Changes

===Clinical signs===

===Clinical signs===

Ingestion of sand without impaction may lead to clinical signs associated with a physical colitis due the abrasive nature of sand. These may include diarrhoea and signs of endotoxaemia such as congested mucous membranes and prolonged capillary refill time. If sufficient sand has been ingested to cause an impaction, the clinical signs are generally dependent on the anatomical siteaffected. Horses affected by a pelvic flexure impaction often present with signs of mild abdominal pain and generally respond well to conservative treatment. Impaction of the transverse colon is often associated with more severe abdominal pain due to the build up of gas in the the colon proximal to the obstruction.  

Ingestion of sand without impaction may lead to clinical signs associated with a physical colitis due the abrasive nature of sand. These may include diarrhoea and signs of endotoxaemia such as congested mucous membranes and prolonged capillary refill time. If sufficient sand has been ingested to cause an impaction, the clinical signs are generally dependent on the anatomical site affected. Horses affected by a pelvic flexure impaction often present with signs of mild abdominal pain and generally respond well to conservative treatment. Impaction of the transverse colon is often associated with more severe abdominal pain due to the build up of gas in the the colon proximal to the obstruction.  

===Diagnosis===

===Diagnosis===

Affected horses may have a history of living in a sandy environment, grazing in dry weather or a reduction in water intake. Auscultation of the abdomen may reveal gritty-sounding 'rubs' heard as the sand moves through the colon. Definitive diagnosis of an impaction is made via rectal palpation or transrectal ultrasonography with identification of sand in the colon. In many cases however the impacted segment is located in the cranial gastrointestinal tract and therefore out of reach. Transrectal ultrasonography may assist in identifying the presence of sand.Sand also may be seen in the faeces by mixing faecal material with water in a plastic rectal examination sleeve and allowing the sand to fall to the bottom. If performed, abdominocentesis should be carried out with extreme caution in order to avoid inadvertent laceration of the sand-impacted colon.

Affected horses may have a history of living in a sandy environment, grazing in dry weather or a reduction in water intake. Auscultation of the abdomen may reveal gritty-sounding 'rubs' heard as the sand moves through the colon. Definitive diagnosis of an impaction is made via rectal palpation or transrectal ultrasonography. In many cases however the impacted segment is located in the cranial gastrointestinal tract and is therefore out of reach. Sand also may be seen in the faeces by mixing faecal material with water in a plastic rectal examination sleeve and allowing the sand to fall to the bottom. If performed, abdominocentesis should be carried out with extreme caution in order to avoid inadvertent laceration of the sand-impacted colon. Abdominal radiography may be useful in assessing the volume and location of sand impactions in foals, minature horses and small ponies.  

 

Abdominal radiography may be useful in assessing the volume and location of sand impactions in foals, minature horses and small ponies.  

===Treatment===

===Treatment===

Bulk laxatives such as Psyllium are widely used to assist in the movement of sand. A mixture of Psyllium mucilloid and water is administered directly into the stomach via a nasogastric tube. This treatment is continued for up to a week until all sand is fully removed from the colon. Some authors however have described no benefical effects of Psyllium and adovate restriction to access to sand as the main component of treatment.  

Bulk laxatives such as Psyllium are widely used to assist in the movement of sand. A mixture of Psyllium mucilloid and water is administered directly into the stomach via a nasogastric tube. This treatment is continued for up to a week until all sand is fully removed from the colon. Intravenous fluid therapy may be beneficial in increasing the fluid content of the impacted ingesta.

If the impaction is large or non-responsive to medical treatment, surgery may be indicated. A colotomy along the pelvic flexure is the most commonly performed procedure.  

If the impaction is large or non-responsive to medical treatment, surgery may be indicated. A colotomy along the pelvic flexure is the most commonly performed procedure.  

Prevention of recurrence is important; horses should be fed from buckets to prevent further ingestion of sand. Water should be freely available and plentiful. Horses should not be allowed access to over-grazed pasture. High fibre diets such as hay are recommended.  

Prevention of recurrence is important; horses should be fed from buckets to prevent further ingestion of sand. Water should be freely available and plentiful. Horses should not be allowed access to over-grazed pasture. High fibre diets such as hay are recommended.  

===Prognosis===

===Prognosis===