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Colic (Treatment (NSAIDs (analgesia) (Requires monitoring as repeated…

- - - - Do not mistake the absence of borborygmus after sedation with detomidine or butorphanol with a more serious small intestinal obstructive lesions.
  - - - Bradycardia
      - hypotension
      - GI ileus
      - Sweating
      - Diuresis
  - - - short-acting, smooth muscle relaxant
      - side effects: increases HR and BP alterations
  - - - respiratory depression
      - non-propulsive GI spasm
      - CV effects: increased BP, HR, CO
      - Excitement
      - Pruritus esp. morphine
    - - 0.01-0.04mg/kg IV or 0.04-0.2mg/kg IM
    - - 0.2-0.6mg/kg
      - Acts 1-3 hours
  - - - Large gauge catheter, wide bore delivery
      - Maintenance = 60ml/kg/day
      - calculate ongoing losses
      - record and monitor (USG, CS, PCV, TP, Lactate)
        
        Blood lactate concentration is important, as in the absence of oxygen pyruvate (produced from glucose by glycolysis and subsequently used in the Krebs cycle to produce adenosine triphosphate) is converted to lactate.
        
        Increase in blood lactate concentration is an early sensitive indicator of anaerobic metabolism and poor peripheral perfusion.
        
        Blood lactate concentration should be less than 0.8mmol/L
      - Isotonic polytonic solution (most common) add 10-20m Eq Kcl/L
      - Hartmanns contains Ca -> binds anticoagulants
      - Hypertonic saline
        
        rapid expansion of circulating volume
        
        follow with 10L isotonic for every 1L hypertonic saline within 2.5 hours
    - - Contraindicated
        
        ileus
        
        intestinal obstruction
        
        severe mucosal inflammation
        
        unable to stand
        
        if a rapid, large volume required for resuscitation
      - Advantages
        
        GIT mucosa acts as a natural selective barrier
        
        Iatrogenic imbalance less likely
        
        Absorption is increased in hypovolaemia
        
        Haemodynamic effects at 30 mins
      - Indications
        
        Restore electrolyte balance
        
        prevent dehydration
        
        increase hydration of contents
        
        stimulate intestinal motility (gastrocolic reflex)
      - usually 4-5L q 2 hrs (stomach can hold up to 10-12L)
      - Magnesium sulphate for impactions (isotonic)
        
        maintenance= 2.5ml/kg/hr
      - Complications: aspirations, NGT associated abdominal discomfort, GI rupture, electrolyte imbalance
  - - - Increases smooth muscle contractility, analgesia and anti-inflammatory.
      - beware of muscle fasciculations, ataxia, seizure
  - - - side effects: excitement, aggression
      - SI ileus (stomach and proximal duodenum)
      - 5-HT and cholinergic
      - good for foals, not adults
    - - Ach inhibitor
      - induces disorganised segmental contractions, good for SI ileus
      - may cause pain via the spasmodic contractions
- - - - Impactions of large colon usually occur at the pelvic flexure or in the right dorsal colon
      - causes include a decrease in water intake and altered function of the pelvic flexure pacemakers
      - Treatment includes osmotic laxatives e.g. magnesium sulphate and over hydration with intravenous crystalloids to promote intraluminal secretions and rehydrate the impaction.
      - Oral balanced electrolyte solution is a good treatment for large colon impactions, as it hydrates the contents of the right dorsal colon without causing electrolyte imbalances.
      - Enteral fluids rehydrate the impaction and cause gastric distension, which elicits the gastrocolic reflex and triggers the contraction of the colon.
      - Check for gastric reflux before each administration of oral fluids, as the impaction can compress the duodenum and occlude gastric emptying.
        
        Usually 4-6L of lukewarm water + NaCL + KCl
        
        Rectal palpation confirms impaction has passed, feed may be gradually introduced with access to grass being the best initial offering.
  - - - Right dorsal colon displacement
        
        Lose doses of analgesics, including flunixin meglumine and xylazine.
        
        IV fluids with calcium gluconate (25ml/l)
        
        Lung horse at trot/canter for 10-15 minutes
        
        Enteral fluids to break up the impaction in the right dorsal colon (frequently present with large colon displacement)
        
        Decreasing colonic gas distension reduces the intraluminal pressure within the caecum and the colon, which should improve gastrointestinal motility.
        
        Trocarisation can remove substantial volumes of gas (use lidocaine subcutaneous and into oblique muscles of right flank before insertion)
        
        Gas distended large colon and tight mesenteric bands that are palpable on rectal examination, but normal colon wall thickness on USS.
      - spontaneous resolution/surgery
      - Nephrosplenic entrapment
        
        Colon moves dorsally in the left abdominal quadrant and hooks over the nephrosplenic ligament.
        
        Rectal palpation finding of colon passing over the nephrosplenic space and confirm with USS. The left kidney cannot be imaged.
        
        Many also have gastric distension because the duodenum is compressed by the large colon, which prevents gastric emptying. Advisable to pass a stomach tube before further medical treatment.
        
        Standard treatment: administration of phenylephrine an alpha1-receptor agonist, to induce splenic contraction (as the colon is entrapped and occludes venous drainage from the spleen).
        
        Causes vasoconstriction, bradycardia and an increase in blood pressure so administer slowly and monitor heart rate and keep it greater than 20 beats/minute.
        
        If considered too risky e.g. horse over 15 years old. Then conservative management consisting of withholding feed, giving enteral +/- IV fluid therapy and providing analgesics without phenylephrine administration reported to be successful in 80% of horses.
        
        If referral is not an option: rolling technique. Xylazine and ketamine and drop to right side.
- - - - reflux
      - Palpable/visible SI on rectal/USS
    - - Abdominocentesis
      - Cardiovascular compromise
- - - - Increased respiratory rate (pain, shock)
      - Abrasions or other signs of trauma from rolling
      - Profuse sweating (pain, shock)
    - - Potentially little haemorrhagic/black reflux (gastric rupture possible)
    - - abnormal abdominocentesis
        
        Haemorrhagic, orange, red
        
        Red blood cells leach into the peritoneal fluid from the ischemic intestine
        
        Nucleated cell count >5 -70x10^9
        
        Protein concentration >25g/L
        
        Can indicate ischaemia or inflammation, such as peritonitis or enteritis
        
        Changes in abdominal fluid are more sensitive for a small than a large intestinal lesion and peritoneal fluid can appear grossly normal in a horse with a large colon volvulus.
        
        Higher lactate concentration in peritoneal fluid than in blood suggests the horse has ischemic or inflamed intestine
      - Abnormal transabdominal ultrasonographic exam
        
        Distended small intestine on rectal palpation
        
        increased abdominal fluid
        
        Tight gaseous distension of large intestine
    - - Large dose of sedative required to examine horse
      - Little response to flunixin meglumine
      - Short lived (<1-3h)
- - - - hyper perfusion of the vascular bed as a result of increased cardiac output in the early stages of systemic inflammatory response syndrome (SIRS).
    - - Vasoconstriction when body attempts to maintain perfusion in response to falling cardiac output.
    - - vessels vasodilate. Seen with serious hypotension and low cardiac output. Change consistent with the later stages of SIRS
    - - Horse anorexic or hepatic disease or haemolysis
- - - - without resection 60-80%
      - with resection 50-70%
    - - Horses with a large colon volvulus and plasma lactate of more than 6mmol/L have a poor prognosis for survival
- - - - Palpable on rectal exam
      - Visible using ultrasonography
    - - Volvulus (around the root of mesentery)
      - Strangulating lipoma
      - Epiploic foramen entrapment
      - Inguinal/scrotal hernia
      - Intussusceptions
      - Diaphragmatic hernia
      - Mesenteric rent
  - - - Ileo-caecal
      - Caeco-colic
      - Caeco-caecal