Basic Colic Exam

Question 1

describe the basic exam for acute abdomen/colic

Answer 1

1. part of every workup
   -exceptions: risk or people or patient
2. physical exam: start with triage!
3. plus:
   -horse: NGT and rectal
   -cow: rectal (+/- ORT)
   -camelid: rectal is possible but limited and of questionable value
4. very important to determine if patient is in shock!!

Question 2

relate distributive shock to colic

Answer 2

in colic, leaky gut allows bacteria, other pathogens, and toxins to enter circulation

ischemia and reperfusion can also lead to SIRS
-inflammatory or strangulating groups most likely

Question 3

describe endotoxin and endotoxemia

Answer 3

1. endotoxin (lipopolysaccharide-LPS)
   -cell wall gram (-) bacteria
   -inner portion = lipid A: toxic, conserved
   -released with rapid death or reproduction
2. endotoxemia findings:
   -SIRS criteria (at least 2; one must be fever or WBC)
   –fever
   –tachycardia
   –tachypnea
   –WBC changes: leukocytosis or leukopenia, left shift

-possible others: colic, injected sclera, toxic line on MM

Question 4

describe triage exam

Answer 4

1. respiratory:
   -airflow/breathing
   -rate, rhythm, pattern
   - +/- auscultation (not in adult horse or cow if no resp signs, won’t be able to hear anything)
2. CV:
   -heart/pulse rate
   -pulse quality
   -CRT/MM color
   -jug refill
   -extremity temp
   - +/- auscultation
3. neuro: mentation

Question 5

relate signs of shock to triage exam

Answer 5

1. decreased preload: prolonged jugular refill
   -can use milk vein on dairy cows
2. MM color can help determine type
3. decreased perfusion:
   -prolonged CRT
   -poor pulse quality
   -cool extremities
   -decreased mentation
4. compensated: normal to increased perfusion, rapid CRT, bounding pulses, increase HR and RR
5. decompensated:
   -progressive decreased perfusion
   -loss of compensatory mechanisms

Question 6

are most horses with colic in shock?

Answer 6

no! have a large fluid reserve, but will eventually go into shock of untreated

Question 7

what type of shock can be seen with non-strangulating obstructions

Answer 7

-small and large intestine: hypovolemic and obstructive possible with time

-shock unlikely!

Question 8

describe the types of shock commonly associated with strangulating obstructions

Answer 8

small intestine:
–hypovolemic variable with reflux
–distributive variable with amount/degree
–obstructive possible with time
–shock less severe/more variable

large intestine:
–hypovolemia very possible with trapped fluid
–distributive very possible due to ischemia/leaky
–obstructive very possible due to distension
–shock common, esp LCV

Question 9

describe the types of shock commonly associated with inflammatory colic

Answer 9

small intestine:
–hypovolemic very possible due to reflux
–distributive very possible due to inflammation/leaky gut
–shock common

-large intestine:
-hypovolemia very possible due to diarrhea
-distributive very possible due to inflammation/leaky gut
-shock common

Question 10

describe the colic exam past triage

Answer 10

1. level of pain
2. temp
3. GI
   -borborygmi
   -distension
   -ruminants/camelids add: rumen/CI contractions, ping, succussion, ballottment, scootch or grunt test
4. other body systems:
   -complete resp, CV, neuro exam
   -add MSK, urogenital, integument, LN
   -look for evidence of less common causes of colic, look alike diseases
   -look for evidence of secondary trauma/concurrent problems that change prognosis or need to be addressed

Question 11

relate fever to small or large intestine and NSO, SO, or inflammatory colic

Answer 11

non-strangulating:
-small intestine: unlikely
-large intestine: generally uncommon
–exceptions: SC and sand impactions

strangulating:
small and large: generally uncommon

inflammatory:
-small and large: common

Question 12

describe abdominal distension

Answer 12

1. horse:
   -LI > SI

-SI non-strangulating distension possible depending on duration and location

2. ruminants/camelids: less likely with severe strangulating obstructions due to rapid progression
3. cow:
   -SI obstruction causes fluid to back up in the abomasum, then the rumen, causing bilateral ventral distension

-cecal dilation/torsion: right flank distension

Question 13

describe GI sounds with GI disease

Answer 13

usually decreased to absent!

Question 14

describe pinging for ruminants

Answer 14

1. right:
   -RDA/RTA: right displaced abomasum
   -cecum
   -spiral colon
   -small intestine
2. bilateral:
   -pneumorectum
   -pneumoperitoneum
   -pneumometrium

some will ping horses, but meh

Question 15

describe nasogastric intubation indications

Answer 15

1. diagnostic:
   -normal: <2L net reflux; fresh feed and grass (looks and smells like)
2. therapeutic:
   -prevent rupture
   -when HR >60, severe colic, reflux from nose, DO IMMEDIATELY
   -decrease pain
   -administer fluids/laxative

Question 16

describe NGT process

Answer 16

1. pass ventral and central!
   -want to be in the ventral nasal meatus
   -if hit middle, will hit the ethmoid and bleed like a bitch
2. supplies:
   -tube: bigger is better
   -buckets: markers for quantification
   -pump or dosing syringe
   -lubricant: water
   -proper restraint: physical, chemical
3. steps:
   -lift false nostril, hand over bridge of nose, lift up with thumb
   -other hand hold tube 4-6 inches from tip, use thumb of first hand to direct
   -pass until get to esophageal sphincter (spongy resistance)
   -wait for swallow
   -pass down esophagus, can use air to open as go
   -enter stomach: gas or stomach contents
   -check for reflux (dose syringe)

Question 17

give tips and tricks for NGT

Answer 17

1. horses need to breathe: don’t occlude opposite nostril with fingers
2. nasal passage is most sensitive part:
   -first 8-12 inches (est with nostril to medial canthus)
   -2-3 quick advancements
   -use thumb to hold tube ventral and central
3. mark tube with pen: nostril to throat latch
4. getting horse to swallow:
   -wait, gently bump back
   -pass up other nostril

Question 18

what to avoid with NGT?

Answer 18

1. nosebleeds:
   -not life threatening but concerning to owners
   -avoid ethmoid by going ventral and central during placement and removal
   -good restraint
2. getting stuck before the esophagus:
   -ethmoid: very firm and bony, go ventral and central to avoid
   -dorsal pharyngeal recess: not far enough in, rotate tube

Question 19

how to be sure you’re in the esophagus when passing NGT?

Answer 19

1. keep flexed at poll while passing
2. check:
   -watch pass down LEFT side
   -check for negative pressure
   -check doesn’t rattle in trachea
   -get gas/stomach contents
3. cough:
   -not reliable!
   -cough when in esophagus, not always in trachea

Question 20

group reflux to colic type

Answer 20

non-strangulating:
-small intestine: depends on duration/location
-large intestine: uncommon (except with LDDLC)

strangulating:
-small intestine: depends on duration/location
-large intestine: uncommon

inflammatory:
-small intestine: LOTS of reflux
-large intestine: uncommon

Question 21

describe rectal exam; what you can feel in a horse

Answer 21

1. only can feel the caudal 1/3 of the abdomen!
2. left side:
   -GI: small colon, large colon
   -non-GI: spleen, left kidney, bladder/lateral ligament of bladder, inguinal rings, uterus/ovaries, aorta
3. right side:
   -GI: cecum (ventral/medial band), small colon, large colon (pelvic flexure)
   -non GI: bladder/lateral ligament of bladder, inguinal rings, uterus/ovaries, aorta

Question 22

describe rectal exam in a cow

Answer 22

left: rumen
midline: left kidney
caudal: bladder, uterus and ovaries, inguinal rings

Question 23

describe rectal exam supplies

Answer 23

1. arm and hand
2. rectal sleeve
3. water soluble lube
4. proper restraint: esp in horses!! physical and chemical (horses get drugs)
5. other for horse: Buscopan, lidocaine

Question 24

give steps of rectal exam

Answer 24

1. proper restraint
2. advance slowly and evacuate feces as you go cranial
3. right cranial, feel cecum
4. middle cranial: small colon +/- large colon
5. left cranial: left kidney, nephrosplenic space, spleen
6. left caudal: tail of spleen
7. middle caudal: bladder +/- uterus/ovaries
8. pelvis: inguinal rings
9. dorsal: aorta

Question 25

how to minimize complications in rectal exams

Answer 25

rectal tear: lubricant, restraint, Bucsopan, intrarectal lidocaine, no jewelry, short fingernails, fingers together, evacuate feces, let contractions push out, be efficient getting kicked: stocks, doorway (stand behind door jam), close to side of hindlimb

Question 26

describe key findings of rectal exam in horses

Answer 26

1. normal versus abnormal 2. grouping: SI vs LI distension -SI: balloons, sausages, bicycle tires; no bands, except ileum -LI: --cecum/large colon: large, tight bands; contents include gas, fluid, ingesta -small colon: wide antimesenteric band, gas backing up into large colon/cecum

Question 27

describe what diseases can be diagnosed via rectal for nonstrangulating obstructions

Answer 27

small intestine: -ileal impaction: firm tubular structure next to cecum on right large: -LDDLC: colon trapped over NS ligament -impactions: distension can be severe, pelvic inlet

Question 28

describe what diseases can be diagnosed via rectal for strangulating obstructions

Answer 28

small intestine: -inguinal hernia: into ring on rectal, externally -ischemic: thickened large intestine: LCV: distension can be severe, by the pelvic inlet

Question 29

describe what diseases can be diagnosed via rectal for inflammatory colic

Answer 29

small intestine: -anterior enteritis: not turgid, just thickened large intestine: -fluidy contents

Question 30

describe pitfalls of the rectal exam

Answer 30

1. differentiating impaction from dehydrated ingesta -SI lesions prevent fluid reaching LI, resulting in dehydrated ingesta -impactions: distend the colon = no sacculations; and obstruct the lumen = gas colon and cecum -dehydration: vacuum packed/haustra and little/no gas distension 2. overinterpretation of horizontal bands across abdomen: -will happen with a RDDLC = can't feel cecum -can also happen with many other causes of LC distension

Question 31

describe the rectal exam of an abnormal cow

Answer 31

1. stomach: -texture of rumen contents will be dry with fluid backing up -sometimes displaces abomasum (RDA more likely to cause colic) 2. small intestinal distension 3. cecal dialtion/dislocation/torsion/volvulus -can be difficult to differentiate from RDA 4. ALWAYS CHECK REPRO