EqMed, Q2, I

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HLW
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207776
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EqMed, Q2, I
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2013-03-17 11:04:06
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EqMed Q2
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EqMed, Q2, I
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  1. what is first structure visualized w/ventral midline incision?
    cecum
  2. what is the cecocolic fold?
    lateral band of the cecum (continuous with lateral free band of right ventral colon)
  3. Of the 4 bands on the cecum, which are vascularized?
    • which bands extend to apex of cecum?
    • medial and lateral = vascularized
    • dorsal and medial = apex
  4. which cecal band is continuous with ileocecal fold?
    • which is continuous with the cecocolic fold?
    • dorsal band continuous with ileocecal fold
    • lateral band continuous with cecocolic fold
  5. how many bands are on the ventral large colons? on pelvic flexure?
    • how many bands are on the dorsal large colons? small colon?
    • 4 on ventral (4 on the floor) - 1 on pelvic flexure
    • 3 on dorsal - 2 on small colon
  6. where are pacemaker cells for the colon motility located?
    in the pelvic flexure
  7. is transverse colon accessible in surgery? by rectal palpation?
    • difficult to visualize in sx (attached to dorsal body wall)
    • NOT palpable per rectum
  8. how is descending/small colon distinguished from small intestine on rectal palpation?
    colon has wide antimesenteric band and "road apples"
  9. why is it important to get vital parameters before giving an alpha 2 agonist as sedation for rectal palpation? what about Buscopan to relax GI tone (not a sedative)?
    • alpha agonists cause bradycardia
    • buscopan = parasympatholytic - tachycardia
  10. how much of the abdomen is palpable per rectum?
    caudal 1/3
  11. what is one of the first things that needs to be done if rectal tear occurs?
    • epidural w/xylazine and lidocaine to reduce straining
    • (takes 30 min. to effect - lose rectal/tail tone)
  12. which vertebral spaces are used for caudal epidural administration? what is then desensitized?
    • cranial space of S6-Co1 or Co1-2
    • large portion of small colon and rectum
  13. what are signs of severe, acute colic? 4
    • down and rolling (evidence = bedding between ears)
    • breathing hard
    • sweating
    • abdominal distention (bloat)
  14. what other medication should be administered if there is a rectal tear? 4
    • sedation (xylazine, detomedine)
    • broad spectrum Abs (penicillin, metro, gentocin)
    • Tetanis prophylaxis
    • flunixin meglumine
  15. why is acepromazine a poor choice for sedation of a horse with rectal tear?
    • causes hypotension
    • (avoid since concerned about sepsis which will also lower BP)
  16. what is the difference between Grade 1 and 2 rectal tear?
    • 1: mucosa + submucosa
    • 2: muscularis ONLY (other layers remain intact)
  17. what is recommended tx for grade 1 rectal tear? medical or surgical? 6
    • good success w/medical mgmt
    • Abs (TMS)
    • NSAIDs (Banamine)
    • laxatives (mineral oil for movement)
    • pelleted diet/softened
    • monitor for dyschezia, fever, LPS
  18. what is recommended tx for grade 2 rectal tear?
    • can be incidental and require NO treatment
    • can predispose to rectal impactions or progress to Gr4
  19. what is the difference between grade 3a, 3b and 4 tear? 4
    • 3: all layers except serosa (abdominal fluid can accumulate in abd)
    • -3a: serosal diverticulum forms
    • -3b: tear enters mesentery
    • 4: full thickness/all layer tear; extends into peritoneal cavity (usu. fatal)
  20. Grade 3 is life threatening and requires what treatment? 5
    • same as Gr1 (Abs, NSAIDs, laxatives, soft diet)
    • + IV antibiotics (penicillin, gentocin, metro)
    • + anti-endotoxemia tx (polymycin B)
    • + tetanis prophylaxis
    • + rectal packing
  21. with Grade 3 what diagnostic helps determine if surgery is required?
    peritoneal paracentesis
  22. Grade 4 is life threatening and usually requires what treatment?
    often fatal due to contamination of abdomen - Euthanasia
  23. what is a salvage surgical option for repairing grade 3/4 rectal tear?
    loop colostomy (poop comes out of the side/flank)
  24. what is normal peritoneal fluid's total protein and WBC count?
    • clear transudate, straw to yellow
    • TP <2.0 g/dl
    • WBC < 5000
  25. what are some causes of serosanguinous fluid?
    • bowel devitalization (as w/volvulus and strangulating lesions)
    • splenic puncture
    • SQ blood vessel
  26. what are some causes of green fluid?
    • enterocentesis (no WBCs)
    • bowel rupture (+WBCs)
  27. what is cause of thick orange fluid?
    peritonitis
  28. what is expected glucose with septic peritoneal fluid? lactate? pH?
    • glucose < 50 pt lower than serumBG (bacteria use glucose)
    • elevated lactate (bacteria prod. lactate)
    • very low pH (lactic acid)
  29. should adults be fasted prior to endoscopy? what about nursing foals? is sedation recommended?
    • yes for 12-18 hours so food bolus not in the way
    • no need to fast nursing foals
    • sedate adults and older foals
  30. is laparoscopy better for acute or chronic diseases? is fasting necessary?
    • chronic
    • yes, fasting is ideal (18-24 hours)
  31. why is it important that horse has balanced acid/base status prior to laparoscopy?
    pumping CO2 into abdomen for visualization - would worsen metabolic acidosis
  32. what can not be visualized when ultrasounding abdomen?
    small colon (behind large colon)
  33. where is US probe placed to visualize the stomach?
    left ICS 9-13
  34. Anatomically where can the duodenum be seen in the abdomen with US?
    right side ventral to caudal pole of kidney and caudal to liver
  35. what are some findings on US that suggest enteritis? 4
    • thickened walls
    • distended SI
    • sediment
    • lack of motility
  36. what is role of scintigraphy in diagnosing GI disease? what are limitations?
    • uses technitium 99 to diagnose/document delayed gastric emptying
    • lacks anatomical specificity
    • (better tool for evaluating bone than GI)
  37. on fecal evaluation, what are some of the more common eggs seen?
    • large and small strongyles
    • tapeworms, round worms
    • Strongyloides westerii
  38. In case of chronic weight loss, patient can be fasted for 18-24hours so an absorption test can evaluation what? what are normal v. abnormal findings?
    • glucose response in relation to D-xylose or D-glucose administration
    • normal = inverted "V"; glucose peak of 80-120mg/dL w/in 60-100min
    • abnormal= low baseline and no spike
  39. how much gastric reflux is considered abnormal? what should be done if there is positive reflux?
    >2L strongly suggests need for referral (may transport with tube in place)
  40. what is the most common clinical signs for esophageal disease?
    ptyalism
  41. what muscle is responsible for the upper esophageal sphincter? what about caudal esophageal sphincter?
    • cricopharyngeal muscle
    • caudal sphincter is indistinct
  42. what cranial nerves are required for proper mastication?
    • 5 (trigeminal)
    • 7 (facial)
    • 12 (hypoglossal)
  43. what cranial nerves are required for swallowing?
    • 5 (trigeminal)
    • 9 (glossopharyngeal)
    • 10 (vagus)
  44. what cranial nerves run through the guttural pouch?
    • 9
    • 10
    • 12
  45. what type of muscle is the esophagus?
    • cranial 2/3 = skeletal
    • caudal 1/3 = smooth
  46. where is the only place the esophagus is covered in serosa?
    short distance btwn diaphragm and stomach w/in abdominal cavity
  47. what is the most common esophageal disease? what are the most common sites for this disease?
    • choke = esophageal obstruction
    • cervical esophagus, thoaracic inlet/cranial to heart, terminal esophagus
  48. what are CS of choke? 7
    • ACUTE
    • frothy nasal discharge
    • feed in nostrils
    • ptyalism
    • gagging/retching
    • coughing
    • colic, signs of discomfort, neck extended
  49. what is treatment for choke?
    • sedation so head lower than shoulders/relax esoph. (xylazine)
    • endoscope so visualize mucosa
    • nasogastric tube to point of resistence - pump water
  50. If tube + water is unsuccesful at relieving choke, what should you do?
    place in stall + NPO + IV fluids to hydrate + meds to relax esophagus and sedate
  51. what are some drug options for relaxing the esophagus?
    • buscopan (N-butylscopolammonium bromide)
    • oxytocin
  52. what treatments need to be added if choke is prolonged?
    • broad spectrum Abs
    • NSAIDs
    • sucralfate
  53. what are considerations for returning horse to feed after relieving obstruction? 4
    • could reobstruct or have motility issues
    • slowly return to feed after confirm mucosa is healed via endoscope
    • feed fresh grass and pelleted/soft feed (no long stem fibers)
    • +/-esophagotomy
  54. once the choke is resolved, what are some complications to be aware of? 5
    • dilation cranial to the obstruction; reobstruction
    • traumatic mucosal injury; stricture
    • esophagitis; ulceration
    • rupture
    • aspiration pneumonia w/prolonged cases
  55. will choke cause metabolic acidosis or alkalosis?
    alkalosis from loss of saliva (NaCl)
  56. what type of fluids would you use for horse with choke?
    • isotonic crystalloids + K and Ca
    • (dehydration, not getting K/Ca since off feed)
  57. what are clinical signs of esophageal rupture? what is common sequella of ruptured esophagus?
    • palpate crepitus if ruptures in neck
    • pleura fluid accumulation if intrathoracic
    • -leads to cellulitis and endotoxemia
  58. what is a functional obstruction? how do these clinical signs compare to mechanical obstruction?
    • motility dysfunction of esphagus - megaesophagus
    • same clinical signs
  59. is megaesophagus usually acquired or conenital?
    • acquired - after prolonged episode of choke (may only be transient)
    • congenital from myopathy is rare
  60. how do you treat esophageal stricture?
    • allow up to 60 days for esophagus to heal on its own (maximum stricture will occur around 30 days then hopefully improve)
    • -sx/bouginage not successful in the horse
  61. how do you treat ruptured esophagus? 4
    • debride/lavage tissues
    • esophageal rest - esophagotomy tube -
    • broad Abs + tetanus prophy
    • hopefully heals by 2nd intention
  62. what additional complications are associated with ruptured esophagus?
    • Horner's syndrome
    • left laryngeal hemiplasia
  63. how do you definitively diagnose esophageal motility problem?
    barium and fluoroscopy
  64. If megaesophagus is secondary to esophageal reflux, it may respond well to what treatment?
    metaclopramide or bethanecol (prokinetic agents) to tighten lower esophageal sphincter

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