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[急性腹痛马匹的检查——临床病理学与诊断影像学]

[Examination of horses with acute colic - clinical pathology and diagnostic imaging].

作者信息

Cavalleri J-M V, Bienert-Zeit A, Feige K

机构信息

Klinik für Pferde, Stiftung Tierärztliche Hochschule Hannover, 30559 Hannover.

出版信息

Tierarztl Prax Ausg G Grosstiere Nutztiere. 2013;41(2):124-34; quiz 135.

Abstract

The article summarizes the relevant clinical pathological assessment of horses with acute colic. A minimal laboratory evaluation should include the patient's haematocrit (or packed cell volume), total protein, and lactate concentration in the blood. Haematocrit and total protein provide an indication of the severity of dehydration (haematocrit < 0.45 l/l is evidence of no to mild dehydration whereas > 0.5 l/l points to a severe dehydration). The degree of dehydration is often associated with the severity of the colic. Additionally, the blood lactate concentration rises with increasing intestinal compromise with a concentration of > 4 mmol/l indicating a guarded prognosis. However, it is crucial to assess laboratory values only in the context of the clinical findings. If an abdominocentesis is performed, the leukocyte count and the protein and lactate concentrations offer valuable information regarding the type of colic, the severity of the lesion, further therapy, and prognosis of the colic. Reddish discolouration of peritoneal fluid may be a sign of a strangulating obstruction. Transcutaneous abdominal ultrasonography may provide a crucial insight into the colic cause and severity in a relatively short time, even for inexperienced examiners. In regards to small intestinal lesions, dilated small intestinal loops can often be imaged ultrasonographically before they can be palpated transrectally. The occurrence of free peritoneal fluid and dilated small intestine as well as the evaluation of the intestinal wall and the extent of the gastric wall, allow a better management of the acute colic patient. In ponies and foals, radiography as a further diagnostic imaging modality of the abdomen is of great value. It can help to visualise sand impactions, meconium impactions, or gastrointestinal atresia in the neonate.

摘要

本文总结了马急性腹痛的相关临床病理评估。最低限度的实验室评估应包括患者的血细胞比容(或红细胞压积)、总蛋白以及血液中的乳酸浓度。血细胞比容和总蛋白可提示脱水的严重程度(血细胞比容<0.45 l/l表明无脱水至轻度脱水,而>0.5 l/l则提示严重脱水)。脱水程度通常与腹痛的严重程度相关。此外,随着肠道损害的加重,血液乳酸浓度会升高,浓度>4 mmol/l表明预后不佳。然而,仅在临床检查结果的背景下评估实验室值至关重要。如果进行腹腔穿刺术,白细胞计数、蛋白和乳酸浓度可提供有关腹痛类型、病变严重程度、进一步治疗以及腹痛预后的有价值信息。腹腔液发红可能是绞窄性梗阻的迹象。经皮腹部超声检查即使对于经验不足的检查者来说,也可能在相对较短的时间内对腹痛的原因和严重程度提供关键的见解。对于小肠病变,在经直肠触诊之前,扩张的小肠袢通常可以通过超声成像显示。游离腹腔液和扩张小肠的出现以及肠壁和胃壁范围的评估,有助于更好地处理急性腹痛患者。在矮种马和驹中,腹部X线摄影作为另一种腹部诊断成像方式具有重要价值。它有助于观察到沙子阻塞、胎粪阻塞或新生儿胃肠道闭锁。

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