Internal Medicine

In addition to general expertise in internal medicine, the veterinarians specialised in the field at the Equine Hospital have further specialties based on their interests.

Horses can be brought for examinations either by booking an appointment with no examination history or by referral from a veterinarian. Some patients stay in the hospital after emergency treatment for more detailed examinations and, if necessary, further treatment.

In addition to laboratory diagnostics, internal medicine examinations and therapies utilise radiography and ultrasonography as well as a range of endoscopies. The hospital is equipped with fit-for-purpose endoscopes, as well as high-quality ultrasound and X-ray equipment.


Most commonly, horses suffering from digestive tract ailments are brought to the emergency department because of colic, but some patients are examined for chronic, prolonged symptoms. Colic denotes pain symptoms originating in the abdominal cavity. These can be caused by a number of factors, including constipation, accumulation of gas in the gut, changes in the position of the gut, gastric ulcers, peritonitis, intestinal infections and other inflammations. In addition to a general physical examination and the collection of blood samples, colic patients undergo an ultrasonography of the abdominal cavity, sometimes also a gastroscopy in case of ulcers. Radiographic imaging of the abdominal cavity in the case of sand accumulations is another regularly performed procedure.


Gastroscopies are usually carried out when determining a cause for gastric symptoms, which may include mild colic, tenderness of the sides and lack of appetite. However, gastric ulcers can also cause reluctance to move or general irritability. The stomach must be empty at the time of endoscopy to allow examination, for which reason the horse must fast before the endoscopy. The recommended fasting period is roughly 14 hours. Endoscopy is performed under sedation, with the endoscope guided to the stomach through a nostril. Endoscopy is used to assess the emptying of the stomach, the status of the mucous membranes of the epithelial and glandular stomach regions, and the status of the mucous membrane in the superior part of the small intestine. If necessary, biopsies can be taken in conjunction with endoscopy. After the horse has recovered from the endoscopy, it must be gradually fed small portions of food because of the fasting. Any medication determined necessary on the basis of endoscopic findings is initiated at the hospital visit, at which point a control appointment for monitoring progress can be booked.


Horses are most often brought for respiratory tract examinations because of a cough, panting, abnormal breath sounds, nosebleeds or poor performance. In addition to a general physical examination, respiratory tract patients undergo a respiratory endoscopy and, when necessary, other examinations and tests, including blood tests, ultrasonography and radiography. When necessary, samples (tracheal mucus specimens, bronchoalveolar lavage samples, air sac samples, thoracic fluid samples) are collected from the respiratory tract and analysed in the central laboratory of the hospital. When necessary, biopsies can be collected from the respiratory organs (lungs, bronchi) for pathological analysis. Causes underlying respiratory tract problems include structural and functional problems of the pharynx and throat, respiratory tract infections and asthma.


Most often, horses are brought for cardiac examination because of arrhythmia or cardiac murmurs. Some of the changes are reversible, such as those detected in connection with colic or dehydration, but in sports horses heart problems can prevent their participation in competitions. In addition to a general physical examination and blood samples, methods used to examine the cardiovascular system include electrocardiogram (ECG) and ultrasonography. ECGs can be used to investigate, for example, arrhythmia either in connection with other examinations or as 24-hour monitoring at rest and during exercise. Ultrasonic cardiography can be used to investigate the structure (walls, size, valves) of and blood flow in the heart. For ultrasonic cardiography, a small area behind the armpits is shaved. Cardiac examinations are carried out while the horse is awake.


Equine kidneys are sensitive to, for example, drugs and disorders of the circulatory system, making equine renal diseases fairly common. Kidneys are examined with the help of blood and urine samples, ultrasonography and biopsies. In renal disease, hydration is the most important part of care. In fact, horses with kidney defects are sent to the hospital for round-the-clock hydration.

Problems with the lower urinary tract in horses are fairly uncommon compared to small animals. However, cystitis or tumours in the urinary tract sometimes occur in horses. In addition to blood and urine samples, the equine urinary tract can be examined through endoscopy and ultrasonography.

Diseases of the liver are not a typical cause of seeking care. Hepatic failure is usually diagnosed in conjunction with other examinations. The liver has a fairly high functional capacity, and, as with renal diseases, hepatic diseases only manifest when most of the liver tissue has already ceased to function. The symptoms of liver disease are non-specific, including failure to eat, tiredness and weight loss, which are also associated with other diseases. When disease cause a horse not to eat for an extended period, the animal’s altered energy metabolism can strain the liver. This must be taken into consideration in treatment. The risk is particularly high in obese horses, ponies and pregnant mares. The liver is examined with the help of blood samples, ultrasonography and, when necessary, biopsies.

Muscle diseases can be congenital, related to feeding, injury, poisoning or infection, or immune-mediated. In muscle diseases, muscle cells are damaged or inflamed. This results in the non-functioning of the muscle, which can manifest as, for example, stiffness, muscular atrophy, pain, cramps or slow recovery. In addition to a general physical examination, muscle diseases are investigated through blood tests and ultrasonography. The Equine Hospital’s repertoire also includes electromyography (EMG), which can be used to assess the electrical activity of muscles and to obtain information on the state and nerve supply of muscles. Electromyography is carried out together with a neurologist.

When necessary, specialists in internal medicine treat patients together with veterinarians specialised in neurology. The most common neurological patients are horses suffering from various mobility disorders, which are usually due to problems with the cervical spine. However, patients with, for example, a herpes infection that requires treatment arrive at the hospital as acutely ill patients requiring isolation. However, the hospital lacks the capacity for supporting horses in hammocks or treating chronically recumbent patients.


Equine endocrinological diseases include Cushing’s disease, or pituitary pars intermedia dysfunction (PPID), and equine metabolic syndrome (EMS). Endocrinological diseases affect metabolism and usually manifest as changes in the body condition score as well as in the condition of the skin and coat. Metabolic diseases increase the risk of, for example, laminitis. When suspecting a metabolic disease, a general physical examination is carried out on the horse and blood samples are taken.

The most common cause of skin symptoms is hypersensitivity as well as parasitic and bacterial infections. Other equine diseases, such as intestinal and endocrinological diseases, also affect skin condition. In addition to a general physical examination, blood tests are conducted as well as skin specimens and biopsies collected, when necessary, to determine the cause of the symptoms. When necessary, equine skin diseases are investigated together with a suitably specialised veterinarian.

Infectious diseases are common in horses. In spite of effective modern vaccines, increased travel and transportation of horses raise the risk of contracting infectious diseases, in addition to which changing climate conditions have a role in disease transmission by insects (mosquitoes). In fact, certain globally circulating infectious pathogens not usually found in Finland are expected to become increasingly common here as well over time (e.g., equine infectious anaemia). Some of these diseases are zoonotic, meaning that they also infect humans (e.g., West Nile virus). While most infectious diseases cause mild illnesses, some can have more serious consequences. Depending on the pathogen, infections affect various organ groups, such as the respiratory tract (e.g., influenza, herpesvirus), the digestive tract (e.g., salmonella, coronavirus), or several organ groups simultaneously (e.g., Rhodococcus equi pneumonia in foals, equine distemper). The Equine Hospital has a separate isolation ward where patients suspected of carrying an infectious disease are treated. The isolation ward has a separate entrance, and protective clothing is worn when treating patients at the ward.