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HISTORICAL FINDINGS AND PRESENTING SIGNS

HISTORICAL FINDINGS AND PRESENTING SIGNS. 4 year-old Warmblood mare (500kg) No history of previous illness Good vaccination and anthelmintic programmes ------------------------------------------------------------------------------------------------

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HISTORICAL FINDINGS AND PRESENTING SIGNS

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  1. HISTORICAL FINDINGS AND PRESENTING SIGNS 4 year-old Warmblood mare (500kg) No history of previous illness Good vaccination and anthelmintic programmes ------------------------------------------------------------------------------------------------ One day prior to presentation - transvaginal ultrasound-guided needle aspiration of a 45 day twin conceptus On the day prior to and the day of the procedure, 30mg/kg trimethoprim/sulphadiazine was administered orally twice daily ------------------------------------------------------------------------------------------------ One day following the procedure, the mare presented with depressionand moderate to severe colic CASE B Slide 1/3

  2. CLINICAL FINDINGS (on day of presentation) • Depressed • Moderate to severe abdominal pain (flank-watching / pawing / rolling) • Rectal temperature - 40.5˚C • Pulse rate - 76/min • Respiratory rate - 62/min • Prolonged skin tent, dry gingival mucous membranes, sunken eyes, prolonged capillary refill time (3-4 seconds) • Hyperaemic conjunctival mucous membranes • Abdominal auscultation – absence of audible intestinal sounds • Rectal examination – fluid filled large intestine • Naso-gastric intubation – no reflux Slide 2/3

  3. When you enter the examination room, you will be asked to • Interpret the individual presenting clinical problems and clinical examination findings • Interpret the combined clinical examination findings to formulate a differential diagnosis list, giving justification for the inclusion of each differential diagnosis • Comment on how you would further differentiate between the main differential diagnoses From this stage onwards, further information (clinical and laboratory data) will be provided either on your request or automatically. You will be asked to comment on this data. Slide 3/3

  4. PERITONEAL FLUID ANALYSIS

  5. LABORATORY DATA ON PRESENTATION

  6. Further information • Later on the day of presentation, the mare developed marked diarrhoea • Arterial blood gas data

  7. Further information • Later on the day of presentation, the mare developed marked diarrhoea • Arterial blood gas data Anion gap calculation = 28 (normal = 12-16)

  8. Urinalysis

  9. Therapeutic aims that you would consider at this stage?

  10. The mares progress over the following 6 days is provided below: • Day 1 to 3 • Mare remained clinically depressed • Diarrhoea profuse / 5% dehydration • i.v. hypertonic saline and Ringer’s solution • Day 4 to 5 • The mare was moderately depressed • Diarrhoea profuse / 5% dehydration • Mare willing to drink and maintain hydration • Fluid administration rate reduced (half maintainence) • Days 6 • The mare was clinically bright (heart rate – 44/min) • Diarrhoea still present but less profuse / no clinical dehydration detected • Noted to drink excessively (approximately 70 – 120L water per day) • Bedding very wet

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