approach to eq d+

History

·    How long been going on for? – want to differentiate acute from chronic

·    Do they seem well in themselves? Are they more quiet/depressed?

·    Any colic signs?

·    Any weight loss? – more likely to be chronic

·    What is the diarrhoea like? Volume? Colour? Consistency?

·    How often?

·    Any other clinical signs? – oedema = chronic

·    Risk factors for acute diarrhoea: GI disease, immunosuppression, history of abx use, GA, recent abdominal surgery, hospitalisation, dietary changes – any of these?

Investigations

·    Clinical exam

o  Ventral oedema – suggests chronic D+ as loss of albumin ® decreased oncotic p

o  Pyrexic

o  Hypovolaemic – acute, normovolaemic – chronic

Management

·    If suspect salmonella – ISOLATE as can spread rapidly

·    Acute diarrhoea cases:

o  Fluid replacement and electrolytes – IVFT Hartmann’s if not drinking

o  Anti-inflammatories/analgesia – flunixin best for abdominal pain +/- xylazine

o  Anti-microbials – prevent risk of secondary infection, use if patient is neutropenic or showing signs of sepsis – penicillin IM + gentamicin IV (broad spec)

o  Probiotics – faecal transfaunation

o  Adsorbents – biosponge, binds endotoxins

o  Nutrition – ideally completely pellets, no grain/hay to reduce bulk in GIT

·    if identify underlying cause – treat that:

o  RDC – stop NSAIDs, misoprostal to treat ulcers

o  Cyathostomiasis – moxidectin (pre-treat with preds to reduce inflammation from killing encysted larvae)

o  Sand enteropathy – psyllium +/- Mg sulphate

o  Lawsonia intracellularis – doxycycline

·    If septic: IVFT, flunixin, cryotherapy (cool feet), plasma transfusion, polymyxin B (prevent initiation of pro-inflammatory cascade)

·    If 2/3 of D+, pyrexia, neutropenia = ISOLATE

Causes of acute diarrhoea in adults

·    Salmonella – large volume, watery

·    Clostridium difficile, Clostridium perfringens – when have overgrowth of normal commensals

·    Antimicrobial use – disrupts GI flora ® allows bacteria to proliferate

·    Right dorsal colitis – due to NSAID use

·    Grain overload – SI digestive capacity overwhelmed ® soluble carbohydrates enter LI, rapidly fermented and lactic acid produced ® pH decreases, endotoxins released

·    Cyathostomiasis

·    Coronavirus

·    Dietary

Causes of chronic diarrhoea in adults

·    Salmonella

·    Cyathostomiasis

·    Right dorsal colitis

·    Sand enteropathy – accumulation of sand in LI over time, irritates mucosa

o  Risk factors: pasture on sandy soil, feeding on ground

·    IBD = granulomatous enteritis, lymphocytic-plasmacytic enteritis, eosinophilic epitheliotrophic disease, lymphosarcoma

·    Dietary – dietary imbalance, recent diet changes, changes in gut flora

Causes of diarrhoea in young horses  (6w-9m)

·    Same as adult for acute + chronic plus:

o  Equine proliferative enteropathy – Lawsonia intracellularis

o  Rhodococcus equi

Potential complications

·    Risk of SIRS/sepsis

·    Laminitis

·    Secondary infections – can deteriorate rapidly