Equine Med- Inflammatory Bowel dz

drraythe's version from 2016-04-29 15:09


Question Answer
what is the Hallmark of malabsorption?WEIGHT LOSS
what does the SI do and how does it do it?Nutrient absorption (CHO / fats / proteins), Brush border created by SI villi is what absorbs things
Malabsorption syndrome if absorption at ___ failsvillous tip
what are all your choices for SI diagnostic options?Physical exam! Bloodwork, Ultrasonography (U/S), Endoscopy, Absorption tests, Biopsies (rectal, endoscopic, laparoscopic) (full thickness preferred), Laparoscopy / Ventral midline celiotomy (try to avoid these if we can)
What is the HALLMARK SIGN of an ACUTE SI dz? What will your diagnostics look like to confirm it is acute?HALLMARK: COLIC. Usually a Functional obstruction if acute SI. On US you will see dilated SI loops, there will be Copious gastric reflux, on Rectal Exam you will feel many loops of intestines, and belly tap will reveal elevated TP
what is the HALLMARK SIGN of a CHRONIC SI dz? What will your diagnostics look like to confirm it is acute?HALLMARK: WEIGHT LOSS. U/S: thickened SI walls. You might see colic also, esp if it is a acute episode of a chronic dz.
Which of these is an acute U/S? chronic? Left is acute bc DILATED loops. Right is chronic bc THICKENED WALLS
what are the 5 diseases which fall under "inflammatory bowel dz"?(1) Granulomatous enteritis (2) Multisystemic eosinophilic epitheliotropic disease (MEED) (3) Lymphocytic-plasmacytic enterocolitis (4) Eosinophilic enterocolitis (5) Idiopathic focal eosinophilic enteritis (IFEE): (IBD without weight loss)
how do you definitively dx IBD/ any of the particular dzs which fall under IBD?Histopathology
what are 4 clinical signs you see with IBD? (what is a CS you SHOULDN'T see?)SEE: Progressive weight loss despite good appetite, Protein-loosing enteropathy (Hypoalbuminemia / peripheral edema), Lethargy, Intermittent colic. WON'T SEE diarrhea most likely, because not typical with SI dz
what will bloodwork look like with IBD?low TP (albumin)
what will IBD look like with Abdominal ultrasound / Rectal palpation?SI wall thickness
what is a test you can run to prove the SI isnt absorbing things well?Absorption test
Biopsy= definitive diagnosis for IBD. What else does it tell you and how do you get this bx?also differentiates the type of IBD (see list of 5). can try: Laparoscopy / celiotomy / rectal
explain the steps you do for a Glucose Absorption test. What do you expect a normal result to be?18-24h fasting / take sample “0”. 0.5-1g/kg glucose as 10% solution per NG tube. Blood glucose samples every 30 minutes. Expect glucose to elevate 1.5-2x baseline with a peaked inverted "V" shape.
what are things that can affect your glucose absorption test?stress (makes glucose spike!! which is why you take sample 0 BEFORE you put in NG tube, bc that is stressful), drug administration, delayed gastric emptying
which graph represents an IBD horse?the BOTTOM ONE, because the top one shows the typical spike of glucose they should have after being administered glucose and absorbing it properly
which part of the sm int is most affected by IBD?distal portion
how would you describe histopath of IBD? (pic too)Diffuse and patchy infiltrates and distinct granulomas, composed of epitheloid cells, macrophages and lymphoid cells
how do you treat IBD?Immunosuppressive doses of corticosteroids (but this is largely unsuccessful, and there are some major Complications of steroid therapy such as ulcers, cushings, laminitis). you should Differentiate IFEE (Idiopathic focal eosinophilic enteritis-- remember, no weight loss) and other causes of IBD. Also, Intramural masses indicate surgical resection

specific dzs of IBD

Question Answer
Granulomatous Enteritis--> which AGE tends to get this, which BREED tends to get this?Young horses, and Standardbreds have a genetic predisposition
what does histopath look like with granulomatous enteritis?you will see tons of macrophages (hence granulomatous)
what is the cause of Granulomatous enteritis?UNKNOWN, current theories are: possibly Mycobacterium avium, possibly Immune mediated response to dietary, parasitic, or bacterial antigens?
multisystemic eosinophilic, epitheliotropic dz (MEED)--> what AGE tends to get this?young horses.
multisystemic eosinophilic, epitheliotropic dz (MEED)--> what are some more distinct CSs of this dz, other CS?*Dermatitis common, also see diarrhea and tissue eosinophilia
multisystemic eosinophilic, epitheliotropic dz (MEED)--> what causes thisMAYBE a Hypersensitivity response? (there are lots of eosinophils)
multisystemic eosinophilic, epitheliotropic dz (MEED)--> what will histopath look like?1° eosinophils, also see Lymphocytes + macrophages
which IBD dz has the grave prognosis?Lymphocytic-plasmacytic enterocolitis
what age/ breed gets Lymphocytic-plasmacytic enterocolitis?no age or breed predilection!!
what are CS of Lymphocytic-plasmacytic enterocolitis?similar to Granulomatous enteritis-- it is mainly a problem of malabsorption (not always low alumin!)
what does histology look like for Lymphocytic-plasmacytic enterocolitis? (where do you get your sample?)(rectal mucosa sample) see **Lymphocytes + plasma cells present in lamina propria with villous atrophy
how does Idiopathic focal eosinophilic enteritis vary from the other IBD dzs?No Weight loss, protein normal
which IBD dz is the weird one with no weight loss?Idiopathic focal eosinophilic enteritis (acute COLIC caused by intramural masses or bands)
what is the most common clinical sign of Idiopathic focal eosinophilic enteritis ? (how do you tx?)Acute colic... Surgical decompression= therapeutic
Standardbreds are predisposed to..Granulomatous Enteritis
which IBD dzs are prone to happen in young horses?GE and MEED
dz where main histo cell is macrophages?GE
dz where main histo cell is eosinophils?Multisystemic eosinophilic epitheliotropic disease (MEED)

Lawsonia intracellularis

Question Answer
lawsonia intracellularis causes what dz?Proliferative Enteropathy
WHO (sp/age) tends to get lawsonia intracellularis most?PIGS / weanling foals
what IS Lawsonia intracellularis?Obligate intracellular bacterium
how is LI transmitted?Fecal oral
main CS of LI infection?if you see CS it's often ill thrift (65% Subclinical cases. in endemic areas, most foals have titers but some cant deal with it so we need to help them)
what exactly is ill thrift?Poor haircoat / pot-bellied appearance, Weight loss / lethargy / poor growth rate
what are the CSs of LI?(1) ill thrift (2) Peripheral edema (bc hypoprotenemia) (<--not commonly seen unless end stage) (3) MAYBE some diarrhea (sporatic) (not common bc usually doesnt affect LI and horses dont really get SI diarrhea) (4) very uncommonly, colic
Suspicion of Lawsonia intracellularis based on...Signalment: weanling (5/6mo), Clinical signs (ill thrift!), Bloodwork (hypoproteinemia), Abdominal ultrasound
what will Abdominal ultrasound look like with LI?thickened walls bc intracellular bact
which stain for histopath of LI?Warthin Starry silver stain
what is the gold standard DX of LI?Isolation / culture: very difficult! requires biopsy (full thickness): Warthin Starry silver stain (....PCR (faeces / tissue) / Serology are options but not gold standard)
LI TX: what is supportive care you can provide?NSAIDs / Omeprazole (help w ulcers) / Fluids: remember TP (might be low, think of this with your fluid plan- maybe colloids)
LI tx--> what are your drug choices for Antimicrobial Tx? (3)Remember you are targeting INTRACELLULAR organisms: Tetracyclines, Macrolides (disrupts floar, caution) / rifampin
prog of LI?fair to good (if dont recognize till late stages though, prog isnt as good)

Duodenitis Proximal Jejunitis aka anterior enteritis

Question Answer
what is happening/ what is the problem/ cause of Duodenitis proximal jejunitis?A syndrome of inflammation and edema of the duodenum and proximal jejunum. There is Excessive fluid and e-lyte secretion in SI, High volume of enterogastric reflux, SI distention --> abdominal pain. UNKNOWN ETIOLOGY
how would you describe this dz in terms of what is happening?Functional gastrointestinal ileus (No mechanical obstruction to flow of ingesta)
since DPJ has excessive fluid secretion in the SI, this can back up into the stomach, cause stretch receptors to say "severe colic". How can you differentiate this from Colic?If HR >60, place NG tube, in case it is obstruction/strangulation. if put NG tube in and they look calmer after, helps dx this (if obstruction, they still colic after placement of tube)
Sources of Accumulated Fluid in DPJ? How much fluid can accumulate in one day?Parotid saliva, Gastric secretions, Pancreatic secretions, Bile... Total 80-120 L/day for a 500kg horse
7 CSs of DPJ?Colic, Fever, Tachycardia, Endotoxemia, Decreased borborygmi, Copious amounts of gastric reflux, Dehydration & volume depletion (note-- if you need to tube them to relieve 20-30L from their GI, you are gonna have to replace those fluids)
ddx for DPJ?All SI obstructions (Simple or strangulating)
Goal: rule out surgical disease-- what will rectal be like if it's DPJ? dilated loops of SI
Goal: rule out surgical disease-- what will NG tubing be like if it's DPJ?large volumes and improved comfort after decompression
Goal: rule out surgical disease-- what will U/S be like if it's DPJ?dilated SI, increased wall thickness
*** what will the fluid from abdominocentesis look like with DPJ?dark yellow/ orange. Elevated protein (if you see this, high high chance of DPJ, dont send to sx, it wont help this dz)
what are the main drugs used to tx DPJ?Anti-inflammatory, NSAIDs / 2% Lidocaine CRI (lidocaine helps with ileus)
when would you want to give nutritional support to DPJ hoses, and how would you provide it?NPO>72 hours (3d) is indication Do TPN with a double lumen catheter
Why would you wanna provide laminitis prophylaxis for a DPJ horse?bc risk of endotoxemia
what are 5 main complications of duodenitis proximal jejunitis?Laminitis (bc possible endotoxemia), Thrombophlebitis (bc risk of caths) Peritonitis (bc severe inflammation), Adhesion formation (inflammation again), Pharyngitis / esophagitis (Also consider lots of fluids= high cost of tx)
CQ: a horse affected with idiopathic focal eosinophilic enteritis usually presents with....acute colic