This document provides information on colic in horses. It begins by defining colic as abdominal pain that can have many potential causes, both within and outside the gastrointestinal tract. The document then discusses the importance of a thorough history and physical examination to determine the severity of colic and appropriate treatment. Key aspects of the history and exam findings that help determine the cause and severity of colic are outlined. Common causes of colic and factors that can predispose horses to colic are also listed.
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This document provides information on colic in horses. It begins by defining colic as abdominal pain that can have many potential causes, both within and outside the gastrointestinal tract. The document then discusses the importance of a thorough history and physical examination to determine the severity of colic and appropriate treatment. Key aspects of the history and exam findings that help determine the cause and severity of colic are outlined. Common causes of colic and factors that can predispose horses to colic are also listed.
This document provides information on colic in horses. It begins by defining colic as abdominal pain that can have many potential causes, both within and outside the gastrointestinal tract. The document then discusses the importance of a thorough history and physical examination to determine the severity of colic and appropriate treatment. Key aspects of the history and exam findings that help determine the cause and severity of colic are outlined. Common causes of colic and factors that can predispose horses to colic are also listed.
Copyright:
Attribution Non-Commercial (BY-NC)
Available Formats
Download as PPTX, PDF, TXT or read online from Scribd
This document provides information on colic in horses. It begins by defining colic as abdominal pain that can have many potential causes, both within and outside the gastrointestinal tract. The document then discusses the importance of a thorough history and physical examination to determine the severity of colic and appropriate treatment. Key aspects of the history and exam findings that help determine the cause and severity of colic are outlined. Common causes of colic and factors that can predispose horses to colic are also listed.
Copyright:
Attribution Non-Commercial (BY-NC)
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Download as PPTX, PDF, TXT or read online from Scribd
P |ake an accurate dIagnosIs In terms of the type of condItIon causIng the colIc and the part of the anatomy Involved. PetermIne the best method of treatment, dIagnostIc workup and offer a realIstIc prognosIs on a colIc case. PolIc means sImply sIgns of abdomInaI paIn orIgInatIng from the CIT (true colc or other organs (1,lse colc. Pusually CastroIntestInal In orIgIn dolor colI P or AbdomInal organ e.g. lIver, spleen,kIdney PThus colIc Is not a specIfIc dIsease or but a clInIcal syndrome cf.AbdomInal crIsIs. P t Is the most common cause of equIne morbIdIty and mortalIty Pnon CT orIgIn abdomInal paIn P|yopathIes PDbstructIve dIsease of the UrInary tract PUterIne contractIon, ovulatIon paIn PAcute hepatItIs/Acute pancreatItIs PPerItonItIs/PleurItIs PAbdomInal abscess, ystocIa, Cranulosa cell tumour P Acute LamInItIs, PrepubIc tendon rupture PDrchItIs, FabIes, Tetanus PystItIs, PyelonephrItIs, PerIcardItIs PDesophageal obstructIon PDver 70 causes of colIc have been IdentIfIed In the horses. P |ore than 90 of the colIc horses that are lIkely seen In practIce are uncomplIcated and respond to medIcal treatment. PolIc Is consIdered a medIcal emergency. PThe clInIcal/physIcal eamInatIon should be rapId but at the same tIme systematIc, very thorough and complete so that no Important clInIcal InformatIon Is mIssed. PTympanIc (gas) colIc: ecessIve gas productIon usually Involves the large colon and /or the caecum Pon stranguIatIng obstructIon : e.g. ImpactIons P$tranguIatIng obstructIons: 8lood supply Interrupted, e.g ;ol;ulus (rotatIon around mesentery, small IntestIne, torson (twIstIng of bowel, large colon, ntussuscepton (telescopIng of bowel, Ileum Into caecum. PIspIacement of boweI: usually large colon, can result In strangulatIng obstructIon. PInfIammatory dIsorders: colItIs and anterIor enterItIs. PonstranguIatIng InfarctIon: ThromboembolIc colIc. PNon ClT 1,lse colc) e.y. bl,//er stone. P$pasmodIc PTympany (gas dIstentIon(gas dIstentIon PntestInal obstructIon (gas dIstentIon P$trangulatIon obstructIon (IschaemIa PonstrangulatIng InfarctIon ( (IschaemIa PnterItIs (spasm or InflammatIon PPerItonItIs (parIetal paIn PUlceratIon (InflammatIon Porses cannot vomIt prone to gastrIc dIlatatIon. PThe left dorsal and ventral colon are not fIed and can dIsplace. PLong mesentery of the small IntestIne prone to volvulus ParrowIng of the lumen of the large colon at the pelvIc fleure. Paecum Is a blInd sac. PTermInatIon of the rIght dorsal colon Into a much narrower small colon. P|econIum ImpactIon (foals 1 5 days PLarge colon torsIon (older mares durIng pregnancy or after foalIng PUterIne artery rupture (mares ImmedIately after foalIng PCas colIc (ew grass pastures, lack of eercIse PernIa through epIploIc foramen (older horses PnterolIths (horses feedIng a dIet wIth too much ammonIum trIphosphate PoreIgn body In feed eg hay nets balIng twIne PPoor dentItIon PIppIng wIth amItraz or DP P$Imple colIc; rIsk horses 2yrs- 10yrs P 1year old rIsk of ulcers E Ileocecal PIntussusceptIons 12 lIpoma PFeduced physIcal actIvIty PCT parasItes, rIbbIng, Pregnancy, PyreIa PTransportatIon, nclement weather PLarge colon dIsplacements (Warmbloods E large frame horses P$trangulatIng lIpoma (horses older than 12 years PLarge colon ImpactIons (poor dentItIon, water deprIvatIon, stable confInement Paecal ImpactIon (older horses P$mall colon obstructIon (ponIes PAscarId ImpactIons (foals after recent dewormIng PAbdomInal abscess (more common In mares Pleum ImpactIons (poor qualIty roughage PIstory of prevIous colIc PPrevIous abdomInal surgery Phange In dIet the last 2 weeks (concentrates/changes . PatIng more than 2.5 kg concentrates/day Phanges In concentrates or hay Porses between 2 10 years old Pay to day care gIven by nonowner (compared to when owner Is carIng for the horse Porses not goIng out In pastures durIng the day Porses where whole mealIes (corn Is part of the dIet Po water In paddock/pasture PThe fIrst aIm should be to determIne the severIty of the colIc and not necessary the eact cause of the colIc. P After the fIrst InItIal eamn you should be able to say If thIs horse should be treated IntensIvely or perhaps referred for surgery or can you treat the horse relatIvely conservatIvely. P T WA$TE UECE$$APY TIhE The foIIowIng aspects of the hIstory are Important: PAttItude of the horse (depressed or alert P$Igns of paIn (onset and duratIon PntensIty and nature of the paIn PPossIble causes (If known PTherapy already gIven (type and response PefecatIon (frequency and composItIon E when last PPregnancy and breedIng hIstory PabItat E management Peed -- type and changes PaIly routIne PUse of horse P|edIcal hIstory PParasIte control PWater access and qualIty P FatIons ecessIvely hIgh In carbohydrates can result from overfeedIng graIn, Pn the absence of adequate quantItIes of roughage, predIspose to the development of an atypIcal IntestInal mIcroflora and may lead to dIarrhoea, ecessIve gas productIon, derangement of IntestInal motIlIty and colIc. Prregular tIme Intervals between feedIng PCroup feedIng allowIng aggressIve horses to overeat concentrates PPoor qualIty roughage, mouldy hay or an Inadequate water supply can predIspose anImals to sImple colonIc ImpactIons. P$udden changes In feedIng pattern PParasIte control PFegular dental care. PnvestIgatIon of the horse's envIronment P"uantIty and qualIty of stable beddIng PvIdence of crIb bItIng/ Access to oreIgn 8s. P$andy pastures and "starvatIon paddocks" may lead to sand colIc, especIally If anImals are fed from the ground. PndIvIdual horse or herd problem: PuratIon of colIc PLast tIme fed onsumptIon of food and water PAny hanges ood/water |edIcatIon ousIng/beddIng TravelTravel ercIse Pegree and change In paIn P$weatIng PPrevIous colIc or abdomInal surgery PetermIne the cardInal sIgns (temperature, pulse, respIratIon PLook for the presence of abdomInal dIstensIon (usually means dIstensIon of the large colon or caecum If present PTake note of the clInIcal sIgns the horse Is showIng (pawIng, rollIng, recumbency, abrasIons over bony promInences PTemperature Pncreased, ormal, ecreased PPulse Fate 80 (emergency 100 Crave "ualIty ormal, 8oundIng, Weak PFespIratIons Fate ffort .PaIn Is the response to stImulatIon of receptors In the gut wall. IstentIon (vIsceral paIn caused by: PPrImary flatulence Pleus PProImal to obstructIon $tranguIatIon on-stranguIatIng PIsplacement PmpactIon PoreIgn body IschemIa (1` due to strangulatIon P'olvulus Pon strangulatIng InfarctIon PncarceratIon of segment of bowel LIpoma strangulatIon pIploIc foramen IncarceratIon InfIammatIon PnterItIs (small or large IntestIne Acute hronIc PUlcers (usually gastrIc PPerItonItIs PPegardIess of the IesIon the manIfestatIon of paIn symptoms may IncIude: pawIng, rollIng, lyIng down kIckIng at abdomen, lookIng at flanks, sweatIng frequent attempts to urInate PacIng up and down restlessness stretchIng Pog sIttIng, Unusual posItIons Past or lyIng on back, 'Iolent behavIor PProtrude penIs, |uscle tremors Plevated vItals, $traInIng P o borborygmI, epressIon (or sometImes stoIcIsm PonstIpatIon PIarrhoea PAnoreIa P$uckIng, but not swallowIng water PardIac murmurs - cause unknown! PType of paIn: ntense contInuous paIn Is often assocIated wIth the most severe lesIons lIke small IntestInal obstructIons or strangulatIons. PDbstructIon of the bowel leads to accumulatIon of gas and fluId, resultIng In paIn and subsequently shock. The foIIowIng can be used as generaI assumptIons: P$evere paIn small IntestInal obstructIon wIth strangulatIon PhIId paIn nonobstructIve lesIons wIthout strangulatIon P$evere contInuous paIn tralumInal obstructIons wIth IschemIc bowel wall PmIIder paIn- usually ntralumInal obstructIon of large bowel wIth Intact blood supply PAcute moderateIy Intense paIn may be assocIated wIth spasmodIc contractIons of the IntestInal wall In stressed or ecItable horses. P$pontaneous remIssIon of severe paIn may mean that the problem Is resolved. owever, It may also mean that some part of the bowel has ruptured. PThe pulse rate and strength are related to the degree of paIn, vascular volume (degree of shock and response to endotoaemIa. P$evere paIn usually Increases the heart rate to 80 beats per mInute or more. P$Imple obstructIons lIke ImpactIons usually cause a much lower Increase In the heart rate, usually between 40 60 beats/mInute. PehydratIon and shock wIll also lead to an Increase In the heart rate due to the fact that the horse Is tryIng to Increase hIs cardIac output to maIntaIn cIrculatIon. PPerIpheral perfusIon assessed by the mucous membrane colour and the capIllary refIll tIme. CoIour ormal Fed (vasodIlatIon Pale (cIrculatory shock |uddy/cyanotIc (vasoconstrIctIon(ToIc gum lIne CapIIIary PefIII tIme ormal ast $low P$hould be done on every horse wIth sIgns of colIc. PAdequate restraInt of the horse and lIberal lubrIcatIon are key factors. $pecIfIc thIngs to feeI for durIng the rectaI examInatIon are as foIIows: PPresence or absence of dIstended bowel. Pf dIstended, whIch part of the bowel (small or large P|edIal dIsplacement of the caudal edge of the spleen (often assocIated wIth nephrosphlenIc entrapment. PAlteratIons of the pelvIc fleure (most common sIte for ImpactIons P8ase of the caecum for tympanI or ImpactIons. PTIght bands (taenIa of the large colon In cases of dIsplacement PPerItoneal surface (rough In cases of rupture and/or perItonItIs Pnternal InguInal rIngs In stallIons. PPelvIc fleure on left orsal colon Is smooth 'entral colon has haustrae Pecum on rIght austrae $lIght dIstentIon |edIal band PLeft kIdney and nephrosplenIc lIgament left dorsal quadrant P$pleen (left sIde agaInst flank PUrInary bladder (pelvIc brIm PnguInal rIngs stallIons E geldIngs P orsal aorta (dorsal mIdlIne P$mall colon wIth faecal balls and a band Pheck uterus and ovarIes Pheck nephrosplenIc In left dorsal space quadrant P $mall IntestIne (usually not palpable unless dIstended P$mooth perItoneum (ventral Pormal gut sounds are gurglIng sounds of fluId mIIng wIth gas. Pn the rIght paralumbar fossa, Ileocaecal sounds are heard. t sounds lIke water runnIng down a draIn pIpe and In normal horses are heard 1J tImes/mInute. PDbstructIons wIll cause a decrease In CT sounds. P$pasmodIc contractIons wIll result In an Increase In CT sounds PAbsence of CT sounds are usually very serIous. PFemember to reassess CT sounds frequently In a horse wIth contInuIng abdomInal paIn. Pf fluId Is obtaIned you can check the p. PluId from gastrIc orIgIn wIll usually have an acId p and from small IntestInal orIgIn an alkalIne p. Pn horses wIth severe paIn, passIng a stomach tube should be done at the start of the eamInatIon to prevent possIble gastrIc rupture. Pn general proImal lesIons wIll result In a more rapId accumulatIon of reflu. Pf reflu persIsts the stomach tube can be left In and taped to the halter. PAbdomInocentesIs Is IndIcated In aII cases of severe, persIstent or recurrent colIc. PUseful InformatIon can be obtaIned from the gross appearance as well from cytology later on In the lab. $Ite $Ite; ; P P'entral abdomen 'entral abdomen just just caudal to the caudal to the IphoId IphoId cartIlage, 6cm to the rIght cartIlage, 6cm to the rIght of the mIdlIne of the mIdlIne |ethod |ethod P PI I lIp/shave area lIp/shave area P P$edatIve; $edatIve; etomIdIne etomIdIne - -also also an analgesIc but epensIve an analgesIc but epensIve ylazIne ylazIne o not use AP o not use AP PII $urgIcally scrub usIng betadIne PIII 12ml of local anaesthetIc PIv stab IncIsIon wIth scalpel blade Pv Insert teat cannula/ large needle Into perItoneum PvI collect fluId In TA tube PvII heck fluId for -colour, vol, TP, W8,gram staIn bacterIa 1. aIlure to collect sample due to; PA Incomplete penetratIon thru perItoneum P8 obstructIon of the needle wIth omentum P occlusIon of tIp of needle/cannula wIth bowel wall P absence of sIgnIfIcant volumes of perItoneal fluId (eg a very dehydrated horse 2. ollectIon of bowel contents due to penetratIon of the lumen J.ollectIon of blood due to; Pa penetratIon of spleen Pb haemoperItoneum Pc entry Into blood vessel 4. aematoma at collectIon sIte 5. Prolapse of omentum thru the collectIon sIte !CV (X) TotaI pIasma proteIn (glL) IndIcatIon for fIuId therapy 40 75 o fluId requIred (observe for deterIoratIon 45 - 55 85 - 95 ntravenous fluIds requIred (4060 ml/kg 55 95 FapId and large volume ' fluIds requIred (60 100 ml/kg 60 100 'ery few horses wIll survIve regardless of therapy IntroductIon PDnly a small percentage of colIc horses encountered In practIce wIll requIre surgery. PThe majorIty can be treated wIth medIcal therapy alone. P arly and progressIve medIcal therapy may also ensure the survIval of a horse that has a surgIcal lesIon. The coIIc causes that can be treated medIcaIIy IncIudes: PCastrIc, caecal and colonIc ImpactIons PCastrIc dIlatatIon P$and colIc PTympanIc colIc P$ome nephrosphlenIc entrapments PCastrIc ulceratIon PAnterIor enterItIs PFIght dorsal colItIs P1. $evere unlentIng paIn wIth eart rate 80bpm P2. leus due to aprolonged dIstentIon of vIscera bshock celectrolyte dIsturbances dpaIn 4J.$evere abdomInal dIstensIon eg. Cas accumulatIng oral to obstructIon 44. large quantIty of gastrIc reflu due to I. $ obstructIon II. leus III. ProImal enterItIs P5.$evere IntestInal dIstentIon palpable per rectum P6.AbdomInal fluId by abdomInocentesIs The treatment objectIves In a horse wIth coIIc PProvIdIng paIn relIef P|aIntaIn perIpheral and organ perfusIon J PPromote IntestInal motIlIty and passage of Ingesta PTreat the effects of endotoaemIa PThe hallmark of any colIc treatment Is paIn relIef and often It may be the only treatment requIred. PDne of the potent stImulI for paIn In the CT Is dIstensIon of the bowel wall. PecreasIng the dIstensIon wIll provIde ImmedIate paIn relIef. Two methods are avaIIabIe PasogastrIc IntubatIon relIeve gastrIc tympanI or remove gastroIntestInal reflu. P ecal trocharIzatIon to relIef gas accumulated In the caecum. PFeductIon of paIn stops refle InhIbItIon of motIlIty on the entIre IntestInal tract whIch can resolve the Ileus or IntestInal spasm causIng colIc. IunIxIn nadyne) ose: 1.1 mglkg IV exceIIent, P1 st choIce analgesIc PwIll have no effect on CT motIlIty yIazIne #omun/Chanazne) 0ose: 0.2 - 1.1 mglkg IV or Ih Pecellent analgesIc wIth strong sedatIve propertIes PwIll decreases motIlIty of all CT segments temporarIly PwIll cause hypotensIon and decreased cardIac output due to bradycardIa etomIdIne 0omosedan) ose: 10-40 uglkg IV or Ih Pecellent analgesIc wIth strong sedatIve propertIes PwIll decreases motIlIty of all CT segments temporarIly PwIll cause hypotensIon and decreased cardIac output due to bradycardIa utorphanoI %orbuyesc) ose: 0.05 0.1 mg/kg ' or | Ppotent analgesIc PwIll decrease CT motIlIty Pdecrease the dose by 50 when gIven In combInatIon wIth alpha agonIsts Ipyrone !anbutazol) ose: 5 - 22 mglkg IV or Ih P|Ild analgesIc PUsed for mIld colIc Po effect on motIlIty $copoIamIne-metamIzoI uscoan) ose: 0.15 - 0.2 mglkg IV P|Ild analgesIc propertIes Pot regIstered In $A any more PwIll cause stasIs of all IntestInal segments !henyIbutazone 2,2 -4,4 mglkg IV PPoor vIsceral analgesIa AspIrIn 20-40 mglkg ! PPoor vIsceral analgesIa P ntravenous and/or oral fluId therapy may be benefIcIal In restoratIon of the perIpheral cIrculatIon as well as causIng a flu of fluId Into the large colon In cases of ImpactIons. P Pn horses wIth moderate to severe dehydratIon (7 10 should receIve a polyIonIc Intravenous fluId to restore the cIrculatIon. The amount of fluIds requIred may vary from 18 J0 lItres In the average 500 kg horse. PAt least 50 of the defIcIt should be gIven In the fIrst hour and often a 12C catheter Is used for thIs. P8y usIng a system of gravIty flow It Is ImpossIble to eceed a rate of more than 15 18 lItres/hour. P$erum electrolytes can be measured and calcIum and magnesIum can be admInIstered In the Intravenous fluId as requIred. P The best means of monItorIng the effIcacy of electrolyte supplementatIon Is contInued monItorIng. PypertonIc salIne (7 admInIstratIon can be used In sItuatIons where large volume fluId therapy Is ImpossIble. PThe dose usually used Is 4 6 ml/kg gIven over J0 mInutes. Pt Is belIeved to shIft fluId from the Intra to the etracellular space thereby epandIng the cIrculatIng volume. Pt should always be followed by IsotonIc fluIds to restore the total body water defIcIt PWIth no reflu or In mIlder dehydratIon ( 7 oral fluIds can be gIven vIa nasogastrIc tube. PThIs approach Is very useful In horses wIth large colon ImpactIons or low grade dIarrhea. Pf large volumes of fluIds are to be gIven vIa a nasogastrIc tube, electrolytes should be added to It, especIally In anorectIc patIents. PThe maImum volume that can be gIven at any tIme should not eceed 8 lItres In a 500 kg horse due to the anatomIcal lImIt to the capacIty of the stomach and the horse's InabIlIty to vomIt. Pf the horse Is more uncomfortable after oral fluId admInIstratIon, the fluId should be draIned ImmedIately. Pleus, the absence of propulsIve bowel actIvIty may be short term or paralytIc lIke In cases of tr,tx toIcIty. Pvery effort should be made to correct the underlyIng cause and restore the cIrculatIon. PDften thIs Is all that Is requIred to restore normal CT motIlIty PThe use of analgesIcs that affect CT motIlIty should be lImIted. P!rokInetIc drugs are IndIcated In colIc cases wIth Ileus where there Is no obstructIon hetocIopramIde, dose 0.04 mg/kg contInuous ' InfusIon or 0.25 mg/kg ' In J0 mInutes PLower dose may have lIttle prokInetIc effect CIsaprIde (propuIsId), dose: 0.1 0.2 mg/kg every 8 hours PD PstImulates Ileal, cecal and colonIc contractIon and may have some prokInetIc effect on stomach and small IntestIne ethanechoI (urachoIIne, dose: 0.025 0.0J0 mg/kg every 6 hours $ PIncrease gastrIc emptyIng Pmay cause urInatIon and salIvatIon eostIgmIne, dose: 0.022 mg/kg subcut Pshort duratIon of effect ( J0 mInutes PmaIn effect In large colon YohImbIne, dose 75 mg/kg ' Pprevents Ileus In horses gIven low doses of endotoIns LIdocaIne, dose: 1.J mg/kg slow ' bolus followed by 0.05 mg/kg/mIn ' InfusIon ErythromycIn, dose: 0.1 mg/kg ' PWIll Induce small IntestInal, cecal and colonIc motIlIty In normal horses PLaatIves or lubrIcants are usually IndIcated In cases of ImpactIon. P t should be used In combInatIon wIth hydratIon (' or vIa nasogastrIc tube PhIneraI oII (LIquId paraffIn - as a lubrIcant and Is usually gIven at 5 10 ml/kg or1 lItre/ 100 kg adult. Ilute wIth warm water or salIne and can be repeated effectIve for mIId ImpactIons. PAllows reduced absorptIon of bowel contents and monItorIng of complete transIt through bowel Poes not treat dehydratIon! P!syIIIum (metamucIl Is usually gIven at 1 gram/kg every 24 hours for sand ImpactIons IoctyI sodIum suIfosuccInate ($$) - decrease surface tensIon and allow penetratIon of water, dose; 10 20 mg/kg as a 5 solutIon, t may cause mucosal 77taton. hagnesIum suIphate dosed at 1 gram/kg Is an osmotIc laatIve and very effectIve for more severe ImpactIons P When the lIpId component of gram ve bacterIal cell walls (LP$ bInds to the host phagocytes a large group of hormones and Inflammatory medIators are released resultIng In endotoaemIa. P These medIators are dIrected agaInst the vascular endothelIum causIng a hyper coagulable state, mIcrovasculature dIsturbance, tIssue IschaemIa and hypoIa and eventually organ faIlure. PThe horse CT Is host to many gram negatIve bacterIa and when the mucosal barrIer becomes compromIsed endotoaemIa wIll result. CIInIcaI $Igns: PepressIon, fever PtachycardIa PhyperemIc mucous membranes wIth a bluIsh tInged "toIc rIm" to the gums above the IncIsors PIleus PsIgns of shock PpetechIal haemorrhages Pprolonged bleedIng from venupuncture sItes PleucopaenIa PTreatment Is aImed at correctIng the underlyIng cause and aggressIve supportIve therapy to restore hydratIon. PIunIxIn at 0.25 mg/kg three to four tImes/day wIll not have any analgesIc effect at thIs dose P!oIymyxIn at 6000 U/kg Is used In humans and wIll bInd endotoIns. $Ide effects are renal and $ toIcIty PDther human drugs Include AllopurInol and pentoIfyllIne. PAntImIcrobIals are recommended In foals younger than 6 months and adults wIth gram negatIve sepsIs. PAntIbIotIcs can also alter the CT flora and may eacerbate the enterIc problem.