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Colitis (Treatment (Nutritional support (Alfalfa or similar hay ad libitum…

- - - - Replacement with a balanced polytonic crystalloid fluid such as lactated Ringer's solution is most suitable.
      - In acute, severe cases, hypertonic saline may be used, but it is essential this is followed by an appropriate volume of polytonic crystalloid fluid to replace the extravascular extracellular fluid
    - - monitor calcium and potassium balance and supplement intravenous fluids if necessary
    - - treatment = colloidal solution such as hetastarch or plasma
        
        expensive tho
  - - - activated charcoal administered at 0.5 - 1g/kg by stomach tube once or twice daily.
    - - Flunixin meglumine
        
        0.25mg/kg intravenously 3x a day
        
        recommended to prevent endotoxin-induced prostanoid synthesis in horses
        
        Compared to other NSAID regimens it has a lower risk of adverse effects including gastrointestinal ulceration, ileus and renal papillary necrosis
        
        Firocoxib (cyclooxyrgenase-2 inhibitor drug)
        
        fewer adverse effects
      - Polymixin B
        
        Risk potential for nephrotoxic effects so use with care and not recommended in azotaemic horses
      - Endotoxin specific IgG
    - - dilution at 1:10 or 1:20 to minimise the risk for immune mediated hypersensitivity reactions
  - - - up to 4 litres/500kg orally 2x a day
  - - - Flunixin (0.5-1.1mg/kg IV)
    - - Dexamethasone 0.05mg/kg IV or IM
  - - - Anthelmintics
        
        Fenbendazole (7.5-10mg/kg orally once daily for 5 consecutive days)
        
        Ivermectin
        
        0.2mg/kg orally
        
        moxidectin
        
        0/4mg/kg orally
    - - Metronidazole 15mg/kg orally 3x a day
      - probiotics/yoghurt may be beneficial
    - - nasogastric intubation to allow gastric decompression
      - Epsom salts (magnesium sulphate) 1g/kg by stomach tube
      - Aspirin 10mg/kg orally or IV once daily
      - Sodium bicarbonate intravenously if indicated by blood gas analysis
      - Laminitis prophylaxis (frog supports and topical nitroglycerine)
    - - Broad spectrum bactericidal antimicrobials 3 x daily in combination with gentamicin 2.2mg/kg IV 3x daily or 6.6mg/kg IV once daily
    - - Psyllium mucilloid 0.25-0.5kg for a 500kg horse in 4-8 litres of water by stomach tube
      - Ispaghula husk 300-400g for a 500kg horse in 4 litres of water by stomach tube
    - - Psyllium mucoid 30-60g administered in feed for 3-6 months
      - Misoprostal orally
        
        decrease gastric acid secretion and increase recovery of the ischaemia-injured equine jejunum
      - Sucralfate 22mg/kg orally 2 or 3x daily
      - Metronidazole 10-15mg/kg orally 2x daily
    - - Tetracyclines 6/6mg/kg slowly IV once daily for 3-5 days
        
        Oxytetracycline only early in disease process, once colon inflamed it increases the permeability of the vasculature
      - Intracellular bacteria therefore penicillin/gentamicin will not work
      - Neorickettsia risticii is the causative agent which causes biphasic fever, laminitis, and colitis of variable severity
      - N risticii-associated colitis may be supported by comparing paired serum titers using immunofluorescence assay testing techniques
      - Diagnosis confirmed using antigen detection by identification of N risticii morulae in WBCs during the acute phase of the disease, isolation of the organism from WBCs or PCR testing of WBCs or faeces
  - - - digital pulses should be monitored 3-4x daily until systemic signs of colitis abate
  - - - can contribute to further damage of the intestinal epithelial barrier, so lower and less frequent does should be considered
    - - selective cyclooxyrgenase 2 inhibitor so safer in horses with similar beneficial anti-inflammatory effects
    - - Endogenous prostaglandins are important inhibitors of intestinal inflammation, an blocking these agents with nonselective NSAIDs may slow recovery and healing of inflamed intestinal mucosa
    - - butorphanol (0.96-0.1mg/kg IM) and detomidine (0.01-0.02mg/kg IM)
  - - - Potassium penicillin G + gentamicin common regimen for horses with ongoing systemic disease
    - - May have local anti-inflammatory effects and can cause loss of appetite in some horses
- - - - Laminitis
      - Ventral oedema
- - - - parasitic colitis
      - Gastric ulceration
    - - Extent of any endotoxaemia
        
        Salmonellosis
        
        Clostridiosis
        
        Peritonitis
    - - Increased as a consequence of dehydration
      - decreased as a result of protein loss into the intestinal tract
      - Globulin concentrations may be increased as a result of dehydration or a chronic inflammatory response
      - Serum protein electrophoresis
        
        helpful in distinguishing parasitic colitis, where an elevation in beta1 globulins may be appreciated
    - - Sodium, potassium, calcium and bicarbonate especially
    - - often allow identification of cyathostome larvae in cases of parasitic colitis
      - Faecal worm egg count results should be interpreted with caution
        
        the pathogenic stage of both large and small strongyles primarily involves immature parasites (not acquired ability to lay eggs)
        
        both cyathostomosis and strongylosis may not be associated with a significant faecal worm egg count
      - faecal culture = vital step in identification of bacterial enteritis
        
        e.g. salmonellosis, clostridiosis
        
        Advisable to collect multiple samples over a period of at least 3 days
        
        Does not mean cultured pathogenic bacteria is causative e.g. in cases of chronic diarrhoea where salmonella species are often cultured in association with a separate primary enteropathy
  - - - Can be seen in some cases of parasitic colitis and intestinal lymphosarcoma and the infiltrative bowel diseases
    - - In a normal horse the blood glucose concentration reaches a peach of approx. double the baseline concentration at 2 hours
      - a reduced peak indicates a state of malabsorption and in an adult horse with diarrhoea, this suggests that there are significant changes present in both the small and large intestine
  - - - can only be taken at laparotomy and usually requires general anaesthesia to allow samples to be collected from multiple sites along the intestinal tract
    - - can be performed laparoscopically in the standing animal
- - - - Salmonellosis
        
        Initial pyrexia, depression and colic prior to onset of diarrhoea
        
        profound leucopenia present at the acute stage
        
        Salmonellosis often associated with previous stress or intercurrent disease
        
        highly infectious and has zoonotic potential
        
        isolate and barrier nurse
        
        Rarely a cause of chronic diarrhoea
        
        consider underlying disease process
        
        Identification by bacterial culture or PCR analysis
      - Parasitism (Larval cyathostominosis, strongylosis)
        
        Moxidectin, fenbendazole
        
        Can cause a plaque of oedema on ventral abdomen
        
        Often younger animals (1-5) but can be seen in elderly
        
        Weight loss may occur prior to diarrhoea
        
        Usually occurs late winter and spring
        
        Initial pyrexia and leucopenia are variable and faecal worm egg counts are often negative. Macroscopic faecal (or rectal glove) examination may identify larvae. Elevated Alpha and beta globulin concentrations may be seen.
        
        Histopathological examination of a rectal mucosal biopsy can be diagnostic
        
        Strongylosis usually a cause of colic or ill thrift. The condition may be associated with diarrhoea as a result of changes to blood supply in the large intestine. Faecal worm egg count may be negative.
      - Clostridiosis
        
        often associated with start (or cessation) of antimicrobial therapy
        
        other stresses e.g. transport, GA, withholding roughage may be risk factors
        
        Both C perfringens and C difficile have been identified
        
        103 colony-forming units/g feces or intestinal contents; demonstration of enterotoxin or cytotoxin A or B (for C difficile)
      - Antimicrobial associated diarrhoea
      - NSAID toxicity (right dorsal colitis)
        
        Slower onset, oral cavity ulcers; early ventral edema associated with hypoproteinemia; gastric or intestinal ulceration
      - sand enteropathy
      - Carbohydrate overload
      - signs of endotoxaemia
        
        Depression
        
        Tachycardia
        
        Tachypnoea
        
        Fever
        
        Colic
        
        Diarrhoea
        
        Hyperaemic (toxic) mucous membranes
        
        Usually see low white cell count, low neutrophil count, immature 'band' neutrophils
        
        Treatment: polymyxin b, hyperimmune plasma, pentoxyfilline, flunixin
  - - - Salmonellosis
      - Parasitism (Larval cyathostominosis, strongylosis)
        
        Most cases in late winter and early spring
        
        More common in younger animals (1-5 years old)
      - Sand enteropathy
        
        Usually causes an impaction colic
        
        Diarrhoea often mild and intermittent
        
        Acute deterioration associated with bowel wall inflammation and perforation
        
        Sand is present in faeces and may be identified using sand sedimentation test.
      - NSAID toxicity (Right dorsal colitis)
        
        Hypoproteinaemia and hypoalbuminaemia develop rapidly and may present before the onset of diarrhoea
        
        Ventral oedema (increased hydrostatic pressure and vascular permeability, decreased oncotic pressure and lymphatic drainage)
      - Inflammatory of infiltrative disorders
        
        IBD
        
        Lymphosarcoma
        
        Typically insidious onset and slow progression and primarily affect small intestine.
        
        Concurrent malabsorption and weight loss often occur.
        
        Thickened bowel may be seen on rectal exam or USS
        
        Dx - histopath of bowel wall or LN biopsy
        
        Prognosis poor, but horse may respond to high-dose corticosteroids.
      - Dietary: abnormal fermentation
      - Neoplasia
        
        Lymphoma
        
        Peritonitis, abdominal abscessation
      - Peritonitis
        
        Diagnosis is confirmed by abdominal paracentesis and peritoneal fluid analysis. Aggressive treatment required.
        
        Prognosis depends on underlying cause e.g. gut perforation, abscess, neoplasia
- - - - Frequent complications include laminitis, thrombophlebitis, debilitation and marked weight loss
- - - - Strongyloides westeri