Nutrient absorption (CHO / fats / proteins), Brush border created by SI villi is what absorbs things
Malabsorption syndrome if absorption at ___ fails
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"?
how do you definitively dx IBD/ any of the particular dzs which fall under IBD?
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?
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?
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
(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
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....
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