A farm-based prospective study of equine colic incidence and associated risk factors

Abdominal pain (colic) in the horse is one of the most acute problems facing equine practitioners. Several causes and risk factors are associated with colic. The current study evaluated the incidence and associated risk factors of colic during a 1-year evaluation in horse farms of Kerman, Iran. The study investigated age, sex, breed, anthelmintic control program, and nutritional status of 128 horses of four breeds on six farms that took part in the study. The mean incidence density rate of colic in the horse population was 8.6% (11/128) in a year. Crossbred horses had more chance of developing colic (P < .05). Horses between the ages of 2 and 10 years also had more risk of developing colic (P < .05). There was no significant difference between sexes (P < .05), and nutritional factors were the most associated risk factors in the cases under study.     

Hemostatic abnormalities in equine colic

Hemostatic profiles were determined in 30 horses with clinical colic. Blood samples were obtained at the time of the animal's admission, and the following hemostatic tests were done: blood platelet count, plasma fibrinogen, plasma antithrombin, prothrombin time, partial thromboplastin time, thrombin time, protamine sulfate test for soluble fibrin monomer, and fibrin-fibrinogen degradation products. The patients were categorized in retrospect, according to the cause of the colic: group 1--colic associated with colitis and/or severe diarrhea, group 2--colic associated with torsion or obstruction of the intestine, and group 3--colic associated with impaction of the intestine or the presence of enteroliths. Of the 30 horses with colic, 28 had at least 1 abnormality in their coagulogram--the most frequent abnormalities being high plasma fibrinogen concentration, high circulating soluble fibrin monomer, or a long partial thromboplastin time or thrombin time. The horses in group 1 seemed to have the most severe coagulopathies, as indicated by the average number of demonstrable abnormalities. The horses in group 3 showed the fewest abnormalities--usually a high plasma concentrations of fibrinogen and/or soluble fibrin monomer. The results indicated that hemostatic abnormalities are not uncommon in horses with gastrointestinal disease and colic--the degree of severity depending to some extent on the cause of the colic.     

A multivariable prognostic model for equine colic patients

A survey of 1965 equine colic cases was conducted from August 1985 to July 1986 ten equine referral hospitals located througout the U.S.A. Two-thirds of the cases were randomly selected for model development (1336), while the remaining cases (629) were used only for subsequent validation of the model. The following outcomes were defined: (1) died or killed prior to discharge from the hospital; or (2) alive at the time of discharge. Only variables which were significant (P<0.05) in an initial bivariate screening procedure and for which there were less than 400 missing values were considered in the multivariable modelling. A multivariable logistic regression model was constructed using a stepwise algorithm. The model used 666 cases and included the following variables: peripheral pulse (normal or weak), pulse rate, surgical or medical treatment, packed cell volume, self-inflicted trauma (absent or present) and capillary refill time. For each horse in the validation data set which had the appropriate variables recorded (n=335), the estimated expected probability of death (expected value) was calculated using the logistic regression equation. Using Bayes theorem, the post-test probability was calculated from the expected value (an estimate of the test odds) and the present probability (the case-fatality rate at each institution). Nomograms of predictive values for different case-fatality rates and expected values were constructed. Hosmer-Lemeshow goodness-of-fit statistics indicated that the model fitted the model data set well but the validation set poorly. However, when the observed case-fatality rates were compared with the average post-test probabilities for 0.10 increments of post-test probability, qualitatively, the model's performance was better.     

Clinical evaluation of blood lactate levels in equine colic.

Blood lactate levels were evaluated in 36 horses (43 cases) presented with colic. A correlation between increasing blood lactate levels and decreasing percentage survival has been shown. An appreciable anion gap was found in 7 of 10 cases analyzed in detail but in each case the entire gap could not be accounted for by lactate alone. Proposals are offered to account for the unmeasured anions. Blood lactate determination is suggested as a prognostic rather than a diagnostic aid for the equine practitioner and should be used to augment other clinical findings in the horse exhibiting colic.     

A survey of caesarean operations on cattle in general veterinary practice

The animal most frequently requiring operation for dystocia in this survey of 133 cases was the Friesian/Holstein heifer. In 38 per cent of cases the reason for surgery was an oversized calf and in 84 per cent the operation was performed on the farm of origin. The majority of the dams were operated on while standing, using a left flank incision, and under paravertebral or field infiltration with local anaesthetic solution. Exteriorisation of the uterus did not appear to be essential except when the calf was dead. Ninety-five per cent of the calves alive in utero and 91 per cent of the dams survived, although 30 per cent of the dams suffered ill-health afterwards. In nine cases neither dam nor calf survived. The fertility indices of those which were rebred were not markedly affected, but milk production was reduced by an estimated 12 per cent of the potential yield.     

Prognosis in equine medical and surgical colic

A retrospective study was performed on 649 horses admitted to the Clinic of Equine Internal Medicine (Utrecht University) for gastrointestinal colic. The aim of this study was to provide a better guideline for determining prognosis in horses with colic. Short- and long-term survival were evaluated, and Cox regression analysis was performed to identify the clinical and clinicopathologic variables usable to predict survival. Intestinal displacements and strangulations were the most frequently diagnosed causes of colic. Regarding the surgically treated horses, 54% were discharged and 88% of these were still alive after 1 year. In comparison, 85% of medically treated patients were discharged and 93% were still alive after 1 year. Only 4.4% of all long-term survivors did not return to the expected level of performance, and 32% suffered from recurrent colic. Duration of colic signs, heart rate, intestinal motility, skin tenting, level of pain, and gross appearance of peritoneal fluid were shown to be significantly associated with survival. White blood cell count, packed cell volume, blood pH, and color of the mucous membranes did not show any prognostic significance. Thus, clinical variables appeared to be the most relevant predictors of the outcome of gastrointestinal colic.     

Whole blood re-calcification time in equine colic

Whole blood re-calcification times were evaluated as a measure of endotoxin-associated coagulopathy in horses. First, the effects of endotoxin concentration and duration of in vitro incubation of citrated whole blood with endotoxin on the whole blood re-calcification time of blood collected from healthy horses were determined. Increasing concentrations or incubation times of endotoxin accelerated the whole blood re-calcification time. This effect was attributed mainly to increased monocyte thromboplastin activity. Second, whole blood re-calcification time, a clotting profile, plasma factor VII activity and plasma endotoxin concentration on blood samples obtained from 35 equine colic patients and 10 healthy horses were determined. Compared with healthy horses, colic patients had a longer mean whole blood re-calcification and prothrombin time, lower per cent factor VII activity and higher mean fibrin degradation products concentration. Within the colic patient group, horses that did not survive had detectable endotoxin in plasma, longer whole blood re-calcification and prothrombin times, and lower plasma factor VII activity, compared with colic patients that survived. These data indicate that colic patients with endotoxaemia experience hypercoagulable states, followed by consumptive coagulopathy. Although the cause of endotoxin-associated coagulopathy is likely multi-factorial, increased expression of monocyte thromboplastin activity may be involved in the pathogenesis of coagulopathy. The whole blood recalcification time is a simple, fast and inexpensive way to detect coagulopathy during endotoxaemia and determine the prognosis for survival.     

Detection of endotoxin in cases of equine colic

The Limulus amoebocyte lysate assay was used to test for the presence of endotoxin in 37 clinical cases of equine colic. Positive plasma titres were detected in 10 cases and the presence of endotoxin was significantly correlated with a high heart rate, a high packed cell volume and a poor prognosis. High levels of endotoxin were detected in gut contents taken from several sites in the gastrointestinal tract of normal horses.     

Advances in equine practice management.

As equine practices move forward in the 21st century, we feel increasing pressure to manage our businesses like business people. This requires outside expertise, in-house business-trained managers, and continuing education on various aspects of practice life. Aside from the AAEP, several other organizations are providing continuing education in management, including the Association of Veterinary Practice Managers, the Veterinary Management Institute offered at Purdue University Krannert Graduate School of Management, the American Animal Hospital Association through (The Virginia-Maryland Regional College of Veterinary Medicine's) on-line practice management course, and the University of Illinois Equine Practice Management modules.     

Prognosis in equine colic patients using multivariable analysis

Multiple logistic regression was used to investigate prognosis in 308 horses referred to the University of Minnesota veterinary teaching hospital with colic. Bivariate results identified the following significant individual parameters: absent or hypomotile abdominal sounds, medical or surgical classification, peritoneal fluid total protein, anion gap, serum glucose, capillary refill time, blood pH, heart rate, packed cell volume, base excess, serum chloride, plasma bicarbonate, serum urinary nitrogen and age. Two multivariable prognostic models were developed using logistic regression. Model I (based on 257 cases with a mortality rate of 39%) included age, sex, medical or surgical classification, capillary refill time, packed cell volume and heart rate. Model II (based on 138 cases with a mortality rate of 48%) included age, sex, medical or surgical classification, capillary refill time, serum bicarbonate, serum chloride and respiratory rate. Predictive performance of the models was evaluated by treating the calculated probability of death for each horse as a continuous test result. The influence of varying the probability cutoff point for death on test characteristics (sensitivity, specificity and positive and negative predictive values) was determined. These models have not been validated and thus their performance in a different population is uncertain.