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Equine Colic:Ultrasonographic and RadiographicDiagnosis
Mattie McMaster and Friends
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Introduction Colic
ABDOMINAL PAIN
Most commonly associated
with gastrointestinalabnormalities
Outcome:
Resolve spontaneously
Medical treatment Surgical treatment
In the wild,there is no healthcare.
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Diagnostic Tools Patient history and
signalment
Physical exam
CBC, biochemistry andblood-gas
Naso-gastric intubation
Rectal palpation
Abdominocentesis
ULTRASONOGRAPHY
RADIOGRAPHY
Exploratory surgery
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Indications Obtain a more specific
diagnosis
Decide if surgicalintervention isnecessary
Estimate prognosis
This is a good dayto save lives
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Ultrasonography: Equipment
+ + +/- =
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Preparation
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Transducer Low frequency
transducer
Sector transducer
Curvilinear transducer
Machine position
Game-face
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Scan Regions
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Normal
No surgery?
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Spleen
Left
Oh hey.
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Stomach
Left
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Kidneys
Left Right
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Duodenum
Right
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Small Intestine
Left
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Large Intestine
Left Right
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Cecum
Right
Thats what
she said.
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Scan Patterns Three patterns
Mucous
Fluid
Gas Evaluate
Wall thickness
Layering
Uniformity Luminal Contents
Peristalsis
Mmmmm,scan patterns.
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Abnormal Through concentration,I can raise and lowermy cholesterol at will.
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Medical Colic Enteritis/ duodenitis
Right dorsal colitis
Verminous arteritis
Gastric distension
Gastric ulceration
Gastric SCC
Intestinal neoplasia Abdominal abscess
Peritonitis
Brilliant diagnosis.
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Enteritis/ Duodenitis Fluid distension of
intestinal tract withincreased peristalsis
Developing enteritis Wall thickened,
edematous and morehypoechoic
Shreds of intestinalmucosa in lumen
Marked fluid distension ofstomach
Figure 1
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Duodenitis
Figure 2
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Right Dorsal Colitis Non-steroidal anti-
inflammatory drugtoxicity
Thickened right dorsalcolon
Ventral to liver in right10th-14th intercostal
spacesFigure 3
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Gastric Distension Stomach is enlarged
and filled with fluid
Hyperechoic ventrallayer representingingesta
Hyperechoic dorsal
layer casting dirtyshadows consistentwith gas
Figure 4
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Intestinal Neoplasia Not routinely visualized
on transcutaneousultrasound
Lymphosarcoma
Within intestinal wall
Diffuse irregular filling
Marked enlargement of
mesenteric lymph nodes
Figure 5
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Abdominal Abscess Found:
Ventral abdomen
Root of mesentery
Cecum
Large colon
Fluid-filled or solid
Movement of adjacentbowel should beexamined: Adhesions between
adjacent intestine andabscess
Figure 6
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Peritonitis Ventral abdomen
6.0 to 10.0 MHz transducer
Evaluate fluid: Relative quantity
Character
Evaluate: Abdomen, gastrointestinal
and abdominal viscerashould be scanned forsource of peritonitis
Abdominal abscess ordevitalized bowel
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Surgical Colic Herniation/ displacement
Nephrosplenic ligamententrapment
Sand colic/ enterolithiasis
Intussusceptions
Large colon torsion
Strangulating smallintestinal and small colonlesions
Small intestine masses
Impaction
Lets havesome fun.
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Herniation/ Displacement Abnormal position of
gastrointestinal visceradifficult to diagnose
Exceptions:
Scrotum
Thoracic cavity
Umbilical hernia
Figure 9
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Nephrosplenic Ligament Entrapment Dorsal spleen and left
kidney not visible in leftcaudal abdomen
Visualize ingesta or gas-filled large bowel
Spleen ventrallydisplaced
Bright hyperechoicreflection dorsal to thespleen from the bowel
Figure 10
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Sand Colic/ Enterolithiasis RADIOGRAPHS
Not often used in adulthorses
Exceptions: Sand Colic
Enteroliths
Figure 11
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Enterolithiasis
Figure 12
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Sand Colic Small, pinpoint
granular hyperechoicechoes
Multiple acousticshadows
Ventral most portion ofthe affected intestine
Limits peristalticmovement
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Enterolithiasis Enteroliths, bezoars,
fecaliths, Hasselhoffs
Affected bowel in
ventral abdomen Hyperechoic mass
casting strongacoustic shadow
within intestine lumen Distension of intestine
proximal
Oh hey..
Figure 13: Badness.
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Intussusceptions Ileum and large bowel
Right side of abdomen
Target sign
Fibrin tags betweensegments of intestine
Figure 14
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Intussusceptions
Figure 15
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Large Colon Torsion Increased wall
thickness of the largecolon
Increased wall thicknessis diffusely hypoechoic
Figure 16
Badness!
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Strangulating Small Intestinal Lesions Distended, fluid-filled small
intestine proximal tostrangulated portion of
small intestine Strangulated small
intestine
Thickened, edematous,
hypoechoic walls Little or no peristaltic
activity
Ventral portion of abdomen
Figure 17
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Small Intestinal Masses Within intestinal wall
Thickened wall
Anechoic to echogenic
Carcinoids, leiomyomas,
granulomas, hematomas,and fibrosis
Stricture secondary tochronic colic
Intestinal obstruction
Within lumen Hemorrhage appears as
echogenic clots or echoicswirling fluid
Figure 18
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Impaction Round to oval distended
viscus
Lack visible sacculations
Wall normal toincreased thickness
Large acoustic shadowsfrom impacted ingesta
Distension of intestineproximal
Little to no motilityFigure 19
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Conclusion Early referral and
surgical intervention iskey to successful
outcome Ultrasonography and
Radiology:
Obtain a more specific
diagnosis Decide if surgical
intervention isnecessary
Estimate prognosis
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QUESTIONS?