Lecture Equine GI 1-2 Flashcards
(48 cards)
1
Q
Most equine obstructions occur
A
in the proximal esophagus
2
Q
Esophageal obstuction
CS
A
- Distress
- Head extension
- Salivation
-
Nasal d/c
- food
- saliva
- milk
- Lethargy, dehydration
- +/- abnormal lung sounds
3
Q
Esophageal obstuction
DX
A
- HX and CS: head neck extension/nose d/c
- esophageal palpation
- Resistance to NG tube
- additional
- endoscopy
- radiography
4
Q
Esophageal obstuction
Resolution
A
-
SEDATE
- xylazine
- detomidine
- butorphanol
- gentle passage stomach tube
- wash gently with warm water
- esophageal relaxation
- buscopan
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
6
Q
Basic mechanisms of GI pain
A
- distension of a viscus
- traction on mesentary
- ischemia
- inflammation
7
Q
Questions regarding colic workup
A
- Can pain be controlled?
- Is problem small or large intestine?
- rectal exam
- US
- Strangulating or non-strangulating?
- pain
- US
- abdominocentesis
- Is sx likely indicated?
- No? - DON’T do abdominocentesis
- Prognosis?
- Is immediate euthanasia indicated?
- has the horse already ruptured
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
9
Q
Colic
Subtle CS
A
- anorexia
- lying down more than usual
- decreased fecal production
10
Q
Mod signs colic
A
- pawing
- stretching
- flank watching
- abdominal distention
11
Q
Severe signs colic
A
- Rolling
- Thrashing
- Becoming cast
- facial abrasions
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
13
Q
Initial colic
A
- analgesic therapy
- gastric decompression
- drugs
- fluid therapy
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
15
Q
EGUS
Risk factors
A
- Diet (alfalfa: protective)
- Exercise - Any
- Environment
- NSAIDS
- Foals
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
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
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
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
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
Strangulating obstructions
In a nutshell
* 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
Choke
Causes
* **Hay, pellets or cubes**
* Beet pump if not moistened
* foreign bodies (apples, potatoes)
* Rapid consumption
27
Choke
Complications
* Recurrent laryngeal nerve damage: Roaring
* Strictures
* Esophageal rupture is terminal
* Limit treatment attempt to 30 minutes
28
Recurring esophageal obstruction
Scope and look for esophageal neoplasia
29
Characteristics of pain
* Duration
* Persistence
* Severity
* Response to analgesics
* Breed/ind variability
* **Severe pain replaced by depression: Major concern**
30
Physical exam
* 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
Buscopan will Decrease
Gut sounds
32
Rectal Palpation
Basic question
* Sedation good
* Basic questions
1. **Distention**
2. **SI or LI**
3. Gas, fluid, feed
4. Masses
33
Abdominocentesis
Interpretation
* Lactate compared to plasma
* \> 2X typical of strangulation
* Cytology
* blood or hemorrhage
* normal protein \< 2 g/dL
* Normal fluid does not rule out strangulation
## Footnote
\*Used to differentiate between SI strangulating and non-strangulating
\*Strangulating: serosanguinous
34
Analgesics/Sedatives
* NSAIDS
* alpha-2s
* Opioids
* Buscopan
35
Banamine/Flunixin
Most common NSAID for visceral pain in horse
36
alpha -2s
* Xylazine: cheap
* Detomidine: longer acting
37
Opiods in horses
* Butorphanol: not very long acting
38
Buscopan
* anticholinergic
* antispasmodic
* short duration of action: 20 minutes
* causes tachycardia
\*buscopan contraindicated when something is already VERY tachycardic
39
Anticholinergics
* Block acetylcholine
* inhibits parasympathetic stuff
40
Fluid therapy options
Enteral
* 6-8L Q 2-6 unless there is reflux (\>2-3L) or small intestinal distention
41
Fluid therapy options
IV
* If there is
* reflux
* severe pain
* substantial dehydration
42
Laxatives
* Psyllium: sand
* Mineral oil
* MgSO4
43
EGUS
CS
* **Colic after a grain meal**
* Decreased performance
44
Only approved TX for gastric ulceration
* Omeprazole (Gastroguard)
* PPI
* TX: 4mg/kg q24
* preventative: 1-2 mg/kg q24
45
H-2 antagonist
* Famotidine
* Ranitidine
\*cheaper, less effective
46
SI strangulation
Prognosis
* Survival to d/c 80-85%
* Poor to grave if \> 50% SI affected
47
SI strangulation
Possible lesions
1. Volvulus
2. Incarceration
* Epiploic foramen
* Inguinal hernia
* Umbilical hernia
* Mesenteric rent
3. Intestinal adhesions
4. Intussusception
5. Pedunculated lipoma
48
Large Colon Volvulus
CS
Rectal
TX
Prognosis
* 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
