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Ultrasound is useful for the diagnosis of what lesions? (7)
small intestinal lesions, cecocecal intussusception, nephrosplenic entrapment of LC, uterine artery rupture, inguinal/scrotal hernia, left dorsal displacement of large colon, +/- right dorsal colon exam (loss signal due to gas)
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With what lesions is ultrasound NOT helpful and why?
large colon due to gas artifact
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What types of colic present with a fever? (3)
[most likely a medical condition] colitis, anterior enteritis, peritonitis
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What diagnostics can you pursue to determine if a medical condition is causing fever with colic? (4)
- CBC (ID colitis, neutropenia/leukopenia)
- electrolytes (ID colitis, hyponatremia/hypochloremia)
- NG reflux
- abdominocentesis (ID anterior enteritis, protein> 3g/dL) (ID peritonitis)
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What are the most important criteria that you will use to decide whether or not to
refer the horse to a tertiary facility? (7)
- Ship if:
- small intestinal distention
- large amount of NG reflux
- toxic mucous membranes
- HR > 70bpm
- no response to NSAIDs
- tight large intestinal distention
- UNCONTROLLABLE PAIN
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How important is unrelenting pain in yourdecision making regarding whether to refer a case to a tertiary hospital?
ship an animal with uncontrollable pain regardless of other signs
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Which types of colic are associated with insidious (4) onsets of pain, and what are
associated with more severe (4) signs of pain?
- Insidious: large intestinal simple obstruction, incomplete luminal obstruction, luminal/extraluminal obstruction of distal SI, ileal impaction
- Severe: complete luminal obstruction, enteritis (enterocolitis, anterior enteritis- sever then depression), torsions/volvulus, incarceration of proximal SI, intussusception
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Why is NG tube passage important in colic workup and treatment?
- can be life-saving because horses cannot vomit
- copious reflux specific for SI lesion
- copious reflux with minimal pain- anterior enteritis
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What are treatment options for left (3) and right (2) displacements of the large colon?
- Left: specific rolling procedure, phenylephrine injection with jogging and rolling, surgical correction if first 2 methods fail
- Right: supportive/no food (works sometimes, don't wait too long though), surgical repair (pelvic flexure enterotomy)
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What can you diagnose specifically by rectal exam? (7)
intussusception, ileal impaction, inguinal hernia, small intestine distention, large colon impaction, cecal impaction, right and left dorsal displacement of large colon
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What lesions are NOT diagnosed by rectal exam?
can only feel the caudal 1/3 of the abdomen--> go to US
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What is the most common colic seen by field practitioners, and how is it diagnosed and treated?
- > 90% of colic cases seen in practice
- “Flatulent” or “spasmodic” colic
- Usually low heart rate, minimal to no gas
- distention of colon on rectal exam
- Usually respond to sedation, NSAIDs
- (flunixin meglumine), and possibly mineral
- oil
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How would you diagnose and treat a colon impaction in the field?
- diagnose by rectal palpation- most commonly at pelvic flexure/ ventral colon and right dorsal colon
- get baseline abdominocentesis
- oral fluids- JUST WATER
- IV fluids
- mineral oil
- NSAIDs
- If no response, peritoneal fluid changes--> refer
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