critical decision making and case management in equine colic Flashcards
List 6 factors that influence treatment/ management of colic
Cause / severity of colic
Prognosis following treatment
Finances / insurance cover
Owner’s wishes
Availability & ease of transport
Intrinsic factors e.g. age, concurrent disease
List 6 differentials for colic that always have medical treatment
Spasmodic colic
gaseous colic
anterior enteritis
colitis
gastric ulceration
grass sickness (ileus)
List 6 differentials for colic that sometimes need medical and sometimes need surgical treatment
colon displacement
colon impactions (ingesta/ sand)
peritonitis
non G.I lesions
S.I. simple obstruction
parasites
list 3 causes of colic that always need surgical treatment
S.I/ small colon incarceration
SI/ small colon volvulus
colon torsion
How do we assess colic severity / achieve diagnosis
- History
- Pain level and response to analgesia
- Mucous membrane colour and capillary refill time – perfusion
- Hydration status
- Heart rate & pulse strength
- Respiratory rate
- Gut sounds
- Abdominal distension
- Temperature
- Rectal findings
- Volume of naso-gastric reflux
- Abdominal fluid analysis
- Ultrasound findings
Blood analysis
How long should flunixin provide analgesia for in cases of colic
12 hours
If colic signs seen through this- it is bad
What is a severe sign of colic - MM colour
Pale or dark injected membrane and prolonged CRT suggest poor peripheral perfusion
How do you assess hydration status in horse
dry/ tacky MM
prolonged CRT
prolonged skin tent- age affects skin tent
Where can you assess pulse quality in horses
Facial artery under the jaw
T/F transient heart murmur in colic horse is bad
False - not uncommon
check few days after colic to see if still there
how often should caecal emptying occur in normal horse
1-3 times a minute
sounds like toilet flushing
if gut sounds are increased during colic what does this mean
guts are hypermotile
e.g. spasmodic colic
if gut sounds are decreased during colic what does this mean
guts are hypomotile
e.g. colon impaction
if gut sounds are absent during colic what does this mean
Guts are non-motile
e.g. SI incarceration
How should you grade gut sounds in horses
listen to all 4 quadrants and grade them separately
T/F can get ‘ping’ following abdominal percussion in colicing horses
True
indicates gas distension within intestinal lumen - is a bad sign
what is the normal rectal temperature of a horse
37.5-38.5
List 4 abnormal findings on rectal exam of colicing horse
hard ingesta
gas distended intestines
abnormally located structures
tight taenia bands
What does the normal horse stomach contain
normally holds 2-3L of green non-malodourous fluid and will empty quickly after drinking
what does larger amount of fluid in horse stomach suggest
SI obstruction –> fluids backs up behind the blocked point
what is the max volume of horse stomach
8-15 L
What is important to test abdominal fluid for in colic horses
Lactate- is because some of the bowel is dying off- BAD SIGN
If horse has peritonitis describe what the abdominal fluid will look like
white/ yellow
turbid
large volume
ELvated WBC, total potein and lactate
If horse has ruptured intestine describe what the abdominal fluid will look like
green/ brown (ingesta)
opaque
large volume
elevated WBC, total protein, lactate
If horse has compromised intestine describe what the abdominal fluid will look like
Pink/ brown (serosanginuous)
opaque
slightly increased volume
WBC, Total protein, lactate- slightly increased
what is the most common analgesia to give to horses with colic
flunixin meglumine IV- good for visceral pain
describe how to try and treat pelvic flexure impaction
Analgesia
Oral laxative fluids (MgSO4/ liquid paraffin) - causes fluid to come into the intestines
No food but allow water
monitoring by owner- re examine
At what point do consider treatment of impaction successful
large volume of faeces produced
colic signs resolve
rectal exam confirm impaction has cleared
List 6 parts of the pre-surgical management of surgical colic
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
describe surgical management of colic
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
describe how you systematically examine the abdomen in surgical management of colic when suspect SI problem
for small intestine start at caecum, work through proximally through ileum, jejunum & duodenum
describe how you close midline exploratory laparotomy of horse
3 layer closure
linear alba, sub-cutis , skin
Describe what viable bowel looks like
pink/ red colour
colour improves as time passes
mild oedema
strong pulse in mesenteris arteries
serosa is shiny
motile
describe what necrotic bowel looks like
purple/ green colour
colour does not improve
severe oedema
weak/ absent pulse in mesenteric arteries
serosa is dull
non-motile
Describe the post surgical management of colic horse
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
why is regular naso-gastric intubation important after colic surgery
post operative ileus is common following S.I. surgery
List 5 pre-surgical factors that can affect post-surgical outcome
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)
List 5 Intra-operative / post-surgical that affect surgical outcome
specific lesion
length of bowel involved
if resection and anastomosis required
expertise of veterinary staff
owner financial position
What is SAA in horses
Serum amyloid A protein
Is the major acute phase protein in horses
List some post surgical complications in horses
Laminitis
repeat colic surgery
D+
reflux
Ileus
incisional hernia
jugular thrombosis
wound infection
repeated colic
