IN THE NAME OF GOD

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EQUINE COLIC

Presented by: Salam Elayh; DVM Urmia University

College of veterinary medicine2014.5.5

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WHAT IS COLIC?

Not a disease General term indicating abdominal pain

Every case should be taken seriously

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ORGANS INVOLVED IN COLIC

Stomach Small intestineCecumColonSmall colonRectum

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ETIOLOGY

Several classification systems of equine colic have been

described including a disease-based system classifying the

cause of colic as:

Obstructive

Obstructive and strangulating

Non strangulating infarctive

Inflammatory (peritonitis, enteritis)

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SIMPLE OBSTRUCTION

1-luminal → sand colic

2-mural blackage→ neoplasia

3-extra mural blackage →large colon displasmen

4-functional→ paralytic ileus

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SIMPLE INFARCTION

Infarction→ thromboembolic colic

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INFLAMMATION

infection(salmonella , actinobacillus) → peritoneitis and enteritis

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OBSTRUCTION +INFARCTION

Torsion

Intussusception

Diaphragmatic and

Inguinal hernia

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OBSTRUCTIVE AND INFLAMMATORY

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INFRACTIVE AND STRANGULATION

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CLASSIFICATION BASED ON DURATION

Colic cases can also be classified on the basis of the

duration of the disease: acute « 24-36 h), chronic (> 24-

36 h) and recurrent (multiple episodes separated by

periods of > 2 days of .normality)

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OCCURRENCE

Equine colic accurs world wide.

The incidence rate: 3.5-10.6 percent

Mortality: 2.5 percent

The case fatality rate:

6-13 percent

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RISK FACTORS

1) intrinsic horse characteristics

2) Management

those associated with feeding practices

medical history

parasite control

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HORSE CHARACTERISTICS

Age

Horses 2-10 years of age are 2.8 times more

likely to develop colic that horses less than 2

year.

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HORSE CHARACTERISTICS

Breed

There is a consistent

finding that Arabian

horses are at increased

risk of colic, but the

reason for this apparently

greater risk has not been

determined.

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MANAGEMENT

Environmental or

feeding change

Watering

Housing

change in the

amount of

physical activity

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MEDICAL HISTORY

Horses with a history of colic are 6

times more likely to have colic again

Previous abdominal surgery are 5

times as likely

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PARASITE CONTROL

Inadequate parasite control programs have been estimated to put

horses at 2-9 times greater risk of developing colic.

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PATHOGENESIS

The features common to severe colic, and often

present to a lesser degree in milder colics, are

pain, gastrointestinal dysfunction, intestinal

ischemia, endotoxemia and compromised

cardiovascular function (shock )

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PAIN

Distension of the gastrointestinal tract

stimulation of stretch receptors and pain →

inhibits normal gut motility and function →

accumulation of ingesta and fluid further

destination and pain

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GASTROINTESTINAL DYSFUNCTION

Alterations to motility or absorptive function

Examples

spasmodic colic→ severe contraction of

intestine

Impaction → blockage of the intestine

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ISCHEMIA OF THE INTESTINAL WALL

Ultimately → most forms of lethal colic involve some degree of

ischemia of the intestine because of loss of barrier function

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SHOCK

► because of restricted respiration by pressure on the diaphragm and reduced

venous return to the heart because of pressure on the caudal vena cava

► endotoxemia and hypovolemia

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CLINICAL FINDINGS

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CLINICAL FINDINGS

stamping or kicking at the belly looking or nipping at the flank

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CLINICAL FINDINGS

pacing in small circles and repeatedly getting up and lying down

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CLINICAL FINDINGS

rolling, and lying on the back

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CLINICAL FINDINGS

Vomiting Sweating is common Abdominal destination

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CLINICAL FINDINGS

↑pulse rate with ↓pulse amplitude Endotoxemia → bright red mucous Membranes Terminal stages of disease→ cold, purple, dry

mucous with CTR of more than 3 seconds and toxic line

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Sow horse standing

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DIAGNOSTIC TOOLS

Patient history and signalment Physical exam Rectal palpation Naso-gastric intubation Ultrasonography Radiology CBC, biochemistry Exploratory surgery

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DIAGNOSTIC TOOLS

Patient history and signalment Physical exam Rectal palpation Naso-gastric intubation Ultrasonography Radiology CBC, biochemistry Exploratory surgery

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AUSCULTATION

All four quadrants of the abdomen should be examined for at least 1 minute at each site. Continuous, loud borborygmi→ intestinal

hypermotility Absence of sounds→ ileus

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'pinging‘ sound → the tightly gas-distended bowel near body wall

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RECTAL EXAMINATION

Normal anatomy

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RECTAL EXAMINATION

All four quadrants of the abdomen should be examined for at least 1 minute at each site. Continuous, loud borborygmi→ intestinal hypermotility Absence of sounds→ ileus

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RECTAL EXAMINATIONSMALL INTESTINE DISTENSION

The structure is often compressible, akin to squeezing a fluid-filled tubular balloon, and slightly

moveable. is suggestive of a small-intestinal obstructive lesion or anterior enteritis

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RECTAL EXAMINATION

COLONIC DISTENSION, IMPACTION

Gas and fluid distension of the large colon is evident as large (> 20 cm) taut structures often extending into pelvic canal. Tenial bands are often not palpable.

Impaction is evident as columns of firm ingesta. The most common site is the pelvic flexure

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RECTAL EXAMINATION

DISPLACEMENT OF THE LARGE COLON

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RECTAL EXAMINATION

DISPLACEMENT OF THE LEFT LARGE COLON

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NASOGASTRIC INTUBATION

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ANCILLARY DIAGNOSTIC TECHNIQUES

1-Ultrasonography2-radiology 3-Course of the diseaseSpasmodic and gas colic: usually resolves within hours of onset. Horses with strangulating lesions have severe clinical signs and usually die within 24 hours of the onset of signs.Horses with non strangulating obstructive lesions : have longer courses, often 48 hours to 1 week

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CLINICAL PATHOLOGY

Hematocrit and plasma total protein blood leukocyte: Combination of leukopenia and a left shift are

consistent with the endotoxemia Hyperkalemia → in horses with severe acidosis

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CLINICAL PATHOLOGY

Hypokalemia → in horses with more long-standing colic Hypocalcemia and hypomagnesemia →severe

colic (GGT)→its activity is elevated in 50% of

horses with right dorsal displacement of the colon (compression of bile duct).

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CLINICAL PATHOLOGY

Serum urea nitrogen and creatinine Prerenal azotemia is common in horses Acid-base status: Most horses with severe colic have metabolic acidosis

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CLINICAL PATHOLOGY

Abdominocentesis The presence of intracellular bacteria, plant

material and degenerate neutrophils is indicative of Gastrointestinal rupture

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PROGNOSIS

Arterial systolic blood pressure →90 mmHg (12 kPa) having a 50% chance

below 80 mmHg→ fewer than 20% Capillary refill time: 3 seconds or more→30% HR: 8O/min →50% chance of survival 50/min → has a 90% chance

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NECROPSY

The nature of the necropsy findings depends on the underlying disease

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DIFFERENTIAL DIAGNOSIS

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TREATMENT

• Medical• surgical

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MEDICAL TREATMENT

1-Provision of analgesia2-Correction of fluid, electrolyte and Acid- base abnormalities3- Gastrointestinal lubrication or administration of fecal softeners 4-Treatment of underlying disease

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MEDICAL TREATMENT- ANALGESIA

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MEDICAL TREATMENT- ANTIBIOTICS

A suitable regimen includes anaminoglycoside and a penicillin, possibly with metronidazole

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FLUID AND ELECTROLYTE THERAPY

Preferably a balanced, isotonic, polyionic Fluid such as lactated Ringer's solution.

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LUBRICANTS AND FECAL SOFTENERS

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SURGICAL TREATMENT

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PREVENTION

adequate parasite control Feeding large quantities of forage minimizing the amount of concentrate fed providing dental care

Acknowledgements

From S.ElayhTo

All my dear friendsAnd specially

Dear M.Shokreh2014.5.5

Reference

Radostits OM, Gay CC, Hinchcliff KW, Constable PD.Veterinary medicine.edition10.SAUNDERS 2006; page: 215-230