Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.

com

A number of factors
influence whether
a horse with colic is
a medical or potential
surgical case

Decision mnaking in the mnanagemnent

of the colicky horse DEBRA ARCHER

COLIC is one of the most commonly encountered emergency conditions of the horse seen in practice.
Many owners are aware of the potentially life-threatening consequences of colic and such cases can be
stressful to deal with, particularly for inexperienced practitioners or those who deal infrequently with
horses. Decisions about which diagnostic tests to perform and the most suitable treatment options are
important in ensuring that appropriate action is taken. Although many cases of colic seen in first opinion
practice are mild and recover spontaneously or following medical treatment, it is vital to identify those
animals that may require surgery, if this is an option for the owner. For such patients, early referral is
essential as this will maximise the chance of a successful outcome. This article discusses the factors which
Debra Archer should be considered in this decision-making process.
graduated from
Glasgow in 1996.
She worked in MANIFESTATION OF ABDOMINAL PAIN strangulating obstructions. Many textbooks describe the
mixed practice in
Bedfordshire for pathogenesis of these types of obstruction and the course
two years and then Colic is the behavioural manifestation of paini that is of time over which they manifest. It is important to note
in equine practice
in Yorkshire. localised in the abdomen and is most often related to the that strangulating obstructions develop rapidly and can
She subsequently gastrointestinal tract. In most cases, pain results from result in death within 24 to 36 hours.
completed a three-
year residency in a disturbance in normal gut motility. Horses suffering
equine surgery at from colic may exhibit varying degrees of pain, ranging
Liverpool University. from mild to severe, or depression. Pain may arise from
She holds the RCVS
certificate in equine one or a combination of intestinal spasm, mucosal irrita-
surgery (soft tissue) tion, distension of the bowel wall by gas or ingesta,
and is currently
undertaking a PhD at tension on the mesentery or ischaemia of the intestinal
Liverpool University wall. Such pain is termed visceral. Obstruction of the
on the epidemiology
of colic. gastrointestinal tract is broadly divided into simple and

Is it colic?
A variety of conditions may
Causes of 'false' colic
mimic the signs of gastrointestinal-
* Laminitis
associated pain (so-called 'false * Rhabdomyolysis
colic', see box on the right). It is * Urinary tract obstruction/rupture
important to differentiate between * Dystocia/uterine torsion
colic and false colic in order to * Pleuritis/pleuropneumonia
ensure that appropriate treatment
* Liver disease
is administered. In some cases, this * Aortoiliac thrombosis
can be a challenge but valuable
* Splenic lesions
information can be obtained from * Central nervous system disease
the history and by observing the
(eg, tetanus)
horse before starting a clinical * Ovulation/granulosa cell tumour Telltale signs of colic that has been present for several
examination. hours include disturbed bedding and abrasions, particularly
around the head and over the tuber coxae

378 In Practice o JULY/AUGusT 2004

 Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

HISTORY TAKING
Specific information that should be obtained
A good history provides valuable information and helps
to determine the possible cause of colic. Certain risk fac- U Signalment
tors (eg, age, recent box rest) are associated with particu- U When the colic was first observed
lar types of colic. The duration and severity of colic may U Signs of colic observed
be difficult to establish when an affected horse has been U When the horse was last seen to be normal
found in the morning. Where a strangulating lesion has U Any recent episodes of colic
been present for several hours, acute signs of pain may U Recent changes in management or exercise
become less obvious and the horse may appear quiet U Worming history (including prophylaxis against tapeworms)
and dull due to the progressively worsening bowel wall U Recent dental examination
necrosis and endotoxaemia. U Current medications (eg, non-steroidal anti-inflammatory drugs [NSAIDs])
Where bouts of colic are recurrent in nature, it is U Whether the mare is pregnant and the stage of gestation (or recent foaling)
important to determine whether the episodes are changing
in frequency, duration or severity. Initially. the priority
is to assess whether the current episode is potentially RECTAL EXAMINATION
life-threatening. If medical therapy is successful, further Rectal examination should always be performed in any
investigations shoLild then be undertaken. horse exhibiting moderate to severe, or persistent, pain
despite analgesia. In mild cases of colic seen for the first
time, rectal examination may be omitted, particularly if
CLINICAL EXAMINATION the horse is fractious or strains relentlessly. Rectal exam-
ination will not be possible in foals or very small ponies.
The severity of the clinical signs and possible cause of Fractious horses should be sedated; xylazine is useful
colic should be determined before making a decision on for its short-term sedative and analgesic effects. Spasmo-
how to manage an affected case. The initial clinical exam-
ination should be quick but thorough and systematic, and
should include an assessment of heart and respiratory
rates, mucous membrane colour, hydration status, rectal Colic in the pregnant mare
temperature and abdominal distension, and auscultation It is important to establish whether colic in the preg-
for abdominal borborygmi (intestinal sounds). For safety nant mare is related to the gastrointestinal tract
reasons, if the horse is in extreme pain and likely to make or directly to the uterus and fetus (eg, impending
violent movements, sedation may be justified before start- abortion or parturition). Most analgesic drugs are
ing an examination. It is useful to assess the horse's heart not specifically licensed for use in the pregnant
rate before the administration of any sedatives or butyl- mare and the lack of such data relating to the mare
scopolamine (Buscopan Compositum; Boehringer Ingel- can make it difficult to decide on the most appropri-
heim) due to their transient effects on the resting heart ate drugs to use. Most data have been extrapolated
rate, which make further comparisons more difficult. from other species and the effects of many drugs
Such information provides a picture of the systemic on the fetus are inconclusive. In general terms,
status of the horse and also a baseline against which sufficient analgesia should be administered to con-
the results of a repeat examination can be compared. trol the signs of pain. In a mare with a surgical
In many cases, a specific diagnosis cannot be made. lesion, the priority is to provide analgesia and anti-
Regardless of the diagnosis, continued deterioration of endotoxic therapy and to get the patient to a refer-
the horse's parameters despite medical therapy indicates ral centre as soon as possible.
the need for potential surgical intervention.

Colic in the foal

Diagnosis of colic in the foal can be challenging and
it can be difficult to determine the need for surgical
intervention. Common conditions in the neonatal foal
include meconium impaction and gastric ulceration.
In addition, other conditions, such as ruptured blad-
der, can be confused with signs of true colic in the
neonatal animal. Imaging modalities, such as ultra-
sonography and radiography, can be useful in the
evaluation of these cases. Neonatal foals can deterio-
rate quickly so they should be monitored carefully
if medical therapy is undertaken; they should be
referred immediately if there is no response to treat- Suitable NSAIDs include flunixin and carprofen.
ment or if the foal's condition continues to deterio- Stress in conjunction with the use of NSAIDs can
rate. No NSAIDs are licensed for use in foals less than result in gastroduodenal ulceration; therefore, anti-
six weeks of age, but they can be used at lower dose ulcer therapy should be administered concurrently
rates. Care should be taken to ensure the foal is using a proton pump inhibitor (omeprazole) or one
adequately hydrated before NSAIDs are administered. of the H2-antagonists (eg, cimetidine or ranitidine).

In Practice o JULY/AUGUST 2004 37

 Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

I>vtIcs (in Inisti Ltitto (t a1 local anacsthictic tlito tiic Ircctal ABDOMINOC ENTESIS
ILIItiicii catI1 ~id Icctai C\amiiiatIil0Ii HIi aht11SC that pci sis- ~\hdo-(in iii)ccn1tcsi s cani he pci 101 mcd rclautsvci castlw>ssith
min111ivCialcnipmcnt (scc bo\ hcios. lcli) and Canl pr(idotc
tCliti\ strain,'IlS tiict Ch\ CdILICIIII tiic risks Of calisHiti a
Ircctal tclar lUii 110-iii ma M0in hniUt a-cLme andIC CCLI-Ciicmt SCS ni Colic.
Rcctal cxamntiivtiOii niVi tic ttc(iicisiv c cg. pevcisi kcctal cxamination Shoni,1d hCpc m)1()ICd1
n in1itially to dCCii-
ticX\iit c ti~iactOiiti. stiial1 nt csttiaiL1 CiiStClist0ii. ticlilt taCtItal tii tO1-ss CiiStCiisioii ot aI VCLSiscils hdo 1minccntcsis inl
hand1CS 0to casdSCistCndCICC at cc titinti) hUt. InI matLiV cascs Sitch caISCS (CI c LIa hCasIIi)i>iCiLTani maiec)I 01 cioss sinai
Oi IIIIICI colic. tIlt ahtiot -1mal ics Will hc toi1iiii. III hot -SCS -iiicst iMx )iii lar-c citionl diistenlston Icanl canLSC iaccraItiOnn Ol
sliowsitic mnr(1c scVC\cics Ois ni colic. t'Ialiic to iCic1titil MIa a ViscLIS Ii a nICCdIIC is nISCdL thlC nISC Ol aI iCal caniiiaca M1i
ahnlor1Iiait CiiiCS no0t ILitic oult a[ SLIIrical icsionI tot- cXaiii CdnLcc thiS i-isk. \Vhicrc i-cctaIl flitind (inS ai indicativecoti
PlC, thc icsiOnn maV hC tint Otf Cacii .Iin ativ casc of coiiii SCVCsci itCStInai dIiscaISC thlC csniltS Ol a1hdioinnoccn1tcsts
thaLt is I11)1I C5pllii5Iv c tit aniaigcsia-. recpcat cctai cxamiiirt mhs tint altcrtiiiciiccisioii to scndc a lwiii sc In aridci-a
cilIit. Ill SLIch caISCS. dcflii al Shoni,11 no0t [I lc dcia ciiliitii
OtF thins C\an1ii nat1Sito hid iic considered toLCtthti wsith nlis inns chancLCS inlpcC-tioliCal1 Imid OCCntIF iiV Whiihkiilic
tiliC ICSiiitS Of Otthcitiiical11,1 tCStS. iiic di,SCaSC pi loccss iS nISnaiiv aiisaincCcd ii Iiais. iiic thinl
Iiicsiitinal wsalis ma>1 iic ca-sil\ 1 iccatcdii wsitii a iicccllc:
NASOGASTRIC INTUBATION tiici cliii -c. 'It' at Saniplic itt PfiltolIiCaIl i'iI'Iiii isiCmiIIICdI. iltiti a
Nasogastric tittLthatiot Shot11ld WtI,VSas hc tail1Cciint sonodt,aph\is ot ii athdloiicni is ii dciCahic in tiic fI si
III a htimsc w5ithl iidct aItc in scs ci c. (i Piictsistctit. tn)lic insiaiicc licinic a icat caIi11iiiia IS Cmpio>1)Cii
dlcsiiitc atiiadccsia. 'Iiiis 1ma> lilt he5warranitcdl onl tiic t'lsts 'I hc ISC Oi iiciritoiicai taps tot iiiSittigoLi shit hgfctwsccii
visit to aI caIsc c\iihitiii1- iiiiiii simls itl citlic. Iii iiost t(i-s- a~scs Oii tiiCdCai, andI Snrl1Cica coI)iCWicll hediciSCiISSCd ili at
Cs. 01oiV a smal aiilii1IL1tOlt'idC
1 CaIn ioriiiaiiy hc recrieiceci 1)ticiiiic tticici InPIll I
LISiLal>\ <5tIll nil \. Itoc ICli iX\ ii 2 litt cs oto 1iiittc 1isl icttCi
eitcant aIiiii ndCI~tcaCS tiic p)Otciitai~ IICCCI t(Ito Sot1 gCt
s fi HAEMATOLOGY AND BIOCHEMISTRY
R(CflLiX IS iisiiaii> CaILISCCI ih> PIISICi1 Ic, iiCdnCILICatcdl Iii piracticiai tcrmiis. hactiatniogtcai aiii hiiiochcmcal cv ai-
1IiOMttia-lilt-Iittictiina (Ccg. (IV>Sanftolnonita' OI-t iICLItS) lthstt Lit- na~tint i IS nncccssatS iti1,IlcaISCS ihai ohsVoLISIV i-CoIiiit c
tiortI 01 tiic siii'ai itcst tic OItt -sMilliti nics. hv klarec citon Slit1'Cci aiid tiic ii ito it> is to L'ci tiic hutw sc iii rctic iiai
CIiSpkactCII1CIt CSLiitvili III dILIOdcnal compiprcssimi. Hotrscs lacIlIIt>vas Sowni aIs po)ssihic. lHi\\ cs\ci-. packcd ccii vs ni
Ntasogastric intubation is t',Iinilt v i)iit. Sit iivsi)Lvistt it iltl,ihati(li is imipiirtanitt ill iiiii1C. s\ SitClint' total p tii
ii ict iphci wiitc hlloodl
vMdJCI1)1i-Ils
irmnportant diagnostically
aiind for
tiic cfiac'iiutis tIc-astr it tlistcnisiml as it ailosvs tiic '4toiii oclmlini ii c h;asic pl-at :iiitCdi s tht Sho0uld hIC mICaISnt-CIi
gastric inl ICSS CiiticalI CatSCS atid SCt--1i1iCtIicSI-ii HCIlctS tan hIcip inl
dlecompression achii tich dlcc)ittpt csscdl. I)ccmIpircssiitn als) ii its\ iiics
pi clict' aniid pircsects iptiii- cf tlic asscssmcnt i)tt a rcspoiisc in thlcrap> \(Ic Nio c\tcniss 'C
ittilic SitO1tnCii. Whitch is
intaail atatl. hiociciiical anid iiacninatoio''ical pir(I tics atCcJLISt itICtI ill
1Vcst caIt0iot Ot' ccii-l1tiCiii c.i
tiills t

Abdominocentesis REPEAT EXAMINATION

Site
Rcpcait cvaiimntatinti IS C,scititai III caIscs titiic that
Midline or to the right of midline
til ti nt c sp Oit it to a iia i t'C LIl atI>_ It
Most dependent portion of the abdomen
ptctit atnaIicsic s Ihavc heit'llciVCii alICI tiiC CAISC Ot Colict
cannot hc ciCtCt i1CIc. tLiii i-C-Cs vIILnaInOI tiic patictit
Preparation
scrub
ShititId tic iicrfin iicii Chariucs ini a, litosc's hacmatninci-
Clip a small area and clean with a surgical
solution
Normal results Caii vuiid hinIch1cmcai platranictcr s, ir fIIdIIItics OItiI cectal
COLOUR. Straw cxaim Inati)ii. tiisi -Icastric Itititht anld v11ihilnm nncc titc-

coloured/colourless SIS Canl hci to dcCtCt 1iiitiC Ws ict1iCic doliI tHitic IIICdCli,Il
Equipment
VISCOSITY. Clear t -ivip> IS
'ILISti "CCI if' in) tCiitivil Silt i-1 c al hI tid sc liti toI
Sterile gloves
TOTAL PROTEIN. IS I-CCIi ititCCi. SnIiic n\V oCt sCdi 110t vipprICC'IatC tiic Sig iii I-
EDTA and plain blood tubes
<20 to 25 g/l itre cviICC if I-CCUiii ctit. viihcit s iinictlitiics icss scsv crc. sicos
18 gauge, 3.75 cm needle or teat cannula (local
WHITE BLOOD CELL
patil iOnc tiic clfccts o vaiiva igcstvi 5w cvii It is thiici ifirc
anaesthetic and No 15 scalpel blade is required if
COUNT. <-5 x 109/litre LISCI'iii lto v-1ii icc aI Fcpcvtt cx viiii1 Itiai ni tio tsW Oi iiOiii S
using a teat cannula)
ivItcri s ititt ict It siLdlis oii paiii I-CC Itt at Itic vcirv ic vast.

tiic sv ctct iMtivit S ilt iti S1i LI1ii tc ic p)I OIIt C tiiC ict_ lto ect

vIi I- pdC atC O nl tiic lint SC'S pi nd1css lto iICCICIlC it' i-C CsV ilit_1
viiti Is iiccc ssvit

ADVICE TO THE OWNER

T cvIoSC ot itoc nlit cpisotdcs itf citlic m a> hic c viir ti-oiti
tiic liist trv vipprilp riivtc lad sv icc S1iOiiii _inscii

rccviirditic tiic prICsVClitinti tiirtiiC- C)pisItiCS. III -SCS

tut aiC to0t r-cciLIvariy nticd. It IS \VO1iiih Suihittittitic

S viiiipiC S tOin tvIC t'vIl I -rIII c cL void V tioL ti S at id a

(above) Equipment needed for abdominocentesis vini iissis tvipc w orttmi b iiirlic i scr-itmo F L-IS ,A\ tit ritic O LIt
and (right) collection of peritoneal fluid
IIICSC ittCti Ivi vIiiscs Ciii c T cctli shioti id clicckccl.

380 ~~~~~~~~~~~~~~~ ~~~~In Practice J( YAuU ST 2004

 Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

particularly where regular dental care is not undertaken.

Further investigations are not usually necessary in most
one-off episodes unless the signs of colic recur.

ANALGESIA

The choice of analgesic is one of the most important deci-

sions that need to be made regarding the management of a
colicky horse. Analgesia should be sufficient to relieve the A variety of drugs are
licensed for use in horses
signs of visceral pain, but should not alter the ability to with colic, but they vary in
detect persistent or increasing pain. Drugs such as flunixin potency and the duration
and detomidine provide potent relief of visceral pain, but of analgesia they provide
can mask signs of continued pain if the animal is not mon-
itored carefully. Failure to respond to these more potent Phenylbutazone
analgesics can indicate the need for surgery or euthanasia. Phenylbutazone provides mild visceral analgesia, similar
Where potent analgesia has been given, the results of a to the effects of metamizole. It is therefore useful for
rectal examination, nasogastric intubation and abdomino- colic cases exhibiting mild signs of pain.
centesis will usually indicate the need for surgery, hence
highlighting the importance of a thorough repeat examina- Other NSAIDs
tion in such cases. Other NSAIDs, such as carprofen, vedaprofen and
eltenac, are licensed for use in horses with musculo-
NON-STEROIDAL ANTI-INFLAMMATORY DRUGS skeletal pain and soft tissue inflammation. However,
Flunixin meglumine their use in cases of visceral pain has not been fully eval-
Flunixin meglumine provides good to excellent analge- uated (ie, their potency is unknown).
sia. Its anti-endotoxic effects will reduce the degree of
pain and lessen alterations in mucous membrane colour ALPHA2-AGONISTS
and heart rate in strangulating lesions. Hence, this drug Xylazine provides good to excellent visceral analgesia,
should be used with caution where signs of mild pain are but is relatively short acting. Therefore, it is useful for
evident or if no definitive diagnosis has been reached on horses with painful colic because it allows sufficient
the initial examination. time to perform a full clinical examination safely, with-
out masking the effects of pain for prolonged periods of
Ketoprofen time. Detomidine has more potent sedative and analgesic
Ketoprofen provides good visceral analgesia and has effects and should be used with caution; a failure to
anti-endotoxic properties. It is not as potent an analgesic respond to detomidine, or a recurrence of signs within
as flunixin, but may still mask the signs of mild to mod- an hour, indicates the potential need for surgery. Romi-
erate visceral pain. fidine provides good, but less potent visceral analgesia.

i. S-I
100P 691 ILM : IUU S

Active ingredient and tradenames Dose and administration Approximate duration of analgesia Comments
Flunixin meglumine 0 25-1 1 mg/kg every 12 hours One to 24 hours, depending on Anti-endotoxic dose 0 25 mg/kg every six to eight hours
Finadyne (Schering-Plough) iv or po the cause and severity of the pain
Meflosyl (Fort Dodge)
Binixin (Bayer)
Cronyxin (Bimeda)
Ketoprofen 2 2 mg/kg every 24 hours iv Similar to flunixin
Ketofen (Merial)
Phenylbutazone Up to 44 mg/kg iv or po Up to 14 hours Many potential side effects, but rarely seen in practice;
Equipalazone (Arnolds) do not exceed stated dose (low therapeutic index)
Butylscopolamine/metamizole 5 ml/100 kg iv Combined NSAID and spasmolytic; transient increase in
Buscopan Compositum heart rate following administration (parasympatholytic
(Boehringer Ingelheim) effect)
Xylazine 02-1 10 mg/kg iv 10 to 40 minutes depending Contraindicated in the first and last month of
Virbaxyl (Virbac) on the dose used pregnancy. Available as 2 per cent and 10 per
Rompun (Bayer) cent solutions
Chanazine (Chanelle)
Xylacare (Animalcare)
Xylapan (Vetoquinol)
Detomidine 0 01-0 02 mg/kg iv or im One to three hours Do not use in the last month of pregnancy
Domosedan (Pfizer)
Romifidine 0.04-0-08 mg/kg iv 0-5 to three hours Do not use in the last month of pregnancy
Sedivet (Boehringer Ingelheim)
Butorphanol 01 mg/kg iv 0 5 to three hours Often combined with alpha2-agonists at lower dose
Torbugesic (Fort Dodge) rates
Pethidine 2-0 mg/kg im 20 to 60 minutes Only licensed for use in spasmodic colic
Pethidine Injection (Arnolds)
po Orally, iv Intravenously, im Intramuscularly

In Practice * JULY/AUGUST 2004 381

Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

All of these drugs may be combined at lower dosages colon impactions that do not respond to laxatives or orall
with butorphanol, which provides useful sedation in the fluid therapy. Ideally, intravenous therapy should be
field and allows a rectal examination to be performed undertaken in facilities where the catheter site and tluid
safely. However, not all of these combinations are rate can be monitored closely by veterinary staff. Intra-
licensed for use in horses with colic. venous fluid therapy is critical in the managemenit of sLi-
gical colic cases, but generally it is far better to get the
OPIATES horse to a reterral facility quickly rather than waste time
Butorphanol provides good visceral analgesia and will placing an intravenous catheter or collecting the neces-
not mask the signs of severe pain for long periods of sary equipmiient to do so. Large volumes of fluid need to
time. Excitatory effects can be seen, but tend to be less be administered to have a significant effect, which is
evident in horses exhibiting signs of pain. Pethidine is impractic,al in mrany cases. If there is a delay in obtaining
licensed for use in cases of spasmodic colic and provides transport, pafrticularly if the referral facility involves a
short-term analgesia. journey ot several hours or more, fluid therapy may he
administered during this time.
SPASMOLYTICS
Butylscopolamine is a spasmolytic and mild analgesic
that acts mainly on the smoothnmuscle of the gastro- KEY DECISIONS
intestinal and urinary tracts. It is combined with the
NSAID metamii.zole, a weak visceril analgesic. It is use- IS SURGICAL INTERVENTION REQUIRED?
ful in horses with miild, spasmodic colic and the degree The question ot whether surgical intervention is required
of analgesia will not mask signs ot mlore severe pain. is one of the key decisions which need to be made in the
management of the colicky horse. Although most hor-ses
seen in first opinion practice will have mild colic of
OTHER MEDICAL THERAPIES unknown origin that responds to medical therapy alone.
approximately 7 per cent of ccases will have a suL-gical
LAXATIVES lesion. A number of factors will help to determiinle
Laxatives are most commonly indicated in the manage- whether the horse should be treated medically or reterr-ed
ment of large colon impactions. They help to increase for potential surgery. In many cases, the lack of responise
the softness of ingesta and may be combined with flLiid to medical therapies will help to decide this. Some cases
therapy in more severe cases. Laxatives include mineral will fall into the 'in-between' category. Where refer-r-al is
oil (liquid paraffin), osmotic laxatives (magnesium sLl- an option, it is better to refer cases early rather than delay
phate and sodium chloride), dioctyl sodium sulphosucci- further by which time the decision regarding the need for
nate and psyllium hydrophilic mucilloid. surgery may be easy, but valuable hours may then be lost
during transport.
FLUID THERAPY
Oral fluids
Administration of oral fluids via a nasogastric tube can
be useful in any horse with colic, although mild cases
that respond to analgesia will rapidly correct any fluid
deficits without intervention. Oral fluids should never be
administered in any case in which reflux occurs.

Intravenous fluids
Intravenous fluid therapy can be useful in the medical
management of some cases of colic, particularly large

W. it fi0. _I
Improvements in anaesthetic and surgical techniques
have contributed to improved success rates for the
surgical treatment of colic over the past 20 years

382 In Practice * JULY/AUGUST 2004

 Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

Large colon torsion of shorter duration than that pictured on the left,
Large colon torsion showing severe infarction of the colon wall and tears exhibiting less severe compromise of the bowel wall. Resection was
in the serosa. In this case, surgical correction was not possible due to the unnecessary in this case and the horse made a full recovery following
degree of strangulation and the location of the torsion surgery

Indicat for countiued

mdkal
* Mild to moderate pain
* Good response to mild analgesics
Heart rate <50 beats per minute
* Normal packed cell volume and total protein

* Negative findings on rectal examination

* Continuous or improving intestinal motility

. No nasogastric reflux
* Resolving or no abdominal distension

* Grossly normal peritoneal fluid with normal total

protein and white blood cell count

DECISION TO CONTINUE MEDICAL THERAPY

Large colon impactions are often encountered in practice
and most will respond to treatment with analgesics, oral Strangulation of a short
fluids and laxatives. Those that show no sign of portion of small intestine
improvement over 24 to 48 hours may require more by a pedunculated lipoma.
REFERRAL This type of lesion is most
aggressive medical therapy (eg, intravenous fluid thera- commonly seen in older
py). Practitioners should be aware that this condition REFERRAL FACILITIES ponies
may occasionally occur secondarily to another lesion, A large number of equine clinics in universities and pri-
such as concurrent large colon displacement or im- vate practices provide facilities for surgical and intensive
paction of the right dorsal colon. These cases can often medical treatment of colic. The decision to refer can
only be resolved by surgical intervention. sometimes be difficult to make, but advice can always
be sought from these clinics. In some horses, the need
for surgery is obvious, but this should not deter the refer-
ral of animals that show equivocal signs. The facilities in
icatimk for the stable yard or in the field may preclude a full clinical
* Severe, unrelenting pain despite the use of examination and referral clinics may have other more
analgesia sophisticated diagnostic or imaging equipment that can
* Recurrence of pain following the administration be of great help in deciding whether or not to operate.
of moderate to potent analgesia Even if initial medical treatment is instituted, the horse
* Heart rate persistently >60 beats per minute can be monitored intensively and surgery can be under-
* Net gastric reflux of >2 litres taken quickly if the patient's condition deteriorates
* Positive findings on rectal examination suddenly. Although the horse's clinical signs may have
* Alterations in peritoneal fluid improved dramatically on arrival at a referral facility
* Progressive deterioration in mucous membrane (the 'therapeutic box ride'), most owners are usually
colour delighted that their horse does not need (expensive)
Progressive reduction in intestinal motility surgery and this situation is preferable to the surgical
* Progressive abdominal distension case in which referral is delayed, which may make the
prognosis hopeless, despite surgery.

In Practice 0 JULY/AUGUST 2004 383

 Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

ing at the long-term survival of these cases and the

"anaa?
A Case for problems encountered following discharge. It is hoped
that information from such studies will provide owners
Surgery may be ruled out by the owner for financial and practitioners with a better understanding of what to
or personal reasons. The priority in such cases is to expect in the long term in horses that have been treated
provide sufficient analgesia if a definitive diagnosis surgically for colic.
cannot be made. Failure to respond to potent
analgesia and a continued deterioration in the
Acknowledgements
horse's condition indicates progressive endotoxic The author would like to thank colleagues
shock and the need for euthanasia. Rupture of a at Leahurst for their helpful comments
viscus may result in a dramatic decrease in the during the preparation of this article.
degree of abdominal pain. Such cases rapidly suc-
Further reading
cumb to severe endotoxic shock, showing marked MAIR, T., DIVERS, T. & DUCHARME,
tachycardia, cyanosis of the mucous membranes N. (2002) Manual of Equine
and profuse sweating. The patient will often exhib- Gastroenterology. Philadelphia,
W. B. Saunders
it 'boarding' of the abdomen due to peritonitis MALONE, E. & GRAHAM, L. (2002)
and peritoneal fluid contaminated with green Management of gastrointestinal pain.
Veterinary Clinics of North America:
ingesta will be obtained. These animals should be Equine Practice 18, 133-1 58
euthanased immediately. PROUDMAN, C. J., SMITH, J. E., EDWARDS,
G. B. & FRENCH, N. P. (2002) Long-term
survival of equine surgical colic cases.
Part 1. Patterns of mortality and morbidity.
Equine Veterinary Journal 34, 432-437
CONTACT WITH THE REFERRAL FACILITY SINGER, E. R. & SMITH, M. A. (2002)
Examination of the horse with colic: is it
The facility to which a horse is to be referred should medical or surgical? Equine Veterinary
always be contacted before a case is sent and referral Education 14, 87-96
costs and medical therapy discussed. Cases of colic with
pyrexia and/or diarrhoea may indicate impending colitis.
Salmonellosis is always a potential consideration in
these horses and, consequently, some clinics may prefer
such animals to be treated on their own premises or will
admit them into isolation.

OWNER INFORMATION
In cases of severe, unrelenting colic, referral should be
discussed at an early stage and transport arrangements
made (to avoid any unnecessary and frustrating delays .......................................................................................................................

in getting a horse to a suitable facility). Costs should

always be discussed with the owner first and the insur-
ance company should be notified at the earliest opportu-
nity where applicable. The owner or transporter should
be given contact telephone numbers and clear directions
to the facility. Updates are usually appreciated by the
referral facility if any unforeseen delays occur.

PROGNOSIS FOLLOWING SURGERY

The management of the surgical colic patient has

improved significantly over the past 20 years. Early
referral, improved management of the patient under
anaesthesia and postoperatively, as well as advances in
surgical techniques have all contributed to improved sur-
gical success rates. The practitioner is essential in identi-
fying the need for surgery and referring the horse at an
early stage before the effects of endotoxaemia worsen.
The horse's chances of survival postoperatively are also Sufl IP3 9U
dictated by a number of other, often interrelated, factors e (O139)234
Fa O 59 430
including the duration of the colic, the duration of NOW THAT IS SOMETHING
surgery and the need for intestinal resection. Certain
types of surgical colic (eg, large colon torsion and epi- TO SING A DANCE ABOUT
ploic foramen entrapment) may have an inherently worse Fortfex is a tasty one a day supplement for the maintenance
of healthy joints in dogs. Fortfifex is available in 3 pack sizes,
prognosis. A precise diagnosis can be difficult to make each containing 30 palatable tablets.
preoperatively; therefore, it can be difficult to offer the VIPRSAC UNITED
owner a prognosis until exploratory laparotomy has been VVoopk Busineu Park,
undertaken. While most studies have concentrated on (0159 243200
WindmiIIAvenue.
horse survival until discharge from the hospital (ie,
short-term survival), several studies are currently look-

InPractice a JULY/AUGUST 2004 385

 Downloaded from inpractice.bmj.com on September 4, 2014 - Published by group.bmj.com

Decision making in the management of the

colicky horse
Debra Archer

In Practice 2004 26: 378-385

doi: 10.1136/inpract.26.7.378

Updated information and services can be found at:

http://inpractice.bmj.com/content/26/7/378

These include:
Email alerting Receive free email alerts when new articles cite this article. Sign up in
service the box at the top right corner of the online article.

Notes

To request permissions go to:

http://group.bmj.com/group/rights-licensing/permissions

To order reprints go to:

http://journals.bmj.com/cgi/reprintform

To subscribe to BMJ go to:

http://group.bmj.com/subscribe/