Approach to Colic Flashcards
What are the mild signs of colic?
Restless, pawing, Flank watching
What are the moderate signs of colic?
Lying down flat, groaning
What are the severe signs of colic?
Very fractious, violent rolling
Name 5 things that can cause colic aetiology?
Smooth muscle spasm
Inflammation
Distension
Obstruction
Tension on the mesentry
Tissue congestion
What is endotoxaemia?
Common feature with strangulating intestinal lesions
LPS is found in abundance in the horse GIT
Mucousal injury results in an increase in LPS absorption
Horses are extremely sensitive to even small amounts of blood
What are the three priorities when approaching colic?
Provide analgesia and triage
Assess severity of the case
Construct a treatment plan
What is false colic?
Any non-GIT source of abdominal pain
Liver disease/ hepatomegaly
Urinary disease
Peritonitis
Intra-abdominal neoplasia
What is the aim of the clinical examination?
Assess the severity of of the horses condition
Establish the level of treatment
What are the four steps of the clinical examination?
1) Briefly observe from a distance
2) Rapid assessment of cardiovascular status
3) Assessment of hydration status
4) Auscultation of the GI tract
What is the rectal temp for the clinical temperature?
- Most uncomplicated colic cases will have normal rectal temperature
- Very low core temp – usually associated with severe/end stage shock
- Pyrexia (>38.5oC)– Can indicate alternate diagnosis, e.g. peritonitis, colitis
- Endotoxaemia can cause a mild pyrexia
What would you notice for respiration during the clinical exam?
- Tachypnoea: usually due to pain, but could be associated with endotoxaemia
- Detailed auscultation of lungs rarely necessary
What is the impact of pain on the clinical exam?
- Mild-moderate increase in HR (40-60bpm) common
- Marked-severe tachycardia (>60bpm) is a sign of hypovolaemia
- Tachypnoea
What quick-acting analgesics can you administer for pain in horses?
2
-agonist
Xylazine
Detomidine
Romifidine
opioid
Butorphanol
What do you have to be aware of in donkeys with colic?
Good at masking signs of pain and disease
Rectal examination usually can be done
What is impaction colic?
Most common type of colic in donkeys
Hyperlipaemia is a secondary risk
Treatment = reverse the energy balance
When should you do nasogastric intubation?
- Should perform in most, if not all colic cases on first presentation
- Done before or after rectal examination, depending on severity of case
What is abdominocentesis?
- Not indicated in every case. Useful prognostic indicator
- Assess for presence of changes in peritoneal fluid
What is abdominal ultrasonography?
- ‘FLASH’ (Fast Localised Abdominal Sonography
of Horses) - Can assess structures not palpable on rectal
- Excellent for assessing;
- Distension of small intestine
- Thickness of intestinal wall
- Motility of intestine
- Presence of displacements
- Peritoneal fluid volume/appearance
- Foals – can visualise entire abdomen
What is an alpha-2 agonist?
- Potent analgesics with rapid onset and short
duration of action - Allow rapid re-assessment of case progression
- Xylazine
- Dose rate: 0.2-1.1mg/ml
- Analgesia for 15-20min
- Or Detomidine
- Dose rate: 0.01-0.02mg/kg
- Analgesia for 1-2 hours
- Or Romifidine
- Dose rate: 0.04-0.08mg/kg
- Analgesia for 1-3 hours
What is an opiod?
Butorphanol
* 0.05-0.075mg/kg iv
* Potent analgesic; 1 hour duration
What are the general rules for analgesia in the field?
For first-line treatment, or where diagnosis is uncertain, use short acting analgesic agents
* Progression, rapid recurrence of pain as alpha-2 agonists wear off, or deteriorating CV
status is vital in the decision to refer
* Consider the potent anti-inflammatory effects of flunixin, which could mask the early
signs of endotoxaemia. Consider using Phenylbutazone if unsure.
* Only administer NSAIDs after the CV status and severity has been established
* Alpha-2 agonists and opioids may be repeated if required
* Do NOT ‘top-up’ NSAIDs > overdose > renal compromise or right dorsal colitis
What is a spasmolytic?
- N-Butylscopolamine (Buscopan Injectable )
- Smooth muscle relaxant
- Rapid onset and short duration of activity
- Good for:
- Treating hypermotile/spasm type colic
- ‘Gas’ colic
- Relaxing rectum prior to rectal examination
What are Enteral Fluids?
- Indicated in the majority of colic cases
- (Most cases will have at least slight dehydration)
- bolus of isotonic fluid
- IV fluid bolus is used if rapid resuscitation is required
What is an IV fluid bolus?
- 10-20mL/kg over 30min – 1h (5-10L/500kg horse)
- If rapid resuscitation and volume expansion required:
- Hypertonic saline: 3-5mL/kg bolus (2L per 500kg horse) followed up with
isotonic fluids
What is Magnesium Sulphate?
- 1g/kg by nasogastric tube once daily
- Osmotic effect > softens gut content
- Systemic effects may be seen with repeated administration (electrolyte
derangements)
How do you administer liquid parafin?
- Via nasogastric tube
- Lubricant effect within lumen of gut
- Efficacy as a laxative debated
- Good marker of GI transit
