Chapter 33 - Colic

Question 1

1. The heart rate is a useful indicator of the physiologic response to (3)

Answer 1

• Physiologic response to pain
• Dehydration
• Endotoxemia

Question 2

2. Conditions associated with pyrexia include (4) and do not generally require immediate ___________.

Answer 2

• Anterior enteritis
• Colitis
• Septic peritonitis
• Pleuropneumonia
• surgical intervention

Question 3

3. Examination of oral mucous membranes gives indicators for what 2 relevant conditions?

Answer 3

• Hydration status
• endotoxemia

Question 4

4. What 2 characteristics of endotoxemia may be observed at the oral mucous membranes?

Answer 4

• Prolonged capillary refill time
• Dark brick red or purple color, a toxic line may appear

Question 5

5. Audible movements of the cecum and ventral colon include _________, ________, and _______ contractions.

Answer 5

• Propulsive
• Retropulsive
• Mixing

Question 6

6. How often do propulsive contractions of the cecum and colon occur?

Answer 6

• 3-4 minutes

Question 7

7. Propulsive contractions of the cecum and colon may be decreased in frequency by conditions including _________ and _______.

Answer 7

• Anorexia
• sedation (α2-agonists)

Question 8

8. What purported sound does sufficient quantities of sand within the gastrointestinal tract make on auscultation?

Answer 8

• As if a paper bag were partially filled with sand and slowly rotated

Question 9

9. Where is the most likely place to auscultate sounds associated with sand in the ingesta?

Answer 9

• Ventral abdomen, just caudal to the xiphoid process

Question 10

10. What colic pain signs are more commonly seen in foals over adult horses? (4)

Answer 10

• Bruxism
• Ptyalism
• Abdominal distention
• Straining

Question 11

11. Mild colic pain typically responds to analgesic treatment for a period of ____-____ hours.

Answer 11

• 8-12 hours

Question 12

12. What are the characteristics of pain which indicates immediate surgical care?

Answer 12

• Violent behavior, which may not respond to analgesia

Question 13

13. Anatomy which may be palpated rectally (9), under normal conditions

Answer 13

• Small (descending) colon
• Cecum
• Spleen
• Caudal pole of the left kidney
• Nephrosplenic (lienorenal) ligament
• Left dorsal colon
• Left ventral colon
• Pelvic flexure
• Reproductive tract

Question 14

14. 2 therapies in addition to sedation which may be used to increase relaxation for rectal palpation

Answer 14

• Buscopan
• Lidocaine enema

Question 15

15. 3 characteristics to assess for each palpable organ during rectal exam

Answer 15

• Size
• Position
• Content

Question 16

16. What structure is always an abnormal finding on rectal exam?

Answer 16

• Small intestine

Question 17

17. A small -colon presenting as a long, tubular structure without obvious fecal balls suggests ________

Answer 17

• Impaction

Question 18

18. __________ should always be palpated in pregnant mares in order to diagnose possible _______.

Answer 18

• broad ligaments
• uterine torsion

Question 19

19. Characteristics that should be evaluated for gastric reflux (3)

Answer 19

• Net volume
• Color
• Smell

Question 20

20. On nasogastric intubation, it is normal to recover up to _____L of ________, ________ fluid.

Answer 20

• 2L
• Green
• Nonodorous

Question 21

21. Excessive net reflux indicates ________ or __________, resulting in an accumulation of fluid in the stomach.

Answer 21

• gastric outflow obstruction
• decreased small intestinal motility

Question 22

22. Anterior enteritis cases often yield a ________ volume of _________ fluid on nasogastric intubation.

Answer 22

• Large
• Malodorous orange or yellow

Question 23

23. What in the reflux may indicate gastric impaction?

Answer 23

• Large amount of feed material

Question 24

24. List 2 causes for gastric outflow obstruction other than impaction.

Answer 24

• Gastroduodenal ulceration (foal)
• Neoplasia (the adult horse)

Question 25

25. Why is low TP a poor prognosis in horses undergoing colic surgery?

Answer 25

- Potentially reflecting protein loss into the abdominal cavity

Question 26

26. Changes on hematology that may indicate inflammation, endotoxemia, or sepsis (4)

Answer 26

- Leukopenia - Neutropenia with appearance of immature and toxic neutrophils - Lymphopenia - Thrombocytopenia

Question 27

27. Lactate is a product of ______ and its presence may reflect ______ and aid in determining prognosis.

Answer 27

- anaerobic glycolysis - ischemic injury

Question 28

28. In horses with large colon volvulus, a serum lactate concentration >____mmol/L was associated with a poor prognosis for survival.

Answer 28

- >6mmol/L

Question 29

29. Measurement of the ________ allows for indirect measurement of blood lactate and is thus helpful in determining prognosis.

Answer 29

- anion gap

Question 30

30. In large colon displacement, horses with right dorsal displacement had increased GGT in ___% of cases but horses with left dorsal displacement had increased GGT in only ___% of cases.

Answer 30

- 49% - 2%

Question 31

31. The increase in GGT in horses with right dorsal displacement is caused by ____________

Answer 31

- obstruction of the bile duct

Question 32

32. Horses with inflammatory causes of medical colic (colitis, etc.) have a (higher/lower) level of SAA than horses with surgical colic.

Answer 32

- Higher

Question 33

33. Where should peritoneal fluid be collected in the standing horse (without US fluid pocket identification)?

Answer 33

- The most dependent part of the abdomen on or slightly to the right of midline to avoid the spleen

Question 34

34. Other than enterocentesis, what may inadvertently occur in the pregnant mare during abdominocentesis?

Answer 34

- amniocentesis

Question 35

35. What 2 tubes should be used for abdominal fluid collection and for what diagnostics?

Answer 35

- Plain tube – protein concentration - EDTA (purple top) tube – cell count and hematology

Question 36

36. What is the appearance of normal abdominal fluid?

Answer 36

- A clear, colorless to light yellow appearance

Question 37

37. What is the normal total protein concentration of abdominal fluid?

Answer 37

- <2g/dL

Question 38

38. When a strangulating lesion is present, there is movement of ______, followed by ______, and finally ______ into the peritoneal cavity and peritoneal fluid.

Answer 38

- Protein - red blood cells - leukocytes

Question 39

39. What may have inadvertently happened if the PCV of abdominocentesis is similar to that of the peripheral blood?

Answer 39

- Splenic puncture

Question 40

40. Clinical biochemistry that may be performed on abdominal fluid includes (5)

Answer 40

- Fibrinogen - Lactate - Phosphate - Glucose - pH

Question 41

41. 3 criteria of abdominal fluid that may indicate septic peritonitis

Answer 41

- A difference in glucose of greater than 50 mg/dL between serum and peritoneal fluid - A low peritoneal fluid glucose level (<30 mg/dL) - Peritoneal pH of <7.3

Question 42

42. What rib space may be used to measure the gastric wall height and evaluate success of decompression?

Answer 42

- 12th

Question 43

43. Normal wall thickness of the small intestine is <___mm and increase may indicate ______ or ______.

Answer 43

- <3mm - Enteritis - strangulating obstruction

Question 44

44. Normally, the sacculated ventral colon with a wall thickness of <___mm is identified on ventral midline.

Answer 44

- <5mm

Question 45

45. If a large colon volvulus of ____˚or ____˚ is present, the nonsacculated dorsal colon can be identified on the ventral midline.

Answer 45

- 180° - 540°

Question 46

46. A large colon wall thickness of greater than ___mm has a sensitivity of 67% and specificity of 100% for diagnosing large colon volvulus.

Answer 46

- 9mm

Question 47

47. Identification of mesenteric blood vessels coursing horizontally along the right body wall at the level of the costochondral junction between the 12th and 17th intercostal spaces is a sensitive and specific method of predicting _____ or ______.

Answer 47

- right dorsal displacement - 180˚ large colon volvulus

Question 48

49. What ultrasonographic changes are associated with right dorsal colitis?

Answer 48

- Thickened colonic wall - Hypoechoic layer of submucosal edema and inflammatory infiltrate

Question 48

48. Right dorsal colitis diagnosis may be confirmed by ultrasonographic evaluation between the ____ and _____ right intercostal spaces.

Answer 48

- 10th - 14th

Question 49

50. Though US may be used, what is the gold standard for diagnosing sand impaction?

Answer 49

- radiographs

Question 50

51. Radiographs have a (high/low) sensitivity for diagnosis of small colon enterolithiasis.

Answer 50

- low

Question 51

52. ______ may be used in the rectum for minimally invasive investigation of rectal tears.

Answer 51

- Endoscopy

Question 52

53. The sensitivity and specificity of laparoscopy as a diagnostic technique is greater in horses with (chronic/acute) colic.

Answer 52

- Acute

Question 53

54. What findings on colic exam frequently indicate need to proceed to surgery? (4)

Answer 53

- Uncontrollable abdominal pain - Distended, hypomotile small intestine on rectal and US - Serosanguinous peritoneal fluid with increased TP and WBC - Continued production of gastric reflux or deterioration in physical parameters

Question 54

55. What are the most frequently reported isolates from incisional infections? (3)

Answer 54

- E. coli - Streptococcus spp. - Staphylococcus spp.

Question 55

56. Prophylactic antimicrobials are best administered within ____ minutes of a clean contaminated surgery. Early administration >___ minutes or late administration <___ minutes reduces efficacy

Answer 55

- 60 minutes - >120 minutes - <30 minutes