Case Report Experiment

2008-11-06T16:41:24Z

Jtulloch: /* Diagnostic Imaging Results */

'''Harvey Saunders'''

==Signalment and Initial Complaint==

[[Image:harvey.jpg|right|thumb|200px|Harvey Saunders]]

* 13 year old, Anglo-Arab Gelding, weighing 559kg.
* He presented with an intermittent right forelimb lameness of 2 -3 month duration.

==What would your work up now consist of?==
There are 6 things that could be done to achieve a full work up.... (highlight to reveal answers)

<font color="white">
* Further history
* Physical Examination
* Gait Analysis
* Diagnostic Analgesia
* Radiographs or Ultrasounds
* Scintigraphy
</font>

==Clinical Examination Results==
'''A link could be put in here to show you have to perform a clinical exam on a horse'''

* Forelimb palpation:
** Right Forlimb:
*** heat and swelling at proximal metacarpal region
*** mild pain elicited on suspensory ligament palpation
*** mild thickening of lateral branch of SL (no pain)

* Hoof testers: negative

==Gait Analysis==
'''A link could be put in here to show you have to perform gait analysis on a horse'''

* Trot straight line: 2/10 Right Forelimb lame

* Soft lunge:
** right rein: 3/10 Right Forelimb lame
** left rein: 2/10 Right Forelimb lame

* Hard lunge:
** right rein: 2/10 RF lame
** left rein: no lameness

* Proximal forelimb flexion, right and left: negative

* Distal forelimb flexion, right and left: negative

==What is your Problem List and Differential List?==

===Problem List===
<font color="white">
* Pain on palpation
* Swelling
* Lameness
* Thickening of Suspensory Ligament
</font>

===Differential List===
<font color="white">
* ?????????
* ????????
</font>

===What is your revised action plan?===
<font color="white">
* Diagnostic Analgesia
* Radiographs and Ultrasound
* Scintigraphy
</font>

==Diagnostic Imaging Results==

===Ultrasonography===
'''Could put in the video of the ultrasound in here and also a link on how to perform an ultrasound'''

Q: What do you think is going?

A: <font color="white"> There is a focal hypoechoic area on the dorsal border of the suspensory ligament at its proximal insertion </font>

===Radiographs===
'''Put in the actual radiographs and a link on how these radiographs where taken'''

Q; How would you interpret these radiographs?

A: <font color="white"> Small radiolucent area with new bone formation on palmar mid aspect of the MC3 of RF. This has questionable significance. </font>

===Scintigraphy===
'''Put in the scintigraphy images and a link'''

Q: How would you interpret these results?

A: <font color="white"> Mild IRU w/in proximal aspect of left MC2. Mild IRU w/in middle aspect of R MC2 - unlikely to be of clinical significance </font>

Has this affected your differential list:
<font color="white">
* ?????????
* ????????
</font>

==Treatment==

Case Report Experiment

Species Considerations with Gastrointestinal Drugs

2008-11-05T14:03:02Z

Jtulloch:

Species Considerations with Gastrointestinal Drugs

2008-11-05T12:12:58Z

Jtulloch:

Species Considerations with Gastrointestinal Drugs

2008-11-05T11:53:06Z

Jtulloch:

Species Considerations with Gastrointestinal Drugs

2008-11-05T11:45:40Z

Jtulloch: New page: {{unfinished}} {{toplink |linkpage =WikiDrugs |linktext =WikiDrugs |sublink1 = Gastrointestinal Drugs |subtext1 = Gastrointestinal Drugs |pagetype = Drugs }}

{{unfinished}}
{{toplink
|linkpage =WikiDrugs
|linktext =WikiDrugs
|sublink1 = Gastrointestinal Drugs
|subtext1 = Gastrointestinal Drugs
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Gastrointestinal Drugs

2008-11-05T11:45:24Z

Jtulloch:

{{unfinished}}
{{toplink
|linkpage =WikiDrugs
|linktext =WikiDrugs
|sublink1 = Body Systems Affected by Drugs
|subtext1 = Body Systems Affected by Drugs
|pagetype = Drugs
}}

* [[Gastroprotective Drugs]]
* [[Emetics and Anti-Emetic Drugs]]
* [[Drugs Acting on the Intestines]]
* [[Liver Drugs]]
* [[Species Considerations with Gastrointestinal Drugs]]

Liver Drugs

2008-11-05T11:44:47Z

Jtulloch: New page: {{review}} {{toplink |linkpage =WikiDrugs |linktext =WikiDrugs |sublink1 = Gastrointestinal Drugs |subtext1 = Gastrointestinal Drugs |pagetype = Drugs }} This is still an area of research...

{{review}}
{{toplink
|linkpage =WikiDrugs
|linktext =WikiDrugs
|sublink1 = Gastrointestinal Drugs
|subtext1 = Gastrointestinal Drugs
|pagetype = Drugs
}}

This is still an area of research as currently there are very few drugs that are capable of treating liver disease.

*'''Trientine dihydrochloride''' is used to treat dogs with'''copper hepatotoxicity''' as it chelates the copper in the liver.

*'''Ursodeoxycholic Acid''', displaces toxic hydrophobic bile acids and increases bile secretion. It is often used for chronic hepatobiliary disorders.

*'''Menbutone''' is given to horses, pigs, cattle and sheep, to increase bile acid secretion and may increase appetite.

Gastrointestinal Drugs

2008-11-05T11:37:55Z

Jtulloch:

Drugs Acting on the Intestines

2008-11-05T11:37:15Z

Jtulloch:

{{review}}
{{toplink
|linkpage =WikiDrugs
|linktext =WikiDrugs
|sublink1 = Gastrointestinal Drugs
|subtext1 = Gastrointestinal Drugs
|pagetype = Drugs
}}

==Drugs Increasing Smooth Muscle Contractility==
These drugs are used for conditions that are associated with '''hypomotility''', such as megacolon, oesophageal reflux, atony and ileus.

====Drugs Acting on 5-HT<sub>4</sub> Receptors====
An examples is '''metoclopramide''' that is an agonist at serotonin and dopamine receptors, this results in an increased release of acetylcholine and so increases gut motility.

====Muscarinic Receptor Agonists====
Examples are '''carbachol''' and '''bethanecol'''. They should be used with slight caution as their resultant contractions can be painful.

==Laxatives and Purgatives==

These drugs should mainly be used to treat '''constipation''', but bulk luxatives can be used to help control diarrhoea.

====Lubricant Laxatives====
An example is '''liquid paraffin''' that is given orally. They supposedly coat and lubricate the contents of the gastrointestinal tract and help soften the faeces, thus making them easier to pass. The use of liquid paraffin is under debated between some clinicians as some feel that it works just as well as water, but has the added risk of causing a very serious pneumonia if the paraffin enters the trachea. On the other hand most equine vets in practice feel that it is a useful tool to help resolve impaction colics.

====Bulk Laxatives====
Examples are '''bran, ispaghula''' and '''stericula''', and they are administered orally. They work by absorbing water and so swell, this stimulates stretch receptors in th gastrointestinal tract and waves of peristalsis are stimulated. They are usedful in controlling diarrhoea because of their absorbant properties.

'''NB''' Never use in dehydrated animals as animals will loose water when these laxatives are in use. Please remember to offer the animal plenty of drinking water.

====Osmotic Laxatives====
An example is '''lactulose''', which is given orally. It works by drawing water into the intestinal lumen, this stretches the intestinal walls resulting in increased peristaltic waves.

'''NB''' Never use in dehydrated animals as animals will loose water when these laxatives are in use. Please remember to offer the animal plenty of drinking water.

====Stimulant Laxatives====
An example is '''bisacodyl''' and is given orally. This works by having an irritant effect on the intestinal mucosa. This stimulates enteric nerves, resulting in increased peristalsis and increased water and electrolyte secretion into the lumen.

====Enemas====
This is where warm water and mineral oil or sodium citrate are administered into the rectum and lower bowels of an animal. This helps evacuate the bowels of an animal before radiographs or surgery.

==Drugs Decreasing Smooth Muscle Contractility==
These drugs are used to treat conditions associated with smooth muscle spasms or diarrhoea.

====Muscarinic Receptor Antagonist====
Examples are '''hyoscine, atropine''' and '''propantheline'''. '''Buscopan''' is a preparation commonly used in large animal medicine that contains hyoscine and the analgesic, dipyrone. They are all administered by injection.

They work by competitively inhibiting the effect of acetylcholine on the intestinal smooth muscle muscarinic receptors. This results in decreased motility and intestinal mucus secretions. It has no effect on fluid secretions. It has a lack of selectivity and so any side effects experienced are due to it's actions on muscarinic receptors at other sites around the body.

'''It is used to help reduce smooth muscular spasms in the gastrointestinal tract.'''

====Opioid Receptor Agonists====
Examples are '''loperamide, diphenoxylate''' and '''codeine''', which are administered orally.

They work by mimicking the action of endogenous endorphins and enkephalins. This results in an increase of transit time of ingesta through the gastrointestinal tract. This allows more time for absorption of fluid; combining this action with it's ability to decrease intestinal fluid secretions it is often a good treatment for diarrhoea.

Loperamide works for prolonged periods on the gastrointestinal tract, as it undergoes enterohepatic recycling. Though it is poorly absorbed and won't cross the blood-brain barrier and so will have no CNS side-effects.

Diphenoxylate is better absorbed than loperamide but doesn't have any effects on the CNS.

Care should be used when given to cats as they cause hyperexcitability on overdose.

==Other Drugs==

====Adsorbents====
Examples are '''bismuth salts, kaolin''' and '''pectin''', which are all given orally. They are used to treat diarrhoea and work by coating the mucus membrane and absorb any chemicals or poisons and so hopefully protect the intestinal mucosa from damage.

====Other Diarrhoea Treatments====
'''Sulphasalasine''' an active 5-amino salicylate and '''glucocorticoids''' sometimes used in some chronic cases of diarrhoea.

====Pancreatin====
This is given to dogs with '''exocrine pancreatic insuffiency'''. Most preparations of it contain enyzmes with protease, lipase and amylase activity to help with the digestion of protein, fat and starch.