2 diagnosis of colic in equines prof.dr hamed attia

1. Colic In Equines
2-Diagnosis & Differential Diagnosis

2. ‫ا‬
.
‫د‬
‫عطية‬ ‫حامد‬
‫الحيوان‬ ‫طب‬ ‫استاذ‬
–
‫البيطرى‬ ‫الطب‬ ‫كلية‬
‫الزقازيق‬ ‫جامعة‬
-
‫مصر‬
‫الخبربالرياض‬ ‫اوميجا‬ ‫بمؤسسة‬ ‫الفنى‬ ‫المستشار‬
‫البيطرية‬ ‫لألدوية‬
‫الخيول‬ ‫فى‬ ‫المغص‬
‫الثانى‬ ‫الجزء‬
:
‫التفريقى‬ ‫والتشخيص‬ ‫التشخيص‬

3. ‫الخيول‬ ‫فى‬ ‫المغص‬
‫الثانى‬ ‫الجزء‬
:
‫التفريقى‬ ‫والتشخيص‬ ‫التشخيص‬ ‫طرق‬

‫السونار‬ ‫باستخدام‬ ‫التشخيص‬

‫اكس‬ ‫أشعة‬ ‫بأستخدام‬ ‫التشخيص‬

‫البطن‬ ‫منظار‬ ‫باستخدام‬ ‫التشخيص‬

‫المعملى‬ ‫التشخيص‬

‫البطن‬ ‫فتح‬ ‫طريق‬ ‫عن‬ ‫التشخيص‬
‫االستكشافى‬

‫التفريقى‬ ‫التشخيص‬

‫الحالة‬ ‫على‬ ‫الحكم‬
.

‫الحالة‬ ‫تاريخ‬

‫األكلينيكى‬ ‫الفحص‬

‫النبض‬ ‫قياس‬

‫الجفاف‬ ‫درجة‬ ‫قياس‬

‫المخاطية‬ ‫األغشية‬ ‫فحص‬

‫السماعة‬ ‫باستخدام‬ ‫التشخيص‬

‫ال‬ ‫اللى‬ ‫انبوبة‬ ‫باستخدام‬ ‫التشخيص‬
‫معدى‬

‫الشرجى‬ ‫الفحص‬ ‫طريق‬ ‫عن‬ ‫التشخيص‬

4. Method of diagnosis

5. Normal Temp. Pulse & Resp.
Temp 37.5
Pulse 28-40
Resp 8-18

6. ‫التشخيص‬ ‫أساسيات‬

7. 1-Case history
• A-How sever has the pain been?
• B-When did the horse last defecate?
And what was the character of the
feces?
• C-Has the horse shown specific
behavior such as playing with water?

8. 1-Case history
• D-Could the horse have graine access
highly fermentable food?
• What is the horse’s past medical
history?

9. Clinical Signs
• Flank-watching or -biting,
• pawing,
• trying to roll,
• an elevated heart rate,
• a lack of gut sounds or bowel
movements.
• While these signs and others are pretty
clear, common indicators your horse is
colicking,

11. 2- Auscultation of the
heart

12. 2- Examination of heart:
• The heart rate and the character of
pulse are important in determining the
degree of severity of colic.
• Rates greeter than 80 bpm should be
considered the result of sever lesion or
disease
• ‫عن‬ ‫القلب‬ ‫ضربات‬ ‫زيادة‬
60
‫مؤشر‬ ‫يعتبر‬ ‫الدقيقة‬ ‫فى‬ ‫ضربة‬
‫خطر‬

13. 3-Estimation to
Degree of
Dehydration:
‫الجفاف‬ ‫درجة‬ ‫تحديد‬
A- Skin Pinch Test.
B-Capillary Refile
Time(CRT).

14. A-Skin-pinch test
• Pinch the skin near the point of the
shoulder.
• Skin snaps quickly back into place =
sufficient hydration.
• Skin stays tented for 2-4 seconds =
moderate dehydration.
• Skin remains lifted from the flesh for 4-
6 seconds = severe dehydration.

15. B-Capillary Refile Time(CRT)
• Pressing a finger or thumb on the upper
gum, above an incisor, for a second or
two.
• Color returns to the gum in one to two
seconds: horse is amply hydrated.
• Gums remain blanched for longer than
two seconds: horse is likely dehydrated.

16. Degree dehydration
1- Mild
• Mild:
• 5-7% body weight in water loss.
Symptoms:
• Depression.
• Dry mucous membranes.
• Slow capillary refill time (>2 seconds).

17. 2-Moderate Dehydration
• Moderate:
• 8-10% water loss.
• Signs:
• Depression,
• Weak pulse,
• Elevated heart rate
• Prolonged capillary refill time (2-4
seconds).

18. 3-Severe Dehydration
• Greater than 10% water loss.
• Symptoms:
• Cold limbs
• lethargy.
• persistent skin “tenting.”
• Horses may be near death with
multiple organ failure.

19. 4 Colure of the
MM

20. • In simple dehydration the oral
mm is slight bluish.
• in mild dehydration it becomes
brick red or cyanosed.

21. • In Sever Dehydration:
• it becomes pale blue-grey color.
• Severe dehydration normally occurs when
the damaged gut is no longer capable of
absorbing fluid into the body.

22. 5- Auscultation of the
abdomen

23. Motilty may be one the following
• 0 - Silent, no motility heard during 30
seconds.
• 1 - Less than normal motility.
• 2 - Normal motility.
• 3 - Hypermotile, more gut sounds than
usual.
• ‫الرمل‬ ‫حركة‬ ‫صوت‬ ‫نسمع‬ ‫القولون‬ ‫فى‬ ‫رمال‬ ‫وجود‬ ‫حالة‬ ‫فى‬
‫ورقة‬ ‫على‬

24. ‫السماعة‬ ‫وضع‬ ‫مكان‬
‫ومن‬ ‫اليمين‬ ‫جهة‬ ‫من‬
‫اليسار‬ ‫جهة‬
‫اليمين‬
‫اليسار‬

26. Listen to the upper right
quadrant
• Listen to the upper right quadrant
where gas is often heard since this
roughly corresponds to the base of the
cecum.
• Move down to the lower right quadrant
•
‫عدم‬
‫سماع‬
‫صوت‬
‫حركة‬
‫األمعاء‬
‫فى‬
‫الجزء‬
‫العلوى‬
‫من‬
‫ناحي‬
‫ة‬
‫اليمين‬
‫احتمال‬
‫امتالء‬
‫االعور‬
‫بالغازات‬
‫او‬
‫الطعام‬
•
‫فى‬
‫حالة‬
‫الغازات‬
‫نسمع‬
‫الصوت‬
‫المعدنى‬
•
‫عدم‬
‫سماع‬
‫صوت‬
‫حركة‬
‫األمعاء‬
‫فى‬
‫الجزء‬
‫السفلى‬
‫دليل‬
‫وجود‬
‫لكمة‬
‫فى‬
‫القولون‬
‫او‬
‫رمال‬

27. Listen to the upper& lower left
quadrant
• Listen to the upper left quarter
• Drop the stethoscope down about 8
inches and listen to the lower left
quadrant.
‫ضعف‬
‫حركة‬
‫االمعاء‬
‫فى‬
‫الجزء‬
‫العلوى‬
‫من‬
‫اليسار‬
‫دليل‬
‫على‬
‫حدوث‬
‫شلل‬
‫فى‬
‫االمعاء‬
‫عدم‬
‫سماع‬
‫صوت‬
‫فى‬
‫الجزء‬
‫السفلى‬
‫من‬
‫اليسار‬
‫يدل‬
‫على‬
‫احتمال‬
‫حدوث‬
‫انزياح‬
‫للقولون‬
‫اليسار‬
‫السفلى‬
‫من‬
‫مكانه‬

28. 6-Nasogastric intubation
‫والعالج‬ ‫للتشخيص‬ ‫المعدى‬ ‫اللى‬ ‫انبوبة‬

29. 1-Passing a Nasogastric
(Stomach) Tube
‫استخدام‬ ‫دواعى‬
‫المعدى‬ ‫اللى‬ ‫انبوبة‬
‫الخيول‬ ‫فى‬

30. ‫المعدى‬ ‫اللى‬ ‫انبوبة‬ ‫ادخال‬ ‫خطوات‬
1
-
‫االولى‬ ‫الخطوة‬

31. ‫المعدى‬ ‫اللى‬ ‫انبوبة‬ ‫ادخال‬ ‫خطوات‬
1
-
‫الثانية‬ ‫الخطوة‬

32. ‫المعدى‬ ‫اللى‬ ‫انبوبة‬ ‫ادخال‬ ‫خطوات‬
1
-
‫الثالثة‬ ‫الخطوة‬
‫انها‬ ‫للتأكد‬ ‫االنبوب‬ ‫نفخ‬
‫المعدة‬ ‫داخل‬

33. Introduction of naso -gastric
intubation

34. Introduction of naso -gastric
intubation
Diagnosis Therapy

35. Gastric reflux
•
:
‫ظاهرة‬
‫ارتداد‬
‫السوائل‬
‫فى‬
‫المعدة‬
:
• A blockage in the bowel
(usually the small intestine)
that causes the build up of fluid
in front of it.

36. Complications
• Hemorrhage
• Aspiration
Pneumonia
• Gastric rupture
• Esophageal
necrosis

37. Complications
• Hemorrhage
• Aspiration
Pneumonia
• Gastric rupture
• Esophageal
necrosis

38. 7-Rectal palpation
• :‫اآلتية‬ ‫االعضاء‬ ‫فحص‬ ‫يمكن‬

39. 7-Rectal palpation
• :‫اآلتية‬ ‫االعضاء‬ ‫فحص‬ ‫يمكن‬
• Caudal portions of the large intestine,
• Caudal edge of spleen,
• Left kidney,
• Aorta,
• Mesenteric root,
• Reproductive tract of mares,
• Inguinal rings in stallions.

40. Precautions
• Administration of sedatives:
• (Buscopan :hyosin hydrobromide)
• VET:(N-Butylscopolammonium
bromide)
• Xylazine:
• Doses of up to 0.5mg/kg of xylazine IV
can be useful for short durations (15 to
30 minutes)

41. Precautions
• Glove lubricated with lubricant.
• Short nails
• Application of a nose twitch
• Lifting one of the fore limb

42. Normal anatomical structure viewed from the caudal
aspect of the equine abdomen.

43. Examination of colon & cecum
A-In large colon impaction:
is characterized by an enlarged, firm,
filled viscous located on the pelvic floor.
B-Cecal impaction :
• palpation of a firm, impacted cecum or
a grossly distended
• fluid-filled cecum per rectum.

44. 8-Ultasonography
2-5 MGz

45. Indications
1- Intestinal motility and distension
can be evaluated for both the large
and small intestine.
2-The thickness of the intestinal wall
can be evaluated and measured.

46. Indications
3-some abdominal abscesses.
4- Intussusception.
5-Peritoneal effusion(Volume and
type).
6-Gastric dilatation

47. Indications
• 7-Adhesions, masses,
• 8-Left dorsal displacement of the
large colon,
• 9-Hemoperitoneum
• 10-Splenic abnormalities.

48. Trans-abdominal ultrasonography
showing thickened loops of small
intestine due to inflammatory bowel
disease.

49. 9- Radiography

50. 8-Radiology
• Sand accumulation
• Enteroliths

51. 10- Endoscopy

52. Endoscopic examination
• Through esophagus and the rectum
can be performed to evaluate for:
• the presence of obstructions,
• tears or other perforations.
• Inflammation.
• ulcers .
• in association with a colic episode,

53. Gastric ulcer
• Sand accumulation
• Enteroliths
Gastric ulceration – endoscopic
appearance of grade 1 ulcers.

54. 11- Laboratory
Investigations

55. A-Faecal examination
• Ascaris
• Strongyloides
are the most common causes of
colic in equines.

56. B- CBC
▪ Blood picture revealed increase
in case of:
▪ Hb and PCV percentage in all
the three types of colic.
▪
‫هذا‬
‫دليل‬
‫على‬
‫حدوث‬
‫جفاف‬
‫فى‬
‫معظم‬
‫أنواع‬
‫المغص‬
‫ويتم‬
‫تحديد‬
‫كمية‬
‫المحاليل‬
‫بناءا‬
‫على‬
‫نسبة‬
‫الج‬
‫فاف‬

58. Bile acid concentrations
▪ Can be increased in some
horses with intestinal
disorders, such as colic,
enteritis,

59. Bile acid concentrations
▪ Horses with displacement of the
left colon to the right occasionally
have increases in:
▪ GGT activity .
▪ Direct (conjugated) bilirubin.
▪ Bile acids.
▪ ( resulting from obstruction of bile
flow)

60. Plasma volume contraction
▪ An Increase in:
▪ hematocrit PCV.
▪ electrolyte derangements
(hyponatremia- hypochloremia, and
hypomagnesemia).
▪ Occurs secondarily to fluid
sequestration and loss via the
intestines.

61. Total protien
▪ Lower than total protein (especially
albumin) concentration .
▪ indicates protein loss from the
diseased bowel.

62. Analysis of peritoneal fluid
Reflects these changes.
• Leukocytosis
• Increase of protein
• ( in colonic impaction & strangulation.)

63. SURGICAL DIAGNOSTICS
Exploratory celiotomy and laparoscopy
are both surgical procedures.
This done when all other methods of
diagnosis are failed to reach the actual
cause of colic.

65. 11- Surgical exploratory
examination

66. Ileo- cecal impaction

67. Colon impaction

68. Differential Diagnosis

70. Prognosis

71. Causes of Endotoxemia in
Horses
• Toxin called lipopolysaccharide (LPS),
which is present in the cell walls of
gram-negative bacteria.
• Some types of gram-negative bacteria
are naturally in the gut flora and don’t
cause any harm unless the horse is
sick for some other reason .

72. Causes of Endotoxemia in
Horses
• and these bacteria excessively proliferate
and then breach the intestinal wall, thus
entering the bloodstream.
• When these bacteria die, their cell walls
rupture, releasing the LPS into the
bloodstream and causing endotoxemia.
• E. coli, Salmonella, and Enterobacter are
common Gram-negative bacteria that
cause endotoxemia.

73. Symptoms of Endotoxemia in
Horses
• Fever
• Dehydration
• Dark mucous membranes .
• Sweating
• Increased heart and respiratory rate
• Laminitis
• Pain

74. Endotoxin shock
• Acute strangulation.
• Intussusception.
• Salmonellosis.
• Neonatal bacteremia and
septicemia

75. The value of measurement blood
pressure in prognosis of colic

78. a 17- to 21-gauge catheter is placed into a
metatarsal, metacarpal, facial, or transverse
facial artery and is connected to a monitor

79. Prognosis
• The most notable prognostic indicators
include :
• heart rate.
• packed cell volume.
• plasma lactate.
• creatinine.
• blood glucose concentrations

80. Pad prognosis
• Increase in heart rate.(more than 80/m)
• Increase packed cell volume.(more than 40)
• Increase plasma lactate.
• Increase creatinine.
• Increase blood glucose concentrations.
• Hypotension ( less than 60 mmHg).

81. Need Surgery
‫سريع‬ ‫جراحى‬ ‫تدخل‬ ‫الى‬ ‫تحتاج‬ ‫الحاالت‬ ‫هذه‬
• 1- Clean rectum( No feces in the
rectum).
• 2- pulse rate over 80/M.
• 3- Cyanosed mm.
• 4- Absence of intestinal sounds
• 5- Gastric reflux
• 6- Sandy colic

82. Any
Question?