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Colic Flashcards

1
Q

What is colic

A

Abdominal pain - usually from GI viscus - spasmodic gas, impaction, displacement, strangulation
can be liver or urogenital system

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2
Q

Clinical signs

A 
pawing
trying to go down (relieve pain)
abrasions (more often in chronic cases)
Recumbency
muscle fasciculations (twitching)
look at flanks
restless
kick at abdomen
sweating
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3
Q

spasmodic/gas

A

motility?
diet?
parasites?

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4
Q

Impaction

A

usually large colon

pelvis flexture

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5
Q

Displacement

A

usually large colon

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6
Q

strangulation

A

usually severe

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7
Q

ulcers

A

usually in the stomach

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8
Q

Colic work up

A 
history, Physical exam (PE), nasogastric tube (NGT)
rectal exam
abdominocentesis
ultrasound exam
clinical pathology
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9
Q

history

A 
age
time of onset
degree of colic
treatments
previous colic
last passed faeces
management
worming routine
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10
Q

physical exam (PE)

A 
demeanor
signs of pain
TPR
GI borborygmi (gut sounds)
CV status (mucous membranes, pulses, skin turgor)
abdo distention
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11
Q

TPR

A

Temp - take before rectal. if febrile think colitis, peritonitis or enteritis
Pulse - may be high due to anxiety, pain or hypovolaemia. higher suggests worse colic
Resp rate - may be high due to pain, anxiety

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12
Q

Borborygmi

A

intestinal motility check

hyper/hypomotile, normal or absent

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13
Q

cardiovascular status

A 
mucous membrane color - could be a rupture if dark/puple 
crt
pulse quality
jugular fill
limb temp
abnormalities suggest more complex colic
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14
Q

Nasogastric tube (NGT)

A

should always be done
can potentially stop a stomach rupture
only way to relieve gastric distention
unlikely to be spontaneous - may need siphon
more than 2l is abnormal
if you get reflux, dont give anything via tube

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15
Q

monitoring

A

short duration colic
horse no longer painful
PE unremarkable
NGT no reflux

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16
Q

medical treatment

A

only if mild abnormalities on PE, no reflux
may give analgesia if horse is comfortable
oral fluids if no reflux

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17
Q

rectal exam

A

identify normal, distension, displacements, abdominal structures (masses etc)
LI has wide diameter with sacculations + taenial bands exept pelvis flexure which is smooth
small colon has sacculations, 2 taenial bands + faecal balls
SI not usually palpable
not all colics need a rectal

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18
Q

abdominocentesis

A

method - teat cannula + needle

assesses bowl health. compromised intestine leaks cells + protein

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19
Q

peritoneal fluid colour

A

normal = clear/straw colour, macs + neuts in cytology, 5000/ul cell count

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20
Q

ultrasound

A

rectal/transcutaneous

evaluate - peritoneal fluid, size of viscus (SI), position of viscus (LI), liver, kidneys, spleen

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21
Q

clinical pathology

A

helps assess severity
circulatory + electrolyte status
packed cell volume (PCV) + plasma total solids are important data

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22
Q

causes of abdominal pain

A

distension
infl or ischaemia of intestine
irritation of peritoneum

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23
Q

distension - gas

A

mechanical obstruction
non-strangulating (blood supply not affected)
impaction
displacement

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24
Q

distension - fluid

A 
mechanical obstruction
strangulating (blood supply compromised)
Volvulus
torsion
incarceration
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25
distension - ingesta
``` functional obstruction motility dysfunction (ileus; blood supply not compromised) enteritis grass sickness post-surgical ileus ```
26
inflammation
``` non-strangulating (blood supply not affected) enteritis colitis typhlitis peritonitis ```
27
ischaemia - strangulating
blood supply compromised volvulus torsion incarceration
28
ischaemia - thrombotic
blood supply compromised parasitic (strongylus vulgaris) coagulopathy DIC
29
spasmodic colic
non-strangulating (cramp) brief episode of pain that resolves with little/no treatment
30
impaction
non-strangulating impacted feed in LI most resolve with enteral/IV fluid therapy only worst cases need surgery
31
displacement
non-strangulating LI shifts to abdomen without compromising blood supply can resolve on its own but may need surgery
32
Enteritis/Ileus
non-strangulating infection/infl of SI causes hypomotility or amotility large amounts of nasogastric reflux requires intensive medical treatment
33
typhlocolitis
non-strangulating infection/infl of LI variable amounts of diarrhoea needs intensive medical treatment
34
peritonitis
non-strangulating infection/infl of peritoneum variable clinical signs - often fever, depression, mild to moderate colic signs needs intensive medical treatment or surgery
35
Strangulating lesions - small intestine
``` vovulus (around root of mesentary) strangulating lipoma epiploic foramen entrapment inguinal/scrotal hernia intussusceptions diaphragmatic hernia mesenteric rent ```
36
strangulating lesions - large intestine
colon torsion | intussusception - caeco-colic, ileo-caecal, caeco-caecal
37
small intestinal lesion
reflux | distended SI - palpable on rectal, visible using ultrasonography
38
large intestinal lesion
+/- abdominal distension impaction or gas accumulation palpable displacement of LI palpable usually no reflux
39
small intestinal lesion - treatment - medical
enteritis/ileus | grass sickness
40
small intestinal lesion - treatment - surgical
``` volvulus (around root of mesentary) strangulating lipoma epiploic foramen entrapment inguuinal/scrotal hernia intussusceptions diaphragmatic hernia mesenteric rent (grass sickness) ```
41
large intestinal lesion - treatment - medical
``` spasmodic colic impaction left dorsal displacement right dorsal displacement colitis typhlocolitis ```
42
large intestinal lesion - treatment - surgical
colon torsion | non-resolving displacements + impactions
43
resons for Referral of colic
any suspicion of strangulating lesion SI lesions best referred - high likelihood for surgery + medical treatment is intensive intensive medical treatments non-resolving impaction - may need IV fluids or surgery recurring colic/chronic colic for further work up
44
pre - referral
finances, insurance expectations willingness to agree to abdominal surgery
45
signs showing need for referral
``` moderate/severe pain recurrent pain pain poorly responsive to analgesia sign of cardiovascular compromise severe abdo distension (painful) SI lesion signs strangulating lesion signs ```
46
reasons for surgery
abdo surgery is diagnostic + therapeutic - only 20-30% abdomen can be evaluated with rectal exam + ultrasonography strangulating lesion non-resolving displacement or impaction non-responsive or recurrent pain
47
response to treatment - medical lesion
pain controlled with small dose of sedative or 1 dose of flunixin meglumine/buscopan no recurrence of colic after initial dose horse comfortable for >12-24h
48
response to treatment - surgical lesion
large dose of sedative needed for examination little response to flunixin meglumine response short lived
49
complication after surgery - short term
``` <2-4 weeks anaesthetic complications post op colic or ileus incisional complications thrombosis peritonitis laminitis ```
50
complication after surgery - long term
>2-4 weeks recurrent/chronic colic incisional hernia
51
prognosis
simple medical - good 90% non strangulating surgical - good 70-90% strangulating SI lesion guarded - 50-70% with and 60-80% without resection strangulating large intestinal lesion - guarded to poor 36-83% without resection
52
signalment + history - suggestive of medical lesion
``` Low grade pain Still interested in feed No worsening over time Lying down more than usual No rolling, thrashing, kicking at abdomen ```
53
signalment + history - suggestive of surgical lesion
Acute onset sever pain Owner has already given one/multiple doses of analgesic Sweating, rolling, kicking at abdomen Progressive deterioration
54
Physical Exam findings – Cardiovascular Status - Suggestive of medical lesion
No signs of cardiovascular compromise – Normal heart rate, Pink, moist mucous membranes, CRT <2sec, Normal skin tenting, Good jugular filling, Warm extremities and ears, Good pulse quality
55
Physical Exam findings – Cardiovascular Status - Suggestive of surgical lesion
cardiovascular compromise – Heart rate >48bpm, Abnormal membrane colour, CRT> 2sec, Prolonged skin tent, Delayed/no jugular filling, Cold extremities and ears, Poor pulse quality
56
Physical Exam findings – Gastrointestinal System - Suggestive of medical lesion
No change in abdominal shape Good borborygmi Passage of normal manure No/reduced manure for some time
57
Physical Exam findings – Gastrointestinal System - Suggestive of surgical lesion
Distended abdomen | No borborygmi
58
Physical Exam Findings – Other Organsystems - Suggestive of medical lesion
No other abnormalities Fever (enteritis/colitis) Icteric mucous membranes (liver disease)
59
Physical Exam Findings – Other Organsystems - Suggestive of surgical lesion
Increased respiratory rate (pain, shock) Abrasions or other signs of trauma from rolling Profuse sweating (pain, shock)
60
Nasogastric Intubation and Transrectal Palpation - Suggestive of medical lesion
No reflux (<2L) Normal palpation Palpable impaction +/- Palpable displacement
61
Nasogastric Intubation and Transrectal Palpation - Suggestive of surgical lesion
Reflux (> 2L) Little haemorrhagic/black reflux (gastric rupture possible) Distended small intestine on rectal palpation Tight gaseous distension of large intestine

Alimentary (13 decks)

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