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bvetmed3 alimentary > Colic - Decision Making > Flashcards

Colic - Decision Making Flashcards

1
Q

Define colic

A

A healthy horse that suddenly experiences an acute GI (or non-GI) incident

Occurs in an otherwise healthy horse

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2
Q

What kinds of obstructions can result in abdominal distension?

A

Mechanical or functional

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3
Q

What mechanical obstructions can result in colic?

A

Non-strangulating or strangulating

Impaction
Displacement

Volvulus
Torsion
Incarceration

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4
Q

What functional obstructions can result in colic?

A

Motility dysfunction - Ileus

Enteritis

Grass sickness

Post-surgical ileus

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5
Q

What is grass sickness?

A

Clostridium botulinum type C
- usually a commensal BUT sudden overgrowth or increase in (neuro)toxin production leads to disease

Results in gut paralysis - can be complete or partial.

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6
Q

What is inflammation of the caecum called?

A

Typhlitis

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7
Q

What is the difference between torsion and volvulus?

A

Volvulus - short axis twist

Torsion - long axis twist

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8
Q

Which parasite is particularly important to consider when a patient presents with colic?

How does it cause colic?

A

Strongylus vulgaris
L3 larvae are ingested when host feeds on pasture
L3 enter small intestine then migrate across the mucosal surface where they become L4
L4 migrate through arterioles and arteries.

Vessel damage results in thrombus formation

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9
Q

What non strangulating lesions can cause colic?

A 
Spasmodic colic
Impaction
Displacement 
Enteritis 
Typhlocolitis 
Peritonitis
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10
Q

What is spasmodic colic?

A

Any unexplained colic episode which resolves very quickly

Brief episode of pain of unknown origin that resolves with no/minimal treatment

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11
Q

What is an impaction colic?

A

Impacted feed material in the LARGE intestine (ileum possible)

Resolves in most cases with enteral/IV fluid therapy

Only worst cases require surgery

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12
Q

What is a displacement colic?

A

Large intestine shifts in the abdomen without compromising blood supply

Can resolve spontaneously but may require surgery at some point

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13
Q

How can enteritis cause colic?

A

Infection of the small intestine causes hypomotility or amotility

Large amounts of nasogastric reflux

Requires intensive medical treatment

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14
Q

How can typhlocolitis cause colic?

A

Infection/inflammation of large intestine

Variable amounts of diarrhoea

Requires intensive medical treatment

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15
Q

What strangulating lesions may be present in the small intestine?

A 
Volvulus (around the root of the mesentry) 
Strangulating lipoma 
Epiploic foramen entrapment 
Inguinal/scrotal hernia
Intussuceptions 
Diaphragmatic hernia 
Mesenteric rent
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16
Q

What is the epiploic foramen?

A

Right caudal abdomen between liver and caudal vena cava

17
Q

What is mesenteric rent?

A

Slits in the mesentry which the SI can go through

18
Q

What strangulating lesions can occur in the large intestine?

A

Colon torsion

Intussuception (caecocolic, ileocaecal, caecocaecal)

19
Q

Why are strangulating lesions in the large intestine so severe?

A

Bacterial toxins can enter blood

Difficult resect

20
Q

What clinical signs would indicate the the lesion was in the small intestine?

A

Reflux (although may be absent)

Distended small intestine
— palpable on rectal exam
— visible using ultrasonography

21
Q

What clinical signs would indicate a lesion in the large intestine?

A

(+/-) abdominal distension

Impaction or gas accumulation palpable in large intestine

Displacement of large intestine palpable

USUALLY no reflux

22
Q

Which small intestine causes of colic only require medical treatment?

A

Enteritis/ileus

Grass sickness - no treatment, may require surgical biopsy to confirm

23
Q

Which Large intestine causes of colic require surgical treatment?

A

Colon torsion

Non-resolving displacements and impactions

24
Q

When would you refer a colic?

A
  • Suspect strangulating lesion - needs immediate treatment
  • Small intestinal lesions - likely to need surgery
  • Require intensive medical treatment e.g. fluid therapy for enteritis
  • Non-resolving impactions
  • Recurring colics
25
Q

What should you discuss with the client prior to referring a colic?

A
  • Circumstances - age of horse, emotional and financial value, situation of owner
  • Finances
  • Insurance
  • Expectations
  • Willingness to agree to abdominal surgery
26
Q

What clinical signs indicate the need of referral?

A

Moderate to severe pain
Recurrent pain
Pain poorly responsive to analgesia
Signs of CV compromise
Severe abdominal distension
Signs of small intestine lesion - reflux, rectal palpation, ultrasound
Signs of strangulating lesion - Abdominocentesis, CV compromise

27
Q

When would surgery be indicated for a colic?

A

Suspicion of strangulating lesion

Non-resolving displacement

Non-resolving impaction

Non-responsive or recurrent pain

Diagnostic value - rectal + ultrasound only reveal 20-30% of abdomen

28
Q

How could the history help you distinguish between a medical and surgical colic?

A

Medical
- Low grade, intermittent pain

Surgical

  • Severe or progressive pain
  • No/transient response to analgesia
29
Q

How could physical examination help you distinguish between a medical and surgical colic?

A 
Medical - 
Low HR
Normal borborygmi
No CV compromise 
Fever

Surgical -
CV compromise
Severe abdominal distension

30
Q

How could nasogastric intubation help you distinguish between a medical and surgical colic?

A

Medical
- no reflux

Surgical
- Reflux more than 2 litres

31
Q

How could rectal palpation help you distinguish between a medical and surgical colic?

A

Medical
-Normal, impaction, mild gas distension of large intestine

Surgical
-Distended small or severely distended large intestine

32
Q

What additional diagnostics could help differentiate between a medical and surgical colic?

A

Abdominocentesis

Transabdominal ultrasound

33
Q

How could Abdominocentesis help you distinguish between a medical and surgical colic?

A

Medical
- normal abdominocentesis - straw coloured, clear

Surgical 
-Haemorrhagic, orange, red 
- high nucleated cell count 
- high protein concentration 
PERITONITIS
34
Q

How could ultrasound help you distinguish between a medical and surgical colic?

A

Medical
-normal ultrasound

Surgery

  • Distended small intestine
  • increased abdominal fluid
35
Q

What are potential short term complications after colic surgery?

(less than 2-4 weeks)

A 
Anaesthetic complications 
Post op colic 
Post op ileus 
Incisional complications - infection, breakdown
Thrombosis
Peritonitis
Laminitis
36
Q

What is a quick explanation of laminitis?

A

Pedal bone detaches from hoof capsule

37
Q

What are long term complications of colic surgery?

A

Recurrent colic

Incisional hernia

38
Q

Rank the types of colic from best to worst prognosis

A

Simple medical colic,
Non strangulating surgical colic
Strangulating small intestinal colic
Strangulating large intestinal colic

39
Q

How could response to analgesics help you distinguish between a medical and surgical colic?

A

Medical
Signs of pain controlled with small dose of sedative
No recurrence of colic signs after initial dose

Surgical
Large dose of sedative required to examine
Response to analgesics short lived

bvetmed3 alimentary (16 decks)

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