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Diagnosis of Colic

     Generally,  the symptoms of a horse in distress from acute colic is pretty straight forward.  The real question is what type of colic your horse may be experiencing and, accordingly, how does this point to the appropriate treatment? To cut to the chase, the race horseman has to primarily worry about three types of colic: (1) stomach distention, (2) small or large intestinal impaction/distention, and  (3) spasmodic colic.  There are a number of symptoms the horseman can look at for answers.  The first is to evaluate the history of the colicky horse. Then evaluate the affected horse's posture/attitude , listen to the gut sounds, and pass a stomach tube--if practical.  Later, to get an idea of the seriousness of the colic, note heart rate/pulse, examine color of mucus membranes, and monitor blood pressure.  Some of these procedures may sound beyond  the capabilities of most lay-people.  Not so! They are quite simple and can tell you much about your horse's condition.  The key is to know what is normal for your horse. One can not wait till colic strikes and then not know what your horse's normal signs were. The horseman should have a stethoscope and an appropriate blood pressure cuff waiting and ready for use in the tack room or trunk.  He should have periodically used these instruments on his horse and know what is normal.  Only then can the symptoms and seriousness of colic be interpreted.

     Most likely the first scenario:  you will go into the barn and find your horse  pawing and acting very uncomfortable. If it is feed time, he will show no interest in eating. He may go down, lay a few seconds, look rearwards, perhaps roll once, then pop back onto his feet. Depending on the pain being experienced, there will be a wide array of gradients of these signs, all the way from mild anxiety to profuse sweating, violent rolling, and rapid respirations.

     The first thing is to quickly evaluate your horse's history.  What happened that day which  might precipitate colic? Was he inadvertently fed a different ration?  Was he worked differently?  Is his water buckets still full?  The predisposing conditions found in most racehorse shedrows are dehydration, diet changes, injury, and stress.  Dehydration is mainly seen in the Fall when freezing weather brings new drinking habits to the horse. Water buckets may be frozen.  Whatever the cause of dehydration, be it temperatures, stress, work, etc. the horse's lack of water can stimulate ingesta impaction.  A diet change can take in the feeding of new or different hay/grains. Injury to the horse can precipitate colic by a pain reflex that acts by decreasing the activity of the intestinal musculature. Make no mistake, the nervous system and the gut are closely related. Pain can also cause a decrease in water consumption.  Stress can go hand in hand with pain or can be a result of tougher training works or other barn routines which may put stress on the horse.  The gastrointestinal tract tends to shut down from many variances of stress, opening the horse up to bouts of colic. 

     Posture and attitude of the colicky horse can give further clues.  The amount of pain being experienced will be reflected in the posture and attitude.  As a very broad rule of thumb, generally,  low grade pain means that the point of colic is further away from the stomach, most likely in the large intestines.  The more severe and consistent the pain, the more likely the anterior portions of the GI tract are involved, but be aware that horses are individuals and pain is a very subjective gauge at best.  The degree of anxiety can pretty much be a gauge to the pain being experienced.   Depression in the colicky horse is always a bad sign and a result of exhaustion and impending shock.  The posture of the colicky horse can be difficult to interpret at times. This does not mean that one should disregard stance, just be wary of a definite meaning for any one individual affected horse.

Organs:    Y--left dorsal colan,   W--left ventral colan,     U--spleen.

     Evaluating the gut sounds (peristalsis) in your horse is probably the one most important task any horseman can perform. If you don't own a stethoscope, get one or place your ear directly on the appropriate gut area. I've seen many an old timer lay his ear directly on the abdomen, so this will suffice in a pinch. Become acquainted with where specific regions the GI tract may come in contact with the belly's skin surface.  What sections of that tract are located where?  You should become acquainted with the normal gut sounds.  Generally, the presence of normal intestinal sounds indicates that the colic is not serious and only transitory.  A decrease in sounds tends to point to some degree of impaction. Tinkling sounds may suggest gaseous distention as observed in distentions.  Spasmodic colic will be characterized by loud gurglings of a constant nature.  Gut sounds tend to be the loudest when the ingesta contains large amounts of water.  Thus, with little water consumption, the sounds will be very soft and inconsistent, if present at all. If the racehorse has hay and water in front of him most of the day, normal sounds should be present as a result of his constant eating/drinking. A lack of food intake for whatever reason will cause the normal horse to have decreased sounds.  The evaluator must take the horse's previous eating habits into consideration. The presence of no sounds which seems to be often the case in my experiences with race track colic indicates that an impaction/distention  is probably present.  Again, the sound of a very active gut with abnormally prolonged gut sounds may indicate spasmodic colic or other types of irritable bowels. 

          With the aid of the stethoscope, the horseman should be able to differentiate between an impaction/distention (no sounds to tinkling sounds) of the small and large intestines vs. spasmodic colic (overactive sounds). That leaves a more anterior stomach impaction or distention diagnosis as the question.  An impacted stomach is somewhat rare in the race horse and will not be covered. The  distention of the stomach is fairly common.  The equine stomach is very hard to evaluate because of the nature of its location.  It is deep within the body and cannot be easily listened to by any means.  Likewise, a distention of the stomach cannot be observed externally.  The passing of a stomach tube will be the only sure way to discover the stomach's role in all of this. This can sometimes be a problem if a vet is not handy. I have long mastered the passing of a stomach tube as a layperson, but I do not advise this of most horsemen. One must absolutely know when the tube is in the esophagus vs. the trachea, particularly if one plans to infuse anything into the stomach.. Horses can die from a mistake of placing the tube in the trachea and running liquids into the lungs. The passing of the stomach tube into the stomach should relieve any gas distention of that region by allowing the trapped gas to escape.

     Trying to assess whether the horse with colic is improving or worsening is certainly one of the worries that face every horseman. Every minute the horse is suffering is an ordeal. To gauge the progressive seriousness of the patient, one should monitor the heart rate, pulse, mucus membrane color, and systolic blood pressure. Equus magazine did a most informative article many years ago citing an Australian study in determining the most effective means in forecasting the prognosis of cases of colic. The study involved 100 horses and found that systolic blood pressure determination was the best guide to gauge whether your horse was on the improve or on the road to further deterioration.

     One can actually monitor the systolic blood pressure of the horse by utilizing a human blood pressure cuff or  sphygmomanometer. You need a pediatric blood pressure cuff or an adult cuff which can be sized down to snugly fit the upper tail bone of the horse. Place the cuff around the upper tail bone like you would your arm. Secure the cuff either with velcro or metal buttons which comes on that individual instrument. Close the air valve on the rubber bulb and pump the pressure up to 160 or greater.  Next, barely crack the air valve and allow a very gradual escape of air in the cuff.  The needle will fall slowly and evenly on the gauge. Watch very carefully until you start seeing a slight hesitation of that needle. When the needle hesitates, but then immediately bounces back up to a higher reading–this is your systolic pressure. The number where the needle first hesitates before bouncing up to the higher reading will be your systolic blood pressure value. One should take three readings in succession and average the pressures for the most accurate determination of your horse at that time. You should continue to monitor your horse in 20 to 30 minute increments to get a feeling on how the horse's cardiovascular system is progressing or deteriorating.  Normal values will be in the range of 105-125 to, perhaps as high as 140 in colic cases.  High is far better than low in the case of systolic blood pressure.  When the blood pressure drops below 80, we have a serious situation in the making.  The cardiovascular system is collapsing.  This is a procedure which needs to be practiced both by yourself and on your horse. You should know what is normal for your horse long before he is colicky.  Some horses will not take to kindly to having a cuff squeezing their tail, another reason for practice.

      The Heart rate normally will be around 40 beats per minute.  You need to take your stethoscope and place it directly behind the elbow on the left side.  The heart makes two sounds for each beat. When the heart rate shoots above 65/minute it is a sign of impending endotoxemia and cardiovascular collapse. 

     An accurate pulse may be difficult to take if the colicky horse is in much discomfort, but you may want to try. Probably the easiest place to take a pulse in on the jaw, to be more precise the external maxillary artery.  It may be found in front of the heavily muscled cheek as it goes under and around the lower jaw bone in that region.  Take your first and second fingers and lightly press the artery against the jaw bone. You should feel the character of the pulse. Normal ranges are from 28-40 beats per minute.  A strong pulse is to be desired. A weak pulse may suggest dehydration or impending cardiovascular shock.

     The color of the mucous membrane is a simple and very easy way to quickly gauge the condition of the colicky horse. Check the color by raising the upper lip of the mouth and examining the gums and inner lip. The normal horse will have pink gums and under-lip. Red membranes suggests a compromised venous system with a bright red color being a sign of vasodilation and the dark red color of the vasoconstriction stage–impending endotoximia.  A blue color denotes a lack of oxygen and impending death.


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