critical decision making and case management in equine colic

Question 1

List 6 factors that influence treatment/ management of colic

Answer 1

Cause / severity of colic
Prognosis following treatment
Finances / insurance cover
Owner’s wishes
Availability & ease of transport
Intrinsic factors e.g. age, concurrent disease

Question 2

List 6 differentials for colic that always have medical treatment

Answer 2

Spasmodic colic
gaseous colic
anterior enteritis
colitis
gastric ulceration
grass sickness (ileus)

Question 3

List 6 differentials for colic that sometimes need medical and sometimes need surgical treatment

Answer 3

colon displacement
colon impactions (ingesta/ sand)
peritonitis
non G.I lesions
S.I. simple obstruction
parasites

Question 4

list 3 causes of colic that always need surgical treatment

Answer 4

S.I/ small colon incarceration
SI/ small colon volvulus
colon torsion

Question 5

How do we assess colic severity / achieve diagnosis

Answer 5

1. History
   
   2. Pain level and response to analgesia
   3. Mucous membrane colour and capillary refill time – perfusion
   4. Hydration status
   5. Heart rate & pulse strength
   6. Respiratory rate
   7. Gut sounds
   8. Abdominal distension
   9. Temperature
   10. Rectal findings
   11. Volume of naso-gastric reflux
   12. Abdominal fluid analysis
   13. Ultrasound findings
       Blood analysis

Question 6

How long should flunixin provide analgesia for in cases of colic

Answer 6

12 hours
If colic signs seen through this- it is bad

Question 7

What is a severe sign of colic - MM colour

Answer 7

Pale or dark injected membrane and prolonged CRT suggest poor peripheral perfusion

Question 8

How do you assess hydration status in horse

Answer 8

dry/ tacky MM
prolonged CRT
prolonged skin tent- age affects skin tent

Question 9

Where can you assess pulse quality in horses

Answer 9

Facial artery under the jaw

Question 10

T/F transient heart murmur in colic horse is bad

Answer 10

False - not uncommon
check few days after colic to see if still there

Question 11

how often should caecal emptying occur in normal horse

Answer 11

1-3 times a minute
sounds like toilet flushing

Question 12

if gut sounds are increased during colic what does this mean

Answer 12

guts are hypermotile
e.g. spasmodic colic

Question 13

if gut sounds are decreased during colic what does this mean

Answer 13

guts are hypomotile
e.g. colon impaction

Question 14

if gut sounds are absent during colic what does this mean

Answer 14

Guts are non-motile
e.g. SI incarceration

Question 15

How should you grade gut sounds in horses

Answer 15

listen to all 4 quadrants and grade them separately

Question 16

T/F can get ‘ping’ following abdominal percussion in colicing horses

Answer 16

True
indicates gas distension within intestinal lumen - is a bad sign

Question 17

what is the normal rectal temperature of a horse

Answer 17

37.5-38.5

Question 18

List 4 abnormal findings on rectal exam of colicing horse

Answer 18

hard ingesta
gas distended intestines
abnormally located structures
tight taenia bands

Question 19

What does the normal horse stomach contain

Answer 19

normally holds 2-3L of green non-malodourous fluid and will empty quickly after drinking

Question 20

what does larger amount of fluid in horse stomach suggest

Answer 20

SI obstruction –> fluids backs up behind the blocked point

Question 21

what is the max volume of horse stomach

Answer 21

8-15 L

Question 22

What is important to test abdominal fluid for in colic horses

Answer 22

Lactate- is because some of the bowel is dying off- BAD SIGN

Question 23

If horse has peritonitis describe what the abdominal fluid will look like

Answer 23

white/ yellow
turbid
large volume
ELvated WBC, total potein and lactate

Question 24

If horse has ruptured intestine describe what the abdominal fluid will look like

Answer 24

green/ brown (ingesta)
opaque
large volume
elevated WBC, total protein, lactate

Question 25

If horse has compromised intestine describe what the abdominal fluid will look like

Answer 25

Pink/ brown (serosanginuous) opaque slightly increased volume WBC, Total protein, lactate- slightly increased

Question 26

what is the most common analgesia to give to horses with colic

Answer 26

flunixin meglumine IV- good for visceral pain

Question 27

describe how to try and treat pelvic flexure impaction

Answer 27

Analgesia Oral laxative fluids (MgSO4/ liquid paraffin) - causes fluid to come into the intestines No food but allow water monitoring by owner- re examine

Question 28

At what point do consider treatment of impaction successful

Answer 28

large volume of faeces produced colic signs resolve rectal exam confirm impaction has cleared

Question 29

List 6 parts of the pre-surgical management of surgical colic

Answer 29

broad spectrum antibiotics (penicillin IM and Gentamicin IV)- prophylaxis IV catheterisation IV fluid bolus Tetanus prophylaxis naso-gastric intubation to empty stomach of reflux clip and scrub ventral abdomen

Question 30

describe surgical management of colic

Answer 30

Immediate ventral midline exploratory laparotomy under G.A Systematic examination of abdomen Identify and correct lesion viable bowel is left in situ necrotic bowel is removed by resection and anstomosis

Question 31

describe how you systematically examine the abdomen in surgical management of colic when suspect SI problem

Answer 31

for small intestine start at caecum, work through proximally through ileum, jejunum & duodenum

Question 32

describe how you close midline exploratory laparotomy of horse

Answer 32

3 layer closure linear alba, sub-cutis , skin

Question 33

Describe what viable bowel looks like

Answer 33

pink/ red colour colour improves as time passes mild oedema strong pulse in mesenteris arteries serosa is shiny motile

Question 34

describe what necrotic bowel looks like

Answer 34

purple/ green colour colour does not improve severe oedema weak/ absent pulse in mesenteric arteries serosa is dull non-motile

Question 35

Describe the post surgical management of colic horse

Answer 35

5-7 days broad spectrum ABs - pen and gent 5-7 days analgesia- usually flunixin regular re examination regular naso-gastric intubation IV fluids gradual re-introduction of food stable rest for approx 8 weeks then gradual turn out

Question 36

why is regular naso-gastric intubation important after colic surgery

Answer 36

post operative ileus is common following S.I. surgery

Question 37

List 5 pre-surgical factors that can affect post-surgical outcome

Answer 37

Duration of signs prior to surgery level of dehydration (TP and PCV) level of endotoxaemia (MM colour, HR) SAA- serum amyloid A Lactate (circulating vs peritoneal)

Question 38

List 5 Intra-operative / post-surgical that affect surgical outcome

Answer 38

specific lesion length of bowel involved if resection and anastomosis required expertise of veterinary staff owner financial position

Question 39

What is SAA in horses

Answer 39

Serum amyloid A protein Is the major acute phase protein in horses

Question 40

List some post surgical complications in horses

Answer 40

Laminitis repeat colic surgery D+ reflux Ileus incisional hernia jugular thrombosis wound infection repeated colic