weightloss diagnosis

Question 1

what is seen with serum proteins in cases of equine weight loss?
total protein?
albumin?
globilin?

Answer 1

◦ Total protein
‣ Decreases may be masked by concurrent hypovolaemia
‣ Hyperproteinaemia usually due to hyperglobulinaemia
◦ Hypoalbuminaemia
‣ Gl loss far more common than renal
‣ Effusions - peritoneal/pleural
‣ Liver disease - rarely a cause
◦ Hypoglobulinaemia
‣ GI loss
◦ Hyperglobulinaemia
‣ (Chronic) inflammatory disease (including cyathostominosis
‣ neoplasia

Question 2

what is seen on bloodwork of cases of weightloss?
WBC?
RCBS?
protien?
acute phase proteins?
liver values?

Answer 2

• White blood cells: leukopenia/cytosis
  ◦ mild elevation can be seen in cases of parasitism or inflammatory bowel disease
• Anaemia (RBC and HB)
• Protein concentration: hypoalbuminemia, hyperglobulinemia
• acute phase proteins: Fibrinogen, SAA, Globulins
  ◦ can be elevated in cases of parasitism or bacterial infection or some cases of neoplasia
• Liver values: SDH, GGT, AST, Bile acids
  ◦ Liver values can be mildly elevated in chronic cases in enteropathy
  ◦ moderate to marked elevations are consistent with a liver aetiology.

Question 3

what are the abnomal results of abdominocentesis in horses? what are the causes of theses?
colour?
protein?
lactate?
WBC?
glucose?

Answer 3

• Colour: Turbid, serosanguinous, green-dark
• Protein (refractometer): abnormal if >30g/L: Inflammation/infection
• Lactate: Abnormal if >2.5mmol/L
  ◦ intestinal ischemia= >double systemic
  ◦ bacteria production
• WBC: Abnormal if >5000cells/ul; likely infection if >10 000cells/ul
  ◦ >90% neutrophils
  ◦ Features of degeneration
  ◦ Intra and extracell bacteria
• Abdominal glucose>2.8mmol/L blood glucose
  ◦ bacterial production

Question 4

what are the diagnosic tests for weight loss in horses?

Answer 4

• blood work
• ultrasound
• rectal exam
• abdominocentesis
• oral glucose absorption test
• intestinal biopsies
• faecal analysis
• faecal culture and PCR
• sedementation test for sand enteropathy

Question 5

what is an abnormal thickness of the SI and LI on ultrasound in horses?

Answer 5

• SI wall thickness: inguinal area, cranioventral abdomen, next to R-Kidney
  ◦ Abnormal >4mm
• LI wall thickness: right dorsal colon (11-13th ICS), left ventral abdomen
  ◦ Abnormal >6mm

Question 6

what are the result ranges for the oral glucose absoption test?

Answer 6

Question 7

what are the differernt intestinal biopies that can be taken and what do they typically diagnose?

Answer 7

◦ Rectal: 50% of Granulomatous enteritis and Multisystemia Eosinophilic Epitheliotrophic Disease (confirmatory diagnosis is made in 50%of cases)
‣ little diagnostic value on lymphocytic-plasmacytic and eosinophilic
◦ Duodenal: 20% cases: Lymphocytic-plasmacytic and eosinophilic
◦ Full-thickness: Eosinophilic enteritis, Lymphoma and Grass sickness (ileum)
‣ Full thickness biopsies will be the gold standard, but those can only be performed by laparoscopy or laparotomy under general anaesthesia. can be done during colic surgery and used to confirm other diseases eg grass sickness

Question 8

what clinical signs, albumin, bloodwork, Glu Abs test and biopsy are seen/used to diagnosis, granulomatous enteritis?

Answer 8

clin signs: weightloss, anorexia, skin lesions on coronet (+/-)
albumin: low
blood work: anaemia
Glu aBs test: abnormal
biopsies: good correlation with rectal

Question 9

what clinical signs, albumin, bloodwork, Glu Abs test and biopsy are seen/used to diagnosis, lymphocytic enterocolitis?

Answer 9

clin signs: weightloss,
albumin: +/- low
blood work: normal
Glu aBs test: abnormal
biopsies: unreliable

Question 10

what clinical signs, albumin, bloodwork, Glu Abs test and biopsy are seen/used to diagnosis, focal eosinophilic enteritis?

Answer 10

clin signs: colic, weightloss rare
albumin: normal
blood work: normal
Glu aBs test: +/-
biopsies: focal full thickness: no rectal

Question 11

what clinical signs, albumin, bloodwork, Glu Abs test and biopsy are seen/used to diagnosis, Multisystemic eosinophilic epitheliotropic disease (MEED)?

Answer 11

clin signs: weightloss, skin lessions, liver disease
albumin: normal initially, low in advanced cases
blood work: normal (+/- eosinophilia) anaemia, high GGT)
Glu aBs test: normal (LI)
biopsies: 50% with rectal

Question 12

what clinical signs, albumin, bloodwork, Glu Abs test and biopsy are seen/used to diagnosis, intestinal lymphoma?

Answer 12

clin signs: weightloss, mild colic, diarrhoea
albumin: low
blood work: anaemia
Glu aBs test: generally abnormal
biopsies: full thickness rectal or duodenal if diffuse

Question 13

what are the issues with feacal analysis for weight loss diagnosis?

Answer 13

• Adult produce eggs, larvae cause the clinical signs and pathology
• Encysted forms: do not produce eggs!
• negative result in an acute clinical case does not rule out parasites
• Ultrasound might help to determine Ascarids burden in weaning, yearling horses

Question 14

what is the testing for sand enteropathy?

Answer 14

• sedimentation test> low sensitivity, false negatives
• Radiography and ultrasound
• abdominal radiography is the gold standard to diagnose this problem,
  the faecal sedimentation test is an easy and cheap way, or at least having an idea of whether this horse is consuming sand