Vomiting In Small Animals
Help! Sally says her 7 y/o setter 'Sandy' vomited variable volumes in the mudroom most of this morning. Sally was sitting near Sandy when she soiled the space.
To help define the problem, you're going to ask Sally several questions to ascertain what?
Is she actually vomiting, or is it regurgitation, gagging, coughing, or reflux.
Define acute vs chronic D
Chronic = longer than 3 weeks
When defining the location with equine dysphagia, we localize to these three zones
1. Prepharyngeal
2. Pharyngeal
3. Postpharyngeal
When defining the location for an adult horse with diarrhea, what is most likely
large intestine
The three factors involved in farm animal diarrhea are
1. Pathogens
2. Host Factors (stress, immune system)
3. Environment and Management
Sort these into either primary or secondary GI problems:
-Chronic Kidney disease
-Chronic Inflammatory enteropathy
-Gastric Foreign body
-Rat Bait ingestion
1º: CIE, GiFB
2º: CKD, rat bait ingestion
Describe typical small bowel diarrhea for me
liquid/watery, large volumes 1-2/day, if blood it's dark
Pt has: weight loss, can vomit, usually decreased appetite
This symptom will help you differentiate prepharyngeal dysphagia from other types
nasal regurgitation and/or coughing
Larval cyathostominosis is a differential for equine diarrhea in all groups except
neonatal foals
Give me three pathogens that might cause acute diarrhea in calves. Daily double if you can tell me which is most likely responsible symptoms in calves ages 5-14 days
E. coli
Cryptosporidia
Rotavirus
Coronavirus
Coccidia
Salmonella
Rick the Rottweiler (4 y/o MN) presents with a 24 hour history of vomiting twice with some diarrhea. His owners report he has vomited after eating dinner last night and this morning, and had some diarrhea on his morning jog. Owners are very strict about his diet, they only give him well balanced commercial food. He is however, a counter-hoppin' butter-licker and will steal from their kitchen.
Rick's vitals are WNL although he's a bit dry, he's drinking water on his own, and he's kept down some rice the owners fed him an hour before the appt. He has good energy.
Rick's owners are concerned about costs but want what's best for him. Is it reasonable to send him home with medical management?
Yes, Treat and yeet and most 1º GI issues are medically manageable and he seems to be tolerating a bland diet.
What are 5 possible causes of large bowel diarrhea
Infection: Parasites, Protozoa, Bacteria
Dietary: toxic, fiber-responsive, hypersensitivity/intolerance
Inflammatory: idiopathic ulcerative, eosinophilic, granulomatous
Neoplasia
Stress
Strictures
What are three risk factors for esophageal obstruction in horses
-poor dentition
-bolt eaters
-type of feed/preparation
-previous choke history
-sedation
-GA
-exhaustion and dehydration
There are two causes for diarrhea that could be included in the differential lists for both acute and chronic diarrhea. Name them. (1/2 points possible)
Larval cyathostominosis
NSAID induced ulcerative right dorsal colitis
Despite its name, this pestivirus is most likely to cause reproductive disease and immunosuppression
Bovine Viral Diarrhea Virus
How would your diagnostic workup change if you are investigating a 1º vs 2º GI disease
1º generally start with imaging, BW if you're concerned about the effects from the problem
2º generally start with bloodwork and urinalysis
What diagnostics would you only use on chronic small bowel
serum trypsin like immunoreactivity
cobalamin and folate
From what side of the neck could you possibly feel an esophageal obstruction?
The left
A definitive diagnosis of clostridiosis in horses requires two tests. What are they and why.
Fecal culture and evidence of bacterial toxins (either by ELISA toxin assay or toxin gene PCR)
C. diff and C. perfringens can be normal GIT bacteria. Need evidence of toxins to dx as the cause of disease
Johne's disease is caused by a bacterium of this genus and species (bonus points for subspecies)
Mycobacterium avium subspecies paratuberculosis
Give me 5 causes of regurgitation
1. Persistent right aortic arch
2. Space occupying lesion (tumors in mediastinum/chest)
3. Esophageal foreign body
4. Esophageal stricture
5. Hiatal hernia
6. Diverticulum
7. Esophagitis (trauma, gastric reflux, doxycycline)
What might push you to do a GI biopsy sooner rather than later
significant changes on ultrasound (significant thickening of the intestinal wall or loss of wall layering)
significant weight loss
lethargy
hypercalcaemia
hypocobalaminemia
strong suspicion of neoplasia
owners.
When doing an esophageal lavage, what specific anatomical landmark does the head need to be below to avoid aspiration.
Point of the shoulder
The treatment of acute diarrhea often involves fluid therapy. What is the maintenance rate of fluids for adult horses. Daily double if you also provide the foal maintenance rate.
Adults: 40-60mL/kg/day
Foals: 80-100mL/kg/day
One must be very cautious about interpreting fecal results with this bacteria, as many strains are normal commensals of the GIT. Especially, Take Extra Care to think about these two pathogenic strains.
Enterotoxigenic EC
E coli 0157