Approach to the Atypical Colic

colic

symptom of abdo pain, which in horses usually caused by problems in GI tract

type of colic

-impaction

-displacement

-torsion

-strangulation

-obstruction

non intestinal causes of colic

-renal

-urogenital tract disorders

-liver disease

-peritonitis

-thoracic disease

what to do first with atypical colic

-major body system assessment

-rectal exam

-abdo US

-peritoneal fluid analysis

-NGT

thoughts on case

there is a palpable part on rectal but cannot be pelvic flexure impaction as normally systemically well but this horse is not

causes of increased HR

-hypovolaemia

-SIRS

-stress response with pain

-dysrhythmias

how does hypovolaemia cause increased HR

reduced circulatory volume

how does SIRS cause increased HR

inflam cytokines, vasodilation etc.

how do dysrhythmias cause increased heart rate

electrolyte abnormalities and myocarditis, etc.

is hypovolaemia likely in this case

-pulse quality poor

-CRT 3s

-slow jugular fill

-cold extremities

are dysrhythmias likely in this case

rate is regular and no murmurs audible

haem and biochem show?

-manual PCV 21% as not enough RBCs to carry o2

-lactate high suggesting hypovolaemia

-SAA high suggesting inflam but over 100 interesting not this

-fibrinogen normal

what does PCV low and lactate high suggest

there is hypovolaemia and not enough RBCs to carry O2 so where did blood go? is it in abdo or chest? need to tap or US

abdo US show

large quantity of echogenic free fluid

US findings and peritoneal tap showing frank blood gives diagnosis of

haemoabdomen

thoughts on case

causes of increased RR

-pain causing stress response

-primary lung disease (infectious or inflam)

-pleural space causing a reduction in tidal volume

is pain likely in case 2 to be cause of high resp rate

-60 mins after admin of flunixin, resp rate and demeanour unchanged

primary lung disease likely in case 2 diagnostics

-tracheal wash

-radiography

-US

diagnostics for pleural space disease in case 2

-auscultation

-radiography

-US

pleural space diagnostics return with increased resp nopsie dorsally, muffled ventrally, crackles audible over trachea

thoughts?

pleural effusion

what do further diagnostics tell us

pleuropneumonia

thoughts on case

causes of abdo pain in horse

intestinal lesion

how to assess intestinal lesion

-peritoneal fluid analysis

-abdo US

US shows

IF A DISTENDED SI THEN WILL SINK DOWN

when watchign case 3 more, saw posturing to urinate, chewing at flank, half exteriorising penis

what to do

sedate to inspect sheath and found maggots

thoughts on case

-patchy sweating

-highHR

-RR high

-present gut sounds but reduced

-NGT shows green fluid from stomach

why is case grass sickness

-pyrexic

-young

-lots of reflux

what pathology can be seen on US per rectum

-distended loops

-thickened loops

-two distinct populations

peritoneal fluid analysis shows pathology how

-devitalised intestine produces lactate

-peritoneal lactate >2x peripheral is indicative

case 4 has high TP, high TNCC, high lactate and exceptionally thick walls on US

anterior enteritis

management for anterior enteritis

-supportuve care

-analgesia

-ivft

-gastric decompression

-prokinetics

-SIRS management