Alimentary System

Question 1

History

Answer 1

Appetite
Water intake 
Prehension
Mastication
Swallowing 
Defecation
Pain (colic)

Question 2

Body condition scoring

Answer 2

Scale 1-9
Visual inspection and palpation of regions
Positively related to body fat percentage
No correlation to body weight!
Foals the scale is 1-5

Question 3

Exam of the oral cavity

Answer 3

Odour
Mucus Membranes 
Saliva 
Teeth
Tongue

Question 4

Examination of the Salivary Glands

Answer 4

Parotid
Mandibular
Sublingual
Buccal

Question 5

Examination of the Pharynx

Answer 5

External:
Inspection
Palpation

Internal:
Palpation
Endoscopy- small nodules of lymphatic tissue especially in young horses 
Nasogastric tubing 
Watering and feeding test

Question 6

Exam of the esophagus

Answer 6

Inspection
Palpation
Nasogastric tubing 
Watering and feeding test 
Endoscopy 
X-ray- with contrast material
US

Question 7

Exam of the abdomen methods

Answer 7

Inspection
Palpation
Auscultation
Percussion
Rectal Palpation
Nasogastric intubation
Abdominocentesis 
Endoscopy
Radiography
US...

Question 8

Inspection of the abdomen

Answer 8

From all angles! behind, the side, the front, below

Shape, contour, volume, movements

Question 9

Palpation of the abdomen

Answer 9

Temp
Thickness
Tenseness
Sensitivity
Pain
Swellings

Question 10

Auscultation of the abdomen

Answer 10

Gurgling, rumbling
Tinkling, splashing

Physio: +
Decreased: 1/- large colon obstruction and displacement
Increased: ++ borborygmi: early stages of enteritis, colitis, typhlitis

Reduced/absent sounds: atony, impaction, obstruction, shock, poor perfusion, high sympathetic tone

At least 3 areas on each side and spend 1 minute on each area

Question 11

Percussion of the abdomen

Answer 11

Info regarding gas distension of caecum and large colon
Not used as frequently anymore

Left:
dorsal third: dulled tympanic
Middle third: dulled tympanic
Ventral third: dulled

Right:
Dorsal third: tympanic
Middle third: dulled tympanic
ventral third: dulled

Question 12

Rectal palpation as an exam of the abdomen

Answer 12

40% of abdomen is palpable in this way
Prep: restraint, spasmolytics, sedation
Inspection: perianal area, anus
Some palpable structures: Bony pelvis, internal inguinal rings, prostate, bladder, abdominal aorta, left kidney, spleen, pelvic flexure etc

Question 13

Abdominocentesis: patho conditions

Answer 13

Peritonitis 
Abd neoplasia 
Abscesses
Strangulation
Uroperitoneum
GI rupture

Question 14

Abdominocentesis: fluids

Answer 14

Transudate
Modified transudate 
Exudate 
Blood
Urine

Question 15

Radiography of abdomen indications

Answer 15

Check NG placement in foals
Dignose diseases in neonates
Sand in ventral colon
Enteroliths

Question 16

US of the abdomen indications

Answer 16

Colic 
Weight loss, anorexia 
Pyrexia 
Leucocytosis or penia
Elevated plasma fibrinogen 
Elevated liver enzymes 
Elevated kidney values 
Abnormal peritoneal fluid

Question 17

US of the stomach

Answer 17

Left
10-15th ICS
Medial to hylus of the spleen
Content, wall thickness and size

Question 18

US of caecum

Answer 18

Right paralumbar fossa adjacent to the right kidney and descending duodenum

Question 19

Ultrasound of the large intestine

Answer 19

Wall thickness
Content (gas vs. fluid)
Displacements

Question 20

US of the peritoneum

Answer 20

Septic peritonitis
Abdominal neoplasia
Hemoperitoneum
Uroperitoneum

Question 21

Exam of the stomach

Answer 21

Location is deep in the diaphragmatic dome
Nasogastric intubation: Look at gastric content: quantity, quality, colour, smell, pH, components, foreign materials
Gastroscopy
US
Biopsy

Question 22

Exam of the liver

Answer 22

Location is deep in the diaphragmatic dome, asymmetrically
Phys exam also possible!

Ancillary diagnostic methods:
US
Biopsy
Clinicopathological exam: 
Serum hepatic enzymes 
Bile salts 
Ammonia 
Glucose 
Bilirubin
Clotting factors 
Plasma proteins

Question 23

Exam of the pancreas

Answer 23

Location is behind the stomach and liver, in the dorsal part of the r. epigastrica above the duodenum
No physical exam
No US

Lab diagnostic methods:
Serum amylase and lipase
Peritoneal fluid amylase (this is not specific)

Question 24

Auscultation regions

Answer 24

Quadrants
Left upper: small colon and small intestines
Left lower: left ventral colon and pelvic flexure
Right upper: head of caecum- ileocaecalis sound which is longer! (sounds like a thunderstorm)
Right lower: right ventral large colon

Question 25

Abdominal US prep and instruments

Answer 25

Clean hair coat 
Soak with diluted isopropyl-alcohol
Use UH gels for good contact
May be necessary to clip hair 
Macroconvex probe: 3.5MHz- the higher the frequency, the better the image quality but there is less penetration
Depth of 25-30cm

Question 26

Regions of abdominal US

Answer 26

LEFT
Left flank area: spleen and kidney
Lower colon and spleen
Inguinal: bladder and small intestinal loops
Cranially: stomach and spleen

RIGHT
16 and 17 ICS is the kidney
ventrally: caecum
cranially: lung, liver, duodenum (from dors to ventral)
Inguinal: small intestine loops and bladder
Ventrally: colon

Question 27

Gastroscopy

Answer 27

12hr fasting prior 
3m long flexible endoscope 
Decompress stomach at the end 
Non-glandular: esophageal part
Glandular: cardia, fundus and pylorus 

Can use nasogastric tube to protect endoscope

Question 28

Pathological findings of a gastroscopy

Answer 28

Hyperkeratosis
Ulcerations
Bleeding
Fibrin