Equis ISSN 2398-2977

Gastrointestinal: tympany/flatulent colic

Contributor(s): Roberta Baxter, Graham Munroe, Peter Rakestraw

Introduction

  • Tympany accounts for approximately 5% of colic cases.
  • Cause: may be due to a highly fermentable diet or secondary to other gastrointestinal disease.
  • Signs: include colic and abdominal distention.
  • Diagnosis: is based on clinical and rectal examination.
  • Treatment: ranges from medication to relieve pain and promote bowel motility, to trocharization and surgery to release gas.

Pathogenesis

Etiology

Predisposing factors

General

  • Recent dietary change to one that is highly fermentable such as new season hay, grass clippings, grain, lush grass.
  • Crib biting Behavior: crib-biting and wind-sucking/windsucking.
  • Abrupt changes in diet.

Specific

Pathophysiology

  • Primary intestinal tympany can occur due to the provision of a readily fermentable diet, that causes gas build up on digestion, or reduced motility in the specific organ affected such as the cecum.
  • Tympany can also occur secondarily to other types of colic, particularly those that cause obstruction Colon: small - obstruction or reduced general motility Gastrointestinal: ileus. A number of factors have been associated with reduced motility, particularly in the colon, and these include parasitism, lack of or change in exercise, colitis Colon: colitis, peritonitis Abdomen: peritonitis, stress factors such as transport or surgery, and exposure to parasympatholytic agents such as drugs, toxins, or plants. Displacement or impaction Colon: impaction and/or windsucking Behavior: crib-biting and wind-sucking may also affect gut motility and lead to secondary distension.
  • Gastric tympany may also occur in small intestinal obstruction Colon: small - obstruction but is more likely to lead to gastric filling with large volumes of fluid.
  • Overeating readily-fermentable feedstuffs results in production of large amounts of lactic acid and volatile fatty acids (VFAs).
  • VFAs inhibit GI motility promoting further fermentation and gas production.
  • If rate of gas production exceeds motility to move it through GI tract, gas accumulates in stomach, cecum and/or large colon.
  • Gaseous build up within the intestines, can cause stretching of the bowel wall. Excessive gas production in the stomach can cause rupture of the structures Stomach: rupture.
  • This stretching normally stimulates peristalsis but if the gut is obstructed (either physiologically or pathogenically) or if sufficient peristalsis does not occur, pockets of gas can build up and cause abdominal pain. As an example gas build up in the stomach may not be belched out via the esophagus because of distortion at the gastroesophageal junction due to the stomach dilation.
  • This pain can vary from moderate to severe, depending on the degree of stretching of the abdominal wall.
  • Distention may increase the contractility of other bowel segments resulting in spasm and pain.
  • In most cases that do not involve bowel compromise, circulatory parameters remain relatively normal, though tachycardia relating to pain is common.
  • Large colon tympany may lead to instability of the organ within the abdomen and predispose to large colon displacements Colon: displacement - left dorsal Colon: displacement - pelvic flexure Colon: displacement - right dorsal or torsion Colon: torsion.

Diagnosis

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Treatment

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Prevention

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Outcomes

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Further Reading

Publications

Refereed papers

  • Recent references from PubMed and VetMedResource.
  • Unger L et al (2014) Peritonitis, abscessation and haemorrhage: Complications of transcutaneous caecal decompression. Equine Vet Educ 26 (8), 430-435 VetMedResource.
  • Scotti G B, Lazzaretti S S, Zani D D & Magri M (2013) Transrectal decompression as a new approach for treatment of large intestinal tympany in horses with colic: preliminary results. Equine Vet Educ 25 (4), 184-188 VetMedResource.
  • Voigt A, Saulez M N, Donnellan C M & Gummow B (2009) Causes of gastrointestinal colic at an equine referral hospital in South Africa (1998-2007). J S Afr Vet Ass 80, 192-198 PubMed.
  • Hillyer M H & Mair T S (1997) Recurrent colic in the mature horse - a retrospective review of 58 cases. Equine Vet J 29 (6), 421-424 PubMed.

Other sources of information

  • Fehr J (2012) Trocharization. In: Practical Guide to Equine Colic. Ed: Southwood L L. John Wiley & Sons Inc, West Sussex. pp 160-163.
  • Mair T S (2009) Treatment of Flatulence and Tympany. In: The Equine Acute Abdomen. 2nd edn. Eds: White N A, Moore J N & Mair T S. Teton Newmedia, Jackson. pp 302.
  • Moore J N & Hardy J (2009) Specific Diseases, Cecal Tympany. In: Equine Acute Abdomen. 2nd edn. Eds: White N A, Moore J N & Mair T S. Teton Newmedia, Jackson. pp 618-619.
  • Edwards R B (2002) Cecal Ciseases that can Result in Colic. Cecal Tympany. In: Manual of Equine Gastroenterology. Eds: Mair T S, Divers T and Ducharme N. W B Saunders, London. pp 268-269.
  • Hackett R P (2002) Primary Colonic Tympany. In: Manual of Equine Gastroenterology. Eds: Mair T S, Divers T & Ducharme N. W B Saunders, London. pp 292-293.


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