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A - Equine GIT > Colic > Flashcards

Colic Flashcards

1
Q

Behavioural observations of colic

A 
Pawing
Head tossing
penile protrusion
yawning
flehming
rolling
dog sitting
throwing themselves on ground
etc.
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2
Q

What is colic?`

A

Collection of clinical signs that are observed, that are interpreted as evidence of pain which is originating from within the abdominal cavity

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3
Q

What are the 2 broad categories of colic? i.e. the two broad areas pain is coming from

A

Extra-abdominal disease misinterpreted

Abdominal cavity pain

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4
Q

What 3 things cause gastrointestinal pain?

A

Distension
Ischaemia
Inflammation

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5
Q

2 causes of distension of the GIT

A

Abnormal gas production

Obstruction - either functional or physical

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6
Q

What is the number 1 differential for extra-abdominal disease that is misinterpreted as colic?

A

Laminitis

- Stand on their heels compared to a ‘saw horse’ stance of colic

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7
Q

2 causes of nervous system diseases that can look like colic?

A

Hendra virus

Botulism

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8
Q

Liver disease that can look like colic?

A

Hepatic encephalopathy

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9
Q

Respiratory disease that can look like colic?

A

Pleuropneumonia - pleural pain

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10
Q

Cardiovascular disease that can look like colic?

A

Heart failure

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11
Q

2 immune system disorders that can look like colic?

A

Shock

Vasculitis

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12
Q

2 Metabolic disorders that can look like colic?

A

Hyperkalaemic periodic paralysis

Hypocalcaemia

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13
Q

The 5 broad steps of treating a horse with colic? -not specifically treatment options

A 
History
Physical examination
Diagnostic tests
Treatment options
Prognosis
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14
Q

If under 1yo what parasite and what pathogen should be included as a possible cause?

A 
Parascaris equorum 
Lawsonia intracellularis (6mths-1yo)
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15
Q

Does old age affect fecal egg counts, metabolic function and immunity?

A

No

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16
Q

What breed are enteroliths more common in?

A

Arabians

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17
Q

What breed are faecolyths more common in?

A

Miniature ponies

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18
Q

3 female specific reasons for colic?

A

Uterine torsion
Ovarian disease
Pregnancy

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19
Q

2 male specific reasons for colic?

A

Testicular torsion

Scrotal hernia

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20
Q

Why can the colour of a horse be important when diagnosing the cause of colic?

A

Because of the overo lethal white syndrome - Ileocolonic aganglionosis

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21
Q

The 7 most important parameters of the physical exam in a colicing horse?

A

Heart rate (over 48 worry, over 60 emergency)
Attitude (how much pain)
Respiratory rate (over 20 or over 30)
Mucus membranes
Temperature (normal 37-38.5)
GIT sounds (borborigmi and ileocaecal flush/30sec)
Peripheral pulse quality

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22
Q

Why is it important to get baseline vital values?

A

To monitor the horse’s response to treatment

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23
Q

What are the 7 most common diagnostic tests for the colic patient?

A 
Nasogastric intubation
Abdominal palpation per rectum
Abdominocentesis 
Abdominal ultrasound
Abdominal radiography 
Gastroscopy 
Haematology and biochemistry profile
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24
Q

What are the signs of gastric distension?

A

very painful

Tachycardia over 60 bpm

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25
What are the two areas that reflux can come from?
Stomach - acidic | Retrograde flow from S.I. - alkaline
26
After passing a NGT, if no significant reflux is returned what can you start doing?
Start entral fluid therapy
27
What is the approximate volume percentage of a horse's stomach?
1.5% of it's body weight | 500kg horse = around 8litres
28
What 5 causes of colic can be identified/helped to identify by abdominal palpation per rectum?
``` Bowel distension Large colon displacement Large or small colon impactions Masses Hernias ```
29
What can be felt in the left dorsal quadrant during abdominal palpation per rectum?
Caudal edge of spleen Nephrosplenic space Nephrosplenic ligament Left kidney
30
What can be felt in the dorsal midline during abdominal palpation per rectum?
aorta
31
What can be felt in the right dorsal quadrant during abdominal palpation per rectum?
caecal base
32
What can be felt in the left ventral quadrant during abdominal palpation per rectum?
Pelvic flexure of large colon
33
What can be felt in the ventral mid abdomen during abdominal palpation per rectum?
Female repro. organs Bladder Small colon
34
What can be felt in the right ventral quadrant during abdominal palpation per rectum?
Caecum
35
What two things can peritoneal fluid analysis be used to assess?
Intestinal injury | Peritoneal cavity disease
36
Where should you perform an abdominocentesis?
Most ventral aspect of linea alba on the midline or slightly to the right
37
What can happen if you perform an abdominocentesis slightly left of the midline?
Can hit the spleen - splenic tap
38
What three samples are taken when doing an abdominocentesis?
EDTA - cytology Lith Hep - biochem Plain tube - culture
39
What is the normal colour and protein amount of peritoneal fluid?
Straw colour and protein under 20g/L
40
What does serosanginous light red peritoneal fluid that is over 30 g/L indicate?
Marked intestinal injury has occurred
41
What does bright yellow/orange peritoneal fluid indicate?
Peritonitis
42
What causes increased turbiditiy in a peritoneal fluid sample?
Increased nucleated cells - WBC's, from inflammation
43
What cells predominantly appear in a normal cytology of peritoneal fluid?
Mononuclear - macrophages
44
What is the TNCC level (nucleated cells) of normal, inflammed and septic peritoneal fluid?
Normal - 5x10^9 cells/L Inflammation - Over 5x10^9 cells/L Sepsis - Over 2.5x10^10 cells/L
45
What has more nucleated cells, a transudate or an exudate?
Exudate
46
What 3 types of cells will you predominantly see in a transudate?
Mononuclear cells Non-degenerative neutrophils Some RBC's
47
What 2 types of cells will you predominantly see in a modified transudate?
Macrophages | Non-degenerate neutrophils
48
What cell type will you predominantly see in a transudate?
Non-degenerate or degenerate neutrophils
49
What has a higher protein concentration- a transudate or an exudate
An exudate
50
What is lactate an indicator of?
Anaerobic metabolism - tissue ischaemia
51
What does plasma lactate reflect?
The metabolic state of every organ (with large organs contributing more)
52
What does peritoneal fluid plasma lactate reflect?
It is an ultra-filtrate of plasma so should equal plasma levels. However it will become higher if there is local production within the abdominal cavity
53
What is the normal level of lactate?
Under 2mmol/L
54
What are the 2 sites that ischaemic intestines can hide that Won't have a corresponding rise in lactate?
Epiploic foramen | Inguinal ring into scrotal sack
55
What are the 5 most common potential abdominocentesis complications?
``` Enterocentesis Amniocentesis Splenic tap Omental evisceration Haemorrhage - if in DIC ```
56
What are the 5 clinical signs of intestinal rupture?
``` Evidence of previous abdominal pain But no active signs of pain now Severe depression Evidence of shock - trembling and endotoxaemia Tachycardia 80-100bpm ```
57
If you suspect an intestinal rupture what is the first thing you should do?
Abdominal palpation per rectum to see if there is free gas in abdomen Only time where you don't pass a NGT immediately with a HR over 60 since it won't do anything
58
What are the 4 limitations of abdominal ultrasound examination?
Can only penetrate 35cm Can't see through gas filled organs Lots of intra-abdominal fat Expensive equipment
59
What are 2 indications where radiography might be useful in colic cases?
Sand or an enterolith present
60
What 4 things can gastroscopy/endoscopy diagnose?
Equine gastric ulcer syndrome Tumors Emptying defects and impactions Oesophageal obstruction
61
What 3 things can cause an elevated PCV?
Haemoconcentration Splenic contraction - adrenalin Primary increase in red cell mass
62
What 3 things can cause a decreased PCV?
Hemorrhage Haemolysis Failure of production
63
What other thing should you assess PCV with?
The total protein level - can have multiple things occurring in one patient
64
What 3 things will cause a decrease in white blood cells?
Endotoxaemia profile Leukopaenia due to neutropaenia Rebound neutrophilia on recovery
65
What parameter is most specific for azotaemia in horses?
Creatinine - BUN is non-specific in horse
66
What 2 muscle parameters are likely to be increased in a colic patient?
CK and AST | CK can be increased from just lying down
67
What 3 hepatic parameters are useful in colic horses?
AST GGT Billirubin
68
When are you most likely to see an increased serum GGT in horses?
Right dorsal displacement of the large colon - get direct pressure on the common bile duct
69
What 4 electrolyte imbalances commonly occur in a colic horse?
Sodium -decreased from loss or increased from dehydration Hypocalcaemia Hypophosphataemia Hypomagnesaemia
70
What are the 4 main goals of treatment in the colic patient to re-establish GIT function?
Relieve pain Restore tissue perfusion Restore metabolic status Address secondary complications
71
What are the 5 classes of visceral pain management in the colic patient?
``` Alpha 2 agonists NSAIDS Opioids Antispasmotics Na channel blockers ```
72
What is flunixine meglumine most effective for, its onset and duration of action?
Visceral and ocular pain that can be managed medically Onset 15minutes Duration 12 hours
73
What 2 things do you need to remember about administering NSAIDS?
Never administer IM | Has a 'ceiling' effect
74
What is the only licensed NSAID for use in foals?
Meloxicam
75
What NSAID least effects retardation of SI mucosal repair ?
Meloxicam
76
What NSAID is the most effective for musculoskeletal pain?
Phenylbutazone
77
What 2 properties make alpha 2 agonists useful in a colic case?
Sedative | Short duration analgesic
78
What are 4 disadvantages of alpha 2 agonists?
Marked decrease in GIT motility Cardiovascular and respiratory depression Increased sweating and urine production Rarely can produce violent behaviour
79
What must you also administer if you choose to use an opioid in a colic horse?
Alpha 2 agonist - except in extremely very sick
80
``` What are the duration of action of the 4 common opioids, and if they are used for colic - Butorphanol Buprenorphine Morphine Fentanyl Tramadol ```
Butorphanol - 4 hours Buprenorphine - 12 hours Morphine - suppresses GIT motility too much Fentanyl - not used much, patch is variable Tramadol - short 1/2 life and oral bioavailability so not great
81
What Na channel blocker can be used in colic, and what is it used for?
Lignocaine Topical local anaesthesia rectally Analgesic and anti-inflammatory so is a prokinetic of the S.I.
82
What drug is only used for spasmodic colic and why?
Anti-spasmodics - N-Butylscopolammonium bromide (Buscopan) | Is a parasympatholytic and further decreases GIT motility
83
What are 3 advantages of administering enteral fluids?
Cheap Relatively easy Stimulates the gastrocolic reflex
84
In a 500kg horse with an 8L stomach, what volume of enteral fluid can you give daily?
96Litres/day | -Max 8litres every 2 hours
85
Why is paraffin oil used?
As a transit marker only
86
How does magnesium sulfate work?
Is an irritant cathartic - ticks off the GIT to make it move more
87
What is dioctyl sodium succinate and what should you never administer it with?
Surface-wetting agent which reduces surface tension - allows water and fat to penetrate ingesta Never administer with paraffin oil - Will be absorbed into circulation

A - Equine GIT (1 decks)

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