Colic Workup (Mudge)

Question 1

Although sometimes not readily available or necessary in every case, what is a great way to identify a free fluid-filled small intestine?

Answer 1

Abdominal Ultrasound

Question 2

What is abdominocentesis helpful for?

Answer 2

To diagnose small intestinal strangulation/ischemia and peritonitis

Question 3

(T/F) Abdominal Radiography are helpful for diagnosis of enteroliths and sand impaction

Answer 3

True

Question 4

Colic in Foals – Differential Diagnoses:
- Meconium impaction (usually < 2 days of age)
- Enterocolitis
- Inguinal hernia with ruptured tunic
- Gastroduodenal ulceration
- Ruptured bladder (usually newborn)
- Atresia coli (congenital, signs in 0-2 days)

Answer 4

Neonate (<2 weeks)

Question 5

Colic in Foals - Differential Diagnoses:
- Gastroduodenal ulceration -> gastric outflow obstruction
- Enterocolitis
- Small intestinal volvulus, intussusception
- Fecalith, especially in Miniature horses

Answer 5

Older Foals

Question 6

Initial Treatment of Colic
List the Pain Management options:

Answer 6

• Alpha-2 Agonists: Sedation with an intravenous alpha2 agonist (e.g. xylazine) is usually the most effective medication for short-term pain management
• Opioids: (i.e. butorphanol) can also be useful for pain management, although they may further decrease GI motility
• Non- steroidal anti-inflammatory drugs (NSAIDs) such as flunixin meglumine (‘Banamine’) are commonly used to treat abdominal pain

Question 7

Enteral Fluids:
What can help to soften ingesta, but are not part of a fluid therapy plan?

Answer 7

• Laxatives such as magnesium sulfate
• Mineral oil

Question 8

What is something that is not needed in the majority of colic cases, but necessary for horses with signs of shock, large volumes of reflux, or severe dehydration?

Answer 8

IV Fluids

Question 9

What are 5 different behaviors that could indicate colic in the horse?

Answer 9

• Pawing
• Rolling
• Kicking at abdomen
• Stretching out as if to urinate
• Flank watching
• Inappetance
• Depression
• Increased incumbency
• Decreased defecation

Question 10

What is the normal range of heart rate in an adult horse?

Answer 10

30-40/min

Question 11

What are 3 reasons that you might see more than 2 liters of net reflux after passing an NG tube in an adult horse?

Answer 11

• Anterior enteritis
  
  • Usually large volumes of reflux (5-15L)
    -Often fetid/malodorous
• Small intestinal strangulation
  
  • Variable amounts of reflux
  • Often sour/fermentation

Question 12

What are the normal values for total protein and lactate in abdominal fluid?

Answer 12

Total protein: < 2.5 g/dl (clear, yellow)
Lactate: < 2.0 mmol/l (or < blood lactate)

Question 13

Getting a head start - Pattern Recognition:
10 yr old Arabian in California

Answer 13

Enterolith

Question 14

List the Normal Vital signs for Adult Horses:

Answer 14

Heart Rate: 30-40 bpm (> 60 – pain, hypovolemia, SIRS)
Temperature: 99-100.5 F (Fever may indicate enteritis/colitis)
Respiratory Rate: 8-16 breaths/min

Question 15

Pain:
Associated with strangulating lesions or severe, acute intestinal distention or mesenteric tension

Answer 15

Severe Pain

Question 16

Pain:
Associated with incomplete obstructions

Answer 16

Mild, insidious, or intermittent pain

Question 17

A horse’s stomach can only hold _______ liters (average adult horse)

Answer 17

10-15

Question 18

Rectal Examination
List the abdominal structures palpated per rectum:

Answer 18

• Caudal aspect of large colon and cecum
• Small colon
• Bladder
• Uterus & ovaries (mare)
• Caudal aspect of left kidney and spleen

Question 19

List the possible conditions you can diagnose with Rectal examination:

Answer 19

• Large colon impaction
• Large colon displacement/volvulus
• Small colon impaction
• Small intestinal distention

Question 20

Rectal Examination Tips:
What is good for smooth muscle relaxation?

Answer 20

Buscopan

Question 21

• Auscult ventral abdomen - sounds “like the ocean”
• Mix feces with water and allow to settle in the rectal sleeve
• Radiographs = gold standard, but impractical in the field

Answer 21

Sand test

Question 22

Definition:
Fluid distension and wall thickness

Answer 22

Small intestinal disease

Question 23

Small Intestinal Distention
DO NOT give any additional fluids through the tube if:

Answer 23

• You palpate distended small intestine on rectal exam
• You visualize distended small intestine on ultrasound
• get >2L net reflux

> > Will likely need a referral for IV fluids and frequent NG refluxing «

Question 24

You pass a tube on a 500kg horse and obtain 10 liters net reflux. Which of the following is part of your treatment plan?
a. Give 10L water and electrolytes via NG
b. Start broad-spectrum antibiotics
c. Place an IV catheter for continuous IV fluids
d. Recommend exploratory surgery

Answer 24

c. Place an IV catheter for continuous IV fluids

Question 25

List the indications for Abdominocentesis:

Answer 25

- Baseline when treating conditions like LC impaction - Diagnose ischemic intestine - Confirm gastrointestinal rupture

Question 26

Abdominocentesis - Diagnoses: - Could be blood contamination - Check lactate - if abd > blood, likely ischemia (strangulation) - Serial taps can be helpful if in the gray zone

Answer 26

Serosanguinous

Question 27

Abdominocentesis - Diagnoses: - Submit for cell count and cytology - Lactate may be high with bacterial sepsis

Answer 27

Cloudy/Cellular

Question 28

Abdominocentesis - Diagnoses: - Confirm rupture vs enterocentesis - intracellular bacteria on cytology (+ septic shock)

Answer 28

Green/plant material

Question 29

Which of the following is a simple obstruction? a. Transverse colon impaction b. Peritonitis c. Inguinal hernia d. Large colon volvulus

Answer 29

a. Transverse colon impaction

Question 30

Which type of colic would most commonly be seen in a neonatal (< 2 weeks old) foal? a. Ascarid impaction b. Large colon impaction c. Cecal tympany d. Enterocolitis

Answer 30

d. Enterocolitis

Question 31

What is your top differential diagnosis for a young foal (e.g. 3‐6 weeks old) that is colicky and lying on it's back?

Answer 31

Gastric ulceration

Question 32

What would be your treatment of choice for softening a pelvic flexure impaction in an adult horse?

Answer 32

Water and electrolytes via nasogastric tube

Question 33

List 4 possible causes of *chronic* or *recurrent colic*:

Answer 33

- Gastric Ulcers - Enteroliths - Sand accumulation - Large colon impaction or displacement - Intra-abdominal mass

Question 34

Your client calls on emergency about her favorite mare, who is 4 weeks post‐foaling and has suddenly developed signs of severe abdominal pain and abdominal distension. You are over an hour away from the farm with another emergency. What do you advise your client?

Answer 34

Hitch up the trailer and prepare to take her to the nearby referral center if she doesn’t get better in the next 10 minutes