Colic I Flashcards
(85 cards)
1
Q
Two most common causes of GI colic:
A
- Bad management
2. Intestinal “accidents”
2
Q
Common management factors that can cause GI colic:
1. 2. 3. 4. 5.
A
- sand
- high quality
- excessive CHO
- enough water
- fecals/deworming performed
3
Q
Two most broad causes of non-strangulating lesions:
1.
2.
A
- Impactions
2. Displacements
4
Q
Most common places for impactions:
1. 2. 3. 4. 5.
A
- Pelvic flexure
- right dorsal colon
- transverse colon
- small colon
- gastric impaction
5
Q
Sand impactions:
Dx methods:
1.
2.
3.
A
- auscultation
- Fecal float/sink
- Abdominocentesis reveals sand
6
Q
Sand impactions:
Most common location for impaction?
A
RIGHT DORSAL COLON
7
Q
Sand impactions:
Clinical presentation
A
chronic MASSIVE and HEAVY lump
8
Q
Cecal Impactions:
Clinical presentation
A
mild to moderate pain, usually acute but can be chronic.
9
Q
Cecal Impactions:
- most common type affected?
- Prognosis with sx?
- ___% can rupture
A
- cecal base/cupula impactions
- excellent
- 57
10
Q
Fecal impactions: Tx options?
A
Medical = fluid therapy
Surgical = pelvic flexure enterotomy***
11
Q
What parasite can cause ascarid GI impaction? when?
A
Parascaris equorum. 24hrs after deworming
12
Q
What parasite can cause verminous arteritis that leads to thromboembolic disease induced ischemic bowel?
How do you treat it?
A
Strongylus vulgaris
anthelmintic/ivermectin
13
Q
What parasite causes problems at the ileocecal junction? What disease does it cause?
A
Anoplocephala perfoliata (tapeworm).
Ileocecal intussusception
14
Q
Bezoars / Enteroliths:
- Name if caused by hair? By fiber?
- Where do they impact?
A
- trichobezoars. phytobezoars.
2. Transverse colon
15
Q
Stangulating lesions:
- Usually broadly caused by ______
- cause of ___-___% of SI colic are caused by strangulating lesions
A
- intestinal “accidents”
2. 58-85%
16
Q
4 Main types of strangulating lesions:
1.
2.
3.
4.
A
- Lipoma
- volvulus/torsion of large colon
- EFE (epiploic foramen entrapment
- Mesenteric volvulus
17
Q
Strangulating Lipoma:
Prognosis?
A
short term survival in 48-85% of cases
18
Q
Lipoma:
- Most common location?
- Average age affected?
- Tx via
A
- > 90% in small intestine
- 14-19 yr
- Exploratory celiotomy to perform resection/anastomosis
19
Q
Epiploic Foramen Entrapment
- EF aka _____
- Boundaries of EF?
A
- Foramen of Winslow
2. Caudate process of the liver, Portal vein, Gastropancreatic fold
20
Q
EFE:
- Usually strangulates the (small/large) intestine?
- Usually (left to right / right to left)?
- Ages?
- Predisposing behavior?
A
- small
- left to right
- all ages
- cribbing
21
Q
EFE Surgery:
- surgical technique?
- Main complication?
A
- manual reduction
2. Portal vein tear
22
Q
EFE Surgery:
- __x more likely to require repeat surgery.
- EFE associated with
A
- 4x
2. decreased survival
23
Q
Volvulus is (common/rare) in large colon?
A
common
24
Q
Clinical presentation of Large Colon volvulus?
A
severe unrelenting pain with rapid CV compromise.
25
Risk factors for large colon torsion:
1.
2.
3.
1. Post parturient mare
2. diet change
3. recent access to lush pasture
26
In addition to PE for colic exam, ALWAYS _____
***insert NG tube***
27
Rectal Exam: what can be palpated in the middle?
1.
2.
3.
1. Aorta = dorsal midline
2. Inguinal rings = ventral
3. Small colon
28
Rectal Exam: what can be palpated on the right?
1.
2.
3.
1. cecum
2. colon
3. right ovary
29
Rectal Exam: what can be palpated on the left?
1.
2.
3.
1. left kidney
2. spleen
3. left ovary
30
T/F: abdominal ultrasound is a routine part of the colic exam?
T
31
Things abdominal ultrasound can confirm:
1.
2.
3.
4.
1. LDD
2. SI distension
3. bowel thickening
4. free fluid
32
FLASH technique:
left side:
1.
2.
3.
4.
1. Ventral abdomen
2. Gastric window
3. Spleno-renal window
4. Left middle 1/3rd of abdomen
33
FLASH technique:
right side:
1.
2.
3.
1. Duodenal window
2. Right middle 1/3rd of abdomen
3. cranial ventral thorax
34
Therapeutic uses for Nasogastric Intubation:
1.
2.
3.
1. gastric decompression
2. Esophageal choke
3. Administration of medication
35
NG tube placement:
You want to place your thumb and forefinger of your non-dominant hand (ventrally/dorsally) and (medially/laterally) into the ventral meatus
ventrally and medially
36
NG tube placement:
1. Place with tube facing (down/up)?
2. What do you do when you reach the pharynx?
1. down.
| 2. rotate 180 degrees and gently bump the pharynx to stimulate swallowing
37
NG tube intubation complications:
1.
1. Iatrogenic epistaxis
38
How to create a siphon using an NG tube?
Pump water down the tube, disconnect, than pull the tube back in short jerky motions to create a siphon
39
T/F: Spontaneous reflux is never normal
T
40
Net increase in reflux via NG tube can be due to :
1.
2.
3.
1. Ileus
2. Obstruction
3. Strangulation
41
T/F: If net reflux or spontaneous reflex is present, you cannot give medication through an NG tube
T
42
Copious amounts of net reflux is probably coming from (small/large) intestine, and is probably due to:
1.
2.
3.
small intestine
1. anterior enteritis
2. Impaction
3. Strangulation
43
Response to NG decompression if colic is due to Ileus?
HR decrease, pain relief that leads to depression
44
Response to NG decompression if due to mechanical obstruction or strangulation?
Persistent pain and tachycardia
45
Why is it important to remove NG tube asap?
It can be irritating to mucosa and pharynx/esophagus
46
Location for abdominocentesis for colic?
** on or to the right of ventral midline, caudal to xyphoid (most ventral)
47
Abdominocentesis: Cannula Technique:
1. (is/is not) aseptic?
2. Anesthetic?
1. is.
| 2. local block - carbocaine and 25 ga needle
48
Abdominocentesis: Cannula technique:
1. Incision technique?
1. Use #15 blade through skin and SQ and into linea alba/external sheath
49
Abdominocentesis: Needle Technique:
1. (is/is not) aseptic?
2. Insertion technique?
1. is
| 2. 18-20 ga needle through skin, SQ, linea, and peritoneum
50
Peritoneal fluid analysis:
Lactate:
1. ***Normal levels?
2. 30% survival if what level?
1. < 2.0
| 2. > 7.0
51
T/F: Normal abdominocentesis does not rule out the need for surgery
T
52
Signs of early shock due to colic:
1.
2.
3.
4.
1. elevated HR
2. Pale mm
3. Slow prolonged CRT
4. Decreased pulse pressure
53
Signs of late shock due to colic:
```
1.
2.
3.
4.
5.
6.
```
1. elevated HR
2. weak/thready pulse
3. muddy/red mm
4. SLOW as shit CRT
5. cool/cold extremities
6. acid/base abnormalities
54
Multimodal options for pain management in colic:
1.
2.
3.
4.
1. NSAIDs
2. Alpha-2 agonists
3. Opioids
4. Spasmolytics
55
NSAIDs for pain mangement of colic:
1. Which is given most commonly? What is the main rule of it's administration
Flunixin meglumin
Do not give more often than every 12 hours
56
Alpha 2 agonists for pain management of colic:
Drug options:
1.
2.
3.
1. Xylazine
2. detomidine
3. Romifidine
57
Pain management of colic:
1. Main opiod you can give?
2. Main spasmolytic you can give?
1. Butorphanol
| 2. Buscopan
58
U/S of umbilicus and abdomen for PE of colicky foal:
What are the normal sizes of the:
1. Umbilical vein?
2. Umbilical artery?
3. Arteries/urachus combo?
1. < 1 cm
2. < 1.3 cm
3. < 2.5 cm
59
Umbilical U/S:
1. Probe size?
1. > 5MHz probe
60
Most common umbilical infectious agent?
Gram - and B- hemolytic strep infections
61
Etiologies of newborn foal colic:
```
1.
2.
3.
4.
5.
```
1. Meconium impaction
2. Gastric ulceration
3. Enteritis
4. Inguinal hernia with ruptured tunic
5. Sepsis
62
Etiologies of colic in 2-5 day old foal:
1.
2.
3.
1. Ruptured bladder
2. Gastric ulcers
3. Enteritis
63
Etiologies of colic in older foals:
```
1.
2.
3.
4.
5.
```
1. Gastroduodenal ulcers
2. Enteritis
3. SI volvulus
4. Intussusception
5. Ascarid impaction
64
Etiologies of Colic in Foals: Gender disposition:
Colts more likely to get ____ and ___
Fillies more likely to get ____ and ___
1. Meconium impaction and inguinal hernia
Ruptured bladders and ureteral abnormalities
65
Sedative Options for Pain Management in a Colicky Foal:
1.
2.
3.
1. Benzos - Diazapam
2. Alpha 2 agonists (MUST BE 2 WEEKS OF AGE MINIMUM) - Xylazine
3. NSAIDs - Banamine
66
Newborn Foal Colic - Meconium Impaction:
1. Typical end result?
2. A (common/rare) cause of colic in newborns?
1. Passes w/i 3 hours
| 2. common
67
Newborn Foal Colic - Meconium Impaction:
Treatment method?
Fleet enema using warm soapy water, 4% acetylcysteine. DO NOT FORCE IT IN
68
Newborn Foal Colic - Inguinal Hernia
1. (acute/chronic) onset?
2. (mild/severe)?
1. acute
| 2. severe
69
Newborn Foal Colic - Inguinal Hernia
Treatment methods?
1. Inguinal approach surgery
2. IgG admin
3. Antibiotics
4. Pain control
70
2-5 Day old foal - Ruptured Bladder:
1. Where is rupture likely to happen in males? in females?
2. Three main aspects of clinical presentation?
1. dorsal aspect of bladder. Urachal rupture
| 2. Abdominal distension, colic, and electrolyte derangement
71
Diagnosis of Ruptured Bladder in foal: Options
```
1.
2.
3.
4.
5.
6.
```
1. Signalment
2. History
3. Bloodwork = ELECTROLYTES
4. ECG abnormalities!
5. U/S
6. Measure Peritoneal creatinine
72
1. U/S of Ruptured bladder in a foal will reveal...
| 2. Peritoneal Creatinine levels in a foal with ruptured bladder?
1. Free fluid in abdomen with no/very small bladder
| 2. Elevated. Serum: PEritoneal Creatinine ratio > 1:2
73
T/F: Ruptured Bladder is not a surgical emergency
T
74
How would you medically stabilize a ruptured bladder before surgery?
Ensure K+ > 5.5mEq/L
75
Ruptured Bladder: Surgical Treatment:
1. Approach?
2. Describe initial Incision?
1. Ventral Midline
| 2. Elliptical incision around umbilicus
76
Ruptured Bladder: Surgical Treatment:
1. Remove _____
2. Double ligate what structures?
3. Trim ____
1. Urachal remnants
2. 2 umbilical arteries and vein
3. edges of the tear
77
Ruptured Bladder Surgery:
1. Closure technique?
2. Suture type?
3. DO NOT USE WHAT SUTURE TYPE? WHY
1. Two layer closure: simple continous followed by cushing/lembert pattern
2. Absorbable monofilament 3-0
3. Dexon - may create urolith
78
Ruptured Bladder: Aftercare/Prognosis:
1. (Do/Do not) give antibiotics?
2. Prognosis is (bad/good)?
1. Do! Broad spectrum
| 2. Excellent
79
Atresia Coli:
1. (common/rare)?
2. Diagnosis method?
1. rare
| 2. Radiographs +/- Barium enema
80
Intussusception in Older Foals:
1. Colic presentation?
1. acute severe colic
81
Intussusception: in Older foals: Best ways to dx?
1.
2
3.
1. PE
2. Bloodwork
3. U/S = Bullseye appearance with distended amotile SI proximal to lesion
82
Intussusception in Foals: Prognosis?
Fair to guarded, depending upon severity, whether or not you had to R/A, and if adhesions formed
83
SI Volvulus in Foals:
1. "___" formation.
2. Twists where?
1. Corkscrew
| 2. At root of mesentery.
84
SI Volvulus in Foals:
1. Treatment?
1. R/A the compromised bowel
85
Gastric outflow obstruction in foals:
1. Secondary to...
2. Treatment?
3. Prognosis?
1. Pyloric stenosis from ulceration
2. Bypass - Gastroduodenostomy
3. Guarded
