Equine Diagnostic Procedures

Front 1

What are some indications for abdominocentesis?

Back 1

GI disease (colic, D, Wt loss, fever of unknown origin, others)

Front 2

What materials do you need prior to starting an abdominocentesis?

Back 2

SEdation/twitch. Clippers, prep, lidocain, gloves, #15 blade, sterile teat cannula, 4x4 sponges, LTT, RTT, culture swab/broth and +/- green top tube.

Front 3

What is the LTT for in an abdominocentesis?

Back 3

Cytology

Front 4

Which way should you face when standing at the shoulder for an abdominocentesis

Back 4

Back to the TAIL

Front 5

What side of the abdomen are you performing the abdominocentesis on?

Back 5

RIGHT

Front 6

What are the landmarks for an abdominocentesis site?

Back 6

a hand width CAUDAL to the end of the sternum, and a HAND WIDTH to the RIGHT

Front 7

How do you place the local anes for an abdominocentesis?

Back 7

SQ and into the muscle AFTER you do the ROUGH prep.

Front 8

When do you switch gloves?

Back 8

Between the sterile prep and the incision

Front 9

What kind of incision do you make into the skin?

Back 9

STAB

Front 10

What other layers are you incising on that first stab incision of the abdominocentesis?

Back 10

Skin, SQ, external rectus sheath.

Front 11

How do you form the safety stop on the blade

Back 11

PINCH it just below the cutting bit.

Front 12

What do you do to the belly wall once you have made your stab incision?

Back 12

You "lift" the belly wall -- then turn the blade 90º and bring the blade out -- makes the incision easier to find.

Front 13

You have a hole, now what?

Back 13

You place the sterile teat cannula through, and push!! Needs to get through the internal rectus sheath and the peritoneum.

Front 14

What is a way that you can ensure that you are in the right spot once the teat cannula is in place?

Back 14

1) inject air -- inject fast and detach - air rushes out = retroperitoneal space

Front 15

How much fluid do we need?

Back 15

at least 1/2 ml.

Front 16

What should you do to the LTT prior to filling?

Back 16

Shake it out! Too much EDTA will through off values.

Front 17

How do we close an abdominocentesis site?

Back 17

We don't close abdominocentesis site (healing by 2nd intention).

Front 18

What type of info do we get from cytology?

Back 18

Total nucleated cell count, differential nucleated cell count (% that are PMN), total protein concentration, cell morphology

Front 19

What tube do we use for culture collection

Back 19

RTT - can do aerobic, anaerobic culture; sensitivity; gram stain.

Front 20

What can we use swabs for?

Back 20

Cultures (make sure to use one okay for anaerobics or use two different swabs for culture).

Front 21

What is the GTT used for?

Back 21

"Blood gas analysis" (lactate, glucose, pH)

Front 22

What is a normal cell count for an abdominocentesis

Back 22

< 5,000-10,000/µL (<1,500 cells/µL in foals)

Front 23

What is a normal pmn/MØ count in abdominal fluid?

Back 23

< 80% pmn, > 20% MØ

Front 24

What is a normal protein level in abdominal fluid?

Back 24

< 2.5g/dL

Front 25

What type of abdominal fluid is orange to red in color +/- cloudy, with > 2.5g/dL protein and 5,000 to 50,000 cells/µL?

Back 25

Strangulating lesion!

Front 26

What type of disease process produces an abdominal fluid that in > 20,000 -50,000 cells/µL and >80% pmn?

Back 26

Septic peritonitis

Front 27

What is a normal glucose concentration in abdominal fluid?

Back 27

Slightly higher than peripheral (plasma values)

Front 28

What does a septic peritonitis do to glucose levels?

Back 28

decreases them >50mg/dL compared to plasma

Front 29

What is the normal pH of peritoneal fluid?

Back 29

>7.5

Front 30

What happens to pH in a septic peritonitis?

Back 30

drops to < 7.3

Front 31

What value is helpful in a strangulating colic?

Back 31

LACTATE

Front 32

What is a normal lactate level in peritoneal fluid?

Back 32

< plasma levels

Front 33

What does a strangulating lesion do to lactate levels?

Back 33

elevates them to > 2x plasma values

Front 34

And what does a non strangulating lesion do to peritoneal lactate values?

Back 34

elevates < 2 x plasma

Front 35

What does it mean if I got a low cell count, low protein fluid that has plant material and a malodor to it with a green/brown color?

Back 35

You performed an enterocentesis

Front 36

What should you do if you suspect you accidentally performed an enterocentesis?

Back 36

Abx for 3 days, monitor for septic peritonitis, and +/- ex lap.

Front 37

What does a splenic aspiration look like?

Back 37

BLOODY -- PCV will be > peripheral PCV

Front 38

What is a complication that can be due to contamination of your abdominocentesis?

Back 38

Cellulitis/abscess formation

Front 39

What should you do if there is a cellulitis or abscess?

Back 39

drain the abscess, start on abx, nsaids and hydrotherapy

Front 40

What can herniate through on a foal through an abdominocentesis?

Back 40

Omentum.

Front 41

How do you treat an omental herniation

Back 41

Resect close to the body wall, apply antiseptic ointment, bandage and +/- abx

Front 42

What are some indications for passing an NG tube?

Back 42

Colic - check for reflux, administer enteral fluids, e-, laxatives.

Choke - determine/relieve obstruction

Others - admin laxatives to soften feces

Inappetant adults - admin nutrition

Foals - admin nutrition

Front 43

What materials do you need for NG intubation?

Back 43

Sedation, twitch

NG tube

Bucket with warm water

Empty bucket

Pump, funnel or large dose syringe

Front 44

What is the hardest part about getting the NG tube started?

Back 44

Getting it in the nares -- so get it in and then let them chill a bit.

Front 45

Which way should you be directing the NG tube?

Back 45

Medial and ventral

Front 46

How do you hold the NG tube that is not in the nostril?

Back 46

Looped in your hand

Front 47

What does it mean if you reach a "crunchy" part

Back 47

You hit the ethmoid turbinates -- STOP

Front 48

You meet a soft resistance passing the NG tube - what is it?

Back 48

the nasopharynx

Front 49

What do you need the animal to do in order to pass an NG tube?

Back 49

SWALLOW when you get to the nasopharynx.

Front 50

You are at the nasopharynx and it feels like the tube passed really easy- where are you?

Back 50

TRACHEA

Front 51

What are other ways to see if you are in the trachea and not where you should be?

Back 51

Blow into the tube - no resistance? = Trachea

ASpirate - air comes back? = Trachea

Front 52

What is one way to make room for the tube as you pass it down the esophagus?

Back 52

Blow air in the tube

Front 53

What point in the esophagus will you really need to work past?

Back 53

the cardia

Front 54

What is another indicator that you may be in the right place?

Back 54

SMELL (not 100% but pretty darn sure)

Front 55

What would happen if you put mineral oil into the lungs?

Back 55

NECROTIZING pneumonia and a hell of a law suit

Front 56

What do we need to see in the water line to ensure that we reached stomach and are not still in the esophagus?

Back 56

Stomach contents, feed

Front 57

We are all done, what do you need to do to the end of the tube as you pull it?

Back 57

BLOW HARD into tube (like blowing bubbles in milk) and then KINK THE TUBE in 2 places. Control it all the way out (no nose bleeds) - shake head a bit if you need a distraction

Front 58

What do you do if you do happen to cause epistaxis?

Back 58

Cover the bridge of the nose under the halter and just carry on.

Front 59

What is an abnormal amount of reflux in a horse?

Back 59

> 2L net in 1000 # horse (check pH if it is < 2 L)

Front 60

What can happen if fluid just accumulates?

Back 60

they can RUPTURE -- the strong LES prevents vomiting