Equine Colic:

Ultrasonographic and Radiographic Diagnosis

Mattie McMaster and Friends

Introduction

In the wild, there is no healthcare.

Colic

ABDOMINAL PAIN Most commonly associated with gastrointestinal abnormalities Outcome:

Resolve spontaneously Medical treatment Surgical treatment

Diagnostic Tools

Patient history and signalment Physical exam CBC, biochemistry and blood-gas Naso-gastric intubation Rectal palpation Abdominocentesis ULTRASONOGRAPHY RADIOGRAPHY Exploratory surgery

Indications
This is a good day to save lives

Obtain a more specific diagnosis Decide if surgical intervention is necessary Estimate prognosis

Ultrasonography: Equipment

+/-

Preparation

Transducer
Game-face

Low frequency transducer Sector transducer Curvilinear transducer Machine position

Scan Regions

Normal
No surgery?

Equine Abdomen

Spleen
Oh hey.

Left

Stomach

Left

Kidneys

Left

Right

Duodenum

Right

Small Intestine

Left

Large Intestine

Left

Right

Thats what she said.

Cecum

Right

Scan Patterns

Three patterns

Mucous Fluid Gas Wall thickness Layering Uniformity Luminal Contents Peristalsis

Mmmmm, scan patterns.

Evaluate

Abnormal

Through concentration, I can raise and lower my cholesterol at will.

Medical Colic
Brilliant diagnosis.

Enteritis/ duodenitis Right dorsal colitis Verminous arteritis Gastric distension Gastric ulceration Gastric SCC Intestinal neoplasia Abdominal abscess Peritonitis

Enteritis/ Duodenitis

Fluid distension of intestinal tract with increased peristalsis

Developing enteritis

Wall thickened, edematous and more hypoechoic Shreds of intestinal mucosa in lumen Figure 1 Marked fluid distension of stomach

Duodenitis

Figure 2

Right Dorsal Colitis

Non-steroidal antiinflammatory drug toxicity Thickened right dorsal colon

Ventral to liver in right 10th-14th intercostal spaces

Figure 3

Gastric Distension

Stomach is enlarged and filled with fluid Hyperechoic ventral layer representing ingesta Hyperechoic dorsal layer casting dirty shadows consistent with gas

Figure 4

Intestinal Neoplasia

Not routinely visualized on transcutaneous ultrasound Lymphosarcoma

Within intestinal wall

Diffuse irregular filling

Marked enlargement of mesenteric lymph nodes

Figure 5

Abdominal Abscess

Found:

Ventral abdomen Root of mesentery Cecum Large colon

Fluid-filled or solid Movement of adjacent bowel should be examined:

Adhesions between adjacent intestine and abscess

Figure 6

Peritonitis

Ventral abdomen

6.0 to 10.0 MHz transducer Relative quantity Character Abdomen, gastrointestinal and abdominal viscera should be scanned for source of peritonitis

Evaluate fluid:

Evaluate:

Abdominal abscess or devitalized bowel

Surgical Colic

Lets have some fun.

Herniation/ displacement Nephrosplenic ligament entrapment Sand colic/ enterolithiasis Intussusceptions Large colon torsion Strangulating small intestinal and small colon lesions Small intestine masses Impaction

Herniation/ Displacement

Abnormal position of gastrointestinal viscera difficult to diagnose

Exceptions:

Scrotum Thoracic cavity Umbilical hernia

Figure 9

Nephrosplenic Ligament Entrapment

Dorsal spleen and left kidney not visible in left caudal abdomen Visualize ingesta or gasfilled large bowel Spleen ventrally displaced Bright hyperechoic Figure 10 reflection dorsal to the spleen from the bowel

Sand Colic/ Enterolithiasis

RADIOGRAPHS

Not often used in adult horses

Exceptions:
Sand Colic Enteroliths

Figure 11

Enterolithiasis

Figure 12

Sand Colic

Small, pinpoint granular hyperechoic echoes Multiple acoustic shadows Ventral most portion of the affected intestine Limits peristaltic movement

Enterolithiasis

Enteroliths, bezoars, fecaliths, Hasselhoffs Oh hey.. Affected bowel in ventral abdomen Hyperechoic mass casting strong acoustic shadow within intestine lumen Distension of intestine Figure 13: Badness. proximal

Intussusceptions

Ileum and large bowel Right side of abdomen Target sign Fibrin tags between segments of intestine
Figure 14

Intussusceptions

Figure 15

Large Colon Torsion

Increased wall thickness of the large colon

Increased wall thickness is diffusely hypoechoic

Badness!

Figure 16

Strangulating Small Intestinal Lesions

Distended, fluid-filled small intestine proximal to strangulated portion of small intestine Strangulated small intestine

Thickened, edematous, hypoechoic walls Little or no peristaltic activity

Figure 17

Ventral portion of abdomen

Small Intestinal Masses

Within intestinal wall

Thickened wall Anechoic to echogenic Carcinoids, leiomyomas, granulomas, hematomas, and fibrosis Stricture secondary to chronic colic Intestinal obstruction Hemorrhage appears as echogenic clots or echoic swirling fluid

Within lumen

Figure 18

Impaction

Round to oval distended viscus Lack visible sacculations Wall normal to increased thickness Large acoustic shadows from impacted ingesta Distension of intestine proximal Little to no motility

Figure 19

Conclusion

Early referral and surgical intervention is key to successful outcome Ultrasonography and Radiology:

Obtain a more specific diagnosis Decide if surgical intervention is necessary Estimate prognosis

QUESTIONS?