Colic in horses

Question 1

Causes of colic - 2

Answer 1

• GI viscus (usually; spasmodic/gas, impaction, displacement, strangulation)
• Other (liver, urogenital)

Question 2

How horses express pain

Answer 2

Laminitis - recumbency
Neurologic - recumbency
Botulism - recumbency
MSK - tying up and severe lameness

Question 3

Clinical signs - colic

Answer 3

incessant pawing, trying to go down, rolling incessantly, abrasions on head (suggests recumbency/rolling), recumbency (sternal to lateral the more severe it gets), muscle fasiculations, looking back at flanks, restlessness, kicking at abdomen, sweating

Question 4

Causes of colic and %

Answer 4

Over 100 reported:
72% spasmodic and undiagnosed
14.5% pelvic flexure and other impactions
5-7% surgical
5.5% gas
1% colitis

Question 5

Broad causes of colic - 5

Answer 5

Spasmodic/gas - motility, diet, parasites
Impaction - usually large colon
Displacement - usually large colon
Strangulation
Ulcers

Question 6

Aim of examining a horse with colic - 2

Answer 6

• Does it need referral or can it be treated in the field (majority)?
• Make a diagnosis

Question 7

3 most important features of a colic work-up

Answer 7

History, PE and NGT

Question 8

Other features of a colic work-up 4

Answer 8

Rectal exam, abdominocentesis, ultrasound, clinical pathology

Question 9

History to obtain during PE 7

Answer 9

age, time of colic onset, degree of colic shown, any treatments given, previous colic, last passed faeces, managment (diet, exercise, worming regime)

Question 10

In what age of horses are strangulating lipomas more commonly seen?

Answer 10

Older horses (teenagers)

Question 11

What should you focus on during the PE? 5

Answer 11

Demeanor (signs of pain), TPR, GI borborygmi, CV status (MM, CRT, pulse quality, turgor, jugular fill, limb temperature) and abdominal distension

Question 12

Signs of mild colic pain - 7

Answer 12

occasionall pawing, looking at flanks, strectching out, intermittent recumbency, inappetence, backing up to wall, playing with water

Question 13

Signs of severe colic pain - 4

Answer 13

sweating, violent rolling, dropping to ground, extreme rolling

Question 14

Important information from TPR

Answer 14

T = take before rectal exam (introduces air): febrile = colitis/peritonitis/enteritis/rupture
P=may be increased due to anxiety/pain/hypovolaemia (higher suggests more severe colic)
R=may be increased due to anxiety/pain/abdominal distension

Question 15

Where to listen for borborygmi?

Answer 15

4 quadrants (left dorsal, left ventral and vice versa)

Question 16

What does a high pitched ping suggest?

Answer 16

Gas distension of a viscus (LI)

Question 17

How do you assess abdominal distension?

Answer 17

Difficult, look at paralumbar fossa, ask owner if it appears different to normal

Question 18

When should you pass a NGT?

Answer 18

All colics (opinion varies) as horses cannot vomit and gastric rupture may occur. This is the only way to relieve gastric distension.

Question 19

What is an abnormal NGT finding?

Answer 19

NORMAL = 2L fluid (suggests SI dysfunction)

If you get any reflux, don’t give anything by the tube

Question 20

Steps after initial PE

Answer 20

Monitor, medical treatment (analgesia, laxatives, fluids),monitor response to Tx, further diagnostics, refer

Question 21

When to give medical treatment

Answer 21

Only if mild abnormalities on PE, no reflux, analgesia possibly even if horse appears comfortable, oral fluids if no reflux

Question 22

Aims of a rectal exam

Answer 22

Identify normal structures, identify distension (SI/LI and type), identify displacements, identify abnormal structures (masses etc.)

Question 23

Do you reach a diagnosis from rectal exam?

Answer 23

Often no. But it can raise your index of suspiscion

Question 24

4 points to remember when doing a rectal exam

Answer 24

Restraint, sedation, spasmolytic and lubrication

Question 25

How do you identify large intestine?

Answer 25

Wide diameter, sacculation and taenial bands (except pelvic flexure which is smooth with mesenteric band only

Question 26

How do you identify small colon? 3

Answer 26

sacculations, 2 taenial bands and faecal balls are normally palpable. SI not normally palpable.

Question 27

What can you feel during a rectal exam?

Answer 27

Large intestine, small colon, caecum (on RHS), left kidney, spleen (on LHS), bladder (midlines), reproductive organs, inguingal rings, mesenteric root, aorta

Question 28

Where does large colon impaction often occur?

Answer 28

Pelvic flexure

Question 29

What might you feel in SI distension?

Answer 29

‘bicycle tyres’

Question 30

Why (not) perform rectal?

Answer 30

WHY: diagnosis, prognosis
NOT: risk to you and horse

Question 31

Method of abdominocentesis. Why?

Answer 31

Teat cannula and needle. To assess bowel health (compromised intestine leaks cells and proteins)

Question 32

Distinguish a normal and abnormal peritoneal fluid sample (4)

Answer 32

NORMAL: clear/straw colour, 5000cells/UL, >25G/L, cytology (bacteria, feed material

Question 33

What does rectal/transcutaneous ultrasound allow evaluation of?

Answer 33

peritoneal fluid, size of SI, position of LI, also look at liver, kidneys and spleen

Question 34

Why do clinical pathology?

Answer 34

• Unlikely to help make specific diagnosis
• helps assess severity of colic (circulatory and eletrolyte status)
• PCV and plasma total solids(important baseline data)
• haematology and biochemistry (useful to differentiate some conditions e.g. enteritis and cholangiohepatitis).