Colic Flashcards
What important history information should you collect for an animal that is ocicing?
How long? When last normal? How severe? Intermittent or continuous? Meds given and any response ? What do they eat? Water supply? Heated? Where do they eat? Deworming history?
What are the most common places for impactions in the GI?
Pelvic flexure
Right dorsal colon
Transverse colon
Small colon
Gastric impaction
Most common place for sand impactions?
Right dorsal colon
How can you confirm sand impaction?
Auscultation
Fecal float/skin
Abdominocentesis
What are your top differentials if on rectal palpation you find a distended structure in the right dorsal quadrant ?
Cecal impaction or cecal tympany (dysfuntion)
What intestinal parasites commonly can cause colonic impactions?
Strongylus vulgaris
Anoplocephala perfoliata (ileoceceal intussusception)
What are the most common locations for enteroliths?
Transverse colon
Right dorsal
Small colon
Pelvic flexure
What is the most common composition for enteroliths in horses?
Struvite
Mg Ammonium Phosphate
T/F: most lesions of the small intestine are strangulating
True
58-85%
What are the strangulating lesions of the SI?
Lipoma
EFE (epiploic foramen entrapment)
Volvulus
Mesenteric rent
Meckels diverticulum
Herniation
Intussusception
Where is the most common location for lipomas to occur?
Small intestine (90%)
Small colon (10%)
The treatment for a strangulating lipoma is resection and anastomosis. What are some complications that can arise from this surgery?
Shortening of mesentery can predispose to volvulus?
Adhesions
Ileus/impactions
Boundaries of the epiploic foramen ?
Caudal process of the liver
Portal vein
Gastropancreatic fold
T/F: most epiploic foramen entrapment are right to left ?
False
Left to right > 95%
Predisposing factors do epiploic foramen entrapment?
Cribbing
Complications and Pr sos is for EFE surgery?
Surgery is a manual reduction
Complication — portal vein tear
4x more likely to required repeat surgery
Risk factors for large colon torsion?
Post parturient mare
Diet change
Recent access to lush pasture
Clinical signs associated with large intestinal torsion/volvulus ?
Severe colic pain
-unable to control with analgesics
Rapid CV compromise
- tachycardia
- hemoconcentration
First step for examination of a colicky horse?
NG tube
When doing a rectal exam, what is normally palpated on the right?
Cecum
Right colon
R ovary
When doing a rectal exam, what is normally palpated on the left?
Left kidney
Spleen.
Left ovary
Left colon
When doing a rectal exam, what is normally palpated in the middle??
Dorsal midline — aorta
Ventral midline — inguinal rings
Small colon
What is the FLASH technique for abdominal US?
Left side
- ventral abdomen
- gastric window
- splenic-renal window
- left middle 1/3rd of abdomen
Right side
- duodenal window
- right middle 1/3rd of abdomen
- cranial ventral thorax
How do you place an NG tube?
Good restraint
Measure distance to pharynx
Guide tube ventrally and medially into the ventral meatus
Pass tube curving down
Will feel soft resistance at pharynx — stop then rotate tube 180 degrees and then gently bump the pharynx to simulate swallowing
Pass tube as horse swallows
How can you make sure your NG tube is in the correct place?
Watch the tube go down
Negative pressure
Create siphon — reflux feed material
Palpate ventral neck
Complications to NG intubation?
Iatrogenic epistaxis
Tube in trachea — will usually cough
You passed an NG tube.. now can you initiate reflux?
Create a siphon
—pump water down tube, disconnect, then pull the tube back in short, jerky motions to create siphon
T/F: spontaneous reflux is never normal
True
You should never get more back than what you put in.
Can have a small amount of “net” reflux with indwelling tube
T/F: you should only give medication orally if you have a net postive reflux
False
Never give medication through tube if “net” reflux is present
Where is the lesion usually located when there is a large amount of reflux?
Small intestine
— anterior enteritis
—impaction
—strangulation
If colic pain is relieved by reflux and decompression, what is the likely cause of colic?
Anterior enteritis
Ileal impaction
If colic pain is NOT relieved by reflux and decompression, what is the likely cause of colic?
Mechanical obstruction/strangulation
— persistent tachycardia
—persistent pain
What is the location that you will do an abdominocentesis?
On or right of midline
Caudal to xyphoid (most ventral)
What tubes do you ue for peritoneal fluid analysis?
Red top : TP (culture if indicated)
EDTA: cytology, lactate
What is normal lactate levels in peritoneal fluid?
< 2
What is normal for WBC in peritoneal fluids?
<5000/uL in adults
<1500/ul in foals
T/F: normal abdominocentesis rules out the need for surgery
False
Methods for pain managment for colic?
NSAID —flunixin meglumine 1mg/kg every 12hours (do NOT give more ofthen than q12hrs)
A2 - Xylazine / detomidine/ romifidine
Opioid - butorphanol
Spasmolytics
When should colic be managed medically vs surgically?
Medically — mild to moderate pain or intermittent, easily controlled with medication
Surgically — severe or persistent, unresponsive to meds
What do you do in PE of colicky foal?
TPR, bloodwork, IgG status
Pain level and CV status
Radiographs of abdomen
US
— umbilical vein <1cm
—umbilical artery <1.3cm
—arteries/urachus combo
Treatment of patent urachus?
Surgical if >2x normal size or combination with other perinatal infections
Common causes of foal colic?
Meconium impaction (should be passed in 1 day)
Gastric ulceration
Enteritis
Inguinal hernia with ruptured tunic
Sepsis
Ruptured bladder (2-5days old)
Common causes of colic in older foals?
Gastroduodental ulcer — gastric outflow obstruction
Enteritis
SI volvulus
Intussusception
Impaction (ascarid)
Most common electrolyte derangement in foals
Hyponatremia
Hypochloremia
Hyperkalemia
Most common location of cystorrhexis in male vs female foals?
Male — dorsal aspect of the bladder
Female— urachal rupture
What is the the normal serum: peritoneal creatinine ratio?
> 1:2
T/F: cystorrhexis is a surgical emergency
False
Medically stabilize first — K+ >5.5 mEq/L —> muscle tremors and arrhythmias
Surgical approach for ruptured bladder?
Ventral midline
Elliptical incision into bladder
Remove urachal remnants
Double ligate umbilical arteries and vein
Trim edges of tear, close
Broad spectrum ABs
Prognosis of cystorrhexis?
Excellent with good medical and surgical intervention
Why is there a guarded pronsosis for SI enterotomy in cases of ascarid impaction?
Adhesions formation
Surgical intervention for intussusception ?
Manually reduce, R/A
— mesenteric difficulty
—excessive mesenteric shortening - predisposes to volvulus
Surgical intervention for gastric outflow obstruction ?
Bypass— gastroduodenostomy
Secondary to pyloric stenosis from ulceration
