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Equine Surgery and Medicine 2 > Spasmodic colic and Proximal Enteritis > Flashcards

Spasmodic colic and Proximal Enteritis Flashcards

1
Q

Aetiology of spasmodic colic

A

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

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2
Q

Spasmodic colic: Pathogenesis

A

SM spasm

Hypermotility (parasymp vagus nerve)

Vagotonia

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3
Q

Clinical signs of Spasmodic Colic

A

Sudden mild to moderate colic

Comes in bursts

Vitals may be normal!

Increased borborygmi

Gas prod

Loose faeces

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4
Q

Spasmodic Colic Differenitals

A

Tympany (primary or secondary)

Impaction

Ileus

Acute gastric dilation

Acute enteritis

Pregnancy colic

Urinary colic: kidney, ureter, urethra

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5
Q

Treatment of Spasmodic Colic

A

Spasmolytics: butylscopalamine (Buscopan?)

NSAIDs

Hand Walking

Absorbents e.g activated charcoal (via NG tube)

IV fluids

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6
Q

Prognosis of Spasmodic colic

A

Good-excellent if treated correctly

May reoccur- especially in sporthorses

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7
Q

What regions does proximal enteritis affect?

A

Duodenum and jejunum

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8
Q

Aetiology of prox enteritis

A

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

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9
Q

Pathogenesis of prox enteritis: Increased secretion

A

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!)

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10
Q

Pathogenesis of prox enteritis: Initially hyperperistalsis, then functional ileus

A

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)

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11
Q

Pathogenesis of prox enteritis contd

A

Decr absorption

Fluid and electrolyte loss

Haemoconc

Hypovol

Decr tissue perfusion

Oliguria (prerenal azotemia)

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12
Q

Pathogenesis of Prox enteritis: macroscopic changes

A

Light to dark red haem: patechia or ecchymosis

Yellowish bands

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13
Q

Pathogenesis of prox enteritis: microscopic changes

A

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!

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14
Q

Pathogenesis of prox enteritis: Hepatic changes

A

Asc infection!

Endotoxins in portal circ

Vacuoles in liver cells

Billiary stasis

Billiary hyperplasia

Inflamm

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15
Q

Appearance of peritoneal fluid in proximal enteritis

A

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

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16
Q

Prox enteritis clinical signs

A

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)

17
Q

Clinical pathology of prox enteritis

A

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
18
Q

Prox enteritis: abdominocentesis

A

Dark yellow, turbid

Diapedesis makes it serosanguineous

Incr cell count! (still remains below 10G/L)

Incr TP >35G/L

19
Q

Diagnosis of Prox enteritis

A

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
20
Q

Treatment of prox enteritis

A

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

21
Q

Fluid therpay for prox enteritis

A

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
22
Q

Anti-inflamm and analgesia

A

Flunixin meglumine

Butorphanol

23
Q

Antibiotics (only in severe cases of prox enteritis)

A

*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
24
Q

Prokinetic drugs

A

Less effective in inflamm

When there is no movement in the SI

  1. Lidocaine: also offers analgesia and anti-inflamm
  2. Metoclopramide
25
Q

Parenteral feeding

A

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!

26
Q

Prevention of laminitis

A

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

27
Q

Prognosis of prox enteritis

A

from 25-94%

Good with early intensice care

if develop SIRS from endotoxaemia/septicaemia the prognosis is poorer

Complications:

  • Laminitis
  • Thrombophlebitis
  • Weight loss

Equine Surgery and Medicine 2 (15 decks)

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