defect in the muscle. Generally, these diverticula are less serious, but
can be fatal if they lead to chronic impactions. - Grade 3 rectal tears involve all layers of the rectum except for the serosa (grade 3a) or all layers but the mesorectum and the retroperitoneum (grade 3b). Grade 3 tears can be treated conservatively or with direct suturing.
- Grade 4 tears involve all layers of the rectum and must be treated surgically to prevent septic peritonitis.
Rectal tear repair using barbed suture in the horse
javma 24
What was the effect of intraoperative dexamethasone on the risk of postoperative reflux (POR) in horses undergoing small intestinal surgery?
A. It significantly increased the risk of POR.
B. It significantly reduced the risk of POR.
C. It had no significant effect on the risk of POR.
D. It eliminated the risk of POR entirely.
Correct Answer:
C. It had no significant effect on the risk of POR.
Intraoperative dexamethasone was not associated with the development of POR in this study population, nor did it have an effect on postoperative survival or incisional infection in horses undergoing surgical management of small intestinal disease.
Retrospective evaluation of the effects of a single intraoperative dose of dexamethasone in horses undergoing exploratory laparotomy for small intestinal lesions (2008–2019): 240 cases
J Vet Emerg Crit Care. 2024
Which factor was negatively associated with short-term survival in horses undergoing small intestinal surgery?
A. Administration of dexamethasone.
B. The development of postoperative reflux (POR).
C. A PCV < 40% 24 hours postoperatively.
D. Small intestinal resection.
Correct Answer:
B. The development of postoperative reflux (POR).
Risk factors associated with the development of POR included small intestinal resection, a PCV >40% 24 hours postoperatively , and a WBC count >10 × 10^9/L on admission.
Retrospective evaluation of the effects of a single intraoperative dose of dexamethasone in horses undergoing exploratory laparotomy for small intestinal lesions (2008–2019): 240 cases
J Vet Emerg Crit Care. 2024
What was the main finding regarding the survival of horses with post-operative reflux (POR) following large colon volvulus (LCV) surgery (without concurrent lesions)?
A. Horses with POR had similar survival rates to those without POR.
B. Horses with POR were more likely to survive long-term than those without POR.
C. Horses with POR were significantly less likely to survive to hospital discharge and long-term.
D. POR did not influence survival rates after LCV surgery.
Correct Answer:
C. Horses with POR were significantly less likely to survive to hospital discharge and long-term.
Ccl°: POR in LCV cases is a negative prognostic indicator for survival.
Factors associated with development of post-operative reflux in horses with large colon volvulus and association with complications and outcomes
evj 24
What was the prevalence of post-operative reflux (POR) in horses undergoing surgery for large colon volvulus (LCV)?
A. 5%
B. 18%
C. 44%
D. 86%
Correct Answer:
B. 18%
Post-operative reflux (POR) is rare following large colon volvulus (LCV) but does occur despite the absence of a small intestinal lesion.
Factors associated with development of post-operative reflux in horses with large colon volvulus and association with complications and outcomes
evj 24
What was the main finding regarding the impact of age on survival in horses with colitis?
A. Age had no significant impact on survival rates.
B. Younger horses (2–12 years) had lower survival rates compared to geriatric horses (≥20 years).
C. Geriatric horses (≥20 years) were significantly more likely to die than young-adult horses (2–12 years).
D. Horses aged 13–19 years had the highest survival rates.
Correct Answer:
C. Geriatric horses (≥20 years) were significantly more likely to die than young-adult horses (2–12 years).
Ccl° : Outcome of colitis was less favorable in aging horses and patients receiving a plasma transfusion.
Assessment of the impact of age and of blood-derived inflammatory markers in horses with colitis
J Vet Emerg Crit Care. 2021
Did the detection of more than one potential enteric pathogen or toxins in feces or blood affect the outcome of horses with colitis ?
Detection of more than 1 PEP or PEP-T did not affect outcome.
Detection rates of PEP/PEP-T in horses with colitis vary with cohorts and tests performed.
Detection of pathogens in blood or feces of adult horses with enteric disease and association with outcome of colitis
jvim 21
Which of the following was most strongly associated with the development of laminitis in horses hospitalized for acute colitis?
A. Total solids concentration
B. Heart rate on admission
C. Presence of band neutrophils
D. Bicarbonate concentration
Correct Answer:
C. Presence of band neutrophils
Admission heart rate (OR 1.08), total solids (OR 0.17), band neutrophils (OR 1248.47), and bicarbonate concentration (OR 0.68) were predictive of development of laminitis during hospitalization.
Risk factors for laminitis and nonsurvival in acute colitis: Retrospective study of 85 hospitalized horses (2011-2019)
jvim 21
Which horses are more susceptible to develop laminitis between Neorickettsiosis, Salmonelloris, and coronavirus cases ?
There was no significant difference in laminitis between salmonellosis and neorickettsiosis cases.
Neorickettsiosis cases (11/26, 42%) were more likely to develop laminitis than coronavirus (0/16, 0%) cases.
PCV (hazard ratio [HR] 1.17), L-lactate concentration (HR 1.33), and development of laminitis (HR 7.07) were retained in the final multivariable model for prediction of nonsurvival to discharge.
Risk factors for laminitis and nonsurvival in acute colitis: Retrospective study of 85 hospitalized horses (2011-2019)
jvim 21
What is the clinical significance of increased serum biliverdin reductase B in horses with colitis ?
On day 1 of treatment, eight proteins in the colitis group were upregulated compared with the healthy group. Among the eight proteins, biliverdin reductase B was significantly upregulated (P < .05) in the non-survivor group compared with the survivor group.
A comprehensive and comparative proteomic analysis of horse serum proteins in colitis
evj 22
Based on the retrospective study of 35 horses diagnosed with right dorsal colitis (RDC), what were the key clinical findings and prognostic factors associated with survival, and how might these influence the management of horses receiving NSAIDs?
The study identified that an overdose of NSAIDs was common in RDC cases (84% of known doses).
Clinical signs frequently included diarrhea, colic, and tachycardia, with 77% of cases showing ultrasonographic thickening of the right dorsal colon.
Key prognostic indicators for nonsurvival included elevated HR, increased PCV, and abnormal mucous membrane appearance. Case fatality rate was 43%.
These findings suggest that serum albumin monitoring and early recognition of critical signs are essential for managing horses on prolonged NSAID treatment and improving RDC outcomes.
Right dorsal colitis in horses: A multicenter retrospective study of 35 cases
jvim 23
Is subclinical shedding or clinical infection with Salmonella enterica more prevalent in horses ?
What are the 3 factors associated with sheddings ?
Subclinical infection and shedding is much more common than clinical infections. When Salmonella spreads among patients, environmental contamination is predictably present and can become widespread before the scope of the problem is realized.
Shedding prevalence of S enterica can vary markedly with health status (hospitalized horses), season of the year (late summer, early fall), and geographic region (warmer and wetter regions in USA).
What are the clinical signs associated with Salmonellosis ?
S enterica transmission occurs by the fecal–oral route and can result in enterocolitis, often manifesting with diarrhea, bacteremia, or subclinical infection.
Historically, we consider a triad of clinical signs—diarrhea, fever, and leukopenia—to be indicating Salmonella shedding among horses. But some studies suggest that by the time fever and/or diarrhea are recognized, animals are likely to already be shedding Salmonella in their feces.
Some studies have reported an increased risk associated with abdominal surgery or with vascular compromising conditions, whereas other studies have not found similar associations. One subgroup that is consistently reported to be more likely to shed Salmonella during hospitalization are those admitted to critical care units.
How long should a shedders be isolated?
A more recent prospective study preliminarily found an estimated median shedding duration of 54 days (range 14–121 days) and 31 days (range 4–138 days) among horses with clinical disease and subclinical infection, respectively.
With this in mind, it is likely prudent to take precautions when managing these horses for 6 to 8 weeks.
Why Salmonellosis is a diagnostic challenge ?
Detection of S enterica in horses can present a diagnostic challenge due to the intermittent nature and low level of organisms shed in equine feces → poorer epidemiologic sensitivity.
The general recommendation is to test 3 to 5 enriched-cultures, obtained in a short time frame (every 12h for 36 hours). Estimated sensitivity of 97% for 5 cultures.
What is the best diagnostic method to detect a shedder, and a contaminated environment ?
In general, culture of a rectal mucosal sample is more sensitive than a fecal culture, which is more sensitive than a rectal swab. However, the invasive nature of obtaining a rectal mucosal sample may preclude its routine use. And use enriched culture methodologies (enriched in tetrathionate broth TET).
PCR is generally considered to be sensitive and specific for the detection of Salmonella.
Best practice is to refrigerate samples until processing as soon after collection as possible.
In general, the larger the sample, the greater the sensitivity.
When sampling the hospital environment, electrostatic dust wipes are more sensitive than sterile sponges.
Which of the following factors were significantly associated with Salmonella shedding in horses presenting with colic at a referral clinic?
A) Increased lactate, neutropenia, and history of fever.
B) History of diarrhea, leukocytosis, and hypoproteinemia.
C) Hyperlactatemia, thickened colon wall, and absence of fever.
D) Neutrophilia, decreased lactate, and presence of reflux.
Correct Answer: A
Increased lactate, neutropenia, and a history of fever were identified as significant predictors of Salmonella shedding in colic cases.
Equids shedding Salmonella were more likely to present in July.
Hospitalised equids shedding Salmonella were more likely to be febrile (OR= 4.8) and 10 times more likely to
develop reflux (OR= 10.1) compared to colic controls.
Certain predictors such as the development of a fever or reflux in hospitalised colic cases were associated with Salmonella shedding and may help the clinician to promptly identify horses likely to shed; thus, helping institute effective use of barrier nursing precautions.
Prevalence of and risk factors associated with Salmonella shedding among equids presented to a veterinary teaching hospital for colic (2013–2018)
evj 23
Which of the following best describes the findings of the study on pooling fecal samples for Salmonella culture in horses?
A) Pooling 10 fecal samples significantly reduces sensitivity compared to individual cultures.
B) Pooling 5 fecal samples maintains high sensitivity and is a cost-effective approach for detecting Salmonella shedding.
C) Homogenization time was critical for improving the recovery of Salmonella spp. from pooled samples.
D) Salmonella spp. were not recoverable from spiked samples with a concentration of 10^2 cfu.
Correct Answer: B
Pooling of 5 fecal samples for Salmonella culture is a sensitive and cost-effective diagnostic approach to detect horses that are shedding the organism.
Homogenization protocols indicated that the addition of 20 mL of broth (bouillon de culture) to the pooled sample improved recovery, whereas homogenization time did not.
Recovery of Salmonella bacterial isolates from pooled fecal samples from horses
jvim 23
What are the clinical signs of ECoV?
Most infections are mild, self-limiting enteritis.
Anorexia, lethargy, fever → most common
Diarrhea, colic → inconsistent (colic)
Encephalopathy due to hyperammonemia→ rare, could be fatal
Blood test → neutropenia, lymphopenia
Fecal-oral route of infection.
Diagnosis → PCR of feces or rectal swab (peak 3-4 days following clinical signs)
Morbidity → 10-80% , Mortality → low
What are the major risk factors for Clostridium difficile-associated disease ?
ATM-treatment and hospitalization
Virulence factors → toxins A and B which mediate toxin binding to enterocytes → cell death
Toxigenicity of the strain determine its virulence
What are the major risk factors for Clostridium perfringens-associated disease ?
Any disruption to the normal microbiota can lead to overgrowth of C. perfringens and infection : sudden dietary changes, ATM adm°, stress, deworming horses with heavy parasite load, surgery, gastric acid suppression.
Entero +/- colitis → diarrhea and colic of toxigenic origin.
Toxins expressed used to classify CP into 7 toxinotypes → CP type A, B, C
Type C → most common in foals in USA, produces major toxins CPA and CPB
Type A → enteric infection in adult horses
CPB (beta) binds to endothelial cells → vascular damage, thrombosis, and necrosis
NetF → necrotizing toxin
How to diagnose Clostridial infection ?
Presumptive → clinical signs, history of ATM TT, deworming, colic surgery, hospitalization…
CD → isolation of large number of bacteria + PCR for toxin A and B + ELISA of fecal toxins.
CP → culture and isolation + specific PCR of enterotoxin, toxins alpha, beta, epsilon, iota or ELISA
What are the consequences on the microbiome of colitis or ATM adm° ?
Horse with colitis demonstrate decreased alpha diversity, β-diversity and changes in taxonomy.
Most studies using NGS methods to evaluate the effects of antimicrobials on the fecal microbiome of healthy horses report that antimicrobials reduce the richness and evenness (homogénéité) of the microbiome. Usually, the maximal effect on diversity is seen on Day 3 to 5, with recovery often occurring after 30 days.
Does dysbiosis play a role in the fecal water syndrome in horses ?
Dysbiosis is not present in horses with fecal water syndrome when compared to controls in spring and autumn.
Dysbiosis is not present in horses with fecal water syndrome when compared to controls in spring and autumn
jvim 20
What was the primary finding regarding the fecal microbiota of donkeys after transportation, as determined in the study?
A. Transportation significantly increased the bacterial diversity in the fecal microbiota of donkeys.
B. Transportation led to a significant decrease in bacterial richness without notable changes in diversity.
C. The abundance of all bacterial species increased significantly after transportation.
D. Transportation had no measurable effect on the composition of fecal microbiota in donkeys.
Correct Answer: B. Transportation led to a significant decrease in bacterial richness without notable changes in diversity.
Transport stress affects the fecal microbiota in healthy donkeys
jvim 21
True or false
Younger foals have a higher microbiota diversity than older foals ?
False
Foals aged 1-2 weeks had significantly lower microbiota richness than older foals.
Firmicutes and Bacteroidetes were dominant in the faecal microbiota.
Faecal microbiota and antimicrobial resistance gene profiles of healthy foals
evj 21
Which of the following statements accurately reflects the findings regarding the fecal microbiota in horses with antimicrobial-associated diarrhea (AAD) and Salmonella infection compared to healthy horses?
A. Horses with AAD showed increased richness and evenness of their fecal microbiota compared to healthy horses.
B. Salmonella-infected horses had a more severe dysbiosis than do horses with AAD.
C. Horses with AAD and Salmonella had decreased richness and evenness compared to healthy horses.
D. The amount of grain in the diet had a greater impact on the fecal microbiome than colitis caused by AAD or Salmonella infection.
Correct Answer: C. Horses with AAD and Salmonella had decreased richness and evenness compared to healthy horses.
A. Horses with AAD showed decreased richness and evenness of their fecal microbiota compared to healthy horses.
B. Horses with AAD had a more severe dysbiosis than do horses with Salmonella.
D. Although the amount of grain in the diet had some impact on the fecal microbiome, colitis had a significantly larger influence.
The effects of signalment, diet, geographic location, season, and colitis associated with antimicrobial use or Salmonella infection on the fecal microbiome of horses
jvim 21
True or false
There are major differences in the microbiota of horses with colitis that survive or do no survive, and no difference in horses with colitis that do or not develop laminitis.
False
Differences in the microbiota of horses with colitis that survive or do not survive are minor and, similarly, the microbiota differences in horses with colitis that do or do not develop laminitis are minor.
Fecal microbiota of horses with colitis and its association with laminitis and survival during hospitalization
jvim 22
Is there gastric microbiome differences in horses with and without equine glandular gastric disease ?
A modest difference was detected in the community structure of the gastric glandular mucosal microbiome in association with EGGD score.
Gastric microbiome in horses with and without equine glandular gastric disease
jvim 21
Do dietary and management factors influence the equine gastric microbiome ?
Yes
Differences were detected in association with offering hay, type of hay, sweet feed, turnout, and stalling. Offering hay and stalling showed differences in similarity indices, whereas hay type, sweet feed, and turnout showed differences in similarity and diversity indices.
Offering hay, hay type, and sweet feed were also associated with differences in individual sequence read counts.
→ complex relationship between the glandular gastric microbiome and diet/management factors.
Dietary and management factors influence the equine gastric microbiome
javma 22
Antimicrobials can have a marked effect on the GI microbiome by reducing diversity and altering the bacterial community composition of the microbiome, even when animals remain healthy and maintain normal fecal consistency. This effect has been demonstrated with commonly used antimicrobials, such as penicillin, TMPS, ceftiofur, enrofloxacin, and metronidazole.
What about the effect of oral doxycycline ?
Transitory intestinal dysbiosis occurs under oral administration of doxycycline in horses.
A significant decrease in alpha diversity, characterised by a decrease of richness and diversity, and a decrease in beta diversity, characterised by changes in relative abundance, occurred after initiation of and during the administration of doxycycline.
It took 23 days after discontinuing the treatment for the faecal microbiota to return close to the initial state.
Oral administration of antimicrobials alters the intestinal microbiota of healthy horses resembling horses with dysbiosis, potentially resulting in intestinal inflammation and predisposition to diarrhea.
Characterisation of faecal microbiota in horses medicated with oral doxycycline hyclate
evj 23
Longitudinal effects of oral administration of antimicrobial drugs on fecal microbiota of horses
jvim 23
Is there an effect of oral administration of omeprazole on the microbiota of the gastric glandular mucosa and feces of healthy horses ?
Oral administration of misoprostol ?
Omeprazole did not induce significant major changes in composition of fecal or gastric glandular microbiota. Oral administration of omeprazole could have
fewer effects in gastrointestinal microbiota in the horse compared to other species.
Differences in microbiota parameters were primarily associated with interindividual variation and management rather than misoprostol administration.
Multidose misoprostol pharmacokinetics and its effect on the fecal microbiome in healthy, adult horses
AJVR 23
Effect of oral administration of omeprazole on the microbiota of the gastric glandular mucosa and feces of healthy horses
jvim 20
Which of the following is true regarding the findings and outcomes in horses with gastric impactions (GI) in this study?
A. Horses with concurrent gastric impactions (CGI) resolved more quickly than those with lone gastric impactions (LGI).
B. Horses with LGI were significantly more likely to experience gastric rupture compared to those with CGI.
C. Long-term survival was significantly better in horses with CGI compared to LGI.
D. Gastric impactions were more likely to recur in horses with CGI than in those with LGI.
Correct Answer:
B. Horses with LGI were significantly more likely to experience gastric rupture compared to those with CGI.
LGI and CGI present similarly with a comparable prognosis and recurrence rate, but LGI are more likely to rupture.
Concurrent gastric impactions resolved more slowly (4 days) than LGI (2 days).
Long-term dietary changes are often necessary for horses with LGI.
Clinical presentation and outcome of gastric impactions with or without concurrent intestinal lesions in horses
jvim 23
Which of the following findings was observed in the study of lymphocytes and eosinophils in the mucosa of asthmatic horses?
A. The duodenal and rectal epithelium contained a mix of T lymphocytes (CD3) and B lymphocytes (CD20) in both asthmatic and control horses.
B. Symptomatic asthmatic horses showed a significantly higher number of T lymphocytes in the duodenal epithelium compared to control horses.
C. Eosinophil counts in the duodenal mucosa were significantly lower in symptomatic asthmatic horses compared to controls.
D. Horses treated with alfalfa pellets showed significantly fewer T lymphocytes in the rectal mucosa than fluticasone-treated horses.
Correct Answer:
B. Symptomatic asthmatic horses showed a significantly higher number of T lymphocytes in the duodenal epithelium compared to control horses.
A. The duodenal and rectal epithelium contained a mix of T lymphocytes (CD3) and B lymphocytes (CD20) in both asthmatic and control horses.
- Why it’s wrong:
The study specifically stated that the** duodenal and rectal epithelium** of both asthmatic and control horses contained exclusively T lymphocytes (CD3). B lymphocytes (CD20) were not found in the epithelium, so this statement contradicts the findings.
C. Eosinophil counts in the duodenal mucosa were significantly lower in symptomatic asthmatic horses compared to controls.
- Why it’s wrong:
The abstract does not mention any significant differences in eosinophil counts between symptomatic asthmatic horses and controls in the duodenal mucosa. The study focuses on T lymphocyte infiltration rather than eosinophil differences, making this answer unsupported by the data.
D. Horses treated with alfalfa pellets showed significantly fewer T lymphocytes in the rectal mucosa than fluticasone-treated horses.
- Why it’s wrong:
The study found that fluticasone-treated horses had significantly fewer T lymphocytes in the rectal lamina propria compared to symptomatic asthmatic horses. However, it does not indicate that alfalfa-fed horses had fewer T lymphocytes than fluticasone-treated horses. Thus, this statement is inaccurate.
B- and T-cell lymphocytes and other immune cell infiltration in the duodenal and rectal mucosa of severe asthmatic horses
AJVR 23
Which of the following is NOT a correct statement based on the study’s findings regarding large intestinal trocarization in equids with colic?
A. Large intestinal trocarization is associated with complications leading to death in equids.
B. Multiple trocarization procedures are associated with an increased likelihood of nonsurvival.
C. Equids with nephrosplenic ligament entrapment of the large colon have a decreased likelihood of nonsurvival.
D. Clinically relevant peritonitis (CRP) occurred in a subset of equids receiving medical treatment only.
Correct Answer:
A. Large intestinal trocarization is associated with complications leading to death in equids.
Justification for the Answer:
-
A. Large intestinal trocarization is associated with complications leading to death in equids.
This statement is incorrect. The study explicitly states that none of the equids died or were euthanized due to complications from large intestinal trocarization. Thus, the procedure is considered relatively safe. -
B. Multiple trocarization procedures are associated with an increased likelihood of nonsurvival.
This is correct. The study found that an increasing number of trocarization procedures was significantly associated with nonsurvival, highlighting a risk factor for poorer outcomes. -
C. Equids with nephrosplenic ligament entrapment of the large colon have a decreased likelihood of nonsurvival.
This is correct. The study identified that a diagnosis of nephrosplenic ligament entrapment decreased the odds of nonsurvival, possibly because it is more manageable or has a better prognosis compared to other conditions. -
D. Clinically relevant peritonitis (CRP) occurred in a subset of equids receiving medical treatment only.
This is correct. CRP was observed in 20% of the medically treated equids, meeting the defined clinical criteria for this complication.
Outcome and complications following transrectal and transabdominal large intestinal trocarization in equids with colic: 228 cases (2004–2015)
javma 20
Which of the following statements is NOT supported by the study findings on inflammatory bowel disease (IBD) in horses?
A. Horses with IBD show significant disruption to the networks of interstitial cells of Cajal (ICC).
B. The density of enteric neurons and glial cells does not differ significantly between IBD horses and controls.
C. The reduction in ICC networks in horses with IBD is most pronounced in the myenteric plexus region.
D. Eosinophilic gastroenteritis (EG) and granulomatous enteritis (GE) significantly differ in their effects on ICC density.
Correct Answer:
D. Eosinophilic gastroenteritis (EG) and granulomatous enteritis (GE) significantly differ in their effects on ICC density.
Justification for the Answer:
-
A. Horses with IBD show significant disruption to the networks of interstitial cells of Cajal (ICC).
This statement is supported by the study, which found that ICC networks were significantly reduced in IBD horses compared to controls, which may contribute to the clinical signs of colic in some horses with IBD. -
B. The density of enteric neurons and glial cells does not differ significantly between IBD horses and controls.
This is correct. The study reported no significant difference in the density of neuronal or glial cell markers between the two groups. -
C. The reduction in ICC networks in horses with IBD is most pronounced in the myenteric plexus region.
This statement is supported by the findings, as the reduction in ICC networks was specifically noted in the myenteric plexus region. -
D. Eosinophilic gastroenteritis (EG) and granulomatous enteritis (GE) significantly differ in their effects on ICC density.
This is not supported by the study. While the study includes cases of EG and GE, it does not report any significant differences in the effects of these two forms of IBD on ICC density.
Myenteric networks of interstitial cells of Cajal are reduced in horses with inflammatory bowel disease
evj 20
Is there any beneficial effect of supplementation with germinated barley of the colic incidence in horses ?
With the inclusion of germinated barley, there was a significant decrease in the colic events in the total population. It was concluded that supplementation with germinated barley might decrease the occurence of colic in stabled horses.
Comparison of the colic incidence in a horse population with or without inclusion of germinated barley in the diet
eve 20
What is the estimated water consumption of feed deprivation horses ?
Feed deprivation immediately and persistently reduced water consumption to ~16% of fed values.
Feed consumption has a marked effect on water requirements in healthy horses. Because current guidelines for water needs were obtained in the fed state, they might not apply to horses that are denied feed for any reason or have reduced feed intake. This study provides new information on water consumption in horses that should apply to this essential nutrient in health and disease.
Effect of feed deprivation on daily water consumption in healthy horses
evj 21
Which of the following statements is NOT supported by the study findings on acute diarrhea in horses?
A. Survival rates of horses with acute diarrhea were similar across geographic regions.
B. Horses with SIRS and elevated creatinine or L-lactate concentrations had lower survival rates.
C. The prevalence of laminitis in horses with acute diarrhea was significantly higher in Europe compared to other regions.
D. Horses that developed laminitis had significantly higher odds of non-survival than those without laminitis.
Correct Answer:
C. The prevalence of laminitis in horses with acute diarrhea was significantly higher in Europe compared to other regions.
Justification for the Answer:
-
A. Survival rates of horses with acute diarrhea were similar across geographic regions.
This is supported by the study, which reported no significant differences in survival rates between geographic regions. -
B. Horses with SIRS and elevated creatinine or L-lactate concentrations had lower survival rates.
This statement is correct. The study found that horses with SIRS and higher creatinine (>159 μmol/L) or L-lactate concentrations (>2.8 mmol/L) had significantly lower survival rates. -
C. The prevalence of laminitis in horses with acute diarrhea was significantly higher in Europe compared to other regions.
This is not supported by the study. In fact, the study found that the prevalence of laminitis was lower in Europe (4%) compared to North America (8%), Australia (8%), and Latin America (11%). -
D. Horses that developed laminitis had significantly higher odds of non-survival than those without laminitis.
This is supported by the findings, as horses with laminitis had 3.73 times greater odds of non-survival than those without laminitis.
Survival rates and factors associated with survival and laminitis of horses with acute diarrhoea admitted to referral institutions
evj 24
What were the main findings regarding the skeletal neuromuscular junctions (NMJs) in horses with equine grass sickness (EGS), as compared to control horses and a horse with botulism?
A) EGS NMJs showed significantly higher synaptic vesicle (SV) density than controls, suggesting enhanced neurotransmitter release.
B) EGS NMJs exhibited a significantly higher percentage of abnormal morphology and a lower mean volume fraction of SVs compared to controls.
C) The skeletal NMJs in horses with botulism displayed the same morphological changes as those in EGS horses, indicating that both conditions affect the NMJ similarly.
D) EGS NMJs showed no significant differences in morphology or synaptic vesicle content compared to control horses, suggesting that EGS does not affect the NMJ.
Correct Answer:
B) EGS NMJs exhibited a significantly higher percentage of abnormal morphology and a lower mean volume fraction of SVs compared to controls.
Explanation:
- The study found that horses with EGS had a significantly higher percentage of NMJs with abnormal morphology (72.2% in EGS horses vs. 6.9% in controls).
- EGS NMJs also had a lower mean volume fraction of synaptic vesicles (18.7%) compared to controls (36.3%), indicating disruptions in synaptic function. SV depletion may reflect increased exocytosis coupled with reduced repopulation of SVs via anterograde axonal transport and endocytosis, consistent with the action of an excitatory presynaptic toxin and/or neurotransmitter reuptake inhibitor.
- Additionally, NMJs from the botulism horse showed different characteristics, specifically dense packing of synaptic vesicles, which is consistent with botulinum toxin action but not seen in EGS.
Equine grass sickness is associated with major abnormalities in the ultrastructure of skeletal neuromuscular junctions
evj 24
What are the most common esophageal tumors ?
SCC, leiomyoma
- SCC arises from epithelial cells, specifically keratinocytes, and occurs rarely in horses.
- Leiomyomas are benign tumors, derived from smooth muscle cells with slow growth tendency and rare in horses.
VetClinics Oncology 2024
What is the difference between SCC and adenocarcinoma ?
SCC arises from epithelial cells, specifically keratinocytes.
Adenocarcinoma emerges from the glandular crypt epithelium.
Lymphoma arises from the submucosa or mucosal lymphoid tissue. Lymphoid-rich organs like spleen, bone marrow, and pharynx are predisposed for metasasis.
VetClinics Oncology 2024
What are the most common gastric tumors ?
Gastric tumors are relatively uncommon, accounting for less than 2% of equine neoplasia, with SCC and lymphoma the most common diagnoses.
- SCC is the most common gastric neoplasia reported in horses and originates from the squamous mucosa. Recently Equus caballus papillomavirus-2 has been identified in a subset of primary gastric SCC and metastasis.
- Leiomyoma is a benign tumor, and leiomyosarcoma a malignant tumor of gastric smooth muscle.
- Gastric adenocarcinoma emerges from the glandular crypt epithelium.
VetClinics Oncology 2024
What are the most common intestinal tumors ?
- Lymphoma is the most common equine neoplasm. Within the alimentary form, the small intestine is most commonly affected, with T-cell lymphomas being most frequent.
- Intestinal adenocarcinoma is the second most common intestinal neoplasia, arising from the glandular crypt epithelium of the intestine, and reports differ between predispositions for large or small intestine. It has been reported mostly in older horses and Arabian breeds.
- Intestinal leiomyoma/leiomyosarcoma arise from intestinal smooth muscle layers and have been reported to involve the jejunum, duodenum, large and small colon, and cecum.
- Gastrointestinal stromal tumors (GIST) are mesenchymal tumors, identified in the ileum, jejunum, cecum, and large colon, and make up around 15% of equine intestinal tumors.
VetClinics Oncology 2024
What is the diagnostic use of thymidine kinase in equine lymphoma ?
The diagnostic use of serum thymidine kinase in equine lymphoma is controversial, with one study showing promising results and another one revealing no association.
VetClinics Oncology 2024
What are the potential chemotherapeutic drugs in horses with lymphoma ?
Doxorubicin is an anti-tumor antibiotic that has cytotoxic properties inhibiting DNA and RNA synthesis. It has been used successfully in horses with lymphoma.
Other options include cyclophosphamide, vincristine, L-asparaginase, lomustine, cytosine arabinoside, and corticosteroids.
VetClinics Oncology 2024
Which horses seem predisposed to intestinal adenocarcinomas ?
It has been reported mostly in older horses and Arabian breeds
VetClinics Oncology 2024
What is the most common pancreatic tumor ?
Pancreatic adenocarcinoma is commonly associated with liver dysfunction/liver enzyme increase, likely related to the anatomic association between liver and pancreas. Hyperammonemia has also been reported.
VetClinics Oncology 2024
What are the most common splenic tumors ?
- Splenic lymphoma with pseudohyperparathyroidism due to paraneoplastic syndrome leading to polyuria and polydypsia has been reported.
- Splenic hemangiosarcoma derives from the vascular system and may appear as a primary splenic tumor or metastasis.
- Due to abundant blood supply and organ functions, splenic metastasis is common. Frequently metastasizing tumors are melanoma, hemangiosarcoma, and lymphoma.
VetClinics Oncology 2024
