EqMed, Q2, V

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EqMed, Q2, V
2013-03-17 14:45:14
EqMed Q2

EqMed, Q2, V
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  1. what are most common sites for large colon impaction? are they palapable on rectal?
    • pelvic flexure, left colon (can palpate via rectal )
    • right dorsal colon - transverse colon junction (in front of cecum, can't palpate)
  2. what is classic sign noted with large colon impaction?
  3. what are clinical signs associated with large colon impaction?
    • mild colic; mild dehydration
    • minimal systemic deterioration unless prolonged w/o tx
  4. what is peritoneal fluid like with large colon impaction?
    typically normal, if left untreated can see elevated TP
  5. what is seen on US? rectal palpation? gastric reflux?
    • US: wnl
    • unmistakable lesion w/rectal palpation; pelvic flexure at pelvic inlet
    • generally no reflux
  6. what is treatment for large colon impaction?
    • isotonic *enteral fluid therapy* to hydrate + stim. gastrocolic reflex
    • laxatives; Mg therapy to pull fluid into lumen
    • *NPO*
    • analgesia
  7. what is complication associated w/returning horse to feed after relieving large colon impaction?
    • re-obstruction
    • -return slowly, monitory water intake
  8. what gets entrapped in nephrosplenic space?
    • left dorsal colon
    • - pelvic flexure or entire left colon
  9. what are perfusion parameters like with nephrosplenic entrapment? colic signs?
    • normal
    • mild-severe colic signs
  10. what is determined via rectal palpation?
    • feel taenia/bands of L ventral colon coursing dorsocranially
    • enlarged spleen - displaced ventromedially
    • gas/feed in colon
  11. what would US show with nephrosplenic entrapment? Peritoneal fluid?
    • US shows colon btwn kidney and spleen
    • fluid is normal (caution not to puncture spleen)
  12. what are the 4 options for treating nephrosplenic entrapment?
    • 1: restrict feed + fluids, hope for spontaneous recovery
    • 2: phenylephrine (alpha agonist) - splenic contracture - jog to free
    • 3: IV GA and roll (R lateral - Dorsal recumbency - L lateral)
    • 4: surgery - GA, ventral midline
  13. what are options to prevent reoccurrence of nephrosplenic entrapment?
    • laparoscopy to ablate the space
    • colopexy and colonic resection (more side effects)
  14. what minerals comprise an enterolith?
    magnesium ammonium phosphate crystals around a nidus
  15. what is geographic distribution for enterolithiasis? what breed? what age? what feed?
    • SW, California, Florida, Indiana
    • arabians
    • adults/mature horse
    • alfalfa (high Mg concentration)
  16. what are clinical findings associated w/enterolithiasis?
    • recurring acute bouts of pain
    • if obstructs transverse colon - severe pain and distended prox. colon
  17. can you palpate enteroliths via rectal? what will peritoneal fluid be like?
    • not usually, if in transverse can't feel them
    • normal fluid
    • can see on rads
  18. what is treatment for enterolithiasis?
    • surgery - pelvic flexure enterotomy
    • (perfectly round - single stone; polyhedral/flat - look for more)
  19. what is signalment associated with fecaliths?
    • miniature horses; ponies (dental problems; dietary indiscretion)
    • young; <1yr and older too
    • no sex predilection
  20. where is fecalith usually found? what signs are associated?
    • small colon
    • no feces being passed
    • mild to mod. colic
    • severe abdominal distention
  21. what is recommended treatment for fecalith?
    • surgical removal - pelvic flexure enterotomy
    • (trocharize cecum prior to surgery if necessary to improve venous return/ventilation)
  22. what leads to small colon impaction? what season is associated?
    • dehydrated feces (winter, decr. water intake)
    • inspissated fibrous fecal material
    • foreign body
  23. what is felt on rectal palpation with small colon impaction?
    • feel impaction in small colon
    • could be difficult to feel due to distention proximal to impaction
  24. How are perfusion paremeters with small colon impaction?
    endotoxemia common (blood from SC bypasses liver -strait back to heart/circulation)
  25. what is a common complicating feature of small colon impaction?
  26. T/F: Small colon impaction should be considered in any horse presenting for colic or w/history of diarrhea, and a rectal should be performed.
  27. how is small colon impaction treated?
    • can try medical (fluids + laxatives)
    • surgery usually necessary (colon massage or enterotomy)
    • - also do pelvic flexure enterotomy to remove ingesta proximal so small colon can "rest"
  28. what is the cause of thromboembolic colic?
    strongylus vulgaris migrating through cranial mesenteric artery - arteritis from molting L4-5
  29. what are clinical findings associated with thromboembolic colic?
    • large intestine gas distention
    • fremitus (when rectal - cr. mesenteric a.)
    • mild-mod-severe colic signs
    • CV failure
  30. how old are horses affected by thromboembolic colic?
    >1 year due to long prepatent period of the strongyle
  31. how is thromboembolic colic treated?
    • surgical resection of the infarct
    • Ivermectin as prevention (highly effective)
  32. what is signalment commonly associated with large colon volvulus?
    • brood mares
    • lush pastures/high CHO
  33. what are clinical signs associated w/large colon volvulus?
    • severe unrelenting pain; sudden onset
    • non-responsive to analgesia = hallmark
    • abdominal compartment syndrome (severe gas distention - depressed ventilation/venous return)
    • +/- gastric reflux
  34. what is treatment for large colon volvulus?
    • resection of devitalized sections (may not be devitalized if only rotated 270 degrees)
    • colopexy to prevent recurrence
    • laminitis prophylaxis post-op