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BVM3 Alimentary > Horse Colic - Diagnosis > Flashcards

Horse Colic - Diagnosis Flashcards

1
Q

What is the annual % of horses developing colic?

A

10%

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2
Q

What % of horses with colic respond to medical therapy after 1-2 treatments?

A

75% and 89% respectively

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3
Q

What % of horses with colic require referral/surgery?

A

Anywhere from 2-10%

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4
Q

What is “simple colic”? What proportion of colics fall into this category?

A

Simple distension - spasmodic or gas colic
Majority of colics seen in practice fall into this category

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5
Q

What is the clinical presentation of “simple colic” ie. spasmodic and gas colic - give brief causes, clinical signs, treatment

A

Spasmodic - gut spasms, not sure what causes it, respond well to 1-2 doses of analgesics
Gas colic - flatulence, too much rich grass, no other clinical signs

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6
Q

What are the 2 causes of simple obstruction in the horse?

A

Intraluminal obstruction
Non-strangulating displacements or entrapments

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7
Q

Define simple obstruction

A

Mechanical obstruction of SI or LI that results in obstruction of food or gas moving through gut
Results in distension and subsequent pain

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8
Q

What is an intraluminal obstruction? How common is this presentation? How are these cases usually managed?

A

Impaction within the lumen of the intestine
Common medical condition in horses
Horse presents as cardiovascularly stable and can be managed in the field

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9
Q

What is a non-strangulating displacement? How are these cases usually managed?

A

Entrapment of intestine due to proximal part of the intestine being gas/fluid/ingesta filled
Can usually be managed medically

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10
Q

What can happen if a simple obstruction is not managed well medically?

A

Can become more severe and decrease perfusion to mucosa, which can compromise patient cardiovascularly (more serious case)

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11
Q

What is a strangulating obstruction?

A

Infarction - cut off blood supply to a portion of the intestine
Compromised blood flow to intestine as a result of twist/entrapment = ischemic necrosis

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12
Q

What kind of intervention is required for strangulating obstruction?

A

Surgical intervention required
Very painful - needs analgesia

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13
Q

How does a patient with strangulating obstruction typically present?

A

cardiovascularly compromised due to toxins in the blood - emergency situation

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14
Q

What kind of test should you perform to determine the severity of infarction in the horse?

A

Abdominocentesis of abdominal fluid

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15
Q

What are the top differentials for a horse with inflammatory/toxic colic (Hint - give LI and SI causes)?

A

SI - enteritis, strangulation
LI - acute colitis, diarrhea

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16
Q

What are the 5 main causes of colic?

A

Simple distension
Simple obstruction (impaction)
Strangulating obstruction (infarction)
Inflammatory/Toxic
Non-GIT (false) colic

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17
Q

What is the diagnostic approach for a colic work-up?

A
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18
Q

What are the 2 immediate assessments you must make when arriving on a farm to treat a horse with colic (immediate needs of the horse)?

A

Rapid assessment of cardiovascular status
Degree of pain

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19
Q

Heart rate is an important indicator of WHAT in the sick patient?

A

Cardiovascular system status

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20
Q

HR over ___ is associated with mortality rate of 38-55%
HR over ___ is associated with mortality rate of 83%

A

> 80/min
90/min

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21
Q

Abnormal color of ____ and altered ____ associated with 23-40% risk of post operative death (Hint - another important indicator of CVS status)

A
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22
Q

Severity of pain is associated with increased WHAT in the colicing patient?

A

higher risk of mortality

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23
Q

Pain is a very important indicator for the need for WHAT kind of intervention for the colicing patient?

A

Surgical intervention

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24
Q

What are the typical pain signs in the horse?

A

Recumbency, Restlessness
Flank Watching, Flehmen
Stretching, Kicking at abdomen
Pawing
Trying to go down
Rolling, Sweating

25
Q

When seeing a colicing patient: What is step 2 after assessing the patient’s immediate needs?

A

Obtain a very thorough history

26
Q

What is SHED-C (history)?

A

Signalment
Medical history
Environment
Diet
Complaint

27
Q

What are some important questions to ask about a colicing patient’s history?

A

Age
Time of colic onset
Degree of colic shown
Any treatments given
Previous colic
Last passed feces
Management
Worming regime

28
Q

What GI issue can increase the likelihood of colic? Why?

A

Intestinal parasites
Impaction in the intestine

29
Q

You should always complete a thorough physical exam in a colicing patient, but you should especially focus on what?

A

Demeanor, signs of pain
Behavior, abrasions
TPR
CV status (MM, pulses, skin turgor)
GI borborygmi
Abdominal distension

30
Q

Abrasions around the head suggest what kind of behavior in a colicing patient?

A

Rolling, recumbency

31
Q

What can a depressed, quiet horse with many abrasions indicate in terms of colic?

A

Horse has likely had colic for a long time (long term colic)
Generalized, dull discomfort, no longer in severe pain
Now just very depressed, needs to be worked up

32
Q

When should you take a horse’s temperature on physical exam?

A

Before rectal

33
Q

What are your top DDx for colic in a febrile patient?

A

Typhylocolitis (inflammation of cecum and colon)
Peritonitis
Enteritis
Potential rupture?

34
Q

What kind of gut sounds would you expect to hear with a strangulating obstruction?

A

Quiet or absent

35
Q

What does a high pitched ping suggest on auscultation/percussion of a horse with colic?

A

Gas distension of a viscus (large intestine)

36
Q

If you notice abdominal distension on a colicing patient, what does this tell you about the location of the lesion?

A

Suggests a large colon problem

37
Q

What % of the abdomen can you palpate on rectal exam?

A

20-40% of the abdomen

38
Q

How often can you reach a diagnosis based on rectal palpation of a colicing patient?

A

Often you do not reach a diagnosis
You use it as a tool to provide more information regarding severity of the problem and inform the need for surgery

39
Q

What are the aims of rectal palpation/examination of a patient with colic?

A

Identify normal structures
Identify distension (localize to LI/SI)
- Identify gas vs. ingesta
Identify displacements
Identify abnormal structures
- Masses, etc.

40
Q

What are the important tools you need in order to perform a proper rectal examination?

A

TAKE CARE
Restraint - physical or chemical
Spasmolytic (Buscopan)
Lubrication

41
Q

What are the normal structures that you can feel on rectal exam of a horse?

A
42
Q

What are the rectal exam findings that may indicate the need for referral?

A

Tightly distended loops of SI (bicycle tires)
Tightly gas distended large colon
Tight or painful taenial bands
Palpable hard masses Ex. enteroliths

43
Q

What should be done in all (or most) colicing horses (for stabilization)?

A

Passing NG tube

44
Q

Why should NG tube be passed in all (or most) colicing patients?

A

Horses cannot vomit
Stomach will rupture if it becomes too full, which is fatal for the horse
Better to pass NG tube to relieve gastric distension, fluid/gas will pass up NG tube
Saves patient!

45
Q

What should you NEVER do when passing NG tube?

A

NEVER force anything, must be done very gently

46
Q

What does reflux from NG tube over 2L indicate in the colicing patient?

A

Abnormal - suggests SI dysfunction

47
Q

Are you allowed to give anything via NG tube if patient has reflux coming out?

A

No - do not give anything via the tube if you get any reflux

48
Q

If reflux from NG tube is not spontaneous, what can you do?

A

Set up siphon, not likely to be spontaneous

49
Q

What are the indicators for the need to refer a colicing patient?

A

Unrelenting pain or poor response to analgesics
Progressive abdominal distension
Absent borborygmi
Gastric reflux
Abnormal peritoneal findings
Abnormal rectal findings
Systemic deterioration

50
Q

What are your main aims when formulating a treatment plan for a colicing patient?

A

Restore GIT function if required
- Surgical decompression, enterotomy, resection/anastomosis, correction of displacements
Control visceral pain
Soften and facilitate passage of ingesta
Correct and maintain dehydration and electrolyte, acid/base abnormalities
Treat endotoxemia
Treat ileus

51
Q

What is the best short-acting visceral analgesic for horses?

A

a-2 agonist Ex. xylazine, detomidine, romifidine

52
Q

What should you evaluate when using ultrasound to assess a colicing patient?

A

Evaluate peritoneal fluid, size of viscus (SI), position of viscus (LI), liver, kidneys, spleen

53
Q

What is the FLASH protocol for abdominal ultrasound of the horse?

A
54
Q

What should you do if you notice fluid distension of the stomach on ultrasound of a horse with colic?

A

Pass NG tube IMMEDIATELY!

55
Q

When the left kidney is no longer visible adjacent to the spleen on U/S what is this suggestive of?

A

Nephrosplenic entrapment

56
Q

What is normal vs. abnormal fluid obtained on abdominocentesis?

A
57
Q

What is this fluid obtained on abdominocentesis suggestive of? What does the lactate indicate?

A
58
Q

What values on BW are useful indicators of hydration status?

A

TP and PCV

59
Q

What is lactate a useful indicator of?

A

Lactate useful indicator of tissue perfusion and helpful in identifying horses with cardiovascular compromise that will likely require referral

BVM3 Alimentary (24 decks)

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