Colic Flashcards

Question

Spasmodic/gas colic

Answer 1

Most common Not well defined No physical abnormalities, except maybe distended intestines Responds to basic treatment (analgesia and buscopan)

Answer 2

Increased borborygmi, systemically well, may have loose faeces (e.g. lush grass with be bright green loose droppings)

Answer 3

Change in diet Tapeworm Other changes in management, poor dentition etc.

Answer 4

Prone to developing impactions due being a tight ‘bend’ in the colon, and due to the broader, sacculated ventral colon narrowing at this bend to become narrower dorsal colon

Answer 5

E.g. diet change, box rest, reduced water intake etc.

Answer 6

E.g. colon displacements, altered motility for example due to grass sickness/equine dysautonomia

Answer 7

Less turnout (box rest, weather etc.) Diet change Poor dentition

Answer 8

Mild to moderate pain Reduced faecal output

Answer 9

Ractal palpation - firm mass in pelvic flexure - ventral midline/left of midline - variation in size/consistency - can be very large - consitency can be very firm, or softer and indentable

Answer 10

Enteral fluid therapy is superior to IVFT § Isotonic solution superior to liquid paraffin § Magnesium sulphate (irritates gut lining into secreting fluid itself) Use meaningful volumes § 1L/100Kg bodyweight § Every 2-4 hours unless contraindicated Sometimes leave tube indwelling if in the hospital Withhold feed

Answer 11

Orthopaedic surgery, ocular disease (NSAID use – correlation isn’t necessarily causation! - seen in very painful horses rather than horses) Dentition Tapeworm Decreased turnout

Answer 12

Type I: dry ingesta Type II: underlying motility disorder, more fluid consistency

Answer 13

Reduced faecal output Although will continue to pass faeces, so often this early warning sign is missed Often deceptively mild colic Often have a normal heart rate Sometimes very subtle until point of rupture - life threatening

Answer 14

Rectal palpation (4-5 o'clock)

Answer 15

Enteral fluid therapy, surgery if not improving (more quickly than for pelvic flexure impaction) Withhold feed

Answer 16

Surgical? More likely to rupture Prokinetics? Withold food

Answer 17

Feed that swells in stomach

Answer 18

Motility disorders Liver disease

Answer 19

Poor quality hay, lack of exercise, parasite burden, reduced water intake,salmonella Relatively rare

Answer 20

Regional – sandy soil Diarrhoea/weight loss, or acute colic - due to how abrasive it is

Answer 21

Auscultation: specific, not sensitive (may sound like waves on a beach) Sand sedimentation (faecal) test: not sensitive/specific. Do it because its free but don’t rely on it Radiography - gold standard

Answer 22

Magnesium sulphate and psyllium found to be superior to either alone If very severe sometimes do require surgery - difficult! Colon very heavy, sand is abrasive and causes injury to the colon epithelium -> very sick Minimise sand ingestion

Answer 23

Mild to moderate colic, may wax and wane Proposed causes: - Large concentrate meals fermentation -> gas distension -> migration of large colon - Altered motility

Answer 24

Cranial displacement of pelvic flexure towards diaphragm Colon moves cranially - either medially or laterally to the caecum

Answer 25

Rectal § Gas distended colon § Tight taenial bands § Abnormal location (may be coursing laterally) or absence in normal location Ultrasound § ‘turtle sign’: visualisation of colonic mesenteric vessels against right body wall § Mural oedema Often have increased GGT concentration

Answer 26

64% reported to respond to medical treatment Withhold feed Fluid therapy (enterally/IV/both) Exercise Can progress into a colon torsion which is always critical and needs surgery

Answer 27

Pelvic flexure moves dorsally into the nephrosplenic space

Answer 28

Rectal - colon in nephrosplenic space US - large colon obscures left kindey

Answer 29

76% reported to respond to medical treatment Lunging Phenylephrine and lunging § Sympathomimetic – splenic contraction § Contraindicated if > 15 yrs, increased risk of haemorrhage (general vessel compliance issue?) Rolling under anaesthesia with phenylephrine superior

Answer 30

Enteric and autonomic neuronal degeneration ○ Variation in severity/extent of neuronal damage ○ Different sub-categories of EGS (acute, subacute, chronic) Functional obstruction - may also develop impactions secondary to this Pathogenesis unknown GI absorption and haematogenous spread of a putative neurotoxin Strongly associated with grazing

Answer 31

○ 2-7yrs old ○ Recent movement ○ Recent anthelmintics ○ Particular pasture ○ Disturbed pasture ○ Mechanical poo picking ○ Cool, dry weather, frost

Answer 32

Acute - Fatal (<48hrs) - Definitively they will die Subacute - Fatal (<7 days) Chronic - Some survive - Reports vary, approx. 40-50% fatality rate

Answer 33

Sometimes colic Tachycardia (80-120bpm) Innapetance Patchy/generalised sweating Muscle fasciculations Normal to distended abdominal stance

Answer 34

Sometimes colic HR 60-80bpm Dyspahgia Mild rhinitis sicca Patchy/generalised sweating Muscle fasciculations Normal to distended abdomen May progress to narrow-based stance

Answer 35

Usually no colic HR: 45-60bpm Patchy sweating Muscle fasciculations Tucked up Narrow based stance

Answer 36

Ileal biopsies Phenylephrine eye drops - reverse ptosis, poor sensitivity and specificity

Answer 37

Select appropriate cases to treat - Ability to swallow? - Degree of colic? Treatment - Nutritional support - Monitor hydration status - Analgesia - Treat secondary problems

Answer 38

Very, very difficult if they cannot swallow Stop if continuous weight loss, no recovery of appetite

Answer 39

Common post surgery Nasogastic reflux, (distended SI, discomfort, tachycardia)

Answer 40

Neurogenic phase - sympathetic stimulation of GI tract after moving the abdominal contents during surgery Inflammatory phase - due to touching the GI tract, good surgical technique is key

Answer 41

Nasogastric intubation Early feeding - stimulate GI tract NSAIDs - May affect healing of anastomosis - Deleterious effects on mucosal healing - Analgesic - Beneficial effects WRT systemic inflammation - Consensus between specialists is to use flunixin – but we actually have little data, may move towards using cox 2 selective drugs

Answer 42

Restrictive fluid therapy? § Don’t overload them § Monitor electrolyte status Prokinetics § Lidocaine, Probably more useful as an anti-inflammatory, Beneficial to give alongside flunixin § Metoclopramide - works better on proximal GI tract, so better to use with something else like lidocaine (Erythromycin, neostigmine (better for LI disease)

Answer 43

Commonly idiopathic Usually secondary

Answer 44

Iatrogenic Septic Traumatic Parasitic Miscellaneous

Answer 45

Meconium impaction Ascarid impaction Enteritis Ulcer Perforation Intussusception Ruptured bladder Urachal abscess Septicaemia Abscess Neoplasia

Answer 46

Colic (50%) Pyrexia of unknown origin (>80%) Lethargy (80%) Anorexia (68%) Uveitis

Answer 47

Often haematology/biochemistry first due to presentation (leukogram and increased inflammatory markers) Peritoneal fluid analysis

Answer 48

Abdominocentesis - Gross appearance □ Turbid, abnormal colour - TNCC – increased - Total protein – increased - Culture □ Often negative even in cases of septic peritonitis - Lactate, pH, glucose Ultrasonography, rectal palpation, gastroscopy, parasite investigation…

Answer 49

Broad spectrum antimicrobials pending culture § Penicillin, gentamicin, metronidazole (hospital) § Doxycycline more feasible for non-hospitalised cases as long as oral medication possible § NOT TMPS (inactivated by pus) Analgesia/anti-inflammatories Supportive treatment Lavage may be required May require surgical exploration if non-responsive/recurrent Monitor response to treatment with serial abdominocentesis/haematology and biochemistry

Answer 50

Fluid therapy Nutritional considerations - refeed gradually - consider total/partial parenteral nutrition if cannot start enteral feeding High risk of catheter complications (thrombophlebitis in particular)

Answer 51

NSAIDs - Flunixin - Phenylbutazone - Ketoprofen - Others Opioids - Reduce motility (but can be used) Other - Lidocaine

Answer 52

Ice feet if you think they are prone to septic laminitis - Continuously - 10°C for 72h - Different systems

Answer 53

Unremitting, severe pain, despite analgesia - can be sole reason Large volume of naso-gastric reflux Combination of: - certain rectal findings - signs of severe CV compromise/toxaemia - peritoneal tap (high WBC count, serosanguinous, presence of RBC, high peritoneal lactate)

Answer 54

5-10K depending on lesion, CV compromise etc.

Answer 55

Generally good LI>SI>caecum Non-strangulating>strangulating

Answer 56

Pain less acute, often reponds to analgesia CV compromise less severe, slowly progressing Usually doesn't need surgery but if complete obstruction of SI then it will

Answer 57

Typically severe pain, may reduce once section is completely dead CV compromise severe and rapidly deteriorating Always requires surgery (or euthanasia)

Answer 58

General anaesthesia Dorsal recumbency Ventral midline (maybe lateral if LDD) Sew prepuce shut if gelding

Answer 59

Clip while standing and sedated if poss If hypovolaemic: hypertonic saline If diluted SI loops: induce with stomach tube in place If severe colic sedate heavily, flash US scan

Answer 60

Pack off area with saline soaked drapes Use bowel clamps to block off area to be opened/removed May use a separate small stitch kit which is then 'dirty'

Answer 61

Jejunum Distal caecum Left ventral colon Left dorsal colon Small colon

Answer 62

VERY uncommon to have a surgical gastric lesion Normal sized stomach not surgically accessible in adult Can palpate it deep in cranial abdomen

Answer 63

Rare * Primary motility problem * Unsuitable feeding

Answer 64

Difficult to diagnose ultrasound – detect stomach much more caudally than normal

Answer 65

medical first lavage (sedated, via naso gastric tube) Occasionally - evacuation at surgery, high risk of abdominal contamination

Answer 66

FOALS Rare <4mo : congenital? Older foals: secondary to gastro-duodenal ulceration syndromes Surgery rarely indicated - difficult due to poor exposure

Answer 67

1-1.5m long Distinctive antimessenteric band -> ileo-caecal fold Thicker wall (muscularis) Distal ileum -> caecum, cant exteriorise/visualise ileo-caecal junction

Answer 68

Require resection and anastamosis Jejunum ORAL to strangulated portion becomes distended because it is obstructed -> ileus As it progresses orally -> stomach fills with fluid If left -> eventually stomach ruptures which is fatal

Answer 69

Ileus often a post-op problem Start lidocaine infusion intra-operatively (expensive) Gentle handling Keep lubricated with fluids Decompression - empty contents into caecum to promote motility

Answer 70

Surgically inaccessible unless very distended Gastric impactions are the only surgical lesion – often managed medically first High risk of abdominal contamination when emptying at surgery. Pyloric stenosis foals – very rare. Sx = pyloromyotomy or bypass of affected area

Answer 71

Duodenum: 1m, attached to transverse colon (duodenocolic fold), unable to be exteriorized Jejunum: 20-25 m, mesentery lengthens as go distal; most exteriorizable Ileum: 1m, thicker walled (muscle) distinctive antimesenteric band (ileocecal fold) that attaches to dorsal band of cecum; distal ileum and cecum cannot be exteriorized

Answer 72

Resection of affected segment and ligation of vessels supplying it 3 techniques of small intestinal anastomosis: End to end SI anastomosis – usually jejuno-jejunal. - Best for post-operative function. Side to side SI anastomosis – not commonly utilised in horses Jejuno-caecal anastomosis – peformed if the resection involves the ileum

Answer 73

Impaction Inflammation/anterior enteritis Adhesions Neoplasia

Answer 74

Pedunculated lipoma Entrapment (epiploic foramen, gastrosplenic ligament, mesenteric rent) Volvulus (foals, yearlings) Intussusception Inguinal hernia Diaphragmatic hernia

Answer 75

Commonly ileum or jejunum Mild/moderate colic Risk factors: fine stem hay, switch from grass to hay, tapeworm, ascarids etc. Diagnose with NGI, rectal, abdominocentesis

Answer 76

Anterior enteritis Eosinophilic enteritis Grass sickness Ileus Adhesions Neoplasia

Answer 77

Inflammatory condition, proximal SI only Aetiology: unknown ?clostridial? Better treated medically but sometimes is mis-diagnosed as a surgical colic Marked fluid distention of SI, thickened and red wall but no ‘impaction’ Tx = decompress SI-> caecum Prog = 50-70% survival

Answer 78

small red lesions along SI, often ileum—usually diagnosed at surgery

Answer 79

Due to previous surgery; idiopathic, after frost

Answer 80

Due to previous colic surgery

Answer 81

Rare lymphosarcoma most common Also adenocarcinoma etc. Often multifocal +/- metastases so non treatment possible

Answer 82

Identify cause of strangulation Reduce (disentangle) strangulation Assess gut viability once reduced Decompress, resect, and anastomose if gut non-viable Prognosis depends on length of gut involved- 60-85% survival

Answer 83

Benign smooth walled tumour Grow from mesentery Often grow on long stalks which entrap loops of SI

Answer 84

Older horses, usually >14 ponies, arabs, QH Can be in obese or poor conditioned horses

Answer 85

may start as non-strangulating but then progress to venous +/- arterial occlusion. Colic is often severe and palpate distended SI on rectal + dx on u/s. Progressing CV compromise over time. NG reflux as/when fluid backs up to the stomach

Answer 86

Resection of entrapped gut often required + suitable anastomosis

Answer 87

Small intestine entraps in potential space – almost always strangulating lesion

Answer 88

Caudate liver lobe Portal vein Gastropancreatic fold

Answer 89

Cribbers (68% of horses with this condition are cribbers), stabled horses, males, TB

Answer 90

Signs of SI strangulating disease

Answer 91

Resection often required and suitable anastomosis

Answer 92

Can get trapped almost anywhere Naturally occuring locations - epiploic foramen - inguinal ring (hernia, post-castration) - umbilicus (hernia) Through rents (tears) in structures - mesenteric rent - gastrosplenic rent - diaphragmatic hernia ETC.

Answer 93

Rent in the ligament or mesentery Causes: congenital/trauma/Stretched due to another lesion/post partum mare/previous sx Can be difficult to close the defect at surgery

Answer 94

acute severe colic with rapidly deteriorating CV signs (foals or yearlings usually)

Answer 95

abdominal contents in thoracic cavity rare usually after trauma

Answer 96

Obstruction or strangulated (depends on length of SI that is involved – longer segment -> more likely strangulating lesion) Many locations possible - Ileocecal most common, jejuno-jejunal, jejuno-ileal etc Mainly a disease of foals, weanlings-3 yo Can be acute or chronic

Answer 97

Segmental motility differences due to enteritis, ascarids or tapeworms, abrupt diet change

Answer 98

if chronic/partial obstruction, sometimes just weight loss/unthrifty But often acute colic episode esp if strangulated

Answer 99

Surgery: reduction +/- resection and anastomosis or incomplete bypass with ileocecostomy

Answer 100

Strongylus vulgaris larval migration -> vascular infarction Rarer now Mesenteric vascular thrombi -> thickened, devitalised section of SI

Answer 101

Usually acquired after breeding or strenuous exercise (jumping) Usually strangulates quite quickly because inguiinal ring is quite small/tight Testicle becomes cold and firm, may not feel strangulated intestine externally and need rectal of internal inguinal ring/US

Answer 102

Usually congenital, reducible and larger amounts of bowel Most spontaneously resolve over first 3-4 months of life – tell owner to manually reduce daily Only become emergency if non reducible, assoc with colic or large increase in size

Answer 103

easy if palpate testicle and u/s probe on testicle/inguinal area, plus rectal exam in adults: feel distended SI entering inguinal ring

Answer 104

no surgery required unless >5-6 months and no resolution or become strangulated

Answer 105

Surgery - Can manually reduce in adult by massage if acute and no major CV compromise (i.e. quick referral). - Unilateral (hemicastration) castration recommended as testicle can become non functional due to vascular compromise - +/- closure of internal inguinal ring – easier done laparoscopically at later date

Answer 106

Water resorption (mostly cecum) and microbial digestion/fermentation 1.25 m, 30 L. Right side; extends down to xyphoid, Base is dorsal, body, apex is ventral Attached dorsally to body wall/kidney Ileocecal fold - attaches to ileum. Caecocolic fold - attaches to RVC (lateral band) Ileum empties into cecum via ileocecal orifice Only apex and part of body are exteriorisable

Answer 107

Caecum -> RVC -> LVC -> LDC -> RDC -> transverse colon -> small colon Water resorption (mostly cecum) and microbial digestion/fermentation 3.5 m, 50-60L Short mesenteric attachment between dorsal and ventral colons ONLY—no attachment to body wall. Ventral colon well sacculated, dorsal colon less sacculated Transverse colon: continuation of RDC aborally and joins to small colon; attached to body wall and also duodenum via duodenocolic ligament

Answer 108

Fecal ball formation 3.5 m Caudodorsal within abdomen; palpable rectally

Answer 109

Primary impaction or secondary to motility disorder. Most common in hospitalized patients due to pain/stall rest/not moving/change in diet. Watch hospitalized horses for faecal output and rectal if reduced – may not show overt signs of colic.

Answer 110

Tx medically first. Surgery may be required if any deterioration of clinical signs or increasing distension on rectal Surgical procedure: typhlotomy and empty out contents – occasionally require caecal bypass because condition often recurs.

Answer 111

Caeco-caecal or caeco-colic. Tx = reduce and may require resection if gut is compromised.

Answer 112

- Starts at apex (occasionally at base) - Chronic/intermittent pain - No complete obstruction until-> obstruct caecocolic area = simple obstruction

Answer 113

- Caecum -> into RVC - Caecocolic artery obstructed - > strangulating lesion - Need to do a caecal bypass - Difficult surgery with lots of contamination

Answer 114

Gas colic Impaction Displacement Torsion Enterolith/faecolith Colitis Small colon impactions

Answer 115

Ventral = large, sacculated Dorsal = smaller, smoother surface Pelvic flexure on the left side (narrowest)

Answer 116

For most surgical procedures on large intestine Improves post-op motility For relief of colon impaction/distension - eases manipulation of colon - allows re-positioning - improves post operative motility

Answer 117

To decompress colon Pass water up dorsal and then ventral colons Colon evacuated bit by bit Sterile saline used to wash colon surface Closed in two layers

Answer 118

Non strangulating – but get secondary distention with gas -> can get CV compromise over time

Answer 119

Displaces cranial then clockwise or counter clockwise

Answer 120

Entrapment of the colon between the spleen and the kidney causes total or partial obstruction

Answer 121

Flips 180 degrees

Answer 122

Correction of displacement LDD: Phenylephrine may assist with correction by shrinking spleen in surgery Standing or anesthetized Can recur - if the second surgery consider colopexy (for RDD) or closure of nephrosplenic space (LDD) Good prognosis >80% survival

Answer 123

Strangulating Lesion - true emergency - one of most painful, emergent and devastating GI problems in horse Success depends on rapid referral and surgical intervention Can start as a displacement that becomes torsion

Answer 124

Large horses, post foaling broodmares, spring (lush pasture), recent diet change

Answer 125

Rectal: gas, tension/bands. US: position, thickening/edema, dilated colonic vessels

Answer 126

Most require surgery and quickly 270-720 degree torsions described – more rotation -> more severe pain and CV compromise Surgical Options (depending on colonic viability): - Reduce the torsion then evacuate the colon contents and re-evaluate bowel - May require resection (if devitalized) or even euthanasia

Answer 127

Gut wall is compromised (purple, thickened) Haemorrhage into colon interior Treatment: surgical correction

Answer 128

If torsed at caeco-colic juntion there will be some compromised tissue left in situ -> post op complications

Answer 129

Not common in UK Common sites: RDC, transverse colon, small colon Presdisposed in arabs, or on alfalfa hay

Answer 130

Intermittent mild/moderate colic

Answer 131

Often diagnosed at surgery Rectal: +/- large colon distension

Answer 132

Surgical intervention required Enterotomy and removal of stone

Answer 133

Non-strangulating Medical treatment first Surgery recommended with increasing pain - enema performed intra op and manual massage - may need small colon enterotomy Increased shedding of salmonella therefore isolation necessary

Answer 134

Less common Same etiology as small intestine - Pedunculated lipoma - mesenteric rent - volvulus

Answer 135

Recurrent episodes of colic Post operative SI ileus Incisional infection Adhesions

Answer 136

common – particularly in first year after surgery. Severity varies.

Answer 137

Approximately 10-20% cases (upwards of 30% with SI lesion) Associated with 38-40% post op deaths in horses treated for colic Aetiology: Inflammation, surgical manipulation, endotoxemia, distension of gut (pre-operatively or post-operatively)

Answer 138

10-40% prevalence after colic surgery—higher if >1 surgery Pyrexia, pain at incision site, sudden increase in oedema Remove sutures/staples over site of drainage, bacterial culture & sensitivity Wipe incision twice daily with saline and gently milk out any drainage fluid if present +/- lavage 17.8 x more likely to develop incisional hernia if infection

Answer 139

Can occur upto 2-3 months post op

Answer 140

Foals more predisposed than adults Occur frequently after surgery, mostly for strangulating lesions May cause colic or may never cause a problem - Can cause low grade recurrent colic Usually diagnosed at repeat celiotomy

Answer 141

Minimize trauma/good technique, keep intestines moist, reduce inflammation post op (NSAIDs, Lidocaine), CMC (carboxymethycellulose---lubricating), heparin (inhibits thrombin mediated conversion of fibrinogen to fibrin)