7.1.2: Approach to the atypical colic Flashcards
What are some possible non-intestinal causes of colic?
- Renal disease
- Urogenital tract disorders
- Liver disease
- Peritonitis
- Thoracic disease
How should you approach to atypical colic?
- Opt for a problem based approach rather than pattern recognition.
- Start with standard colic exam: major body systems, rectal exam, abdominal ultrasound, peritoneal fluid analysis
What is your top differential in this case?
Top differential = pelvic flexure impaction.
HR is very high - this is too high for just pain, may suggest hypovolaemia, dysrhythmias, SIRS etc.
What are some possible reasons for elevated heart rates in a colicking horse?
- Hypovolaemia (reduced circulatory volume -> increased HR)
- SIRS (inflammatory cytokines, vasodilation -> increased HR)
- Pain (stress response -> increased HR)
- Dysrhythmias (electrolyte abnormalities, myocarditis -> increased HR)
What is normal blood lactate? Why might you be concerned about elevated lactate?
- Normal blood lactate <2 mmol/L
- Lactate is a marker of poorly oxygenated tissues
What is your top differential in this case?
Peritonitis
(mild colic signs + pyrexia)
What are some causes of an increased RR in a colicking horse?
- Pain (stress response)
- Primary lung disease (infectious/inflammatory)
- Pleural space disease (reduction in tidal volume)
You want to assess whether a horse’s colic can be adequately controlled with analgesia. What do you give and how long do you wait?
Flunixin meglumine
Re-assess HR, RR, and demeanour after max 60mins
What is your top differential in this case? How will you investigate this?
Top differential = some kind of intestinal lesion
How to assess: peritoneal fluid analysis, abdominal ultrasonography
Describe the process of abdominal ultrasonography for the colicking horse
FLASH: fast localised abdominal sonography of horses
* Undertake FLASH scan - this allows you to imagine spleen, liver, stomach, small intestine, caecum, right kidney, right dorsal colon.
* If you can see the spleen and kidney next to each other, the horse doesn’t have a nephrosplenic entrapment.
What diagnostic technique is this and why is it helpful in a colic case?
FLASH scan
Fast way to assess major abdominal organs of the horse.
At the end of a FLASH scan, where will you position your ultrasound probe and why?
- At the end of the scan, scan back down the ventral midline to see if there is a fluid pocket you can sample.
- You can then perform a peritoneal tap and analyse the fluid.
What is your top differential in this case?
Strangulated small intestine
True/false: you can adequately assess a horse for a strangulated small intestine per rectum.
False
* You cannot palpate the whole abomen per rectum.
* To identify strangulated loops of intestine, you could use ultrasonography (look for distended/thickened loops) and peritoneal fluid analysis (devitalised intestine produces lactate)
When peritoneal fluid is ??? times peripheral, this suggests strangulation/surgical colic?
Peritoneal fluid 2x peripheral lactate -> suggests strangulation
