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Alimentary > Colic in the horse - decision making > Flashcards

Colic in the horse - decision making Flashcards

1
Q

What can be the actual cause of pain in colic?

A

Distension, inflammation/ischeamia of intestine, irritiation of peritoneum

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2
Q

How must obstructions be differentiated?

A

Mechanical versus functional

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3
Q

Distinguish torsion and volvulus

A 
TORSION = twisting along long axis
VOLVULUS = twisting along short axis
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4
Q

Reasons for non-strangulating mechanical obstruction? 2

A

Blood supply not affected - impaction or displacement

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5
Q

Reasons for strangulating mechanical obstruction?3

A

Blood supply compromised - volvulus, torsion, incarceration

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6
Q

Examples of functional obstruction/motility dysfunction

A

enteritis, grass sickness, post-surgical ileus

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7
Q

Causes of non-strangulating inflammation 4

A

enteritis, colitis, typhlitis, peritonitis

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8
Q

Examples of ischaemia-induced colic 4

A

volvulus, torsion, incarcaration, parasitic (s. vulgarus)

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9
Q

Define spasmodic colic

A

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

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10
Q

How does impaction resolve in most cases?

A

Enteral/IV fluid therapy. only worst cases require surgery (aim is to soften the impaction to allow it to pass out)

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11
Q

How do displacements resolve?

A

Can resolve spontaneously but may require surgery at some point

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12
Q

What does infection/inflammation of the SI cause? Treatment?

A

Hypomotility or amotility, large amounts of nasogastric reflux. Tx = medical treatment (IV fluids)

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13
Q

Define typhlocolitis. treatment?

A

infection/inflammation of large intestine. variable amounts of diarrhoea. intensive medical treatment required

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14
Q

Clinical signs of peritonitis. Treatment?

A

Variable, often fever, depression, mild to moderate colic. Intensive medical treatment or surgery

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15
Q

How long does it take for a strangulating lesion to kill off a bit of intestine?

A

6-8 hours (absorption of toxins into blood at this point)

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16
Q

Describe a compromised intestine

A

leakage of blood and protein into abdomen, loss of fluid into intestine.

17
Q

Examples of strangulating lesions in the SI 7

A
  • volvulus (around root of mesentery),
  • strangulating lipoma
  • epiploic foramen impaction
  • inguinal/scrotal hernia
  • intussusceptions
  • diaphragmatic hernia
  • mesenteric rent
18
Q

Examples of LI strangulating lesions - 2

A

Colon torsion

Intussusception (caeco-colic, ileo-caecal, caeco-caecal)

19
Q

Clinical signs of a SI lesion 2

A
  • reflux (may be absent)

- distended SI (palpable on rectal exam, visible on ultrasound)

20
Q

Clinical signs - LI lesion - 4

A

+/- abdominal distension

  • impaction or gas accumulation palpable in the LI
  • displacement of LI palpable
  • usually no reflux
21
Q

Indications for medical treatment of SI lesions 2

A

Enteritis/ileus

grass sickness - diagnoses surgically by biopsy

22
Q

Indications for SURGICAL treatment of SI lesions 8

A
  • Volvulus
  • strangulating lipoma
  • epiploic foramen entrapment
  • inguinal/scrotal hernia
  • intussusceptions
  • diaphragmatic hernia
  • mesenteric root
  • (grass sickness)
23
Q

Indications for MEDICAL treatment of SI lesions 6

A
  • spasmodic colic
  • impaction
  • left dorsal displacement
  • right dorsal displacement
  • colitis
  • typhlocolitis
24
Q

Indications for SURGICAL treatment of SI lesions 2

A
  • colon torsion

- non-resolving displacements and impactions

25
Q

When should you refer a colic case? 11

A
  • slightest suscpicion of a strangulating lesion (abdominocentesis, cardiovascular compromise)
  • SI lesions - reflux, palpable, visible on rectal/ultrasound - (high likelihood for surgery, medical diseases need intensive therapy)
  • conditions requiring intensive medical treatment (enteritis/colitis)
  • non resolving impactions (may require IV fluids or surgery = impaction+displacement)
  • recurring colic/chronic colic for further work up
  • if you’re not sure and the owner is willing
  • moderate to severe pain
  • recurrent pain
  • pain poorly responsive to analgesia
  • signs of CVS compromise
  • severe abdominal distension
26
Q

What to do BEFORE referral? 5

A

Discuss:

  • circumstances (horse age, emotional/financial value, owner situation)
  • finances (medical £1000-3000, surgical £4000-70000, colitis/enteritis £2000-5000)
  • insurance (type of cover)
  • expectations
  • willingness to agree to abdominal surgery
27
Q

Reasons for surgery in colics 4

A

Therapeutic and diagnostic reasons:

  • suspiscion of strangulating lesion
  • non-resolving displacement
  • non-resolving impaction
  • non-responsive or recurrent pain
28
Q

Signs suggestive of medical lesion 5

A
  • low grade pain
  • still interested in feed
  • no worsening over time
  • lying down more than usual
  • no rolling, thrashing or kicking at abdomen
29
Q

Signs suggestive of SURGICAL lesion 5

A
  • acute onset severe pain
  • owner has already given one/multiple analgesic doses
  • sweating, rolling, kicking at abdomen
  • progressive deterioration
30
Q

CVS findings - differentiate surgical and medical lesions

A 
MEDICAL = no signs of CVS compromise
SURGICAL = cardiovascular compromise (HR>48bpm, abnormal membrane colourm CRT>2sec, prolonged skin tent, delayed/no jugular filling, cold extremities and ears, poor pulse quality)
31
Q

GIT findings - differentiate surgical and medical lesions

A

MEDICAL - no change in abdominal shape, good borborygmi, passage of normal manure, no/reduced manure for some time (impaction)
SURGICAL = distended abdomen (ask owner), no borborygmi

32
Q

Other organ systems - differentiate medical and surgical lesions

A 
MEDICAL = no other abnormalities, fever (enteritis/colitis), icteric mucous membranes (liver disease)
SURGICAL = increased respiratory rate (pain, shock), abrasions or other signs of trauma from rolling, profuse sweating (pain, shock)
33
Q

NGT intubation and transrectal palpation - differentiate medical and surgical lesions

A

MEDICAL = no reflux (2L), little haemorrhagic/black reflux (gastric rupture possible), distended SI on rectal palpation, tight gaseous distension of LI

34
Q

Response to treatment - differentiate medical and surgical lesions

A

MEDICAL - signs of pain controlled with small dose of sedative or one dose of flunixin meglumine/buscopan, no recurrence of colic signs after initial dose, horse remains comfortable for 12-24h

SURGICAL - large dose of sedative required to examine horse, little response to flunixin meglumine, response short lived (<1-3h)

35
Q

Additional diagnostics - differentiate medical and surgical lesions

A

MEDICAL - normal abdominocentesis (straw coloured, clear), abdominocentesis with high nucleated cell count (>100*10^9/L) and protein (>4.5-6g/L): peritonitis, normal transabdominal ultrasonographic exam

SURGICAL - abnormal abdominocentesis (haemorrhaic, orange, red, nucleated cell count >525g/L), abnormal transabominal ultrasonographic exam (distended SI, increased abdominal fluid)

36
Q

List short term complications (<2-4 weeks) after colic surgery 7

A
  • Anaesthetic complications
  • post-operative colic
  • post-operative ileus (reflux)
  • incisional complications (infection, breakdown)
  • thrombosis
  • peritonitis
  • laminitis
37
Q

Long term complications (>2-4 weeks) after colic surgery - 2

A
  • Recurrent/chronic colic (adhesions)

- incisional hernia

38
Q

Suggest some rough prognostic guidelines - 4 types (simple medical, non-strangulating surgical, strangulating SI surgical, strangulating LI surgical)

A
  • Simple medical colic - good (around 90%)
  • Non-strangulating surgical colic - good (70-90%)
  • Strangulating SI lesion - guarded (without resection 60-80%; with resection 50-70%)
  • Strangulating LI lesion - guarded to poor (without resection 36-83%, resection (difficult/rarely possible) 50-80%)

Alimentary (37 decks)

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