A Commitment to Research
What would be a good description for a resistor? If you already know the value of digestive enzymes, the next few paragraphs may be all you need to read. It absorbs whatever it can, especially water, but then the rest will expelled as waste after about 12 hours. Diagnosing and Monitoring IBD. If an endoscopy is required, the patient receives the procedure at the endoscopy unit or at our nearby Ambulatory Endoscopy Center.
Most of us including most doctors do not recognize or know that digestive problems wreak havoc in the entire body, leading to allergies , arthritis, autoimmune disease, rashes, acne , chronic fatigue , mood disorders, autism, dementia, cancer, and more. So having a healthy gut means more than simply being free of annoyances like bloating or heartburn! It is absolutely central to your health. That's why I almost always start helping people treat chronic health problems by fixing their gut, which is what I want to help you do today.
Today, you will learn how you can find out if you have a problem with your gut though many of you won't need me to tell you — your gut will speak for itself!
Fixing your digestion is the fourth key of the 7 Keys to UltraWellness or functional medicine, and it is absolutely essential that you heal this critical system in your body if you want to achieve optimum health. The health of your gut determines what nutrients are absorbed and what toxins, allergens, and microbes are kept out. It is directly linked to the health of your whole body. Intestinal health could be defined as the optimal digestion, absorption, and assimilation of food.
But that is a big job that depends on many other factors. Let's look at a few of them. First, there are bugs in your gut that form a diverse and interdependent ecosystem like a rainforest. In fact, there are species and 3 pounds of bacteria in your gut which form a HUGE chemical factory that helps you digest your food, regulate hormones, excrete toxins, and produce vitamins and other healing compounds that keep your gut and your body healthy.
Too many of the wrong bacteria, like parasites and yeasts, or not enough of the good ones, like Lactobacillus or Bifidobacteria, can seriously damage your health. It's important to understand that many diseases that seem to be totally unrelated to the gut — such as eczema or psoriasis or arthritis — are actually CAUSED by gut problems.
Second, there is your gut-immune system. Your entire immune system — and the rest of your body — is protected from the toxic environment in your gut by a lining that is only ONE cell-thick layer. If spread out, this lining would take up a surface area the size of a tennis court, and the entire thing is covered by a sewer! If that barrier is damaged, you can become allergic to foods you may normally be able to digest perfectly well, you will get sick, your immune system will become overactive, and it will begin producing inflammation throughout your body.
Filtering out the good molecules from the bad molecules and protecting your immune system is yet another important factor in gut health. Third, there is your second brain — your gut's nervous system. Did you know your gut, actually contains MORE neurotransmitters than your brain?
In fact, the gut has a brain of its own. It is called the "enteric nervous system" and it is a very sophisticated piece of your biology that is wired to your brain in intricate ways.
Messages constantly travel back and forth between your gut-brain and your head-brain, and when those messages are interfered with in any way your health will suffer. Fourth, your gut also has to get rid of all the toxins produced as byproducts of your metabolism , which your liver dumps into bile. If things get backed up when you are constipated, you will become toxic and your health will suffer. And last but not least, your gut must break down all the food you eat into its individual components, separate out the vitamins and minerals, and shuttle everything across the one cell-thick layer mentioned above so it can get into your bloodstream and nourish your body and brain.
Your gut has quite a lot to manage. Even in perfect world it is hard to keep all of this in balance. But in our modern world there are endless insults that can knock our digestive systems off balance; it is that much more difficult to maintain excellent digestive health. To fix your digestion, you first need to understand what is sending your gut out of balance in the first place.
However, because horses with severe colic or pain may hurt themselves and become dangerous to people nearby, analgesics often must be given first. Additionally, many horses with less severe problems may need pain relief until the other treatments have time to be effective. Medications used commonly for abdominal pain are NSAIDs that reduce the production of prostaglandins. When these drugs are used as recommended, their toxic effects on the kidneys and GI tract occur infrequently.
Clinical experience suggests that flunixin meglumine may mask the early signs of conditions that require surgery and, therefore, must be used carefully in horses with colic. Within a few minutes after administration, the horse stands quietly and is less responsive to pain.
Unfortunately, the effects of xylazine are short-lived, and it inhibits intestinal muscular activity; it also decreases cardiac output and thus reduces blood flow to the tissues. Of the narcotic analgesics, butorphanol is used most often in horses with colic. Butorphanol has few adverse effects on the GI tract or heart. However, when given in large doses, narcotics can cause excitement, and the horse may become unstable.
Although pain relief usually is provided by analgesics, there are other important ways to reduce the degree of pain. For example, passing a nasogastric tube also an important part of the diagnostic evaluation may remove any fluid that has accumulated in the stomach because of an obstruction of the small intestine.
The removal of this fluid not only relieves pain from gastric distention but also prevents rupture of the stomach. Horses with displacement of the colon over the renosplenic ligament ie, left dorsal displacement of the colon may benefit from administration of phenylephrine.
This drug is given to contract the spleen and often is followed by light exercise on a lunge line in an effort to dislodge the entrapped colon. Many horses with colic benefit from fluid therapy to prevent dehydration and maintain blood supply to the kidneys and other vital organs.
The fluids may be given either through the nasogastric tube or IV, depending on the particular intestinal problem see General Concepts Regarding Fluid Needs in Dehydrated Horses. Horses with strangulating obstruction or enteritis must be given fluids IV, because absorption of fluids from the diseased intestine is impaired and fluid may be secreted into the lumen of the intestine. The latter mechanism causes a buildup of fluid in the intestine, which must be removed from the stomach through a nasogastric tube.
This abnormal movement of body fluids into the intestine contributes to the development of circulatory shock, which is often the ultimate cause of death. In healthy horses, most of the fluid in the intestinal tract is reabsorbed in the cecum and colons. Therefore, horses with intestinal obstructions near the pelvic flexure usually require relatively small amounts of IV fluids, whereas horses with small-intestinal obstructions need extremely large amounts.
The volume and type of fluid to be given are determined by the severity and cause of the problem. Laboratory tests to determine the degree of hemoconcentration and whether concentrations of electrolytes are abnormal are critical for accurate treatment of horses with severe colic.
The balance of body fluids can be reestablished by administering IV fluids formulated to replenish the deficient electrolyte s. In most instances, however, fluid therapy must be started before laboratory results are available, particularly when the horse is showing clinical signs of circulatory shock. When IV fluids are needed but the clinical signs are mild to moderate, the horse is usually given 8—10 L of a sterile replacement fluid that contains electrolytes in concentrations similar to those that normally exist in the blood.
This volume is administered throughout 1—2 hr, and the horse is reevaluated to determine whether additional fluids are needed. Horses in circulatory shock require much larger volumes of IV fluids, given as rapidly as possible; as much as 20 L in 1 hr may be needed to reestablish tissue perfusion. Depending on the cause of colic, IV fluids may be needed for several days until intestinal function has returned, electrolyte concentrations are balanced, and the horse can maintain its fluid needs by drinking.
Under such circumstances, the daily IV fluid requirements may range from 30 to L. Fluids are sometimes given through the nasogastric tube as part of the treatment of impactions of the colon. Many clinicians believe the same result can be accomplished by giving large volumes of fluids IV. If the horse will not drink voluntarily and there is no obstruction in the small intestine, hydration may be maintained by administering fluids through the tube.
Fluids or medications should not be given through the nasogastric tube if fluid reflux is being removed from the stomach, because this indicates either the stomach or the small intestine is not emptying properly.
In healthy horses, the mucosal lining of the GI tract restricts enteric bacteria and their structural components eg, endotoxins, lipoproteins, nucleic acids, flagellin to the intestinal lumen. These bacterial components exist in high concentrations in the intestinal lumen, because they are released when the bacteria die or, in some cases, when bacteria multiply rapidly.
However, when this mucosal barrier is disrupted, as occurs with intestinal ischemia or inflammation, the bacterial components can move into the peritoneal cavity and then be absorbed into the systemic circulation. Based on recent research studies, equine leukocytes are most sensitive to endotoxins but also respond strongly to other components, most notably flagellin. Most studies performed to date have focused on endotoxins, because they are assumed to be the primary triggers for the systemic inflammatory responses that occur in many horses with GI disease.
These responses can include fever, depression, hypotension, reduced tissue perfusion, and coagulation abnormalities. Flunixin meglumine reduces the cellular production of prostaglandins and can help prevent some of their effects.
Because flunixin can help prevent some of the early effects of endotoxemia at dosages less than the recommended dosage 1. There is considerable controversy regarding the efficacy of plasma or serum that contains antibodies designed to neutralize endotoxin.
These antibodies are directed against the components of endotoxins that are consistent among different gram-negative bacteria. The results of clinical studies using such antibodies have been conflicting, with evidence of protection being seen in some studies and no positive effects identified in others.
This apparent lack of efficacy of anti-endotoxin antibodies also may indicate that some of the systemic inflammatory responses encountered are triggered by other bacterial components. Because endotoxin itself stimulates the generation of a wide array of inflammatory substances that ultimately produce the pathophysiologic effects, neutralizing antibodies should be used as early as possible in the course of the disease.
Polymyxin B has well-documented nephrotoxicity; however, concentrations of polymyxin B that bind endotoxin are far less than those that cause toxic effects. This form of therapy should be started as early as possible in the clinical course of the disease. In addition, fluid replacement therapy should be maintained in hypovolemic horses, and serum creatinine concentration should be closely monitored. This latter concern is especially relevant for azotemic neonatal foals, because they appear to be more susceptible to the nephrotoxic adverse effects of polymyxin B.
A common cause of colic in horses is simple obstruction of the large colon by dehydrated ingesta, sometimes mixed with sand. These impactions generally develop near the pelvic flexure or in the right dorsal colon but may involve any portion of the large colon, descending colon, or cecum.
In most instances, lubricants or fecal-softening agents given through a nasogastric tube soften the impacted ingesta, allowing it to be passed. This form of therapy can be aided by the simultaneous administration of IV fluids. Keeping the horse muzzled is advised to prevent further impaction of feed material while the obstruction is softening.
Mineral oil is the most commonly used medication in the treatment of a large-colon impaction. It coats the inside of the intestine and aids the normal movement of ingesta along the GI tract. It is administered through a nasogastric tube, as much as 4 L, once or twice daily, until the impaction is resolved.
Although mineral oil is safe, it is not highly effective in treating severe impactions or sand impactions, because it may simply pass by the obstruction without softening it. Dioctyl sodium sulfosuccinate DSS is a soap-like compound that acts by drawing water into the dry ingesta. It is more effective than mineral oil in softening impactions; however, it may interfere with the normal fluid absorptive functions of the colon and can be toxic.
Thus, DSS can be given safely only in small quantities two times 48 hr apart. A safe and useful compound to treat impactions, especially those containing sand, is psyllium hydrophilic mucilloid. When mixed with water, it forms a gelatinous mass that carries ingesta along the GI tract. Although usually given through a nasogastric tube to horses with impactions, psyllium also may be used as a preventive by mixing the dry powder into the feed. This treatment is repeated 2—3 times each year in an effort to prevent development of sand impactions.
Strong laxatives that stimulate intestinal contractions are not commonly used to treat impactions and, in fact, may worsen the problem. Occasionally, horses with extremely hard impactions are treated with magnesium sulfate , which draws body fluids into the GI tract. Adverse effects include dehydration and an increased risk of diarrhea.
Fluid therapy, whether the fluids are administered through a nasogastric tube or IV, is an important and effective part of treating horses with colonic or cecal impactions. If an impaction does not start to break down within 3—5 days, surgery may be necessary to evacuate the intestine and help restore normal motility.
The normal migratory routes of the larvae of large bloodworms, particularly Strongylus vulgaris , have been implicated in many cases of colic. In response to the migratory and maturation processes of the larvae in the cranial mesenteric artery, the wall of the artery becomes thickened and forms loose plaques of inflammatory tissue. It has been hypothesized that these plaques activate coagulation, resulting in thromboembolism.
The blood supply to the intestine may be reduced, resulting in altered intestinal motility, a change in the absorption of nutrients from the intestine, or death of the intestine. Thus, thromboembolism has been presumed to be a cause of recurrent episodes of colic and weight loss. Modern deworming medications, such as ivermectin and moxidectin, have activity against migrating S vulgaris larvae.
Fenbendazole kills migrating strongyles if given at twice the recommended dosage daily for 5 days or at 10 times the recommended dosage daily for 3 days. As a result of common use of these anthelmintics, chronic intermittent colic once thought to be caused by thromboembolism or parasite larval migration has largely been eliminated from equine practice.
There is considerable evidence that damage caused by cyathostomins causes colic, diarrhea, and loss of condition, particularly in young horses. These signs are seen on a seasonal basis and are synchronous with the emergence of large numbers of encysted larvae into the lumen of the large colon.
In temperate areas of the Northern hemisphere, the larvae encyst during the winter months and emerge in the late winter and spring, causing ulceration, edema, and inflammation of the mucosa of the large colon. This may result in diarrhea, protein loss, weight loss, and mild intermittent colic and fever. Horses with cyathostomosis require treatment with larvacidal dosages of anthelmintics such as ivermectin , moxidectin, and fenbendazole.
Some horses require analgesics, supportive care, and proper nutritional support. Also see Gastrointestinal Parasites of Horses for a detailed discussion of treatment for large and small strongyles. Surgery usually is necessary if there is a mechanical obstruction to the normal flow of ingesta that cannot be corrected medically or if the obstruction also interferes with the intestinal blood supply. The latter conditions result in death of the horse unless surgery is performed quickly. Occasionally, surgery is indicated as an exploratory diagnostic procedure for horses with chronic colic that have not responded to routine medical therapy.
Under most circumstances, horses exhibiting signs of severe abdominal pain nonresponsive to analgesic therapy require emergency abdominal surgery. Generally, the lumen of the intestine is completely obstructed, such as occurs with a strangulating obstruction, enterolithiasis, or severe displacement. Similarly, horses with an abnormally distended intestine on rectal examination and peritoneal fluid with an increased total protein concentration and number of erythrocytes probably have a strangulating lesion that requires surgical correction.
However, these classic findings that characterize horses requiring emergency surgery do not always exist. Some horses with mild or moderate pain may also require surgery, and a judgment must be based on a thorough physical examination and other methods of evaluation, including abdominal ultrasonography. Performing surgery if indicated early is critical to success and improves the prognosis for survival. Therefore, it is more important to decide whether the horse should be referred to a clinic where surgery could be performed if needed than to determine whether emergency surgery is definitively required.
It is generally prudent to refer the following types of cases: When surgery is required, in most instances, the horse is anesthetized and positioned in dorsal recumbency, and the surgical incision is made on the ventral midline.
Once the peritoneal cavity is entered, portions of the intestine should be examined to determine the definitive cause of the colic. Correction may involve repositioning a displaced portion of intestine, removing an obstruction, or resecting devitalized intestine. When devitalized segments of intestine must be removed or an enterotomy performed, postoperative care may include antibiotics, IV fluids, polymyxin B , antibodies directed against endotoxin, and NSAIDs to combat endotoxemia.
When a displaced segment of intestine is simply returned to its normal location, the postoperative care is much less intense. Each horse must be handled individually, and its treatment needs are based on the response to surgery and development of complications. When the segment of the GI tract was considered, the survival rates for conditions affecting the small intestine and stomach were poorer than for those affecting the large colon.
In addition, conditions that interfered with both the passage of ingesta and the intestinal blood supply dramatically decreased the chances of survival. Although data on longterm survival ie, the horse returning to its intended use are more difficult to obtain, recent findings indicate that most horses that die or are euthanized because of serious problems do so within 3 mo after surgery. Values obtained from several variables are often combined to predict survival in horses with colic.
Prognostic indicators include pain assessment, intestinal distention, mucous membrane color, and cardiovascular system function. Survival rates are highest for horses with mild abdominal pain and are lowest for horses with severe pain. Horses with palpable intestinal distention have lower survival rates than horses lacking evidence of intestinal distention, and survival rates are even lower if no intestinal sounds are audible on auscultation of the abdomen. Red mucous membranes are frequently associated with endotoxemia, which decreases the survival rate.
Cardiovascular system function reflects the degree of shock and, therefore, correlates with the prognosis for survival. For instance, horses with low systolic blood pressure or a high heart rate have a decreased chance of survival. Of the laboratory analyses used to predict survival, blood lactate concentration and the anion gap are used most often.
Measurement of blood lactate has been used as an indicator of tissue perfusion, with increasing concentrations of lactic acid corresponding with poor tissue perfusion. In recent studies, changes in blood lactate concentration over time have been particularly useful to determine the prognosis for survival, with increasing concentrations being associated with a poor prognosis.
Furthermore, changes in peritoneal fluid lactate concentrations over time have been used to help identify horses that require emergency abdominal surgery. Similarly, the anion gap the calculated difference between the measured cations and the measured anions reflects the generation of organic anions, most notably lactic acid, due to reduced tissue perfusion.
The concentration of protein in the peritoneal fluid also has been used to predict survival, with higher concentrations associated with a poorer prognosis. Cardiology is not a required rotation at OVC, but I picked it up nonetheless because it is one of my weakest subjects. Overview of Colic in Horses. Protection Against Components of Enteric Bacteria: Intestinal Lubricants and Laxatives: Cecum and right colon, horse Left medial view of cecum and right colon, horse.
Base of cecum, horse Base of the cecum in the horse. Equine gastrointestinal anatomy Equine GI anatomy relevant to colic, median section. Large intestine, horse The large intestine of the horse.
Nephrosplenic ligament, horse Nephrosplenic ligament in the horse. Umbilicus, horse Umbilicus in the horse. Inguinal hernia, horse Inguinal hernia in the horse. Inguinal canal, horse Inguinal canal in the horse.
In healthy horses, it is common to retrieve.