Decision making regarding GI disease Flashcards
What are the critical questions when deciding to refer a colic case?
What is the severity of the condition?
Is referral indicated?
Is surgery indicated?
What is the prognosis?
During what timeframe do you need to make the decision: to cut or not to cut?
Rapidly- the earlier the better
- ideally within the first 10-30 min of your evaluation
- subsequent evaluation and monitoring may lead to a change in the plan (always be open to changing plans)
- additional diagnostic information can be useful but is not always required to formulate an appropriate plan
T/F: a definitive diagnosis is always required in order to make a decision regarding surgical colic
False- it is not always available and is not required
- often GI surgery is a diagnostic as much as a therapeutic (and its not always therapeutic)
What are the most critical history questions in colic cases?
signalment, history of previous colic, duration of signs, severity of signs, changes in signs over time, response to treatment prior to referral
What types of colics are more likely in mare vs stallion? What about older horses?
Mare: uterine artery rupture, uterine torsion
Stallion: testicular torsion, inguinal hernia
Old horses- strangulating lipomas, epiploic entrapments
How can breed impact differentials in colic cases?
Ponies: at decreased odds of colon displacements, as well as increased odds of strangulation of the small intestines by lipomas
Miniature types: decreased odds of strangulating small intestinal lesions
Drafts: increased odds of cecal conditions
T/F: longer duration of signs is usually associated with a better outcome
True- usually less severe
- however, if it’s a short duration and you catch earlier you can have an improved outcome
-but if its severe and acute, often there’s a worsened outcome
While severity of signs is usually associated with a worse prognosis, what are some confounding factors?
-with severe strangulation, minimal signs may be present and interpretation can be clouded by severe obtundation
-also with ruptures, signs of pain often subside (though all these horses have to be euthanized)
T/F: Increasing pain level means the lesion is more likely to be surgical. Decreasing pain levels are always associated with a better prognosis
False- both increasing and decreasing pain levels can be associated with worsening of the lesion
What is tachycardia, MM color, CRT associated with in terms of colic?
Tachycardia- mediated by hypotension and/or pain
MM color- related to peripheral vascular tone and blood pressure
CRT- indicator of perfusion
*if one is abnormal, others are more likely to be as well. Abnormalities may be associated with SIRS unrelated to GI pathology
T/F: An increasing HR is associated with decreased survival especially in conjunction with abnormal mucous membranes
True
-but there is poor sensitivity and specificity (just associated with severity of systemic illness)
Why is abdominal distension poorly sensitive?
-the absence of visible distension does not rule out internal distension/displacement
-test is inherently subjective
If borborygmi is absence, what may this indicate?
You are much more likely to be dealing with a surgical lesion (OR 11.97)
Describe the diagnostic value of nasogastric reflux
- it is nonspecific and reflux presence may be a result of either a functional or mechanical obstruction
-reflux volume >5 correlates with worsening severity of lesion
-copious reflux may suggest proximal jejunitis, or anterior enteritis
If a horse presents with a high HR and is actively painful, what is the first thing you should do?
Pass a tube to prevent stomach rupture!
What signs in addition to reflux can help you determine i the reflux is due to enteritis or is surgical?
Fever- more likely enteritis
- although owner has often already treated with banamine
*best indicator is relief after tube is passed- if horse is no longer actively painful more likely to be enteritis
T/F: unless alternative diagnosis is available (impaction), most horses that respond poorly to analgesics are surgical candidates
True
What are the advantages and disadvantages of abdominocentesis?
Advantages: easily performed, abnormal findings are typically significant
Disadvantages: complete analysis may not be possible or timely, poor sensitivity and specificity
What should you evaluate peritoneal for?
Appearance, TP, nucleated cell count, cytology, lactate
What does normal peritoneal fluid look like?
Light yellow and clear
-discoloration (red brown or green) is a bad sign (most diagnostic) as well as increased turbidity (which may be due to cells, protein, GI contents or fat)
Which is more helpful prognostically: normal or abnormal color of abdominal tap?
Abnormal- much more likely to be surgical
-however a horse with normal fluid still may be surgical
T/F: total protein is a very useful factor in determining whether surgery is indicated
False- low sensitivity, fair specificity
- normal values range widely
Is NCC of peritoneal fluid diagnostically useful?
Not really
- looking at color is much more predictive for whether a horse needs surgery
DONT WAIT FOR RESULTS THAT WONT AFFECT DECISION MAKING
Is lactate levels diagnostically useful?
YES
- elevated concentration is strongly correlated with need for surgical intervention
