Digestive System Flashcards
DS01-09
1
Q
start of DS01
name 4 abnormalities observed while eating in a horse with dental disease
A
- loss of feed or quidding
- difficulty chewing or refusing to eat
- excessive salivation
- packing of feed into cheeks
2
Q
name 3 changes in ridden performance seen in horses with dental disease
A
- resistance and evasion to the bit or bridle
- head tilting or tossing, mouth open and/or irregular head carriage
- dangerous ridden behaviours (rearing or bolting)
3
Q
name 4 facial abnormalities seen in horses with dental disease
A
- facial swellings and/or discharge
- foul odour from mouth or nostrils
- nasal discharge (usually unilateral)
- enlarged submandibular lymph nodes
4
Q
how often should regular dental exams be done on horses
A
at least every 12months
5
Q
name 4 diagnostic procedures that can be performed in a first opinion setting for a horse with suspected dental disease
A
- clinical exam
- oral exam
- upper airway endoscopy
- radiography
6
Q
name the 6 steps of the oral exam in a horse
A
- history, clinical exam, watch eat
- sedation
- external exam and check rostral cavity
- place speculum, lavage mouth
- assess caudal oral cavity
- chart and treatment plan
7
Q
name 10 pieces of equipment you should have access to in order to perform a thorough oral exam on a horse
A
- bright light source
- speculum
- gloves
- dental syringe
- dental mirror
- periodontal depth probe
- occlusal surface explorer
- high pressure water irrigation
- diastema forceps
- dental chart
8
Q
name the piece of equipment
used to assess depth of periodontal pockets in cases of periodontal disease or depth of infundibular caries
A
periodontal depth probe
9
Q
name the piece of equipment
used to identify defects in secondary dentine on occlusal surface of teeth
A
occlusal surface explorer
10
Q
what is the recommended sedation in order to perform an oral exam?
A
combo of alpha-2 agonist and an opioid
(romifidine or detomidine and butorphanol)
11
Q
name 4 things the incisors should be assessed for during an oral exam
A
- dental calculus or draining tracts around gingival margins
- diastemata (food packing between teeth)
- tooth mobility
- secondary dentine defects
12
Q
until what age can horses be aged by their teeth?
A
until 5 years
13
Q
when does the first deciduous incisor (Triadan 01) erupt in horses?
A
at birth
14
Q
when does the second deciduous incisor (Triadan 02) erupt in horses?
A
within 4-6 weeks of birth
15
Q
when does the third deciduous incisor (Triadan 03) erupt in horses?
A
within 6-9 months of birth
16
Q
when does the first permanent incisor (Triadan 01) erupt in horses?
A
2.5 years
17
Q
when does the second permanent incisor (Triadan 02) erupt in horses?
A
3.5 years
18
Q
when does the third permanent incisor (Triadan 03) erupt in horses?
A
4.5 years
19
Q
name 5 benefits of using oral endoscopy for an exam
A
- visualise subtle disorders
- records pictures and videos for continued monitoring
- allows client to observe pathology in real time
- useful for specialist procedures
- sometimes tolerated better than mirror
20
Q
what is the main indication for upper airway endoscopy?
A
horses with unilateral nasal discharge
21
Q
what is the most common cause of sinusitis in horses?
A
dental disease
22
Q
name 4 indications for oral radiography
A
- fractured or loose teeth
- diseased incisors
- suspected sinusitis
- facial swelling and/or drainage tracts from face
23
Q
name the 3 views that should be taken for oral radiography
A
- latero-lateral
- dorsoventral
- oblique views (dorso30lateral-ventrolateral oblique for maxillary arcades)
24
Q
in oral radiographs, which side should the label be associated with?
A
side adjacent to plate
25
what are latero-lateral radiograph views of the oral cavity used to image?
paranasal sinuses and conchal bullae
26
name 3 abnormalities that can be seen with latero-lateral radiographs of the oral cavity
1. fluid lines
2. intra-sinus soft tissue opacities
3. fractures
27
what are oblique radiograph views of the oral cavity used to image?
maxillary cheek tooth apices
28
name 7 abnormalities that can be seen with oblique radiographs of the oral cavity
1. periapical sclerosis
2. periapical halo formation
3. peridontal ligament widening
4. loss of lamina dura
5. clubbing of tooth apices
6. hypercementosis
7. reserve crown fragmentation
29
what are dorsoventral radiograph views of the oral cavity used to image?
nasal cavity and axial compartments of paranasal sinuses
30
name 2 abnormalities that can be seen with dorsoventral radiographs of the oral cavity
1. ventral conchal sinusitis
2. space occupying lesions
31
what is the major disadvantage of oral radiographs
difficult to interpret
32
name 3 advantags of oral CT scans
1. prevents superimpositions of anatomical structures
2. allows user to look at tissue and bone in multiple orientations
3. can 3D reconstruct images post-processing
33
name 4 indications for oral CT
1. radiographs equivocal or normal in face of disease
2. planning Tx for complex dental or sinus conditions
3. if previous medical or surgical Tx unsuccessful
4. evidence of extensive disease or extent of disease unknown
| (referral level procedure!)
34
# start of DS02
name the 3 dental hard tissues
1. dentin
2. enamel
3. cementum
35
which dental hard tissue is the most calcified?
enamel
36
which dental hard tissue is the least calcified?
cementum
37
# name the dental hard tissue
wears first, leaving dentin with elevated regions of enamel called transverse ridges that help grind forage
cementum
38
there are 2 of these along the buccal surface of each maxillary cheek tooth which act as pillars to strengthen teeth and increase occlusal surface area
cingula
39
where do dental overgrowths occur on the maxillary arcade?
buccal aspect
40
where do dental overgrowths occur on the mandibular arcade?
lingual aspect
41
this is a disparity in width between maxillary and mandibular arcades which contributes to dental overgrowths
anisognathia
42
this is the removal and shaping of tooth crown to decrease interference with another tooth or eliminate soft tissue trauma
odontoplasty
43
name 3 things that are removed during odontoplasty
1. sharp enamel points associated with soft tissue lacerations/ulcerations
2. overgrowths that create abnormal forces along occlusal surface
3. overgrowths as consequence of malocclusions that cause soft tissue trauma
44
what is the max amount of secondary dentine that can be removed at one time during odontoplasty to avoid pulp horn exposure
no more than 2-3mm
45
name the 4 types of rasps needed for odontoplasty
1. up-angled
2. medium open angled
3. long straight
4. short offset
46
name 2 motorised instruments commonly used for odontoplasty
1. rotary burr
2. rotary discs
47
this is a malocclusion in which maxillary incisors and canine teeth project over mandibular teeth excessively;
aka 'parrot mouth'
brachygnathism
48
name the 2 types of brachygnathism
1. overjet
2. overbite
49
# name the type of brachygnathism
upper incisors protrude rostrally in relation to lower incisors;
often protrude at an outward angle;
horizontal misalignment of teeth
overjet
50
# name the type of brachygnathism
occlusal surfaces of maxillary incisors lie in front of occlusal surfaces of mandibular incisors ;
vertical misalignment of incisors
overbite
51
how to treat brachygnathism in foals?
surgically brace upper incisors to cheek teeth
| (prior to 6mo of age)
52
how to treat brachygnathism in adult horses?
reduce overgrowths on 06s, 11s, and central incisors bi-anually
53
# name the type of malocclusion
aka 'sow mouth'
uncommon in horses, more common in donkies, mini horses, and ponies;
clinically insignificant but may develop overgrowths
underbite
54
these are permanent incisors in addition to the normal 6 on each arcade;
have long reserve crowns when compared to retained deciduous incisors;
extraction difficult and risks damaging normal teeth
supernumerary incisors
55
name 3 treatments that should be given for incisor fractures in acute stages
1. tetanus prophylaxis
2. antibiotics (7-10d, TMPS)
3. NSAIDs
56
this is resorption of reserve crown, apical region and adjacent alveolar bone with proliferation of irregular cementum in lytic regions;
prominent clinical feature;
primarily involves incisors and canine teeth
EOTRH
(Equine Odontoclastic Tooth Resorption and Hypercementosis)
57
name 5 clinical signs of EOTRH
(Equine Odontoclastic Tooth Resorption and Hypercementosis)
1. reduced ability of grasping apples and carrots
2. sensitivity to placing a bit in mouth
3. head shaking
4. hypersalivation
5. head shyness
58
what age of horses are mostly affected by EOTRH
(Equine Odontoclastic Tooth Resorption and Hypercementosis)
older horses (15+ years)
59
name 4 abnormalities on oral exam seen in horses with EOTRH
(Equine Odontoclastic Tooth Resorption and Hypercementosis)
1. hyperaemia
2. drainage tracts within gums
3. calculus and feed accumulation around teeth
4. gingival recession
60
name 3 abnormalities seen on radiographs in a horse with EOTRH
(Equine Odontoclastic Tooth Resorption and Hypercementosis)
1. bulbous enlargement of apices of involved teeth
2. resorptive lesions of reserve crowns
3. widening of periodontal space
61
how to treat EOTRH
(Equine Odontoclastic Tooth Resorption and Hypercementosis)?
surgical extraction of clinically affected teeth
62
in what sex of horses are canine teeth absent or rudimentary
females
63
these are the small, vestigial first premolars (Triadan 05)
wolf teeth
64
name 5 indications for wolf teeth removal
1. displaced
2. large
3. blind
4. fractured
5. mandibular
65
which artery could be lacerated during wolf teeth extraction
greater palatine artery
66
# start of DS05
name 7 suggested indications for surgery/euthanasia of colics
1. severe, continuous pain showing no improvement w analgesia
2. pulse >60 (progressively rising and weakening)
3. progressive CV collapse
4. rectal findings positive for acute abdominal disease
5. progressive reduction in intestinal motility
6. increasing abd distension
7. serosanguineous peritoneal fluid w incr protein & WBCs
67
name 7 steps of tasks prior to referring/transferring colics to a referral centre
1. refer early
2. decompress stomach (just prior to departure)
3. analgesia for travel
4. stabilise prior to referral
5. put rug on horse and apply leg bandages
6. provide referral centre w detailed Hx and Tx given
7. provide owner with good directions to referral centre
68
name 4 steps of general management of simple colics (when no indications for Sx have been thoroughly evaluated)
1. house on deep inedible bedding
2. remove all feed for several hours (until several piles of normal faeces have been passed)
3. provide free access to water
4. hand walk horse 10-15min every 2-3h (owner)
69
name 3 reasons you must think carefully before administering drugs to horses with colic
1. potentially contraindicated due to mode of action (reduced GI motility?)
2. may mask important indicators of requirements for Sx
3. may alter subsequent clinical exam findings
70
name a common 1st line analgesic used for treatment of colic;
do not depress gut motility;
excessive usage can lead to side effects: GI ulceration, renal papillary necrosis
NSAIDs
71
# name the commonly used analgesic in colic cases
less likely to mask the CV signs of endotoxaemia;
not licensed for use in colic
Phenylbutazone
72
# name the analgesic commonly used in colic cases
esp effective in reducing effects of endotoxins on CV parameters;
use only after a thourough evaluation
Flunixin meglumine
73
# name the analgesic commonly used in colic cases
very potent analgesics;
temporarily prolong gut transit time;
do not mask the clinical signs of endotoxaemia
opioids
| (butorphanol and morphine)
74
# name the sedative commonly used in colic cases
sedation and good visceral analgesia;
side effects: reduced gut motility and bradycardia - influence on clinical parameters
alpha-2 agonist
75
# name the alpha-2 agonist
potent visceral analgesia;
short duration of action (20-30min) - transient masking of important clinical findings
xylazine
76
# name the alpha-2 agonist
30-40min duration;
least amount of ataxia
romifidine
77
# name the alpha-2 agonist
longest duration of action (60+ min);
may result in greatest degree of ataxia
detomidine
78
# name the spasmolytic drug commonly used in colic cases
metamizole (NSAID) + Butylscopolamine bromide (spasmolytic);
commonly used first line of treatment
buscopan compositum
79
# name the spasmolytic drug commonly used in colic cases
hyoscine butylbromide;
no NSAID;
useful to facilitate per rectum exam
buscopan vials
80
name 4 laxatives that can be used for treatment of simple large intestinal impactions
1. isotonic fluid
2. oral magnesium sulphate
3. liquid paraffin
4. dioctyl sodium sulfosuccinate (Dioctyl)
81
# name the IV fluid used for treating colic
correction of dehydration;
hyperinfusion for impactions;
most commonly used
polyionic fluid (Hartmann's)
82
# name the IV fluid used for treating colic
rapid restoration of vascular fluid volume (stabilisation of shock patient);
at expense of intracellular and interstitial fluid volume;
deficit must be corrected by immediate IV infusion of large volumes isotonic fluid
hypertonic (7.2%) saline
83
# name the IV fluid used for treating colic
restoration of vascular fluid volume;
good retention in vascular space
colloids
84
# name the specific colic
usually secondary to distal (SI) obstruction - fluid accumulation;
occasionally primary (highly fermentable feeds - gas accumulation);
Dx: nasogastric intubation - reflux, gastroscopy following feed witholding, U/S gastric margin, rectal - caudal displacement of spleen
gastric dilation
85
# name the specific colic
rare in UK;
caused by C. perfringens?;
often febrile, incr gastric reflux of 'tomato soup' fluid, decr gut sounds
anterior enteritis
86
name 3 medical treatments of anterior enteritis
1. gastric decompression
2. fluid therapy
3. abx/anti-endotoxic therapy
87
name the surgical treatment of anterior enteritis
small intestinal decompression
88
# name the specific colic
most commonly reported type of colic;
rapid onset;
intermittent mild to moderate pain;
incr gut sounds;
no classical rectal findings;
often resolve spontaneously;
usually complete response to analgesic +/- spasmolytic
spasmodic colic
89
# name the specific colic
abdominal distension;
Dx by rectal exam;
Tx: analgesia, exercise
tympanic colic
90
what is the most common site for large colon impaction
pelvic flexure
91
name 3 predisposing factors for large colon impaction
1. reduced water intake
2. poor quality roughage
3. poor dentitions
92
name 3 clinical signs of large colon impaction
1. slow onset over several days
2. low-grade pain
3. reduced gut sounds on LHS (normal on R)
| (HR and RR usually normal)
93
name 4 treatments for large colon impaction
1. feed restriction
2. analgesics
3. intra-gastric laxatives
4. intravenous fluids (isotonic)
94
# name the type of colic
more common in small ponies and Arabs;
mild colic initially - gas accumulation proximally - incr severity of pain ;
Dx: reduction in faecal output and rectal exam
small colon impaction
95
name 4 treatments for small colon impaction
1. IV fluids
2. enteral fluids/liquid paraffin
3. enemas (risk of bowel perforation)
4. Sx may be required
96
what is the most common site for small intestinal intraluminal obstruction in horses
ileum
97
name 2 predispositions to ileal impaction
1. Anaplocephala perforliata (tapeworm)
2. heavy ascarid burdens in foals (post-worming)
98
what is the treatment for ileal impaction?
surgery!
99
name 4 predisposing causes of caecal impaction
1. as with colon impactions
2. hospitalisation
3. general anaesthesia
4. NSAIDs
100
# name the type of caecal impaction
impactions of dry ingesta filling the caecum
type 1
101
# name the type of caecal impaction
impaired caecal outflow due to motility dysfunction - prone to spontaneous rupture
type 2
102
what is the treatment for sand impactions
psyllium mucilloid administered via nasogastric tube
103
name 5 predisposing factors of colon displacement
1. age (>7y)
2. breed (warmbloods)
3. recent foaling
4. abrupt change in feeding
5. previous displacements
.
104
# name the type of colic
migration of colon between spleen and body wall - entrapment over nephrosplenic ligament
left dorsal displacement of the colon (LDDC)
105
# name the type of colic
pelvic flexure moves between caecum and body wall in craniocaudad direction ;
+/- partial or complete torsion;
degree of colic depends of degree of obstruction/torsion
right dorsal displacement of the colon (RDDC)
106
name 5 causes of secondary functional obstructive colic
1. bowel ischaemia
2. post-op
3. drug admin
4. peritonitis
5. metabolic disorders
107
name 3 common abdominal neoplasms that may result in recurrent or chronic colic of varying severities
1. gastric squamous cell carcinoma
2. intestinal lymphosarcoma
3. pedunculated lipoma
108
# start of DS03
this is the name for retained deciduous cheek teeth
caps
109
these are abnormal spaces between adjacent teeth which allow entrapment of feed material and subsequent periodontal disease
diastema
110
name the two types of diastema
1. valve diastema
2. open diastema
111
# name the type of diastema
space between adjacent teeth wider near gum than occlusal surface;
created one-way valve, where food becomes trapped between teeth but cannot escape
valve diastema
112
# name the type of diastema
space between adjacent teeth equal width from occlusal surface to gum;
food less likely to become trapped
open diastema
113
which teeth are most commonly affected by diastema
caudal mandibular cheek teeth
114
this is thought to be the most painful oral disease - due to gingivitis and periodontal disease;
most common clinical sign of oral pain from thos disease is quidding
diastema
115
what plays the greatest role in development of periodontal disease due to a diastema
impacted food
116
name the two parts of treatment for oral diastema
1. odontoplasty
2. food removal
117
this is typically performed 3-4wks after initial treatment of diastema if initial treatment is ineffective at treating periodontal disease
diastema widening
| (using diastema burr)
118
what type of packing can be used in a diastema to prevent further food packing while allowing gingiva to heal
polyvinyl soloxane
119
if diastema are the result of severe cheek tooth displacement, what may be required?
extraction of displaced tooth
120
what dietary managment should be done for a horse with dental diastema
eliminate/reduce consumption of food containing long fibres (hay)
| (more likely to become trapped in diastema)
121
if left untreated, name 3 diseases that could result from diastema/periodontal disease
1. periapical infection
2. osteomyelitis
3. orosinus fistulas
122
where do supernumerary cheek teeth most commonly develop at?
| (more than 6 cheek teeth in a row)
caudal aspect of maxillary cheek teeth rows
123
# name the cheek teeth disorder
inflammation and progressive destruction of periodontal tissues;
if left untreated, tissues surrounding and supporting tooth are destroyed until eventually tooth itself may be lost
periodontal disease
124
what induces periodontal disease in brachydont teeth
(dogs and cats)
plaque-induced
125
how is periodontal disease initiated in hypsodont teeth (horses)
by entrapment of feed in anatomical defects (such as diastema)
126
name the 6 parts of the cycle of periodontal disease
1. initial insult to periodontum
2. inflammation of periodontal tissue
3. degradation of periodontal tissue
4. loss of periodontal support
5. periodontal pockets create anaerobic environment
6. invasion and proliferation of bacteria
127
why is periodontal disease able to be reversed in horses?
prolonged eruption and continuous development of periodontal fibres
128
# name the cheek teeth disorder
demineralisation of calcified (inorganic) dental tissues and eventual destruction of the organic component of teeth
dental caries
129
name the two types of dental caries
1. infundibular caries (IC)
2. peripheral caries
130
# name the dental caries type
developmental disorder where there is incomplete filling of infundibula with cementum;
food material packs into defects and bacterial fermentation ensues, resulting in progressive IC;
extremely common with almost all horses having some degree present in the maxillary cheek teeth
infundibular caries (IC)
131
if left untreated, name 3 conditions infundibular caries (IC) can lead to
1. sagittal fractures
2. pulp involvement
3. secondary apical infection
132
# name the infundibular carry (IC) grade
normal tooth
grade 0
133
# name the infundibular carry (IC) grade
cementum only
grade 1
134
# name the infundibular carry (IC) grade
cementum and underlying enamel affected
grade 2
135
# name the infundibular carry (IC) grade
cementum, enamel, and dentine affected
grade 3
136
# name the infundibular carry (IC) grade
secondary dental fracture
grade 4
137
# name the dental caries type
contributing factors: feeding hay and grain high in water soluble carbohydrates, feeding haylage and water low in pH;
severe cases can lead to periodontal disease or dental fracture
peripheral caries
138
# name the peripheral caries grade
normal tooth
grade 0
139
# name the peripheral caries grade
cementum only affected, superficial pitting lesions
grade 1.1
140
# name the peripheral caries grade
cementum only affected, but complete loss in some areas exposing enamel
grade 1.2
141
# name the peripheral caries grade
cementum and underlying enamel affected
grade 2
142
# name the peripheral caries grade
cementum, enamel and dentine affected
grade 3
143
# name the peripheral caries grade
secondary dental fracture
grade 4
144
which teeth are most commonly affected by cheek tooth fractures
maxillary cheek teeth
(Triadan 09s)
145
name the 3 most common cheek teeth fracture configurations
1. maxillary buccal slab fracture (1st and 2nd pulp chambers)
2. mandibular buccal slab fracture (4th and 5th pulp chambers)
3. midline saggital fracture (infundibula)
146
what type of cheek teeth fractures MUST be treated with dental extraction
midline sagittal fractures
147
name the most common soft tissue neoplasm of the quine oral cavity
squamous cell carcinoma
148
name the 3 types of dental tumours
1. epithelial tumours (ameloblastomas)
2. calcified tumours from dentinal tissues (odontoma)
3. combos of all 3 dental components (compound odontoma)
149
this is the most common route of infection for cheek tooth apical infection;
blood or lymphatic borne bacterial infection of a possibly compromised apical pulp
anachoresis
150
what is the treatment of cheek tooth apical infection in early stages if infection is confined to apex of affected tooth and pulp cavities remain vital
antibiotics
151
what is the treatment for cheek tooth apical infection if infection progresses
extraction of affected tooth
152
what kind of sedation should be given for a tooth extraction?
1. bolus of an alpha-2 agonist + opioid
2. CRI of an alpha-2 agonist for duration of procedure
153
name 4 nerve blocks of the head to assist with patient comfort during dental extractions
1. maxillary
2. infraorbital
3. mandibular
4. mental
154
name 3 methods of teeth extraction
1. extraction per os (removal of tooth orally)
2. minimally invasive transbuccal technique (MTE)
3. repulsion with a dental punch or Steinmann pin
155
# name the tooth extraction technique
systematic stretching and break down of periodontal ligament followed by intra-oral extraction along eruption pathway of tooth ;
technique of choice;
should always be attempted first
extraction per os
156
how long is packing left in place following a per os tooth extraction before re-evaluation
10-14d
157
# name the tooth extraction technique
used if clinical crown fractures to a point that forceps cannot be applied to the tooth to attempt oral extraction;
a threaded bar is seated into the tooth to be extracted through a buccotomy incision and ventral force is applied to the bar until the tooth is removed
minimally invasive transbuccal technique (MTE)
158
# name the tooth extraction technique
performed using a Steinmann pin or dental punch;
technique of choice if clinical crown fractures to a point that the extraction equipment cannot be applies to the tooth and the minimally invasive transbuccal technique fails or is not possible
extraction through repulsion
159
# start of DS04
this is a clinical sign, NOT a dagnosis;
clinical signs consistent with abdominal (usually GI) pain
colic
160
name 3 'fasle colics'
origin of pain fron non-GI structures
1. peritonitis
2. cholangiohepatitis
3. pleuritis
161
name 5 signs associated with colic
1. flank watching
2. pawing
3. rolling
4. signs of bed disturbance
5. abnormal position - lying on back
162
name the order of the 6 parts of the wquine GI tract
1. stomach
2. small intestine
3. caecum
4. large colon
5. small colon
6. rectum
163
name 4 causes of colic
1. distension
2. inflammation
3. ischaemia
4. stretching of mesentery
164
what will be the outcome if there is obstruction of ingesta/gas flow within the bowel
distension of bowel in front of the obstruction
165
what is the main objective of a clinical exam of a colic patient
determine whether condition can be treated medically or requires surgery
166
what is the most common cause of colic in young horses
intussusceptions
167
what is the most common cause of colic in old horses
pedunculated lipomas
168
what is the most common cause of colic in neonate horses
meconium impactions
169
what is the most common cause of colic in large breeds of horses
large colon displacements
170
what is the most common cause of colic in recently foaled mares
colonic torsions
171
what is the most common cause of colic in stallions
inguinal herniation
172
name 3 common causes of tachycardia in horses
1. haemoconcentration
2. reduced venous return
3. endotoxaemia
| (rarely due to pain)
173
name 3 common causes of increased RR in horses
1. pain
2. acidosis
3. severe gastric distension / hind gut tympany
174
name 4 things to check the consistency of faeces for?
1. blood
2. worms
3. sand
4. mucous (prolonged transit time)
175
# name the abnormal rectal finding
very common;
doughy mass;
when severe - often palpable within the pelvis;
can be secondary in some conditions with colonic stasis (eg subacute grass sickness)
impaction of pelvic flexure (PFI)
176
# name the abnormal rectal finding
may be palpable in ileus (acute grass sickness), enteritis, strangulating SI obstructions, non-strangulating SI obstructions, non-strangulating infarctions;
immediate referral should be considered
small intestinal distension
177
# name the abnormal rectal finding
invagination of the caecal apex;
may be palpated as a mass within the caecum
caecocaecal intussusception
178
# name the abnormal rectal finding
painful, oedematous mass within the caecal base;
also results in small intestinal distension
caecal intussusception
179
# name the abnormal rectal finding
primary flatulent colic;
transverse or small colon obstruction;
large colon displacements;
large colon torsions
large intestinal gaseous distension
180
# name the abnormal rectal finding
left large colon migrates dorsally between spleen and body wall;
ultimately hooks over nephrosplenic ligament;
colon palpated in left/dorsal abdominal quandrant running in a dorsoventral direction
nephrosplenic entrapment of large colon (LDDLC)
181
# name the abnormal rectal finding
may be palpable per rectum if situated in a suitable position;
can range in size from golf ball-sized to football-sized;
may be one or more;
may be discernible increases in the lymphoid tissue
intra-abdominal abscess(es) or neoplasia
182
name 3 indications for nasogastric intubation
1. diagnosis of gastric distension with gas or liquid
2. relief of gastric distension
3. admin of therapeutic agents directly into the stomach
183
name 6 conditions that result in gastric dilation/reflux and may benefit from nasogastric intubation
1. ileus
2. enteritis
3. strangulating SI obstructions
4. non-strangulating SI obstructions
5. non-strangulating infarctions
6. some cases of LI obstruction
184
what is the normal total protein of peritoneal fluid?
less than 25 g/L
185
# start of DS06
name 3 indications for surgical referral of a colic case
1. failure to respond to medical treatment
2. pain that cannot be controlled
3. signs of surgical lesion during diagnostic evaluation
186
what is the most common approach to colic surgery
ventral midline incision under GA with horse in dorsal recumbency
187
name 2 specific conditions of the stomach that may be treated surgically
1. gastric impaction in adult horses
2. gastric outflow obstruction in foals
188
# name the surgical stomach disorder
idiopathic smooth muscle hypertrophy or stricture due to severe gastric ulceration;
most managed medically but surgical Tx can be pursued as a last resort - bypass procedures or pyloroplasty
gastric outflow obstruction
189
# name the surgical stomach disorder
excess feed material in stomach;
can be primary or due to underlying cause;
most managed medically through gastric lavage;
surgery may be pursued if impaction fails to resolve - intraoperative infusion of fluids or manual removal by gastrotomy
gastric impaction
190
# name the strangulating obstruction of the small intestine
fatty tumours most often associated with small intestine mesentery;
benign, slow growing, with mesenteric attachments that elongates to form a stalk;
stalk encircles adjacent sm intestine or small colon, resulting in a strangulating obstruction;
most cases seen in horses >15y of age
pedunculated lipoma
191
# name the strangulating obstruction of the small intestine
entrapment of sm intestine in epiploic foramen, resulting in strangulating obstruction;
signalment: taller horses and thoroughbred, crib-biting and wind-sucking behaviour, incr incidence in winter, recent episodes of colic
epiploic foramen entrapment (EFE)
192
# name the anatomical structure
located in R dorsal abdo;
slit-like opening, bordered by caudal vena cava, caudate lobe of liver, hepatoduodenal ligament, portal vein, and pancreas;
small intestine can displace through this opening, resulting in a strangulating obstruction of involved sm intestine
epiploic foramen
193
# name the strangulating obstruction of the small intestine
rotation of jejunum or ileum greater than 180 degres about its mesentery;
primary or secondary to pre-existing lesions;
esp present in 2-4mo old foals
small intestinal volvulus (SIV)
194
# name the strangulating obstruction of the small intestine
invagination of one part of the intestine into an aboral intestinal segment that receives the invagination;
believed to be caused by altered motility of intestine
intussusception
195
# name the strangulating obstruction of the small intestine
small intestine passes through inguinal canal into scrotum
inguinal hernia
196
euthanasia is advised due to risk of malabsorption syndrome post-op if more than what percent of small intestine requires resection?
60-70%
197
name 4 observations used to assess viability of intestine
1. colour of serosa
2. motility
3. constriction at site of obstruction
4. odour
198
# name the non-strangulating obstruction of the small intestine
caused by inappropriate feed (coastal bermuda hay), intestinal tapeworm, or Parascaris spp.;
surgical decompression into caecum without enterotomy (except when due to bermuda hay);
prognosis good for longterm survival
small intestinal impaction
(ileal impaction most common)
199
# name the non-strangulating obstruction of the small intestine
inflammatory condition of duodenum and proximal jejunum causing a functional obstruction;
Tx: gastric decompression via nasogastric tube OR surgery if not responding;
prognosis for survival to hospital discharge 25-94%
anterior enteritis
200
# name the lesion of the caecum
due to accumulation of dry ingesta or abnormal caecal motility resulting in an impaction of fluid consistency;
motility disorder in hospitalised patients (post GA, repeated sedation, limited movement, painful conditions);
decision for surgery must be made early as caecum can spontaneously rupture
caecal impaction
201
name 4 medical treatments for caecal impaction
1. analgesia
2. enteral fluids
3. IV fluids
4. feed restriction
202
# name the lesion of the caecum
rare cause of colic;
chronic intermittent pain;
caeco-caecal (within the caecum) or caeco-colic (within the lg intestine);
Tx with typhlectomy or ileocolostomy
caecal intussusception
203
# name the lesion of the large colon
causes include feed, sand, enteroliths, and foreign bodies;
occur most often at pelvic flexure or R dorsal colon at transition into transverse colon;
majority managed medically (fluids +/- analgesia)
large colon impaction
204
name 4 indications for surgery for lg colon impaction
1. uncontrollable pain
2. CV parameters deteriorate
3. evidence of intestinal devitalisation
4. concurrent lg colon displacement
205
what is the surgical treatment for lg colon impaction
pelvic flexure enterotomy to decompress colon
206
# name the lesion of the large colon
colon rotates around longitudinal axis, usually with ventral colon moving dorsomedially;
onset of abdominal pain sudden and severe;
prompt surgical intervention needed!
post-op complications common;
large colon volvulus
207
once the large colon is replaced following lg colon volvulus, what 4 options does the surgeon have
1. resection
2. coloplexy for prevention of recurrence
3. recovery with no further intervention
4. euthanasia
208
name 6 possible complications following large colon resection
1. septic peritonitis
2. haemoabdomen
3. pain
4. adhesion formation
5. weight loss
6. diarrhoea
209
# name the large colon surgical procedure
taking out part of the lg colon to prevent lg colon displacement and torsion;
extensive and expensive as an elective procedure
large colon resection
210
# name the large colon surgical procedure
create a surgical adhesion from ventral colon to body wall to prevent recurrence of lg colon volvulus or displcement;
can be incorporated into closure of linea alba during a ventral midline coeliotomy
large colon colopexy
211
name 4 possible complications of large colon colopexy
1. recurrent colic
2. incisional hernia
3. catastrophic rupture of colon
4. enterocutaneous fistula
212
# name the small colon/rectum lesion
faecal impaction, enteroliths, bezoars (concretions of magnesium ammonium phosphate crystal, plant material and/or hair), foreign bodies, intramural haematomas, retained meconium;
medical management: improve hydration, soften impaction by admin of osmotic laxatives and analgesia;
surgical management: manual decompression/enterotomy
small colon impaction
213
# name the small colon/rectum lesion
uncommon cause of colic in foals;
heritable congenital condition;
diagnose with contrast radiography or colonoscopy;
treat with surgical correction if segment missing is not too long
atresia coli/atresia ani
214
# name the small colon/rectum lesion
often secondary to conditions causing tenesmus;
mild cases treated by replacement under epidural anaesthesia and a purse-string suture placed in anal sphincter;
severe cases may require surgical amputation
rectal prolapse
215
# name the small colon/rectum lesion
occur during rectal palpation, usually at attachment of mesocolon in the 10-2 o'clock position;
diagnosis: blood on rectal sleeve
rectal tears
216
name the 4 most important steps for management of rectal tears
1. realise and identify the lesion early
2. report it to the owner
3. first sid
4. refer if necessary
217
name the 7 steps of first aid for rectal tears
1. sedate
2. epidural or lidocaine topically per rectum
3. evacuate rectum with care
4. pack rectum with damp cotton wool
5. broad spectrum abx
6. NSAIDs
7. referral/surgery
218
# start of DS07
how long will the ventral midline incision be for colic surgery
30+ cm
219
what type of suture material is used to close the linea alba and what pattern
large gauge absorbable suture (vicryl or PDS) in continuous pattern
220
# name the time period following colic surgery based on recommendation
box rest with hand-grazing for 10-15min, 2-4 times per day
weeks 1-8
221
# name the time period following colic surgery based on recommendation
small paddock turnout (3-4 times the size of a normal stable)
weeks 9-16
222
# name the time period following colic surgery based on recommendation
normal turnout
weeks 17-24
223
# name the time period following colic surgery based on recommendation
ridden exercise gradually introduced
weeks 25+
224
this can be added to rations to increase calorie count, improve palatability or increase moisture;
high, particularly soluble fibre feed which is readily digested and yields slow-release energy;
low in sugar and does not contain starch;
must be given soaked to avoid oesophageal choke!
sugar beet (beet pulp)
225
how often should horses be checked following colic surgery?
2-3 times per day (at least)
226
what percent of colic patients will have a further episode of colic following hospital discharge
25-33%
227
name 3 specific types of colic that have been shown to be associated with incr risk of postop colic
1. large colon volvulus
2. R or L dorsal displacements of the lg colon
3. sm intestinal resection and anastomosis
228
name 3 prophylactic surgeries that can be performed to prevent postoperative colic
1. nephrosplenic ablation
2. large colon colopexy
3. large colon resection
229
# start of DS08
name the 2 diseases that are part of Equine Gastric Ulcer Syndrome (EGUS)
1. Equine Squamous Gastric Disease (ESGD)
2. Equine Glandular Gastric Disease (EGGD)
230
name 3 risk factors for ESGD
1. high concentrate diet
2. no access to adlib forage
3. limited access to water
231
name 5 risk factors for EGGD
1. exercise
2. transport
3. stabling
4. multiple handlers
5. concurrent disease
232
what is the only way to diagnose EGUS
gastroscopy
233
name 5 non-specific clinical signs for EGUS
1. changes to temperament
2. poor performance
3. adverse behaviour
4. dull coat
5. weight loss/reduced appetite
234
how long to starve horses prior to gastroscopy to diagnose EGUS
overnight (from 6pm)
235
how long to remove water for prior to a gastroscopy to diagnose EGUS
2h prior
236
what sedation should be used for gastroscopy
standard - Alpha 2 and opioid
237
# name the ESGD grade based on the squamous mucosa description
epithelium is intact, no appearance of hyperkeratosis
grade 0
238
# name the ESGD grade based on the squamous mucosa description
mucosa is intact, but there are areas of hyperkeratosis or gastritis
grade 1
239
# name the ESGD grade based on the squamous mucosa description
small, single or multi-focal lesions
grade 2
240
# name the ESGD grade based on the squamous mucosa description
large single or extensive superficial lesions
grade 3
241
# name the ESGD grade based on the squamous mucosa description
extensive lesions with areas of apparent deep ulceration
grade 4
242
# name the ESGD treatment
licensed first line treatment;
70-80% healing within 28d treatment;
lower bioavailability in presence of food
oral omeprazole
(Gastroguard and Peptizole - paste)
(Equizole - granules)
243
name 3 options for treating EGGD
1. oral omeprazole and sucralfate
2. misoprostol
3. long-acting injectable omeprazole
244
name 4 'Pros' of oral omeprazole and sucralfate for the treatment of EGGD
1. licensed product + human prep
2. good for needle shy horses
3. no human health concerns
4. treats both ESGD and EGGD
245
name 3 'Cons' of oral omeprazole and sucralfate for the treatment of EGGD
1. compliance
2. horses not tolerant of syringing
3. ideally give on empty stomach
246
name 3 'Pros' of misoprostol for the treatment of EGGD
1. oral tablet can be given in feed
2. good for needle shy or difficult to syringe horses
3. no requirement for empty stomach
247
name 3 'Cons' of Misoprostol for the treatment of EGGD
1. not licensed
2. human health implications
3. only suitable for EGGD
248
name 5 'Pros' of long-acting injectable omeprazole for the treatment of EGGD
1. good for horses unable to syringe
2. no starving requirements
3. no human health concerns
4. treats both ESGD and EGGD
5. no compliance issues
249
name 3 'Cons' of long-acting injectable omeprazole for the treatment of EGGD
1. not licensed
2. injection site reactions/abscesses
3. not suitable for needle shiy horses
250
this is an obstruction of the lumen of the oesophagus;
most frequently associated with hard feed
choke
251
name 4 broad causes of choke
1. dietary indescretion
2. dental
3. behavioural
4. oesophageal abnormalities
252
name 5 clinical signs of choke
1. distress
2. coughing/stretching out neck
3. bilateral nasal discharge
4. salivation
5. firm oesophagus may be palpable
253
name 7 treatments for choke
1. sedation
2. spasmolytics
3. smooth muscle relaxants
4. NSAIDs
5. pass NGT
6. oesophageal lavage
7. broad spectrum abx
254
name 4 reasons to refer a horse with choke
1. poor response to standing lavage
2. choke >24h duration
3. systemic concerns
4. recurrent choke episodes
255
name 2 possible complications choke can cause
1. aspiration pneumonia
2. oesophageal stricture
256
name 6 clinical signs of equine grass sickness (EGS) attributable to ANS (autonomic nervous system) derangement
1. tachycardia
2. dysphagia
3. salivation (acute)
4. bilateral ptosis
5. sweating
6. rhinitis sicca (chronic)
257
name 2 clinical signs of equine grass sickness (EGS) attributable to ENS (enteric nervous system) derangement
1. gastric reflux (acute)
2. faecal alterations (sub-acute)
258
name 2 faecal alterations seen with sub-acute equine grass sickness (EGS)
1. firm
2. mucus coating
259
name 4 general clinical signs of equine grass sickness (EGS)
1. dull demeanour (acute)
2. tucked up abdo sillhouette (sub-acute & chronic)
3. penile prolapse (chronic)
4. muscle fasiculations
260
name 5 diagnostics for equine grass sickness (EGS)
1. trans-rectal exam
2. nasogastric intubation
3. U/S
4. phenylephrine eye drops
5. exploratory laparotomy
.
261
# start of DS09
diarrhoea in adult horses is almost exclusively due to this
disorders of the large intestine
262
name 4 infectious causes of acute diarrhoea
1. Salmonella typhimurium
2. Clostridium difficile
3. Clostridium perfringens
4. Coronavirus
263
name a parasitic cause of acute diarrhoea
Cyathostomiasis
264
name a toxic cause of acute diarrhoea
NSAIDs
265
name 5 chronic inflammatory conditions causing chronic diarrhoea
1. chronic salmonellosis
2. chronic cyathostomiasis
3. Lawsonia intracellularis
4. sand
5. NSAID toxicity
.
266
name 3 infiltrative disorders/inflammatory bowel disease (IBD) that cause chronic diarrhoea
1. granulomas
2. lymphocytic-plasmacytic
3. multisystemic eosinophilic epitheliotropic disease (MEED)
267
name 3 non-GI causes of chronic diarrhoea
1. liver disease
2. congestive heart failure
3. renal disease
268
name 4 signs of dehydration/hypovolaemia
1. prolonged CRT
2. tachycardia
3. skin turgor
4. gum moisture
269
name 2 signs of endotoxaemia
1. injected mucous membranes
2. tachycardia
270
name 3 electrolyte abnormalities that may be seen with acute diarrhoea
1. hyponatraemia
2. hypochloraemia
3. hypokalaemia
271
name 4 signs of chronic inflammation
1. decreased PCV
2. decr erythrocyte count
3. elevated WBCC
4. elevated fibrinogen
272
where does glucose/xylose absorption occur?
in small intestine
273
name the 3 part treatment approach to acute diarrhoea
1. replacement of fluid losses
2. replacement of electrolyte losses
3. replacement of protein losses
274
# name the type of IV fluid
limited retention in vascular space;
more suited to correction of dehydration
lactated ringers
275
# name the type of IV fluid
'quick fix'
always follow with isotonic solutions
hypertonic NaCl
276
# name the type of IV fluid
better retention in vascular space;
preferable if associated protein loss (oncotic pressure)
colloids
277
what is the specific treatment for Clostridiosis
metronidazole
