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Prepared by
Dr. Ghalib S. Ridha
Visiting Assistant professor of
Internal medicine & Infectious
Dept. of Internal Medicine
Faculty of Veterinary Medicine
Al-Fateh university
Tripoli, LIBYA

• The term “colic’’ means
only ’’pain in the
• Colic is potential horse
killer. It occurs
sporadically and may be
mild or severe, acute or
• Repeated bouts or
recurrent colic are not

• A tour of GIT to explain
why there are so many
forms of colic.
• Horse has a fairly small
• Food passes from stomach
into S.I. (22 m length),
capacity 40-50 liters.
• At junction of S.I with
L.I, a large blind-ended
cecum (1 m length),
capacity of 25-30 liters.


• Colic due to some intestinal problems appears
to be age related as meconium impactions are
restricted to neonatal foals whereas feed
impactions occur more frequently in older
• Accurate history is essential in defining possible
etiologies and pathophysiologies of medical colics.
• A complete physical examination should be
attempted in all cases of colic to determined the
site and cause of gastrointestinal pain.
• The examination should be performed without
sedation in tractable horses. If sedation is
necessary, it should be administered only after
complete general examination because sedation
will affect clinically important findings.

Manifestations of horse colic
 Pain and anxiety which is manifested by
straining, pawing, stretching and sweating.
It is important to determine if the pain is
continuous or intermittent, static or
changing in intensity, responsive or
unresponsive to medication.

 Change of attitude e.g. mild colic due to colon

impaction may cause slight to moderate
depression and animal will often continue to
eat, while colic due to strangulation
obstructions produce severe depression and
toxemia resulting in severe colic. 5
 The temperature readings are normal to slightly
elevated with medical colic. Subnormal
temperature may accompany cases of terminal
shock and toxemia. High temperatures are
associated with infections or septic conditions. If
the owner or other veterinarian have been use
antipyretics e.g. dipyrone, phenylbutazone, flunixin
meglumine, the temperature may be normal.

 The respiratory rates usually increased in

proportion to the amount of pain. Metabolic
acidosis causes an increase in the rates.

The pulse rates may reflect the nature of
colic as a slight increase in the rate occurs in
mild colic whereas an increase of rate up to
100 or more may indicate serious and severe
colic. Pulse quality should also be evaluated.
Strong full pulse rather than a weak thready
pulse is reflective of a mild and medically
responsive colic.
Normal mucosal color is indicative of normal
circulatory status and mild or early colics.
Congested mucous membrane indicates fluid
loss or shock. 7
Colic in the Vet school Tripoli 30042008.3gp

Examination of digestive tract:
• Normal abdominal contour of horse with medical
colics. Distension is not a feature of serious small
intestine obstruction but is most commonly
observed with large intestine problems that are
usually surgical in nature.
• Sharp molar teeth may predispose to impaction
• Abdominal auscultation showing normal to
increased borborygmi usually indicate a good
prognosis for medical management. Hypermotility
indicates early intestinal distention or enteritis.

• Examination of gastric fluid could be
determined. Low pH fluid (4-5) indicates
gastric source whereas higher pH (6-7)
indicates that the fluid is from the small
• Rectal examination may identify normal and
subnormal palpable structures.
• Abdominocentesis often is performed on
midline using 18 gauge hypodermic needle or
blunt cannula to penetrate the peritoneum
to collect fluid for analysis.

• Abnormal peritoneal fluid:
- Flocculent fluid, no odor----Bacteria and toxin in
early infarction.

- Serosanguinous, no odor----RBCs, bacteria and toxin

from necrotic intestine.

- Sanguineous, malodor, feces---- Ruptured viscous,

teared rectum.

- Frank blood in abdomen ---- Usually blood vessel


• Physical findings differentiating mild (medical) colics
from severe (surgical) colics.
Mild colic Severe colic
-Yawing - Rolling, thrashing,
- Muscle tremors - Self traumatization.
- Straining - Depression, dullness
- Groaning - Labored breathing
- Pawing ground - Distended abdomen
- Looking at flank - Sweating
- Getting up & down - Attempts at vomiting
- Possible sweating.

Spasmodic colic
• It is the most common type of colic in horses.
• Etiology:
1) High carbohydrates diet (grain based feed,
lush pasture) are the most common cause.
2) During thunder storms, preparation for
showing or racing and drinks of cold water
when hot and sweating after work.
3) Mucosal penetration and migration of
strongylus vulgaris larvae causing intestinal
spasm or ileus due to change of ileal
myoelectrical activity.
• An increase in parasympathetic tone under the influence
of the factors mentioned above cause the hypermotility
of spasmodic colic in horses.
Clinical findings:
• Most cases are mild, not fatal and solve on their own
within few hours or with simple medical treatment.
• Abdominal pain is intermittent with signs of rolling,
pawing and kicking for few minutes then stand for few
minutes until the next bout of pain occurs.
• Intestinal sounds are often audible some distance and
loud borborygmi are heard on auscultation.
• A moderate increase in pulse rate (60/ minute) occur
and patchy sweating may be seen.

• Laboratory tests are not used in diagnosis.
• D.D;
• Enteritis & spasmodic coilc, both show abdominal
pain and increased intestinal sounds but diarrhea
is usually present in enteritis.

• Acute intestinal obstruction may be confused with

it but scant feces and presence of blood and
mucus in rectum are typical of obstruction.

• Obstructive urolithiasis, show similar posture
adopted by a horse with spasmodic colic.

• Because of the transient nature of spasmodic
colic, it may be not necessary to use specific
spasmolytics. However, depomidine, xylazine
or butorphanol are effective.

Intestinal tympany in horses
(flatulent colic)
• Excessive gas accumulation in the
intestinal tract.

• Gas builds up in the intestine, most
commonly in large intestine and / or
• In most cases it occur secondarily to
obstruction of small intestine.

Continu: Etiology
• Flatulent colic is either primary due to
– Ingestion of large quantities of highly
fermentable green feed
– Administration of medicine such as
– Horse that crib (wind suck) often cause
colic and pain.
• Or it may be secondary due to
• Stenosis caused by constricting fibrinous
adhesion after castration.
• Verminous aneurysm. 23
• It develops due to either excessive gas
production Or gas retention in the
intestine causing over distention and
abdominal pain due to stretching the

• In primary tympany, distention is

relieved periodically due to evacuation
of some gases but the course of
tympany is longer.
Continu: Pathogenesis

• In secondary tympany, the

pathogenesis depends on primary

• Tympany may interfere with circulation

or respiration which may contribute to
death of affected horse.

Clinical findings :
• There is abdominal distention and in thin
animal, distended loops may be visible
through the abdominal wall.

• Cecal tympany cause filling in right

paralumber fossa, whereas large colon
tympany cause bilateral abdominal gas

• Acute abdominal pain of affected horses

characterized by rolling and pawing.
Continu: Clinical findings
• Peristaltic intestinal sounds are reduced
but tinkling and metallic sounds may be
heard due to fluid rushing in the gas-
filled intestinal loops.

• On rectal palpation, gas filled loops fill

the abdominal cavity.

• In primary tympany, much intestinal

gases (flatus) are passed out.
• A history of engorgement on highly
fermentable green feed, with signs of
feces and intestinal gases passed out
may indicate a primary tympany.

• In secondary tympany due to

intestinal obstruction, rectal
examination is difficult because of the
gas-filled intestine beside it is usually
cause death in much shorter time than
other type of tympany.

Continu: Diagnosis
• P.M. findings of primary cases reveals
that the intestines are filled with gases
and feces is pasty and loose, while in
secondary tympany, the cause of
obstruction is evident.

• Laboratory tests are of no value in


• All cases should receive mineral oil (2-4
liters) containing antiferments such as
turpentine oil, formalin or chloroform.

• It may be necessary to administer a

sedative if pain is acute. In secondary
tympany correction of the obstruction
cause relief.

Verminous mesenteric
Synonym: Verminous aneurysm, thrombo-
embolic colic.
• Migration of strongylus vulgaris
larvae into the wall of cranial
mesenteric artery cause restriction
of the blood supply or damage to the
nerve supply to the intestines. Cases
may occur in foals as young as 4-6 31
• Complete vascular occlusion leads to
infarction of sections of large intestine.
In this disease the death rate is high in
affected horses.

• Recurrent colic of VMA is explained as being

due to low-grade impairment of vascular
and nerve supply to the intestine.


Continu: Pathogenesis
• Recurrent colic of low grade abdominal
pain over a period of several months
(chronic) also occur when secondary
bacterial invasion of aneurysm, usually
Strept. equi, Actinobacillus equuli or
Salmonella typhimurium, causing gross
enlargement and local peritonitis,
development of adhesions and eventual
constriction of the intestine.

Clinical findings:

1- Animals with infarction show severe

abdominal pain for 3-4 days with
complete cessation of defecation and
absence of intestinal sounds due to
stasis although
- in early stage gut sounds are increased
as it occurs in spasmodic colic.

Continu: Clinical findings
2- Rectal examination may reveal distended
loops and stretched mesentery. It is often
possible to palpate the artery as a fixed,
firm swelling in midline, level with caudal pole
of left kidney and it is usually pulsate.

3- Rupture of intestine may cause peritonitis,

gangrene of the intestine causes toxemia.
These cases always terminate fatally.

Continu: Clinical findings
4- Uncommon syndrome may occur, such as:

a) Development of massive hemorrhage

within the mesentery.

b) Occurrence of extensive occlusion

leading to rapid death (12-24 Hours)
probably due to endotoxic shock.

• Blood-stained feces may be passed due to
extensive hemorrhage leakage into the intestinal

A- Clinically, there is abdominal pain and shock with
pallor. Commonly the disease is not suspected until
recurrent attacks of acute colic.

Continu: Diagnosis
B- Paracentesis show blood-stained fluid in
peritoneal cavity with high leukocytic count
and shift to left.

C- Radiological examination has been used to

determine the presence of verminous
aneurysm in ponies.

Continu: Diagnosis
D- P.M. findings;
• Partial or complete occlusion of the arteries

• Presence of larvae in the arterial walls or

free in the lumen.

• In severe cases, large patches of gangrene

are present in the intestinal wall.

D.D: The signs produced by this disease are
similar to those of mesenteric abscess and
very similar to those of terminal ileal

• Ivermectin (0.2 mg/kg. b.w) is recommended
but it does nothing to infracted intestine.
• Surgical intervention is of little help.

Impaction of large intestine of
the horse
• Impaction is a term used when the
intestine become blocked by a firm mass
of food. It occurs mostly at one of
• Etiology:
1) Feeding on low grade indigestible
roughage over long intervals.
– Defective teeth may contribute in the
occurrence of impaction due to
improper mastication of the roughage.
Continu: Etiology
2) Dietary causes are:
• a) Over eating immediately after
surgery, impaction may occur in horse
as result manifesting itself next days.
• b) Feeding horses on high fiber diets
such as maize plants or ingestion of
large amounts of indigestible seeds
may cause outbreaks of impaction
• c) Change of diet; horses offered hard
feed after being on soft grass or
pasture is also likely to develop
impaction colic. 44
3- Other causes;
a- Breeding susceptibility. b- General debility is a
predisposing cause because of decreased
intestinal muscle tone.
c- Interference of local blood supply to the
d- Enteroliths and fiber balls may also cause
obstruction of large intestine result in recurrent
attacks of colic.
e- Foreign bodies especially pieces of rope may
cause impaction of small colon.
f- Retention of meconium in foals is a common
occurrence of impaction.
g- Rectal paralysis in mare near parturition leads
to constipation.

• Overloading of the colon and cecum
occur primarily due to dietary errors or
secondarily because of poor intestinal
motility cause prolongation of intestinal
sojourn of fecal materials with
subsequent impairment of fecal mass
movement by peristalsis leading to
chronic constipation.

Clinical findings:

• 1- There is anorexia and the horse drinks

small quantities of water. The feces are
scanty, hard covered with thick sticky

• 2- The temperature and respiratory rates

are normal but pulse rate increased
moderately (50/ minute).

Continu: Clinical findings
• 3- Moderate abdominal pain is the
typical signs in affected horses,
manifested by stretching out and
lying down. The bouts of pain occur at
intervals of up to 30 minutes and
often continue for 3-4 days. In cases
associated with enteroliths, with signs
of complete absence of feces, or
cecal impaction, the abdominal pain is
prolonged up to 2 weeks.

Continu: Clinical findings
4- On rectal examination, the
commonest sit of impaction are:
• Large colon as the distended loops of
pelvic flexure often extend to the
pelvic brim or even to the right of
• Impacted small colon felt dorsally to
right of the midline. Enteroliths and
similar foreign bodies are usually
located in small colon which may be
palpable per rectum.
• Impacted cecum can be palpated in the
right flank. 49
Continu: Clinical findings
5- Drugs used in anesthesia may seriously reduce
gut motility predisposing to dilatation and
rupture of colon or cecum.
6- The signs of retention of meconium in
foals are:
• Continuous straining and tail flagging
• Humping of the back
• Restlessness, lying down for much of time
• Hard fecal balls can be palpated with the
finger in the rectum.

• Laboratory tests are not of value
except for fecal examination of
nematodes eggs. Paracentesis,
hematology and clinical pathology are
• In necropsy findings, the large intestine
is full of firm, dry fecal materials and
rupture may have occurred. Enteroliths
are located in the junction between
dorsal colon and small colon.

Continu: Diagnosis
• Palpation of cranial mesenteric artery is
necessary to diagnose verminous mesenteric

• Tympany of large intestine in foals is much

more serious than impaction beside abdominal
distention and acute abdominal pain is the
cardinal signs of tympany.

Differential diagnosis:
• Peritonitis and dehydration may
show similarity to impaction colic
in respect of constipation.
• Rectal palpation, absence of
systemic signs and intestinal
sounds may be used to
differentiated impaction from
other forms of colic
• Acute gastric dilatation, acute
intestinal obstruction and
spasmodic colic are more severe
• Most cases of impactions respond to
treatment, recurrence of impaction may
occur due to failure to correct the cause
and death occurs due to rupture or

• Cecal impaction is difficult and may be

fatal and idiopathic rupture or
perforation of impacted cecum may occur
causing death.
Continu: Treatment

• Analgesics may be administered and IV

fluid therapy should be provided.

• 3-5 liters of mineral oil via nasogastric

tube may be administered to soften the
fecal mass which usually takes 12-24

Continu: Treatment
• An effective fecal softening agent, dioctyl
sodium sulpho-succinate (DOSS) has
been used extensively for treatment of
impaction of large intestine in horses in a
dose of 7.5-30 g / adult horse orally with
maximum dose of 200 mg / kg. b.w. Doss
commonly used in the first day of
treatment followed by administration of
mineral oil on the second day.
The 2 medicines should not be mixed nor
given simultaneously. 56
Continu : Treatment
• If medical therapy is not effective by
72 hours after 2 treatment at 48 hours
intervals with mineral oil, surgical
correction is necessary.

• If surgical therapy is not practical, a

parasympathetic stimulant such as
neostigmine (10-12 mg. IM) may be used
but rupture of the gut is possible sequel
and increased pain is expected.
• Treatment of retention of meconium in foals:
• Using mild soap and water, rectal enemas
are repeated until soft feces appear.
• Injection of mineral oil, glycerin or DOSS
(coloxyl) into the rectum may be required.
• Oral doses of coloxyl or mineral oil (100-200
g) are also advisable. Affected foals should
be treated regularly at 4 hours intervals
until recovery.

• Surgical removal is indicated when foal not

sucked for more than 2 hours and its life is
endangered or when amount of meconium is
large and the rectum has been damaged.
Sand colic
The syndrome is a combination of chronic
impaction and enteritis.
• Grazing on sandy pasture or feeding horses on
stored feed contaminated with sand or soil
may cause sand colic.
Clinical findings:
• Signs vary in horses with sand impaction.
Coarse sand frequently accumulates in the
right colon, transverse colon and pelvic
flexure, where fine sand may accumulate in
the ventral colon.
• Recurrent attacks of colic vary from
mild to severe combined with chronic
diarrhea and loss of weight with case
fatality rate of 30%.

• Recently, auscultation of abdominal

sounds has been reported as being useful
to reveals gritty sounds.

• Rock-hard large intestine impacted with

sand may be palpated but in most cases
there is only an increasing density of
contents in distended cecum and colon. 61
• Case history of sandy feed and
characteristic clinical signs which may be
similar to the signs resulting from
impaction caused by certain feed but sand
may also cause diarrhea.
• Sand impaction can be diagnosed by rectal
examination and palpation of a firm sand
in the colon.

• Examination of the feces for detection of
sands is performed by mixing feces with
water in a bucket, then pouring off the
water & looking for sand sediment.
• On surgery, it has been found that;
– There is a series of obstructions between
iliocecal valve and the rectum.
– Concurrent displacement or torsion of the
colon occur in 50% of cases that comes to
• Radiologically deposit of sand in the gut
could be visualized
Radiograph showing sand collected in pony's

• The laxative of choice for sand impaction is
administration of psyllium which is more
effective than mineral oils in penetration and
breaking down the fecal masses and
recommended for treatment of chronic cases in a
dose of 250-500 g. orally in 10 liters of warm

• When mixed with water, psyllium forms a

gelatinous mass that carries ingesta along the GI
tract. Although usually given through a
nasogastric tube, it also may be used as
preventive by sandy environment or that
persistently develop impactions may be given
psyllium powder 0.5-2 cups / day in their feed.