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Y3 MOD Gastroenterology > Investigation of the colic case > Flashcards

Investigation of the colic case Flashcards

1
Q

Colic is a term used to describe?

A

Abdominal pain

- it is a clinical sign not a disease or diagnosis

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2
Q

What are the clinical signs of colic?

A
  • Flank watching
  • Lying down
  • Pawing at the ground
  • Rolling
  • Repeatedly getting up and down
  • Violently thrashing around
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3
Q

Describe the pathophysiology of colic

A
  • Anything that prevents the normal progression of intestinal contents
  • Simple obstruction
  • Strangulating obstruction
  • Intravascular occlusion of the blood supply
  • The most severe forms will result in shock
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4
Q

Shock due to colic is the result of?

A
  • Loss of the vascular supply to the mucosa
  • Absorption of endotoxins into the circulation
  • Systemic inflammatory response system (SIRS)
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5
Q

What are the different colic classifications?

A
  • Spasmodic
  • Impactions
  • Gas distention
  • Obstructions: simple and strangulating
  • Non-strangulating infarction
  • Inflammation: enteritis, colitis
  • Idiopathic
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6
Q

What initial advice can be given over the phone to the owner in colic cases?

A
  • Put the horse in a well bedded stable (may not be possible in all cases)
  • Remove any buckets / feed / anything it could potentially injure itself on
  • Let the horse roll if it wants to
  • A short period (10 minutes ) of walking exercise is fine but nothing longer than this should be undertaken without veterinary examination firs
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7
Q

How must a violently painful colic be initially managed?

A
  • Quickly assess the horses heart rate (do this before administering any medications)
  • Administer intravenous xylazine (200mg for a 500kg horse): provides analgesia and sedation
  • Obtain a succinct history
  • Perform a clinical exam
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8
Q

What are the key points of information to gather when history taking?

A
  • Signalment, use & pregnancy status
  • Stereotypic behaviour
  • Horse’s usual management: stabling, turnout and feeding
  • Routine parasite prophylaxis & dental care
  • Any changes in feeding, turnout or premises
  • Any ongoing medical problems / medications
  • Previous history of colic/ diagnosis and treatment for this
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9
Q

What are some specific questions to ask for a colic epidose?

A
  • Signs of colic observed
  • When these signs started or when the horse was last seen to be normal
  • Feed intake & faecal output over last 24hours
  • Any diarrhoea
  • History of equine grass sickness on the premises
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10
Q

Describe the initial observation and evaluation of a colic case

A
  • Any signs of disturbance of the bed / covered in mud?
  • Skin abrasions?
  • Gross abdominal distension?
  • Observe the horse for a short time – does it have colic?
  • Beware: late stages of severe colic
  • Heart rate (28-44bpm normal)
  • MM colour, CRT
  • RR (12-15 bpm normal)
  • Temperature (37.5-38.40C normal)
  • Digital pulses
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11
Q

What are some causes of ‘false colic’?

A
  • Musculoskeletal
  • Respiratory
  • Urogenital
  • Hepatic
  • CNS
  • Endocrine
  • Cardiovascular
  • Haemolymphatic
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12
Q

Describe abdominal auscultation of colic cases

A
  • Palpation is of no use in horses
  • Auscultation to determine whether the normal propulsive / mixing sounds are present is useful (intestinal borborygmi)
  • Listen on both sides of the abdomen for around 1 minute at each quadrant:
    • Normal (++)
    • Reduced (+)
    • Absent (-)
    • Hypermotile (+++)
  • Will be reduced following administration of sedation drugs
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13
Q

What is one of the most useful diagnostic test in the colic case?

A

Rectal exam

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14
Q

What are the main considerations before performing a rectal exam?

A 
Safety is important
• Your safety (kicks)
• Minimising the risk of rectal tears
\+/- sedation (xylazine)
\+/- twitch application
\+/- Administration of butylscopolamine (Buscopan®)
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15
Q

What structures will be felt on a rectal exam?

A
  • Small intestine – inner tubes of bike tyres
  • Large intestine – pelvic flexure / taenia / direction of these
  • Caecum – vertical band
  • Don’t forget the small colon!
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16
Q

Name some abnormal findings on a rectal exam

A
  • Distended Small Intestine
  • Pelvic Flexure Impaction
  • Left Dorsal Displacement
  • Right Dorsal Displacement
  • Large Colon Torsion
  • Caecal Impaction
  • Small Colon Impaction
17
Q

Name some other diagnostic tests that can be used?

A
  • Abdominocentesis
  • Nasogastric intubation
  • Haematology
  • Abdominal ultrasound
18
Q

What is assessed using abdominocentesis?

A

Peritoneal fluid - change in the gut wall will result in a change in this

19
Q

Describe the technique for Abdominocentesis

A 
• Ventral midline 
• Most dependent part of abdomen
• +/- clip, scrub
•  18 g, 1.5 inch needle 
May need spinal needle if fat!
20
Q

Describe the visual assessment of peritoneal fluid

A

Quantity – note if large amount
Colour – normal: straw coloured
Clarity – normal: clear
Ingesta present – enterocentesis / rupture

21
Q

Describe the laboratory assessment of peritoneal fluid

A
  • Total protein (<20g/L)
  • White blood cell count (<5x109/L)
  • Lactate (<2mmol/L)
22
Q

What is important to remember when performing nasogastric intubation?

A
  • Horses cant vomit
  • The stomach will continue to secrete fluid so if there is an obstruction of normal flow of ingesta, large quantities will build up
  • Rupture of the stomach can occur ultimately
23
Q

Describe the nasogastric intubation diagnostic test

A

> 2L net reflux significant

24
Q

Why else is nasogastric intubation good/used for?

A
  • Decompression will also provide some pain relief

- Can be used to administer fluids as part of medical therapy

25
Q

Describe haematological testing for colic cases

A
  • Packed cell volume (normal 35-45%)
  • Systemic total protein (normal 60-70g/L)
  • Systemic lactate (normal <2mmol/L)
  • Other tests may be indicated e.g. white blood cell count, biochemistry
26
Q

What are the used of abdominal ultrasonography in colic cases?

A
  • Very useful in foals
  • Increasingly used in adult horses in practice
  • Per-rectum / per-cutaneous
27
Q

What is one of the most common causes of colic in a foal?

A

Meconium impaction

Ruptured bladder can cause colic signs too

28
Q

Describe colic cases in donkeys

A
  • Usually present with signs of dullness: uncommon to show marked signs of colic
  • Impaction colic common
  • Rectal examination can be performed safely
  • They can have a lot of retroperitoneal fat: spinal needle may be needed for abdominocentesis
  • Always check for dental abnormalities in impaction cases
29
Q

Equine dysautonomia is also known as?

A

Equine grass sickness

30
Q

What is the causative agent of equine grass sickness?

A

Suspected to be toxico-infection with C. botulinum type C

31
Q

Describe equine grass sickness

A
  • Frequently fatal form of intestinal disease (paralytic ileus)
  • Acute, sub-acute and chronic forms
  • Diagnosis based on key clinical signs +/- biopsy (definitive)

Y3 MOD Gastroenterology (3 decks)

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