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Large animal GI > Lecture Equine GI 3-4 > Flashcards

Lecture Equine GI 3-4 Flashcards

1
Q

Inflammatory GI conditions

A
  • Small intestine
    • Duodenitis/proximal jejunitis
    • mescellaneous inflammatory
    • proliferative enteropathy
  • Colon
    • Acute diarrhea
    • chronic diarrhea
  • Peritonitis
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2
Q

Dudenitis-Proximal Jejunitis

(DPJ)

A
  • inflammation and stasis of proximal segments of small intestine
  • cause
    • salmonella
    • clostridium (esp Canada, UK)
    • fungal toxins
  • relatively uncommon
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3
Q

DPJ

CS

A
  • moderate pain
  • low-grade fever
  • rectal: dilated SI
  • U/S: dilated +/- thick SI
  • Ab tap: inc TS
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4
Q

DPJ vs. Strangulation

A
  • DPJ
    • low grade fever 101.5-103.0 R
    • Pain, HR dec with gastric decompression
    • peritoneal fluid inc protein +/- WBC, normal RBC
  • Strangulation
    • normothermic
    • Pain, HR not related to reflux
    • peritoneal fluid typically serosanguinous
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5
Q

DPJ

TX

A
  • Gastric decompression
  • Anti-inflammatories
    • NSAIDS
    • Lidocaine (systemic)
  • IV fluids
  • Don’t usually need antibiotics
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6
Q

DPJ

Prognosis/Complications

A
  • adequate supportive care and resources = good
  • may require sx: prognosis still good
  • complications: Endotoxemia
    • laminitis
    • peritonitis
    • adhesions
    • cholangiohepatitis
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7
Q

Inflammatory bowel disease

A
  1. granulomatous enterocolitis
  2. lymphocytic-plasmacytic enterocolitis
  3. eosinophilic, basophilic enterocolitis
  4. multisystemic eosinophilic epitheliotropic disease
  5. lymphoma/lymphosarcoma
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8
Q

Inflammatory bowel disease

CS

A
  • weight loss
  • recurrent colic
  • severe colic - eosinophilic enteritis
  • edema
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9
Q

Inflammatory bowel disease

Pathophisiology

TX

A
  • Pathophysiology
    • likely related to interaction of multiple immune functions
  • TX
    • corticosteroids
    • immune suppressants
      • SX for EE with obstruction
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10
Q

Acute diarrhea

Infectious causes

A
  • salmonella species
  • Neorickettsia risticii (Potomac horse fever)
  • Clostridium difficile
  • Clostridium perfringens
  • Larval cyathostomosis
  • Coronavirus
  • Other viral (foals)
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11
Q

Acute diarrhea

Non-infectious causes

A
  • diet changes (composition, quantity)
  • antibiotics (routine, ionophore)
  • NSAIDS (right dorsal colitis-RDC)
  • Cantharidin (blister beetle)
  • hoary alyssum
  • heavy metals
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12
Q

Colitis

CS

A
  • Endotoxemia
    • fever
    • inc HR, RR
    • Toxic MM
  • Dehydration
  • Diarrhea
    • volume, consistency variable
    • Hemorrhagic (rare)
  • Colic (+/-) - can precede diarrhea
  • ventral edema (+/-)
  • Borborygmi: can inc; may dec initially
  • Rectal
    • fluid filled colon +/- cecum; variable distention
    • indicated if colicky
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13
Q

Colitis

Lab data

A
  • CBC is important
  • neutropenia w/ toxicity and left shift
  • metabolic or lactic acidosis
  • Dec Na, Cl, K, Ca
  • Azotemia (often pre-renal)
  • Decreased TP
    • may be relative if hemoconcentrated
  • Inc liver enzymes (AST, GGT, SDH)
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14
Q

Colitis

Diagnostics

A
  • Whole blood
    • N. risticii - PCR
  • Feces
    • salmonella (culture, PCR?)
    • clostridium toxin (ELISA)
    • Parasites (direct/flotation)
    • sand sedimentation
    • coronavirus (PCR)
  • U/S
  • Rads
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15
Q

Colitis

Basic TX

A
  • Volume replacement, maintenance
    • crystalloids
  • Colloids
  • Oral fluid replacement
    • less severe cases
  • Bind intestinal free toxin
    • biosponge
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16
Q

Colitis

endotoxin related TX

A
  1. NSAIDS
    • analgesic, COX-inhibition
    • flunixin meglumine
  2. Polymixin B
    • binds circulating free endotoxin
  3. Digital hypothermia
    • preventative for laminitis
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17
Q

Colitis TX

Supportive care

A
  • ISOLATION
  • catheter maintenance
  • Tail wrap
  • Heavy bedding
  • Perineal care
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18
Q

Colitis TX

Antibiotics

A
  • avoid in adults horses
  • exceptions
    • PHF
    • Clostridiosis
    • Substantial leukopenia
    • Peritonitis
  • Significant risk factor for diarrhea
  • No significant effect on outcome
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19
Q

Colitis

Potential sequelae

A
  • Laminitis
  • Renal failure
  • Thrombophlebitis
  • Peritonitis
  • Fungal pneumonia
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20
Q

Salmonellosis

A
  • intermittent shedding
  • detection influenced by
    • inc diarrhea
    • method (fecal culture vs PCR)
    • time of year (inc summer and fall)
  • no specific therapy for acute cases
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21
Q

Salmonellosis

Risk factors

A
  • change in microbiota
    • transportation
    • antimicrobial tx
    • change in diet
    • sx
    • nasogastric tubes
    • wet, dark conditions
    • GI dz
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22
Q

Salmonellosis

Prognosis/Shedding

A
  • good with early therapy; dec w/ complications
  • horses may shed sig number organisms 1-2 months
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23
Q

Neorickettsia risticii

A
  • Potomac horse fever (PHF)
  • Infectious, not contagious
  • Seasonal (may-Oct)
  • geographic variability
  • transmission through fresh water snails, insects
24
Q

N. Risticii

CS

A
  • Incubation 9-11 days
  • Biphasic clinical signs
    • lethargy, anorexia, fever
    • +/- colic, diarrhea
    • may progress rapidly
  • Not a cause of chronic diarrhea
  • Lethargic and Febrile
25
Q

N. risticii

DX

A
  • Whole blood PCR
  • response to treatment
  • Can remain PCR positive up to 30 d post infection
26
Q

N. risticii

Therapy

Prevention

A
  • Tetracyclines: resp w/in 12-24 hours
  • Vaccination
    • questionable efficacy
    • may reduce severity
  • Prognosis
    • good with early therapy
    • Laminitis common complication
27
Q

Clostridial infection

spp

A
  • Clostridium difficile
    • commonly assoc w/ antimicrobial-associated diarrhea
    • adults
  • Clostridium perfringens
    • foals
28
Q

Clostridiosis

Risk factors

A
  • Antimicrobial use
    • ​Big problem in CA
    • individual
    • mares of foals treated with macrolides, azolides
  • management
    • tubes, hands
  • hospitalization
  • age
  • geography
29
Q

Clostridiosis

DX

A
  • Fecal toxin tests
    • enterotoxin (C. perfringens)
    • ELISA (A +/- B C. difficile)
    • PCR (C. difficile)
  • Fecal gram stain
30
Q

Clostridiosis

TX

A
  • Metronidazole
  • BioSponge
    • DTO-smectitie
    • synthetic clay
    • shown to bind clostridial toxin
31
Q

Coronavirus

CS

A
  • Fever
  • Anorexia
  • lethargy
  • +/- diarrhea
  • frequent in colder months
  • usually lasts 1-4 days
32
Q

Coronavirus

Transmission

DX

TX

Prognosis

A
  • Fecal-oral transmission
    • often occurs in outbreaks
  • DX: fecal PCR
  • TX: supportive
  • no vaccine
  • Prognosis pretty good
33
Q

Cantharidin toxicosis

CS

A
  • Inc temp, HR, RR
  • DIarrhea
  • lethargy
  • colic
  • Sudden death
34
Q

Cantharidin toxicosis

Lab findings

Diagnosis

A
  • Lab findings
    • decreased Ca, Mg, TP
  • DX
    • toxin detectedin serum, urine: 500 mL
    • gastric contents 200 g
35
Q

Chronic diarrhea

A
  • Diarrhea of longer than 1 month duration
  • variablel weight loss
  • no major clinical exam findings
  • no major abnormal lab findings: no evid protein loss
36
Q

Inflammatory causes chronic diarrhea

Infectious

A
  • Salmonellosis
  • Parasites
    • giardia
    • strongyles
37
Q

Inflammatory causes chronic diarrhea

non-Infectious

A
  • inflammatory bowel disease
  • neoplasia
  • sand
  • right dorsal colitis
38
Q

chronic diahrrea

Diagnostic tests

A
  • CBC, Chem
  • Abdominocentesis
    • helps identify IBD, neoplasia
  • Rectal exam
    • check for masses
    • check for lymphadenopathy
  • Rectal biopsy
    • inflammatory bowel disease
    • salmonellosis
39
Q

Chronic diarrhea

Fecal diagnostics

A
  • Gross examination for parasites
  • Flotation/McMaster’s quantification
  • Direct smear
  • Culture
  • Sand sedimentation
  • Gram stain
40
Q

Chronic diarrhea

TX

A
  • Supportive therapy
    • fluid therapy
    • NSAIDS
  • Antibiotics ?????
    • salmonellosis
  • Larvicidal deworming
  • Withdrawel meds
41
Q

Chronic diarrhea

Other TX

A
  • Diet mod
  • BioSponge
  • Probiotics not helpful
    • contraindicated in foals
  • Transfaunation
    • Acid suppression first
42
Q

Sand enteropathy

TX

Prevention

A
  • Diarrhea usually mild
  • May be accompanied by recurrent colic
  • TX
    • environmental
    • psyllium mucilloid
  • Prevention
    • feed over mat
43
Q

Right Dorsal Colitis

NSAID use

Risk factors

CS

A
  • NSAID use
    • non-selective COX inhibitors
    • Does not have to be abuse
    • can occur within one weak
  • Risk factors poorly identified
  • CS
    • albumin drop may precede clinical signs
    • Ventral edema often first CS
    • colic
    • diarrhea
    • weight loss
    • inappetence
    • icterus
44
Q

Right Dorsal Colitis

DX

A
  • HX
  • Hypoalbuminemia
  • U/S: thickened R. Dorsal colon
45
Q

Right Dorsal Colitis

TX

A
  • avoid NSAIDS
  • Complete pelleted diet
    • small, frequent meals
    • decrease bulk
  • Psyllium mucilloid
46
Q

Peritonitis

Causes

A
  • GI perforation
    • Abscess
  • Iatrogenic
    • Rectal tear
    • Castration
  • Trauma
    • post-foaling
  • Post-op
  • Actinobacillus equuli: assoc with primary peritonitis
    • good prognosis
47
Q

Peritonitis

Foals

A
  • GI perforation
  • Omphalitis
  • Uroperitoneum
  • Abscess
  • Sepsis
48
Q

Peritonitis

DX

A
  • Ab tap
    • > 10,000 cells/microL
    • Culture
    • Intracellular bacteria
    • High lactate, low glucose (bact in periton. eat it)
  • U/S
    • inc free peritoneal fluid
49
Q

Peritonitis

TX

A
  • Exploratory
  • Antibiotics
  • Lavage
  • NSAIDS
  • Analgesics
50
Q

Peritonitis Prognosis

GI rupture

Uterine tear

A. equuli

Post-op

A
  • GI rupture
    • Grave
  • Uterine tear
    • fair to good
  • A. equuli
    • good
  • Post-op
    • moderate
51
Q

Determining factor for infectious colitis

A
  • Number of animals affected
52
Q

Colitis

Signalment and history

A
  • Number affected
  • Recent therapy
    • NSAIDS
    • antimicrobials
  • Feeding plan and recent changes
53
Q

Endotoxemia causes

54
Q

Fever + Diarrhea =

55
Q

Hallmark blister beetle signs

A
  • Horses on alfalfa
  • Low serum Ca
56
Q

Common complication of peritonitis

Large animal GI (5 decks)

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