Colic, Equine - contd.
Treatment is dictated by the severity of the clinical signs, physical exam findings, and response to pain-relieving medications such as flunixin meglumine or xylazine. Fortunately, most cases will respond to early medical treatment. This early treatment typically consists of controlling pain with injectable medications such as nonsteroidal anti-inflammatory agents, analgesics, and narcotics. Gastric decompression, or removal of stomach contents via a nasogastric tube, is an important early treatment of most colics. Patients with mechanical or functional obstruction will commonly experience progressive discomfort from distension of the stomach. Removal of the stomach contents relieves the pain.
Nasogastric intubation also permits fluid delivery for rehydration of dehydrated horses that have no apparent obstruction. Mineral oil is also commonly administered via a nasogastric tube to coat any irritated bowel segments and to ease the passing of fluid, gas, or ingesta. Many impactions and minor obstructions will be successfully treated with analgesics and mineral oil on an outpatient basis.
The patient's fluid needs are assessed and addressed with nasogastric or intravenous fluid administration, as needed. Intravenous fluid therapy is indicated for horses with cardiovascular compromise. Most colic patients will receive laxatives or lubricants via a nasogastric tube.
If little or no relief occurs with such early, conservative treatment, or if clinical signs reappear within hours of treatment, more aggressive intervention is warranted, including the possibility of surgery. Anti-inflammatory agents such as flunixin meglumine may be indicated to counter the effects of bacterial toxins and reduce the risk of laminitis, a hoof problem that commonly occurs after endotoxemia, or bacterial toxins in the blood. Antibiotics are administered if bacterial infection is suspected or if surgery is planned.
Patients with a clinical diagnosis of strangulating obstruction must undergo prompt surgical exploration. Such patients are usually referred to a surgical facility, as colic surgery is a major undertaking.
