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LA Gastroenterology (Spring 2015) > L01: Equine Gastro 1 Pt.1 (Sanchez) > Flashcards

L01: Equine Gastro 1 Pt.1 (Sanchez) Flashcards

1
Q

esophageal obstruction aka

A

Choke

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2
Q

causes of choke

A

hay, pellets, or cubes
beet pulp
FB
rapid consumption w/o adequate chewing

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3
Q

where do most esophageal obstructions occur?

A

proximal esophagus (less commonly: thoracic inlet)

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4
Q

CS of choke

A 
distress
head extension
salivation
nasal d/c of food/saliva** (complication = aspiration pneumonia)
lethargy
dehydration
\+/- abn lung sounds
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5
Q

Dx of choke

A

Hx/CS
external palpation
resistance upon passage of nasogastric tube
endoscopy/rads

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6
Q

drugs used in tx of choke for sedation

A

xylazine
detomidine
butorphanol
help prevent aspiration pneumonia

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7
Q

resolution of choke

A

sedation**
gentle passage of stomach tube
esophageal relaxation with buscopan/oxytocin/lidocaine (caution: oxytocin can cause constriction)

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8
Q

management of choke

A
  • Analgesia: NSAIDs
  • slow return to normal diet
  • exclusion of underlying causes (dental exam, endoscopy)
  • tx/prevent. of pneumonia (abx)
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9
Q

complications of choke

A
  • damage to recurrent laryngeal n. –> roaring
  • linear esophageal erosions
  • circular erosions
  • ruptured esophagus
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10
Q

basic mechs. of GI pain*

A

distension of a viscus
traction on the mesentery
ischemia
inflammation

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11
Q

how to determine small vs. large intestine colic?

A

rectal exam, U/S

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12
Q

how to determine strangulating vs. non-strangulating?

A

pain, U/S, abdominocentesis

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13
Q

1 reason for surgical referral

A

pain that is non-responsive to meds

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14
Q

most common types of colic**

A

large intestinal non-strangulating:

  1. Gas/spasmodic
  2. large colon impaction
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15
Q

what percent of colic resolve in field w/o tx?

A

80-85%

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16
Q

CS of subtle colic

A

anorexia
lying down more than usual
dec. fecal prod.

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17
Q

CS of moderate colic

A

pawing
stretching
flank watching
abd. distention

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18
Q

“Kidney Colic”

A

horse stretches out and urinates frequently (not necessarily problem of KID)

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19
Q

CS of severe colic

A

rolling
thrashing
becoming cast
facial abrasions

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20
Q

chars. of pain

A

duration
persistence
severity
response to analgesics
breed and individual variability (ie. Tennessee Walkers stoic, foals drama queens)
severe pain replaced by depression: major concern

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21
Q

take temp before or after rectal exam?*

A

BEFORE

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22
Q

HR 80-100 indicative of:

A

very painful horse

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23
Q

check mm for:

A

color
moisture
CRT (reflection of hydration status/perfusion)
toxic line (indicative of strangulating lesion)

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24
Q

where check horse’s perfusion?

A

mm, extremities

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25
Q

Borborygmi

A

gut sounds

-complete absence of sounds is clinically relevant

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26
Q

basic questions that may be answered by rectal palpation

A

distention (yes/no)?
if distended, is it SI or LI?
gas, fluid, or feed causing distention?
masses?

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27
Q

when to use nasogastric intubation

A

for EVERY moderate to severely painful colic

  • can be life-saving
  • > 2-3L net reflux is significant
  • > 5L –> consider leaving tube in place
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28
Q

relevance of lactate in colic workup

A

can indicate hydration status or hypoxemia or indicate anaerobic process happening in the body

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29
Q

What gives measures of hydration status/lactate?

A

PCV/TP/Blood gas

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30
Q

FLASH exam

A

transabd. U/S in 7 key spots to give you view of all the important things
- looks at gastric distention, kidneys/spleen, free abd. fluid, etc.

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31
Q

types of imaging used for colic

A
  • transabd. U/S
  • Rads
  • Endoscopy
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32
Q

use of abdominocentesis in colic

A

used to differentiate between SI strangulating and non-strangulating
-shouldn’t be performed if results won’t influence the course of tx

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33
Q

interpretation of abdominocentesis in colic

A

interpret. based on gross appearance and odor: -strangulating usually serosanguinous fluid (red)
- rupture usually indicated by feed material in liquid (could also indicate accidental enterocentesis)
- compare lactate to plasma: >2x plasma indicates strangulation
- N fluid does NOT rule out strangulation!

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34
Q

clicker Q: which of the following would be most indicative of severe pain?

A

rolling repeatedly

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35
Q

inital colic therapy

A 
analgesic therapy (gastric decompression, drugs)
fluid therapy
36
Q

analgesics/sedatives used for colic

A

NSAIDs
a2-agonists
opioids
buscopan

37
Q

maintenance fluid dose

A

40-50 ml/kg/day

38
Q

management of dehydration for colic considerations

A 
maintenance fluids
hydration status
deficits
metabolic status
electrolyte abnormalities
enteral or IV fluids
*need less fluids when not eating*
39
Q

fluid therapy options

A

Enteral
-excellent option unless >2-3L reflux
IV fluids
-use if lot of reflux, severe pain, substantial dehydration
Laxatives (ie. Psyllium for sand, Mineral oil, MgSO4)
mineral oil good marker of GI transit only but doesn’t have much therapeutic use

40
Q

Equine Gastric Ulcer Syndrome (EGUS) CS

A

mild colic after eating, not eating grain, not eating as vigorously, behavioral changes

41
Q

Dx of EGUS

A
  • CS, response to tx

- gastroscopy (view squamous vs. glandular)

42
Q

most common site for ulceration

A

squamous mucosa along lesser curvature

43
Q

T/F: should hold horse off feed at least 12 hr. before scoping for ulcers

A

T

44
Q

Risk factors for EGUS

A 
diet
exercise
environment
NSAIDs
Foals
45
Q

Antacids act on:

A

lumen to prevent HCl release

46
Q

Sucralfate acts on:

A

M-B Barrier to prevent pepsin and H+ release

47
Q

PPI acts on

A

gastric gland

48
Q

H2-antagonists acts on

A

gastrin, Ach, H2 binding to parietal cell where H+ is pumped out

49
Q

omeprazole

A

(GastroGard)

  • oral proton pump inhibitor
  • preventative therapy for ulcer formation
  • more effective than H2 antagonists for horses kept in work
50
Q

Gastroduodenal Ulcer disease (GDUD)

A
  • usually in foals stricture)

- CS: colic, poor appetite, etc.

51
Q

Prognosis of GDUD

A
  • fair to good with sx
  • reasonable with medical tx if no outflow obstruction
  • expensive and labor-intensive tx
52
Q

most common kind of stomach cancer

A

squamous cell carcinoma

53
Q

ways to determine if GDUD has outflow obstruction

A

rads +/- contrast
U/S
gastroscopy

54
Q

Causes of Non-strangulating colic (SI and LI)

A

1) intraluminal obstruction (gastric/ileal/cecal/large ascending colon/small colon impaction)
2) large colon displacement
3) gas/spasmodic colic

55
Q

T/F: gastric impaction is rare

A

T

56
Q

ileal impaction risk factors

A

SE US
Coastal Bermuda hay (esp. with new bale)**
tapeworms

57
Q

CS of ileal impaction

A
  • mod. to severe pain
  • distended SI on rectal exam
  • initially no reflux
  • peritoneal fluid: usually normal, TS N or high, lactate similar to plasma
58
Q

2 most common small intestinal non-strangulating colics

A

1) ileal

2) proximal enteritis

59
Q

Tx of ileal impaction

A
  • gastric decompression
  • withdrawal of feed/water
  • analgesics, IV fluid tx
  • Sx if not improving or abn peritoneal fluid
  • de-worm for tapes
  • good/excellent prognosis
60
Q

Cecal impaction risk factors

A
  • broodmare near parturition

- recent general anesthesia

61
Q

freq. of cecal impaction

A

rare; occurs spontaneously

62
Q

CS of cecal impaction

A
  • variable pain
  • no net reflux
  • N peritoneal fluid (usually)
  • cecal distension with feed or fluid on rectal exam**
63
Q

Tx of cecal impaction

A
  • withdraw feed
  • enteral laxatives
  • IV fluids
  • sx often needed
  • guarded prog.; rupture common
64
Q

Common causes of large colon impaction

A

feed or sand

65
Q

most common site of large colon impaction

A

pelvic flexure

-2nd most common cause of colic

66
Q

Risk factors for large colon impaction

A
  • inadequate water intake
  • sand ingestion
  • parasites
  • poor dentition
  • sudden stall confinement
  • alternate source of pain (ie. eye)
  • coarse roughage
67
Q

CS of large colon impaction

A
  • mild/mod. pain
  • dec./absent fecal output
  • dec. borborygmi
  • impaction/variable gas distention on rectal exam
  • variable reflux
  • normal ab tap
68
Q

Tx of large colon impaction

A
  • withdraw feed
  • manage pain
  • enteral fluids
  • IV fluids if reflux
  • very good prognosis
69
Q

CS of small colon impaction

A

colic, abd. distention, low volume diarrhea

70
Q

dx of small colon impaction

A

via rectal exam

71
Q

tx of small colon impaction

A

usually medical

72
Q

frequency/prognosis of small colon impaction

A

rare freq., good prog.

73
Q

enterolith

A

calculi within the intestine (Mg ammonium phosphate (struvite))

74
Q

Enterolith risk factors

A
  • Arabians
  • High protein diet
  • high colonic luminal pH
75
Q

CS of enterolith

A
  • intermittent mild/mod. pain
  • rectal exam often normal
  • may NOT see in rads!
  • peritoneal fluid usually N
76
Q

Tx of enteroliths

A

sx!
restrict alfalfa
decrease pH?

77
Q

type(s) of extraluminal non-strangulating obstruction(s)

A

Large Colon displacement (Left or Right dorsal)
Retroflexion
Spasmodic (gas) colic

78
Q

T/F: large colon displacement difficult to differentiate from other non-strangulating LC obstructions

A

T

79
Q

direction of large colon displacement

A

left or right dorsal

80
Q

prognosis/frequency of large colon displacement

A

prognosis: good with medical or surgical therapy
frequency: relatively common

81
Q

types of non-strangulating intraluminal obstructions

A 
ileal impaction
cecal impaction
large colon impaction
small colon impaction
enteroliths
82
Q

types of strangulating obstructions

A

small intestinal lesions

large intestinal volvulus

83
Q

left dorsal large colon displacement aka

A

nephrosplenic entrapment

84
Q

dx of left dorsal displacement

A

Rectal exam: distended colon lat. to KID +/- ventrally displaced spleen
U/S: gas-filled colon prevents imaging of L kid; ventral displacement of SP

85
Q

tx of left dorsal displacement

A
  • phenylephrine (to shrink spleen)/excercise
  • rolling under gen. anesthesia
  • sx correction

LA Gastroenterology (Spring 2015) (6 decks)

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