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97 Cards in this Set
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Liver and Urinary tract disease in the horse (LIZ)
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Lecture 1
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List some of the common liver diseases in the horse
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- PA (pyrrolizidine alkaloids) toxicosis
- Theiler's disease - Colangiohepatitis - Hepatic lipidosis - Abscess - Flukes - Acarid migration - Tyzzer's disease - Cholelithiasis - Neoplasia - Hepatomegaly (associated with Rt CHF) |
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How does hepatic disease manifest in the horse?
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- Icterus
- Weight loss - Diarrhoea - Ascites - Change in faecal colour - Haemorrhage - Derm signs (dermatitis, pruritis) - Inspiratory stertor and dyspnea Subtle neuro signs - Behaviour alterations - Inappetence - Yawning - Resp stertor Obvious neruo signs - Depression - Head pressing - Aimless wandering - Blindness - Resp stertor - Hepatic coma |
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Briefly describe the pathogenesis of hepatic encephalopathy
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Toxins that would normally be processed by the liver bypass it
Ammonia increases in the blood Glutamine increases in the brain (which is toxic) Glutamine acts synergistically with GABA and you get false neurotransmitters (serotonin) |
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What are some of the tests that are used to help diagnose liver disease?
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Indicators of stasis/injury
- GGT - ALP - AST - GLDH - SDH Indicators of function - TBA - Blood ammonia levels - Albumin - Globulins - Glucose - PTT US (located RHS 8th-14th intercostal, below and caudal to lung). Look at: - Size - Shape - Parenchymal architecture |
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What are the 3 main causes of toxicosis?
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- PA
- Mycotoxins - Sporodesmin |
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What is PA toxicosis? What plants causes it?
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- Toxic alkaloids build up from ingesting plants
- Toxic dose in dried plants is 5% of BW - Has a cumulative effect (months to years) Plants - Fire weed (senecio madagascariensis) - Patterson's curse (echium plantagineum) - Heliotrope (heliotropium amplexicaule) - Darling Peas (swainsona) |
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What bicohem results do you see with PA toxicosis?
What histology do you see? |
Biochem results
- Increase GGT - Increase ALP - Increase/Decrease GLDH Histology - Megalocytes - Centrilobular necrosis - Necrosis of portal areas - Fibrosis |
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What is the prognosis for PA toxicosis?
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Mild liver injury
- Good - Reversible, as long as no more exposure - Appetant is a good sign Liver failure - Chronic end stage disease with fibrosis - Acute |
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What is theiler's disease?
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- Seen in mares that have recently given birth and are now lactating
- It is an idiopathic acute hepatic disease - Associated with type 3 hypersensitivity - Usually a reaction to tetanus antitoxin or equine plasma |
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What clinical signs are associated with theiler's disease?
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- Fever
- SC oedema - Jugular pulses - Acute resp distress - Ileus - IV haemolysis |
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What will you see on biochem with theiler's disease?
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- Increased GGT
- Increased ALP - Increased GLDH |
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What causes liver disease in foals?
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Bacterial
- Lepto - Actinobacillus equii - Tyzzer's disease - Sepsis Viral - EHV1 Other - NI - Hyperlipaemia - Parasitism - Congenital |
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What is cholangiohepatitis?
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- It's an ascending infection from the SI
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What are the clinical signs associated with cholangiohepatitis?
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- Fever
- Weight loss - Depression - Dermatitis |
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What are the biochem results of cholangiohepatitis
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Increased
- GGT - ALP - GLDH |
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What is hyperlipaemia?
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Commonly seen in
- Mini horse - Shetland ponies - Mini donkeys - Starts with a negative energy balance (energy output exceeds energy intake... they are starving) - You get an increase in triglycerides in the blood - Triglycerides then accumulate in the liver - This leads to hepatic lipidosis |
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What clinical signs are associated with hyperlipaemia?
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- Depression
- Anorexia - Neuro signs - Diarrhoea - Hepatic insufficiency |
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What lab results are associated with hyperlipaemia?
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Increased
- TG - GGT - ALP - GLDH - TBA Decreased - PH Azotaemia |
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How do you treat hyperlipaemia?
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- Enteral/parenteral nutrition
- Glucose IV/PO - Heparin - Insulin |
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How do you treat liver disease generally?
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- Remove cause (PA, remove from pasture. Hepatic lipidosis, address the neg energy balance. Remove toxic drugs)
- Antimicrobials - Control abnormal behaviour (sedate) - Nutritional support (branched chain AAs, vit B, enterel/parenteral) |
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What are common UT diseases in the horse?
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- Renal failure
- Urolithiasis - Cystitis/Pyelonephritis - Urinary incontinence - Haematuria/pigmenturia - Bladder rupture - Renal tubular acidosis - Neoplasia |
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What are some common clinical signs and lab results of renal disease?
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Clinical signs
- PU/PD - Oliguria/Anuria - Haematuria/Pigmenturia - Weight loss Lab results - Azotaemia - Energy imbalances - Isosthenuria - Proteinuria, protein casts, pyuria USG = 1.008 - 1.020 |
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What are some common clinical signs of distal urinary disease?
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- Pollakiuria
- Incontinence - Discomfort/colic - Haematuria - Pyuria - Proteinuria |
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How do you diagnose urinary tract diseases?
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- Haematology
- Biochem - Urinalysis - Fractional excretion of electrolytes - Urinary GGT: urinary creatinine ratio - Cystoscopy - Rectal exam - Renal US (via rectum and via abdomen) - Renal biopsy |
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What are some common causes of acute renal failure?
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- Aminoglycosides
- NSAIDs - Pigment nephropathy (when there is severe haemolysis and the cells of the kidney become packed with haemoglobin leading to kidney failure) - Vitamin D/K3 toxicity - Vasomotor nephropathy (leads to dehydration and hypovolaemia) Sepsis, diarrhoea and haemorrhage --> all lead to decreased renal blood flow Obstructive --> urolithiasis, neoplasia |
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What is chronic renal failure?
What are some common clinical signs? What are common lab results? |
- Proliferative glomerulonephritis
- Interstitial nephritis Common clinical signs - Weight loss - PU/PD Common lab results - Azotaemia - Decreased Na, Cl and PO4- (phosphorus) - Increased K and Ca |
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How do you treat renal failure?
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Acute
- Increase GFR Chronic - Increase GFR - Furosemide - Mannitol IV Fluid therapy!!!!!!!!!! |
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What are some of the causes of UTIs?
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Cystitis
- Neurogenic causes - Bladder injury (e.g. calculi) Pyelonephritis |
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How do you treat UTIs?
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- Treat primary disease
- Maintain urine outflow - Antimicrobials (penicillin, TMS) |
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What are the different forms of urolithiasis?
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- Nephrolithiasis (kidney)
- Ureterolithiasis (ureter) - Cystic calculi (bladder) - Urethral calculi (urethra) |
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Discuss cystic calculi.
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- Common in males
Factors that contribute: - Urine (increased pH, nidus, increased crystalluria, mucoprotein and CaCO3) - Diet (increased mineral content) - Others (urine stasis, decreased water intake, bacterial infection) |
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How do you treat urolithiasis?
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- Surgical remove (via cystotomy, perineal urethrostomy, lithotripsy)
- Complications likely |
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What are some causes of urinary incontinence?
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- EHV1
- Cystitis - Sabulous (sandy/gritty) urolithiasis - Cauda equine syndrome - Sorghum ataxia cystitis syndrome - Ectopic ureter |
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How do you treat urinary incontinence?
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- Treat primary disease
- Manual bladder evacuation/catheterisation - Repeated flushing of bladder - Pharmacological therapy |
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Treatment of urinary neoplasia (bladder and renal)
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- Stabilise with NaCl and dextrose
- Surgical repair |
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Colic (TONY)
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Lecture 2 and 3
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Describe the behavioural signs that define colic.
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- Depression
- Anorexia - Looking at abdomen - Pawing - Frequent urination (especially in geldings) - Recumbency - Getting up and down (can't get comfortable) - Rolling |
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What kind of historical questions should you ask?
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- Change of diet recently (within last week)
- Duration and severity of colic - Has this happened before? - Have you treated it yet - Any other recent diseases or medications (if so, what are they) - Appetite? - Faecal output (quantity, quality, frequency) - Weight loss - Deworming (when and with what) - Dentistry |
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What should you focus on in your PE?
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- Signs of colic
- Abnormal abdominal contour - Vitals (TPR) - CV status (MM colour, CRT, skin turgor, pulse quality, palpate distal extremities) - GI sounds - Pings - Faecal consistency - Evidence of self trauma (particularly over bony prominences) - Sweating - Signs of non-GI disease |
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What diagnostics are best for colic?
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- Nasogastric tube
- Rectal palpation - Periotneal fluid sample |
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Describe the features of nasogastric tubing
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- Perform of every colic case
- Do it early (maybe even before PE) - Must release the pressure in stomach - If you get more than 1-2L reflux, keep the tube in there or regularly decompress - Can be both diagnostic and therapeutic - Do not administer ANYTHING via nasogastric tube if significant reflux is present |
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Describe the features of rectal exam
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- Not as necessary as nasogastric tube (don't do it if unsafe)
- Only use your longest digit in small horses/foals Look for - Distension of GIT - Abnormal positions - Taut taenial bands - Faeces (consistency and volume) - Assess non-GI tract (caudal border of spleen, caudal border of L kidney etc.) |
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Describe the features of peritoneal fluid examination.
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- Can use needle or teat cannula
- Done on most dependent part of abdomen (fluid is heavy, it will sit at the base of abdomen) --> on midline or just right of midline to avoid spleen - Examine colour and consistence - Difficult to assess volume (maybe use US to assess this) - Can send to lab for assessment of TP, total nucleated cell count and cytological exam |
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What are some other diagnostics you can perform on a horse demonstrating signs of colic.
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- PCV/TPP
- US - Rads (mainly useful for sand... can't rad entire abdomen or adult horse) - Endoscopy |
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When should you refer your colic case?
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- Severe pain
- Poor response to analgesia - Need for repeated analgesia - CV compromise - Significant gastric reflux - Abnormal rectal findings - Abnormal peritoneal fluid (evidence of peritonitis?) - Abdominal distension (along with all other signs) - Decreased or absent GI sounds (along with all other signs) |
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What analgesics should you use and what shouldn't you use?
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Dos
- Alpha 2 agonsts (xylazine, detomidine, romifidine) - Opioids (butorphanol, morphine, pethidine) - NSAIDs (flunixin, ketoprofen) - Buscopan Compositum Solution (for spasmodic colic) Don'ts - Phenylbutazone (good for muscular, not great with GIT) - Acepromazine (not an analgesic) - Repeated administration of drugs that compromise GIT motility in horses with low or absent GIT sounds - Repeated administration of really potent analgesics (like flunixin) |
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What laxatives can you use in the horse?
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- Paraffin oil (can also be diagnostics - when you see it come out the butt, you know that the GIT is at least partially patent)
- Magnesium sulphate (is osmotic, draws water into GIT and flushes crap out) - Dioctyl sodium sulfosuccinate (DSS, coloxyl) --> not used much anymore, irritates the GIT so more movement occurs and water is drawn in due to inflammation - Enemas (not used in adult horses, can be useful in foals... flush water into the anus) |
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What other medical therapy can be used for colic?
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- Oral/IV fluid therapy (horses are usually dehydrated)
- Anthelmintics (parasites can be a cause of colic) - GIT rest!!!!! really important, colic horses should NOT be eating whether they are hungry or not - Prokinetics (increase gut motility... do not really have a role) |
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What are some of the major medical causes of colic?
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- Spasmodic colic
- Flatulent/Gas colic - LI impaction - Meconium impaction in foals - Gastric dilation/impaction - Gastroduodenal impaction - Peritonitis - Duodenitis/proximal jejunitis - Colitis, typhlocolitis, enteritis - Sand colic - Non GIT causes |
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Discuss spasmodic colic.
What is it? What causes it? What are the clinical signs? How do you treat it? |
- Spasm of GIT (excessive movement)
Causes - Stress - Transport - Changes in diet - Environment - Parasitism - Deworming Clinical signs - Mild-moderate colic - Increased GIT sounds Treatment - Analgesics - Correct primary problem |
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Discuss Flatulent colic.
What is it? Causes? Clinical signs? Treatment? |
- Colic due to gas build up in GIT
Causes - Primary cause - Secondary cause (due to impaction) Clinical signs - Moderate-severe colic - Variable GIT sounds - Distended abdomen - Pings - Maybe flatulence - Maybe CV compromise - Maybe gastric reflux - Gas distended GIT on rectal exam Treatment - Analgesics - Gastric decompression - Maybe caecal trocharization (put a needle in and release air) - Maybe surgery |
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Discuss LI impaction (think of as constipation).
Common areas for impaction? Causes? Clinical signs? Treatment? |
Common areas for impaction
- Pelvic flexure - Large colon - Caecum - Small colon Causes - Poor dentition - Very fibrous diet - Parasitism - Dehydration (water is taken from large colon to supplement CV system... harder to push stuff out) - Decreased access to water - Decreased exercise (exercise promotes gut motility, but also promotes gastric ulcers) Clinical signs - Mild-moderate colic - Decreased GIT sounds - Might be able to palpate impaction via rectal exam Treatment - Analgesics - Laxatives (LOTS) - Rehydrate - Withhold feed (impaction, don't want anything to build up and burst) - Maybe surgery for caecal and small colon impactions |
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Discuss gastric dilation/impaction.
Causes? Clinical signs? Treatment? |
Causes
- Primary due to dietary indiscretion - Secondary due to ileus or SI obstruction Clinical signs - Mild-severe colic - Variable GIT sounds - Maybe spontaneous gastric reflux Treatment - Analgesics - Gastric decompression!!!!!!!!!!! REALLY IMPORTANT - Gastric lavage (if blockage) |
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Discuss gastroduodenal ulcer.
Causes? Clinical signs? Diagnosis? Treatment? |
Causes
- Stress - Other diseases - NSAID - High concentrate diets - Infrequent feeding - Restricted access to pasture - Exercise Clinical signs - Mild-mod colic - Variable GIT sounds - Maybe colic after eating? Diagnosis - Can see the ulcer with gastroscopy Treatment - Remove stress - Change diet - Some anti-secretory drugs that may work (e.g. omeprazole, ranitidine) - Analgesics?? --> BUT NOT NSAIDs |
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Discuss peritonitis.
Causes? Clinical signs? Treatment? |
Causes
- Primary (e.g. actinobacillus) - Secondary (gastric perforation, penetrating wounds, abscessation, uterine rupture, infection of non GI viscera) Clinical signs - Mild-mod colic - Variable GIT sounds - Maybe CV compromise - Maybe fever - Maybe gastric reflux if ileus also present - Maybe abnormal rectal findings - DEFINITELY abnormal peritoneal fluid - Abnormal haematology - US (increased fluid in peritoneum) Treatment - Analgesics - Treat primary disease - Antimicrobial therapy - Fluid therapy - Anti-endotoxin therapy - Perioteneal lavage - Maybe surgery |
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Discuss duodenitis/proximal jejunitis.
What? Clinical signs? Diagnosis? Treatment? |
What
- Ileus caused by proximal SI inflammation Clinical signs - Mod-severe colic - Decreased GIT sounds - Large vol of gastric reflux - Maybe CV compromise - Colic signs decrease after gastric decompression Diagnosis - Clinical signs - Pain relief after gastric decompression - Mild SI distension felt via rectal exam Treatment - Analgesics - Fluid therapy - Gastric decompression regularly - Anti-endotoxin therapy - Prokinetics - Antimicrobial therapy if you suspect inflamm is due to bacterial infection |
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Discuss sand colic.
What is it? Clinical signs? Diagnosis? Treatment? |
What is it
- Sand is ingested and accumulates in large colon (usually right dorsal colon) - Sand irritates the mucosa - May cause physical obstruction Clinical signs - Mild-severe colic - Maybe diarrhoea/endotoxaemia - Maybe CV compromise - Maybe abnormal peritoneal fluid Diagnosis - History - Auscultate ventral abdomen - Faecal examination (you see sand) - Rads (you see sand) Treatment - Analgesics - Fluid therapy - Laxatives (psyllium mucilloid) - Husbandry changes (don't feed off sandy area) - Maybe surgery to remove the sand (difficult) |
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What are the non-GIT causes of colic?
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- Hepatic disease
- Pleuropneumonia - Parturition - Intra-abdominal haemorrhage - Urogenital disease - Laminitis - Oesophageal obstruction |
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When to refer a colic and surgical management of colic (MARTA)
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Lecture 4 and 5
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What are the advantages and disadvantages of referring a colic case?
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Advantages
- More indepth monitoring - Can monitor around the clock - Further diagnostics are easier - Fluid therapy - Surgery is possible - More experienced clinicians Disadvantages - Cost $$$ |
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Why is it important to determine strangulation vs non-strangulation and SI vs. LI?
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All strangulating lesions are surgical (strangulating means the blood supply to that segment of intestine is cut off)
SI lesions are more likely to be strangulating and more likely to be surgical If you suspect SI, refer early |
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How do you detect strangulating lesions?
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- Severe pain (multiple doses of analgesia required)
- Endotoxaemia - CV compromise (HR > 60, prolonged CRT, injected MM colour, abnormalities in lab data) - Reflux if SI lesion - Abdominocentesis = abnormal (colour is serosanguinous, TP > 30, TNCC variable) - Rectal exam (easily detectable abnormalities --> suss) |
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How do you detect non-strangulating lesions?
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- Varying levels of pain (but respond to analgesia)
- Minimal or no endotoxaemia/CV compromise - Reflux if SI - Abdominocentesis usually normal (unless peritonitis) - Rectal exam could be normal or abnormal |
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How do you transport a horse safely?
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- Analgesia
- Remove partitions - Do not tie - Do not take the horse's 'friend' - Do not stop (keep foot on accelerator) - No humans in float |
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What are some common lesions of the SI requiring surgery?
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Strangulating
- Volvulus - Lipoma - Rent in the mesentery - Epiploic foramen entrapment - Intussusception - Hernia Non-strangulating - Ileal impaction - Anterior enteritis - Intussusception - Adhesions |
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Discuss strangulating lipomas.
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- Horses over 15yrs
- Lipoma wraps around intestine, cuts off blood supply - Resection and anastomosis of affected intestine usually required - Lipomas are NOT seen on US - They vary in size |
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Discuss SI volvulus
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- Young animals
- SI twists around root of mesentery - If not corrected within 2-3hrs, requires resection and anastomosis |
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Discuss intussusception
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Most common areas for it to occur are:
- Cecal-cecal - Ileo-cecal - Ceco-colic Can be strangulating or non (depending on chronicity) |
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Discuss adhesions
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Causes include:
- Peritonitis - After a laparotomy - SI resection and anastomosis They lead to non-strangulating obstrcutions Generally require resection of affect segments Can involve any part of GIT |
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What are some common lesions requiring surgery of the LI?
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Strangulating
- Torsion/volvulus - Infarction Non-strangulating Displacement - Left dorsal/nephrosplenic - Right dorsal Impaction - Pelvic flexure - Fecalith - Enterolith - Sand |
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Discuss LI impaction
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Common sites
- RDC - Pelvic flexure - TC Can attempt medical treatment However, if severely painful - it may indicate that its close to rupture and surgery should be performed (enterotomy) |
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Discuss GIT rupture
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Clinical signs
- Profound depression - Maybe some pain - Severe CV compromise - On rectal palpation, you will feel gritty peritoneal surface and free air in the abdomen - On abdominocentesis, peritonitis will be evident and faecal contamination |
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What is the prognosis for SI involvement?
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Poor - guarded - good
Complication rate is higher than in LI Factors contributing to prognosis include: - degree of distension (really distended = less good) - systemic condition (systemic = less good) - duration of disease (longer = less good) - length of compromised bowel (longer = less good) |
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Discuss what's involved with post-op care.
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- Fluid therapy (crystalloids) --> maintenance is 50ml/kg/24hs
- Blood work to monitor (WBC, acid/base, electrolytes, vitals) - Antibiotics (broad spectrum) - Anti-inflamms/analgesics - Anti-endotoxins - Prokinetics |
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What are some post-op complications that can occur?
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In stall
- Fractures - Myopathy - Airway obstruction - Recurrence of lesion (e.g. torsions) - Haemorrhage (may need blood transfusion?) - Endotoxaemia - Ileus (especially SI) - Colitis - Laminitis - Thrombophlebitis - Peritonitis - Pleuropneumonia - Adhesions - Incision complications - Hyperlipaemia |
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Equine Diarrhoea
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Lecture 6
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What is the most anatomical cause of diarrhoea in the horse?
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Large intestine
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What is the definition of acute vs. chronic diarrhoea?
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> 1 month = chronic
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What clinical signs are commonly associated with diarrhoea?
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- Diarrhoea
- Colic - Depression/anorexia - Weight loss - Dehydration and endotoxaemia - Dependent oedema - Fever/tachycardia/tachypnea |
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When dealing with acute diarrhoea, what historical questions should you think about asking?
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- Duration and severity
- Previous episodes? - Other recent diseases and/or medications - Recent stresses - Appetite - Dietary changes - Evidence of colic - Any other horses with diarrhoea on property - Any weight loss - Deworming regimen (when, with what, how often) |
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What should you focus on in your PE when investigating acute diarrhoea?
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- Faecal consistency and frequency
- Vitals - CV status - GIT sounds (can vary) - Abnormal abdominal contour - Pings - Signs of colic? - Urination? - Dependent oedema |
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What further diagnostics can you do to investigate acute diarrhoea?
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- Colic golden 3 (nasogastric tube, rectal --> though, be careful with this, the lining might be more fragile, and abdominocentesis)
- Haematology and biochem - Serology Faecal analysis - Parasite exam (gross and FEC) - Bacterial cultures/toxin assays/PCR - Any sand? - Any blood? - Any WBCs? - Virology tests |
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How should you go about diagnosing chronic diarrhoea?
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Similar to acute
- History - PE - Rectal - Abdominocentesis - Haematology and biochem - US***** - Intestinal absorption tests***** - Rectal mucosal biopsy (if disease is diffuse) Faecal analysis the same, but you might also look for protozoa |
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What lab abnormalities might you see with diarrhoea?
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- Haematoconcentration
- Azotaemia - Dysproteinaemia (protein increased or decreased) - Coagulopathies (up or down) - Electrolyte/acid-base abnormalities - Elevated blood lactate - Hyperfibrinogenaemia - Leukopaenia/leukocytosis |
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What sort of complications do you see associated with diarrhoea?
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- Endotoxic shock
- Laminitis (sometimes even when the diarrhoea has resolved!) - Thrombophlebitis - DIC - Acute renal failure (pre-renal or renal) - Chronic malabsorption (scarring of LIT) |
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How do you treat diarrhoea?
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- Rehydrate
- Correct electrolyte/acid-base imbalances - Plasma or other colloids - NSAIDs - Antimicrobials (?? usually not, but in some circumstances yes) - Antidiarrhoeal agents (avoid products with antimicrobials) - Probiotics/transfaunation - not actually proven to be that useful, don't even know if they get to LI - Anti-endotoxin therapy - Antithrombotic therapies - Corticosteroids possibly? |
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What do you need to think about in terms of biosecurity when it comes to diarrhoea?
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- Isolate infected horses
- Investigate outbreak situations - Routine surveillance |
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What are some of the common causes of acute colitis?
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- Dietary indiscretion
- GIT parasitism - Antimicrobial associated - Acute salmonellosis - Clostridiosis - Other infectious causes - Other causes |
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Discuss dietary indiscretions in relation to diarrhoea.
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- Too much grain
- Rapid dietary change - Sand - Specific irritants/toxins (linseed, castor oils, heavy metals, toxic plants) |
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What are some parasites that commonly cause diarrhoea?
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Ascarids (round worms)
Cyanthostones (small strongyles) |
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Discuss salmonella in regards to the cause of diarrhoea
What? Diagnosis? Treatment? |
- Often associated with stress/antimicrobial therapy
- Very contagious Diagnosis - Faecal culture (may need up to 6 consec samples) - PCR Antmicrobial therapy NOT indicated |
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Discuss clostridia in relation to diarrhoea?
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Species = clostridium difficile/perfringens
+/- haemorrhagic diarrhoea Very contagious Treatment = oral metronidazole |
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What are some other common infectious causes of diarrhoea?
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- Rotavirus
- Cryptosporidium |
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What are some other non-infectious causes of diarrhoea?
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- NSAIDs
- Peritonitis - Stress - Exotic diseases - Idiopathic |
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What are some common causes of chronic colitis?
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- Chronic salmonella
- Chronic parasitism - Liver disease - Chronic peritonitis - Sand enteropathy - IBD - Neoplasia - Giardia - Dietary indiscretion - Idiopathic |
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Discuss lawsonia intracellularis
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- A chronic inflamm bowel disease
- Young horses (5-7 months) - Causes a protein losing enteropathy Clinical signs - Depression - Anorexia - Weight loss - Diarrhoea - Ventral oedema Diagnosis - PCR - Serology - Thickened SI on US - Histopath (demonstrate organism in enterocytes) Treatment - Macrolide + rifampin - Tetracyclines Good prognosis |
