18. Medical GIT 1 Flashcards
(20 cards)
What are the steps to a colic work up?
Screen the call - emergency or not
Observe the horse
TRP and Nasogastric Tube
PE
Rectal Palpation (W/Ultrasound)
Abdominal ultrasound
Abdominocentesis - if referring may want to see severity
Bloodwork
What are some important questions to ask to determine if a colic is emergent?
What are they doing? How long have they had those signs? How severe? Have they had colic surgery in the past?
How do you know the horse needs immediate care?
Severity - breaking through pain drugs
Signalment
Recent history (colic or foaling)
Diet change
If a horse is trying to go down and you got a HR of 62 what do you do?
Sedate and pass a nasogastric tube and measure the amount of reflux
How do you determine if the colic is a “treat on farm” or a “referral” case?
Referral:
Look at MM
Think about amount of reflux (obstruction) >6-8L
-Pain level (Unrelenting pain only briefly controlled with sedation)
HR >60bpm, slow CRT
Abnormal rectal palpation
Client willingness to refer
What findings indicate euthanasia?
Evidence advanced endotoxic shock, rupture possible
Advanced disease and client can’t or won’t refer to a hospital
Advanced disease and horse is a long distance from practice making recheck or return for euthanasia difficult
How do you estimate hydration status in a horse?
MM color
CRT
Pulse quality
Peripheral temperature
Skin Tent
PCV and TP
4-6% = 2-3 sec ST, fair MM, 1-2CRT, 40-50PCV, 6-7.5PCV
7-9% = 3-5 sec ST, Sticky MM, CRT 2-4, 50-65PCV, 7-8.5 TP
>9% = >5ST, Dry MM, >4CRT, >65 PCV, >8.5 TP
How do you calculate the volume of fluid therapy a horse with GI disease should receive?
Dehydration = 0.08% x BW Kgs = L
Maintenance = 50ml/kg/day
Ongoing loss = guess x 24hr x 1.5 = L
Add up for total fluid needed
What are the goals of fluid therapy?
Rehydrate and establish perfusion
Keep up with Maintenace and ongoing losses
How do you know if you should use oral or venous fluids?
Does the GIT have motility (yes - oral, no - IV)
How quickly does the horse need them (fast -IV)
How well does the horse tolerate the NG tube? (well, oral)
How long do they need fluid (long time, IV)
Can the owner afford or manage IV?
How available are you
How do you administer oral fluids to a horse?
Place small bore (8mm) NG - tape in place, over with a syringe or glove to keep air out, mark position black marker
-Teach client to check reflux
Prep: Plain water ok for a few dosease, repeat with water deplete electrolytes (add 75g lite salt per 10L)
Make up perfusion deficit quickly 40-50% first hour, remaining 4-6hr
Keep up Maintenace and ongoing
What is the maximum volume of fluid that can be administered in a horses stomach?
500kg = 16L
Only deliver 10L in 30 min
For oral delivery, what is the shock rate for the first hour?
45mls/kg/hr
20L/hr
No more than 10L per 30min
Recheck reflux before administering more fluids
*Monitor protein if diarrhea
What does IV fluid administraion look like in the field?
1 time administration 5-20L
Shock rate 45ml/hr or 22.5L/hr in 500kg
Why use IV rehydration in field?
-Reestablish perfusion, bridge to oral fluid, bridge tube feeding in neonates
-Shock or exhaustion
-Restore hydration/perfusion
-Acute hemorrhage
What are the advantages and disadvantages of the oral route?
Cheap, on farm, low risk
Tube pulled out in trachea, client needs to recognize reflux
What are the advantages and disadvantages of IV?
Fast rehydration
Hard to manage on farm
Shock may need it
How do you monitor a horses response to fluid therapy?
PE
Weight
USG
PCV/TS
Electrolytes
Every few hours rapid delivery
12hr unstable, 24 once stabilized
When monitoring your patient what would you see if you overhydrate or under hydrate them?
Over: Excessive urination, edema, increase RR, fluid sound, dull
Under: Tachy, elevated abdomen, not enough urine
Edema but concentrated urine = protein issue
How do you provide rapid, temporary restitution of perfusion?
Hypertonic saline
4ml/kg (1-2L 500kg horse)
