Examination of the GI Tract & Decision Making Flashcards
T/F: the decision to take a patient to surgery or not can be made within the first 10-30 minutes of evaluation
true
the plan can change with subsequent monitoring and evals
but a definitive diagnosis is not always required to make a decision
What all is a part of the required “minimum database” for every horse GI case?
- history
- physical exam
- rectal exam
- nasogastric intubation
- response to therapy (ie did banamine control the pain)
How is signalment helpful to determine a rule out list for a suspect GI case?
stallion – testicular torsion or inguinal hernia more likely
mare – uterine rupture or torsion more likely
older horses – strangulating lipoma, epiploic foramen entrapment, etc.
neonate – meconium impaction
young – FB, ascarids, intussusception
What 3 things can you evaluate on your physical exam that can assess perfusion?
MM (moisture, refill, color)
extremity temperature
pulse quality
CRT is an indicator of …
perfusion
What does ‘OPQRST’ stand for?
O- onset
P- palliation / provocation
Q- quality
R - region/radiation
S- symptoms/severity
T- timing
What can you infer from a CRT > 2-3 seconds?
poor perfusion from either decreased cardiac output and/or hypovolemia
What 3 things are you assessing during a rectal exam?
- distention
- displacement
- abnormal structures
In what scenario/instance would you want to immediately do a nasogastric intubation FIRST?
if the heart rate is >60.
You do this to check for /relieve gastric distention and to measure the volume of reflux (>4L abnormal)
what is the purpose of using Butylscopolamine (Buscopan) prior to rectal examination?
- anticholinergic
- parasympatholytic
- antispasmodic
What is “FLASH”?
fast localized abdominal sonography of horses
looks at 7 areas of the horse and can assess the presence of free fluid, small intestine appearance, contents in the large intestine, spleen, and left kidney.
normal pcv in horses?
32-45%
abnormalities can be from dehydration, splenic contraction, or SIRS; anything >60 = poor prognosis
normal TP in horses?
4.6-6.9
abnormalities can be from SIRS or altered mucosal function
normal lactate in horses?
<2
higher indicated anaerobic metabolism or reduced hepatic clearance
>6.5 = poor prognosis
what does decreased WBC count indicate?
endotoxemia – leukocyte margination
fibrinogen > ____ indicates inflammation
400
describe how to perform an abdominocentesis
sterile prep
insert teat cannula or needle just to right of midline (ultrasound guided)
What are NORMAL abdominal fluid characteristics?
color - clear/yellow
protein <2
WBC < 5000
RBC rare
what are the risks of abdominocentesis?
- enterocentesis
- bowel laceration
- hemoabdomen
- omental herniation
Peritoneal fluid lactate > 4 at admission and increasing over time indicates what type of disease?
strangulating lesion
Ponies are at DECREASED odds of ____________
colon displacements
Ponies are at INCREASED odds for _____________
strangulation of small intestine
miniature horses are at DECREASED odds for _______________
strangulating small intestinal lesions
Draft breeds are at INCREASED odds of ________
cecal conditions