I’ve been spending the last couple of weeks on Equine Emergency Surgery. I’ve been expanding my knowledge of horses and how to treat them in emergency situations. One of the most common emergency presentations for horses is colic or abdominal discomfort. These horses often present to the clinic because their owner has noticed them staring at their flanks, rolling around, refusing to eat, or not passing feces as they normally would.
There are many possible causes that would lead a horse to exhibit colic signs. Some causes include impacted feed in the intestines, displaced intestines that twist and move where they are able to block passage of feces or gas, bacterial infections or, more commonly in older horses, strangulating lesions such as lipomas (fatty tumors) that twist around loops of intestine and block proper blood flow or movement of feed.
The first step in a colic exam is to obtain a history to learn how long the instance has been going on, what signs the horse is showing or if this has happened in the past. Then, a thorough physical exam is performed. Horses that present for colic are often very uncomfortable and their heart rates are commonly elevated. It is also crucial to listen to the intestines with a stethoscope to evaluate whether normal gut motility is occurring and if it’s not, to localize where there may be abnormalities.
Then, a rectal exam is performed to assess the anatomical location of the GI tract to assess whether there is a build-up of gas or if any of the intestines are in the wrong place in the abdomen. A quick scan with an ultrasound and/or abdominal radiographs can help to confirm gut motility and GI tract positioning as well.
Horses are unable to vomit due to a very strong lower esophageal sphincter so when their stomach feels upset the reflux builds up with no way to exit. For this reason, it is important to pass a nasogastric tube. This is a tube that is placed in the horse’s nose, through the esophagus into the stomach and helps to empty any reflux that is unable to leave the stomach on its own and help the horse to feel more comfortable.
In addition, a belly tap (or abdominocentesis) is performed to analyze the peritoneal fluid for signs of inflammation, infection or unhealthy intestinal tissue. Ultimately, by utilizing all of the information obtained from a thorough colic workup helps to localize the source of the discomfort and determine if the horse needs surgery or can be treated medically. Every colic case is unique, so a thorough workup is key to ensuring the best outcome for the patient.