Colic - Decision Making Flashcards
Define colic
A healthy horse that suddenly experiences an acute GI (or non-GI) incident
Occurs in an otherwise healthy horse
What kinds of obstructions can result in abdominal distension?
Mechanical or functional
What mechanical obstructions can result in colic?
Non-strangulating or strangulating
Impaction
Displacement
Volvulus
Torsion
Incarceration
What functional obstructions can result in colic?
Motility dysfunction - Ileus
Enteritis
Grass sickness
Post-surgical ileus
What is grass sickness?
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.
What is inflammation of the caecum called?
Typhlitis
What is the difference between torsion and volvulus?
Volvulus - short axis twist
Torsion - long axis twist
Which parasite is particularly important to consider when a patient presents with colic?
How does it cause colic?
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
What non strangulating lesions can cause colic?
Spasmodic colic Impaction Displacement Enteritis Typhlocolitis Peritonitis
What is spasmodic colic?
Any unexplained colic episode which resolves very quickly
Brief episode of pain of unknown origin that resolves with no/minimal treatment
What is an impaction colic?
Impacted feed material in the LARGE intestine (ileum possible)
Resolves in most cases with enteral/IV fluid therapy
Only worst cases require surgery
What is a displacement colic?
Large intestine shifts in the abdomen without compromising blood supply
Can resolve spontaneously but may require surgery at some point
How can enteritis cause colic?
Infection of the small intestine causes hypomotility or amotility
Large amounts of nasogastric reflux
Requires intensive medical treatment
How can typhlocolitis cause colic?
Infection/inflammation of large intestine
Variable amounts of diarrhoea
Requires intensive medical treatment
What strangulating lesions may be present in the small intestine?
Volvulus (around the root of the mesentry) Strangulating lipoma Epiploic foramen entrapment Inguinal/scrotal hernia Intussuceptions Diaphragmatic hernia Mesenteric rent
What is the epiploic foramen?
Right caudal abdomen between liver and caudal vena cava
What is mesenteric rent?
Slits in the mesentry which the SI can go through
What strangulating lesions can occur in the large intestine?
Colon torsion
Intussuception (caecocolic, ileocaecal, caecocaecal)
Why are strangulating lesions in the large intestine so severe?
Bacterial toxins can enter blood
Difficult resect
What clinical signs would indicate the the lesion was in the small intestine?
Reflux (although may be absent)
Distended small intestine
— palpable on rectal exam
— visible using ultrasonography
What clinical signs would indicate a lesion in the large intestine?
(+/-) abdominal distension
Impaction or gas accumulation palpable in large intestine
Displacement of large intestine palpable
USUALLY no reflux
Which small intestine causes of colic only require medical treatment?
Enteritis/ileus
Grass sickness - no treatment, may require surgical biopsy to confirm
Which Large intestine causes of colic require surgical treatment?
Colon torsion
Non-resolving displacements and impactions
When would you refer a colic?
- 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
What should you discuss with the client prior to referring a colic?
- Circumstances - age of horse, emotional and financial value, situation of owner
- Finances
- Insurance
- Expectations
- Willingness to agree to abdominal surgery
What clinical signs indicate the need of referral?
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
When would surgery be indicated for a colic?
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
How could the history help you distinguish between a medical and surgical colic?
Medical
- Low grade, intermittent pain
Surgical
- Severe or progressive pain
- No/transient response to analgesia
How could physical examination help you distinguish between a medical and surgical colic?
Medical - Low HR Normal borborygmi No CV compromise Fever
Surgical -
CV compromise
Severe abdominal distension
How could nasogastric intubation help you distinguish between a medical and surgical colic?
Medical
- no reflux
Surgical
- Reflux more than 2 litres
How could rectal palpation help you distinguish between a medical and surgical colic?
Medical
-Normal, impaction, mild gas distension of large intestine
Surgical
-Distended small or severely distended large intestine
What additional diagnostics could help differentiate between a medical and surgical colic?
Abdominocentesis
Transabdominal ultrasound
How could Abdominocentesis help you distinguish between a medical and surgical colic?
Medical
- normal abdominocentesis - straw coloured, clear
Surgical -Haemorrhagic, orange, red - high nucleated cell count - high protein concentration PERITONITIS
How could ultrasound help you distinguish between a medical and surgical colic?
Medical
-normal ultrasound
Surgery
- Distended small intestine
- increased abdominal fluid
What are potential short term complications after colic surgery?
(less than 2-4 weeks)
Anaesthetic complications Post op colic Post op ileus Incisional complications - infection, breakdown Thrombosis Peritonitis Laminitis
What is a quick explanation of laminitis?
Pedal bone detaches from hoof capsule
What are long term complications of colic surgery?
Recurrent colic
Incisional hernia
Rank the types of colic from best to worst prognosis
Simple medical colic,
Non strangulating surgical colic
Strangulating small intestinal colic
Strangulating large intestinal colic
How could response to analgesics help you distinguish between a medical and surgical colic?
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
