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Y4 Equine - GI > Management of equine diarrhoea > Flashcards

Management of equine diarrhoea Flashcards

1
Q

Aims of diagnostic investigation

A

▪Determine likely cause of D++
▪Determine need for supportive therapy
▪Determine need for specific therapy
▪Determine risk to in-contact horses and personnel

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2
Q

How much fluid can a 500kg horse with profuse d+ lose a day? What would its fluid requirement be?

A
  • It can lose 100L/day
  • Fluid requirement = 125L/day
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3
Q

Management – Acute D+ (Young and Adult Horses)

A
  • Fluid Replacement and Electrolytes
  • Anti-inflammatories
  • Analgesia
  • Antimicrobials
  • Probiotics
  • Adsorbents
  • Nutrition
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4
Q

Fluid replacement and electrolytes for acute d+ management

A
  • Mild to moderate D+: May maintain hydration with voluntary drinking +/- NGT
  • Moderate to severe: IVFT (Hartmans)
  • Think about decreased osmotic pressure
    – generally with d+ and colitis they’ll have reduced albumin (losing it from GIT), so decreased oncotic pressure
    – care with rapid boluses for IVFT as decreased oncotic pressure increases their risk of developing oedema
  • Many require KCl, some may require NaHCO3 and general Na supplementation
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5
Q

Anti-inflammatories for acute d+ management

A
  • Negative effects on colon?
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6
Q

Analgesia for acute d+ management

A
  • Minimal to severe abdominal pain
  • NSAIDs: Flunixin meglumine (Other COX 2 selective?)
  • Temporary relief: Xylazine, detomidine +/- butorphanol
  • CRI: Butorphanol, Lidocaine +/- Ketamine
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7
Q

Antimicrobials for acute d+ management

A
  • Debateable
  • If neutropaenic or signs of sepsis, or signs of complications
  • Penicillin IM and Gentamicin IV
  • Metronidazole PO for Clostridiosis
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8
Q

Probiotics for acute d+ management

A
  • Faecal Transfaunation (Poo soup via NGT)
  • Debatable
    – need the right horse which hasn’t had antimicrobials recently
    – worry about other infectious dz that could pass
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9
Q

Adsorbents for acute d+ management

A
  • Di-Tri Octahedral Smectite (Biosponge®️)
  • Very useful
    – helps bind some of the endotoxins (mainly from clostridia)
  • Better to give SID-BID via NGT
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10
Q

Nutrition for acute d+ management

A
  • Vital
  • Ideally complete pelleted diet- no grain and no hay
  • If inappetent – good quality grass hay → anything
  • Can add oil (corn oil) for added calories
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11
Q

Management of RDC

A
  • Misoprostal may be useful
  • Psyllium may be useful
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12
Q

Management of cyathostomiasis

A
  • Anthelmintics: Moxidectin
  • Pre-treatment with steroids (Dexamethasone or prednisolone)
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13
Q

Management of sand enteropathy

A
  • Psyllium
    – binds to the sand
  • Magnesium sulphate is also used in combination with psyllium
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14
Q

Management of Lawsonia intracellularis

A
  • Doxycycline (antibiotic)
    – Course many weeks
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15
Q

Management of Sepsis in acute D+

A
  • Circulatory Support
  • Flunixin
  • Cryotherapy
  • Plasma
  • Pentoxyfyline
  • Polymixin B
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16
Q

Circulatory support for managing sepsis in acute d+

A
  • Mild to moderate D+: May maintain hydration with voluntary drinking +/- NGT
  • Moderate to severe: IVFT (Hartmans)
  • Think about decreased osmotic pressure
  • Many require KCl, some may require NaHCO3 and general Na supplementation
  • ± Dobutamine (for bp support)
17
Q

Flunixin for managing sepsis in acute d+

A
  • May help to block parts of the sepsis cascade
  • Lower dose?
    – evidence for efficacy of lower dose to combat sepsis cascade, but generally use full dose
18
Q

Cryotherapy for managing sepsis in acute d+

A
  • Critical
  • Reduces incidence of laminitis in horses diagnosed with colitis
  • Under-utilised
  • Important: Constant low hoof temperature
  • Often means replacing ice every 2 hours (24h a day)
19
Q

Plasma for managing sepsis in acute d+

A
  • £££ as lots required to make a difference to the protein levels
    – 7-10L for a 500kg horse
  • Toxin neutralisation (1-2L for a 500Kg adult horse) → debatable
20
Q

Pentoxyfyline for managing sepsis in acute d+

A
  • ?supresses proinflammatory cytokines
  • Increases RBC deformability
  • Currently no published controlled clinical trials supporting its use
21
Q

Polymixin B for managing sepsis in acute d+

A
  • Prevents initiation of the pro-inflammatory cascade - Debatable
22
Q

Management of a normovolaemic pt with mild d+

A

▪ Diet
– Simple grass diet
– Pelleted diet
– No grains
▪+/- Biosponge
▪ Monitoring

23
Q

Management of the neonate

A

▪Consider referral
▪ IVFT
– Care with sodium and acid base
▪Antimicrobials
– Mostly sepsis related
– FPT
▪GI Rest – 24-48h
– Partial parenteral nutrition (PPN)
– Total parenteral nutrition (TPN)
▪Supportive care ▪Secondary infections

24
Q

Acute Diarrhoea in Adult Horses – What to Test

A

▪Salmonella spp. ▪Clostridium difficile ▪Clostridium perfringens
▪ Coronavirus ▪Cyathostomiasis ▪Antimicrobial Associated ▪Right Dorsal Colitis ▪Grain overload
▪ Dietary

25
Q

When to Isolate the D+ Case

A

▪2 out of 3 = Isolation
– Pyrexia
– Neutropenia
– Diarrhoea

But most places also recommend isolating pts who have had progressive d+ for over 24-48h, even if they don’t have 2/3^

26
Q

How to Isolate

A

▪At home vs hospital
▪Separate affected horse
▪Monitor in contact horses
▪ PPE
– overalls, wellies/boots, gloves, hairnet
▪Separate tack, grooming and cleaning equipment
▪Separate water source
– Ideally buckets so can also monitor intake

27
Q

Why is moxidectin the anthelmintic of choice for cyathostomiasis?

A
  • It targets encysted larvae as well as the other lifecycles
28
Q

What can help reduce the volume of IVFT needed?

A
  • variety of water: plain, molasses, electrolytes, etc

Y4 Equine - GI (25 decks)

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