Changes

==Diagnosis==

==Diagnosis==

The identification of copious amounts of gastric reflux in the absence of small intestinal distension on rectal examination and the absence of endotoxaemia, increase the possibility of primary gastric dilation.Should the signs of pain abate following

'''Primary gastric dilation''' should be suspected if there are copious amounts of [[Colic Diagnosis - Naso-gastric Intubation|gastric reflux]] in the absence of small intestinal distension on [[Colic Diagnosis - Rectal Examination|rectal examination]] and the absence of endotoxaemia.  A retrospectvie diagnosis of '''primary gastric dilation''' can be made if colic signs cease following decompression, and other clinical parameters return to normal.  Primary gastric dilation does not cause any significant change in peritoneal fluid parameters until rupture occurs.(Proudman)

decompression, and other clinical parameters return to

 

normal, then a retrospective diagnosis of primary gastric

'''Secondary gastric dilation''' should be considered if there is persistent [[Colic Diagnosis - Clinical Signs|colic]], repeated retrieval of [[Colic Diagnosis - Naso-gastric Intubation|nasogastric reflux]], intestinal distension on [[Colic Diagnosis - Rectal Examination|rectal examination]] and clinical signs of [[Colic Diagnosis - Clinical Signs|endotoxaemia]].  These are all indications for '''exploratory laparotomy''' to look for an intestinal obstruction.

dilation may be made. Frequently, the situation is more

 

complex and gastric dilation is secondary to some other

Failure to detect excessive gastric contents by stomach tube aspiration does not entirely preclude their presence. Repeated attempts at obtaining reflux with frequent repositioning of the stomach tube are necessary. For reasons unknown, there are occasions when even the most diligent attempts at gastric decompression are unsuccessful in spite of large volumes of fluid being present. It should also be emphasised that gastric impaction with solid food material is probably too firm to be siphoned by stomach tube.  

gastrointestinal disorder.Persistent abdominal pain, repeated retrieval of

 

gastric reflux, intestinal distension on rectal examination

Septic peritonitis as a result of gastric rupture is reflected in a foetid, turbid peritoneal fluid sample containing particulate matter, a white cell count often in excess of 40 x 10% and a protein content of >30g/l.

and clinical signs of endotoxaemia are all indications that

The diagnosis of gastric rupture may be supported by characteristic findings on rectal examination, namely: a gritty feeling on the serosal surfaces of intestine due to adherent food material, and the impression of 'space' in the abdomen due to gas in the peritoneal cavity.(Proudman)

exploratory laparotomy is necessary to determine

whether there is an intestinal obstruction.Failure to detect excessive gastric contents by

stomach tube aspiration does not entirely preclude their

presence. Repeated attempts at obtaining reflux with

frequent repositioning of the stomach tube are

necessary. For reasons unknown, there are occasions

when even the most diligent attempts at gastric

decompression are unsuccessful in spite of large volumes

of fluid being present. It should also be emphasised that

gastric impaction with solid food material is probably too

firm to be siphoned by stomach tube.

occurs. Septic peritonitis as a result of gastric rupture is

reflected in a foetid, turbid peritoneal fluid sample

containing particulate matter, a white cell count often in

excess of 40 x 10% and a protein content of >30g/l.

The diagnosis of gastric rupture may be supported by

characteristic findings on rectal examination, namely: a

gritty feeling on the serosal surfaces of intestine due to

adherent food material, and the impression of 'space' in

the abdomen due to gas in the peritoneal cavity.(Proudman)

'''[[Colic Diagnosis - Clinicopathologic Evaluation|Laboratory findings]]<ref name="Camp">Campbell-Thompson, M.L, Merritt, A.M (1999) Alimentary system: diseases of the stomach.  In Colahan, P.T, Mayhew, I.G, Merritt, A.M, Moore, J.N ''Equine medicine and surgery'', St Louis, Mosby, pp 699-715.  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>:'''

'''[[Colic Diagnosis - Clinicopathologic Evaluation|Laboratory findings]]<ref name="Camp">Campbell-Thompson, M.L, Merritt, A.M (1999) Alimentary system: diseases of the stomach.  In Colahan, P.T, Mayhew, I.G, Merritt, A.M, Moore, J.N ''Equine medicine and surgery'', St Louis, Mosby, pp 699-715.  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>:'''