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Equine > Colic > Flashcards

Colic Flashcards

1
Q

Colic

A

Clinical signs of abdominal pain

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2
Q

Impaction/obstruction

A

Intestinal blockage
Sometimes medical, sometimes surgical

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3
Q

Excessive gas

A

Gas/tympanic colic
Always medical

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4
Q

Hypermotility

A

Spasmodic colic
Always medical

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5
Q

Gut stasis

A

Ileus - not moving
Always medical

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6
Q

Telescope into itself colic

A

Intussusception colic
Always surgical or euthanasia

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7
Q

Herniated colic

A

Epiploic foramen - between liver and ometum common location
Always surgical or euthanasia

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8
Q

Move from normal location

A

Displacement colic
Sometimes medical sometimes surgical

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9
Q

Infected/inflamed intestines

A

Enteritis
Always medical

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10
Q

Twisted intestines

A

Torsion
Always surgical (colon) or euthanasia

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11
Q

Loss of blood supply intestines

A

Strangulation

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12
Q

Clinical signs of colic

A

Pacing/box walking
Flank watching
Rolling
Sweating
Straining
Fewer droppings
Change in droppings
No droppings
Rapid respiratory rate
Pawing
Lying down
Not eating
Teeth grinding
Playing with food
Reduced appetite
Lip curling
Yawning
Dull
Depressed

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13
Q

Severe colic clinical signs

A
  • Severe unrelenting pain (including signs of self trauma)
  • Dullness and depression (can indicate septicaemia, rupture)
  • Abdominal distension
  • Heart rate >60bpm
  • Discoloured mucous membranes or delayed capillary refill time
  • Absence of gut sounds in one or more quadrants
    Relate to obstruction or strangulation +/- cardiovascular compromise
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14
Q

Colic signalment

A
  • Age
  • Gender/reproductive status
  • History of crib biting or wind sucking
  • Recent changes in weight/condition
  • Attitude to pain (stoic or expressive)
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15
Q

Management/yard factors - colic

A

Recent changes in:
- Stabling/pasture turn-out
- Forage feed
- Exercise regime
- Hard feed
- Access to water
- Previous episodes of colic on the yard
- Whether horse has access to sand

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16
Q

Preventative health - colic

A

Preventative healthcare
- Whether any parasite control/treatment is used
- Whether strategic parasite control (e.g., faecal egg counts and strategic worming) is used
- Date horse last received anthelmintic (de-wormer)

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17
Q

Previous history - colic

A
  • Previous history of colic
    - If yes, frequency and nature of colic episodes
  • Previous abdominal surgery
  • Current medication
  • Other medical issues
  • Recent history of sedation or anaesthesia
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18
Q

Current episode colic questions

A
  • When horse last seen behaving normally
  • When horse last passed faeces; appearance of faeces
  • Signs horse has been exhibiting and whether they have changed over time
  • If colic has occurred previously, comparison with previous episodes
  • Management since vet contacted
  • Administration of any treatment/analgesics
19
Q

Main colic assessment

A

Painful horses must get treatment
Pain
Heart rate
Mucous membranes
Gut sounds
Temperature

20
Q

Colic diagnostic tests

A

Response to analgesia
Rectal examination
Nasogastric intubation

21
Q

Nasogastric intubation - colic

A

> 4L reflux - critical
Reduce risk of gastric rupture
Route for enteral fluids

22
Q

Rectal tears

A
  • Grade I – mucosa and submucosa torn (a)
  • Grade II – muscular layer only torn (b)
  • Grade IIIa and b – all layers torn except serosa or mesorectum (c and d)
  • Grade IV – all layers torn (e)
  • Grade I and II – most will heal with medical treatment (antibiotics, laxatives and dietary changes)
  • Grade III – require careful monitoring and most will require surgery
  • Grade IV – many euthanased, some can be managed surgically
  • Surgical options are direct suturing if possible, plus temporary indwelling rectal liner and colostomy
23
Q

How to deal with rectal tear

A

Identify, inform owner
Essential first aid - reduce straining and contamination
Phone for help

Sedate, spasmolytic (buscopan)
Repalpate with ungloved hand
Remove faeces from tear and rectum
Treat septic shock and peritonitis - NSAIDs and broad spectrum antibiotics
- TMPS - trimethoprim sulphonamide
Administer epidural and pack rectum
Refer

24
Q

Mild colic

A

Responds to medical management - flunixin, withholding food

25
Q

Colic diagnosis

A

History
Physical exam
Rectal exam
NGT
+/- haematology and biochemistry
Leukopenia, azotaemia, acidosis, increase acute phase proteins (SAA)
+/- abdominocentesis
TNCC (nucleated cells) >5x10^9, cytology, lactate (>2), Glucose (<2), C&S)

26
Q

Differentials for colic and pyrexia

A

Peritonitis
Colitis
Enteritis
Pleuropneumonia
Other infections

27
Q

Colic and pyrexia - treatment

A

Antimicrobials - Penicillin and gentamycin
IV fluids - hypovolaemia as not eating drinking
+/- abdominal lavage/drainage - not great

28
Q

Always medical colic

A

Spasmodic colic
Gaseous colic
Anterior enteritis
Colitis
Gastric ulceration
Grass sickness - ileus

29
Q

Sometimes medical sometimes surgical colic

A

Colon displacement
Colon impaction - ingesta/sand
Peritonitis
Non GI lesions - e.g. kidney disease
SI simple obstruction
Parasites

30
Q

Always surgical or euthanasia colic

A

SI, small colon incarceration
SI, small colon volvulus
Colon torsion

31
Q

Assessing colic severity

A

History - passed droppings?
Pain level and response to analgesia
Mucous membrane colour and capillary refill time – perfusion
Hydration status
Heart rate & pulse strength
Respiratory rate
Gut sounds
Abdominal distension
Temperature
Rectal findings
Volume of naso-gastric reflux
Abdominal fluid analysis
Ultrasound findings
Blood analysis

32
Q

Response to analgesia - colic

A

Response to analgesia is usually predictable.
E.g. flunixin 1.1mg / kg should provide analgesia within 10 minutes and last about 12 hours.
If colic signs do not improve following analgesia or return within a few hours something more significant is occurring.

33
Q

Mucous membranes

A

Normal colour – salmon pink
Normal CRT 1-2 seconds
Pale or dark injected membrane and prolonged CRT suggest poor peripheral perfusion – cardiac compromise, endotoxemia

34
Q

Colic heart rate

A

20-44 normal
44-60 -mild
60-80 - moderate
80+ - severe

35
Q

Respiratory rate - colic

A

8-12 - normal
12-20 - mild
20-30 - moderate
30+ - severe

36
Q

Gut sounds

A

Gut sounds (borborygmi) occur constantly
→ Low grade constant grumbling – peristalsis in S.I. and colon
→ Caecal emptying 1-3x / minute – sounds like a toilet flushing
During colic sounds may be normal, decreased or increased
Listen in all 4 quadrants and grade separately
Abnormal sounds may also be heard e.g. sand

37
Q

Abdominal distention colic

A

Difficult for us to tell between fat / distended– ask owner
- May expand between examinations
- May get a ‘ping’ following abdominal percussion
- Indicates gas distension with intestinal lumen
→ excess gas production or blockage passage of gas?
→ usually large intestine

38
Q

Rectal temperature colic

A

<37 - hypothermic - cardiovascular compromise/shock
37-37.5 - important in foals, irrelevant in adults
37.5-38.5 - normal but does not rule out colic
38.5-39 - may be pain
>39 - hyperthermic - infectious/inflammatory condition

39
Q

Rectal findings - colic

A

Normal rectal is soft and without tension or distension
Abnormal findings include hard ingesta, gas distended intestines, abnormally located structures and tight taenial bands.
Can palpate small intestine, caecum, large colon, caecum, spleen, ovaries, uterus, bladder.

40
Q

Peritoneal fluid - colic

A

Normal - yellow, clear, small volume, <5000cells/ul, <30g/l protein, <2.5mmol/L
Compromised intestine - pink/brown (serosanginous), opaque, increased volume, cells, protein and lactate
Rupture intestine - green/brown - ingesta
Peritonitis - White/yellow, turbid

41
Q

Abdominal ultrasound - colic

A

Peritoneal fluid - increased volume?
Small intestines - motility, distended?
Stomach - full of fluid?
Colon - distended, displaced?
Intestinal wall thickness - increased?

Full circles in SI - indicate SI distention - fluid backing up

42
Q

Blood analysis of colic

A

PCV and total protein - increased in dehydration/shock
WBC - increased or decreased in infectious processes - time frame dependant
SAA - serum amyloid A or fibrinogen - increased if inflammatory/infectious
Lactate - increased if compromised bowel present
Electrolyte abnormalities

43
Q

Blood lactate in colic

A

Increased if compromised bowel

Equine (18 decks)

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