1. Equine Physical Exam
VET 112L

2. The General PE
The general examination should start with the observation of the horse from a distance in order to detect abnormalities that might be obscured by handling and restraint.
Horses’ stance and general behavior in the stall will reflect their general mentation, which is frequently affected by systemic illness, neurologic disease, and pain in various organs.
The respiratory rate and effort should be noted prior to handling, as well as a general evaluation of body condition.

3. EQUINE BODY CONDITION SCORES
Ideal BCS
BCS 1 2 3 4 5 6 7 8 9
Point of Evaluation
Emaciated
Very Thin
Thin
Moderately Thin
Moderate
Moderate Fleshy
Fleshy
Fat
Extremely Fat
Neck
Bones Prominent
Bones Faintly Prominent
Accentuated Not
Obviously Thin
Not Obviously Thin
Rounded, Smooth
Slight Fat Deposit
Fat Deposit
Thickened
Bulging
Withers
Area Behind Shoulder
Filled In
Area Below Elbow
Top Line
Ridge
Slight Ridge
Flat
Possible Slight Crease
Crease Present
Obvious Crease
Ribs
Slight Fat Covering, Easily Discernable
Faintly Discernable
Not Seen
Easily Felt
Slightly Spongy, Not Easy to Feel
Palpable, but with Fat Filling Between
Difficult to Palpate
Patchy Fat
Tail Head
Prominent, but Can’t See Individual Vertebrae
Fat Palpable, Prominence Conformation Dependent
Slightly Spongy
Soft
Very Soft
Point of Hip
Rounded by Easily Discernable
Not Visually Discernable
Point of Buttocks
Spinous Processes
Thin Layer of Fat Covering
Rounded but Easily Discernable
Inner Thighs
Fat Deposits
Fat Deposits May Rub
Flank
Fat Fillled

4. Approach to a PE
Examining the horse from nose to tail along the left side and then tail to nose along the right side is one way of ensuring a complete general examination.
Again, there are no strict rules regarding the proper physical examination procedures.
It is recommended that a consistent approach be adopted.

5. Observe & Check Stall
Always start your PE by observing the horse from a distance.
This can be done in their stall, noting breathing pattern, stance, sneezing, coughing, and respiratory effort.
If the horse is in their stall – take time to evaluate food & water intake, as well as feces and urination. (Note: sometimes you won’t be able to do this, but it’s a good habit to at least check).

6. General Attitude & Pain Level
Horses have a low threshold for pain. Observe for any sweating, quivering, flared nostrils, dullness of eyes, position of the ears, pawing, rolling, biting at the flank, kicking at the belly or stretching.

7. Beware of “COLIC”
Colic is a very broad term that refers to any condition that causes abdominal pain in a horse. It has a wide range of severity resulting in anything from mild discomfort to death, depending on the circumstances.
Horses are monogastric animals, meaning they have a relatively small stomach without any compartments. The stomach empties into the small intestines, which is divided into the duodenum, jejunum and ileum. The small intestines connect to the cecum and then to the colon or large intestines. The inability to vomit, and a long intestinal tract- which narrows in some places and sits freely in the abdomen- combined with a large deep- chested animal makes colic a common problem for horses.

8. 5 Types of Colic
Gas or Spasmodic: The cecum and colon become distended with gas and overstretches the intestinal wall. This causes the intestines to spasm instead of contracting to move the gas along.
Obstruction: Food material, sand, or even parasites cause an impaction in the intestines. This most commonly occurs in the left colon where it folds back on itself and the diameter narrows substantially. Blood supply may also be cut off.
Twist or Torsion: A twist can occur in either the jejunum due to its length, or the left portion of the colon, because of the lack of attachment to the body wall. This causes a complete obstruction and cuts off blood supply, resulting in damage or death to the intestines. As the intestines die, toxins are released into the horse’s body.
Lipoma: Fatty tumor which wraps around the small intestines cutting off blood supply and obstructing food and liquids moving through.
Enteroliths: Intestinal stones that develop inside the large intestines causing an obstruction, or death to the intestines.

9. Noticing Signs of Colic
increased heart and respiration rate
pawing the ground
looking, kicking, or nipping at sides
stretching, restlessness, circling
sweating and other signs of distress
getting up and down, rolling
abdominal distension
decreased or lack or bowel movements
Determining the severity of the horse’s pain may help to determine the character of the cause of the colic, i.e., milder more intermittent pain may point to a luminal obstruction while continuous, more violent signs of pain may point to a vascular obstruction (volvulus, torsion, or strangulation).

10. Hands-on part of the PE

11. Examine the Nostrils
Flared nostrils can indicate pain or increased effort to bring in air.

12. Examine the Nostrils
Check both nostrils for presence of airflow and whether or not it is equal on both sides.

13. Examine the Nostrils Any nasal abnormalities should be noted.
Important considerations are: unilateral/bilateral, +/- blood, color, consistency.  

14. Nasolacrimal Duct
The nasolacrimal duct opening can be seen near the mucocutaneous junction inside the nostril.
It is especially important to check animals presented with a complaint of excessive tearing
In older animals the duct may become obstructed.

15. Examine the Mouth
It is important to check the nostrils and mouth for odor since this is often associated with the presence of anaerobic bacteria which may be contributing to an infection.
This is also a good time to listen to the horse’s breathing, noting any abnormal noises.  

16. Check MMs
The mucous membranes are first examined by raising the upper lip as shown.
Mucous membranes are examined for moistness, icterus, hyperemia, cyanosis, pallor, ulceration, and petechia.

17. MM Colors
Examining the mucous membranes of the conjunctiva and gingiva are critical parameters in the assessment of a patient.
Normal Mucous Membranes: The mucous membranes should be pink and moist.
Pale mucous membranes: Occurs in horses suffering from shock, hypovolemia or pain. This finding may accompany other signs such as cold extremities.

18. MM Colors
Red mucous membranes: Associated with septic or endotoxic shock when blood pools in the capillaries and small vessels.

19. MM Colors
Cyanotic mucous membranes:  The result of severe or prolonged shock. This may be seen along with an overlying hyperemic tone due to the pooling of blood in the capillaries and the cell’s subsequent depletion of oxygen. This indicated a poor prognostic sign and presents as a high surgical and anesthetic risk.

20. Check CRT
Capillary refill time is also evaluated at this time by blanching the mucous membranes.
To test an animal's capillary refill time use your thumb to press on the animal's gums, after you withdraw your thumb the color of the gums should return to normal within 1- 2 seconds.

21. Check the Tongue & Teeth
Take a look at the horse’s incisors
AGE?
The tongue can also be grasped through the inter-dental space at this time to evaluate for oral ulceration .

22. Check the Sclera
The sclera are then examined for icterus, petechia, vesicles, or injection by placing the thumb over the upper lid and grasping the bottom of the halter and rotating the horse’s head away to expose the sclera

23. Check Lymph Nodes
Palpate the intermandibular lymph nodes, noting any enlargement or painful response to palpation.
The thyroid gland is frequently palpable in older horses and should not be confused for a lymph node.

24. Taking a Pulse
The facial artery is palpated at the ventral aspect of the mandible.
The normal pulse rate for an adult horse is between beats per minute.

25. Other Pulse Taking Sites
Pulse can be taken at the facial artery, transverse facial artery, carotid artery, median artery, metatarsal artery, digital artery, and coccygeal artery.
The character, strength and rhythm of the arterial pulse should be assessed.

26. Jugular Fill The left jugular vein is then occluded and palpated
The veins should be evaluated for distensibility, refill, thrombosis and estimated venous pressure. Jugular pulsations are normally seen in the ventral third of the neck (distal 10 cm) and are reflections of right atrial pressure changes.
The evaluation of jugular venous refill is another indication of perfusion and hydration status.
The jugular veins are collapsed and should fill rapidly (within several seconds) when held off (Valsalva maneuver).

27. Evaluate the Heart
The normal resting heart rate of the horse is BPM.

28. Distal Extremities & Hoof
The hand is then run down the forelimb to evaluate temperature of the distal extremities if cardiovascular shock is a concern and also to palpate temperature of the hoof and evaluate digital pulses if laminitis is a concern.
Also check extremity for any swelling or pain
Check hoof for any cracks

29. Respiration & Lung Sounds
You can check a horse's respiratory rate and effort by observing the movement of the thorax and evaluating nostril flare. The normal respiratory rate in an adult horse is 8-16 breaths/minute. There is a slight noticeable abdominal component during expiration.

30. Listen to Gut Sounds
This is a good indication of gastrointestinal motility.
Frequency, duration, intensity and location of intestinal sounds should be noted.
If no sounds are heard for a long time, the bowel is presumably not functioning.

31. Inguinal Area/Mammary/Hind Limbs
The inguinal area is then carefully palpated to evaluate testicles in stallions, scrotal remnants in geldings, and the mammary gland in mares.
The distal hind limbs are visually inspected for joint effusion or distal limb edema.
If edema is present, it should be determined if it is warm or painful to palpation.

32. Temperature
The tail is carefully raised from the side and a thermometer is inserted in the rectum, noticing tail tone and anal reflexes.
Most resting horses have rectal temperatures of 99.0°-101.5° F.

33. PE continued on the Right Side
Examination is then continued on the left side.
In the general examination, the right side of the heart is then listened to, the right jugular vein is occluded, and the right side of the head and neck are visually examined.

34. Thorough PE is Important!
As one can see, this general physical examination can be easily performed in just a few minutes, yet it can provide important information that would otherwise be easily missed.

35. EQUINE VITALS Low Avg. Avg. High Avg. Temperature 99.0°F 100.2°F
Pulse
(beats per minute) 28
BPM 36
44 BPM
Respiration
(breathes per minute) 6 9 12