Specific Gastro- Intestinal Diseases Flashcards by Corinne Perra

What conditions are most frequently seen in the stomach?

Gastric dilation and impaction — highly fermentable feeds

Equine gastric ulcer syndrome —> can progress to stenosis

Neoplasia —SCC

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T/F: the small intestine usually presents with strangulating disease

True

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What are the non-strangulating small intestinal obstructions?

Ascarid inactions (often appear strangulating)
Small intestinal feed or foreign body impaction
Muscular hypertrophy
Abscess
Adhesions
Neoplasia

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What is the signalment usually seen with ascarid impaction?

Young horses : weanlings/yearlings

Recent administration of very effective antheminitics

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Clinical signs associated with small intestinal ascarid impaction?

Looks strangulating —> severe necrosis and inflammation by death of the worms

Toxic, shocky, moderate to severe colic

Can see worms on gastric reflux

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What is the treatment for ascarid impaction?

Might required surgical intervention if complete obstruction
Severe necrosis of the small intestine is the normal

Conservative : laxatives (mineral oil) and IV fluids
Prevention: slow deworming

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Where do small intestinal feed impactions usually occur?

Ileal

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What feed is usually associated with feed impactions?

Bermuda gras

Fine hay particles

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Clinical signs seen with SI feed or FB impactions?

Intermittent, partial, or complete obstrucion

Rectal : SI distention and can palpate impaction dorsally on the right just cranial to the cecum. As impaction progresses, it gets pulled out of reach

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Treatment for SI feed/ FB impactions?

Conservative : laxatives (mineral oil), IV fluids, and analgesics

Surgical correction — post op ileus seen

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What is the prognosis for SI feed/FB impactions?

Duration < 17hrs : likely to survive

Duration > 17hrs : usually die

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What are causes of muscular hypertrophy of the SI ?

Primary (idiopathic)

Secondary - proximal hypertrophy associated with a distal stenosis

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Risk factors for SI muscular hypertrophy?

Ileal impactions

Can be associated with tapeworms

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Clinical signs of SI muscular hypertrophy?

Intermittent colic with mild to moderate pain after eating

Anorexia and weight loss

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Treatment of SI muscular hypertrophy ?

If associate with tapeworms — pyrantel pamoate

Ileomyotomy
Side-to side ileocecal anastomosis (without resection)
Side-to-side jejunocecal anastomosis

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How do abscesses cause SI obstructions?

Direct compression or stricture due to the abscesses or mass itself OR due to adhesions which result from the local inflammation

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Signalment associated with abscesses resulting in SI obstructions?

Less than 5yrs

History of weight loss and/or unthriftiness

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Clinical signs associated with abscesses causing SI obstrucion??

Depressed, anorexic, and febrile

Neutropenia with a left shift and hyperfibrogenemia

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What do you usually see on an abdominocentesis of a horse with abscesses ?

Elevated protein and WBC count
Intracellular or fee of bacteria occur only rarely

Usually — strep zooepidemicus, strep equi, rhodococcus equi, and cornybacterium pseudotuberculosis

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Treatment for abdominal abscessation?

Conservative : long term antibiotics are the treatment of choice — has guarded prognosis

Surgical
— removal of abscess and/or affected bowel
— marsupilaization of abscess
— by-pass affected bowel

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T/F: adhesions can occur in either the LI or SI, but are of more significance in the SI?

True

SI has many hair-pin curves and tight adhesions are more likely to cause significant obstruction

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What causes of inflammation can lead to adhesions ?

Infection
Foreign body
Vascular insufficiency

Peritonitis — usually resulting from microbial contamination of abdomen

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What can peritonitis be caused by?

Previous abdominal surgery
Parasitic larval migration
Abdominal abscessation
Interstitial ischemia

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Clinical signs associated with a intestinal obstruction caused by adhesions?

History of recurrent episodes of colic

Usually responsive to medical therapy until severe obstruction
Can have severe unresponsive pain

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Treatment for intestinal obstrucion caused by adhesions?

Reception of adhesions and involved bowl By-pass Guarded to poor prognosis, recurrence is a major problem

What are the two most important neoplasms of the equine abdomen?

Squamous cell carcinoma a | Lymphosarcoma

What are causes of a strangulating SI obstructions?

``` Volvulus Strangulating lipoma Internal hernia - epiploic foramen - gastrospelnic ligament - mesenteric defect External hernia -inguinal -umbilical -diaphragmatic Intussusception ```

Signalment associated with SI volvulus?

<3yrs | If <1yr, associated with change in diet or ascarid infection

SI volvulus may be secondary to other conditions that result in a fulcrum. What are some of these conditons>?

Mesodiverticuar bands (embryonic remnant of vitelline circulation) Meckel’s diverticulum (embryonic remnant of omphalomesenteric duct) Adhesions Hernias— inguinal, mesenteric

Signalment associated with strangulating lipoma?

Older horse > 9-10yrs | Peducutated - fat masses on the end of a fibrovascular stock

What are the boundaries of the epiploic foramen?

Dorsal: caudate lobe of the liver and vena cava Ventral: right lobe of the pancreas, gastropancreatic fold and portal vein Cranial: hepatoduodenal ligament Caudal : intersection of the pancreas and mesodudodenum

What are two mechanisms that epiploic foramen entrapment can occur?

Right to left passage of intestine from right of midline through foramen into the omental bursa Left to right passage of bowel ruptures the omentum and pushes through the foramen

What are risk factors for epiploic foramen entrapment?

Older horse: reduction in size of liver results in enlargement of space Cribbing

Clinical signs of epiploic foramen entrapment?

Rectal exam SI distention with fewer loops than you would expect Peritoneal fluid can be misleading — only abnormal isn 56% of cases

What is the treatment for epiploic foramen entrapment?

Surgical correction But can result in immediate death of the horse (particular complicating factor for this surgery) —> due to inflammation, local damage, and necrosis you can have rupture of the caudal cava or portal vein

Where is the gastrosplenic ligament located?

From left part of greater curvature of the stomach t the hilus of the spleen

With gastrosplenic ligament entrapment, which part of the SI is usually trapped?

Distal jejunum and ileum

What is the signalment fo inguinal hernias?

Newborn colts Breeding stallions: usually after breeding or significant physical exertion Standardbreds, saddlebreds, and Tennessee walkers

Clinical signs of inguinal hernia?

Usually unilateral and indirect in stallions (within vaginal tunic) Newborns Indirect — reducible, non-painful Direct (outside the vaginal tunic, in SQ tissue, passing through rent in peritoneum or fascia) Acute and painful Rectal palpation— intestine through vaginal ring

What are predisposing factors for umbilical hernias?

Manual breaking of the umbilical cord Umbilical infection Excessive straining Ligation of cord

When are umbilical hernias in need of surgical correction?

If there is increase in size of hernia If presence of firmness, warmth, edema If presence of pain on palpation of the area

What are causes of diaphragmatic hernias ?

Congenital Trauma Increased intraabomdinal pressure: blow, parturition, severe GI distention or strenuous exercises

T/F: horses usually present only with GI signs with diaphragmatic hernias, respiratory dysfunction is not commonly seen

True

What are predisposing causes to intussusception?

``` Dietary change Heavy ascarid infection Enteritis Previous SI surgery Anthelmitic administration Tapeworm infestation Intramural tumors Obstruction secondary to foreign body— luminal polyp ```

T/F: intussusception is more common in older horses

False usually <3yrs

What portion of the intestine is most frequently involved in intussusception?

Ileum and ileocecal junction

The subacute form of intussusception is associated with what clinical sign in foals?

Diarrhea

Why would peritoneal fluid changes not reflect the degree of necrosis caused by intussusception ?

Because the “dead” bowl is inside another piece of bowel and isolated from peritoneal cavity

What inflammatory disease is a major differential for what appears to be a strangulating lesion of the SI?

Dudodenitis proximal jejunitis (DPJ)

What are the disease characteristics of duodentitis proximal jejunitis (DPJ) ?

Inflammation and edema of the duodenum and variably the stomach and jejunum

Signalment associated with DPJ?

Mostly adults especially those on a high plain of nutrition

What bacteria is thought to be involved with DPJ?

Salmonella and or clostridia (c.difficile)

Clinical signs seen with DPJ?

Moderate to severe pain with copious amounts of NG reflux, often with orange-brown fetid odor Initial volumes may reach 12-16L Pain usually subsides after decompression but most horses remain depressed

Abdominocentesis results that could indicate DPJ?

Increased TP Mild to moderate WBC Fluid yellow-turbid, in severe cases RBC might be present

What are the two major components of therapy for DPJ?

Gastric decompression — every 1-2hrs | Fluid administration — CV support

You want to give your DPJ horse something to treat endotoxemia .. what can you administer?

Polymixin B or endoserum Lidocaine DMSO NSAIDS — flunixin

T/F: we give DPJ horse antibiotics as part of their therapy to treat the enteritis

False —given to cover systemic effects of altered mucosa Use penicillin due to possible association of clostridum

T/F: motility drugs are used in cases of DPJ?

True In cases of persistent reflux IV lidocaine

Common complications assoicated with DPJ ?

``` Peritonitis Myocardial and renal infarction Aspiration pneumonia Adhesions of small intestine Laminitis ```

What is usually responsible for thromboembolic injury resulting in necrotic, comprised bowel segments ?

Large strongly —> cranial mesenteric arteries Vasculitis, purpura and DIC can also result in thrombosis