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ZUKU NAVLE PREP > Equine Flash Notes - Equine Colic Exam & Key Colics > Flashcards

Equine Flash Notes - Equine Colic Exam & Key Colics Flashcards

1
Q

what is the basic mechanism of colic pain in horses?

A
  1. distension of gut with fluid, gas, or ingesta
  2. something is pulling on the root of the mesentery
  3. something causing ischemia/infarction
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2
Q

what are the 2 manifestations of colic pain in horses?

A

visceral abdominal pain - pushing on abdomen doesn’t cause pain unless you’re touching the effected organ

parietal abdominal pain - peritonitis, external palpation elicits pain

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3
Q

what are some examples of severe, life threatening colics?

A

infarctive disease - volvulus, torsion, or thromboembolism

severe visceral distension - extreme gas, impaction, or dilation

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4
Q

T/F: 90% of colics are uncomplicated & respond to analgesic treatment

A

true

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5
Q

what are the main clinical signs of colic?

A

signs of pain variable

rolling, sweating, flank watching, kicking at abdomen, anorexia, depression

severe - cold extremities, increased CRT, bright right mucus membranes from vasodilation

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6
Q

what are the ten p’s needed for colic diagnosis?

A
  1. physical exam
  2. pain
  3. pulse - > 60 bpm, pass NG tube, palpate digital pulses for signs of laminitis
  4. perfusion
  5. peristalsis
  6. percussion
  7. pass NG tube
  8. palpation per rectum
  9. peritoneal fluid tap - if you see plant material or RBC, indicative of rupture, euthanize
  10. PCV & TPR
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7
Q

what are the normal values of peritoneal fluid in horses?

A

protein < 2.5 g/dl

normal cells between 5-10,000

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8
Q

what are clinical signs of colic that indicate surgery is necessary?

A

severe abdominal pain that is poorly responsive or unresponsive to analgesics

discolored peritoneal fluid with increased protein, RBC, & WBC

on rectal - obstruction or displacement of viscera

progressive deterioration of cardiovascular status with abdominal pain & uncertain diagnosis

significant gastric reflux

recurrent abdominal pain with uncertain cause

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9
Q

what is the prognosis for colic in horses?

A

90% respond to analgesics

surgery - guarded to poor with 50% recovering from surgery, HR of 100 = 30% survival, & PCV >60 = 25% survival

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10
Q

what are some examples of toxic causes of colic?

A

blister beetle, warfarin, herbicides, lead, phenylbutazone/other nsaids, & poisonous plants

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11
Q

what are some examples of extra-gi causes of colic?

A

mesenteric abscess, ovarian tumor/abscess, parturition, acute hepatitis/hepatic lipidosis, diaphragmatic hernia, ruptured bladders in foals, urolithiasis, & uterine torsions

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12
Q

what are some common gi causes of colic in horses?

A

gas distension of intestines/cecum/colon

hypermotility & intestinal spasms

feed impaction/constipation

meconium impaction in foals

gastric ulcers in foals

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13
Q

what should you do before giving any drugs to a horse with colic?

A

check their heart rate/evaluate cardiovascular status

can mask pain

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14
Q

what are some common initiating factors of colic?

A

changes in diet, water consumption, exercise, weather

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15
Q

what are some signs of hypovolemia/poor perfusion in a horse with colic?

A

pulse higher than 52 of fair/poor quality

prolonged CRT

prolonged skin turgor

cool extremities

need for fluid therapy

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16
Q

if you hear a ping when doing a colic exam, where does that localize to?

A

large bowel or cecum

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17
Q

how is rectal palpation of a colic horse done? how are organs identified?

A

palpate backwards - sigmoid loop (long mesocolon in front of pelvic inlet), go in as far as possible & move backwards

start at left kidney & move across to spleen & nephrosplenic ligament

small colon - fecal balls & bands & sacculations

cecum - medial band

ventral large colon - bands

pelvic flexure - no bands felt, but it does have 1

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18
Q

where is a peritoneal tap done on a horse?

A

ventral midline caudal to xiphoid & to the right of midline to avoid the spleen - done at the lowest part of the abdomen

EDTA tube for cytology & sterile tube with no additives for visual inspection & culture

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19
Q

what are the cardinal clinical signs of colic that indicate surgery should be done?

A

severe abdominal pain poorly/non-responsive to analgesia

discolored peritoneal fluid containing increased protein, RBC, WBC

on rectal - obstruction and/or displacement of viscera

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20
Q

T/F: the earlier the decision is made for colic surgery, the better chance of recovery

A

true

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21
Q

what medical treatment is used for colic?

A
  1. analgesia - xylazine & banamine
  2. decompression - nasogastric tube
  3. fluids - oral/iv or both, oral if not refluxing at 1-2 L/hour - LRS is fluid of choice

avoid peripheral vasodilators

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22
Q

what percentage of horses die after R&A surgery?

A

75%

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23
Q

what are some physical parameters that indicate a poor prognosis for a horse with colic?

A

HR > 80

PCV > 60%

uncontrollable pain

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24
Q

what should be done before colic surgery?

A

stabilization!!! pre-op fluids, abx, banamine

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25
Q

what anesthesia is used for colic surgery?

A

xylazine/ketamine combined with glycerol glycolate

isoflurane - intubate in sternal

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26
Q

after open the abdomen in a colic surgery, what should you immediately assess?

A

apex of cecum on midline

ventral colon surrounds apex of cecum

abdominal cavity - look for ingesta, distended loops of intestines ballooning out the incision (need to decompress with needle/tubing to continue exploration)

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27
Q

what is included in the preliminary explore of a colic surgery?

A

gently explore abdomen by gently sweeping viscera with hand - cause may be immediately apparent

look for: turgid loops of bowel, hard masses, tight mesenteric bands, roughened peritoneal surfaces of fibrin adhesions, & root of mesentery & connection of cecum & colon for volvulus

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28
Q

what is included in the deeper explore of a colic surgery?

A

cecum is reference point - if cause isn’t apparent, systemically explore abdomen

apex of cecum on ventral midline

ventral colon surrounds apex of cecum - right ventral, sternal flexure, & left ventral

4 bands & sacculations of ventral colon & cecum - locate cecocolic ligament between lateral band of cecum & right ventral colon

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29
Q

what structures can be exteriorized during colic surgery?

A

apex of cecum

pelvic flexure

dorsal colon - left dorsal (small with 1 band in mesentery) , diaphragmatic flexure, & right dorsal part (3 bands but no sacculations)

mesocolon - connects ventral & dorsal colon & contains blood supply (colic branch to ventral colon & right colic artery to dorsal colon) & connects to dorsal abdomen at root of mesentery

jejunum

small colon/descending colon - located to left of the base of cecum heading into pelvic cavity (2 bands, sacculations, & fecal balls) part of it can be exteriorized

transverse colon - connects right dorsal colon with small colon that transverses abdomen from right to left in front of cranial mesenteric artery

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30
Q

after finding the small intestines, how do you work your way through the organs of a horse during a colic surgery?

A

ileocecal ligament - pull apex of cecum up & locate the ligament connected to the dorsal band

ileum - follow ileocecal fold from cecum to ileum or reach down the left side of the base of the cecum to blindly find it

jejunum - trace small intestines forward (pull out & replace going along entire length, point thumb in direction you’re going to keep track) ascending duodenum becomes jejunum at duodenojejunal flexure

ascending duodenum - located by its connection to small colon, duodenocolic ligament on left side of cecum (can’t be exteriorized)

duodenocolic ligament - connects ascending duodenum to the small colon

descending duodenum - reach between the base of the cecum & the right body wall dorsally (only tubular structure located here but can’t be exteriorized)

pylorus - found by following the descending duodenum cranially but can’t be exteriorized

liver - located along right body wall & touching base of cecum

right kidney - nestled in the renal impression of the caudate lobe of the liver dorsally

epiploic foramen - pass hand between descending duodenum & right body wall to the liver & right kidney, so if no bowel is present in this region, no need to check epiploic foramen

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31
Q

how do you enter the epiploic foramen during a colic surgery?

A

pass a finger under the caudate lobe of the liver forward into epiploic foramen between the portal vein ventrally & caudal vena cava dorsally

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32
Q

after finding the large intestines, how do you work your way through the organs of a horse during a colic surgery?

A

find them by returning to the cecum

cecum - palpate up body to base in right paralumbar fossa

body of cecum - along the right abdominal wall from base to apex (can be partially exteriorized)

base of cecum - right paralumbar fossa anchored to dorsal abdomen (can’t be exteriorized)

ventral colon - around apex & body of cecum with 4 bands

cecocolic ligament - pull up on cecum & see connection between lateral band & right ventral colon

pelvic flexure - found on left side near pelvic inlet, junction between ventral & dorsal colon

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33
Q

what is a decompression surgery?

A

colic surgery - distended bowel (jejunum, cecum, or large colon)

punctured with needle through purse string suture & tie as you remove the needle

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34
Q

when are pelvic enterotomies used for colic surgery?

A

opened to empty out large colons (dirty, special table used)

incision made toward ventral or dorsal colon not in pelvic flexure

empty colon - garden hose up enterotomy!!!

wash gi & put back into correct positions

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35
Q

what are some examples of end to end anastomosis used in colic surgeries?

A

jejunum to jejunum

jejunum to small colon

large ventral colon

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36
Q

when are side to side anastomosis surgeries used for colics?

A

used to unite unequal sizes of bowel

jejunocecal anastomosis if ileum must be resected

anastomose end to end jejunum to dorsal band of cecum as far towards the base as possible

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37
Q

what is probably the most common cause of colic in horses? what is the suggested pathophysiology?

A

spastic colic - spasm/hypermotility of intestinal tract

pain caused by spasms of gut - hyperexcitable horses predisposed

causes unknown, but implicated: ANS imbalances, irritation of gut by parasites, enteritis, & moldy feed, & s. vulgaris

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38
Q

what is the classic case presentation of spastic colic in horses?

A

loud gassy intestinal sounds, intermittent abdominal pain, patchy sweating on neck, & no systemic deterioration

frequent passage of feces

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39
Q

how is spastic colic diagnosed?

A

auscultation - loud rumbling borborygmi, elevated pulse, & normal rectal

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40
Q

how is spastic colic treated?

A

may spontaneously recover in 10-60 minutes

if not - dipyrone, rompun, & mineral oil

no atropine as an antispasmodic because it may cause adynamic ileus

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41
Q

what is the cause of primary intestinal tympany colic in horses?

A

microbial fermentation of lush grass, grains, or pelleted feeds

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42
Q

what is the cause of secondary intestinal tympany colic in horses?

A

obstruction of colon/cecum

mechanical - fecoliths/enteroliths in small colon, large colon displacement

functional - adynamic ileus

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43
Q

what is the cause of flatulent colic in horses?

A

tympanic horse that passes large amount of gas - no obstruction

synonymous with primary tympany

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44
Q

what is the classic case presentation of primary intestinal tympany?

A

moderate to severe abdominal pain that is usually intermittent

bloat, flatulence, & little systemic deterioration early

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45
Q

what is the classic case presentation of secondary intestinal tympany?

A

severe distension of cecum & large colon, dyspnea due to pressure on the diaphragm, severe bloat, & systemic deterioration

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46
Q

how do you differentiate between primary & secondary intestinal tympany causing colic in horses?

A

primary - flatulence, gas sounds & loud borborygmi, distended colon/cecum on rectal, & little systemic deterioration

secondary - no feces passed & systemic deterioration

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47
Q

how is primary intestinal tympany treated?

A

analgesics, mineral oil through NG tube, walking to promote passing gas - no need to trocar if flatulent

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48
Q

how is secondary intestinal tympany treated?

A

usually requires surgery

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49
Q

what is the pathophysiology of strangulating/obstructing colic?

A

venous return stops - area swells as arterial still pumps, arterial supply then shut off

ischemia & necrosis - leads to loss of mucosal barrier (bacteria/endotoxin absorption, proximal distension, loss of fluids & electrolytes

dehydration & hemoconcentration occurs -> metabolic acidosis & severe cardiopulmonary dysfunction

decreases peripheral perfusion markedly decreased

increase in lactate formation

if rupture, leads to peritonitis

50
Q

what are examples of different causes of strangulating colic?

A

volvulus, strangulating lipomas, external hernias, internal hernias, intussusception, & meckel’s diverticulum

51
Q

what is the classic case presentation of strangulating colic?

A

acute/rapid/severe unrelenting pain, increased HR > 60, sweating, increased RR, & dehydration

> 5L of gastric reflux after passing a tube, silent abdomen, metabolic acidosis, distended small intestinal loops

52
Q

how is strangulating colic treated?

A

stabilize before surgery!!!!

decompress intestine, correct problems, R&A of nonviable sections

53
Q

what are some examples of causes of intussusception in horses?

A

changes in motility

enteritis, intestinal polyps, diet changes, heavy ascarid load, tapeworms, parasite migration, anthelmintic treatment, intestinal surgery, or foreign body

54
Q

what is the classic case presentation of intussusception in horses?

A

frequent in < 3 year olds

if ileal ileal - chronic abdominal pain

jejunal or ileocecal - acute colic signs, depression, anorexia, gradually shocky/dehydrated

55
Q

what is the difference between intussusceptum & intussuscipiens?

A

intussusceptum - orad gut, propelled by peristalsis into the intussuscipiens

intussuscipiens - enveloping portion

56
Q

what is the prognosis of intussusceptions in horses?

A

ileal-ileal is better than jejunal or ileocecal

57
Q

how is an intussusception diagnosed in a horse?

A

history, clinical signs

peritoneal tap - maybe normal because damaged intestinal isolation, or may see increased RBC, WBC, & protein or bacteria if ruptured

rectal - 50% of intussusceptions have distended loops, may palpate it (painful & firm)

ileocecal - may feel firm, turgid intestine within cecum

exploratory surgery

58
Q

how is a horse with an intussusception treated?

A

stabilize before surgery with intense fluid therapy

surgery - decompress intestine, surgical R&A

59
Q

what is an internal hernia in a horse causing colic?

A

displacement of intestine through a normal or pathologic foramen within the abdominal cavity without the presence of a hernial sac

60
Q

what are types of mesenteric defects causing internal hernias in horses?

A

acquired or congenital - gastrosplenic, cecocolic, broad ligament

congenital fibrous bands/adhesions

epiploic foramen

61
Q

what is a major difference between internal & external hernias causing colic in horses?

A

internal hernias often cause strangulation/intestinal obstruction

external often doesn’t cause strangulation

62
Q

what is incarceration in relation to internal hernias?

A

intestine goes through a hole & gets trapped

63
Q

what is the classic case presentation of internal hernias causing colic?

A

acute/rapid/severe unrelenting pain, increased HR, prolonged CRT, increased RR, & dehydration

abdominocentesis - cloudy to serosanguinous/turbid, TP > 3, increased cell count

64
Q

what horses are at risk of epiploic entrapment?

A

older horses more susceptible - hepatic atrophy leads to an increased size of the epiploic foramen

65
Q

where is the gastrosplenic ligament located in the abdomen? what often gets stuck there?

A

between the left greater curvature of the stomach & spleen

distal jejunum & ileum most commonly incarcerated

66
Q

what is the problem that mesodiverticular bands potentially cause in horses?

A

connective tissue that forms between mesentery & antimesenteric border of small intestine which forms a passage for a possible internal hernia

67
Q

where is the location where epiploic entrapment occurs in horses?

A

right dorsal abdomen - beneath the caudate lobe of the liver, between caudal vena cava & portal vein

68
Q

epiploic entrapment is an example of what type of colic in horses?

A

internal hernias

69
Q

what is the number one cause of colic in horses? what type is more common?

A

large colon impaction

simple obstruction much more common than strangulating

feed impaction - in large intestines due to decrease in diameter size at pelvic flexure & transverse colon

ileocolic impaction - hypertrophy of ileum or ileocecal intussusception

no reflux

70
Q

what are some predisposing factors for large colon impaction?

A

coarse feed, poor dentition, dehydration, cold weather, & decreased water intake

71
Q

what are the 3 most common impaction sites in large colon impaction colic?

A
  1. pelvic flexure, most common
  2. transverse colon - junction with large right dorsal colon
  3. ileocecal opening - hypertrophy & intussusception
72
Q

what is the classic case presentation of large colon impaction?

A

mild to moderate pain

decreased fecal output

progressive anorexia

dehydration

73
Q

how is large colon impaction diagnosed?

A

firm ingesta filled colon on rectal at pelvic flexure

74
Q

what are some indications for surgery in large colon impaction?

A

unrelenting pain, increased peritoneal nucleated cells/protein, & colonic displacement

75
Q

what is the prognosis of large colon impaction?

A

if caught early - can shift quickly

if late - pelvic flexure can rot

76
Q

how is large colon impaction treated?

A

aggressive fluids, galloon of mineral oil, DSS, saline cathartics

surgery - often burst when trying surgery

77
Q

what is lethal white? what is the pathopysiology? what is the treatment?

A

completely white foal with blue eyes - overo paint sire & dam (autosomal recessive trait) born dead or weak with colic

appears normal at birth, develops colic & dies on 2nd day

absence of submucosal & myenteric ganglia in terminal ileum, cecum, & colon

no treatment - euthanize

78
Q

what is the number one cause of law suits in horses?

A

rectal tears that occur iatrogenically

79
Q

what are the different grades for rectal tears?

A

grade 1 - only mucosa/submucosa

grade 2 - muscle layers only, mucosa intact

grade 3 - mucosa, submucosa, & muscle layers into space between layers of mesorectum where the serosa is the only thing separating it from the peritoneal cavity MOST COMMON

grade 4 - full thickness into peritoneal cavity

80
Q

what can you give a horse to stop it from straining resulting in a rectal tear?

A

acepromazine, xylazine, or detomide

propantheline bromide

lidocaine lubricant enema

epidural with xylazine

81
Q

what horses often get rectal tears?

A

males > females

arabians

82
Q

how are different rectal tears treated?

A

grade 1 - heal by 2nd intention

grade 4 - can’t treat

grade 3 - emergency, tell owner immediately, & prepare to ship to a surgical facility

83
Q

what is DPJ colic? what happens if left untreated?

A

duodenitis-proximal jejunitis colic - mimics obstruction colic

proximal small intestines slow down, fluid & gas builds up, refluxes into stomach

shock or gastric rupture

84
Q

what are the clinical signs of DPJ?

A

acute onset moderate to severe colic - gastric reflux, colic abates after decompression

85
Q

what are major complications of DPJ?

A

laminitis, renal dysfunction, fibrous adhesions, multifocal abscessation, aspiration pneumonia from tubing, diarrhea in resolution stage, peritonitis, & shock/gastric rupture

86
Q

how is a post mortem diagnosis of DPJ made?

A

duodenum > jejunum - transmural hemorrhage, thickened intestinal wall

87
Q

how is DPJ diagnosed?

A

decompression relieves colic

decrease gut sounds

small intestines filled but not distended

metabolic acidosis

88
Q

T/F: medical treatment of DPJ carries a better prognosis that surgical treatment

A

true

89
Q

how is DPJ treated medically?

A

empirical

continuous gastric decompression (indwelling NG tube), iv fluids, don’t feed, NSAIDS, abx, laminitis prophylaxis

90
Q

what horses end up with sand colic?

A

sandy regions - florida, california

91
Q

what is the pathophysiology of sand colic?

A

fine sand accumulates in ventral colon, coarse sand in dorsal colon/transverse colon/pelvic flexure

fills right dorsal colon - fluid/gas can flow through present with soft feces

92
Q

how is sand colic diagnosed?

A

put feces in glove & fill with water - sand will settle out in fingers

93
Q

how is sand colic treated?

A

metamusil - NG tube

94
Q

how is sand colic prevented?

A

monitor feeding & don’t feed off the ground

95
Q

what are surgical indications for sand colic?

A

unrelenting pain, increased peritoneal nucleated cells/protein, & colonic displacement

96
Q

how does metamusil work when treating sand colic?

A

lubricates & binds sand to move it out

forms gel when mixed with water so have tube in place before mixing

after initial dose, mix dry with feed for prolonged use

97
Q

what horses are predisposed to enteroliths/fecoliths?

A

california (hay high in may), arabians more than others, 5-10 years old

98
Q

what are enteroliths?

A

magnesium ammonium that starts as a nidus

99
Q

what are fecoliths?

A

concentration of fecal material that can be as big as a soccer ball

100
Q

how do horses with enteroliths/fecoliths present?

A

decreased feces, scant/liquid feces if partial obstruction

variable pain - depending on extent of distension

101
Q

how are enteroliths/fecoliths diagnosed?

A

distension of colon on rectal exam

102
Q

what is the conservative treatment for enteroliths/fecoliths? what is another option for treatment?

A

apple cider vinegar

surgical removal

103
Q

where are enteroliths/fecoliths commonly found in the abdomen?

A

obstruction at the junction of right dorsal colon & transverse colon where there is a diameter change

104
Q

why is it common to see displacement of the ascending/large colon causing colic in horses?

A

double U shaped but only proximal & distal ends attached, so the rest of the U (pelvic flexure at its center) is free to move around

other organs usually keep it in place - alterations in motility or digestive mechanisms can flip/kink the large colon resulting in obstruction because colon/cecum fill with gas, but ileocecal junction is efficient so no back up into the small intestines

105
Q

what clinical signs are seen with displacement of the ascending large colon?

A

colic, increased HR/RR, sweating, decreased fecal output, gas distension of colon & cecum

106
Q

how is displaced ascending colon diagnosed?

A

rectal - colon out of place, normally sacculations on the bottom & smooth on top, but if reversed, obstructed

pings due to gas distension

107
Q

how is a displaced large colon treated?

A

conservative attempt done first in right & left displacement

surgery indicated for volvulus or obstruction

108
Q

what is a right dorsal displacement colic in horses?

A

twist of 180-260° of large colon at the mesentery

large colon displaces between the cecum & right body wall

pelvic flexure pointed cranially with 2 possible ways to twist

clockwise around cecum (most common) or counter clockwise around cecum

109
Q

what clinical signs are seen with a colic horse with a right dorsal displacement?

A

colic, increased HR/RR, decreased fecal output, gas distension of cecum/colon, no gastric reflux

110
Q

how is right dorsal large colon displacement diagnosed?

A

rectal - large gas distended colon & can’t find pelvic flexure

cecum located medial to colon

pings heard

111
Q

what is another name for left dorsal colon displacement?

A

nephrosplenic entrapment

112
Q

what is the pathophysiology of nephrosplenic entrapment?

A

large colon is caught in nephrosplenic space (left side between dorsal spleen, nephrosplenic ligament, left kidney, & left abdominal wall)

113
Q

what horses are predisposed to nephrosplenic entrapment?

A

warmbloods & thoroughbreds

114
Q

what is the main difference between left displacement of the colon & nephrosplenic entrapment?

A

increased pain & systemic shock because more colon is entrapped which increases the pull on mesentery

115
Q

how is nephrosplenic entrapment diagnosed?

A

rectal - distended large colon & spleen displaced away from body wall

116
Q

what conservative treatment is used for nephrosplenic entrapment? what is used if that doesn’t work?

A

conservative - deny food & allow to spontaneously return

rolling - put in right lateral recumbency to have the spleen up, hoist by legs held for 1 minute & shaken, return to dorsal recumbency, & slowly turn to left lateral recumbency

surgical correction - ventral celiotomy for better room & visualization

117
Q

what is the pathophysiology of colonic volvulus?

A

vascular occlusion & severe colonic devitalization at > 270° twist - twists 360° causing lots of strangulation, endotoxemia, & no venous return to thorax

  1. base of colon
  2. sternal & diaphragmatic flexures
118
Q

what predisposes horses to colonic volvulus?

A

adult horses, brood mares 1 week postpartum due to extra room, summer

119
Q

what clinical signs are seen with colonic volvulus?

A

severe colic, marked distension/bloat, shock, dehydration, cold extremities, weak pulses, increased CRT, increased HR/RR, pings

rectal - large gas distension & edematous colonic wall

120
Q

how is colonic volvulus treated?

A

stabilize before surgery with large volume fluids!!!!!

analgesics for pain

surgically untwist

121
Q

what is the prognosis of colonic volvulus?

A

poor

if caught within 2 hours, can surgically correct

if later than 4 hours, poor

prognosis depends on amount of devitalization

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