Colic I Flashcards
Where do impactions most commonly occur?
Ileum, cecum and sm/lg colon
What can cause impactions?
Food, sand and enteroliths
What are the two types of non-strangulating lesions?
Impactions and displacements
What is another name for a LDD?
Nephrosplenic entrapment
What are the most common places for an impaction?
(1) pelvic flexure
(2) RDC
(3) TC
(4) SC
(5) Gastric
What is the path of blood supply to the cecum?
Cranial mesenteric a. -> ileocolic a. -> cecal a. -> lat and medial cecal a.
What does the medial cecal a. supply?
The cecal apex
What artery supplies the ventral colon?
The colic branch of the ileocolic a.
What artery supplies the dorsal colon?
The right colic a. from the right and middle colic aa.
What artery supplies the ileum?
The ileocecolic a. -> ileal a.
How do you diagnose a sand impaction?
(1) auscultation (sounds like an ocean)
(2) fecal float/sink in a glove
(3) abdominocentesis that produces sand instead of fluid
Where does sand settle?
RDC
What kind of colic (acute, chronic, intermittent or continuous) and pain does a cecal impaction cause?
Acute or chronic intermittent colic with mild to moderate pain
What is the surgical treatment for a colonic impaction?
Pelvic flexure enterotomy
When you perform a pelvic flexure enterotomy, where do you make the incision?
At the pelvic flexure on the anti mesenteric border
What parasite causes verminous arteritis?
Strongyles Vulgaris
What anthelmintic is used to treat verminous arteritis caused by strongylus vulgaris?
Ivermectin
What parasite causes ileocecal intussusception in horses?
Anoplocephala perforliata
What is trichobezoar made of?
Hair
What is a phytobezoar made of?
Fiber
What are the most common enteroliths in horses?
MAP (magnesium, ammonium, phosphate)
If an enterolith is round, what does it indicate? Likewise, if a enterolith is triangular, what does that indicate?
If an enterolith is round that indicates that it is alone while if an enterolith is triangular, that indicates that it has friends
Bezoars/enteroliths most likely end up in which section of the GI tract?
Transverse colon
Is SI colic more likely to be non-strangulating or strangulating?
Strangulating
What are the five types of strangulating SI lesions?
(1) lipoma
(2) EFE
(3) volvulus
(4) Mesenteric rent
(5) Developmental abnormalities
Describe the pathology of a strangulating lipoma
The lipoma becomes pedunculated and the pedicle wraps around the intestine and the mesentery
Where do the majority of lipomas occur and what is the avg age?
The small intestine
14-19 yrs old
What is the treatment for a strangulating lipoma?
Resection and anastomosis
What is an increasing risk factor for epiploic foramen entrapment?
Cribbing
What is another name for the epiploic foramen?
the Foramen of Winslow
What are the boundaries of the epiploic foramen?
(1) The caudate process of the liver
(2) Portal vein
(3) Gastropancreatic fold
What section of the GI tract is usually becomes entrapped in the epiploic foramen?
The ileum and distal jejunum
What is a major complication of epiploic foramen entrapment surgery?
portal vein tear
What are CS of LI torsion/volvulus?
Severe, unrelenting pain, acute colic and rapid CV compromise
What are risk factors of large colon torsion?
Post parturient mares, acute diet change, and lush pasture
What do you always do with a horse that is colicking?
Place an NG tube
What is the difference in reflux between SI colic and LI colic?
SI colic produces copious gastric reflux while LI colic produces only a few L of gastric reflux
If a horse has a fever >102 and is colicking, what does that indicate and what do you do?
It indicates that there is a medical cause and not a candidate for sx. Find the medical cause and treat it
What can be palpated on midline in a rectal exam?
The aorta is located dorsal midline, the inguinal rings are located on ventral midline, and the small colon as well
What can be palpated on the right side of the horse on a rectal exam?
The cecum, colon, and right ovary
What can be palpated on the left side of the horse on a rectal exam?
The left kidney, spleen and left ovary
What imaging device should be used as a routine part of a colic exam?
U/S
Should you administer medication through an NG tube if there is “net” or spontaneous reflux is present?
No
How can you tell if the NG tube is in the right location?
(1) You can see it on the left side of the neck
(2) There is neg pressure if you suck on the tube
(3) You can palpate the NG tube and the trachea separately
What sedative do you use on horse to place an NG tube?
Xylazine
If you are placing a NG tube and cause iotrogenic epistaxis, what structure did you run into?
The turbinates
T/F Spontaneous reflux is normal
F: spontaneous reflux is never normal
Why should you always record the amount of net reflux?
So that you can give replacement fluids
In what location do you perform an abdominocentesis?
Caudal to the xyphoid and on or to the right of ventral midline
What gauge needle do you use for an abdominocentesis?
18-20 g
What tubes do you use for (1) TP and culture, (2) cytology and lactate in a peritoneal fluid sample?
(1) red top
2) purple (EDTA
What are normal lactate levels in a horse? What lactate level indicates a 90% survival rate? What lactate levels indicate a reduction in prognosis?
<2
<6
>7
What is a normal WBC count in a foal? In an adult?
<5000
<1500
Does a normal abdominocentesis r/o the need for sx?
No
What spasmolytics can you administer to a horse with colic?
Lidocaine and buscopan
What NSAID can you administer to a horse with colic, how often should you administer it and why?
Flunixin meglumine
Q 12 hrs but no more bc of renal and GI implications
What alpha 2 agonists can you administer to a horse with colic?
Xylazine
Detomidine
Romifidine
What opioid is best to administer for colic pain?
butorphanol
What level of IgG indicates failure of passive transfer?
<800
In a colicky foal, what should you U/S
The umbilicus and abdomen
What should the umbilical vein measure below on an U/S of a foal? The umbilical artery? The aa./urachus combo just cranial to the bladder?
<1 cm
<1.3 cm
<2.5 cm
What are common causes of newborn colic?
(1) Meconium impaction
(2) Gastric ulceration
(3) Enteritis
(4) Inguinal hernia w/ruptured tunic
(5) Sepsis
A 3 day old foal presents to you with colic. What is most common cause and what is the most common age for this to occur?
Ruptured bladder
2-5 days old
Besides a ruptured bladder, what are two other causes of colic in a 2-5 day old foal with colic?
Gastric ulcers
Enteritis
What are common causes of colic in foals <5 days?
Gastroduodenal ulcers (gastric outflow obstruction) Enteritis SI volvulus Intussusception Impaction (ascarid)
What causes of colic are more typical in colts?
Meconium impaction
Inguinal hernia
What causes of colic are more typical in fillies?
Ruptured bladder (at the urachus) Ureteral abnormalities
A foal is stretched out on their back and has been seen straining. What is most likely causing this presentation?
Pain from colic
What can you give as a sedative for colic in a foal?
Diazepam (benzo)
What can’t you give foals less than 2 weeks of age and why?
xylazine
Because it decreases CV output and HR. The formula for CO is CO = HR x SV. Foals can’t adjust their SV
What NSAID can you administer to a foal with colic and what is the recommended dosage?
Banamine
TID
What gastroprotectant can you use on a foal with colic and what is its MOA?
Ranitidine
H2 antagonist
What gastroprotectant is not effective in a foal <1 month and what is its MOA?
omeprazol
PPI
What type of colic does an inguinal hernia cause?
Acute, severe colic
What type of approach is used to correct a foal with an inguinal hernia?
An inguinal approach
What is a cystorrhexis?
A ruptured bladder
Where are male foals more likely to suffer a cystorrhexis?
The dorsal aspect of the bladder
Where are female foals more likely to suffer a cystorrhexis?
a urachal rupture
What is the most common bloodwork abnormality in a 2-5 day old foal with cystorrhexis?
electrolyte derangement
T/F A foal with cystorrhexis can still urinate
T
What would you see on U/S in a foal with cystorrhexis?
Free fluid in the abdomen
No or very small bladder
What would you see in a serum sample for the peritoneal creatinine ratio in a foal with cystorrhexis?
a ratio >1:2
Is a cystorrhexis a surgical emergency?
No
How do you treat a foal with cystorrhexis?
You medically stabilize first. If the K+ is >5.5 mEq/L you’ll see muscle tremors and arrhythmias. Treat those first and then perform sx only after stable
What is your approach and what kind of incision do you make to correct a ruptured bladder?
Ventral midline elliptical incision around the umbilicus
In a ruptured bladder surgery, what do you do?
You remove the brachial remnants, double ligate the umbilical arteries (2) and vein, and then administer broad spectrum antibiotics
What parasite causes ascarid impaction in foals?
Parascaris equorum
When does ascarid impaction usually occur in the foal?
~24 hrs after deworming
What is the surgical intervention for ascarid impaction?
SI enterotomy
Why do foals have a guarded prognosis for ascarid impaction treated with SI enterotomy?
Because foals and GI sx don’t do well together
In an older foal with acute severe colic, what may be the cause?
Sliding intussusception
What is an intussuscipien and intussusceptum?
The intussuscipien is the telescoping part of the intussusception and the intussusceptum is the telescoped part of the intestine
What surgical intervention is required for an intussusception?
Manual reduction, resection and anastomosis
What happens if there is excessive mesenteric shortening with reduction and anastomosis of intussusception?
Predisposition to volvulus
Parasites cause what kind of intussusception?
Ileocecolic
What is the prognosis for intussusception in a foal?
Fair to guarded
SI volvulus in a foal causes what kind of formation?
Corkscrew
Gastric outflow obstruction in a foal is secondary to what?
pyloric stenosis from ulceration
What surgical intervention is used to treat gastric outflow obstruction and what is the prognosis?
Bypass - gastroduodenostomy
Guarded
