Approach to Conditions of GIT in the Foal and Horse Flashcards
what are the classifications of colic (5)
- simple medical: spasmodic, flatulent/tympanic
- obstructive
- non strangulating infarction
- enteritis/colitis
- false colic
what are the types of obstructive colics (4)
- intraluminal
- extraluminal
- strangulating
- ileus
what are intraluminal obstructive colics (2)
- impaction
- enterolith
what are extraluminal obstructive colics (4)
- displacement
- compression
- adhesion
- mural mass
is the degree of pain a foal is in linked to the severity of the condition
no
what are foals more prone to (4)
- meconium impaction (<24 hours)
- congenital abnormalities
- intussusception
- pyloric stenosis
what are weanlings prone to
ascarid impactions
what information do we need to prioritize for our ddx
recent colic history
management history
medical history
what are some history questions you want to know from the owner (8)
- try to assess the duration: when did signs start, last seen normal
- assess severity: what colic signs? be specific
- fecal output? amount and consistency
- appetite
- management: feeding (any changes), turnout/stable, exercise, deworming, dental history
- access to pasture
- types of pasture
- concentrate (type, amount, changes)
what does coastal bermuda hay cause
ileal impactions
what can alfalfa hay cause
enterolithiasis
what are stabled horses more susceptible to
impactions
pelvic flexure > cecal > gastric
what parasites are associated with colic (2)
- anoplocephala perfoliata (tapeworm): ileal impaction, intussusceptions
- strongylus vulgaris: non-strangulating infarction
what is the relationship between dentals and colic (2)
- increasing time since last dental exam increases risk of large colon impaction –> poor dentition leads to longer fibre length
- recent over rasping also causes impactions
what medical history can increase the risk of colics (3)
- previous colic or colic surgery
- recent NSAID or antimicrobials (colitis)
- orthopaedic injury
how do orthopaedic injuries increase the risk of colic
pain increased risk of cecal impaction
stable rest increases risk of pelvic flexure impaction
what should you observe before you examine the horse (5)
- assess pain level
- muscle fasciculations
- sweating
- abdominal contour (distention)
- environement (feed quality, water, bedding)
what should you do before you admin sedation or analgesics (5)
- heart rate
- mucus membranes
- pulse quality
- respiratory rate
- GI sounds?
what heart rate is concerning
> 60 bpm
how can you determine if there is endotoxemia in your clinical exam
toxic line –> dilation of capillary beds in the mouth
what should you listen for in you GI auscultations
assess over 4 quadrants
increased vs decreased sounds
gas ‘ping’
what else should be in your physical exam (6)
- BCS
- resp auscultation
- digital pulses
- assess for trauma (eyes, limbs)
- check jugular veins
- temperature
when should you perform immediately an NG intubation (3)
- reflux seen from nostrils
- HR >60bpm
- gastric dilation on US
what are the risks of nasogastric intubation (4)
- tracheal intubation (aspiration pneumonia)
- hemorrhage from ethmoturbinates (ensure placement is in ventral meatus)
- trauma to retropharyngeal recess or esophagus (lubrication, gentle pressure, extra caution if dehydrated)
- gastric rupture (not too much water)
how do you create a siphon with NG intubation
use water to create a siphon action
measure water in and reflux out, calculate the net reflux
how much net reflex is considered normal
<2 L
how much net reflex indicates lack of gastric emptying and what colics might be present
>2L
ileus, obstruction, enteritis
what might indicate gastric impaction with NG intubation
copious amounts of feed on lavage
is gastric reflux a significant finding always
yes
what does transrectal palpation allow you to assess
contents of caudal abdomen
what might be required to facilitate a transrectal palpation (3)
- sedation
- buscopan
- twitch
what are the risks of a rectal palpation
- rectal tear
- injury to you
how can you prevent rectal tearing (5)
- appropriate restraint
- lubrication
- relaxation
- increased risk if stallion, Arab, very small, dehydration
- do not push against contractions
what is present dorsally in a rectal palpation
aorta
what is felt in the left of the rectal palpation
kidney, spleen agaisnt body wall
what is felt in the ventral left of the rectal palpation
pelvic flexure
what is felt in the right of the rectal palpation
band of cecum
what is rectal palpation most useful for (2)
- impactions of the large or small colon (firm contents palpated)
- gas distention: displacement/torsion (tight teniae bands –> possibly in abnormal orientation)
where is the left dorsal and ventral colon normally found
left side medial to the spleen, smooth colon dorsal, sacculated colon ventrally
what would indicate a colon impaction
abnormal contents in the left dorsal and ventral colon, pelvic flexure
where is the cecum normally found
right side with bands palpable
what would indicate a cecal impaction
abnormal contents in the cecum on rectal palpation
what would indicate a cecal torsion
abnormal position in rectal palpation
what should you be able to feel with the small colon
fecal balls, anti mesenteric band
what findings are always significant with transrectal palpation (4)
- small intestine is always abnormal
- tight bands from distention/displacement
- abnormal organ position or content
- free gas of feed material (rupture)
what should you do if there is a rectal tear (5)
- immediately inform owner (boss, insurance)
- assess extent of the tear (rectal palpation or endoscopy)
- recommend referral for all grade 2, 3, or 4 tears or if you feel further assessment is required
- anitmicrobials
- reduce straining and further fecal contamination (epidural anesthesia, rectal packing, buscopan)
what should you do if you plan to refer (3)
- speak to hospital (history and details of drug admin, ask for cost)
- prepare client (estimate cost for medical care and/or surgery)
- stabilize patient for transport
how wouls you stabilize a patient for referral (3)
- analgesia approrpiate for duration of travel
- place NG tube in place if reflux (one way valve ex. glove finger with hole)
- fluid therapy if required (clinical dehydration) IV or enteral (not if suspect SI abnormality)
