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Diagnostic Assessment of Foals with Colic

M. Keith Chaffin, DVM, MS and Noah D. Cohen VMD, PhD

Diagnosis of colic in foals can be very challenging. The list of differential diagnoses is long, and the
diagnostic approach includes numerous diagnostic modalities. The most critical decision is determin-
ing whether surgical intervention is indicated. Authors’ address: Dept. of Large Animal Medicine
and Surgery, College of Veterinary Medicine, Texas A&M University, College Station, TX
77843-4475. r 1999 AAEP.

1. Introduction helpful in assessing adult horses with colic. Ex-

The presentation of foals with colic is common in
equine practice and can result from multiple etiolo-
gies. Arriving at a definitive diagnosis for foals
with colic can be challenging, but accurate diagnosis
is critical for successful management. The purpose
of this article is to provide practitioners with an
overview of the diagnostic approach used for the
assessment of foals with colic.
Frequently, the most critical and most challenging
decision is whether or not surgical intervention is
indicated for the foal with colic. In general, young
foals are less tolerant of pain than are adult horses.
In addition, many foals with nonsurgical causes of
colic, such as enteritis, may exhibit severe signs of
colic, particularly in the acute stages of the disease
process. These characteristics of foals make sever-
ity of pain a less reliable indicator of the need for
surgical intervention.1–11 Determining the need for
surgery can be difficult, but assessment of multiple
diagnostic tools will aid in determining the correct
treatment. Because of size limitations, some of the
diagnostic modalities applicable to adult horses,
such as rectal palpation, are not useful in foals.11,12
Conversely, the small body size of foals facilitates use
of other diagnostic methods that are not frequently
amples include abdominal ballotment, transcutane-
ous abdominal palpation, abdominal radiography,
and abdominal ultrasonography.11 The practitio-
ner’s diagnostic assessment should include consider-
ation of the differential diagnoses of colic in foals,
signalment, history, physical examination findings,
clinicopathologic findings, and results of other ancil-
lary diagnostic tests.
2. Differential Diagnoses
The differential diagnoses for colic of foals are mul-
tiple and include infectious and noninfectious causes
of enteritis, obstructive disorders (mechanical and
functional), congenital disorders, gastroduodenal ul-
ceration, peritonitis, and uroperitoneum.1,2 Table 1
provides a list of the more common causes of colic in
foals.
3. History
Historical information can be helpful in generating a
list of differential diagnoses. For neonatal foals,
the owner should be questioned regarding events
that happened prior to, during, and after parturi-
tion.13 In addition, the owner should be questioned
specifically about the age at onset of colic, duration of

NOTES

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IN DEPTH: PEDIATRICS
Table 1. Differential Diagnoses for Colic in Foals ulceration. Neonates that are receiving critical care
Congenital anomalies for disorders such as neonatal septicemia, hypoxic–
Inguinal hernia ischemic encephalopathy, prematurity, enteritis,
Diaphragmatic hernia peritonitis, or metabolic disorders frequently have
Umbilical hernia complications related to altered GI motility. These
Scrotal hernia foals are often intolerant of enteral feeding and may
Atresia ani develop signs of gastric reflux, colic, and abdominal
Atresia coli distension.5,7
Atresia recti
Ileocolonic agangliosis 4. Signalment
Myenteric hypogangliosis
Gastrointestinal obstruction Consideration of the foal’s age at onset of colic is
Meconium impaction important to narrow the list of differential diag-
Functional obstruction (ileus) noses. Signs of colic exhibited at birth or shortly
Small intestinal volvulus thereafter suggest the possibility of retained meco-
Large intestinal volvulus nium or a congenital problem.3–9 Foals with meco-
Intussusception nium retention usually show signs of colic within 6 to
Small colon impaction 24 hours following birth. Most congenital anoma-
Large colon impaction
lies usually become apparent within the first few
Duodenal stricture
Adhesions
days of life.15–17 Foals that are all white or are the
Colonic strictures offspring of overo-overo breedings and show signs of
Ileal impaction colic should be suspected of having colonic aganglio-
Large colon displacement nosis (lethal white foals).18 Signalment is also im-
Ascarid impaction portant for the diagnosis of uroperitoneum; most
Phytobezoar affected foals are normal at birth and for a variable
Fecalith period of time thereafter. Clinical signs are first
Other causes noticed at 48 to 72 hours of age, although some foals
Gastroduodenal ulceration may not exhibit signs until 5 to 6 days of age.7,10,19–22
Abdominal abscess
Foals of either sex may be affected with bladder
Umbilical abscess
Peritonitis
rupture; however, colts are affected most frequently.21
Uroperitoneum Small intestinal intussusceptions are most com-
Enteritis mon in foals 3 to 5 weeks of age, and small intestinal
Nutritional diarrhea volvulus is most common in foals 8 to 16 weeks of
Foal heat diarrhea age; however, these conditions can occur in foals of
Overfeeding any age.1 Signalment is also helpful for diagnosis of
Carbohydrate intolerance fecaliths, which have been described in American
Antibiotic-induced diarrhea Miniature Horse foals and pony foals.23
Neonatal septicemia
Ingestion of fibrous material
5. Clinical Signs and Physical Examination
Coprophagy
Rotavirus A complete physical examination is imperative in the
Salmonellosis assessment of foals with colic. Restraint of an older
Clostridium perfringens foal with colic for physical examination can be
Clostridium difficile difficult, particularly if the foal is not halter trained.
Clostridium sordelli Such foals are often too strong for one handler to
Strongyloides westeri restrain, yet they are too small for most equine
Cryptosporidiosis stocks designed for adult horses. For these foals,
two or three experienced handlers may be needed to
restrain the foal for physical examination. With
colic, severity of colic, specific clinical signs exhib- some foals, subtle signs of colic cannot be appreci-
ited, progression of clinical signs, passage of feces ated until the foal is left unrestrained with its dam
and urine, consistency of any feces passed, medica- and observed from outside the stall.10 Less violent
tions administered, results of immunoglobulin G signs such as straining, laying down, assuming
testing, and dietary information.13 Owners should awkward positions, bruxism, and pawing may then
be questioned regarding farm history of current or become apparent. Newborn foals with meconium
previous foals with enteritis. retention usually show restlessness, straining to
Information relative to concurrent disorders is defecate, walking around the stall, and frequent
imperative for proper diagnosis. Foals with concur- elevation and/or swishing of the tail.24 Straining to
rent clinical disorders have a higher prevalence of defecate is evidenced by a dorsoflexed posture with
gastric ulcers than do normal foals.14 Information the rear limbs placed under the body and the tail
regarding administration of nonsteroidal anti-inflam- extended. Stranguria, which is sometimes demon-
matory agents (phenylbutazone or flunixin meglu- strated by foals with uroperitoneum, must be differ-
mine) should raise suspicion of gastroduodenal entiated from straining to defecate. Foals with
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stranguria tend to have a ventroflexed posture with
the limbs stretched out.10 Advanced signs of colic
include frequent rolling, thrashing, kicking at the
abdomen, abdominal distension, tachycardia, and
tachypnea. Frequent assessments of the severity
and persistence of abdominal pain, as well as the
pain response following medical therapy are critical
parameters for determining the need for surgery.
The practitioner should also examine the cardiovas-
cular, respiratory, urogenital, musculoskeletal, and
neurologic systems.13 Mucous membranes should
be assessed for color, moistness, and capillary refill
time to assess hydration and peripheral perfusion
and to detect cyanosis or signs of endotoxemia.
Assessment of hydration and peripheral perfusion
are important to dictate initial fluid therapy. Vital
parameters should be assessed with awareness of
age-related changes in normal values for rectal
temperature, heart rate, and respiratory rate.13,25
The heart should be carefully auscultated to detect
murmurs and arrhythmias, and the lungs should be
carefully auscultated to identify primary or second-
ary pulmonary disorders.
The abdomen should be ausculted for intestinal
and peristaltic sounds to assess gastrointestinal
motility. Decreased motility suggests ileus, which
may be caused by inflammatory, obstructive, or
ischemic lesions.3 Increased borborygmi sounds are
often detected in the early phases of enteritis.
Simultaneous auscultation and percussion may al-
low detection of any gas-distended viscus adjacent to
the body wall.13 Rectal examination, a diagnostic
technique of paramount significance in adult horses
with colic, is impossible in most foals.3
Digital examination of the rectum with a well-
lubricated gloved finger is helpful in neonates to
detect meconium retention; however, care must be
exercised so as to avoid iatrogenic rectal tear. In
newborn foals, the absence of fecal material on the
anus on the perineum or the presence of clear, clean
mucus on the finger after digital examination of a
neonate is suspicious of intestinal atresia.12,17
External palpation of the abdomen is helpful in
neonatal foals; however, in older foals, this technique
is usually of limited value except for identification of
hernias.13 The ventral abdomen and inguinal rings
should be palpated for evidence of umbilical or
inguinal hernias.13 The external umbilicus should
be palpated for evidence of enlargement, infection, or
herniation. The presence of a normal external um-
bilicus does not exclude infection of the internal
umbilical remnants.
With visual observation and abdominal palpation,
the practitioner should assess the foal’s abdomen for
abdominal distension. Abdominal circumference
can be measured with a flexible tape measure with
the foal in a standing position; serial measurements
can be used to monitor progression of abdominal
distension in foals with colic. To assure repeated
measurements at the same location, corresponding
areas on the ventral and dorsal midline of the
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IN DEPTH: PEDIATRICS
abdomen can be marked by shaving a small area of
hair.3 Abdominal distension is most commonly asso-
ciated with gas or fluid accumulation within the
lumen of the gastrointestinal tract. Extraluminal
accumulation of peritoneal fluid and abdominal
masses (abscess or neoplasia) can also result in
abdominal distension.10
It is important to determine the source of abdomi-
nal distension, when possible. Physical examina-
tion, ballotment, simultaneous auscultation and
percussion, radiography, ultrasonography, and ab-
dominocentesis are useful to determine the source of
abdominal distension.10 Detection of fluid waves
upon ballotment of the abdomen suggests excessive
peritoneal fluid. Excessive peritoneal fluid most
commonly results from uroperitoneum (i.e., disrup-
tion of the urinary tract), hemoperitoneum (lacera-
tion of umbilical vessels or spleen), or peritonitis.13
Less common causes of excessive peritoneal fluid
include chylous effusion and heart, liver, or kidney
failure.26
The practitioner should sequentially reassess the
foal for progressive changes in clinical signs. Foals
with colic should be continuously monitored for
changes in severity of pain, heart rate, respiratory
rate, capillary refill time, mucous membrane color,
and degree of abdominal distension. Assessment of
changes in clinical signs are critical for determining
the need for surgical intervention. In general, signs
of colic are more severe with mechanical obstruc-
tions than functional obstructions; however, foals
with ileus or enteritis sometimes will demonstrate
severe signs of colic.3 Indications for surgical
therapy include persistent pain, lack of appro-
priate response to analgesic agents, persistent tachy-
cardia (⬎120 beats/min), and progressive abdominal
distension.9
6. Laboratory Findings
Clinicopathologic findings are helpful for determin-
ing the cause of colic in foals. A complete blood
count, serum biochemical analysis, blood gas
analysis, and quantitation of serum electrolyte con-
centrations should be performed. In neonates mea-
surement of serum immunoglobulin G concentration
is indicated to assess adequacy of passive immunity.
Failure of passive transfer should be corrected, when
present.
Hematology results should be assessed for indica-
tions of anemia, hypoproteinemia, inflammatory re-
sponse, and sepsis.3 The presence of leukopenia,
left shift, toxic neutrophils, and lymphopenia should
suggest sepsis, bacterial enteritis, or severe viral
enteritis.3,9 In older foals with colic, the presence of
neutrophilia and hyperfibrinogenemia should raise
suspicion of an abdominal abscess.3
Serum biochemical and electrolyte concentrations
can provide beneficial information for diagnosis,
assessment of the foal’s systemic condition, detection
of secondary complications (i.e., azotemia), and meta-
bolic derangements (hypoglycemia) and for directing
AAEP PROCEEDINGS 9 Vol. 45 / 1999 237
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IN DEPTH: PEDIATRICS
supportive therapy (i.e., fluid therapy).12,13 When
interpreting serum biochemical and electrolyte as-
says, one should be cognizant of age effects on
normal reference ranges.27–30 Foals with colic caused
by enteritis are often characterized by hyponatre-
mia, hypochloremia, and acidosis.9 Foals with uro-
peritoneum frequently are azotemic, hyponatremic,
hypochloremic, hyperkalemic, and acidotic.20
Results of blood gas analysis are important to
assess the acid-base status of the foal and to guide
supportive care. For most foals with colic, venous
blood gas analysis is adequate to guide fluid therapy.
If respiratory dysfunction is considered likely or if
abdominal distension may be compromising respira-
tory function, arterial blood gas analysis may pro-
vide further information relative to pulmonary
function.31–33
7. Gastric Decompression
Passage of a nasogastric tube allows assessment of
gastric distension with gas or fluid and facilitates
gastric decompression, if necessary. A soft, rubber,
male urinary catheter can be used in neonates; a
small-bore equine nasogastric tube can be used for
older foals. A 60-ml catheter-tip syringe can be
used to check for reflux.11 The presence of gastric
reflux indicates intestinal obstruction, which may be
mechanical or functional. The character of gastric
reflux does not differentiate mechanical and func-
tional obstruction.3 In neonatal foals it can be
difficult to obtain gastric reflux even when gastric
distension is present. Ileus is common in neonates
and can be caused by endotoxemia, enteritis, as-
phyxia, electrolyte imbalances, or defective innerva-
tion.3,26 Ileus can also result from overzealous
enteral feeding of critically ill neonates that are
intolerant of enteral nutrition. In older foals gas-
tric reflux is more frequently associated with me-
chanical obstruction.
8. Abdominocentesis
Abdominocentesis and analysis of peritoneal fluid
are beneficial for assessing the integrity of the
gastrointestinal tract.3 Abdominocentesis should be
performed with caution in foals because enterocente-
sis is more likely to occur than in adult horses,
particularly in foals with gas or fluid distended
bowel.12 Because of this risk, we prefer to ultra-
sound the abdomen first to identify localized pockets
of peritoneal fluid and facilitate appropriate site
selection for abdominocentesis. During abdomino-
centesis the foal should be adequately restrained to
avoid sudden movements that may result in trauma
to the intestine or mesentery.3 If necessary, abdomi-
nocentesis may be performed with the foal in a
recumbent position. In foals, we prefer to use a
blunt instrument, such as a teat cannula to mini-
mize risk of enterocentesis or intestinal laceration.
A subcutaneous bleb of carbocaine often minimizes
stuggling by the foal. A small stab incision is made
through the skin and the teat cannula is advanced
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through the body wall. If enterocentesis inadver-
tently occurs during the procedure, the foal should
be placed on systemic broad-spectrum antibiotics,
metronidazole (10–15 mg/kg PO or IV q 6 h) and
nonsteroidal anti-inflammatory medications.12
Cell counts of normal peritoneal fluid are lower for
foals than for adult horses. The nucleated cell
count for foals ranges from 64 to 1420 cells/µl. One
study suggested that concentrations of nucleated
cells greater than 1500/µl in peritoneal fluid should
be considered elevated.34 Another study indicates
that nucleated cell counts up to 3000/µl should be
considered normal.35 Cytologic findings of perito-
neal fluid of foals are similar to those of adult horses.
Peritoneal fluid is frequently normal in foals with
enteritis or the early stages of mechanical obstruc-
tions.9 Peritoneal fluid cell counts and protein con-
centration usually progressively rise as these
conditions progress. Strangulating obstructions fre-
quently have elevated peritoneal fluid protein concen-
tration and nucleated cell count.9 Fluid that is
serosanguinous uniformly throughout collection sug-
gests devitalized bowel with transudation of leuko-
cytes, erythrocytes, and protein.12 Elevated
nucleated cell counts with degenerate neutrophils
and visible bacteria indicate septic peritonitis, which
may be associated with an abscess, umbilical rem-
nant infection, or generalized sepsis.12 The pres-
ence of degenerate neutrophils, intracellular bacteria,
and plant material is suggestive of a ruptured vis-
cus.9 Foals with uroperitoneum have voluminous,
clear to pale-yellow peritoneal fluid that is character-
ized by a creatinine concentration greater than twice
that of the serum creatinine concentration.11,22
9. Abdominal Radiography
Abdominal radiographs frequently provide valuable
information for the diagnosis and management of
foals with colic and abdominal distension. To mini-
mize the effects of motion, abdominal radiographs
should be obtained using a grid, rare earth screens
and sufficient mAs (5–28) and kVP (75–95).36–39 For
neonates, usually the entire abdomen can be imaged
on one 14 ⫻ 17 inch cassette. Because the appear-
ance of gas and fluid within the abdomen is depen-
dent upon positioning, it is helpful to obtain
radiographs in the standing, left recumbent, and
right recumbent positions, when possible. Ventro-
dorsal views are also helpful but can be difficult to
obtain. Specific anatomic regions of the abdomen
can be better evaluated with radiographs taken with
the foal in specific positions.36
Interpreting abdominal radiographs of foals with
colic is not always straightforward.12 Radiographs
seldom provide a definitive diagnosis, nor do they
always indicate the need for surgery; however, when
assessed in conjunction with other clinical findings,
radiographs often provide information that is helpful
in clinical decision-making.11 For some cases, it is
helpful to obtain sequential radiographs to assess
progressive changes that may occur.39
 Reprinted in the IVIS website with the permission of AAEP
Gas distension of the small intestine is a nonspe-
cific finding and may be found in foals with a
multitude of disorders. Ileus often produces diffuse
small intestinal gas distension.12 Small intestinal
obstructive disease is commonly associated with
large, distended, erectile, inverted U-shaped bowel
loops with multiple, uneven, intraluminal, gas-fluid
interfaces, and hairpin turns.8,9,11,12,38,39 Enteritis
often results in gas distension of the small intestine
as well, but the loops of intestine tend to be smaller
in diameter than that of foals with mechanical
obstruction.9 In many cases radiographs do not
definitively distinguish between mechanical and
functional obstruction.
Foals with enteritis commonly have gas distension
of the large bowel, also.39 Gas distension of the
large bowel tends to be more pronounced in foals
with large intestinal obstructive disease than in
foals with enteritis. Radiographs demonstrating a
large, distended gas- and fluid-filled stomach with no
intestinal distension aborally suggest obstruction of
gastric outflow. Radiographs are also helpful for
identifying free peritoneal fluid and ingesta or for-
eign objects (i.e., sand) within the gastrointestinal
tract.
Pneumoperitoneum is indicated by a gas cap in the
dorsal aspect of the abdominal cavity when radio-
graphs are taken in the standing foal. Further
evidence of pneumoperitoneum includes enhanced
visualization of the renal silhouette and the serosal
surfaces of the intestine.12,37 Pneumoperitoneum is
suggestive of bowel rupture. If previous abdomino-
centesis or abdominal surgery has been performed,
iatrogenic introduction of air into the peritoneal
cavity can also cause pneumoperitoneum.37
Foals with necrotizing enterocolitis may have a
radiographic pattern called pneumatosis intestinal-
is,40 which is characterized by localized, cystic or
diffuse, linear radiolucencies within the bowel
wall.26,40 Necrotizing enterocolitis is further charac-
terized by abdominal distension, colic, ileus, gastric
reflux, sepsis, and melena in foals that are critically
ill with concurrent disorders.
10. Contrast Radiography
Contrast studies are helpful in some cases to detect
and localize intestinal obstruction. Contrast stud-
ies include barium enemas and an upper gastrointes-
tinal contrast series. Survey radiographs should be
obtained prior to administering contrast material, so
as to establish proper radiographic technique. A
barium suspension (5 ml/kg of 30% wt/vol adminis-
tered via nasogastric tube) can be administered to
outline the gastrointestinal tract. Radiographs
should be taken at 0-, 15-, 30-minute intervals and
then at 2-hour intervals until most of the barium has
reached the small colon.36 In the normal foal, the
stomach should empty within 2 hours. Filling de-
fects of the proximal duodenum confirm duodenal
stricture.12 An upper GI series may be con-
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IN DEPTH: PEDIATRICS
traindicated in foals with severe small intestinal
distension.12
A barium enema may be useful when there is
suspicion of obstruction of the small colon or rectum.
A soapy-water enema can be administered first to
evacuate any feces from the rectum.8 A 24-F Foley
catheter is placed per rectum and its bulb inflated.
Up to 20 ml/kg of 30% wt/vol barium sulfate suspen-
sion is administered via gravity flow per rectum.41
Lateral and, if possible, ventrodorsal radiographs
are obtained immediately. In a report41 of 25 foals
with colic in which barium enemas were studied, this
technique was 100% sensitive and 100% specific for
identifying obstructions of the small colon or trans-
verse colon. For identifying obstructions of the
large colon, barium enemas were 85% sensitive and
83% specific.41
In foals with uroperitoneum, contrast cystography
can be useful for detecting bladder rupture and
urachal leakage. Once these differentials have been
excluded, other contrast studies, including excretory
urography, urethrography, and intraoperative con-
trast ureterography can be helpful to localize the site
of urine leakage.20,22,42
11. Abdominal Ultrasonography
Abdominal ultrasonography is frequently valuable
for shortening the list of differential diagnoses and,
in some foals, for determining the specific cause
of colic. Some conditions, including uroperitoneum,
peritonitis, strangulating obstruction, intussuscep-
tion, ascarid impaction, and colonic impaction, can
be tentatively diagnosed via ultrasound.43–46
Sonographic findings should always be interpreted
in conjunction with other clinical findings.44 The
abdomen of foals can be scanned in either a standing
or recumbent position; however, a standing position
allows gravitational movement of fluid or edematous
bowel to the ventral abdomen and into the near field
of the image.11,12 If ultrasound must be performed
while the foal is recumbent, particular attention
should be focused on scanning the down
side.44 Sector, linear, or convex array ultrasound
machines can be used, depending on their availabil-
ity. A 5.0 to 7.5 MHz transducer provides optimum
image quality.11,47 For foals with long or course hair
coats, the entire ventral abdomen should be clipped
and cleaned prior to examination, and acoustic cou-
pling gel should be generously applied. For foals
with short, fine hair coats, an adequate examination
can often be performed with topical application of
alcohol.
Peritoneal fluid can usually be imaged and charac-
terized with regard to quantity, character, and echo
pattern. When performed prior to abdominocente-
sis, ultrasound allows localization of appropriate
sites to collect peritoneal fluid; if no peritoneal fluid
is visualized sonographically, it may be indicated to
forego abdominocentesis.47 Peritoneal fluid can be
characterized to some degree based on sonographic
patterns; however, peritoneal fluid analysis should
always be used to definitively characterize the fluid.44
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IN DEPTH: PEDIATRICS
Detection of voluminous anechoic, free fluid within
the peritoneal cavity is consistent with ascites or
uroperitoneum. Large volumes of echogenic perito-
neal fluid are suggestive of peritonitis46; echogenic
strands of fibrin are sometimes apparent within the
fluid. Associated foci of infection may also be im-
aged, such as abscesses of the abdominal lymph
nodes.13,47 Sonographic findings of abdominal ab-
scesses are variable depending on the size, shape,
location, and content of the abscess.11 The internal
umbilical remnants should always be imaged for
evidence of infection.47 Peritonitis caused by gastro-
intestinal leakage usually appears as echogenic peri-
toneal fluid that may contain gas echoes.44
Small intestine is readily imaged and assessed for
wall-thickness, luminal content, and peristaltic activ-
ity. Normal small intestine in the foal appears as
amorphous tissue, and little fluid is imaged within
the lumen of small intestine.47 Rhythmic contrac-
tions of the intestine and progressive movement of
intraluminal fluid can be imaged in foals with nor-
mal intestinal motility. Normal small intestine has
a wall thickness of ⬍4 mm. Wall thickness ⬎4 mm
suggests inflammation, infiltration, or edema of that
section of small intestine.12 The absence of rhyth-
mic contractions of bowel and the absence of progres-
sive fluid movement within the lumen are findings
consistent with ileus.11 Strangulated sections of
small intestine usually have a thickened, hypoechoic
wall, a fluid-distended lumen, and decreased peristal-
tic activity46; however, similar sonographic findings
may be apparent in foals with severe enteritis.
With strangulating obstructions, there often is an
increased volume of free peritoneal fluid.44 In cross
section, small intestinal intussusceptions have a
characteristic target or bulls-eye appearance. Two
concentric rings are imaged with a centrally located,
circular, echogenic core.43–46 Intussusceptions can
have a variable appearance depending upon the
amount of edema present and the level and direction
of the scanning plane.
Foals with enteritis have variable sonographic
findings; however, they frequently have distended,
fluid-filled, hypermotile small intestine. Some foals
with enteritis have amotile small intestine, thus
making differentiation from a mechanical obstruc-
tion difficult.43 Gas distended small intestine ap-
pears as an echogenic curvilinear interface that
obscures visualization of the opposite wall of the
intestine.47
Meconium impactions in neonates can some-
times be imaged as intraluminal echogenic masses
of the large or small colon. In older foals with
ascarid impaction, individual ascarids or echogenic
masses of ascarids may be imaged within the small
intestine.45,46 Sonographic examination of the
cranial aspect of the left abdomen may identify
gastric distension in cases of ileus or mechanical
obstruction.
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12. Gastroscopy
Diagnosis of gastroduodenal ulceration is based upon
clinical signs, gastroscopic findings, and response to
therapy. Fecal occult blood testing and contrast
gastrography are not reliable indicators of gastric
ulceration.48 Clinical signs of gastric ulceration in-
clude inappetance, bruxism, sialorrhea, colic, diar-
rhea, and a tendency to lie in dorsal recumbency.
There are four clinical syndromes of gastric ulcer-
ation in foals: subclinical erosions and ulcers, symp-
tomatic ulcers, perforating ulcers, and strictures
from healing ulcers.48 Gastroscopic examination
provides a method to confirm a diagnosis of gastric
ulceration, visualize the location and severity of the
ulcers, and assess response to therapy.
Direct diagnosis of gastroduodenal ulceration is
made by examination of the stomach with a flexible
fiberoptic endoscope. For most foals up to 30 to 60
days of age, a standard 100-cm endoscope will permit
gastroscopic examination; however, for older foals or
for duodenoscopy, a minimum length of approxi-
mately 200 cm is needed to thoroughly examine the
stomach and duodenum. For foals over 6 months of
age, a 300-cm endoscope may be needed to visualize
the duodenum.49
Suckling foals, up to 20 days of age, are allowed to
suckle but are withheld from solid feed for 6 to 10
hours prior to gastroscopy. For older foals, solid
food should be withheld for 12 to 24 hours to allow
adequate emptying of gastric contents.49 Ingesta
and gastric secretions may sometimes still hinder
visualization of the glandular mucosa and pyloric
areas of the stomach. Depending on the size and
temperament of the foal, sedation (xylazine, 0.3 to
0.5 mg/kg IV plus or minus butorphanol, 0.01 to 0.02
mg/kg IV) and several handlers may be needed.
Neonatal foals can generally be restrained without
sedation.
The endoscope is passed through the esophagus
and into the stomach. Once the endoscope has
entered the stomach, room air should be insufflated
to distend the stomach. The squamous mucosa of
the nonglandular fundus, the margo plicatus (border
between glandular and squamous mucosa), and the
glandular fundus are visualized. The squamous
mucosa is pale white, and in neonates consists of a
thin mucosal layer.49 The glandular mucosa nor-
mally appears smooth, velvety, and darker red than
the squamous mucosa. The endoscope is advanced
along the transverse curvature until the lesser curva-
ture and cardia are visualized. The squamous mu-
cosa should be closely examined around the cardia
and lesser curvature. If the foal’s stomach is empty,
the pylorus can be visualized ventral to the cardia.
The scope can usually be advanced into the pylorus
and into the duodenum.49 The duodenal surface
has a pink velvet appearance. The common duode-
nal papilla may be observed. Detailed and illus-
trated descriptions of gastroduodenoscopy are
available.50,51
The mucosal surfaces of the entire stomach should
 Reprinted in the IVIS website with the permission of AAEP
be examined for ulcerations, erosions, and other
areas of inflammation. If possible, the duodenum
should be observed for similar findings and for
evidence of stricture formation. Gastroscopic find-
ings must be interpreted in conjunction with the age
of the foal, location and severity of the lesions, and
other clinical findings. Epithelial desquamation is
apparent in most normal foals and appears as flakes
or sheets of tissue separating from the squamous
mucosal surface. Inflammation of the glandular
mucosa may appear as a roughened surface to the
mucosa.50 The esophageal mucosa should also be
evaluated for evidence of inflammation, ulceration,
strictures, or diverticuli.
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