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Equine Surgery and Medicine 2 > Exam of the Colic Horse > Flashcards

Exam of the Colic Horse Flashcards

1
Q

What is colic?

A

Abdominal pain- usually acute and usually of GI origin

Other orgins: urinary (e.g stone form bladder) or uterine torsion)

Most frequent emergency situation in horses

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2
Q

What is colic-like behaviour

A

When there is no abd pain!

Can be caused by:

  1. neuro e.g WNV or encephalitis or Rabies
  2. Skin diseases- pruritis
  3. Tight bandages
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3
Q

Aetiology/anatomy

A

At pelvic flexure there is 180degree turn and the diameter is also narrowing therefore prone to impactions

Stomach: is small and cranially located within the ribcage

Cannot vomit because no help from abd muscles

sharp angle btw cardia and esophagus

SI: very long and v.long mesentery but hangs from a short mesenteric root

Ventral colon: large and not fixed

Right dorsal colon: the diameter widens BUT massive decr before entering the small colon

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4
Q

Aetiology of colic

A

Change of diet

Poor quality conc

Hay

Low fibre

Decreased water

Parasites

Meterological changes- tone of NS and balance

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5
Q

Common features despite origin?

A

Pain and exhaustion

Hypovol

Endotoxaemia

These all leading to periperal circ failure!!!

  • decr tissue perfusion
  • haemoconc
  • metabolic acidosis
  • azotemia (creatinine and urea)
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6
Q

3 main origins of colic

A

Non-strangulating

Strangulating

Enteritis

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7
Q

Features of non-strangulating colic

A

Muscle spasm

Intestinal damage

Tense mesentery

These lead to:

  • vasoC
  • Splenic contraction
  • Sweating
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8
Q

Features of Strangulating colic

A

Local circ disorder

Fluid sequestration

(necrosis?)

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9
Q

Colic caused by enteritis

A

Incr wall permeability

Dysbacteriosis

These lead to:

  • release of inflamm mediators
  • DIC
  • Organ dysfunction
  • Vessel dilation
  • SIRS–MODS
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10
Q

Examination of the colic horse

A

Management is very different to other diseases (esp from chronic)

Aim of phys exam: decide if medical or surgical therapy

Usually impossible to get a definitive diagnosis- usually only see cause during surgery)

Exam must be quick, systematic and effective

Focus on CV and GIT

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11
Q

Important questions to ask for history

A

Duration of colic signs

Grade of signs: mid, moderate or severe

Frequency: continuous vs intermittent

Medication- if so if success?

Previous colic episodes

Changes in feeding or management - environment, feed, hay, concentrates

Worming

*should start the treatment then ask these questions

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12
Q

Physical exam: behaviour possibilities

A

Bright, alert and responsive

Colicky

Dull, non-responsive (bad outcome)

Rocking horse posture: usually indicates large colon infections

Dog-sitting: V. high P on diaphragm because something is distended usually

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13
Q

Phys exam: body surface:

A

Dry

Sweat patches

Profuse sweating- indicates something more severe

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14
Q

Other aspects of the Phys exam

A

Skin tent test

Skin temp- trunk, feet, ears- if cold indicates hypovolaemic shock

Rectal temp

HR:

  • Normal: 28-40
  • >50
    • >100- indiactes rupture!!
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15
Q

Phys exam: resp rate and effort

A

Normal: 10-18

Tachypnoea, laboured breathing if something distended!

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16
Q

Phys exam: colour of mucus membranes

A

Pink: pale - dark

Brick red/dirty red

Toxic purple rim- usually around incisors

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17
Q

Phys exam: shape and size of abdomen

A

Degree of distension

Location could aid in identifying the affected part of the GIT

e.g if R side and upper- usually the caecum!

if bilat: enlarged colon

18
Q

Phys exam: scrotum and inguinal area

A

Must be checked in stallions! could be enlarged, painful and either hot or cold

If there is an inguinal herniation- part of the SI gets into the scrotum

19
Q

Phys exam: abd auscultation

A

Left and right paralumbar fossa (behind the last rib)

Left and right lower abdomen behind the costal arch at level of the stifle

Listen for a minimum 1 minute at each area

Sound heard behind xiphoid cart indicate sand in the large colon (moving sound, very characteristic)

Should be organised, itermittent sounds

20
Q

Types of intestinal sounds

A

Weak: mixing of ingesta

Louder: propulsion of ingesta

At right paralumbar fossa: ileocaecal and caeco-caecal activity

21
Q

Increased borborygmi indicates:

A

early stages of enteritis/colitis

Spasmodic colic (this is a mild type of colic)

22
Q

Reduced or absent intestinal sounds indicates:

A

Impaction

Obstruction

Hypoperfusion

Ileus

23
Q

Prep for rectal palpation

A

Restraint: stocks, twitch, picking up a FL, sedation (xylazine and butorphanol)

Lubrication

Buscopan: spasmolytic! relaxes the rectum and reduces the risk of tearing the rectum

Enema: if large amount of hard/dry content

24
Q

Aim of rectal palpation

A

Diagnosis?

Distension and displacement- to identify the location

25
Q

Rectal palpation technique

A

Remember only 30-40% of cavity is palpable!

Not possible to move hand from spine to ventral abdomen if there is gas acc due to colic

Right kindey is more cranial therefore not palpable!

26
Q

Palpable structures in normal horses

A

Rectal mucosa

Bony pelvis

Internal inguinal rings

Cervic, uterus and ovaries

Urinary baldder

Small colon: has wide and thick antimesent, taenia will contain faecal balls

Abdominal aorta- in the midline

Left kidney: caud pole

Spleen: caud part, along the L body wall

Nephrosplenic ligament and space

Left dorsal and ventral colon and pelvic flexure

Cranial mesenteric root

Right dorsal colon

Base of caecum with ventral and medial taeniae

Peritoneum

(Small intestines)- if you can palpate it means they are distended

27
Q

US

A

FLASH: Fast localised abdominal sonography of horses takes an average of 10.7 minutes

28
Q

Whata re the 7 US windows

A
  1. Ventr abd (check for fluid acc)
  2. Gastric window: 10th ICS
  3. Nephrospleic window: on L, behind last rib, last2 ICS dosrally
  4. Left middle part of the abdomen- SI
  5. Duodenal window- R, caudodors
  6. Right middle third of abdomen
  7. Cranial ventral thorax
29
Q

What does visualisation of mesenteric vessels in US indicate

A

Right dorsal displacement of large colon or

180degree volvolus (this is on L side)

Sensitivity: 67.7%

Specificity: 97.9%

30
Q

In an US, what is between the R dorsal colon and the R liver lobe?

A

The duodenum- there should be no liquid content.

If distended more than 5cm= abnormal

31
Q

What is a useful method of detecting sand in the abdomen?

A

Put faeces in a latex glove and it shoyld sink to the bottom of the glove

32
Q

Technique for nasogastric tubing

A

Lubricate

Go through the ventral nasal meatus

Flex head

Check swallow reflex

Tube should be visible in the jugular groove

Create a siphon: can aspirate and release content from the stomach

33
Q

Normal findings of nasogastric tubing

A

<0.5L liquid but can get up to 2L

pH should be a max of 5

34
Q

When is reflux seen when doing nasogstric tubing

A

Spontaneous release of gs and fluid

When pH is greater or equal to 8

The small intestinal content is flowing backwards into the stomach

35
Q

Prep for abdominocentesis

A

Wall, stocks

Twitch, sedation

Clip either side of the linea alba

Prep as for surgery!

36
Q

Abdominocentesis: Needle technique

A

18-19G needle (spinal?)

Use left side (or midline)

Don’t use R becaue could puncture head of the caecum

Rotate and move needle if necessary

37
Q

AbdominocentesisL teat cannula method

A

23-25G needle (end is completely blunt)

1-2ml of local anaesthetic

Blade 11 or 15 to make short stab incision

Sterile swab

Rotate and move needle

With sample:

  • EDTA: nucleated cell count and cytology
  • Plain: TP, lactate and glucose which are NB if we suspect peritonitis
    • Cytospin- cytology
38
Q

Normal findings of abdominocentesis

A

Usually only a small amount

Pale/straw yellow colour

Should be clear- newspaper test

TP:<25 g/L

Total nucleated cell count: non-degen Ne> mononuclear cells> lymphocytes

Should be no RBC’s

39
Q

What colour is sample from abdominocentesis a few hours after strangulation

A

Bright red

40
Q

What colour is sample from abdominocentesis after GIT rupture

A

Very dark red

May contain some plant material

41
Q

Blood and Peritoneal fluid lactate

A

Increased lactate: hypovol means decr O2 delivery to the periphery- inadequate O2 utilisation (SIRS)

Lactate usually indicates strangulation if >4.4 mmol/L and rises despite fluid therapy

Normal lactate is <1.8mmol/L

Equine Surgery and Medicine 2 (15 decks)

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