Approach to atypical colic

Question 1

Non-intestinal causes of colic

Answer 1

▪Renal Disease
▪Urogenital tract disorders
▪ Liver disease
▪ Peritonitis
▪Thoracic disease
▪ Dysautonomias

Question 2

How to Approach the atypical colic

Answer 2

Start with a standard colic exam
▪Major body system assessment
▪Rectal exam
▪Abdominal Ultrasound
▪Peritoneal fluid analysis

Question 3

US - FAST scan views (& where to get them)

Answer 3

1. ventral abdomen
   - place the probe just causdal to the sternum and move caudally to assess the most gravity dependent area of the abdomen
2. gastric window
   - visalise the stomach at the level of the 10th left ICS in the middle 3rd (dorsoventrally) of the abdomen, then move the probe in the 2-3 ICS cranial and caudal to the 10th
3. spleno-renal window
   - place the probe between the dorsal and middle 3rd of the abdomen, at the level of the 17th ICS
4. left middle third of the abdomen
   - freely move the probe around in the middle 3rd of the abdomen
5. duodenal window (right side)
   - place the probe in the 14-15th ICS in the dorsal part of the middle 3rd (dorsoventrally) of the abdomen
6. right middle third of the abdomen (right side)
   - freely move the probe around in the middle 3rd of the abdomen
7. cranioventral thoracic (on the right side)
   - place the probe over the cranial ventral thorax just caudal to the triceps muscle

At each site note free abdominal fluid (visible as anechoic [black] regions, often triangular, between the abdominal viscera), the aspect SI loops, including motility, the contents of LI, presence of the spleen in direct contact with the left kidney (spleno-renal window).

Question 4

FLASH scan for colic cases

Answer 4

• Don’t usually worry about spleen and liver view in colic cases
• Spleen + kidney view is important
  – If had nephrosplehnic entrapment or dorsal displacement you wouldn’t be able to see the kidney
• There should be a bit of duodenum between right dorsal colon and liver

Question 5

What to do if the diagnostic findings don’t fit the clinical signs

Answer 5

• switch to a problems-based approach

Clinical examination findings:
* Repeat them

Clinical pathology results:
* Machine error does happen
* Repeat runs if necessary

Diagnostic imaging:
* Get more pictures, spend more time
* Consider other modalities

Diagnostic procedures:
* Find other ways to investigate suspicious findings
* E.g. markers of strangulation