BACK TO BASICS: FOUNDATIONAL CLINICAL SKILLS FOR EQUINE PRACTICE


will assist the practitioner in gauging the severity of the patient’s colic and facilitate documentation of potential treatment complications (e.g., clostridial myositis from intramuscular flunixin meglumine administration). Administration of a nonsteroidal anti-inflammatory drug (NSAID) is often inadvisable if the owner has already done so, particularly in the face of dehydration, which is common in horses exhibiting signs of colic.


Diet


A brief investigation of the patient’s diet may also suggest certain etiologies. Feedstuffs or feeding practices that have been associated with a specific disease-causing colic include coastal Bermuda grass (especially free-choice access to round bales) leading to ileal impactions, alfalfa hay with resultant can- tharidin toxicosis or enterolithiasis, and high-grain/ concentrate diets that can predispose to equine gas- tric ulcer syndrome.


Dentistry and Deworming


An additional part of the abbreviated history should include inquiries into the client’s dental and deworm- ing history. It is well established that poor dentition can lead to impactions at various locations within the gastrointestinal tract. Endoparasitism, espe- cially ascarid impactions and emergence of encysted strongyles, can be associated with clinical signs of colic. History is a key component of diagnosis of these disorders; without history, these diseases may not be diagnosed, leading to treatment failure and poor client-patient outcomes.


Additional Information


Two final points of consideration include whether the patient is a surgical candidate and if the patient has insurance coverage. Important questions to ask regarding insurance include type (e.g., colic surgery, major medical) and amount of insurance coverage. Additionally, the practitioner should inquire as to other noninsurance coverage that patient may have for colic as it is becoming more commonplace for feed and supplement companies to offer some form of cov- erage. This information is often required for insur- ance claim reports as many insurance companies will inquire as to any additional coverage the patient may have beyond that which the insurance company provides.


3. Physical Examination


The baseline colic examination should include a dis- tance examination to gauge the patient’spain level, assessment of heart rate, temperature, respiratory rate, auscultation of gastrointestinal borborygmi, and mucusmembrane color and consistency. As the practi- tioner is driving up on the farm, walking up to the patient, or the patient is being brought into the clinic, the examiner should perform an assessment of the patient’s overall pain level exemplified by attempts to


lay down, sweating, and abrasions/wounds that indi- cate that the patient has been aggressively rolling. First and foremost, the heart rate should be obtained; if the patient is tachycardic, all other history taking, assessment, and diagnostics should be postponed, and nasogastric intubation should be performed to facilitate gastric decompression and to help prevent gastric rupture. With respect to gastrointestinal aus- cultation, at minimum, four quadrants (namely paired right and left dorsal and ventral quadrants)


should be auscultated; however, the author prefers a fifth location to be auscultated for a minimum of 30 seconds on the cranioventral abdomen to assess for sand (which has been likened to the sound of “waves crashing on a seashore”). Assessment of the mucus membrane tackiness can also be an indicator of the level of hemoconcentration, whereas assessment of the color can suggest other pathological conditions (e.g., toxicity associated with colitis, strangulating lesions, etc. and petechiation associated with throm- bocytopenia or anaplasmosis, etc.). Other relevant parts of the clinical examination, especially to rule out clinical syndromes that mimic colic associated with gastrointestinal disease, may include palpation of themuscles for evidence of rhabdomyolysis, assess- ment of pleural pain for pleuropneumonia, and visu- alization of jugular fill following venous occlusion for volume status evaluation.


4. Diagnostics


While determining a definitive diagnosis is ideal, it may not always be feasible. Furthermore, an exhaus- tive list of etiologies for colic in horses is not only beyond the scope of this review but also less clinically useful in an emergency situation. As such, the author prefers to attempt to categorize lesions identified dur- ing a clinical workup of the acute abdomen into (1) small intestinal, (2) large intestinal, and (3) other. Regardless of the underlying etiology or categoriza- tion, the diagnostic modalities employed will be simi- lar, yet it is the interpretation of these diagnostics that can facilitate achieving a definitive diagnosis. The secondary goal beyond classifying the lesion as small versus large intestinal should be to elucidate whether the lesion is surgical in nature. This should be performed as early in the clinical presentation as possible and as prospectively as feasible. The previ- ously mentioned nasogastric intubation, which may have already been performed by this time due to the clinical presentation of the patient (e.g., tachycardia), is both diagnostic and therapeutic. The presence of gastric refluxmay indicate either a primary or second- ary small intestinal lesion. As mentioned previously, gastric decompression is also important to avoid stom- ach rupture.


Clinical Pathology


Clinicopathological data can determine the severity of the colic episode, classify medical versus surgical lesions, and assist in monitoring the response of the


AAEP PROCEEDINGS / Vol. 68 / 2022 191


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