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Alimentary > Colic > Flashcards

Flashcards in Colic Deck (61):
1

What is colic

Abdominal pain - usually from GI viscus - spasmodic gas, impaction, displacement, strangulation
can be liver or urogenital system

2

Clinical signs

pawing
trying to go down (relieve pain)
abrasions (more often in chronic cases)
Recumbency
muscle fasciculations (twitching)
look at flanks
restless
kick at abdomen
sweating

3

spasmodic/gas

motility?
diet?
parasites?

4

Impaction

usually large colon
pelvis flexture

5

Displacement

usually large colon

6

strangulation

usually severe

7

ulcers

usually in the stomach

8

Colic work up

history, Physical exam (PE), nasogastric tube (NGT)
rectal exam
abdominocentesis
ultrasound exam
clinical pathology

9

history

age
time of onset
degree of colic
treatments
previous colic
last passed faeces
management
worming routine

10

physical exam (PE)

demeanor
signs of pain
TPR
GI borborygmi (gut sounds)
CV status (mucous membranes, pulses, skin turgor)
abdo distention

11

TPR

Temp - take before rectal. if febrile think colitis, peritonitis or enteritis
Pulse - may be high due to anxiety, pain or hypovolaemia. higher suggests worse colic
Resp rate - may be high due to pain, anxiety

12

Borborygmi

intestinal motility check
hyper/hypomotile, normal or absent

13

cardiovascular status

mucous membrane color - could be a rupture if dark/puple
crt
pulse quality
jugular fill
limb temp
abnormalities suggest more complex colic

14

Nasogastric tube (NGT)

should always be done
can potentially stop a stomach rupture
only way to relieve gastric distention
unlikely to be spontaneous - may need siphon
more than 2l is abnormal
if you get reflux, dont give anything via tube

15

monitoring

short duration colic
horse no longer painful
PE unremarkable
NGT no reflux

16

medical treatment

only if mild abnormalities on PE, no reflux
may give analgesia if horse is comfortable
oral fluids if no reflux

17

rectal exam

identify normal, distension, displacements, abdominal structures (masses etc)
LI has wide diameter with sacculations + taenial bands exept pelvis flexure which is smooth
small colon has sacculations, 2 taenial bands + faecal balls
SI not usually palpable
not all colics need a rectal

18

abdominocentesis

method - teat cannula + needle
assesses bowl health. compromised intestine leaks cells + protein

19

peritoneal fluid colour

normal = clear/straw colour, macs + neuts in cytology, 5000/ul cell count

20

ultrasound

rectal/transcutaneous
evaluate - peritoneal fluid, size of viscus (SI), position of viscus (LI), liver, kidneys, spleen

21

clinical pathology

helps assess severity
circulatory + electrolyte status
packed cell volume (PCV) + plasma total solids are important data

22

causes of abdominal pain

distension
infl or ischaemia of intestine
irritation of peritoneum

23

distension - gas

mechanical obstruction
non-strangulating (blood supply not affected)
impaction
displacement

24

distension - fluid

mechanical obstruction
strangulating (blood supply compromised)
Volvulus
torsion
incarceration

25

distension - ingesta

functional obstruction
motility dysfunction (ileus; blood supply not compromised)
enteritis
grass sickness
post-surgical ileus

26

inflammation

non-strangulating (blood supply not affected)
enteritis
colitis
typhlitis
peritonitis

27

ischaemia - strangulating

blood supply compromised
volvulus
torsion
incarceration

28

ischaemia - thrombotic

blood supply compromised
parasitic (strongylus vulgaris)
coagulopathy
DIC

29

spasmodic colic

non-strangulating
(cramp)
brief episode of pain that resolves with little/no treatment

30

impaction

non-strangulating
impacted feed in LI
most resolve with enteral/IV fluid therapy
only worst cases need surgery

31

displacement

non-strangulating
LI shifts to abdomen without compromising blood supply
can resolve on its own but may need surgery

32

Enteritis/Ileus

non-strangulating
infection/infl of SI causes hypomotility or amotility
large amounts of nasogastric reflux
requires intensive medical treatment

33

typhlocolitis

non-strangulating
infection/infl of LI
variable amounts of diarrhoea
needs intensive medical treatment

34

peritonitis

non-strangulating
infection/infl of peritoneum
variable clinical signs - often fever, depression, mild to moderate colic signs
needs intensive medical treatment or surgery

35

Strangulating lesions - small intestine

vovulus (around root of mesentary)
strangulating lipoma
epiploic foramen entrapment
inguinal/scrotal hernia
intussusceptions
diaphragmatic hernia
mesenteric rent

36

strangulating lesions - large intestine

colon torsion
intussusception - caeco-colic, ileo-caecal, caeco-caecal

37

small intestinal lesion

reflux
distended SI - palpable on rectal, visible using ultrasonography

38

large intestinal lesion

+/- abdominal distension
impaction or gas accumulation palpable
displacement of LI palpable
usually no reflux

39

small intestinal lesion - treatment - medical

enteritis/ileus
(grass sickness)

40

small intestinal lesion - treatment - surgical

volvulus (around root of mesentary)
strangulating lipoma
epiploic foramen entrapment
inguuinal/scrotal hernia
intussusceptions
diaphragmatic hernia
mesenteric rent
(grass sickness)

41

large intestinal lesion - treatment - medical

spasmodic colic
impaction
left dorsal displacement
right dorsal displacement
colitis
typhlocolitis

42

large intestinal lesion - treatment - surgical

colon torsion
non-resolving displacements + impactions

43

resons for Referral of colic

any suspicion of strangulating lesion
SI lesions best referred - high likelihood for surgery + medical treatment is intensive
intensive medical treatments
non-resolving impaction - may need IV fluids or surgery
recurring colic/chronic colic for further work up

44

pre - referral

finances, insurance
expectations
willingness to agree to abdominal surgery

45

signs showing need for referral

moderate/severe pain
recurrent pain
pain poorly responsive to analgesia
sign of cardiovascular compromise
severe abdo distension (painful)
SI lesion signs
strangulating lesion signs

46

reasons for surgery

abdo surgery is diagnostic + therapeutic - only 20-30% abdomen can be evaluated with rectal exam + ultrasonography
strangulating lesion
non-resolving displacement or impaction
non-responsive or recurrent pain

47

response to treatment - medical lesion

pain controlled with small dose of sedative or 1 dose of flunixin meglumine/buscopan
no recurrence of colic after initial dose
horse comfortable for >12-24h

48

response to treatment - surgical lesion

large dose of sedative needed for examination
little response to flunixin meglumine
response short lived

49

complication after surgery - short term

<2-4 weeks
anaesthetic complications
post op colic or ileus
incisional complications
thrombosis
peritonitis
laminitis

50

complication after surgery - long term

>2-4 weeks
recurrent/chronic colic
incisional hernia

51

prognosis

simple medical - good 90%
non strangulating surgical - good 70-90%
strangulating SI lesion guarded - 50-70% with and 60-80% without resection
strangulating large intestinal lesion - guarded to poor 36-83% without resection

52

signalment + history - suggestive of medical lesion

Low grade pain
Still interested in feed
No worsening over time
Lying down more than usual
No rolling, thrashing, kicking at abdomen

53

signalment + history - suggestive of surgical lesion

Acute onset sever pain
Owner has already given one/multiple doses of analgesic
Sweating, rolling, kicking at abdomen
Progressive deterioration

54

Physical Exam findings – Cardiovascular Status - Suggestive of medical lesion

No signs of cardiovascular compromise – Normal heart rate, Pink, moist mucous membranes, CRT <2sec, Normal skin tenting, Good jugular filling, Warm extremities and ears, Good pulse quality

55

Physical Exam findings – Cardiovascular Status - Suggestive of surgical lesion

cardiovascular compromise – Heart rate >48bpm, Abnormal membrane colour, CRT> 2sec, Prolonged skin tent, Delayed/no jugular filling, Cold extremities and ears, Poor pulse quality

56

Physical Exam findings – Gastrointestinal System - Suggestive of medical lesion

No change in abdominal shape
Good borborygmi
Passage of normal manure
No/reduced manure for some time

57

Physical Exam findings – Gastrointestinal System - Suggestive of surgical lesion

Distended abdomen
No borborygmi

58

Physical Exam Findings – Other Organsystems - Suggestive of medical lesion

No other abnormalities
Fever (enteritis/colitis)
Icteric mucous membranes (liver disease)

59

Physical Exam Findings – Other Organsystems - Suggestive of surgical lesion

Increased respiratory rate (pain, shock)
Abrasions or other signs of trauma from rolling
Profuse sweating (pain, shock)

60

Nasogastric Intubation and Transrectal Palpation - Suggestive of medical lesion

No reflux (<2L)
Normal palpation
Palpable impaction
+/- Palpable displacement

61

Nasogastric Intubation and Transrectal Palpation - Suggestive of surgical lesion

Reflux (> 2L)
Little haemorrhagic/black reflux (gastric rupture possible)
Distended small intestine on rectal palpation
Tight gaseous distension of large intestine