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Veterinary Nursing > Equine Gastrointestinal Disease > Flashcards

Equine Gastrointestinal Disease Flashcards

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1
Q

What is colic?

A

Abdominal pain.

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2
Q

What are the signs of colic?

A

Rolling
Pawing
Flank watching
Lip curling

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3
Q

What should we clinically examine in a suspected colic patient?

A

Cardiovascular - heart rate/rhythm, resp. rate, PCV + TP, lactate
Abdominal - auscultation (4 quadrants), distension
Rectal - distension, impaction, displacement
Stomach tubing
Ultrasound - rectal/transabdominal
Abdominoparacentesis (belly tap) - intestinal damage, haemoperitoneum, rupture, inflammatory/neoplastic cells
Oral
Gastroscopy - ulceration, outflow obstruction, impaction
Radiography

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4
Q

What tests can we run on a suspected colic patient?

A

Blood - PCV, TP, lactate, haematology/biochemistry
Peritoneal fluid - gross appearance, cytology, protein
Faecal - egg count, culture
Glucose absorption test
Laparoscopy
Laparotomy

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5
Q

Describe dental disease in horses.

A 
Eruption disorders
Dental decay
Periodontal disease
Fractured tooth
Diastema
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6
Q

How can we treat dental disease in horses?

A

Filling, widening
Rasp at least 1x a year
Removal has problems - opposite tooth has nothing to grind against (long-term management)
Or risk dysphagia, impaction from not chewing properly

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7
Q

How can we examine a horse’s mouth?

A 
Watch horse eat
Palpate 
Sedate
Mouth gag
Wash out
Torch, mirror
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8
Q

What are the primary/secondary causes of oesophageal obstruction (choke) in horses?

A 
Primary = bad luck, eating too fast, dry concentrate, poor dentition
Secondary = rare, oesophageal damage, mass
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9
Q

What are the clinical signs of choke?

A

Neck extended, food/discharge from nose, cough, gag
Over time - dehydrated, acid-base imbalance, weight loss
Aspiration pneumonia
Risk acute oesophageal rupture / stricture or diverticulum long-term

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10
Q

How do we diagnose choke?

A 
Auscultation
Cardiovascular parameters
Gastroscopy
Stomach tube
(Bloods, ultrasound, plain/contrast radiography)
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11
Q

How do we treat choke?

A

Sedate - low head carriage = reduced risk of aspiration
Stomach tube, lavage obstruction via tube
Check obstruction cleared, no damage to mucosa, no aspiration, underlying problems?
Rest from feeding, start with mash and grass
May need antibiotics and anti-inflammatories

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12
Q

What are the causes of gastroduodenal ulceration?

A

Imbalance between inciting and protective factors
Inciting = HCl, bile acids, pepsin
Protective = mucus-bicarbonate layer, mucosal blood flow, mucosal prostaglandin E, epidermal growth factor production, gastroduodenal motility
Risk factors = empty stomach exercise, diet, stress, NSAIDs, hospitalisation

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13
Q

What are the clinical signs of gastroduodenal ulcers?

A

Range from asymptomatic

Poor appetite, recurrent colic, tooth grinding, dog sitting, diarrhoea, poor performance

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14
Q

How do we diagnose gastroduodenal ulcers?

A

Gastroscopy (foals difficult as too small)

Remember ulcers are common, therefore presence does not mean significance/cause of clinical signs!

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15
Q

How do we treat gastroduodenal ulcers?

A

Depends on cause
Management
Adult = omeprazole (or misoprostal off licence)
Foals = sulcralfate

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16
Q

What are the primary causes of gastric dilation and rupture?

A

Gastric impaction (acute/chronic colic, difficult to treat)
Grain engorgement
Etc.

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17
Q

What are the secondary causes of gastric dilation and rupture?

A

More common
Small or large intestinal obstruction
Ileus (secondary, equine grass sickness)

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18
Q

What are the clinical signs of gastric dilation and rupture?

A 
Overfilling of stomach
Acute colic
Tachycardia
Fluid from nose (right before rupture!)
Dehydration
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19
Q

How do we diagnose gastric dilation and rupture?

A

Clinical signs
Reflux
Colic work-up
Gastroscopy

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20
Q

How do we treat gastric dilation and rupture?

A 
Stomach tube!!
Treat underlying cause
IV fluids
Nil per os - IV nutrition
Electrolytes
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21
Q

Describe anterior enteritis (SI).

A

Inflammatory condition affecting proximal small intestine
Most cases = underlying aetiology cannot be determined
Some = salmonella or clostridia cultured from gastric reflux
Recent diet change to high concentrate is a risk factor

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22
Q

What are the clinical signs of anterior enteritis?

A

Distended small intestine and stomach
Signs same as gastric dilation
Often pyrexic

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23
Q

How do we diagnose anterior enteritis?

A

Colic investigation:
Peritoneal fluid = raised protein but not serosanguinous
Reflux - culture
Often need ex-lap

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24
Q

How do we treat anterior enteritis?

A

Repeated gastric decompression (life-saving!)
Antibiotics - penicillin, gentamicin, metronidazole
IV fluids
Electrolytes
Nil per os - nutritional support
Analgesia
Ex-lap, SI decompression

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25
Q

What is the main clinical sign of SI malabsorption and maldigestion?

A

Weight loss!

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26
Q

How do we diagnose SI malabsorption and maldigestion?

A

Abdominoparacentesis
Ultrasound
Oral glucose tolerance test (not absorbed)
Laparoscopic biopsy

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27
Q

How do we treat SI malabsorption and maldigestion?

A

Method depends on diagnosis
Prognosis depends on diagnosis and response to treatment
Resection? Corticosteroids?
May be no treatment

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28
Q

Describe a simple SI obstruction.

A

Obstruction of lumen without direct obstruction of vascular flow
Food material - coarse, ileal hypertrophy (secondary to tapeworm)
Ascarid impaction
Adhesions

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29
Q

Describe a strangulation SI obstruction.

A

Simultaneous occlusion of intestinal lumen and its blood supply
Pedunculated lipoma, epiploic foramen entrapment, SI volvulus, mesenteric rent, inguinal/diaphragmatic hernia, intussusception
Results in gastric overfilling - risk rupture
Deterioration of intestinal mucosa

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30
Q

What are the clinical signs of SI obstruction?

A

Colic - severe as gut dies, eases when gut dead
Reflux
Tachycardia
Hypovolaemia
Rectal - distended small intestine
Peritoneal fluid - serosanguinous, increased protein/lactate

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31
Q

How do we treat SI obstruction?

A

Surgery/euthanasia
Rarely, ileal impaction can clear
Act fast!

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32
Q

What are the primary/secondary causes of caecal impaction?

A 
Primary = ? underlying motility disorder
Secondary = usually young horses after painful orthopaedic procedures (monitor faecal output/appetite/pain level after any surgery)
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33
Q

What are the clinical signs of caecal impaction?

A

Colic

Can just rupture - signs of severe shock, death

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34
Q

How do we diagnose caecal impaction?

A

Clinical signs and history
Rectal exam
Abdominoparacentesis

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35
Q

How do we treat caecal impaction?

A

Medical vs surgical
Oral and IV fluids
Surgery = typhlotomy / caecal bypass

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36
Q

Describe caecal intussusception.

A

Ileo-caecal or caeco-caecal
Young horses
Tapeworm

37
Q

What is the main clinical sign of caecal intussusception?

A

Colic - varying severity, can be chronic

38
Q

How do we diagnose caecal intussusception?

A

Rectal exam
Ultrasound
Peritoneal fluid unreliable!

39
Q

How do we treat caecal intussusception?

A

Surgery

Then treat tapeworm

40
Q

Describe impaction of the large intestine (LI).

A

Usually pelvic flexure
Food material
Poor teeth, long fibre, motility disorder, recent box rest, sand

41
Q

What are the clinical signs of LI impaction?

A

Usually mild colic, can be chronic

Reduced faecal output

42
Q

How do we diagnose LI impaction?

A

Rectal exam

Abdominoparacentesis

43
Q

How do we treat LI impaction?

A 
Oral fluids and cathartics
Analgesia
Paraffin?
IV fluids?
Eventually surgery
44
Q

Describe LI displacement.

A

Right/left dorsal displacement
Nephrosplenic entrapment
Can: correct itself +/- medical treatment, remain displaced and become compromised (needs surgery), torsion (emergency surgery)

45
Q

How do we diagnose LI displacement?

A

Rectal exam
Ultrasound - nephrosplenic entrapment
Abdominoparacentesis

46
Q

How do we treat LI displacement?

A

Medical if not too painful and no evidence of gut damage - fluids oral/IV, analgesia, nephrosplenic entrapment = phenylephrine and lunging
Otherwise surgery, or if persistent

47
Q

Describe LI torsion.

A

Strangulating lesion of LI
Extreme pain, violent horse
Distended abdomen
Respiratory compromise

48
Q

How do we diagnose LI torsion?

A

Rectal exam

49
Q

How do we treat LI torsion?

A

Immediate surgery
Prognosis depends on damage to LI
LI resection?
Risks recurrence

50
Q

How do we diagnose LI diarrhoea?

A 
Cardiovascular parameters
Rectal exam
Ultrasound
Abdominoparacentesis
Rectal biopsy
Faecal egg count/cultures
51
Q

How do we treat LI diarrhoea?

A 
Hydration
Electrolytes
Anti-endotoxic
Laminitis prevention
Antibiotics?
Plasma?
Feeding
Nursing care! - clean, treats, groom
52
Q

Describe small colon impaction.

A

Quite rare
Foreign body (e.g. plastic bags), salmonella
Difficult to diagnose - intermittent diarrhoea and colic
Can try medical treatment
Many require surgery

53
Q

Describe peritonitis.

A 
Primary = pyrexia and mild colic, abdominoparacentesis, antibiotics, laparoscopy/laparotomy if persistent or recurrent
Secondary = intestinal surgery contamination etc.
54
Q

What colic findings would imply possibly surgical treatment?

A

Moderate-severe pain
Persistent behavioural signs despite analgesia
Absence of faeces
Heart rate > 60 bpm
Poor MM colour
Reduced/no gut sounds on auscultation
Rectal - distension +/- displacement of S/L intestine
Increased PCV/TP/lactate
Positive reflux with nasogastric tubing (more than 2L)
Distended SI/displaced LI on ultrasound
Discoloured and turbid peritoneal fluid on abdominoparacentesis

55
Q

What practicalities of surgery need to be considered?

A

Cost - unsuccessful cases likely to end in dead horse + big bill
Transport of horse to surgery
Prognosis - hard to be sure pre-surgery
Complications many/common - owner awareness from outset

56
Q

How do we prep a horse for colic surgery?

A

Jugular IV catheter placement
Decompress stomach with nasogastric tube (‘refluxing’)
Administration of analgesia/antimicrobials
IV fluids to support circulation
Clip abdomen?
Shoe removal/tape feet
Wash out mouth

57
Q

How can we carry out refluxing with nasogastric tubing?

A

Horse restrained - stock/twitch/sedation (xylazine)?
Tube passed into ventral nasal meatus
Head flexed to encourage passage into oesophagus not trachea
Horse swallows as tube advanced
Observe left-hand side of neck for end of tube advancing into oesophagus to confirm correct placement (critical!)
Pass down into stomach - if no spontaneous reflux establish syphon by attaching funnel to end of tube and pouring in measured amount of water from jug and then lowering end of tube into bucket, collect and measure what comes out

58
Q

How do we prep a horse for laparotomy?

A

After induction
Move to table from recovery box - place in dorsal recumbency for ventral midline incision
Urinary catheter (suture prepuce in males)
Clip abdomen plus second fine clip
Cover legs and feet
Drape
Sterile skin prep
Surgical colic kit - different surgeons have different instrument preferences

59
Q

Describe simple intestinal obstructions.

A

Lumen only obstructed (e.g. food), vasculature minimally compromised
Prognosis usually good
E.g. pelvic flexure impaction

60
Q

Describe functional intestinal obstructions.

A

Peristalsis fails to propels ingesta (i.e. ileus) leading to distension
E.g. grass sickness/post-operative ileus secondary to distension

61
Q

Describe strangulating intestinal onstructions.

A

Compromise of vasculature resulting in ischaemia of intestine
E.g. pedunculated lipoma/large colon volvulus
Veins obstructed first, causing oedematous thickening of gut wall
Release of endotoxins into circulation (endotoxaemia) - systemic compromise/shock
Prognosis increasingly poor after 6-8hrs
Later secondary problems e.g. laminitis - further worsen prognosis

62
Q

Describe SI strangulating obstructions.

A

Strangulated section goes maroon/purple/black as blood supply compromised
Mucosa becomes permeable to endotoxins which leak into peritoneal cavity/circulation
Proximal = ‘simple obstruction’ with just distension as gas/fluid cannot pass obstruction
Distension will however cause ileus if protracted which can be hard to reverse
Distal = intestine appears relatively normal

63
Q

Which specific conditions cause a SI strangulating obstruction?

A

Pedunculated lipomas
Herniation - epiploic foramen/inguinal/mesenteric defects
Intussusceptions

64
Q

How do we resect and anastomose SI to treat a strangulating obstruction?

A

Isolate affected segment with bowel clamps
Ligate blood vessels supplying affected segment
Resect affected segment
Anastomose intestine with sutures/staples
Close defect in mesentery to prevent herniation
Check patency of lumen, integrity of anastomosis (no leaks) and mesentery (no holes)
Lavage and remove packing
Decompress remaining bowel
Replace bowel in abdomen

65
Q

Describe SI simple/functional obstructions.

A

E.g. ileal impaction/enteritis
Decompression of SI +/- enterotomy to remove obstruction
Non-strangulating so blood supply not compromised
No resection or anastomosis required

66
Q

What are the common LI obstructions?

A

Displacements (left dorsal/nephrosplenic entrapment, right dorsal)
Large colon torsion
Enteroliths (not common in UK)

67
Q

How do we surgically manage colonic displacements?

A

Recognising nature of displacement
Decompression of distended bowel (needle/suction for gas)
Evacuation of colon via pelvic flexure enterotomy may be necessary if distension is with food/fluid
Correction of displacement
Resections rarely necessary and technically challenging
Colopexy (anchoring colon by suturing e.g. to body wall) occasionally performed in non-athletes to prevent recurrence of displacement

68
Q

Describe large colon volvulus.

A

Commonly a strangulating obstruction with ischaemia of huge section of GI tract
May occur at sternal flexure or close to attachment of right ventral colon to cecum
Results in great deal of gas distension of affected colon
Usually affects larger horses and particularly seen in brood mares ~90 days after foaling

69
Q

What are the clinical signs of large colon volvulus?

A

Sudden and sever abdominal pain
Colon extremely enlarged, very evident on rectal exam
Mucosal ischaemia leads to endotoxinaemia and systemic status deteriorates rapidly
High heart rate, poor peripheral perfusion

70
Q

How do we treat large colon volvulus?

A

Surgery to correct the problem and remove ischaemic colon if necessary

71
Q

What is the prognosis for large colon volvulus patients?

A

Directly related to time that elapses between onset of condition and surgery
As a result, survival rates much higher for veterinary facilities located near e.g. brood mare farms

72
Q

What post-op care can we provide for equine GI patients?

A 
'Colic check' every 2-4hrs
Analgesia
Antimicrobials
IV fluid therapy
Belly bandage
Monitoring for complications
Regular blood sampling - PCV, TP, lactate
Nasogastric intubation
73
Q

What are the potential post-op complications?

A 
Endotoxinaemia
Ileus
Jugular thrombophlebitis
Incisional infection
Further obstruction
Anastomosis leakage
Peritonitis
Adhesions
74
Q

What should we be monitoring post-operatively?

A

Pain - behavioural signs, HR, specific e.g. peritoneal/incisional/MSK
Pyrexia (rectal temp.)
GI system - reflux through NG tube, faecal output, gut sounds, appetite
Cardiovascular - HR, MM colour/CRT, PCV/TP/lactate/electrolytes
Incision - swelling, pain, discharge
Catheter - swelling, pain, jugular patency
Feet - mobility, digital pulses, heat
Respiratory - auscultation, rate, nasal discharge/cough

75
Q

How do we provide post-op feeding?

A

If significant reflux on passing NG tube - nil by mouth, IV fluid therapy, muzzle to prevent horse eating bedding
Once reflux ceased/parameters improving, start with 5cm depth water in bucket (gradually increase)
Grass = good first solid food
Small wet mashes of concentrates, less appetising
Hay reintroduced in handfuls, gradually increased
Return to normal volumes over ~3 days

76
Q

What post-op exercise is allowed?

A

Initially box rest for 6 weeks, maybe very short walks in hand to allow grazing/promote GI motility
Check no incisional problems (e.g. breakdown of underlying abdominal wall) - may require prolonged restriction
At 6 weeks can turn out into small paddock for further convalescence
Ridden exercise may resume after 3 months if abdominal repair sound

77
Q

What are the potential post-op complications?

A 
Immediate = endotoxaemia, ileus
Short-term = laminitis, jugular thrombophlebitis, peritonitis, colitis, incisional infection
Longer-term = adhesions
78
Q

What are the clinical signs of endotoxaemia?

A

Tachycardia, tachypnoea
Pyrexia leading to hypothermia
Hyperaemic MMs leading to dark purple/brown
Colic signs, dullness

79
Q

How do we treat endotoxaemia?

A

IV fluid therapy
Flunixin
Polymixin B
Hyperimmune plasma

80
Q

How do we treat ileus?

A

Nasogastric intubation, refluxing - gastric decompression to relieve gastric distension
Fluid IV - maintenance + dehydration correction + 80% net reflux losses
Supplement electrolytes if needed
Prokinetics? - lidocaine infusion/erythrocytes/metoclopramide

81
Q

Describe laminitis.

A

Inflammation of laminae
Endotoxic horses at greatest risk
Prevention attempted - ice boots on at-risk patients
Clinical signs = increased/bounding digital pulses, heat, foot pain
Treatment = frog support/deep bedding, analgesia

82
Q

How do we treat jugular thrombophlebitis?

A

Remove catheter
Local anti-inflammatory treatment
Can consider thrombolytics such as aspirin
Antibiotics?
Catheter not placed in other jugular - alternative site if IV access still required

83
Q

Describe signs and treatment of peritonitis.

A

Clinical signs = colic, inappetence, pyrexia
Antibiotics (broad spectrum, often penicillin/gentamycin/metronidazole)
Abdominal drainage/lavage?

84
Q

What are the clinical signs of colitis?

A

Clinical signs = pyrexia, colic, diarrhoea
After colon torsion/displacement, where colon has been compromised
From antibiotics and NSAID usage plus sudden change in management

85
Q

How do we treat colitis?

A 
Can require intensive nursing
IV fluid therapy
Analgesia - may need to avoid NSAIDs
Misoprostal and sucralfate may help
Probiotics?
86
Q

Describe incisional infection.

A

Occurs in 10-15% of cases, more common after 2nd laparotomy
Local oedema around incision is normal
Palpate for focus of pain
Look for drainage of purulent material

87
Q

How do we treat an incisional infection?

A

Antibiotics if horse systemically affected, e.g. pyrexia
Culture for sensitivity
Encourage drainage
Tends to persist until suture material resorbs (~6 weeks)

88
Q

Describe adhesions.

A

Consequent on surgery/general handling of intestines at surgery
May result in further obstruction and colic
Recurrence of significant colic often ends in euthanasia, as owners reluctant to put horse through further surgery for which prognosis likely to be guarded at best

Veterinary Nursing (65 decks)

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