Colic Decision Making

Question 1

Give 2 examples of simple colics

Answer 1

Spasmodic, impaction

Question 2

Give 3 examples of potentially complicated colic

Answer 2

Displacement, enteritis, colitis

Question 3

What is a definitive surgical colic?

Answer 3

Strangulating lesion

Question 4

What is a common cause of non-GI colic?

Answer 4

Pariparturient mare uterus

Question 5

What are 3 general causes of abdominal pain?

Answer 5

• Distension (MECHANICAL: gas, fluid, ingesta or FUNCTIONAL)
• Inflammation/ischaemia of intestine
• Irritation of peritoneum

Question 6

What are the 2 forms of mechanical obstruction?

Answer 6

• Non-strangulating eg. impaction , displacement

- Strangulating eg. volvulus, torsion, incarceration

Question 7

Where are impactions usually seen?

Answer 7

• pelvic flexure and RDC -> thin transverse colon flexure

Question 8

Where are displacements usually seen

Answer 8

LI

Question 9

What are functional obstructions?

Answer 9

Motility (paralytic) dysfunction - ileus etc. [blood supply not compromised]
- Enteritis, grass sickness [equine dysautonomia], post-surgical ileus

Question 10

What are cuases of inflammation? Are these strangulating?

Answer 10

Enteritis, colitis, typhlitis, peritonitis

Question 11

What are causes of ischaemia?

Answer 11

• Volvulus, torsion, incarceration
• Thrombotic
• Parasitic [migrating strongylus vulgaris larvae, coagulopathy, DIC]

Question 12

Outline the 6 non-strangulating lesions that may cause colic

Answer 12

• Spasmodic colic
• Impaction
• Displacement
• Enteritis/ileus
• Typhocolitis
• Peritonitis

Question 13

In horses where does the cause of diarrhoea ALWAYS originate?

Answer 13

LI

Question 14

How do SI pathologies manifest?

Answer 14

Spontaneous reflux

Question 15

What time frame do you have for saving strangulating lesions?

Answer 15

~ 1 hour = viable intestine (distension of intestine and stomach)
~ 3-4hrs = Compromised intestine (leakage of blood/protein -> abdo, loss of fluid -> intestine [may -> hypovolaemic shock])
~ 6-8hrs = Dead intestine (absorption of toxins -> blood)

Question 16

Give 7 causes of strangulating lesions of the SI to cause colic. Which is most common? Which is rare?

Answer 16

1. Volvulus (root of mesentry)
2. Strangulating lipoma [most common]
3. Epiploic foramen entrapment [R abdo between portal V and caudal vena cava]
4. Inguinal/scrotal hernia
5. Intussusceptions
6. Diaphragmatic hernia [rare]
7. Mesenteric rent

Question 17

Give 2 causes of strangulating lesions of the LI to cause colic. How serious are these problems?

Answer 17

1. Colon torsion - very severe colic.
2. Intussusception
   - Ceaco-colic
   - Ileo-ceacal
   - Ceaco-ceacal

Question 18

What clinical signs distinguish SI lesions?

Answer 18

• reflux (though may be absent)

- Distended SI (palpable on rectal, ultrasound)

Question 19

What clinical signs distinguish LI lesions?

Answer 19

± abdo distension

• impaction/gas accumulation palpable on rectal
• distension of LI palpable on rectal
• no reflux (usually)

Question 20

Give 2 SI conditions requiring medical Tx

Answer 20

• Enteritis/ileus

- Grass sickness

Question 21

Give 7 conditions requiring surgical Tx

Answer 21

• Volvulus (root of mesentry)
• Strangulating lipoma
• Epiploic foramen entrapment
• Inguinal/scrotal hernia
• Intussusceptions
• Diaphragmatic hernia
• Mesenteric rent

Question 22

How is grass sickness Dx?

Answer 22

Biopsy (ileal?)

Question 23

Give 6 LI conditions requiring medical Tx

Answer 23

• Spasmodic colic
• Impaction
• Left dorsal displacement
• Right dorsal displacement
• Colitis
• Typhlocolitis

Question 24

Give 2 LI conditions requiring surgical Tx

Answer 24

• Colon torsion

- Non-resolving displacement and impactions

Question 25

In what situations should a colic be referred?

Answer 25

- SI lesions (Sx likely, medical cases need intense Tx) - Conditions requiring intensive medical Tx (enteritis/colitis) - Non-resolving impactions (IV fluids, surgery if displaced) - Recurring/chronic colic for further work up

Question 26

How much does a medical colic cost to treat in referral centres? Surgical colic? Colitis/enteritis?

Answer 26

~ £1000-£3000 ~ £4000-£7000 ~ £2000-£5000

Question 27

How should referral be decided wrt owner?

Answer 27

- age of horse - willingness to undergo abdo surgery - insurance (type of cover, be aware colic may have been removed if suffered previously)

Question 28

SEE LECTURE FOR FINDINGS ON HISTORY, PE, NGT, TX RELATED TO PROGNOSIS ETC.

Answer 28

~

Question 29

What complications can be seen <2-4 weeks post-surgery?

Answer 29

- aneasthetic complications (1/100 die) - post-op colic - post-op ileus (reflux) - incisional complications (dehiscence, infection) - thrombosis - peritonitis - laminitis

Question 30

What complications can be seen >2-4 weeks post-surgery?

Answer 30

- recurrent/chronic colic due to adhesions | - Incisional hernia

Question 31

What are the prognoses for a) simple medical colic? b) non-strangulating surgical colic? c) strangulating SI lesion? d) strangulating LI lesion?

Answer 31

a) 90% good b) 70-90% good c) guarded (without resection 60-80%; with resection 50-70%) d) guarded/poor (wihtout reseaction 36-83%; with resection[rarely possible] 50-80%)