Colic and its Management

Presented to:
Sir Hafiz Manzoor Ahmad

Presented by:
Tauseef Ahmad
2017-dvmn-023
Outline :
1. Introduction
2. Types of colic
3. Risk factors
4. Pathogenesis
5. Clinical findings
6. Diagnosis
7. Differential Dx
8. Colic in Mares
9. Colic in Foals
10.Colic in ruminants
11.Colic in pets
12.Management of Colic
13.Ref.
Introduction:
o By definition, Colic means abdominal pain,
evident as a constellation of clinical and
behavioral signs
o As this specie is very sensitive to pain, so
very low threshold is required
o Still largest cause of death in equines
o Pain can be..
i. Per-acute
ii. Acute
iii. Sub-acute
iv. Chronic
Types of Colic:
Different classification systems are there but
broadly can be classified in
1. Spasmodic
2. Impactive
3. Obstructive
4. Flatulent (intestinal tympany)
5. Idiopathic
Second classification:
1. Obstructive, non-strangulating
2. Obstructive, strangulating
3. Non-strangulating infarctive
4. Inflammatory
 Classification based on Etiologies:
Primary Secondary

1) Spasmodic colic 1) Peritonitis

2) Flatulent colic 2) Urolithiasis
3) Impactive colic 3) Urine retention
4) Obstructive colic 4) Mesenteric neoplasia
5) Gastric dilatation 5) Verminous mesenteric arteritis
6) Gastric ulcers 6) African horse sickness
7) Meconium retention 7) Chemical or plant poisoning
8) Foreign bodies
9) Hernias
Spasmodic Colic:
o Increase bowel motor activity resulting in waves of
intermittent pain and relaxation periods
Etiology:
o Excited temperament
o Drinking of cold water soon after race
o Thunderstorm
o Loud drum beating during any show
Pathogenesis:
o parasympathetic tone…..> peristaltic
movements….> periodic distension of intestinal
loops by ingesta or gas….> intermittent pain
Findings:
o Rolling, pawing on ground
o Kicking at belly
o Flank watching
o Patchy sweating
o Dysentery in later stages
o In case of acute obstruction… no fecal content
except blood tinged mucous in rectum
Impactive Colic:
o Also known as impaction of large
intestine( esp. colon)
o Most common type
Etiology:
 (Primary)
o Feeding low grade roughages
o Molar defects
o Greedy feeders
o Sand with grazing on pasture
o Pica
 (Secondary):
o General debility
o Enteroliths or fiber balls
o Foreign bodies
o Verminous mesenteric arteritis
o Rectal paralysis by encephalitis by rabies or at
time of parturition
Pathogenesis:
o Excessive loading of colon/
rectum….>insensitivity to reflex……> no
defecation reflex…..>metabolic toxemia
develops due to prolong staying of fecal
material
Findings:
o Mild-moderate pain( 3-4 days )
o Anorexia , depression, TPR normal
o Cecal impaction more serious( per rectal)
Flatulent Colic:
o Also known as Intestinal Tympany
Etiology :

1. Primary
• Excessive eating of highly fermentable fodder
or grain overload

2. Secondary
• Partial / compete obstruction develops after
castration due to intestinal adhesions or
verminous aneurysm
Pathogenesis:
o Hindgut fermenters…..>excessive carbs…..>
fermentation…..> gas production but no
evacuation and thus intermittent pain …...>
labored breathing due to pressure on thoracic
cavity…..> rupture, shock and death
Findings:
o Right abdominal flank distension
o No motility but moving fluids can be heard by
stethoscope
o Per rectal, large gas filled on the right of the
flank
Strangulating Colic:
1. Strangulating lipomas:
• Benign and inside intestine
• Ticking time bomb for developing colic

2. Intestinal hernias:
• Moving of intestine through normal ( epiploic
foramen/ inguinal canal) or abnormal
developed in case of any trauma…trap intestine
3. Intussusception:
• One piece telescopes into another piece of
intestine
4. Twisted gut
5. Entrapment in any body cavity

Patho-physiology:
• Blockage…>blood supply cut
off….>tissue necrosis…>toxemia, shock
and death
Risk Factors:
Horse associated:
1. Age
• Foals <6 months 1/100 case
• Foals >6 months 4-6/100 cases

2. Sex
• Females with 1 parturition…. Higher chances
of volvulus
• Intestinal entrapment in mesometrum …..
Higher in females
• Inguinal hernias…….. males
3. Breed
• Higher in thoroughbred horses
4. Diet
• Risk varies with pasture grazing as compared to
stabled feeding
Management associated:
1. Water availability
2. Exercise
3. Medical history
• Previous colic history in 1 year
• Any previous colic surgery
4. Dental issues
5. Wind sucking
1. Parasite control strategies

• 3-16 times chances by Tap worms….iliocecal

lesions
• Roundworms (Parascaris equorum) …. Young
horses
Pathogenesis:
1. Pain
• Hallmark of GI disease
2. GI dysfunction
• Higher motility….spasmodic colic
• Altered in condition….impaction
• Movement absent….ileus secondary to
inflammation/ ischemia of bowel
3. Endotoxemic shock
• Rupture of stomach/ intestine…..> feces in
peritoneal cavity……> shock by;
 Increase tumor necrosis factors
 IL-6 increase in blood and peritoneal fluid

4. Hypovolemic Shock
• Previous dehydration
• CVS collapse followed by endotoxemia
• Increase distension of gut….> pressure on
diaphragm….> reduced venous return and low
resp. ….> shock and death
Clinical Findings:
1. Behavior
• Rolling
• Stretching
• Near water trough but not drinking
• Pawing
• Flank gazing
• Frequent but low urine quantity
• Penis protruding without urination
• Kicking at the belly
• Pain maybe intermittent or continues
2. Posture
• Saw horse
• Dorsal recumbency to stretch mesentery

3. Abdominal size
• If symmetric distension…..caused by dis. Of
colon, cecum, colon torsion, gas accumulation
• If asymmetric distension…. Only cecum
distended
4. Vomiting
• Projectile vomiting through nose shows
severity of disease and impending rupture
Diagnosis:
Physical Exam:

1. Heart rate & resp. rate:

• 40 BPM……mild disease
• 120 BPM…..terminal stage of disease
• 40-60 BPM...obstruction but non-strangulation
• Resp. rate of 80…….severe disease
2. Mucous membranes:
• Dry , pale
• CRT >2 sec
• Toxemic line develops on gingival margins…..
Terminal stage

3. Extremities :
• Cold
• Sweating Poor prognosis
4. Percussion and auscultation :
• Pinging sound
• Check all 4 quadrants…..1 minute for each
• Borborygmi sound louder….intestinal hyper
motility and impending diarrhea
• Absence of sounds…..ileus
5. Rectal Palpation:
• Most important part of Dx in colic
• But anatomy of the posterior abdomen should
be clear

6. Ancillary diagnostics techs.

• Ultrasonography f= 2.0-3.5 MHz
• Radiography
 Enteroliths/ sand/ diaphragmatic hernia
• Arterial blood pressure
 Normal systolic 100 mm Hg
 <80 mm Hg…. Critical situation
 250 mm Hg…. Severe pain without shock

7. Nasogastric intubation:
• Important part of exam
• Try to get reflux by simple intubation or by
adding 500 mL water and immediately
lowering the tube and note the quantity of
fluid… more than 2 L is important
• No reflux in iliocecal valve impac till 24 hrs
D. Dx:
1. Laminitis
2. Pleuritis
3. Enterocolitis
4. Rhabdomyolysis
5. Obstructive urolithiasis
6. Uroperitonium
7. Foaling and dystocia
8. Uterine torsion
9. Peritonitis
10. Cholelithasis
11. Ovulation and ovarian pain
12. Esophageal obstruction
13. Duodenitis-proximal jejunitis
14. Gastric ulceration
15. Anthrax
16. Testicular torsion
17. Lactation tetany
18. Tetanus
19. Rabies
20. Botulism
21. Grass sickness
22. Purpura hemorrhagica
23. Clostridial myonecrosis (gas gangrene)
24. Psychogenic colic
Colic in pregnant and post-parturient
Mares:
Late-term colic causes:
• Idiopathic chronic or recurrent low grade colic
• Large colon distension/ impaction
• Colon/ cecum rupture
• Uterine torsion
• Utero-ovarian artery rupture
• Abdominal wall hernia
• Diaphragmatic hernia
• Dystocia / imminent foaling
• Hydrops
Post-parturient colic (<24 hrs):
• Cramping and involution pain
• Cecal/ colon rupture
• Primary idiopathic ileus and gastric rupture
• Rectal prolapse
• Inversion of uterine horn
• Bladder prolapse through urethra
• Retained fetal membranes
Colic in Foals:
• <1 year of age
• Both congenital and acquired types
• Symptoms are same as for large horses
• Diseases are mentioned in the table
Colic in ruminants:
Colic in Pets:
Etiologies:
Acute
• Spoiled feed
• Garbage eating
• Toxic substances
Chronic
• Any infection
• Worm overload
• Liver failure
• Gallbladder deficiency
• Stomach ulcers
• Tumors
Symptoms :
• Crying / whining
• Bloated stomach
• Off feed
• Hard belly
• Arched back with paws tucked in
• Sluggishness
• Restlessness and thrashing on the floor
Management :
Following line of treatment will be followed:
90 %..... Medicinal cases
10 %..... Surgical cases
1. Analgesia:
• Many are present but be precise and reasonable
while using the drugs because it masks the pain
and so the worsen the situation if it is the case
of surgery
• Flunixin meglumine @ 0.25-1 mg/kg iv or IM
q 8-24 hrs
• @1.1 mg/kg ………….cat/ dog
• Keto-P @ 2.2 mg/ kg iv q 12 hrs horses
• Cattle 2-4 mg/ kg and Cat & dog @1.1
• Phenylbutazone @ 2.2-4.4 mg/kg iv q 12 hrs
( weak analgesic)
• Cattle 4 mg/kg and D 15-22 mg/kg, cat 6-8
• Xylazine @ 0.1-1 mg/kg iv IM per need
Effective for short term ( 30 min)
• Lidocaine @ 1.5 mg/ kg iv…. Loading dose
Then 0.05 (mg/kg )/min iv infusion. Aniti-inflam
and promotility agent
 2. Fluid resuscitation:
Animal % dehydration Rehydration Maintenance (L/24
(Liters) hrs)
Mature horse 500 8 40 25-50
kg

12 60 25-50

Newborn calf 8 4 2.5-5

12 6 2.5-5

Mature cow 8 56 35-70

12 84 35-70
Hydration:
• 1st 4-6 hr…. @100-150 ml/kg
• Dogs….60-90 ml/kg
• Cats….45-60 ml/kg
• 4-10 lit P.O/hr…… more important
Maintenance ( losses added)
• Avg 64 ml/kg/ 24 hr or 3 ml/kg/hr
• Higher weight of dogs…. Less fluid
Fluids:
• Balanced electrolyte sol e.g. Lactated Ringer or
N.S or Dextrose saline or 5% dextrose
3. Lubricants:
• Liquid paraffin/ vegetable oil @ 2-4 liters P.O
Large animals
Or
• MgSO4 @ 200-400 g P.O Large animals
Laxative
• Duphalac @ 1ml/4.5 kg BW q 8 hr cats/dogs
If flatulent colic
• Turpentine oil @ 30-60 ml Large animals P.O
4. Trocarization :
• Just for flatulent colic
• Trocar of 12.5-15 cm long and 14-16 G
• Right paralumber fossa just caudal to last rib
but where there would be loudest sound
• Cause rupture or peritonitis and so antibiotics
must be given before procedure and with great
care
5. Surgery:
• Last resort for recurrent issue
• Done only after thorough exam
Colic Drafts for Horses:
1. Spasmodic Colic
• Atropine sulphate 2 dose @ 15-30 mg/kg IM or
S/C…… Large animals
• Chlorate hydrate 60 g+ simple oil 300 ml….PO
2. Flatulent Colic
• Chloral hydrate 60 g+ turpentine oil 30 ml +
simple oil 300 ml…..PO
3. Impactive Colic
• Simple oil 1000 ml + chloral hydrate 60
g….PO
Prevention:
 Proper parasitic control measures and regular
screening mechanism
 Close observation on animals with minimal
colic signs
 Regular fecal sampling and screening for eggs
 Regular dental care every 6-12 months
 Maintain a regular feeding protocol
 If desired, gradually change(2-3 weeks) the
feeding but not suddenly
 Avoid buying of mares with windsuck
 Regular exercise
 Off feed 1-6 days till recovery… just parenteral
and then soft feed
References:
• Veterinary medicine 11th edit by D. Constable
• Clinical veterinary medicine by Dr. Mumtaz
Ahmad
• Small animal surgery Fossum ( just for fluid
therapy)
• Preventive veterinary medicine by Amalendu
Chakrbharti