colic in the older horse colin mitchell bvm&s certep mrcvs scottmitchellassociates, hexham
TRANSCRIPT
![Page 1: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/1.jpg)
Colic in the Older Horse
Colin Mitchell BVM&S CertEP MRCVSScottMitchellAssociates, Hexham
![Page 2: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/2.jpg)
General
• Diagnosis & treatment – similar to younger animals
• Increased prevalence of certain conditions
• Reduced prevalence of certain conditions
![Page 3: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/3.jpg)
Increased Prevalence
• Pedunculated lipoma• Large bowel
impaction• Some forms of
neoplasia / cancer
![Page 4: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/4.jpg)
Decreased Prevalence
• Grass sickness
• Small intestinal “twists”
• Some forms of intussusception
![Page 5: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/5.jpg)
Pedunculated Lipoma
• 70 % of surgical cases >20yo
• a lump of fat, on a string, suspended in abdomen wraps around loops of intestine!!!
obstruction, distension and pain
![Page 6: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/6.jpg)
Pedunculated Lipoma
• May be intermittent
• If persistent – need surgical correction
• +/- bowel resection
![Page 7: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/7.jpg)
![Page 8: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/8.jpg)
![Page 9: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/9.jpg)
![Page 10: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/10.jpg)
![Page 11: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/11.jpg)
![Page 12: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/12.jpg)
Large Bowel Impaction
• “oro – dental syndrome”
• Reduced water intake
• Can be managed medically
1. Oral liquid paraffin
2. Intravenous fluids
• May need surgical correction
![Page 13: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/13.jpg)
![Page 14: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/14.jpg)
Older Horse Colic
• Pre-existing disease conditions
• Should be considered in decision making process
• ECS – poor wound healing
• Chronic laminitis - welfare
![Page 15: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/15.jpg)
Conclusion
1. Do not rule out possibility of referral for possible surgery on basis of age alone
2. Better to refer early and not need surgery, than send a surgical case too late
![Page 16: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/16.jpg)
Conclusion
1. Do not rule out possibility of referral for possible surgery on basis of age alone
2. Better to refer early and not need surgery, than send a surgical case too late
Majority of colic is medical !!!
![Page 17: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/17.jpg)
Prevention of Colic
1. “Rules” of good feeding
2. Worm Control
3. Routine
![Page 18: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/18.jpg)
Good Feeding
• Feed according to work , temperament & condition
• Plenty of roughage• Little & often – 3kg
max hard feed at any 1 time
• Routine
• Change gradually• Water before feeding• Good quality
feedstuffs
![Page 19: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/19.jpg)
Worm Control
1. Worm egg counts
2. Routine interval worming
![Page 20: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/20.jpg)
Worm Control
YEAR 1• Equest every 13 weeks• Tape worm Spring /
Autumn• (Equitape / DD Stro-P
DD Pyratape P etc)
YEAR 2• Ivermectin every 6-8
weeks (Eqvalan etc)• Tape worm as Year 1
![Page 21: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/21.jpg)
Routine
• Feeding times• Feeding quality /
quantity• Turn-out• Bedding : straw v
shavings / paper• Dental prophylaxis
![Page 22: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/22.jpg)
Recurrent Airway Obstruction
• RAO• Heaves• Asthma in horses• COPD
![Page 23: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/23.jpg)
Recurrent Airway Obstruction
• RAO• Heaves• Asthma in horses• COPD
![Page 24: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/24.jpg)
RAO
• Reaction of small airways to inhaled substances
• Fungal spores, dust, noxious gases, ammonia, mites
![Page 25: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/25.jpg)
RAO
• Increased resp rate & effort
• +/- cough• +/- nasal discharge• Poor performance
![Page 26: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/26.jpg)
RAO - management
1. Drug therapy
2. Environmental control
![Page 27: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/27.jpg)
Drug Therapy
1. Oral
2. Inhaled
3. Systemic
![Page 28: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/28.jpg)
Oral Therapy
• “Ventipulmin”, “Sputulosin”,
• “Prednisolone”
![Page 29: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/29.jpg)
Inhaled
• Less side-effects• High local
concentration of drug• Rapid onset of action• Delivered at site where
required
![Page 30: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/30.jpg)
Systemic Therapy
• Usually at time of respiratory distress :-
1. Frusemide
2. Steroid
3. Atropine
![Page 31: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/31.jpg)
Environmental
• Turn – out• Haylage• Paper / dust-extracted
shavings• Rubber matting• Soak hay
![Page 32: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/32.jpg)
Weight Loss
![Page 33: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/33.jpg)
Mechanisms of Weight Loss
1. Reduced intake
2. Reduced digestion, absorption
3. Increased losses
4. Increased requirements
![Page 34: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/34.jpg)
Common causes
• Malnutrition• Dental disease• Inability to compete
for feed• Chronic Peritonitis• Grass sickness
• Protein losing enteropathy ( PLE )
• Neoplasia ( GI / non-GI )
• Liver disease• Internal parasitism
![Page 35: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/35.jpg)
My Approach
1. Good history• Feeding• Worming• Previous disease /
lameness• Housing
![Page 36: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/36.jpg)
My Approach
• Clinical Examination
1. Worm & rasp teeth
![Page 37: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/37.jpg)
My Approach
• Clinical Examination
1. Worm & rasp teeth
2. Blood tests – liver / PLE
![Page 38: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/38.jpg)
My Approach
• Clinical Examination
1. Worm & rasp teeth
2. Blood tests – liver / PLE
3. Peritoneal fluid / urine
![Page 39: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/39.jpg)
My Approach
Hospitalise :-
• Oral glucose tolerance test ( OGTT )
• Rectal biopsy if diarrhoea
• Gastroscopy
• Ultrasonography
![Page 40: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/40.jpg)
OGTT
• Starve overnight
• 1g per kg glucose administered by naso-gastric tube
• Blood sample regularly
• Plot glucose level in blood – compare peak
![Page 41: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/41.jpg)
OGTT
• >85% increase : normal
• 15 – 85 % : partial
• <15 % : complete
![Page 42: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/42.jpg)
OGTT
• Tests small intestinal function
• Blood glucose should peak 2hrs after glucose given
• If not – reduced absorption
![Page 43: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/43.jpg)
OGTT - normal
blood glucose
time2 hrs
![Page 44: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/44.jpg)
OGTT - partial
blood glucose
time2 hrs
![Page 45: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/45.jpg)
OGTT - complete
blood glucose
time2 hrs
![Page 46: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/46.jpg)
OGTT - compare
blood glucose
time2 hrs
![Page 47: Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham](https://reader036.vdocuments.us/reader036/viewer/2022081506/56649e575503460f94b4fc1f/html5/thumbnails/47.jpg)
Weight Loss - further
• Laparotomy• Once gone beyond
common causes – can be difficult to pinpoint cause