Final Flashcards
(275 cards)
1
Q
True/False: Inflammation (Ex. Enteritis) leading to Colic will Typically present as Strangulating Disease
A
True
2
Q
How to Diagnose Choke
A
NG Intubation- Inability to Enter Stomach
*Endoscopy- Used to Asses Presence and Extent of Damage to Esophagus but not necessary for Diagnosis
3
Q
Diagnostic Test used to Confirm Cases of Diaphragmatic Hernias
A
Ultrasound
4
Q
Medical Managment that can be used in Patients with Equine Metabolic Syndrome in Horses not responding to Exercise and Diet Strategies
A
Levothyroxine Sodium
5
Q
How would Non-Strangulating Small Intestinal Disease Differ from Strangulating Small Intestinal Disease?
A
Less Cardiovascular Compromise
Variable/Less Reflux
Less Tightly Distended Loops on Rectal Palpation
6
Q
Typical Clinical Sign in Horses with Dsyuria/Stranguria
A
Urine Scalding of Hind Limbs
7
Q
Treatment for Left Dorsal Displacement (LDD) of Large Colon
A
Medical: IV Phenylephrine -Causes Contraction of the Spleen and Release of Large Colon
Surgery: Ventral Celiotomy- If Phenylephrine does NOT work
*When Done with Phenylephrine Drip, Jog the Horse around for 15 Mintues and then Re-Rectal the Horse
8
Q
Three Most Useful Indicators of Liver Disease
A
SHD
GGT
Serum Bile Acids
*In the Face of Significant Liver Disease, at least one of the three will be Elevated
9
Q
After Gastric Decompression the Horse is in Less Pain. 100 mg Xylazine is Administered. The Mare stays relatively Pain Free for 30 Min. Pain Increases Again and another 9.5 L of Reflux is Obtained. The Mare is Administered another 100 mg of Xylazine which keeps her Comfortable for longer. It is 1 Hour later that she is Refluxed again, 10L reflux Obtained. The Mare is Progressively Depressed. Analysis of the Peritoneal Fluid is Obtained by Abdominocentesis reveals Serosanguinous TP = 4.5 g/dL, WBC = 11,600
What Features of the Case helped Make the Decision for this Diagnosis (Duodenitis Proximal Jejunitis)?
A
The Rectal Palpation- Moderately Distended Loops
The Abdominocentesis- TP Increased
The Volume of Reflux- Copious Amounts of NG Reflux
The Response to Reflux- Pain Subsides or abates after Decompression, most Horses Remain very Depressed
The Temperature- Rectal Temperature > 101 F
The CRT- Prolonged CRT (> 3 seconds)
10
Q
Renal Toxicity Described Below:
Most common Cause of Tubular Nephrosis in Horses
Risk of Acute Renal Failure- Increased if concurrent use of NSAIDs, Dehydration, Endotoxemia, Prolonged Administration (> 10 Days)
Clinical Signs- Typically Polyuric, Depression and Anorexia
A
Aminoglycoside Nephrotoxicity
11
Q
A
Free-Flow
*Free-Flow most commonly used- Put new Bedding in Stall
12
Q
What Drug should be AVOIDED when Treating Liver Disease
A
Diazepam
*Enhances Effects of GABA on Inhibitory Neurons
*AVOID Diazepam in Horses with Liver Disease
13
Q
A
1. The Rectal Palpation- Empty Caudal Abdomen/Reduced Palpable Loops
2. The Abdominocentesis
7. The Progression- Recurrence/Episodic Colic
*Most Diaphragmatic Hernias in the Horse are going to be Large- More than just the Small Intestine will be herniated through the Diaphragm into the Thorax. Will not Feel normal Structures on Rectal Palpation because they are all pushed Forward (Empty)
14
Q
Three Risk Factors of PRIMARY Non-Strangulating Large Colon Impaction
A
Teeth- Dental Abnormalities
Winter Season
Water Restriction
*Most Notably will see Primary Non-Strangulating Large Colon Impactions Develop in Winter Months
If horses have Poor Dentition they are going to be Chewing their hay less well and therefore will have larger Fiber Components in their colon which will predispose them to impactions
15
Q
______ Mechanisms likely MAJOR underlying Cause of Ileus regardless of Initial insult
A
Inflammatory
*Late stage POI is mainly associated with Inflammatory Mechanisms irregardless of what the underlying cause is
16
Q
Differential for Small Intestinal Strangulating Disease where the Animal gets Progressively Depressed
A
DPJ (Anterior Enteritis)
17
Q
Three Most Common Etiologies leading to Cresty Necked Horses
A
Hypothyroid
Pituitary Adenoma
Equine Metabolic Syndrome
18
Q
A
B, C, D, E
*High Levels of Glucose in the Blood leading to Glucosuria
19
Q
Pathophysiology of which Cause of Colitis:
Obligate Intracellular Parasite which Infects Trematode
Trematode then Infects Snails and many Aquatic Insects
Focus on Fresh Water Snails and Fluke
Inadvertent Ingestion of Aquatic Insects and Snails
A
Potomac Horse Fever
*Accidental Ingestion of the Infected Trematode Vector- How the Horse Develops Disease- Be Careful with Feed and Water Sources
20
Q
Most Diagnostic Serum Abnormality in Patients with Hyperlipemia
A
Serum Triglyceride Levels in Excess of 500mg/dL
21
Q
NG Reflux: None
Rectal: Very Firm Slightly Indentable Structure in Left Ventral Quadrant. Filled Structure coming across Pelvic Inlet
Abdominocentesis: TP
What is the Likely Diagnosis in this Case?
A
Large Colon Impaction
*Non-Strangulating Large Intestine
*Normal Abdominocentesis- Common with Non-Strangulating Lesions
Colitis- Inflammatory Disease of the Large Colon that looks STRANGULATING
Large Colon Volvulus = Strangulating
Cecal Impaction- Would be Located in the Right DORSAL Quadrant
22
Q
On Rectal Palpation, if Kidney is Larger, Softer and Painful it is ____Disease
A
Acute
23
Q
_____ Dorsal Displacement of the Large Colon is also known as Nephrosplenic Entrapment
A
Left Dorsal Displacement (LDD)
*Large Colon becomes Distended and Filled with Gas. The Colon Migrates up along the Body Wall and hooks into the Nephrosplenic Ligament. Large Colon becomes stuck in the Space because there is a Ledge on the Spleen
*Main Therapy for Left Dorsal Displacement of the Large Colon targets the SPLEEN. Contraction of the Spleen will Minimize the Ledge and the Large Colon will no longer be Entraped
24
Q
A
Albuminocytologic Dissociation
*VERY Elevated Protein in the Abscence of Increased WBC
25
Treatment for **Ruptured Bladder in Foals**
**Stabilize First- Correct Electrolyte Imbalance**
**NaCl Fluids**
_\*MEDICAL EMERGENCY (not a Surgical Emergency)_
26
**Ileal Impaction associated with Bermuda Grass Hay**
_\*Non-Strangulating Small Intestine_
27
**Review Card: Comparison of DPJ to Strangulating Obstruction**
_**\***Patients with **DPJ are Depressed and Painful** while Patients with **Strangulating Obstruction are just Painful**. In Patients with DPJ the Depression Increases as the Pain decreases (Decompression). In Patients with Strangulating Obstructions the Pain never Decreases_
_After **Nasogastric Intubation**, Patients with **DPJ will become Depressed and Quiet as Decompression relieves the Pain**, while Patients with **Strangulating Lesions will have No Pain Relief**_
_Rectal Temperature- Patients with **DPJ will have a Rectal Temperature between 101.5-102.5 (Infection)** while Patients with **Strangulating Obstrufctions will have a Rectal Temperature**_
_Abdominocentesis- Patients wtih **DPJ will have WBC less than 5,000/uL** while patients with **Strangulating Obstructions will have WBC between 3,000-20,000/uL**_
28
Normal **Urine Specific Gravity** in a Horse
**1.020-1.050**
29
Differential for **Small Intestinal Strangulating Disease** where the Animal is **Febrile**
**DPJ (Anterior Enteritis)**
_**\***Fever Typically \> 101 F_
30
What will you find on _Abdominocentesis_ in a **Foal with Ruptured Bladder**
**Creatinine Greater than That of Serum**
31
_Three Electrolyte Abnormalities_ seen in **Foals with Bladder Rupture**
**Hyponatremia**
**Hypochloremia**
**Hyperkalemia**
32
**The Abdominocentesis**- _Peritoneal Fluid Changes may not Reflect the Degree of Intestinal Necrosis because "Dead" Bowel is essentially isolated from the Peritoneal Cavity_
**The Progression-** _Acute Colic Followed by Intermittent Colic_
_**\***The More Gut that Telescopes into the next segment, the more compromise you're going to have to that Internal Segment_
_\*There is a HUGE Lag in seeing Abnormalities on the Abdominocentsis in these Horses_
33
Three Causes of **SECONDARY _Non-Strangulating_ Large Colon Impaction**
**Sand Enteropathy**
**Enterolithiasis**
**Colonic Displacements**
_**\***Secondary Non-Strangulating LI Disease is MORE Likely to Progress to Strangulating Disease_
34
**Review Card: C1 and C2**
_**\***Be abe to Recognize C2 and C6 on a Radiograph_
_**Arrows = Skijumps:** On the Ventral Aspect of the Vertebrae in an Abnormal Vertebrae they are going to get Remodeling Ventrally such that it makes a Scoop. At the end of the Vertebrae they will have Caudal Epiphyseal Flare. A Scoop and Flare Together looks like a Skijump_
**_Three Cervical Vertibra on a Radiograph that Look Identical- C3, C4, C5_**
35
Only Specific _Antemortem Test_ used to Diagnose **Rabies**
**IFA of Tactile Hair**
_\*Immunoflouresence = IFA_
36
Patients with **Blister Beetle Toxicosis** Frequently Develop Severe \_\_\_\_\_\_
**Hypocalcemia**
_**\***Blister Beetle Toxicosis- High Degree of Hypocalcemia_
37
In Horses with _Icterus_, **Ratio of Direct (Conjugated) Bilirubin to Total Bilirubin in Excess of 25-30%** is associated with \_\_\_\_\_\_\_
**Cholestatic Disease**
38
Typical Protocol used to _Manage Pain_ in Horses with **Spasmodic/Simple Colic**
**1. Flunixin Meglumine-** _Every one of these Horses should be given a dose of Flunixin Meglumine. Flunixin not only helps to control the pain but it is also part of the therapy for Endotoxemia_
**_2. Xylazine (Alpha 2 Agonist)_**
_\*There is NO Better group of Drugs addressing Gastrointestinal Pain associated with Colic than **Alpha 2 Agonists: The Best drugs to use to address the Pain in a Colic Horse**_
_**Protocol:** First Administer Flunixin Meglumine. If it Doesn't really work then Dose with Xylazine. After a Couple Doses of Xylzaine, if it is Not working then add in Butorphanol. If you are Administering Xylazine and Butorphanol and its not really Holding off the Pain and you need to ship the Horse then you could potentially give Detomidine_
39
Treatment for **Acute Renal Failure**
**Fluid Therapy**- _Correct Volume Deficits and Electrolyte, Acid-Base Abnormalities_
_**Furosemide-** Every 1-2 Hours_
_\*Stop Nephrotoxic Drugs_
40
**Review Card: Colic in Foals**
**_In the First Few Days of life we have two Major Differentials- Meconium Impaction, Ruptured Bladder_**
41
Which **Small Intestinal Strangulating Disease** tend to have **Recurrent Colic Episodes?**
**Strangulating Lipomas**
**Diaphragmatic Hernias**
42
One of the Number one Treatments that we use in **Colic** Patients on a Routine Basis is _____ Infusions, to _Prevent Post-Op Ileus_
**Lidocaine**
_**\***Prevents Post-Op Ileus in Colic Patients- **The vast majority of Surgical Colic Cases are going to routinely be placed on Lidocaine**_
43
Diagnosis based on this Myelography of the **Equine Neck**
**Equine Wobblers (Cervial Stenotic Myelpathy)**
**\***Definitive Diagnosis- **_50% or Greater Decrease in Diameter of Dorsal and Ventral Dye Column at Diametrically Opposed Sites_**
44
Risk Factors for which **Brain Stem Disease:**
**Head Shakers**
**_Eating Hard Feeds (Corn)_**
**_Loud Vocalization_**
**_Yawing_**
**Otitis Media Interna**
**\***_Fusion of the Temporal Bone and as Forces are Repurrcused through the bone structures they will end up Fractoring_
45
How to Diagnose **Clostridial Colitis**
**Identify Toxins in Feces (ELISA)**
_\*Clostridial Organisms are Ubiquitous in the Environment- Horse Normally have Clostridum in their Intestinal Tract_
46
_Six Syndromes_ of Equine ______ Infection:
## Footnote
**_Fever with Leukopenia_**
**_Colic with Diarrhea_**
**_Colic Without Diarrhea_**
**_Proximal Enteritis/Jejunitis_**
**_Septicemia_**
**_Asymptomatic Carriers_**
**Salmonellosis**
_**\***Classic Case- Colic with Diarrhea_
47
How to Monitor for **NSAID (Phenylbutazone) Nephrotoxicity** in Horses
**Specific Gravity**
_**\***Loss of Concentrating Ability is the EARLIEST sign of NSAID Toxicity_
48
Is this the Right or Left **Ureter?**
**Right**
_**\***You are coming from Behind the Horse_
49
_Infectious Etiology_ of **Colitis** Described Below:
**_Most Frequently Diagnosed Infectious Cause of Diarrhea in Horses_**
_**Highly Contagious** and Potentially Zoonotic_
_Risk Factors: **STRESS Induced Disease**_
_Asymptomatic Carriers under stress can shed the Organism_
**Salmonellosis**
_**\***STRESS INDUCED- Ex. Long Distance Shipping, Competing a Lot_
_The Patients that are Brining in the Salmonella are NOT Sick- Asymptomatic Carriers_
50
_Risk Factors/Predisposing Factors_ associated with \_\_\_\_\_:
**_Feed Associated Problems- Hay Cubes, Pellets, Beet Pulp_** _(Expansible Feeds)_
**_Horse Associated Problems- Dental Abnormalities, Esophageal Abnormalities_**
**_Managment Associated Problems- Competition, "Bolting"_**
**Choke**
_**\***VERY COMMON Cause of Choke- Dental Abnormalities_
51
**Post-Operative Ileus** Describe Below:
**Uncomplicated Post-Op Ileus**
_\*Post-Op Ileus is Common in the Horse- **20% of Post Op Colic Cases deveop Ileus**_
**_Uncomplicated Post-Op Ileus is expected after Abdominal Surgeries- Motility should Return within a Couple of hours after Surgery in Uncomplicated Cases._** _When performing Abdominal surgery, Gut Manipulation activates Mechanoreceptors which inhibits Motility_
**_\*_**_If the Horse has Post Op Ileus more than 5 Hours after surgery that is considered ABNORMAL_
52
Important _Risk Factors_ for which Cause of **Colitis:**
**Cyathostomiasis**
_**\***Season- Mainly seen in Winter_
**_\*DEWORMED within Two Weeks- Recent Deworming History_**
53
Most commonly Affected Nerves with **Brainstem Disease**
**Facial Nerve**
**Vestibular Nerve**
_**\*V, VII, and VIII**_
54
Horses with **Wobblers**, will be _____ the 52% and 56% Cutoff for Intravertebral Sagittal Ratio Along the **ENTIRE Cervical Spine**
**BELOW**
_**\***Wobblers- Narrowed Canal Throughout_
55
**What would NOT be Included in the Treatment of this Horse?**
**NSAIDs**
**DMSO**
**Thiamine**
**Vitamin E**
**Antiparasitic Agent**
**All would be Included**
**\***_Since we don't have a Diagnosis we Treat the Treatable_
**_Deworming Agent- Classically Fenbendazole_** _(Gets into the CNS)_
56
How to Diagnose **Equine Herpes Myeloencephalopathy**
**PCR: Blood, Nasopharyngeal Swabs**
57
Most Horses with **West Nile Virus** devlop _Mild or Subclinical Disease_. However, about 10% of the Population develops ______ when the Virus enters the CNS
**Encephalomyelitis**
_**\***Horse would develop Neurologic Signs within 8 DAYS of Infection_
58
Common Finding on Physical Exam in Horses with **Equine Wobblers (Cervical Stenotic Myelopathy)**
**Small Focal Area of Atrophy on Neck**
_**\***Very Specifically Located and ONLY one small focal area on the neck_
59
Test used to Make _Postmortem Diagnosis_ of **Rabies**
**IFA of Brain**
60
True/False: In the Face of **Liver Disease**, Horses are **RARELY Hypoalbuminemic**
**True**
_**\***Only 5-20% of Horses with Liver Disease will be Hypoalbuminemic_
61
Clinical Signs of \_\_\_\_\_:
**_Profuse Bilateral Nasal Discharge_**
**_Often Feed Tinged_**
_Retching- Gagging, Neck Stretching_
**_Neck Extension_**
_Anxious_
_Profuse Salivation_
**Choke**
_**\***# 1 Clinical Signs- Feed Tinged Nasal Discharge_
62
Treatment of **Spasmodic/Simple Colic**
**NO Feed-** _Until passes Substatial Amounts of Manure_
**Walking-** _Promotes Motility_
**Manage Pain**
**Nasogastric Intubation-**_Mineral Oil_ (1 Gallon)
_\*Manage the Pain- if we don't then we will be Perpetuating the Decrease in Motility_
63
Neurologic Exam- When Circling you notice he Swinging his Hind Legs out too Far (Circumduction) and its Swinging in the Air prior to Stepping Down
## Footnote
**Is this Upper or Lower Motor Neuron Disease?**
**Upper Motor Neuron**
**\***_# 1 Criteria to Differentiate UMN vs. LMN: Muscle Atrophy. There is No Evidence of Muscle Atrophy in this animal therefore it is UMN_
64
**Surgical Procedure** that is used in Patients with **Wobblers,** where the **Best Result Possible is a Two Grade Improvement**
**Ventral Stabilization**
_**\***Will NOT get any better than a Two Grade Improvment_
_Ex. In a Horse with Grade IV, they will AT BEST become a Grade II_
65
Vectors for **Rabies Virus**
**Bats**
**Raccoons**
**Skunks**
**Fox**
66
_Important Risk Factor_ for **Large Colon Volvulus/Torsion**
**Broodmare 1 Month Pre - 1 Month Post Partum**
_**\***Particular Group of Horses that are Predispoed to Large Colon Torsion- Most commonly in Broodmares 1 Month Post Partum that have Just Foaled. After giving Birth they have a Sudden Emptyness of their Abdomen leading to Torsion of the Large Colon_
67
**Colic in Foals** Described Below:
## Footnote
**_Impaction of Normal Foal Feces_**
**Meconium Impaction**
_**\***Meconium is Sticky, which is why it Impacts_
68
Treatment for **Otitis Media Interna**
**General Therapy- Acute Fracture/Trauma Therapy**
**Blood From the Ear (Open Fracture)-** _Antimicrobials_
69
Three A's (Clinical Signs) that we look for in Horses with **Equine Protozoal Myelitis (EPM)**
**Asymmetric Ataxia with Atrophy**
70
After Gastric Decompression the Horse is in Less Pain. 100 mg Xylazine is Administered. The Mare stays relatively Pain Free for 30 Min. Pain Increases Again and another 9.5 L of Reflux is Obtained. The Mare is Administered another 100 mg of Xylazine which keeps her Comfortable for longer. It is 1 Hour later that she is Refluxed again, 10L reflux Obtained. The Mare is Progressively Depressed. Analysis of the Peritoneal Fluid is Obtained by Abdominocentesis reveals Serosanguinous TP = 4.5 g/dL, WBC = 11,600
## Footnote
**Which of the Following is the Likely Diagnosis in this Case?**
**Duodenitis Proximal Jejunitis (DPJ)**
_**\***Classify Colic as Small Intestinal Strangulating Lesion._ Colitis is Immediately taken off the List
_\*This Case is absolutely and Inflammatory Strangulating Small Intestinal Disease. **No Mechanical Obstruction but DPJ Cases look Strangulating because of Gut Wall Compromise**_
**_Main Manifestations of Duodenitis Proximal Jejunitis- Extensive Reflux and ileus_**
71
Etiology of **Colitis** Described Below:
**_Small Strongyles (Red Worms)_**
_Emergence of Encysted Larvae "En Masse" leading to Acute Inflammation of Large Colon Mucosa_
**Cyathostomiasis**
_**\***Diagnosis- Small Strongyles (Red Worms) in Feces_
72
_Risk Factors_ for Development of **Blister Beetle Toxicosis**
**Diet of Alfalfa Hay**
**Hay Harvested after First Cutting** (Second or Later)
**CUTTING and Bailing at SAME TIME**- _Traps Beetles in Hay_
73
**Pars Intermedia Pituitary Dysfunction** is most Commonly associated with Advancing \_\_\_\_\_
**Advanced Age**
_\*Average Age of Onset- **20 Years**_
**_Incidence Increases in Horses greater than 20 years old and significant increases from "old" to "very old" horses_**
74
Clinical Presentation of **Liver Disease** Described Below:
**_Clinical Syndrome Characterized by Abnormal Mental Status that occurs Secondary to Hepatic Insufficiency_**
_Seen in 80% of Liver Disease/Dysfunction Cases_
_Mechanism of Action- **Decrease in Branched Chained Amino Acids and Increase in Aromatic Amino Acids**_
**Hepatic Encephalopathy**
_**\***Imbalance of Brached Chain Amino Acids and Aromatic Amino Acids. Leads to Imbalance between Excitatory and Inhibitory Neurotransmitters_
75
Treatment for **Pars Intermedia Pituitary Dysfunction (PIPD)**
**Excellent Managment:** _Dental Care, Routine Vaccinations, Exercise, Good Quality Feed **(MOST IMPORTANT)**_
**Peroglide Mesylate** _**(Treatment of Choice)-** Decrease POMC Level_
_\*Excellent Managment is the Most important Treatment Factor. Once you start Medically treating the Horse you will have to treat FOR LIFE so some clients would prefer just to manage these horses- Delay the amount of time the Horse will have to be on Medication via Ideal Managment_
_If you get to the point where you need Medical Therapy, Peroglide Mesylate is the Treatment of Choice_
76
Important Clinical Signs associated with\_\_\_\_\_:
**Hypersensitivity**
**Hyperesthesia-** _Excessive Physical Sensitivity/Pain_
**Muzzle Faciculations**
**Twitching/Muscle Tremors**
**Rabies**
_**\***These are Clinical signs that Heighten our Index of Suscpision for Rabies_
77
Most Common Clinical Sign of **Cystic Calculi**
**Hematuria AFTER Exercise**
78
Majority of the **Sand Enteropathies** that you see will present as _______ _Large Colon Colics/Impactions_
**Non-Strangulating**
79
_Gold Standard_ for Diagnoses of **Pars Intermedia Pituitary Dysfunction (PIPD)**
**Overnight Dexamethasone Suppression Test**
_**\***Excellent Screening Test- Considered the Gold Standard_
**_\*DON'T want to use this Screening Test in Laminitic Horses- use Diurnal Cortisol instead_**
80
Two Signficiant Causes of **Acute Renal Failure**
**Vasomotor-** _Dehydration, Endotoxemia, Septic Shock, Severe Hemorrahge_
**Toxic-** _NSAIDs, Aminoglycosides_
81
Four Pathophysiologic Categories for **Small Intestinal Strangulating Disease**
**True Strangulating Obstruction**
**Inflammatory**
**Thromboembolic**
**Progressed Non-Strangulating**
_**\***Very Unlikely to have a Non-Strangulating that Progressed_
82
Diagnosis based on this Endoscopic Image
**Bladder Stone**
83
Treatment for **Blister Beetle Toxicosis**
**No Specific Therapy**
**Supportive Care**
84
Characteristics of which **Small Intestinal True Strangulating Obstruction:**
**Diaphragmatic Hernia**
_**\***Empty Abdomen Feel on Palpation, Recurrent/Episodic Colic_
**_MAIN RISK FACTOR- History of Trauma (Strong Blunt Trauma to the Abdomen)_**
**_\*_**_Possible Clinical Findings- Silent Abdomen/Absence of GI Sounds in Abdomen but can hear them in Thorax_
85
**Cecal Impactions** are Mainly ______ **Large Intestinal Obstructions**
**Non-Strangulating**
86
True/False: Horses with **Equine Metabolic Syndrome** should have a NORMAL Dexamenthasone Suppression Test
**True**
**_\*Horses with EMS have Normal Dex Suppression Test and Normal TSH Stimulation Tests- How to Distinguish from PIPD_**
87
_Triad of Clinical Syndromes_ that when Appear Together should suspect **Liver Disease**
**Coagulation**
**Nervous System Involvement**
**Cutaneous Involvement**
88
**Review Card: Normal CSF Values**
89
Differential for **Small Intestinal Strangulating Disease** where **Abdominocentesis is NOT as expected**
**Intussusception**
**Diaphragmatic Hernia**
**Epiploic Foramen Entrapment**
_**\***Dead/Compromised Segment not Contiguous with Peritoneum_
_\*Expected Abdominocentesis in SI Strangulating Lesions- Increase in RBC, WBC, and Total Protein all to the same degree at the same time_
90
Treatment for **PRIMARY _Non-Strangulating_ Large Colon Impaction**
**Fluids- Per Os (Nasogastric Intubation)**
**Pain Control- Alpha 2 Agonist (Xylazine)**
**No Feeding**
**Walking**
**\***These Horses have a Large Colon Impaction and we are trying to move that Impaction- Need to Improve Motility and Soften the Content so that it is more Easily Moved (Per Os Fluids). The horse will be More Painful now because there will be more pull on the mesentary with all the Fluids administered- _Horse will get more Painful before it gets better (Expect this)_
91
**Review Card: Liver Enzymes**
_Acute Hepatocellular Disease- High SDH_
_Chronic Hepatocellular Disease- High AST_
92
**C6**
93
How to Differentiate **Equine Protozoal Myelitis (EPM)** vs. **Verminous Encephalomyelitis**
**_CSF Cell Type_**
**EPM-** _Increase in White Cells and Increase in Proteins with **Large Mononuclears**_
**Verminous-** _Eosinophils_
94
Prognosis in cases of **Hyperlipemia**
**Mortality Rate: 40-50%**
_**\***Poor Prognosis usually correlated to RENAL DYSFUNCTION rather than Hepatic Dysfunction_
95
Treatment for **Cervical Stenotic Myelopathy (Wobblers)**
**Foals \< 1 Year: PACE Diet**
**Adults- Symptomatic Therapy**
_\*PACE: Low Carb, Low Protein_
96
**Post-Operative Ileus** Describe Below:
**Late Stage Post Op Ileus**
_**\***These Horses are going to have Significant Compromise to the GI Motility- Some of these horses are going to have Compromise in GI Motility up to 7 Days or More (Big Problem in Equine Patient)_
_\*Ileus that is associated with Inflammatory Changes in the Gut Wall- **Infiltration of Neutrophils/Leukocytes into the Intestinal wall resulting in Total Shut down of Motility.** These horses will be Refluxing for Days_
97
Clinical Signs of which **SECONDARY Non-Strangulating Large Colon Colic:**
**_Impacted Large Colon_**
**_Diarrhea_**
**_Weight Loss_**
**Sand Enteropathy**
_**\***Animal may present for Fluctuating Fecal Consitencies- Diarrhea_
98
If **Urine Disocoloration** from the Horse is **Red (Red-Orange)**, what are the Likely Causes?
**Hemoglobin**
**RBC**
**Rifampin-** Is the Horse being Treated with Rifampin?
_\*Urine is going to change to Orange if the Horse is being Treated with Rifampin_
99
List the Differences between _Type I and Type II_ **Cecal Impaction**
**Type I Cecal Impaction:**
**_Primary Cecal Impaction_**
**_Dryer/Firm Impaction of Ingesta (Dehydrated Type)_**
_Diets High in Corncobs, Kernel Corn and Coarse Hay_
**Type II Cecal Impaction:**
**_Secondary Cecal Dysfunction_**
_MOST COMMON type of Cecal Impaction_
**_Fluid Ingesta Filled Cecum_**
_Cecal Impaction rapidly followed by Rupture_
100
_Clinical Signs_ assocaited with which Etiology of **Colitis:**
**_Very HIGH FEVER (104-106) for 2-3 Days before Onset of Clinical Signs_**
**_High Incidence of Laminitis_**_- At Onset of Fever or Concurrent with Onset of Diarrhea_
**_Diarrhea and Colitis_**
**Potomac Horse Fever**
_**\***High Fever, Laminitis, then Diarrhea- VERY Suspicious for Potomac Horse Fever_
101
In Horses with **West Nile Disease**, Early in the Course you have Predominately _____ on CSF
**Neutrophils**
102
**Endocrine Disease** shown below:
"Happy, Hungry, Hairy Horses"
**Pituitary Pars Intermedia Dysfunction (Pituitary Adenoma)**
103
Treatment for **Meconium Impaction**
**Enamas: Soapy Water**
104
Predominant **CSF Cell Type** seen in Horses with **Rabies**
**Mostly Neutrophils**
_**\***Increased WBC, Increased Protein and **Predominately see Neutrophils**_
105
Pathophysiology of which **Brain Stem Disease:**
## Footnote
**Petrous Temporal Fracture**
**Otitis Media Interna**
106
Any _Acute Neurologic Disease_ **Less than 10 days Duration** consider \_\_\_\_\_\_
**Rabies**
**\***_Any Acute Neurologic Disease less than 10 days duration should be considered Rabies until proven otherwise_
107
**The Rectal Palpation**
**The Auscultation of GI Sounds**
_\*The Rectal Palpation- On Rectal Palpation, **There will be a GRITTY Feel.** Gritty Feel will be within the Small Colon. The Manuer with sand is moving through_
_Auscultation of GI- The Horse who Colics and Presents to you for a Sand Impaction is likely going to have Reduced Motility. **On Ventral Midline you will hear "Waves on the Beach" sounds**_
_**\***The Gross appearance of the Feces is probably not going to be abnormal unless the animal ate a tremendous amount of sand. Normally, you are not going to see the sand in the feces_
108
Four Pathophysiologic Categories of **Colic**
**TRUE Obstructions-** _Simple or Strangulating_
**Thromboembolic-** _Ex. Strongylus Vulgaris (Classic Example)_
**Ulcerations-** _NSAID Toxicity_
**Inflammatory-** _Ex. Enteritis/Colitis (Mainly Bacterial Infections)_
_**\***Colic = Abdominal Pain_
109
Treatment for **Cystic Calculi (Urolithiasis)**
**Males**- **Ventral Midline Abdonimal Approach for Urethrostomy or Celiotomy**
**Females- Manually Remove from Bladder by Hand or Retrival with Instrument**
_Post Surgery Antiobiotics_**- Trimethoprim Sulfa**
110
**Foal Colic** Described Below:
**_Colic occurs witihin FIRST 24 HOURS of Life_**
_Signs of Colic by about 12 Hours_
**Meconium Impaction**
111
How do we Diagnose **Salmonellosis?**
**Fecal Cultures** (Gold Standard)
**\***_Need to run at least 3-5 Fecal Cultures- Going to start being Positive as Feces Firm Up_
112
**History of Cribbing in the Affected Horse**- _Higher Incidence of Epiploic Foramen Entrapments in Horses that are Cribbing. **Horse is Cribbing with an Acutely Developed Strangulating Small Intestine = Epiploic Foramen Entrapment**_
**Reduced Number of Palpable Loops of Small Intestine on Rectal-** _ONLY for Epiploic Forament Entrapment._ Epiploic Foramen is on the Dorsum and Cranial by the Liver. T_he Small Intestine will be Pulled Cranially leading to Few Palpable Loops_
**Presence of Serosanguinous Abdominocentesis-** _Seen in BOTH Strangulating Lipoma and Epiploic Foramen Entrapment_
_**Older Horses**- More Commonly have Strangulating Lipomas. **Epiploic Foramen Entrapment can be seen in any age horse, not distinct to Older Horses**_
113
True/False: EEE, WEE, and VEE are ALL **Reportable Diseases**
**True**
114
Treatment for **Clostridial Colitis**
**Metronidazole**
**Supportive Treatment**
115
In Horses with a **PRIMARY Non-Strangulating Large Intestinal Impaction,** what would you Expect on **Abdominocentesis?**
**Should Be Normal (Non-Strangulating)**
_**\***If the Impaction is severe then you may start seeing changes in the Abdominocentesis_
116
**Large Colon Displacement** Mainly Presents as ______ **Secondary Large Intestinal Disease**
**Non-Strangulating**
117
Treatment for **Duodenitis Proximal Jejunitis (DPJ)**
**Gastric Decompression**- _Every 1-2 Hours_
**Fluid Administration**
_**\***Mainstay of Therapy is the Fluid Therapy and Decompression_
118
Most Common Finding on Blood Tests in Horses with **Equine Metabolic Syndrome**
**Hyperinsulinemia (\> 30-40ul/mL Fasted)**
_**\***The Majority of Horses with Equine Metabolic Syndrome will be Hyperinsuliniemic_
119
Gold Standard for Diagnosing **Otitis Media Interna**
**Radiography**
_**\***Straight DV/VD Shots_
120
In Horses, If **Fractional Excretion of Sodium** is \>\_\_\_\_\_% , the Function of _Renal Tubular Cells are Inadequate_
**\> 1%**
_**\***If Fractional Excretion of Sodium is \> 1%, the Horse is Eliminating too much Sodium = Tubular Dysfunction_
121
**Review Card: Strangulating vs. Non Strangulating Colic**
_Non Strangulating Abdominocentesis:_
1. No Change Initially
2. Increase in TP
3. Increase in WBC
4. Increase in RBC
_Strangulating Abdominocentesis:_
Increase in TP, WBC, and RBC at the Same Time to the Same Degree
122
For Which **NON-Strangulating Small Intestinal Lesions** can you palpate the LESION ITSELF on Rectal Palpation
**Ileal Impaction**
_**\***Might be able to specifically palpate the lesion itself on Rectal Palpation- Only can Palpate Early in the Disease_
123
_Clinical Signs_ of which Etiology of **Colitis:**
## Footnote
**_Colic_**
**_Development of Diarrhea- Malodorous, Profuse Watery_**
**_Dependent on Syndrome_**
**Salmonellosis**
_**\***Classic Manifestation- Depression, Fever, Fluid Sequestration, Colic and Diarrhea (Particular Odor)_
124
Main Risk Factor for the Development of **Potomac Horse Fever**
**Stagnant Fresh Water Pools (Ponds)**
_\*NO Horse to Horse Transmission_
125
**Foal Colic** Described Below:
## Footnote
**_Clinical Signs typically between 24-72 Hours of Age_**
**_HYPERKALEMIA_**
**_Hyponatremia, Hypochloremia_**
**Ruptured Bladder**
126
**Physical Exam**
**Neurologic Exam**
**CSF Cytology**
**LS CSF Tap**
**Cervical Spine Radiography**
_**\***We do NOT do AO CSF Tap because we have spinal disease and therefore we need to be Downstream from the Lesion, which means you are running Lumbosacral Taps_
**_\*We will run a CSF Cytology and LS CSF Tap on all of these Horse- Routine Evaluation_**
**_The only thing you can Radiograph is an Equine patient is the Cervical Spine_**
127
**Nasogastric Intubation:** _Malodorous Fluid Volume 15L, pH 7.6_
**Heart Rate:** 110 bpm
**RR:** 48/min
**Temp** = 99.2 F
**MM Congested with CRT of 3.5 sec**
**What is the Top Differential in this Case?**
**NON-Strangulating Ascarid Impaction**
_**\***Generally seen in **Young Horses (6 Months-1 Year) with Recent Deworming with Effective Medication**- All the Ascarids get killed at the Same Time and they plug up the Small Intestine_
_\*Why do these Horses look Strangulating? Dead Parasites generally cause Immense amount of Reaction and Necrosis_
128
Horses with **West Nile Encephalitis** that Develop Ataxia will commonly Display _____ Limb Weakness
**Hind**
129
Main Way to Diagnose **West Nile Virus**
**Capture ELISA WNV (IgM)**
_**\***ELISA will Detect within 8-10 Days_
**_\*You will NOT see a Positive Result on this Test because of Vaccinates_**_- Good Test to Determine if you are dealing with a Vaccination Serology Titer or a True Infection_
130
**Saggital Ratio** associated with _C4-C6_ as well as _C7_
**C4-C6 = 52%**
**C7 = 56%**
_\*C3, C4, C5, and C6 will be 52% as your Low Cutoff_
_C7 will be 56% as your Low Cutoff_
_\*If you have a Number below that that means there is a Narrowing at that Location._
131
True/False: **West Nile Virus** is a REPORTABLE Disease
**True**
132
_Protein Pattern_ seen on Biochemistry in Patients with **Acute Colitis**
**Hypoproteinemia**
_**\***Huge surface area of Damaged Mucosa- These Patients loose Protein like crazy- HYPOPROTEINEMIA_
133
For which **Equine Viral Encephalitides** does the Horse act as a **Multiplier (Amplifier)?**
**VEE (Venazualen Equine Encephalitis)**
**_VEE- Circulating Virus levels High enough that can act as Ampifier of Disease_**
_\*The Horse is NOT a Multiplier to WEE and EEE- Do NOT Transmit Disease_
134
In Cases of **West Nile Virus,** _Prognosis_ can be Related to Temperature in Febrile Horses. Horses with a Temperature Greater than ______ usually did NOT survive
**\>103**
135
Best way to Accurately assess the **Thyroid** in the Horse
**Thyroid Response Function (TSH Stimulation Test)**
136
True/False: **Spasmodic/Simple Colic** Cases are typically Associated with Copious amounts of Reflux
**False**
_\*In Patients with Spasmodic/Simple Colic we DO NOT expect Reflux since the Small Intestine is not Involved_
137
When Referring Cases of **Colic**, ALWAYS Refer them with a \_\_\_\_\_\_
**Nasogastric Tube**
_**\***Regardless of whether the Patient has Reflux you should ALWAYS refer them with a NG Tube. The Patient could start Refluxing during the time that they are being referred- Transport TIme. In that time if the patient doesn't have a NG Tube we could loose them to a Gastric Rupture_
_\*Make sure that you send a Record of everything that you have administered_
138
How do you Diagnose **Sand Enteropathy?**
**Rectal Exam**- _Gritty Feeling Impaction_
**Auscultation**- _If you are Hearing Sand on the Ausculation of Ventral Abdomen then there is a Clinically Significant Quantity of Sand. "Waves on the Beach"_
**Sedimentation of Feces**_-Use Glove to bring Fecal Material out of Colon on Rectal Palpation. Pull Sleeve Inside out. Fill Sleeve with Water. All the sand wil sediment out into the Fingers of the Glove/Sleeve_
139
Differential for **Small Intestinal Strangulating Disease** where you **Palpate a Few Tight Sausage Bandless Loops (Only 3-4)**
**Diaphragmatic Hernia**
**Epiploic Foramen Entrapment**
**Gastrosplenic Ligament Entrapment**
_\*Very Proximal Lesion or Hiding Somewhere/Out of Reach_
140
Most Common Type of **Simple Obstruction Colics**
**Spasmodic Colic**
_**\***Functional Obstruction_
141
Based on what Criteria or Parameters do we Recommend _Surgical Correction/Exploration_ in Cases of **Colic**
**Determination of Strangulating Colic**
**\***If it Looks like Strangulating Disease- Generally what we are using to make the decision of Surgical Intervention
142
**A. The Horse would show Signficant Weakness**
**\*Equine Herpes Myeloencephalopathy is characterized by ATAXIA and PARESIS (WEAKNESS)**
**\***_Two Differentials for Significant Weakness- Herpes and Botulism_
143
_At Risk_ Population for which **Endocrine Disease:**
## Footnote
**_Ponies_**
**_Miniature Horses_**
**_Miniature Donkeys_**
**Hyperlipemia**
144
For **CSF Analysis** where do we take the Sample?
**Closest to the Site of the Lesion and DOWNSTREAM of CSF Flow**
Ex. If you have a Horse with a C1 Lesion, where are you taking your Sample for CSF Analysis? Lumbosacral Space
145
**Neurological Disease** Described Below:
_Acute to Peracute Onset_
_Rapid Progressive Development of Ataxia for first 24-36 Hours Followed by Stabilization of Deficits and occasionally Signs of Improvement_
**_Characterized by ATAXIA and PARESIS (Weakness)_**
**_Urine Dribbling_** _commonly Seen_
_Occasionally **Lingual Paresis (Tongue Sticking Out)**_
**Equine Herpes Virus**
**\***_WEAKNESS_
146
Where do we most typically see **Uroliths** in the Equine Patient?
**Bladder (Cystic Calculi)**
147
How to Diagnose **Potomac Horse Fever**
**PCR** (Most Common)
**Isolation/Culture Blood or Feces** (Ideal but Uncommon)
148
_#1 Complication_ in Patients with **Choke (Esophageal Obstruction)**
**Aspiration Pneumonia**
149
How to make Definitive Diagnosis of **Meconium Impaction**
**Radiographs**
_**\***Visualize Impacted Material and Location_
150
**Neurologic Disease** that produces a **POSITIVE CSF Western Blot** Analysis
**Equine Protozoal Myelitis (EPM)**
_**\***If the Western Blot is Negative, then Most likely not EPM_
**_\*Positive CSF Westernblot with Increased IgG Index = EPM_**
151
**Urinary Condition** Described Below:
_Problem in **Males (Stallions and Geldings)**_
**_Pelvic Urethral Lesions_** _and **Tears at Ischial Arch**_
**_Blood at END of Urination and Possible Blood Clots at Beginning of Urination_**
**Urethritis**
152
When Treating Patients with **Equine Metabolic Syndrome**, Feed Hay at \_\_\_\_\_% of Ideal BWT
**1-1.5%**
_**\***Want to feed at NO LESS than 0.75% of Normal BWT_
153
Four Criteria used to Determine _Surgery/Referral_ in Cases of **Colic**
**PAIN**
**Looks Strangulating**
**Definitive Rectal Abnormalities**
**Large Amount of Reflux where Pains Persist despite Gastric Decompression**
154
_NG Intubation- Little/No Reflux_
_Severely Distended Abdomen- Obvious External Flank Distention_
_Rectal Examination- Only get into Rectum to your Mid-Forearm, very Tight Distended Balloon, Tight Bands_
**_1 HOUR LATER: HR = 90, T = 99F, RR = 40, CRT = 3 Seconds_**
**_Mucous Membranes- Toxic Line and Congested_**
**What is the Likely Diagnosis in this Case?**
**Large Colon Volvulus/Torsion**
_\*Strangulating Large Intestine_
**_\*Horses with Large Colon Volvulus- VERY Painful, VERY Rapidly and they will have a lag in term of Cardiovascular Compromise_**
_\*Inconsistency- Severly Painful Animal with Minimal/No Cardiovascular Compromise. Why don't they Match? Most Likely the Colic was Very Early and the Cardiovascular Compromise had yet to Manifest. 1 Hour later, the Cardiovascular Compromise has Manifested_
155
Treatment for **Hyperlipemia**
**Get the Animal to EAT (Most Important)-** _Various Feeds_
**Insulin**_- Blocks Mobilization of Adipose Tissue_
156
Treatment of **Late Stage Post-op Ileus**
**Address Primary Problem-** _Relief of Pain/Treat Shock ect._
**Motility Enhancers- Lidocaine**
_**\***With the Exception of Lidocaine, motility enhancers in the equine patient are considered the second level of intervention_
157
Three Main Infectious Causes of **Duodenitis Proximal Jejunitis (DPJ)**
**Salmonella**
**C. Perfringens**
**C. Difficile** _(Most Common)_
_\*Clostridium Difficile accounts for over 50% of DPJ Cases_
158
**Symmetric**
**Hindlimbs \> Forelimbs** _(Hindlimbs are More Effected)_
**_\*Symmetrically affected animal with the Hindlimbs more effected than the Forelimbs- The MOST COMMON Presentation for Spinal Ataxia in the Equine Patient_**
**_\*_**_Symmetry refers to Right vs. Left Limbs_
159
Common _Clinical Signs_ seen which which Form of **Equine Encephalitis:**
**_Head Pressing_**
**_Circling,Blindness_**
_Hyperexcitability_
**_Progressive Ataxia_**
**Eastern Equine Encephalitis (EEE)**
_**\***VEE has Similar Clinical Signs, except commonly have GI Signs as well- Colic, Diarrhea, Consitpation_
160
Etiology of **Colitis** Described Below:
## Footnote
**_EXTREMELY PAINFUL_**
**_Toxin Component- Cantharidin (Extremely Caustic)_**
**_Beetles Found in Alfalfa Hay_**
**Blister Beetle Toxicosis**
_\*Cantharidin- Erosions and Ulcers throughout the GI Tract_
161
**Four Liver Enzymes** that are used to _Evaluate Liver Function_
**SDH-** _Liver Specific_
**ALK PHOS-** _Not Liver Specific_
**AST-** _Not Liver Specific_
**GGT-** _Fairly Liver Specific_
162
On Rectal Palpation, if **Kidney is Smaller, Firmer and Non-Painful** it is ______ Disease
**Chronic**
163
True/False: We do NOT make a Recommendation for Surgery based on _Abdominocentesis Alone_ or _Rectal Palpation Alone_ in Cases of **Colic**
**True**
164
_Main Indication_ for Use of **Antibiotics (Antimicrobial Therapy)** in Cases of **Acute** **Colitis**
**Horses with Low WBC Counts**
_**\***Immunocompromised Horses_
165
Four Pathophysiologies leading to **Small Intestinal Strangulating True Obstructions**
**Volvulus**
**Strangulating Lipoma**
**Herniation**
**Intussusception**
_**\***Bandless, Tubular/Sausage like Structure Tightly Distended on Rectal Palpation- Small Intestine_
_Strangulating Lipoma- Significant Cause of a Strangulaing Lesion in the Small Intestine_
166
Which **Small Intestinal Strangulating Disease** may **Progress from Chronic Non-Strangulating to Strangulating?**
**Intussusception**
167
Where does the Majority of the Pain come from in a **Duodenitis Proximal Jejunitis (Anterior Enteritis)**
**Stomach Distension**
168
_Potential Complications_ that can be seen in Cases of **Hyperlipemia** due to Fatty Infiltration
**Liver Failure/Disease**
**Kidney Failure/Disease**
_**\***Deposition of Lipids into the Liver and Kidney_
**_\*Renal Fatty Infiltration is associated with a Poor Prognosis in the Horse_**
169
Typical Clinical Signs of which **Endocrine Disease:**
_PU/PD_
_Coat Abnormalities (85%)- **DELAYED SHEDDING (Hirsutism)**_
_Type II Diabetes Mellitus (38%)_
**_REDISTRIBUTION of Fat_**_- Accumulation in Neck (Cresty Neck)_
**_Chronic/Recurrent Low Grade Laminitis (33-52%)_**
**_Muscle Wasting_**
**Pars Intermedia Pituitary Dysfunction (PIPD)**
_**\***PU/PD- Caused by Destruction of Pars Nervosa_
**_\*Cases of Chronic Recurrent Low Grade Laminitis- Top of your List should be PIPD_**
170
**All of the Above can cause Colitis in the Horse**
171
Risk Factors for \_\_\_\_\_:
_Regional: **California (CA)**_
**_Undigestible Materials- Sand, Stones, Rubber Fencing, Bailing Twine_**
**_Feeding Alfalfa Hay_**
_Breed: Arabian_
**Enterolithiasis**
**(Secondary Non Strangulating Large Colon Impaction)**
_**\***Enteroliths are Mineral Concretions made in the Large Colon_
_Tend to see Enterolithiasis in Horses that have Lived in California for some time_
172
Three Viruses that **ALL Horses** should be **Vaccinated** against
**EEE**
**WEE**
**West Nile Virus**
**Tetanus**
173
True/False: Vast Majority of Colics will be **Non-Strangulating Simple Obstructions**
**True**
_**\***70-80% of Colics will be Simple/Non Strangulating that will resolve with Medical Therapy_
174
_Triad of Histologic Findings_ that are Diagnostic of **Pyrrolizidine Alkaloid Toxicity**
**Fibrosis**
**Bile Duct Proliferation**
**Megalocytosis**
_**\***Pyrrolizidine Alkaloid Toxicity- Chronic Progresseive Intoxication resulting from Consumption of Plants containing Pyrrolizidine Alkaloids_
175
Potential _Clinical Signs_ in Horses with \_\_\_\_\_:
**_Colic- Common_**
**_Frequent Yawning_**
**_Behavior Changes- Aggression/ Unruly, Depression, Incoordination_**
**_Aimless Wandering, Head Pressing_**
**Liver Disease**
_\*Behavoir Changes secondary to Hepatic Encephalopathy_
_**\***Ascites in the Horse is Very RARE_
176
Characteristics of which **Small Intestinal True Strangulating Obstruction:**
**Risk Factors:**
**_Parasitic (Esp. Tapeworms)_**
_Rapid Changes in Fecal Consistency (Normal Feces to Acute Diarrheas and vice versa)_
**Intussusception**
_**\***Intussusception- Longitudinal Displacement of one Section of Bowel into another (Jejuno-Jejunal, Jejuno-Ileal, Ileocecal)_
177
**In General, the Secondary Non-Strangulating Large Colon Impactions don't show anything different than Primary Non-Strangulating Large Colon Impactions**
_**\***If there is anything, it would be the PROGRESSION. Secondary Non-Strangulating Large Colon Impactions are going to progress to Strangulating Presentations in most cases_
_\*Enterolith- Stone in the Intestinal Tract_
178
_Clinical SIgns_ associated with which **Liver Disease:**
**_Abdominal Pain (Colic)_**
**_Febrile (Fever)_**
**_Icterus_**
**Cholelithiasis**
**_\*Colic Horse that is Febrile with Icterus = Cholelithiasis_**
_Cholelithiasis- Gall Stones in Bile Ducts_
179
CSF: Protein 50 mg/dL; WBC 5, diff. WNL
## Footnote
**What Differentials can we REMOVE from the List?**
**Wobblers**
**\***_What Factor Dicated your Choice to Remove this Differential? Analysis of the Plaine Standing Cervical Films_
**_\*C3, C4, C5, and C6 will be 52% as your Low Cutoff_**
**_C7 will be 56% as your Low Cutoff_**
**_\*If you have a Number below that that means there is a Narrowing at that Location. In a Wobbler we normally see a Narrow Canal Throughout_**
180
Prevention Protocol for **West Nile Virus**
**VACCINATION**
**Vector Control** (Mosquito Control)
181
_Clinical Presentation_ of **Liver Disease** Described Below:
**_Abnormal Reactivity of Skin to Light in Response to Photosensitizing Agents_**
_**Typically only WHITE Areas Affected-** Eyrthema, Edematous Infiltration, Full Thickness Damage, Skin Becomes Dry_
**Photosensitization**
182
Common **CSF Changes** in Horses with **Equine Encephalitis**
**Increase in Lymphocytes/Plasma Cells**
_**\***Common CSF Findings in Horses with EEE,WEE, and VEE_
183
True/False: **Thromboembolisms** leading to **Colic** will Typically present as _Strangulating Disease_
**True**
184
Characteristics of which **Small Intestinal True Strangulating Obstruction**:
**_Twist on the Long Axis of the Mesentery at least 180 Degrees_**
_Any Age Horse/Any Signalment_
**Volvulus**
185
**West Nile Viremia** is Short Duration and Low Magnitude, so Horse is ____ to be an Amplifier or WNF
**Unlikely**
_**\***Horses are Not Likely to be an Amplifier of WNV, **however they can Be Sentiles for WNV to indicate the Viral Load in the Environment**_
186
_Preferred Screening Test_ for **Pars Intermedia Pituitary Dysfunction (PIPD)** in an animal that has **Laminitis**
**Diurnal Cortisol**
_**\***Preferred Procedure especially if Laminitic_
**_\*Affected Horses have LESS than 30% Variation between Two Samples_**
187
Due to **Contagious/Infectious** Nature of the Disease, if you believe that a Horse has \_\_\_\_\_\_, you should be **Isolating and Quarantining that Facility**
**Equine Herpes Myeloencephalopathy**
188
Most common Problem with **NSAID Induced Nephrotoxicity**
**Renal Crest Necrosis**
_**\***NSAID Toxicity = Renal Crest Necrosis in Equines_
189
General Treatment of **Liver Disease**
**Correct Abormal Behavoir-** _Xylazine, Correct Acid-Base Distrubance, Supplment Branched Chain Amino Acids_
**Decrease Hepatic Workload-** _Constant 5-20% Dextrose Drip_
**Dietary Managment- Low Protein Diet** (Beet Pulp and Cracked Corn)
190
In Horses with **Basilar Fractures**, the Odds of Death are 18 times more Likely if Recumbancy persists Greater than ___ Hours after Initial Evaluaation
**4**
_**\***Prognosis for Head Trauma cases in the Horse- Gaurded to Grave_
191
_Clinical Features_ of Which Etiology of **Colitis:**
**_Synchronous Diaphragmatic Flutter (SDF)_**
**_HYPOCALCEMIA_**
_Hypokalemia_
_Metabolic Acidosis_
**Blister Beetle Toxicosis**
192
Description of which **Endocrine Disease** in Horses:
**_Increased Adiposity Generally (Obesity)_**
**_Insulin Resistance_**
_Predisposition to **Laminitis**_
**Equine Metabolic Syndrome**
193
Etiology of **Colitis** Described below:
_Mostly Indistinguishable from Salmonella_
**_Agent: Neorickettsia Risticii_**
**_Life Cycle: Flukes, Fresh Water Snails, Aquatic Insects Consumed by Birds and Bats_**
**Potomac Horse Fever**
194
How to Diagnose **Urolithiasis (Cystic Calculi)** in Horses)
**Confirmed by Rectal Palpation**
**Confirmed by Rectal Ultrasound-** _Leave Bladder Full_
**Confirmed by Endoscopy (Preferred)**
195
**Ideal** way to Monitor Nephrotoxicity with **Aminoglycosides**
**Trough and Peak Levels**
_**\***Monitor Plasma Trough Levels of Aminoglycosides_
**_\*Most Clinics do NOT have the ability to Monitor Trough Levels, therefore we just Monitor for Casts in Urine_**
196
Treatment for **Choke (Esophageal Obstructions)**
**1. HEAVY Sedation Initially- Xylazine (Large Dose)**
**2. NG Intubation and Flush- Plain Water**
_3. If Step 1 and 2 did NOT Resolve Issue- Add Carbocaine_
_4. If Step 1,2, and 3 did NOT work- Use Intratracheal Tube in Esophagus (Cuff Filled) to Increase Pressure on Flush_
**Surgical Procedures (Last Resort)- Esophagotomy**
_\*Once you have Diagnosed Choke, First step should be to Sedate with Xylazine. Wait 15-20 Minutes and Nasogastric Intubation and Flush with Plain Water and the choke will likely Resolve on its own_
197
Treatment for **Enterolithiasis**
**Surgical Removal** (_Midline Celiotomy)_
_\*Tend to Obstruct most Notably at the Transverse Colon_
198
**Impairment of Normal Propulsive Bowel Motility**
**Ileus**
_\*Ex. Drugs- Atropine is VERY likely to Result in Ileus in Horses_
199
_Most Consistent and Characteristic Clinical Sign_ of **Duodenitis Proximal Jejunitis (DPJ)**
**Pain Subsides or Abates after NG Decompression, but Horse will remain Very Depressed** _(Response to Refluxing)_
200
**Neurological Disease** Described Below:
_Many Breeds_
_**Dietary Vitamin E Deficiency** in Genetically Predisposed Animals_
**_Clinical Signs start at 6 Months of Age_**
**_UMN Disease_**
**_HYPOREFLEXIA OF Cutaneous Trunci_**
**_Symmetric Ataxia, Weakness, Spasticity of all 4 Limbs_** _(Typically Worse Hindlimbs)_
**Equine Degenerative Myeloencephalopathy (EDM)**
**_\*HYPOREFLEXIA of Cutaneous Trunci- Run a Pen down the Spine and the Cutaneous Trunci Muscle does not Respond_**
_**\***Degenerative Disease associated with Vitamin E Deficiency- These Horses have a Lower Vitamin E Status_
201
**Secondary Hyperlipemia** is most common, namely the presence of any concurrent Disease or Physiologic State which will put Increased demands when associated with Decreased Intake, most commonly \_\_\_\_\_\_\_
**Pregnancy**
_**\***Lactation and Pregnangy in a Pony, Miniature Horse, or Miniature Donkey is an Associated Risk Factor for developing Hyperlipemia_
202
If **Urine Disocoloration** from the Horse is **Dark Red-Brown**, what are the Likely Causes?
**Myoglobin (Typing Up Disease)**
203
Common Clinical Signs seen with Which **Virus:**
**West Nile Virus**
_**\***If they have Ataxia they are most likely going to be affected in their Hind Limbs_
_\*Most common Causes of **Muscle Tremors- Botulism, Rabies and WNV**_
204
**Review Card: Neurology**
205
In Horses with a **PRIMARY Non-Strangulating Large Intestinal Impaction**, what would you Expect on _Rectal Palpation?_
**Large Colon will Displace Caudally and towards Right**
**Ability to Depress Contents (Indentable)**- _Firmness of Impaction_
_\*The Pelvic Flecture is in the Left Ventral Quadrant. The More filled it is, the more it is going to come across the Pelvic Inlet towards the Right Side and the More Easily Palpable it will be_
206
Three Phases of **Acute Renal Failure**
**Induction- _Loss of Concentrating Ability (60% Damage)_**
**Maintenance- _Significant Azotemia with 65-75% Damage_**
**Recovery- _Return to Normal SG, Resolving Azotemia_**
**_\*_**_You will Likely have Resolution in Acute Renal Failure Cases in Equines because most injury will NOT be affecting Basement Tubular Cells_
207
How do we _Most Commonly_ Monitor for Nephrotoxicity with **Aminoglycosides?**
**Casts in Urine**
208
**Acute Peripheral Vestibular Disease from Temporohyoid Osteoarthropathy**
**Otitis Media/Interna**
**\***In Horses Otitis is commonly Subclinical that is normally a Chronic Inflammatory Process. They get DJD in the Temporohyoid area and they are basically fusing the joint. When forces are Repercussed through the Area it results in a Fracture
**_\*Mainly what you are seeing in these Horses is a Petrous Temporal Fracture leading to Injury of Cranial Nerves VIII and VII_**
209
Neurologic Exam- When Circling you notice he Swinging his Hind Legs out too Far **(Circumduction)** and its Swinging in the Air prior to Stepping Down
## Footnote
**What Type of Disease are you Dealing with?**
**Focal Disease**
**\***_You can explain all the Abnormalities in this animal with a Lesion in One Location- Focal Disease_
210
Treatment for **Equine Metabolic Syndrome**
**EXERCISE (Most Important)**
**Diet Changes-** _**Eliminate Grains,** Reduce Food Intake_
_\*Exercise is a Huge Component to getting these Horses back to a normal Endocrine Status_
211
**The Cervical Spine Radiographs**
**The Intravertebral Saggital Ratios**
_**\***Wobblers = Cervical Stenotic Myelopathy_
212
Three Causes of **STRANGULATING Large Colon Disease**
**True Strangulating Obstruction- Large Colon Torsion/Volvulus**
**Colitis** (Inflammatory)
**Thromboembolic**
213
**Idiopathic Acue Hepatic Disease (IAHD)**, also known as "Theilers Disease", is mainly associated with the use of any **Equine Serum Product**, most frequently \_\_\_\_\_\_\_
**Tetanus Antitoxin (TAT)**
214
Three most common Differentials in Terms of Prevalence
**EPM** (Equine Protozoal Myelitis)
**EHV** (Equine Herpes Myeloencephalopathy)
**WNV** (West Nile Virus)
215
For Which **Equine Viral Encephalitides** do we **Vaccinate?**
**EEE**
**WEE**
_**\***Trivalent Vaccine Increases Specific Antibody to all Viruses_
216
_Clinical Presenation_ of **Liver Disease** Described Below:
**_Yellow Discoloration to Mucous Membranes associated with the Retention of Bilirubin_**
**_Seen Mostly in ACUTE Liver Disease_**
_Frequently associated with **Fasting Hyperbilirubinemia (Anorexia)**_
**Icterus**
_\*Normal Bilirubin Value in Horse: 0.5-2.0_
**_\*In the Face of being Signficantly off feed (Fasting) the Horse is going to Develop and Indirect (Unconjugated) Hyperbilirubinemia -_** _There is NO Liver Dysfunction or Disease associated with this_
_\*We can have Horses that have Diseases of other Natures (Ex. Fasting) unrelated to any Liver Disease that will lead to Elevated Unconjugated Bilirubin_
217
Treatment for **Potomac Horse Fever**
**Oxytetracycline**
**Supportive Therapy**
218
Treatment for **Cecal Impactions**
**Medically:**
**_Nasogastric Intubation with DSS (Dioxal Sodium Succinate)_**
**Surgically:**
**_Cecal Impaction Type II- Generally Recommend Surgery_**
219
Findings on _Transrectal Palpation_ in a Patient with **Left Dorsal Displacement (LDD)** of the Large Colon
**Bands running in a Verticle Direction on the Left Side of the Abdomen**
**Feel Colon in Space of the Nephrosplenic Ligament**
**Find Colon in Dorsal Left Abdomen and Cannot Displace it**
220
Most Reliable Prognosticator in Cases of **Spasmodic/Simple Colic**
**Heart Rate**
221
How we assess **Narrowing in the Spinal Canal**
**Intravertebral Saggital Ratio**
222
True/False: **Ulcerations** leading to **Colic** will Typically present as _Strangulating Disease_
**False**
_**\***Typically, Ulcerations are going to present as NON-Strangulating Disease_
223
Treatment for **Hypothyroidism** in Horses
**Thyroxine Supplementation**
224
Pathogenesis of which **Neurologic Disease:**
**_"OUTBREAKS" Of Acute Neurologic Disease_** _(Ex. 30-40 Horses Affected at one Time)_
**Equine Herpes Myeloencephalopathy**
_**\***Ex. 30-40 Horses on a Farm may be Affected at one time_
225
**Review Card: Neurology**
226
We Recommend ____ Vaccinations for **Rabies Virus**
**Yearly**
_**\***Vaccination Recommended Annually_
227
**B.**
**_Normal Appearance of Horse Urine- Cloudy/Turbid due to Mucus and Crytals (Calcium Carbonate)_**
**\***Horse urine is usually NEVER Clear- Too Dilute
228
Treatment for **Rabies**
**No Treatment- Euthanize**
229
**What would be the Top Differential in this Case?**
**Mesenteric Rent**
_\*This Horse just had Abdominal Surgery- Most likely the Reason why the Abdominocentesis looks like that. Abdominocentesis probably has nothing to do with the Strangulating Small Intestinal Disease_
**_Mesenteric Rent is most Commonly Iatrogenic and most commonly occuring in Young Horses. Young Horses have much more Friable Mesentary, so while you are running the SI during surgery, you can create Tears in the Mesentary. You put a Tear in the Mesentary and then a piece of Small Intestine finds its way in_**
230
Name the Common **Motility Enhancers** used to Treat Ileus
**Proximal GIT- _Lidocaine, Metaclopramide_**
**Large Intestine- _Neostigmine, Cisapride_**
**General- _Erythromycin, Lidocaine_**
_\*Neostigmine- Inhibits Small Intestinal Motility_
_By far and away the Lidocaine is the most commonly used!_
231
Most Common Location of **Choke**
**Thoracic Inlet**
232
\_\_\_\_\_ Causes Simply an **Esophageal Obstruction**, where Repercussion to the Trachea from Local Compression is Extremely Rare
**Choke**
_**\***Respiratory Complications are Rare_
233
Two Clinical Signs typical of **Foals with Colic** that Differ from Adults
**Straining**
**Dorsal Recumbancy**
234
How can we Diagnose **Cholelithiasis**
**Ultrasonography**- _**Distended Biliary Tracts**, Increase Echogenicity Focal Circular Patches_
235
**Which of the Following is the Most Likely Diagnosis?**
**Strangulating Lipoma**
_**\***Main Reason to Suspect Strangulating Lipoma- **Age of the Horse** (17 years Old). **Strangulating Lipomas occur most typically in Older Horses**. The older the Horse gets, the more likely that a Strangulating Lesion is going to be a Strangulating Lipoma_
_\*In Horses over 20 years old, Strangulating Lipomas account for 50% of Strangulating Lesions in Small intestinal Disease_
_**\***Duodenitis Proximal Jejunitis- Inflammatory Disease. This animal has none of the Classic Characteristics that we would expect to see in an Inflammatory Disease_
236
Treatment for **Urethritis**
**Urethrostomy**
_**\***Creating **"Urethral Rest"**_
_\*Repeated Antimicrobial Protocols and Anti-Inflammatory Use often leads to Resolution of Clinical Signs only to have them recur when Treatment ceases_
237
**Chemistry** Exam Described Below:
**_Good Screen of Liver Failure: Sensitive Indicator_**
**_Increases within 24-48 Hours of Liver Disease_**
**Serum Bile Acids**
238
**Only Factor which is ever used Alone** to Determine _Referral for Surgery_ in Cases of Colic
**PAIN**
**\***_The one and only Criteria that you may ever use alone is **Pain that is Uncontrollable and Unresponsive to Therapy**_
239
_Risk Factor_ leading to **Type II Cecal Impaction**
**Very PAINFUL Chronic Musculoskeletal Problem**
_**\***Typical Scenario with Type II Cecal Impaction- Horse comes into Practice for Musculoskeletal Problem that is going to be corrected surgically. Horse goes to Surgery. 24-36 Hours Following Surgery the Horse is Acutely Colicky with Cecal Impaction_
**_\*Virtually all of these Horses have a Rupture at the Base of the Cecum that is associated with a Weakness in the Cecum wall_**
240
A **BUN** below _____ Indicates Liver Dysfunction
_**\***BUN_
241
Pathophysiology of which **Endocrine Disease:**
_**Secretion of POMC** from Melanotropes under Inhibitory Regulation by Dopamine_
**_Loss of Dopaminergic Control in Pars Intermedia_**
**_Large amounts of MSH and Beta-Endorphins Produced_**
**Pituitary Pars Intermedia Dysfunction (Pituitary Adenoma)**
_**\***Destruction of Dopaminergic Function and these cells are then Overproducing MSH and Beta Endorphins_
_\*Inhibition of the Inhibitory Effects of Dopamine_
242
Etiology of **Colitis** Described Below:
## Footnote
**_HEMORRHAGIC Diarrhea_**
**Clostridial Colitis (Clostridium Perfringens)**
_**\***Major Cause of Colitis in the Horse- Horses with Clostridial Infections do not do well_
**_\*Hemorrhagic Diarrhea in Adult Horse (Rare)- Top Differential is Clostridial Colitis_**
243
**Meconium Impactions** and **Ruptured Bladder** in Foals present as _____ Colics
**Non-Strangulating**
244
Therapy in Confirmed **Equine Herpes Virus**
**Corticosteroids**
**Antiviral Agents: Acyclovir**
245
Treatment for **Equine Protozoal Myelitis (EPM)**
**Pyrimethamine Sulfa**
_**\***Specific Treatment for EPM_
246
Most Common **NSAID** Associated with **Nephrotoxicity**
**Phenylbutazone**
247
Pathophysiology of which **Neurological Disease:**
## Footnote
**_Chronic Spinal Ataxia (Undiagnosed Lameness)_**
**_Multifocal Disease_**
**_Obscured Lameness Progressing to Ataxia, Spasticity and Incoordination_**
**Equine Protozoal Myelitis (EPM)**
_\*Frequent Complaint- Obscure Lameness Progressing to Ataxia, Spasticity and Incoordination_
248
Endoscopy can be used to Diagnose **Otitis Media Interna.** You scope the _____ and the **_Stylohyoid Bone will be Enlarged and Remodeled_**
**Gutteral Pouch**
**\*_If the Stylohyoid Bone is Remodeled/Enlarged in Conjunction with a Cranial Nerve VIII associated Vestibular Disease = Otitis Media Interna_**
249
**Brainstem Diseases** are Mainly indicated by the Presence of ____ Signs
**Cranial Nerve**
_**\***Cranial Nerve Signs- Easiest way to Localize Lesion to the Brainstem_
250
_Dietary Managment_ in Horses with **Liver Disease**
**Frequent Small Feedings**
**Beet Pulp and Cracked Corn mixed with Molasses**
**Vitamin B1, Folic Acid and Vitamin K1 should be Supplemented**
251
Which Two **Equine Viral Encephalitides** Cause the **Highest Mortality**
**EEE (Eastern Equin Encephalitis)**
**VEE (Venezualen Equine Encephalitis)**
_**\***Both have High Mortality Ranges_
252
Findings on _Ultrasound_ in Patients with **Left Dorsal Displacement** of the Large Colon
**Cannot Visualize Left Kidney**
**See Intestine between Spleen and Kidney**
253
Treatment for **Basilar Fractures**
**Prevent/Diminish Edema- Glucocorticoids** _(Dexamethasone)_
**DMSO-** _Rapidly Reduces Edema in CNS_
254
Pathophysiology of which **Neurologic Disease:**
**Viral Endotheliotropism** and Results in Vasculitis and Thrombosis in the Central Nervous System with Resultant Ischemia and Myelomalacia
**Equine Herpes Virus**
255
What Species is the _Principle Natural Host_ for **West Nile Encephalitis** and what is the _Vector?_
**Birds- Principle Natural Host**
**Mosquitoes- Vector**
_**\***Transmitted by Mosquitoes feeding on Viremic Birds_
256
_WBC Pattern_ that is Commonly Found on Biochemistry in Patients with **Acute Colitis**
**Neutropenic Leukopenia**
_**\***The Patients has an acute Severe Colitis- These Patients also have SEVERE Endotoxemia and by virtue of the Endotoxemia they are going to have a drop in their WBC count_
**_\*Vast Majority of Acute Severe Colitis Cases are likely going to present with a Neutropenic Leukopenia_**
257
Main Risk Factor for **Ileal Impactions**
**Bermuda Grass Hay**
_**\***Bermuda Grass Hay turns into very Fine Fiber Material_
258
Treatment for **Sand Enteropathy/Impaction**
**Medically**- **_Large Volumes of Psyllium and Mineral Oil via Nasogastric Intubation_**
**Surgery**-I_f Larger Pebbles, Stones, Gravel_
259
**Production of \> 20-25 Liters of Urine** that may be Dilute
**Polyuria**
_**\***May be due to Increased Water Intake and Electrolyte Intake- Overhydration, Excess Electrolytes_
260
Define Premature and Dsymature Foals
**Premature- Gestation Less than 320 Days**
**Dysmature- Gestation Over 320 Days with Clinical Signs of Prematurity**
\*_Normal Gestation- 335-340_
261
**A. TB = 6.0 mg/dL, Direct = 0.2 mg/dL, Indirect = 5.8 mg/dL**
_**\***Fasting Hyperbilirubinemia- Our Direct Bilirubin should be within Normal Range, our Total Bilirubin should be High and our Indirect Bilirubin should be Elevated_
262
**Cystic Calculi** are Typically \_\_\_\_\_in Composition
**Calcium Carbonate**
263
Description of _____ Colic:
_Mild-Moderate_
_**Little to No Abnormal Findings**- NG, Rectal_
_**Feces- Dry**, **Mucus on Surface**_
**_GI Motility- Hypermotility with Gassy and Fluidy Sounds_**
**Spasmodic/Simple Colic**
_**\***Motility, Especially in Cases of Spasmodic Colic, is likely going to be Hypermotile_
264
Less than \_\_\_% of Horses with **Hypoalbuminemia** have **Liver Disease**
**_\*If you see Hypoalbuminemia in Horses, Usually NOT Liver Disease_**
_Hypoalbuminemia is NOT Related to Liver Disease in the Equine Patient_
_Most Likely Cause of Hypoalbuminemia in Equines? GI Tract_
265
Which Two **Equine Viral Encephalitides** are used as **Sentinels** for the Human Population
**WEE (Western Equine Encephalitis)**
**EEE (Eastern Equine Encephalitis)**
_**\***As Incidence begins to rise in the horse we start worry about Incidence Increasing in the Human Population_
266
**Endocrine Disease** Described below:
_Severe Imbalance between Energy Intake and Demand in a specific population of Susceptible animals. Increase Demand due to Stress of disease associated with Decreased Intake (Consumption) results in **Mobilization of Peripheral Adipose Tissue**_
**Hyperlipemia**
267
Treatment for **Hepatic Encephalopathy**
**Supplement with Branch-Chained Amino Acids- Ex. Beet Pulp**
**Low Protein Diet**
268
Most Helpful _Diagnostic Procedure_ for **Left Dorsal Displacement (LDD)** of the Large Colon
**Rectal Exam**
269
_Risk Factor_ leading to **Cystic Calculi**
**High Alfalfa Intake**
270
_Neurologic Exam- When Circling you notice he **Swinging his Hind Legs out too Far (Circumduction)** and its Swinging in the Air prior to Stepping Down_
## Footnote
**Characterize the Neurologic Disease**
**Symmetric Tetraparesis and Ataxia with Hindlimb \> Forelimbs**
_Circumduction- When Circuling the Animal you see him Circumduct his Hind Limbs- Grade 1 Spinal Ataxia_
271
**Specific Syndrome** of Horses Described Below:
_Horses 8-18 Years Old_
**_Anormal Fat Deposition: Neck (Cresty Neck)_**
**_Overweight to Obese_**
**_Recurrent Low Grade Laminitis_**
**Cresty Necked Horse**
272
Which Virus is an **Incidental Infection** in _Both Horses and Humans?_
**West Nile Virus (Flavivirus)**
273
True/False: **Spasmodic/Simple Obstructions** are most commonly _Large Intestinal Lesions_
**True**
_**\***Small Intestinal Lesions are usually Strangulating, therefore in patients with Simple Obstructions its probably NOT going to be involving the Small Intestine_
**_\*In Patients with Spasmodic/Simple Colic we DO NOT expect Reflux since the Small Intestine is not Involved_**
274
**Cresty Neck Score** Greater than ____ is common in **Equine Metabolic Syndrome** Affected Animals
**3**
275
**Head Trauma** in the Horse Described Below:
**_Occurs when Horse Flips Over Backwards and Impacts the Poll_**
**_Commonly Training to Lead Accidents_** _(Trying to Get Young Horse to Learn how to Walk on Lead Rope)_
**Basilar Fractures**
_**\***Because of the Thickness of the Skull in that location, the Forces are reprocussed through the Skull and blow out at the point of least resistance- Basilar Bones_
_\*Leads to Trauma at the base of the Brain_
