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Digestive Sys Exam 3 > Week 11: Horses (Mudge) > Flashcards

Week 11: Horses (Mudge) Flashcards

1
Q

Colitis & Enteritis in Horses

A

Colitis & Enteritis in Horses

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2
Q
  • Rapid onset of diarrhea
  • Usually High-volume
    Etiology
    • Infectious
    • Non-infectious
A

Acute Colitis

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3
Q

List the Infectious causes of Acute Colitis:

A

Bacterial
- Salmonella
- Clostridium perfringens
- Clostridium difficile
- Neorickettsia risticii
Viral
- Coronavirus
Parasitic
- Cyathostomiasis
- Strongylosis

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4
Q
  • May be associated with stress of transportation, feed changes, antibiotics
  • Contagious and zoonotic potential
    • Fecal cultures (5) or PCR!
  • Can have active shedding without diarrhea
  • Affected horses often have low WBC, signs of endotoxemia
  • Always on our list of differentials
A

Salmonella

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5
Q

(T/F) Horses are very sensitive to small amounts of gram-negative endotoxin

A

True

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6
Q

Systemic Inflammatory Response Syndrome
- Fever
- Tachycardia
- Tachypnea
- Low or high WBC (or left shift/toxic changes)

A

Endotoxemia

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7
Q
  • Type C and A
  • Severe, peracute cases in adult horses have been called “Colitis X”
    • Salmonella would be the other top differential
  • More common in neonatal foals
  • Acute, often hemorrhagic, enterocolitis - may be typhlocolitis (involves the cecum)
A

Clostridium perfringens

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8
Q
  • May be antibiotic-associated (common in humans)
  • Enterotoxin (A) and Cytotoxin (B) act synergistically
    - Leading to mucosal damage
  • May be isolated in hospitalized horses
A

Clostridium difficile

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9
Q
  • Infects intestinal epithelial cells (SI and LI)
  • Horses are infected via primary or secondary intermediate hosts
  • Peak incidence June-September
  • Dull, anorexic, variable diarrhea
  • Fever
  • Initial leukopenia +/- monocytosis
  • Serology (IFA) and PCR of whole blood or feces
A

Potomac Horse Fever (Neorickettsia risticii)

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10
Q
  • Small intestine – sloughing of enterocytes, inflammation
  • Diarrhea in only 20% of reported cases
    • Anorexia, fever, lethargy = most common
    • Encephalopathy possible
  • PCR of feces
A

Equine Coronavirus
- Main viral diarrhea cause

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11
Q
  • Large Strongyles
    • Well-controlled by macrocyclic lactones (e.g. ivermectin)
  • Small Strongyles - Cyathosomes
    • Late winter-spring -> emergence from hypobiotic state
    • Encysted cyathostomes often associated with weight loss, chronic diarrhea
A

Gastrointestinal Parasites

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12
Q

List the Non-Infectious causes of Acute Colitis

A
  • Carbohydrate overload
    • Accidental or Intentional
    • Acidification of the large intestine
    • Intestinal inflammation, death of normal GI flora, endotoxemia
  • Cantharidin
    • Blister beetles in alfalfa hay
    • Oral ulcerations, colic, hypocalcemia, diarrhea
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13
Q

List Colitis Complications:

A
  • Laminitis
    • 40% of PHF cases
  • Jugular thrombosis
  • Intestinal ischemia/infarction
  • Septicemia
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14
Q

What may you need to treat hypoproteinemia?

A

Colloids

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15
Q

List some Anti-inflammatories for the treatment of Colitis:

A
  • Flunixin meglumine for systemic inflammation
  • Bismuth subsalicylate to control GI inflammation
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16
Q

Treatment of Colitis - Antibiotics:
- ABs indicated with severe neutropenia

A

Salmonella
- Enrofloxacin
- Gentamicin

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17
Q

Treatment of Colitis - Antibiotic:
Clostridium perfringens

A

Metronidazole (10-15 mg/kg PO q8h)

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18
Q

Treatment of Colitis - Antibiotic:
Clostridium difficile

A
  • Stop ABs if you suspect antibiotic-induced colitis
  • Metronidazole (some resistance)
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19
Q

Treatment of Colitis - Antibiotic:
Potomac Horse Fever

A

Oxytetracycline (6.6 mg/kg IV q12h)

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20
Q

Treatment of Colitis:
- Polymyxin B (IV)
- Bind endotoxin
- Antiserum (e.g. salmonella typhimurium)
- Di-tri-octahedral smectite (PO)
- Binds clostridial toxins

A

Anti-toxin treatments

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21
Q
  • Hypersecretion from small intestine
  • Functional ileus 2 to inflammation
  • Leakage of protein
  • AKA Proximal Duodenitis-Jejunitis
A

Anterior Enteritis

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22
Q

List the Clinical Signs of Anterior Enteritis:

A
  • Colic
    • Mild to severe
    • Often improves after refluxing
  • Nasogastric reflux
    • Large volumes (often >60L/day)
  • Fever
  • Leukopenia /Leukocytosis
  • Hemoconcentration
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23
Q

(T/F) Ultrasound is very useful for diagnosing anterior enteritis

A

True

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24
Q

Anterior enteritis vs SI Strangulation
- Continued, severe pain
- Serosanguinous abdominal fluid with high lactate

A

SI Strangulation

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25
Q

Anterior enteritis vs SI Strangulation
- Less pain after refluxing
- Normal to orange/hazy abdominal fluid

A

Anterior Enteritis

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26
Q

List the Treatment for Anterior Enteritis:

A
  • Gastric Decompression
  • Intravenous Fluids
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27
Q

List the reasons you would Refer colitis and enteritis:

A
  • Hypovolemic shock
    • need very large volumes of IV fluids
  • Unable to control pain
  • Continued nasogastric reflux
  • Need to isolate
  • Faster test results
  • Unresponsive to treatment
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28
Q
  • Wide range of severity and symptoms
  • Weight loss frequently reported
  • Hypoproteinemia
  • Etiologies
    • Infectious
    • Inflammatory/IBD
    • NSAID toxicity
    • Sand
    • Idiopathic
A

Chronic Diarrhea in the Adult Horse

29
Q

List the Infectious etiologies for Chronic Diarrhea in the Adult Horse:

A
  • Salmonella
  • Lawsonia intracellularis aka “Proliferative enteropathy”
  • Rhodococcus equi
  • Peritonitis
30
Q

(T/F) Chronic Parasitism (Cyathostomes) can cause Chronic Diarrhea in the Adult Horse

A

True
- Small strongyles – most common parasite of horses
- Encyst in winter (LI), emerge in spring
- Damage to intestinal mucosa
- Colic, diarrhea, low albumin

31
Q
  • Malabsorption & Malgigestion
  • Most often small intestinal inflammatory bowel disease
  • Hypoalbuminemia
  • Dependent edema
  • Weight loss
  • Diarrhea (not always)
A

Inflammatory Bowel disease / Protein Losing Enteropathy

32
Q
  • Idiopathic Granulomatous enteritis
  • Multisystemic Eosinophilic epitheliotrophic disease (MEED)
  • Lymphocytic-Plasmacytic Enterocolitis
  • Lymphosarcoma
A

Inflammatory Bowel Disease

33
Q

Other etiologies:
Right Dorsal Colitis seems to be linked with …

A

NSAID toxicity

34
Q
  • Colic, ventral edema, low-volume diarrhea
  • Excessive phenylbutazone administration
  • Decreased prostaglandin production -> decreased blood flow, decreased mucous and bicarbonate secretion -> ulceration RDC
A

Right Dorsal Colitis

35
Q

Chronic Diarrhea in the Adult Horse
List Anthelmintics used:

A
  • Fenbendazole
  • Moxidectin
36
Q

Diarrhea in Neonatal and Older Foals

A

Diarrhea in Neonatal and Older Foals

37
Q

List the common causes of diarrhea in neonatal foals and older foals:

A

Non-Infectious Neonatal diarrhea
- “Foal heat” diarrhea
- 5-15 days
- changes in GI flora
- Usually still bright and nursing
- Self-limiting
- Perinatal asphyxia
- May lead to intestinal ischemia, maldigestion, ileus
- Necrotizing enterocolitis
- Lactose intolerance
- May be primary
- Most commonly 2 to rotavirus or C difficile
Infectious Causes - Bacterial
- C. perfringens
- Type C associated with severe hemorrhagic diarrhea
- C. difficile
- May be asymptomatic carriers
- Salmonella
- Often have neutropenia with a left shift
- 5 serial fecal cultures
- Fecal PCR
- Actinobacillus
- Blood culture positive
Infectious Causes - Viral
- Rotavirus**
- Highly contagious
- Coronavirus ?
- Adenovirus ?
Infectious Causes - Parasitic and Protozoal (uncommon)
- Parasitic
- Strongyoides westeri **
- Protozoal
- Cryptosporidium patvum
- Zoonotic

38
Q

Describe the steps in a diagnostic workup for a foal with diarrhea:

A
  • Physical exam
  • CBC
  • Chem profile
  • IgG
  • Blood Culture
  • Ultrasound
  • Radiographs
  • +/- Abdominocentesis
  • Collect feces
  • Real-time PCR screening in healthy and sick foals 1-20 weeks of age

Infectious Causes - Bacterial
- Culture
- PCR
- Toxin assays
- Fecal smear gram stain
- Suspect in sick foals with Hemorrhagic diarrhea

39
Q

Create a treatment plan for a foal with diarrhea, including adjunctive and supportive treatment:

A
  • Supportive care
  • Specific therapies
    - Broad-spectrum parental antibiotics for bacteremia
    - Metronidazole for Clostridial spp
  • Withhold milk/provide parental nutrition
  • Lactase tablets
  • Di-tri-octahedral smectite
  • NO probiotics
40
Q

(T/F) E. coli is not a direct GI pathogen in foals, but diarrhea can occur in septic foals

A

True

41
Q

(T/F) Older foals with diarrhea are less likely to become septic

A

True

42
Q

(T/F) ALL horses can be affected by Salmonella spp and Clostridium spp

A

True

43
Q

Rhodococcus equi (lung) & Lawsonia intracellularis are …

A

specific weanling-age diarrhea

44
Q
  • Ages 1-6 months
  • Respiratory signs are the most common
  • Can cause abdominal abscesses
  • Multiple foals are often affected
A

Rhodococcus equi
Treatment: Clarithromycin + Rifampin

45
Q
  • Most common at 4-7 months
  • Clinical Signs
    • Weight loss
    • Diarrhea
    • Edema
  • Severe hypoalbuminemia
  • Ultrasound: THICK small intestine
  • Serology and Fecal PCR
A

Lawsonia intracellularis
Treatment: Oxytetracycline, Doxycyclin, Chloramphenicol, clarithromycin also options

46
Q

Peritonitis

A

Peritonitis

47
Q

Definition:
Is the mesothelial lining of the peritoneal cavity (parietal peritoneum) and the viscera (visceral peritoneum)

A

Peritoneum

48
Q

Definition:
Is innervated by branches of spinal nerves

A

Parietal peritoneum

49
Q

Definition:
Has no pain receptors

A

Visceral peritoneum

50
Q

What is removing fluid and solutes from the peritoneal cavity?

A

Lymphatics
- Especially diaphragmatic lymphatics

51
Q

What contains macrophages, mast cells, mesothelial cells, and lymphocytes which contribute to the immune response?

A

Peritoneum

52
Q

Is defined as infection of the peritoneal cavity with no identifiable intraperitoneal source of infection (possible hematogenous or lymphatic origin)

A

Primary peritonitis
- Not common
- Most often Monomicrobial, such as infection with Actinobacillus equuli in horses

53
Q

Is defined as infection from an underlying primary disease or injury

A

Secondary peritonitis
- Leakage of gastrointestinal contents
- Urogenital infection with leakage
- Abdominal trauma
- Abdominal abscess
- Iatrogenic

54
Q

What is the most common source of peritonitis in horses and dogs?

A

Secondary peritonitis of gastrointestinal origin

55
Q

What bacterium is most commonly associated with primary peritonitis in adult horses?

A

Actinobacillus equii

56
Q

(T/F) Non-septic peritonitis can occur when there is chemical irritation from urine, lavage solutions, or talc powder from gloves

A

True

57
Q

Fill in the blanks:
Animals with ______________ and ___________ often have a longer history of poor appetite, lethargy, and fever

A

primary peritonitis, abdominal abscess

58
Q

How can you differentiate between GI rupture and enterocentesis?

A
  • Both will have plant material and mixed bacterial populations, but cytology will show an inflammatory response, usually with intracellular bacterial and degenerate neutrophils with rupture. Also, ruptured animals will usually have a large amount of peritoneal fluid seen on ultrasound and will have signs of septic shock
  • GI rupture cytology will show mixed bacterial population, plant debris, degenerate neutrophils
  • Enterocentesis will have plant material and microorganisms, but NO inflammatory response
59
Q

How do a cell count, total protein, lactate, and glucose change in peritoneal fluid with septic
peritonitis cases?

A
  • Total Proteins: Increased
  • Lactate: Increased
  • Glucose: Decreased (relative to blood lactate & glucose)
  • Cell count: Increased (usually > 10,000 & often > 100,000/ul)
60
Q
  • Is very sensitive for the detection of free peritoneal fluid
  • Other findings:
    • Thickened intestinal wall
    • Ileus
    • Abdominal abscess
A

Abdominal Ultrasound

61
Q

What is your initial empirical antibiotic therapy in a dog with acute septic peritonitis? In a
horse?

A
  • Dogs: Unasyn (ampicillin/sulbactam) or ampicillin/enrofloxacin +/- metronidazole
  • Horses: Penicillin, Gentamicin (or enrofloxacin) +/- metronidazole

Main idea is to use to use broad-spectrum antibiotics initially, and include something that will target anaerobes if you suspect GI leakage

62
Q

When is surgical exploration indicated for peritonitis?

A

Toxic/degenerate neutrophils, intracellular bacteria, especially if polymicrobial; suspicion of GI leakage (or uterine leakage, or intraabdominal abscess) based on cytology or imaging (ultrasound, CT)

63
Q

Peritoneal Inflammation:
(T/F) Pain arises from afferent nerve endings in parietal peritoneum

A

True

64
Q
  • Usually polymicrobial
    • E. coli is common
  • Sources
    • GI (50%)
    • Urogenital
    • Abdominal abcess
    • Bile
    • Iatrogenic
A

Secondary Peritonitis – Most common source of peritonitis

65
Q

Definition:
Relating to illness caused by medical examination or treatment

A

Iatrogenic

66
Q

Definition:
A former name for a surgical procedure in which a hollow needle is pushed through the wall of the stomach or intestines to release an abnormal accumulation of gas or fluid or to introduce a catheter for feeding

A

Enterocentesis

67
Q

What is Serum Amyloid A (SAA)?

A

Is an acute-phase protein that will increase rapidly in response to inflammation or infection
- It should also decrease quickly (in days) as the infection or inflammation resolves
- This test helps to have a baseline to determine if the antibiotic treatment is effective

68
Q
  • tachycardia
  • fever
  • hypovolemia
  • bacterial peritonitis
A

Evidence of sepsis

Digestive Sys Exam 3 (7 decks)

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