Ultrasound is useful for the diagnosis of what lesions? (7)
small intestinal lesions, cecocecal intussusception, nephrosplenic entrapment of LC, uterine artery rupture, inguinal/scrotal hernia, left dorsal displacement of large colon, +/- right dorsal colon exam (loss signal due to gas)
With what lesions is ultrasound NOT helpful and why?
large colon due to gas artifact
What types of colic present with a fever? (3)
[most likely a medical condition] colitis, anterior enteritis, peritonitis
What diagnostics can you pursue to determine if a medical condition is causing fever with colic? (4)
- CBC (ID colitis, neutropenia/leukopenia)
- electrolytes (ID colitis, hyponatremia/hypochloremia)
- NG reflux
- abdominocentesis (ID anterior enteritis, protein> 3g/dL) (ID peritonitis)
What are the most important criteria that you will use to decide whether or not to
refer the horse to a tertiary facility? (7)
- Ship if:
- small intestinal distention
- large amount of NG reflux
- toxic mucous membranes
- HR > 70bpm
- no response to NSAIDs
- tight large intestinal distention
- UNCONTROLLABLE PAIN
How important is unrelenting pain in yourdecision making regarding whether to refer a case to a tertiary hospital?
ship an animal with uncontrollable pain regardless of other signs
Which types of colic are associated with insidious (4) onsets of pain, and what are
associated with more severe (4) signs of pain?
- Insidious: large intestinal simple obstruction, incomplete luminal obstruction, luminal/extraluminal obstruction of distal SI, ileal impaction
- Severe: complete luminal obstruction, enteritis (enterocolitis, anterior enteritis- sever then depression), torsions/volvulus, incarceration of proximal SI, intussusception
Why is NG tube passage important in colic workup and treatment?
- can be life-saving because horses cannot vomit
- copious reflux specific for SI lesion
- copious reflux with minimal pain- anterior enteritis
What are treatment options for left (3) and right (2) displacements of the large colon?
- Left: specific rolling procedure, phenylephrine injection with jogging and rolling, surgical correction if first 2 methods fail
- Right: supportive/no food (works sometimes, don't wait too long though), surgical repair (pelvic flexure enterotomy)
What can you diagnose specifically by rectal exam? (7)
intussusception, ileal impaction, inguinal hernia, small intestine distention, large colon impaction, cecal impaction, right and left dorsal displacement of large colon
What lesions are NOT diagnosed by rectal exam?
can only feel the caudal 1/3 of the abdomen--> go to US
What is the most common colic seen by field practitioners, and how is it diagnosed and treated?
- > 90% of colic cases seen in practice
- “Flatulent” or “spasmodic” colic
- Usually low heart rate, minimal to no gas
- distention of colon on rectal exam
- Usually respond to sedation, NSAIDs
- (flunixin meglumine), and possibly mineral
How would you diagnose and treat a colon impaction in the field?
- diagnose by rectal palpation- most commonly at pelvic flexure/ ventral colon and right dorsal colon
- get baseline abdominocentesis
- oral fluids- JUST WATER
- IV fluids
- mineral oil
- If no response, peritoneal fluid changes--> refer