Unit 2 - Upper GI and Endotoxemia

Question 1

How many deciduous teeth do horses have?

Answer 1

24

Question 2

How many permanent teeth do horses have?

Answer 2

40 or 42

Question 3

Is the maxilla or the mandible wider?

Answer 3

maxilla

Question 4

What are some dental diseases that horses get?

Answer 4

Eruption disorders, oral trauma, dental decay, peridontal disease, dentigerous cyst (ear tooth), malalignment

Question 5

What is monkey mouth?

Answer 5

prognathism, underbite

Question 6

What is parrot mouth?

Answer 6

brachygnathism, over bite

Question 7

What is dysphagia?

Answer 7

difficulty or inability to swallow

Question 8

What are the classifications of dysphagia?

Answer 8

Prepharyngeal, pharyngeal, and postpharyngeal

Question 9

What are the clinical sings of prepharyngeal dysphagia?

Answer 9

Dropping food, hypersalivation, and prehension difficulty

Question 10

What are the clinical signs of pharyngeal dysphagia?

Answer 10

coughing, nasal discharge, gagging, and neck extension

Question 11

What are the clinical signs of postpharyngeal dysphagia?

Answer 11

same signs as pharyngeal

Question 12

How is dysphagia diagnosed?

Answer 12

Based on clinical signs, endoscopy, radiography, and ultrasonography

Question 13

What are the differential diagnoses for dysphagia?

Answer 13

There are a lot, we are going to go general here: pain, muscular, obstructive, and neurologic

Question 14

How is dysphagia treated?

Answer 14

resolve underlying disorder, dietary modifications, and esophagostomy tubes

Question 15

What disease processes can affect the oral cavity?

Answer 15

foregin bodies, neoplasia, salivary gland conditions, infectious disease, congenital/developmental disorders, and salivation

Question 16

What agent can cause excessive salivation?

Answer 16

Slaframine toxicosis (red clover)

Question 17

What disease processes can affect the esophagus in horses?

Answer 17

Esophageal obstruction, esophagitis, motility disorders, stricture, diverticula, congenital, and perforation

Question 18

What is the most common cause of esophageal obstruction?

Answer 18

Primary impaction

Question 19

What can cause primary esophageal impaction?

Answer 19

roughage, bedding, grain, apples, and beet pulp

Question 20

What is esophageal obstruction associated with?

Answer 20

poor dentition, wolfing, or gulping food

Question 21

Is esophageal obstruction an emergency?

Answer 21

yes

Question 22

Where are the common locations that esophageal obstruction occurs?

Answer 22

cervical, thoracic inlet, heart base, and caudal thorax

Question 23

How is esophageal obstruction treated?

Answer 23

Relieve obstruction - heavy sedation, pass nasograstric tube, lavage with water, and protect the airway

Question 24

If you cannot resolve esophageal obstruction, what is the treatment?

Answer 24

Wait and try again later - general anesthesia, muzzle, oxytocin, and maintain hydration

Question 25

What is the treatment for post esophageal obstruction?

Answer 25

Endoscopy, radiographs, systemic antimicrobials, sucralfate, NSAIDs, diet modifications, dental exam

Question 26

Where does esophageal perforation occur?

Answer 26

in the cervical region

Question 27

What can cause esophageal perforation?

Answer 27

external trauma, impaction necrosis, diverticulum rupture, or iatrogenic with an NG tube

Question 28

How is esophageal perforation diagnosed?

Answer 28

cellulitis, tissue necrosis, and endotoxemia

Question 29

How is esophageal perforation treated?

Answer 29

Debridement, supportive care, esophagostomy tube

Question 30

What is the prognosis for esophageal perforation?

Answer 30

poor

Question 31

What is the prevalence of Equine Gastric Ulcer Syndrome (EGUS) in foals? Adults?

Answer 31

25-50% in foals, 60-90% in adults

Question 32

What separates the non-glandular from the glandular part of the equine stomach?

Answer 32

the margo plicatus

Question 33

Where are gastric ulcers most commonly found in horses?

Answer 33

in the non-glandular region adjacent to the margo plicatus - NSAID ulcers may be in the glandular region

Question 34

What might lead to foal gastric ulcers?

Answer 34

They may have duodenal ulcers which leat do gastric ulcers from delayed gastric emptying

Question 35

What can cause stomach ulcers on a physiologic level?

Answer 35

Horses continuously secrete HCl - the result from a disequilibrium between aggressive factors and protective mechanisms

Question 36

What are squamous ulcers likely related to?

Answer 36

increased acid exposure

Question 37

What are glandular ulcers likely related to?

Answer 37

disruption in blood flow and prostaglandins

Question 38

If stomach ulcers are due to fasting, what can be done to mitigate this?

Answer 38

Provide high roughage diets - alfalfa may decrease acidity

Question 39

Why do performance horses have a higher incidence of gastric ulcers?

Answer 39

There is a lot of abdominal pressure which allows for splashing of the HCl around in the abdomen. Their high carbohydrate diets also produce a lot of volatile fatty acids which could lead to ulcers

Question 40

What clinical signs are associated with gastric ulcers?

Answer 40

Poor appetite, not wanting to eat grain, weight loss, attitude changes, dullness, decreased performance, and low grade colic

Question 41

How are gastric ulcers diagnosed?

Answer 41

Gastroscopy

Question 42

What is a grade 0 ulcer?

Answer 42

Stomach lining is intact, and there is no appearance of reddening

Question 43

What is a grade 1 ulcer?

Answer 43

Stomach lining is intact, but there are areas of reddening

Question 44

What is a grade 2 ulcer?

Answer 44

Stomach has small single or multiple ulcers

Question 45

What is a grade 3 ulcer?

Answer 45

Stomach has large single or multiple ulcers

Question 46

What is a grade 4 ulcer?

Answer 46

Stomach has extensive ulcers; often merge to give areas of deep ulceration

Question 47

What is the treatment for stomach ulcers?

Answer 47

Alfalfa hay, gastric acid secretion (H2 antagonists, or omeprazole), and adherence to ulcers

Question 48

How are stomach ulcers prevented?

Answer 48

Management changes, alfalfa hay, and Ulcergard

Question 49

Aside from gastric ulcers, what other disease processes can affect the equine stomach?

Answer 49

Pyloric stenosis and delayed gastric emptying, gastric dilation and rupture, gastric impaction, gastritis, and neoplasia (SCC)

Question 50

What causes endotoxemia?

Answer 50

presence of endotoxin in the bloodstream

Question 51

What disease processes can endotoxemia result in?

Answer 51

Systemic inflammatory response syndrome (SIRS), sepsis, septic shock, and multiorgan dysfunction syndrome

Question 52

__________ equals endotoxin.

Answer 52

Lipopolysaccharide

Question 53

When gram-negative bacteria die, what to they release into the systemic circulation?

Answer 53

large aggregates of lipopolysaccharide

Question 54

What are the three components of the LPS?

Answer 54

O-region (in extracellular environment), lipid A region (in outer bacterial membrane), and core polysaccharide region (holds O and A together)

Question 55

What infections can cause endotoxemia?

Answer 55

any gram negative bacteria

Question 56

What is the pathogenesis of endotoxemia?

Answer 56

LPS binds to macrophages. The macrophages then activate and produce multiple cytokines (TNF, IL1, IL6, and IL8). The activation of these cytokines causes activation and propagation of inlammation (neutrophil activation). The coagulation cascade is activated and the immune system is activated.

Question 57

What happens when the coagulation cascade is activated?

Answer 57

it causes hemostatic disorders such as DIC

Question 58

What happens when endotoxin activates the immune system?

Answer 58

It causes release of anaphylatoxins resulting in vasodilation and increased vascular permeability

Question 59

What are the clinical signs of endotoxemia?

Answer 59

Depression, weak arterial pulses, prolonged CRT, congested mucus membranes, tachycardia, fever, thrombosis or bleeding, renal failure, laminitis, respiratory distress and colic

Question 60

What clinical pathology abnormalities are associated with endotoxemia?

Answer 60

Neutropenia, hyperglycemia/hypoglycemia, and changes reflective of primary disease

Question 61

How is endotoxemia treated?

Answer 61

Supportive care, NSAIDs to counteract the effects of endotoxin, hyperimmunized plasma, polymyxin B, DMSO, Pentoxifylline, and heparin

Question 62

What NSAIDs can you use to treat endotoxemia?

Answer 62

Flunixin Meglumine, Phenylbutazone, and ketoprofen

Question 63

What is the prognosis for endotoxemia?

Answer 63

Guarded - early aggressive treatment can improve the outcome