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Large animal GI > Lecture Equine GI 1-2 > Flashcards

Lecture Equine GI 1-2 Flashcards

1
Q

Most equine obstructions occur

A

in the proximal esophagus

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2
Q

Esophageal obstuction

CS

A
  • Distress
  • Head extension
  • Salivation
  • Nasal d/c
    • food
    • saliva
    • milk
  • Lethargy, dehydration
  • +/- abnormal lung sounds
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3
Q

Esophageal obstuction

DX

A
  • HX and CS: head neck extension/nose d/c
  • esophageal palpation
  • Resistance to NG tube
  • additional
      1. endoscopy
      1. radiography
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4
Q

Esophageal obstuction

Resolution

A
  • SEDATE
    • ​xylazine
    • detomidine
    • butorphanol
  • gentle passage stomach tube
    • wash gently with warm water
  • esophageal relaxation
    • buscopan
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5
Q

Esophageal obstuction

Management

A
  • analgesia
  • slow return to normal diet
    • water, gruel
  • exclude causes
    • dental exam
    • scope for repeated episodes
  • If they had food in naries
    • broad spectrum abx to prevent pneumonia
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6
Q

Basic mechanisms of GI pain

A
  1. distension of a viscus
  2. traction on mesentary
  3. ischemia
  4. inflammation
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7
Q

Questions regarding colic workup

A
  1. Can pain be controlled?
  2. Is problem small or large intestine?
    • rectal exam
    • US
  3. Strangulating or non-strangulating?
    • pain
    • US
    • abdominocentesis
  4. Is sx likely indicated?
    • No? - DON’T do abdominocentesis
  5. Prognosis?
    • Is immediate euthanasia indicated?
    • has the horse already ruptured
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8
Q

Most common types of colic

A
  • Large intestinal non-strangulating
    • gas/spasmodic
    • large colon impaction
  • 80-85% resolve in field with one treatment
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9
Q

Colic

Subtle CS

A
  1. anorexia
  2. lying down more than usual
  3. decreased fecal production
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10
Q

Mod signs colic

A
  1. pawing
  2. stretching
  3. flank watching
  4. abdominal distention
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11
Q

Severe signs colic

A
  1. Rolling
  2. Thrashing
  3. Becoming cast
  4. facial abrasions
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12
Q

NG intubation

A
  • tube every moderate to severe colic (LIFE-SAVING)
  • > 2-3 liters net reflux is significant
  • If > 5 liters net reflux consider leaving tube in
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13
Q

Initial colic

A
  • analgesic therapy
    • gastric decompression
    • drugs
  • fluid therapy
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14
Q

Management of dehydration

A
  • Maintenance: 40-50 mL/kg/day (may be less if anorexic)
  • Assess hydration status
  • Calculate deficits
  • Consider metabolic status
  • Electrolyte abnormalities
  • Enteral or IV fluids
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15
Q

EGUS

Risk factors

A
  • Diet (alfalfa: protective)
  • Exercise - Any
  • Environment
  • NSAIDS
  • Foals
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16
Q

Gastroduodenal ulcer disease

(GDUD)

A
  • Foals < 6 mo
  • outflow obstruction
  • CS
    • drooling
    • lethargy
    • distended stomach
  • Diagnostic imaging
    • rads
    • contrast
    • US
  • Prognosis: fair to good, expensive sx usually required
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17
Q

Non-strangulating causes of colic

A
  • Intraluminal obstructions
    • gastric impactions - rare
    • ileal impaction
    • cecal impaction
    • large (ascending) colon impaction
    • small colon impaction
  • Large colon displacements
  • Gas/spasmodic colic
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18
Q

Ileal impaction

Causes

CS

TX

A
  • Causes
    • Coastal bermuda hay
    • tapeworms (live at ileocecal junction)
  • Clinical signs
    • Distended small intestine (SI is 90 feet long)
  • TX
    • GI decompression
    • Remove feed/water
    • analgesics, IV fluids
    • deworm for tapeworms
    • good to excellent prog: usually resolve w/in 24 hours

*can do an ab tap to rule out strangulating lesion

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19
Q

Cecal impaction

Risk factors

DX

TX

Prognosis

A
  • Risk factors
    • Broodmares near parturition
    • recent general anesthesia
  • Diagnosis
    • rectal dx
    • little evident pain possible
  • TX
    • rupture common
    • sx often required
  • gaurded prognosis

*not very common, and a severe condition

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20
Q

Large Colon impaction

Cause

DX

TX

Prognosis

A
  • VERY COMMON
  • Cause
    • feed or sand
    • occurs at pelvic flexure
    • inadequate water intake, poor teeth, poor quality roughage, pain elsewhere, parasites
  • Diagnosis
    • Rectal
  • TX
    • medical therapy, red feed, fluids (enteral), laxatives
    • SX for severe cases
  • prognosis good
21
Q

Small colon impaction

A
  • CS
    • Colic, abdominal distention, low vol. diarrhea
    • often in winter
  • Diagnosis
    • rectal exam dx: friable
  • Treatment
    • medical management
  • rare, good prognosis
22
Q

Enteroliths

Risk factors

DX

TX

Prevention

A
  • Magnesium ammonium phosphate
  • Risk Factors
    • arabians
    • diet high in protein, Mg
    • high colonic luminal pH
  • common in CA
  • DX: radiographs, palpation
  • TX: surgical removal
  • Prevention
    • restrict alfalfa
23
Q

Large Colon Displacement

Left dorsal displacement

DX

TX

A
  • nephrosplenic entrapment
  • DX
    • rectal dx
    • U/S: if you see bowel on left side
  • TX
    • phenylephrine (decreases splenic volume), and exercise < 6 yo
    • Rolling under general anesthesia
    • surgical correction
24
Q

Large Colon displacement

Right dorsal displacement

A
  • Difficult to DX
  • Rectal exam
  • fluid therapy, limited exercise, sx correction
25
Q

Strangulating obstructions

In a nutshell

A
  • all require surgery
  • acute, severe pain: distention and mesenteric traction
  • very sick
    • sig. tachycardia > 80bpm
    • toxemia
    • reflux
    • dehydration
  • rectal
    • distended SI
    • small, thickened
  • relatively uncommon
  • serosanguinous ab tab
26
Q

Choke

Causes

A
  • Hay, pellets or cubes
  • Beet pump if not moistened
  • foreign bodies (apples, potatoes)
  • Rapid consumption
27
Q

Choke

Complications

A
  • Recurrent laryngeal nerve damage: Roaring
  • Strictures
  • Esophageal rupture is terminal
    • Limit treatment attempt to 30 minutes
28
Q

Recurring esophageal obstruction

A

Scope and look for esophageal neoplasia

29
Q

Characteristics of pain

A
  • Duration
  • Persistence
  • Severity
  • Response to analgesics
  • Breed/ind variability
  • Severe pain replaced by depression: Major concern
30
Q

Physical exam

A
  • Take a HR before sedating the horse
  • Take a temp before recal exam
    • introducing air affects temp
  • MM
    • toxic line
    • Purple: bad
  • Extremities
    • if bottom of limbs are cool
  • Gut sounds
31
Q

Buscopan will Decrease

A

Gut sounds

32
Q

Rectal Palpation

Basic question

A
  • Sedation good
  • Basic questions
    1. Distention
    2. SI or LI
    3. Gas, fluid, feed
    4. Masses
33
Q

Abdominocentesis

Interpretation

A
  • Lactate compared to plasma
    • > 2X typical of strangulation
  • Cytology
    • blood or hemorrhage
    • normal protein < 2 g/dL
  • Normal fluid does not rule out strangulation

*Used to differentiate between SI strangulating and non-strangulating

*Strangulating: serosanguinous

34
Q

Analgesics/Sedatives

A
  • NSAIDS
  • alpha-2s
  • Opioids
  • Buscopan
35
Q

Banamine/Flunixin

A

Most common NSAID for visceral pain in horse

36
Q

alpha -2s

A
  • Xylazine: cheap
  • Detomidine: longer acting
37
Q

Opiods in horses

A
  • Butorphanol: not very long acting
38
Q

Buscopan

A
  • anticholinergic
  • antispasmodic
  • short duration of action: 20 minutes
  • causes tachycardia

*buscopan contraindicated when something is already VERY tachycardic

39
Q

Anticholinergics

A
  • Block acetylcholine
  • inhibits parasympathetic stuff
40
Q

Fluid therapy options

Enteral

A
  • 6-8L Q 2-6 unless there is reflux (>2-3L) or small intestinal distention
41
Q

Fluid therapy options

IV

A
  • If there is
    • reflux
    • severe pain
    • substantial dehydration
42
Q

Laxatives

A
  • Psyllium: sand
  • Mineral oil
  • MgSO4
43
Q

EGUS

CS

A
  • Colic after a grain meal
  • Decreased performance
44
Q

Only approved TX for gastric ulceration

A
  • Omeprazole (Gastroguard)
    • PPI
    • TX: 4mg/kg q24
    • preventative: 1-2 mg/kg q24
45
Q

H-2 antagonist

A
  • Famotidine
  • Ranitidine

*cheaper, less effective

46
Q

SI strangulation

Prognosis

A
  • Survival to d/c 80-85%
  • Poor to grave if > 50% SI affected
47
Q

SI strangulation

Possible lesions

A
  1. Volvulus
  2. Incarceration
    • Epiploic foramen
    • Inguinal hernia
    • Umbilical hernia
    • Mesenteric rent
  3. Intestinal adhesions
  4. Intussusception
  5. Pedunculated lipoma
48
Q

Large Colon Volvulus

CS

Rectal

TX

Prognosis

A
  • Typically in broodmares 30 days post-foaling
  • acute severe colic
  • CS
    • tachycardic
    • toxic
  • Rectal
    • Severe LC gas distention
  • TX
    • SX to resolve, not resect, usually
  • Prognosis
    • gaurded to good if caught w/in 2 hours

*Do a physical, rectal, and sent to SX immediately, no ab tap, no passing go

Large animal GI (5 decks)

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