Primary assessment of colic Flashcards
(43 cards)
What is colic?
- colic describes the clinical signs of abdominal pain
Broad causes of colic
▪Many different diseases can cause colic
▪Most are caused by gastrointestinal disease, but can also be caused by pathology of other abdominal structures (liver, spleen, urogenital system)
Intestinal causes of colic
- Impaction/obstruction
- Strangulation (loss of blood supply)
- Ulcers
- Enteritis
- Displacement
- Herniated intestine
- Intussusception (rare unless young animal)
- Ileus (common after surgery)
- Spasmodic colic (moves too much)
- Gas/tympanic colic (excess gas)
Clinical signs associated with severe/critical cases
▪ Severe unrelenting pain (including signs of self trauma)
▪ Dullness and depression (can indicate septicaemia, rupture)
▪ Abdominal distension
▪ Heart rate >60bpm
▪ Discoloured mucous membranes or delayed capillary refill time
– Horses mm are smoked salmon, more yellowy cf other spp
▪ Absence of gut sounds in one or more quadrants
▪ Relate to obstruction or strangulation +/- cardiovascular compromise
Approach to colic - horse: signalment, behaviour, attitude
- Age
- Gender/reproductive status
- History of crib biting or wind sucking
- Recent changes in weight/condition
- Attitude to pain (stoic or expressive)
Approach to colic - management/yard environment related q’s
- Recent changes in:
i. Stabling/pasture turn-out
ii. Forage feed
iii. Exercise regime
iv. Hard feed
v. Access to water - Previous episodes of colic on the yard
- Whether horse has access to sand
Approach to colic - Owner factors
Is surgical tx/referral an option?
Approach to colic - Preventative healthcare
- Whether any parasite control/treatment is used
- Whether strategic parasite control (e.g., faecal egg counts and strategic worming) is used
- Date horse last received anthelmintic (de- wormer)
Approach to colic - Previous medical history
- Previous history of colic
i. If yes, frequency and nature of colic episodes - Previous abdominal surgery
- Current medication
- Other medical issues
- Recent history of sedation or anaesthesia
Approach to colic - Current episode
- When horse last seen behaving normally
- When horse last passed faeces; appearance of faeces
- Signs horse has been exhibiting and whether they have changed over time
- If colic has occurred previously, comparison with previous episodes
- Management since vet contacted
- Administration of any
treatment/analgesics
Basic assessment
(must be performed in all cases)
* Heartrate
* Mucous membranes
o Capillary refill time
o Colour
o Moistness
* Gut sounds
* Rectal temperature
Assessment of pain
- Pawing
- Attempting to lie down
- Flank-watching
- Box-walking/circling
- Sweating
- Rolling
- Kicking
- Demeanour
- Facial expression
- Pain scoring - Colorado pain socre
How to approach a severe/critical case
Basics of history
▪ Age, duration of signs, previous history, recent changes
Basics of physical examination
▪ Pain assessment
▪ Heart and respiratory rate
▪ Mucous membrane colour and CRT
▪ Gut sounds
Analgesia or sedation to control situation and allow more thorough examination
Shared decision making with owner
How are critical cases of colic defined?
Those in which the horse requires:
* Euthanasia on humane grounds
OR
* Hospitalisation for intensive medical or surgical treatment
Signs of a critical case of colic - pain
- Pain despite analgesia
- Abrasions
– Result from rolling/thrashing/being cast
– Typically found above the eyes and on other bony prominences - Thrashing
- Unresponsive
- Rolling continuously/throwing
themselves to the ground - Continuous box walking
- Sudden alleviation of signs
– This usually indicates gastric or intestinal rupture
Signs of a critical case of colic - the CV system
- Tachycardia (>60 bpm)
- Abnormal mucous membranes
– Colour: Red, purple, blue, grey
– Moistness: Dry
– ‘Toxic ring’ (red or purple line above teeth) - Capillary refill time >2.5 seconds
- Weak pulse character
- Elevated packed cell volume
Signs of a critical case of colic - the GIT
- Significant (>4 L in a 500 kg horse) or spontaneous NG reflux, and/or foul mouth odour
- Identification per rectum of:
– Distended Sl loops
– Severe LI distension
– LI displacement - Peritoneal fluid discoloured or turbid
- Abnormal abdominal ultrasound
- Severe abdominal distension on
visual observation - No gut sounds in ≥1 quadrant
- Peritoneal lactate >2 mmol/L
Signs of a critical case of colic - case progression
- Rapid deterioration of signs
Diagnostic tests
- Response to analgesia
- Rectal examination
- Nasogastric intubation
Safe approach for diagnostic tests
▪Identify a suitable area for examination and procedures in a
colicing horse
▪Make sure the owner/handler is working safely and understands what you will be doing
▪Make sure you are in a safe position and protected where possible
▪Consider use of sedation (alpha-2 agonists) and GI relaxants (hyoscine)
Reasons for performing a rectal exam
- Key diagnostic test for horses with suspected colic
- May allow you to rule various diagnoses in or out
Indications for performing a rectal exam
Any horse with:
o Clinical signs of colic
o Recent history of colic
Particularly indicated if the horse:
* Demonstrates severe pain
* Has a high heart rate (>60 bpm)
* Has other critical signs, and requires a decision around referral for surgical or intensive medical treatment
Contraindications for performing a rectal exam
- Risk to vet, handler, or horse which cannot be managed by restraint/sedation
- Unacceptable risk of rectal tear
Other factors to consider before performing a rectal exam
- Lubrication must always be used prior to insertion of your arm into the rectum
- The owner should be informed immediately about any complications or rectal tears
- Assess potential risks to the horse, yourself, and the handler
- Rectal examination allows palpation of the caudal third of the abdomen only
– Clinically significant lesions may not be palpable - Tell the owner what you’re planning to do and explain the rationale for the procedure
