18 – Equine GI 1 & 2 Flashcards
1
Q
General approach to patient
A
- Signalment
- History
- PE
- Further diagnostic tests (diagnostic plan)
- Differential diagnoses
- Diagnosis
- Treatment plan
2
Q
What are the 3 ‘parts’ that could cause dysphagia?
A
- Prehension
- Mastication
- deglutition
3
Q
What are the clinical signs of dysphagia?
A
- Feed/water exiting nostrils
- Ptyalism
- Coughing
- Weight loss
- +/- aspiration pneumonia
- +/- CN deficits
o Decreased tongue tone
o Facial nerve paralysis
4
Q
What are the causes of dysphagia?
A
- Pain
o Dental disease
o Foreign body
o TMJ osteoarthritis - Obstruction
o DDSP
o (retro)pharyngeal abscess (strangles)
o Choke - Neurologic disorder
o Guttural pouch mycosis
o Botulism
o EPM (equine protozoal myoencephalitis)
o Facial nerve trauma
o THO
5
Q
How do you diagnose dysphagia?
A
- History
- PE
- Neurologic exam
- Oral exam
- Bloodwork
- Endoscopy
- Radiographs
- CT
6
Q
What are some examples of esophageal disorders?
A
- *Choke
- Esophageal stricture
- Esophageal diverticula
- Esophagitis
- Esophageal ulcers
- Esophageal rupture
- Megaesophagus
- *many of these can predispose them to choke or a secondary to choke
7
Q
What are the clinical signs of choke?
A
- Dysphagia
- Coughing
- Inappetence
- Ptyalism
- Colic signs
- Anxiety
o Tachycardia
o Tachypnea
8
Q
How do you diagnose choke?
A
- Signalment
o Friesian: megaesophagus (predisposing to choke) - History
o Feed: unsoaked beet pulp
o Previous choke - PE
- *nasogastric intubation
- Oral exam
- Endoscopy
9
Q
What are examples of gastric disorders?
A
- *Gastric ulcers
- Gastric impactions
- Gastric rupture
- Neoplasia
10
Q
What are the clinical signs of gastric ulcers?
A
- *non-specific
- Mild acute colic
- Recurring colic
- Poor body conditions
- Parital anorexia
- Poor performance
- Attitude changes
- Frequent stretching to urinate
- “girthy”; behaviour change
- NO bleeding! (NO anemia), no melena
11
Q
How do you diagnosis gastric ulcers?
A
- Gastroscopy
o Need to be fasted for 18 hours
o **equine squamous gastric ulcer syndrome=most common (along margo plicatus)
o Equine glandular gastric ulcer syndrome (usually localized in the pylorus)
12
Q
Colic signs
A
- *manifestation of visceral abdominal pain
- Frequently getting up and down
- Pawing
- Rolling
- Flank watching
- Posturing to urinate
- Downward dog
13
Q
How do you diagnose colic?
A
- Signalment
- History
- PE
- Nasogastric intubation
- Rectal palpation
- Abdominal ultrasound
- Abdominocentesis
- Blood work
- Fecal examination
- (radiology)
14
Q
What are the DDx for colic?
A
- Laminitis
- Rhabdomyolysis
15
Q
What are the common causes of colic: surgical and medical: SMALL intestine?
A
- Strangulating lipoma
- Mesenteric rent
- Epiploic foramen entrapment
- Ascarid impaction
- Intussception
- Hernia
- Meckel’s diverticulum
- Mesenteric torsion
16
Q
What are the common causes of colic: surgical and medical: LARGE intestine?
A
- Gas
- Spasmodic
- Impaction
- Displacement
- Enterolith/fecalith
- Sand
- Volvulus
- Cecal impaction
- *diarrhea=hind gut problem in horses
17
Q
Colic signalment: age importance
A
- Strangulating lipoma: typically older
- Proliferative enteropathy: weanling, yearling
- Ascarid impactions: typically less than 1 year old
18
Q
Colic signalment: sex
A
- Stallion: check scrotum always!
- Mare: pregnant; pre vs. post partum
19
Q
Colic signalment: breed
A
- Different temperatures
o Stoic (drafts, donkeys) vs. ‘drama queens’
20
Q
Colic history importance
A
- Duration of colic signs (treatments and response)
- Passing feces/urinating normally
- Fever
- Current diet, water
- ANY changes
- Purpose/use of horse
- Exercise routine
- Weight loss
- Deworming and vaccination history
- Dental care
- Travel history
- Any other animals sick
- Sand paddocks/pastures
- Medications (NSAIDs: R. dorsal colitis)
- Orthopedic injury
- Previous colic or surgery
21
Q
Horse with fever and colic: what should you think?
A
- Infection or inflammation
- Lean away from impaction
22
Q
Colic: physical exam
A
- Mentation
- Heart rate: suggestive of disease severity
- Respiratory rate
- Temperature
- MM colour and moisture: CRT
- Digital pulses (ex. may help DDx laminitis)
- Ventral or peripheral edema
o Hypoalbuminemia?=colitis; enteropathy - Borborygmi; cecal flush
- Distance exam: Abrasions on head
23
Q
**Nasogastric intubation: colic
A
- DO FIRST IF TACHYCARDIA
- Diagnostic and therapeutic
- Normal reflux <2L
- *if >2L suggestive of SI issue (strangulation AND duodenal-proximal jejunitis (DPJ))
o Relief of pain
o If strangulation=less painful but will still be painful (unchanged pain)
o If DPJ=visible relax - *no reflux=NO SI obstruction (could be distal jejunum)
- *horses with DPJ usually less painful post reflux, unlike surgical lesion (ex. strangulation)
24
Q
Rectal palpation: colic
A
- *normal or NOT?
- If abnormal: ID exact abnormality ideal, but NOT critical to case management
- Ex. impaction: pelvic flexure
- Ex. small or transverse colon impaction
- Ex. L dorsal displacement
25
Abdominocentesis: colic
- Help to differentiate strangulating (vascular=transudate) VS. non-strangulating (inflammation=exudate) lesion
- NORMAL= straw-colour and transparent
- Maybe not in late stage pregnancy OR if concerned about a large impaction
26
Abdominocentesis: evaluation
- *gross examination
- *lactate (normal <2mmol/L)
- Total solids
- Nucleated cell count
- PCV (beware of inadvertent splenic puncture)
- Cytology
27
Peritoneal fluid lactate
- Visceral/intestinal ischemia
o Peritoneal fluid lactate increases BEFORE blood/plasma lactate
o *higher with strangulating obstructions compared to non-strangulating
28
What are some abnormal findings that can be found on ultrasonography (colic)?
- EXCESSIVE free fluid
- Stomach: distension
- SI
o Increased diameter
o Increased wall thickness
o Absent or increased motility
o “target” sign (intussusception)
- LI
o Nephrosplenic ligament entrapment
o Colon torsion
o Colitis
- *limitations=gas artifacts
29
Radiography (colic)
- Abdomen of adult horse
o Portable x-ray units not powerful enough
o *referral clinic
- *2 main indications: sand impaction and enteroliths
30
Radiography: sand impaction
- Large colon
- Along ventral abdomen
- Diagnosis and monitoring of resolution
31
Radiography: enteroliths
- Solid concentration of material
o Varied mineral composition=different opacities
- Generally formed around nidus (ex. foreign body)
- Mid-abdominal radiography
o Radio-opaque
o +/- adjacent air
- 96.4% PPV in high prevalence areas
32
Clinical pathology: colic
- PCV/total solids
- Lactate
33
*Blood gas (venous): colic
- Acid/base imbalances
- Electrolyte concentrations
- Lactate concentration
- Glucose concentration
- +/- creatinine concentration
34
What are other tests you could do but that you don’t routinely need?
- Biochemistry
- CBC
35
Blood lactate concentration
- Marker of tissue perfusion
- Normal=<2mmol
- Ischemia and cellular hypoxia = anaerobic glycolysis = increased lactate
- Dehydration = decreased perfusion = increased lactate
- Portable analyzer
36
Diarrhea: etiological diagnosis;
- ID cause
o Culture
o PCR
o Toxin assays
o Fecal egg count
o Sand
- Serology:
o Lawsonia intracellularis
o Neorickettsia risicii
- *hang it in a glove and leave overnight
