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<\/a><\/p>\nCauses of colic can broadly be classified as gastrointestinal or extragastrointestinal. The equine digestive tract is extremely complex and can be affected by a wide range of issues.<\/span><\/p>\nCommon gastrointestinal causes can be separated by location (e.g., gastric, small intestine, large intestine) and include impactions, gas or tympany (e.g., obstruction), displacements or torsions, inflammation (e.g., diarrhea, colitis), and parasitism. <\/span><\/p>\nExtragastrointestinal causes of colic may involve reproductive tract disorders (e.g., uterine or testicular torsion, ovarian disorders such as large granulosa theca cell tumors, ovarian cysts, estrus during routine heat cycles), urinary tract conditions (e.g., stones, infection, bladder rupture, urethral obstruction), liver or splenic conditions (e.g., organ failure, enlargement, rupture, abscessation, neoplasia, infarction), and peritoneal or abdominal wall issues (e.g., neoplasia, peritonitis, adhesions, hernia, trauma). <\/span><\/p>\nSigns of musculoskeletal disorders such as laminitis or rhabdomyolysis (tying-up) may resemble signs of colic and are commonly misclassified due to overlapping clinical signs such as restlessness, sweating, and reluctance to move.<\/span><\/p>\nColic Workup<\/h2>\nHistory<\/h3>\n
In working up a routine colic case, obtaining a thorough history from the owner or caretaker is critical and should be completed first. A detailed history can help distinguish the severity of the pain as well as the duration and progression of the colic episode. Information that can provide context for the physical examination and diagnostic findings as well as identifying the specific cause of colic includes any predisposing factors (e.g., diet changes, recent deworming, administration of medications such as NSAIDs), previous or current health issues, recurrent colic episodes, activity level or routine exercise practices and discipline, recent transport or stressful event, and changes in manure output or consistency.<\/span><\/p>\nPhysical Examination<\/h3>\n
After a detailed history is obtained, a physical examination should then be performed efficiently and systematically. All physical examinations should begin with simply observing the horse and its surroundings. Note the horse\u2019s attitude, behavior, and posture to identify any signs of discomfort or agitation (e.g., up-and-down behavior, inability to stand quietly [depending on the horse\u2019s natural behavior], pawing, flank watching, flehmen response, sweating, muscle fasciculations or tremors, abrasions on distal extremities or bony prominences along the face or body, abnormal abdominal contour, fecal staining along the rear or tail). In addition, the surrounding environment and housing area should be examined for things such as disruption of bedding secondary to rolling or thrashing, manure output and consistency, uneaten feed, and quality of feed or hay.<\/span><\/p>\nFor the hands-on portion of the physical examination, clinicians should develop their own systematic process and ensure that all components are addressed during each examination. Interpretation of vital parameters can indicate severity of the colic episode as well as potential for systemic compromise. <\/span><\/p>\nAuscultation of the heart and lungs, aside from just obtaining heart and respiratory rates, is a crucial part of the colic workup and is often overlooked when the focus is on the abdomen. Auscultation of these areas can provide vital information about both extragastrointestinal causes of colic and overall systemic status. Abdominal auscultation should include assessment of borborygmi as absent, hypomotile, normal, or hypermotile, as well as any pinging sounds.<\/span><\/p>\nEvery physical examination of a horse should include obtaining rectal temperature, regardless of the nature of the visit (i.e., healthy\/preventive or sick). In addition, asking the client whether temperatures are routinely taken on the farm can be useful for identifying any trends or differentiating between possible infectious or systemic disease. <\/span><\/p>\nBounding digital pulses, weight shifting, or reluctance to lift feet or walk when asked may suggest laminitis, and these signs in addition to stiff or sore muscles may indicate rhabdomyolysis, both of which are frequently confused for episodes of colic.<\/span><\/p>\nDifferentiating Between Gastrointestinal and Extragastrointestinal Cause<\/h3>\n
Differentiating between gastrointestinal and extragastrointestinal causes of colic may require further diagnostics. Although each case is unique and may necessitate alternative diagnostics, a routine colic diagnostic workup may include transrectal palpation, nasogastric intubation, ultrasonography, blood work, and abdominocentesis. Although all of these diagnostics together will provide a comprehensive evaluation of the horse, the ability to perform them depends on patient compliance, case presentation, availability of supplies, financial considerations, and clinician preference. <\/span><\/p>\nTransrectal Palpation<\/b><\/p>\n
Transrectal palpation can often yield a diagnosis and is also useful for determining the degree of bowel distention, although inadequate restraint or lack of amenability of the horse can preclude the ability to perform.1<\/sup> In addition, the diagnostic usefulness of transrectal palpation is limited to evaluation of the caudal one-third of the abdomen; therefore, more cranial abnormalities may be missed.<\/span><\/p>\nNasogastric Intubation<\/b><\/p>\n
Nasogastric intubation can be both diagnostic and therapeutic, depending on the underlying cause. Assessment of the amount, consistency, contents, and odor of the reflux may be useful. Abnormal findings include ><\/span>\u2009<\/span>2 L of reflux for an average-sized adult horse, foul- or fetid-smelling reflux, excessive feed <\/span>quantity or volume of gas, hemorrhagic reflux, or overall difficulty with advancing the nasogastric tube. Portable meters for measuring L-lactate and serum amyloid A have also become more accessible and can provide beneficial information during a colic examination and be used to help determine if referral is needed.<\/span><\/p>\nUltrasonography<\/b><\/p>\n
Abdominal ultrasonography is less invasive and can yield a plethora of information. Ultrasonography equipment is becoming more accessible in ambulatory settings, although inadequate user comfort and experience may deter clinician use. During ultrasonography, examining the abdomen as well as the caudal thoracic area may aid in identifying conditions such as pleuropneumonia, diaphragmatic hernias (<\/span>FIGURE 1<\/b><\/span>), or other thoracic pathologies that may mimic or complicate abdominal disorders.<\/span><\/p>\n