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Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)2022; 32(S1); 81-96; doi: 10.1111/vec.13117

Interpreting abdominal fluid in colic horses: Understanding and applying peritoneal fluid evidence.

Abstract: Interpreting changes in peritoneal fluid helps clinicians manage colic and other diseases in horses. During abdominal problems in the horse, abdominal fluid characteristics such as color, turbidity, total nucleated and red blood cell counts, cytology, total protein, and l-lactate change in predictable ways, helping the clinician characterize the disease. Methods: Normal abdominal fluid in horses is odorless, clear to light yellow in color, and transparent. Peritoneal fluid becomes more turbid with increasing levels of protein, number of WBCs or RBCs, or with gross contamination following intestinal rupture. The color of abdominal fluid will also change with the type and quantity of cells or other elements present. The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, common with strangulating intestinal lesions. Serosanguinous defines fluid that is both turbid and orange to bloody because of increased total protein, WBCs, and RBCs, and is considered classic for diseases characterized by intestinal ischemia. Peritoneal fluid may also be red or blood-colored because of a hemoperitoneum, or secondary to blood contamination during sample collection. l-Lactate measurement in the abdominal fluid has proven invaluable for the identification of strangulating intestinal injury. Cytology acts as an important supplement to cell counts in peritoneal fluid, and the normal ratio of non-degenerate neutrophils:mononuclear cells of 2:1 changes during various gastrointestinal diseases. Culture of peritoneal fluid samples should be performed when septic peritonitis is suspected. Conclusions: Abdominal fluid is a sensitive indicator of intestinal injury and a useful tool to direct treatment. Peritoneal fluid evaluation includes gross visual and olfactory examination, nucleated cell count, total protein, RBC count, lactate levels, cytology, and culture. The changes noted in such variables are related to the type and duration of the abdominal problem. Conclusions:  Abdominal fluid interpretation has become central to the triage and management of challenging equine colic patients.  The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, common with strangulating intestinal lesions.  Contamination with RBCs at various concentrations may be secondary to vascular (eg, abdominal wall or mesenteric vessels) or splenic trauma during abdominal fluid collection; however, this must be distinguished from orange to red fluid associated with intestinal strangulating obstruction or hemoabdomen  Peritoneal fluid analysis reveals abdominal pathology by recognizing specific changes that occur with disease processes affecting the tissues and organs within this cavity.  Abdominal fluid examination should be used as a tool to direct treatment rather than the definitive test for diagnosis of the acute abdomen  Septic peritonitis in horses most commonly originates secondary to intestinal compromise or accidents (vascular damage, perforation, or surgical manipulation), leading to bacterial translocation into the abdomen.
© Veterinary Emergency and Critical Care Society 2022.
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Publication Date: 2022-01-20 PubMed ID: 35044063DOI: 10.1111/vec.13117Google Scholar: Lookup
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  • Journal Article

Summary

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The research article discusses the crucial role that interpreting changes in peritoneal fluid (abdominal fluid) plays in managing colic and other diseases in horses, especially with respect to identifying and treating severe intestinal injuries.

Content of the Study

  • The study begins by examining the predictable changes in characteristics such as color, turbidity, total nucleated and red blood cell counts, cytology, total protein, and l-lactate levels of abdominal fluid when a horse develops abdominal problems.
  • The paper describes normal abdominal fluid as being odorless, clear to light yellow in color, and transparent. These characteristics, however, change in predictable ways when horses encounter issues such as colic.
  • The article mentions that the fluid becomes more turbid with increasing levels of protein, number of white and red blood cells (WBCs and RBCs), or gross contamination due to intestinal rupture. These changes indicate the nature and severity of the disease involved.

Changes in Abdominal Fluid

  • The transformation of peritoneal fluid color from golden to orange to red represents increasing levels of RBCs, which is common in horses with strangulating intestinal lesions.
  • Likewise, fluid that is both turbid and orange to bloody is termed as ‘serosanguinous,’ and usually indicates diseases characterized by intestinal ischemia.
  • The article points out that peritoneal fluid may also be red or blood-colored due to a hemoperitoneum, or secondary to blood contamination during sample collection.

Measures in Abdominal Fluid

  • The document highlights the importance of measuring l-Lactate levels in the peritoneal fluid for the identification of strangulating intestinal injury.
  • It denotes cytology as a supplement to cell counts in abdominal fluid, noting that the normal ratio of non-degenerate neutrophils to mononuclear cells changes with various gastrointestinal diseases.
  • The authors recommend performing a culture of peritoneal fluid samples when a horse is suspected to have septic peritonitis, a dangerous condition often caused by bacterial translocation into the abdomen due to intestinal compromise or accidents.

Conclusion of the Study

  • The paper concludes by defining abdominal fluid as a sensitive indicator of intestinal injury and thus, a crucial tool for directing the treatment of equine patients suffering from abdominal issues.
  • These conclusions underscore the need for regular evaluation of peritoneal fluid to improve the diagnosis and treatment outcomes of equine abdominal diseases.

Cite This Article

APA
Radcliffe RM, Liu SY, Cook VL, Hurcombe SDA, Divers TJ. (2022). Interpreting abdominal fluid in colic horses: Understanding and applying peritoneal fluid evidence. J Vet Emerg Crit Care (San Antonio), 32(S1), 81-96. https://doi.org/10.1111/vec.13117

Publication

Journal of veterinary emergency and critical care (San Antonio, Tex. : 2001)
ISSN: 1476-4431
NlmUniqueID: 101152804
Country: United States
Language: English
Volume: 32
Issue: S1
Pages: 81-96

Researcher Affiliations

Radcliffe, Rolfe M
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Liu, Sharon Y
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.
Cook, Vanessa L
  • Emergency Surgery and Medicine, Cornell Ruffian Equine Specialists, Elmont, New York, USA.
Hurcombe, Samuel D A
  • Department of Large Animal Clinical Sciences, College of Veterinary Medicine, Michigan State University, East Lansing, Michigan, USA.
Divers, Thomas J
  • Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, New York, USA.

MeSH Terms

  • Animals
  • Ascitic Fluid
  • Colic / diagnosis
  • Colic / veterinary
  • Horse Diseases / diagnosis
  • Horses
  • Intestinal Obstruction / veterinary
  • Peritonitis / veterinary

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This article includes 22 references
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Citations

This article has been cited 7 times.
  1. Fikri F, Hendrawan D, Wicaksono AP, Purnomo A, Khairani S, Chhetri S, Maslamama ST, Purnama MTE. Incidence, risk factors, and therapeutic management of equine colic in Lamongan, Indonesia. Vet World 2023;16(7):1408-1414.
    doi: 10.14202/vetworld.2023.1408-1414pubmed: 37621536google scholar: lookup
  2. Nocera I, Cingottini D, Di Franco C, Sala G, Bindi F, Spadari A, Rinnovati R, Vitale V, Jose-Cunilleras E, Sgorbini M. In-Depth Analysis of the Prognostic Factors Associated with Short-Term Outcome in Equine Colic Patients: Multicentric Retrospective Study. Animals (Basel) 2026 Feb 5;16(3).
    doi: 10.3390/ani16030496pubmed: 41681477google scholar: lookup
  3. Parra-Moyano LA, Cedeño A, Darby S, Johnson JP, Gomez DE. Blood and Peritoneal Lactate, Ratio and Difference, and Peritoneal Lactate to Total Solids Ratio for Detection of Intestinal Strangulating Obstructions in Horses. J Vet Intern Med 2025 Jul-Aug;39(4):e70121.
    doi: 10.1111/jvim.70121pubmed: 40448701google scholar: lookup
  4. Tharwat M, Al-Sobayil F. Equine colic: A comprehensive overview of the sonographic evaluation, diagnostic criteria, and management of different categories. Open Vet J 2025 Mar;15(3):1116-1139.
    doi: 10.5455/OVJ.2025.v15.i3.5pubmed: 40276205google scholar: lookup
  5. Martin E, Sarkan K, Viall A, Hostetter S, Epstein K. Clinicopathologic Parameters of Peritoneal Fluid as Predictors of Gastrointestinal Lesions, Complications, and Outcomes in Equine Colic Patients: A Retrospective Study. Animals (Basel) 2024 Dec 24;15(1).
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  6. Viterbo L, Hughes J, Milner PI, Bardell D. Arterial Blood Gas, Electrolyte and Acid-Base Values as Diagnostic and Prognostic Indicators in Equine Colic. Animals (Basel) 2023 Oct 17;13(20).
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  7. Birckhead EM, Das S, Tidd N, Raidal SL, Raidal SR. Visualizing neutrophil extracellular traps in septic equine synovial and peritoneal fluid samples using immunofluorescence microscopy. J Vet Diagn Invest 2023 Nov;35(6):751-760.
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