The Colic Exam

Colic in horses can be a frightening and gut-wrenching ordeal (literally). If you have horses and have not already dealt with this emergency, eventually you likely will. Over the past couple of years I have encountered occasional misconceptions regarding colic that I think can be cleared up by getting a handle on what colic is and what is going to happen when you call your veterinarian to come examine your horse.

​Colic is abdominal pain. The term by itself is simply descriptive of the collection signs you observe that indicate that the horse has a belly-ache (not eating, pawing, looking at its flank, laying down/rolling, yawning, sweating, etc.). Its causes are limited only by the horse’s anatomy and your imagination. The gastro-intestinal tract is the most common source of abdominal pain observed in horses but the liver, reproductive organs and kidneys can also have problems that may cause the horse to act colicky. Occasionally, even problems in the thorax or chest can cause discomfort that will look like colic.

​When I look at a colicky horse in the field I am going to try to get several things done in a hurry. I have usually already started to ask questions and get an idea of how long the horse has been ill, normal diet, previous episodes of colic and other pertinent medical history while I start with the exam. This gives me a few minutes to observe the horse, get baseline vitals (temperature, pulse rate, respiration rate, gum color, gut sounds and jugular refill time) and decide if any immediate treatments are necessary or if immediate referral should be considered before proceeding.

​If the horse is stable, I usually then perform a FLASH (Fast Localized Abdominal Sonogram of the Horse) abdominal ultrasound. This is a quick exam that is meant to identify significant problems of the small intestine, colon, kidneys, spleen, liver, abdominal fluid and thoracic fluid. If it can be done safely, the horse can then be palpated feeling for impactions, distension of small intestine or colon and proper positioning of the intestines. I will always pass a nasogastric tube at this point, if I have not already done so. This step can be helpful diagnostically and therapeutically. It is very uncommon for a horse to “throw up” so passing this tube through their nose, down the esophagus and into the stomach can relieve pressure if it exists (which can be a significant source of pain) by allowing undigested food, gas or reflux to exit the stomach. The presence of any of these may also give insight into the cause of the abdominal pain.

​There are a couple of quick laboratory tests that are usually a good idea for colic patients . The PGVS mobile lab has the ability to get a packed cell volume, total protein and lactate reading from a small volume of blood. Abdominocentesis is another very helpful diagnostic tool that may be performed. This procedure involves the sterile preparation of the abdomen and collection of abdominal fluid for analysis (total protein and lactate). Analysis of abdominal fluid can be quite helpful in determining if some part of the intestine is experiencing circulatory compromise and may also be an aid in determining prognosis.

​The goal of the exam and diagnostics is obviously to determine the specific cause of the colic. If that cannot be achieved we can usually at least categorize the colic. From a practical perspective being able to categorize the illness lets us answer the question of whether referral for surgery is necessary as quickly as possible. There are certain causes of colic that will need surgery every time (ie: Large Colon Volvulus). These cases are very time sensitive and outcomes are closely related to how quickly the condition is corrected with surgery. Other causes may not need surgery immediately but may progress to that point if medical interventions are unsuccessful (ie: Pelvic Flexure Impaction). Finally, there are several causes where surgery would be either contraindicated or unnecessary (ie: gastric ulcers). The take home message is that for horses that are surgical candidates, the question of whether surgery is necessary or not is the first, and arguably most important, question that must be answered.

​That, in a nutshell, is my approach to a colicky horse. Hopefully it has shed some light on the medical decision-making that goes into evaluating a colicky horse and what you should expect to happen when you call your veterinarian out. Usually at this point there is enough information available to make a good decision about whether it would be best to refer the horse or treat at home.

So if you suspect your horse may be experiencing colic here is what I recommend you do:

  • Be prepared—Invariably this scenario unfolds at an inconvenient time and can catch you off guard. If the horse is insured, know what the policy says and have contact numbers saved in your phone or in an easy to access location. As unpleasant as it may be, give some thought ahead of time to how far financially you can afford to go. If you are out of town and someone else is caring for your horse, make sure they know how to get a hold of you and your veterinarian and authorize them ahead of time to make emergency medical decisions for you about your horse if you cannot be reached. These are just a few examples, but being prepared can go a very long way in insuring that your horse receives the level of care you expect in a timely manner.
  • Call your vet—This is a very good reason to have a Veterinary Client Patient Relationship (VCPR) with a skilled local veterinarian. Time can be saved if your vet knows you and the horse and how to get to your property. I think it’s a good idea to make this phone call before giving any medications or treatments your self.
  • Remove feed and water.
  • I do not recommend delaying treatment by driving the horse around in a trailer or hand walking for extended periods of time. That said, some people swear by this. So if you feel you must try it, set a strict time limit of 10-15 minutes. (Note: Often the horse will pass manure either getting on the trailer or in transit. While the passage of manure is not a bad thing, it is not an event that signals the end of the colic.)

If you made it this far, thanks for reading and feel free to call or e-mail to say hello or set up an appointment!

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