Colic Flashcards
What is colic
Abdominal pain - usually from GI viscus - spasmodic gas, impaction, displacement, strangulation
can be liver or urogenital system
Clinical signs
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
spasmodic/gas
motility?
diet?
parasites?
Impaction
usually large colon
pelvis flexture
Displacement
usually large colon
strangulation
usually severe
ulcers
usually in the stomach
Colic work up
history, Physical exam (PE), nasogastric tube (NGT) rectal exam abdominocentesis ultrasound exam clinical pathology
history
age time of onset degree of colic treatments previous colic last passed faeces management worming routine
physical exam (PE)
demeanor signs of pain TPR GI borborygmi (gut sounds) CV status (mucous membranes, pulses, skin turgor) abdo distention
TPR
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
Borborygmi
intestinal motility check
hyper/hypomotile, normal or absent
cardiovascular status
mucous membrane color - could be a rupture if dark/puple crt pulse quality jugular fill limb temp abnormalities suggest more complex colic
Nasogastric tube (NGT)
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
monitoring
short duration colic
horse no longer painful
PE unremarkable
NGT no reflux
medical treatment
only if mild abnormalities on PE, no reflux
may give analgesia if horse is comfortable
oral fluids if no reflux
rectal exam
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
abdominocentesis
method - teat cannula + needle
assesses bowl health. compromised intestine leaks cells + protein
peritoneal fluid colour
normal = clear/straw colour, macs + neuts in cytology, 5000/ul cell count
ultrasound
rectal/transcutaneous
evaluate - peritoneal fluid, size of viscus (SI), position of viscus (LI), liver, kidneys, spleen
clinical pathology
helps assess severity
circulatory + electrolyte status
packed cell volume (PCV) + plasma total solids are important data
causes of abdominal pain
distension
infl or ischaemia of intestine
irritation of peritoneum
distension - gas
mechanical obstruction
non-strangulating (blood supply not affected)
impaction
displacement
distension - fluid
mechanical obstruction strangulating (blood supply compromised) Volvulus torsion incarceration
distension - ingesta
functional obstruction motility dysfunction (ileus; blood supply not compromised) enteritis grass sickness post-surgical ileus
inflammation
non-strangulating (blood supply not affected) enteritis colitis typhlitis peritonitis
ischaemia - strangulating
blood supply compromised
volvulus
torsion
incarceration
ischaemia - thrombotic
blood supply compromised
parasitic (strongylus vulgaris)
coagulopathy
DIC
spasmodic colic
non-strangulating
(cramp)
brief episode of pain that resolves with little/no treatment
impaction
non-strangulating
impacted feed in LI
most resolve with enteral/IV fluid therapy
only worst cases need surgery
displacement
non-strangulating
LI shifts to abdomen without compromising blood supply
can resolve on its own but may need surgery
Enteritis/Ileus
non-strangulating
infection/infl of SI causes hypomotility or amotility
large amounts of nasogastric reflux
requires intensive medical treatment
typhlocolitis
non-strangulating
infection/infl of LI
variable amounts of diarrhoea
needs intensive medical treatment
peritonitis
non-strangulating
infection/infl of peritoneum
variable clinical signs - often fever, depression, mild to moderate colic signs
needs intensive medical treatment or surgery
Strangulating lesions - small intestine
vovulus (around root of mesentary) strangulating lipoma epiploic foramen entrapment inguinal/scrotal hernia intussusceptions diaphragmatic hernia mesenteric rent
strangulating lesions - large intestine
colon torsion
intussusception - caeco-colic, ileo-caecal, caeco-caecal
small intestinal lesion
reflux
distended SI - palpable on rectal, visible using ultrasonography
large intestinal lesion
+/- abdominal distension
impaction or gas accumulation palpable
displacement of LI palpable
usually no reflux
small intestinal lesion - treatment - medical
enteritis/ileus
grass sickness
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)
large intestinal lesion - treatment - medical
spasmodic colic impaction left dorsal displacement right dorsal displacement colitis typhlocolitis
large intestinal lesion - treatment - surgical
colon torsion
non-resolving displacements + impactions
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
pre - referral
finances, insurance
expectations
willingness to agree to abdominal surgery
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
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
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
response to treatment - surgical lesion
large dose of sedative needed for examination
little response to flunixin meglumine
response short lived
complication after surgery - short term
<2-4 weeks anaesthetic complications post op colic or ileus incisional complications thrombosis peritonitis laminitis
complication after surgery - long term
> 2-4 weeks
recurrent/chronic colic
incisional hernia
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
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
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
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
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
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
Physical Exam findings – Gastrointestinal System - Suggestive of surgical lesion
Distended abdomen
No borborygmi
Physical Exam Findings – Other Organsystems - Suggestive of medical lesion
No other abnormalities
Fever (enteritis/colitis)
Icteric mucous membranes (liver disease)
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)
Nasogastric Intubation and Transrectal Palpation - Suggestive of medical lesion
No reflux (<2L)
Normal palpation
Palpable impaction
+/- Palpable displacement
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
