Equine Med- Stomach

wilsbach's version from 2016-02-18 23:15


Question Answer
CQ: common complication after an episode of choke....?re-obstruction (they get food too early) (reflux esophagitis not common in choke, rupture is not common either)
Gastric Ulcers (EGUS)-- why do ulcers form? what are the two kinds of ulcers?Occur when protective mechanisms are overcome by destructive factors (acids). There are bleeding ulcers and perforating ulcers (True clinical gastric ulcers are uncommon)
why do we care about the age of a horse when we say it has an ulcer?foal vs adult have different etiology and clinical signs for ulcers
what is usually protective against the squamous portion of the stomach getting damage from acid?Forage ball in lower half protects squamous epithelium from HCL + bile acids
in what ways is the glandular mucosa protected against the acid?Mucus barrier & HCO3- secretion, Rapid regeneration and repair
how does the stomach pH differ between grazing and meal feeding?meal feeding causes lower pH
how does grain feeding affect the stomach/ its defenses?grain feeding--> Saliva (saliva produced in response to chewing, grain requires less chewing, so less saliva produced) decrease and feed ball decrease
which feed has greater buffering effect in protecting squamous mucosa?Legume forage (alfalfa)
how does exercising impact ulcer formation?High concentrate diet and withholding feed increases risk of mucosal injury (which is how many performance horses are fed), Strenuous exercise lowers pH in upper part stomach, “Sloshing effect” of HCL to upper part of the stomach due to increased abdominal pressure
everyone gets ulcers, but which types of horses tend to get them more?Endurance horses and Thoroughbred racehorses (basically high performance horses)
6 major risk factors for ulcer formation in ADULTS?(1) Stall confinement (vs pasture) (2) Stress (individual variation) (3) Increased intensity of exercise (4) High CHO diets (5) NSAID use (6) Helicobacter pylori????? <--mostly human prob, they are trying to see if prob in horses
what are primary risk factors for ulcers in FOALS?Hypoxemia, Nsaid, Hospitalization, Stress!
how is hypoxemia in the foal a risk factor for ulcers? Which part of stomach is most effected? mainly in GLANDULAR part! dec O2-- less production of prostaglandin E which helps prevent ulceration
1° Gastric / duodenal ulcer disease is risk factor for ulcers in..foals
which type of foals are most at risk for ulcers and why?neonates and weanlings, bc they are under sig. stress at these times
What are the CS of ulcers in ADULTS?? (diff from foals!)In adult the signs are subtle and non-specific. Intermittent colic, Appetite (grain) (take a long time to eat their grain, or will start eating and then stop, but are fine with the forrage), Loss of BCS, Poor hair coat, Behavior change
what are the CS of ulcers in FOALS?? (diff from adults)in foals the signs are much more specific to ulcers-- Bruxism / ptyalism (teeth grinding is the #1 ulcer sign), Mild-severe pain (they will want to lie on their back all the time to relieve the pain), Intermittent nursing
what is the only way to definitively dx an ulcer?Gastroscopy!! but very expensive. Also need a 3m scope (not everyone has this) (if cant, you can go off of CS and watch response to tx aka "diagnostic tx")
what is a common location predisposed to ulcers?pylorus
How do you communicate to other vets how bad an ulcer is?you grade them (she said she will not ask us to grade anything, but here is the info to read over) Grade 0: WNL, Grade 1: mucosa intact / squamous hyperkeratosis, Grade 2: small single / multifocal lesions, Grade 3: large single / extensive multifocal superficial lesions, Grade 4: extensive lesions / deep ulceration
what are the 3 big ddx for a gastric ulcer?Gastric Impaction, Gastric Neoplasia, Pyloric stenosis
who would you see Pyloric stenosis in?foals
gastric neoplasia is a big ddx for ulcers- what would the most likely neoplasia be?SCC
what is happening with a gastric impaction? how might you be able to help?(dry feed material) Rare but poor prognosis, Gastric wall becomes strectched and thin, Easy to rupture/ no surgical access, Diet Coke may help break up impaction
ulcer treatment heavily depends on management modification. What are some things you should tell owners to do?realistic advice to owners. if possible to modify certain things, that's great, but often difficult to change management. minimize concentrate in high volumes-- better to give mult times a day in smaller amounts.
what are the Medical Therapy approaches you can consider (and examples of the drugs for each)(1) Proton pump blockers (omeprazole) (2) Histamine Type-2 Receptor Antagonists (Ranitidine / Cimetidine) (3) Coating agents (sucralfate)
what is the Only FDA approved / licensed drug to treat and prevent EGUS?Omeprazole (gastrogard / ulcergard)
what is the H+ pump blocker used to tx ulcers? pros and cons?CON: expensive. PRO: Only FDA approved / licensed drug to treat and prevent EGUS
what are the 2 H2-Receptor Antagonists used to tx ulcers? which is more potent? how do they work?Ranitidine / Cimetidine..... Ranitidine is more potent. Lowers gastric acid production (long term use means cost adds up to about equal the expensive omeprazole)
what are the 2 Coating Agents used to tx ulcers? WHO do you want to use this tx with? how does it work? how must you admin?Sucralfate / Carafate....These are good to tx foals with problems due to hypoxemia, not very effective for adults. IT Binds to ulcerated areas and Stimulates PG activity (mucosal blood flow) (hence, hypoxic foals), Must be given without feed! Works for 2-6 hours
2 drugs used as alternative tx (she said we never use these, forget about them, just here to read)(1) Misoprostol (synthetic hormone)- Improves blood flow, may cause cramping. (2) Prokinetic agents- Increase gastric emptying, but concerns of colitis and diarrhea