GI - colic Flashcards
What are the 4 types of medical colic?
Spasmodic
Undiagnosed
Gas
Impaction
What are the 9 Ps that indicate that a horse needs emergency colic surgery?
Pain
Passage of time
Pulse
Pass a tube
Palpate per rectum
Peritoneal fluid
PCV
Pyrexia
Per abdominal ultrasonography
Should you give a horse with medical colic flunixin? What is it?
Pain relief - masks some signs of colic pain eg. pain but there are other ways of telling
so can give but just change monitoring accordingly
What should you do if the horse is still in pain despite having a full dose of flunixin?
Surgery
What analgesia/sedation should you give a horse that has mild to moderate pain from a medical colic?
IV phenylbutazone - pain relief
Hyoscine (buscopan) to aid rectal exam
Xylazine - sedate
What is spasmodic colic?
Spasm of the muscle layers in the small intestine causing pain
What are some risk factors for spasmodic colic?
Excitement
Exercise
Fatigue
Parasites - tapeworm
Changing diet
What signs do you use to diagnose spasmodic colic?
Recent onset
Mild-moderate pain
Intermittent
Passes all the Ps
Responds to treatment
What is the treatment for spasmodic colic?
Spasmolytic agent - buscopan
NSAIDs
Phenylbutazone/half dose flunixin
Starve for 8 hours then back to normal
What should you do after the horse has recovered from spasmodic colic?
If reoccurs multiple times then investigate - probably not spasmodic
Reduce future risk factors
Review parasites and teeth
What is gas colic?
Excess production of gas in the large intestine
Pain from stretching intestinal wall
What are some risk factors for gas colic?
Diet change
Rich grass/haylage
Too much concentrates
Parasites
Poor dentition
How can you diagnose gas colic?
Passes the Ps
Rectal - gas distended but still squishy intestines
What can gas colic be a precursor to?
LI displacement
LI torsion
What is the treatment for gas colic?
Buscopan
Phenylbutazone
NSAIDs
STOMACH TUBE WITH WATER - activates gastro-colic reflex
What should you do before stomach tubing with water a gas colic case?
Always check for reflux first
What is the location for most impactions in the horse?
At the pelvic flexure - intestinal narrowing, active pacemakers
What can impaction of the intestines cause in horses?
Stretches mucosal wall - pain
Vascular compromise
What are the risk factors for LI impactions?
Reduced water intake
Physical exertion
Reduction in exercise - sudden box rest
Parasite migration
Dental disease
What are LI impactions associated with in donkeys?
Dental diastema
How do you diagnose LI impactions?
Pass the Ps
Abnormal rectal
Had some risk factors, pain
What is something that you can do to diagnose a LI impaction that is very risky?
Peritoneal tap - risk puncturing intestine
What is the treatment for LI impactions?
Hydrate ingesta - oral fluids via stomach tube
Magnesium sulphate - draws more fluid into LI
Analgesia - phenylbutazone
What should you not use to treat LI impactions?
Pro-motility drugs - can cause intestinal rupture
Liquid paraffin - may help but doesnt break down impacted material
What parasites can cause ilial impactions?
Parascaris
Tapeworm
What is a secondary cause of caecal impactions?
After surgical procedures causing pain eg. orthopaedic
What is dangerous about caecal impactions?
Can be hard to detect and then rupture without warning - fatal
How do you diagnose a caecal impaction?
Rectal - impaction over RHS
Why does sand cause colic?
Irritates LI wall causing recurrent colic, poor motility, and inflammation
This can lead to impaction
How do you diagnose sand impaction?
From the history
Sedimentation test - poo and water mixed, sand will settle at bottom
Lateral abdominal radiograph
What is the treatment for sand impaction?
Lots of fluids
Analgesia
Feed psyllium - binds up the sand and forms jelly
What are common causes of small colon impactions?
Eating plastic bags
Salmonella?
What causes gastric impactions?
Unknown - motility disorder?
How do you diagnose gastric impactions?
Difficult to pass stomach tube
Spleen pushed caudally on rectal
Large stomach on ultrasound
How do you treat gastric impactions?
Stomach tube lavage
Coke
Difficult surgery
What is the prognosis of gastric impaction?
Poor
Not very common though
What is choke?
Oesophageal impaction
What are the signs of acute choke?
Froth at nose
Food material coming from nose
Gag
Cough
Head and neck extended
What predisposes to choke?
Eating very quickly
Dental abnormalities
What is the treatment for choke?
Sedate - puts head down
Lavage obstruction back out of the oesophagus by pouring water in and then tube down to empty out again - takes ages
When should you refer choke?
If secondary effects of choke eg. dehydration, aspiration pneumonia, rupture
What is equine grass sickness?
Equine dysautonomia - acquired degenerative polyneuropathy
Neurones of autonomic and enteric nervous system damaged causing dysphagia
What causes grass sickness?
Thought to be caused by a toxin - clostridium botulinum toxicoinfection?
But unknown
What horses are at risk of getting grass sickness?
Young horses - between 3 and 5
Location
If been in contact with EGS cases
If recently moved to the premises
Soil disturbance
Spring
What are the different forms of grass sickness?
Acute
SUbacute
Chronic
What occurs during acute grass sickness?
GI ilius causing SI and gastric distention, severe abdominal pain and death
What are the signs of acute grass sickness?
Hypovolaemia
Tachycardia
High PCV/TP
Distended SI
Corrugated LI impaction
Sweating
Pyrexia
Dysphagia
Ptosis
What causes death from equine grass sickness?
Cardiac failure - reduced circulating volume
Gastric rupture
How is subacute form of grass sickness different to acute form?
Course of disease 3-7 days
Clinical signs less severe
Usually dont reflux initially
What are the signs of subacute grass sickness?
Large colon impactions - colic
Rhinitis sicca - sound like darth vader
Dysphagic - lose weight
Patchy sweating
What is the prognosis of subacute grass sickness?
May be euthanased
May progress to chronic
What are the features of chronic form of grass sickness?
Occurs over weeks to months
Rapid severe weight loss
Mild recurrent colic
Rhinitis sicca
Sweating
Narrow base stance - elephant on a ball
How is grass sickness diagnosed?
Exclusion based diagnosis
Phyenylephrine eye test on ptosis - not very accurate
Tongue biopsy - difficult
Ileal biopsy - best
Ex-lap
Post mortem
How do you treat acute grass sickness?
IV fluids
Gastric decompression
Histology results - if positive PTS
PTS if doesnt improve
When should you treat for grass sickness?
Horse wants to eat and is able to eat - no reflux or dysphagia
Committed owner
No colic
What is the treatment for chronic grass sickness?
High energy, easily swallowed palatable food
Lots of supportive care
What is the prognosis for chronic grass sickness?
50% will survive
Residual abnormalities - mild dysphagia, sweating
What is duodenitis-proximal jejunitis (DPJ)? What does it cause?
Inflammed and oedema of duodenum and jejunum from bacteria or unknown aetiology
Causes ilius, reflux, colic, GI distention, hypovolaemia, endotoxaemia
What are the clinical signs of peritonitis in horses?
Toxaemia
Weakness
Colic
Tachycardia/Tachypnea
Circulatory failure
Sweating
Red gums
How do you diagnose peritonitis?
If its fever and colic combined then it will either be colitis or peritonitis
Take PERITONEAL FLUID SAMPLE
Colitis usually accompanied by diarrhoea
What can be seen on peritoneal fluid sample to diagnose peritonitis?
Neutrophils
What is the treatment for peritonitis?
Euthanase if rupture
Fluids, flunixin
Antibiotic - penicillin, gentamycin
What is the risk of doing surgery in peritonitis case?
Adhesions
What causes IBD?
Immune mediated disease
What are the clinical signs of IBD?
Acute or chronic colic
+/-Diarrhoea with no fever
+/-Weight loss
How do you diagnose IBD?
Biopsy - preferably by ex-lap, can do rectal
What is the treatment for IBD?
Prednisolone - corticosteroids
Diet - hay, yeasacc, probiotics
Increase short fibre - grass
What are the two types of gastric ulcer a horse can get?
Squamous and glandular
Where is a glandular ulcer most likely to form in horses?
In the pylorus
What are risk factors for equine gastric ulcer syndrome?
Exercise
Periods with an empty stomach
Concentrates
What are the clinical signs of equine gastric ulcer syndrome (EGUS)?
Poor performance
Recurrent colic
Polyphagia, weight loss
Change in behaviour/attitude
How can you diagnose equine gastric ulcer syndrome?
Gastroscopy
How do you treat equine gastric ulcer syndrome?
Proton pump inhibitor - omeprazole
Graze - no long periods without food
Less concentrates, more roughage
What does hypermetric bounding pulses mean in horses?
Circulatory shock
What does weak thready pulses mean in horses?
Circulatory failure
What does red mucous membranes mean?
Circulatory shock?
What does purple rings mean around the teeth?
Endotoxaemia
Where per rectum can you palpate the pelvic flexure in horses?
Left ventral quadrant
What on nasogastric intubation suggests obstruction?
Large amounts (more than 1-2L) of dark malodorous fluid
Is usually light coloured mucous
What does high lactate suggest?
Tissue ischaemia
Where do you do abdominal paracentesis in a horse?
Ventral midline 4 inches caudal to the sturnum
What is the normal colour of abdominal fluid?
Clear or straw coloured
What does amber/orange abdominal fluid indicate?
Vascular compromise eg FIP
What does red/black abdominal fluid indicate?
Necrosis
What does cloudy abdominal fluid indicate?
Cellular - peritonitis
What are red flags of colic?
Nasogastric reflux more than 5L
Rectal findings - dilated SI, colon torsion
Severe mm congestion
Unrelenting pain
HR more than 60bpm
What percenage of colic cases are surgical?
7-9%
What are the survival rates for medical and surgical colic?
medical -91% survive
Surgical - 69% survive
What is the first structure visible as you incise into the abdomen?
Caecum
What is an anti adhesion treatment in equine surgery?
Carboxymethylcellulose - CMC
What is the blood supply to the small intestine?
Cranial mesenteric artery
Caecocolic artery
What is a common cause of strangulating intestinal lesions in horses?
Lipomas - usually older fat pony geldings
How long does it take for the intestinal mucosa to become necrotic?
4-5 hours
What is any intussception involving the caecum linked to?
Tapeworms
What is the most common indication for intestinal surgery in foals between 2-4m old?
Small intestinal volvulus
What is the epiploic foramen?
Slit like opening into the omental bursa in right dorsal abdomen
What vices predispose a horse to epiploic foramen entrapment herneation?
Wind sucking
Crib biting
What are common internal hernias in horses?
Nephrosplenic space
Epiploic foramen entrapment
Gastrosplenic ligament incarceration
What is the mesodiverticular band?
Resisdual persistent embryonic vitteline duct - forms a mesenteric pouch which SI gets trapped in
What is Mechels diverticulum?
A remnant of the embryonic yolk sac which can form diverticulum of jejunum and trap SI
What is the most common external hernia? Is it dangerous?
Umbilical hernia - rarely causes pathology
What are the two types of inguinal hernia? What do they cause?
Indirect - common, reducible, fine
Direct - tear in peritoneum, intestine in subcut tissue, local swelling and necrosis, painful
How do acquired inguinal hernias occur in horses and how are they treated?
Post mating
Castration complication
Testicle gets congested due to pressure on vessels - castrated
What diseases do you do intestinal biopsies for in horses?
Chronic IBD
Recurrent intermittent colic
Malabsorption
Neoplasia
Equine grass sickness
What is the order of the large intestine in horses?
Right ventral colon - sternal flexure - left ventral colon - pelvic flexure - left dorsal colon - diaphragmatic flexure - right dorsal colon - small colon - rectum
What is the most common colon entrapment? What is the other name for it?
Nephrosplenic entrapment
= left dorsal displacement
What causes nephrosplenic entrapment?
Excess gas production and altered motility
What horses tend to get nephrosplenic entrapment?
Mature performance horses - 4-8 years
What are the signs of nephrosplenic entrapment?
Pain
Spleen displaced medial and ventral on rectal palpation
Colon distended
How do you treat nephrosplenic entrapment?
Starve
Fluids
Analgesia
Phenylephrine - splenic contraction
Rolling - right recumb to left
Surgical correction
What is the success rate for medically managing nephrosplenic entrapment cases?
75% success rate
What causes RIGHT dorsal displacement of the colon?
Thought to be impaction at the pelvic flexure - displaces cranially causing twisting of colon
What is found on rectal examination of right dorsal displacement of the colon?
Bands on the distended colon run transversely across the pelvic inlet
Cant feel caecum
Which colon displacement does high GGT indicate?
Right dorsal displacement
What is the most critical problen affecting the horses large colon that requires urgent surgery?
Large colon volvulus
Where does larhe colon volvulus tend to occur?
Sternal flexure
Or at right ventral colon attachment to caecum
What causes large colon volvulus? What horses are typically affected?
Unknown cause
But usually affects larger horses, particularly multiparous brood mares that foaled in last 3 months
What happens in a caeco-caecal or caeco-colic intussuception?
Tip of cecum invaginates into the body
May continue so its inside out
What are the risk factors with caeco-caecal or caeco-colic intussuception?
Prone to rupture
May not be able to reduce - may need resecting
Abdominal contamination risk
What is the name for mineralised concretions of food material?
Enteroliths
What are the pain scoring systems in horses?
Horse grimace scale
Equine acute abdominal pain scale
Post abdominal surgery pain assessment scale
What is the maintenance for fluids?
2ml/kg/hr
So roughly 1L/hr for 500kg horse
How do you feed a horse that is refluxing?
No food by mouth
Hydrate by IV
May need to muzzle to stop horse eating bedding
Only feed small amount of water and hand picked grass/wet mash concentrates once stop refluxing
What is used to significantly reduce incisional infections?
Belly bandage
How should horses exercise post operatively?
Initial box rest for 6 weeks - very short hand walks
Small paddock after 6 weeks
Ridden exercise after 3 months
What percentage of horses get post op colic?
28-30%
How do you manage rectal tears?
Incomplete tear - starve then laxative diet with antibiotics
Complete tear - euthanase
What are two potential complications of colic surgery immediately post op?
Endotoxaemia
ilius
What can endotoxaemia lead to?
Laminitis
Disseminated intravascuar coagulation
How do you treat endotoxaemia?
Fluids
Flunixin
Hyperimmune plasma
How do you treat ileus immediately post op?
Nasogastric intubation
FLuids
Prokinetics - lidocaine
What is a reaction to the jugular catheter in horses?
Jugular thrombophlebitis
What is usually the treatment for adhesions?
Euthanasia
