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Y4 EQ - Gastrointestinal tract > Medical treatment of colic > Flashcards

Medical treatment of colic Flashcards

1
Q

Why is colic so important in practice?

A

One of the most common emergencies in first opinion equine practice

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2
Q

List some risk factors for critical colic cases

A
  • Pain score
  • Heart rate
  • CRT
  • Weak pulse
  • Absence of gut sounds in one or more quadrants
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3
Q

Describe the steps involved in approaching a colic case

A
  • History taking
  • Observation
  • Clinical exam
  • Assessment
  • Plan
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4
Q

How is the plan for colic cases devised?

A

Results of clinical exam and further tests
-> medical or surgical colic?
- Medical = analgesia and repeat examination
- Surgical = contact referral facility asap

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5
Q

List the indications/clinical signs that show colic can be managed medically

A
  • Mild/moderate pain
  • Good response to analgesia
  • HR <50bpm
  • GI motility continuing
  • No net reflux
  • Resolving/no abdominal distention
  • Normal peritoneal fluid
  • Normal PCV/TP and systemic lactate
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6
Q

Why should you keep your mind open during colic cases

A

A diagnosis may not always be possible on the initial examination
Response to initial medical treatment and results of repeat clinical examination are key

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7
Q

Which diagnostic finding is always an indication for the possible need for surgery in colic cases

A

Non-response to analgesia

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8
Q

What are the key components of medical treatment for colic?

A
  • Analgesia
  • +/- oral fluids
  • +/- other specific therapies based on initial diagnosis: IV fluids, Phenylephrine, psyllium
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9
Q

What needs to be considered when providing horses with analgesia for colic?

A

Potency
Duration of action
Sedative / other effects e.g. smooth muscle relaxation
Potential side effects

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10
Q

The 3 main analgesia agents used in colic cases are?

A

NSAIDs
Alpha 2 agonists
Opiates

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11
Q

Name 5 NSAIDs that can be used for colic cases

A

Phenylbutazone
Flunixin
Metimazole - Buscopan compositum
Ketoprofen
Meloxicam

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12
Q

Describe the features of phenylbutazone for use in colic cases

A
  • Moderate potency
  • 12 hours duration
  • Beware perivascular administration
  • Good first line analgesic for the colic case with mild/moderate pain
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13
Q

Describe the features of flunixin for use in colic cases

A
  • Potent analgesia
  • 12 hours duration
  • Very effective in masking increase in HR with SIRS (endotoxaemia)
  • Should be used with caution in cases of colic showing mild/ moderate pain where cause is unknown
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14
Q

Name 3 alpha 2 agonists that could be used in colic cases

A

Xylazine
Romifidine
Detomidine

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15
Q

Describe the features of xylazine for use in colic cases

A

Good analgesia
Short acting ~ up to 30 mins duration in painful colic cases
Very useful in assessment of the painful colic case

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16
Q

Describe the features of romifidine for use in colic cases

A

Around 2-4 hours analgesia in colic cases
Usually combined with butorphanol
Can also be administered IM
Useful in colic cases showing moderate – severe signs of pain

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17
Q

Describe the features of detomidine for use in colic cases

A

Potent analgesia for around 2-4 hours in colic cases
Usually combined with butorphanol
Useful in colic cases showing moderate – severe signs of pain

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18
Q

Name 3 opiates used in colic cases

A

Butorphanol
Pethidine
Morphine

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19
Q

Describe the features of butorphanol for use in colic cases

A

Usually combined with alpha 2 agonist
Can be used on its own
Useful in colic cases that are moderately / severely painful

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20
Q

What is the action of Butylscopolamine/Hyoscine?

A

Smooth muscle relaxant

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21
Q

What is Buscopan compositum?

A

Muscle relaxant combined with Metimazole (NSAID)

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22
Q

When is butylscopolamine indicated/useful?

A
  • Indicated in spasmodic colic cases / mild colic pain
  • Useful when performing rectal examination where horses are straining: reduces the risk of a rectal tear occurring
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23
Q

Why is the use of flunixin debated?

A
  • Its a potent analgesic
  • Signs of colic masked: owners may not appreciate the severity of the situation
  • Masks the effects of SIRS (endotoxaemia): increases in HR and PCV are delayed
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24
Q

When is it acceptable to give flunixin? (3 scenarios)

A
  1. When referral is not an option & horse is exhibiting moderate / severe pain (if no response seen euthanasia is appropriate)
  2. When an exact diagnosis is known & medical treatment is appropriate (e.g. pelvic flexure impaction)
  3. When the decision to refer has already been made
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25
Q

In which situation would you be cautious to give flunixin?

A

Mild / moderate pain of unknown cause & where referral is an option

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26
Q

Describe the administration and uses of oral fluids

A
  • Easy and inexpensive
  • 4-6 litres water (500kg horse) / electrolytes administered q.4h by nasogastric intubation -> stimulates gastrocolic reflex
  • Can place an indwelling stomach tube for continuous administration of fluids
  • Provides hydration provided the horse is not refluxing
  • Hydrates ingesta assisting resolution of large colon impactions
27
Q

Describe the administration of IV fluids

A

Expensive
Does not directly hydrate ingesta – excess fluids lost by urination
Difficult to administer and monitor safely outside clinic facilities

28
Q

When are IV fluids indicated?

A

Reflux obtained on nasogastric intubation (is there a surgical lesion?)
Severe systemic compromise & immediate systemic support needed

29
Q

Describe the features and signs of spasmodic colic

A
  • Pain due to intestinal spasm
  • Undiagnosed / spasmodic colic is the most frequent diagnosis in first opinion veterinary practice
  • Mild pain
  • Normal cardiovascular parameters
30
Q

How is spasmodic colic treated in most cases?

A

Butylscopolamine +/- NSAID (metimazole / phenylbutazone)

31
Q

Describe the features and signs of large colon impaction

A

Mild / moderate signs of pain
Classic findings on rectal examination: doughy, firm structure on LHS of caudal abdomen

32
Q

What is a common epidemiological clue for large colon impaction?

A

Recent increase in stabling due to weather/injury

33
Q

How can you make sure not to confuse a large colon impaction with secondary large colon impaction?

A
  • Corrugated feel: not smooth and large ‘vacuum packed’
  • Usually a primary small intestinal lesion
  • Results of initial +/- repeat assessments indicative of need for surgical management
34
Q

How is a large colon impaction treated?

A

Oral fluid therapy via nasogastric intubation q.4h until faeces passed
Analgesia – IV flunixin meglumine appropriate
Surgery may be required in some cases

35
Q

What can be added to oral fluids in large colon impaction cases? Why?

A

Magnesium sulphate as an osmotic laxative agent to increase hydration of ingesta

36
Q

Caecal impactions may occur in horses secondary to treatment for which conditions?

A

Important to monitor faecal output in hospitalized horses that have been treated for a painful ocular / orthopaedic condition and received NSAIDs

37
Q

Describe gastric impaction as a cause of colic

A
  • Uncommon cause
  • Variable history and presenting signs
  • Medical / surgical management depends on severity of findings
  • May be suspected on ultrasonographic assessment – gastric distention
38
Q

How is a gastric impaction colic diagnosed?

A

Gastroscopy

39
Q

How is gastric impaction treated?

A

IV fluid therapy
Repeat gastric lavage important
+/- use of carbonated drinks

40
Q

Describe the medical therapy needed for large intestinal displacement/distention

A
  1. Analgesia – careful monitoring if using potent analgesia
  2. Light walking / trotting exercise
  3. Oral fluid therapy – bolus fluids as for primary large colon impaction
  4. Withhold feed until faeces start to be passed
41
Q

When can large intestinal displacement/distention be managed medically?

A

Horses CV parameters normal
Degree of pain not severe
Marked gaseous distention of the large colon is absent

42
Q

When is surgical intervention indicated for large intestinal displacement/distention?

A

Severe pain / marked or increasing gas distention of colon
Deteriorating CV parameters
Non-response to treatment

43
Q

How is nephrosplenic ligament entrapment diagnosed?

A

Rectal examination
Ultrasonography

44
Q

How does nephrosplenic ligament entrapment appear on ultrasound?

A

Failure to image left kidney and spleen – gas distended large colon visualised

45
Q

Medical vs surgical management of nephrosplenic ligament entrapment depends on?

A

Initial evaluation
Medical therapy indicated if systemic status good, pain can be controlled and mild degree of gaseous distention

46
Q

Describe how to medically treat nephrosplenic ligament entrapment

A

Phenylephrine infusion
Horse lunged for 15 mins
Repeat rectal examination to assess if LC has repositioned itself
* increased risk of haemorrhage in older horses (>15 y.o 64 x the risk) – owners should be made aware of this

47
Q

When does sand colic occur?

A

More common in certain geographic regions
Potential to ingest sand
- Sandy soil
- Poor grazing
- Turnout on sand arenas

48
Q

Why does sand cause colic?

A

Irritation of the colonic mucosa by sand can result in diarrhoea / recurrent mild colic
Can cause colonic impactions and colon displacement / torsion

49
Q

How is sand colic diagnosed?

A

Sand in the faeces
Classic ‘seashore’ sound on auscultation
Sand retrieved on abdominocentesis
Ultrasonography
Abdominal radiography

50
Q

Medical/surgical management of sand colic depends on?

A

Presenting signs of colic

51
Q

How can you treat mild cases of sand colic?

A

Remove source of sand
Provide plenty forage
+/- psyllium added to feed intermittently

52
Q

How is a medical sand colic treated?

A

Intensive medical treatment with Magnesium sulphate and psyllium sulphate
Monitoring of clearance using radiography

53
Q

Describe the features of colic in neonatal foals

A

Degree of pain is less useful to assess need for potential surgery - Enteritis can present as severe abdominal pain
Ultrasound particularly valuable (+/- radiography occasionally indicated)

54
Q

List the most likely causes of colic in the neonatal foal?

A

Meconium impaction
(Ruptured bladder)
Enteritis
SI volvulus
Congenital anomalies

55
Q

How does colic in donkeys most commonly present?

A

Signs of dullness – uncommon to show marked signs of colic
Degree of pain less useful

56
Q

Which type of colic is most common in donkeys?

A

Colonic impactions

57
Q

What should be assessed when colic is suspected in donkeys?

A

Always check for dental abnormalities
May be due to ingestion of foreign materials in working equid populations

58
Q

What is the main advice to give to the owners in colic cases?

A
  • Remove feed & leave water with the horse
  • Ask owners to provide an update in 2 hours, sooner if signs of colic recur
  • If the horse responds to treatment: offer small amounts of food once faeces passed (and increase back to normal over around 24h)
  • If the horse does not respond to treatment perform repeat visit
59
Q

How can recurrence of colic be prevented?

A

Important to consider the potential cause of any medical episode of colic and advise the owner regarding prevention of future episodes
- Parasite testing / discussion about parasite control
- Dental examination / treatment
- General management (irregular turnout / poor feeding management)

60
Q

Name 4 risk factors for recurrence of colic

A

Known dental problem
Crib-biting / windsucking behaviour
Weaving
Time at pasture

61
Q

When should euthanasia be considered in colic cases?

A
  • Uncontrollable pain despite potent analgesia
  • Severe CV compromise: HR >90bpm
  • PCV >60%: purple mucous membranes
  • Gastrointestinal rupture: brown / red ingesta contaminated peritoneal fluid. Profuse sweating, sudden reduction in pain
62
Q

How can you confirm gastrointestinal rupture has occurred?

A
  • Marked, progressive increase in HR, PCV and deterioration in mucous membranes
  • ‘Boarding’ of the abdomen
  • Dark red / brown peritoneal fluid containing ingesta (differentiate from accidental enterocentesis)
63
Q

Why does gastrointestinal rupture occur?

A

Frequently due to rupture of the stomach (usually along the greater curvature)
This is why nasogastric intubation can be life- saving
Hopeless prognosis even if surgery attempted

Y4 EQ - Gastrointestinal tract (9 decks)

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