Colic Decision Making Flashcards
Give 2 examples of simple colics
Spasmodic, impaction
Give 3 examples of potentially complicated colic
Displacement, enteritis, colitis
What is a definitive surgical colic?
Strangulating lesion
What is a common cause of non-GI colic?
Pariparturient mare uterus
What are 3 general causes of abdominal pain?
- Distension (MECHANICAL: gas, fluid, ingesta or FUNCTIONAL)
- Inflammation/ischaemia of intestine
- Irritation of peritoneum
What are the 2 forms of mechanical obstruction?
- Non-strangulating eg. impaction , displacement
- Strangulating eg. volvulus, torsion, incarceration
Where are impactions usually seen?
- pelvic flexure and RDC -> thin transverse colon flexure
Where are displacements usually seen
LI
What are functional obstructions?
Motility (paralytic) dysfunction - ileus etc. [blood supply not compromised]
- Enteritis, grass sickness [equine dysautonomia], post-surgical ileus
What are cuases of inflammation? Are these strangulating?
Enteritis, colitis, typhlitis, peritonitis
What are causes of ischaemia?
- Volvulus, torsion, incarceration
- Thrombotic
- Parasitic [migrating strongylus vulgaris larvae, coagulopathy, DIC]
Outline the 6 non-strangulating lesions that may cause colic
- Spasmodic colic
- Impaction
- Displacement
- Enteritis/ileus
- Typhocolitis
- Peritonitis
In horses where does the cause of diarrhoea ALWAYS originate?
LI
How do SI pathologies manifest?
Spontaneous reflux
What time frame do you have for saving strangulating lesions?
~ 1 hour = viable intestine (distension of intestine and stomach)
~ 3-4hrs = Compromised intestine (leakage of blood/protein -> abdo, loss of fluid -> intestine [may -> hypovolaemic shock])
~ 6-8hrs = Dead intestine (absorption of toxins -> blood)
Give 7 causes of strangulating lesions of the SI to cause colic. Which is most common? Which is rare?
- Volvulus (root of mesentry)
- Strangulating lipoma [most common]
- Epiploic foramen entrapment [R abdo between portal V and caudal vena cava]
- Inguinal/scrotal hernia
- Intussusceptions
- Diaphragmatic hernia [rare]
- Mesenteric rent
Give 2 causes of strangulating lesions of the LI to cause colic. How serious are these problems?
- Colon torsion - very severe colic.
- Intussusception
- Ceaco-colic
- Ileo-ceacal
- Ceaco-ceacal
What clinical signs distinguish SI lesions?
- reflux (though may be absent)
- Distended SI (palpable on rectal, ultrasound)
What clinical signs distinguish LI lesions?
± abdo distension
- impaction/gas accumulation palpable on rectal
- distension of LI palpable on rectal
- no reflux (usually)
Give 2 SI conditions requiring medical Tx
- Enteritis/ileus
- Grass sickness
Give 7 conditions requiring surgical Tx
- Volvulus (root of mesentry)
- Strangulating lipoma
- Epiploic foramen entrapment
- Inguinal/scrotal hernia
- Intussusceptions
- Diaphragmatic hernia
- Mesenteric rent
How is grass sickness Dx?
Biopsy (ileal?)
Give 6 LI conditions requiring medical Tx
- Spasmodic colic
- Impaction
- Left dorsal displacement
- Right dorsal displacement
- Colitis
- Typhlocolitis
Give 2 LI conditions requiring surgical Tx
- Colon torsion
- Non-resolving displacement and impactions
In what situations should a colic be referred?
- SI lesions (Sx likely, medical cases need intense Tx)
- Conditions requiring intensive medical Tx (enteritis/colitis)
- Non-resolving impactions (IV fluids, surgery if displaced)
- Recurring/chronic colic for further work up
How much does a medical colic cost to treat in referral centres? Surgical colic? Colitis/enteritis?
~ £1000-£3000
~ £4000-£7000
~ £2000-£5000
How should referral be decided wrt owner?
- age of horse
- willingness to undergo abdo surgery
- insurance (type of cover, be aware colic may have been removed if suffered previously)
SEE LECTURE FOR FINDINGS ON HISTORY, PE, NGT, TX RELATED TO PROGNOSIS ETC.
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What complications can be seen <2-4 weeks post-surgery?
- aneasthetic complications (1/100 die)
- post-op colic
- post-op ileus (reflux)
- incisional complications (dehiscence, infection)
- thrombosis
- peritonitis
- laminitis
What complications can be seen >2-4 weeks post-surgery?
- recurrent/chronic colic due to adhesions
- Incisional hernia
What are the prognoses for
a) simple medical colic?
b) non-strangulating surgical colic?
c) strangulating SI lesion?
d) strangulating LI lesion?
a) 90% good
b) 70-90% good
c) guarded (without resection 60-80%; with resection 50-70%)
d) guarded/poor (wihtout reseaction 36-83%; with resection[rarely possible] 50-80%)
