Colic 1 Flashcards
What is colic?
Pain manifesting from the abdomen
-doesn’t have to be GI related
The classification of Colic can be broken down into 2 main etiological categories:
1) Management issues
2) Accidents
What are some of the most important History question to be thinking about when a Horse presents with Colic?
1) how long?
2) when last normal?
3) how severe?
4) intermittent or continuous?
5) Meds? Response?
6) What do they eat? Water supply? Heated?
7) where do they eat?
8) deworming history?
If a Horse has an Iliad impaction and you suspect it is due to what the owner has been feeding, what feed are you suspicious of?
Bermuda grass
What is the NUMBER 1 predisposing factor for horses to get Colic?
MANAGEMENT!!!!!
- Sand?
- High quality roughage?
- CHO?
- water?
- FECs/ deworming?
What are the 3 general types of Non-strangulating lesions?
1) impactions
——Locations (I Leal, Cecil, colonic sm/ lg)
——Types (food, sand, enter olives
2) Displacements
——RDD/LDD (medical/surgical)
3) Strictures
——Transverse colon
What surgical position are Strictures of the transverse colon usually placed in?
Usually they are dorsal
-palpable only
What are the 5 most common places for impactions?
Usually large colon:
-Pelvic flexure
-Right dorsal colon
-transverse colon
………………………………………….small
-small colon
-Gastric impaction
When a horse presents with a small colon impaction and mild fever what other disease are we concerned about?
Salmonella
What are the 3 clinical signs of Salmonella
Small colon impaction
- mildly febrile
- Diarrhea
- neutropenia
2/3 they should go to ISO!!!!!!! while PCR and cultures are pending
Sand impactions usually affect which part of the GI tract?
Right dorsal Colon
How are sand impactions primarily treated?
Medically:
- fluids
- sellium
She reallly tires hard to not take these guys to surgery
How do you Diagnose a Sand impaction?
Auscultation
Fecal float/sink
Abdominocentesis —> sand
Massive and Heavy
Chronic
What is a surgical complication of a Sand impaction?
Area of impaction (right dorsal colon) is HEAVY and MASSIVE!!!!
-split /rupture
Why are Cecal impactions difficult to treat?
They can be insidious, they can creep up on you
-go from not doing alright to rupture
How can you differentiate on rectal a Cecal impaction vs large colon impaction
Cecal impaction:
- Right
- cant palpate around (whereas colon is free)
What prognosis does Cecal/cecal base/ Cupula impaction have with surgery?
Excellent prognosis!
What are the clinical signs of a horse with Cecal impaction?
1) Mild-moderate pain
2) Acute / Chronic intermittent colic
When treating a colonic impaction medically what is the best way to treat it?
-FLUIDS (IV/orally)
????? Check this
What surgical procedure is performed for a horse with Colonic impaction?
- *Pelvic flexure enterotomy**
- incision on the anti-mesenteric surface
What two parasite can cause colic in horses?
1) Strongylus Vulgaris
—->verminous arthritis
———>thromboembolic disease (ischemic bowel)
———>Tx: anthelmintic / ivermectin
2)Anoplocephala perfoliata
—->ileocecal intussusception
A horse has an ileocecal intersussception what parasite is suspected to be the cause?
Anoplocephala perfoliata
What is trichobezoars?
Enterolith made of hair
What is Phytobezoars?
Enteroliths made of fiber
You find a Triangular enterolith during surgery, What should you do?
Look for another one
What is the composition of enteroliths?
MAP
- Magnesium
- Amonisium?
- Phosphate
How do strangulating lesions manifest?
SEVERE Unrelenting PAIN!!!
-increased HR, RR,
T/F: the majority of strangulating lesions are Large Intestine
FALSE
- the majority of strangulating lesions are SMALL intestine
- 58-85% of SI colic are caused by strangulating lesions
List 5 strangulating SI causes of colic!
1) Lipoma
2) EFE (epiploic foramen entrapment)
3) volvulus
4) mesenteric rent
5) developmental abnormalities (meckel’s diverticulum)
What is the prognosis for strangulating lipoma?
Short term survival 48-84%
Where do we see most of strangulating lipomas?
Small intestine >90%
Older horses (14-19yrs)
How do you treat a strangulating Lipoma?
Resection/anastomoses
-using a TA 90
-end to end
What is the epiploic foramen and what are its boundaries?
Foramen of Winslow
- *Boundaries**:
1) caudate process of the liver
2) Portal vine
3) gastropancreatic fold
Importance: catastrophic hemorrhage (Portal vein)
What is a predisposing factor for EFE?
Cribbing
T/F: The majority of EFE are usually RIGHT to LEFT
FALSE
They are usually left to right >95%
All ages
What surgical treatment can be performed for EFE?
-and what are the complications
Manual reduction
Complications : portal vein tear
- 4x more likely to require repeat six
- associated with decreased survival
A postpartum horse presents with severe, unrelenting pain. What goes on the top of your differential lists?
Large intestinal Torsion/Volvulus
33% of all colic undergoing celiotomy are________________?
Large intestinal torsion/Volvulus
What are the risk factors that predispose to LARGE Colon TORSION?
1) Post parturient mare (30-90days)
2) Diet change
3) Recent access to lush pasture
What does a colic exam include?
Starts with a good PE!!!
1) distance exam and history
2) TPR
3) MM/CRT
4) GI sounds (auscultation/percussion)
5) DP/extremity Palpatine
What must always always always be done during a Colic Exam?
In addition to PE
- NG tube*always
- rectal exam
- U/S abdomen
- Bloodwork
- Abdominocentesis
- Other ancillary tests
Why is it important to pass a Nasogastric tube in a Colic Horse?
To prevent gastric rupture!!!
-Diagnostic and therapeutic
T/F: always cut a fever!!!
FALSE never cut a fever
If>102 look for a medical disease!!!
What is a normal Respiration Rate for a Horse?
-if increased what does this suggest
8-16
increased RR :
- Pain
- Acid/Base imbalance
Why is a rectal exam an important part of a complete colic exam?
Can provide valuable information:
- dissension
- displacement
- rupture
But if its not safe DONT do it!!
For a rectal exam on a colic horse what restraint is best!!
STOCKs
What is a spasmolytic that can be used during a rectal exam on a colic horse?
- Buscopan
- Lidocaine
During a rectal exam of a horse what can be palpated in the middle?
- Aorta (dorsal midline)
- inguinal ring (ventral)
- small colon
During a rectal exam on a horse what can be palpated on the RIGHT?
- Cecum
- Colon
- R ovary
On a rectal exam of a horse what can be palpated on the LEFT?
- Left kidney
- Spleen
- Left Ovary
What is the best tool for evaluating the GI in real time?
Abdominal ultrasound
-FLASH technique
abdominal ultrasound is a ROUTINE part of the colic exam
What abnormalities can be confirmed with abdominal ultrasound?
1) LDD
2) SI distinction
3) Bowel thickening
4) free fluid
What is the FLASH technique?
......LEFT........... 1) ventral abdomen 2)Gastric Window 3) Spleno-Renal Window (check for NE/LDD) 4)Left middle 1/3rd of abdomen ......RIGHT......... 5)Duodenal windows 6)Right middle 1/3rd of abdomen 7) Cranial Ventral Thorax (Check for Pleural effusion)
Nephrosplenic -Entrapment is also called ____________?
Left Dorsal Displacement
What are the complications of NG intubation?
1) Iatrogenic epistaxis
How is an NG tube placed in relation to the Ventral meats?
Centrally and medically
Is Spontaneous reflux ever normal???
NO never!!!
-you should never get more back than what you put in
“Net” reflux = problem
—->lieu’s, obstruction, strangulation
T/F: You can give medication through the NG tube if “ net” reflux or spontaneous reflux is present
FALSE never give anything through the tube if net/spontaneous reflux is present
If you NG a colic horse and you receive copious amounts of net reflux what are you suspicious of?
Small intestine:
- anterior enteritis
- impaction
- strangulation
If you NG a colic horse and you receive SMALL amounts of net reflux what are you suspicious of?
Possible large colon compressing duodenum
A horse presents with Reflux and upon decompression its HR decrease and there is pain relief. What likely abnormality does this horse likely have?
Ileus (AE, ileal impaction)
A horse presents with Reflux and upon decompression there is no decrease in HR or relief in pain. What likely abnormality does this horse likely have?
Mechanical obstruction/strangulation
You are presented with a horse that is colicing and you want to perform an abdominocenesis, where should this be performed?
- on or to the RIGHT of Ventral midline**
- caudal to the symphonies (most ventral)
During an abdominocentesis in a colic horse why do we not take the sample form the left of the midline?
SPleen is on the LEFT
-hemorrhagic tap
What equipment/ technique should be used for a horse abdominocentesis?
- Aseptic technique
- 18-20ga needle through skin, SQ, Linda and peritoneum
- Teat cannula /bitch catheter
When collecting peritoneal fluid what collection tubes should be used and for what?
Red top: TP (culture if indicated)
Purple (EDTA) top: cytology, lactate
What are the normal values for Foal Peritoneal fluid analysis?
WBC <1500
TP <2.0
Lactate <2.0
What are the normal values for Adult horse Peritoneal fluid analysis?
WBC<5000ul
TP <2
Lactate<2
A Horse has a lactate value of 5 obtained from a peritoneal fluid sample. What is the prognosis?
90% survival
Normal is <2
A Horse has a lactate value of 7 obtained from a peritoneal fluid sample. What is the prognosis?
Poor 30% survival
Normal = <2
What is another value other than lactate that can be used to determine the prognosis of a colic horse from a peritoneal sample?
SAA (serum amyloid A)
T/F: Normal abdominocentesis can rule out the need for surgery!!!
False:
a normal abdominocentesis does not rule out the need for surgery
What can be used to manage PAIN in a Colic horse?
1) NSAIDs
2) Alpha2 agonists
3) opioids
4) spasmolytics
What NSAID can be used in a colic horse for pain management?
-GIVE the Dose, route and duration
Flunixin meglumine (banamine) 1mg/kg up to every 12 hours (IV)
DO NOT give more often than Q12h!!!!!!
What are some Alpha 2 agonists that can be used in a colic horse to manage PAIN?
Xylazine (romping) 0.4mg/kg (IV)
Detomidine (Dormosedan)
Romifidine (sedivet)
What is an opioid that can be used in a horse colic case to manage PAIN?
Butorphanol 0.01-0.02mg/kg (IV/IM)
Why should you never give Banamine more often than 12 hours for a painful colic horse?
Because it is not strong enough????
- after 12 hours, reevaluate:
- you can add opioids and alpha 2 agonists but do not give banamine again!!!!!!
What diagnostic technique must always be used in a Colicky Foal?
U/S (umbilicus/abdomen)
Umbilical vien <1cm
Umbilical artery <1.3cm
Arteries/Urachus combo (just cranial to the bladder <2.5cm with horizontal measurements)
What type of probe should be used to perform an umbilical U/S in a colicky horse?
> 5MHz probe
Transverse and Sagittarius planes
What size should the umbilical artery and vein be during U/S of a colicky foal to need to go to surgery?
Surgical if >2x normal size or combination with other perinatal infections
Normal :
Umbilical vein <1cm
Umbilical artery <1.3cm
Combo <2.5 cm
List 5 common causes of Colic in a Newborn Foal
1) Meconium impaction**
2) gastric ulceration (stressfully being born)
3) enteritis
4) inguinal hernia with ruptured tunic
5) sepsis
The meconium of a foal should be passed by _____________.
-How is it managed?
1 day
-managed medically
List three common causes of Colic in 2-5 day old foals
1) Ruptured bladder***
2) Gastric ulcers
3) enteritis
If a foal has a ruptured bladder when did it most likely happen?
- Where do we commonly see the tears
- Why is this not seen straight away?
Partition
- dorsal aspect (Colt)
- urachus (fillies)
*the bladder is ruptured so the abdomen has to fill up (abdominal stretch receptors) takes 2-5 days.
List 5 common causes of Colic in older (>5days) foals
1) Gastroduodenal ulcers (gastric outflow obstruction)
2) Enteritis
3) SI volvulus
4) intussusception
5) impaction (Ascarid, round worms, para ascaris equorum)
What is the gender predisposition for a Ruptured bladder in a 2-5day old foal?
Fillies more predisposed at the urachus
-fillies are also predisposed to urethras abnormalities
What is the gender predisposition for a meconium impaction?
Colts are predisposed
Males are also predisposed to inguinal hernias
When evaluating a foal for Colic what clinical signsmight you see indicating Pain?
- on their back
- stretched out
- straining
What can you use for Pain management of a colicky foal?
Sedative:
- Benzodiazepine (Diazepam 1-2ml IV)
- Alpha2s (Xylaxine 0.5-1mg/kg IV, not until 2 weeks of age)
NSIDs (BID max)
GAstroprotectants (ranitidine)
NG tube
Why do we not like to use alpha 2s (xylazine) for Pain management of colicky foals under 2 weeks of age?
- DECREASEs heart rate (not a lot of ability to address the stroke volume)
- Due to decrease GI motility
What is important to consider about the use of omeprazole in Foals <30days?
It doesn’t work, use something else like ranitidine
How do Inguinal hernias present in colicky foals?
Acute, severe colic!
-palpable abnormality, requiring surgical intervention
What approach is used for an inguinal hernia in a Newborn Foal?
inguinal approach
May also need a ventral midline approach
Check:
IgG
Antibiotics
Pain control
What is the medical term for a ruptured Bladder?
Cystorrhexis
Cystorrhexis is a common cause of colic in which age group of foals?
2-5 day old foals
What are the electrolyte derangement that we are concerned about with cystorrhexis of a 2-5 day old foal?
Hyponatremia
Hyperkalemia
Hypochloremia
What ECG abnormalities are seen with cystorrhexis in a foal?
A fib???????????
These need to be managed before surgery
What will you see Diagnostically on ultrasound dealing with a foal with Cystorrhexis??
Free fluid in the abdomen
- still somtimes see a bladder (but very small)
- CHECK: Serum : peritoneal creatinine ratio > 1:2 (peritoneal creatinine elevated!!!)
Some can void a normal stream (depending on the size of the rent)
Is Cystorrhexis in a foal a surgical emergency?
NO, need to treat electrolyte and ECG abnormality first before surgery!!!!!!
What is pathopnuemonic to check in a Cystorrhexis case?
Serum : peritoneal creatinine > 1:2
Elevated creatinine in the peritoneum !!!!
After stabilization of the patient what surgical approach should be taken for a foal with cystorrhexis?
VENTRAL Midline
-Elliptical incision!!!! Around the umbilicus because we will have to remove it en bloc
- remove urachal remnants
- double legate umbilical arteries (2) and vein!!!
- trim edges of tear, close
- brand spectrum antibiotic
What structure becomes your falsiform ligament?
Umbilical VIEN
-cranial to the umbilicus towards the liver
What is the prognosis for a foal with Cystorrhexis?
Excellent with good medical intervention in addition to surgical correction of tear!
What is the prognosis for Foals that go to surgery for a GI lesion, and why?
Guarded, due to adhesions and complications post operative lay
Are ascarid impactions common? What is the usual parasite encountered?
Not as common because people are better at deworming
-Parascaris equorum
What is the prognosis for foals that go to surgery for Ascarid impaction?
Poor, they don’t end well
- small intestines is not meant to have a enterotomy performed
- so much inflammatory response already from the worm burden, that they tend to have poor prognosis over time
- Adhesion formation
A foal presents with colic 24 hours post deworming, what is high on your differential list?
-What surgery is required?
Ascarid impaction with Parascaris equorum!!!!!
Poor prognosis
-SI enterotomy
Why is there a guarded prognosis for foals with Parascaris equorum impactions?
1) the SI wasn’t made to be cut into
2) so much inflammatory response already from worm burden
3) lots of adhesion formation from worms and inflammation
How does an intussusception present in older foals with colic?
Acute severe Colic
-can be “sliding”
How would you diagnose a foal intussusception?
What is the Treatment?
- PE/bloodwork
- U/S
- Bullseye appearance
- Distended amotile SI proximal to lesion
Surgical intervention required!!!!
What is intussusception?
Recieves the bowel = the one on the outside
Intersussceptum
Bowel on the inside
What surgical intervention is required for an intussusception?
Requires surgical intervention!!!
-manually reduce, (resection and anastomoses)
- *results in mesenteric difficulty
- *excessive mesenteric shortening can predispose to volvulus!
Intussusception is a common complication with what type of parasite?
- where does this commonly occur?
- what is the prognosis?
Tapeworms (Anoplocephala)
- ileocecocolic intussusception
- fair to guarded
Is SI volvulus a common abnormality? What does it look like?
What is the prognosis?
Not common, “corkscrew” formation
- usually secondary to enteritis!!!!
- twists at the root of the mesenteric
- compromised bowel (R/A)
Prognosis depends
What is Gastric outflow obstruction secondary to?
What is the treatment?
Pyloric stenosis from ulceration
- requires surgery:
- *Bypass (gastroduodenostomy)
Guarded prognosis!!!
What is Atresia Coli?
White foal syndrome
RARE, usually have other problems
Diagnosis is:
-rads/Barium enema
Tx: Surgical intervention, REFER
How many anatomic bands:
1) Ventral colon
2) Pelvic Flexure
3) Dorsal colon
4) Small colon
1) VC :4
2) PF:1
3) DC:3
4) SC:2
How many palpable bands:
1) ventral colon
2) Pelvic flexure
3) Dorsal Colon
4) Small colon
1) VC:3
2) PF: 0
3) DC:2
4) SC:1
In general what are the most common locations for impaction?
Left Ventral colon
Pelvic Flexure
