Equine physical examination 1......General & GIT examination

Equine physical examination

The General Examination

The general examination should start with the observation of the horse from a distance in order to detect abnormalities that might be obscured by handling and restraint. Horses’ stance and general behavior in the stall will reflect their general mentation, which is frequently affected by systemic illness, neurologic disease, and pain in various organs (P). The respiratory rate and effort should be noted prior to handling, as well as a general evaluation of body condition (P).

Examining the horse from nose to tail along the left side and then tail to nose along the right side is one way of ensuring a complete general examination. Again, there are no strict rules regarding the proper physical examination procedures. It is recommended that a consistent approach be adopted. The mucous membranes are first examined by raising the upper lip as shown.

Mucous membranes are examined for moistness, ictrus, hyperemia, cyanosis, pallor, ulceration, and petechia. Capillary refill time is also evaluated at this time by blanching the mucous membranes.

The tongue can also be grasped through the interdental space at this time to evaluate for oral ulceration (P). The sclera are then examined for icterus, petechia, vesicles, or injection by placing the thumb over the upper lid and grasping the bottom of the halter and rotating the horse’s head away to expose the sclera .

Although many horses do not like their ears touched, one can slowly and gently palpate the ear for temperature if there is a suspicion that the horse may be in cardiovascular shock and experiencing poor peripheral perfusion. The intramandibular space is then palpated for submandibular lymphadenopathy].

The retropharyngeal lymph nodes are not readily palpated in the normal animal but may be if enlarged. The facial artery is palpated at the ventral aspect of the mandible.

The thyroid gland is frequently palpable in older horses and should not be confused for a lymph node (P). The left jugular vein is then occluded and palpated to evaluate jugular fill and to examine for thrombophlebitis.

The heart is then ausculted in three locations on the left cranial ventral thorax: over the pulmonic, aortic, and mitral valves. The normal resting heart rate of the horse is 28-42 BPM. The hand is then run down the forelimb to evaluate temperature of the distal extremities if cardiovascular shock is a concern and also to palpate temperature of the hoof and evaluate digital pulses if laminitis is a concern.

Firm, upward pressure is then placed on the ventral thorax on midline to evaluate for ventral edema.

A discussion of auscultation of the thorax and abdomen is included in the focused examination of the respiratory and gastrointestinal tracts respectively (LINK). The inguinal area is then carefully palpated to evaluate testicles in stallions, scrotal remnants in geldings, and the mammary gland in mares. The distal hind limbs are visually inspected for joint effusion or distal limb edema. If edema is present, it should be determined if it is warm or painful to palpation. The tail is then carefully raised from the side and a thermometer is inserted in the rectum, noticing tail tone and anal reflexes.

Most resting horses have rectal temperatures of 98.0°-101.5° F. Examination is then continued on the left side for visual inspection of the integument and auscultation of the abdomen and thorax, as noted in the focused physical examination. In the general examination, the right side of the heart is then ausculted, the right jugular vein is occluded, and the right side of the head and neck are visually examined. As one can see, this general physical examination can be easily performed in just a few minutes, yet it can provide important information that would otherwise be easily missed.

The Gastrointestinal Physical Exam

Most often a gastrointestinal physical exam is performed in cases suspected of colic.

Colic simply means abdominal pain, and one must remember to also consider less obvious causes of colic than pain elicited from the gastrointestinal system.

A general medical history is an essential part of the initial exam. It should include a description of the horse’s housing/environment, feeding program, parasite control, vaccination, previous medical problems, and the value of the horse to the owner. Obtaining information about the duration, progression and severity of signs and the horse’s response to any medications (if administered) are crucial in determining the necessity for surgical treatment.

In cases of colic, there are no simple pathognomonic signs to determine the cause, thus a consistent and complete physical exam must be performed.

NO 1 : GENERAL ATTITUDE / PAIN LEVEL

Horses have a low threshold for pain.
It is an easy parameter to obtain from a distance. Observe for any sweating, quivering, flared nostrils, dullness of eyes, position of the ears, pawing, rolling, biting at the flank, kicking at the belly or stretching.

Determining the severity of the horse’s pain may help to determine the character of the cause of the colic, i.e., milder more intermittent pain may point to a luminal obstruction while continuous, more violent signs of pain may point to a vascular obstruction (volvulus, torsion, or strangulation).

NO 2 : CHARACTER AND COLOR OF THE MUCOUS MEMBRANES / CRT

Examining the mucous membranes of the conjunctiva and gingiva are critical parameters in the assessment of a patient presented for colic. The color of the mucous membranes in a colicky horse may vary from pale pink to brick red to cyanotic blue to purple. A colicky horse can have normal mucous membranes. Simple obstructive or spasmodic colics rarely show degenerative changes in the color or refill time of the mucous membranes. Changes in color are most likely associated with vascular strangulating lesions which cause hypovolemic changes due to fluid redistribution.

Normal mucous membranes:

Pale mucous membranes:

Occurs in horses suffering from shock form hypovolemia or pain. This finding may accompany other signs such as cold extremities.

Red mucous membranes:

Associated with septic or endotoxic shock when blood pools in the capillaries and small vessels.

Cyanotic mucous membranes:

The result of severe or prolonged shock. This may be seen along with an overlying hyperemic tone due to the pooling of blood in the capillaries and the cell’s subsequent depletion of oxygen. This indicated a poor prognostic sign and presents as a high surgical and anesthetic risk

NO 3 : PULSE RATE AND QUALITY

A rapid thready or weak pulse may indicate a patient going into hypovolemic shock.

High pulse rates due to sympathetic stimulation from pain alone will be strong and bounding.

The degree of increase in rate is a good indication of the severity of the horse’s condition.

Evaluating the pulse may be a more valuable assessment of cardiovascular status than taking the heart rate directly via a stethoscope over the heart

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NO 4 : RESPIRATORY RATE

The respiratory rate of a colicky patient will usually be increased because of pain. In some instances it may also be elevated due to excursion of distended bowel against the diaphragm which causes a decrease in tidal volume

NO 5 : AUSCULT THE ABDOMEN FOR BORBORYGMUS

This is a good indication of gastrointestinal motility. Frequency, duration, intensity and location of intestinal sounds should be noted.

If no sounds are auscultable for a long time, the bowel is presumably not functioning. Conversely, intestinal sounds do not necessarily mean propulsive motility. Start ausculting in the paralumbar fossa and then ventrally (both points on each side).

One may percuss the abdomen while ausculting to listen for high-pitched resonant sounds associated with gas-distended bowel

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NO 6 : TEMPERATURE AND RECTAL EXAM

[Rectal Temperature: This is a critical parameter. Most colicky horses do not have an increased rectal temperature, thus this finding may help to rule out luminal or extra-luminal GI obstruction. Conversely, a colicky horse with a septic or infectious condition can have an elevated temperature usually from enteritis or peritonitis from a ruptured or necrotic bowel. Colic accompanied by an elevated temperature is a poor prognostic sign. A decreased temperature is usually a sign of circulatory collapse and is a grave sign. It is very important to obtain the rectal temperature before performing a rectal exam since air introduced into the rectum may falsely decrease the rectal temperature

Rectal Exam: Feces, or the absence of feces, should be noted. If the horse offers resistance in the form of a peristaltic wave, one should follow the wave back until it dissipates by withdrawing the hand, or at least by not trying to extend the hand further into the rectum. Forcing one’s way through the center of a peristaltic contraction is inviting rectal perforation in the horse. The pelvic flexure is a frequent site for impaction of ingesta because of its decreased lumen size and hairpin turn. In cases of obstruction, distended bowel is frequently palpable.

In a normal abdomen, the left side of the abdomen should reveal the distal left ventral colon, the pelvic flexure, the proximal left dorsal colon, the spleen, the left kidney and the left ovary. The ventral abdomen contains the bladder, inguinal rings, cervix and uterus. The right side of the abdomen contains the cecum and segments of the small colon. The small intestine is usually not palpable. In the cranial aspect of the dorsal abdomen, the root of the mesentery and the nephrosplenic ligament may be palpable.

: Rectal palpation diagrams

Palpating the Spleen
Palpating the Left Kidney
Palpating the Aorta
Palpating the Mesenteric Root
Palpating the Cecum
Palpating Cecal Tympany
Palpating the Pelvic Flexure
Palpating an Impaction of the Large Colon
Palpating a Small Intestinal Strangulation

NO 7 : NASOGASTRIC INTUBATION

This offers an escape route for gas and fluid that may have accumulated within the stomach.

NG intubation is also important for administering laxatives or fluids. Bowel secretes fluid into its lumen in response to distension, thus the volume of accumulated fluid relieved from the stomach via stomach tube can be helpful in locating a lesion.

The nearer the obstruction to the stomach, the faster the fluid will accumulate. If it re-accumulates rapidly, the problem is nearer the pylorus than in cases where re-accumulation doesn’t occur at all or occurs very slowly.

It is essential to create a siphon in order to be able to remove fluid through the stomach tube. This is done by filling the tube with water and aspirating gently with a stomach pump or syringe.

Repeated efforts to create a siphon and to move the tube in and out are essential since feed material from the stomach may obstruct the end of the tube. The volume and pH of the gastric fluid should be noted. One should be aware that while not a surgical condition, small intestinal enteritis may produce large volumes of fluid

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موضوع: ABDOMINOCENTESIS الجمعة نوفمبر 19, 2010 10:16 pm

Abdominocentesis

Changes can occur in the peritoneal fluid in a horse with colic. Abdominal paracentesis is a good indicator for surgical treatment.

1. Displaced or strangulated bowel: the peritoneal fluid can increase in volume and protein content due to lymphatic or venous obstruction.

2. Necrotic bowel: red cells and hemoglobin are present in the fluid due to vascular occlusion.

3. Strangulation: increased numbers of rbcs plus increased wbc count of the fluid.

4. Iatrogenic, abdominal abscesses or thromboembolism: increase in wbc and protein content without and increase in rbc/Hb.

5. Obstruction of bowel without vascular strangulation or necrosis: No changes in peritoneal fluid.

6. Ruptured bowel: increased wbcs, protein and fecal material.

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