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A - Equine GIT > Colic > Flashcards

Colic Flashcards

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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
Q

What are the two areas that reflux can come from?

A

Stomach - acidic

Retrograde flow from S.I. - alkaline

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26
Q

After passing a NGT, if no significant reflux is returned what can you start doing?

A

Start entral fluid therapy

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27
Q

What is the approximate volume percentage of a horse’s stomach?

A

1.5% of it’s body weight

500kg horse = around 8litres

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28
Q

What 5 causes of colic can be identified/helped to identify by abdominal palpation per rectum?

A 
Bowel distension
Large colon displacement
Large or small colon impactions
Masses 
Hernias
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29
Q

What can be felt in the left dorsal quadrant during abdominal palpation per rectum?

A

Caudal edge of spleen
Nephrosplenic space
Nephrosplenic ligament
Left kidney

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30
Q

What can be felt in the dorsal midline during abdominal palpation per rectum?

A

aorta

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31
Q

What can be felt in the right dorsal quadrant during abdominal palpation per rectum?

A

caecal base

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32
Q

What can be felt in the left ventral quadrant during abdominal palpation per rectum?

A

Pelvic flexure of large colon

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33
Q

What can be felt in the ventral mid abdomen during abdominal palpation per rectum?

A

Female repro. organs
Bladder
Small colon

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34
Q

What can be felt in the right ventral quadrant during abdominal palpation per rectum?

A

Caecum

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35
Q

What two things can peritoneal fluid analysis be used to assess?

A

Intestinal injury

Peritoneal cavity disease

36
Q

Where should you perform an abdominocentesis?

A

Most ventral aspect of linea alba on the midline or slightly to the right

37
Q

What can happen if you perform an abdominocentesis slightly left of the midline?

A

Can hit the spleen - splenic tap

38
Q

What three samples are taken when doing an abdominocentesis?

A

EDTA - cytology
Lith Hep - biochem
Plain tube - culture

39
Q

What is the normal colour and protein amount of peritoneal fluid?

A

Straw colour and protein under 20g/L

40
Q

What does serosanginous light red peritoneal fluid that is over 30 g/L indicate?

A

Marked intestinal injury has occurred

41
Q

What does bright yellow/orange peritoneal fluid indicate?

A

Peritonitis

42
Q

What causes increased turbiditiy in a peritoneal fluid sample?

A

Increased nucleated cells - WBC’s, from inflammation

43
Q

What cells predominantly appear in a normal cytology of peritoneal fluid?

A

Mononuclear - macrophages

44
Q

What is the TNCC level (nucleated cells) of normal, inflammed and septic peritoneal fluid?

A

Normal - 5x10^9 cells/L
Inflammation - Over 5x10^9 cells/L
Sepsis - Over 2.5x10^10 cells/L

45
Q

What has more nucleated cells, a transudate or an exudate?

A

Exudate

46
Q

What 3 types of cells will you predominantly see in a transudate?

A

Mononuclear cells
Non-degenerative neutrophils
Some RBC’s

47
Q

What 2 types of cells will you predominantly see in a modified transudate?

A

Macrophages

Non-degenerate neutrophils

48
Q

What cell type will you predominantly see in a transudate?

A

Non-degenerate or degenerate neutrophils

49
Q

What has a higher protein concentration- a transudate or an exudate

A

An exudate

50
Q

What is lactate an indicator of?

A

Anaerobic metabolism - tissue ischaemia

51
Q

What does plasma lactate reflect?

A

The metabolic state of every organ (with large organs contributing more)

52
Q

What does peritoneal fluid plasma lactate reflect?

A

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
Q

What is the normal level of lactate?

A

Under 2mmol/L

54
Q

What are the 2 sites that ischaemic intestines can hide that Won’t have a corresponding rise in lactate?

A

Epiploic foramen

Inguinal ring into scrotal sack

55
Q

What are the 5 most common potential abdominocentesis complications?

A 
Enterocentesis 
Amniocentesis
Splenic tap
Omental evisceration
Haemorrhage - if in DIC
56
Q

What are the 5 clinical signs of intestinal rupture?

A 
Evidence of previous abdominal pain
But no active signs of pain now
Severe depression
Evidence of shock - trembling and endotoxaemia
Tachycardia 80-100bpm
57
Q

If you suspect an intestinal rupture what is the first thing you should do?

A

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
Q

What are the 4 limitations of abdominal ultrasound examination?

A

Can only penetrate 35cm
Can’t see through gas filled organs
Lots of intra-abdominal fat
Expensive equipment

59
Q

What are 2 indications where radiography might be useful in colic cases?

A

Sand or an enterolith present

60
Q

What 4 things can gastroscopy/endoscopy diagnose?

A

Equine gastric ulcer syndrome
Tumors
Emptying defects and impactions
Oesophageal obstruction

61
Q

What 3 things can cause an elevated PCV?

A

Haemoconcentration
Splenic contraction - adrenalin
Primary increase in red cell mass

62
Q

What 3 things can cause a decreased PCV?

A

Hemorrhage
Haemolysis
Failure of production

63
Q

What other thing should you assess PCV with?

A

The total protein level - can have multiple things occurring in one patient

64
Q

What 3 things will cause a decrease in white blood cells?

A

Endotoxaemia profile
Leukopaenia due to neutropaenia
Rebound neutrophilia on recovery

65
Q

What parameter is most specific for azotaemia in horses?

A

Creatinine - BUN is non-specific in horse

66
Q

What 2 muscle parameters are likely to be increased in a colic patient?

A

CK and AST

CK can be increased from just lying down

67
Q

What 3 hepatic parameters are useful in colic horses?

A

AST
GGT
Billirubin

68
Q

When are you most likely to see an increased serum GGT in horses?

A

Right dorsal displacement of the large colon - get direct pressure on the common bile duct

69
Q

What 4 electrolyte imbalances commonly occur in a colic horse?

A

Sodium -decreased from loss or increased from dehydration
Hypocalcaemia
Hypophosphataemia
Hypomagnesaemia

70
Q

What are the 4 main goals of treatment in the colic patient to re-establish GIT function?

A

Relieve pain
Restore tissue perfusion
Restore metabolic status
Address secondary complications

71
Q

What are the 5 classes of visceral pain management in the colic patient?

A 
Alpha 2 agonists
NSAIDS
Opioids
Antispasmotics
Na channel blockers
72
Q

What is flunixine meglumine most effective for, its onset and duration of action?

A

Visceral and ocular pain that can be managed medically
Onset 15minutes
Duration 12 hours

73
Q

What 2 things do you need to remember about administering NSAIDS?

A

Never administer IM

Has a ‘ceiling’ effect

74
Q

What is the only licensed NSAID for use in foals?

A

Meloxicam

75
Q

What NSAID least effects retardation of SI mucosal repair ?

A

Meloxicam

76
Q

What NSAID is the most effective for musculoskeletal pain?

A

Phenylbutazone

77
Q

What 2 properties make alpha 2 agonists useful in a colic case?

A

Sedative

Short duration analgesic

78
Q

What are 4 disadvantages of alpha 2 agonists?

A

Marked decrease in GIT motility
Cardiovascular and respiratory depression
Increased sweating and urine production
Rarely can produce violent behaviour

79
Q

What must you also administer if you choose to use an opioid in a colic horse?

A

Alpha 2 agonist - except in extremely very sick

80
Q 
What are the duration of action of the 4 common opioids, and if they are used for colic - 
Butorphanol 
Buprenorphine
Morphine
Fentanyl
Tramadol
A

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
Q

What Na channel blocker can be used in colic, and what is it used for?

A

Lignocaine
Topical local anaesthesia rectally
Analgesic and anti-inflammatory so is a prokinetic of the S.I.

82
Q

What drug is only used for spasmodic colic and why?

A

Anti-spasmodics - N-Butylscopolammonium bromide (Buscopan)

Is a parasympatholytic and further decreases GIT motility

83
Q

What are 3 advantages of administering enteral fluids?

A

Cheap
Relatively easy
Stimulates the gastrocolic reflex

84
Q

In a 500kg horse with an 8L stomach, what volume of enteral fluid can you give daily?

A

96Litres/day

-Max 8litres every 2 hours

85
Q

Why is paraffin oil used?

A

As a transit marker only

86
Q

How does magnesium sulfate work?

A

Is an irritant cathartic - ticks off the GIT to make it move more

87
Q

What is dioctyl sodium succinate and what should you never administer it with?

A

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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