Term
| List the clinical signs of oral disease |
|
Definition
*reduced feed intake: inappetance or anorexia
* difficult or slow eating
dropping feed, quidding
abnormal odor
excess salivation
bloody saliva
weight loss
Performance/Behavioral problems: head tossing/shaking/tilt, excess mouthing of bit, resistance to turns, bit contact, flexion, resistance to placement of bit and bridle |
|
|
Term
| list some DDx for reduced feed intake |
|
Definition
significant pain at any body location
infection w/ toxemia
neurological disease
renal disease
anorexia in horses= icterus |
|
|
Term
| list the clinical signs of difficulty eating |
|
Definition
prehension problems
quidding
painful chewing
ptyalism
dysphagia
**different problems in the mouth cause variable presentations...
ie- neuro dz, dental dz, slobbers,
stomatitis, TMJ pain, white
muscle dz, etc |
|
|
Term
| What neurologic diseases cause dysphagia and prehension problems in the horse? |
|
Definition
*Rabies, *Botulism, *tetanus
Also: equine protozoal myelitis, west nile virus, EEE/WEE, EHV-1, yellow star thistle toxicity, guttural pouch disease w/ cranial nerve dysfunction
**PERFORM A NEURO EXAM** |
|
|
Term
T/F:
exam w/out sedation and a speculum limits your exam and may result in failure to ID problems with the caudal oral cavity and cheek teeth |
|
Definition
|
|
Term
| What structures should you exam in the oral cavity |
|
Definition
lips and labial mucosa
tongue and beneath
buccal mucosa
teeth and gums
mucous membranes: color, moistness, CRT, presence of any lesions |
|
|
Term
| List some causes of stomatitis |
|
Definition
*Dental abnormalities causing mucosal trauma
*coarse, spiky feeds (traumatic stomatitis)
*vesicular stomatitis-REPORTABLE
*Slobbers (excess salivation w/o oral lesion)
Also: oral neoplasia, cantharadin toxicosis, NSAID toxicity, uremia) |
|
|
Term
| Is vesicular stomatitis federally important? |
|
Definition
|
|
Term
What is vesicular stomatitis?
List some clinical signs
Pathogenesis? |
|
Definition
viral dz of horses, cattle, and swine whose primary DDx in non-equine is foot & mouth
signs: fever, oral mucosal vesicles that rupture and coalesce into large erosions
Path: trasmitted by Culicoides sp vector and direct contact
endemic in southwest US & intermittent outbreaks in the Rockies |
|
|
Term
| Stomatitis may occur as a consequence of course feeds. What are some clinical signs? |
|
Definition
| slow/difficult eating, possibly excess salivation, weight loss over time; history of exposure to pasture/forage containing sharp awns or spines |
|
|
Term
|
Definition
profuse salivation but no other evidence of oral disease
*NO stomatitis evident on oral exam |
|
|
Term
| What is the inciting cause? |
|
Definition
horses pastured on clover or alfalfa
caused by *slaframine*, a mycotoxin produced by a fungus that infests clovers and alfalfa |
|
|
Term
T/F:
the orophaynx is almost completely divided from the nasopharynx by the soft palate |
|
Definition
|
|
Term
|
Definition
inflammation secondary to viral or bacterial upper respiratory infection
may be associated with marked lymphoid hyperplasia in young horses
may be secondary to pharyngeal trauma, use of balling guns, or migrating FB's |
|
|
Term
| What are some possible clinical signs of pharyngitis |
|
Definition
GI signs: inappetance, slow eating, painful eating, dysphagia
+/-Respiratory signs:
**abnormal resp noise**
or resp obstruction |
|
|
Term
| What is lymphoid hyperplasia? what age horse is affected? what causes it? |
|
Definition
common condition affecting the dorsal and lateral pharyngeal walls in YOUNG horses (1-3yo)
lymphoid follicles in the mucosa of the pharynx have a nodular cobblestone look
reflects normal immune responses
associated with pharyngitis caused by *viral or bacterial infxn |
|
|
Term
| What are some signs associated with lymphoid hyperplasia? |
|
Definition
impaired athletic performance
airway noise during exercise
+/- mucopurulent nasal discharge
painful swallowing-> inappetance |
|
|
Term
| What are some other causes of pharyngeal dysfunction? |
|
Definition
external compression
neurological and neuromuscular disorders
- Botulism
- White muscle disease in foals
- HYPP in foals
- cranial nerve dysfunction due to
primary neuro disease or
guttural pouch disease |
|
|
Term
| What kind of teeth and how many of each are in the lower and upper jaw? |
|
Definition
Lower Jaw:
3 incisors per side
1 canine per side (*males)
6 cheek teeth per side
(premolars 2-4; molars 1-3)
(premolar 1= wolf tooth)
Upper Jaw:
3 incisors per side
1 canine per side (males*)
6 cheek teeth per side
(premolars 2-4, molars 1-3)
+/- premolar 1 (wolf tooth)
total number of possible teeth: 42-44
(includes canines & wolf teeth) |
|
|
Term
| What is the Triadan System? |
|
Definition
each tooth is assigned a 3digit number based on its quadrant and its rostral to caudal position w/in that quadrant
upper right= 100
upper left = 200
lower left = 300
lower right= 400 |
|
|
Term
how many deciduous teeth does a horse possess in the first 2 years of life?
how many teeth take their place? |
|
Definition
24 (3 incisors per quadrant; 3 cheek teeth per quadrant)
replaced by 36-44 teeth |
|
|
Term
| what are caps? Are they pathological? |
|
Definition
deciduous teeth not yet completely shed as permanent teeth erupt from the gumline beneath
*only pathological when they fail to detach |
|
|
Term
| at what age does a horse have its permanent dentition? |
|
Definition
|
|
Term
| do horses generate new tooth material throughout their life |
|
Definition
|
|
Term
| at what age do old horses "run out" of tooth material? |
|
Definition
| 20-30yo (depends on rate of wear) |
|
|
Term
| if a permanent tooth is lost will a new one grow in its place? |
|
Definition
|
|
Term
| List some common equine dental problems |
|
Definition
retained caps & impacted permanent teeth
sharp "points" w/2nd trauma of mucosa
Malocclusions
"runnning out of crown" in geriatrics |
|
|
Term
| Where do points most commonly occur? (ie where are the regions of least wear?) |
|
Definition
buccal edges of upper cheek teeth
lingual edges of lower cheek teeth |
|
|
Term
|
Definition
lack of proper even contact b/w the upper and lower teeth-> uneven bite plane*
may affect the cheek teeth or incisors |
|
|
Term
| List the types of malocclusions that occur with cheek teeth |
|
Definition
"Wave Mouth"- undulating bite plane; involves several teeth
Rostral Hook
Caudal Hook
Ramp (similar to rostral hook, but occurs on lower jaw cheek teeth) |
|
|
Term
| What types of malocclusions occur with the incisors? |
|
Definition
[Note: incisors usu meet with a slight overbite]
Parrot Mouth: mandibular brachygnathism (extreme overbite)
Others occur too, but dont have specific names
-interfere with cheek teeth ability
to chew food normally |
|
|
Term
|
Definition
smooth little "nubbins"
not effective for grinding feed
need pelleted food |
|
|
Term
| How often should routine dental care be done? |
|
Definition
Dictated by horse's age
- young horses (2-5)
*dental exam every 6months
*routine floating, check for
retained caps, extract wolf
teeth? (as needed)
- mature adults
* annual exam and floating of
points
*if >20 may need more attention
Most horses benefit from annual* exams
(some need more frequent attention)
(exams every 2yrs may be OK depending
on history) |
|
|
Term
|
Definition
abrasive hand- or power- tools are used to lightly file down points and reduce malocclusions
**be CAREFUL not to avoid tooth injury or remove too much crown |
|
|
Term
| Why does acute diarrhea "strike fear into the hearts of horse owners"? |
|
Definition
| expensive; may be fatal; risk of laminitis; risk of contagious spread; biosecurity; zoonosis |
|
|
Term
| What are the common INFECTIOUS etiologies for acute diarrhea in foals and in all ages? |
|
Definition
Foals:
*Rotavirus
*Lawsonia intracellularis
*Cryptosporidium spp
Parasites: Strongyloides westerii,
ascarids
All ages:
*Salmonella spp
*Clostridium difficile
*Clostridium perfringens
*Neorickettsia risticii (Potomac Horse
Fever)
Parasites: Strongyles, tapeworms |
|
|
Term
| Name some common NON-infectious etiologies for acute diarrhea in horses? |
|
Definition
Foal Heat Diarrhea
NSAID toxicity (right dorsal colitis)
Sand enteropathy
Nutritional: change feed, overconsumption, grain overload, moldy feed, poisonous plants |
|
|
Term
| List some causes of Chronic diarrhea in horses |
|
Definition
Associated with significant weight loss
Sand enteropathy
Parasitism
Salmonella spp
Malapsorption syndromes (infiltrative disease):
*Inflammatory Bowel Disease
granulomatous enteritis
eosinophilic enteritis
lymphocytic/plasmacytic
enteritis
*Neoplasia |
|
|
Term
| what is the appropriate clinical approach to diarrhea? (4 steps) |
|
Definition
1. History
2. Triage/ PE
3. Supportive therapy
-fluids
-anti-inflammatories
-laminitis prophylaxis
4. Dx testing--> etiology-specific
therapy |
|
|
Term
| What should your PE exam include? |
|
Definition
Assess GI & CV systems
hydration status
*signs of hypovolemic and/or
endotoxemic shock? (tachycardia,
abnormal mm/CRT, weak pulses, weak
jugular fill, cold extremities)
Clin signs of electrolyte derangement?
weakness, arrhythmias, seizures,
muscle fasiclations
*Colic may precede diarrhea!
Endotoxemic mm-> high risk of laminitis
Inspect the feces
*fetid odor= Salmonella
*blood/fibrin= salmonella or
clostridium
*check for sand, parasites, abnormal
feed/content |
|
|
Term
| What data is important to obtain from bloodwork? |
|
Definition
hematology: hydration, inflammation, TP (increased/decreased), fibrinogen
*many horses have PLE with
diarrhea (edema!; maintain with
colloids)
Chem: electrolyte/acid/base status; renal function; albumin; liver enzymes/ function |
|
|
Term
| What diagnostic tests can you run on a fecal sample? |
|
Definition
culture, PCR, ELISA, IHC, fecal float, sand test
(can also do a blood PCR for Potomac Horse Fever) |
|
|
Term
| What are the general principles of therapy for acute diarrhea? |
|
Definition
*Rehydrate (saline or LRS, +/- K+)
*replace ongoing fluid/protein losses
*correct electrolyte/acid/base derangement
*treat endotoxemia; anti-inflammatories
*laminitis monitoring/prophylaxis/trx
*gut protectants/absorbents
*etiology specific therapy |
|
|
Term
| What is the recommended therapy for endotoxemia? |
|
Definition
NSAIDs (Banamine)
Polymyxin B
Hyperimmune anti-endotoxin plasma
other anti-inflammatories?
DMSO, Pentoxifylline, Aspirin (for
anti-thrombotic properties) |
|
|
Term
| List some supportive therapies for diarrhea in horses |
|
Definition
*Bio-Sponge(DTO-smectite): intestinal
absorbant
*Saccharomyces boulardii: a probiotic
yeast
(reduces the duration and
severity of clinical signs of
acute enterocolitis as an
adjunctive therapy)
Bismuth salicylate
Fecal Transfusion
Enteral and/or parenteral nutrition
Ceftiofur- commonly chosen broad-
spectrum antibiotic |
|
|
Term
What is Foal Heat Diarrhea?
What age is affected?
Trx? |
|
Definition
Mild diarrhea; NOT assoc. with systemic illness; likely due to developmental changes in the intestinal epithelium (physiologic)
Age affected: foals 5-14 days old
Trx: no specific treatment; just supportive/ general trx
*Need to r/o other causes* |
|
|
Term
| What is the most common cause of infectious diarrhea in foals under 6mo? |
|
Definition
| Rotavirus; Highly contagious!!!! |
|
|
Term
| How is rotavirus transmitted? |
|
Definition
|
|
Term
| Does rotavirus affect adults? |
|
Definition
|
|
Term
| Describe the pathophys of rotavirus |
|
Definition
| virus attakcs SI villus epithelium-> maldigestion and malabsorption-> diarrhea |
|
|
Term
| How do you diagnose rotavirus? |
|
Definition
*Fecal ELISA (most sensitive; rapid)
or electron microscopy |
|
|
Term
| Cryptospridiosis is a CONTAGIOUS protozoan...describe its pathogenesis |
|
Definition
villous atrophy of small intestine
(lower in DDx list for foal diarrhea) |
|
|
Term
| is cryptosporidosis a zoonotic dz? |
|
Definition
|
|
Term
| How do you diagnose crypto? |
|
Definition
| direct fecal smear/parasitology |
|
|
Term
What is the pathogenesis of Lawsonia intracellularis*?
What are the associated clinical signs/diagnostic findings? |
|
Definition
causes proliferative enteropathy, malabsorption and protein-losing enteropathy
weight loss, *hypoproteinemia, *edema, +/-diarrhea* in young horses |
|
|
Term
| What age does Lawsonia commonly affect? |
|
Definition
|
|
Term
| How is Lawsonia transmitted? |
|
Definition
fecal-oral
contagious disease, but not extremely contagious...usu only a small # of affected animals |
|
|
Term
| How do you diagnose Lawsonia? |
|
Definition
*rule out more common causes of enteritis and weight loss (ie-parasites, salmonellosis)
*Ultrasound (marked thickening of small intestine*
Lab tests: *marked hypoproteinemia
fecal PCR; serology |
|
|
Term
| What is the best treatment for Lawsonia? |
|
Definition
Oxytetracycline IV*
(or azithromycin or chloramphenicol)
Plasma transfusion/hetastarch-> boost protein levels |
|
|
Term
| Which salmonella species is usu involved with equine salmonellosis? |
|
Definition
|
|
Term
|
Definition
|
|
Term
| Why is Salmonellosis a mojor concern in equine hosptials? |
|
Definition
increased shedding by stressed/sick horses
risk nosocomial infxn |
|
|
Term
| List some sources of salmonella |
|
Definition
| shedding horses, environment, cattle, wildlife, rodents, birds, contaminated feed |
|
|
Term
| Describe the pathogenesis of Salmonella |
|
Definition
blood/fibrin is suggestive
gram-neg org: *marked endotoxemia*!
*high risk of laminitis, DIC
PLE
tends to invade the bloodstream, then seed other organs- thrombosis and infarction |
|
|
Term
| How would you diagnose Salmonellosis? |
|
Definition
Serial fecal cultures*
*Need 5 cultures to r/o in horses
- only 3 to r/o in ruminants
*Fecal PCR |
|
|
Term
| What is the cause of clostridial enterocolitis? |
|
Definition
| Clostridium difficile or perfringens |
|
|
Term
| Why might antibiotic therapy and dietary changes lead to clostridial enterocolitis? |
|
Definition
| disrupt native colonic flora |
|
|
Term
| How do you diagnose Clostridial enterocolitis? |
|
Definition
| ELISA* - tests for enterotoxins |
|
|
Term
| is there a specific treatment for clostridial enterocolitis? |
|
Definition
|
|
Term
| What is the causative agent of Potomac Horse Fever (PHF)? |
|
Definition
|
|
Term
| Where/when is PHF more commonly seen? |
|
Definition
more common around bodies of water
summer/fall in MN
(aquatic snail is host) |
|
|
Term
| What is another name for PHF? |
|
Definition
| *equine monocytic erlichiosis |
|
|
Term
| PHF is clinically indistinguishable from which other diarrhea causing disease? |
|
Definition
|
|
Term
| What are some clinical signs of PHF? |
|
Definition
fever, limb edema
**HIGH risk of laminitis!! |
|
|
Term
|
Definition
| PCR of feces/blood (often trx on clinical suspicion in endemic areas) |
|
|
Term
|
Definition
*IV oxytetracycline
(can be nephrotoxic in dehydrated
animals-> restore hydration first)
Trx laminitis too! |
|
|
Term
| Is there a vaccination for PHF? |
|
Definition
YES, a bacterin vaccine is available
(short-lived protection)
(vaccinated horses can sill be
infected) |
|
|
Term
| what body sites are affected by NSAID toxicity? |
|
Definition
oral ulcers
gastric ulcers
*right dorsal ulcerative colitis
renal papillary necrosis |
|
|
Term
| List the clinical signs of right dorsal colitis |
|
Definition
| lethargy and anorexia, colic, +/- diarrhea, PLE-> ventral/distal limb edema, fever, endotoxemia, oral/gastric ulcers |
|
|
Term
| How do you diagnose right dorsal colitis? |
|
Definition
| AUS: thinkened intestinal wall |
|
|
Term
| how would you trx right dorsal colitis? |
|
Definition
*NSAIDs contraindicated
*Dietary management
Sucralfate
Misoprostil
Plasma +/- hetastarch
Omeprazole
supportive therapy |
|
|
Term
| Describe the clinical approach to chronic diarrhea |
|
Definition
affects individual horses
patient is likely stable w/ normal hydration and no endotoxemia
results in malabsorption, weight loss, and protein loss
History (diet, sand, parasite control, meds, supplements, NSAIDs, management, toxins
CBC, Chem, Fecal (sand, pasasitology)
*Can't detect encysted small strongyles and tapeworms shed infrequently* |
|
|
Term
| Diagnostic tests for chronic diarrhea |
|
Definition
Rectal
AUS
Glucose absorption test
rectal mucosal biopsy
intestinal biopsy |
|
|
Term
|
Definition
inflammation of the mesothelial lining of the peritoneal cavity
parietal peritoneum: mesothelial lining of the diaphragm, abdominal walls, pelvic cavity
visceral peritoneum: serosal surfaces of the abdominal organs |
|
|
Term
| List some possible causes of peritonitis |
|
Definition
bacterial, viral, fungal, perasitic
traumatic, chemical, neoplastic |
|
|
Term
| List some routes of infection |
|
Definition
penetrating abdominal injury
leakage from GI tract
- 2nd to obstruction/strangulation
- perforated ulcers
- heavy parasitism
- iatrogenic (rectal, biopsy,
enterocentesis, trocharization)
complication of abdominal surgery
- iatrogenic
-leakage from compromised gut
- rough handling of viscera
- anastomosis breakdown
- FB
leakage from the urogenital tract
-breeding/foaling trauma
- iatrogenic - repro procedures
- bladder rupture in foals
hematogenous spread of bacteria |
|
|
Term
| List the clinical signs of peritonitis |
|
Definition
Depends on primary problem, causative agent, severity, and duration of dz
*fever
*abdominal pain: splinting, not moving,
colic
Depression, inappetance/anorexia
tachycardia
reduced GI motility
Loose feces
If gut rupture and diffuse peritonitis:
-ENDOTOXEMIC SHOCK
-CV collapse
-muscle fasiculations
- hypothermia
- rapid progression-> death |
|
|
Term
| Systemic signs may be minimal with only a mild local peritonitis for which bacteria? |
|
Definition
A. equuli
carries a better prognosis**
very high WBC counts in peritoneal fluid; less likely to cause critical illness; adhesions rarely occur |
|
|
Term
| How do you diagnose peritonitis? |
|
Definition
Abdominocentesis: increased WBC and TP
(>2.5)
+/- lactate
gram stain
Cytology: increased protein and neutrophil* count, degenerate changes, +/- intra- and extracellular bacteria
CBC/Chem: inflammation; hypoproteinemia, prerenal/renal azotemia, high globulins, metabolic acidosis
Rectal: painful, +/-adhesions, serosa feels sticky/rough
AUS: fibrin, abscesses, peritoneal fluid accumulations
Culture: *negative culture does NOT rule out septic peritonitis
-most common organisms: E.coli,
Staph and Strep, Rhodococcus, A.
equuli, Bacterioides fragilis
- BROAD-SPECTRUM COVERAGE |
|
|
Term
| Describe the principles of therapy |
|
Definition
1. know when to refer
2. kill bacteria (broad-spec,
bactericidal)
-penicillin, gentamycin,
metronidazole
3. correct dehydration/electrolytes
- TPP<4.5 is an indication for
colloid therapy
4. trx inflammation and endotoxemia
5. provide pain relief
6. correct hypoproteinemia
7. Monitor/ trx complications
8. correct primary problem?
9. peritoneal lavage |
|
|
Term
| What are adhesions? How to manage? |
|
Definition
initially fibrinous*; later oranize and become fibrous"
may result in partial or complete intestinal obstruction by locking the gut into abnormalconfigurations
Trx/manage: flunixin, heparin, abdominal lavage |
|
|
Term
| What is the prognosis for peritonitis? |
|
Definition
100% mortality w/ GI rupture
56% mortality for post-op peritonitis
Excellent prognosis for A. equuli |
|
|
