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RUSVM Large Animal Surgery > Colic > Flashcards

Colic Flashcards

1
Q

What important history information should you collect for an animal that is ocicing?

A 
How long? 
When last normal? 
How severe? 
Intermittent or continuous? 
Meds given and any response ? 
What do they eat? Water supply? Heated? 
Where do they eat? 
Deworming history?
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2
Q

What are the most common places for impactions in the GI?

A

Pelvic flexure

Right dorsal colon

Transverse colon

Small colon

Gastric impaction

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3
Q

Most common place for sand impactions?

A

Right dorsal colon

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4
Q

How can you confirm sand impaction?

A

Auscultation
Fecal float/skin
Abdominocentesis

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5
Q

What are your top differentials if on rectal palpation you find a distended structure in the right dorsal quadrant ?

A

Cecal impaction or cecal tympany (dysfuntion)

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6
Q

What intestinal parasites commonly can cause colonic impactions?

A

Strongylus vulgaris

Anoplocephala perfoliata (ileoceceal intussusception)

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7
Q

What are the most common locations for enteroliths?

A

Transverse colon

Right dorsal
Small colon
Pelvic flexure

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8
Q

What is the most common composition for enteroliths in horses?

A

Struvite

Mg Ammonium Phosphate

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9
Q

T/F: most lesions of the small intestine are strangulating

A

True

58-85%

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10
Q

What are the strangulating lesions of the SI?

A

Lipoma
EFE (epiploic foramen entrapment)

Volvulus
Mesenteric rent

Meckels diverticulum

Herniation
Intussusception

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11
Q

Where is the most common location for lipomas to occur?

A

Small intestine (90%)

Small colon (10%)

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12
Q

The treatment for a strangulating lipoma is resection and anastomosis. What are some complications that can arise from this surgery?

A

Shortening of mesentery can predispose to volvulus?

Adhesions

Ileus/impactions

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13
Q

Boundaries of the epiploic foramen ?

A

Caudal process of the liver
Portal vein
Gastropancreatic fold

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14
Q

T/F: most epiploic foramen entrapment are right to left ?

A

False

Left to right > 95%

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15
Q

Predisposing factors do epiploic foramen entrapment?

A

Cribbing

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16
Q

Complications and Pr sos is for EFE surgery?

A

Surgery is a manual reduction

Complication — portal vein tear

4x more likely to required repeat surgery

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17
Q

Risk factors for large colon torsion?

A

Post parturient mare

Diet change

Recent access to lush pasture

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18
Q

Clinical signs associated with large intestinal torsion/volvulus ?

A

Severe colic pain
-unable to control with analgesics

Rapid CV compromise

  • tachycardia
  • hemoconcentration
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19
Q

First step for examination of a colicky horse?

A

NG tube

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20
Q

When doing a rectal exam, what is normally palpated on the right?

A

Cecum
Right colon
R ovary

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21
Q

When doing a rectal exam, what is normally palpated on the left?

A

Left kidney
Spleen.
Left ovary
Left colon

22
Q

When doing a rectal exam, what is normally palpated in the middle??

A

Dorsal midline — aorta
Ventral midline — inguinal rings

Small colon

23
Q

What is the FLASH technique for abdominal US?

A

Left side

  • ventral abdomen
  • gastric window
  • splenic-renal window
  • left middle 1/3rd of abdomen

Right side

  • duodenal window
  • right middle 1/3rd of abdomen
  • cranial ventral thorax
24
Q

How do you place an NG tube?

A

Good restraint

Measure distance to pharynx

Guide tube ventrally and medially into the ventral meatus

Pass tube curving down
Will feel soft resistance at pharynx — stop then rotate tube 180 degrees and then gently bump the pharynx to simulate swallowing

Pass tube as horse swallows

25
Q

How can you make sure your NG tube is in the correct place?

A

Watch the tube go down

Negative pressure

Create siphon — reflux feed material

Palpate ventral neck

26
Q

Complications to NG intubation?

A

Iatrogenic epistaxis

Tube in trachea — will usually cough

27
Q

You passed an NG tube.. now can you initiate reflux?

A

Create a siphon

—pump water down tube, disconnect, then pull the tube back in short, jerky motions to create siphon

28
Q

T/F: spontaneous reflux is never normal

A

True

You should never get more back than what you put in.

Can have a small amount of “net” reflux with indwelling tube

29
Q

T/F: you should only give medication orally if you have a net postive reflux

A

False

Never give medication through tube if “net” reflux is present

30
Q

Where is the lesion usually located when there is a large amount of reflux?

A

Small intestine
— anterior enteritis
—impaction
—strangulation

31
Q

If colic pain is relieved by reflux and decompression, what is the likely cause of colic?

A

Anterior enteritis

Ileal impaction

32
Q

If colic pain is NOT relieved by reflux and decompression, what is the likely cause of colic?

A

Mechanical obstruction/strangulation
— persistent tachycardia
—persistent pain

33
Q

What is the location that you will do an abdominocentesis?

A

On or right of midline

Caudal to xyphoid (most ventral)

34
Q

What tubes do you ue for peritoneal fluid analysis?

A

Red top : TP (culture if indicated)

EDTA: cytology, lactate

35
Q

What is normal lactate levels in peritoneal fluid?

A

< 2

36
Q

What is normal for WBC in peritoneal fluids?

A

<5000/uL in adults

<1500/ul in foals

37
Q

T/F: normal abdominocentesis rules out the need for surgery

A

False

38
Q

Methods for pain managment for colic?

A

NSAID —flunixin meglumine 1mg/kg every 12hours (do NOT give more ofthen than q12hrs)

A2 - Xylazine / detomidine/ romifidine

Opioid - butorphanol

Spasmolytics

39
Q

When should colic be managed medically vs surgically?

A

Medically — mild to moderate pain or intermittent, easily controlled with medication

Surgically — severe or persistent, unresponsive to meds

40
Q

What do you do in PE of colicky foal?

A

TPR, bloodwork, IgG status
Pain level and CV status
Radiographs of abdomen

US
— umbilical vein <1cm
—umbilical artery <1.3cm
—arteries/urachus combo

41
Q

Treatment of patent urachus?

A

Surgical if >2x normal size or combination with other perinatal infections

42
Q

Common causes of foal colic?

A

Meconium impaction (should be passed in 1 day)

Gastric ulceration

Enteritis

Inguinal hernia with ruptured tunic

Sepsis

Ruptured bladder (2-5days old)

43
Q

Common causes of colic in older foals?

A

Gastroduodental ulcer — gastric outflow obstruction

Enteritis

SI volvulus

Intussusception

Impaction (ascarid)

44
Q

Most common electrolyte derangement in foals

A

Hyponatremia
Hypochloremia
Hyperkalemia

45
Q

Most common location of cystorrhexis in male vs female foals?

A

Male — dorsal aspect of the bladder

Female— urachal rupture

46
Q

What is the the normal serum: peritoneal creatinine ratio?

A

> 1:2

47
Q

T/F: cystorrhexis is a surgical emergency

A

False

Medically stabilize first — K+ >5.5 mEq/L —> muscle tremors and arrhythmias

48
Q

Surgical approach for ruptured bladder?

A

Ventral midline

Elliptical incision into bladder
Remove urachal remnants

Double ligate umbilical arteries and vein

Trim edges of tear, close

Broad spectrum ABs

49
Q

Prognosis of cystorrhexis?

A

Excellent with good medical and surgical intervention

50
Q

Why is there a guarded pronsosis for SI enterotomy in cases of ascarid impaction?

A

Adhesions formation

51
Q

Surgical intervention for intussusception ?

A

Manually reduce, R/A
— mesenteric difficulty
—excessive mesenteric shortening - predisposes to volvulus

52
Q

Surgical intervention for gastric outflow obstruction ?

A

Bypass— gastroduodenostomy

Secondary to pyloric stenosis from ulceration

RUSVM Large Animal Surgery (18 decks)

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