Colic

Question 1

Yawning alone in horses is a sign of which particular organ malfunctioning?

Answer 1

The liver

Question 2

The 3 main causes of gastrointestinal pain are:

Answer 2

Distension, ischaemia and inflammation.

Question 3

What heart rate is considered worrying in horses and at what point does it become severely abnormal?

Answer 3

48-58bpm is worrying. >60 is severely abnormal.

Question 4

What are the 4 main goals of physical examination of a colic patient?

Answer 4

1. Obtain baseline values to monitor response to treatment. 2. Determine degree of cardiovascular compromise. 3. Assess for secondary complications. 4. Aid in diagnosis of cause of abdominal pain.

Question 5

What options are there for diagnostic tests in the colic patient?

Answer 5

Nasogastric intubation; Abdominal palpation per rectum; Abdominocentesis; Abdominal ultrasound; Abdominal radiography, Gastroscopy; Haematology and biochemistry.

Question 6

When using nasogastric intubation as a diagnostic tool for colic cases, what technique is used to work out how much fluid comes out of the horse?

Answer 6

The two bucket technique - clean water of known volume goes IN from one bucket and reflux is emptied into a second.

Question 7

What is the stomach volume of a horse?

Answer 7

1.5% of its body weight

Question 8

From what location would you perform abdominocentesis?

Answer 8

Most ventral aspect of the linea alba at midline or slightly to the right. (*Spleen on the left)

Question 9

What does it mean if the peritoneal fluid looks like orange juice?

Answer 9

Peritonitis

Question 10

Above what number is the amount of protein in abdominal fluid considered abnormal?

Answer 10

20g/L

Question 11

Can you culture from a purple top (EDTA) tube?

Answer 11

No! Need to use a red top (plain) tube.

Question 12

What is the normal measurement of lactate (in plasma OR peritoneal fluid)?

Answer 12

Less than 2mmol/L

Question 13

Fill in the blanks: “No horse with blood lactate >_____ mmol/L or peritoneal fluid lactate >_____ mmol/L survived”

Answer 13

No horse with blood lactate >8.6 mmol/L or peritoneal fluid lactate >16.9 mmol/L survived

Question 14

In which 2 sites might damaged intestine ‘hide’ and not leak lactate into the peritoneal fluid?

Answer 14

The epiploic foramen or through inguinal ring into scrotal sac

Question 15

What would you think of in relation to a finding of elevated GGT?

Answer 15

Right dorsal displacement of the large colon

Question 16

What happens to calcium levels in a colicy horse?

Answer 16

They become hypocalcaemic - their whole system is geared up to absorb calcium so when absorption is disrupted they quickly become hypocalcaemic.

Question 17

What are the treatment goals for a colic patient?

Answer 17

Relieve Pain. Restore Tissue Perfusion. Restore Metabolic Status. Treat Secondary Complication.

Question 18

What drug classes available for visceral pain management?

Answer 18

NSAIDS. Opiods. Na channel blockers. a2 agonists. Antispasmotics.

Question 19

What are the effects of flunixin?

Answer 19

Anti-inflammatory, analgesic, antipyretic

Question 20

What is the onset and duration of flunixin?

Answer 20

Onset: 15 min Duration: ~12hrs

Question 21

How should you administer flunixin?

Answer 21

IV or PO. NEVER ADMINISTER IM - will cause clostridial myonecrosis.

Question 22

Which NSAID is licensed for use in foals?

Answer 22

Meloxicam

Question 23

Which NSAID is most effective for musculoskeletal pain?

Answer 23

Phenylbutazone.

Question 24

What are the disadvantages of using a2 agonists in colic cases?

Answer 24

Profound decrease in GI motility. Cardiovascular and respiratory depression. Increased sweating and urine production. Rarely - xylazine rage!

Question 25

What are a2 agonists most useful for in a colic case?

Answer 25

To immediately control abdominal pain and allow procedures to be performed safely.

Question 26

When can you administer opioids to a horse?

Answer 26

Only ever in conjunction with (and after) an a2 agonist.

Question 27

Which is the most commonly used opiod in colic cases?

Answer 27

Butorphanol.

Question 28

Why would you not use morphine for a colic case?

Answer 28

Decreased GIT motility too significantly.