The critically ill horse with GI disease EXTRA

Question 1

CONDITIONS OF THE GIT THAT LEAD TO PATIENTS BEING ‘SICK IN COMPANION ANIMALS

A lot of stuff is comparable to stuff in other SA especially dogs

What makes them really sick?

Answer 1

• Retained fetal membranes
• Septic peritonitis
• LC torsion/GDV
• Bacteremia
• GI perforation
• Contamination post surgery
• Gall bladder rupture in SA
• Bacterial translocation into anywhere that is not contained in healthy GI tract

Question 2

Discuss SIRS?

Answer 2

Systemic inflammatory response system

A self-amplifying dysregulated upregulated systemic inflammatory response which can go from beneficial effects to negative effects seen in SIRs

Triggered by:

• Bacterial toxins
• Lipopolysaccharide derived from gram negative bacteria
• S aureus (gram + can also trigger)
• Burns, Neoplasia, Pancreatitis (not equine)
• In SA pancreatitis
• Can result in severe coagulopathies

Question 3

Discuss SIRS being called endotoxaemia?

Answer 3

Previously referred to as endotoxaemia but this suggest endotoxin is causing clinical signs but with SIRS we see it because:

• Inflammation leading cell death and apoptosis in SIRS
• LPS has some direct roles
• Includes non-LPS bacteria

Question 4

Define sepsis?

Answer 4

Sepsis

SIRS plus : Culture proven infection (in vetmed a likley bacteraemia)

Question 5

Define severe sepsis?

Answer 5

Severe sepsis –Sepsis with organ hypoperfusion or dysfunction (reduction in organ perfusion can be measured by looking at renal output)

Question 6

Define septic shock?

Answer 6

Septic shock

• Severe sepsis + systemic hypotension (non-responsive to drugs hypo-tension)
• Common in foals, rare in adult horses
• Occurs in small animals

Question 7

Discuss multi-organ dysfunction syndrome?

Answer 7

If horses get MODs they are on way to PM. In SA it can be reversed.

Altered organ function in an acutely ill animal such that haemostasis cannot be maintained without intervention (In SA they will bleed in horses they will clot and form microthrombi)

Question 8

Outline primary and secondary MODs?

Answer 8

Primary –resulting from well-defined insult where organ dysfunction occurs early and is a direct consequence of the insult itself e.g Burns and neoplasia

Secondary –Organ failure not in direct response to the insult but as a consequence of a host response (SIRS)

Question 9

Discuss disseminated intravascular coagulation?

Answer 9

DIC= death is coming

“Consumptive coagulopathy”

Pathological inappropriate activation of coagulation

• microvasculature clotting
• haemorrhagic diathesis
• consumption of procoagulants

Associated with

• SIRS, SEPSIS, SEPTIC SHOCK
• MODS
  
  • systemic neoplasia
  • enteritis and colitis

Question 10

Clinical signs of DIC?

Answer 10

In large animals, DIC is usually manifested by thrombosis rather than spontaneous haemorrhage

• petechial haemorrhages
• bleeding at following trauma
  
  • Venipuncture
  • surgical sites
  • nasogastric intubation

Question 11

How to diagnose DIC?

Answer 11

DIC : DIAGNOSIS

3 out of 5 abnormalities of

• Thrombocytopenia (low platelet count)
• Prolonged prothrombin time
• Prolonged activated partial thromboplastin time
• Increased fibrin degradation products
• Decreased antithrombin 3
• (Low fibrinogen –not used very often as ref range <5 g/L)