Colic craziness at Littleton Equine

Hello all,
I hope summer is treating you well. It has been so busy here at the clinic lately. Our ICU is full and most of the cases are colics. I thought I'd give a brief overview of what colic means and how we address it. 
Horses colicing has been a very common occurrence this summer. Colic is a general term for any abdominal discomfort a horse experiences. Colic's can have many causes, ranging from an impaction of feed material, gas colic, sand colic, strangulation of the gut, entrapment of the gut, or even when the gut ruptures. To work up a colic we start with a basic physical exam including:  temperature, listening to gut sounds, check mucous membranes and CRT, feel digital pulse, and get a heart and respiratory rate. We will also get a history of feed and medications from the owner. Then we will then do a rectal exam on the horse to feel for dissented loops of small intestine, to feel if the colon is caught between the kidney and spleen (a nephrosplenic entrapment), or to see if we can feel an impaction in the cecum or colon. We then pass a nasogastric tube into the stomach to see if the horse will reflux. Each patient will also be ultrasounded to help assess what type of colic is occurring (can you see the kidney and spleen, are there dilated loops of SI, ect). We will also run a CBC, chem, and lactate on the patients. A very helpful piece of blood work is the lactate. Lactate is a byproduct of anaerobic metabolism, so if the lactate is high it indicates something is depleted of oxygen, and commonly with colics it is due to strangulated/dying gut. Depending on what we finds on the physical exam and with diagnostics, the patient is either determined to be a medical colic or a surgical colic. If the horse needs surgery, then they will head up to the clinic to our surgeons. If they are a colic that can be treated medically, we will give them NSAID for pain management, start then on a Lidocaine CRI for pain and to increase GI motility, IV fluids, and sedation. If the patient continues to be painful, we can add in additional medication like Buscopan, more intense pain meds, and more effective prokinetics. If the patients pain can not be controlled, then we either have to go to surgery or we have to euthanize. This week I got to see a colic surgery which was a large colon torsion. Unfortunately the torsion had cut off enough of the blood supply to the colon that is was too compromised and the prognosis for the patient was not good. We ended up euthanizing on the table. It was a sad case, but the owners felt that they had truly done everything they could for their horse and were very kind and thankful to us. One of our clinicians like to say that a little over half of colics with resolve on their own, 30% need some sort of meds and basic care, and around 15% need surgery. Working in the ICU we see so many really sick ponies that I have to keep in my mind those numbers because it is nice to know that many more horses are still out in the world happy and healthy. Please let me know if you have any questions (denneyk1@msu.edu). 

Thanks for following along :)