what is colic
- abdominal pain
- not a disease, but a group of clinical signs
- can be both GI and non-GI caused
- one of most common deaths, 20-28%
non-GI causes
-pneumonia
-uterine torsion
renal or bladder stones
laminitis
‘tying up’
neurological diseases
normal foaling, abortion, dystocia
ruptured bladder
GI causes
esopageal obstruction equine gastric ulcer syndrome (EGUS) intestinal obstructions (simple or strangulations) duodenitis-proximal jejunitis (DPJ) parasite impaction ileus inguinal hernia sand impaction of large colon nephrosplenic entrapment right dorsal displacement of large colon large colon volvulus, impaction right dorsal colitis due to NSAID toxicity potomac horse fever salmonellosis
clinical signs
pawing, rolling, kicking or biting abdomen, repeated turning to look at flank
posturing to urinate, sweating, repeated lying down or getting up, sitting dog-like or lying on back, lack of appetite, putting head down to water without drinking, rapid respiration and/or flared nostrils, teeth grinding, fewer feces indicating lack of bowel movements
role of veterinarian
gather info about history: living conditions:pasture vs stall -feed? daily routine? changes in routine? medical/colic history? solic surgery? parasite control? pregnant?
colic specific history
duration of colic signs?
last time fed?
last time seen defecating?
have clinical signs change? pain worsened?
administered medication? analgesia, sedatives? have these helped?
physical exam
temp, resp, heart rate (normal= 38C, 10-14RR, 28-40HR)
increases in any can reflect pain
-caution on HR>50=pain, low blood volume, perfusion, or endotoxemia
-attitude
mucous membranes: purple gums=toxemia, pale=dehydration
-distended abdomen?
(note: horse may need sedation)
exam diagnostics: nasogastric intubation procedure
- important for relieve pressure in stomach and examine reflux
- place tube in nares, down esophagus and into stomach
- blockage will result in build up of fluids in stomach
nasogastric intubation results
- consider amount, colour, smell, and pH
- > 2L and alkaline pH indicates small obstruction in small intestine
- 3-6L/hour for 3-7 days, brown and fetid odor indicats DPJ and requires immediate treatment
Auscultation
- listen with stethascope for frequency, intensity, and duration of sounds
- should be sounds in all 4 quadrents
- listen for percussion/ping, and where the ping occurs
rectal palpation
- can find where in GIT distension occurs, and whether it is fluid, gas, feed, or soild
- check the following: spleen, left kidney, nephrosplenic space, base of mesentery, pulse of aorta, cecum (normally flaccid), pelvic brim and inguinal rings, bladder, pelvic flexure of large colon, dorsal and ventral colon, and small colon
other diagnostic tests
abdominocentesis-collect fluid from peritoneal cavity, can help identify strangulating lesions (red-necrotic gut, have to measure proteins in cells)
- ultrasound
- blood tests
- fecal culture/PCR
- sand test
surgical colic requirements
pain: uncontrollable without drugs or severe
- gastric reflux: >2L alkaline, yellow
- rectal exam abnormal-distended small intestine, large colon, distension unresponsive to medical treatment, palpable foreign body
- peritoneal fluid: high rbc/wbc count evidence of devitalized gut (requires immediate surgery)
medical colic
- no pain, easily controlled
- high temperature
- few wbc=serious infection
- normal motility when ausculate
treatment 3 steps
- analgesia (NSAIDs, sedatives, opiates)
- fluid therapy (laxitives, oral fluids, IV fluids)
- husbandry (fasting, preventing self-injury_
analgesia
- pain control most important therapeutic factor for all colics
- may be sole therapy in some like spasmodic colic
- may be adjunctive therapy like in strangulating lesions
fluids
correcting dehydration
softens intestinal contents
administer with IV or somtach tube
-use laxatives like mineral oil or mucilloid for sand collic
fasting
slowly reintroducing feed until horse has passed significant amount of feces and or mineral oil
classifications of colic
distension
- simple obstruction or blockage
- obstruction or blockage with partial or complete shut-off of blood supply
- enteritis or colitis (inflammation)
distension
no blockage but digestive material cannot move, it is painful
-ie. gas colic, spasmodic colic
simple obstruction or blockage
- material cannot move in GIT but vascular flow remains intact
- mild to moderate pain and slow to progress
- ie. feed impaction, parasite impaction, enteroliths, sand, foreign bodies, entrapments
obstruction or blockage with partial or complete shut-off of blood supply
- aka strangulating obstruction
- constant and severe pain with rapid descent into shock due to intestinal death and subsequent release of toxins and bacteria into bloodstream
- ie. torsions, pedunculated lipomas, epiploic foramen entrapment, intussception
enteritis/colitis
inflammation in wall of intestine, which causes stasis
-ie. salmonella diarrhea, gastric ulcers, potomac horse fever, DPJ
prognosis, % need of treatment for colic
40% recovery without therapy
30% recover with moderated therapy, pain relief, mineral oil
20% require intense medical therapy ie repeated pain control, fluids, mineral oil
10% require surgery or immediate euthanasia
