Equine GI Flashcards
Common equine GIT conditions
-dysphagia
-choke
-gastric ulcers
-colic
-diarrhea
General approach to patient
-signalment
-history
-physical exam
-further diagnostic tests (diagnostic plan)
-differential diagnoses
-diagnosis
-treatment plan
What can play a role in Dysphagia?
- prehension
- Mastication
- Deglutition
Clinical signs of dysphagia
-feed/water exiting nostrils
-ptyalism
-coughing
-weight loss
-sometimes aspiration pneumonia
-sometimes CN deficits (decreased tongue tone and facial nerve paralysis)
Causes of dysphagia
- pain
-dental disease, foreign body, TMJ osteoarthritis - Obstruction
-DDSP, retropharyngeal abscess, choke - neurological disorder
-guttural pouch mycosis, botulism, Equine Protozoal Myeloencephalitis, facial nerve trauma, THO
Diagnosing dysphagia
-history
-physical exam
-neurological exam
-oral exam
-bloodwork
-endoscopy
-radiographs
-CT
Esophageal disorders
-choke
-esophageal stricture
-esophageal diverticula
-esophagitis
-esophageal ulcers
-esophageal rupture
-megaesophagus
Clinical signs of choke
-dysphagia
-coughing
-inappetence
-ptyalism
-colic signs
-anxiety (tachycardia and tachypnea)
Diagnosing choke
-signalment (Friesian’s commonly have megaesophagus)
-history (feed such as unsoaked beet pulp, previous choke present)
-physical exam
-nasogastric intubation- helps determine if blockage, then lavage to see if it can relieve choke
-oral exam (look for ulcers)
-endoscopy
Gastric disorders
-gastric ulcers*** most common
-gastric impactions
-gastric rupture
-neoplasia (squamous cell carcinoma)
Gastric ulcers clinical signs
Non specific
-mild acute colic
-recurring colic
-poor body condition
-partial anorexia
-poor performance
-attitude changes
-frequent stretching to urinate
-Girthy; behaviour change
-ulcers typically DO NOT cause bleeding and melena in horses
Diagnosis of gastric ulcers
Must use a gastroscopy
-need to fast for 18hrs
-look for ulcers
1. non-glandular (portion of stomach) squamous ulcers along the minor curvature= most common
2. Glandular gastric ulcers
Grading systems of ulcers
Colic and clinical signs
The manifestation of visceral abdominal pain
-getting up and down, pawing, rolling, flank watching, posturing to urinate, downward dog
How to diagnose colic?
-signalment
-history
-physical exam
-nasogastric intubation
-rectal palpation
-abdominal ultrasound
-abdominocentesis
-blood work (blood gas, PCV, TP, lactate)
-Fecal examination (gross, culture, PCR)
-Radiographs
Common causes of colic (small intestines)
Common causes of colic (large intestines)
Common small intestinal inflammatory/infectious causes of colic
Common large intestinal inflammatory/infectious causes of colic
General causes of abdominal pain
Age important specifics with colic
-strangulating lipoma= typically older
-proliferative enteropathy= weanling, yearlings
-ascarid impactions= typically less than 1 yr
Sex important considerations for colic
-Stallion= check scrotum for torsions
-Mare= pregnancy; pre vs post partum
Breed important considerations for colic
Different temperaments
-Stoic (drafts, donkeys)
-“Drama queens”
Important history considerations for colic
-duration of colic, treatments, responses
-passing feces/urinating normally
-fever-immediately think infectious!
-current diet, water
-any changes
-purpose/use of horse
-exercise routine
-weight loss
-deworming, vaccine history
-dental care, travel history
-other animals?
-sand paddocks/pastures
-medications
-orthopedic surgery
-previous colic or surgery
NSAIDs impact on colic
Can lead to right dorsal colitis
Horses with colic AND fever
Immediately think infectious
-not an impaction/obstruction
Physical exam for colic
-mentation, posture, sweating, etc.
-HR, RR, temp, MM/CRT
-digital pulses
-evidence of diarrhea
-ventral or peripheral edema
-borborgymi; cecal flush
Nasogastric intubation
-do first if painful and tachycardic!
- normal reflux less than 2L; if more than 2L suggestive of small intestinal issue (Strangulation vs Duodenal Proximal Jejunitis)
**will reduce pain visibly with DPJ, not really with strangulation - if no reflux= likely no small intestinal obstruction
Rectal palpation
Looking for normal vs. abnormal!
-if abnormal, ID exact abnormality is ideal but not critical to case management.
-will also help to determine if medical or surgical problem
*help to determine impactions, left dorsal displacement, tight bands
Abdominocentesis
Normal= straw colour and transparent
Helps differentiate between strangulation (see transudate) vs non strangulation (see exudate)
Can be done in the field
Evaluation of abdominocentesis results
-gross exam
-lactate (normal <2mmol/L)
-total solids (normal <2.5g/dL)
-nucleated cell count
-PCV (if lots of blood)
-cytology
Importance of lactate evaluation
Compare peritoneal and serum lactate
- two values should be the same
-if more strangulating lesion or part of bowel is less perfused, then peritoneal concentration would be twice as high as what you would get in the serum
Ultrasonography of abdomen
Can be used to look at:
-excessive free fluid
-stomach distension (more than 4 intercostal spaces)
-diameter and wall thickness of small intestines; motility
-look for any torsions or nephrosplenic ligament entrapments in large intestines; wall thickness for inflammation
*should feel spleen, kidney, GI
Radiography for colic
Abdomen of adult horse
-need referral clinic
-to rule out sand impaction or find enteroliths
Sand impaction on xrays
-large colon
-along ventral abdomen
-diagnosis and monitoring of resolution
Enteroliths on xrays
Solid concretion of mineral
-varied mineral composition=different opacities
-often form around nidus (foreign body)
-check mid abdomen
Minimum database Diagnosis tests
-PCV/total solids
-lactate
-blood gas
-biochemistry (not always needed)
-CBC
Blood lactate concentration
Marker of tissue perfusion
-normal= <2mmol/L
-will be increased with ischemia, hypoxia, anaerobic glycolysis OR dehydration
*portable analyzer available
Diarrhea etiologic diagnosis
ID causes: culture, PCR, toxin assays, fecal egg count, sand, and serology (lawsonia, Neorickettsia)
