1. Evaluation of colic in foals Rectal Tears/ Rectal Prolapse
Large Animal Surgery
Evaluation of colic in foals
Rectal Tears/ Rectal Prolapse

2. What important factors in the history can help to diagnose colic in foals
Breed
Sex
Birth circumstances (immune status, weak down foals)
Deworming
Vaccination
Other illnesses
Pregnancy problems
Health of other mares and foals

3. What is the normal temp for a foal
degrees

4. What is the normal HR for a foal
bpm

5. What do you need to evaluate in a foal with colic
Pain
CV status
GI tract

6. How do you evaluate for possible sepsis
Look for hypoglycemia
Depressed immune function
Decreased intake

7. How to you evaluate the GI tract of foals
Observe for distention and feces
Auscultation
NG reflux
Abdominal palpation
Ancillary procedures

8. What types of ancillary procedures might be done in a foal with colicUS
Rads
Contrast rads
Abdominocentesis
CBC

9. What is the TP in foals compared to adults
Lower in foals

10. What are the main differentials in a foal with colic in the neonatal period
Meconium impaction
Enteritis
Ulcers
Hernia w ruptured tunic

11. What are the main differentials in a foal w colic from 2-5 days of age
Ruptured bladder
Atresia coli
Enteritis
Ulcers

12. What are the main differentials in older foals w colic
Ulcers
Enteritis
Gastric outflow obstruction
Small intestinal volvulus
Intussusception
Hernias

13. What are the general principles when treating colic in foals
Evaluate immunity and correct w IV plasma
Minimal use of analgesics
Rehydrate
Resume feeding ASAP or use TPN
Preventative therapy for ulcers

14. Meconium impaction commonly occurs in foals of what age
<36 hours

15. Which foals have an increased risk for meconium impaction
Males
FPT foals
Weak foals

16. What are the CS of meconium impaction
Straining
Absence of feces
Abdominal distention

17. What is the main ddx for meconium impaction
Atresia

18. How do you rule out atresia
Digital palpation
Rads
Barium enema

19. How is meconium impaction treated
Acetylcysteine enema

20. What are some causes of enteritis in foals
C perfringens
C difficile
E coli
Rotavirus

21. How do you diagnose enteritis in foals
Fever, leukopenia
Diarrhea
Response to fasting

22. How do you treat enteritis in foals
Check for systemic illness and give ATBS if necessary
Decrease or discontinue milk if bloat
NPO w TPN for a few days

23. How do you diagnose ulcers in foals
Bruxism
Colic after nursing
Excessive salivation in older foals

24. How do you treat ulcers in foals
Ensure hydration
Address other problems
Sucralfate
If d/t NSAIDS give H2 blockers or omeprazole

25. What are the CS of ruptured bladder
Depression, decreased nursing
Progresive abdominal distention

26. What lab data is associated w a ruptured bladder
Hyponatremia, hypochloremia, hyperkalemia

27. How do you diagnose a ruptured baldder
US, rads, contrast rads

28. Is a ruptured bladder a surgical emergency
No but it is a medical emergency

29. How do you treat a ruptured bladder
Decrease serum potassium
Abdominal drainage
Sx when stabilized

30. What is the prognosis for uroabdomen
Good-excellent for urachal or bladder tear
Guarded for ureteral tear

31. What are the CS of atresia coli
Initial signs of meconium impaction
Progressive abdominal distention
No feces

32. How do you dx atresia coli
Confirm w barium enema

33. What is the cause of gastric outflow obstruction
Duodenal ulcers

34. What are the CS of gastric outflow obstruction
May be no hx of illness
Bruxism
Spontaneous reflux
Colic after nursing

35. What is the tx for gastric outflow obstruction
Gastrojejunostomy (w or wo jejunojejunostomy)

36. What are the CS of small intestinal obstruction
Pain
Abdominal distention
reflux

37. What types of small intestinal obstruction occur
Congenital or acquired hernia
Intussusception
Volvulus
Meckels diverticulum

38. Which Cs should make you suspect intussusception or volvulus
Pain following onset of diarrhea

39. What is your diagnosis
Meckels diverticulum

40. What is a meckels diverticulum
Embryologic remnant of the omphalomesenteric duct
Band that connects antimesenteric surface of the ileum to the umbilicus

41. What is your diagnosis
Umbilical hernia

42. What is your diagnosis
Intestinal adhesions

43. What is the prognosis for foals <14 days old w SI obstruction
10% survival

44. What is the prognosis for foals 15-150 days old w SI obstruction
46% survival

45. Why is the prognosis so bad for SI obstructions
Increased risk of adhesions
Delayed indentification
Sepsis

46. What are some examples of LC and SC obstructions
Fecalith, bedding ingestion, hairball

47. What is the main cause of rectal tears
Iatrogenic d/t rectal palpation

48. How will you first know that there is a rectal tear
Blood on the rectal sleeve
Feel rectum suddenly relax

49. Where are most rectal tears
Dorsally between 10 and 2 oclock

50. What is a grade 1 rectal tear
Mucosa and submucosa

51. What is a grade 2 rectal tear
Disruption of the muscular layer (mucosa and serosa still intact)

52. What is a grade 3 rectal tear
Disruption of the mucosa, submucosa and muscularis

53. What is the difference between a 3a and 3b tear
3a the serosa remains intact
3b is extension into the mesocolon

54. What is a grade 4 rectal tear
Disruption of all layers of the rectal wall

55. What is your dx
Grade 4 rectal tear

56. What is your dx
Grade 1 rectal tear

57. What is your dx
Grade 2 rectal tear

58. What is your dx
Grade 3a rectal tear

59. Which grades of rectal tear should be referred
Grade 3 or 4

60. What should be done prior to referring a grade 3 or 4 rectal tear
Pack rectum cranial to tear
Banamine
ATBs
Atropine (to slow intestinal motility)

61. What is the tx for grade 1 or 2 rectal tear
No palpation for a few weeks
Banamine
ATBs
Diet that will cause soft feces

62. What are the options for surgical repair of a grade 3 or 4 rectal tear
Rectal liner
Colostomy

63. What surgical approach is needed to place a rectal liner
Caudal ventral midline incision

64. What is the principle behind placing a rectal liner
Liner is placed using a PVC pipe and long plastic bag so that feces will pass through the bag and not interrupt the rectal tear
The tear heals by second intention

65. How is the rectal liner removed
Chromic gut is used to suture it in place…breaks down in 2 weeks and the PVC pipe and plastic bag are passed in feces

66. What is a complication of placing a rectal liner
Retraction of the liner into the rectum when the horse lies down

67. What can be done to prevent retraction of the liner into the rectum
Patient should be kept standing until the ring has been passed

68. What is a colostomy
Fecal diversion to the left paralumbar fossa

69. How long are colostomys left in place
6-7 weeks

70. What is the prognosis for for a grade 1 or 2 tear
Good

71. What is the prognosis for for a grade 3 or 4 tear
Fair-poor

72. What is the etiology of rectal prolapse
Straining to defecate
Chronic pneumonia
Short tail

73. What is the tx for rectal prolapse
Epidural anesthesia
Manual reduction or sx resection
Topical agents/astringents
+/- purse string

74. What can be done to create inflammation and adhesions around the rectum in ruminants
Inject iodine perirectally

75. What can be done to create inflammation and adhesions around the rectum in foals or mares
Nothing you cant inject iodine in equines

76. What is your diagnosis
Grade 4 rectal prolapse; full thickness tear w omentum coming out

77. What is your diagnosis
Rectal and vaginal prolapse

78. How would you treat the previous case
Amputate the devitalized tissue

79. What is the prognosis with a grade 1 or 2 rectal prolapse with reduction
Good

80. What is the prognosis with a grade 1 or 2 rectal prolapse with resection
Guarded

81. What is the prognosis with a grade 3 or 4 rectal prolapse
Guarded-poor