Colic

Question 1

what is colic

Answer 1

• abdominal pain
• not a disease, but a group of clinical signs
• can be both GI and non-GI caused
• one of most common deaths, 20-28%

Question 2

non-GI causes

Answer 2

-pneumonia
-uterine torsion
renal or bladder stones
laminitis
‘tying up’
neurological diseases
normal foaling, abortion, dystocia
ruptured bladder

Question 3

GI causes

Answer 3

esopageal obstruction
equine gastric ulcer syndrome (EGUS)
intestinal obstructions (simple or strangulations)
duodenitis-proximal jejunitis (DPJ)
parasite impaction
ileus
inguinal hernia
sand impaction of large colon
nephrosplenic entrapment
right dorsal displacement of large colon
large colon volvulus, impaction
right dorsal colitis due to NSAID toxicity
potomac horse fever
salmonellosis

Question 4

clinical signs

Answer 4

pawing, rolling, kicking or biting abdomen, repeated turning to look at flank
posturing to urinate, sweating, repeated lying down or getting up, sitting dog-like or lying on back, lack of appetite, putting head down to water without drinking, rapid respiration and/or flared nostrils, teeth grinding, fewer feces indicating lack of bowel movements

Question 5

role of veterinarian

Answer 5

gather info about history:
living conditions:pasture vs stall
-feed?
daily routine? changes in routine?
medical/colic history?
solic surgery?
parasite control?
pregnant?

Question 6

colic specific history

Answer 6

duration of colic signs?
last time fed?
last time seen defecating?
have clinical signs change? pain worsened?
administered medication? analgesia, sedatives? have these helped?

Question 7

physical exam

Answer 7

temp, resp, heart rate (normal= 38C, 10-14RR, 28-40HR)
increases in any can reflect pain
-caution on HR>50=pain, low blood volume, perfusion, or endotoxemia
-attitude
mucous membranes: purple gums=toxemia, pale=dehydration
-distended abdomen?
(note: horse may need sedation)

Question 8

exam diagnostics: nasogastric intubation procedure

Answer 8

• important for relieve pressure in stomach and examine reflux
• place tube in nares, down esophagus and into stomach
• blockage will result in build up of fluids in stomach

Question 9

nasogastric intubation results

Answer 9

• consider amount, colour, smell, and pH
• > 2L and alkaline pH indicates small obstruction in small intestine
• 3-6L/hour for 3-7 days, brown and fetid odor indicats DPJ and requires immediate treatment

Question 10

Auscultation

Answer 10

• listen with stethascope for frequency, intensity, and duration of sounds
• should be sounds in all 4 quadrents
• listen for percussion/ping, and where the ping occurs

Question 11

rectal palpation

Answer 11

• can find where in GIT distension occurs, and whether it is fluid, gas, feed, or soild
• check the following: spleen, left kidney, nephrosplenic space, base of mesentery, pulse of aorta, cecum (normally flaccid), pelvic brim and inguinal rings, bladder, pelvic flexure of large colon, dorsal and ventral colon, and small colon

Question 12

other diagnostic tests

Answer 12

abdominocentesis-collect fluid from peritoneal cavity, can help identify strangulating lesions (red-necrotic gut, have to measure proteins in cells)

• ultrasound
• blood tests
• fecal culture/PCR
• sand test

Question 13

surgical colic requirements

Answer 13

pain: uncontrollable without drugs or severe
- gastric reflux: >2L alkaline, yellow
- rectal exam abnormal-distended small intestine, large colon, distension unresponsive to medical treatment, palpable foreign body
- peritoneal fluid: high rbc/wbc count evidence of devitalized gut (requires immediate surgery)

Question 14

medical colic

Answer 14

• no pain, easily controlled
• high temperature
• few wbc=serious infection
• normal motility when ausculate

Question 15

treatment 3 steps

Answer 15

1. analgesia (NSAIDs, sedatives, opiates)
2. fluid therapy (laxitives, oral fluids, IV fluids)
3. husbandry (fasting, preventing self-injury_

Question 16

analgesia

Answer 16

• pain control most important therapeutic factor for all colics
• may be sole therapy in some like spasmodic colic
• may be adjunctive therapy like in strangulating lesions

Question 17

fluids

Answer 17

correcting dehydration
softens intestinal contents
administer with IV or somtach tube
-use laxatives like mineral oil or mucilloid for sand collic

Question 18

fasting

Answer 18

slowly reintroducing feed until horse has passed significant amount of feces and or mineral oil

Question 19

classifications of colic

Answer 19

distension

• simple obstruction or blockage
• obstruction or blockage with partial or complete shut-off of blood supply
• enteritis or colitis (inflammation)

Question 20

distension

Answer 20

no blockage but digestive material cannot move, it is painful
-ie. gas colic, spasmodic colic

Question 21

simple obstruction or blockage

Answer 21

• material cannot move in GIT but vascular flow remains intact
• mild to moderate pain and slow to progress
• ie. feed impaction, parasite impaction, enteroliths, sand, foreign bodies, entrapments

Question 22

obstruction or blockage with partial or complete shut-off of blood supply

Answer 22

• aka strangulating obstruction
• constant and severe pain with rapid descent into shock due to intestinal death and subsequent release of toxins and bacteria into bloodstream
• ie. torsions, pedunculated lipomas, epiploic foramen entrapment, intussception

Question 23

enteritis/colitis

Answer 23

inflammation in wall of intestine, which causes stasis

-ie. salmonella diarrhea, gastric ulcers, potomac horse fever, DPJ

Question 24

prognosis, % need of treatment for colic

Answer 24

40% recovery without therapy
30% recover with moderated therapy, pain relief, mineral oil
20% require intense medical therapy ie repeated pain control, fluids, mineral oil
10% require surgery or immediate euthanasia