Horse stuff Exam 1

Question 1

What are some of the causes of ‘choke’?

Answer 1

Hay, pellets, cubes
Beet pulp if not moistened first
Foreign bodies
Rapid consumption of food w/o chewing

Question 2

Where are most esophageal obstructions located?

Answer 2

Proximal eso-, just past the larynx.

Question 3

S/S of choke

Answer 3

Distress
Head extension
Salivation
Nasal d/c (food/saliva)
Lethargy
Dehydration
\+/- abnormal lung sounds

Question 4

How is choke dx?

Answer 4

Hx and s/s.
Esophageal palpation
Resistance upon passage of NG tube.
+/- endoscopy or rads

Question 5

How is choke treated?

Answer 5

Sedate 1st! (xylazine or detomidine, torb)
Gentle passage of NG tube, lavage w/ warm water. Rest and repeat.
Eso- relaxation w/ buscopan, OT, or topical lidocaine.

Question 6

Management of choke

Answer 6

NSAIDS
Slow return to normal diet.
Deal with underlying cause, if one found.
+/- AB’s for possible aspiration pneumonia.

Question 7

What are the 4 basic mechanisms of GI pain?

Answer 7

Distension of a viscus
Traction on mesentery
Ischemia
Inflammation

Question 8

What are the primary questions for any colic workup?

Answer 8

Can pain be controlled?
SI or LI?
Strangulating or non?
Sx indicated?
Prognosis?

Question 9

What is the most common type of colic?

Answer 9

LI non-strangulating
*Gas/spasmodic
*Lg colon impaction
80-85% resolve in the field with one treatment.

Question 10

Subtle signs of colic

Answer 10

Anorexia
Lying down more than usual
Decreased fecal output
(normal output 10-12 piles per day)

Question 11

Signs of moderate colic

Answer 11

Pawing
Stretching
Flank watching
Abdominal distention

Question 12

Signs of severe colic

Answer 12

Rolling
Thrashing
Becoming cast
Facial abrasions

Question 13

Characteristics of pain

Answer 13

Duration
Persistence
Severity
Response to analgesics
Breed and individual variability
Severe pain replaced by depression...

Question 14

Basic questions to ask yourself when doing a rectal palpation on colic patient

Answer 14

Distention?
SI or LI?
Gas, fluid, feed?
Masses?
GIVE BUSCOPAN 1ST

Question 15

Colic - when should an NG tube be placed?

Answer 15

EVERY moderate to severely painful colic!
>2-3L reflux is significant.
If >5L, keep tube in.

Question 16

Normal characteristics of abdominal fluid in horse

Answer 16

WBC 5,000-10,000 cells/uL
TP <2 g/dl
NOTE: normal fluid does not r/o strangulation.

Question 17

Initial tx of colic

Answer 17

Analgesia w/ drugs and gastric decompression.

Fluid therapy

Question 18

What is the maintenance fluid requirement for horses?

Answer 18

40-50ml/kg/day

Question 19

How is EGUS diagnosed?

Answer 19

Clinical signs and response to treatment.

Can do gastroscopy, but animal must be fasted for 12-18 hours.

Question 20

What are the risk factors for equine squamous gastric disease?

Answer 20

Diet
Exercise
Environment
NSAIDs

Question 21

What is the only FDA approved product for tx of ulcers in horses?

Answer 21

Omeprazole

Question 22

Treatment of EGUS

Answer 22

Squamous disease: omeprazole 4mg/kg PO SID x 28d. Can cut dose in half if cost a concern. Or use Ranitidine 6.6mg/kg PO TID.
Glandular disease: same as above but add sucralfate and longer duration.

Question 23

What does GDUD stand for?

Answer 23

Gastroduodenal ulcer disease

Question 24

Characteristics of GDUD

Answer 24

Foals <6mo.

Possible outflow obstruction.

Question 25

Ileal impaction colic

Answer 25

Relatively common. SI non-strangulating Southeastern US. Coastal bermuda grass hay or tapeworms.

Question 26

Clinical findings w/ Ileal impaction colic

Answer 26

Pain - moderate, but can be severe Rectal - distended SI Reflux - initially none, but may develop. Peritoneal fluid - typically normal, possible ^ in TS, lactate similar to plasma.

Question 27

Tx of Ileal impaction colic

Answer 27

``` Gastric decompression Withhold feed/water Analgesics, IV fluid therapy Sx intervention if not improving within 24-36hr or abnormal peritoneal fluid. Good to excellent prognosis. ```

Question 28

Cecal impaction colic

Answer 28

LI non-strangulating. Can occur spontaneously in ANY horse Risk factors - stall confinement, broodmare near parturition, recent general anesthesia. RARE.

Question 29

Clinical findings Cecal impaction colic

Answer 29

Pain - mild Reflux - typically none Peritoneal fluid - normal Rectal - cecal distention, feed or fluid.

Question 30

Tx of Cecal impaction colic

Answer 30

``` Early ID. Withhold food/water Enteral laxatives IV fluids Rupture common and sx then required. Guarded prognosis, better with surgery. ```

Question 31

Large colon impaction colic

Answer 31

LI non-strangulating. Typically feed and sand. Most occur at the pelvic flexure. COMMON.

Question 32

Risk factors of Large colon impaction colic

Answer 32

``` Inadequate water intake (change in weather) Ingestion of sand Parasite burden Poor dentition Sudden stall confinement Alternate source of pain Coarse, poor quality roughage ```

Question 33

S/S of Large colon impaction colic

Answer 33

Pain - mild to moderate Reflux - variable Peritoneal fluid - normal Rectal - impaction, variable gas distention Decreased gut sounds, and absent fecal output.

Question 34

Tx of Large colon impaction colic

Answer 34

``` Withhold food water. Pain management. Enteral fluids, lubricants/laxatives, psyllium if sand. IV fluids if reflux develops Px - very good. ```

Question 35

S/S of Small colon impaction colic

Answer 35

Colic, abdominal distention, low volume diarrhea. Often winter months.

Question 36

Dx of Small colon impaction colic

Answer 36

Via rectal small colon feels friable...?

Question 37

Tx, Px, and frequency of Small colon impaction colic

Answer 37

Tx - typically medical Px - good RARE.

Question 38

Enterolith colic

Answer 38

LI non-strangulating. Magnesium ammonium phosphate (struvite) calculi within intestine. Frequency - variable, high in CA.

Question 39

Risk factors for Enterolith colic

Answer 39

Arabians >5y Diet high in protein High colonic luminal pH

Question 40

S/S of Enterolith colic

Answer 40

Pain - intermittent mild to moderate. Fluid - normal Rectal - often normal Radiography - lack of enterolith does not r/o.

Question 41

Tx of Enterolith colic

Answer 41

Surgical removal | Restrict alfalfa <50%

Question 42

Large colon displacement S/S Px Frequency

Answer 42

S/S - similar to other non-strangulating LC obstructions. Px - good with medical or surgical therapy. Freq - relatively common.

Question 43

Left dorsal colon displacement

Answer 43

Nephrosplenic entrapment. Rectal - distended colon lateral to kidney, spleen may be displaced ventrally. U/S - gas filled colon prevent imaging of left kidney, spleen may be ventral.

Question 44

Tx of Left dorsal colon displacement

Answer 44

Phenylephrine and exercise. Rollings under general anesthesia Surgical correction

Question 45

Right dorsal colon displacement

Answer 45

Pelvic flexure migrates cranially (medial or lateral to cecum) Rectal - gas distention of LC, hard to definitively dx. Tx - fluid therapy, limited exercise, sx correction.

Question 46

SI strangulation S/S

Answer 46

Pain - acute, severe Tachycardia >80bpm, clinical evidence of toxemia. Hemoconcentration, PCV >50%. Rectal - distended SI, often thickened and/or edematous. Reflux - high volume U/S - SI distention, possibly thick walled. Fluid - serosanguinous, ^TP, ^WBC, ^lactate. Relatively uncommon.

Question 47

SI strangulation Tx

Answer 47

Surgical correction - resection/anastomosis. Px - typically good, but depends on lesion location. Poor if >50% of SI affection. Survival to d/c 80-85%. Expensive...6-10K!