1. General Evaluation of the Gastrointestinal System

What are important aspects of the history? These aspects are important in evaluating what?

S
F
M
C

• signalment

• feeding and housing

• metabolic status

• cardiovascular status

pain

Colic is not a ________ but a ________ ________, and can be ________ or ____-________.

diagnosis; clinical sign; intestinal; non-intestinal

What are some common symptoms associated with colic?

L
S
K
E
P
L
N
E

• looking or biting at sides

• stretching out

• kicking at belly

• excessive rolling

• pawing

• lip curl

• not eating

• excessive lying down

What are the main components of a physical exam?

G
F

• general (hydration, endotoxemia, septicemia)

• focused (gastro intestinal, gut sounds, feces, extra intestinal)

What are the components of a colic work up?

D
S
P
R
N

• detailed history

• signs of colic

• physical exam

• rectal exam

• nasogastric intubation

What heart rate is considered mildly elevated?

40-60

What heart rate is considered moderately elevated?

60-80

What heart rate is considered severely elevated?

over 80

What respiratory rate is considered mildly elevated?

20-30

What respiratory rate is considered moderately elevated?

30-40

What respiratory rate is considered severely elevated?

over 40

What are components of the laboratory exams?

C
B
U
F

• CBC and inflammatory markers

• biochemistry

• urinalysis

• fecal analysis

What are components of the biochemistry aspect of the laboratory exam?

L
G
E
B
G

• lactate

• glucose

• electrolytes (acidosis)

• BUN/creatinine (dehydration)

• GGT (right dorsal displacement)

What are normal lactate levels?

< 2 mmol/L

What lactate levels indicate poor prognosis?

> 6 mmol/L and or peritoneal lactate 2X serum

What is normal glucose level?

80-100 mg/dL

What glucose level indicates a poor prognosis?

> 300 mg/dL

What indicates endotoxemia?

severe neutropenia or diverging PCV/TP

What is the heart rate when dehydration is 6%?

40-60

What is the CRT when dehydration is 6%?

2

What is the PCV when dehydration is 6%?

40

What is the TP when dehydration is 6%?

7

What is the creatinine when dehydration is 6%?

1.5-2

What is the skin when dehydration is 6%?

2

What is the eyes when dehydration is 6%?

±

What is the MM moisture when dehydration is 6%?

moist

What is the MM color when dehydration is 6%?

pink

What is the heart rate when dehydration is 8%?

61-80

What is the CRT when dehydration is 8%?

3

What is the PCV when dehydration is 8%?

45

What is the TP when dehydration is 8%?

7.5

What is the creatinine when dehydration is 8%?

2-3

What is the skin when dehydration is 8%?

2-3

What is the eyes when dehydration is 8%?

±

What is the MM moisture when dehydration is 8%?

tacky

What is the MM color when dehydration is 8%?

pink

What is the heart rate when dehydration is 10%?

81-100

What is the CRT when dehydration is 10%?

4

What is the PCV when dehydration is 10%?

50

What is the TP when dehydration is 10%?

8

What is the creatinine when dehydration is 10%?

3-4

What is the skin when dehydration is 10%?

3-4

What is the eyes when dehydration is 10%?

+

What is the MM moisture when dehydration is 10%?

dry

What is the MM color when dehydration is 10%?

red

What is the heart rate when dehydration is 12%?

> 100

What is the CRT when dehydration is 12%?

> 4

What is the PCV when dehydration is 12%?

> 50

What is the TP when dehydration is 12%?

> 8

What is the creatinine when dehydration is 12%?

> 4

What is the skin when dehydration is 12%?

> 4

What is the eyes when dehydration is 12%?

++

What is the MM moisture when dehydration is 12%?

dry

What is the MM color when dehydration is 12%?

cyanotic

Why is passing a naso-gastric tube so important in a horse with colic?

they cannot vomit and the stomach can rupture if the pressure is not relieved

Depending on the horse’s behavior, what needs to be done before passing a nastro-gastric tube?

P
S

• physical restraint (twitch)

• sedation with an alpha 2 agonist

Where does the NG tube pass through first? How do you know when to stop? What happens next?

ventral meatus; measure the difference between the end of the tube to the end of the horse’s throat; once you reach the horse’s throat, angle the head relative to the neck and apply slight pressure to get the horse to swallow the tube

Where do you have to make sure you are before you continue advancing the NG tube into the stomach? What can be done to help?

in the esophagus; blow in the tube while advancing because it can help to dilate the esophagus

How do you check if you’re in the esophagus?

look and feel the tube

Once you are in the stomach with the NG tube, what needs to be done?

6-8 pumps of water once in the stomach to create a siphon

What does reflux mean? What is a significant amount?

any fluid that we get back in addition to what we put in; if we get 1-2 L more than we put in

What are other reasons to pass a NG tube?

O
R

• obstruction

• reflux

What does it mean if you get reflux from the NG tube?

O
I

• obstruction

• ileus

What are we evaluating when it comes to information about the reflux obtained from the NG tube?

V
C
O
C
F

• volume

• color

• odor

• consistency

• feed material

Why does reflux occur if there is ileus?

SI motility is reduced and fluid accumulates into the stomach

How can a NG tube be caused as a treatment?

R
R
N

• routine medication

• relieve choke

• nasogastric decompression

What is the most common complication when it comes to NG tubes?

nose bleeds

What are other complications associated with NG tubes that can be avoided with careful use>
A
P

• aspiration

• perforation

Prior to performing a rectal exam, what needs to be prepared?

Y
C
P

• yourself

• client

• patient

What other aspects are important prior to performing a rectal exam?

R
S
A

• restraint

• sedation

• additional measures

What are common and normal things you should feel on rectal exam?

A
C
S
O
F
P

• aorta (midline)

• caudal border of left kidney (left)

• spleen (left abdominal wall)

• one of the bands of the cecum (right)

• fecal balls in small colon (right)

• pelvic flexure sometimes (right)

What are abnormal findings on a rectal exam?

C
I
T
M
F
T
P
G
I
D

• crepitus

• irregular or rough surface

• thickened wall

• masses

• firm tubular small bowel

• tight bands

• painful areas

• gas filled LI

• impacted LI

• distended SI

What is the main possible complication associated with rectal exams?

rectal tear

What is being palpated in this picture?

pelvic flexure

What is a common issue that horses without enough water or horses that have been recently moved from pasture to stalls have?

pelvic flexure impaction

The horse had a hoof abscess and is stabled on straw. What is the most likely problem in picture B?

impaction

What are reasons to perform an abdominocentesis?

D
S
T
P

• diagnosis

• surgery

• treatment

• prognosis

What type of patient preparation is done with abdominocentesis?

sterile prep and can use a little bit of lidocaine on the skin

What are the possible techniques when it comes to abdominocentesis?

needle or teat cannula

If using the needle technique, where should you insert it?

ventral midline at the lowest point of the abdomen

If using the teat cannula technique, where should you insert it? Why?

right of ventral midline; you do not want to puncture the spleen

Can you use an ultrasound when performing an abdominocentesis? Why or why not?

yes; allows you to maximize your chances of getting fluid because you can visualize it

What should normal abdominal fluid look like?

pale/translucent yellow

What information can be obtained from abdominal fluid?

G
L
P

• gross aspect

• lab analysis

• prognosis

What gross aspects of abdominal fluid can be evaluated?

C
S
T

• color

• smell

• turbidity

What other information can be evaluated from abdominal fluid?

V
C
L
D
T
L

• volume

• color

• leukocyte count

• differential count

• total protein

• lactate

What is the normal volume of abdominal fluid?

slow drip that is not profuse or streaming

What is the normal color of abdominal fluid?

yellow and clear

What is the normal leukocyte count of abdominal fluid?

< 5000 cells/uL

What is the normal differential count of abdominal fluid?

< 50% neutrophils

What is the normal total protein of abdominal fluid?

< 2.5 g/dL (usually < 1.5 g/dL)

What is the normal lactate of abdominal fluid?

< 2 mmol/L

When is the prognosis bad based off of abdominal fluid?

if the abdominal fluid appears serosanguinous and changes from pale yellow

What are possible complications associated with abdominocentesis?

C
A
S
B
O

• cellulitis

• abscess

• splenic puncture

• bleeding

• omental herniation

You are an equine surgeon and a colleague referred you a horse with colic. He felt small intestinal distention on rectal exam and got the peritoneal fluid depicted in the image on the left. You see the horse a couple of hours later and get the sample in the image on the right. Does this horse need surgery?

yes

What type of probe is best to use with ultrasound?

2-5 MHz curvilinear transducer

What is a good approach for ultrasound?

1. C

2. P

3. D

1. consistent systematic approach

2. position of transducer and marker

3. depth of the field of view

What type of technique is used in a horse with colic? How long does it usually take?

fast localized abdominal sonography (FLASH); 15 minutes

What are the 7 locations viewed with FLASH ultrasound?

1. V

2. G

3. S

4. L

5. D

6. R

7. T

1. ventral

2. gastric

3. spleno-renal

4. left middle third

5. duodenal

6. right middle third

7. thoracic

What information can be obtained with ultrasound?

L
P
W
D
C
A

• location

• peristalsis

• wall aspect

• diameter

• content

• abnormal structures