Hello, my name is Jane Boswell, and I'm one of the surgeons at the Lipocatine Hospital in, Hampshire, in the United Kingdom. And I'm gonna be talking, today about, colic in folds. So, the approach to the foal with colic will be very similar in the steps that we take when we're assessing the adult fo, the adult horse, I beg your pardon, with, with colic.

And, certainly, there are some differences that are unique to the folds, though, that we do need to consider. There are some, additional diagnostics that are more relevant to foals than, than in, in adult horses with colic, that we'll discuss. And, and some, diagnostics that are available to the adult that are less useful for the foal.

The aim of working up the fold is obviously to get working diagnosis so that we can institute appropriate treatment or surgery. So, as with any case, the important place to start, is to consider the signalment. And in the fold, there are certain causes of colic that are, far more prevalent, depending upon the age of that fo.

So, if we consider the very young, the neonatal fo, less than a few days old, then Some of the more common causes of colic are gonna be meconium impaction. Hypoxia or neonatal maladjustment syndrome, those, falls may present as false with colic. These young neonates are also very prone to sepsis, and that can result in ileus.

Enteritis is also a common cause. Of, of colic in in this young age group. Ruptured bladder, typically, ruptured bladder, these vols will start to show colic, perhaps in the sort of, 1 to 3 day, age group.

And, and, that is, an important consideration, in this category. And obviously, congenital defects, and we're thinking about things like autresio coli can present as colic in this very young, group of folds. Again, signalment can be useful when we're considering the slightly older folds, the sort of, from a few days old, up to a couple of weeks old.

And typical causes of colic that we see in this age group may be due to enteritis. These, folds are, predisposed to interception. Sepsis ileus, again, is, is, quite a common cause of, of colic in this age group.

And other, things that we may see in this group are small intestinal vulvulus, or indeed, foals starting to show colic due to gastroduodenal ulceration. When we're thinking of the older, fo, then there are some other conditions that we have to consider. Enteritis, .

Ascrid impaction and, and neonate, sorry, and, and, worm injury. Interceptions, again, are still common in this age group, as is of gastroduodenal alteration and small intestinal vulvas, and perhaps also in the slightly older fold, you may have to consider things, infectious conditions such as Lawsonia. So, having considered the signalment, then As with any colour, it's important to get a general history or a background history.

Want to establish, was there any problems at birth? Was this, was there any dystopia? Was intervention needed?

And was the foal normal at birth, or was there signs of prematurity or hypoxia, neonatal maladjustment syndrome, etc. Did the foal get adequate, passive transfer? That is important, particularly, if we're considering that this vole may be septic, or have issues, due to enteritis, which may arise due to a failure of adequate colostrum intake in, in the 1st 24 hours.

Also, it's important to understand, the management and, where that the foal is kept. Certain, studs and, and farms may have a history of problems with that, diarrhoea, and it's, important to be aware of this. Also, to know what treatments or medication the foal has had, what the worming practise has been, and generally the standard of management and upkeep and how this fall has been managed to this point.

Once we have the general background history, then we want to get some specific details about this colic episode. It's important to establish how long the fold has been colouring, when were signs first noted, or perhaps more importantly, when was the last time that the fold was seen apparently normal. And how have these signs progressed?

Thoses can deteriorate very rapidly. And it's important to be on top of this and to be, aware of, of this, and, and to, get a good feeling of how, how rapidly, things are changing or progressing. One of the nature of the signs that had been seen was a severity of pain.

Falls, pain signs can, can be hugely variable and folds, and we'll go on and talk about that a little bit later. Is this for bright? Has it become depressed, inaptent?

Is it off suck? When, has it been seen to nurse? When did it last nurse?

All of these are important, as is, the passage of faeces, for example, particularly. In the, the young foal that's seen colicine the first day or so, has meconium been seen? Has it been seen to, defecate and urinate normally?

And what was the appearance of those faeces? Were there, for example, signs of diarrhoea? Where does the faeces look particularly, dry and, and firm?

Has there been any sign of straining? Again, straining and tail flagging is something that we commonly associate, with folds, with, meconium impactions. And the other thing that's important is just to, evaluate is whether.

There's any signs of abdominal distention, certainly with your peritoneum, secondary to bladder rupture, then often, one of the things you'll notice is that these falls are becoming progressively, more distended. And any other observations that the owner, may have, for example, signs of tooth grinding, etc. All of these are gonna be useful and, and useful pointers, in helping you to, reach a diagnosis.

As we said before, falls, can show a variety of quite dramatic positions, associated with pain. And often I think that pain tolerance is quite low. But, certainly, vols may show prolonged time periods of, being in dorsal recumbency or twist and, and, and turn and get themselves in all manner, of, of, of positions.

Sometimes signs are more subtle, typically, as we talked about earlier, the meconium impactctions often you just see a little bit of tail flagging, and, perhaps a straining, to try and, and defecate. It's important to, again, as I said earlier, to understand what the signs have, have been shown and also how these have progressed and changed and and over what duration. So having established some of the general history and perhaps more of the specific history associated with this colic episode, then we're obviously the first thing to do is to turn to physical examination.

Physical examination, we're usually gonna start by checking the false temperature. Elevated temperature, may be a sign of, of some sort of, inflammatory, condition and enteritis, may be septic. Although sometimes the, false temperature will actually be subnormal if they are, in, in, showing signs of septic shock.

Peritonitis, etc. May also, increase the temperature. Remembering, when we're considering heart rate, the normal resting heart rate of a fall, particularly a young fall is, is, higher than the that of an adult, but a persistent heart rate of over about 120 beats per.

Then it is, is very suggestive that you may have a serious and and surgical lesion going on here. Consider the the falls, respiratory rate, and also the respiratory pattern. Falls, may show an elevated respiratory rate just as a response to pain.

It may be that actually, we are dealing with a primary respiratory disease that is mimicking, a colic. But you'll also see elevated respiratory rates, secondary to abdominal distention. And remember again, falls that have had, an episode of dystopia may have fractured their ribs as they've .

And, and, these, these can often present with signs of pain and an elevated respiratory rate. Mucous membrane colour, I think this is always, a slightly tricky one to assess and can be, misleading. But obviously, if we have the severe brick red, coloration of the membrane shown in these pictures, then we're gonna be thinking of, of some sort of, severe septic, process with, with, potentially, this fall is, is very seriously, compromised here.

Continuing with the physical examination, having, assessed TPR, and also, whilst you're doing that, just assessing the false general demeanour, is it bright? Is it interested in you, or is it dull and depressed? Is it actually showing signs of pain and, and colic now?

Then I, I think the next stage is to, excuse me, is to, auscultate the abdomen. And here we're trying to assess whether there is, normal. Or hypo or hyper motor gastrointestinal sounds.

Gastrointestinal sounds will be expected to be decreased with ileus, with strangulating causes of colic, but also in, ischemic conditions or in horses with early enteritis. In other cases, enteritis, actually sounds can be hypermotile. And even, in the early, stages of strangulation, you may hear slightly hypermotile gastrointestinal sounds, but generally, over time, these are gonna become, decrease and ultimately become absent.

In the fall, unlike in, in the adulthood, then abdominalment and palpation, and also percussion is really useful. And we're particularly trying to assess, with this, whether that, if there is abdominal distention, whether we think this is due to increased fluid in the abdomen, perhaps with, for example, your peritoneum, or to gaseous distention. In the so, what further, having, done an initial, physical examination, then what other additional diagnostic methods are gonna be used for?

And certainly, we're gonna talk in a little bit of detail about these, and the, the, the value and the, the use of these in, in determining the cause of colic in a fault. Ultrasonography. This is easily performed in, in the fold, and, and certainly, a lot of practitioners now will be carrying ultrasound machines around in your car.

So I would certainly encourage you, to, to have a look, ultrasonographically. Passing a tube, we're again used to considering doing this in adult horses with colic and certainly can be useful, diagnostic information, to pass the a nasogastric tube in the fall. Bloods, again, we talk a little bit about what we can learn from haematology, biochemistry, etc.

And, certainly, other diagnostic, methods may be, more, likely to be undertaken if, if the fold is referred into a clinic or into a hospital. And we're here, we're thinking of abdominal radiography, perhaps abdominal paracentesis and gastroscopy. Ultrasonography, as I mentioned, this is something that very much can be done at the, the sort of first consult and, and is is easy to get good pictures of the abdomen in the full.

Things that we are considering is, looking for, conditions where we're gonna see changes in the appearance of the small intestine, perhaps looking at, thickened intestine, characteristic fluid-filled loops of intestine. So for these, scans, for example, are taken of a vol with enteritis. And generally here we'll see that we've got distended fluid-filled loops, a small intestine, which have a thicker than normal wall.

Usually the wall thickness is greater than about 3 millimetres. And in some cases we'll actually see, gas, in, in the, wall of the small intestine. Another common condition that we see as a cause of colic, well, common surgical condition, of course, of colicing folds is interception.

And these have a very characteristic ultrasound appearance. We can see what's, termed as a bull's eye appearance in these ultrasound scan pictures here, where we have got a small intestinal interception. And if you see these then certainly that is going to be pathomonic of, of a small intestinal intersection.

It folds with small intestinal voles just as in adult horses with a strangulating obstructive lesion of the small intestine, then we're looking for these stacked loops of distended fluid-filled small intestine. These are usually a motile. Sometimes you'll see sedimentation, in, of, of food material, settling, eventually.

But if you see a file with these multiple. A motor, distended fluid filled loops of small intestine, then certainly some sort of, obstructive, strangulating lesion and, vvis is one of the most common causes of this in, in, in the younger animal, would be very high on your differential list. If you compare the appearance of these, here they have a much thinner wall than, than, those, Extended lobes that we saw with with enteritis.

Other conditions, Lawsonia. This is, a condition that we, commonly consider in, in sort of the older, folk. But these are gonna have markedly thickened, small intestinal walls, offering, often, measuring more than sort of 2 centimetres of thickness and very edematters, and we can see.

That's in, in, in the slide, in, in the ultrasound picture here on the, on the right of your slide. Other conditions that are It can be readily diagnosed with ultrasound, is, is a ruptured bladder. And certainly, typically, in these cases we're gonna see an excess amount of anechoic fluid.

Within, the abdomen. It's also gonna be, usually very difficult to, visualise the bladder, or if you can, then the bladder is, is small and occasionally, you will actually be able to visualise the defect more commonly in, in the dorsal wall of the bladder. The scan on the right is the, typical, appearance of a hemo abdomen.

And in this, there is excess, fluid within the peritoneal cavity. But in comparison, to the scan on the left of the ruptured bladder, this, fluid is quite echo and has a sort of rather speckled, tight pattern. You'll, classically see it sort of having a very swirly, appearance.

Rectal examination, rectal examination is, something that, we, rely on very heavily, particularly, in, in, first opinion practise when assessing the adult horse we call it. And obviously, due to the size, then, of a fold, then, then our ability to do that is limited. But actually, even just putting a glove on and using, a lot of lubrication, just, inserting a finger into the rectum in order to, perform digital palpation can, be useful.

In this, we are perhaps, can we look to see, can we feel, impacted meconium sitting in the rectum? Or, is there, can we feel any faeces, in fact, and, and what is the consistency of those faeces? And, and also, possibly, in the very young for, you may, you can, be able to, diagnose something like A2 or A9, or be suspicious of a A9 following, digital palpation.

Passing the stomach tube. Again, this can is important, both diagnostically and therapeutically, in the, in the colicing fold. And just, as with, with adults, then, this is, usually a sign of, ileus or some sort of physical obstruction.

Can be, occur with enteritis, which we talked about already, is quite common in, in this age group. But occasionally you will see, reflux associated with, gastroduodenal ulceration. Bloods, these can be, useful to assess the systemic condition, and also, important, I think, when, working out a sort of treatment plan, as well as having potentially, some, some useful diagnostic information.

In an emergency, then certainly, knowing what the, serum lactate concentration is, and, and also the pat cell volume total protein, I think these are, can easily be run, and, and, again, many practitioners will have a small handheld held lactate monitor, available to them. Certainly, in, in, . The, the more comprehensive workup, and, and certainly in clinics or hospitals, then looking at haematology, and, and, and white blood cell count, in particular, as, as well as biochemistry and, also assessing electrolyte levels is important.

So if we're looking at blood and considering haematology, then certainly, anaemia is, is something that may be, indicative of haemorrhage, may be indicative of neonatal erythrolysis, or, an anaemia or chronic disease. We're looking to see whether there's any sign of hema concentration that's gonna be important to establish, in order to, come up with an appropriate fluid therapy plan. Elevated fibrinogen levels, or SAA levels are gonna be associated with inflammation, or sepsis.

And, equally, when we're considering the white blood cell counts, then, a leukopenia or neutropenia with a left shift, we're thinking of perhaps sepsis, enteritis, peritonitis, some acute inflammatory condition. With more chronic inflammation, actually what we sometimes find is, is that you get a, end up with a leukocytosis. Total protein concentration, this can be useful, indicator if we have got, an enteropathy and getting intestinal, loss of protein, can be associated with failure of acid transfer.

Measuring urine and creatinine levels is obviously important to assess renal function and particularly important if we're concerned about a urop peritoneum and and a ruptured bladder. Equally, liver enzymes, can be useful to monitor. And electrolytes are really important, particularly in the full, the sick with diarrhoea, in the fall with suspected or, confirmed urop peritoneum, it's important to, get a handle on, electrolytes irregularities, so again, that we can, institute appropriate treatment.

Aerol taps, I think these can, be useful. I would suggest that you would only do this if you think it may alter your treatment plan. Don't think it needs to be part of your routine workup.

And certainly, iatrogenic. Injury to the small intestine causing small intestinal perforation, I think is a very real risk. For that reason, I was, advised that if you are considering, doing a peritoneal tap on a full.

That this is done under ultrasound guidance and also using a teat cannula. So, this way, the, the risk of inadvertent penetration of the intestine is, considerably reduced. Personal fluid, is, is gonna be useful to assess its colour, its turbidity.

And then, also, we're gonna be, looking at parameters like the white blood cell count and that, total protein, the lactate concentration, the cytology, and the creatinine levels, there. Certainly, diarrhoea is a very common and frequent . Thing that can, produce colic signs, in, folds.

And certainly there are a range of, infectious and non-infectious causes, as, as outlined here on this slide. And certainly, in those cases with, diarrhoea, then taking a faecal sample, in order to, Test for to either culture or, perform, LISA tests, serology, a LISA test or PCR tests or, or, for, things like Clostridial, toxins for rotavirus, etc. Is, important.

So the good thing about vols being small compared to the adult course in call it, is actually that, radiography can be really useful, in, this, this age group. And, and, particularly useful, as many of these falls, it's impossible to do any sort of, meaningful rectal examination. And we get very good, visualisation of, of gas distention.

So either we can have as is shown in in this X-ray radiograph at the top where we can see a lot of gas both in the small. Intestine and the large intestine, compared to the picture on the bottom which is with a full which has an meconian obstruction and a lot of gas throughout its large colon. So this can be very useful diagnostically and can help us to visualise, and a site of, of obstruction.

And also the use of barium, either barium swallows or stomach tubing, with, with barium in order to assess gastric empty, or barium enemas can be invaluable in, the, the workup of, of, some of these folds. So we can see here, we've got a, a picture, taking about 30 minutes off. With, with barium.

And we can see this very sort of corrugated appearance here of, the barium outlining the corrugations of the small intestine in, a foal with enteritis. This, radiograph is, taken following a barium enema. And we can see here, we've got an area where there's some stenosis or narrowing, of, of the rectum that's clearly demarcated, by the barium.

And also then this very abrupt, stop to the, the, barium column. And this, this is, due to atresia coli in this fall. Ulceration in the stomach is a common, in vols and can certainly, be associated, with signs of colic.

Typically, these, voles may have a poor appetite or, be on and off suck. They may colic. Just generally look, poor.

Often they'll show. Prolonged periods of, recumbency on their back, as well as, some of the perhaps more classic signs that we think with teeth grinding, and excess salivation. And sometimes, these falls may have, diarrhoea too.

And so gastroscopy to assess, the stomach is, is useful and, important, in order to, definitively, diagnose, gastric ulceration in, in these animals. So Moving on to how do we manage and how do we treat. Certainly, the, the first thing, that we may want to, do is to, consider sedatives, and these can be very useful, particularly, allowing us to further assess these faults and, and to, undertake some.

Some of these diagnostic methods. And then, I think burophenol, diazepam, and xylazine, can all, be, very useful and, and would be the sort of go to sedatives. In the older fo, then, You may be happy to use another other alpha twos likedomidine, but in the younger cohort I think we would be tending to stick with these sedatives.

Analgesia, obviously, is, is, gonna be an important mainstay, part of your treatment. And, and certainly Buscopan, meloxicam, fexine, as, as well as the previously mentioned, Xylazine, and are important analgesics. And certainly, Xylazine is, is, not only a sedative, but also has some, some very good.

Analgesics, there. But again, in the, in the, perhaps the sicker, younger fo, then, perhaps, using, meloxicam, would, would often be our sort of first go to, analgesic. And then we need to, consider, some specific treatments of specific com, of specific conditions.

So, voles with meconium impaction or constipation, then certainly, using the proprietary fleet enemas can be, very useful. Or to use a sort of soapy water, enema, usually sort of 300 to 500 mLs of, of warm soapy water, delivered by gravity, can, can, be useful. Or relaxed is something that some people may use, and, and.

And certainly, you know, if, if you are, just be aware and, and mindful of the small size of the bow stomach, and so certainly wouldn't be using much more than 120 mLs of liquid parain by a stomach tube. Or, and acetylcysteine enemas can be really, useful. So if you, if you're looking at doing this, we were gonna sedate the fall, if necessary, and, and usually, diasam betortional combination would work well for this.

You want to, then, excuse me, elevate the, back end of the full on, using on a towel or a mat. Introduce a Foley catheter into the rectum, usually about 6 inches, and, and, don't inflate the, balloon of that Foley. And then mixing about 40 mL of acetylcysteine with 160 mLs of warm water.

This is slowly infused just by gravity flow again. And then clamp the foley for about 20 to 30 minutes, before, releasing it. Fluid therapy, this is obviously a huge topic and and out with the the scope of, of this presentation, but it's important that to consider fluid and electrolyte therapy.

Is, is, really important in, in some of these, sick folds. And, and certainly, as with any neonatal, species, the, the, the young, neonates of any species, sorry, that they will, deteriorate very quickly. And you need to be mindful, of the, the fluid status and the electrolyte status of these.

And it's important to, to, to sort of formulate your plan, your flu, plan, considering, the ongoing losses, and also, the, the, whether this fault is or, or capable of, drinking or, or, or eating there. In perhaps milder cases then oral rehydration sachets can be useful, but obviously for if you're considering oral rehydration and you need to. Be having successful absorption across the GI tract.

And so very sick folds or falls with severe enteritis, etc. This is, not gonna be, appropriate. But in the milder cases, then the stomach tubing with half to a litre, of electrolyte solution, may be, may be of, of use.

Certainly, so you need to consider when coming up, a, a, For specific requirements, you need to also consider where this is gonna be performed and and certainly. I think, for me, any fault that is going on to intravenous fluids, then I think you ideally want to get this animal into, a hospital or to a clinic, which has, the facilities, certainly trying to deliver IV fluids out in the stable, is, is, is far more challenging. And, and I think, that the foal is gonna need to be kept, somebody with it.

At, at all times. Remember that diarrhoea is often associated with sodium and electrolyte losses, and we need to, to, you know, take note of these and, and, and consider. If you've got a bowl that's up and about and, and is perhaps less sick, then, then sort of intermittent bowling, bolusing, sorry, with, with fluids, can, be useful.

So, IV fluids, I think that, if you're undertaking IV fluid therapy, you need to check the acid base and the electrolyte status. A strong iron acidosis is common in these, and often, hypernaemia with a relative hyperkalemia. So you may need to use sodium bicarbonate volume replacement fails to fix this acetosis, there.

And remember that the bicarbonate, requirement, can be worked out using this formula. So, body weight times based deficit times, 0.5.

And you want to give that half of that deficit as a bolus, and then give the remainder of that, that, that, bicarbonate over a 6 to 12 hour period. Obviously, those that have, respiratory, compromise, you need to, to, take, particularly care with when bolusing, bicarbonate. It falls with, hyperproteinemia, then, rapid resuscitation and, and improvement can be seen, using colloids or, so we're thinking genusing, perhaps he starch, or, plasma.

And these can, really rapidly turn full round. And whereas, things like head starch genusing can be. Cost prohibitive in the adult halls, that's not always, you know, they are, more, more accessible financially, in, in, in the small folds.

Falls with diarrhoea, then we're thinking about anti-diarrheal agents, intestinal protectants that can, bind the toxins. For example, by a sponge, this has been shown to absorb cholesterol, clostridial toxins. And certainly is, is easily and, and usefully administered to foals with diarrhoea, and we generally we think about 30 mLs by mouth twice daily.

Bismuth sysylate, and Kaine pectin would be two other, intestinalal, protectants that that we might consider. And also, gastric ulceration. Gastric ulceration, the question is whether we need to be considering prophylactic treatment involves with other types of colic.

And, there is some suggestion that this may predispose them to diarrhoea. But there is overall an increased incidence of gastric ulcers in falls with GI disease. And so, frequently, gastroprotectants would be used, in, in foals with, other, other causes as well, as, as fos with colic arising from.

Gastric ulceration. And those that are, most commonly, used and, and valuable in our, voles would be omeprazole. And this would be a 4 me perk, orally, once daily.

And, and this can be both used in both, healthy and ill voles, and, and, to suppress acid. Soucralfate, this is gonna bind to the ulcers and promote mucosal blood flow, and this is, is, gonna be used at 20 mg per kg orally 3 times daily. And ranitidine as well, again, is, is something that, that will, frequently be used in in folds with gastric ulceration.

In very young foals with diarrhoea, I think we should consider using, antimicrobials to, prevent bacteremia and using broad spectrum therapy. In folds which have, confirmed, clostridial infections, then metronidazole would be indicated. I think it's also important to, consider, perhaps falls with, severe enteritis or falls with marked abdominal, distension, to actually give the gut a period of, of rest.

And certainly, muzzling folds and stripping the air, or separating the fall from the mare. For, for, sort of 6 hours or so, I think can be, useful, in order just to, allow the, the gut to rest. And it's something that we're very familiar with doing in other, in adult horses and with other species, but I think it's often overlooked in the full.

And ultimately surgery. So I think indications for surgery. If you have a fall that is showing progressive and uncontrollable pain, a fall with persistent tachycardia, heart rate over about 120 minutes per, beats per minute.

Sorry. Or a file with a confirmed surgical lesion on abdominal ultrasound. All of these are gonna be indications for an exploratory laparotomy.

And generally, the, the falls are, do have a slightly increased mortality and morbidity compared to adults. In this retrospective study, published by SAI in 2000, they found that 85% of foals, were discharged. But 13% of them would have recurrent, colic, which required further surgery or, or euthanasia.

And of these, 8%, had evidence of adhesions, sorry, 8% of the population had, colic, the current colic was due to adhesions. And in that study, the cohort of, fos that, had undergone colic surgery, 63% of those were able to race compared to, 82% in the unoperated, fold. Population.

So, I think that certainly, these, figures are better than perhaps sort of previous, studies which suggested a, a much poorer long-term survival. But, obviously, foals are more susceptible to, postoperative, adhesions and, associated problems with, recurrent colics, and, their, their. Adult counterparts.

So in summary, I think it's important to remember that young folks can deteriorate very rapidly and we need to be . On top of, our, our care of these and, and to, to make sure that these, particularly these young foals are, are carefully, and appropriately monitored. Intensive treatment is often, required for these, particularly for the young foals, and, and therefore, would.

Urge prompt an early, referral into a centre that is set up, with the facilities, and, importantly, the manpower, to, to do, and this, and to look after these animals. And also, that does come with an expansion, financial consideration, that, that does need to be discussed, and considered, with, with the owner. Thank you very much for your attention.