11. Clinical examination of the colic patient with different disorders, topical anatomy Flashcards
What is coli?
Acute abdominal pain.
There are many causes of colic and symptoms range from very mild to violent
Origins of colic:
- Gi-tract
- Urinary colic
- Uterine torsion
Causes of colic:
- Change in diet
- Decreased water uptake
- Parasitic infections
- Meterological changes
What are the different types of colic?
- gas colic
- spasmodic colic
- impaction colic
Gas colic =
caused by excessive production of gas in any portion of the horse’s intestinal tract. It is believed that sudden changes in feed may contribute to gas colic
Spasmodic colic =
defined as painful contractions of the smooth muscle in the intestines
Impaction colic =
caused by obstructions in the bowel, typically in areas where the large intestine changes in direction or diameter. These obstructions may be caused by dry, firm masses of feed, or foreign material such as dirt or sand
Important to remember when examining a colic patient:
Quick ,systematic and effective examination. Focus on Cardiovascular and GI-system
Examination steps for a colic patient:
- History
- Physical examination
- Ancillary methods
Important to ask under history:
- Which colic signs: duration, grade, frequency
- Which medications given prior
- Previous colic episodes?
- Change in feeding?
- Change in management?
- Deworming?
Steps to perform under “physical examination”:
- Behaviour and posture
- Body surface: dry/sweaty, skin temp.
- Temperature
- Heart rate
- Respiratory rate
- mucous membrane
- CRT
- Shape and size of the abdomen
- Abdominal auscultation
- Rectal palpation
Behaviour and posture signs of colic:
- Frequently looking to their side
- Biting or kicking the abdomen
- Lying down
- rolling
Heart rate in case of colic:
Mild: Over 50
Severe: Over 100 - could indicate ruptured intestines!!
Mucous membrane in case of colic:
Usually darker
Landmarks for abdominal auscultation:
- Paralumbar fossa
- Lower abdomen, behind the costal arch
What can it indicate if there are no abdominal sounds?
- Impaction
- Obstruction
- Hyperfusion
- Ileus
- Dislocaton
- Torsion
What can it indicate if there are increased abdominal sounds?
- Early enteritis/colitis
- mild spasmodic colic
What to look for in case of rectal palpation?
- Displacement
- Distension
Name some ancillary methods of colic examination:
- Ultrasound
- X-ray (rare!)
- Nasogastric tubing
- Abdominocentesis
- Lactate in blood + peritoneal fluids
What can be observed during US of a colic patient?
- Visualisation of the colonic mesenteric vasculature
= indicator for right dorsal displacement of the large colon. - Distension of small intestinal loops
- Fluid accumulation
When do we perform abdominocentesis
In severe cases!
What does the numbers indicate?
- Normal transudate
- Darker red, modified transudate
- Red, blood = Strangulation for several hrs
- Yellow, opaque = Exudate, indication acute peritonitis
- Brown, plant materal = indication rupture
What can increased lactate levels indicate?
Over 4.4 mmol/L indicates strangulation, and it will keep increasing with fluid therapy
- Diaphragm
- Heart
- Pharynx
- Esophagus
- Liver
- Right kidney
- Small intestine
- Base of caecum
- Rectum
- Small colon
- Caecum
- Right ventral colon
- Right dorsal colon
- Oesophagus
- Liver
- Stomach
- Left kidney
- Small intestine
- Rectum
- Sternal flexure, left ventral colon
- Diaphragmatic flexure, left dorsal colon
- Heart
- Diaphragm
- Pharynx
Disorders of a colic patient:
- Obstipation
- Colitis
- Large colon displacement
Clinical signs of obstipation:
- Apatic
- Decreased apetite
- increased heart rate
- decreased gut sound
- With palpation we might find a hard structure
Blood measurements in case of obstipation:
- Increased haematocrit
- Increase total protein
- increased creatinine
- Leukopenia (decreased leukocytes)
Treatment of obstipation:
- Fluids
- Laxatives: paraffin oil, bismouth salt
- Walking
Complications of obstipatoin:
- Rupture
- Colitis
- Peritonitis
Clinical signs of colitis:
- soft faeces
- thickened intestinal wall
- Fluid visible
- Severe: have gas
Causes of colitis:
Can be both contagious or non-contagious
Contagious:
1. Parasites
2. Bacteria (salmonella feks)
3. Vuris (rotavirus)
Non-contagious:
1. change in diet
2. Stress
3. Weather
4. Tumour
5. Poisoning
Treatment of colitis:
- Hay
- Fluids
- Painkillers (flunixin)
- Charocal
Complications of colitis:
- dehydration
- bacteriaemia
- toxins
- pneumonia
Increased risk of secondary problems and death!!
clinical signs of large colon displacement:
- Colic signs
- lays down
- Bloated
- Bad condition (sweating, cold limbs)
- increased heart rate
- no gut sounds
- CRT = 5 sec
Treatment of torsion:
in severe cases it might be euthanised
otherwise surgery
Treatment of left/right dorsal displacement:
Not severe: trotting, faster + slower movements
Severe: surgery
Complications.
Cause and treatment!
1.Pneumonia: due to NG-tube. T: tracheal lavage, AB?
- Lamnitis: due to endotoxaemia. T: ice boots, cast elevation,
