Colic in the Older Horse Colin Mitchell BVM&S CertEP MRCVS ScottMitchellAssociates, Hexham

General Diagnosis & treatment – similar to younger animals Increased prevalence of certain conditions Reduced prevalence of certain conditions

Increased Prevalence Pedunculated lipoma Large bowel impaction Some forms of neoplasia / cancer

Decreased Prevalence Grass sickness Small intestinal “twists” Some forms of intussusception

Pedunculated Lipoma 70 % of surgical cases >20yo a lump of fat, on a string, suspended in abdomen wraps around loops of intestine!!!  obstruction, distension and pain

Pedunculated Lipoma May be intermittent If persistent – need surgical correction +/- bowel resection

Large Bowel Impaction “oro – dental syndrome” Reduced water intake Can be managed medically Oral liquid paraffin Intravenous fluids May need surgical correction

Older Horse Colic Pre-existing disease conditions Should be considered in decision making process ECS – poor wound healing Chronic laminitis - welfare

Conclusion Do not rule out possibility of referral for possible surgery on basis of age alone Better to refer early and not need surgery, than send a surgical case too late

Majority of colic is medical !!! Conclusion Do not rule out possibility of referral for possible surgery on basis of age alone Better to refer early and not need surgery, than send a surgical case too late Majority of colic is medical !!!

Prevention of Colic “Rules” of good feeding Worm Control Routine

Good Feeding Feed according to work , temperament & condition Plenty of roughage Little & often – 3kg max hard feed at any 1 time Routine Change gradually Water before feeding Good quality feedstuffs

Worm Control Worm egg counts Routine interval worming

Worm Control YEAR 1 Equest every 13 weeks Tape worm Spring / Autumn (Equitape / DD Stro-P DD Pyratape P etc) YEAR 2 Ivermectin every 6-8 weeks (Eqvalan etc) Tape worm as Year 1

Routine Feeding times Feeding quality / quantity Turn-out Bedding : straw v shavings / paper Dental prophylaxis

Recurrent Airway Obstruction RAO Heaves Asthma in horses COPD

Recurrent Airway Obstruction RAO Heaves Asthma in horses COPD

RAO Reaction of small airways to inhaled substances Fungal spores, dust, noxious gases, ammonia, mites

RAO Increased resp rate & effort +/- cough +/- nasal discharge Poor performance

RAO - management Drug therapy Environmental control

Drug Therapy Oral Inhaled Systemic

Oral Therapy “Ventipulmin”, “Sputulosin”, “Prednisolone”

Inhaled Less side-effects High local concentration of drug Rapid onset of action Delivered at site where required

Systemic Therapy Usually at time of respiratory distress :- Frusemide Steroid Atropine

Environmental Turn – out Haylage Paper / dust-extracted shavings Rubber matting Soak hay

Weight Loss

Mechanisms of Weight Loss Reduced intake Reduced digestion, absorption Increased losses Increased requirements

Common causes Malnutrition Dental disease Inability to compete for feed Chronic Peritonitis Grass sickness Protein losing enteropathy ( PLE ) Neoplasia ( GI / non-GI ) Liver disease Internal parasitism

My Approach Good history Feeding Worming Previous disease / lameness Housing

My Approach Clinical Examination Worm & rasp teeth

My Approach Clinical Examination Worm & rasp teeth Blood tests – liver / PLE

My Approach Clinical Examination Worm & rasp teeth Blood tests – liver / PLE Peritoneal fluid / urine

My Approach Hospitalise :- Oral glucose tolerance test ( OGTT ) Rectal biopsy if diarrhoea Gastroscopy Ultrasonography

OGTT Starve overnight 1g per kg glucose administered by naso-gastric tube Blood sample regularly Plot glucose level in blood – compare peak

OGTT >85% increase : normal 15 – 85 % : partial <15 % : complete

OGTT Tests small intestinal function Blood glucose should peak 2hrs after glucose given If not – reduced absorption

OGTT - normal blood glucose time 2 hrs

OGTT - partial blood glucose time 2 hrs

OGTT - complete blood glucose time 2 hrs

OGTT - compare blood glucose time 2 hrs

Weight Loss - further Laparotomy Once gone beyond common causes – can be difficult to pinpoint cause