At the end of these lecture serIes

the student should be able to:

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.