Changes

*Ingesta appears at the nares in severe cases (rare)

*Ingesta appears at the nares in severe cases (rare)

*Gastric reflux  

*Gastric reflux  

NB: the time to development of reflux is proportional to the distance to the intestinal segment involved, (e.g. 4 hours with duodenal obstruction<ref>Puotunen-Reinert, A, Huskamp, B (1986) Experimental duodenal obstruction in the horse.  ''Vet Surg'', 15:420-428.  In: Sanchez, L.C (2010) ''Other Disorders of the Stomach'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 15.</ref>).  Furthermore, '''''nasogastric intubation does not preclude the possibility of gastric rupture.<ref name="Todhunter">Todhunter, R.J, Erb, H.N, Roth, L (1986) Gastric rupture in horses: a review of 54 cases. ''Equine Vet J'', 30:344-348.</ref>'''''

''NB: the time to development of reflux is proportional to the distance to the intestinal segment involved, (e.g. 4 hours with duodenal obstruction<ref>Puotunen-Reinert, A, Huskamp, B (1986) Experimental duodenal obstruction in the horse.  ''Vet Surg'', 15:420-428.  In: Sanchez, L.C (2010) ''Other Disorders of the Stomach'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 15.</ref>).  Furthermore, '''nasogastric intubation does not preclude the possibility of gastric rupture.<ref name="Todhunter">Todhunter, R.J, Erb, H.N, Roth, L (1986) Gastric rupture in horses: a review of 54 cases. ''Equine Vet J'', 30:344-348.</ref>'''''

'''Gastric rupture''' typically results in:

'''Gastric rupture''' typically results in:

*Muscle fasciculations

*Muscle fasciculations

*Blue or purple mucous membranes<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>

*Blue or purple mucous membranes<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>

NB: rupture of a stomach containing dry, fibrous material may produce a more insidious onset of clinical signs of peritonitis than rupture of a fluid distended viscus. This probably relates to the speed at which gastric contents are able to disperse around the peritoneum.<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>

''NB: rupture of a stomach containing dry, fibrous material may produce a more insidious onset of clinical signs of peritonitis than rupture of a fluid distended viscus. This probably relates to the speed at which gastric contents are able to disperse around the peritoneum.''<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>

==Diagnosis==

==Diagnosis==