Common Gastrointestinal Ailments

Transcription

1 Common Gastrointestinal Ailments EQS 110

2 Table of Contents Click on the different sections of the table of contents to jump through this document Esophageal Obstruction ( Choke )... 3 How Do Horses Choke?... 3 Signs of Choke... 4 Diagnosing & Treating Choke... 4 Preventing Choke... 5 Eats Too Fast / Bolts Feed... 5 Dental Issues... 6 Prior Choking, Small Esophagus, Etc Equine Gastric Ulcer Syndrome ( Ulcers )... 7 Causes of Ulcers... 7 Signs of Ulcers... 8 Diagnosing Ulcers... 8 Treating and Preventing Ulcers... 9 Colic Why Do Horses Colic? Classifying Colic Impaction Gas Displacement Signs of Colic Diagnosing Colic Treating of Colic Preventing Colic Self-Knowledge Checks Answers Glossary... 16

3 Esophageal Obstruction ( Choke ) Esophageal obstruction, better known as choke, is a blockage of the esophagus. Unlike in humans, where choking is a lifethreatening situation due to the person s inability to breathe, horses are still able to breathe since it is the esophagus being blocked and not the trachea. While choke in horses is not necessarily lifethreatening, it can become a serious issue if not quickly resolved. How Do Horses Choke? The causes of choke revolve around items that can obstruct the esophagus, both edible and non-edible. The most common items horses choke on are hay and grain, the two main feedstuffs we provide our horse. Horses have a tendency to choke on these items due to: Fast Eating Poor Dental Health Prior Choking Small Esophagus This is commonly referred to as bolting This results in the inability to properly chew, resulting in larger particle sizes to be swallowed Choking can scar the esophagus, resulting in scar tissue that narrows the pathway Ponies and other smaller-bred horses may be more likely to choke due to an anatomically smaller esophagus While hay and grain are likely culprits of choking episodes, they are not the only thing a horse can get lodged in their esophagus shavings, treats, and pieces of tack or metal are just a couple of endless possibilities!

4 Signs of Choke The signs of choke are quite visible to the equine caretaker. If it is hay or grain that the horse is choking on, they will suddenly back off from eating. This is followed by the inability to swallow food or water, which can lead to the horse making repeated attempts to swallow with no success. You might start to see the horse stretch his head and neck in an effort to swallow and push the mass along. Some horses may start to become distressed at the fact they cannot swallow. If the horse is unsuccessful in dislodging the blockage, you will begin to see saliva drool out of the mouth. If feed material is the cause of choke, you will see thick nasal discharge with food particles present after several minutes of the choking episode. In severe cases, the obstruction in the esophagus may be visible or palpable (can feel it). Diagnosing & Treating Choke Diagnosis of choke is quite clear from clinical signs alone. Depending on the severity and what exactly is lodged in the esophagus, the horse may pass the blockage on its own with minimal assistance. Some suggest massaging the esophagus in an effort to help move the feed material along. If you do not know what the horse is choking on this is not advised, as it may be something you don t want moving to the rest of the gastrointestinal tract. Once the situation is assessed and choking is clearly diagnosed and has not been resolved, your veterinarian will need to be contacted. The most common treatment for esophageal obstruction is sedation this will help the soft tissue of the esophagus relax so the obstruction may pass on its own. If this does not work, your veterinarian will need to take a more invasive approach via nasogastric tube and a warm lavage, which is a sterile wash. The veterinarian will insert this tube through the nose and down the esophagus so warm, sterile water can be administered to loosen and soften the obstruction. If it is not clear that feed material is the cause of the obstruction, your veterinarian may choose to run an endoscope down the esophagus to view the obstruction and esophageal tissue. If the obstruction is non-edible, then your veterinarian will need to surgically remove the item via an incision to the esophagus. Depending on how long the horse was choking for, intravenous fluids may need to be administered to combat dehydration.

5 While choke is not life-threatening, the timeliness of treatment is key to preventing serious complications. For example, aspiration pneumonia can occur due to food or water getting into the trachea during repeated attempts to swallow or the esophagus can even rupture. Remaining calm, assessing the situation, and working quickly and effectively to resolve this ailment will give your horse the best prognosis. Preventing Choke Prevention of choke comes from good management! Depending on what the root cause is, a variety of strategies can be implemented to prevent this from happening again: Eats Too Fast / Bolts Feed Horses that eat too fast need to be managed appropriately. If the horse is eating grain too quickly we need to focus on strategies that will slow him down. One way of doing this is to make sure we are providing small meals multiple times a day the less grain provided the less likely he will be to choke. If the horse is already receiving multiple small meals, then we need to look at his feed tub and find a way to make him work for his supper. We can do this by introducing a slow feeder or placing large, smooth rocks or even salt blocks in the feed tub so he must work around it to get his grain; this will prevent him from taking large mouthfuls. A second strategy to make a horse take longer to eat is adding water to grain so it is mushy or even a light soup this has the added benefit of making sure your horse gets some water intake! If the horse is choking on hay, we first need to evaluate the quality of the hay being provided. If the hay is too coarse/rough, it may be too difficult for the horse to chew effectively. If the hay is of good quality, we may then need to implement a slow feeder hay bag. Similar to a slow feeder for grain, slow feeder hay bags make a horse work for his food and limit the amount of hay that can be grabbed at one time.

6 Dental Issues If choking is a result of poor dental health or specific dental issues, you will need to work with your equine dentist to resolve these problems. For dental issues as a result of old age, soaking both hay and grain may be of benefit because it will make it easier for the horse to chew, making it less likely to be swallowed in a large chunk. Prior Choking, Small Esophagus, Etc. Horses with prior choking episodes and/or anatomical differences in esophagus size will benefit from any of the strategies discussed thus far as helping the horse slow down its eating and chew more effectively will deter choke from occurring.

7 Equine Gastric Ulcer Syndrome ( Ulcers ) Ulcers, a wound in the lining of the stomach caused by acid, is a prevalent problem among athletic horses; it is suggested that up to 90% of young racehorses suffer from equine gastric ulcer syndrome. With such a high prevalence, one might think that ulcers are an unavoidable ailment, but this is quite the opposite. The causes of ulcers are often due to modern management of the horse, especially the racehorse. By understanding what management techniques can make ulcers more likely, equine caretakers can take appropriate precautions in minimizing this gastrointestinal issue. Causes of Ulcers In the most basic sense, ulcers are caused by mismanagement of the horse s gastrointestinal tract. Let s consider the anatomy of the horse s stomach a little more in-depth stomach acid is continuously secreted due to the horse s original intent of being a roaming herbivore. When a horse ingests feedstuffs, such as grass or hay, it absorbs the stomach acid and keeps it at a low level in the protected region of the stomach, known as the glandular mucosa. Without food, which is often the case in horses that are confined and/or not allowed access to free-choice hay, the stomach acid rises and hits the non-protected region of the stomach, known as the squamous mucosa. Ulceration typically occurs in this non-protected region and at the margo plicatus, a region of the stomach that separates the glandular and non-glandular parts of the stomach. In addition to gastrointestinal anatomy, several other factors have been found to increase the risk of ulceration: Stress High-Grain Diet NSAIDs This can be caused by confinement, training, shipping, etc. Ingestion of grain increases the production of a hormone that stimulates stomach acid production large amounts of grain can result in higher stomach acid production, which if not absorbed by additional feedstuffs (such as hay or pasture), can result in ulceration Non-Steroidal Anti-Inflammatory Drugs have been found to block the production of a chemical that decreases acid production After reading the above chart think about how many of these factors occur with the racehorse all of them!

8 Signs of Ulcers The outward signs of ulcers are minimal and typically revolve around an attitude change and loss of appetite. For example, a normal pleasant horse suddenly becomes crabby this sudden shift in attitude can be a result of a wide range of issues but taking inventory at this horse s lifestyle. Questions to ask include: Is he in heavy training? Is he being shipped or traveling a lot? Is he under stress? Is he on NSAIDs or a high-grain diet? With ulcers being an internal issue that is not outwardly visible, we must act as almost as a detective in investigating mitigating factors that could make ulcers likely. Diagnosing Ulcers The only way to confirm the presence of ulcers is through a gastroscopy, which is an endoscope passing into the stomach. Scoping the horse s stomach will reveal the presence and severity of ulceration. Ulcers are graded on a scale from 0 to 3, with 0 being healthy, nonulcerated stomach lining and 3 being extensive lesions, deep ulceration, and bleeding. Click here to watch a video of gastroscopy

9 Treating and Preventing Ulcers Successful treatment and prevention of ulcers must involve a combination of medication and management changes! Providing only medication to treat the ulceration will be ineffective if the cause of the ulcer is still present. While management changes for a racehorse can be tricky due to limitations present at a racetrack/training center environment, increasing turnout, hand grazing, and ensuring forage availability while stalled can all help to maintain that natural intent of the horse continuous grazing. Re-evaluating the horse s diet and current medication protocol may also be necessary if the horse s lifestyle includes those risk factors. When looking at medications, about 99% of horses respond to Omeprazole (GastroGard). This medication stops acid production so the stomach lining can have a chance to heal. Other gastric-pump inhibitors, such as Cimetidine and Ranitidine, can also be utilized in the treatment of ulcers as they partially block acid production. Sucralfate (Carafate) is a mucosal adherent that may also be used in conjunction with other gastric-pump inhibitors because this particular medication provides a protective coating over injured mucosa (stomach lining).

10 Colic Colic, a term that refers to abdominal/gastrointestinal pain, is a word that strikes fear in any equine caretaker s heart. It is a great cause of concern for anyone involved in the equine industry because it is the number one cause of death for mature, non-geriatric horses. Colic is an ailment that can come on quickly and fiercely; being able to recognize the warning signs within minutes of their appearance can truly be the difference between life or death. Shared Belief, Nehro, and Regal Ransom are just a few of numerous famous Thoroughbreds who succumbed to colic Why Do Horses Colic? The majority of colic cases stem from the gastrointestinal tract. A horse s gastrointestinal system is complex in structure and function, predisposing them to this ailment simply because of their gastrointestinal anatomy. Unfortunately, it is not enough to say a horse colics just because of its GI tract numerous other factors can contribute to colic, including: Inadequate water intake Consumption of poor quality feed Abrupt changes in diet Ingesting sand or non-food items Exposure to (and consumption of) toxins, poisons, molds Stress In addition to all of these possible causes, understand the fact that the inciting cause for a particular colic episode is sometimes never determined.

11 Classifying Colic Horses can suffer from various types of colics and we classify the type of colic based on its anatomical location and issue. The most common types of colics are impaction, gas, and displacement. Impaction An impaction colic refers to a blockage of the intestinal tract, typically due to a lack of gut motility and/or water intake. Impaction colics typically take place in the large colon at the various flexures since these are tightly angled spaces. The most common cause of this colic is dehydration; appropriate water intake is vital for digestion and motility! Horses experiencing an impaction colic often show less aggressive signs of pain and discomfort when compared to other colics. Gas Gas colics result in a distended/bloated gut. This type of colic is often very painful, resulting in the horse showing heightened signs of discomfort and pain think of when you have had a gas pain and now imagine being a 1,100 lbs animal! While all colics will have some degree of gas buildup, this type does not begin with structural changes or abnormalities but can turn into a displacement or twist if not quickly resolved. Displacement Displacement colics involve the structures of the GI tract moving. For example, certain GI structures can get hooked on other internal structures. A torsion displacement involves a twisting of the GI structures, which is extremely painful to the horse. Twists can be in various degrees the higher the degree the more painful (and severe) it is. Displacements often show high degrees of pain and discomfort from the horse. The above image shows a left dorsal displacement this part of the large colon has gotten hung up between the spleen and kidney. The other name for this type of displacement is nephrosplenic entrapment

12 Signs of Colic Identifying the signs of colic is vital to your horse s survival! The most common signs of colic are: Restlessness Kicking/biting belly Lack of/dry manure Sweating Increase in HR & respiration Pawing Rolling & not shaking when rising Lack of gut sounds Standing stretched out Getting up and laying down frequently Laying down more than usual Backing off feed Presentation of colic signs always requires immediate notification to your manager and possibly a call to your veterinarian. Always try to retrieve the horse s vitals before calling as this will help establish the severity. Follow any instructions provided by your veterinarian, such as removing hay/grain and medication administration, until he/she can arrive. Diagnosing Colic Colic is typically diagnosed based on clinical signs and degree of pain shown, but further diagnostic efforts may be necessary to determine the type and severity. Once your veterinarian arrives, he/she will take vital signs and ask about your horse s history, including previous colic episodes. Depending on what your veterinarian sees, he/she may choose to perform a rectal examination, which involves inserting an arm into the horse s rectum to feel for displacements, impactions, and gas distension of the large intestine. Another commonly performed diagnostic is nasogastric intubation, often referred to as tubing a horse. This involves passing a tube through the horse s nose to the stomach to determine if there is excess fluid present, known as reflux. Remember that the stomach is small in size and that horses are unable to vomit we want to make sure fluid from the small intestine is not backing up into the stomach, causing distention (which can lead to the stomach rupturing) and pain.

13 Treating of Colic Treating colic focuses on three main areas: Control the Pain Correct Motility Issue(s) Banamine (Flunixin Meglumine) is the most common NSAID used to treat colic pain. We will often provide 10cc of this medication IV to a 1,000 lbs horse. Stronger analgesic medication, such as Torbugesic (Butorphanol) can be used at the discretion of your veterinarian Your veterinarian may provide your horse with intravenous fluids in order to improve GI motility and correct any fluid deficiencies. Laxatives may also be provided, such as mineral oil, to help the flow of GI material Correct the GI Issue If the colic cannot be resolved through medication administration and nasogastric intubation surgery may be required, especially with displacements and torsions. Surgical candidates are often identified if the heart rate remains above 60 bpm and pain persists after initial treatment. Click here to watch an impaction colic surgery One of the most common treatments that horse owners are encouraged to do during a colic case is walk the horse. Walking is helpful because it can distract the horse, stimulate gut motility, and keep him safe from going down to the ground and thrashing but you do not want to walk the horse until exhaustion. One of the fears many equine caretakers have is if the horse goes down to roll it can cause their intestines to twist studies have shown that a twist or displacement happens before rolling, not the other way around! If a horse is colicing but laying quietly in their stall it is OK to leave them as long as they are not thrashing/putting themselves in harm's way. Preventing Colic Preventing colic is often the result of lifestyle changes. We will never be able to correct the horse s gastrointestinal anatomy and therefore must work with what we were given. Some simple, yet effective, strategies to reduce colic involve keeping the daily routine consistent, making sure the horse has access to fresh water and providing quality forage to keep the structures of the large intestine full, which will make it less likely to displace or twist. Horses with a history of colic need to be carefully monitored, as colics tend to repeat themselves. These horses should have a diet that is minimum 60 70% forage (hay/pasture). Also making sure the horse s overall health is monitored and appropriately managed will combat against instances of colic.

14 Self-Knowledge Checks 1. A horse that is choking is unable to breathe. 9. What are the signs/symptoms of colic? a. True b. False 2. What are signs/symptoms of choke? 3. What is the function of an endoscope? a. To push the cause of an obstruction down the esophagus b. To view the obstruction and esophageal tissue c. To administer medications d. To suck the cause of an obstruction out of the horse 10. The most common NSAID given to treat colic pain is: a. Phenylbutazone ( Bute ) b. Omeprazole c. Flunixin Meglumine (Banamine) d. Isoxsuprine 4. How can choke be prevented in a horse that bolts their feed? 5. Which of the following situations can increase the risk of gastric ulcers? (Circle all that apply) a. High-grain diets b. Stressful situations, such as training or shipping c. Administration of NSAIDs 6. The only way to diagnose ulcers is by: a. Ultrasound b. X-ray c. Gastroscopy d. MRI e. Nasogastric intubation 7. Which grade of ulceration would be the most severe? 8. Which of the following statements best describes a gas colic? a. A gas colic refers to a blockage of the intestinal tract b. A gas colic involves structures of the GI tract moving, such as twisting c. A gas colic results in a distended/bloated gut

15 Answers 1. A horse that is choking is unable to breathe. b. False Unlike in humans, choke does not impact the trachea (windpipe), so horses that have an esophageal obstructions can still breathe 2. What are signs/symptoms of choke? Backing off from feed / Inability to swallow / Repeated attempts to swallow / Stretching of the head and neck / Distress / Drooling of saliva / Thick nasal discharge with feed particles 3. What is the function of an endoscope? b. To view the obstruction and esophageal tissue An endoscope is an instrument used to visually examine internal parts of the horse. In the case of choke, endoscopes are used to view any present obstruction and esophageal tissue 4. How can choke be prevented in a horse that bolts their feed? A horse that bolts their feed eats too fast in the case of grain, large, smooth rocks can be placed in the feed tub to slow eating or a slow feeder can be used. You can also trying wetting the grain to make it mushy. For hay, one can introduce a slow feeder bag to make the horse take longer to eat 7. Which grade of ulceration would be the most severe? Ulcers are graded on a scale from 0 3, with 0 being a healthy, nonulcerated stomach lining and 3 being extensive lesions, deep ulcerations, and bleeding 8. Which of the following statements best describes a gas colic? c. A gas colic results in a distended/bloated gut Gas colics involve a buildup of gas, resulting in a distended/bloated gut. While all colics will have some degree of gas buildup, this type does not begin with structural changes or abnormalities 9. What are the signs/symptoms of colic? Restlessness / Kicking or biting at the belly / Lack of or dry manure / Sweating / Increase in HR and respiration / Pawing / Rolling and not shaking upon rising / Lack of gut sounds / Standing stretched out / Getting up and laying down frequently / Laying down more than usual / Backing off feed 10. The most common NSAID given to treat colic pain is: c. Flunixin Meglumine (Banamine) 5. Which of the following situations can increase the risk of gastric ulcers? (Circle all that apply) a. High-grain diets b. Stressful situations, such as training or shipping c. Administration of NSAIDs All of the presented situations can increase the risk of ulceration 6. The only way to diagnose ulcers is by: c. Gastroscopy A gastroscopy is an endoscope that passes into the stomach this will allow us to see the current state of the stomach lining and the presence of ulcers

16 Glossary Banamine Generic name is Flunixin Meglumine, a type of non-steroidal anti-inflammatory drug commonly used during colic cases Colic Refers to abdominal/gastrointestinal pain Endoscope An instrument used to visually examine internal parts of the horse Esophageal Obstruction Blockage/obstruction of the esophagus, better known as choke Free-Choice Providing at all times, for example, free-choice hay means the horse has access to hay at all times Gastroscopy Using an endoscope to examine the health of the stomach Glandular Mucosa Protected region of the stomach Impaction A type of colic, refers to a blockage of the intestinal tract Margo Plicatus A region of the stomach that separates the glandular and non-glandular portions Nasogastric Tube A plastic tube that a veterinarian will insert through the nostrils and into the esophagus to help loosen an obstruction or continue on into the stomach to expel gas and excess fluid NSAIDs Stands for non-steroidal anti-inflammatory drugs, a category of medication that looks to reduce inflammation, fever, and endotoxins Omeprazole Gastric Acid Pump Inhibitor medication, used to treat gastric ulcers, trade name is GastroGard Rectal Examination Involves insertion of the arm into the rectum to check the health of reproductive and/or gastrointestinal structures Squamous Mucosa Also called non-glandular, non-protected region of the stomach Torsion A type of colic that involves a twisting of the GI structures Trachea Takes air to the lungs, windpipe Ulcers A wound in the lining of the stomach caused by acid