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
Why is it the case that a horse with signs of colic for longer duration may be associated with having better outcomes?
perhaps the lesion is less severe
T/F: some severe strangulation cases may present with minimal signs of pain
true – can be severely obtunded/decompensated which is blurring overt signs of pain.
typically, the worse the lesion, the worse the signs, but this is an exception.
T/F: an increased level of pain is associated with increased need for surgery
true (severe pain has an OR of 57)
T/F: tachycardia, abnormal mucous membrane color, and abnormal CRT have only a FAIR correlation with the severity of signs and indication for surgery
true – this is because they can be really ill horses, but NOT have surgical lesions. the abnormalities in these specific parameters can be from non-surgical things.
T/F: increasing heart rate is associated with decrease survival
true – poor prognosis is >80
T/F: if abdominal distention is present, it is significant and indicates a higher likelihood for surgery; however if it is not present, it does not rule out something significant or the need for surgery.
true
poor sensitivity
T/F: abnormal borborygmi is clinically signfiicant
true – OR of ~12 for surgery
what rectal exam finding is MOST significant and the best predictor for needing surgery?
distended small intestine
(OR of ~31)
T/F: the presence of nasogastric reflux is non-specific for surgery indication. However, it is important for diagnosis and is also therapeutic.
true
if you get reflux and they are STILL painful after removing the fluid, then this indicates a strangulating lesion is likely.
what is the most important/useful “additional diagnostic”?
abdominocentesis
abnormal findings are significant!
but it does have a poor sensitivity and specificity.
what causes turbid peritoneal fluid?
the presence of cells, protein, GI contents, and/or fat.
T/F: abnormally colored peritoneal fluid indicates the need for surgery
true -
sensitivity = 92%
specificity = 74%
much lower for normal color because a horse can have a mild/mod GI lesion and still have NORMAL peritoneal fluid.
T/F: elevated total protein or NCC in the peritoneal fluid is not a useful indicator for surgery
true
they only indicate inflammation
T/F: elevated peritoneal fluid lactate is correlated with need for surgical intervention
true (OR 15.5)
predicts intestinal ischemia better than plasma lactate.
if the lactate increases over time, this is an even higher OR for surgery (OR 62)
What is Hct useful for – diagnosis, surgical indication, or prognosis?
prognosis
>60 = grave prognosis
not useful for decisions regarding surgery.
T/f: hyperglycemia is associated with non-survival
true (>195)
T/F: aozetemia and hypoproteinemia are non-specific in regards to surgical decision making
true
What can we use serum lactate for?
as a marker for severity of disease
elevations are due to decreased tissue perfusion
so we can use it for prognosis.
what are the 3 most important parameters for estimating prognosis?
- heart rate
- PCV
- abnormal mucous membranes
T/F: serosanguinous peritoneal fluid indicates that the patient is a surgical candidate
true
