15. GIT Exam Flashcards
What should you be thinking about when performing a GIT exam on a horse?
How will what I find out next effect or change my thinking process?
What is the minimum database for an equine GIT workup?
History - determine why
PE
Rectal Exam - tell normal or abnormal
Nasogastric Intubation - 1st protect stomach
Response to Therapy
What is most important when obtaining a hisotry?
Signalment and chief complaint
What are some common reasons for colic for the following signalments:
-Neonate:
-<2yr:
->12yr:
Arabian/Morgan:
American Minature:
Standardbred and Andalusian:
Stallions:
Mare -pregnant:
Mare - post-partum:
-Neonate: Meconium impaction, clostridium, enteritis, strangulation, volvus
-<2yr: FB, Ascarid, intussusception
->12yr: SI strangulating lipoma, large colon impaction
Arabian/Morgan: Enterolithiasis
American Miniature: Fecalith, sand, enterolithaiasis
Standardbred and Andalusian: Inguinal hernia
Stallions: Inguinal hernia
Mare -pregnant: Uterine torsion, uterine artery rupture
Mare - post-partum: colonic volvulus, uterine artery rupture, mesenteric hematoma
What questions should you ask about the main problems?
OPQRST
-Onset
-Palliation/Provocation
-Quality
-Region/Radiation
-Symptoms/Severity
-Timing
What are some other historical details that are critical when getting the history on a colic case?
Past medical history
Farm details
Social details
What may you see from a distance that may indicate colic?
Muddy side, sweaty, dirt
What are some of the critical points of your PE?
Head to toe
-Auscult bilaterally
Focus problem area - GI, TPR, MM, GI sound, Feces
-Consider non GIT cause
Tachycardia or tachypnea and fever (more medical)
MM - color and CRT (shock or septic)
Abdominal Distension - hard if new, helpful over time (measure)
Auscultation (borborygmi and abnormal sounds (ping or tinkling)
Pain level (if suddenly no more good or really bad)
What do the following parameters indicate:
Increased HR
Increased RR
Increased Temp:
Increased HR: Pain, cardiovascular status
Increased RR: Pain and acid-base status
Increased Temp: Inflammatory and Infectious
How do you asses perfusion?
MM - moisture, refill, color
Extremity temp
Pulse Quality - bound or weak and thready
What does it mean if your MM are:
-Hyperemic:
-Dark/cyanotic:
-Hyperemic: (RED) Endotoxemia, SIRS (Severe systemic inflammation), Hyperdynamic (terminal) shock
-Dark/cyanotic: Hypodynamic shock, terminal shock
What is the percent dehydration if the mm are dry?
5%
Where should you hear borborygmi?
All 4 quadrants
-Over time important
What are some other critical intial pieces of information?
Rectal Exam - distension, displacement, abnormal structure
Nasogastric Intubation - reflux presence and volume (>2L problem)
Response to therapy - breaking through drugs
When should you definatly place a nasogastric tube?
HR >60bpm
What volume is indicative of an issue when placing nasogastric tube?
> 2L
4L indicates severity of disease
What drugs can help with rectal palpation?
Sedation
Buscopan
What are you looking for when palpating via rectum?
Distension (gas or fluid)
Position
Mass
Serosal Surface
What organs can be palpated via rectum?
Spleen, left kidney, small colon, pelvic flexure, cecum, female repro, inguinal rings
What drugs can be used to treat/sedated and see how it helps the horse?
Sedation - xylazine, detomidine, butorphaol, ace
Get painful again, how quick?
-Break through = bad!
What are further diagnostics that may be helpful in the case of colic?
Abdominal ultrasound
CBC
Chem
Abdominocentesis (help with euthanasia decision)
What can the transrectal ultrasoudn ID?
SI distension
Bowel wall thickening
Motility
Abdominal fluid
Intersection
Nephrosplenic entrapment
Inguinal hernia
Sand
Masses and FB
What is some laboratory data helpful for colic work ups?
PCV (32-45%) - dehydration, splenic contraction, SIRS, PCV >60 = poor prognosis
TP (4.6-6.9g/dl) - SIRS, altered Mucosal funciton
Lactate (<2mmol/L - anaerobic metabolism, dehydration, reduced hepatic clearance, >6.5mmol/L poor prognosis
Glucose
Hyperglycemina (>135mg/dl)
Extreme hyperglycemia (>180)
What can the CBC tell you?
Elevated WBC (inflammatory)
Decreased - endotxemia
Fibrinogen - inflammation >400 (2-3 days to see)
What can the chem tell you?
Azotemia, liver enzymes elevated, electrolyte issues
Where do you obtain and abdominocentesis?
Right of midline
dependent location
ultrasound guide and sterile prep (teat canula or needle)
What are the normal values of abdominocentesis?
Clear yellow, protien <2, WBC <5000, RBC rare
What does red abdominocentsis mean? Feed particles?
Red: strangulation
Feed: Rupture
What can peritoneal fluid lactate tell you?
> 4 mmol/L
- Increase over time
-Significant factor strangulating
What are some further diagnostics?
Gastroscopy, fecal exam, abdominal rad, laparoscopy, explore
