GI -> Ileus Flashcards
T/F: The first third of the esophagus is striated muscle, and the caudal 2/3 of the esophagus is smooth muscle.
False. Prox 2/3 is skeletal, distal 1/3 is smooth
Define primary choke.
Esophageal obstruction with no actual issue with the esophagus itself.
Ex: dental issues, feed types
What are some risk factors with choke concerning horse management and husbandry?
Competition for feed -> bolting
What are some horses associated risk factors for choke?
Dental abnormalities (wavemouth), naturally fast eaters, underlying disease
What are some feed associated factors that can lead to choke?
Feed that expands with water: dry beet pulp, bran, hay cubes, pellets
What are some CxS seen with choke?
Profuse bilateral nasal discharge* (tint of food particles)
Salivation, gagging, retching, ‘colic’ signs
What is the landmark for nasogastric tubing?
13th rib
What is the best diagnostic tool for choke?
Endoscopy
What is the #1 complication with choke to worry about?
Aspiration pneumonia
What are some methods to treat choke?
Heavy sedation (lots of alpha2-agonist: xylazine)
NG tube and flushing
Oxytocin
On physical examination with a horse that has apparent GI complications, what does a high elevated heart rate suggest?
Strangulation of the intestines
How do you grade a horse with colic?
Grade 1 - mild. playing in water, pawing
Grade 2 - moderate. frequent pawing, kicking, crouching
Grade 3 - severe. rolling, thrashing, up and down constant
With GI auscultation, what does +, ++, +/-, and - indicate?
+ : present, normally usual sounds
++ : more than usual sounds
+/- : more or less, difficult to tell
- : absent sounds
With GI auscultation, what does LD, RD, LV, RV represent?
LD: left dorsal quadrant - small intestine and small colon
RD: right dorsal quadrant - cecum
LV: left ventral quadrant - large colon
RV: right ventral quadrant - large colon
If you observe the external abdominal outline of a horse with colic, what would a more proximal contour of the abdomen usually indicate? What if it was blown up like a tick?
Proximal contour - small intestine, large colon displacement
Tick size - large colon involvement
Because a horse cannot vomit, what is a big consequence that can occur?
Gastric rupture
When should NG intubation be attempted when dealing with a severe colicky horse?
Immediately (first)
What does a large volume (>2L) indicate about the location of the colic?
Large volume usually means small intestinal colic
What is the prognosis of a horse that has spontaneous reflux?
Poor prognosis
What would the pH be of the NG reflux fluid if it were <7? >7?
<7 : gastric
>7 : small intestine
What could you guess is a contributor of colic if the reflex from NG tubing is malodorous?
Infectious disease
What can transrectal palpation tell you on a colicky horse?
The type of distention (gas, liquid, etc), location, organ involved, and impact to other organs
T/F: Most of the structures in the abdomen cannot be reached by rectal palpation
True
T/F: If you can palpate small intestine, there is something wrong
True
When would abdominocentesis be indicated?
Only if it will add to information and the decision making process
What are normal values to obtain from a fluid from abdominocentesis?
TP: <2.5 g/dL
WBC: <5,000 - 10,000 cells/uL
RBC: none
What would you expect to see on TP, WBC, RBC values on an abdominocentesis of a horse that has colic?
Increased for all
What can CBC, blood gas, and blood chemistries tell you about a horse with colic?
The status of the horse and severity of shock and disease
What do you see on CBC with a case of inflammatory colic?
Low/normal total WBC count and neutrophil count
What is the best imaging tool to aid in the diagnosis of a colicky horse?
Endoscopy
T/F: Colic can be attributed to both GI-related and non GI-related pain in the abdomen.
True
What are the three biggest risk factors for a horse to get colic?
- ) Diet
- ) Changes in exercise
- ) History of previous colic
What are the four pathophysiologic GI causes of colic?
- ) True obstruction
- ) Non-strangulating infarction
- ) Ulcerations
- ) Inflammatory
What is the physiological difference between strangulating and non-strangulating GI colic?
Gut wall compromise
Which pathophysiologic GI cause of colic looks like a strangulation, but really isn’t?
Infarction (thromboembolic)
T/F: Inflammatory pathophysiologic GI causes are strangulation forms of colic.
True
Which part of the GI tract is most common associated with non-strangulating colic?
Large intestine
What is the HR usually for non-strangulating colic? CV signs?
HR = 60-70 bpm CV = normal RR = increased from pain
How much reflux may you see with a NG tube on a non-strangulating lesion?
Typically none, since it is a large intestine situation
What will you initially see with abdominocentesis of a non-strangulating colic, and what is the the 1st, 2nd, and last value to increase over time?
Initially = normal 1st = TP increase 2nd = WBC increase 3rd = RBC increase
T/F: Strangulating lesions are more painful than non-strangulating colic but have less CV compromise.
False. Higher heart rate, and CRT increased.
What portion of the GI is typically affected by strangulating colic?
Small intestine
How much reflux will you normally get with NG tube on a strangulating colicky horse?
> 5L
What does the vascular compromise from strangulating colic lead to for the horse?
Metabolic acidosis, endotoxemic shock, hypovolemia, change in CV
What do you initially see on abdominocentesis on a strangulating colic? What increases at the same time as the disease progresses?
Initially = serosanguinous fluid
Increases in TP, WBC, RBC at the same degree
What is the single most important indicator for surgery in a colicky horse?
Persistent and/or uncontrollable pain
What are some things to make sure you do before you send a colicky horse to a referral doctor?
NG tube, record the meds, no fluids
T/F: Even if the horse has a strangulating colic, you may still see defecation.
True
What meds would you give to treat spastic or mild colic?
Flunixin meglumine, dipyrone, busopan
What meds would you give to treat moderate to severe colic?
Xylazine, butorphanol
What are general methods used to treat colic, collectively?
No eating for a while, walking it off, NG intubation
What can you give through the NG tube in a colicky horse with no reflux?
Mineral oil
What are the most common ways a horse gets ileus?
Post-operatively, alteration of motility from an abnormality, obstruction, inflammation, drug-induction
How can you treat ileus?
gastric decompression, FLUID THERAPY, pain control, prokinetics
What are the best pain meds to use for ileus?
Flunixin megalmine
What are the best prokinetic drugs to use for ileus?
Metaclopramide, cisapride, neostigmine
What are the best #1 drug to use for ileus in all?
Lidocaine!
