AERC March 8: Kira Epstein–> Colic in Endurance horses, or…?

Disclaimer that goes for ALL my blog entries, but especially when I am reporting on what others said: I can be wrong, I welcome corrections and comments, and I will remove any spam, flame, or non-productive comments. Let’s stay CIVIL and show respect; 3 R’s: respect the post, respect each other, and respect this place. Thank you.
In addition, I am thinking of myself as a *connector*, So, if you have questions about the content, do contact the person who did the presentation. I will provide as much information about contact info as I can.

Presenter: Kira Epstein, Works in the Equine Emergency Clinic at University of Georgia ( 6 years, I think?)
DVM Dr of Veterinary Medicine
DACVS Diplomate, American College of Veterinary Surgeon
DACVECC Diplomate, American College of Veterinary Emergency and Critical Care
http://www.vet.uga.edu/lam/department/epstein.php

I am hoping that you, reader, as I did, find this information educational and helpful because I can now be a much better advocate and helper for my veterinarian if this happens to my horses. I find information calming and soothing.

Dr. Epstein, Kira, she said…. *Horses will Colic, they are just made badly* and then she started out asking the audience how many people had a horse that had colicked– 90% of the people in the room ( I think the room holds 150-200 people and it was fairly full at this session).
then, she asked how many people had had horses colic as a result of an endurance ride, less people raised their hands but maybe about half of the 90% who initially raised their hands at the starting question.

Then she said that at this time, there is not much information on colics in endurance horses so she was going to give us the basics of colic then talk a bit about colic in endurance horses. She mentioned she sees 5-6 colics per week present at the clinic where she works and she wanted to educate us a bit about colic so we all have the same language as well as a basic understanding of how she deals with colic cases and makes decisions about colic cases.

This was an extremely helpful session in colic education.

Kira started with the basics of Colic, that Colic is abdominal pain in the horse. What causes the pain? Stretch receptors and chemical receptors in the peritoneum ( lining of the abdominal wall). Stretch receptors in the mesentery ( double lining in the GI tract) that sense distention. and Chemical receptors that sense products o inflammation and anaerobic metabolism. These receptors are in the whole lining of the peritoneum so the pain in the abdomen is not as localized as you might think so finding where the pain is actually coming from can be difficult.

Symptoms of colic are variable and include: off feed, changes in manure, pawing, looking at or kicking at abdomen, posturing, stretching to urinate, laying down, quietly laying down to rolling convulsively; there are breed and sex differences in symptoms as well. You, the owner know your horses the best so PAY ATTENTION.

The Dr. Kira Epstein decision tree: you may assume my notes above and below are my renditions of Dr. K’s presentation.

Anatomy of Colic: Is the colic in the GI tract or not or localized elsewhere?
GI tract is where almost all colics are, there are a few cases when the colic is not in the GI tract.
GI tract is stomach, small intestine( duodenum and jejunem and ileum— **** Most colics happen in the Ileum****), and large intestine ( cecum, lg colon,transverse colon, small colon). A question that popped into my mind as Dr. K was talking was that I have heard the phrases Hind Gut and Fore Gut used, so I was wondering how the two anatomy languages match up. So when I had a chance I looked it up and logically it works out, see here http://www.barastochorse.com.au/gastrointestinal-tract-basics-the-horse%E2%80%99s-foregut-and-hindgut/

Other stuff that is in the equine abdomen are reproductive organs, spleen, urinary tract, lover, kidney ( Colics rarely happen in these areas and organs)

There are diseases that present like colic and need to be ruled out: Typing up– muscuoloskeletal system, Unable to get up=neurological, *shipping fever= lung or pleural infection*= respiratory, and cardianc failure.

Ok, Back to GI Colic: There are three mechanisms of colic: non strangulating, strangulating, and inflammatory.
Non Strangulating colics impact the aforementioned stretch receptors via impaction, displacement, ileus ( intestine stops oand ingesta cannot move– **** 80% of colics are ileus of the large intestine***

Strangulating colics impact the stretch and chemical receptors hence the purple colors of organis due to strangulating obstructions.

Inflammatory Colics impact the chemical receptors resulting in diahrrea if in small intestine and fluid in stomach if small intestine not working.

Treatment plans for colics in the Field: treat or refer and/or in the hospital medical or surgical
First, a colic exam is done: Physical exam, Nasogastric tube and Rectal Exam plus in lessening order of getting good information back: bloodwork, ultrasound, abdominocentesis, radiographs, fecal testing and gastroscopy.
Physical exam determines level pain : mild– pawing, stretching; moderate–wanting to lay down w or w/o rolling
and severe–constantly wanting to roll and roll onto their back. ****Strangulating colics result in sicker horses with typically more pain.**** Then, Triage exam: Cardiovascular stats: HR, pulse, mucous membrane color and cap refill, jug refill, leg and ear temperature. **** Strangulating and Inflammatory Colics present as much sicker horses than non strangulating colics). Then, yep! GUT SOUNDS– all quadrants, both sides, and a ping test ( this was interesting– hold stethoscope on gut in different quadrants and flick the skin, results in a different sound if there is a gas bubble trapped in the gut — wow. The veterinarians call it simultaneous auscultation ( listening) and percussion– which is self explanatory); then take temperature; a fever is more associated with the inflammatory colic. Then, rule out other diseases/causes of the colic symptoms in other body symptom such as concurrent illness, look for self- traumatization and injury and any other look-alike diseases.

Next–>Pass the Nasogastric tube look for more fluid– this can be diagnostic and treatment– because if the horse’s small intestine has stopped working and fluid is building up in the stomach, the tube can help empty the fluid and take the pressure off the stomach since horses cannot vomit. Use the tube to pass fluids, elytes, laxatives and stuff that can bind toxins. Passing the tube is followed by the rectal exam– CAUTION! a normal rectal exam does not mean nothing is wrong. Blood work is next or simultaneously looking at WBC, inflammation,elyte levels, Ultra sound cab be employed to look at displacement, distention, abdominal fluid,liver, kidney,and spleen.
Abdominocentesis the Belly Tap= can allow us a look at WBC, protein, lactate and color: RED/Oraneg is usually associated with strangulating colics, WBC, protein and lactate increase w strangulating colics. Radiographs can show us sand, enteroliths, Fecal testing can show us bacteria, parasites, sand and gastroscopy can show us ulcers and impaction or telescoping gut.

Treatment decision and comparative cost and once you have diagnosed the type and severity and location of the Colic cause:
Non strangulating in the small and large intestine usually treat medically first then consider surgery $$
Strangulating in the small and large intestine usually surgery is considered first– Cost is about the same as intense medical treatment $$$
Inflammatory in small and large intestine usually intense medical treatment. Cost is about the same as surgery $$$

If you are in the field, then it is important to decide quickly if it is strangulating or not to be able to refer faster to the hospital; once at the hospital all tests are re-run. Sometimes surgery and be exploratory.

Treatment: withhold feed, allow to nibble on grass,

Medical Treatment: pain management= antinflammatories (banamine), sedatives,, analgesics, antispasmodics. CAUTION= NO BANAMINE INTRAMUSCULARLY– FOR SOME REASON IT CARRIES A HIGH RISK OF CLOSTRIDIUM INFECTION, SO JUST DON’T EVEN IF IT SAYS YOU CAN ON THE BOTTLE. Fortunately–Banamine has good oral availability so give it orally or IV. Remember that pain can reduce gut motility. Give Fluids, orally or IV– Hydration is good, get fluids, elyltes and nutrition into the horse. Oral fluids help with impactions IV fluids don’t do that as well. Give Laxatives orally– such as mineral oil, epsom salts, psyllium, and balanced elytes. Can Give medicines orally as well– biosponges, antibiotics, laminitis prophylaxis. Trocharization is a possibility to reduce gas, usually there is limited indication for trocharization.

Surgical Treatment: Dr. K says *majority of horses do not go to surgery* Surgical procedures include: decompression, correct orientation,resection. 20% of horses coming in for colic are referred for surgery– 25% of that 20% actually GO to surgery.

Recovery from Colic Surgery is usually: in the hospital 1 week, 1 mo stall rest, 1 mo small paddock, 1 mo reg turn out. Prognosis post colic surgery: Non-strangulating colic– very good to excellent; Strangulating -variable– in the small intestine and uncomplicated surgery 80% of horses return to work; 60-80%.
Inflammatory– variable. Dr. K says, that the Majority of horses return to previous or higher level of performance; Racing and non Racing.

Dr. K did caution us that if our horse is lame prior to colic surgery that the colic surgery is not likely to cure the lameness. ***SNORT** Veterinary humor…

Ok, the Endurance connection, whew, finally! The final 10 min of an hour and a half plus talk!
Colic is one of the more common reasons for elimination from endurance competition. this is based on a paper written by Dr. Langdon Fielding–> 40% of endurance eliminations are due to colic; usually exercised induced ileus, displacements, impactions, salmonellosis, and gastric ulcerations. Ulcers are really really REALLY common in performance horses.

But, luckily,Dr. K did say that most horses can be treated in the field, medical management is the norm, and prognosis is excellent.

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