11. Clinical examination of the colic patient with different disorders, topical anatomy

Question 1

What is coli?

Answer 1

Acute abdominal pain.

There are many causes of colic and symptoms range from very mild to violent

Question 2

Origins of colic:

Answer 2

1. Gi-tract
2. Urinary colic
3. Uterine torsion

Question 3

Causes of colic:

Answer 3

1. Change in diet
2. Decreased water uptake
3. Parasitic infections
4. Meterological changes

Question 4

What are the different types of colic?

Answer 4

1. gas colic
2. spasmodic colic
3. impaction colic

Question 5

Gas colic =

Answer 5

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

Question 6

Spasmodic colic =

Answer 6

defined as painful contractions of the smooth muscle in the intestines

Question 7

Impaction colic =

Answer 7

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

Question 8

Important to remember when examining a colic patient:

Answer 8

Quick ,systematic and effective examination. Focus on Cardiovascular and GI-system

Question 9

Examination steps for a colic patient:

Answer 9

1. History
2. Physical examination
3. Ancillary methods

Question 10

Important to ask under history:

Answer 10

1. Which colic signs: duration, grade, frequency
2. Which medications given prior
3. Previous colic episodes?
4. Change in feeding?
5. Change in management?
6. Deworming?

Question 11

Steps to perform under “physical examination”:

Answer 11

1. Behaviour and posture
2. Body surface: dry/sweaty, skin temp.
3. Temperature
4. Heart rate
5. Respiratory rate
6. mucous membrane
7. CRT
8. Shape and size of the abdomen
9. Abdominal auscultation
10. Rectal palpation

Question 12

Behaviour and posture signs of colic:

Answer 12

1. Frequently looking to their side
2. Biting or kicking the abdomen
3. Lying down
4. rolling

Question 13

Heart rate in case of colic:

Answer 13

Mild: Over 50
Severe: Over 100 - could indicate ruptured intestines!!

Question 14

Mucous membrane in case of colic:

Answer 14

Usually darker

Question 15

Landmarks for abdominal auscultation:

Answer 15

1. Paralumbar fossa
2. Lower abdomen, behind the costal arch

Question 16

What can it indicate if there are no abdominal sounds?

Answer 16

1. Impaction
2. Obstruction
3. Hyperfusion
4. Ileus
5. Dislocaton
6. Torsion

Question 17

What can it indicate if there are increased abdominal sounds?

Answer 17

1. Early enteritis/colitis
2. mild spasmodic colic

Question 18

What to look for in case of rectal palpation?

Answer 18

1. Displacement
2. Distension

Question 19

Name some ancillary methods of colic examination:

Answer 19

1. Ultrasound
2. X-ray (rare!)
3. Nasogastric tubing
4. Abdominocentesis
5. Lactate in blood + peritoneal fluids

Question 20

What can be observed during US of a colic patient?

Answer 20

1. Visualisation of the colonic mesenteric vasculature
   = indicator for right dorsal displacement of the large colon.
2. Distension of small intestinal loops
3. Fluid accumulation

Question 21

When do we perform abdominocentesis

Answer 21

In severe cases!

Question 22

What does the numbers indicate?

Answer 22

1. Normal transudate
2. Darker red, modified transudate
3. Red, blood = Strangulation for several hrs
4. Yellow, opaque = Exudate, indication acute peritonitis
5. Brown, plant materal = indication rupture

Question 23

What can increased lactate levels indicate?

Answer 23

Over 4.4 mmol/L indicates strangulation, and it will keep increasing with fluid therapy

Question 24

Answer 24

1. Diaphragm
2. Heart
3. Pharynx
4. Esophagus
5. Liver
6. Right kidney
7. Small intestine
8. Base of caecum
9. Rectum
10. Small colon
11. Caecum
12. Right ventral colon
13. Right dorsal colon

Question 25

Answer 25

1. Oesophagus 2. Liver 3. Stomach 4. Left kidney 5. Small intestine 6. Rectum 7. Sternal flexure, left ventral colon 8. Diaphragmatic flexure, left dorsal colon 9. Heart 10. Diaphragm 11. Pharynx

Question 26

Disorders of a colic patient:

Answer 26

1. Obstipation 2. Colitis 3. Large colon displacement

Question 27

Clinical signs of obstipation:

Answer 27

1. Apatic 2. Decreased apetite 3. increased heart rate 4. decreased gut sound 5. With palpation we might find a hard structure

Question 28

Blood measurements in case of obstipation:

Answer 28

1. Increased haematocrit 2. Increase total protein 3. increased creatinine 4. Leukopenia (decreased leukocytes)

Question 29

Treatment of obstipation:

Answer 29

1. Fluids 2. Laxatives: paraffin oil, bismouth salt 3. Walking

Question 30

Complications of obstipatoin:

Answer 30

1. Rupture 2. Colitis 3. Peritonitis

Question 31

Clinical signs of colitis:

Answer 31

1. soft faeces 2. thickened intestinal wall 3. Fluid visible 4. Severe: have gas

Question 32

Causes of colitis:

Answer 32

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

Question 33

Treatment of colitis:

Answer 33

1. Hay 2. Fluids 3. Painkillers (flunixin) 4. Charocal

Question 34

Complications of colitis:

Answer 34

1. dehydration 2. bacteriaemia 3. toxins 4. pneumonia Increased risk of secondary problems and death!!

Question 35

clinical signs of large colon displacement:

Answer 35

1. Colic signs 2. lays down 3. Bloated 4. Bad condition (sweating, cold limbs) 5. increased heart rate 6. no gut sounds 7. CRT = 5 sec

Question 36

Treatment of torsion:

Answer 36

in severe cases it might be euthanised otherwise surgery

Question 37

Treatment of left/right dorsal displacement:

Answer 37

Not severe: trotting, faster + slower movements Severe: surgery

Question 38

Complications. Cause and treatment!

Answer 38

1.Pneumonia: due to NG-tube. T: tracheal lavage, AB? 2. Lamnitis: due to endotoxaemia. T: ice boots, cast elevation,