Medical colic (Yr 4)

Question 1

what are indications that a colic is suitable for medical treatment?

Answer 1

mild-moderate pain
good response to analgesia
HR <50
continued/improving GI motility
no net reflux
resolving/no abdominal distention
normal peritoneal fluid
normal PCV, TP, lactate

Question 2

what is a good first line analgesic for mild/moderate colic pain?

Answer 2

phenylbutazone

Question 3

what is the risk with using flunixin meglumine for treating colic medically?

Answer 3

masks possible signs of SIRS (endotoxaemia)

Question 4

how strong is flunixin meglumine as an analgesic?

Answer 4

potent (strongest NSAID)

Question 5

how long does xylazine work for?

Answer 5

30 minutes (is fast acting)

Question 6

what alpha 2 agonists could be used for analgesia of colics?

Answer 6

xylazine
romifidine
detomidine

Question 7

what is romifidine usually combined with?

Answer 7

butorphanol (opioid)

Question 8

what are some possible analgesics classes to use for medical colic management?

Answer 8

NSAIDs, alpha 2 agonist, opiates

Question 9

what is the main opioid used for first opinion colic cases?

Answer 9

butorphanol

Question 10

what does butylcopolamine do?

Answer 10

smooth muscle relaxant (buscopan)

Question 11

what is the strongest NSAID for colic pain management?

Answer 11

flunixin meglumine

Question 12

when is flunixin acceptable to use in first opinion colic cases?

Answer 12

if referral is not an option and horse is very painful
when exact diagnosis is known and medical treatment is appropriate
if decision to refer has already been made

Question 13

how much water should you give a horse for oral rehydration?

Answer 13

4-6 litres every 4 hours

Question 14

should oral or IV fluids be used for large colon impactions?

Answer 14

oral - helps to hydrate the ingesta

Question 15

how does the cardiovascular system parameters present with spasmodic colic cases?

Answer 15

normal

Question 16

how is spasmodic colic treated?

Answer 16

butylscopolamine with NSAIDs

Question 17

what are some medical colics?

Answer 17

spasmodic
large colon impaction
caecal impactions
gastric impactions
large intestinal displacement/distention
sand colic

Question 18

what is a common cause of large colon impaction?

Answer 18

recent increase in stabling

Question 19

what is the typical clinical finding on a large colon impaction case?

Answer 19

on rectal exam there is doughy firm structure on caudal left abdomen

Question 20

what causes secondary large colon impactions?

Answer 20

primary small intestinal lesions (don’t confuse with primary impactions as they often need surgery)

Question 21

what is an important risk factor for causing caecal impactions?

Answer 21

horses receiving sedation/pain medication for other conditions

Question 22

what is a possible medical treatment for gastric impactions?

Answer 22

carbonated drink (gastric lavage)
IV fluids

Question 23

when is it acceptable to manage a large intestinal displace/distention medically?

Answer 23

normal CV parameters
not severe pain
no marked gas distention of large colon

Question 24

what initial medically therapy would be used for large intestinal displacement/distention?

Answer 24

analgesia
light walk/trot/exercise
oral fluids
withhold feed until faeces

Question 25

what are some types of large colon displacements?

Answer 25

nephrosplenic entrapment

Question 26

how is nephrosplenic entrapment diagnosed?

Answer 26

rectal and ultrasound (can’t image left kidney/spleen)

Question 27

what therapy is used to medically treat nephrosplenic entrapment?

Answer 27

phenylephrine infusion then lunge (shrinks spleen

Question 28

how can sand cause colic?

Answer 28

irritation of colonic mucosa resulting in diarrhoea and recurrent colic
colonic impactions or displacements

Question 29

how can sand colic be diagnosed?

Answer 29

sand in faeces
seashore sound on auscultation
abdominal radiographs

Question 30

what therapy is used for sand colics?

Answer 30

intensive fluid therapy with magnesium sulphate and psyllium sulphate

Question 31

what are common causes of colic in neonatal foals?

Answer 31

meconium impaction
enteritis
small intestine volvulus
congenital abnormalities

Question 32

what are some indications for euthanasia in colic cases?

Answer 32

uncontrolled pain with potent analgesics
severe cardiovascular signs (HR >90, PCV >60%, purple MM)
GI rupture (red/brown ingesta contaminated peritoneal fluid)