Page 823 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

798 CHAPTER 4

VetBooks.ir acute colic episodes (e.g. large-colon impaction, cae- Differential diagnosis
Chronic and recurrent colic are vague syndromes
cal impaction, peritonitis or enteritis). Other causes
include colonic displacement, inflammatory bowel
tinal disorders.
disease (IBD), peritonitis, lymphosarcoma, other GI encompassing a vast number of GI and extraintes-
neoplasms, intestinal adhesions, abdominal abscess,
ileal obstruction, grass sickness, sand impaction, Diagnosis
pyloric stenosis, diaphragmatic hernia, right dorsal A thorough history is essential (Table 4.4). A com-
colitis (NSAID toxicity), verminous arteritis, pleuri- plete physical examination is essential to identify
tis, urinary tract disease, liver disease, reproductive both intestinal and extraintestinal abnormalities.
tract abnormalities, enteroliths, intussusceptions The linea alba should be palpated for a scar from
and EGUS. previous laparotomy if the complete medical his-
The pathophysiology is varied depending on the tory is unknown. It is not unusual to find no sig-
inciting cause. nificant abnormalities during examination of horses
with chronic or recurrent colic. In general, a thor-
Clinical presentation ough diagnostic testing plan is required, which may
Intermittent or continuous colic of 3 days’ dura- include many of the tests described in Table 4.5.
tion or longer is the main presenting complaint of Although sometimes unrewarding this work-up is
chronic colic. Pain may range from mild and inter- necessary to rule out differentials such as sand enter-
mittent to severe and continuous. Weight loss and opathy, EGUS, IBD, enteroliths and endoparasites.
poor body condition may be evident in some cases, A provisional diagnosis can be reached in the major-
especially recurrent colic. ity of cases.

Table 4.4 mportant historical information in the Table 4.5 Diagnostic options for chronic colic
I
investigation of recurrent colic
• Age COMMON INITIAL TESTING
• Duration of ownership Haematology: complete blood cell count, serum biochemical
profile, plasma fibrinogen and serum amyloid A assay
• Appetite
Palpation per rectum
• Ability to maintain good body condition
Gastroscopy
• Faecal consistency
Abdominal ultrasonography
• Reproductive status: pregnant, recently bred, recently
foaled Abdominocentesis
• Pain: duration, recurrent/continuous, frequency, intensity, Abdominal radiography
response to analgesics, patterns of onset (e.g. associated FURTHER TESTING
with feeding)
Carbohydrate absorption test
• Deworming history: deworming programme, recent
deworming Rectal mucosal biopsy
• Diet: type, quality, amount, frequency of feeding, recent Thoracic radiography
changes Thoracic ultrasonography
• Management changes: exercise, turn-out, change in Reproductive tract examination
routine, comingling with new horses, place in hierarchy
with comingled horses Cystoscopy
• Dental prophylaxis Liver biopsy
Urinalysis
• Previous medical problems: colic, abdominal surgery,
extraintestinal infection (i.e. S. equi), NSAID therapy Exploratory laparoscopy
• Water: access, quality, change in source, intake Exploratory laparotomy with multiple intestinal biopsies