Final: Little Part 1 - Colic 1

Question 1

Give 2 reasons why impactions are more common in the winter.

Answer 1

Frozen water source / water too cold

Water heater malfunction (shocking the horse)

Question 2

What type of feed causes ilial impaction?

Answer 2

Costal bermuda grass

Question 3

What drug would you give a horse with a LDD/ nephrosplenic entrapment to help resolve the displacement?

Answer 3

Phenylephrine (then exercise horse q20 min and recheck by rectal and US)

Induces splenic contraction

Question 4

Which flexure can be involved with a right dorsal displacement of the colon?

Answer 4

Pelvic

Question 5

What are the most common places for impactions?

Answer 5

Pelvic flexure

RDC

Transverse colon

Small colon

Gastric impaction

Question 6

What part of the colon does a sand impaction affect?

Answer 6

RDC

Question 7

How can you differentiate a cecal from a colon impaction by rectal palpation (not bands)?

Answer 7

Cecum will be attached to the body wall dorsally

Question 8

What is the prognosis post-op in a horse with a (uncomplicated, early diagnosed) cecal impaction?

Answer 8

Excellent

Question 9

What conditions predispose to cecal impaction?

Answer 9

Previous orthopedic surgery

Ophthalmic issues

Change in exercise routine

Question 10

What surgery is performed for a colonic impaction?

Answer 10

Pelvic flexure enterotomy

Elevate colon onto colon tray and incise pelvic flexure on anti-mesenteric aspect

Question 11

What is the foramen of Winslow?

Answer 11

Epiploic foramen

Question 12

Which tapeworm can cause ileocecal intussesceptions in horses?

Answer 12

Anoplocephala perfoliata

Question 13

Where do bezoars or enteroliths become loged?

Answer 13

Transverse colon

Question 14

What makes up enteroliths?

Answer 14

MAP (Magnesium ammonium phosphate/ Struvite)

Question 15

What is the most common location for a strangulating lipoma? Where else do they occur?

Answer 15

Small intestine (90%)

Small colon (10%)

Question 16

What are the boundaries of the epiploic foramen?

Answer 16

Caudate process of the liver

Portal vein

Gastropancreatic fold

Question 17

What behavior predisposes to epiploic foramen entrapment? Why?

Answer 17

Cribbing

Changes intraabdominal pressure

Question 18

What becomes entrapped in the epiploic foramen and in which direction does the entrapment usually occur?

Answer 18

Small intestine

Left to right (>95%)

Question 19

What is the most major complication with an EFE surgery?

Answer 19

Portal vein tear -> Fatal hemorrhage

Question 20

What are the risk factors for a large colon torsion? What is usually the presentation?

Answer 20

Post parturient mare

Diet change

Recent access to lush pasture

Presentation: Unrelenting severe pain

Question 21

What must you do on every horse you are examining for colic?

Answer 21

NG tube

Question 22

What drug can you administer to reduce the risk of a rectal tear during a rectal examination?

Answer 22

Buscopan (spasmolytic)

+/- epidural or lidocaine per rectum

Also LUBE!!!

Question 23

What can be examined on the left side using the FLASH / FAST ultrasound technique?

Answer 23

1. Ventral abdomen: Ventral colon, some small intestine
   * Fluid, inguinal region (small intestine), tenea of ventral colon, thickening of ventral colon*
2. Gastric window
3. Nephro-splenic window - LDD?
4. Left middle third of the abdomen

Question 24

What can be examined on the right side using the FLASH / FAST ultrasound technique?

Answer 24

5. Duodenal window
   * Duodenum doesn’t move - gastric outflow obstruction, enteritis*
6. Right middle third of the abdomen
   * RDD-> Mesenteric vasculature between body wall and cecum*

T. Cranial ventral thorax

Chest pain (pleuropneuminia, pleuritis, pleural effusion = +++ pain) can mimic colic

Question 25

A NG tube should be passed _________ to minimize the risk of hitting the ethmoid turbinates

Answer 25

**Ventro-medially** (as ventral as possible) into the ventral meatus

Question 26

Which side of the neck are you looking at when passing an NG tube?

Answer 26

Left

Question 27

What is the repsonse to NG decompression in a horse with ileus?

Answer 27

HR decrease Depression (due to pain relief)

Question 28

What is the repsonse to NG decompression in a horse with a mechanical obstruction or strangulation?

Answer 28

Minimal/no response Persistent pain Persistent tachycardia

Question 29

Where do you stick a horse for abdominocentesis?

Answer 29

On or to the **right** of ventral midline *- to avoid the spleen* Caudal to the xyphoid

Question 30

What test can you perform to determine whether the hemorrhagic abdominocentesis sample you obtained is truly from the abdomen or if you aspirated the spleen?

Answer 30

PCV If hit the spleen, PCV is higher than the blood

Question 31

Why do you insert the cannula through gauze and then into the stab incision when performing an abdominocentesis?

Answer 31

To **prevent blood contamination** of the sample from superficial vessels in the skin

Question 32

What is the normal WBC, TP, and lactate of peritoneal fluid?

Answer 32

WBC \< 5000/uL (\<1500 in foals) TP \<2.0 Lactate \<2.0

Question 33

When the lactate level in peritoneal fluid increaes from \< ___ to \> ____ the survival of the horse decreases from 90% to 30%

Answer 33

\<6.0 \>7.0

Question 34

Which tube do you use for measuing TP and to obtain a culture from peritoneal fluid? Which tube is used for cytology and lactate?

Answer 34

RTT LTT / EDTA

Question 35

What components should be included in pain management of a colic patient?

Answer 35

_NSAID_: Flunixin *BID (more if for anti-endotoxic effect because dose is 1/4)* _A-2_ agonists: Xylazine, Detomidine, Romifidine _Opioids_: Butorphanol _Spasmolytics_: Buscopan, Lidocaine

Question 36

What diagnostic could you perform on a colicking foal that is not feasible in an adult?

Answer 36

Abdominal rads

Question 37

What must you be sure to ultrasound on a colicing foal? What are the normal values?

Answer 37

Umbilical structures Umbilical vein \<1cm Umbilical artery \<1.3cm Arteries/urachus combo \<2.5cm (horizontally; measured just cranially to the bladder) *Mickey mouse*

Question 38

When is colic surgery in a foal indicated (US findings)?

Answer 38

If umbilical structures are \>2x their normal size

Question 39

What are the 2 most common causes of newborn colic?

Answer 39

Meconium impaction Gastric ulcers

Question 40

What is the most common surgical colic in a 5 day old foal?

Answer 40

Ruptured bladder

Question 41

What condition of older foals can result in a gastric/pyloric outflow obstruction?

Answer 41

Gastroduodenal ulcers

Question 42

What does it indicate if a foal is stretched out and laying on it's back?

Answer 42

Colic pain

Question 43

Why are A-2s not indicated until a foal is 2 weeks of age?

Answer 43

A-2s induce bradycardia for which a foal cannot compensate

Question 44

What gastroprotectants are commonly used in foals?

Answer 44

Ranitidine Sucralfate

Question 45

What surgical approach do you take to repair an inguinal hernia?

Answer 45

Inguinal

Question 46

What e-lyte derrangements indicate cytorrhexis foals?

Answer 46

Hyperkalemia Hyponatremia Hypochloridemia

Question 47

What potassium level in foals can lead to muscle tremors and arrythmias?

Answer 47

\>5.5 mEq/L

Question 48

What type of incision is made to repair a ruptured bladder in a foal? What must you be careful to avoid when making your approach?

Answer 48

Elliptical Umbilical arteries (2) and vein (1)

Question 49

Why is the prognosis for a foal with an ascarid impaction guarded?

Answer 49

+++ Intestinal damage already present and the amount of manipulation that will be required in surgery