Equine Colic: Ultrasonographic and Radiographic Diagnosis

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Equine ColicUltrasonographic and Radiographic
Diagnosis

• Mattie McMaster and Friends

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Introduction
In the wild, there is no healthcare.

• Colic
• ABDOMINAL PAIN
• Most commonly associated with gastrointestinal
  abnormalities
• Outcome
• Resolve spontaneously
• Medical treatment
• Surgical treatment

COLIC
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Badness!!!
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Diagnostic Tools

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

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Ultrasonography and Radiology
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Indications
This is a good day to save lives

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

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Ultrasonography Equipment


/-

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Preparation
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Transducer
Game-face

• Low frequency transducer
• Sector transducer
• Curvilinear transducer
• Machine position

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Scan Regions
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Normal
No surgery?
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Equine Abdomen
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Spleen
Oh hey.
Left
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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
Thats what she said.
Right
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Scan Patterns
Mmmmm, scan patterns.

• Three patterns
• Mucous
• Fluid
• Gas
• Evaluate
• Wall thickness
• Layering
• Uniformity
• Luminal Contents
• Peristalsis

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Abnormal
Through concentration, I can raise and lower my
cholesterol at will.
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Medical Colic
Brilliant diagnosis.

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

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Enteritis/ Duodenitis

• Fluid distension of intestinal tract with
  increased peristalsis
• Developing enteritis
• Wall thickened, edematous and more hypoechoic
• Shreds of intestinal mucosa in lumen
• Marked fluid distension of stomach

Figure 1
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Duodenitis
Figure 2
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Right Dorsal Colitis

• Non-steroidal anti-inflammatory drug toxicity
• Thickened right dorsal colon
• Ventral to liver in right 10th-14th intercostal
  spaces

Figure 3
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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
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Intestinal Neoplasia

• Not routinely visualized on transcutaneous
  ultrasound
• 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 adjacent bowel should be examined
• Adhesions between adjacent intestine and abscess

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 viscera
  should be scanned for source of peritonitis
• Abdominal abscess or devitalized bowel

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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

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Herniation/ Displacement

• Abnormal position of gastrointestinal viscera
  difficult 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 left
  caudal abdomen
• Visualize ingesta or gas-filled large bowel
• Spleen ventrally displaced
• Bright hyperechoic reflection dorsal to the
  spleen from the bowel

Figure 10
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Sand Colic/ Enterolithiasis

• RADIOGRAPHS
• Not often used in adult horses
• Exceptions
• Sand Colic
• Enteroliths

Figure 11
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Enterolithiasis
Figure 12
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Sand Colic

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

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Enterolithiasis

• Enteroliths, bezoars, fecaliths, Hasselhoffs
• Affected bowel in ventral abdomen
• Hyperechoic mass casting strong acoustic 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 between segments of intestine

Figure 14
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Intussusceptions
Figure 15
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Large Colon Torsion

• Increased wall thickness of the large colon
• Increased wall thickness is diffusely hypoechoic

Badness!
Figure 16
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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
• 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 to chronic colic
• Intestinal obstruction
• Within lumen
• Hemorrhage appears as echogenic clots or echoic
  swirling fluid

Figure 18
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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
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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

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QUESTIONS?