7.1.2: Triage and first aid in equine colic Flashcards
What factors may influence your choice of treatment for a colic case?
- Cause/severity of colic
- Prognosis following treatment
- Finances/insurance cover
- Owner’s wishes
- Availability and ease of transport
- Intrinsic factors e.g. age, concurrent disease
What are some causes of colic that are always treated medically?
- Spasmodic colic
- Gaseous colic
- Anterior enteritis
- Colitis
- Gastric ulceration
- Grass sickness (ileus)
What are some causes of colic that are surgical/euthanasia cases?
- Small intestine/small colon incarceration
- Small intestine/small colon volvulus
- Colon torsion
What are some causes of colic that may be treated surgically or medically?
- Colon displacement
- Colon impactions (ingesta, sand)
- Peritonitis
- Non-GI lesions (e.g. kidney disease)
- Small intestinal simple obstruction
- Parasites
Which horses are colon torsion more common in?
a) mares
b) stallions
b) stallions
Which horses are more likely to get intusseceptions?
a) older horses
b) younger horses
b) younger horses
Which horses are more likely to get pedunculated lipomas?
a) older horses
b) younger horses
a) older horses
When might a mare be most at-risk of colon displacement?
During pregnancy but especially after parturition
Which of the following aspects of a horse’s demeanour are red flags for severe colic?
a) standing quietly
b) reduced appetite
c) lip curling
d) pained facial expression
e) restlessness
f) bruxism
g) pawing the ground
h) flank-watching
i) kicking at abdomen
j) repeatedly getting up and down
k) lying flat out or on back
l) rolling
j) repeatedly getting up and down
k) lying flat out or on back
l) rolling
True/false: donkeys are very stoic and will hardly ever show pain.
True
Part of a colic investigation involves assessing response to analgesia. Which drug will you use, how soon should it take effect and how long should it last?
Flunixin 1.1mg/kg IV
Should provide analgesia within 10mins and last about 12hrs
Pale or dark injected mucous membranes and a prolonged CRT suggest what?
Poor peripheral perfusion
Possible endotoxaemia
True/false: skin tent is an accurate way of assessing hydration in horses.
False
It should be used as a guide only; not hugely accurate.
Age affects skin tent because skin elasticity decreases in older horses.
Most accurate site - beside the shoulder
True/false: transient heart murmurs may be heard in a horse with colic.
True
Transient heart murmurs are not uncommon and happen due to disturbances in blood flow within the heart.
Often resolve with the colic.
What heart rate is a red flag for severe colic?
- > 80 bpm
Normal = 28-44 bpm
True/false: assessment of pulse quality is a waste of time in a colic assessment.
False
Pulses may be weak and thready.
Why might respiratory rate be elevated in colic?
- Pain/stress
- Concurrent respiratory disease
What respiratory rate suggests a severe colic?
- > 30bpm
When might you expect to hear increased gut sounds in a horse with colic?
Increased gut sounds -> guts are hypermotile
e.g. spasmodic colic
When might you expect to hear decreased gut sounds in a horse with colic?
Decreased gut sounds -> guts are hypomotile
e.g. colon impaction
When might you expect to hear absent gut sounds in a horse with colic?
Absent gut sounds -> guts are non-motile
e.g. small intestine incarceration
Describe the normal gut sounds you should hear in a healthy horse
- Gut sounds (borborygmi) occur constantly
- Constant low grade rumbling = peristalsis in the small colon
- Caecal emptying = 1-3x per minute, sounds like a toilet flushing
True/false: during colic, gut sounds may be normal/increased/decreased.
True.
How should you grade gut sounds?
- Listen in all 4 quadrants and grade them separately
- ++ is the normal amount of sound
What is the normal horse temperature?
37.5-38.5⁰C
What is the normal horse temperature?
37.5-38.5⁰C
A horse with colic is hypothermic. What temperature indicates this and what does it suggest?
- <37.0⁰C = hypothermia
- 37.0-37.5⁰C = mild hypothermia
- Mild hypothermia important in foals but probably irrelevant in adults
- Hypothermia suggests cardiovascular compromise/shock
True/false: Abdominal percussion and auscultation for a ping is pointless in horses due to normal gas production in the caecum.
False
* Ping indicates gas - either excess gas production or blockage in the passage of gas
* Ping is generally heard in the large intestine
* This indicates gut distension within the intestinal lumen (this is a red flag for critical colic cases)
Describe the abnormal findings you might feel on rectal exam of a horse with colic.
- Normal rectum is soft and without tension or distension; if everything feels soft and squishy with no tension, that is likely to be normal
- Abnormal findings = hard ingesta, gas-distended intestines, abnormally located structures, tight taenial bands
Describe the normal volume of fluid you would expect to get back if you placed a nasogastric tube and what it would look like. Compare this to abnormal findings and their cause.
- Normal = 2-3L (some sources say 4L) of green, non-malidorous fluid
- Larger volumes (7-12L) suggests small intestinal obstruction -> fluid backs up behind a blocked pipe
- This fluid may be foul-smelling
- Larger than expected volumes = red flag for critical cases of colic
What is the maximum volume of horse’s stomach?
8-15L
You have obtained fluid via a peritoneal tap. Describe your expected normal findings for the following:
* Colour
* Clarity
* Volume
* WBC count
* Total protein
* Lactate
Normals (peritoneal fluid)
* Yellow
* Clear
* Small volume
* <5000 cells/µl WBC count
* <30g/dL Total protein
* <2.5 mmol/L lactate
You have obtained fluid via a peritoneal tap. Describe your expected findings if you had compromised intestine.
Compromised intestine - findings on peritoneal tap:
* Pink/brown/serosanguinous
* Opaque
* Slightly increased volume
* Slightly elevated WBCC
* Slightly elevated total protein
* Elevated lactate
If fluid from a peritoneal tap is brown, this may suggest:
a) normal finding
b) compromised intestine
c) ruptured intestine
d) peritonitis
b) compromised intestine - if pink-brown/serosanguinous
c) ruptured intestine - if green/brown with food particles present
You have obtained fluid via a peritoneal tap. Describe your expected findings if you had ruptured intestines.
- Green/brown colour with ingesta
- Opaque with food particles visible
- Large volume
- Elevated WBCC
- Elevated total protein
- Elevated lactate
You have obtained fluid via a peritoneal tap. Describe your expected findings if you had peritonitis.
- White/yellow colour
- Turbid
- Large volume
- Elevated WBCC
- Elevated total protein
- Elevated lactate
Which of the following peritoneal fluid samples suggest peritonitis?
Far R = peritonitis
Which of the following peritoneal fluid samples suggests intestinal rupture?
Second from R
Might expect darker green/brown but can see food particles settled at the bottom
This image shows loops of small intestine. Is this:
a) normal
b) abnormal
b) abnormal
There are multiple loops of distended small intestine. This suggests an obstruction, behind which fluid is backing up.
