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Equine Medicine and Surgery > Lecture 5: Approach to Medical Diseases of the Equine Small Intestine > Flashcards

Lecture 5: Approach to Medical Diseases of the Equine Small Intestine Flashcards

1
Q

What is anterior enteritis

A

Inflammatory/infectious disease of the duodenum and proximal jejunum

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2
Q

What infections is anterior enteritis associated with

A

Clostridia spp, salmonella spp, or idiopathic

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3
Q

What is anterior enteritis characterized by

A

Voluminous SI secretions, functional ileus, copious gastric reflux

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4
Q

What is the pathophysiology of AE

A
  1. C-diff spores ingested in stomach
  2. Spores then pass through pylorus to the duodenum
  3. Proximal SI is rich in bile acids secreted the major duodenal papilla
  4. Spores interact with the bile and germinate into vegetative cells
  5. These cells then multiply, colonize, and produce toxins cause the epithelial damage and inflammation that ultimately leads to ileus and colic signs
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5
Q

What are the clinical characteristics of horses with Anterior enteritis

A
  1. Increase HR- due to pain from gastric distention
  2. Increase reflux
  3. Fever
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6
Q

What is the other primary differential when considering anterior enteritis

A

Strangulating SI lesion

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7
Q

What are some complications of anterior enteritis

A

Laminitis (endotoxins), arrhythmias (increase HR), ascending hepatic/pancreatic disease, peritonitis

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8
Q

What are the therapeutic goals for Anterior Enteritis

A
  1. Remove excess GI secretions
  2. Restore normal GI motility
  3. Maintain hydration and volume status
  4. Maintain electrolyte balance
  5. Maintain colloid osmotic pressure (20 mm Hg)
  6. Maintain a positive energy balance
  7. Prevent laminitis
  8. Address inflammation and endotoxemia
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9
Q

What is a likely cause of equine proliferation enteropathy

A

Law Sonia intracellularis

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10
Q

What age group primarily gets equine proliferative enteropathy

A

Weaklings (4-6 months)

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11
Q

What does a horse with equine proliferative enteropathy present with/like

A

Weight loss, unthriftiness, edema, depression, fever

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12
Q

How can you diagnose equine proliferative enteropathy

A

Clinical signs, serology, fecal PCR

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13
Q

What is the most common change on blood work in horses with equine proliferative enteropathy

A

Hypoproteinemia

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14
Q

What is the treatment for equine proliferative enteropathy

A

Long term antibiotics

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15
Q

What are some common comorbidities of equine proliferative enteropathy

A

Parasites, gastric ulcers, other infections

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16
Q

What are the therapeutic goals for equine proliferative enteropathy

A
  1. Eliminate organism
  2. Restore protein levels to normal range
  3. Restore volume and hydration
  4. Restore patient to a proper plane of nutrition
  5. Treat co-morbidities
  6. Initiate biosecurity measures
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17
Q

What age group does IBD occur

A

Any age

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18
Q

How do horses with IBD present

A

Weight loss +/- colic +/- diarrhea

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19
Q

What is the treatment for IBD

A

Corticosteroids, surgical excision, parasite control, diet

20
Q

What is the prognosis for longterm survival in horses with IBD

A

Poor to moderate due to repeated colics and long term use of corticosteroids

21
Q

What is Eosinophilic enterocolitis

A

Infiltration of eosinophils and lymphocytes into the mucosa of the SI and large colon

22
Q

What is idiopathic focal Eosinophilic enteritis

A

Intramural masses or bands within the SI, possibly representing an acute, focal exacerbation of diffuse infiltrate

23
Q

What is multisystemic Eosinophilic epitheliotropic disease

A

Infiltration of eosinophils into other tissues such as skin, lungs, and liver in addition to GIT

24
Q

What is granulomatous enteritis

A

Infiltration of lymphocytes and macrophages most severely in ileum. Horses with granulomatous enteritis occasionally have granulomatous in other organs such as lungs and liver

25
Q

What is lymphocytic-plasma cystic enterocolitis

A

Infiltration of lymphocytes and plasma cells without the presence of macrophages

26
Q

Case example: horse presents with colic, pawing, attempting to lay down and roll. What is first thing you do

A

Take a heart rate- good indicator of pain

27
Q

Case example: horse that presents with colic has HR-68, why?

A

Pain, hypovolemia, excitement, fever, metabolic/electrolyte derangements, primary heart disease

28
Q

Case example: after you take a heart rate , what do you do next

A

Pass a nasogastric tube, may need to sedate first

29
Q

Case example: pass NG tube and reflux 8L of reddish foul-smelling fluid
T=102.7, P=52, R=20
MM- bright red and tacky
CRT-3 seconds
GI sounds decreased in 4 quadrants
Rectal exam: loops of distended fluid filled small intestine

What are you two top differentials

A
  1. Anterior enteritis
  2. Small intestinal strangulation/ obstruction
30
Q

Case example: after you establish differentials of AE and SI strangulation, what do you do next

A

Referral
Give Banamine
Leave NG tube in

31
Q

CBC results for AE case: increase HCT, platelets, and increase fibrinogen. What does this tell you

A

HCT: increase RBC-dehydrated
Platelets decrease: dehydrated, inflammation
Fibrinogen: acute systemic inflammation

32
Q

Chemistry results for AE: total protein increases, GGT increase, increased total bilirubin, increase indirect bilirubin, increase creatinine, decrease Na+, K+. And Cl-
Increase lactate

A

Total protein, GGT, and total bilirubin increased: dehydration
Increased indirect bilirubin: anorexia
Increased creatinine- dehydrated
Decrease Na, K, Cl-: fluid loss to intestines
Increased lactate: hypovolemia/hypoperfusion

33
Q

What is wrong in these two photos

A

Left: dilated SI loops
Right: enlarged stomach

34
Q

Abdominocentesis for AE horse reveals protein of 2.4mmol/L wht does that mean

A

Inflammation- losing protein to abdomen

35
Q

Case example: what are some signs that lead to diagnosis of AE vs SI strangulation

A

AE:
1. Decrease HR after reflux
2. Fever present
3. Pain controlled early on with low dose analgesics

36
Q

What is the treatment plan for AE

A
  1. NG tube
  2. IV fluids: maintenance and loss: 2-3mL/kg/hr
  3. Potassium added to fluids (20 to 40mE/L)
  4. Add calcium gluconate 23% (125mL/5L fluids)
  5. Colloids- plasma hetastarch- for protein loss- will decrease more with hydration
  6. Antibiotics
  7. Pro kinetics- lidocaine CRI
  8. NSAIDS/anti-endotoxin: banamine, polymixin B
  9. Laminitis prevention- cryotherapy
  10. Parental nutrition
37
Q

Calculate the maintenance fluids for 450kg horse

A

3mL(450kg)-1.3L.hr=32.L/ day

38
Q

Do not exceed ___ potassium when adding to fluids

A

0.5mEq/kg/hr

39
Q

Case example: 9 month old filly is unthrifty, quiet, BCS 3/9, T=102.1, P-50, R-36, ventral pitting edema, pot-bellied

What are you top differentials

A
  1. Parasitism
  2. Equine proliferative enteropathy
  3. IBD
40
Q

Case example with unthrifty 9 month old filly. After physical, what do you do next

A
  1. Abdominal ultrasound
  2. Blood sample
  3. Fecal screen- FEC, PCR for L. Intracellularis, culture
41
Q

Case example with unthrifty 9 month old filly test results:
1. CBC- mild leukocytosis
2. Fecal float: strongly and ascarid eggs
3. FEC 500 peg
4. PCR + for L. Intracellularis
5. Fecal culture negative for Salmonella and clostridia

How does this help determine differentials

A

equine proliferative enteropathy- positive L. Intracellularis

42
Q

Case 9 month old filly: after Bloodwork, physical, what do you do next for treatment

A
  1. Antibiotics- macrolide+rifampin, chloramphenicol, tetracycline
  2. Plasma
  3. Anthelmintics
  4. Repeat FEC in 2 weeks
43
Q

Case 9 month old unthrifty filly. What if tests for L. Intracellularis were negative what other tests would you do

A
  1. Rectal, intestinal biopsy
  2. D-xylose absoprtion test
    Looking for IBD, lymphoma
44
Q

A 10 year old paint are presents with colic, a heart rate of 64pm, respiratory rate 25bpm, and temperature of 103.2. What is most appropriate first step in working up case

A

Pass NG tube

45
Q

Treating a 475kg thoroughbred mare for anterior enteritis. What parameters will you monitor to ensure that fluid plan is working

A
  1. Protein levels
  2. Electrolytes
  3. PCV/TP
  4. MM, skin tent, distal pulse
  5. Urine output
  6. Heart rate
  7. Lactate
46
Q

What three things would be supportive of a diagnosis of anterior enteritis rather than strangulating lesion

A
  1. Fever
  2. Improvement with low dose analgesia
  3. Decrease HR after reflux

Equine Medicine and Surgery (27 decks)

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