approach to the atypical colic

what is colic

describes a symptom of abd pain

what can cause colic

problem in git usually

• impaction

• displacement

• torsion

• strangulation

• obstruction

there are non git causes too

list some non git causes of colic

• renal disease

• urogenital tract disorders

• liver disease

• peritonitis

• thoracic disease

basic colic exam

• major body system assessment

• rectal

• abdo us

• peritoneal fluid anaysis

• ng tube

15yo gelding

History

24 hour history of depression, anorexia and reduced faecal output

Physical exam

QAR, mild colic signs, membranes pale pink, HR84, RR24, T36.2oC

Rectal

Large, firm viscus palpable in the left ventral abdomen

Top differential??

pelvic flexure impaction?

causes of increased hr

• hypovolaemia

  • reduced circ vol

• sirs

  • inflam cytokine,s vasodilation ect

• pain

  • stress response

• dysrhythmias

  • electrolyte abnormalities, myocarditis etc

in this case what is more likely to be causing an incrs hr

Hypovolaemia

• Clinical examination: poor pulse qual, crt 3s, slow jug refill, cold extremities

• do PCV/TP/Lactate

SIRS? → need to do:

• WBC

• Acute phase proteins

What haem and biochem results would you expect with uncomplicated impaction?

-PCV high due to dehydration

-lactate to be normal to high

-SAA to be normal to high

-normal pulse quality

haem and biochem

abnormalities?

Manual PCV 21%

• low→ blood loss or anaemia

Lactate 6.2mmol/l (normal <2mmol/l)

• high→ poor tissue perfusion

SAA 84mg/l (normal <20mg/l)

• systemic inflam

Fibrinogen 3.4mg/l (normal <4mg/l)

-impaction colic would not cause anaemia with hypoperfusion this severe

Abdominal ultrasound

• Large quantity of echogenic free fluid

Peritoneal tap

• Frank blood – PCV 50%

definitive diagnosis?

haemoabdomen

case 2

8yo gelding MWH

History

Reduced mentation and mild colic signs for 48 hours.

Physical exam

QAR, mild colic signs, injected membranes, HR44, RR36, T39.2oC

Rectal

No abnormalities detected

problem list? top ddx

• reduced mentation

• colic signs

• injected mems

• tachypnoea

• high temp

sirs induced sepsis

causes of incrs rr

• pain

  • stress response

• primary lung disease

  • infectious inflammatory

• pleural space

  • reduced tidal vol

how can we assess which is the likely cause of incrs rr in case 2

which diagnostics are needed

Pain

• Response to analgesia

Primary lung disease

• Tracheal wash/BAL

• Radiography

• Ultrasonography

Pleural space disease

• Auscultation

• Radiography

• Ultrasonography

60 minutes after the administration of flunixin meglumine, reparatory rate and demeanor remain unchanged

radiography

Ambulatory machines unable to obtain good thoracic radiographs

Endoscopy unlikely immediately available

ausc

Increased respiratory noise dorsally, muffled ventrally, crackles audible over trachea

does this case need referral

yes want to image

thoughts and definitive diagnosis

• endoscopy: excess mucus

• us: pleural effusion

diagnosis: pleuropneumonia

case 3 13yo sport horse

History

Rolling, flank watching and kicking at abdomen for the last 3 hours

Physical exam

Agitated, constant kicking at abdomen. HR44, RR16, T37.9oC, gut sounds reduced but present in all quadrants

Rectal

No abnormalities detected

Colic signs persist following analgesia

problem list

• colic signs

• reduced gut sounds

• colic persistent after analgesia

how can we assess an intestinal lesion

peritoneal fluid analysis

abd us→ flash scan

what is a flash scan

Fast Localised Abdominal Sonography of Horses

Haematology and Biochemistry

• unremarkable

Peritoneal fluid

• Lactate 0.7mmol/l

• Nucleated cell count 1.2x109 cells/l

Abdominal ultrasonography

• NAD

Gastroscopy

• No lesions identified

• 
  

Posturing to urinate

Chewing at flanks

Half exteriorising penis

what do next?

inspect sheath → sedate to do this

case 4- ella, 5yo thoroughbred mare

History

Horse reported to be dull, off feed and showing mild but consistent colic signs

Physical exam

Horse is restless and flank watching, with some patchy sweating. HR is 60, RR20, T38.7oC. Gut sounds present but reduced.

Rectal

No abnormalities detected

Nasogastric intubation

16 liters of green fluid recovered form stomach

Top differential??

grass sickness

impaction→ but no abnormalities on rectal

strangulation

what are the limitations of palp per rectum

Cannot evaluate the entire abdomen per rectum

what other ways can we identify strangulated si

ultrasound

peritoneal fluid analysis

what is seen on us with strangulted si

disteneded loops

thickened loops

two distinct populations → normal part and abnormal part

what is seen on peritoneal flud analysis of strangulated si

devitalised tissue → lactate produced

if peritoneal lactate >2x peripherial → indicative

Peritoneal fluid:

Total protein 50g/l

TNCC 7x109 cells/l

Lactate 3.9 mmol/l

(peripheral 3 mmol/l)

does not indicate strangulation

Ultrasonography=

• Moderate distension of small-intestinal loops (2–4 cm diameter)

• Wall thickness normal ( < 3 mm )

• Motility sluggish

• 
  

No free peritoneal fluid or distinct populations of loops

• Peritoneal lactate < 2× systemic → not strongly supportive of a strangulating lesion.

• Elevated protein + mild inflammation → leakage or inflammation, not necrosis.

• 
  

Consistent with proximal enteritis / non-strangulating obstruction, rather than ischaemic strangulation.

• Supports a diagnosis of proximal enteritis (DPJ) or functional ileus, rather than mechanical obstruction.

how would you manage this case 4

supportive care

analgesia

ivft

gastric decompression

prokinetics

sirs management

what to do or what could be wrong if your clinical findings disagree

Clinical examination findings:

• Repeat them!

Clinical pathology results:

• Machine error does happen

• Repeat runs if necessary

Diagnostic imaging:

• Get more pictures, spend more time

• Consider other modalities

Diagnostic procedures:

• Find other ways to investigate suspicious findings

• E.g. markers of strangulation

How to treat proximal enteritis (DPJ) or functional ileus?

• gastric decompression

• ivft

• anti inflam/ analgesia

• antimicrobials

• supportive care

what referral indications for proximal enteritis

Persistent or increasing pain despite decompression

Rising peritoneal lactate (> 2× systemic)

Worsening cardiovascular parameters or refractory ileus

what supportive care for proximal enteritis

-Anti-endotoxin therapy (flunixin, polymyxin B if severe).

-Muzzle or withhold feed until reflux resolves.

-Monitor for laminitis (systemic inflammatory risk).

-Serial lactate, PCV/TP, heart rate monitoring.

what abx for proximal enteritis

-Often indicated because DPJ may have bacterial or toxin component (e.g. Clostridial species).

-Broad-spectrum IV (penicillin + gentamicin or similar).

what analgesia for proximal enteritis

-Flunixin meglumine 1.1 mg/kg IV (anti-endotoxic + analgesic).

-Opioid (butorphanol) if further analgesia needed.

-Lidocaine CRI (1.3 mg/kg/h after loading dose 1.3 mg/kg IV) – promotes motility, reduces endotoxaemia.

what ivft for proximal enteritis

-Isotonic crystalloids (e.g. Hartmann’s) to replace losses from reflux and dehydration.

-Estimate: 20–40 L bolus initially, then maintenance + ongoing reflux replacement.

what gastric decompression for proximal enteritis

-Leave nasogastric tube in situ for intermittent drainage (every 1–2 h) to prevent gastric rupture.

what is pleuropneumonia often associated with

with shipping fever which is long-distance transport

causing stress and elevated head carriage which inhibits mucociliary clearance