Other GI Disease Flashcards
What is the common name for equine dysautonomias
Grass sickness
What is the highest age of incidence for grass sickness
2-7 years
What are the 3 categories of grass sickness
Acute - die rapidly
Sub-acute - survive 2-7 days
Chronic - survive >7 days
Risk factors for grass sickness
Stress
Mechanical dropping removal
Good-fat bcs
Frequent worming
Cool (7-11°c) dry weather
History on premises
Signs of acute grass sickness
Severe gut paralysis (acute colic)
Difficultly swallowing
NG reflux
Drooling
Mucous coated hard faeces
Tachycardia
Muscle tremors
Signs of sub-acute grass sickness
Difficultly swallowing
Mild-mod colic
Rapid weight loss
Sweating/muscle tremors
Severely depressed
May eat small amounts
Signs of chronic grass sickness
Mild/intermittent colic
Reduced appetite
Some difficulty eating
Rapid and severe weightloss
Diagnostic tests for grass sickness
Ileal biopsy - requires laparotomy
Rectal biopsy - sensitivity lower than ileal
Phenylephrine test - topical application to one eye (positive reversal of ptosis)
Oesophageal endoscopy - linear ulcers possible
Treatment for grass sickness
Nursing care
- feeding every 30-60 mins
- hand grazing
- diazepam (appetite stimulation)
-grooming/horse access/steam therapy
Analgesia
Prokinetics
- cisapride
- neostigmine
Dietary causes of choke
Legume contamination with pizoctonia leguminicola
Oral PBTZ with clembuterol
Clinical signs of choke
Regurgitation
Ptyalism
Pysphagia
Coughing
Anxiety
Repeated extension of head an neck
Others
Distension of left jugular furrow
Crepitus
Dehydration
Abnormal respiratory pattern
Fever
Morphological causes of choke
Malformation/injury/oedema (pharynx, larynx and oesophagus)
Pharyngeal disorders (abscess, cicatrix, inflammation)
Laryngeal disorders (epiglottic cysts, RDP arch)
Palate disorders (DDSP, cleft palate)
Guttural pouch (tympany ans empyema)
Oesophageal (obstruction and diverticular)
Teeth (root abscesses, broken teeth, abnormal wear)
Glossitis (FB)
Stomatitis (ulcerative, vesicular, bacterial)
Temporohyoid OA
Temporomandibular osteopathy
Functional abnormalities causing choke
Infection (rabies, viral encephalitis, verminous encephalitis and EPM, botulism, tetanus, meningitis)
CNS (cerebral damage/oedema, brainstem haemorrhage)
CNS masses (cholesteroloma)
Toxic (lead poisoning, yellow star thistle, hepatoencephalopathy)
Other (polyneuritis, grass sickness, thosteoarthropathy, gutteral pouch disease, petrous temporal bone)
Diagnostics for choke
Palpation of neck and thoracic inlet
Oral exam
Thoracic exam
NG intubation
Clinical pathology
What support is needed for spontaneous resolution of choke
Remove feed and water
IV fluids
Analgesia
Sedation
Oxytocin (for proximal obstruction)
What support is needed for assisted resolution of choke
Oesophageal lavage and drainage
-sedate and maintain head below thoracic inlet
Aggressive oesophageal lavage
- cuffed nasotracheal/nasoeosophageal tube
- standing or GA (minimizes aspiration)
Oesophagostomy management of choke
Incision 5cm distal to lesion with indwelling tube into stomach
Complications of oesophagostomy
Laryngeal hemiplegia
Aspiration pneumonia
Oesophageal ulcer
Oesophageal stricture
Megaesophagus
Diverticula
Oesophageal rupture
What is SIRS
A self amplifying dysregulated systemic inflammatory response
Triggers of SIRS
Bacterial toxins
Staphylococcus aureus
Lipopolysaccharide derived from G-ve bacteria
Burns
Neoplasia
Difference between sepsis, severe sepsis and septic shock
Sepsis = SIRS plus culture proven infection
Severe sepsis = sepsis with organ hypoperfusion or dysfunction
Septic shock = severe sepsis with systemic hypotension
What is Multi-organ dysfunction syndrome
Altered organ function in an actually ill animal, hemostasis is not maintained without intervention.
Primary = caused by a well defined insult
Secondary= organ failure as a consequence of host response
Definition of DIC
Disseminated intravascular coagulopathy
DIC pathology
Activation of coagulation with microvascular clotting, haemorrhagic diathesis and procoagulant consumption
Clinical signs of DIC
In large usually thrombosis
Also petechial haemorrhage
Bleeding following trauma
Diagnosis for DIC?? (3 out of 5 of)
Thrombocytopenia
Prolonged prothrombin time
Prolonged activated partial thromboplastin time
Increased fibrin degradation products
Decreased antithrombin 3
Common name for Gasterophilus spp
Bot fly
What is the lifecycle of Parascaris quorum nearly identical to
That if ascaris suum
At what age do ascarids cause disease
Under 2 years
Prevalence of Parascaris equorum
10-50%
Diagnosis of Parascaris equorum
Coughing and nasal discharge
Poor coat, weight gain, dull, anorexic
Occasionally colic
Disorders of bone and tendon
Treatment of Parascaris equorum
Avermectins Pyrantel
(Can survive 10 years on pasture)
Test for oxyuris equi
Sellotape test on anus
Treatment of oxyuris equi
All anthelmintics effective
Topical or systemic anti-inflammatories for pruritis
Keep clean
Most important equine parasite
Cyathostomiasis
Diagnosis of strongylus vulgaris
Thrombi on rectal palpation
Faecal analysis (not always able to tell from other strongyles)
Treatment for strongylus vulgaris
Benzimidazoles and avermectins
Faeces removal
Avoid overgrazing
What type of strongyle is S edentatus
Hepatoperitoneal
What type of strongyle is S equinus
Hepatopancreatic (do not enter blood vessels like others)
Risk factors for gastric disease
Lack of water
Lack of forage
High carbohydrate diets
High stress
Pain focuses
Clinical signs of gastric disease
Colic signs
Weight loss
Bucking/rearing under saddle
Resentment of girthing and leg aids
Poor performance
Temperament changes
Preparation for scoping
Withhold food 12 hours and water 4
Sedate - Dom/torb, nose twitch can be useful in addition
3 people - hold horse, pass endoscope, control endoscope
Descriptions of gastric lesions
0 - epithelium intact with no hyperkeratosis
1 - mucosa intact but areas of hyperkeratosis
2 - small single/multifocal lesions
3 - large single or extensive superficial lesions
4 - extensive lesions with areas of deep ulceration
Treatment for squamous gastric ulceration
Oral Omeprazole 4mg/kg
+/- oral sucralfate (10-40mg/kg/
Treatment for glandular ulceration
Oral misoprostal 5mcg/kg
+/- oral sucralfate (10-40mg/kg)
Optional treatment for squamous/glandular ulceration
Long acting injectable Omeprazole
4mg/kg once a week IM
Management of horses with gastric disease
Forage ad lib
Reduce stress
Eliminate carbohydrates
Supplements - limited evidence (pectin and lecithin growing in evidence)
Oral Omeprazole 1mg/kg can be used long term and is fei but not bha legal
Types of liver disease
Colangiohepatitis
Toxic hepatitis
Viral hepatitis
Choleliths
Common blood work findings for intestinal/liver disease
WBC - normally low
Anaemia
Proteins - hyperglobulinemia, hypoalbuminemia
Fibrinogen, SAA, globulins
Liver values - SDH, GGT, AST, bile acids
Creatinine, Na, K, Ca +/- phosphorus
Common ultrasonographic findings with intestinal/liver enteropathy
SI wall thickness - reduced absorptive capacity >4mm
LI wall thickness - abnormal >6mm
Liver - sharpness of edges, echogenicity, masses, gas shadowing
Peritoneal fluid - anechoic viscous
Masses - round, lobulated with varying echogenicity
Common findings on abdominocentesis
Colour - turbid, serosanguinous, green/dark
Protein - abnormal >30g/L (inflammation/infection)
Lactate - abnormal >2.5mmol/L - intestinal ischemia >double systemic
Abdominal glucose >2.8mmol/L
Intestinal function test
Glucose absorption
Serial blood tests after nasogastric infiltration of sugar
Elevation in 90-120 mins should be >85% normal
Granulomatous enteritis LEARN
Cs - weight loss, anorexia, skin lesions on coronet
Low albumin
Anaemia
Abnormal glucose absorption
Good correlation with rectal biopsy
Lymphocytic enterocolitis LEARN
Cs - weightloss
+/- low albumin
Normal blood
Abnormal glucose absorption
Unreliable on biopsy
Foal eosinophilic enteritis LEARN
Cs - colic, weightloss (rare)
Normal albumin
Normal blood work
Glucose absorption+/-
Focal full thickness biopsy, no rectal
MEED - LEARN
Cs - weightloss, skin lesions, liver disease
Albumin - normal initially, low in advanced
Blood - normal, anaemia, high GGT
Glucose absorption - LI>SI
50% biopsies on rectal
Intestinal lymphoma LEARN
Cs- weight loss, mild colic, diarrhoea
Low albumin
Anaemia
Generally abnormal glucose absorption
Full thickness rectal or duodenal biopsy
How to diagnose proliferative enteropathy
Faecal PCR for L. intracellularis
Chronic - biopsy, PCR and histo with silver staining
How to diagnose chronic salmonella
PCR and enriched culture
How to diagnose sand enteropathy
Sedimentation test - low sensitivity
What does SDH (sorbitol DH) measure
Liver specific hepatocellular enzyme
Low stability >4 hours
What does AST show
Hepatocellular enzyme marking muscle +++ RBCs and kidney
Need to interpret with muscle and liver enzymes
What does GGT show
Biliary duct enzymes with reproductive, urinary, pancreas - local elevation but not systemic
Takes longer to reduce after insult
What is ALP
Biliary duct enzyme 80% liver, 20% bone
Non specific
Elevation in growing foals and horses with fractures
Bile acids use
Liver specific function test higher in hepatobiliary than hepatocellular - moderate to severe dysfunction needed to elevate
Use of bilirubin
Liver specific function test - total of little value, anorexia, haemolysis, liver disease. Driven in acute masses >170umol/L. Chronic = mild elevation
Where is a liver biopsy taken
14-15 ics right side
Likely findings on liver histopathology
Toxins
-pyrrolizidine causes megalocytosis, hyperplasia and fibrosis
- mycotoxins, severe hepatic necrosis
- iron supplements, hepatic necrosis, haemochromatosis
Likely bacterial and viral culture from liver biopsy
Clostridium piliforme (foal 1w-2m)
Klebsiella, E.coli, salmonella in ascending cholangiohepatitis
Viral - equine parvovirus-hepatitis virus (EaPV-H)
What types of worm are anoplocephala perfoliate/magna
Equine tapeworm
Clinical signs of anoplocephala perfoliate/ magna
Colic (various types)
Diarrhoea
Diagnosis of anoplocephala perfoliate/ magna
Blood test
Saliva test
Elisa - for groups only
Treatment/prevention of anoplocephala perfoliate/manga
High dose Pyrantel and praziquantal - treat in autumn/winter
What dose strongylus vulgaris cause
Large strongyle causing verminous arteritis due to travel through mesenteric arteries
Clinical signs of strongylus vulgaris
Colic
Diarrhoea
Anorexia
thrombi at aorto-illiac junction
Ischaemic
Diagnosis of cyathostomiasis
Difficult as PPP disease, history and clinical signs important (young/poor worming history)
Larvae on glove after rectal
IgG Elisa
Disease of cyathostomiasis
Acute larval cyathostomiasis seen in spring
- mucosal damage
- colic
- weight loss
- diarrhoea acute/chronic
- wasting/death
Autumn - larva entering intestinal wall
- colic
- diarrhoea (due to inflammation)
Treatment of clinical parasite cases
Moxidectin for larval cyathostomiasis
Pyrantel for high Parascaris burden
Praziquantal or double Pyrantel for anaplocephala
How to avoid larval cyathostomiasis
Strategic anthelmintic use
Pasture management - faecal collection
Pasture rotation
Grazing with ruminants
Dung heap away from grazing area
