Equine med & Surg

Exam 1

Veterinary client patient relationship

• Basis for interaction among veterinarians, their clients and their patients

• Critical to the health of the animal

• Can only be established when a veterinarian examines the animal and meets the owner in person.

T/F: A VCPR cannot be established solely on the telephone, but you can use other electronic means

False - must be in person

Veterinary client patient relationship steps

1. Veterinarian has assumed the responsibility for making critical judgements regarding the health of the patient

2. The client has agreed to follow the veterinarian’s instructions

3. The veterinarian has sufficient knowledge of the patient to initiate a general diagnosis

4. Veterinarian is readily available for follow-up care

5. Veterinarian provides oversight of treatment, compliance and outcome.

6. Patient records are maintained

Establishing a contract or agent: Decision makers

• owners

• riders

• trainers

• barn managers

Establishing a contact or agent: A priori agreements

• Who makes decisions on what and when?

• What if the owner is unavailable?

• Is an insurance company involved?

Initial History: Signalment

• age

• breed

• gender

Initial history: Ownership history

• previous owners

• length of ownership

• reason for sale

initial history: previous or current medical history

• preventative care

• conditions

• lameness

• medications

Initial History: reproductive history

• foals

• castration

Initial history: Herd health

• new horses

• previous health concerns

Initial history: atheletic history

• pets vs athletes

• variety of use

• Knowledge of sport helps narrow down the importance of presenting complaint.

Immediate HIstory steps:

1. onset

2. duration

3. behavior of the horse

4. appetite

5. appearance of the lesion

Give the professional and common name for the red box

Carpus - Knee

Give the professional and the common name for the yellow box

Metacarpal III - Cannon bone

Give the professional and the common name for the green box

Metacarpal II/IV - Splint bone

Give the professional and the common name for the blue box

Metacarpophalangeal joint - Fetlock/ankle

Give the professional and the common name for the purple box

Proximal interphalangeal joint - Pastern

Give the profesisonal and the common name for the pink box

Distal interphalangeal joint - coffin

Label the red square

Poll

Label the orange square

Crest

Label the yellow square

withers

Label the green square

croup

Label the blue square

Dock

Label the purple square

Gaskin

Label the pink square

Tarsus/Hock

Label the black square

Ergot

Label the white square

chestnut

Visual observation during PE: Ease of handling

• stallion vs gelding vs mare

• foal vs adult

• feral vs broke

Visual observation during PE: Ground manners

• pawing

• moving

• neighing

Visual observation: vices

• headshaking

• weaving

• biting

• cribbing

Behavior: Horses are prey animals

• strong flight instinct

• predators are everywhere

Behavior: Perceptive and sensitive

• near instantaneous response time

• desensitized to stimuli over time.

Behavior: Ocular

• Developed different ocular anatomy due to being prey

• nearly 360 degree field of vision

• Have a combination of monocular and binocular vision

• Poor 3D vision except directly in front of the horse

• creates blind spots that can increase risk of injury to animal and human

Mentation of this horse?

Bright, alert, responsive

Mentation of this horse?

Quite, alert, responsive

Mentation of this horse?

lethargic, dull

Mentation of these horses?

unresponsive, obtunded

What to look at to score the body condition on a horse?

1. Neck

2. withers

3. down the crease of the back

4. tailhead

5. ribs

6. behind the shoulder at the girth

Normal temperature for a horse

99 - 101.5 F

Normal Heart rate for a horse

24 bpm - 48 bpm

Normal respiratory rate for a horse

8 brpm - 24 brpm

Cardiovascular exam: Auscultation of the heart

• both sides of the heart

• Pre- and post- exercise

cardiovascular exam: common abnormalities

• tachycardia

• 2nd degree AV block

• murmurs - aortic and mitral regurgitation

Cardiovascular exam: Pulses

• palpate pulses

  • digital pulses

  • mandibular pulse

• evaluate strength

  • weak vs bounding

T/F: a weak pulse under the mandible is fine

False bad

T/F: strong digital pulses are good

False BAD

Cardiovascular exam: Mucous membranes

• color

  • normal: pale pink in horses

  • bad: brick red, toxic line

• capillary refill time

  • <2 seconds

Cardiovascular exam: Potential issues

• peripheral vasculature

  • waterhammer jugular pulse

• Edema

  • peripheral edema

  • limb edema

Respiratory exam:

1. upper and lower airway

2. rebreathing bag

3. Pre-and post-exercise

Respiratory exam: Nostrils

• airflow

• discharge

• epistaxis

Respiratory exam: sinuses

percussion

Respiratory exam: Larynx

palpation

What is the pink labeled?

Frontal sinus

What is the purple labeled?

caudal maxillary sinus

Name the light blue label

rostral maxillary sinus

Label the red sinus

ventral conchal sinus

Label the dark blue sinus

Dorsal conchal sinus

Label the green sinus

palatine sinus

Gastrointestinal exam:

• Auscultate for gastrointestinal sounds

  • Borborygmi

• Normal

  • constant gurgle

• Abnormal

  • Hypo- or hypermotile

  • gas pings

In a GI exam, what are you listening to in the left dorsal compartment?

small intestine

In a GI exam, what are you listenting to left ventral?

• large colon (left dorsal/ventral colon, pelvic flexure)

In a GI exam, what is located right dorsally?

cecum

In a GI exam, what is located right ventrally?

• cecum and large colon (right dorsal/ventral colon)

Gastrointestinal exam: examine feces

• under tail head, rear end, and hind limbs

• consistency

• parasites

Gastrointestinal exam: transrectal palpation

under certain circumstances

Examinaiton of the heat:

1. supraorbital fossa

2. Nostrils

3. muzzle

4. ears

5. poll

6. temporal muscles

7. Temporo-mandibular joint

8. Masseter muscles

9. Lymph nodes

10. Mandible

11. Maxilla

12. Facial crest

Opthalmic examination

1. normal features

2. work from the outside in

3. important to evaluate front and back of the eye

Opthalamic examination:

1. vision

2. comfort

3. scars

4. neoplasia

5. discharge

Oral examination

• routine care recommended annually

• performed additionally if

  • drooling

  • dropping feed/weight

  • odor from mouth

  • health certificates

Oral examination requirements:

1. sedation

2. light

3. speculum

4. head restraint

Oral examination: look for

1. hooks and points

2. ulcerative lesions

3. missing teeth

4. incisor wear

Oral examination: aging

1. eruption

2. size of incisors

3. Galvayne’s groove

4. stars and cups on incisors

Musculoskeletal exam:

looking at conformation and symmetry

Musculoskeletal exam: angular deformaties

• varus

• valgus

musculoskeletal exam: Flexural deformities

• contracture

• laxity

Musculoskeletal examination: evaluation and palpation

1. hoof

2. bones

3. joints

4. tendons

5. visual examination

6. palpation

7. range of motion

8. passive flexion

9. hoof testers

Lameness examination:

• at the walk - straight line and circling

• at the trot - hard and soft surfaces

• athletic evaluation - on a lunge line, under saddle.

• Flexion tests - place stresses on joints, can exacerbate lameness and localize pain

• Peripheral nerve blocks - further localization of pain (separating distal structures, etc).

Neurologic examination:

• cranial nerves

• conscious proprioception

• weakness

• ataxia

Reproductive exam

• External exam

  • conformation

  • neoplasia

• Ultrasonography

• semen evaluation

Special focus

• abnormalities

• presenting signs

• owner’s concerns

• welfare concerns.