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Special Topics in Equine Clinical Practice > Medical Disorders of the GI Tract > Flashcards

Medical Disorders of the GI Tract Flashcards

1
Q

You arrive at a barn for a horse with suspect colic. What will you do to evaluate this horse?

A
  1. observe to see if its too painful (sedate if too painful to be handled)
  2. physical exam
  3. pass NG tube and measure amount of net reflux (normal <2 L)
  4. rectal exam
  5. PCV, TP, blood lactate (if able: CBC/Chem, blood gas with electrolyte analysis)
  6. abdominal ultrasound
  7. abdominocentesis + peritoneal fluid sampling
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2
Q

as you evaluate a horse on the farm for colic, what are you trying to ultimately decide?

A
  1. treat on farm
  2. refer to hospital
  3. euthanize
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3
Q

what 5 findings may indicate referral is necessary?

A
  1. unrelenting pain (only briefly controlled by sedation)
  2. persistently increased HR (>60), slow CRT
  3. large amount of net reflex (>6-8L)
  4. abnormal rectal palpation findings
  5. client willingness to refer
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4
Q

what 3 findings may indicate euthanasia may be the best option opposed to treating on the farm or referring?

A
  1. advanced endotoxic shock / possible rupture (purple mucus membranes, cold extremities, extreme depression, prolonged CRT)
  2. advanced disease and client cant/wont refer to hospital
  3. advanced disease and horse is long-distance from the practice which makes rechecks or return for euthanasia later difficult
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5
Q

How can you estimate hydration status in a horse?

A
  1. skin tent (3-5 sec = 7-9%)
  2. mucuous membrane moisture (sticky 7-9%)
  3. CRT (2-4 sec = 7-9%)
  4. PCV (50-65 = 7-9%)
  5. TP (7.5-8.5 = 7-9R)
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6
Q

How do you calculate volume of fluid therapy that a horse with GI disease should receive?

A
  1. Rehydrate (% dehydration x weight kg) = __L
  2. Maintenance (50 mL/kg/day) = ___L
  3. Ongoing losses (__L/hr of losses x 24 hr) = ____L

add them up to get the total daily fluid needs.

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7
Q

what questions should you ask yourself when determining whether to admin fluids orally versus intravenously?

A
  1. does the GI tract have adequate motility (if so, oral ok)
  2. how quickly does the horse need replacement (if quickly, IV)
  3. how well does the horse tolerate the HG tube (if ok, oral)
  4. how long will the horse need fluids
  5. what can the owner afford and or manage?
  6. how available are you
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8
Q

How do you give a horse ORAL fluids?

A

place a small bore (8mm) nasogastric tube
tape it into place and cover the end with a catheter case to keep air out.
leave in place and ALWAYS teach the client how to check for reflux prior to adding fluid!!!!

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9
Q

what is the MAXIMUM stomach volume of a 500 kg horse and what is the comfortable delivery volume for a 500 kg horse?

A

max stomach volume = 16L
comfortable delivery volume = 10L/30 min

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10
Q

T/F: it is appropriate to administer solely plain water with oral fluid administration

A

false – its ok for a single/few doses, but repeated administration of plain water with deplete electrolytes that are stored in the cecum/colon
So you should add 75 grams of lite salt (KCl and NaCl) per 10L of water

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11
Q

How quickly should you replace a fluid deficit?

A

quickly!
deliver 40-50% of the deficit within the 1st hour; if the horse tolerate this, give the remaining deficit in the next 4-6 hours.

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12
Q

What is the shock rate for horses?

A

45 mL/kg/hr which is 20L/hr, but remember only give 10L per 30 minutes, then wait 30 minutes, check for reflux, and administer the other 10L.

Monitor the horses blood protein after the first 20L are given

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13
Q

When rehydrating a horse in shock, you administer 20L in the first 1.5 hours. Why should you check the horses blood protein after you give the first 20 L of fluids BEFORE starting the maintenance and ongoing loss fluid rate?

A

horses with diarrhea are often or often develop hypoproteinemia once they are rehydrated.
By monitoring the blood protein, you can adjust your rate accordingly.

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14
Q

What are 4 reasons for IV fluid administration in the field?

A
  1. to re-establish perfusion to the gut and improve motility (a bridge to oral)
  2. general tx for shock and/or exhaustion
  3. restore adequate hydration/perfusion to get to a referral hospital
  4. one time need (acute hemorrhage)
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15
Q

What are advantages to oral fluids?

A

cheap
effective
can do on farm

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16
Q

what are disadvantages to oral fluids?

A
  • if the tube gets pulled out, fluid will be administered into the trachea and aspiration will occur.

probably not a good idea if the client cannot recognize reflux.

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17
Q

what parameters would you want to monitor during fluid therapy?
How often?

A
  1. physical exam
  2. body weight
  3. USG
  4. PCV/TP
  5. blood electrolytes

monitor frequently with rapid fluid delivery (every few hours) or monitor every 12 hours in unstable patients
monitor every 24-48 hours if patient is stabilized.

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18
Q

what changes would you expect in a patient that has been OVERhydrated?

A

hypoproteinemia
excessive urination
edema
elevated RR

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19
Q

what changes might you expect to see in a patient that is UNDER hydrated during fluid therapy?

A
  • tachy MM
  • tucked up
  • less urination
20
Q

if a horse develops edema but still has mildly concentrate urine, what might be going on and how would you treat the problem?

A

the fluid must be leaking into the tissue due to poor oncotic pressure. They are actually still dehydrated because the fluid just keeps leaking out of the IV space.

21
Q

You are examining a horse and you think based on rectal palpation that they have a large colon impaction. Before you pass a NG tube, what would you want to prepare based on your current diagnosis?

A

mineral oil and epsom salts + water ready to administer if she not have reflux.

22
Q

what is the field treatment for large colon impaction?

A
  • If GI motility still present –> oral fluids
  • if not clinically dehydrated 10L/30 min of warm fluids with electrolytes added.
    provide 4x maintenance per day
23
Q

T/F: if there is more than 1-2 L of net reflux, you should not give PO fluids or any oral medications

A

true

24
Q

what is the purpose of adding mineral oil?

A

fecal softener
increase lubrication around an impaction

25
Q

what is the purpose of epsom salts?

A

fecal softener
penetrates the impaction and brings in water.

26
Q

what is the use for hypertonic saline?

A

rapid, temporary restitution of perfusion

improves CV status for 2 hours. follow up with IV fluids to replace.

27
Q

Replacement fluids should be delivered over __ hours.

A

~8

28
Q

What properties of blood retain fluid in the capillary bed? (3 things)

A

oncotic and osmotic pressures due to:
1. charged proteins that keep water in (albumin*, globulins, and fibrinogen)

  1. charged molecules (Na+, Cl-, K+, Mg-, Ca++, and HCO3-)
  2. biological membrane / endothelium (selectively permeable to charged particles)
29
Q

T/F: the cumulative oncotic effect of albumin is twice that of globulin

A

true – albumin 1/2 the weight of globulin (smaller and can leak easier), so 1 gram of albumin contains 2x the molecules than 1 gram of globulin

30
Q

what creates the osmotic effect that helps retain fluid in the capillaries?

A

charged ions (sodium)

donnan effect

31
Q

T/F: when a large concentration of charged molecules are on one side of a membrane and they cannot permeate the membrane, water will not permeate the membrane either in order to maintain equal concentrations.

A

false – water will move across the membrane to equalize the concentration.

32
Q

What is a reflection coefficient?

A

how readily a molecule is passed through a membrane

RC of 0 indicates that there is minimal selectivity (molecules FREELY move across the membrane). The liver, for example, has an RC of 0.

RC of 1 indicates maximal membrane selectively (no molecules go through membrane). The brain, for example, has an RC of 1.

33
Q

What disease process can alter blood protein concentration and capillary wall integrity leading to higher risk of hypoproteinemia and edema?

A
  1. Vasculitis
  2. Protein-decreasing diseases (increased protein consumption, increased protein loss, or decreased protein production)
34
Q

What are diseases that DECREASE ONCOTIC pressure through low blood protein (albumin)?

A
  1. gut inflammation (PLE)
  2. PLN
  3. hepatopathy
  4. peritoneal or pleural effusion
  5. lack of substrate (starvation or malabsorption)
35
Q

What diseases lead to DECREASED OSMOTIC pressure due to electrolyte (sodium) loss?

A
  1. gut inflammation (interfering with Na absorption and retention)
  2. water overload
  3. pleural or peritoneal fluid (Na sequestered in fluid)
  4. ruptured bladder
  5. adrenal dysfunction (rare)
36
Q

What diseases reduce membrane selectivity?

A

Vasculitis (endotoxemia*, infection, immune-mediated)

37
Q

What occurs during GI disease specifically that disrupts the ability to retain fluid in the vasculature?

A
  1. gut inflammation causing PLE (decrease oncotic pressure) –> hypoproteinemia, edema
  2. gut inflammation interfering with Na absorption and retention (decrease osmotic pressure) –> hyponatremia
  3. endotoxemia (vasculitis) –> petechiae
38
Q

How do we re-establish oncotic pressure in hypoproteinemic horses?

A

Oncotic replacement via plasma or hetastarch

39
Q

What are indications to perform plasma transfusion in a horse to re-establish oncotic pressure?

A
  1. TP < 4 (alb <2)
  2. Edema (limbs, prepuce, pectoral, ventral region, muzzle)
  3. harsh, wet lung sounds and increased RR
  4. thickened bowel (u/s)
40
Q

How do you calculate the amount of replacement plasma needed for a hypoproteinemic horse?

A

(desired TP - measured TP) x (0.05 x BW) / donor plasma protein concentration

41
Q

T/F: plasma protein will increase 1 g/dL for every 4L of plasma

A

true - if said plasma has a TP of 6 g/dL

this is a “quick way” to do the calculation. so if your horse’s TP was 4, you would need to increase the TP by 2 g/dL, therefore you would give 8L of plasma.

42
Q
A
43
Q

how do you deliver plasma to a hypoproteinemic horse? (rate, technique, and materials needed)

A

0.5 mL/kg over 30 minutes through a PLASMA ADMINISTRATION SET.

You need to monitor HR, RR, and temp every 5 min for the 1st 30 minutes. Then, observe continuously through the entire perfusion.
If no reactions during first 3 min, then increase the rate GRADUALLY by increasing 1 mL/kg for 10 min, until you get to 40 mL/kg/hr.

44
Q

T/F: hetastarch is less expensive than plasma and has low toxicity associated with use.

A

true!

45
Q

how do you replace electrolytes in horses with GI disease that are hyponatremic?

A

put 1/4 box of baking soda + water in a bucket (+ a bucket of PLAIN water too) and see if they will drink it.
If not, give an injectable dose of Sodium Bicarbonate.

46
Q

how do you supplement potassium in a horse that has GI disease?

A

lite salt! contains KCl and NaCl.
Add 1/3-2/3 of a box of lite salt to 5 gallons of water. Always provide fresh plain water too.

47
Q

How can you treat vasculitis in horses with GI disease?

A

First, identify and treat the cause of the vasculitis (endotoxemia vs infection vs immune-mediated)

Then, give NSAIDs (reduce inflammation) and +/- pentoxifyline (reduces blood viscosity, improves RBC flexibility, and improves microcirculation).

Special Topics in Equine Clinical Practice (18 decks)

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