Equine Med - Ulcers

Front 1

equine gastric ulcer dz

Back 1

2 forms: squamous disease (EGUS), glandular dz, may coexist

Front 2

gastric ulcder dz pathophysiology

Back 2

chemical damage by acid and bile salts: protective factors (saliva, roughage mat-buffer, mucus epithelial integrity-PGs, gastric emptying), harmful factors (disruptors of the roughage mat, NSAIDs, mucosal ischemia, pooling of acid or bile salts)

Front 3

risk factors for squamous dz

Back 3

occupation/training (90% racehorses in training, 50% of show horses), intermittent feeding (anorexia/withholding food), stress (change in environment, hauling, stall confinement)

Front 4

risk factors for glandular dz

Back 4

illness (90% foals in ICU, post-op colic), gastric outflow obstruction, NSAID toxicity, heliobacter infection

Front 5

clinical signs in adults gastric ulcers

Back 5

colic (chronic, intermittent, after a meal), occasional hypersalivation, occasional bruxism, reluctance to eat

Front 6

clinical signs in foals gastric ulcers

Back 6

colic signs more common and often more severe than adults, hypersalivation, bruxism, mild non-hemorrhagic diarrhaea

Front 7

diagnosis gastric ulcers

Back 7

gastric endoscopy, response to therapy

Front 8

specific therapy gastric ulcers

Back 8

proton pump blocker omeprazole-high dose 4mg/kg PO daily, H2 antagonist ranitidine, promote healing (sucralfate-glandular), 2-4wks of therapy

Front 9

compounded omeprazole

Back 9

legal issues, clinical trial comparing gastroguard and compounded omeprezole found compounded formulation ineffective

Front 10

management/diet gastric ulcers

Back 10

reduce stall confinement, frequent feeding-grazing, less grain more roughage, alfalfa hay appears to be the best roughage buffer, corn oil (increase APGE2), high fat diets, modify training

Front 11

prevention gastric ulcers

Back 11

good dietary and occupational management, low dose omeprazole (continuos during training/racing, intermittent at times of highest risk-3d prior to and during a show, misoprostol if high risk and on an NSAID)

Front 12

esophageal obstruction is known as

Back 12

choke

Front 13

causes of esophageal obstruction

Back 13

poor quality feed-impaction, poor mastication, dehydration/lack of saliva, greedy eaters, corn cobb/apple/foreign body, stricture, diverticulum, neoplasia, abscess or granuloma, inclusion cysts, vascular ring anomaly, motility dysfunction-megaesophagus

Front 14

pathophysiology of esophageal obstruction

Back 14

functional/mechanical obstruction, reflux of saliva and food material, dehydration and electrolyte abnormaltities if prolonged, mucosal injury, possible tissue injury (mucosal ulceration, stretching of the wall, rupture)

Front 15

clincal signs of esophageal obstruction

Back 15

anxious, hypersalivation, nasal discharge (food material, saliva, water), cough, gag (extend neck when eating), swelling cervical region, dehydration

Front 16

lab finding of esophageal obstruction

Back 16

elevated PCV/TP, electrolyte and acid/base imbalances (hyponatremia, hypokalemia, metabolic cidosis), mild azotemia

Front 17

diagnosis of esophageal obstruction

Back 17

establish obstruction (clinical signs, NG tube, endoscopy, ultrasonography, radiography), look for underlying cause

Front 18

radiography of esophageal obstruction

Back 18

use contrast agents, pattern affected by prior passage of an NG tube, spasmolytic drugs (local dilations), combination of NG tube passage and detomidine

Front 19

relief of esophageal obstruction

Back 19

lavage (single NG tube while standing using detomidine for sedation, or couble NG tubes with general anesthesia; place an endotracheal tube, ingress and egress tube), surgery in rare cases of foreign body, strictures, ruptures, masses

Front 20

enteral diet for esophageal obstruction

Back 20

hi fat complete pelleted food (12% protein), 2-3% of body weight per day divided into 6 feedings (gradually increase over week after Sx), supplement w/1 cup of corn oil BID, 1 Tbsp of salt in each feeding, can deliver 23 Mcal of digestible energy per day (1.5 times maintenance)

Front 21

hydration for esophageal obstruction

Back 21

soften impaction, replace fluid deficits (>48h duration), correct electrolyte or acid/base imbalances (0.9% saline with bicarb added as needed is fluid of choice), intravenous or rectal administration

Front 22

pharmacology for esophageal motility

Back 22

acepromazine, X/T, and detomidine (detomidine decreases waveform duration and increases transit time, distension and reduced primary peristalsis in proximal esophagus, decreased swallows, mostly use detomidine), oxytocin (reduce esophageal pressure in the proximal esophagus in a distension model-modest increase)

Front 23

diet for esophageal obstruction

Back 23

bran mashes, pelletted food slurry, avoid hay or grass until function is normal, supplement with salt if salivary loss continues

Front 24

complications of esophageal obstruction

Back 24

rupture, aspiration pneumonia

Front 25

sequela of esophageal obstruction

Back 25

stricture, diverticulum

Front 26

follow up for esophageal obstruction

Back 26

rescope after relieving obstruction (R/O injury to mucosa or underlying dz), if ulcerated (NSAID's to prevent stricture?, sucralfate), rescope in 14 & 30d if injury to the mucosa has occurred