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Alimentary > Colic > Flashcards

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
Q

distension - ingesta

A 
functional obstruction
motility dysfunction (ileus; blood supply not compromised)
enteritis
grass sickness
post-surgical ileus
26
Q

inflammation

A 
non-strangulating (blood supply not affected)
enteritis
colitis
typhlitis
peritonitis
27
Q

ischaemia - strangulating

A

blood supply compromised
volvulus
torsion
incarceration

28
Q

ischaemia - thrombotic

A

blood supply compromised
parasitic (strongylus vulgaris)
coagulopathy
DIC

29
Q

spasmodic colic

A

non-strangulating
(cramp)
brief episode of pain that resolves with little/no treatment

30
Q

impaction

A

non-strangulating
impacted feed in LI
most resolve with enteral/IV fluid therapy
only worst cases need surgery

31
Q

displacement

A

non-strangulating
LI shifts to abdomen without compromising blood supply
can resolve on its own but may need surgery

32
Q

Enteritis/Ileus

A

non-strangulating
infection/infl of SI causes hypomotility or amotility
large amounts of nasogastric reflux
requires intensive medical treatment

33
Q

typhlocolitis

A

non-strangulating
infection/infl of LI
variable amounts of diarrhoea
needs intensive medical treatment

34
Q

peritonitis

A

non-strangulating
infection/infl of peritoneum
variable clinical signs - often fever, depression, mild to moderate colic signs
needs intensive medical treatment or surgery

35
Q

Strangulating lesions - small intestine

A 
vovulus (around root of mesentary)
strangulating lipoma
epiploic foramen entrapment
inguinal/scrotal hernia
intussusceptions
diaphragmatic hernia
mesenteric rent
36
Q

strangulating lesions - large intestine

A

colon torsion

intussusception - caeco-colic, ileo-caecal, caeco-caecal

37
Q

small intestinal lesion

A

reflux

distended SI - palpable on rectal, visible using ultrasonography

38
Q

large intestinal lesion

A

+/- abdominal distension
impaction or gas accumulation palpable
displacement of LI palpable
usually no reflux

39
Q

small intestinal lesion - treatment - medical

A

enteritis/ileus

grass sickness

40
Q

small intestinal lesion - treatment - surgical

A 
volvulus (around root of mesentary)
strangulating lipoma
epiploic foramen entrapment
inguuinal/scrotal hernia
intussusceptions
diaphragmatic hernia
mesenteric rent 
(grass sickness)
41
Q

large intestinal lesion - treatment - medical

A 
spasmodic colic
impaction
left dorsal displacement
right dorsal displacement
colitis
typhlocolitis
42
Q

large intestinal lesion - treatment - surgical

A

colon torsion

non-resolving displacements + impactions

43
Q

resons for Referral of colic

A

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
Q

pre - referral

A

finances, insurance
expectations
willingness to agree to abdominal surgery

45
Q

signs showing need for referral

A 
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
Q

reasons for surgery

A

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
Q

response to treatment - medical lesion

A

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
Q

response to treatment - surgical lesion

A

large dose of sedative needed for examination
little response to flunixin meglumine
response short lived

49
Q

complication after surgery - short term

A 
<2-4 weeks
anaesthetic complications
post op colic or ileus
incisional complications 
thrombosis
peritonitis
laminitis
50
Q

complication after surgery - long term

A

> 2-4 weeks
recurrent/chronic colic
incisional hernia

51
Q

prognosis

A

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
Q

signalment + history - suggestive of medical lesion

A 
Low grade pain
Still interested in feed
No worsening over time
Lying down more than usual
No rolling, thrashing, kicking at abdomen
53
Q

signalment + history - suggestive of surgical lesion

A

Acute onset sever pain
Owner has already given one/multiple doses of analgesic
Sweating, rolling, kicking at abdomen
Progressive deterioration

54
Q

Physical Exam findings – Cardiovascular Status - Suggestive of medical lesion

A

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
Q

Physical Exam findings – Cardiovascular Status - Suggestive of surgical lesion

A

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
Q

Physical Exam findings – Gastrointestinal System - Suggestive of medical lesion

A

No change in abdominal shape
Good borborygmi
Passage of normal manure
No/reduced manure for some time

57
Q

Physical Exam findings – Gastrointestinal System - Suggestive of surgical lesion

A

Distended abdomen

No borborygmi

58
Q

Physical Exam Findings – Other Organsystems - Suggestive of medical lesion

A

No other abnormalities
Fever (enteritis/colitis)
Icteric mucous membranes (liver disease)

59
Q

Physical Exam Findings – Other Organsystems - Suggestive of surgical lesion

A

Increased respiratory rate (pain, shock)
Abrasions or other signs of trauma from rolling
Profuse sweating (pain, shock)

60
Q

Nasogastric Intubation and Transrectal Palpation - Suggestive of medical lesion

A

No reflux (<2L)
Normal palpation
Palpable impaction
+/- Palpable displacement

61
Q

Nasogastric Intubation and Transrectal Palpation - Suggestive of surgical lesion

A

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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