Examination of the GI tract Flashcards
What are the only reasons for not doing a rectal exam in a colic workup?
Patients are too small or too fractious
What is the minimum database in a colic workup?
History, physical exam, rectal exam, nasogastric intubation, response to therapy
What clues can you get from observing the horse from afar in colic cases?
-evidence of rolling- displaced bedding- mud on back
-quality of hay
-mentation/general behavior of horse
Describe the head to toe physical exam for a colic workup
-look at everything
-auscultate bilaterally (borborygmi or abnormal sounds)
-focus on problem area (TPR-tachypnea or tachycardia or fever, MM-color and CRT, gut sounds, feces)
-assess pain level (hard to assess especially since banamine is typically on board)
-look for abdominal distension (sign of ileus- more likely surgical)
If a patient has a fever, is it more likely a medical or a surgical problem?
Medical- likely infectious
What are the two types of obstructions?
Functional (physiologic) or physical (mechanical)
If you ausculate what sounds like a high pitched rainstick, what may this indicate?
A gas fluid interface
How do you best assess perfusion on a physical exam?
-mucous membranes (moisture, refull time and color)
-extremity temperatures
-pulse quality
What should you look for on rectal exam for colic cases?
-distension, displacement, abnormal structures
-be able to recognize normal and describe abnormal
What is normal reflux in a horse?
Less than 2 L
->4 indicates a greater severity of disease
What is the first thing you should do if a horse has a high heart rate and they are painful?
Pass a NG tube prior to any diagnostics to prevent potential stomach rupture
In what colic condition is it common for horses to get more painful with medical treatment?
Severe impactions
- as you rehydrate them intestines will distend further
What are some of the main considerations for rectal palpation?
Safety- horses should be sedated or have adequate restraint (stocks are good)
-Buscopan is a great drug to use for rectals- antispasmoic, anticholinergic, parasympatholytic
What is normally felt on palpation per rectum?
Spleen, left kidney, small colon, pelvic flexure, cecum, female repro tract, inguinal rings
If a horse is breaking through sedation or analgesia, what does this indicate?
More severe lesion- likely surgical
Can you perform CBC/chem in the field to help with colic workups?
Not really- will take a long time to get results back as has to be done in clinic in most cases
What findings can be seen on transrectal and/or transabdominal ultrasound that can help you in a colic case?
-SI distension
-bowel wall thickening
-motility
-abdominal fluid volume/character
-intussusceptions
-nephrosplenic entrapment
-inguinal hernia
-sand
-masses/foreign bodies
What is the FLASH ultrasound?
A very fast and simple way to quickly assess colic cases
- utilize 7 fields of view
- assesses for free abdominal fluid, the appearance of the small intestine, the contents of the large intestine and the contact of the spleen with the left kidney
- first look at ventral abdomen (looking for free fluid), then left cranial abdomen (looking for stomach), then move caudal to left flank region (kidney and spleen), then right paralumbar fossa (cecum and kidney and duodenum), move craniodorsal to find right dorsal colon (looking for right dorsal colitis), then move to right ventral thorax to look at heart
*Should only take 5-10 min
What Lab data is important to get in colic cases if possible?
PCV- should be 32-45%
- if high could indicate dehydration, splenic contraction or SIRS
->60 associated with poor prognosis
TP (4.6-6.9)
- elevations could mean SIRS or altered mucosal function
Lactate- should be <2
- increases could mean anaerobic metabolism (could be due to dehydration) or reduced hepatic clearance
- >6.5 associated with poor prognosis
- good to determine prognosis if surgery is pursued
Glucose
- hyperglycemia if >135, likely due to stress and potential shock
- >180 is extreme- poor prognosis
What can the CBC tell you in colic workups?
WBC count:
- if elevated likely inflammatory disease
- if decreased, likely endotoxemia or leukocyte margination
Fibrinogen (>400)
- indicates inflammation
What can the chemistry help you with in a colic workup?
Azotemia: evidence of dehydration, renal disease or obstruction
Liver enzymes: GGT can be elevated in colic cases
- common with large impactions near liver
Electrolyte abnormalities
Describe the technique of abdominocentesis
Not commonly done in field
- perform just to the right of midline
- can do ultrasound assisted
- should use sterile prep and sterile technique
- teat cannula recommended (but can also use needle- not great if theres no obvious fluid- more risk of puncturing organ)
What does normal fluid on abdominocentesis look like? What are some risks associated with it?
-clear yellow, protein <2, WBC <5000, RBCs rare
Risks: enterocentesis, bowel laceration, hemoabdomen, omental herniation
What is a concerning number for abdominal fluid lactate?
> 4 (aka greater than 2X serum concentration)
- increase in PFL over time is a significant predictor of a horse with a strangulating lesion
