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Colic Flashcards

1
Q

What is colic?

A

The clinical signs of abdominal pain
Normally caused by GI disease, but can be from other abdominal structures (liver, spleen, urogenital system)

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2
Q

Give 4 different pathologies of the intestines that could cause colic

A

Impaction/Obstruction
Excessive gas - tympanic colic
Spasmodic colic
Ileus
Intussusception
Herniation
Displacement
Enteritis - infection/inflammation
Ulcers
Torsion
Strangulation - loss of blood supply

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3
Q

What are the 3 most commonly diagnosed causes of colic?

A

No diagnosis - 25%
Spasmodic unconfirmed - 25%
Large colon impaction non-surgical - 12%

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4
Q

A horse owner has rung up in a panic saying they think their horse has colic. Name 5 clinical signs you might expect to see

A

Pacing
Fewer/No droppings
Change in droppings +/- straining
Not eating - playing with food
Teeth grinding
Lying down +/- rolling
Lip curling and yawning
Dull/Depressed
Pawing
Flank watching
Increased respiratory rate

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5
Q

You are presented with a horse which is dull, has abdominal distension and signs of severe unrelenting pain (wounds on head). On clinical exam she has a heart rate of 80bpm and a CRT of 3 seconds. Does this horse have mild or severe colic?

A

Severe
Clinical signs related to obstruction or strangulation +/- cardiovascular compromise

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6
Q

What management or environmental issues could predispose a horse to colic?

A

Changes to:
- Stabling/Pasture
- Forage feed
- Exercise
- Hard feed
- Access to water
Previous colic episodes on the yard
Access to sand

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7
Q

What preventative health questions are important to ask regarding a colic case?

A

Parasite control - what products and when
Whether strategic parasite control is used - faecal egg counts
Date horse last received an anthelmintic

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8
Q

Which of the following isn’t a relevant history question regarding a colic case?
1. History of crib biting or wind sucking
2. Attitude to pain (stoic)
3. Vaccination history
4. Current medication

A

Vaccination history

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9
Q

What questions do you need to ask about previous medical history when presented with a colicing horse?

A

Previous history of colic - if yes then frequency and severity
Previous abdominal surgery
Current medication
Recent history of sedation or anaesthesia

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10
Q

What are the most important history questions to ask about a horse’s current episode of colic on arrival to a case?

A

Time horse was last behaving normally
Time horse last passed faeces
If faeces were normal
Clinical signs seen and if they have changed
If any treatment/analgesics seen
Management since contacting vet
Previous colic episodes and severity

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11
Q

What parts of the general clinical exam should be performed in every colic case?

A

Pain assessment
Heart rate
Mucous membranes - CRT, colour, moistness
Gut sounds
Temperature - rectal
‘Painful Horses Must Get Treatment’

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12
Q

How can you pain score a horse?

A

Use the Colorado pain scoring system

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13
Q

You arrive at a yard to see a colic case. On presentation, the horse is rolling around on the floor and is severely agitated. What is your next step?

A

Anaesthesia or sedation to control the situation and allow for a more thorough examination

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14
Q

What is the definition of severe colic?q

A

Cases where the horse required euthanasia or hospitalisation for intensive medical or surgical treatment

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15
Q

What clinical signs relating to pain might you see in a horse with critical colic?

A

Pain after analgesia
Abrasions from self-harm
Thrashing
Unresponsive
Continuous rolling/throwing down
Continuous box walking
Sudden alleviation of signs - normally indicated gastric or intestinal rupture
Rapid deteriotation

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16
Q

Would the packed cell volume increase or decrease in horses with severe colic? If so, how?

A

Increases

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17
Q

What is the ‘toxic ring’ seen in horses with severe colic?

A

Red or purple line on the gums above the teeth

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18
Q

You perform nasogastric intubation in a 500kg horse, which produces 3.5L of fluid. Is this significant?

A

No - over 4L in a 500kg horse is significant, or a spontaneous nasogastric reflux

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19
Q

True or False?
Discoloured peritoneal fluid, no gut sounds in 1 or more quadrants and peritoneal lactate >2 mmol/L could indicate a severe case of colic

A

True
Also abnormal abdominal ultrasound, severe abdominal distension and rectal exam anomalies

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20
Q

What are the 3 most frequently used diagnostic tests for colic in the field situation?

A

Response to analgesia
Rectal examination
Nasogastric intubation

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21
Q

What GI relaxant might be good to use in a colicing horse?

A

Hyoscine (Buscopan)

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22
Q

What sedatives might you use in a colicing horse?

A

Alpha-2 agonists (medetomidine)

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23
Q

In which colicing horses should you perform a rectal exam?

A

Any horse with clinical signs of colic or a recent history of colic
Especially important if the horse demonstrates severe pain, has a high heart rate (>60bpm) or other critical signs

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24
Q

When shouldn’t you perform a rectal exam on a colicing horse?

A

If the risk to the vet, handler or horse can’t be managed by restraint or sedation
If there is an unacceptable risk of a rectal tear

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25
Which 3 things should you always do before a rectal examination?
Ensure the horse is adequately restrained/sedated Inform the owner of the risks - let them know immediately if anything happens Lubricate your arm
26
Nasogastric intubation has both diagnostic and therapeutic effects. Describe these.
Diagnostic: - Allows you to see if the stomach contains excessive fluid - >4L of nasogastric fluid indicates a critical case Therapeutic: - Removing fluid helps prevent gastric rupture - If no excessive fluid then can give parenteral medication or fluid down the tube
27
You arrive at yard to look at a colic case. At first glance you can see that the horse has has a spontaneous nasogastric reflux. What is the first thing you should do?
Nasogastric intubation and reflux
28
Give 3 reasons to perform a nasogastric reflux in a colicing horse
Spontaneous nasogastric reflux Suspected critical colic case Distended small intestine Horse needs enteral fluids Heart rate >60bpm Primary impaction Respiratory rate >20 breaths/minute with abdominal pain or distension
29
What do you need to do whilst performing nasogastric intubation to ensure that any fluid present flows out?
Create a siphon in the tube May need to manipulate the tube within the stomach to start the flow of reflux
30
What common complication of nasogastric intubation do owners need to be aware of before you start?
Epistaxis - owners may find this pretty stressful Also there is a risk of accidental administration of treatment into the lungs
31
What is the most common reason for a rectal tear on rectal examination?
Contraction around the hand or forearm Less commonly due to a finger tip penetration Can also occur due to external trauma, impaction or spontaneously
32
Name and describe the 4 different grades of rectal tear
Grade 1 - mucosa and submucosa Grade 2 - muscular layer only Grade 3a and 3b - all layers except serosa or mesorectum Grade 4 - all layers torn
33
You are performing a rectal examination on a colicing horse, and realise a rectal tear has just happened. What are the first 3 things you are going to do?
1. Identify the tear and tell the owner 2. First aid to reduce straining and contamination 3. Phone for help - senior partner and VDS
34
What first aid can you give to a horse with a rectal tear after a rectal examination?
Sedation Give a spasmolytic (hyoscine - buscopan) Repalpate carefully with an ungloved hand to establish extent of injury Gently remove faeces from tear and rectum Treat septic shock and peritonitis - NSAIDs and broad spectrum antibiotics Give an epidural and pack rectum Refer
35
Which grade of rectal tear requires careful monitoring and often surgery?
Grade 3 Grades 1 and 2 normally heal with antibiotics, laxatives and dietary changes Grade 4 often need euthanising, but sometimes can have surgery
36
What surgical options are available for Grade 4 rectal tears?
Direct suturing if possible Temporary indwelling rectal liner and colostomy
37
How do you ensure that a nasogastric tube is in the oesophagus?
Watch the left side of the neck during tube placement Check there is no tracheal rattle Suck back on the tube Listen/Smell contents to check in stomach Give a small amount of water first
38
You have accidentally placed a nasogastric tube down the trachea, and placed a small volume of water down it. What should you do?
Risk of pneumonia, so treat with NSAIDs and broad spectrum antibiotics (flunixin, penicillin and gentamicin)
39
Which one of the following causes of colic is always treated medically? 1. Colon impactions 2. Parasites 3. Colon displacement 4. Spasmodic colic
Spasmodic colic Other colics which are always treated medically are gaseous colic, anterior enteritis, colitis, gastric ulceration and grass sickness (ileus)
40
Which causes of colic are always treated with surgery?
Small intestine/Small colon incarceration Small intestine/Small colon volvulus Colon torsion
41
Which causes of colic may require medical or surgical treatment?
Colon displacement Colon impactions Peritonitis Non-GI lesions (e.g. kidney disease) Small intestinal simple obstruction Parasites
42
How long should it take for flunixin to provide analgesia for colic after administration?
Analgesia within 10 minutes and should last 8-12 hours - if not then something more serious
43
How can you assess hydration status in a horse?
Moistness of mucous membranes CRT Skin tent Not hugely accurate, e.g. age affects skin tent
44
Why is a transient heart murmur not uncommonly heard during a case of colic?
Blood flow disturbances in the heart
45
What is a normal horse heart rate?
20-44bpm
46
What is a normal horse respiratory rate?
8-12bpm
47
What is borborygmi?
Gut sounds - occur constantly
48
How often does the caecum empty?
1-3x per minute
49
What does it mean if you hear increased gut sounds in a horse with colic?
The guts are hypermobile, e.g. spasmodic
50
How should you interpret decreased gut sounds in a horse with colic?
Guts are hypomobile, e.g. during colon impaction
51
How should you interpret an absence of gut sounds in a horse with colic?
Guts are non-motile, e.g. during a small intestine incarceration. Flag as a serious colic case.
52
In horses with colic, is gas distention more commonly seen in the small or large intestine?
Large intestine Caused by excess gas production or blockage of gas passage
53
What is a horse's normal temperature?
37.5-38.5 degrees C Most colic cases have a normal temperature - repeat taking temperatures to track changes
54
What counts as an abnormal finding on a rectal exam?
Hard ingesta Gas distended intestines Abnormally located structures Tight taenial bands
55
You go to a colic case and do a nasogastric intubation. 8L of fluid is removed from a 350kg horse. What does this tell you about this horse's colic?
Small intestinal obstruction Maximum volume of a horse's stomach is 8-15L
56
How can gross peritoneal fluid analysis help you differentiate between compromised intestines, ruptured intestines and peritonitis?
Compromised intestine - pink/brown and opaque Ruptured intestine - green/brown and opaque Peritonitis - white/yellow and turbid
57
You are presented with a colicing 300kg 12 year old mare. She was moved to a new pasture yesterday and is now anorexic and quiet. NAD on clinical exam and all diagnostics. What are your differentials?
Gaseous colic Spasmodic colic Idiopathic (mild) colic
58
For the pony in the previous slide, will you treat her medically or surgically, at home or at the clinic, or euthanise her?
Medically - flunixin meglumine IV, hyoscine IV At home - owner monitoring and gradually return to normal diet the next day; re-examination if not improving
59
You are presented with a colicing 8 year old gelding who has been on box rest for a recent orthopaedic injury. He has had no droppings for 24 hours, is lying down, looking at abdomen and grinding teeth. Skin tent 2 seconds, HR 50bpm, reduced abdominal sounds and large firm mass on left side on rectal. PCV and TP slightly elevated. Will you treat this horse at home or away and medically or surgically?
Pelvic flexure impaction Medically and at home Flunixin, MgSO4/liquid paraffin, starve, owner monitoring Re-examine 12-24 hours later
60
The previous horse passed 1 dropping 24 hours later and still has an impaction on rectal exam. Will you treat the horse medically or surgically and at home or in the clinic?
Medical and at clinic Flunixin IV, oral MgSO4/liquid paraffin, starve, regular re-examinations, grass preferred to hay/straw
61
You are presented with a horse with sudden onset severe colic 2 hours ago, who is continuously rolling and kicking, has purple MM, CR 3 secs, HR 84bpm and breath rate 36bpm. No abdominal sounds and mild distension. Temperature 36.9 degrees C. Multiple gas distended tubes on rectal and 8L on NG intubation. PCV, TP, SAA and lactate elevated. Will you treat the horse medically or surgically and at home or in clinic?
Differentials include a small intestine simple obstruction, incarceration and strangulation. Surgical and at clinic or euthanasia
62
What analgesia could you give a horse that has severe colic whilst it's waiting to get to the referral centre for surgery?
Flunixin meglumine and butorphanol IV Broad spectrum antibiotic (penicillin and gentamicin) can also be given, along with fluids and NG reflux
63
What percentage of horses are alive 12 months after colic surgery?
52%
64
What is the most common complication that occurs after colic surgery?
Another colic (48%) Also wound infections, jugular vein thrombosis, incisional hernia, ileus
65
Name 4 non-intestinal causes of 'colic'
Renal disease Urogenital tract disorders Liver disease Peritonitis Thoracic disease
66
What 4 things are in the standard 'colic exam'?
Major body system assessment Rectal exam Abdominal ultrasound Peritoneal fluid analysis
67
What are the 4 broad causes of increased resting heart rates?
Hypovolaemia SIRS - inflammatory cytokines and vasodilation Pain/Stress Dysrhythmias - electrolytes, myocarditis
68
What is the normal cause of hypovolaemia in colicing horses?
Fluid loss rather than whole blood loss
69
Do most colic cases have a high or low PCV?
High PCV due to fluid loss into the gut lumen
70
What are the 3 main causes of increased respiratory rate in horses?
Pain/Stress Primary lung disease - infectious/inflammatory Pleural space disease
71
What ambulatory diagnostic test can you do to differentiate between primary lung disease and pleural space disease?
Lung auscultation will find increased dorsal respiratory noises, muffled ventral respiratory noises and crackles audible over the trachea in pleural space disease Can also do a tracheal wash/BAL to investigate primary lung disease
72
How would you investigate causes of abdominal pain in colicing horse?
Intestinal lesion - do a peritoneal tap and analysis and abdominal ultrasonography
73
You are presented with a colicing gelding who has been rolling, flank watching and kicking at his abdomen for the last 3 hours. HR 44, RR 16, T 37.9 degrees C. NAD on rest of clinical exam, abdominal ultrasound, bloods, peritoneal tap and gastroscopy. No response to analgesia. As you watch him, he is posturing to urinate, chewing at flanks and half exteriorising his penis. What is your next step?
Sedate him to inspect his sheath Could be maggots, etc. irritating him
74
What diagnostic tests could you do on a colicing horse with a suspected strangulated small intestine?
Abdominal ultrasound - distended or thickened loops of intestine Peritoneal fluid analysis - devitalised intestine produces lactate; >2x peripheral lactate is indicative
75
When presented with a case of suspected mild colic, what are 3 differentials that you need to rule out?
Colitis - colic, anorexia, diarrhoea Diarrhoea Enteritis - chronic weight loss, diarrhoea, uncommon
76
True or False? Neutropenia is common in severe peritonitis
True - all neutrophils are lost into the cavity
77
What is the best diagnostic test to differentiate abdominal disease from early peritonitis?
Abdominocentesis and peritoneal tap - high neutrophils confirm peritonitis
78
What are your top differentials for a horse which presents with colic and pyrexia?
Peritonitis Colitis Enteritis Pleuropneumonia Other infections
79
What does a high TNCC on abdominocentesis indicate?
High total nucleated cell count Indicates an acute inflammatory process >90% neutrophils with increased TNCC may indicate a bacterial infection
80
Which antimicrobials are the best for colic cases?
Penicillin and gentamycin
81
When would you use oral fluids in a horse with colic?
Only if financial constraints - unlikely to be beneficial but worth a try
82
When would you use abdominal lavage/drainage in a horse with colic?
As a last resort as unlikely to help much
83
What is the most likely organ to rupture in a horse with colic? What would you do if this happens?
The stomach Euthanise as it is pretty impossible to effectively stitch up

Horsies (8 decks)

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