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What is a normal HR in an adult horse?
What is the maximum stomach capacity of an adult horse?
What is a normal cell count for peritoneal fluid from an adult horse?
<5,000 cells/ microL
What are hallmark signs of shock in horses? (4)
increased HR, prolonged CRT, weak pulses, cold extremities
What are signs of colic in an equine patient? (9)
poor appetite, depression, flank watching, rolling, abdominal distention, straining, frequent urination, decreased defecation, increased recumbency
What are abdominal causes of colic? Extra-abdominal causes?
- Abdominal: GI colic, uterine torsion/ abortion, urolithiasis
- Extra-abdominal: pleuropneumonia, CNS disease, rhabdomyolysis, toxins, laminitis
What is your top differential for a fat 25YO pony that is colicking?
What is your top differential for a post-foaling mare with severe colic pain?
large colon volvulus
Describe colic evaluation in the field. (9)
- Behavior and response to analgesics
- CV status: HR, MMs color, CRT
- Localization: auscult, rectal palp, NG intubation, abdominal US, abdominocentesis
If the horse has a HR _______, refer immediately.
What are potential causes of prolonged CRT? (3)
hypovolemia, low BP, decreased CO
Venous lactate can help you assess...
perfusion/ shock compensatory reactions (>4mmol/L needs fluid therapy)
What drugs do we use for initial pain management when dealing with a colic case? (4)
- alpha-2 agonists are the best- start with xylazine (detomidine is longer acting)
- can use NSAIDs but be careful in a dehydrated animal (renal toxicity)
- butorphanol- very useful in combination with xylazine
- Buscopan- transient acting antispasmodic; will increase HR
Why is NG intubation important when working up colic? (2)
- horses can't vomit- prevent stomach rupture
- diagnostic by amount of reflux
When do you keep the NG tube in place and when are IV fluids indicated?
- >4L net reflux--> keep the tube in place!
- large volumes of reflux--> IV fluids are indicated
What can you diagnose on rectal exam? (4)
pelvic flexure impaction, nephrosplenic entrapment, gas-distended (esp. check small intestine), large colon displacement
What can you do in the field as far as abdominal ultrasound? (6)
- check inguinal region for small intestine entrapment
- [if you have the right probe] SI distension, increased peritoneal fluid, +/- intussusception, colonic thickening, nephrosplenic entrapment
What gives you the most information in the acute colic as far as abominocentesis? (2)
color and lactate level
What are criteria for referral? (5)
- PAIN- unrelenting, refractory to analgesics
- cardiovascular status- shocky
- large volume reflux
- distended small intestine
- markedly distended large intestine
How do you prepare a horse for referral? (3)
- analgesics and gastric decompression!!
- fluid therapy if shocky- hypertonic saline
What parameters have best prognostic value for surgical colic? (5)
BP, blood lactate, CRT, PCV, HR
How do you treat large colon impaction in the field?
- balanced electrolyte solution, osmotic agents like mag sulfate, mineral oil, cathartics- enteral fluids (4-6L every 4-6hr)
- NSAIDs, alpha-2 agonists, opioids
- trocharization in right paralumbar fossa
- crystalloid fluids- IV fluids (only needed if horse is refluxing or significantly dehydrated)
Do not give enteral fluids if...
horse has reflux or SI distention
How do you treat nephrosplenic entrapment in the field?
- phenylephrine (shrinks spleen)--> jog
- can roll (under anesthesia)
- refer if unstable or not responding to medical txt
How is enteritis/ colitis treated?
- IV FLUIDS!!!- large diameter catheter
- enteritis--> leave tube in place for frequent decompression
- colitis--> significant electrolyte and protein loss possible, endotoxemia likely
How do you treat SI strangulation in the field if you have no surgical option?
- if abdominocentesis--> serosanguinous fluid
- there is no medical option--> euthanasia