Horse colic 1472548 226084248 2008-07-16T19:28:24Z Eventer 474235 /* Prevention */ {{Unreferenced|date=April 2008}} '''Colic in [[horse]]s''' is defined as [[abdominal pain]], but it is a clinical sign or a symptom rather than a diagnosis. The term colic can encompass all forms of [[Gastrointestinal tract|gastrointestinal]] conditions which cause pain as well as other causes of abdominal pain not involving the gastrointestinal tract. The most common forms of colic are gastrointestinal in nature and are most often related to colonic disturbance. There are a variety of different causes of colic, some of which require [[surgery|surgical intervention]] and can prove fatal. Colic surgery is usually an expensive procedure as it is major abdominal surgery. Among [[domesticated]] horses, colic is a major cause of premature death. The incidence of colic in the general horse population has been estimated between 10 and 11 percent on an annual basis. It is important that any person who owns or works with horses be able to recognize the symptoms of colic and determine whether or not a [[veterinarian]] should be called. ==Types== This list of types of colic is not exhaustive but details some of the types which may be encountered. ===Pelvic flexure impaction=== This is caused by an [[impaction]] of food material (Water, Grass, Hay, Grain) at a part of the large bowel known as the ''pelvic [[flexure]]'' of the left [[Colon (anatomy)|colon]] where the intestine takes a 180 degree turn and narrows. Impaction generally responds well to medical treatment, but more severe cases may not recover without surgery. If left untreated, severe impaction colic can be fatal. The most common cause is when the horse is on box rest and/or consumes large volumes of straw, or the horse has dental disease and is unable to [[masticate]] properly. This condition could be diagnosed on rectal examination by a veterinarian. ===Spasmodic colic=== [[Spasm]]odic colic is the result of increased [[peristaltic]] contractions in the horse's gastrointestinal tract. It can be the result of a mild gas buildup within the horse's digestive tract. The signs of colic are generally mild and respond well to spasmolytic and [[analgesic]] medication. ===Ileal impaction=== The [[ileum]] is the last part of the small intestine that ends in the [[cecum]]. Ileal impaction can be caused by obstruction of ingesta. Other causes can be obstruction by [[ascarids]] (''Parascaris equorum'') or [[tapeworm]] (''Anoplocephala Perfoliata'') as mentioned below. ===Sand impaction=== This is most likely to occur in horses that graze sandy or heavily grazed pastures leaving only dirt to ingest. The term sand also encompasses dirt. The ingested sand or dirt accumulates in the pelvic flexure, right dorsal colon and the cecum of the large intestines. As the sand or dirt irritates the lining of the bowel it can cause diarrhea. The weight and abrasion of the sand or dirt causes the bowel wall to become inflamed and can cause a reduction in colonic motility and in severe cases even peritonitis. Historically medical treatment of the problem is with laxatives such as liquid [[paraffin]] or oil and [[psyllium]] husk. More recently doctors are treating cases with specific [[synbiotic]] ([[probiotic|pro]] and [[prebiotic]]) and psyllium combinations. Some cases may need surgery. Horses with sand or dirt impaction are predisposed to ''[[Salmonella]]'' infection. Horses should not be fed from the ground in areas where sand, dirt and silt are prevalent although small amounts of sand or dirt will still be ingested by grazing. Management to reduce sand intake and prophylactic treatments with sand removal products are recommended by most veterinarians. ===Enterolith=== [[Enterolith]]s in horses are round balls of mineral deposits often formed around a piece of ingested foreign material, such as sand or gravel. When they move from their original site they can obstruct the intestine. Enteroliths are not a common cause of colic, but are known to have a higher prevalence in states with a sandy soil and where an abundance of alfalfa hay is fed, such as California. Once a horse is diagnosed with colic due to enterolith it usually requires surgery to correct the condition. ===Large roundworms=== Occasionally there can be an obstruction by large numbers of [[roundworm]]s. This is most commonly seen in young horses as a result of a very heavy infestation of ''Parascaris equorum'' that can subsequently cause a blockage and rupture of the [[small intestine]]. [[Deworming]] heavily infected horses may cause dead worms to puncture the intestinal wall and cause a fatal [[peritonitis]]. A blockage of the small intestines by worms may well require colic surgery. A more conservative approach can be to give a horse a [[laxative]] (eg liquid paraffin) prior to deworming if a heavy worm infestation is suspected. It is often the result of a poor deworming program{{Fact|date=July 2008}}. Horses develop immunity to parascarus between 6 months age and one year and so this condition is rare in adult horses. ===Tapeworms=== [[Tapeworm]]s at the junction of the [[cecum]] have been implicated in causing colic. The most common species of tapeworm in the equine is ''Anoplocephala perfoliata''. However, a 2008 study in Canada indicated that there is no connection between tapeworms and colic, contradicting studies performed in the UK<ref>Oke, Stacy. "Research Ongoing for Tapeworm, Colic Link." ''The Horse'' July 2008: 20.</ref>. ===Cyathostomes=== Acute [[diarrhoea]] can be caused by [[cyathostome]]s or "small Stronglus type" worms that are [[encysted]] as [[larvae]] in the bowel wall, particularly if large numbers emerge simultaneously. The disease most frequently occurs in winter time. Pathological changes of the bowel reveal a typical "pepper and salt" colour of the large intestines. Animals suffering from cyathostominosis usually have a poor deworming history{{Fact|date=July 2008}}. ===Left dorsal displacement=== Left dorsal displacement is a form of colic where the left dorsal colon becomes trapped above the [[spleen]] and against the [[nephrosplenic ligament]]. It may necessitate surgery although often it can be treated with exercise and/or [[phenylephrine]], at times anesthesia and a rolling procedure{{clarifyme}} must be performed to correct the condition medically. This condition can be diagnosed on rectal examination or through [[ultrasonography]] by a veterinarian. ===Right dorsal displacement=== Right dorsal displacement is another displacement of part of the large bowel. Although signs of colic may not be very severe, surgery is usually the only available treatment. ===Torsion=== Various parts of the horse's gastrointestinal tract may twist upon themselves. It is most likely to be either small intestine or part of the colon. [[Occlusion]] of the blood supply means that it is a painful condition causing rapid deterioration and requiring emergency surgery. ===Intussusception=== [[Intussusception (medical disorder)|Intussusception]] is a form of colic in which a piece of intestine "telescopes" within a portion of itself. It most commonly happens in the small intestine of young horses and requires urgent surgery. ===Epiploic foramen entrapment=== On rare occasions, a piece of small intestine can become trapped through the [[epiploic foramen]]. The blood supply to this piece of intestine is immediately occluded. The intestine becomes trapped and surgery is the only available treatment. ===Strangulating lipoma=== [[Benign]] fatty [[tumor]]s known as [[lipoma]]s can form on the [[mesentery]]. As the tumor enlarges, it stretches the [[connective tissue]] into a stalk which can wrap around a segment of bowel, typically small intestine, cutting off its blood supply. The tumor forms a button that latches onto the stalk of the tumor, locking it on place, and requiring surgery for resolution. ===Mesenteric rent entrapment=== The mesentery is a thin sheet attached to the entire length of intestine, enclosing blood vessels, lymph nodes, and nerves. Occasionally, a small rent (hole) can form in the mesentery, through which a segment of bowel can occasionally enter. As in [[epiploic foramen]] entrapment, the bowel first enlarges, since arteries do not occlude as easily as veins, which causes [[edema]] (fluid buildup). As the bowel enlarges, it becomes less and less likely to be able to exit the site of entrapment. This problem also requires surgical correction. ===Gastric ulceration=== Horses form [[ulcer]]s in the stomach fairly commonly. Risk factors include confinement, infrequent feedings, a high proportion of concentrate feeds{{clarifyme}}, excessive non-[[steroid]]al [[anti-inflammatory]] drug use, and the stress of shipping and [[Horse show|showing]]. Most ulcers are treatable with medications that inhibit the acid producing cells of the stomach. [[Antacid]]s are less effective in horses than in humans, because horses produce stomach acid almost constantly, while humans produce acid mainly when eating. Dietary management is critical. [[Bleeding ulcer]]s leading to stomach [[rupture]] are rare. ===Other causes that may show clinical symptoms of colic=== Strictly speaking colic refers only to signs originating from the [[gastrointestinal tract]] of the horse. Signs of colic may be caused by problems other than the GI-tract e.g. problems in the [[kidney]]s, [[ovary|ovaries]], spleen, [[testis|testicular]] torsion, [[pleuritis]], or [[pleuropneumonia]]. Diseases which sometimes cause symptoms which appear similar to colic include [[laminitis]] and exertional [[rhabdomyolysis]]. ==Pathophysiology of equine colic== This can be divided broadly into simple [[obstruction]]s, [[strangulating]] obstructions, and non-strangulating [[infarction]]s. ===Simple Obstruction=== This is characterised by a physical obstruction of the intestine, which can be due to impacted food material, [[stricture]] formation, or foreign bodies. The primary [[pathophysiology|pathophysiological]] abnormality caused by this obstruction is related to the trapping of fluid within the intestine [[oral]] to the obstruction. This is due to the large amount of fluid produced in the upper gastro-intestinal tract (around 125l daily{{clarifyme}}), and the fact that this is primarily re-absorbed in parts of the intestine downstream from the obstruction. The first problem with this degree of fluid loss from circulation is one of decreased plasma volume, leading to a reduced [[cardiac output]], and [[acid-base imbalance|acid-base disturbances]]. There also occur serious effects on the intestine itself, which becomes [[distended]] due to the trapped fluid, and by gas production from bacteria. It is this distension, and subsequent [[activation]] of [[stretch receptor]]s within the intestinal wall, that leads to the associated pain. With progressive distension of the intestinal wall, there is [[occlusion]] of blood vessels, firstly veins, then arteries. The difference in time to onset of occlusion is due to the relatively more rigid walls of arteries compared with veins. This impairment of blood supply leads firstly to [[hyperaemia]] and [[congestion]], and ultimately to [[ischaemic]] [[necrosis]] and [[cellular death]]. The poor blood supply also has effects on the [[vascular]] [[endothelium]], leading to an increased [[permeability]]. This results initially in leakage of [[plasma]], and eventually blood into the intestinal [[lumen (anatomy)|lumen]]. In the opposite fashion, [[gram-negative]] bacteria and [[endotoxin]]s can enter the bloodstream, leading to further systemic effects. ===Strangulating Obstruction=== Strangulating obstructions have all the same [[pathological]] features as a simple obstruction, but the bloody supply is immediately effected. Both arteries and veins may be effected immediately, or progressively as in simple obstruction. Common causes of strangulating obstruction are [[intussusception]]s, [[volvulus]] and displacement of intestine through a hole, such as a [[hernia]], a mesenteric rent, or the [[epiploic foramen]]. ===Non-strangulating Infarction=== In a non-strangulating infarction, blood supply to a section of intestine is occluded, without any obstruction to [[ingesta]] present within the intestinal lumen. The most common cause is infection with ''[[Strongylus vulgaris]]'' [[larvae]], which develop within the (primarily cranial) [[mesenteric artery]]. ==Diagnosis== Many different diagnostic tests can be used to diagnose the cause of equine colic, which may have greater or lesser value in certain situations. The most important distinction to make is whether the condition should be managed medically or surgically. If surgery is indicated, then it must be performed with utmost haste, as delay is a dire [[Prognosis|prognostic indicator]]. ===History=== A thorough history is always taken, including age, sex, recent activity, diet, any recent dietary changes, and routine [[anthelmintic]] treatment. However, the most important factor is time elapsed since onset of clinical signs, as this has a profound impact on prognosis, and the type of treatment that will be undertaken. ===Cardiovascular Parameters=== Heart rate rises with progression of colic, in part due to pain, but mainly due to decreased circulating volume, decreased [[preload]], and [[endotoxemia]]. The rate should be measured over time, and its response to [[analgesic]] therapy ascertained. A pulse that continues to rise in the face of adequate analgesia is considered a surgical indication. [[Mucous membrane]] colour can be assessed to appreciate the severity of [[haemodynamic]] compromise. Reddening of membranes reflects worse prognosis, and [[cyanotic]] membranes indicate a very poor chance of a positive outcome. Laboratory tests can be performed to assess the cardiovascular status of the patient. [[Packed Cell Volume]] (PCV) is a measure of hydration status, with a value 45% being considered significant. Increasing values over repeated examination are also considered significant. The total protein (TP) of blood may also be measured, as an aid in estimating the amount of protein loss into the intestine. It's value must be interpreted along with the PCV, to take into account the hydration status. ===Rectal Examination=== Repeated rectal examinations are a cornerstone of colic diagnosis, as many large intestinal conditions can be definitively diagnosed by this method alone. Other non-specific findings, such as [[dilated]] small intestinal loops, may also be detected, and can play a major part in determining if surgery is necessary. ===Naso-gastric Intubation=== Passing a Naso-Gastric Tube (NGT) is useful both diagnostically and therapeutically. Fluid is [[reflux]]ed from the stomach, and any more than 2 litres of fluid is considered to be significant. Increased fluid is generally as a result of backing up of fluid through the intestinal tract, due to a downstream obstruction. This finding is important as it represents a relatively advanced stage of colic, and is often a surgical indication. Therapeutically, gastric decompression is important, as if fluid build up occurs, gastric rupture may occur, which is inevitably fatal. ===[[Abdominocentesis]]=== The extraction of fluid from the [[peritoneum]] can be useful in assessing the state of the intestines. A [[Sanguine|sanguinous]] fluid represents an [[infarction]], and usually indicates surgery is necessary. A cloudy fluid is suggestive of an increased number of white blood cells, which indicates the disease is relatively advanced. The protein level of abdominal fluid can be analysed, and may also give information as to the integrity of intestinal blood vessels. ===Abdominal Distension=== Any degree of abdominal [[distension]] is usually indicative of a condition affecting the large intestines, as distension of structures upstream of here would not be large enough to be visible externally. ===Auscultation=== [[Auscultation]] of the abdomen, usually performed in a four quadrant approach, can be a useful tool. Increased gut sounds are not usually found with major changes, and may be indicative of [[spasmodic]] colic. A decreased amount of sound, or no sound, may be suggestive of serious changes. ===Faecal Examination=== The amount of [[faeces]] produced, and its character can be helpful, although as changes often occur relatively distant to the anus, changes may not be seen for some time. In areas where sand colic is known to be common, or if the history suggests it may be a possibility, faeces can be examined for the presence of sand, often by immersion in water, or simply by its texture. ==Clinical signs== *Pawing and/or scraping *Stretching *Frequent attempts to urinate *Flank watching{{clarifyme}} *Pacing *Repeated [[flehmen]] response *Repeated lying down and rising *Rolling *Groaning *[[Bruxism]] *Excess salivation *Loss of appetite *Decreased faecal output *Increased pulse rate *Dark mucous membranes ==Prevention== The incidence of colic can be reduced by restricted access to simple [[carbohydrate]]s, clean feed and drinking water, preventing the ingestion of dirt or sand by using an elevated feeding surface, a regular [[Equine nutrition|feeding]] schedule, regular [[deworming]], regular [[Horse teeth|dental care]], a regular diet that does not change substantially in content or proportion and prevention of [[Hyperthermia|heatstroke]]. It is good to note that it was once thought that colic could be prevented by feeding a horse after exercise, and not before. But, recent research has shown that this is a 'wives-tale' and it may actually be beneficial to horses if they are fed a small amount before exercise. Turnout is thought to reduce the likelihood of colic, although this has not yet been proven<ref name=Management>Blikslager, Anthony. "Avoiding Colic Through Management." ''The Horse'' July 2008: 47-54.</ref>. It is recommended that a horse receive ideally 18 hours of grazing time each day<ref name=Management>Blikslager, Anthony. "Avoiding Colic Through Management." ''The Horse'' July 2008: 47-54.</ref>, as in the wild, although many times this is difficult to manage with competition horses and those that are boarded. ==Further reading== * ''The Illustrated Veterinary Encyclopedia for Horsemen'' Equine Research Inc. * ''Veterinary Medications and Treatments for Horsemen'' Equine Research Inc. * ''Horse Owner's Veterinary Handbook'' James M. Giffin, M.D. and Tom Gore, D.V.M. * ''Preventing Colic in Horses'' Christine King, BVSc, MACVSc ==External links== *[http://www.horseandhound.co.uk/horsecare/vet/tag/Colic] Vet advice: Colic in horses *[http://ultimatehorsesite.com/info/colic.html Colic in Horses] *[http://www.horsevet.co.uk/colic.php Colic information sheet] *[http://www.merckvetmanual.com/mvm/index.jsp?cfile=htm/bc/22000.htm Colic in Horses in the Merck Veterinary Manual] ==References== {{reflist}} [[Category:Horse diseases]] [[de:Kolik beim Pferd]] [[eo:Koliko]] [[ia:Colica equin]] [[is:Hrossasótt]] [[ja:疝痛]] [[no:Kolikk (hest)]] [[fi:Ähky]]