Untersuchung des akut kolikkranken Pferdes – labordiagnostische und bildgebende Verfahren

Zusammenfassung

Der Artikel gibt eine Übersicht über die für die Untersuchung des akut kolikkranken Pferdes relevanten labordiagnostischen Untersuchungsparameter in Blut und Bauchhöhlenpunktat. Als minimale Datenbasis werden Hämatokrit und Gesamteiweißkonzentra tion empfohlen. Sie können einen Hinweis auf den Dehydratationsgrad liefern (Hämatokrit < 0,45 l/l als Anzeichen einer maximal geringgradigen und > 0,5 l/l als Hinweis auf eine hochgradige Dehydratation). Der Grad der Dehydratation geht häufig mit dem Schweregrad der Kolik einher. Wertvolle Hinweise auf einen minderdurchbluteten Darm kann die Blutlaktatkonzentration geben, wobei ein Wert von > 4 mmol/l auf eine ungünstige Prognose hinweist. Zu beachten ist, dass die Laborparameter immer in Kombination mit den Befunden der klinischen Untersuchung beurteilt werden. Gerade die Verlaufsuntersuchung des klinischen Zustands und dieser Laborparameter ist für die Beurteilung des Krankheitsgeschehens und dessen Entwicklung äußerst wertvoll. Bei erfolgter Abdominozentese können die Bestimmung von Zellzahl, Proteinund Laktatkonzentration wertvolle Hinweise zu Art der Kolik, Therapie und Prognose liefern. Eine Rotfärbung des Bauchhöhlenpunktats stellt ein Indiz für eine Strangulation des Darms dar (hämorrhagische Infarzierung). Auch durch die transkutane Sonographie des Abdomens lassen sich in kurzer Zeit wertvolle Informationen zur Ursache der Kolik und deren Schweregrad gewinnen. Bei einem Dünndarmileus stellt sich häufig bereits vor der transrektalen Palpation von Dünndarmanteilen dilatierter Dünndarm sonographisch im ventralen Flankenbereich dar. Das Vorliegen freier Flüssigkeit im Peritonealraum, das Auffinden dilatierter Dünndarmanteile, die Beurteilung der Darmwanddicke und die Ausdehnung der Magengrenzen können Anhaltspunkte für das weitere Management akut kranker Kolikpatienten liefern. Besonders bei Ponys und Fohlen eignet sich auch die röntgenologische Untersuchung zur weiterführenden Dia gnostik. Sie kann beispielsweise zur Darstellung von Sandobstipationen, Mekoniumobstipationen sowie gastrointestinalen Atresien beim Neonaten herangezogen werden.

Summary

The article summarizes the relevant clinical pathological assessment of horses with acute colic. A minimal laboratory evaluation should include the patient’s haematocrit (or packed cell volume), total protein, and lactate concentration in the blood. Haematocrit and total protein provide an indication of the severity of dehydration (haematocrit < 0.45 l/l is evidence of no to mild dehydration whereas > 0.5 l/l points to a severe dehydration). The degree of dehydration is often associated with the severity of the colic. Additionally, the blood lactate concentration rises with increasing intestinal compromise with a concentration of > 4 mmol/l indicating a guarded prognosis. However, it is crucial to assess laboratory values only in the context of the clinical findings. If an abdominocentesis is performed, the leukocyte count and the protein and lactate concentrations offer valuable information regarding the type of colic, the severity of the lesion, further therapy, and prognosis of the colic. Reddish discolouration of peritoneal fluid may be a sign of a strangulating obstruction. Transcutaneous abdominal ultrasonography may provide a crucial insight into the colic cause and severity in a relatively short time, even for inexperienced examiners. In regards to small intestinal lesions, dilated small intestinal loops can often be imaged ultrasonographically before they can be palpated transrectally. The occurrence of free peritoneal fluid and dilated small intestine as well as the evaluation of the intestinal wall and the extent of the gastric wall, allow a better management of the acute colic patient. In ponies and foals, radiography as a further diagnostic imaging modality of the abdomen is of great value. It can help to visualise sand impactions, meconium impactions, or gastrointestinal atresia in the neonate.

Schlüsselwörter

Ultraschall - Sonographie - Abdominozentese - Röntgen - Labordiagnostik

Key words

Ultrasonography - abdominocentesis - radiography - clinical pathology

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