Spasmodic colic and Proximal Enteritis Flashcards
Aetiology of spasmodic colic
Individual susceptibility- usually self-limiting and horse improves quickly
Nutrition: both composition and way of feeding
Cold water (decr temp in the GIT)
Changes in weather
Parasites migrating
Strenuous exercise
Spasmodic colic: Pathogenesis
SM spasm
Hypermotility (parasymp vagus nerve)
Vagotonia
Clinical signs of Spasmodic Colic
Sudden mild to moderate colic
Comes in bursts
Vitals may be normal!
Increased borborygmi
Gas prod
Loose faeces
Spasmodic Colic Differenitals
Tympany (primary or secondary)
Impaction
Ileus
Acute gastric dilation
Acute enteritis
Pregnancy colic
Urinary colic: kidney, ureter, urethra
Treatment of Spasmodic Colic
Spasmolytics: butylscopalamine (Buscopan?)
NSAIDs
Hand Walking
Absorbents e.g activated charcoal (via NG tube)
IV fluids
Prognosis of Spasmodic colic
Good-excellent if treated correctly
May reoccur- especially in sporthorses
What regions does proximal enteritis affect?
Duodenum and jejunum
Aetiology of prox enteritis
Often unknown!
Bact: Clostr or Salmonella
Fungi: fusarium
(isolated these from reflux, although this usually comes back negative)
Diet: changes or large amnt of conc
Pathogenesis of prox enteritis: Increased secretion
2 IC mechanisms are present: cAMP,cGMP and calcium system
Na and Cl are transported from the interstitium to the epithelium and lumen (and water follows)
Bact toxins and inflamm mediators
Epithel and endothel damage: this allows for the protein rich fluid to flow into the lumen (the fluid is highly alkaline!)
Pathogenesis of prox enteritis: Initially hyperperistalsis, then functional ileus
Serositis, peritonitis
Inflamm cells in the musc layer migrate
Distension
Endotoxins
*the functional ileus: content flows backwards to the stomach and this is the reflux sample that we obtain)
Pathogenesis of prox enteritis contd
Decr absorption
Fluid and electrolyte loss
Haemoconc
Hypovol
Decr tissue perfusion
Oliguria (prerenal azotemia)
Pathogenesis of Prox enteritis: macroscopic changes
Light to dark red haem: patechia or ecchymosis
Yellowish bands
Pathogenesis of prox enteritis: microscopic changes
These are seen from stomach to the small intestine!
Degen, necrosis, sloughing
Ne infiltrates the propria, submucosa and mucosa
Haem on serosa and in muscular layer
Classicfied as: haemorrhagic, fibrinonecrotic!
Pathogenesis of prox enteritis: Hepatic changes
Asc infection!
Endotoxins in portal circ
Vacuoles in liver cells
Billiary stasis
Billiary hyperplasia
Inflamm
Appearance of peritoneal fluid in proximal enteritis
Higher TP!! (than in the case of mechanical ileus)
Disproportionate increase in TP relative to nucleated cell count
- Leakage of blood or plasma into abd cavity
- No major WBC chemotaxis
Differentials: Strang of the SI will show a correlating increase in the cell count and TP and the colour will be red
Prox enteritis clinical signs
DPJ vs mechanical ileus
Colic signs- LETHARGY!!!
Reflux: with decompression the HR will decrease (not in SI strang the HR does not decrease after decompression)
Elevated clinical values: Temp: 38.6-39.1
Peristalsis sounds decrease (but there is hyperperistalsis initially)
Distended/thicked loops of SI (can be seen by radio or US)
Clinical pathology of prox enteritis
PCV,TP and Lactate all increase
WBC’s can increase, decrease or stay the same
Biochem:
- Blood: decr Na, Cl, K
- Prerenal azotemia
- Increased AST, AP, GGT
- Metab acidosis
Prox enteritis: abdominocentesis
Dark yellow, turbid
Diapedesis makes it serosanguineous
Incr cell count! (still remains below 10G/L)
Incr TP >35G/L
Diagnosis of Prox enteritis
No pathognomic signs!! Although if signs are getting wprse- must consider mechanical ileus
Can only get a definitive diagnosis with surgery
Differentials:
- Mechanical ileus
- Pancreatitis
- Ileal impaction
- Alimentary lymphoma
Treatment of prox enteritis
Supportive
NG tube: repeated or left in horse (however this may increase the amount of reflux)
Fluid therapy
Anti-inflamm and pain management
AB’s
Prokinetics
Parenteral feeding
Prevention of laminitis
Surgery
Fluid therpay for prox enteritis
Rehdration:
- Crystalloids: LRS
- Nacl 7%: max 2 L per 500kg
Maint:
- Basen on oncotic P so do frequent TP checks (as they are loosing a lot of proteins)<40g/L
- Colloids: plasma or HES
- NB to maintain oncotic P so that crystalloids remain in the interstitial space
Anti-inflamm and analgesia
Flunixin meglumine
Butorphanol
Antibiotics (only in severe cases of prox enteritis)
*must be careful because they can causedysbact in the LI!
Only when get a positive from reflux sample- usually clostr toxins
- Penicillin
- Metronidazole
- Gentamicin
- Enrofloxacin
Prokinetic drugs
Less effective in inflamm
When there is no movement in the SI
- Lidocaine: also offers analgesia and anti-inflamm
- Metoclopramide
Parenteral feeding
After 3-4 days of anorexia (must force it to get reflux sample?)
Must get resting energy requirement: 22-23kcal/kg/day
Dextrose,aa’s,lipids
Isotonic solution
First 12 hours: give 35% of required E
2nd 12 hours: 60-65%
Must check the blood glucose level frequently (insulin)– many of them develop acute laminitis!
Prevention of laminitis
Palpate hooves and digital arteries
Ice boots: effective in first 48 hrs
Cast
Low Mr heparin
ACP: vasoD effect, horse spends more time in lat recumbency
Prognosis of prox enteritis
from 25-94%
Good with early intensice care
if develop SIRS from endotoxaemia/septicaemia the prognosis is poorer
Complications:
- Laminitis
- Thrombophlebitis
- Weight loss
