Equine Internal Medicine

Front 1

Age range of a "neonate"

Back 1

birth to 1 month of age

Front 2

name for a male foal

Back 2

colt

Front 3

name for a female foal

Back 3

filly

Front 4

Age range of a "foal"

Back 4

>1 month to weaning (still at mom's side)

Front 5

at what age should a foal be weaned?

Back 5

4-6 months (if less than 4 months, must prepare the GI tract)

Front 6

Age range of a "weanling"

problem with weaning

Back 6

>4-6 months (up to 12 months)

can be very traumatic --> respiratory infections (think of nursery school)

Front 7

Age range of a "yearling"

Back 7

12-18 months (hips may be higher than withers bc still growing)

Front 8

Age range of a "long yearling"

Back 8

18-24 months

Front 9

Age that a horse is considered "adult"

Back 9

2 years

Front 10

Name for a castrated male horse

Back 10

gelding

Front 11

Most common reason to spay a female horse

Back 11

granulosa cell tumor (not done routinely)

Front 12

List of the some "Light horse" breeds

Back 12

arabian
appaloosa
thoroughbred
standardbred
saddlebred
american quarterhorse
american painhorse

Front 13

List of some "Draft horse" breeds

Back 13

Clydesdale
Percheron
Belgian

Front 14

Light horse:
1. height
2. weight
3. temperament
4. what they're built for

Back 14

1. >15 hands tall (4" to a hand)
2. < 1500lbs
3. hot-blooded/temperamental
4. fast/athletic

Front 15

Problem with thoroughbred breeded

Back 15

only natural breeding recognized (no AI)

Front 16

what are thoroughbreds bred for?

Back 16

endurance racing

Front 17

Breed disease predispositions: Thoroughbreds

--which 2 are genetic

Back 17

-Recurrent Exertional Rhabdomyolysis (Tying up) - genetic
-Exercise induced pulmonary hemorrhage ("bleeders") - genetic
-gastric ulcers
-osteochondrosis dessicans (when pushed to grow too fast)

Front 18

Body characteristics of Arabians

Back 18

dished head
large eyes
arches neck
flightly

Front 19

Breed disease predispositions: Arabians

Back 19

-SCID (severe combined immunodeficiency)
-Cerebellar abiotrophy (born normal)
-idiopathic epilepsy

Front 20

What are American Quarterhorses bred for?

Back 20

short races

Front 21

Breed disease predispositions: American Quarterhorse

Back 21

-HYPP (hyperkalemia periodic paralysis)
-PSSM (polysaccharide storeage myopathy)
-HERDA (Hereditary equine regional dermal asthenia - skin slips/falls off)

Front 22

what are Standardbred horses primarily bred for?

Back 22

harness racing

Front 23

facial features of standardbred horses

Back 23

Roman nose
longer head

Front 24

Breed disease predispositions: Standardbred

Back 24

-musculoskeletal racing injuries
-granulomatous enteritis

Front 25

What is unique about the saddlebred horses?

Back 25

Five-gaited (high stepping)

Front 26

Breed disease predispositions: Saddlebred

Back 26

inguinal hernia (Tennessee Walker)

Front 27

What is "soring"?

Back 27

painful stimulation (ex tacks, pins) on the feet of saddlebred horses to train the high-stepping gait for show - illegal!

Front 28

Color patterns of the American Painthorse

Back 28

-Overo - dark on front and over the top, color over at lest 2 or 3 limbs
-Tobiano - white on the back

Front 29

Why so American Painthorses have a breed disease predisposition similar to american quarterhorses?

Back 29

bc they are quarterhorses, they just happened to throw this paint color, so they can be reqistered as both

Front 30

Breed disease predispositions: American painthorse

Back 30

-Consistent with American quarterhorse:HYPP, PSSM, HERDA
-Ileocolic agangliosis: lethal white foal (no neurologic function to the GI - myenteric plexus missing)

Front 31

Name the five distinctive characteristics of the appaloosa

-how many of these characteristics does each horse have?

Back 31

coat pattern (spotted, though may be a solid color)
mottled skin
white sclera
striped hooves
thin mane/tail

-at least 3/5 of these characteristics

Front 32

Breed disease predispositions: Appaloosa

Back 32

-*Equine Recurrent Uveitis (moon blindness)
-SCC (along mottled areas - eyes, ear, nose)

Front 33

Draft Breeds:
1. height
2. weight
3. temperament
4. what are they bred for?

Back 33

1. >17 hands tall
2. >1500lbs
3. cold-blooded/docile/stoic (won't show colic signs until it's really bad)
4. military --> farming --> competitions (pulling/plowing competitions)

Front 34

Which draft breed is the largest?

Back 34

Belgian drafthorse

Front 35

What does a belgian draft horse look like?

Back 35

chestnut colors with white mane and variations of white face and leg markings

Front 36

Breed disease predispositions: Belgian drafthorse

Back 36

-JEB (Junctional epidermolysis bullosa ) aka foal disease (dz of mucocutaneous jncts - skin sloughing, no tx - euthanize)
-PSSM

Front 37

What feature (besides height) is distinctive about the Clydesdale

Back 37

"Feathers" - large amount of hair on the fetlock

Front 38

what colors could a Percheron draft horse be?

Back 38

grey or black

Front 39

How do you measure American miniature Horses?

what is the average height?

Back 39

in inches (NOT hands!!)

<34-38 inches

Front 40

Breed disease predispositions: American Miniature horses

Back 40

fecalith!! (will eat anything)
-dental problems

Front 41

Friesans fall under which category of horse?

Back 41

"other" - lighter than draft breeds, breeders don't like them know as "drafts"

Front 42

Breed disease predispositions: Friesan

Back 42

-esophageal disorders - megaesophagus, esophageal hypertrophy
-neonatal dysphagia

Front 43

what are warmblooded horses bred for?

Back 43

sport (dressing, show jumping)

Front 44

Name some warmblooded horse breeds

Back 44

Trakehner
Hanoverian
Holsteiner
Oldenburg
Rhinelander

Front 45

At what age do warmblooded horses reach their peak competition age?

Back 45

around 8-15 years old

Front 46

Horse coloring: Palomino

Back 46

cream colored w/white mane and vail

Front 47

Horse coloring: Bay

Back 47

brown with black mane and tail
may have some black points

Front 48

Horse coloring: Chestnut

Back 48

aka Sorrel
reddish brown with mane just slightly darker than body

Front 49

Horse coloring: two variations of Chestnut/Sorrel

Back 49

-Chestnut w/flaxen (blonde) mane and tail
-liver chestnut (a little less orangy)

Front 50

Horse coloring: Dun

Back 50

zebra striping along legs (w/dorsal stripe)

Front 51

Horse coloring: Buckskin

Back 51

similar to Palominos and Duns but always has a black mane and tail (unlike Palominos) w/NO dorsal stripe (unlike Duns)

Front 52

Horse coloring: how do you differentiate between white and grey?

Back 52

white: pink skin
grey: grey or black skin

Front 53

Horse coloring: name the 5 head patterns and describe them

Back 53

1. Star - white starshaped pattern between the eyes
2. Snip - short vertical white line between the nostrils
3. Blaze - vertical white line from between the eyes to between the nostrils
4. Bald face - a blaze extending out towards the eyes and nostrils
5. Star, Strip, and Snip - a star, a snip, and a line slightly longer than a snip between them

Front 54

Horse coloring: name the 4 leg markings and what they look like

Back 54

1. Coronet - white line directly above the hoof
2. Pasterns - white from hoof to directly under the fetlock
3. Socks - white from hoof to between the fetlock and hock
4. Stockings - white from hoof to directly under the hock

Front 55

Core equine vaccines

Back 55

EEE/WEE (equine encephalitis)
WNV
Tetanus
Rabies

Front 56

What is one very common reason for colic?

Back 56

any recent change in diet (be it schedule, feed, etc)

Front 57

Change in routine or intensity of exercise could cause what?

Back 57

GI ulcers

Front 58

What is "pulse pressure?"

Back 58

the difference between systolic and diastolic pressure

Front 59

What happens to the heart rhythm if there is a decr of oxygen to the tissues?

Back 59

the beats are close together

Front 60

When will you feel the retropharyngeal lymph nodes?

Back 60

if they are enlarged (ex Strangles)

Front 61

Where would you see a jugular vein pulsation normally?

Back 61

possibly in the thoracic inlet (if it extends of the neck, it's ABNORMAL)

Front 62

Primary sight for venipuncture of the jugular vein and why?

Back 62

upper 1/3 of the neck bc that's where the jugular vein and carotid artery are furthest apart

Front 63

Where is the primary site for IM injection? What are the borders?

Back 63

muscles of the neck

base of the nuchal ligament, proximal portion of the cervical vertebral bodies, start of the shoulder musculature

Front 64

Normal heart rate of the horse

Back 64

24-44bpm

Front 65

What do each of the heart sounds (S1-S4) indicate?

Back 65

S1- closure of the AV valves
S2- closure of the semi-lunar valves
S3- early diastole/rapid passive filling of the ventricles
S4- atrial contraction (right before closure of AV valves)

Front 66

Heart sounds:
1. between S1 and S2 = ?
2. everything outside of S1 to S2 = ?

Back 66

1. systole
2. diastole

Front 67

Which arrhythmias are non-pathologic in a horse at rest?

Back 67

sinus block
1st degree AV block
2nd degree AV block (horse has a strong vagal tone which keeps the HR low, so it can drop beats)

Front 68

What does the P wave indicate?

Back 68

atrial contraction (S4)

Front 69

What is sinus arrhythmia?

Back 69

normal irregularity heard in conjunction with the respiratory cycle

Front 70

What is the most common pathologic arrhythmia?

Back 70

atrial fibrillation

Front 71

Normal respiratory rate of a horse

Back 71

2-24bpm

Front 72

Is it normal or abnormal for the rebreathing exam (with the plastic bag) to invoke coughing?

Back 72

abnormal

Front 73

What would you examine and what would you expect to see in a horse with laminitis?

Back 73

-palpate digital pulses - will see "bounding"
-palpate coronary band - edema, cleft may drop (can push thumbnail in
-palpate hoof capsules - will feel heat
-see if horse willingly lifts each foot
-turn horse in small circles, both directions

Front 74

Normal rectal temperature of a horse

Back 74

99-101.5 degrees F

Front 75

What CS indicate urinary tract dysfunction?

Back 75

urine scalding, straining, polliakuria

Front 76

Where do you measure a horse with a weight tape?

Back 76

around the barrel/thorax at the level of the withers

Front 77

What body condition score scale is used for a horse?

Back 77

1 thru 9

Front 78

What are the 6 points of BCS?

Back 78

neck
withers
shoulder
ribs
loin
tailhead

Front 79

A "poor" BCS for a horse = what number(s)?

Back 79

condition score 1-3

Front 80

A "moderate" BCS for a horse = what number(s)?

Back 80

condition score 4-6

Front 81

A "fat" BCS for a horse = what number(s)?

Back 81

condition score 7-9

Front 82

How much should a horse weight (approx)
1. Foal
2. Weanling
3. Yearling
4. Adult (>2yrs)
5. Light horses (Arabs)
6. Draft breeds (ex Clydesdale)

Back 82

1. 50kg
2. 100-200kg
3. 300-400kg
4. 500kg
5. 400-500kg
6. 1000kg

Front 83

the digestive tract of a horse is best suited for what type of feed?

Back 83

forage diet

Front 84

What type of feed do we give horses more of in "captivity" than what they were used to in the wild?

Back 84

concentrate feeds (grains(

Front 85

what is part of the foregut in horses? (4)

Back 85

mouth
esophagus
stomach
small intestine

Front 86

What is part of the hindgut in horses? )4_

Back 86

cecum
large colon/ascending colon
small colon
rectum

Front 87

What is the purpose of the foregut?

Back 87

digestion and absorption of non-fibrous feed and ingredients
(protein, fat, sugar/starch, water, vitamins/minerals)

Front 88

What is the purpose of the hindgut?

Back 88

digestion and fermentaion of fibrous feed ingredients
(cellulose, hemicellulose)

Front 89

Which (cellulose or hemicellulose) is digested in the cecum/large colon?

Back 89

cellulose

Front 90

What is unique about horses that also occurs in rabbits? (yes i knot he word unique doesn't fit when there's another animals that has the same trait so :P )

Back 90

they are hindgut fermenters

Front 91

What are the lips used for?

Back 91

prehension

Front 92

Why is a deficit of cranial nerve VII so bad?

Back 92

it controls the lips, which are needed for prehension

Front 93

How do horses chew? What is different about the way their chewing habits?

Back 93

lateral excursion

they chew continuously (up to 60,000xs) a day to increase surface area

Front 94

What type of teeth do hroses have?

Back 94

hypsodont

Front 95

What are the incisors used for and how many do they have?

Back 95

cutting

6 upper, 6 lower

Front 96

What are the canines used for and how many do they have? What is unique about them?

Back 96

tearing/fighting

2 upper, 2 lower

occur only in males

Front 97

What are the premolars used for and how many do they have?

Back 97

grinding/mastication

6 upper, 6 lower

Front 98

What are the molars used for and how many do they have?

Back 98

grinding/mastication
6 upper, 6 lower

Front 99

Which teeth are considered the cheek teeth?

Back 99

premolars and molars

Front 100

T/F: the upper jaw of a horse is very narrow

Back 100

false: the lower jaw is very narrow

Front 101

What are the signs of poor dental health in the horse?

Back 101

quidding (feed falls out of mouth)
abnormal head position during chewing
loww of condition
colic

Front 102

Which salivary glands does the horse have?

Back 102

parotid
submaxillary
sublingual

Front 103

What, from the saliva, aids in digestion?

Back 103

amylase

Front 104

What, from saliva, buffers stomach acid?

Back 104

bicarb

Front 105

How much saliva can be produced a day?

Back 105

up to 40L

Front 106

What makes up the upper esophageal sphincter?

Back 106

cricopharyngeus muscle

Front 107

What makes up the lower eso sphincter?

Back 107

distal part of the musculature of the eso (important for prevention of vomiting)

Front 108

What volume can the equine stomach hold?

Back 108

8-12L

Front 109

how long does it take to empty? What is this ideal for?

Back 109

2-12 hours (rapid)

ideal for forage diets

Front 110

The small intestines is the primary site for what?

Back 110

digestion and absorption of protein, fat, starches/sugar, and vitamins/minerals

Front 111

large meals promote what?

Back 111

rapid transit to cecum

Front 112

T/F: digestive enzymes from the liver and pancreas are released every few hours from the common bile duct

Back 112

false: the enzymes are released CONTINUOUSLY from the common bile duct bc the horse has no gallbladder

Front 113

T/F: rate of passage through cecum is relatively rapid

Back 113

false: it is relatively slow

Front 114

Where does fermentation initiate?

Back 114

in the cecum

Front 115

What is necessary for good equine GI health?

Back 115

microbial "happiness"

Front 116

Explain microbial fermentation

Back 116

fibrous and non-fibrous CHO (grasses) are takes up by the microbe and metabolized and released as:
1. VFAs used for energy
2. gas - wasted energy
3. Vit B and K

Front 117

What is the problem with fasting a horse?

Back 117

microbial numbers decr when feed is withheld for >8hrs it may take >1wk to repopulate

Front 118

What's the problem with a heavy CHO diet?

Back 118

incomplete prececal digestion leads to overpopulation of specialized bacteria (bacillus, lactobacillus, and streptococcus) --> reduces number of normal microbes --> mucosal damage + impaired cecal motility --> colic

Front 119

T/f: bacillus, lactobacillus, and streptococcus (the 3 main microbes that overpopulate the GI with a heavy CHO diet) are normal cecal inhabitants

Back 119

true

Front 120

The large/ascending colon is the primary site for what? what else happens there?

Back 120

primary site for water resorption

-additional site for microbial fermentation and microbial production of Vit B & K
-VFAs are absorbed

Front 121

What happens in the transverse colon?

Back 121

no real clue on my part, but it has no real digestive responsibilities

Front 122

What happens in the small colon?

Back 122

water is absorbed and fecal balls are created ('road apples")

Front 123

What is the nutritional equation for energy?

Back 123

Fiber + CHO + Fat

Front 124

**Nutritional requirements of most horses may be met by feeling what?

Back 124

good quality hay/pasture, water, and a trace mineral salt block

Front 125

What is the daily requirement of water?

Back 125

50mL/kg/day
OR
8-12 gallons/day

Front 126

Excess energy may result in what problems? (6)

Back 126

Developmental Orthopedic Dz
Equine Metabolic Syndrome
Laminitis
Obesity
Reduced performance
Colic

Front 127

What is a calorie (cal)?

Back 127

the amount of heat required to heat 1g of water 1 degree celsius

Front 128

What is a Megacalorie (Mcal)?

Back 128

1,000Kcal = 1,000,000cal

Front 129

Forage feeds = ?

Back 129

structural CHOs = fiber

Front 130

What are the most common forages? (2)

Back 130

pasture forage and hay
legumes and grasses

Front 131

What does forages provide?

Back 131

maintenance digestible energy

Front 132

for Gi health, what % of the diet should fiber be?

Back 132

>50%/day

ideal: 1.5-2% bwt (lbs)/day

Front 133

How is hay measured?

Back 133

in "flakes"

Front 134

What is the most important part of the diet?

Back 134

fiber

Front 135

When can something else take the palce of hay?

Back 135

when it has >15% crude fiber (for older horses with bad/no teeth so they don't have to chew)

Front 136

How does fiber lead to energy?

Back 136

fiber digestion --> VFAs (produced by microbial ingestion of forage feeds)

Front 137

What is the primary energy source of a horse?

Back 137

VFAs (30-70% daily energy)

Front 138

How are VFAs absorbed?

What is VFA absorption related to?

Back 138

across LI wall (passive diffusion down pH gradient as free acids)
OR
directly into portal blood (travel to liver/muscle tissue)

related to water/salt movement

Front 139

the rate of absorption of VFAs (acetate, butyrate, proprionate) is related to what? which is the most absorbable (list in order from most to least)

Back 139

molecular weight

acetate > proprionate > butyrate

Front 140

What does VFA absorption do for the intestines?

Back 140

maintains intestinal pH

Front 141

What is the optimal intestinal pH?

Back 141

6.5 for microbial health

Front 142

What is one of the biggest sources of glucose in the horse? (hint: it's one of the primary VFAs)

Back 142

proprionate

Front 143

What are the guidelines of digestibility for hay quality?

Back 143

mature & stemmy = less digestible
immature, leafy (aka protein), & small stems = more digestible

Front 144

T/F: you should avoid round bales of hay when feeding

Back 144

true bc they could be moldy and have botulism or cause a respiratory allergy (RAO)

Front 145

T/F: you should avoid straw when feeding

Back 145

true bc straw is an agricultural biproduct with no nutrient quality that has no digestibility and increases a horses risk of colic

Front 146

What is in straw in high concentration that should be avoided?

Back 146

lignon bc it is unuseful

Front 147

what is the most accurate assessment of hay and pasture quality?

Back 147

Forage testing/Hay analysis

Front 148

"complete feeds" are designed to be fed in place of what? What % of fiber is required

Back 148

hay

>15%

Front 149

What % of the diet should coem from forage?

Back 149

50%

Front 150

Beet pulp is what type of feed?

Back 150

forage

Front 151

Beet pulp has what % of fiber in it? What is it low in? What is it high in?

Back 151

</= 28%

low in protein, high in Ca

Front 152

Why do you moisten beet pulp with water/

Back 152

to prevent eso choke

Front 153

Bran is what type of feed?

Back 153

forage

Front 154

What is the % fiber content of Bran?

Back 154

15

Front 155

T/F: Bran is more suitable for fiber supplement than beet pulp?

Back 155

false: beet pulp is more suitable than bran bc bran is a low density feed, meaning it requires a lot of bran to meet fiber needs

Front 156

Bran is often used as what?

Back 156

treats

Front 157

Fresh grasses contain what % water?

Back 157

90%

Front 158

**What is the disadvantage of fresh grass?

Back 158

high CHO content of spring grass can trigger colic and laminitis

Front 159

How do you introduce a horse to grazing/fresh grasses?

Back 159

SLOWLY (incr time spent in pasture each day)

Front 160

When is the best time to graze and why?

Back 160

early mornings because low non-structural carbohydrates in grasses

Front 161

Pasture grass is contraindicated in which horses?

Back 161

Obese
those predisposed to laminitis (chronic dz)
Equine metabolic syndrome
Equine cushing's syndrome

Front 162

What are non-structural carbohydrates (NSC)?

Back 162

simple sugars

Front 163

Where are NSC digested and into what?

Back 163

small intestine --> glucose

Front 164

in the SI, what helps with starch digestion?

Back 164

amylase (non-digested starch passes into the hindgut)

Front 165

Why would the cecum receive non-digested starch?

Back 165

bc horses have a limited prod'n of amylase

Front 166

What are some examples of NSC?

Back 166

oats, corn, molasses, concentrates/grain

Front 167

What % of NSC should be digested in the SI? too much at one time is a well-known cause of what?

Back 167

70%

colic

Front 168

What are specialized microbes in the cecum for starch fermentation (if the starch isn't digested in the SI)? What is the problem with them?

Back 168

bacillus, lactobacillus, streptococcus

produce lactic acid as a byproduct, which alters cecal pH, injures mucosa --> dysmotility

Front 169

How does the starch reaching the cecum lead to colic? what else can happen?

Back 169

dysmotility --> gas distention in the cecum/colon --> colic

when the normal microbe populations begin to die --> gas prod'n, endotoxic shock --> laminitis

Front 170

How can you improve pre-cecal digestion of starch so none of this nonsense happens?

Back 170

-feed NSC separately from forage (save amylase)
-decr amt of starch intake/meal/day
-consider source: oats are highly digestible, corn requires processing to incr digestion, grinding/popping/heat tx

Front 171

NSC provides what type of energy? What animals is it good for?

Back 171

rapidly available energy

race horses, high performance, lactating mares, underweight/thin

Front 172

Avoid NSC if the horse has what? (4)

Back 172

cushing's syndrome
Equine metabolic syndrome
laminitis
obesity

Front 173

How much starch is too much?

Back 173

2g starch/kg bwt leads to digestive upset

split starch into 2-4 small meals/day

Front 174

What is the glycemic index used for?

Back 174

developed in human med to determine which foods are best suited for diabetic patients

Front 175

What types of feed give a horse instant energy?

Back 175

high glycemic feeds - CHO break down quickly during digestion, releasing glucose rapidly into circulation

Front 176

What types of feed allow for a more balanced energy release?

Back 176

low glycemic feeds - CHO break down more slowly, releasing glucose more gradually into the bloodstream

Front 177

What happens with high glycemic index feeds/

Back 177

get a "bottomed-out" feel after an energy high

Front 178

Fluid Therapy!!

Back 178

BOOOOOOOOOO

Front 179

What are the c/s of hypovolemia?

Back 179

tachycardia
decr pulse pressure
reduced jugular fill
tachypnea
cold extremities
decr urine output
depressed mentation

Front 180

What are the c/s of dehydration?

Back 180

tachycardia
tacky mucous membranes
prolonged skin tent
sunken eyes
incr urine specific gravity
irritable behavior
muscle cramping

Front 181

You will be unable to detect dehydration less than what percent?

Back 181

<5%

Front 182

What % is mild dehydration and what are the c/s?

Back 182

3-5%

decr skin turgor
very slightly tacky mucous membranes

Front 183

What % is moderate dehydration and what are the c/s?

Back 183

7-8%

depressed mentation
tacky mm
CRT >2-3sec
correlated with hypovolemia

Front 184

What % is severe dehydration and what are the c/s?

Back 184

>10%

cool extremities
poor perfusion
CRT > 4sec
not sure will survive

Front 185

What are the parameters used to assess volume status? (3)

Back 185

pulse pressure (the difference between systolic and diastolic pressure)
jugular vein fill
temp of distal extremities

Front 186

What is the one fluid where you must measure colloid oncotis pressure because the refractometer won't work to get a total solids?

Back 186

Hetastarch

Front 187

With volume depletion, what should these parameters look like:
1. urine specific gravity
2. serum creatinine
3. PCV

Back 187

1. concentrated (>1.025)
2. pre-renal azotemia (BUN + CREA), CREA >1.5mg/dl
3. hemoconcentrations

Front 188

Why would lactate be produced with volume depletion?

Back 188

anaerobic metabolism due to poor tissue oxygenation

Front 189

What does central venous pressure (CVP) measure?

Back 189

preload

Front 190

What are the four parameters that will incr as dehydration % incr?

Back 190

heart rate
CRT
PCV/TP
Creatinine

Front 191

What is the most important reason to measure CVP in a horse?

Back 191

we may give it fluids but that's a problem if it has renal disease

Front 192

what does a decreased CVP indicate?

Back 192

hypovolemia

Front 193

what does an increased CVP indicate?

Back 193

fluid overload

Front 194

What are the 4 phases of fluid therapy and do they overlap?

Back 194

Resuscitation
Rehydration
Maintenance
Ongoing losses

yes

Front 195

Rescusitation

Back 195

BOOYAH!!

Front 196

what is the most important part?

Back 196

reversal of hypovolemia (imperative and must be immediate!!)

Front 197

What is a shock dose of fluids?

Back 197

one blood volume

Front 198

What is one blood volume?

Back 198

8% of body weight (kg)

Front 199

Why would you not give oral fluids with a hypovolemic patient?

Back 199

the GI is not getting any blood so it won't absorb

Front 200

Where can you place an IV catheter? (3) Which is the primary site in horses?

Back 200

**jugular vein - primary site
cephalic vein

lateral thoracic vein

Front 201

What are the two types of catheters (materials) used?

Back 201

teflon
polyurethane

Front 202

Teflon catheter:
1. rigid of supple
2. least or most thrombogenic
3. long or short term

Back 202

1. rigid
2. most thrombogenic
**3. short term use (>72 hours)

Front 203

Polyurethane catheter:
1. rigid or supple
2. least or most thrombogenic
3. long or short term use

Back 203

1. supple (making it more difficult to place)
2. least thrombogenic
**3. long term use

Front 204

Over-the-needle catheters are used for long or short term?

Back 204

short term

Front 205

Over-the-wire catheters are used for long or short term?

Back 205

long term (very supple, non-thrombogenic)

Front 206

Which type of fluids are most used for hypoproteinemic patients?

Back 206

colloids

Front 207

What are the primary electrolytes in crystalloid fluids?

Back 207

Na and Cl

Front 208

How much crystalloids should you administers?

Back 208

304xs the amount required bc designed to leak from the intravascular space

Front 209

What is isotonic fluid?

Back 209

a crystalloid fluid with a tonicity equal to that of plasma

(~280mOsm/L)

Front 210

What is the point of isotonic fluid?

Back 210

allows brief volume expansion without cause e-lyte balances

Front 211

Why would you not give 0.9% NaCl to rescusitate?

Back 211

want to give something a little more balanced to resuscitate

Front 212

What is hypertonic saline?

Back 212

7% NaCl (equal parts Na and Cl)

Front 213

What does hypertonic saline do?

Back 213

provides immediate expansion of vasculature volume
--creates a hypertonicity of the ECF
--redistribution of fluid from ICF

vol expansion 2-3xs vol infused

Front 214

What should be done after giving hypertonic saline? What is the Rule of Thumb?

Back 214

give crystalloids

for every 1L hypertonic saline, replace with 10L crystalloid

Front 215

What is hypertonic saline used for?

Back 215

resuscitation (NOT a maintenance fluid)

Front 216

What are the added benefits of hypertonic saline?

Back 216

improves CO by increasing SV (affects preload)
reduces capillary endothelial swelling
suppresses degranulation of PMNs
prevents PMN-endothelial adhesion
blocks nuclear transcription of inflammatory cytokines

Front 217

What do colloids do?

Back 217

plug capillary endothelium (leaky vessels from endotoxin-mediated damage)
draw fluid into vessel from interstitium by incr colloid oncotic pressure

useful for hypoproteinemic patients

Front 218

List some colloids (2 specifically)

Back 218

frozen plasma
hetastarch

Front 219

What are the advantages of frozen plasma?

Back 219

excellent source of albumin, anti-endotoxemic factors, clotting factors
easily read on refractometer

Front 220

What are the disadvantages of frozen plasma?

Back 220

slow administration
transfusion rxn
requires time to thaw
crossmatch
blood administration set
expensive

Front 221

What are the two most common signs seen with transfusion reaction?

Back 221

incr TPR and utricaria (hives)

Front 222

What are the advantages of hetastarch?

Back 222

it's a synthetic product
bolus administration
no thawing
does not require transfusion set
less costly

Front 223

What are the disadvantages of hetastarch?

Back 223

cannot measure on refractometer --> COP
has been associated with prolonged bleeding times at higher doses

Front 224

IT IS IMPORTANT TO NOTE THAT THE REVERSAL OF HYPOVOLEMIA IS THE BEGINNING OF FLUID THERAPY NOT THE END

Back 224

she put that in, I had it starred, so there it is! Hope you feel wise after that.

Front 225

REHYDRATION

Back 225

YIPPEEE!!

Front 226

What is the equation for rehydration?

Back 226

dehydrate % X body weight (kg)

Front 227

What are the guidelines of rehydration?

Back 227

slow replacement of fluid
--as compared to patients w/volume depletion
--rehydration over 12-24 hours
--crystalloid (isotonic) fluid
deficit replacement does nto alway require IV administration
dehydrated patients may require 2-3x maintenance requirements

Front 228

MAINTENANCE

Back 228

NIIIIICE!!!

Front 229

What is the formula for maintenance fluid tx?

Back 229

50mL/kg/day or 1mL/lb/hour

Front 230

T/F: frozen plasma has a higher colloid oncotic pressure (COP) than hetastarch

Back 230

false: hetastarch has a higher oncotic pressure

Front 231

What fluid should be used for maintenance?

Back 231

crystalloid fluid/isotonic

possible electrolyte supplementation

Front 232

nearly every IV fluid plan includes what?

Back 232

Calcium supplementation

Front 233

When should potassium be supplemented?

Back 233

for hypokalemic or horses on IV fluids >24 hours

Front 234

**What should you be very careful about with potassium?

Back 234

K must be <0.5 mEq/kg/hr

Front 235

When should magnesium be supplemented?

Back 235

critically ill patients of patients with hypomagnesmia

Front 236

ONGOING LOSSES

Back 236

ALMOST THERE!!

Front 237

how are ongoing losses typically replaced?

Back 237

by increasing maintenance requirements (2xs maintenance, 3xs maintenance, etc)

Front 238

Classic diarrhea in horses is just like what?

Back 238

losing blood- lose massive amounts of electrolytes and water

Front 239

What is the problem with hypertonic saline in hyponatremic patients?

Back 239

it can cause osmotic demyelination and cell shrinkage

Front 240

how does chronic hyponatremia develop?

Back 240

7% NaCl --> osmolality changes --> fluid pulled from calls --> osmotic demyelination syndrome --> cells shrink

REPLACE Na SLOWLY!!

Front 241

AANNNDD.....

Back 241

YOU'RE DONE FLUIDS!! Now give yourself a pat on the back bc I thought I was done the nutrition packet but apparently I wasn't so back to that...

Front 242

FAT

Back 242

FATTY MCFATTERSON!!

Front 243

Why are many feeds supplemented with fat?

Back 243

bc it is an important source of energy without CHO overload (more calories in less volume)

Front 244

horses typically consume what % of fat/day?

Back 244

<2-3%

Front 245

Fat is required for the absorption of what?

Back 245

Fat soluble vitamins: A, D, E, K

Front 246

What are essential fatty acids?

Back 246

fatty acids that must come from the diet

Front 247

What are essential fatty acids for?

Back 247

necessary for hormone and cell membranes: linoleic acid (omega 3 and omega 6)

Front 248

fat is high in what?

Back 248

energy density

Front 249

What do unsaturated fats do?

Back 249

improve skin and coat condition

Front 250

How much fat should be consumed by:
1. pasture pet
2. please horse
3. performance horse
4. growing/lactating horse

Back 250

1. 3%
2. 3-6%
3. 6-12%
4. 14-16%

Front 251

What can be used for fat supplementation and how much should be fed?

Back 251

corn oil, vegetable oil, safflower oil

Front 252

PROTEIN

Back 252

...i think the mosquitoes are plotting against me

Front 253

T/F: dietary intake is required for very for amino acids

Back 253

true

Front 254

Where is protein absorbed and excreted?

Where is it metabolized?

Back 254

digested and absorbed in the SI
excreted in the kidneys

metabolized by the liver

Front 255

What is protein?

Back 255

the precursors for energy (it can turn into heat and energy that needs to be burned off)

Front 256

Which protein is the rate-limiting step for growth?

Back 256

Lysine (this si critical for growth)

Front 257

Which feeds have high protein content?

Back 257

legumes (alfalfa, soybeans)
seeds (esp oil seeds)

Front 258

Protein should be what % of the diet?

Back 258

7-20

Front 259

Name a non-protein nitrogen source that you can feed to cows for protein

Back 259

urea

Front 260

VITAMINS

Back 260

...ok I've got nothing. brain = fried

Front 261

What form is used for a construction quote?

Back 261

SF-1442
(SAP, 12-4)

Front 262

Where does a horse get water-soluble vitamins? Which vitamins are water-soluble?

Back 262

produced by the body

Vitamins B & C

Front 263

Where does a horse get fat-soluble vitamins? Which vitamins are fat-soluble?

Back 263

dietary intake

Vitamins A, D, E, K

Front 264

Vitamin A
1. what is it turned into in the body?
2. what function is it needed for?
3. where is it found?

Back 264

1. beta-carotene --> retinol
2. essential for vision
3. high-quality leafy forages/pasture grazing

Front 265

Vitamin D
1. what is it needed for?
2. where is it found?

Back 265

1. essential for calcium:phosphorous balance
2. obtained through UV light exposure and feed

Front 266

Vitamin E
1. What is it turned into in the body?
2. what is it needed for?
3. Where is it found?

Back 266

1. alpha-tocopherol
2. essential antioxidant
3. high quality hay and grains

Front 267

Vitamin K
1. What is it needed for?
2. Where is it found/produced?

Back 267

1. blood coagulation (factors II, VI, IX, X)
2. produced by intestinal microbes, forage

Front 268

Vitamin B
1. What are the two subsets?
2. what are these needed for?
3. Where are they found/produced?

Back 268

1. Thiamin (B1) & Riboflavin (B2)
2. neuronal health and RBC production
3. intestinal microbes

Front 269

Vitamin C
1. What does it become?
2. Who may require supplementation?

Back 269

1. ascorbic acid (antioxidant)
2. performance horses/foals

Front 270

Which vitamins are now essential animo acids?

Back 270

vitamin B, C, and mostly K

Front 271

What are PIVKAs?

Back 271

proteins induced by Vitamin K antagonism

Front 272

Where does a horse get water-soluble vitamins? Which vitamins are water-soluble?

Back 272

produced by the body

Vitamins B & C

Front 273

Where does a horse get fat-soluble vitamins? Which vitamins are fat-soluble?

Back 273

dietary intake

Vitamins A, D, E, K

Front 274

Vitamin A
1. what is it turned into in the body?
2. what function is it needed for?
3. where is it found?

Back 274

1. beta-carotene --> retinol
2. essential for vision
3. high-quality leafy forages/pasture grazing

Front 275

Vitamin D
1. what is it needed for?
2. where is it found?

Back 275

1. essential for calcium:phosphorous balance
2. obtained through UV light exposure and feed

Front 276

Vitamin E
1. What is it turned into in the body?
2. what is it needed for?
3. Where is it found?

Back 276

1. alpha-tocopherol
2. essential antioxidant
3. high quality hay and grains

Front 277

Vitamin K
1. What is it needed for?
2. Where is it found/produced?

Back 277

1. blood coagulation (factors II, VI, IX, X)
2. produced by intestinal microbes, forage

Front 278

Vitamin B
1. What are the two subsets?
2. what are these needed for?
3. Where are they found/produced?

Back 278

1. Thiamin (B1) & Riboflavin (B2)
2. neuronal health and RBC production
3. intestinal microbes

Front 279

Vitamin C
1. What does it become?
2. Who may require supplementation?

Back 279

1. ascorbic acid (antioxidant)
2. performance horses/foals

Front 280

Which vitamins are now essential animo acids?

Back 280

vitamin B, C, and mostly K

Front 281

What are PIVKAs?

Back 281

proteins induced by Vitamin K antagonism

Front 282

MINERALS

Back 282

umm, my caps lock key just broke bc the little light next to it is on which means is should be typing in capital letters, but clearly, it's not. something to think about...

Front 283

What are macrominerals? List them

Back 283

minerals required in greater amounts

calsium
phosphorous
magnesium
sodium
chloride
potassium
sulphur

Front 284

What are microminerals? List them

Back 284

minerals required in lesser amount

copper
zinc
iodine
iron
manganese
selenium

Front 285

What should the Ca:K ratio be in young horses? Why?

Back 285

Ca > P (1.5-3:1) --> growth (too much K and won't grow/ossify properly)

Adults can go up to 6:1 w/o problem bc not growing

Front 286

Selenium depends on what?

Back 286

it's a soil-dependent mineral

Front 287

how does selenium deficiency present?

Back 287

white muscle dz aka nutrional myodegeneration

Front 288

Again, nutritional requirements of most horses can be met by what?

Back 288

feeding good quality hay/pasture
water
trace mineral salt block

Front 289

T/F: from birth to 1 month of age (neonate), the foal's only needs mare's milk and water is not needed

Back 289

true: mare's milk is the sole source of nutrition in a neonate

Front 290

What is the digestible energy requirement in a neonate?

Back 290

150kcal/kg/day

Front 291

What is the digestible energy requirement in an adult?

Back 291

32kcal/kg/day (= 16mcals/day)

Front 292

how many kcal/L are in mare's milk?

Back 292

500-600 = great energy source

Front 293

What is not found in mare's milk that is usually needed for a balanced diet?

Back 293

CHO or fiber

Front 294

Foal's consume how much milk each day?

Back 294

20-25% of body weight

Front 295

What should be a foal's daily weight gain?

Back 295

2-4lbs/day

Front 296

When is a mare's peak milk prod'n?

Back 296

~45 days

Front 297

How often do foal's nurse?

Back 297

6-8xs/hour

Front 298

When do foals actually start ingesting something other than mare's milk?

Back 298

~10-14 days old

Front 299

A foal consumed a significant amount of fiber/grain by what age?

Back 299

4-6 weeks

Front 300

T/F: copraphagia is normal and a horse does it 1-2xs a week

Back 300

false: 1-2xs/day

Front 301

T/F: can use calf milk replaces for an orphan foal

Back 301

false

Front 302

What is most similar to mare's milk?

Back 302

goat's milk

Front 303

What do you have to be cautious of when bottle feeding a foal?

Back 303

aspiration pneumonia (foal's neck must be extended horizontally for correct bottle feeding)

Front 304

What should mare's milk replaced provide?

Back 304

>20% protein
>20% fat
<0.5% fiber (milk-based proteins)
acidified product (enhances nutrient digestibility and maintains quality during reconstitution)

Front 305

which is better? list in order

goat's milk, nurse mare, commercial product

Back 305

nurse mare > goat's milk > commercial product

Front 306

What is "creep" feeding?

Back 306

prepares foal nutritionally for the weaning process

allows foal to ingest additional calories w/o interference from mare

Front 307

When does creep feeding begin?

Back 307

~2mos until weaning

Front 308

When are foals weaned?

Back 308

3-6mos

Front 309

Why are foals weaned in groups?

Back 309

to limit stress

Front 310

What does successful weaning depend on?

Back 310

dry matter intake prior to weaning

creep feading is important to avoid "post-weaning slump"

Front 311

T/F: too many nutrients can be just as bad as soo little

Back 311

true

Front 312

The daily requirement of 32kcal/kg/day is standard for what type of horses?

Back 312

pasture pets

Front 313

At what age are horses orthopedically mature?

Back 313

>2yrs old

Front 314

How do you feed a mature horse?

Back 314

1-2% body weight in lbs per day

Front 315

T/F: Ca:P ratio is not a concern for mature or nonpregnant horses

Back 315

true

Front 316

# of calories is measure in...?

Back 316

kg

Front 317

calories/day is measure in...?

Back 317

lbs

Front 318

GERIATRIC/SENIOR HORSES

Back 318

When I was your age...

Front 319

When is a horse considered senior?

Back 319

>/= 20 years

Front 320

What is the goal when feeding a senior horse?

Back 320

maintain BCS of 4.5-6

Front 321

How much should a senior be fed?

Back 321

1.5-2% body weight/day

Front 322

T/F: unlike humans, horses do not have decreased metabolic activity with age

Back 322

true

Front 323

What should be done with fee in winter/cold climates?

Back 323

incr intake

Front 324

Sign of aging in horses

Back 324

graying muzzle and/or coat
decr mobility due to osteoarthritis
halitosis due to poor teeth and gingivitis

Front 325

Why are teeth likely to be an issue in senior horses?

Back 325

hypsodont- wear out with time, present but possibly not functional
dental health is vital for longevity maintain BCS)
dentist important (annual/biannual basis)

Front 326

What can you feed a geriatric horse that's easy to chew and swallow? (sounds dirty, right? RIIIIGHT!?!!)

Back 326

cubed forage/pelleted diets
beet pulp

Front 327

What needs to be kept in mind when feeding a geriatric horse

Back 327

easy to chew/swallow
highly palatable
dust free (heaves)
protein ~12-16%
provide essential vitamins/minerals
aid digestion (high quality fiber)
incr fat if weight gain necessary

Front 328

When are complete feeds used?

Back 328

meant to be fed in place of hay

Front 329

What do you need to consider for energy requirements for specific horses

Back 329

level of activity
production status

Front 330

I have no clue how to ask the next two slides in question form, but it's important so it's going in

Back 330

ready? here it comes...

Front 331

Aerobic exercise and nutrition

Back 331

-HR </= 150bpm
-O2 requried for energy prod'n
rate of energy required is slow- heart/lungs supply O2, aerobic pathways cannot support prolonged of intense training
-glucose/glycogen: from NSC
-fatty acids (O2 required)
-VFA

Front 332

Anaerobic exercise and nutrition

Back 332

-HR >/= 150bpm
-few substances capable of providing energy for anaerobic exercise
-efficiency of energy prod'n is less at higher rates of exercise
-glucose/glycogen: from NSC
-protein: breakdown products - glucose
-VFA

Front 333

What is considered light exercise?

Back 333

aerobic exercise (~20mcal/day)
1-3hrs/week

extra calories/energy from gains

Front 334

What is considered moderate exercise?

Back 334

remains aerobic exercise (~24mcal/day)
incr frequency, intensity, length of workout

grain/fat supplement
water
trace mineral salt block

Front 335

What is considered heavy exercise?

Back 335

aerobic + anaerobic exercise (>32mcal/day)
one hour speed work w/6-12 hours slow work

Front 336

Which horses are considered high performance horses?

Back 336

those w/high energy jobs

show horses
race horses
working horses

Front 337

What is the feed requirement for working horses?

Back 337

-at least 50% of total ration as forage
-high quality grass hay or alfalfa/grass mix
-high quality protein
-fed to meet IMMEDIATE needs (ex restrict grain on rest day)
-water/salt consumption is CRITICAL

Front 338

If NSC is at the upper limit, yet the horse requires more supplementation, what should be added to the diet?

Back 338

fat

Front 339

What is the primary concern when feeding a breeding stallion (Barney Stinson...I hope you watch "How I Met Your Mother")?

Back 339

maintenance of body condition

Front 340

How do you feed a nonbreeding stallion?

Back 340

forage and vitamin/mineral supplement (just like everyone else)

Front 341

What % of hay and concentrate should be fed when a breeding stallion is breeding?

Back 341

concentrate: 0.5%
Hay: 1.75-2% (incr forage)

Front 342

What happens if the BCS of a breeding stallion decreases?

Back 342

can see loss of libido

Front 343

What is the gestation length of a mare?

Back 343

11 months (340 days)

Front 344

What happens to the mare in the last trimester?

Back 344

-gains 15% of body weight with growth of fetus
-significant incr in nutritional requirements

Front 345

When should feed intake increase for a pregnant mare?

Back 345

in last trimester and after she foals (increases A LOT after she foals)

Front 346

T/F: feed should be slightly increased in a pregnant mare as soon as she conceives

Back 346

false: ZERO increase in nutritional requirements in the first 8 months of pregnancy

Front 347

What feed requirements incr in the last 3 months of pregnancy and how should the horse be fed?

Back 347

incr in:
--energy
--protein
--minerals/electrolytes (esp Ca & Phos)

feed as a "light working" horse (>20mcal/day)

Front 348

T/F: It is difficult to overfeed a lactating mare

Back 348

true

Front 349

What BCS should be maintained?

Back 349

>/= 6/9

Front 350

List the ideals for feeding management of horses

Back 350

-assess/assign BCS
-feed at the same time each day
-feed on an individual basis
-feed at least 2xs daily )if confined, allow access to hay throughout the day)
-minimum 1% BW/day in hay/forage (>50% diet = fiber)
-feed concentrates ONLY IF NEEDED (growing, hardworking, lactating mares

Front 351

List the feeding guidelines

Back 351

-feed by weight, not volume
-reduce rate of intake (slow down chow hounds)
-consider dynamics (individual competition/pecking order)
-make ANY change GRADUALLY (>/-10-14 days)
-use BCS guidelines

Front 352

ENDOTOXEMIA

Back 352

NOOOOOOOOOOOOOO!!

Front 353

What is the leading cause of death in equine? What can it be caused by?

Back 353

endotoxemia (big surprise, right?)

colic, colitis, septic foals

Front 354

What is a major complication of endotoxemia?

Back 354

laminitis

Front 355

T/F: endotoxemia increases the risk of SIRS

Back 355

true: or SIRS can lead to entotoxemic shock

Front 356

What is SIRS?

Back 356

systemic inflammatory response syndrome

Front 357

What does the endotoxin come from?

Back 357

LPS (lipopolysaccharide)

Front 358

What is the LPS?

Back 358

the structural cell wall component of all gram negative bacteria

Front 359

What anchors LPS in outer cell wall?

Back 359

Lipid A (this is the toxic principle of LPS and is similar in all bacteria spp)

Front 360

What is the defining characteristic of each LPS, and also the virulence factor?

Back 360

O-chains (they're antigenic) (high structural variability, unlike Lipid A)

Front 361

Which part of the LPS interacts with the host immune system?

Back 361

O-chain

Front 362

Why is endotoxin so bad?

Back 362

if it gains access to the bloodstream, it may overwhelm normal host defense mechanisms, causing a cascade of inflammatory responses which are ultimately responsible for the clinical signs associated w/endotoxemia

Front 363

What are the c/s assoc w/endotoxemia?

Back 363

fever
leukopenia or leukocytosis
coagulopathy
hypotension
shock
death

Front 364

What diseases in equine are commonly assoc w/endotoxemia? (6) What is the most common?

Back 364

**Enterocolitis (most common)
Metritis
Pleuropneumonia
Peritonitis
Wound infection
neonatal septicemia

Front 365

What are the normal daily defenses against LPS?

Back 365

enterocyte endothelium
mucus layer (produced by prostaglandins)
tissue macrophages (MO)
Kupffer cells

Front 366

What are 3 ways for endotoxin to enter the bloodstream?

Back 366

-Damage to GI mucosa or uterine inflammation allows translocation of endotoxin into the bloodstream
-Endotoxin may be inhaled
-Iatrogenic administration (colonic ulceration/NSAIDS, IV catheters)

Front 367

**Explain how endotoxin in the bloodstream works

Back 367

LPS targeted by LPS-binding protein (LBP) --> this complex joins CD14+toll-like receptor (TLR4) on phagocyte surface --> MD2 stim allows translocation of LPS signal to cytoplasm (allows endotoxin into cell) --> IC signaling pathways lead to upregulation of nuclear transcriptiong factors (NF-K-beta)

Front 368

What happens after the upregulation of nuclear transcription factors (and yes, this is bc there's not enough room to cram all of this onto one card)

Back 368

--> produce inflammatory cytokines (IL-1 and TNF) --> responsible for c/s of --> endotoxemia

Front 369

How are inflammatory cytokines responsible for the c/s of endotoxemia?

Back 369

cytokines regulate inflammatory and immune responses by signaling between cells

Front 370

T/F: decreased plasma TNF is associated with increased mortality rates w/acute GI dz and in septic foals

Back 370

false: INCREASED plasma TNF is associated w/increased mortality rates

Front 371

T/F: TNF is considered one of the initial and primary responders to endotoxin and is central in the pathogenesis of endotoxic shock

Back 371

true

Front 372

The c/s of endotoxemia are mediated by what 3 things?

Back 372

1. release of inflamm cytokines
2. activation of the intravascular coagulation pathways (exposure of endothelial tissue factor)
3. complement protein activation.

Front 373

What happens when LPS cleaves the phospholipid cell membrane on every cell in the body?

(it may be easier to look at slide 1 on page 3 of endotoxemia packet for a flow chart)

Back 373

arachadonic acid cascade is initiated, leading to 2 pathways:
--cyclooxygenase pathway = prostanoids/PGH2) --> prostaglandin prod'n (PGI2, PGE2, PGF2) and thromboxane A2
--lipooxygenase pathway (leukotrienes) --> vasoconstriction, bronchospasm, incr vascular permeability

Front 374

The short, sweet version of endotoxemia

(a little too simplistic, but whatever)

Back 374

endoxotin --> destroys endothelium --> tissue damage --> endothelium can no longer protect i=tissue from further damage)

Front 375

What 6 things are released/produced/etc with endotoxemia?

Back 375

Nitric Oxide is produced
Histamine is realsed
Reactive Oxygen species (respiratory burst of neutrophils)
TF stimulation (endotoxin works on endothelium)
Complement
Neutophil activation (selectins, integrins)

Front 376

What happens with neutrophil activation?

Back 376

they are released from the endothelium --> neutrophils stick --> respiratory burst --> endothelial damage/permeability

Front 377

ALL of the mechanisms of endotoxemia lead to what?

Back 377

altered vascular permeability (vessels saggy/permeable/loss of tone --> blood pools --> systemic hypotension --> inadequate perfusion of tissues --> distributive shock

Front 378

What is the hallmark of endotoxemia and endotoxemic shock?

Back 378

altered vascular permeability

Front 379

C/s of EARLY HYPERdynamic shock (15-45min following injury)

Back 379

anorexia, yawning, sweating, depression, fever, recumbency
colic (PGs stim pain/affect horse's pain sensation)
altered vasc permeability (bright red mucous membranes), incr CRT
muscle fasciculations

Front 380

C/s of LATE HYPOdynamic shock (>90min after injury)

Back 380

diarrhea, obtunded mentation, hypothermia, circulatory failure
prolonged CRT (can leave thumb print)
dark red/purple mm (blood pooling outside vasculature walls)
3rd space fluid retention (another reason for colic)
coagulopathy (hypercoagulable)
multiple organ failure (laminitis)
abortion

Front 381

what will you see on bloodwork?

Back 381

neutropenia, lymphopenia, thrombocytopenia (plts <100,000)
hyperglycenmia
hyperlactatemia
prolonged APTT & PT
incr FDP (D-dimer)
reduced fibrinogen concentration (not as high as expected for level of illness)

Front 382

What is FDP? Why are they increased?

Back 382

fibrinogen degredation product

show inflammation

Front 383

Why is there a neutropenia?

Back 383

neutrophils are stuck on sides of endothelium

this is UNIQUE to horses (small animals get neutrophilia)

Front 384

Why is there a hyperlactatemia?

Back 384

bc there is not enough tone in the vessels to use O2 so anaerobic metabolism takes place

Front 385

T/F: there is a very specific, outlined plan of treatment for endotoxemia

Back 385

false: there is no one specific therapy

Front 386

What is the one bright hope for tx of endotoxemia since all other txs have failed miserably? What is the problem with it?

Back 386

Activated protein C (anticoagulant)

side effects = fatal hemorrhage
it's also very expensive

Front 387

What is the best chance of survival for a horse with endotoxemia?

Back 387

early, aggressive cardiovascular resuscitation (w/in the first 6 hours)

use of O2, Iv fluids, pressor therapy (improves contractility and supports BP), packed RBCs

Front 388

**What does early goal-directed therapy include?

Back 388

1. CV resuscitation
2. laminitis prevention
3. removal of the cause(s) of endotoxemia
4. neutralization of free-circulating LPS
5. inhibition of LPS-mediated inflammation

Front 389

ONE

Back 389

CARDIOVASCULAR RESUSCITATION

Front 390

what can be used?

Back 390

hypertonic saline
colloid therapy (hetastarch, frozen plasma)
isotonic crystalloid therapy

Front 391

What is the first line of defense? why?

Back 391

hypertonic saline bc it:
--transiently increases vascular volume
--suppresses degranulation of PMNS (which decr formation of ROS/reactive oxygen species and prevents respiratory burst)
--blocks nuclear transcription of inflamm cytokines

Front 392

what is the maximum amount of hypertonic saline that can be given to an average size horse?

Back 392

2L (must follow w/crystalloids for several hours)

Front 393

Why would you give Hetastarch?

What do you need to be careful of?

Back 393

higher COp than plasma
incr vascular volume (~24hrs)
plugs holes created along endothelium lining --> keeps fluid from leaking out

prolonged aPPT (incr bleeding tendencies)

Front 394

Why would you give frozen equine plasma?

Back 394

excellent source of:
--albumin
--oncotic pressure
--anti-endotoxemic and clotting factors

Front 395

TWO

Back 395

LAMINITIS PREVENTION

(oh please please please prevent this bc if you don't we'll all have to hear about how bad laminitis is AGAIN and I don't think I could stand it)

Front 396

Most successful if initiated when?

Back 396

PRIOR to development of c/s (any horse at risk should receive prophylactic care)

Front 397

What are the two types of prophylactic care for laminitis?

Back 397

cryotherapy and NSAIDS

Front 398

What are you trying to achieve with cryotherapy?

Back 398

50% reduction in metabolic rate w/10 degrees Celsius decrease in hoof temperature

timing of initiation and duration is CRITICAL for success

Front 399

T/F: crytherapy can be used before c/s of laminitis and once c/s begin

Back 399

false: it is NOT useful once signs appear

Front 400

How far up do you ice the foot?

Back 400

up to (and including?) the pastern

Front 401

What NSAID is usually used and what does it do?

Back 401

flunixin meglumine (Banamine)
-At low dose: prevents LPS-associated prostanoid prod'n, minimizes early response to endotoxin
-At higher dose: COX inhibitor, consistently provides excellent visceral analgesia

Front 402

What are the side effects of Banamine?

Back 402

deleterious effect: delays mucosal healing, renal and GI toxicity

Front 403

THREE

Back 403

REMOVAL OF CAUSE(S) OF ENDOTOXEMIA

(remove ischemic bowel or drain septic fluid from cavities)

Front 404

Broad spectrum ABx is warranted but must be used with caution in animals with what/

Back 404

diarrhea

Front 405

When do you use ABx?

Back 405

-horse is <3mos old (materal Ab prod'n waning)
-suspicion of Clostridial or antimicrobial-associated enteritis
-there is a degenerative left shift or PMN or lymphocyte count <1000
-there is clnical evidence of dyshemostasis (jug thrombosis or abnormal coagulogram)

Front 406

FOUR

Back 406

NEUTRALIZATION OF FREE CIRCULATING ENDOTOXIN

Front 407

What combination therapy can be used to neutralize endotoxin?

Back 407

plasma therapy
Polymyxin B

Front 408

At what point in the process do you want to catch the endotoxin?

Back 408

the first thing the endotoxin sees is the LBP so you want to get a hold of the endotoxin before LBP sees it and drags it into a cell

Front 409

What is Polymyxin B and what does it do?

Back 409

it is a cationic cyclic polypeptide antimicrobial drug

scavenges free endotoxin (inhibitory effects)
--suppress NF-K-beta activity
--decr prod'n of pro-inflammatory cytokines

Front 410

What do you need to make sure of when using Polymyxin B?

Possible side effects?

Back 410

make sure the horse is well hydrated (dilute in 1-5L of crystalloid)

renal toxicity

Front 411

FIVE

Back 411

INHIBITION OF ENDOTOXIN-MEDIATED INFLAMMATION

Front 412

What can be used to inhibit inflamm?

Back 412

2% lidocaine
NSAIDS
Pentoxifylline
DMSO
Ethyl pyruvate
Polymyxin B2

Front 413

What does lidocaine do?

how can it be given?

Back 413

anti-inflamm
analgesic
helps w/reperfusion injury

IV or CRI

Front 414

What happens when you combine lidocaine with Banamine?

Back 414

prevents retardation of mucosal healing (which is a bad effect of Banamine itself)

Front 415

name a methylxanthine derivative that can be used to inhibit inflamm

Back 415

pentoxifylline

Front 416

What does pentoxifylline do?

Back 416

-dose-dependent suppression of inflammatory cytokines
-Rheologic agent (deformation/bending of RBCs so they can reach smaller spaces and be of more use - aka foot/laminitis)
-inhibits TNF, promotes PGI2
-in vitro: stimulates IL-10, suppresses PMNs, inhibits NF-K-beta

Front 417

What does DMSO stand for?

Back 417

dimethyl sulfoxide

Front 418

what does DMSO do?

Back 418

free radical scavenger
anti-inflamm
osmotic
laminitis prophylaxis/tx (not proven)

Front 419

problem with DMSO

Back 419

can cause hemolysis
causes animals to stink

(relatively harmless as long as its diluted)

Front 420

What does Ethyl pyruvate do?

Back 420

prevents pro-inflammatory cytokine effects

still being researched

Front 421

What is the bottom line of endotoxemia treatment? (4)

Back 421

Recognize patients at risk of endotoxemia
Restore perfusion/oxygenation
Ameliorate clinical signs
Prevent laminitis

Front 422

LAMINITIS

Back 422

I'm really starting to hate this. Just shoot the horse and move on. NEXT!

Front 423

What is laminitis?

Back 423

the dz which causes degeneration, necrosis, and inflammatin of the dermal and epidermal laminae of the hoof wall in horses (simply put: inflamm of the lamina)

Front 424

What % of horses are likely to get laminitis?

Back 424

15%

Front 425

What is digital lamina and what does it do?

Back 425

interdigitations of sensitive and insensitive lamellae

holds P3 in close proximity to the hoof
acts as suspension mechanism

Front 426

Laminitis is more commonly in which foot?

Back 426

frontlimbs

Front 427

The laminar suspension mechanism depends on what?

Back 427

the maintenance of the cytoskeleton and integrity of the basement membrane

Front 428

How can laminitis be caused by endotoxemia/

Back 428

the lamina is considered a "vital organ" which is affected by the inflammatory mediators of endotoxemia

laminar inflammation is potentiated by SIRS (systemic inflammatory response syndrome)

Front 429

Laminar degeneration is initiated by what?

What is the pathogenesis?

Back 429

diseases that elaborate inflammatory mediators

mediators are cytotoxic to epidermal laminae --> activate MMPs --> lead to dissolution of sensitive/insensitive attachments --> laminar support system fails --> clinical laminitis

Front 430

Which is the sensitive laminae: dermal or epidermal tissue?

Which is the insensitive laminae?

Back 430

sensitive- dermal
insensitive- epidermal

Front 431

T/F: Disorders that decrease laminar energy delivery or protein synthesis have the potential to initiate laminar degeneration.

Why/why not?

Back 431

true

bc maintenance of the cytoskeleton is an energy dependent process

Front 432

What provides laminar energy?

Back 432

glucose

Front 433

Why are both Cushing's and Equine metabolic syndrome causes of laminitis?

Back 433

bc they cause insulin resistance, therefore glucose stays in the bloodstream and doesn't get into the tissues

Front 434

Swelling of the lamina can lead to what? Why?

Back 434

compartmental syndrome (squeezing) --> pressure necrosis (abscessation)

bc the lamina resides inside the rigid hoof wall

Front 435

When do the sensitive and insensitive laminae separate?

Back 435

hours before the onset of clinical signs

Front 436

What are the common risk factors of laminitis?

Back 436

Endotoxemia
Septic metritis
Contralateral limb laminitis
Dietary changes
Endocrinopathic laminitis
Black walnut toxicity

Front 437

Which is the primary risk factor for laminitis in the ICU?

Back 437

endotoxemia

Front 438

T/F: endotoxin alone does not cause laminitis

Back 438

true: the inflammatory cytokines produced in response to endotoxemia cause laminitis

Front 439

What causes septic metritis in the mare which can cause laminitis?

Back 439

retained placenta

Front 440

Contralateral limb laminitis is aka?

Back 440

Support limb laminitis - caused by bearing excess weight on a limb due to injury on the opposite limb

Front 441

What in the diet can cause laminitis?

Back 441

increased readily digestible CHO
grain overload (incomplete pre-cecal digestion, acid burn in the colon)
grazing lush spring grass (ponies, horses with EMS)

Front 442

What endocrinopathies can cause lamintis?

Why?

Back 442

Equine Cushing's dz (aka Pars Pituitary Intermedia Dysfunction)
Equine Metabolic Syndrome
Insulin resistance (impaired glucose utilization, glucocorticoid excess)
Inflammatory upregulation
Hyperinsulinemia

cannot take up insulin

Front 443

What are the main c/s of acute laminitis?

Back 443

bounding digital pulses
heat in hoof capsules (cool the feet, want them body temperature not hot)
coronary band edema/cleft ("sinking" bc laminitis has fully detached)
Shifting weight

Front 444

Other random c/s of acute laminitis

Back 444

refusal to pick up feet
reluctant to walk/turn small circles
PAIN (tachycardia/pnea, anorexia, depression)
lameness score = Obel grade 3

Front 445

What does a lameness score of Obel grade 3 mean?

Back 445

the horse moves very reluctantly and vigorously resists attempts to have a foot lifted

Front 446

When do structural changes associated w/laminar destruction begin?

Back 446

hours before signs apparent

Front 447

T/F: the death of cells/separation of sensitive and insensitive laminae can be seen right away on a radiograph

Back 447

false: cannot be visualized initially

Front 448

What should acute radiographs be used for?

Back 448

a baseline for what the hoof should look like

Front 449

**What may be the only indicator of laminar inflammation on a radiograph?

Back 449

thickening of the dorsal hoof wall

Front 450

What can be seen on radiographs of P3? Where should the coffin joint be?

Back 450

rotation, sinking

coffin joint should be even with the coronary band - if it's not = sinking

Front 451

How should laminitis radiographs be taken?

Back 451

later films with hoof on a block (want to know the depth of the sole

Front 452

What % can the coffin bone be rotated, yet it still be considered normal?

Back 452

0-5% (any more = rotation)

Front 453

Where will the foot be sensitive with hoof testers?

Back 453

toe

Front 454

T/F: a digital nerve block can dx chronic laminitis

Back 454

unsure (ha!) - it can be used to help diagnose, but it will only block the heel of the hoof

Front 455

Which nerve block is better?

Back 455

abaxial nerve block (75-80% improvement bc it blocks the toe)

Front 456

What is the key to tx of laminitis?

Back 456

prophylactic therapy!!

Front 457

the acute phase of laminitis is considered what?

Back 457

a medical emergency!

Front 458

What 3 things can be done for prophylactic therapy for laminitis?

Back 458

cryotherapy
anti-inflammatory therapy
sole support

Front 459

Which 2 NSAIDS are used for prophylactic therapy? What do you need to make sure of?

Back 459

Banamine and Phenylbutazone

avoid IM injection bc it causes inflammation, abscess, and clostridium infections

Front 460

How would shoe removal help prophylactically with laminitis?

Back 460

promotes digital circulation and allow horse to stand as it wants
reduces tension on the laminae

(deep bedding in stall also helps)

Front 461

If c/s of laminitis appears, then what?

Back 461

multimodal therapy!!

Front 462

What can be used for pain management? (8 possibilities)

Back 462

NSAIDS
Opioids (butorphanol CRI, morphine, fentanyl patch)
Alpha2-agonists (detomidine CRI)
2% lidocaine
Ketamine
Gabapentin (chronic)
Regional anesthesia
Epidural

Front 463

what can be used for sole support?

Back 463

stryofoam cushion
commercially available products (reprosil, advance cushion support)

Front 464

What type of bedding should be used?

Back 464

deep- deep sand, peat moss

Front 465

What other therapies can be used?

Back 465

DMSO- osmotic, free radical scavenger
Pentoxifylline- reduces prod'n of cytokines, thromboxanes, and expression of TNF

Front 466

How about exercise?

Back 466

strict stall rest - no forced exercise for at least 1 month once NSAIDS are discontinued (not even walked around the stall)

Front 467

What causes the chronic lameness from chronic laminitis?

Back 467

abnormal hoof conformation

Front 468

What does the hoof look like w/chronic laminitis?

Back 468

misshapen
growth at toe (ski/slipper shoes)
lack of growth at heel
growth rings prominent and not parallel
sole flattened

Front 469

What do you see on rads with chronic laminitis?

Back 469

osteomyelitis
deformation of P3

(remember: acute laminitis = normal radiographs)

Front 470

With chronic laminitis, why is there chronic pain?

Back 470

recurring abscessation
hoof cracks and chips
tendency toward sole bruising --> abscesses

Front 471

What is the classic sign of chronic laminitis?

Back 471

pedal osteitis

Front 472

When is a venogram useful?

Back 472

when rads are normal but horse remains sore (evaluates sinking/loss of blood supply)

(inject contrast into foot to see what's going on with blood supply)

Front 473

How would you decr stress on the DDF?

Back 473

tenotomy
easy breakover- decr toe length (cut off the fulcrum), wedge heel up --> makes it easier to walk bc don't have to lift foot as high

Front 474

What are two other therapies you can use?

Back 474

groove coronary band to stimulate growth (promote normal growth rings
maggot debridement therapy

Front 475

What is the most you are hoping for with derotation of the coffin bone?

How do you do this?

Back 475

pasture soundness

shape the foot around the coffin bone (chop off the heel)

Front 476

What is the prognosis if rotation occurs?

Back 476

guarded for return to previous level of exercise

Front 477

What is the prognosis for sinkers?

Back 477

very poor

Front 478

T/F: without rotation and sinking, horses may still experience prolonged alteration of hoof growth w/a tendency toward cracking, sole bruising, etc that can lead to recurrent lameness

Back 478

true

Front 479

Remember: LAMINITIS IS FOR LIFE

Back 479

You can't get rid of it. Ever. It's like a bloodsucking leech.

Front 480

GI

Back 480

*sob*

Front 481

T/F: the duodenum is short, a little > 1meter

Back 481

false: it's a little < 1meter

Front 482

T/F: pancreatitis is rare in a horse

Back 482

true (amylase and lipase are rarely measured)

Front 483

What is the surgical landmark that runs along the whole small intestines?

Back 483

the duodenal-colic ligament

Front 484

How long is the jejunum? Is it thick or thin walled?

Back 484

long - 25 meters
thin walled

Front 485

How long is the ileum? What dose it have that makes it distinguishable among the intestines?

Back 485

1-3 meters

antimesenteric band

Front 486

T/F: the ileum is more muscular than the rest of the SI

Back 486

true

Front 487

T/F: there is a dual blood supply to the ileum and the cecum

Back 487

false: there is a single blood supply

Front 488

What is the first structure visualized w/a ventral midline incision?

Back 488

the cecum

Front 489

What part?

Back 489

the body

Front 490

What is the lateral band of the cecum called? What does it attach?

Back 490

the cecocolic fold

attached the cecum to the lateral free band of right ventral colon

Front 491

How many bands does the cecum have?

Back 491

4

Front 492

Which band(s) hold the blood supply

Back 492

the lateral and medial bands

Front 493

What is the lateral band continuous with?

Back 493

the cecocolic fold

Front 494

Which band is continuous with the ileocecal fold?

Back 494

the dorsal band

Front 495

How far do the bands go?

Back 495

only halfway to the apex

Front 496

T/F: the sternal flexure is not fixed to the abdomen unlike the right dorsal and ventral colons

Back 496

false: the PELVIC flexure is not fixed to the abdomen

Front 497

How many bands does the pelvic flexure have?

Back 497

1

Front 498

how many bands does the dorsal colon have?

Back 498

3

Front 499

Where can the colon get hung up and may need to be rolled?

Back 499

nephrosplenic ligament

Front 500

T/F: sacculations are everywhere in the colon, except for the ventral colon

Back 500

false: sacculations are everything except for the DORSAL colon (smooth)

Front 501

Where are fecal balls made?

Back 501

SI

Front 502

which part of the intestine has more mesenteric fat?

Back 502

SI

Front 503

T/F: the stomach is relatively large for the size of a horse

Back 503

false: it's relatively small

Front 504

T/F: not all colic is GI

Back 504

true

Front 505

List some c/s of colic (10)

Back 505

kicking at belly
pawing
laying down
looking at sides
curling lip
playing in water
grinding teeth
refusing feed
change in attitude
decr fecal output

Front 506

What will you see in a severe, acute case of colic?

Back 506

down and rolling or evidence horse has rolled
breathing ahrd
sweating
abdominal distention (bloat)

Front 507

Why could you see dysphagia w/GI dz?

Back 507

CrNN IX and X run through the guttural pouch

Front 508

rectal tears will most likely be in which part: dorsal or ventral?

Back 508

dorsal

Front 509

What alpha2s should most likely be used for chemical restraint?

Back 509

xylazine/detomidine

Front 510

Why are parasympatholytics good for chemical restraint for rectal palpation?

Back 510

they decr GI motility and rectal pressure

Front 511

T/F: you can commonly palpate the duodenum on rectal palpation

Back 511

false: can rarely be palpated

Front 512

What portion of the LI is your arm in during rectal palpation? What can you palpate rectally?

Back 512

arm is in the small colon (lg antimesenteric band)
aorta, left kidney, and caudal border of the spleen
dorsal colon and pelvic flexure
cecum on right
ventral cecal band (strumming thick cord; dilated = huge structure on right)

Front 513

T/F: you, as the vet, are liable for all damages incurred during rectal palpation (tearing)

Back 513

false: if proper protocol and proper education to the client are done, you are not liable for rectal tearing

Front 514

How is rectal tearing classified?

Back 514

grades I-IV

Front 515

Which horses are predisposed to rectal tears?

Back 515

old horses, minihorses, arabians (stupid arabians, always messing shit up...tee hee)

Front 516

What do you avoid when sedating a horse? Why?

Back 516

Acepromazine

decr BP

Front 517

how do you knwo if a caudal epidural worked?

Back 517

tail tone is gone

Front 518

how do you prevent rectal tearing from progressing?

Back 518

rectal tampon
purse-string suture the anus

Front 519

Where do you apply the rectal tampon?

Back 519

10cm cranial to the tail

Front 520

What is a grade I rectal tear?

Back 520

mucosa and submucosa tear

simple, almost all survive

most exam tears are grade I

Front 521

What is a grade II rectal tear?

Back 521

muscularis tear only

no blood
incr level of survival

Front 522

What do you tx a grade I tear with?

Back 522

medical management = success
Abx (TMS)
NSAIDS (Banamine)
daily laxatives
pelleted diet - softenef
monitor for fever, LPS, dyschezia

Front 523

How do you manage a grade II tear?

Back 523

no tx necessary - can be incidental finding
can predispose to rectal impactions
can progress to grade IV

Front 524

What is a grade III rectal tear?

What is a grade IIIa tear? IIIb?

Back 524

all layers except serosa tear

IIIa- torn outside of mesocolon/mesorectum

IIIb- ruptures into retroperitoneal space - can easily become grade IV tear

Front 525

What is a grade IV rectal tear?

Back 525

full thickness tear

feces in abdomen

Front 526

Which tear(s) is/are life threatening?

Back 526

grades III & IV

Front 527

What do you do for a grade III tear?

Back 527

tx as for grade I
incl IV antomicrobials (penicillin, metronidazole)
anti-endotoxemic tx
tetanus prophylaxis
rectal packing
**peritoneal paracentesis (RBC count, TP, fluid visualization)

Front 528

What do you do for a grade IV tear?

Back 528

usual fatal bc of overwhelming fecal contamination of the abdomen
few reports of survival
euthanasia

Front 529

Medical vs surgical management of rectal tears: what are the 3 options?

Back 529

abdominal lavage
rectal lines
loop colostomy

Front 530

What do you need to be careful of when doing a peritoneal paracentesis?

Back 530

spleen

Front 531

What does normal peritoneal fluid look like?

Back 531

clear transudate
straw to yellow color
TP < 2g/dl
WBC < 5000

Front 532

What does abnormal abdominal fluid look like and what does it mean?

Back 532

serosanguinous- bowel devitalization, splenic puncture, SQ blood vessel
green fluid- entercentesis, bowel rupture
thick orange fluid- peritonitis

Front 533

What does septic peritoneal fluid look like/have? why?

Back 533

glucose < 50 points lower than that of serum blood glucose
elevated lactate
very low pH

when bacteria are present they metabolize glucose and produce lactate as a metabolic by-product, thereby lowering the pH of peritoneal fluid

Front 534

What is the normal glucose in serum blood gas?

normal lactate?

normal pH?

Back 534

glucose: 80-100 mg/dl

lactate < 1mmol/L

pH = physiologic 7.4

Front 535

What can occur during laproscopy

Back 535

acid/base abnormalities (pump CO2 into abdomen and put pressure on the diaphragm??)

Front 536

What can you CT/MRI in a horse?

Back 536

limbs and head only

Front 537

T/F: abdominal U/S is an invasive but routine part of GI evaluation that requires an alcohol interface

Back 537

false: is it a routine part of GI evaluation that requires an alcohol interface, but it's NONinvasive

Front 538

On U/S, what does fluid look like? bone?

Back 538

fluid = black (anechoic)
bone = white (hyperechoic)

Front 539

Where will you find the stomach?

Back 539

left side
9-13ICS

Front 540

Where will you find the duodenum?

Back 540

right side of abdomen
ventral to caudal pole of the right kidney
caudal to liver

Front 541

T/F: when looking at an U/S of the SI, lollipop formation ("bubbles") is a normal finding

Back 541

false: it's BAAAADD - means the SI is dilated

Front 542

From which side do you visualize the LI and cecum with an U/S?

Back 542

right and left body wall, ventrum

Front 543

What will you see?

Back 543

sacculations
very large diameter
obscures visceral organs (U/S bea,s cannot penetrate gas or bones)

Front 544

T/F: scintigraphy is a good diagnostic tool for the SI

Back 544

false: not very good for GI but great for orthopedics

Front 545

When can you do a full-thickness biopsy?

Back 545

ventral midline celiotomy
laparoscopy

Front 546

when can you do a mucosal biopsy?

Back 546

endoscopy (upper GI only)
rectal mucosal biopsy

Front 547

If you get a fecal float that is negative for sand, can you rule out a sand impaction?

Back 547

no

Front 548

When are absorption tests used? how do they work?

Back 548

use in chronic weight loss

18-24hr fast --> administer 10% soln D-xylose or D-glucose --> take blood samples --> plot curve

Front 549

What should a normal result be? What does it mean is the results are abnormal?

Back 549

peak "inverted V" between 60-120 minutes

almost straight line = not absorbing glucose

Front 550

Is gastric reflux normal on a horse?

Back 550

NO

Front 551

When passing a stomach tube, how can you be sure the tube is in the esophagus and not the trachea?

Back 551

visually observe tube passing down esophagus (left neck)
negative pressure when inhale back on tube
auscult gas bubbles in stomach when air is forced into tube
palpation only works on foals (not adults)

Front 552

ESOPHAGUS

Back 552

...yeah, i've got nothing.

Front 553

what is the most common c/s for esophageal dz?

Back 553

ptyalism/hypersalivation

Front 554

What cranial nerves control mastication?

Back 554

V, VII, XII

Front 555

Which cranial nerves control swallowing?

Back 555

V, IX, X

Front 556

T/F: dysphagia could be caused by guttural pouch dz

Back 556

true (some of the cranial nerves run through there)

Front 557

what is dysphagia>

Back 557

difficulty swallowing

Front 558

Ptyalism can be caused by what?

Back 558

dysphagia
oral davity pain
poor dental health

Front 559

how does a horse get "slobbers?" What does it cause?

Back 559

eating clover

causes salivation (but it's not pathogenic)

Front 560

When should you consider the esophagus for dz?

Back 560

when you can:
--confirm good oral health
--confirm guttural pouch health
--confirm integrity of Cn function

Front 561

Choke aka...

Back 561

esophageal obstruction

Front 562

What are the most common sites for eso obstruction?

Back 562

pharynx
caudal 3rd of the eso
apex of the heart
eso hiatus

Front 563

what are the acute symptoms/c/s of choke?

Back 563

frothy nasal discharge
feed from nostrils
ptyalism
gagging/retching
coughing
colic

Front 564

With choke, how should the horse be positioned when sedating and why?

Back 564

head lower than point of the shoulder to prevent aspiration

Front 565

What can be used to sedation/relax the eso for choke?

Back 565

Bucospan (N-butylscopolammonium bromide) - parasympatholytic
xylazine
oxytocin (promotes eso relaxation)

Front 566

What do you do after choke is confirmed?

Back 566

pass an NG tube --. pump water while gently applying pressure to obstruction --> keep horse's head low as long of fluid will come out the nose (prevent aspiration) --> repeat

Front 567

What do you do if that is unsuccessful?

Back 567

place horse in stall, NPO, IV fluids, and give it TIME (it will likely resolve on its own) (replace bicarb and e-lytes bc losing saliva)

Front 568

You can use NSAIDS for prolonged choke, but what is the problem with using Banamine?

Back 568

it can disrupt mucosal healing, though it is helpful initially

Front 569

What would sulcralfate do?

Back 569

promote healing of eso

Front 570

What is a complication of choke?

Back 570

stricture

Front 571

What is the first c/s of aspiration pneumonia?

Back 571

fever

Front 572

how do you tx aspiration pneumonia?

Back 572

broad spectrum ABx
IV therapy (esp if still obstructed)
Oral TMS when choke is over

Front 573

T/F: circumferential lesions heal better than linear?

Back 573

false: linear heal better than circumferential

Front 574

The stricture is the smallest at what point?

Back 574

between 21 & 28 days

Front 575

Eso rupture is also a complication is choke. What breed does this occur in mostly? Where does it usually tear? What will you find

Back 575

Friesans

intrathoracic tear

pleural fluid accumulation

Front 576

What do you need to consider nutritionally with choke?

Back 576

refeeding (eso inflamed, motility may be abnormal, reobstruction is LIKELY)
modify diet (feed mash, soft hays)

Front 577

What is diet change isn't enough?

Back 577

esophagotomy (done easily in horses when standing)
--done on the LEFT side

Front 578

What can cause a motility dysfunction of the esophagus?

Back 578

megaesophagus

Front 579

What should be considered with megaesophagus?

Back 579

acquired vs congenital
functional obstruction (c/s of choke)
R/O underlying myopathy
tx underlying dx, dietary modifications

Front 580

what is the prognosis for megaeso?

Back 580

poor if it is congenital

Front 581

STOMACH

Back 581

Rollin', rollin', rollin', Keep that ingesta rollin'.. Get 'em up, move 'em out!

Front 582

T/F: glandular mucosa has limited defenses against gastric acid

Back 582

false: SQUAMOUS mucosa has limited defenses against gastric acid

Front 583

Where is the forage ball and what does it do?

Back 583

in the lower half of the stomach and it protects the squamous epithelium from exposure to HCL and bil acids

Front 584

Which parts of the stomach has the squamous mucosa?

Back 584

upper half

Front 585

Lesions in the squamous mucosa are most common with what?

Back 585

decr feed intake or limited forage

Front 586

What defenses does the glandular mucosa of the lower stomach have against gastric acid?

Back 586

mucus barriers and bicarb secretion
rapid regeneration and repair (higher rate than sq cells)

Front 587

What neutralizes HCL?

Back 587

reflux of duodenal secretions (pancreas/hepatocytes)

Front 588

EGUS

Back 588

...sounds like the name of a retarded gremlin

but it really stands for Equine Gastric Ulcer Syndrome

Front 589

What is the term EGUS used for?

Back 589

term for clinical finding of ulcers in the equine stomach

Front 590

Where in the stomach are the ulcers found?

Back 590

erosions/ulcers of sq epithelium along the margoplicatus
lesions in glandular mucosa and pylorus +/- duodenitis

Front 591

Which breeds have a high prevalence for gfastric ulcers?

Back 591

performance breeds (ex thoroughbreds)

Front 592

Name the risk factors for EGUS

Back 592

foals/weanlings
housing in stalls vs pasture
stress
high CHO diets
incr intensity exercise
NSAID use
helicobacter pylori

Front 593

c/s of EGUS in adults

Back 593

mild intermittent colic (coincides with meals)
dexr appetite
failure to finish grain
loss of body condition
poor hair coat
alterations in attitude

Front 594

Where do foals get EGUS?

Back 594

glandular portion of the stomach

Front 595

What are the risk factors for foals?

Back 595

hypoxemia
NSAID administration
hospitalization
STRESS

Front 596

c/s of EGUS in foals

Back 596

mild --> severe pain
bruxism (teeth grinding)/ptyalism

Front 597

What can be used to help dx EGUS?

Back 597

gastroscopy
duodenoscopy

Front 598

What can prostaglandins do to help?

Back 598

good for mucosa blood flow and cytoprotective barrier

Front 599

**T/F: there is no correlation between the presence of squamous and glandular lesions

Back 599

true

Front 600

D/Dx for EGUS

Back 600

gastric impaction
gastric neoplasia

**Remember your signalment!

Front 601

if endoscopy is not available, what else can be diagnostic?

Back 601

response to therapy
--improvement in attitude
--weight gain
--resolution of colic
--improved coat condition

Front 602

How do you tx EGUS in adults?

Back 602

decr concentrate, incr roughage
H2 receptor antagonists (Cimetidine, Ranitidine)
H+ pump inhibitors (omeprazole)
Sucralfate

Front 603

T/F: Regardless of previous risk factors, ulcer dz may develop w.i 24 hours of inappetance/stall rest

Back 603

true

Front 604

How do you treat pyloric dz?

Back 604

may require prolonged therapy
dietary modifications
prophylactic anti-ulcer therapy

Front 605

T/F: squamous ulcer dz is more difficult than pyloric dz

Back 605

false; pyloric dz is more difficult

Front 606

GENERAL SI

Back 606

...yup, still fried

Front 607

What does the Si do?

Back 607

absorption of nutrients
absorption of CHO, fat, proteins

Front 608

What does the Si have that allows for all the absorption? what happens if it fails?

Back 608

brush border created by SI villi

failure of absorption by the villous tip leads to malabsorption syndrome

Front 609

**What is the hallmark of malabsorption?

Back 609

weight loss

Front 610

What are the c/s of acute enteritis?

Back 610

COLIC!! - #1 sign
functional obstruction (tract is patent but things are keeping it from moving)
*dilated loops of SI on U/S
copious gastric reflux (in stomach, not thru nose)
*rectal palpation many loops of SI
incr Tp in peritoneal fluid

Front 611

What are the c/s of chronic enteritis?

Back 611

WEIGHT LOSS - #1 sign
+/- colic
*thickened SI walls on U/S (compare to acute)

Front 612

IBD!!

Back 612

INFLAMMATORY BOWEL DISEASE

Front 613

T/F: It is uncommon for IBD to cause diarrhea

Back 613

true

Front 614

what are the 5 types of IBD?

Back 614

Granulomatous enteritis
Multisystemic eosinophilic epitheliotropic enterocolitis
Lymphocytic-plasmacytic enteritis
Eosinophilic enterocolitis
Idiopathic Focal Eosinophilic enteritis

Front 615

In horses, IBd is typically defined by what?

Back 615

granulocytic cells (other than PMNs)
--eosinophils
--MO
--lymphocytes

Front 616

How do you dx IBD?

Back 616

biopsy is the gold standard

histopath needed to differentiate types

Front 617

c/s of IBD

Back 617

progressive weight loss despite good appetite
protein-losing enteropathy (hypoalbuminemia in absence of proteinuria or liver dz)
lethargy
intermittent colic
NOT diarrhea (SI dz)

Front 618

What will you see on U/S with IBD?

Back 618

incr SI wall thickness

Front 619

what is used to perform an absorption test and why?

Back 619

xylose bc it is one of the only things that cannot be elevated due to anything other than absorption

absorption test should have an inverted V shape - straight ling across means no absorption (I THINK!!)

Front 620

How do you tx IBD?

Back 620

immunosuppressive doses of corticosteroids but it's largely unsuccessful

Front 621

Signalment for granulomatous enteritis (GE)

Back 621

toung horses
standardbreds are genetically predisposed

Front 622

What do you see on histopath for GE?

Back 622

Macrophages (MOs) bc "granulomatous"

Front 623

What are the possible causes of GE?

Back 623

several infectious agents have been implicated incl M avium
possibly immune-mediated response to dietary, parasitic, or bacterial antigens

Front 624

Where do you see multisystemic eosinophilic epitheliotropic enterocolitis (MEED)?

Back 624

young horses

Front 625

What do you see with MEED?

Back 625

dermatitis
diarrhea
tissue eosinophilia
(some lymphs and MOs)

Front 626

MEED is one of the only dzs where you'll see what?

Back 626

eosinophils in the periphery

Front 627

Lymphocytic-plasmacytic enterocolitis (LPE) is what?

Back 627

rare

Front 628

What will you see on histo with LPE?

Back 628

lymphocytes and plasma cells present in the lamina propria w/villous atrophy

Front 629

C/S of LPE

how do you dx?

Back 629

malabsorption

rectal biopsy

Front 630

T/F: horses w/idiopathic focal eosinophilic enteritis (IFEE) vary from typical IBD cases bc they present with signs of acute colic and no evidence PLE

Back 630

true

Front 631

What is therapeutic for IFEE?

Back 631

surgical decompression

Front 632

What causes proliferative enteropathy?

Back 632

Lawsonia intracellularis (infectious)

Front 633

T/F: L intracellularis usually present as a herd problem

Back 633

false: usually individual cases

Front 634

What cells does L intracellularis affect?

Back 634

crypts

Front 635

What is L intracellularis?

How do you get it?

What age is affected?

Back 635

obligate intracellular bacterium

fecal-oral

weanling foals (4-6mos)

Front 636

What are the risk factors for L intracellularis?

Back 636

overcrowding
dietary changes
transpot
weaning

Front 637

**Hallmark of L intracellularis

Back 637

chronic wasting

Front 638

what else do you see with L intracellularis?

Back 638

severe hypoproteinemia
grossly thickened SI w/mucosal ulceration (corrugate appearance)

Front 639

It's affinity for crypt cells has what effect?

Back 639

leads to decr brush border enzyme activity --> decr absorptive capacity
weight loss
malabsorptive diarrhea
hypoproteinemia

Front 640

c/s of L intracellularis

Back 640

ill thrift (growth retardation, poor hair coat, pot bellied, muclsa thickening/villous atrophy)
peripheral edema (hypoproteinemic)
diarrhea (inappropriate absorption of nutrients, soft formed, black and tarry feces)
colic

Front 641

What will bloodwork show?

Back 641

moderate --> severe hypoproteinemia
mild anemia
hyperfibrinogenemia
neutrophilic leukocytosis
prerenal azotemia/e-lyte imbalances may be assoc w/diarrhea

Front 642

How do you dx L intracellularis?

Back 642

gold standard: isolation/culture from tissue (VERY DIFFICULT)
--warthin starry silver stain

biopsy required antemortem

Front 643

How do you tx L intracellularis?

Back 643

supportive care
antimicrobials (tetracyclines, macrolides (esp erythromycin or azithromycin combined w/rifampin)

Front 644

prognosis for L intracellularis

Back 644

good ~93%

foals w/clinical dz suffer poor growth and small stature

Front 645

What is Duodenitis-proximal jejunitis (DPJ)?

Back 645

an anterior enteritis of potentially infectious etiology

a syndrome of inflamm and edema of the duodenum and prox jejunum, excessive fluid and e-lyte secretion into the SI and consequently, high volumes of enterogastric reflux

Front 646

What can you see with DPJ?

Back 646

SI distention
copious reflux
abdominal pain

functional gastric ileus (no mechanical/physical obstruction to flow of ingesta)

Front 647

Where does the reflux come from?

Back 647

SI distention

Front 648

Where does the accumulated fluid come from?

Back 648

-augmented pancreatic and biliary secretions
-bacterial/inflammatory/toxin-mediated secretion
-progressively incr intraluminal pressure (reduced fluid absorption, incr secretion) --> results in abnormal peritoneal fluid TP
-parotid saliva

Front 649

What is the cause of DPJ?

Back 649

idiopathic

true cause remains unknown but suspected inflamm syndrome (salmonella, clostridium, neorickettsia risticii)

Front 650

Where are the gross lesions primarily found?

Back 650

duodenum

Front 651

T/F: Serositis is a common finding in DPJ

Back 651

true: bright red to dark red petechial and ecchymotic hemorrhages on the serosal surface of the proximal SI

Front 652

What will you find on histpath?

Back 652

hyperemia, edema, hemorrhage, fibrinopurulent serosal exudation (fibrin being laid down in sedentary bowel)D

Front 653

How do you definitely dx?

Back 653

surgery or nrcropsy

Front 654

D/dx of DPJ

Back 654

all SI obstructions (simple or strangulating)

Front 655

When would DPJ NOT require medical therapy?

Back 655

clinical deterioration/failure to improve

Front 656

What will you find on rectal exam of DPJ?

on U/S?

Back 656

dilated loops of SI (many loops, fluid filled and palpable)

U/S: large dilated SI loops, fluid-filled, poor motility, incr wall thickness

Front 657

What would make it a surgical lesion?

Back 657

tight, turgid, distended

Front 658

what would you find on abdominocentesis?

Back 658

dark yellow/orange
incr protein (>2.5g/dl)
normal to elevated WBC

Front 659

What is the primary therapy for DPJ?

Back 659

gastric decompression (indwelling stomach tube)

monitor ins and outs

Front 660

T/F: fluid replacement is critical with DPJ

Back 660

true: IV required, monitor e-lyte status, hydration, and body weight

Front 661

Tx for DPJ

Back 661

anti-inflamms (NSAIDS or lidocaine)
prokinetic therapy (metoclopramide, bethanecol, erythromycin)
+/-antimicrobials
nutritional support (NPO >72 hours)
laminitis prophylaxis (endotoxemia!!)

Front 662

What are some possible complications of DPJ?

Back 662

laminitis
thrombophlebitis
adhesion formation
peritonitis
pharyngitis/esophagitis (can lead to eso rupture)
cardiac arrhythmias
EXPENSE

Front 663

SMALL INTESTINE

Back 663

OBSTRUCTION vs STRANGULATION

(duh duh DUUUUUHHHHH!!)

Front 664

What is obstruction?

Back 664

something that's in the lumen that plugs it

mechanical obstruction
luminal obstruction impeded flow of ingesta but NO interruption of blood flow
NON-STRANGULATING

Front 665

What is strangulation?

Back 665

something from outside the lumen that also cuts off blood supply

mechanical obstruction
occlusion from serosal surface
both lumen and blood supply interrupted
could result in devitalized bowel --> endotoxemia, hemoconcentration, dehydration

Front 666

c/s of obstruction

Back 666

mild --> moderate pain
good response to analgesia
minimal CV compromise
peritoneal fluid WNL
+/- gastric reflux
+/- need to surgery

Front 667

c/s of strangulation

Back 667

mild, moderate, or severe pain
only brief response to analgesia
CV deterioration (endotoxemia, hemoconcentration, dehydration)
peritoneal fluid abnormal
+/- gastric reflux
SURGICAL EMERGENCY

Front 668

what can cause obstruction in the SI of a horse?

Back 668

ascarid impaction (roundworm)
ileal impaction

Front 669

NON-STRANGULATING OBSTRUCTIONS

Back 669

almost done almost done almost done...shit, there's another packet.

Front 670

what is the name of the equine roundworm?

Back 670

Parascaris equorum

Front 671

What is the signalment for horses with roundworm?

Back 671

foals/weanlings
typically <1yr bc resistance at ~18-24 mos
affects foals w/poor deworming hx

Front 672

How do the worms cause colic?

Back 672

adult worms live in lumen of SI tract

if there is a heavy burden, deworming can cause all the worms to die and obstruct the lumen

Front 673

C/S of roundworm impaction

Back 673

colic
depression
endotoxemia
tachycardia/pnea
fever
gastric reflux (worms!!)

Front 674

How do you dx roundworm impaction?

Back 674

abdominal U/S
nasogastric fluid
peritoneal fluid
FEC

Front 675

how do you tx roundworm impactions?

Back 675

gastric decompression/lavage
anti-inflamm therapy
surgery- worms are toxic and damage wall of SI so necrosis/bowel rupture is not uncommone

Front 676

Prognosis for roundworm impaction

Back 676

guarded due to severe inflamm resposne triggered by the death of the adult worms
medical resolution for impaction has a more favorable prognosis than surgical

Front 677

When should you first deworm a horse?

Back 677

~60 days (repeat 2-4 months after)

Front 678

What are the roundworms resistant to?

Back 678

Ivermectin

Front 679

What is the best choice for prevention of roundworms?

Back 679

benzimidazoles

Front 680

Best antihelmintic depends on what?

Back 680

farm sensitivities and FEC

Front 681

How would you treat a foal who is suspected to have a very large worm burden?

Back 681

use a less effective antihelmintic to reduce mass killing and possibly avoiding the risk of obstruction

Front 682

ILEAL IMPACTION

Back 682

...

Front 683

What is this caused by/

Back 683

coastal bermuda grass

Front 684

When can you feel the ileus on rectal palpation

Back 684

early in dz

Front 685

T/F: peritoneal fluid will be normal

Back 685

true bc it's nonstrangulating

Front 686

can the impaction resolve w/o tx?

Back 686

possible - natural motility may resolve it (myenteric plexus)

Front 687

Early tx

Back 687

analgesia, IV fluids, mineral oil ?

monitor vitals closely
monitor for escalation of pain

Front 688

Late tx

Back 688

gastric decompression

+/- surgery
pain
deterioration in peritoneal fluid

Front 689

prognosis for ileal impaction

Back 689

good, though postoperative ileus is a risk (distention of bowel, inflammation)

Front 690

How do you prevent ileal impaction?

Back 690

avoid coastal bermuda grass
course fibrous feeds
proper deworming (tapeworms sometimes perturb ileal motility)

Front 691

STRANGULATING DZS

Back 691

And the question is "things we're like to do to most of the people on this island..."

Front 692

What can cause strangulation of the SI?

Back 692

intussusception
Si volvulus
abdominal incarceration (epiploic foramen entrapment, mesenteric rent, gastrosplenic ligament, inguinal ring hernia)
pedunculated lipoma

Front 693

INTUSSUSCEPTION

Back 693

...

Front 694

What are the types of intussusception? (3) Which is most common?

Back 694

jejuno-jejuno
jejuno-ileal
*ileo-cecal - most common
(ceco-colic)

Front 695

How does an intussusception work?

Back 695

oral segment (intussusceptum) invaginated into aboral segment (intussusceptiens) towards the rectum --> telescoping bowel obstructs the flow of ingesta --> oral segment becomes distended

Front 696

T/F: intussusception may involve any portion of the GI tract

Back 696

true

Front 697

intussusceptions are most common in what age/

Back 697

young (<3yrs)
foals and weanlings

Front 698

What can cause intussusception/

Back 698

deworming, abrupt dietary changes, GI parasitism

Front 699

What type of intussusception do ascarids like to cause?

Back 699

jejuno-jejuno intussusception

Front 700

What type of intussusception do tapeworms like the cause?

Back 700

ileocecal and ileocolic intussusceptions

Front 701

intussusception are usually acute or chronic?

Back 701

acute (chronic in rare cases)

Front 702

What will you find on rectal exam?

Back 702

dilated SI

Front 703

What will you see on U/S?

Back 703

target lesion/bulls-eye

Front 704

T/F: peritoneal fluid will be normal

Back 704

false: it will be abnormal bc blood supple is strangulated by the intussusception itself

Front 705

Tx of intussusception

Back 705

resection and anastomosis

Front 706

T/F: You can pull an intussusception apart in sx and it be fine

Back 706

FALSE!!!! bc it WILL happen again

Front 707

Prognosis of a simple intussusception

Back 707

good

Front 708

prognosis of ileocecal intussusception

Back 708

guarded bc the devitalized ileum must be resected and a jejunocecostomy is required

will get necrosis of ileal stump

Front 709

What type of worm can cause intussusception?

Back 709

tapeworm (Anoplocephala perfoliata)

Front 710

Where dose this worm like to be?

Back 710

affinity for ileum/cecum

ileocecal intussusception
cecocolic intussusception

You will see NO proglottids in the feces

Front 711

How do you dx tapeworm intussusception?

Back 711

U/S, poor deworming hx

Front 712

How do you prevent tapeworm intussusception?

Back 712

praziquantel

Front 713

T/F: horses can live w/o the cecum bc the colon can pick up enough slack

Back 713

true

Front 714

SMALL INTESTINAL VOLVULUS

Back 714

...

Front 715

Where does the Si twist?

Back 715

root of the mesentery (complete interruption of intestinal blood supply)

Front 716

This is a common cause of colic in what age?

Back 716

young foals

Front 717

T/F: SIV can be caused by GI parasitism

Back 717

true

Front 718

It is really really bad if which artery twists?

Back 718

cranial mesenteric artery bc all of the SI is supplied by it

Front 719

c/s of SIV

Back 719

colid
gastric reflux
poor tissue perfusion
endotoxemia
absent borborygmi
distended SI onr ectal
serisanguinous peritoneal fluid (incr WBC, incr TP, metabolic acidosis --> prod'n of lactate)

Front 720

Tx of SIV

Back 720

surgical intervention

Front 721

How much of the Si can be resected?

Back 721

</= 50%

Front 722

Why can't you resect > 50%?

Back 722

short bowel syndrome

Front 723

INCARCERATION OF SI WITHIN ABDOMEN

Back 723

Bowel may pass through a mesenteric rent,m inguinal ring, the gastrosplenic ligament, or the epiploic foramen

Front 724

T/F: mesenteric rents are often iatrogenic

Back 724

false: they're often idiopathic (blunt abdominal trauma or accident)

Front 725

Inguinal hernias occur in whom?

Back 725

stallions (must always palpate scrotum!!!)

Front 726

The gastroplenic ligament is what?

Back 726

the lesser omentum (connect stomach to spleen)

Front 727

Where is the epiploic foramen?

Back 727

right craniodorsal abdomen

landmarks: caudate lobe of the liver, caudal vena cava, portal vein, pancreas

Front 728

SI incarceration most commonly involves what?

Back 728

the ileum (required jejunocecostomy for repair)

Front 729

How do you definitely dx this? Why?

Back 729

must take to sx to definitely diagnose SI incarceration bc all you can see on exam is gas/fluid distention and gastric reflux building

Front 730

in SI incarceration, bowel lumen occlusion is from where?

Back 730

serosal surface, not luminal space

Front 731

prognosis for SI incarceration

Back 731

fair for most conditions (higher survival rates coincide with early prompt surgical intervention)

Front 732

What are the potential post-op complications?

Back 732

POI
adhesion formation

Front 733

PEDUNCULATED LIPOMA

Back 733

sound funny...

Front 734

what is a lipoma and how does it cause strangulation?

Back 734

fatty "tumor" w/pendulous stalk, surrounds loop of bowel, causes strangulation

Front 735

What is the usual signalment for this?

Back 735

arabians (overrepresented)
older horses (8-20 years)
fat geldings

Front 736

What c/s will you see?

Back 736

acute colic

Front 737

tx for pedunculated lipoma?

Back 737

sx to remove lipoma

Front 738

prognosis

Back 738

good (though same complications: POI, adhesions)

Front 739

Why would you think this is a luminal obstruction?

Back 739

dessicated feed may be palpated in the large colon w/a strangulating lipoma, but this is not a "typical" feed impaction
--> take a look at the patient!! CV deterioration is NOT a c/s of luminal obstruction (incr HR, poor CRT, cold distal extremities --> NOT IMPACTION!!)

Front 740

ACUTE DIARRHEA IN HORSES

Back 740

LAST PACKET PAST PACKET PAST PACKET (this is gonna take forever)

Front 741

Diarrhea is the primary sign of what

Back 741

LI dz (colon)

Front 742

In adult horses, what is diarrhea considered?

Back 742

emergency

Front 743

What is colitis?

Back 743

ACTIVE inflammation of the colon

Front 744

cardinal sign of colitis

Back 744

diarrhea (though not all patients with colitis have diarrhea

Front 745

What is the acute colitis affector cell?

Back 745

PMNs

Front 746

c/s of colitis

Back 746

fever
endotoxemia
diarrhea
peripheral edema (hypoproteinemia)
colic pain (may be so intense it mimics sx lesion) - appears to escalate before onset of diarrhea (cramping)
+/- gastric reflux

Front 747

Why do a rectal exam?

Back 747

some horses with Si impaction may have diarrhea

Front 748

what will you see on bloodwork with colitis?

Back 748

PLE (inflamed colon wall)
**neutropenia w/left shift (toxic neutrophils) (cells marginated)
metabolic acidosis
hypoproteinemia
**hyponatremia (Na dumped into GI)
hypochloremia
hypokalemia
azotemia

Front 749

What are the 4 things in bloodwork that should be the Big TipOFF

Back 749

neutropenia w/left shift
hyponatremia
metabolic acidosis
hypoproteinemia

Front 750

What will you see on abdominal U/S?

Back 750

swirling fluid in colon/cecum
may see dilated SI
may see excess peritoneal fluid, possibly peritonitis (thickened colon wall)

Front 751

d/dx for colitis

Back 751

salmonellosis
clostridiosis
potomac horse fever
grain overload
cantharidin toxicity
r/o causes of chronic diarrhea (right dorsal colitis, sand enteropathy, cysthostomiasis)

Front 752

definite diagnosis of colitis

Back 752

May be difficult to achieve
use of signalment, hx, and season/time of year

PCR
fecal bacterial cultures
bacterial toxins in feces

Front 753

What is the bright side about the tx of colitis?

Back 753

no matter what the cause is, they're treated the same: supportive care

aggressive fluid therapy (colloid and crystalloid)
anti-endotoxemic therapy (NSAIDS, equine plasma, polymixin B, crytherapy)
antidiarrheals, antimicrobials

Front 754

Why is hypertonic saline dangerous in this patient?

Back 754

idiogenic osmoles --> can swell brain (answer in fluid therapy section)

Front 755

What oral antidiarrheals can be used?

Back 755

bismuth subsalicylate (pepto)
DTO-smectite
probiotics
syllium

Front 756

which antimicrobials?

Back 756

penicillin + gentacin
oxytetracycline good for potomac fever (summer)

Front 757

What are some complications of colitis?

Back 757

laminitis
thrombophlebitis
coagulopathy
prolapsed rectum
infarcted bowel

Front 758

Since salmonella, clostridium, potomac horse fever (PHF), grain overload, and cantharidin toxicity all cause acute fever and have common c/s, we'll be look at the differences today

Back 758

...

Front 759

SALMONELLA

Back 759

SALMONELLA

Front 760

Most common serotype of salmonella in horses

Back 760

S. typhimurium

Front 761

T/F: there is no enteric host-adapted spp of salmonella in horses

Back 761

true

Front 762

Where is salmonella a big problem?

Back 762

nosocomial infections in hospitlas

Front 763

salmonella: transmission

Back 763

fecal-oral

Front 764

T/F: zoonotic potential

Back 764

true

Front 765

risk factors

Back 765

stress
hospitalization
diet change
sx
general anesthesia
small colon impaction
younger, older, sick more susceptible

Front 766

pathophys of salmonella

Back 766

bacT invades mucosa --> ungulfed by MO --> endotoxin produced --> Na/Cl/H2O into GI lumen --> impair mucosa barrier --> inflamm response --> PMNs attracted --> local tissue damage --> endotoxin

Front 767

What will you see in the bowel lumen?

Back 767

hypersecretion, ulceration, and protein/e-lyte loss

Front 768

What cause the virulence of salmonella?

Back 768

it's ability to survive in the MO

Front 769

How do dx

Back 769

c/s, bloodwork (neutropenia, hypoproteinemia)
fecal bact culture (at least 5 take 2 day apart)
PCR of feces/tissue/blood (at least 3 negative)
rectal mucosal biopsy

Front 770

T/F: It's likely the horse is shedding salmonella

Back 770

false: unlikely

Front 771

Prognosis

Back 771

mortality rate is variable (prolonged diarrhea/sepsis decr prognosis)

Front 772

What is a reall poor prognostic indicator?

Back 772

fibrin

Front 773

Why is biosecurity so important?

Back 773

positive horses scan shed for days to months

Front 774

Salmonella at a glance

Back 774

decr appetite
+/- mild colic signs
fever
neutropenia
hypoproteinemia

Front 775

CLOSTRIDIUM

Back 775

C. perfringens (most common)
C. difficile

Front 776

What is clostridium?

Back 776

G(+) spore forming anaerobic rod (normal intestinal flora)

Front 777

how can is overgrow and colonize the colonic mucosa?

Back 777

stress
immunosuppression
antimicrobial therapy alters microflora

Front 778

What is antibiotic associate diarrhea

Back 778

antimicrobials interrupt intestinal microflora and cause this

Front 779

most common ABx that cause antibiotic assoc diarrhea

Back 779

erythromycin PO
TMS
ceftiofurIV
ampicillin PO
lincomycin PO
neomycin

Front 780

Which clostridium is most common after ABx?

Back 780

C. difficile

Front 781

T/F: use of probiotics has been shown to prevent antimicrobial assoc diarrhea

Back 781

false

Front 782

What is the most pathogenic type of clostridium?

Back 782

C perfringens type C

Front 783

How does clostridium cause diarrhea?

Back 783

elaboration of exotoxins cause enterocyte damage and incr intestinal permeability

Front 784

T/F: Hemorrhage diarrhea is uncommon

Back 784

false: it's common

Front 785

why is definitive dx hard?

Back 785

bc it is part of the normal flora

Front 786

best techniques for dx

Back 786

ELISA identification of toxins (A/B)
PCR

suspect is hx of Abx tx
site and smell

Front 787

Which clostridium produced toxins A & B>

Back 787

C difficile

Front 788

How do you tx clostridium?

Back 788

metronidazole
supportive care and laminitis prophylaxis

mortality rate is high

Front 789

POTOMAC HORSE FEVER

Back 789

aka Shasta River Crud
Equine Monocytic Erhlichiosis

Front 790

Potomac horse fever is a ...?

Back 790

water based dz

Front 791

caused by

this is carried by ?

Back 791

neorickettsia risticii

flukes that infect aquatic insects/snails (horse grazing in pastures near fresh water)

Front 792

transmission

seasonality

Back 792

ingestion of vector

late summer, early fall (warmth)

Front 793

How does Potomac horse fever work?

Back 793

N. risticii infects monocytes w/affinity for GI mucosa (blocks phago-lysosome fusion --> proliferation)

Early dz: infiltration of MO, mucosal damage
late dz: fibrinous, necrotizing typhlocolitis (cecum & colon)

Front 794

c/s of Potomac horse fever

Back 794

direct mucosal damage by N. risticii
upregulation of inflammatory mediators
60% have diarrhea
30% have laminitis
abortion syndrome

may be subclinical

Front 795

**if ANY horse has decr appetite, chance in attitude, and fever, what do you do?

Back 795

TX FOR POTOMAS HORSE FEVER!!

Front 796

How do you dx?

Back 796

serology- paired titers 9acute, convalescent samples
PCR detects antigen in blood or feces

Front 797

tx for Potomac horse fever

Back 797

**Oxytetracycline (dilution required bc Ca binding/"stone heart" --> will stop the heart)

if you don't see a difference in 24-48 hrs, it's something else

Front 798

Prognosis of Potomac horse fever

Back 798

5-30% fatal

several vaccines available (poor efficacy)

Front 799

what are the most frequent complications?

Back 799

laminitis and abortion

Front 800

CANTHARIDIN TOXICOSIS

Back 800

aka Blister Beetle Toxicity

swarm pastures in the southeasst

Front 801

Where is cantharidin found?

Back 801

it is a mucosal irritant found in blister beetles

ingestion of just 4 or 5 beetles can do the tricdk (c/s w/i hours)

Front 802

how do horses get it?

Back 802

**accidental ingestion most common when horses eating alfalfa hay

Front 803

How does it work?

Back 803

absorbed from GI, eliminated in kidneys

toxin acts as a mucosal vesicant: interrupts mitotic activity, altered cell permeability --> cellular lysis

cardiac muscle necrosis (not fully understood why)

Front 804

c/s

Back 804

reflect mucosal irritation
oral (salivation)
GI (colid and diarrhea)
urinary tract (hematuria, stranguria) ulceration

myocarditis (incr CK, cardiac troponin I) - can suffer fatal arrhythmias

Front 805

What is the most distinguishing feature(s) of bloodwork with cantharidin toxicity?

Back 805

hypocalcemia
hypomagnesmia

Front 806

What else (cardiac) may occur?

Back 806

synchronous diaphragmatic flutter ("Thumps")

Front 807

How do you dx cantharidin toxicity?

Back 807

suspect in patients with hypocalcemia and concurrent GI/urinary signs
hx confirmation of eating alfalfa
observation of beetles
detect in gastric contents and urine

Front 808

prognosis of cantharidin toxicity

Back 808

>/= 50% fatality rate
if patient survives several days, recovery is possible

Front 809

GRAIN OVERLOAD

Back 809

high CHO content

Front 810

what can cause grain overload?

Back 810

ingestion of heavy concentrate feeds
high starch/NSC content

Front 811

how does this cause colic?

Back 811

inappropriate ore-cecal digestion: insufficient amylase, too much CHO to cecum --> prolif of certain flora (lacto, bac, strep) --> incr lactate/proprionate --> decr cecal pH to 6 --> impairs normal flora --> decr fermentation, cecal/colonic dysmotility, subsequent gas distention, colic pain and laminitis

Front 812

c/s of grain overload

Back 812

colic (may be severe)
severe gas distention/bloat
GI ileus
endotoxemia

Front 813

tx of grain overload

Back 813

gastric lavage (early)
mineral oil/charcoal
anti-endotoxemic therapy
laminitis prophylaxis
*severe gas distention may lead to abd compartment syndrome --> cecal trocharization

Front 814

How much is too much grains?

Back 814

feeding > 2.7 kg of oats/day incr risk of colic by 6xs

2g/kg/Bwt of starch/meal

Front 815

CHRONIC DIARRHEA

Back 815

...

Front 816

SAND ENTEROPATHY

Back 816

sand colic

Front 817

Whereis there a high prevalence of sand enteropathy?

Back 817

S. Carolina
Florida
California
Michigan
Coastal regions

Front 818

c/s of sand enteropathy

Back 818

-mild abdominal pain to severe acute pain (complete obstruction)
-diarrhea is common (small volume, evidence/fecal staining on tail)
-if acute obstruction --> endotoxemia signs

Front 819

What will bloodwork look like?

Back 819

ACUTE: neutropenia and left shift, colitis, endotoxemia, +/- hypoproteinemia, bright red mm

CHRONIC: +/- neutropenia, incr fibrinogen, PLE/hypoproteinemia

Front 820

how do you dx sand colic?

Back 820

auscultation
may be palpable in feces (do fecal float)
radiographs
peritoneal fluid = normal
U/S: haustra disappear

Front 821

how do you tx sand colic?

Back 821

mild colic: oral & IV fluids, analgesics for pain, anti-inflamms, therapy directed at removing sand over time (psyllium/metamucil)

possible pelvic flexure enterotomy to remove sand

Front 822

how do you prevent sand colic?

Back 822

management changes are VITAL
--provide hay in racks
--avoid overgrazing pastures
--prophylactic administration of psyllium to horses at risk

Front 823

RIGHT DORSAL COLITIS

Back 823

aka NSAID toxicity

Front 824

What do NSAIDS do?

Back 824

cause inhibition of COX pathway

Front 825

when does colonic damage occur?

Back 825

with overdose or at recommended doses to horses w/incr sensitivity

Front 826

c/s of acute right dorsal colitis

Back 826

similar to salmonella & sand colis

colic pain
endotoxemia
depends on size of inflamm lesion

Front 827

c/s of chronic right dorsal colitis

Back 827

PLE
**edema <-- hallmark c/s
diarrhea

Front 828

T/F: the right dorsal colon is most sensitive to NSAIDS

Back 828

true (duh) thought mechanisms remain unclear

Front 829

how do you dx right dorsal colitis?

Back 829

c/s and hx
bloodwork (loss of albumin, neutropenia, incr fibrinogen)
may be dx of exclusion
U/S evidence (thickened wall)

Front 830

What may accompany right dorsal colitis?

Back 830

GI ulceration and renal papillary necrosis

Front 831

How do you tx right dorsal colitis?

Back 831

supportive care (may require COP support)
discontinue NSAIDs
dietary modification (feed complete pelleted rations may reduce mechanical load on colon)
corn oil (helps mucosal barrier)
synthetic PGs
psyllium

Front 832

Best pain management

Back 832

lidocaine CRI (opioids decr intestinal motility and NSAIDs caused the problem in the first place)

Front 833

prognosis for right dorsal colitis

Back 833

guarded

complications: laminitis, colon rupture, colonic infarction, colonic stricture

Front 834

CYATHOSTOMIASIS

Back 834

small strongyles

(why do these keep coming back??)

Front 835

What are the two life cycles?

Back 835

1: L3 ingested --> cecal/colonic mucosa --> mature to L4 --> GI lumen --> complete life cycle in 5-6 weeks --> diarrhea

2: L3 ingested --> cecal/colonic mucosa and remain there --> encysted/hypobiotic for months to years --> very sick horses

Front 836

Why does diarrhea occur?

Back 836

occurs as a massive excystation (may present as acute colitis)

Front 837

if chronic diarrhea develops, what is a significant c/s?

Back 837

weight loss

Front 838

When does this occur?

Back 838

seasonal: end of winter, early spring

Front 839

How do you tx cyathostomiasis?

Back 839

many strains resistant to benzimidazole (fenbendazole)

moxidectin (>90% resolution in 1 week)

severe infestations: may be seen in feces or rectal sleeve

Front 840

OBSTRUCTIVE & STRANGULATING DZS OF LARGE COLON

Back 840

I may kill someone when i'm done

Front 841

risk factors

Back 841

ingestion of coarse feeds
meal feeding concentrates (water sucked out of ingesta)
inadequate mastication
poor dental health
insufficient water supply
*reduced water intake (one of the most common causes of constipation)

Front 842

What are the most common sites of impaction? (2)

Back 842

areas of luminal narrowing

pelvic flexure (left ventral colon region)
right dorsal colon (transverse colon junction)

Front 843

feed impaction = ?

Back 843

CONSTIPATION

Front 844

c/s of LI impaction

Back 844

mild intermittent colic
decr appetite
signs of mild dehydration
mild tachycardia
borborygmi present
reduced fecal output

Front 845

What will you find on rectal exam?

Back 845

an unmistakable lesion!

large, firm mass in pelvic flexure (typically sits in pelvic inlet)

Front 846

Is anything else abnormal?

Back 846

U/S: WNL
NG tbe; no reflux
peritoneal fluid normal

Front 847

What do you use as a marker for intestinal motility?

Back 847

mineral oil (see if it's coming out the other end

Front 848

how do you tx LI impaction?

Back 848

**enteral fluid therapy (isotonic)
--goal is to overhydrate the colon and soften the feed
--also stims gastrocolic reflex
magnesium therapy: creates osmotic gradient into lumen
analgesia
if more serious: cecal trocharization

Front 849

What is a BIG NO-NO??

Back 849

no food by mouth!

NPO until impaction is resolved with NO exceptions

Front 850

T/F: horses will pass many piles of manure as an impaction is resolving

Back 850

true (do serial rectal exams)

Front 851

prognosis

Back 851

excellent

risk of reimpaction so go slowly when refeeding and monitor water consumption and fecal output

Front 852

LEFT DORSAL DISPLACEMENT OF THE LARGE COLON

Back 852

nephrosplenic ligament

(roll that horse, baby!!)

Front 853

Where does the left dorsal colon become entrapped?

Back 853

nephrosplenic ligament (no, really?)

Front 854

c/s of nephrosplenic entrapment

Back 854

-mild to severe colic
-perfusion parameters are normal
-rectal exam: taenia of LVC palpable coursing dorsocranially to L kidney, spleen enlarge and displaced cranioventrally
-peritoneal paracentesis: normal
-possible reflux

Front 855

What will a normal U/S look like? What will a U/S look like with this?

Back 855

normal: spleen, kidney, colon

nephrosplenic entrapment: can't see kidney

Front 856

How many tx options are there?

Back 856

4

Front 857

What is option 1?

Back 857

NPO
IV fluids
allow time for colon to empty
entrapment MAY resolve

Front 858

What is Option 2?

Back 858

alpha1 administration --> constricts spleen --> jog horse --> may bounce colon out of that spot

may combine with option 1

Front 859

What is option 3?

Back 859

roll the horse (requires short time general anesthesia): dropped to R lateral --> rolled thru dorsal to L later --> make complete 360 rotation

may combine with option 2

Front 860

What is Option 4?

Back 860

surgery (necessary when 1, 2, and 3 don't work)

reserves for those w/severe gas distention and pain

Front 861

How do you prevent this?

Back 861

chronic offenders: ablation of nephrosplenic ligament, colopexy, colonic resection

Front 862

prognosis

Back 862

good

Front 863

ENTEROLITHIASIS

Back 863

GI stones

Front 864

what are they?

Back 864

formation of mineral concretiong in the LI (mineral deposition around nidus)

mainly magnesium-ammonium-phosphate

Front 865

What is the predisposition?

Back 865

be geographic location (CA, TX, southwest USA)

assoc w/arabians and arabian mixes

dz os mature horse

Front 866

c/s of enterolithiasis

Back 866

severe pain
distention of colon is marked
stones visualized by radiograph
peritoneal fluid: normal
obstruction of luminal flow if lodges (transverse colon/small colon)

Front 867

T/F: stones are commonly palpable on rectal exam

Back 867

false: rarely palpable

Front 868

Where do you do sx?

Back 868

pelvic flexure enterotomy

right dorsal colon enterotomy NOT done bc it's closer to the surgery site and don't want feces all over the table

Front 869

Why is sx done?

Back 869

to prevent GI rupture

Front 870

Single enteroliths have what shape?

Back 870

perfectly rounded, meaning if it has a flatter edge, look for the others

Front 871

SMALL COLON IMPACTION

Back 871

dehydrated feces
inspissated fibrous fecal material
foreign body

winter time dz

Front 872

c/s of SI impaction

Back 872

pain mild to severe (complete obstruction)
tympany of colon and cecum secondary to obstruction
may be difficult to palpate on rectal due to gas distention of colon prox to obstruction
small amts of diarrhea
endotoxemia common

Front 873

What is this dz associated with?

Back 873

Salmonellosis

Front 874

hwo do you tx SI impaction?

Back 874

Medical
--NPO
--IV fluids
--enemas
--laxatives
--anti-inflamm
--anti-endotoxemix

surgical resolution is common

Front 875

T/F: reimpaction is common

Back 875

true

Front 876

What do you do during recovery?

Back 876

use laxatives
refeed cautiously

Front 877

THROMBOEMBOLIC COLIC

Back 877

Cranial Mesenteric arteritis
(non-strangulating INFARCT = bad)

Front 878

this is caused by what?

Back 878

Strongylus vulgaris (everybody's favorite!)

Front 879

How does this cause colic?

Back 879

cr mesenteric arteries go to the intestines --> colonic infarct

Front 880

signalment?

Back 880

horses > 1yr

Front 881

what will you see?

Back 881

large colon gas distention

Front 882

How do you treat this?

Back 882

surgical resection of infarct

Front 883

How do you prevent this?

Back 883

ivermectin

Front 884

RECOVERY OF POST-OP COLIC PATIENT

Back 884

I can't believe I'm still doing this. It's 2am. just shoot the horse already.

Front 885

When do you stop fluid therapy administration?

Back 885

patient should be eating > 80% normal diet before discontinuing fluids

Front 886

anorectic horses are often depleted in what e-lytes?

Back 886

K & Ca

Front 887

Where is magnesium important?

Back 887

in the ICU

Front 888

What % get post-op ileus?

Back 888

30%

Front 889

What WBC abnormality is common following GI sx?

Back 889

neutropenia (bc they're marginating and extravasating to help clear infection)

Front 890

Which bacteria discussed early is REALLY BIG on biosecurity?

Back 890

Salmonella

Front 891

Common post-op ABx combination

Back 891

beta-lactams and aminoglycosides (for 24-96 hrs)

Front 892

What post-op drugs are given?

Back 892

antibiotics
anti-inflamms (NSAIDS)
lidocaine
if indicated: anti-endotoxemic, laminitis prophylaxis

Front 893

What complications may you expect in post-op colic patient?

Back 893

post-op ileus (POI)
peritonitis
EGUS
mechanical obstruction
adhesion formation

Front 894

Which most commonly occurs following sx?

Back 894

POI

Front 895

Is it a functional ileus?

Back 895

yes (development of gastric reflux)

Front 896

What does possible POI depend on?

Back 896

length of resection
age
PCV at admission
duration of anesthesia

Front 897

POI: What's the problem?

Back 897

incr morbidity/mortality
very EXPENSIVE

Front 898

When do c/s develop? What are they?

Back 898

24-96 hrs

tachycardia/pnea
colic
decr manure prod'n
decr borborygmi

Front 899

how do you dx POI?

Back 899

positive gastric reflux (>20L/24 hrs or >8L at any one time)

vol should begin to taper over days (incr amy --> sx)
serial U/S should show improving motility

Front 900

therapy for POI

Back 900

consistent with tx for DPJ

gastric decompression
monitor ins and outs
anti-inflamm
prokinetic tx

Front 901

What else can look like POI (gastric reflux and dysmotility)?

Back 901

mechanical re-obstruction at resection site
peritonitis

Front 902

What are the risk factors for peritonitis?

Back 902

-celiotomy procedure (sterile inflamm)
-leakage of resection and anastomosis site (septic peritoneal fluid expected)

Front 903

how do you dx?

Back 903

abdominocentesis

may be confusing bc >WBC and TP > 6 is common up to 6 days postop, SO...

use peritoneal blood gas (compare with serum blood gas) (low glucose, high lactate, low pH)

Front 904

How do you treat EGUS?

Back 904

proton pump inhibitor (Omeprazole)

Front 905

Mechanical obstruction at site of resection will look like what?

Back 905

POI

reflux that plateaus/incr is suspect

Front 906

how do you dx mechanical obstruction?

Back 906

re-laparotomy/necropsy (unlikely to dx with U/S)

may be related to sx procedure or adhesion formation

Front 907

What is adhesion formation?

Back 907

scar tissue within the abdomen (sutures, etc)

Front 908

T/F: It's more common in the LI than the SI

Back 908

false: most common in the Si (up to 22% of SI patients develop adhesions

Front 909

This is the second most common cause of what?

Back 909

re-laparotomy

Front 910

What is the best prevention of adhesions?

Back 910

ABx + anti-inflammatory tx

Front 911

What two things potentiate adhesion formation?

Back 911

POI and peritonitis

Front 912

What will the horse be doing if adhesions are bad enough?

Back 912

laying down (adult horses don't lay down as a rule - the young do)

Front 913

Where could you get an infection that may cause a fever?

Back 913

catheter site, incision site, GI inflamm/colitis, peritonitis

Front 914

What is the most common multiple drug resistant infection?

Back 914

MRSA

Front 915

T/F: plaque of ventral edema at an infection side is abnormal

Back 915

false: it's normal

Front 916

FML I'M DONE!!!

Back 916

DDDOOOOOOOOOOONNNNNNNEEEEEEEE