Clin Med - Equine GI

drraythe's version from 2016-03-14 21:10


Question Answer
About how long is the esophagus? What are we worried about?About 4-5ft long, bc of this long length it can be predisposed to obstruction
How large is a horse's stomach? What is a limitation of the stomach of a horse? What is it predisposed to?Holds 8-10L (2-2.5gallons), the stomach CANNOT VOMIT & it is predisposed to ulceration
Which parts of the small intestine are attached & where?The duodenum is attached to the body wall, the jejunum is free & the ileum is attached to the cecum (ILEOCECAL VALVE)
Where is the cecum relative to the outside of the horse?RIGHT paralumbar area to midline
What would you be worried about w/ the cecum?Prone to rupture! It's a blind sac!
Name the parts of the large colon in order, starting w/ the cecum (incld flexures)Cecum → R ventral colon-(sternal flexure) → L ventral colon-(pelvic flexure) → L dorsal colon-(Diaphragmatic flexure) → R dorsal colon
What colon occurs after the large colon?Transverse colon & then small colon
What is the average transit time through the horse GI?72 hours!
How often is the pancreas a problem in horses?SUPER RARELY AN ISSUE!
What kinda stomach does a horse have? What does the stomach do? What is the main concern w/ the stomach?MONOGASTRIC stomach, so very little digestion & no absorption take place. The main concern w/ the stomach is the possibility of it RUPTURING (can't vomit!!)
What are the big things to worry about w/ the horse's small intestine?It is VERY delicate & any upset to it can result in Ileus & adhesions (the motility control of the sm int is very complex & there are NUMEROUS ways to disrupt it)
What happens if there is ileus? What will you have to do?No motility is occurring & fluid will start to back up into the stomach-you must REFLUX or the stomach might rupture!!!
What are small intestinal adhesions? What might cz this?They are fibrous connections which are a normal response to insult. However they can cz lots of problems. Common czs of adhesions are Tissue handling, sutures, inflammation, infxn, etc (← asking about these things is an important part of the Hx!)
WHICH PLACES IN THE HORSE GI ARE ACTUALLY ATTACHED TO THE BODY WALL?Duodenum, cecum, R dorsal colon, transverse colon
What does thee hindgut require a lot of?Water!!
What are some of the ways the hindgut digests?Majority of digestion occurs in the hindgut (cecum & colon). This is done through FERMENTATION! The horse has specific flora-bacteria & protozoa, which produce VFAs for energy.
What is the purpose of the sacculations of the cecum? What is the transit time of food in the cecum? What is the big thing we need to worry about w/ the cecum?Sacculations SLOW TRANSIT TIME! TT is apprxn 7 hours. The cecum will RUPTURE (blind sac) which is the big thing to worry about w/ it
What can the large colon do if more digestion is needed?Retrograde flow if extra digestion is needed.
If the sensitive flora of the large colon are disrupted, what happens?Diarrhea!!
Enteritis = ___ & Colitis = ____Reflux
Diarrhea (so, if horse is "puking" its a problem w/ their small intestine & if they have diarrhea, it's a problem w/ their large colon)
The natural locations of narrowing of the lumen of the GI can cz many problems.. Where are some of these areas?Ileocecal valve, pelvic flexure, RDC moving into the transverse colon
What actually is colic?ABDOMINAL PAIN! Which means it's not specific to the GI, but it USUALLY is
The pain of colic can be due to a lot of things... name 4 general czsStretching
What are CS of MILD colic?Inappetant
Flank watching/biting
Stretched out
Flehmen response
Tail flagging
What are CS of MODERATE colic?Pawing, kicking at abdomen
lying down/getting up
What are CS of SEVERE colic?Rolling
Unwilling to walk
Signs of trauma (from being down) ("flopping like a fish outta water")
If a horse is lying down, should you be worried?Maybe. Some horses DO sleep lying down, so if quiet & resting, NOT painful!
How do you know if a horse is rolling around if it's happy, versus colicy?If they roll around & then stand up & shake off the dirt, theyre fine & just went for a roll. But if they DONT shake themselves off & theyre dirty, something is amiss
Which places are prone to rupture?Stomach


Question Answer
How many colics require little or no Tx?90%!!!!
8-10% medical management
1-2% Sx management
Questions (_________ or _________) you should ask about colic (3)Foregut (SI) OR Hindgut (LI)
Medical OR Surgical (← strangulating lesion or not?)
What are the 3 types of colic that all cases will fall into? Is each category painful, sick, or both?Non-Strangulating Obstruction (something that's stuck to prevent gas/poop/fluid to move) (painful)
Strangulating obstruction (painful & sick)
Inflammatory (sick)
Which type of colic category is considered more painful? What would you consider the others?Most painful is STRANGULATING!!!! None strangulating is mild to moderate pain (Dependent on severity of distension, stomach decompression, individual horse) & inflammatory is mild pain
Which type of colic would REQUIRE Sx?STRANGULATING!!! Need to fix this w/ Sx. The non-strangulating is mostly medical but might require Sx (only if like...for instance, cecum is displaced but not strangulated & needs to be put back). Sx will not help an inflammatory colic at all, dont do it
A young horse <3yr is most likely to have WHAT 3 czs of colic happen to them? : (1) Ascarid impaction (post deworming) (ileocecal valve)
(2) Foreign bodies (babies eat stupid things)
(3) Intussusceptions
Question Answer
An older horse is more prone to what 2 things that can cz colic?(1) Enteroliths (takes years to form this, so CANT be in a pony)
(2) Lipomas
Which cz of colic is common in stallions?Scrotal hernias (of course only they'd get this)
What are 2 czs of colic which MARES are prone to have?(1) Post foaling (bunch of spaces suddenly after birth for colon to move around in)
(2) Large colon torsion/uterine issues (these might be related obvi)
What is a diet risk factor for colic?Concentrates & no grazing (supposed to be grazing animals)
What are 5 major risk factors for colic for a horse?Diet (concentrates & no grazing)
Lack of exercise (stalled, recovering from an injury?)
Dental care (bad teeth-cant chew things right & food isnt ready to be in sm int)
What is something horses are prone to in the Southwest US/California?Enteroliths
What is something horses are prone to in the Southeast US?Ileal impactions (Bermuda grass hay is often fed here & is not very good quality feed)
What are 2 previous medical issues a horse could have had that can predispose a horse to colic?Abdominal Sx, umbilical/bladder issues as a foal
What location can a horse eat from that can ↑ chances of colicFrom the ground! (Sand)
What are the things you should ask about in the complaint Hx?Duration, describe level of pain of horse (ask on phone how bad they are!), has the horse pooped? (Are things moving through? is it an abrupt change), appetite/water intake, any Txs?? (What crap did you give your horse before I got here? like Banamine) & any previous colic episodes?
What 3 things should you ALWAYS do for a colicky horse?PE
Nasogastric tube
Rectal exam
(other ancillary diagnostics if seen necessary)
What are a few exceptions to how you can see their level of pain on your PE?Stoic horses, already ruptured (doesnt hurt anymore)
What is the major determinant for surgical intervention?LEVEL OF PAIN & their Response TO Analgesia
What are the 2 most important diagnostic Parameters in colic?Heart rate & MMs
What is heart rate like in colic? & why? (3)Tachycardia is most common.... this can be bc PAIN raises HR, dehydration/hypovolemia from the dz process czs ↑ HR & DEAD BOWEL (strangulating lesion) → ENDOTOXINS RELEASED → tachycardia
If a horses HR is over ___bpm what MUST you do IMMEDIATELY?Over 80, PASS A NASOGASTRIC TUBE (otherwise the stomach can rupture while youre standing there)
What does looking at MMs allow you to do? What colors do you want/dont want?You can assess SYSTEMIC affects from colic-you want nice & pink. If there is a purple line, it is an endotoxic line...endotoxemia
What can temperature tell you about colic?Febrile = inflammatory colic
Hypothermic = hypovolemic!! (SICK). Check the extremities temperatures!
What can RR tell you about the colic?How painful (↑ RR more pain)
What are you looking for in a horses overall appearance w/ colic?Are they bloated?
Borborygamy → what kinds of borbor. Can tell you things?(1) NO SOUNDS
(2) Hypermotile
What is a NORMAL amount of net reflux?About 2L
If there is EXCESS reflux, where is the problem???Small intestine!!!
What can reflux tell you AFTER you've refluxed?What’s the level of pain AFTER decompressing the stomach? (Did the HR ↓?) Might tell you if that was the problem or not
Whats the 1st thing for doing a rectal exam?SAFTEY FIRST!!!!
No straining!!!
This is for YOU & THE HORSE!! (Rectal tears are a serious threat)
What can you usually feel from a rectal exam in a horse?Pelvic flexure
L ventral colon
L dorsal colon
L kidney
Small colon (w/ its fecal balls)
When you are feeling around for a rectal exam, what 5 questions are you asking yourself/ looking for?(1) Is there distension? (small or large intestine? fluid, gas manure?)
(2) Can I feel ingesta? (Fecal balls should be there, but only in the small colon)
(3) Normal structures (if not there,, is there a weird band mid-abdomen?)
(4) Feel anything weird?? (5) Manure consistency (Dry, mucus, sand, parasites?)
What are 4 diagnoses can you make from a rectal exam?(1) Large colon impaction
(2) Large colon displacements (distension, abnormal bands)
(3) Large colon torsion
(4) Small intestinal distension (not definitive, but if you can feel small intestine....well you shouldn't. so that's the problem).
Bloodwork → why would you look at PCV/TP? (3)(1) If PCV & TP are ↑ = Dehydrated
(2) If only PCV is ↑ = splenic contraction
(3) If PCV is normal & TP is ↓ = protein loss through gut
Bloodwork → why would you look at a CBC? (Examples)To determine the type of sick they are. If just an impaction or something, you arent gonna see inflammation or neutrophils or something. But if you have 10 feet of dead small intestine in the horse, the CBC is gonna be abnormal → neutrophils ↑ or ↓ or toxic, inflammatory response
Bloodwork → why would you look at chemistry? (2 main things....& what are some specific things you can look at?)Can assess HYDRATION & also SYSTEMC involvement. For example, you can look at Lactate, acidosis, organ fxn...etc
Abdominocentesis → what does normal look like?Small volume
Clear to straw colored
↓ protein & cell count
Abdominocentesis → what kinda questions could this answer?Health of the gut? It basically tells you if it's a strangulating or non-strangulating (wont tell you if sm int or colon)
Abdominocentesis → what would an inflammatory response look like? What might it tell you?Cloudy, ↑ cell count & protein....most likely strangulating then (gut wall health compromised)
Abdominocentesis → color: RED. What does this mean, what should you do next if you get this result?(Serosanguinous) Could mean Ischemic gut (strangulating), you hit a vessel, Splenic tap, hemoabdomen. DO A PCV & CYTOLOGY
Abdominocentesis → color: BROWN/GREEN. What can this mean, what should you do next if you get this result?This could either mean Enterocentesis (you poked the gut, oops), OR it could be Ruptured bowel (uh oh). You can tell the diff bc if the bowel was ruptured, then you'd see degenerate neutrophils & such. ALSO you could check if the horse grossly looks ok or if they look like theyre dying. & of course, check the PCV & cytology
When doing an ultrasound, what should you see? (Hint: looking around the kidney)The spleen & the kidney should be best buddies. If you only see spleen & colon...might be a nephrosplenic entrapment
When doing an ultrasound, when do you see small intestine?SHOULDN'T see it if it's normal
What is the big question doing an ultrasound can help you answer?Is it FOREGUT or HINDGUT that is involved??
Why are the only reasons you'd do a radiograph for a colicy horse?Can see enteroliths & sand
Medical management → fluids. How important? What are your 2 main routes & what should you keep in mind?SUPER important...almost all colic cases are dehydrated. Via NGT or intravenously.....keep in mind if they are refluxing → THEN NEVER GIVE NGT!! NGT great for impactions (bunch of water to break down the clog) (cant do SQ bc need like 25L a day)
What should you be careful w/ when providing pain management in a colic case?The exam Parameters will change after pain relief. Might be harder to judge if getting better.
How MUST you give laxatives? What are some kinds of laxatives you can give?Via NGT ALWAYS! You can give Mineral oil (lube stuff)
MgSO4 (magnesium sulfate → osmotic lax)
Psyllium (Metamucil → great for sand impactions bc bulk cathartic that can PUSH SAND OUT OF COLON/CECUM!)
Non-steroidal anti-inflammatories → why would you give these?Pain relief, can help w/ some endotoxemia-related problems too
How should you give Flunixin Meglumine (NSAID)?ONLY IV OR PO!!! NEVER IM!!!!!
DO WE HAVE ADULT HORSES ENEMAS WHEN THEY HAVE IMPACTIONS???NO. All you will do is probably tear the rectum....they work good in foals, but in adults, there is TOO MUCH COLON btwn the rectum & the impaction
What are 7 reasons why you'd REFER a colic case?Very painful (ANALGESICS NOT WORKING)
Systemically compromised
Rectal exam abnormal
Reflux or severe diarrhea
Evidence of strangulating lesion (Serosanguinous abdominocentesis)
Client requests
Horse is insured
Keep in mind $$ → how much is management (fluid, ICU)?$1000-2000
Keep in mind $$ → how much is Sx & after care gonna cost them approximately?Non-complicated-$3000-5000