Enteritis

What is the differential for acute enteritis in the adult horse?

Anterior Enteritis (Proximal Jejunitis)

What do you see with US?

Fluid distended loops of SI with thickened walls. It can be difficult to distinguish horses with this from those with ileal impaction or SI strangulation

What are the cardinal findings with enteritis?

Fluid distended loops of small intestine on rectal exam and gastric reflux

What do you see with bloodwork?

Peripheral leukocytosis and a toxic L shift can occur in some cases

What drug may be used for its analgesic, prokinetic, and anti-inflammatory effects?

Lidocaine

What do you see with peritoneal fluid analysis?

Normal in mild cases In more intense cases: sanguinous and generally contains increased protein (>3 gm/dl) but a normal to mildly increased WBC count early on. protein to NCC ratio may be >3

What is the risk of developing laminitis from anterior enteritis?

About 25% so therapy for acute laminitis is also incorporated into treatment

What are the acute clinical signs associated with anterior enteritis?

Acute abdominal pain similar in magnitude to strangulation obstruction. Low-grade fever, dehydration, endotoxemia. + Gastric reflux and moderate distention of SI on rectal exam

Enteritis results in ______ and ______ of the SI

Ileus Hypersecretion

Why are horses so painful with enteritis or colitis?

Intestinal wall inflammation, edema, and in severe cases: necrosis or infarction. Fluid and gas accumulation (distention) in the intestinal lumen secondary to ileus and hypersecretion

What is a common characteristic of the gastric fluid accumulated when refluxing a horse with anterior enteritis?

Voluminous and sometimes very malodorous which in some cases is orange or red in color

What is the prognosis for anterior enteritis? What are the most frequent complications?

Good Secondary colitis, thrombophlebitis, laminitis

Risk factors and cause for Anterior Enteritis?

Higher prevalence of the dz in horses on grain or pelleted diets Cause is unknown (some suspect clostridial or salmonella organisms involved)

What is the tx for anterior enteritis?

IV fluids and removal or reflux (several times per day) are the mainstays of therapy. Mild analgesics (banamine), endoserum and/or polymyxin B, and Abs. Some clinicians elect to take the horse to surgery early in order to decompress the SI contents into the cecum. NPO until reflux subsides...diet gradually reintroduced

What happens to the pain several hours after removing the excessive gastric reflux?

Signs of pain are replaced by depression