20.Decision making in GIT Disease Flashcards
What critical questions should you be asking about GI disease?
What is the severity of the condition
Is referral indicated
Is surgery indicated
Whats the prognosis
How soon should you decide to cut or not to cut?
first 10-30 min of your evaluation
-Rolling in agony
-Harming itself
Do you have to have a definitive diagnosis to refer or cut?
No!
What is the minimum database for diagnosis?
Hx, PE, Rectal exam, NG, response to therapy
What are some other diagnostics?
CBC, Chem, Blood gas, abdominocentesis, ultrasound, rads, exploratory
What is some critical history to have?
Signalment, hx previous colic, duration, severity, changes over time, response to treatment
What are the important pieces of information you need to know about signalment?
Sex, Breed, Age
What are important pieces of history you need to know?
History of colic
Duration of signs
What type of colic is suspected based on the following history:
Acute onset, severe colic, minimally responsive to alpha 2 agonists
Strangulating Obstruction
What type of colic is suspected based on the following history:
Insidious onset of colic of several days duration
Non-strangulating obstruction or displacement
What type of colic is suspected based on the following history:
History of recurrent episodes
Sand, enterolithiasis, gas, ulcers, impaction
What type of colic is suspected based on the following history:
Horse had limited access to water
Large colon impaction
What type of colic is suspected based on the following history:
Feces has diarrhea with progressive colic
Small colon impaction
What type of colic is suspected based on the following history:
Persistent soft, watery diarrhea, fever, dull mentation and inappetance
Colitis
What type of colic is suspected based on the following history:
Variable pain, shock signs, sweating, muscle fasciculation and reluctance to move
GI rupture
What type of colic is suspected based on the following history:
Mild to moderate followed by severe?
Secondary LC displacement and volvulus
What type of colic is suspected based on the following history:
Feeding bermuda grass hay
Ileal impaction
What type of colic is suspected based on the following history:
change to lower-quality fibrous feed
Colon or cecal impaction
What type of colic is suspected based on the following history:
Increased concentrate in diet
Proximal enteritis, large colon displacement
What type of colic is suspected based on the following history:
Feeding alfalfa
Enterolithiasis
What type of colic is suspected based on the following history:
Moldy hay
Proximal enteritis or gastritis
What type of colic is suspected based on the following history:
Gradual weight loss, intermitant soft stool, feeding on grand in particular area
Sand impaction
What type of colic is suspected based on the following history:
Recent deworming in young horse
Ascarid impaction
What type of colic is suspected based on the following history:
Chronic NSAID
Right dorsal colitis, ulcer
Does sign of severity correlate with need for surgery?
Yes, if severe pain need surgery
What are some important parameters to check?
TPR, MM, CRT, Abdominal distension and sounds, Pain level
What is the prognosis if the horse is shocky with a high HR?
Gaurded
What GI parameters help ID if surgery may be needed?
Abdominal distension and abnormal borborygmi and abnormal rectal palpation
If you get back NG reflux then what could be occuring?
Functional or mechanical obstruction
What additional tests may help determine prognosis?
Abdominocentesis, peritoneal fluid analysis (color and turbidity)
-Normal color medical, abdnormal color surgical
What is the normal range for peritoneal TP? NCC?
TP: <2.5g.dl
NCC: <10,000
Lactate: < peripheral (>4mmol/L) (elevated = surgery)
-Periferal predicts intestinal ischemia
Are wbc helpful to tell if they need surgery?
No
What is the prognosis with a HCT>60?
Poor
What is hyperglycemia associated with in colic horses?
Non-survival
What does an elevation in serum lactate mean?
Marker for severity of disease
Elevation due to decrease in tissue perfusion, cytopathic hypoxia or decreased clearance (6 bad, 3 ok)
What are the top prognostic indicators for survival in colic?
HR, PCV, MM, Blood lactate
How is abdominal ultrasound helpful?
Can Id a strong positive, help with abdominocentesis site
How helpful are abdominal rads?
Low, help diaphragmatic, enterolithiasis and sand
