Medical Colic 1 Flashcards
(39 cards)
Types of medical colic.
Spasmodic, undiagnosed, gas, impaction.
P’s of colic to decide if patient needs an emergency surgery.
Pain.
Passage of time.
Pulse.
Pass a tube.
Palpate per rectum.
Peritoneal fluid.
PCV.
Pyrexia.
Per abdominal ultrasonography.
Conditions for giving flunixin in colic cases.
Done a thorough investigation.
You follow up the progress of your case, interpreting info in the light that you have given flunixin.
You move to surgery if pain persists even after the full dose of flunixin has been given.
Analgesia for medical colic cases?
Ambulatory practice, start with IV phenylbutazone for mild-moderate pain.
Often give hyoscine (buscopan) to aid rectal palpation.
Ideally sedate with xylazine (short-acting better if CV compromised) for own safety for rectal.
- can relieve pain as spasmolytic but last 20-30 mins.
If no access to bute, consider half dose flunixin.
If not signed out of food chain, meloxicam.
- Spasmodic colic.
- Proposed risk factors causing spasmodic colic.
- Spasm of muscle layers in SI.
- causes pain. - Excitement.
Physical exertion.
Fatigue.
Parasite migration.
Mouldy feed.
Change of diet.
Excess grain, low fibre.
Weather changes.
Tapeworm infestation - risk increases proportionally to burden.
Spasmodic colic diagnosis.
Fairly recent onset.
Mild-moderate signs of pain.
Can be intermittent.
Passes all the P’s.
Pulse <60.
Might hear/feel/see hypermotile intestine on auscultation / rectal / ultrasound.
Should respond to treatment - always reassess.
Spasmodic colic treatment.
IV.
Spasmolytic agents.
- Hyoscine/butylscolpolamine.
— buscopan.
- butylscolpolamide + dipyrone (weak NSAID).
— buscopan compositum.
If mild colic, can just give either alone.
If doesn’t respond, reassess, but don’t usually need to panic.
Analgesia:
- NSAID.
- can give alone or with hyoscine (but probably already gave that for a rectal).
Judge for individual case (may not matter that much).
Phenylbutazone OR half dose flunixin OR (Carprofen/ketofen/meloxicam).
Starve while treating and shortly after:
- about 8 hours.
Then treat as normal.
Spasmodic colic recovery.
Usually rapid.
Occasionally horse may re-present after several hours.
- need to work-up from beginning again.
Alarm bells ring a little if present twice but can be ok, ring a lot of present a third time.
Spasmodic colic - what next?
Try to identify any risk factors and minimise future risk.
Review routine care - parasites and teeth.
Worming history, FEC, tapeworm ELISA, check teeth.
- Gas colic.
- Proposed risk factors causing gas colic.
- Excess production of gas in all or part of large intestine.
Pain from stretching intestinal wall. - Diet change.
Rich grass.
Rich haylage.
>2kg concentrate on any one meal.
If repeated, consider IBD.
Parasites.
Poor dentition.
Gas colic diagnosis.
May be unable to differentiate from spasmodic or undiagnosed.
Similar presentation but…
- can be a bit more painful.
- may be a bit bloated.
Passes the P’s, but…
- rectal — gas distended but still squishy viscera.
— BUT, get this with LI displacement or LI torsion.
—> gas colic often a precursor to developing these.
—> displacements may need surgery.
—> torsions need surgery NOW!
So, I’d think has colic but fails ANY of the other P’s, doesn’t respond to treatment, or viscous taught with bands and/or large abdominal distension = REFER!
Gas colic treatment.
As for spasmodic.
PLUS
Stomach tube with water (~1L/100kg) may help as activates gastro-colic reflex (ALWAYS check for reflux first).
Gentle trot lunging may help.
Refer more quickly if does not resolve.
Has colic - what next?
Check teeth, parasites.
Check diet.
If recurrent:
- change to wet hay.
- add Yeasacc / another hind gut supplement to feed?
- further investigation (for IBD or other causes).
- Where can impactions occur in the horse?
- The pathophysiology of impactions.
- 40% at the pelvic flexure.
Stomach.
Ileum.
Caecum.
Large colon.
Small colon. - Tend to occur just oral to sites of:
- intestinal narrowing
And/or
- active pacemakers.
E.g. pelvic flexure, ileocaecal junction.
Impaction causes back up of ingesta.
This stretches mucosal wall, stimulating mural stretch receptors, causing pains
If severe/prolonged, potential vascular compromise (pressure on blood vessel).
Proposed risk factors of LI impaction.
Reduced water intake.
Physical exertion (sweating).
Reduction in exercise.
Parasite migration.
Dental disease (don’t chew long fibre).
Others.
LI impactions in donkeys.
Associated with dental diastema.
50% survival rate.
Study bias towards geriatric population.
Often picked up very late.
- show pain differently.
Diagnosis of LI impactions.
May have been exposed to 1 or more possible risk factors.
Mild-moderate signs of pain.
Pass the P’s (do not perform a peritoneal tap - risk puncturing intestine if impaction is large).
- abnormal rectal.
— most LI impactions at the pelvic flexure.
MIGHT perform a peritoneal tap if gives info on whether there is gut damage - have you time to try medical management, or does it need surgery?
Risk-benefit analysis on individual case (CV parameters, duration, response to treatment).
LI impaction treatment.
Aim is to (over) hydrate ingesta so that gut peristalsis can clear the impaction.
Pro-motility drugs contraindicated as may result in intestinal rupture.
Main-stay is oral fluids:
- most effective, cheaper, lower risk.
- just tap water.
- can add Lectade (or similar) to make fluid isotonic rather than hypotonic.
- can add a cathartic — magnesium sulphate (evidence more effective than water alone) —> once per 24hrs (add ~1g/kg).
— Dioctyl Sodium Sulphate (DSS).
—> better than water alone, not as good as MgSO4.
—> once per 24hrs (10-20mg/kg).
(Can supplement with IV to aid over hydration).
Liquid paraffin:
- may have place as emollient.
- doesn’t help break up the impacted material.
- reasonable expensive.
- kills if you mis-place the tube into the lungs.
Give treatments via stomach tube.
ALWAYS check for reflux.
Give water (or water plus whatever you’ve added to it).
About 1L/100kg.
Give by gravity, stop and think again if resistance.
Analgesia is as for spasmodic.
Follow up with at least a phone call after a few hours, probably a visit.
Often need repeated tubing.
Can take days but if not an easy fix, hospitalise.
Can tube more frequently or place indwelling tube to continuously deliver fluid from drip bags.
Can give IV as well (but not instead).
If don’t respond i.e. don’t pass faeces / remain painful or CV deterioration, reassess, may need peritoneal fluid sample.
- might not be just an impaction.
- some need surgery.
— poorer Px.
LI impactions - what next?
Try to identify any risk factors and minimise future risk.
Review routine care - parasites and teeth.
FEC, tapeworm ELISA, check teeth.
Ileal impactions.
Usually at ileocaecal junction of SI.
- impacted with ingesta.
— usually due to hypertrophy of wall at ileocaecal junction secondary to tapeworm (Anoplocaephala).
- or impacted with Parascaris.
— often within 24hrs of deworming ‘too effectively’ when have a high burden.
Is surgical problem.
Ileal impaction - anoplocephala.
Often <4 years old.
Should deworm with praziquantel or double dose Pyrantel in the last 6 months.
Ileal impaction - Parascaris.
Often <2 years old.
Should have had fenbendazole at 2-3 months, 6 months ivermectin/moxidectin/Pyrantel, 9 months moxidectin and praziquantel, 12 months Pyrantel.
Diagnosis of ileal impactions.
Simple small intestinal obstruction.
Takes much longer for compromise to blood supply of gut wall than a strangulation.
Present as for small intestinal strangulation.
- distended SI on rectal, scan.
- raised pulse, PCV up.
- slow to reflux.
- peritoneal tap slow to change.
Needs to go to surgery!
Treatment of ileal impactions.
Whether sure of Dx or not, presenting signs indicate surgery required.
Clear impaction.
May have to perform ileocaecal bypass if junction very thickened.
