7.1.2: Triage and first aid in equine colic

Question 1

What factors may influence your choice of treatment for a colic case?

Answer 1

• 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

Question 2

What are some causes of colic that are always treated medically?

Answer 2

• Spasmodic colic
• Gaseous colic
• Anterior enteritis
• Colitis
• Gastric ulceration
• Grass sickness (ileus)

Question 3

What are some causes of colic that are surgical/euthanasia cases?

Answer 3

• Small intestine/small colon incarceration
• Small intestine/small colon volvulus
• Colon torsion

Question 4

What are some causes of colic that may be treated surgically or medically?

Answer 4

• Colon displacement
• Colon impactions (ingesta, sand)
• Peritonitis
• Non-GI lesions (e.g. kidney disease)
• Small intestinal simple obstruction
• Parasites

Question 5

Which horses are colon torsion more common in?
a) mares
b) stallions

Answer 5

b) stallions

Question 6

Which horses are more likely to get intusseceptions?
a) older horses
b) younger horses

Answer 6

b) younger horses

Question 7

Which horses are more likely to get pedunculated lipomas?
a) older horses
b) younger horses

Answer 7

a) older horses

Question 8

When might a mare be most at-risk of colon displacement?

Answer 8

During pregnancy but especially after parturition

Question 9

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

Answer 9

j) repeatedly getting up and down
k) lying flat out or on back
l) rolling

Question 10

True/false: donkeys are very stoic and will hardly ever show pain.

Answer 10

True

Question 11

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?

Answer 11

Flunixin 1.1mg/kg IV
Should provide analgesia within 10mins and last about 12hrs

Question 12

Pale or dark injected mucous membranes and a prolonged CRT suggest what?

Answer 12

Poor peripheral perfusion
Possible endotoxaemia

Question 13

True/false: skin tent is an accurate way of assessing hydration in horses.

Answer 13

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

Question 14

True/false: transient heart murmurs may be heard in a horse with colic.

Answer 14

True
Transient heart murmurs are not uncommon and happen due to disturbances in blood flow within the heart.
Often resolve with the colic.

Question 15

What heart rate is a red flag for severe colic?

Answer 15

• > 80 bpm

Normal = 28-44 bpm

Question 16

True/false: assessment of pulse quality is a waste of time in a colic assessment.

Answer 16

False
Pulses may be weak and thready.

Question 17

Why might respiratory rate be elevated in colic?

Answer 17

• Pain/stress
• Concurrent respiratory disease

Question 18

What respiratory rate suggests a severe colic?

Answer 18

• > 30bpm

Question 19

When might you expect to hear increased gut sounds in a horse with colic?

Answer 19

Increased gut sounds -> guts are hypermotile
e.g. spasmodic colic

Question 20

When might you expect to hear decreased gut sounds in a horse with colic?

Answer 20

Decreased gut sounds -> guts are hypomotile
e.g. colon impaction

Question 21

When might you expect to hear absent gut sounds in a horse with colic?

Answer 21

Absent gut sounds -> guts are non-motile
e.g. small intestine incarceration

Question 22

Describe the normal gut sounds you should hear in a healthy horse

Answer 22

• 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

Question 23

True/false: during colic, gut sounds may be normal/increased/decreased.

Answer 23

True.

Question 24

How should you grade gut sounds?

Answer 24

• Listen in all 4 quadrants and grade them separately
• ++ is the normal amount of sound

Question 25

What is the normal horse temperature?

Answer 25

37.5-38.5⁰C

Question 26

What is the normal horse temperature?

Answer 26

37.5-38.5⁰C

Question 27

A horse with colic is hypothermic. What temperature indicates this and what does it suggest?

Answer 27

• <37.0⁰C = hypothermia
• 37.0-37.5⁰C = mild hypothermia
• Mild hypothermia important in foals but probably irrelevant in adults
• Hypothermia suggests cardiovascular compromise/shock

Question 28

True/false: Abdominal percussion and auscultation for a ping is pointless in horses due to normal gas production in the caecum.

Answer 28

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)

Question 29

Describe the abnormal findings you might feel on rectal exam of a horse with colic.

Answer 29

• 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

Question 30

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.

Answer 30

• 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

Question 31

What is the maximum volume of horse’s stomach?

Answer 31

8-15L

Question 32

You have obtained fluid via a peritoneal tap. Describe your expected normal findings for the following:
* Colour
* Clarity
* Volume
* WBC count
* Total protein
* Lactate

Answer 32

Normals (peritoneal fluid)
* Yellow
* Clear
* Small volume
* <5000 cells/µl WBC count
* <30g/dL Total protein
* <2.5 mmol/L lactate

Question 33

You have obtained fluid via a peritoneal tap. Describe your expected findings if you had compromised intestine.

Answer 33

Compromised intestine - findings on peritoneal tap:
* Pink/brown/serosanguinous
* Opaque
* Slightly increased volume
* Slightly elevated WBCC
* Slightly elevated total protein
* Elevated lactate

Question 34

If fluid from a peritoneal tap is brown, this may suggest:
a) normal finding
b) compromised intestine
c) ruptured intestine
d) peritonitis

Answer 34

b) compromised intestine - if pink-brown/serosanguinous
c) ruptured intestine - if green/brown with food particles present

Question 35

You have obtained fluid via a peritoneal tap. Describe your expected findings if you had ruptured intestines.

Answer 35

• Green/brown colour with ingesta
• Opaque with food particles visible
• Large volume
• Elevated WBCC
• Elevated total protein
• Elevated lactate

Question 36

You have obtained fluid via a peritoneal tap. Describe your expected findings if you had peritonitis.

Answer 36

• White/yellow colour
• Turbid
• Large volume
• Elevated WBCC
• Elevated total protein
• Elevated lactate

Question 37

Which of the following peritoneal fluid samples suggest peritonitis?

Answer 37

Far R = peritonitis

Question 38

Which of the following peritoneal fluid samples suggests intestinal rupture?

Answer 38

Second from R
Might expect darker green/brown but can see food particles settled at the bottom

Question 39

This image shows loops of small intestine. Is this:
a) normal
b) abnormal

Answer 39

b) abnormal
There are multiple loops of distended small intestine. This suggests an obstruction, behind which fluid is backing up.