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MODULE 16 - Alimentary Tract Disease > PATHOLOGY - Equine Gastrointestinal Disease > Flashcards

PATHOLOGY - Equine Gastrointestinal Disease Flashcards

1
Q

What are the general clinical signs of dysphagia in horses?

A

Gagging
Neck stretching
Nasal regurgitation
Slow feeding

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2
Q

What are some of the causes of dysphagia in horses?

A

Epiglottic entrapement
Glossitis
Temporohyoid osteoanthropathy
Palatoschisis
Guttural pouch diseases
Equine grass sickness

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3
Q

What is one of the most common forms of epiglottic entrapement?

A

Aryepiglottic fold entrapement

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4
Q

What are some of the common causes of glossitis in horses?

A

Tongue foreign body
Tongue neoplasia
Sialoliths

Can cause glossitis which can progress to abscesses and necrosis

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5
Q

How can you diagnose the cause of glossitis in the horse?

A

Assess history
Assess clinical signs
Thorough oral examination
Probe any tracts detected at the tongue
Radiography
Biopsy

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6
Q

When is a biopsy indicated when investigating glossitis in the horse?

A

Glossitis can be cause by neoplasia so a biopsy and histopathology can be used to investigate this

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7
Q

How do you manage glossitis in the horse?

A

Debridement and lavage of any tracts to remove any foreign material
Topical and systemic metronidazole
Nutritional support
Fluid therapy

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8
Q

What is temporohyoid osteoarthropathy?

A

Temporohyoid osteoarthropathy is where there is fusion of the temporohyoid joint (the joint between the hyoid apparatus and the skull). The hyoid apparatus is connected to the tongue and laryns and thus this can result in pain and reduced mobility of these structures. This can eventually result in fractures at the level of the temporohyoid joint which can cause damage to cranial nerves VII and VIII which run near this joint

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9
Q

What are the clinical signs of temporohyoid osteoarthropathy?

A

Clinical signs of dysphagia
Clinical signs of CN VII dysfunction
Clinical signs of CV VIII dysfunction

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10
Q

How do you definitively diagnose temporohyoid osteoarthropathy?

A

Radiography

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11
Q

How do you treat temporohyoid osteoarthropathy?

A

Ceratohyoidectomy

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12
Q

What is a ceratohyoidectomy?

A

A ceratohyoidectomy is the surgical removal of the ceratohyoid bone which will reduce the force applied from the hyoid apparatus to the skull to reduce the risk of further fractures and to decrease pain and discomfort

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13
Q

What is palatoschisis?

A

Palatoschisis is a term for a cleft palate

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14
Q

What are the clinical signs of palatoschisis in horses?

A

Difficulty nursing
Nasal regurgitation
Dysphagia
Clinical signs of aspiration pneumonia

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15
Q

How do you treat palatoschisis in horses?

A

If horses with palatoschisis survive to adulthood you can medically manage their condition and monitor carefully for any signs of aspiration pneumonia

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16
Q

Describe the anatomy of the guttural pouches

A

The guttural pouches have medial and lateral regions seperated by the stylohyoid bone. The medial sections of the guttural pouches have CN IX, X, XI and XII running through them along with the internal carotid artery. The lateral sections of the guttural pouches have CN VII and the external carotid artery running through them

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17
Q

How can disease within the guttural pouches cause dysphagia?

A

Disease within the guttural pouch can cause compression of CN IX (glossopharyngeal nerve) which can result in dysphagia

Guttural pouch mycosis
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18
Q

What can cause linear oesophageal ulceration?

A

Lineal oesophageal ulceration is caused by prolonged gastroesophageal reflux

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19
Q

What is one of the key signs of lineal oesophaeal ulceration?

A

One of the key signs of lineal oesophageal ulceration is extreme pain on passage of a nasogastric tube

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20
Q

What is the most common oesophageal disease in horses?

A

Choke

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21
Q

What is choke?

A

Choke is a simple oesophageal obstruction usually due to horses eating too fast or due to a foreign body obstruction

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22
Q

What are the most common sites for a simple oesophegeal obstruction resulting in choke?

A

The most common sites for a simple oesophageal obstruction resulting in choke include the proximal oesophagus near the pharynx, the oesophagus as it runs through the thoracic inlet and the oesophagus as it runs into the cardia of the stomach

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23
Q

What are the clinical signs of choke?

A

Dysphagia
Nasal regurgitation
Coughing
Clinical signs of aspiration pneumonia

Note the typical appearance of greenish, food containing nasal regurgitation
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24
Q

How do you diagnose choke?

A

Assess history
Assess clinical signs
Palpate the oesophagus (if the horse is resentful of this, it could indicate choke)
Pass a nasogastric tube (if you cannot pass the tube this can indicate oesophageal obstruction and choke)

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25
Q

When should you consider radiography when investigating choke?

A

Radiography is indicated if the horse has had choke for over 12 hours to assess for any complications of choke and the degree of aspiration pneumonia

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26
Q

How do you treat choke?

A

Heavily sedate the patient to allow their head to drop - this will help with drainage . Gently pass a nasogastric tube and gently lavage to try and clear the obstruction. You may have to repeat this several times to fully clear the obstruction. Make sure to remove any feed and bedding from the stable during this process and leave the horse with only access to water. Administer broad spectrum antibiotics for aspiration pneumonia and NSAIDs for analgesia

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27
Q

What are the potential complications of choke?

A

Aspiration pneumonia
Oesophageal ulceration
Oesophagitis
Oesophageal strictures
Oesophageal rupture

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28
Q

What should you do if there are any indications of complications secondary to choke?

A

Endoscopy for further investiagtion

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29
Q

What are the clinical signs of an oesophageal rupture?

A

Swelling at the site of rupture
Pain at the site of rupture
Subcutaneous emphysema
Cardiovascular collpase if there is mediastinitis

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30
Q

How do you diagnose oesophageal rupture?

A

Contrast radiography

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31
Q

How do you treat an oesophageal rupture?

A

If the rupture is at the cervical oesophagus you can surgically debride an necrotic tissue, place a drain to try and prevent mediastinitis and an oesophagostomy tube ventral to rupture site for feeding the horse, and monitor for sepsis and endotoxaemia. However, be aware that most oesophageal rupture cases require euthanasia

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32
Q

What is secondary oesophageal obstruction?

A

A secondary oesophageal obstruction results from damage to the oesophagus (i.e. due to previous choke or injury to the neck) or due to congenital conditons (usually connective tissue disorders) which result in the formation of diverticula or strictures which will cause secondary oesophageal obstruction

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33
Q

Which breed of horse is predisposed to connective tissue disorders which can result in secondary oesophageal obstruction?

A

Friesian

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34
Q

What are the two forms of diverticula which can cause secondary oesopheal obstruction?

A

Pulsion diverticulum
Traction diverticulum

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35
Q

What is a pulsion diverticulum?

A

A pulsion diverticulum is where there is increased intraluminal pressure within the oesophagus causing the oesophageal wall to protrude and form an outpouching known as a pulsion diverticulum. Feed can become trapped within this diverticulum and cause a secondary oesophageal obstruction

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36
Q

What is a traction diverticulum?

A

A traction diverticulum is where there is an increased pulling/stretching (traction) force exerted on the oesophagus causing the oesophageal wall to protrude and form an outpouching known as a traction diverticulum. Feed can become trapped within this diverticulum and cause a secondary oesophageal obstruction

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37
Q

What are the clinical signs of oesophageal obstruction secondary to oesophageal diverticula?

A

Recurrent clinical signs of choke which worsen with age due to further weakening and outpouching of the oesophageal wall

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38
Q

How do you diagnose oesophageal diverticula?

A

Endoscopy
Contrast radiography

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39
Q

How do you treat oesophageal diverticula and secondary oesophageal obstruction?

A

Surgical intervention can be considered for cervical oesophageal diverticula to remove the obstruction and correct the diverticulum

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40
Q

How do you diagnose an oesophageal stricture?

A

Endoscopy
Contrast radiography

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41
Q

How do you treat oesophageal strictures?

A

Serial boughienage (balloon dilatation) unless it is a full thickness stricture which would require a oesophagomyotomy

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42
Q

What is an oesophagomyotomy?

A

An oesophagomyotomy is a longitudinal incision of the oesophageal muscle, whilst leaving the oesophageal mucosa intact, where the stricture is located to allow for widening of the oesophegeal lumen

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43
Q

What is the most significant gastric parasites in horses?

A

Gastrophillus

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44
Q

How do you treat gastrophillus?

A

Ivermectin

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45
Q

What are the risk factors for acute gastric dilatation in horses?

A

Excess feeding
Feed which triggers excessive fermintation

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46
Q

What are the clinical signs of acute gastric dilatation?

A

Severe colic
Reflux
Tachycardia
Clinical signs of endotoxaemia
Metabolic acidosis

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47
Q

What are the clinical signs of endotoxaemia?

A

Toxic lines
Congested mucous membranes
Profound depression
Tachycardia
CRT more than 2 secs

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48
Q

What is the main complication that can be seen with acute gastric dilatation?

A

Gastric rupture

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49
Q

How do you diagnose acute gastric dilatation?

A

You can diagnose acute gastric dilatation based on clinical signs

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50
Q

How do you treat acute gastric dilatation?

A

Gastric decompression with a nasogastric tube
Intravenous fluid therapy (correct metabolic acidosis)
Management of endotoxaemia
Gastroprotectants (risk of ulceration)
Pelleted feed

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51
Q

What are the risk factors for acute gastric impaction in horses?

A

Older horses
Poor dendition
Inappropriate feeding

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52
Q

What are the clinical signs of acute gastric impactions in horses?

A

Severe colic

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53
Q

What is the main complication that can be seen with acute gastric impaction?

A

Gastric rupture

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54
Q

How do you diagnose acute gastric distention?

A

Resistance to passage of the nasogastric tube into the stomach can be a key indication of gastric distention however you can do an ultrasound or endoscopy for a definitive diagnosis

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55
Q

How do you treat acute gastric impactions?

A

Continuous gastric lavage of 5 litres of water per hour until the impaction is cleared
Intravenous fluids to maintain electrolyte balances

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56
Q

Which horse breeds are at an increased risk of chronic gastric impactions?

A

Warmbloods

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57
Q

What is the proposed underlying cuase of chronic gastric impaction in horses?

A

The proposed underlying cause of chronic gastric impactions is that the nerves involved in gastric emptying are dysfunctional and thus feed will chronically accumulate within the stomach

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58
Q

What are the clinical signs of a chronic gastric impaction?

A

Recurrent colic
Ventral oedema
Weight loss
Changes in abdominal sillouette

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59
Q

How do you diagnose chronic gastric impaction?

A

Resistance to passage of the nasogastric tube into the stomach can be a key indication of gastric distention however you can do an ultrasound or endoscopy for a definitive diagnosis

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60
Q

How do you treat a chronic gastric impaction?

A

Continuous gastric lavage of 5 litres of water per hour until the impaction is cleared
Feed management through permanent turnout so all the forage they have access to is grass or pelleted food as these are easier to pass through the pylorus

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61
Q

What is the prognosis for chronic gastric impaction?

A

Horses with chronic gastric impaction require diligent management and often only survive for 2 to 4 years after clinical presentation. They are also at increased risk of spontaneous stomach rupture

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62
Q

What are the risk factors for equine gastric ulceration syndrome (EGUS)?

A

High concentrate, low roughage diets
Prolonged periods without eating
Intense exercise
Concurrent gastrointestinal disease
Pregnancy
Stress
Crib-biting
NSAIDs

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63
Q

Why do high concentrate, low roughage diets increase the risk of equine gastric ulceration syndrome (EGUS)?

A

Increased concentrate and low roughage diets are high in carbohydrates which will be fermented in the stomach and produce acidic byproducts which will make the stomach even more acidic and increase the risk of gastric ulceration

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64
Q

Why does intense exercise increase the risk of equine gastric ulceration syndrome (EGUS)?

A

Intense exercise redirects blood flow from the gastrointestinal tract which reduces the mucosal blood flow, increasing the risk of developing gastric ulceration

65
Q

How does crib-biting increase the risk of equine gastric ulceration syndrome (EGUS)?

A

Crib-biting causes contraction of the abdominal muscles and increases intra-abdominal pressure which can push gastric acid from the glandular region of the stomach into the squamous portion of the stomach, causing gastric ulceration

66
Q

What are the early clinical signs of equine gastric ulceration syndrome (EGUS)?

A

Reduced feed intake
Reduced coat quality
Girthy
Subtle changes in athletic performance

67
Q

What are the later clinical signs of equine gastric ulceration syndrome (EGUS)?

A

Poor appetite
Signs of pain after eating
Poor performance
Refusal to move forward in the saddle
Weight loss
Chronic colic

68
Q

How do you diagnose equine gastric ulceration syndrome (EGUS)?

A

Endoscopy

69
Q

How would you grade this squamous mucosa for gastric ulceration

A

Grade 0 - this is healthy squamous mucosa

70
Q

How would you grade this squamous mucosa for gastric ulceration?

A

Grade 1 - there is a yellowish pigment with hyperkeratosis

71
Q

How would you grade this squamous mucosa for gastric ulceration

A

Grade 2 - beginning to see some evidence of erosion and ulceration

72
Q

How would you grade this squamous mucosa for gastric ulceration

A

Grade 3 - Clear evidence of ulceration with areas of bleeding

73
Q

How would you grade this squamous mucosa for gastric ulceration

A

Grade 4 - More extensive, raised ulceration due to the body’s attempt to heal the ulcers

74
Q

Which squamous gastric ulceration grades are of clinical significance?

A

Grades 3 and 4 are of clinical significance

75
Q

How do you grade glandular mucosa for gastric ulceration?

A

Record the location and the gross appearance of the lesions as they can be very variable

76
Q

How do you treat gastric ulceration?

A

Omeprazole
Sucralfate
Increase access to forage and grazing
Decrease or stop concentrate feeding
Decrease intensity of exercise
Manage crib biting
Reduce stressors

77
Q

What are the general causes of weight loss in horses?

A

Decreased feed intake
Dental disease
Oropharyngeal disease
Parasitism
Malabsorption (e.g. inflammatory diseases)
Protein losing enteropathy
Decreased assimilation of nutrients (e.g. hepatic or metabolic disease)
Protein-losing nephropathy

78
Q

What is protein-losing enteropathy?

A

Protein-losing enteropathy is where serum proteins and lost excessively into the gastrointestinal lumen. Protein-losing enteropathy can be caused by multiple conditons which damage the gastrointestinal mucosa or impede lymphatic drainage (allows lymphatic fluid to leak into GI tract)

79
Q

What is chronic colic?

A

Chronic colic is subacute abdominal pain over a period of days, with or without weight loss

80
Q

How should you approach investigating chronic colic ± weight loss?

A

Detailed history
Clinical examination
Rectal examination
Dental examination
Faecal analysis
Biochemistry and haematology
Abdominocentesis
Referral diagnostics

81
Q

Which referral diagnostics can be done to investigate chronic colic ± weight loss?

A

Endoscopy ± biopsies
Ultrasound
Radiography
Gastrointestinal motility tets
Exploratory laparotomy ± biopsies

82
Q

What is the first thing you should do when investigating chronic colic?

A

Take a detailed history and clinical examination to assess if the chonic colic could be due to management, and give the owner advice on how to prevent managemental colic if applicable

83
Q

What can you advise owners to do to prevent managemental colic?

A
  1. Maintain a daily routine and minimise changes in diet, exercise, turnout etc.
  2. Feed 2 - 3% of the horse’s body weight in forage
  3. Provide daily access to grass
  4. Avoid feeding excess concentrates
  5. Provide constant access to clean water
  6. Anthelmintic protocol
  7. Provide six monthly dental care
  8. Keep a diary of any colic episodes to see if a pattern can be identified
84
Q

What are the gastric causes of chronic colic ± weight loss?

A

Gastric ulceration
Chronic gastric dilatation
Chronic gastric impaction
Pyloric outflow dysfunction
Gastric neoplasia (squamous cell carcinoma)

Most of these can be ruled out using endoscopy and ultrasound

85
Q

What are the small intestinal causes of chronic colic ± weight loss?

A

Ascarid impaction
Non-strangulating infarction
Inflammatory bowel disease
Ileum hypertrophy
Adhesions

86
Q

Which helminths most commonly causes ascarid impactions of the small intestine?

A

Parascaris equorum

87
Q

Which signalement is affected by parascaris equorum impactions?

A

Parascaris equorum affects young horses such as foals, weanlings and yearlings. Adult horses develop resistance against parascaris equorum

88
Q

Which helminths can cause a non-strangulating infarction resulting in chronic colic ± weight loss?

A

Strongylus vulgaris

89
Q

(T/F) Equine inflammatory bowel disease always presents with diarrhoea

A

FALSE. Equine inflammatory bowel disease does not present with diarrrhoea

Diarrhoea in horses is always due to large intestinal disease

90
Q

What are the clinical signs of inflammatory bowel disease in horses?

A

Weight loss
Chronic colic
Hypoproteinaemia
Thickened small intestinal wall on ultrasound

91
Q

How do you diagnose inflammatory bowel disease?

A

Small intestinal biopsies

92
Q

How do you treat inflammatory bowel disease in horses?

A

Immunosuppressive therapy
Increase nutrient and protein content in the diet

93
Q

Which drug do you use for immunosuppressive therapy in horses?

A

Prednisolone

94
Q

What is the prognosis for inflammatory bowel disease in horses?

A

Lymphocytic and plasmocytic inflammatory bowel disease typically have a prognosis of 6 to 12 months from first presentation, whereas eosinophilic and granulomatous inflammatory bowel diseas have a bettwe prognosis and tend to respond better to immunosupporessive therapy

95
Q

Which disease can present in a very similar way to inflammatory bowel disease?

A

Lymphoma

Important to differentiate these on histopathology

96
Q

What is one of the main causes of small intestinal adhesions?

A

One of the main causes of small intestinal adhesions is due to the inflammation, trauma and handling of small intestines during abdominal surgery

97
Q

What are the large colonic causes of chronic colic ± weight loss?

A

Large colon impaction
Sand colic
Enteroliths
Non-strangulating infarction
Right dorsal colitis
Chronic salmonellosis

98
Q

Which helminths can cause a non-strangulating infarction resulting in chronic colic ± weight loss?

A

Strongylus vulgaris

99
Q

What are the caecal causes of chronic colic ± weight loss?

A

Caecal impaction
Enteroliths
Intussussception

100
Q

What is the most common site of intusussception in the horse?

A

Ileocaecal intusussception

101
Q

What are the small colon and rectal causes of chronic colic ± weight loss?

A

Small colon impaction
Faecoliths
Enteroliths
Peri-rectal abscesses

102
Q

What are the peritoneal causes of chronic colic ± weight loss?

A

Peritonitis (more common than you would think)
Abdominal abscess
Neoplasia (lymphoma and squamous cell carcinoma)

103
Q

What causes primary peritonitis?

A

Primary peritonitis is idiopathic

104
Q

What causes secondary peritonitis?

A

Secondary peritonitis can be caused by abdominal trauma, rupture of the gastrointestinal tract or abdominal surgery

105
Q

What are the clinical signs of peritonitis?

A

Colic
Pyrexia
Weight loss (if chronic peritonitis)

106
Q

How does peritonitis typically present on haematology and biochemistry?

A

Normal haematology
Normal fibrinogen
Increased serum amyloid A

107
Q

How does peritonitis typically present on abdominocentesis?

A

Abnormal appearance of peritoneal fluid
Increased leukocytes
Increased TP
Increased lactate
± Bacteria

108
Q

Which bacteria species is most commonly isolated in peritonitis cases?

A

Actinobacillus species

109
Q

How do you treat peritonitis in horses?

A

NSAIDS
Broad spectrum antibiotics
Intravenous fluid therapy
Treat endotoxaemia if indicated

110
Q

Which NSAID is best for treating peritonits?

A

Flunixin (remember peritonitis is very painful)

111
Q

How do you monitor that patients are responding to treatment of peritonitis?

A

To confirm patients are responding to treatment of peritonitis, repeat the abdominocentesis and assess the peritoneal fluid

112
Q

What are the hepatic causes of chronic colic ± weight loss?

A

Chronic hepatitis
Cholelithiasis

113
Q

What are the urinary causes of chronic colic ± weight loss?

A

Urolithaisis
Chronic cystitis
Pyelonephritis

114
Q

Why do horses not typically urinate when they are colicing?

A

Horses do not typically urinate when they are colicing as they require abdominal contraction to urinate

115
Q

How do you approach the investigation of diarrhoea in horses?

A

History and clinical signs
Clinical examination
Haematology and biochemistry
Faecal analysis and culture and sensitivity
Ultrasound

116
Q

Which history questions can be beneficial to ask when investigating diarrhoea in horses?

A
  1. Has there been any recent dietary changes?
  2. Has the horse been inappetent?
  3. Are there any systemic clinical signs?
  4. Has the horse been on any recent medications?
  5. Are any horses in the area affected by these clinical signs?
  6. What is the precise nature of the diarrhoea?
  7. Could the horse have had access to different feed, pasture or potential toxins
117
Q

Which medications can cause diarrhoea in horses?

A

Antibiotics
NSAIDS
Anthelmintics

118
Q

How can antibiotics cause diarrhoea in horses?

A

Antibiotics can induce diarrhoea in horses through disrupting the normal gastrointestinal microbiome resulting in dysbiosis which can result in diarrhoea

119
Q

Which pathogen is the most common cause of post-antibiotic diarrhoea?

A

Clostridium difficile

120
Q

How can NSAIDS cause diarrhoea in horses?

A

NSAIDS can cause right dorsal colitis in horses, resulting in diarrhoea

121
Q

How can anthelmintics cause diarrhoea in horses?

A

Treatment with anthelmintics in horses with a high parasite burden can result in diarrhoea

122
Q

Which toxins can cause diarrhoea in horses?

A

Acorns (more commonly in ponies)
Tannins (components of some plants)

123
Q

What should you particularly assess during the clinical examination of a horse with diarrhoea?

A

Assess if there is evidence of diarrhoea? How much is there etc
Assess for signs of systemic disease
Assess the vital physiological parameters
Abdominal auscultation
Assess for dehydration

124
Q

What is the main thing you should determine on clinical examination of a horse with diarrhoea?

A

The main thing you should determine on clinical examination of a horse with diarrhoea is the patient status and if theu require referral

125
Q

What is the main cause of nutritional diarrhoea?

A

Recent dietary change

126
Q

What are the key signs of nutritional diarrhoea?

A

No systemic clinical signs
Normal vital physiological parameters
No evidence of dehydration
Normal haematology and biochemistry results

127
Q

How do you treat nutritional diarrhoea?

A

You can switch the horse to a simple soaked hay feed and the diarrhoea should resolve itself over a few days

128
Q

Describe the pathophysiology of colitis/typhlitis?

A

Pathophysiological changes in colitis and typhlitis include widespreak mucosal inflammation (with sloughing and necrosis in severe disease). Inflammation will cause vasodilation and increased vascular permeability which allows for the passage of fluid and serum proteins from the intravascular space into the intestinal lumen, resulting in a protein-losing enteropathy. The damage to the mucosa also results in decreased absorption of water, electrolytes and nutrients which contribute to dehydration which can progress to hypovolaemia, electrolyte imbalances and eventual weight loss. Damage to the mucosa also allows for the translocation of bacteria and endotoxins into the bloodstream which will contribute to hypovolaemia, decreased cardiac output and eventual cardiovascular collapse.This can also progress to systemic inflammatory response syndrome (SIRS) and disseminated intravascular coagulation (DIC)

129
Q

What are some of the potential complications of colitis/typhlitis in horses?

A

Acute renal failure
Laminitis
Thrombophlebitis
Disseminated intravascular coagulation (DIC)

130
Q

What are some of the most common infectious causes of colitis/typhlitis in foals?

A

Clostridium perfringens
Clostridium piliforme (Tyzzer’s disease)
Rhodococcus equi
Lawsonia intracellularis
Rotavirus

131
Q

What are some of the most common infectious causes of colitis/typhlitis in adult horses?

A

Clostridium difficile (most common in the UK)
Salmonella
Coronavirus

132
Q

What are some of the parasitis causes of colitis/typhlitis in adult horses?

A

Strongylus vulgaris
Cyathostomins

133
Q

What are some of the other possible causes of colitis/typhlitis in adults horses?

A

NSAIDS
Sand impactions

134
Q

What are the ‘warning signs’ of colitis/typhlitis in horses with diarrhoea on clinical examination?

A

Clinical signs of endotoxaemia
Dehydration
Hypovolaemia
Pyrexia
Colic
Intestinal hyper- or hypomotility
Taut taenial bands on rectal palpation

135
Q

What are the clinical signs of endotoxaemia?

A

Tachycardia
Toxic lines
Congested mucous membranes
Brisk CRT which can progress to a prolonged CRT
Profound depression

136
Q

What is indicated by taut taenial bands on rectal examination?

A

Taut taenial bands indicates the large colon is very fluid filled

137
Q

What are the ‘warning signs’ of colitis/typhlitis in horses with diarrhoea on haematology and biochemistry?

A

Increased PCV and TP
Increased PCV and decreased TP
Increased lactate
Leukopenia
Neutropenia

138
Q

What is indicated by an increased PCV and TP in a patient with diarrhoea?

A

An increased PCV and TP in a patient with diarrhoea indicates dehydration and hypovolaemia

139
Q

What is indicated by increased PCV and a decreased TP in a patient with diarrhoea?

A

An increased PCV and decreased TP indicates dehydration and hypovolaemia with a loss of serum proteins into the intestinal lumen (protein losing enteropathy)

140
Q

What is indicated by increased lactate in a patient with diarrhoea?

A

Increased lactate indicates hypoperfusion and anaerobic metabolism

141
Q

What is a key sign of colitis/typhlitis on ultrasound?

A

Thickening of the colon/caecal wall is a key sign of colitis/typhlitis on ultrasound

142
Q

What is the normal thickness for the colon wall on ultrasound?

A

4 - 5mm

143
Q

What is the normal thickness for the caecal wall on ultrasound?

A

4 - 5mm

144
Q

When should horses be admitted to the isolation unit?

A

Horses presenting with diarrhoea or without diarrhoea but intestinal hypermotility, pyrexia, leukopenia and neutropenia should be admitted to isolation as there is a high risk of infectious disease such as clostridium difficile, salmonella and coronavirus. Barrier nursing is also required as these pathogens and zoonotic

145
Q

How do you diagnose clostridium difficile in horses?

A

Faecal ELISA for toxin A and toxin B

146
Q

How do you diagnose salmonella in horses?

A

Faecal ELISA
Faecal PCR

147
Q

When diagnosing salmonella in horses, how many tests are required for a confirmatory diagnosis?

A

When diagnosing salmonella in horses, three sequential tests should be taken and submitted fo culture, if one comes back positive, five subsequent sequential negative tests are required to determine cessation of shedding

148
Q

How do you diagnose coronavirus in horses?

A

Faecal PCR
Immunohistochemistry

149
Q

What is the main cause of right dorsal colitis in horses?

A

NSAIDS

150
Q

How do NSAIDS cause right dorsal colitis in horses?

A

NSAIDS inhibit cyclooxygenase-1 (COX) and thus prostaglandin production which results in reduced mucosal blood flow to the gastrointestinal tract. The right dorsal colon is particularly sensitive to changes in blood flow and mucosal integrity which increases the risk of gastrointestinal ulceration and inflammation

151
Q

What should owners be advised when being prescribed NSAIDS?

A

Owners should be advised that there is a risk of right dorsal colitis with NSAIDs and to monitor for soft faeces. If they notice soft faeces, they should stop the NSAIDs immediately and seek veterinary advice

152
Q

How do you manage acute colitis/typhlitis?

A

Prevent further endotoxin absorption
Anti-endotoxic drugs
Fluid therapy
Antibiotics (in some cases)

153
Q

What can be used to prevent further endotoxin absorption?

A

Activated charcoal
Biosponge (Smectite)

154
Q

Which drug can act as an anti-endotoxic drug?

A

Flunixin (low dose to prevent the risk of right dorsal colitis)

155
Q

What are the aims of fluid therapy when managing colitis/typhlitis?

A

Replace fluid deficits
Provide maintenance fluids
Replace ongoing losses
Correct electrolyte imbalances
Correct acid bases imbalances
Maintain oncotic pressure

156
Q

What can be used to maintain oncotic pressure in horses with colitis/typhlitis?

A

Plasma

157
Q

What is the main risk of antibiotics in the management of colitis/typhlitis?

A

Antibiotics can cause further dysbiosis and exacerbate the clinical signs of colitis/typhlitis

158
Q

When are antibiotics indicated in the management of colitis/typhlitis?

A

Metronidazole can be used if clostridium difficile has been diagnosed

159
Q

What can be done to try and reduce the risk of laminitis secondary to colitis/typhlitis?

A

Continuous icing on the hooves can reduce the risk of laminitis

MODULE 16 - Alimentary Tract Disease (23 decks)

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