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 include diarrhoea and signs of endotoxaemia, such as congested mucous membranes and a 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.  

Ingestion of sand without impaction may lead to clinical signs associated with a physical colitis due the abrasive nature of sand. These include diarrhoea and signs of endotoxaemia, such as congested mucous membranes and a 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 [[Impaction, Pelvic Flexure|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. 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.  

Also see [[:Category:Colic Diagnosis in the Horse|Colic Diagnosis in Horses]].

[[:Category:Colic Diagnosis in the Horse|Colic Diagnosis in Horses]]

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 intubation in the horse|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.

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.

Also see [[Colic, Medical Treatment|Medical Treatment of Colic in Horses]].

If the impaction is large or non-responsive to medical treatment or analgesia, surgery may be indicated. A ventral midline exploratory coeliotomy is peformed and the sand is removed via a pelvic flexure enterotomy. Post-operative complications such as ileus, peritonitis and endotoxaemia are relatively common due to damage to the colonic wall.

If the impaction is large or non-responsive to medical treatment or analgesia, surgery may be indicated. A ventral midline exploratory coeliotomy is performed and the sand is removed via a pelvic flexure enterotomy. Post-operative complications such as ileus, peritonitis and endotoxaemia are relatively common due to damage to the colonic wall.

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. Psyllium may be administered every four to twelve months to horses that are chronically affected.

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. Psyllium may be administered every four to twelve months to horses that are chronically affected.

For cases that are not resolved by conservative treatment, the prognosis is good if surgery is performed early and the colon has not become necrotic or ruptured. The overall mortality rate for horses requiring surgery is reported to be 40%.

For cases that are not resolved by conservative treatment, the prognosis is good if surgery is performed early and the colon has not become necrotic or ruptured. The overall mortality rate for horses requiring surgery is reported to be 40%.

===References===

===References===

Hammock, P. D., Freeman, D. E., Baker, G. J. (1998) '''Failure of Psyllium Mucilloid to Facilitate the Evacuation of Sand from the Equine Large Intestine''' ''AAEP Proceedings 9 Vol. 44 pp 246-247''

Hammock, P. D., Freeman, D. E., Baker, G. J. (1998) '''Failure of Psyllium Mucilloid to Facilitate the Evacuation of Sand from the Equine Large Intestine''' ''AAEP Proceedings 9 Vol. 44 pp 246-247''

[[Category:To_Do_-_SophieIgnarski]]

[[Category:To_Do_-_SophieIgnarski]]

[[Category:To_Do_-_Review]]

[[Category:Expert_Review]]

[[Category:Surgical Colic in the Horse]]

[[Category:Surgical Colic in the Horse]]