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122 Cards in this Set
- Front
- Back
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what is the primary sign of LI dz
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diarrhea
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is diarrhea an emergency in horses
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yes! they can lose a ton of fluids can cause shock
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what is colitis
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actinve inflammation of the colon wall.
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what is the cardinal sign of colitis
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diarrhea, but not all with this have d+
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what is the effector cell with horses with colic its
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PMN attack the fuck out of the muocsa in the intestine
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what messes up the barrier in the mucosa of the intestine
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PMN and their friends the inflammatory mediators
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what do paitents look like with colitis
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they are really sick
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CS of colitis
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fever
endotoxemia diarrhea peripheral edema colic pain (so intense it mimicis surgical lesion) pain appears to escalate before te onset of diarrhea +/- gastric reflux |
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how does gastric reflux occur in lg colon dz
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ileum, some bacterial like certain places in the intestine
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how can you differntitiate between a colitis horse or a sx horse
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bloodwork
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CS of colitis
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diarrhea is severe or prolonged, signs of hypovolemic shock may ensue
fluid loss through diarrhea fluid loss in 3rd space (secretion Na+ rich fluid into GIT) endotoxemic/septic shock (poor vascular tone) |
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how do you work up colitis horses
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PE/ HS
GI auscultation (slouching/fluid sounds, hyper motility) bloodwork, rectal exam, abdominal US, peritoneal paracentesis |
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what can you see on US in a horse with colitis
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increased wall thickenss of intestines
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colitis bloodwork
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PLE (inflamed colon wall)
neutorpenia with left shift (toxic neuts) metabolic acidosis hypoproteinemia hyponatremia hypochloremia hypokalemia azotemia |
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what are te big tip offs of colitis bw
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NEUTROPENIA left shift (toxic neuts)
metabolic acidosis hypoproteia HYPONATREMIA |
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colitis rectal exam
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fluid in colon
palpation of peritoneal surface ddx- small colon impactation (typically small volume diarrhea) |
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abdominal US of colitis
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swirling fluid in colon/cecum
may see dilated SI/ stomach may see excess peritoneal fluid |
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paracentesis of colitis
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likely normal
non-septic peritonitis may be straw yello WBC should be wnl TP- will often be elevated |
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d/dx of colitis
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salmoneloosis
clostridiosis potomac horse fever grain overload cantharidin toxicity rule out causes of chronic diarrhea (right dorsal colitis, sand enteropathy, cyathostomiasis) |
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def. diagnosis of colitis
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fecal bacT cultures
PCR SIGNALMENT HISTORY SEASON/ TIME OF YEAR |
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colitis treatmnt
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SUPPORTIVE CARE
fluids crystalloids + colloid terapy |
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many patients with colitis they will present with signs of dhhydration and volume depletion what do you do
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aggressive fluids but you have to be careful cause they are already hyponatremic so that osmotic demyleination thing you have to be careful with
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treatment of colitis
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anti endoteoxnmic therpay
NSAIDs equine plasma polymixin B cryotherapy |
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addtional colitis treatments
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oral anti-diarrheal agents
bismuth subsalicylate DTO-smectite (biosponge binds clostridial toxins) probiotics psyllium |
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omg more colitis treatment
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+/- antimicrobials (yea probably a good idea their immune system is all crazy)
nutrition- TPN is encouraged |
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colitis complications
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lamnitisi
thromophelbitis coagulopathy |
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additional complications of coliits
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prolapsed rectum (need to suck the edema out, sugar)
prolapsed rectum infarcted bowel |
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so if you have a horse with infarcted bowel what do you do
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you can do surgery but its risky, problaby euthanize
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salmonellosis, what kind of horses get this
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hospitalized horses. hard to kill most common type in horses. s. typhimurium
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can salmonella in feces be normal
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yes 1-17% have it and its fine its when they are stressed out that this goes nuts and gets shed to immuosuppressed horses
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transmission of salmonella
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fecal-oral
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salmonella is zoonotic, true or false
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yes true
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salmonella risk factors
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stress, hospitalization, diet changes, general anesthesia, abx use, small colon impaction, younger, older, and sick horses are susceptible
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salmonella pathophysiology
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bacteria invade mucosa, engulfed by macrophages, cause entorotxin causes salt secretion into GI lumen potentiates diarrhea causes translocation. they are the ones that cant pass diarrhea they are really colicy
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IL 8 will causes what
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neutrophils to come and hang out
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dx of salmonella
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CS/ BW
fecal bacterial culture PCR of feces/ tissue/ blood rectal mucosal biopsy if at least 5 cultures taken ~ 24 hours apart or 3 PCRs are neg. unlikely the horse is shedding |
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prog of salmonella
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mort rate is variable
prolonged diarrhea/ sepsis decrease prognosis |
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how long can horses shed salmonella for
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for days to months
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biosecurity for salmonella horses
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wear stuff for your face, hair, everywhere don't be lazy you can get sick or get other animals sick
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what would make you think your post-op hock arthroscopy patient is developing a salmonella infection
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colon inflamed- neutropenic and hypoproteinemic
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clostridium common types
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perfingens and difficult
gram +ve spore former ubiquitous normal flora in horse |
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when does clostrum overgrow
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stress
immunosuppression abx |
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which clostrim is common with abx assoc. diarrhea
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difficile
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can probiotics help horses with clostridium stuff
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no its never been proven
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what do the toxins from clostridium do
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elaborate the exotoxin cause enterocyte damage and inc. intestinal permeablitiy
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dx of clostriudium
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diffinitive is difficult because normal flora
suspect if culture in feces ELISA |
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tx of clostridium
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metronidazole
discontinue other abx immediately DOT-smectite saccharymyces bioulardii (yeast messes up the clostrial organisms) additional supportive care |
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prog of clostridium horses
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mort is high
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test for clostridium difficult a and b
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elisa
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clostridium perfringens test
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pcr
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what do you have to have for potomac horse fever
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water
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what causes potomac horse fever
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neorickettsia risticii very much like salmon poisoning in dogs.
it likes leukocytes and enterocytes |
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how caries n. risticii
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flukes-> mayfly/ caddis flies
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when will potomac horse fever be in the year
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summer
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pahtophys of PHF
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n. risticii infects monovyes with affinity for GI mucosa, blocks pahgo-lyosome fusion-> proliferation
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early dz PHF path
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infiltartion of macfophabes- muscoal damage
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late dz PHF path
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fingrions, necrotyzing
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how many PHF get diarrhea
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60%
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how many PHF get laminits
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30%
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what other thing can horses have with PHF
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abortion
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dx of PHF
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serology- paired titers
acute/ convalescent samples PCR detects the antigen in blood or feces |
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what does PCR detect
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DNA alive or dead so it may not be an active infection and again detects ANTIGEN
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phf tx
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oxytet
have to dilute because it BIND CALCIUM!! supportive care for diarrhea and laminitis |
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what kills the horse in PHF
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sequalle the endotoxemia
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why are the vaccines for PHF terrible
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they use the original strains from the freaking 70's
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cantaharidin toxicosis what causes it
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blister beetles
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where do these beetles like to liv
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in alfalfa hay so horses accidentally eat them
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what does the cantharidin do to the body
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its a toxin that affects mucosa
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how many beetles do horses have to eat for CS to occur?
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ingestion of four to five
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pathophysiology of cantharaidin
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absorbed in the GIT, renal elimination
toxin acts as a mucosal vesicant (interrupts mitotic activity, altered cell permeability-> celular lysis) hematuria, stranguluria- goes all the way through the GIT cardiac mm necrosis occurs |
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CS reflect mucosal irritation
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oral (salivation), GI (colic, diarrhea), urintary tract ulceration
myocarditic inc CK, cardiac torponin I |
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BW for canthardidin *
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HYPOCALCEMIA (synchronous diaphragmatic flutter, thumps) can lead to neuronal disability (phrenic nerve moves with the heart beat)
+/- hypomagnesemia |
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where does cantharidin tox happen
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can happen anywhere
you need to detect the toxin in gastric reflux and in the urine for definittive dx |
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prog of canthardidin tox
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fatality rate ~50%
if the patient survives for a few days they may live |
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grain overload
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ingestion of heavy concentrate feeds- excess carb ingestion
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can starch be digested in SI
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some , but if you overwhelm it the excess goes to the cecum and the colon the bacteria have a huge party and cause lactate decal ceceal pH to 6.0 gonna burn the hel out of the cecum leads to colic pain and laminits- if you have got massive inflation you are translocating bacteria across mucosal barrie
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CS of grain overload
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colic-signs may be severe
severe gas distention/bloat GI ileum endotoxemia |
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Tx of grain overload
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gastric lavge
+/- mineral oil/charcoal anti-endotoxic therapy laminitis prophylaxis severe gas distention may bead to abdominal compartment syndrom cecal tracharizaation may be performed |
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how much is too much grain
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feeding >2.7 kg of oats per day increase the risk of clic by 6 times
< 2g / kg btw of starch per meal will halp decrease colic |
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ionophore (monesin) poisoning can happen when horses eat what
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cow food
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overdose of ionophores will effect with organ system
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heart
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chronic diarrhea in horses
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sand enteropathy
right dorsal colitis cyathostomiasis |
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sand enteropathy
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environments with sandy soils
horses ingest when they graze |
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where does sand like to go in the intestine
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sand settles out in the ventral colon
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where is the highest prevalence of sand colic
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s. carolina
florida california, michigan, coastal regions |
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sand colic CS
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mild abdominal pain to severe acute pain (complete obstruction)
diarrhea is common (characteristic, sm. volume, evidence/ fecal staining in tail) acute obstruction= signs of endotoxemia |
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what will happen when you have acute obstruciotn from sand
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signs of endotoxemia acts as sandpaper to mess up the mucosa can cause translocation
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bw for acute sand colic
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neutropenia and left shit
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bw for acute sand colic
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maybe neutopnia
increase fibrinogen PLE/ hypoproteinema |
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dx of sand colic
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ausculatation
sand may be palpate in the feces fecal float for sand |
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sand colic dx
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rads can be very subjective
peritoneal fluid= wnl caution- enterocentesis is possible because its heavy so you'll hit the colon and not the peritoneum |
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what will you see on US with sand impaction
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you cant see the hausta anymore
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sand colic tx mild
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mild- oral and IV fluids
anagestics anti-inflammatories therapy directed from removing the sand and ingest from the colon-over time . after a whle they will just get rid of it on their own just get them off the damn sand psyliium (metamucil)- can be helpful, maybe |
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complications of sand colic
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endotoxemia-> laminits
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if pain is severe and unrelenting from sand colic, what is necessary
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sx to remove the sand
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what do you do with sand clear
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put in feed 1 wk for every month to help px sand colic
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what kind of sx will you do with sand colic
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pelvic flexure enterotomy
put horse on its back take out the cecum from the body lay it on a colon tray cut a hole in the pelvic flexure and put a hose up into the colon and you're going to clean the colon out. suture with layers rinse colon off with sterile saline put it back in |
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px of sand colic
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manangement changes are vital to px recurrence
provide hay in racks or in bind with a tarp, carpet or mat beneath anything that can be swept of shaken to remove the sand avoid overgrazing pastures prophylactic administration of psyliiium |
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right dorsal colitis caused by
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non-steroidal antiflammatory drug toxicity
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NSAIDs path
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mucosal ulceration through inhib of cyclo-oxygenase pathway of the araciodoin ace cascase
COX-1 constitute/physiologic c COS 2- inducible colinic damage may occur with over-dose may occur at recommended dosese to horses with inc. sensitivity |
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PGE 2
PGI2 |
pge 2- builds mucosa
PGI2 |
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CS of right dorsal colitis
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acute cases- similar to salmonella and sand colic
colic pain endotoxemia depends on size of inflammatory lesion chronic cases PLE diarrhea |
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what part of the colon is most sensitive to NSAID tox
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right dorsal colon
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acute on chronic right dorsal colitis CS
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ventral edema in bellly and legs and distention of colon
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what can happen to the right dorsal colon with NSAID tox
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strictures
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ventral edema, scroatal edema, post pole limbs patern up to their elbows
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right dorsal colitis
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dx of RDC
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difficult
supporitve bloodwork (loss of albumin, neutorpenia, elevated fibrinogen) may be diagnosis of exclusion gastric ulceration and RENAL PAPILLARY NECROSIS |
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what can help support you dx of RDC
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ultrasound. it will be largely thickened right dorsal colon wall
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tx of RDC
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supportive care for colitis
keep in mind colloids for protein discontinue NSAIDs feed them pelleted feed, restrict long stem fibers/ roughage can feed them alfalfa cubes corn oil 1 cup q 12-24 hours synthetic prostaglandin's- very expensive mimics PGE2 physillum |
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format of exam
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mostly GI
laminits endotoxemia fluids signalment CS treat recommendations |
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RDC tx
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supportive care
immediate discontinuation of NSAIDs |
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what can mistoprotol do
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its a PGE2 to help lay down mucosal layer
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pain management in RDC
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opiods (morphine, butorphanol) going to slow motility down
2% lidocaine CRI |
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what will you do with uncontrollable pain with RDC
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exploratory celiotomy
colonic resection or bypass of the RDC |
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how can you use torb for RDC
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IM or CRI
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what do you have to remember about torb
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sedative effects last longer than analgesic effects
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prog of RDC
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guarded because of complications
laminitis colon rupture colonic infarction colonic stricutre |
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what will happen in the future for horse that has a colonic stricture
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they will colic in the future
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cyathostomiais
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many species of small strongyles
complex lifecycle option 1: L3 ingestied- migrated into cecal/ colonic mucosa, mature to L4 and exit back into te lumen to complete their life cycle in 5-6 wks option 2: L3 are ingested, migrate into the cecal/colonic mucoa and remain there encysted/hypo biotic, may remain hypobitoic L3 for months to years |
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when do te cyathostomes become hypo biotic
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when they don't think they can live
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CS of cyathostomes
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diarrhea occurs as a result of massive excysttion, may present as acute colitis
chronic diarrhea may also rsult, wt. loss is significant |
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tx of cyanthostomes
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bensizmasole resistant there are 2 products licensed as larvidcieds fenbendazole (power pack 2x dose for 5 days)
moxidection need to look for 90% reduction in FEC in one week of Tx |
