Basic Colic Exam Flashcards
describe the basic exam for acute abdomen/colic
- part of every workup
-exceptions: risk or people or patient - physical exam: start with triage!
- plus:
-horse: NGT and rectal
-cow: rectal (+/- ORT)
-camelid: rectal is possible but limited and of questionable value - very important to determine if patient is in shock!!
relate distributive shock to colic
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
describe endotoxin and endotoxemia
- endotoxin (lipopolysaccharide-LPS)
-cell wall gram (-) bacteria
-inner portion = lipid A: toxic, conserved
-released with rapid death or reproduction - 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
describe triage exam
- respiratory:
-airflow/breathing
-rate, rhythm, pattern
- +/- auscultation (not in adult horse or cow if no resp signs, won’t be able to hear anything) - CV:
-heart/pulse rate
-pulse quality
-CRT/MM color
-jug refill
-extremity temp
- +/- auscultation - neuro: mentation
relate signs of shock to triage exam
- decreased preload: prolonged jugular refill
-can use milk vein on dairy cows - MM color can help determine type
- decreased perfusion:
-prolonged CRT
-poor pulse quality
-cool extremities
-decreased mentation - compensated: normal to increased perfusion, rapid CRT, bounding pulses, increase HR and RR
- decompensated:
-progressive decreased perfusion
-loss of compensatory mechanisms
are most horses with colic in shock?
no! have a large fluid reserve, but will eventually go into shock of untreated
what type of shock can be seen with non-strangulating obstructions
-small and large intestine: hypovolemic and obstructive possible with time
-shock unlikely!
describe the types of shock commonly associated with strangulating obstructions
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
describe the types of shock commonly associated with inflammatory colic
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
describe the colic exam past triage
- level of pain
- temp
- GI
-borborygmi
-distension
-ruminants/camelids add: rumen/CI contractions, ping, succussion, ballottment, scootch or grunt test - 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
relate fever to small or large intestine and NSO, SO, or inflammatory colic
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
describe abdominal distension
- horse:
-LI > SI
-SI non-strangulating distension possible depending on duration and location
- ruminants/camelids: less likely with severe strangulating obstructions due to rapid progression
- cow:
-SI obstruction causes fluid to back up in the abomasum, then the rumen, causing bilateral ventral distension
-cecal dilation/torsion: right flank distension
describe GI sounds with GI disease
usually decreased to absent!
describe pinging for ruminants
- right:
-RDA/RTA: right displaced abomasum
-cecum
-spiral colon
-small intestine - bilateral:
-pneumorectum
-pneumoperitoneum
-pneumometrium
some will ping horses, but meh
describe nasogastric intubation indications
- diagnostic:
-normal: <2L net reflux; fresh feed and grass (looks and smells like) - therapeutic:
-prevent rupture
-when HR >60, severe colic, reflux from nose, DO IMMEDIATELY
-decrease pain
-administer fluids/laxative
describe NGT process
- pass ventral and central!
-want to be in the ventral nasal meatus
-if hit middle, will hit the ethmoid and bleed like a bitch - supplies:
-tube: bigger is better
-buckets: markers for quantification
-pump or dosing syringe
-lubricant: water
-proper restraint: physical, chemical - 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)
give tips and tricks for NGT
- horses need to breathe: don’t occlude opposite nostril with fingers
- 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 - mark tube with pen: nostril to throat latch
- getting horse to swallow:
-wait, gently bump back
-pass up other nostril
what to avoid with NGT?
- nosebleeds:
-not life threatening but concerning to owners
-avoid ethmoid by going ventral and central during placement and removal
-good restraint - 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
how to be sure you’re in the esophagus when passing NGT?
- keep flexed at poll while passing
- check:
-watch pass down LEFT side
-check for negative pressure
-check doesn’t rattle in trachea
-get gas/stomach contents - cough:
-not reliable!
-cough when in esophagus, not always in trachea
group reflux to colic type
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
describe rectal exam; what you can feel in a horse
- only can feel the caudal 1/3 of the abdomen!
- left side:
-GI: small colon, large colon
-non-GI: spleen, left kidney, bladder/lateral ligament of bladder, inguinal rings, uterus/ovaries, aorta - 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
describe rectal exam in a cow
left: rumen
midline: left kidney
caudal: bladder, uterus and ovaries, inguinal rings
describe rectal exam supplies
- arm and hand
- rectal sleeve
- water soluble lube
- proper restraint: esp in horses!! physical and chemical (horses get drugs)
- other for horse: Buscopan, lidocaine
give steps of rectal exam
- proper restraint
- advance slowly and evacuate feces as you go cranial
- right cranial, feel cecum
- middle cranial: small colon +/- large colon
- left cranial: left kidney, nephrosplenic space, spleen
- left caudal: tail of spleen
- middle caudal: bladder +/- uterus/ovaries
- pelvis: inguinal rings
- dorsal: aorta
how to minimize complications in rectal exams
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
describe key findings of rectal exam in horses
- normal versus abnormal
- 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
describe what diseases can be diagnosed via rectal for nonstrangulating obstructions
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
describe what diseases can be diagnosed via rectal for strangulating obstructions
small intestine:
-inguinal hernia: into ring on rectal, externally
-ischemic: thickened
large intestine:
LCV: distension can be severe, by the pelvic inlet
describe what diseases can be diagnosed via rectal for inflammatory colic
small intestine:
-anterior enteritis: not turgid, just thickened
large intestine:
-fluidy contents
describe pitfalls of the rectal exam
- 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
- 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
describe the rectal exam of an abnormal cow
- stomach:
-texture of rumen contents will be dry with fluid backing up
-sometimes displaces abomasum (RDA more likely to cause colic) - small intestinal distension
- cecal dialtion/dislocation/torsion/volvulus
-can be difficult to differentiate from RDA - ALWAYS CHECK REPRO
