Triaging colic patients (Proceedings)


Triaging colic patients (Proceedings)

Nov 01, 2010

Signalment and history

     • The history can be very brief in order to speed up the examination process
     • The history can be conducted after the initial exam for horses with active signs of colic.
     • The most critical pieces of the history:
          o Treatments already administered
          o Any known reactions to medications
          o Duration of colic
          o Severity of colic

Examination of the horse with colic

     • Physical examination (TPR, peripheral pulse quality, mucous membrane color, capillary refill time, auscultation of the chest and abdomen)
     • Assessment of dehydration
     • Listen for the frequency and quality of gut sounds (Over 1-minute, gut sounds should be present in the upper and lower quadrants of both sides of the abdomen). Specific gut sounds include:
          o Opening of the ileocecal orifice (sounds like emptying of a drain)
          o Sand in the ventral colon (sounds like sand within a paper bag as you slowly turn it over)
          o Short, sharp tinkling sounds such as those you experience with 'GI upset.'
     • Rectal findings. Normal findings include:
          o Bladder
          o Reproductive tract
          o Ventral band of the cecum on the right
          o Aorta dorsally
          o Left kidney
          o Nephrosplenic ligament
          o Spleen
          o Pelvic flexure (or doughy colon on the lower left quadrant)
     • Nasogastric reflux (up to 2L is normal)
     • Abdominocentesis (normal: TNCC < 10,000 cells/μl; TP < 2.5g/dl)

When to refer to a case(see table)

     • Refractory or unrelenting pain
     • Lack of response to therapy
          o Be thinking of referral the second time you go out to see a patient
               o Evidence of endotoxemia (consistently elevated heart rate, congested gums, prolonged capillary refill time)
               o A finding inconsistent with a simple colic, such as excessive reflux (> 2-5L), a distended viscous, tight band, or extensive impaction on rectal examination, a serosanguinous abdominocentesis

Causes of nasogastric reflux:

     • Pyloric obstruction
     • Small intestinal obstruction or strangulation
     • Nephrosplenic entrapment of the large colon
     • Occasionally with large colon volvulus
     • Anterior enteritis

Causes of tight bands:

     • Large colon displacement or volvulus
     • Grossly distended cecum
     • Mesentery under tension
     • Uterine torsion

Causes of abnormal abdominal taps:

     • Small intestinal compromise (strangulation or prolonged simple obstruction)
     • Enteritis
     • Large intestinal compromise (prolonged simple obstruction)
     • Splenic tap