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Y4 EQ - Gastrointestinal tract > Medical treatment of colic > Flashcards

Medical treatment of colic Flashcards

(63 cards)

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1
Q

Why is colic so important in practice?

A

One of the most common emergencies in first opinion equine practice

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2
Q

List some risk factors for critical colic cases

A
  • Pain score
  • Heart rate
  • CRT
  • Weak pulse
  • Absence of gut sounds in one or more quadrants
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3
Q

Describe the steps involved in approaching a colic case

A
  • History taking
  • Observation
  • Clinical exam
  • Assessment
  • Plan
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4
Q

How is the plan for colic cases devised?

A

Results of clinical exam and further tests
-> medical or surgical colic?
- Medical = analgesia and repeat examination
- Surgical = contact referral facility asap

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5
Q

List the indications/clinical signs that show colic can be managed medically

A
  • Mild/moderate pain
  • Good response to analgesia
  • HR <50bpm
  • GI motility continuing
  • No net reflux
  • Resolving/no abdominal distention
  • Normal peritoneal fluid
  • Normal PCV/TP and systemic lactate
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6
Q

Why should you keep your mind open during colic cases

A

A diagnosis may not always be possible on the initial examination
Response to initial medical treatment and results of repeat clinical examination are key

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7
Q

Which diagnostic finding is always an indication for the possible need for surgery in colic cases

A

Non-response to analgesia

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8
Q

What are the key components of medical treatment for colic?

A
  • Analgesia
  • +/- oral fluids
  • +/- other specific therapies based on initial diagnosis: IV fluids, Phenylephrine, psyllium
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9
Q

What needs to be considered when providing horses with analgesia for colic?

A

Potency
Duration of action
Sedative / other effects e.g. smooth muscle relaxation
Potential side effects

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10
Q

The 3 main analgesia agents used in colic cases are?

A

NSAIDs
Alpha 2 agonists
Opiates

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11
Q

Name 5 NSAIDs that can be used for colic cases

A

Phenylbutazone
Flunixin
Metimazole - Buscopan compositum
Ketoprofen
Meloxicam

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12
Q

Describe the features of phenylbutazone for use in colic cases

A
  • Moderate potency
  • 12 hours duration
  • Beware perivascular administration
  • Good first line analgesic for the colic case with mild/moderate pain
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13
Q

Describe the features of flunixin for use in colic cases

A
  • Potent analgesia
  • 12 hours duration
  • Very effective in masking increase in HR with SIRS (endotoxaemia)
  • Should be used with caution in cases of colic showing mild/ moderate pain where cause is unknown
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14
Q

Name 3 alpha 2 agonists that could be used in colic cases

A

Xylazine
Romifidine
Detomidine

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15
Q

Describe the features of xylazine for use in colic cases

A

Good analgesia
Short acting ~ up to 30 mins duration in painful colic cases
Very useful in assessment of the painful colic case

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16
Q

Describe the features of romifidine for use in colic cases

A

Around 2-4 hours analgesia in colic cases
Usually combined with butorphanol
Can also be administered IM
Useful in colic cases showing moderate – severe signs of pain

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17
Q

Describe the features of detomidine for use in colic cases

A

Potent analgesia for around 2-4 hours in colic cases
Usually combined with butorphanol
Useful in colic cases showing moderate – severe signs of pain

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18
Q

Name 3 opiates used in colic cases

A

Butorphanol
Pethidine
Morphine

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19
Q

Describe the features of butorphanol for use in colic cases

A

Usually combined with alpha 2 agonist
Can be used on its own
Useful in colic cases that are moderately / severely painful

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20
Q

What is the action of Butylscopolamine/Hyoscine?

A

Smooth muscle relaxant

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21
Q

What is Buscopan compositum?

A

Muscle relaxant combined with Metimazole (NSAID)

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22
Q

When is butylscopolamine indicated/useful?

A
  • Indicated in spasmodic colic cases / mild colic pain
  • Useful when performing rectal examination where horses are straining: reduces the risk of a rectal tear occurring
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23
Q

Why is the use of flunixin debated?

A
  • Its a potent analgesic
  • Signs of colic masked: owners may not appreciate the severity of the situation
  • Masks the effects of SIRS (endotoxaemia): increases in HR and PCV are delayed
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24
Q

When is it acceptable to give flunixin? (3 scenarios)

A
  1. When referral is not an option & horse is exhibiting moderate / severe pain (if no response seen euthanasia is appropriate)
  2. When an exact diagnosis is known & medical treatment is appropriate (e.g. pelvic flexure impaction)
  3. When the decision to refer has already been made
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25
In which situation would you be cautious to give flunixin?
Mild / moderate pain of unknown cause & where referral is an option
26
Describe the administration and uses of oral fluids
- Easy and inexpensive - 4-6 litres water (500kg horse) / electrolytes administered q.4h by nasogastric intubation -> stimulates gastrocolic reflex - Can place an indwelling stomach tube for continuous administration of fluids - Provides hydration provided the horse is not refluxing - Hydrates ingesta assisting resolution of large colon impactions
27
Describe the administration of IV fluids
Expensive Does not directly hydrate ingesta – excess fluids lost by urination Difficult to administer and monitor safely outside clinic facilities
28
When are IV fluids indicated?
Reflux obtained on nasogastric intubation (is there a surgical lesion?) Severe systemic compromise & immediate systemic support needed
29
Describe the features and signs of spasmodic colic
- Pain due to intestinal spasm - Undiagnosed / spasmodic colic is the most frequent diagnosis in first opinion veterinary practice - Mild pain - Normal cardiovascular parameters
30
How is spasmodic colic treated in most cases?
Butylscopolamine +/- NSAID (metimazole / phenylbutazone)
31
Describe the features and signs of large colon impaction
Mild / moderate signs of pain Classic findings on rectal examination: doughy, firm structure on LHS of caudal abdomen
32
What is a common epidemiological clue for large colon impaction?
Recent increase in stabling due to weather/injury
33
How can you make sure not to confuse a large colon impaction with secondary large colon impaction?
- Corrugated feel: not smooth and large ‘vacuum packed’ - Usually a primary small intestinal lesion - Results of initial +/- repeat assessments indicative of need for surgical management
34
How is a large colon impaction treated?
Oral fluid therapy via nasogastric intubation q.4h until faeces passed Analgesia – IV flunixin meglumine appropriate Surgery may be required in some cases
35
What can be added to oral fluids in large colon impaction cases? Why?
Magnesium sulphate as an osmotic laxative agent to increase hydration of ingesta
36
Caecal impactions may occur in horses secondary to treatment for which conditions?
Important to monitor faecal output in hospitalized horses that have been treated for a painful ocular / orthopaedic condition and received NSAIDs
37
Describe gastric impaction as a cause of colic
- Uncommon cause - Variable history and presenting signs - Medical / surgical management depends on severity of findings - May be suspected on ultrasonographic assessment – gastric distention
38
How is a gastric impaction colic diagnosed?
Gastroscopy
39
How is gastric impaction treated?
IV fluid therapy Repeat gastric lavage important +/- use of carbonated drinks
40
Describe the medical therapy needed for large intestinal displacement/distention
1. Analgesia – careful monitoring if using potent analgesia 2. Light walking / trotting exercise 3. Oral fluid therapy – bolus fluids as for primary large colon impaction 3. Withhold feed until faeces start to be passed
41
When can large intestinal displacement/distention be managed medically?
Horses CV parameters normal Degree of pain not severe Marked gaseous distention of the large colon is absent
42
When is surgical intervention indicated for large intestinal displacement/distention?
Severe pain / marked or increasing gas distention of colon Deteriorating CV parameters Non-response to treatment
43
How is nephrosplenic ligament entrapment diagnosed?
Rectal examination Ultrasonography
44
How does nephrosplenic ligament entrapment appear on ultrasound?
Failure to image left kidney and spleen – gas distended large colon visualised
45
Medical vs surgical management of nephrosplenic ligament entrapment depends on?
Initial evaluation Medical therapy indicated if systemic status good, pain can be controlled and mild degree of gaseous distention
46
Describe how to medically treat nephrosplenic ligament entrapment
Phenylephrine infusion Horse lunged for 15 mins Repeat rectal examination to assess if LC has repositioned itself * increased risk of haemorrhage in older horses (>15 y.o 64 x the risk) – owners should be made aware of this
47
When does sand colic occur?
More common in certain geographic regions Potential to ingest sand - Sandy soil - Poor grazing - Turnout on sand arenas
48
Why does sand cause colic?
Irritation of the colonic mucosa by sand can result in diarrhoea / recurrent mild colic Can cause colonic impactions and colon displacement / torsion
49
How is sand colic diagnosed?
Sand in the faeces Classic ‘seashore’ sound on auscultation Sand retrieved on abdominocentesis Ultrasonography Abdominal radiography
50
Medical/surgical management of sand colic depends on?
Presenting signs of colic
51
How can you treat mild cases of sand colic?
Remove source of sand Provide plenty forage +/- psyllium added to feed intermittently
52
How is a medical sand colic treated?
Intensive medical treatment with Magnesium sulphate and psyllium sulphate Monitoring of clearance using radiography
53
Describe the features of colic in neonatal foals
Degree of pain is less useful to assess need for potential surgery - Enteritis can present as severe abdominal pain Ultrasound particularly valuable (+/- radiography occasionally indicated)
54
List the most likely causes of colic in the neonatal foal?
Meconium impaction (Ruptured bladder) Enteritis SI volvulus Congenital anomalies
55
How does colic in donkeys most commonly present?
Signs of dullness – uncommon to show marked signs of colic Degree of pain less useful
56
Which type of colic is most common in donkeys?
Colonic impactions
57
What should be assessed when colic is suspected in donkeys?
Always check for dental abnormalities May be due to ingestion of foreign materials in working equid populations
58
What is the main advice to give to the owners in colic cases?
- Remove feed & leave water with the horse - Ask owners to provide an update in 2 hours, sooner if signs of colic recur - If the horse responds to treatment: offer small amounts of food once faeces passed (and increase back to normal over around 24h) - If the horse does not respond to treatment perform repeat visit
59
How can recurrence of colic be prevented?
Important to consider the potential cause of any medical episode of colic and advise the owner regarding prevention of future episodes - Parasite testing / discussion about parasite control - Dental examination / treatment - General management (irregular turnout / poor feeding management)
60
Name 4 risk factors for recurrence of colic
Known dental problem Crib-biting / windsucking behaviour Weaving Time at pasture
61
When should euthanasia be considered in colic cases?
- Uncontrollable pain despite potent analgesia - Severe CV compromise: HR >90bpm - PCV >60%: purple mucous membranes - Gastrointestinal rupture: brown / red ingesta contaminated peritoneal fluid. Profuse sweating, sudden reduction in pain
62
How can you confirm gastrointestinal rupture has occurred?
- Marked, progressive increase in HR, PCV and deterioration in mucous membranes - ‘Boarding’ of the abdomen - Dark red / brown peritoneal fluid containing ingesta (differentiate from accidental enterocentesis)
63
Why does gastrointestinal rupture occur?
Frequently due to rupture of the stomach (usually along the greater curvature) This is why nasogastric intubation can be life- saving Hopeless prognosis even if surgery attempted

Y4 EQ - Gastrointestinal tract (9 decks)

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