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Equine Medicine > Unit 2 - Diarrhea > Flashcards

Unit 2 - Diarrhea Flashcards

1
Q

What is diarrhea?

A

Passage of feces with increased water content

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2
Q

What is colitis?

A

inflammation of the large bowel

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3
Q

What is the duration of acute diarrhea?

A

1-2 weeks

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4
Q

What is the duration of chronic diarrhea?

A

greater than 1 month

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5
Q

What are the infectious etiologies of acute diarrhea in a horse?

A

Salmonella, Neorickettsia, Clostridium, and Cyanthostomiasis

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6
Q

What else can cause acute diarrhea?

A

antimicrobial induced and toxin induced

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7
Q

What is one of the most common causes of severe infectious diarrhea in horses?

A

Salmonella

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8
Q

What is the most commonly isolated Salmonella species?

A

Salmonella typhimurium (most common), S. agona, S. anatum, S. krefeld

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9
Q

What percentage of the horse population are non-systomatic carriers of Salmonella?

A

3-5%

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10
Q

How is Salmonella spread?

A

It is contagious - spread by direct contact and fomite transmission

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11
Q

What predisposing factors may induce Salmonella diarrhea?

A

Stress, general anesthesia, systemic illness, prolonged transportation, administration of antimicrobials, or exposure to a horse with acute Salmonella-induced colitis

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12
Q

What is severity of Salmonella induced diarrhea related to?

A

The Salmonella species involved, age, and health status of the animal

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13
Q

What are the four clinical presentations of Salmonella?

A
  1. Asymptomatic carriers
  2. Fever, depression, neutropenia, anorexia, without evidence of diarrhea
  3. Severe, profuse diarrhea with dehydration, neutropenia, and endotoxemia
  4. Chronic diarrhea
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14
Q

What clinical signs are associated with Salmonella diarrhea?

A

Acute severe and profuse diarrhea, dehydration, +/- abdominal pain, tachycardia, tachypnea, fever, depression, and anorexia

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15
Q

What clinical pathology abnormalities are associated with Salmonella induced diarrhea?

A

Leukopenia, neutropenia, left shift, hemoconcentrationn, electrolyte derangements, azotemia, hypoproteinemia, and metabolic acidosis

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16
Q

How is Salmonella induced diarrhea diagnosed?

A

Clinical signs and/or history of exposure, serial cultures of feces (at least 3 negative), PCR of feces

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17
Q

How is Salmonella induced diarrhea treated?

A

Overall treatment for acute diarrhea and supportive care

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18
Q

What does Neorickettsia risticii cause?

A

Potomac Horse Fever

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19
Q

What does Neorickettsia risticii infect?

A

the equine macrophage

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20
Q

What cells does Neorickettsia risticii have tropism for?

A

cells of the cecum and large colon

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21
Q

Where does Neorickettsia risticii survive?

A

In cell-derived vacuoles

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22
Q

How is Neorickettsia risticii transmitted?

A

It is not completely understood, but there is some associated between disease and proximity to freshwater streams and rivers

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23
Q

When does Neorickettsia risticii transmission typically occur?

A

during spring/summer months in northern climates

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24
Q

What clinical signs are associated with Neorickettsia risticii induced diarrhea?

A

Soft stool to profuse diarrhea, dehydration, +/- abdominal pain, tachycardia, tachypnea, fever, depression, diarrhea, laminitis

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25
Q

What clinical pathology changes are associated with Neorickettsia risticii infection?

A

Electrolyte deficiencies, metabolic acidosis, hypopriteinemia, azotemia, leukopenia, and neutropenia with a left shift (toxic changes)

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26
Q

How is Neorickettsia risticii diagnosed?

A

PCR tests (feces and blood) or paired blood samples for antibody titers

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27
Q

How is Neorickettsia risticii treated?

A

Supportive therapy and oxytetracycline

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28
Q

What is the prognosis for Neorickettsia risticii infection?

A

Fair to good; mortality rate is 5-30%

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29
Q

How is Neorickettsia risticii prevented?

A

vaccination (efficacy debatable); natural infection protects for 1-2 years

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30
Q

What type of bacteria is Clostridium?

A

Obligate gram + anaerobe

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31
Q

What Clostridium species are the most commonly implicated in causing acute diarrhea?

A

Clostridium difficile and Clostridium perfringens

32
Q

What toxins does C. difficile produce?

A

Toxin A and Toxin B

33
Q

What effects does Toxin A have?

A

Intestinal secretory and cytotoxic effects, increases intestinal permeability, and activates inflammatory cells

34
Q

What effects does Toxin B have?

A

Enterotoxigenic and secretory effects

35
Q

What toxins does C. perfringens create?

A

Toxin A and C

36
Q

What unique clinical sign does Clostridium cause that other acute diarrhea agents dont?

A

Gas distention

37
Q

How is acute diarrhea caused by Clostridium diagnosed?

A

ELISA toxin assay or culture of feces

38
Q

How is Clostridium diarrhea treated?

A

Supportive care and Metronidazole

39
Q

How do Cyathostomes cause diarrhea?

A

The emergence of large numbers of L4 stage larvae from the mucosa of the cecum and colon damages the submucosa/mucosa and provokes a severe granulomatous reaction

40
Q

When does Cyathostome caused diarrhea typically occur?

A

Late winter and spring

41
Q

What intestinal ‘disease’ is associated with Cyathostomes?

A

Hemorrhagic or fibrinous typhlitis (cecum-itis) and colitis

42
Q

What are the distinguishing featurse of Cyathostome induced diarrhea?

A

Profound hypoalbuminemia, larvae found on scrape or biopsy, and chronic changes (weight loss, ill thrift, ventral edema, intermittent fever, and intermittent colic)

43
Q

How is Cyathostome induced diarrhea treated?

A

Fenbendazole, Moxidectin, and supportive care

44
Q

How can antimicrobials cause acute diarrhea?

A

They cause changes in the normal GI flora leading to the diarrhea

45
Q

What is the prognosis for antimicrobial induced acute diarrhea?

A

Poor - it is often fatal

46
Q

What drugs can cause antimicrobial induced acute diarrhea?

A

Trimethoprim suflas, erythromycin, tetracyclines, ceftiofur, and potassium penicillin

47
Q

What NSAIDs can cause toxin induced acute diarrhea?

A

Phenylbutazone and flunixin meglumine

48
Q

What disease processes can NSAID toxicity cause?

A

right dorsal colitis or gastric ulceration

49
Q

What clinical signs are associated with right dorsal colitis?

A

Intermittent colic, diarrhea, lethargy, +/- fever, hypoproteinemia, ventral edema, and history of NSAID use

50
Q

What will you find on ultrasound in patients with right dorsal colitis?

A

Thick or edematous colon wall

51
Q

How is right dorsal colitis treated?

A

Discontinue use of NSAIDs, low bulk feed, sucrulfate, Misoprostol, and Psyllium

52
Q

Why can overfeeding/grain overload cause diarrhea?

A

It overwhelms the small intestinal digestive capacity - excess CHO enter colon, rapidly fermented by lactic acid producing bacteria, decreases the pH and kills gram negative bacteria, endotoxemia

53
Q

How is diarrhea caused by overfeeding/grain overload treated?

A

Lavage and remove gastric contents, anti-endotoxin therapy, fluid therapy, Cathartics, activated charcoal, laminitis treatment/prevention, possibly surgical removal

54
Q

What diagnostics should be performed in all cases of acute diarrhea?

A

CBC, serum chemistry, venous blood gas (acid/base), and fecal samples

55
Q

What supportive care should be considered/given in all cases of adult equine diarrhea?

A

IV fluid therapy, oral fluids + electrolytes, anti-inflammatories, medications to modulate endotoxemia, nutritional support, prevention of laminitis, colloids, and correction of acidosis

56
Q

What is the maintenance rate for IV fluids for adults?

A

50 ml/kg/day

57
Q

What medications can be given to modulate endotoxemia?

A

Flunixin meglumine, hyper immunized plasma, polymyxin B, and pentoxifylline

58
Q

What probiotic can be given to treat adult equine diarrhea?

A

Saccharomyces boulardii

59
Q

What nutritional support can be given in cases of adult equine diarrhea?

A

Ground up pellets via NG tube, IV dextrose, partial parenteral nutrition, and total parenteral nutrition

60
Q

What preventative measures can be attempted to prevent laminitis in patients with diarrhea?

A

Ice boots, NSAIDs, mechanical support, Acepromazine, and Aspirin

61
Q

Why would you want to give colloids in a patient with diarrhea?

A

To maintain vascular oncotic pressure and prevent edema

62
Q

How do you correct metabolic acidosis in patients with diarrhea?

A

Correct with NaHCO3

63
Q

What are the potential causes of chronic diarrhea?

A

Diet, inflammatory bowel disease, primary disorders of other body systems, intestinal parasites, infectious causes, sand enterocolitis, and miscellaneous

64
Q

How could diet cause chronic diarrhea?

A

Excess amounts of CHO, oil, supplements, fresh green grass, and toxic plants

65
Q

What inflammatory cells could cause IBD which could cause chronic diarrhea?

A

granulomatous, eosinophilic, and lymphocytic-plasmacytic

66
Q

What clinical signs are associated with inflammatory bowel disease?

A

Colic, weight loss, hypoproteinemia, and abnormal glucose absorption

67
Q

How do you do a glucose absorption test?

A

Fast overnight, give 1g/kg of dextrose in water. Measure BG every 30 minutes for 4 hours. Peak BG should be 2x the baseline at 60-120minutes

68
Q

How do you diagnose IBD?

A

rectal biopsy, clinical signs, and clin path abnormalities

69
Q

How do you treat IBD?

A

corticosteroids

70
Q

What primary disorders of other body systems cause chronic diarrhea?

A

Liver disease/cirrhosis and congestive heart failure

71
Q

What intestinal parasites can cause chronic diarrhea?

A

Large or small strongyle species

72
Q

What infectious causes can cause chronic diarrhea?

A

Chronic Salmonella infections

73
Q

How does sand cause chronic diarrhea?

A

It irritates the ventral colon and causes inflammation of the mucosa leading to subsequent diahhrea

74
Q

What miscellaneous things can cause chronic diarrhea?

A

peritonitis, abdominal abscess, and lymphosarcoma of the GI tract

75
Q

What diagnostics should be considered for patients with chronic diarrhea?

A

rectal palpation, abdominocentesis, CBC and chemistry profile, fecal analysis, rectal biopsy, intestinal absorption test, abdominal radiography, abdominal ultrasonography, investigate medications/supplements received, diet

76
Q

How is chronic diarrhea treated?

A

treat the underlying cause, corticosteroids, and diet

77
Q

What is the prognosis for chronic diarrhea?

A

poor

Equine Medicine (27 decks)

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