Equine Med- GI tract

wilsbach's version from 2016-03-01 18:15


Question Answer
biggest part of horse GI is..Lg intestine
how long is the eso? what does the eso end with? what is it called if eso is obstructed?2-4ft long, Strong cardiac sphincter. Obstruction= choke
what is the epithelium of the fundus of the stomach like?squamous- no protection against acid
where do stomach ulcers like to be, esp in young horses?around the pylorus
stomach anatomy (pic)
demarcation between non-glandular (squamous) and glandular stomach is...margo plicatus
how she described duodenum, jejunum and ileum is...D: short with a short mesentery. J: very long (majority of small intestines). I: very muscular, smaller lumen (things can get obstructed here)
where is the duodenum located inside the abdomen? (where is it attached?)CONNECTED TO DORSAL BODY WALL/ CECUM. If you can palp top of cecum might be able to feel duodenum
can you palpate the jejunum?small intestine should be non-palpable and non-visible on U/S
so if you are searching through horse guts, how would you be able to tell the jejunum from the ileum?The ileum has an antimesenteric band
what is the mesentery? how does its anatomy vary?Thin membrane that attaches the small intestines to the body wall (dorsal body wall) & brings blood supply and lymphatics to the gut.. Mesenteric length differs per segment
the cecum is a blind ended pouch which plays a big role in regulation of...water
if you want to ascult cecum, where?basically whole R side of body lol (apex of cecum on floor of abd)
what are the parts (in order starting with cecum) of colon?Cecum, right ventral colon, sternal flexure, left ventral colon, pelvic flexure, left dorsal colon, diaphragmatic flexure, right dorsal colon
how can you recognize the structure you are palpating as the cecum?it has 4 bands (feel like violin strings she said- they are small. Not to be confused with LVC which has WIDE bands), and it is the only part of the large intestine connected to the body wall. (pic of cecum in ppt if you wanna look)
how might you be able to recognize pelvic flexure?no bands, and narrow smooth portion
why are we worried about the nephrosplenic ligament?Worried about entrapment with Left dorsal displacement of the colon
how can you recognize the descending colon?there are fecal balls in it! also has one ligament on the dorsal part (sm int have none-- how you can ID descending colon from swollen sm ints)
what are various clinical signs of colic?Kicking at belly, Pawing, Laying down, Looking at sides, Curling lip, Playing in water, Grinding teeth, Refusing feed, Change in attitude, Decreased fecal output
what are signs of SEVERE colic?Down and rolling, Evidence the horse has rolled, Breathing hard, Sweating/abdominal distention (bloating)
if the heart rate is >_________, then you should put in a nasogastric tube.>60 (wise said 80 but WB said 60 in class) horse has to be standing to put in a NG tube, so might have to sedate if theyre rolling around
some possible signs/ ddx of dysphagia?signs: drooling, stuff dripping out of nose. DDX: facial paralysis- always check for symmetry
what are two systems you absolutely must check with a colic case, and how should you check them? What is the minimum data base you must do?(1) G-I tract (ascult and percuss) (2) CV system mm color / CRT / HR. MINIMUM dATA BASE: CBC chem UA
If you see big pieces of roughage in your fecal exam, you should check...mouth/teeth
how can you check for sand in feces?water+ feces in rectal glove (sand will settle to the fingers)
you should slowly transition a horse from grazing all day in summer to fixed meals in winter, or this cause of colic can happenWhat is eating straw bedding and getting an impaction, Alex?
additional dx tests you can do for colic? (list)Fecal exam, Nasogastric intubation, Ultrasound / X-Ray, Rectal examination, Peritoneal paracentesis, Endoscopy / Laparoscopy, Absorption test / Biopsy
which comes first, the rupture or the vomiting?rupture then vomit
when doing a nasogastric intubation, you should prolly put a twitch on, and then aim for where?ventral medial nasal passage (dont hit ethmoid turbinates or they will bleed like crazy)
CQ: When passing a NG tube, where within the nostril should the tube be placed?Medial and ventral
when passing a nasogastric tube-- How can you be sure the tube is in the esophagus?aspirate on tube- eso will collapse, will feel neg pressure. or see it pass on the L hand side. Might get scent of hay if in stomach. might cough if in trach but not reliable indicator. Can Auscult gas bubbles in stomach when air is forced into tube
what are some things you can feel on rectal palpation?L kidney, small colon, pelvic flexure, cecum, maybe spleen...
IF you do a rectal palp on a horse and when you pull your glove out, you see a little blood, how worried should you be?very worried- could be a rectal tear
what is the most common area to get a rectal tear?usually 30cm from anus on dorsal part of rectum
what is a grade 1 rectal tear? What do you do if it's a grade 1?only mucosa+submucosa is torn. Give ABX, NSAIDs, Laxatives / pelleted diet and Monitor closely
what kinda abx would you wanna give in a grade 1 or 2 rectal tear?wanna give broad spectrums. (consider gentamycin and penacillin.... Trimethoprim sulfide also IV. as long as horse still eating, can instruct owner to continue in an oral route. )
what is a grade 2 rectal tear? What problem is associated with this type of tear?where just the muscularis is torn- this might predispose to rectal impactions. It can also become a full tear (IV). Treated the same way as Type I- Give ABX, NSAIDs, Laxatives / pelleted diet and Monitor closely
what is a grade 3a and grade 3b rectal tear?all layers torn except for serosa or mesentery
what is a grade 4 rectal tear?all layers torn :(
which rectal tears are life threatening?grade 3 + 4
how would you tx a Grade 3 rectal tear?Life-Threatening! will need prompt treatment.. Give IV ABX, NSAIDs, Laxatives / pelleted diet and Monitor closely, provide a tetanus prophylaxis, consider rectal packing.
what test might you want to do to determine if you wanna medically vs surgically manage the rectal tear?Peritoneal paracentesis
how would you want to tx a grade 4 rectal tear?Life Threatening, Typically fatal! consider Abdominal lavage, Rectal liner, Loop colostomy
what is a Loop colostomy? why do?(to tx severe grade 4 rectal tears) do enterotomy, cr part will be sutured to body wall and opening there. ca part will be closed. then when tear is healed, do another sx to make an anastomosis
which drugs and where to do a caudal epidural? Why do you do it?Xylazine + lidocaine, Caudal sacral vertebral space (S6-Co1) Do for first aid tx of rectal tears- prevents straining which makes the tear worse
if you are on the farm and you think a rectal tear happened, what would you do for first aid?Sedate horse, Caudal epidural, Bare-armed rectal examination, Remove all faeces from rectum, Systemic ABX + NSAID’s, Prevent tear from progressing... Improve survival: refer early
what is black and what is white on the US? what are the names for black and white?Fluid=black (anechoic), Bone= white (hyperechoic)
what are 4 main things you are looking for when doing abd US?Look for free fluid, Diameter of small intestines, Wall thickness, Motility of the intestines
radiographs of horse abd usually impractical and not very useful- what are two things you WILL be able to see though?Sand and fecaliths are visible with X-Ray
Contrast Radiography can be used to detect which two GI probs?Esophagus obstruction, Atresia ani
what is Peritoneal paracentesis? what do you need to do this? What are the risks you must be aware of?aka Abdominocentesis (Belly Tap). You will need Centrifuge and Refractometer for cytology, and you will probably want to do a culture and sensitivity. Must be aware of proper technique and do it safely- Remember a large part of the colon is on the floor of the abd. Might penetrate colon- be able to try to differentiate fluid from rupture versus a sample from the colon. Do your stick on the R side because the spleen on the L and you dont wanna hit that.
do abdominocentesis on R or L of midline?do it on the r! spleen on the L
what size/length needle do you want to use for an abdominocentesis?can use needle (long) an not too small (relatively low gauge) or needle will be clogged and you wont get any fluid.
Needle versus cannula for abdominocentesis- pros and cons?Needle- sharp and easy to get in, but harder to tell if you have pierced other structures like the colon. With a cannula (like a teat cannula) you will need to do more prep in order to get it in (like do a cut down) but you are less likely to puncture inside structures.
what is the Normals for peritoneal fluid? (clarity, color, TP, WBC, lactate?)Clear transudate, Straw to yellow color (yellow can be normal), TP < 2.5 g/dl, WBC < 5000 G/l, Lactate < 1mmol/ml
what would be some reasons for Serosanguinous abd fluid? (3)Splenic puncture, Bowel devitalization, Compromised blood vessels
what would be 2 reasons for getting green fluid in your belly tap?Enterocentesis, bowel rupture (prog almost 0% survival if bowel rupture)
what would a thick orange fluid from your belly tap mean?Peritonitis (WBC)
which parts of the horse GI can you endoscopy?Esophagoscopy / Gastroscopy / Duodenoscopy (usually looking for ulcers)
should you fast a horse for GI endoscopy?Yes-- If stomach, you can fast food 12-24 hours, water 1-2 hours. not if foal though-- only need like 2 hours. adults take a long time bc of roughage ball- takes a long time for everything to get out of stomach.
what are contraindications for laparoscopy in horses?don't do standing in horses that are difficult to keep quiet in the stocks. like if they decide to lie down or freak out. prolly shouldn't do in horses that already have adhesions (esp young are prone) --> more risks of these.
what are possible complications of laparoscopy?perforate organs, chemical peritonitis. always complications but often goes really well. less invasive than exploratory laparotomy (and takes like 4-6mo for them to recover from exploratory-- so if it is a performing horse, is disaster if gotta wait that long.)
If you wanna get a full thickness bx, what two approaches can you do?Ventral midline celiotomy, Laparoscopy (full thickness most reliable- some dzs this is the only way to dx- like IBD)
2 sites you would get a mucosal bx from?Endoscopy (upper GI), Rectal mucosal biopsy
what is an absorption test/ what does it tell you?use when there is chronic weight loss- do 18-24h fasting, then Administer 10% solution D-xylose / D-glucose. Take blood samples, and plot curve. There should be a Peak that looks like an inverted V between 60-120 min