Abstract
Programme
The Eleventh
International Equine
Colic Research
Symposium
7th – 10th July 2014
Contents
Tuesday 8th July ................................................................................................................................................................................ 1
1.
Egus ...................................................................................................................................................................................... 1
1.1
Effects of SmartGut® Ultra on non-glandular gastric ulcer score and gastric juice pH. Andrews, F.M., Camacho, P.,
Gaymon, G., Loftin, P., Garza Jr., F., Keowen, M.L., Kearney, M.T. ........................................................................................... 1
1.2
D.C.
The effect of a dietary supplement (Succeed™) on gastric ulcer severity. Kerbyson, N., Parkin, T.D.H., Knottenbelt,
2
1.3
Evaluation of a commercial faecal blood test for the diagnosis of gastric ulceration in Thoroughbred racehorses: A
preliminary report. Sykes, B., Jokisalo, J., Hallowell, G.D. .......................................................................................................... 4
1.4
Endoscopic examination of the squamous and glandular gastric mucosa in sport and leisure horses: 684 horses
(2005-2011). Hepburn, R............................................................................................................................................................. 5
2.
Diagnostics ........................................................................................................................................................................... 6
2.1
Observer agreement of colonic microvascular flow assessment in horses with colic. S. D. Hurcombe, B. Welch, J.M.
Williams, and M. Mudge .............................................................................................................................................................. 6
2.2
Evaluation of handheld lactate portable analyzers in blood and peritoneal fluid. Nieto, J.E., Dechant, J.E., le Jeune,
S.S., Snyder, J.R. ........................................................................................................................................................................ 7
2.3
Evaluation of peritoneal fluid parameters for prediction of intestinal ischemia lesions in horses with abdominal
disease. Dechant, J.E., Williams, C., Nieto, J.E. ......................................................................................................................... 8
2.4
Alcohol dehydrogenase in colic horses with strangulation obstruction. Schusser, G.F., Koller, G., Breitenstein, M.,
Thuess, T. ................................................................................................................................................................................... 8
2.5
Variations in eosinophilic infiltration within the rectal mucosa of clinically healthy horses. Sloet van OldruitenborghOosterbaan, M.M., Grinwis, G.C.M.............................................................................................................................................. 9
References ................................................................................................................................................................................ 11
3.
Epidemiology ...................................................................................................................................................................... 11
3.1
Trends in management of horses referred for evaluation of colic: 2004-2013. Blikslager, A.T., Mair, T.S. ................. 11
3.2
Prospective study of primary assessment of equine colic: Part 1: Study population and case presentation. Curtis, L.,
Curran, M.L., Bayes, T.C., England, G.C.W., Burford, J.H., Freeman, S.L. .............................................................................. 12
3.3
Prospective study of primary assessment of equine colic: Part 2: Diagnostic approach, decision-making and
outcomes. Curtis, L., Thomas, J.S.M., England, G.C.W., Freeman, S.L., Burford, J.H. ............................................................ 13
3.4
Could it be colic? Horse-owner decision making and practices in response to equine colic. Scantlebury, C.E., Perkins,
E., Pinchbeck, G.L., Archer, D.C., Christley, R.M. ..................................................................................................................... 15
3.5
Prospective survey of veterinary practitioners' primary assessment of equine colic: Clinical signs, diagnoses, and
treatment of 120 cases of large colon impaction. Curtis, L., Jennings, K.M., Burford, J.H., Freeman, S.L. ............................... 16
3.6
Big data and equine colic. Duz, M., Marshall, J.F., Parkin, T.D.H. .............................................................................. 16
3.7
Risk factors for colic in horses that display crib-biting behaviour. Archer, D.C., Escalona, E.E. .................................. 17
3.8
Patient characteristics, diagnostic findings and short term survival of horses with gastrosplenic or epiploic foramen
entrapments. Kilcoyne, I., Dechant, J.E., Nieto, J.E. ................................................................................................................. 19
3.9
Establishing clinical guidelines for the treatment of equine colic in developing countries. Curran, M.L., Stringer, A.P.,
Harry, J., Freeman, S.L., Burford, J.H. ...................................................................................................................................... 19
3.10
Retrospective evaluations of medical and surgical treatment of colic cases in a veterinary teaching hospital over a
period of 15 years. Van den Boom, R., Sloet van Oldruitenborgh-Oosterbaan, M.M. ............................................................... 20
Wednesday 9th July ......................................................................................................................................................................... 22
4.
Microbiome and Physiology .............................................................................................................................................. 22
4.1
Microbiome of the Thoroughbred racehorse and response to dietary amylase supplementation. Proudman, C.J.,
Hunter, J., Turner, C., Escalona, E., Darby, A. .......................................................................................................................... 22
4.2
Metabonomic characterisation of the Thoroughbred racehorse. Escalona, E.E., Merrifield, C.A., Leng, J., Swann, J.R.,
Dona, A.C., Produman, C.J., Holmes, E.................................................................................................................................... 23
4.3
Identification of a core bacterial community in the large intestine of the horse, including different diets and stability
over time. Dougal, K., Harris, P.A., Girdwood, S., Pinloche, E., de la Fuente, G., Geor, R.J., Nielsen, B.D., Schott II, H.C.,
Elzinga, S., Argo, C., Curtis, C.G., Newbold, C.J. ..................................................................................................................... 24
4.4
Comparison of the faecal bacteria population of equine grass sickness and matched controls by next generation
sequencing of bacterial DNA. Leng, J., Escalona, E., Blow, F., Darby, A., Proudman, C., Swann, J. ....................................... 25
4.5
Investigation of clostridium difficile toxins to experimentally induced duodenitis proximal-jejunitis in horses. Arroyo,
L.G., Costa, M.C., Guest, B.B., Beaudoin-Kimble, M., Lillie, B., Weese, J.S............................................................................. 26
4.6
Microbiota transplantation for equine colitis: revisiting an old treatment with new technology. Mullen, K.R., Yasuda,
Hitchener, G.R., K., Divers, T.J., Bicalho, R.C. ......................................................................................................................... 28
4.7
Transport of calcium and phosphate along the intestinal axis is affected by channel inhibitors and a blocker of the
paracellular pathway in horses. Cehak, A., Schroder, B., Feige, K., Breves, G. ....................................................................... 29
4.8
Effect of food deprivation on daily water requirements in healthy horses. Freeman, D.E., Mooney, A., Giguere, S.,
Giskant, P., Burrow, J., Evetts, C. ............................................................................................................................................. 30
4.9
The effect of temperature changes on in vitro slow wave activity in the equine ileum. Fintl, C., Hudson, N.P.H.,
Handel, I., Pearson G.T. ............................................................................................................................................................ 31
4.10
Effects of ischaemia and reperfusion and effects of selective and nonselective nonsteroidal anti-inflammatory drugs
on the muscular inflammatory reaction in equine jejunum. Roetting, A.K., Franz, S., Hopster, K., Brehm, R. .......................... 32
4.11
Stem cells are retained in reduced numbers in equine strangulated small intestine. Kinnin, L.S., Gonzalez, L.M.,
Blikslager, A.T. .......................................................................................................................................................................... 33
4.12
Analysis of Soluble CD14 in Clinical Equine Cases Presented to a Referral Hospital. Fogle, C., Blikslager, A., Jacobs,
M., Edwards, A., Wagner, B., Fogle, J....................................................................................................................................... 33
4.13
5.
Clinical and Intestinal Histologic Features of Horses with Recurrent Colic. Stewart, H.L., Engiles, J., Southwood, L. 34
Surgical Techniques .......................................................................................................................................................... 35
5.1
Operative Factors Associated with Short-Term Outcome in Horses with Large Colon Volvulus: 47 cases from 2006 to
2013. Gonzalez, L.M., Fogle, C.A., Baker, W.T., Hughes, F.E., Law, J.M., Motsinger-Reif, A.A., Blikslager, A.T..................... 35
5.2
Small intestinal biopsy and resection in standing sedated horses. Coomer, R., McKane, S., Roberts, V., Gorvy, D.,
Mair, T. 36
5.3
In vitro description of a new technique for stapled side-to-side jejuno(ileo)cecal anastomosis in horses and CT scan
anatomical comparison with other techniques. Gandini, M., Giusto, G., Iotti, B., Valazza, A., Sammartano, F. ....................... 38
5.4
The "GR" trocar : an alternative to laparoscopy for the closure of the nephrosplenic space in the standing horse.
Bussy, C.P................................................................................................................................................................................. 39
5.5
Survival in horses with strangulation of the small intestine managed by surgical correction without resection. Cleary,
O.B., Freeman, D.E., Schaeffer, D.J. ........................................................................................................................................ 41
5.6
Surgical and Non-surgical Management of Cecal Impaction in 150 Horses (1991-2011). Aitken, M.R., Southwood,
L.L., Ross. B.M., Ross, M.W. .................................................................................................................................................... 42
5.7
Percutaneous caecal decompression in 100 horses with colic. Witte, S., Schnider, D., Witte, T.H. ............................ 43
5.8
Diagnosis and prognosis of caecal intussusception. A retrospective study (2009-2013). Broux, B., Lefere, L., De
Clercq, D., Deprez, P., van Loon, G. ......................................................................................................................................... 44
5.9
Evaluation of acid-base and electrolyte disturbances using a Fencl-Stewart approach and correlates to survival in
horses with colic. Hallowell, G.D., Berrym K.A., Bowen, I.M. .................................................................................................... 44
5.10
Amelioration of sodium sulphate induced hypokalemia in patients with large colon and/or caecal impactions. T. Latki,
Gembicki N, K. Failing, K. Fey ................................................................................................................................................... 46
Thursday 10th July ........................................................................................................................................................................... 47
6.
Post-operative Management.............................................................................................................................................. 47
6.1
Effects of a continuous rate infusion of lidocaine on ischemic injury, hematological changes, and inflammation in
equine large colon. Morton, A.J., Grosche, A., Graham, A.S., Bauck, A.G., de Cassia Seudo Lopes, M., Freeman, D.E. ...... 47
6.2
Effects of a continuous rate infusion of lidocaine on ischemic injury, hematological changes, and inflammation in
equine jejunum. Grosche, A., Morton, A.J., Graham, A.S., Bauck, A.G., Lopes, M., Freeman, D.E. ....................................... 48
6.3
Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and butorphanol infusions alone and in
combination in healthy horses. Sanchez, L.C., Elfenbein, J.R., Robertson, S.A., MacKay, R.J., KuKanich, B. ........................ 49
6.4
Transabdominal ultrasonography of the duodenum in the early diagnosis of paralytic ileus in postoperative horses.
Belz, J.P., Stroth, C., Tessman, L., Willman, C. ........................................................................................................................ 50
6.5
Nutritional management of hospitalized horses for colic according to their risk category. Valle, E., Bergero, D.,
Gandini, M. ................................................................................................................................................................................ 51
6.6
Indications, complications and short and long term outcome of 95 horses undergoing repeat celiotomy within 14 days
after colic surgery. Mair, T., Dunkel, B., Marr, C.M., Sherlock, C., Carnwath, J., Bolt, D.M. ...................................................... 52
6.7
Peri-operative factors associated with incisional surgical site infection following exploratory laparotomy in horses.
Darnaud, S.J.M., Southwood, L.L., Aceto, H.W., Tomassone, L., Zarucco, L. .......................................................................... 53
6.8
Heart rate variability in horses that undergo exploratory laparotomy for acute GI disease: evidence for transient
myocardial dysfunction. McConachie, E.L., Giguere, S., Rapoport, G., Barton, M.H. ............................................................... 54
6.9
Prospective randomized clinical trial evaluating the use of absorbable skin staples for abdominal closure in horses.
Biedrzycki, A.H., Brounts, S.H. .................................................................................................................................................. 55
6.10
A prospective study of antimicrobial resistance in bacterial isolates from equine celiotomy incisions. Smith, L.J., Mair,
T.S., Rycroft, A., Witte, T.H., Perkins, J.D. ................................................................................................................................ 57
6.11
Intra-abdominal adhesions in horses undergoing primary and repeat celiotomies for colic. Mair, T., Sinclair, D.R.,
Barr, E.D., Sherlock, C.E. .......................................................................................................................................................... 58
6.12
Macrocyclic Lactone efficacy in clien.t owned horses: a retrospective study 2008-2011. Daniels, S.P., Proudman, C.J.
59
Poster presentations ....................................................................................................................................................................... 60
Monday 7th July ............................................................................................................................................................................... 60
7.1
Ventral intra-abdominal pressures in horses with colic: Does intra-abdominal hypertension exist? V.H.L. Scott, S. D.
Hurcombe, M. Mudge, and R. Toribio........................................................................................................................................ 60
7.2
Blood concentrations of ghrelin, leptin, motilin and cortisol in horses with colic: pilot study S. D. Hurcombe, M.
Larberg, M. Mudge, and R. Toribio ............................................................................................................................................ 61
7.3
The effects of bit chewing on right upper quadrant intestinal sounds frequency in adult horses Pagliara, E., Giusto, G.,
Gandini, M. ................................................................................................................................................................................ 62
7.4
Small intestinal perforation caused by metallic wires in horse beddings Caramello, V., Giusto, G., Pagliara, E.,
Gandini, M. ................................................................................................................................................................................ 63
7.5
Geographic disparities in clinical characteristics of duodenitis/proximal jejunitis in horses in the United States
Hassel,D.M., Doddman, C., Steiler, A.L., Elzer, E.J., Hess, A., Southwood, L., Tennant-Brown, B. ......................................... 65
7.6
Displacement and volvulus of the large colon associated with concurrent gastric impaction in seven adult horses
McGovern, K.F., Suthers, J.M., James, F.M., O'Meara, B.J., Parker, R.A., Bladon, B.M. ......................................................... 65
7.7
Endoscopic and histologic observations in gastritis of horses Schusser, G.F., May, M., Rechnagel, S.T. .................. 67
7.8
Effect of pectin, lecithin, and antacid feed supplements (Egusin®) on gastric ulcer scores, gastric fluid pH and blood
gas values in horses Woodward, M.C., Huff, N.K., Garza, N.K., Keowen, M.L., Kearney, M.T., Andrews, F.M. ....................... 67
7.9
S.L.
Equine emergencies: Opinions of yard owners Bowden, A., Brennan, M.L., Burford, J.H., England, G.C.W., Freeman,
69
7.10
Prospective Evaluation of a colic prediction model Mirza, M.H., Cruz-Sanabria, Groue, A., Pescosolido, K., Kearney,
M.T., Andrews, F.M. .................................................................................................................................................................. 70
7.11
Evaluation of a replacement of supplemental inorganic minerals and performance minerals on equine gastric ulcers
Andrews, F.M., Camacho, P., Loftin, P., Bidot, W.A., Zoccarato, S., Woodward, M., Garza Jr., F., Keowen, M.L., Kearney,
M.T., Larson, C. ......................................................................................................................................................................... 71
7.12
Incidence of equine gastric ulceration in horses with enteroliths compared to horses with other simple surgical large
intestinal obstructions Klohnen, A ............................................................................................................................................. 72
7.13
Large colon sand impactions in horses: 1996-2008 Klohnen, A. ................................................................................. 73
7.14
An investigation into the association between changes in air temperature and barometric pressure on the incidence of
colic in horses Dechant, J.E., Davidson, Z., Kass, P.H. ............................................................................................................ 74
7.15
Retrospective study of confirmed fecalith obstructions in horses: 119 cases (2001-2013) Dechant, J.E., Nieto, J.E. . 75
7.16
Focal idiopathic eosinophilic colitis lesions of the equine small (descending) colon de Bont, M.P., Malbon, A.J.,
Blundell, R., Archer, D.C. .......................................................................................................................................................... 75
7.17
The effect of parasite burden on faecally excreted albumin Kerbyson, N., Parkin, T.D.H., Knottenbelt, D.C. ............. 77
7.18
Systematic review of risk factors for equine colic Bayes, T.C., Curtis, L., Burford, J.H., Freeman, S.L. ...................... 78
7.19
Incidence and prevention of gastric ulcers in horses undergoing general anesthesia Scicluna, C. ............................. 79
7.20
J.M.
Colic in the British Military Working Horse Population - A Retrospective Analysis Tannahill, V.J., Witte, T.H., Cardwell,
80
7.21
Prevalence of different types of colic in broodmares and short-term survival in a UK equine referral hospital
population: 146 cases (2000-2012) Suthers, J.M., Vale, L., Archer, D.C. ................................................................................. 81
7.22
Causes of radial lesions in the pylorus region of horses Schusser, G.F., Koller, G., Snyder, A. ................................. 82
7.23
Use of Micro-Lightguide Spectrophotometry (O2C®) in the equine intestine Reichert, C., Hopster, K., Franz, S.,
Wogatzki, A., Rotting, A.K. ........................................................................................................................................................ 83
7.24
Detomidine and gut motility in horses: clinical data Scicluna, C. ................................................................................. 83
7.25
Detomidine prolonged analgesia for colic in horses Scicluna, C. ................................................................................ 84
7.26
Detomidine prolonged analgesia with detomidine in colic horses: retrospective study Scicluna, C. ............................ 85
7.27
J.R.
Objective evaluation of peritoneal fluid color in horses with colic Nieto, J.E., Beldomenica, P., Dechant, J.E., Snyder,
86
7.28
Prevalence of gastric ulceration in free-ranging non-domesticated Equidae (Equus quagga): A post-mortem study
Hillyer, M.H., Wilsher, S., Allen, W.R., Stansfield, F. ................................................................................................................. 87
7.29
Caecocaecal-caecocolic intussusception in three horses from a single farm, with Anoplocephala perfoliata infestation
Tremaine, W.H., Roberts, V.L.H., Grabski, M., Ottridge, R. ...................................................................................................... 88
7.30
The development of a web-based audit and database of equine colic surgery Mair, T.S., Sherlock, C.E., White II, N.A.
90
7.31
Retrospective study of survival rates between medical and surgical treatments in 103 cases of colic at Aracatuba –
Brazil Mendes, L.C.N., Baptista, R.S., Vicarivento, N.B., Pereira, M.A.A.J.S., Chaves, A.A., Bovino, F., Rodrigues, C.A.,
Feitosa, F.L.F., Lucas, F.A., Peiro, J.R...................................................................................................................................... 91
7.32
Medical and surgical intervention for nephrosplenic colonic entrapment Hackett, E.S., Nelson, B.B., Ruple-Czerniak,
A.A., Hendrickson, D.A. ............................................................................................................................................................. 92
7.33
Strategies to overcome increased endotoxin concentrations in the equine gut Jul Reisinger, N., Schaumberger, S.,
Schatzmayr, G. .......................................................................................................................................................................... 92
Tuesday 8th July .............................................................................................................................................................................. 93
8.1
Preliminary evaluation of an early suturing technique for laparotomy incisional infection Gandini, M., Giusto, G. ...... 93
8.2
Ex-vivo computed tomography scan and anatomical characterization of jejuno(ileo)cecal anastomoses in horses
Gandini, M., Giusto, G., Iotti, B., Valazza, A., Sammartano, F. ................................................................................................. 95
8.3
The effect of staple dimension, tissue thickness and precompression time on staple formation in stapled side-to-side
jejunocecal anastomosis in horses Giusto, G., Amedeo, S., Gandini, M. .................................................................................. 96
8.4
Slip knots are effective for mesenteric arteries ligation during jejunal small intestinal resection and anastomosis in
horses Giusto, G., Gandini, M., Comino, F., Pagliara, E. .......................................................................................................... 97
8.5
A continuous single-layer extramucosal appositional suture pattern for end-to-end jejunojejunostomy in horses. In
vitro study Comino, F., Caramello, V., Giusto, G., Pagliara, E., Gandini, M. ............................................................................. 98
8.6
Altered Neutrophil Apoptosis in Horses with Acute Abdominal Disease White, N.A., Krista, K.M., Barrett, J.G., Furr,
M.O., Buechner-Maxwell, V.A. .................................................................................................................................................. 99
8.7
How To Manage Large Intestinal Tympany In Non Surgical Colic Case Using An Improved Pneumatic Transrectal
Decompression Device Magri, M., Scotti, G.B., De Zani, D., Zani, D.D................................................................................... 100
8.8
Piroplasmosis as differential diagnosis of post operative pyrexia in surgical colic patients Lotto, E., Cercone, M.,
Dante, S., Beccati, F., Nannarone, S., Pepe, M., Gialletti, R. .................................................................................................. 102
8.9
The effect of flunixin, indomethacin and prostaglandin E2 on in vitro slow wave activity in the equine ileum Fintl, C.,
Hudson, N.P.H., Handel, I., Pearson G.T. ............................................................................................................................... 103
8.10
Mesenteric strangulation caused by pedunculated lipoma without intestinal involvement Graham, A.S., Bauck, A.G.,
Grosche, A., Morton, A.J., Suedo-Lopes, M., Freeman, D.E. .................................................................................................. 104
8.11
Effects of a continuous rate infusion of lidocaine on mucosal injury and intramural inflammation after mechanical
manipulation of equine jejunum Graham, A.S., Freeman, D.E., Rapp, H.J. ............................................................................ 105
8.12
Construction of an Early Warning Index for Post-Colic Surgery Sutton, G.A., Saar, M. ............................................ 106
8.13
Non Strangulating Intestinal Infarction: Retrospective review of 10 cases Mair, T.S., Sherlock, C.E. ....................... 107
8.14
Treatment of Ulceration of the Gastric Glandular Mucosa: Retrospective evaluation of omeprazole and sucralfate
combination therapy in 204 sport and leisure horses Hepburn, R. .......................................................................................... 108
8.15
Serial venous lactate measurement following gastrointestinal surgery in horses Hackett, E.S., Moser, D.K., RupleCzerniak, A.A., Perry, K.L........................................................................................................................................................ 109
8.16
Surgical correction of Nephrosplenic Entrapment of the Large Colon via Standing Left Flank Laparotomy: Case Series
Krueger, C.R., Klohnen, A. ...................................................................................................................................................... 110
8.17
Experiences (5 horses) using tissue adhesive (GLUture) for skin closure after ventral midline celiotomy Klohnen, A.
111
8.18
Incisional complications following colic surgeries in horses: Does GLUture reduce the incidence of incisional infection
compared to skin staples? Klohnen, A. ................................................................................................................................... 112
8.19
A new approach to identify the incisional site infections time point in horses after colic surgery Klohnen, A. ........... 113
8.20
Does a standardized lidocaine treatment protocol result in therapeutic concentrations in horses following
gastrointestinal surgery? Hackett, E.S., Rowland, A.L., Wittenburg, L.A., Sonis, J.M., Goehring, L.S., Gustafson, D.L. ........ 114
8.21
Effect of hypoproteinemia on lidocaine plasma concentration in horses Hackett, E.S., Sonis, J., Wittenburg, L.A.,
Slovis, N.M., MacGillivray, K.C., Frazer, M.L., David, J.B., Gustafson, D.L. ............................................................................ 115
8.22
Influence of experimental mechanical manipulations on the local inflammatory reaction in the equine jejunum
Hopster-Iversen, C., Hopster, K., Staszyk, C., Freeman, D.E., Rotting, A.K. .......................................................................... 115
8.23
Percutaneous caecal decompression in the horse: Effect and complications Pihl, T.H., Winsborg, Y., Olsen, S.N. . 116
8.24
Investigation of the short chain fatty acid sensors GPR41 and GPR43 in equine large colon Archer, D., Jones, D.,
Tew, S. 117
8.25
Effects of selective and nonselective nonsteroidal anti-inflammatory drugs on in vitro contractility of ischaemia and
reperfusion injured equine jejunum Wogatzki, A., Hopster, K., Tappenbeck, K., Huber, K., Rotting, A.K. .............................. 118
8.26
Development of an in-vitro three-dimensional culture system for equine gastrointestinal crypts Jacobs, C.C.,
Southwood, L.L., Lindborg, S. ................................................................................................................................................. 119
8.27
MPXI as an indicator of post operative inflammation in horses after colic surgery de Graaf-Roelfsema, E., van Mourik,
S.F., van Leeuwen, M.W., Teske, E. ....................................................................................................................................... 121
8.28
Surgical site infection following laparotomy; effect of month and anaesthesia-related variables and reporting of
bacterial isolates in 299 horses Isgren, C.M., Salem, S.E., Archer, D.C., Worsman, F.C.F., Townsend, N.B. ........................ 121
8.29
Comparison of three linea alba suture techniques; clinical and ultrasonographic Wiemer, P., Ugahary, F., Harlaar, J.J.
123
8.30
Use of butorphanol tartrate as a continuous rate infusion (CRI) in the immediate postoperative period for signs of
abdominal pain in the management of large colon resection and anastomosis Klohnen, A., Krueger, C.R. ........................... 124
8.31
Impact of general anaesthesia on intestinal motility in horses undergoing non-abdominal surgery Salciccia, A.,
Gougnard, A., Sandersen, C., de la Rebiere, G., Cerri, S., Grulke, S., Serteyn, D. ................................................................ 125
8.32
Temporal stability of the bacterial community in the large intestine of the horse Dougal, K., Harris, P.A., Girdwood, S.,
Pinloche, E., de la Fuente, G., Argo, C., Curtis, C.G., Newbold, C.J. ...................................................................................... 126
8.33
The proliferative pool of stem cells are decreased by large colon volvulus in horses Gonzalez, L.M., Stranahan, L.W.,
Blikslager, A.T. ........................................................................................................................................................................ 128
8.34
Evaluation of gene expression in leukocytes of horses: analysis of the microarray technique in an ex vivo model of
endotoxemia Peiro, J.R., Dalmago, P., Mendes, L.C.N., Aoki, S.M., Feitosa, F.L.F., da Silva, G.N., Moreira, Y., Mendonca,
V.H.
128
8.35
Comparison of two in-vitro technique for cultivation of equine hoof explants Valle, E., Vercelli, C., Tursi, M., Barbero,
R., Giusto, G., Gandini, M. ...................................................................................................................................................... 129
Tuesday 8th July
1. Egus
1.1 Effects of SmartGut® Ultra on non-glandular gastric ulcer score and gastric juice pH.
Andrews, F.M., Camacho, P., Gaymon, G., Loftin, P., Garza Jr., F., Keowen, M.L.,
Kearney, M.T.
Equine Health Studies Program, Department of Veterinary Clinical Sciences and Department of Pathobiological
Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA 70803,
USA. Tel: (1) 225-578-9580 Fax: (1) 225-578-9605 Email: [email protected]
Background
Gastric Ulcers are common in horses and prevalence ranges from 60% to 90% (Videla and Andrews 2009). Ulcers
occur primarily in the non-glandular mucosa due to its lack of resistance to the erosive effects of gastric acids
(hydrochloric, volatile fatty and bile acids). Horses with this condition perform poorly which makes it a significant
economic problem within the horse industry. Omeprazole is effective in treating gastric ulcers (Andrews et al, 1999),
however long term treatment is expensive and prolonged increase in gastric juice pH might have a negative effect on
digestion. Furthermore, recurrence of non-glandular ulcers after treatment is common due to rebound
hypersecretion after treatment is discontinued (Gillen et al, 1999). SmartGut® Ultra (SmGU; SmartPak Equine LLC,
Plymouth, MA), a supplement containing a proprietary mixture of botanicals and other ingredients might protect the
stomach from the erosive effects of gastric acid and might be a more natural alternative to prevent ulcers from
recurring after omeprazole treatment.
Objectives
The objectives of this study was to determine the effects of a SmGU, a commercially available equine supplement,
on non-glandular and glandular gastric ulcer scores and gastric juice pH in stall-confined Thoroughbred horses during
and after omeprazole treatment.
Methods
Eight clinically healthy Thoroughbred and Thoroughbred-cross horses from the Equine Health Studies Program
(EHSP) herd were used in this study. The study was performed as a 42-day, 2-period crossover consisting of a
treatment group (SmGU; n=8) and an untreated control (n=8). All horses were stall-confined and fed mixed grass hay
and sweet feed (Omolene® 100; Purina Mills, Gray Summit, MO, USA). Horses were stratified by ulcer score on day 1 and assigned to the two treatment groups. Treated horses were fed SmGU (40g, twice daily) added to sweet feed
and control horses received sweet feed only. From days 1-14 all horses were treated with omeprazole (GastroGard®
paste, Merial Limited, Duluth, GA; 4mg/kg, orally q24h), then omeprazole was discontinued for the remainder of the
study. All horses remained stall-confined. From days 28-35, all horses underwent feed-deprivation according to a
published model to induce ulcers (Murray and Eichorn, 1996). During the feed-deprivation days, horses were fed
10% of their normal sweet feed and treated horses received the SmGU. From days 35-42, horses returned to their
normal diet to allow for recovery. Gastroscopy was performed on all horses on Day -1, 14, 28, 35 and 42 and nonglandular gastric ulcer number (NGN) and severity (NGS) scores (MacAllister et al, 1997) were assigned by the PI
(FMA) who was masked to treatment. During gastroscopy, gastric juice was aspirated and pH measured.
Results
On Day -1 before omeprazole or SmGU-treatment NGN and NGS scores were not statistically different (P>0.05) in
the SmGU treated group compared to the untreated controls. By Day 14, NGN and NGS scores significantly
decreased (P<0.05) in both groups. The NGN score remained significantly lower in the SmGU-treated horses when
compared to the untreated controls on Days 28 and 35. By Day 42, NGN and NGS scores were not significantly
different in either group. Gastric juice pH was significantly higher on Day 14 in both groups, when compared to other
days but there was not a treatment effect on gastric juice pH at any day during the study.
Conclusions
SmartGut Ultra (40 gm, mixed with feed twice daily) was readily eaten by all horses. SmartGut Ultra prevented the
increase in the number of gastric ulcers 2 weeks after omeprazole treatment and there were fewer gastric ulcers,
when compared to controls, after feed-deprivation. SmartGut Ultra supplement added to feed prevents the
worsening of gastric ulcers in stall-confined horses after omeprazole treatment, without altering gastric juice pH.
Supplementation with SmartGut Ultra might be an affordable alternative as an aid in protection of the non-glandular
stomach from the rebound acid effects in horses after omeprazole treatment is discontinued and in stall-confined
horses undergoing intermittent feeding.
Acknowledgement
Supported by a grant from SmartPak Equine and the Equine Health Studies Program
References
Videla, R., Andrews, F.M. (2009) New Perspectives in Equine Gastric Ulcer Syndrome. Veterinary Clinics of North
America, Equine Practice. Wyley Publishing, F.M. Andrews, Guest Editor. 2009; 291-296.
Andrews FM, Sifferman RL, Bernard W, et al. Efficacy of omeprazole paste in the treatment and prevention of gastric
ulcers in horses. Eq Vet J Suppl 1999:81-86.
Gillen, D., Wirz, A.A., Ardill, J.E. and McColl, K.E. Rebound hypersecretion after omeprazole and its relation to ontreatment acid suppression and Helicobacter pylori status. Gastroenterology 1999;116: 239-247.
Murray M. J. and Eichorn, E. S. Effects of intermittent feed deprivation, intermittent feed deprivation with ranitidine
administration, and stall confinement with ad libitum access to hay on gastric ulceration in horses. Am J Vet Res
1996;57:1599-1603.
MacAllister, C.G., Andrews, F.M., Deegen, et al. (1997).A scoring system for gastric ulcers in the horse. Equine Vet. J.
1997;6: 430-433.
1.2 The effect of a dietary supplement (Succeed™) on gastric ulcer severity.
Kerbyson, N., Parkin, T.D.H., Knottenbelt, D.C.
University of Glasgow, School of Veterinary Medicine, 464 Bearsden Rd, Glasgow G61 1QH Tel: (+44) 0141 330 5741
Fax: (+44) 0141 330 5602. Email: [email protected]
Background
The prevalence of gastric ulceration in racing Thoroughbreds is high; 66-93% (Hammond et al., 1986; Johnson et al.,
1994; Murray et al., 1996, 1989), with squamous ulceration having a prevalence of 93.6% (MacAllister et al., 1997).
Omeprazole was found to reduce gastric acid secretion by 99% at 5-8hours following administration (Daurio et al.,
1999). It has been found to be effective for the prevention and treatment of gastric ulcers (McClure et al., 2005) and
is currently regarded as the gold standard treatment for this condition. The detection time for omeprazole is 72
hours (Anonymous, 2014) hence appropriate withdrawal times need to be applied in racehorses. Recently there has
been interest in the use of alternative therapies and dietary supplements in the treatment of gastric ulceration (Huff
et al., 2012). Succeed™ is a dietary supplement containing polar lipids (oat oil), soluble fibre (β-glucan) and amino
acids (L-Glutamine and L-Threonine). A diet high in volatile fatty acids is thought to buffer gastric acidity in horses
(Nadeau et al., 2000).
Objectives
To assess the effect of a dietary supplement containing polar lipids and β-glucan (Succeed™) on the development
and treatment of squamous gastric ulceration in racing Thoroughbreds.
Methods
Sixty-seven Thoroughbreds in race training or pre-race training were recruited to the study on the basis of having
≥grade 1 gastric ulceration (The Equine Gastric Ulcer Council, 1999) on day zero of the trial and no history of
receiving anti-ulcer medication or clinical signs pertaining to gastrointestinal disease. Each horse was randomly
assigned to one of two treatment groups; omeprazole or the Succeed™ dietary supplement with even distribution of
numbers of horses between the two treatment groups. Both treatments were administered according to label
dosage for the duration of the trial (omeprazole 4mg/kg SID PO for a minimum of 28 days, continued until gastric
ulceration resolved then reduced to 1mg/kg SID PO, Succeed™ oral paste 27g PO BID q7days then 27g SID PO for
duration of trial). Gastroscopy was then repeated on day 30, 60 and 90. Sixteen horses left the trial prior to the
second gastroscopy, 40 went on to complete the trial (19 omeprazole and 21 Succeed™) and eleven had either 1 or 2
repeat gastroscopies. Gastroscopy videos were reviewed by three boarded equine internal medicine clinicians who
were blinded to the treatment groups. The data from the 11 horses, which did not complete the trial, but had either
1 or 2 repeat gastroscopy procedures performed has also been analysed and will be presented. Those who left the
trial were lost due to racing commitments, being sold or requiring medication for a non-gastrointestinal disorder.
Results
At day zero the squamous gastric ulcer severity was similar between groups (omeprazole two grade 1, eleven grade
2, four grade 3, two grade 4; Succeed™ three grade 1, eleven grade 2, six grade 3). At day 90 six horses receiving
omeprazole had gastric ulcer scores which were one or more grades improved compared to the scores from day
zero, nine horses had scores which were the same and four horses had worsened scores. At day 90, eight horses
receiving succeed had improved gastric ulcer scores, nine remained the same and in four cases the scores had
worsened.
Chi squared tests demonstrated no significant difference between the two treatments in the proportion of horse
improving by two or more grades (P=0.53): three horses in the omeprazole group and five in the Succeed™ group
improved by two or more grades; sixteen horses in each group improved by less than two grades or worsened.
When improvement by one or more grades was assessed the results were similar with six horses in the omeprazole
group and eight in the Succeed ™ group improving by one or more grade (P=0.67).
McNemars tests were applied to assess the effect of each treatment on gastric ulcer score. There was no significant
improvement on gastric ulcer score with either omeprazole (P=0.38) or Succeed ™ (P=0.50) when a clinically
significant gastric ulcer score of ≥2 was used to differentiate between affected and non-affected. When McNemars
tests were repeated using ulcer score of ≥3, there remained a lack of statistical difference (P= 1.0 and P=0.68 for
omeprazole and Succeed, ™ respectively).
Conclusions
There was no statistically significant difference in the effect of omeprazole or Succeed™ dietary supplement for the
treatment of squamous gastric ulceration in horses.
Acknowledgements
Study funded by Freedom Health LLC.
References
Anonymous, 2014. BHA Detection Times www.britishhorseracing.com/resources/equine-science-andwelfare/medication-control.asp. BHA Website.
Daurio, C.P., Holste, J.E., Andrews, F.M., Merritt, A.M., Blackford, J.T., Dolz, F., Thompson, D.R., 1999. Effect of
omeprazole paste on gastric acid secretion in horses. Equine Vet. J. 31, 59–62.
Hammond, C.J., Mason, D.K., Watkins, K.L., 1986. Gastric ulceration in mature Thoroughbred horses. Equine Vet. J.
18, 284–287.
Huff, N.K., Auer, A.D., Garza, F., Keowen, M.L., Kearney, M.T., McMullin, R.B., Andrews, F.M., 2012. Effect of Sea
Buckthorn Berries and Pulp in a Liquid Emulsion on Gastric Ulcer Scores and Gastric Juice pH in Horses. J. Vet. Intern.
Med. 26, 1186–1191.
Johnson, B., Carlson, G.P., Vatistas, N., Snyder, J.R., Lloyd, K., Koobs, J., 1994. Investigation of the number and
location of gastric ulcerations in horses in race training submitted to the California racehorse postmortem program.,
in: Proceedings of the 40th Annual AAEP Convention. Presented at the 40th Annual Convention of the American
Association of Equine Practitioners, Vancouver, British Columbia, pp. 123–124.
MacAllister, C.G., Andrews, F.M., Deegan, E., Ruoff, W., Olovson, S.., 1997. A scoring system for gastric ulcers in the
horse. Equine Vet. J. 29, 430–433.
McClure, S.R., White, G.W., Sifferman, R.L., Bernard, W., Doucet, M.Y., Vrins, A., Holste, J.E., Fleishman, C., Alva, R.,
Cramer, L.G., 2005. Efficacy of omeprazole paste for prevention of gastric ulcers in horses in race training. J. Am. Vet.
Med. Assoc. 226, 1681–1684.
Murray, M.J., GRODINSKY, C., Anderson, C.W., Radue, P.F., Schmidt, G.R., 1989. Gastric ulcers in horses: a
comparison of endoscopic findings in horses with and without clinical signs. Equine Vet. J. 21, 68–72.
Murray, M.J., SCHUSSER, G., Pipers, F.S., Gross, S.J., 1996. Factors associated with gastric lesions in Thoroughbred
racehorses. Equine Vet. J. 28, 368–374.
Nadeau, J.A., Andrews, F.M., Mathew, A.G., Argenzio, R.A., Blackford, J.T., Sohtell, M., Saxton, A.M., 2000. Evaluation
of diet as a cause of gastric ulcers in horses. Am. J. Vet. Res. 61, 784–790.
The Equine Gastric Ulcer Council, 1999. Recommendations for the diagnosis and treatment of equine gastric ulcer
syndrome (EGUS). Equine Vet. Educ. 11, 262–272.
1.3 Evaluation of a commercial faecal blood test for the diagnosis of gastric ulceration in
Thoroughbred racehorses: A preliminary report.
Sykes, B., Jokisalo, J., Hallowell, G.D.
BW Sykes Consultancy, 51 Fridays Creek Road, Upper Orara, NSW, 2450, Australia. Tel: +61 (0) 434 986 703, Fax: + 61
7 5460 1780. Email: [email protected].
Animagi Equine Hospital Hyvinkaa, Hyypparantie 41, 05820 Hyvinkaa, Finland. School of Veterinary Medicine and
Science, University of Nottingham, Sutton Bonington, UK.
Background
It has been proposed that the use of faecal blood tests, either as a standalone diagnostic test or as a screening test,
may be useful in the diagnosis of gastric ulceration in the horse. However, to the authors’ knowledge, these have
not been validated in the peer reviewed literature.
Objectives
The objective of this study was to investigate the accuracy of a commercially available faecal blood test for the
diagnosis of squamous and glandular gastric ulceration in the horse.
Methods
Thoroughbred horses from six stables were recruited in October 2013. One to three days prior to gastroscopy a
freshly passed (< 2 hours old) faecal sample was collected from the floor of each horse’s stable. A commercially
available faecal blood test (Succeed® Equine Fecal Blood Test™, Freedom Health LLC, Aurora, OH, USA) was
performed as per the manufacturer’s instructions. Testing was repeated twice using the same faecal sample in a
sub-group of horses (n=29) to assess the repeatability of the test result obtained.
Gastroscopy was performed as per standard clinical protocol. The squamous and glandular mucosa were scored
separately using a 4 point scale as described by the EGUS council (Andrews, Bernard, Byars, Cohen, & Divers, 1999).
Additionally a subjective assessment of clinical significance of the changes within the stomach as a whole was
assigned on a yes/no basis. One investigator (J.J.) was responsible for performing the faecal blood tests whilst the
remaining investigators, including the principal investigator (B.W.S.) who undertook the gastroscopic examinations
and scoring, remained blinded to the results of the faecal blood test until scoring was completed and recorded.
Data was assessed for normality using a Shapiro-Wilk test. Normally distributed data is displayed as mean ± standard
deviation. Non-normally distributed data is displayed using median (inter-quartile range). Odds ratios (95%
confidence intervals) of positive test result for affected versus unaffected horses are presented. Repeatability of the
test result and the relationship between detection of haemoglobin and albumin were assessed using Wilcoxon
Matched Pairs Test. The relationship between squamous and glandular ulcers ≥ grade 2 and the total stomach
assessment against the detection of albumin and haemoglobin in faeces were assessed using a two-tailed Fisher’s
Exact Test.
The study was performed in accordance with the New South Wales Department of Primary Industries guidelines for
clinical studies and the New South Wales Animal Research Act of 1985.
Results
Forty-four horses (21 mares and 23 geldings) aged 4.8±1.6 years and weighing 489±138kg were examined. Horses
had been in training a median of 10 weeks (5 to 18). Squamous and glandular ulceration ≥ grade 2 was present in the
77% and 64% of horses, respectively. Subjectively 68% of horses were regarded as having clinically significant
ulceration. Median ulcer grade was 2 (2 to 3) and 2 (0 to 2) in the squamous and glandular mucosa, respectively.
There was no association between squamous, glandular or clinically significant ulcers and the detection of either
faecal albumin or haemoglobin. Faecal albumin was positive in 100% and 74% of horses with squamous ulceration ≤
grade 1 and ≥ grade 2 (OR 0.13 (0.007–3.4); p=0.09), respectively, 88% and 75% of horses with glandular ulceration ≤
grade 1 and ≥ grade 2, respectively (OR 0.43 (0.08–2.4); p=0.45) and 86% and 77% of horses without and with
clinically significant ulceration, respectively (OR 0.55 (0.1-3.1); p=0.70). Faecal haemoglobin was positive in 70% and
44% of horses with squamous ulceration ≤ grade 1 and ≥ grade 2, respectively (OR 0.34 (0.08-1.5); p=0.28), 50% and
50% of horses with glandular ulceration ≤ grade 1 and ≥ grade 2, respectively (OR 1.0 (0.29–3.4); p=1.0) and 50%
and 50% of horses without and with clinically significant ulceration, respectively (OR 1.0 (0.28-0.36); p=1.0).
Repeatability was excellent for both albumin and haemoglobin (P>0.99). There was a significant association between
identification of albumin and haemoglobin in the faecal samples (P<0.005).
Conclusions
The findings of this study do not support the use of this test for the diagnosis of gastric ulceration in the population
studied.
Acknowledgements
The kits used in this study were kindly donated by Freedom Health LLC, Aurora, OH, USA.
References
Andrews, F., Bernard, W., Byars, D., Cohen, N., & Divers, T. (1999). Recommendations for the diagnosis and
treatment of equine gastric ulcer syndrome (EGUS). Equine Vet. Educ., 11(5), 262–272.
1.4 Endoscopic examination of the squamous and glandular gastric mucosa in sport and
leisure horses: 684 horses (2005-2011).
Hepburn, R.
B&W Equine Hospital, Breadstone, Berkeley, Gloucestershire, GL13 9HG.
School of Veterinary Science, University of Liverpool, Neston, CH64 7TE.
Department of Gastroenterology, Institute of Translational Medicine, University of Liverpool, Crown St., Liverpool,
L69 3GE. Faculty of Health & Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford GU2
7TE. Email: [email protected]
Background
Equine gastric ulceration syndrome (EGUS) refers to both primary squamous (SQ) and primary glandular (GL)
diseases, yet the majority of the literature describes primary squamous ulceration in racehorses (Anon 1999; Merritt
2009; Nadeau 2009). There is increasing appreciation of gastric disease in sport and leisure horses, however there
are few descriptions of this condition (Sykes 2013). Primary glandular disease which is poorly understood (Murray
2001) may be more common in these populations.
Objectives
To report the signalment, month of presentation, endoscopic findings (anatomical distribution, lesion appearance
and EGUS grade) of gastric squamous and glandular lesions in sport and leisure horses presented for routine
gastroscopy.
Methods
The medical records and digital images from complete gastroscopic examinations of 684 sport horses (dressage,
show jumping, eventing, endurance) and leisure horses (general riding, hunting) were reviewed. Lesions involving
the squamous mucosa of the greater and lesser curvatures, and of the glandular mucosa of the cardia, fundus,
antrum and pylorus were graded following the EGUS Council system (Anon 1999), and their gross appearance typed
via a novel system. Descriptive statistics identified the proportions of horses with SQ and GL disease. Chi-squared
tests identified any significant differences in the proportions of horses affected by clinically significant lesions (EGUS
SQ≥2 or GL≥2) by age, gender, breed and use group. Linear associations between the presence and grade of lesions
between the SQ and GL mucosa, between SQ≥2 and GL≥2 at various anatomic locations, and SQ/GL grade with
month of presentation was tested using a Monte Carlo estimate.
Results
Overall 424 (61.9%) horses had GL≥2, 340 (49.7%) had SQ≥2 and 114 (16.7%) had both SQ≥2 and GL≥2. In 191 leisure
horses, 104 (54.5%) had GL≥2, 95 (49.7%) had SQ≥2 (49.7%), and 60 (31.4%) had both. In 493 sport horses 320
(64.9%) had GL≥2, 245 (49.7%) had SQ≥2 and 167 (33.9%) had both. There was no difference in prevalence or SQ/GL
severity between use groups. Overall and in the sport horse group there was no association between SQ≥2 and GL≥2
(p=0.018), but in leisure horses associations between SQ≥2 and GL≥2 (P=0.016), and between SQ grade (lesser
curvature) and GL grade (antrum) (p=0.025) were found. No effect of age, gender, use or month of presentation was
found on SQ≥2, GL≥2 or GL type (any location). Between the two use groups no difference in gender, month of
presentation, age at presentation, frequency of SQ≥2, GL≥2, or SQ and GL severity was found. In neither use group
was an association found between month of presentation and presence of SQ≥2, GL≥2, GL severity or lesion type at
any location. There were no differences in GL lesion location, with the antrum, then pylorus most commonly
affected in both use groups.
Conclusions
Antral dominant primary glandular disease is common in both sport and leisure horses, where it more frequently
occurs alone than in combination with squamous disease. The absence of identifiable signalment, time and use
effects could indicate that management and feeding practices do not have the same relevance to glandular disease
that they have to squamous disease in racehorses. In leisure horses the association between SQ severity and GL
antral severity could indicate a role for abnormal gastric acidity in disease aetiology.
Acknowledgements
Merial Sanofi Animal Health
References
Anon (1999) The Equine Gastric Ulcer Council: Recommendations for the diagnosis and treatment of equine gastric
ulcer syndrome (EGUS) Equien vet. Educ. 11, 262-272
Merritt, A.M. (2009) Appeal for the proper usage of the term “EGUS”: Equine gastric ulcer syndrome. Equine vet. J.
41, 616
Murray, M.J., Nout, Y.S., and Ward, D.L. (2001) Endoscopic findings of the gastric antrum and pylorus in horses: 162
cases (1996-2000) J. Vet. Intern. Med. 15, 401-406
Nadeau, J.A., Andrews, F.M (2009) Equine gastric ulcer syndrome: The continuing conundrum . Equine vet. J. 41, 611615
Sykes, B.W., Sykes, K.M. and Hallowell, G.D. (2013) A comparison of two doses of omeprazole in the treatment of
equine gastric ulcer syndrome: A blinded, randomised, clinical trial. Equine vet. J. 34, 432-437.
2. Diagnostics
2.1 Observer agreement of colonic microvascular flow assessment in horses with colic.
S. D. Hurcombe, B. Welch, J.M. Williams, and M. Mudge
Galbreath Equine Center, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State
University, 601 Vernon L Tharp Street, Columbus, Ohio, USA, 43210. Tel: (+1) 614 292 6661 Fax: (+1) 614 688 5642
Email: [email protected]
Background
Dark-field microscopy (DFM) has recently been used to evaluate the microvascular blood flow of the colonic serosa
in horses with colic (Hurcombe et al. 2014). Objective microvascular flow indices (MFI) require significant postprocessing analysis making the utility of DFM in surgery obsolete. For DFM to be a more practical tool during colic
surgery in assessing colonic viability, visual assessment of video loops at the time of acquisition in determining
subjective grades of blood flow may prove just as predictive as calculated MFI in blood flow assessment; this is
however yet to be proven. Like many scoring systems (Perkins et al. 2009; Menzies-Gow et al. 2010), inter- and
intraobserver agreement is important in ensuring that a clinician is consistent in his/her scoring and that different
clinicians also agree with one another in interpretation. We sought to assess the level of agreement within and
between four observers in interpreting subjective flow scores (SFS) from DFM videos of colonic microvascular blood
flow.
Objectives
The objective of this study was to determine the inter- and intraobserver agreement in the designation of a colonic
serosal flow score as determined by DFM following a standardized training session for all observers.
Methods
Dark-field microscopy video loops of 10-20 seconds duration were obtained from clinical patients presenting to The
Ohio State University and who underwent exploratory laparotomy for a primary lesion of the large colon (simple,
non-strangulating and strangulating obstructions). Videos were recorded using the videomicroscope (Microscan®
device) and AVA 3.0 computational software.
Observers underwent a single training session to learn SFS based on representative videos as chosen by consensus
agreement of all participants. Score 1- no flow, Score 2- intermittent (start-stop-start etc) flow, Score 3sluggish/slow flow but continuous, and Score 4- normal/good flow.
Fifty videos were chosen based on quality (focus, stability, and contrast) representing videos from a variety of lesions
as well as control horses (no lesion). Each video was given a dummy name (i.e. video 1, video 2, etc) so no identifying
information could link the horse with a specific lesion.
Each observer reviewed the videos in random order according to a generated list of random numbers and assigned a
SFS to each video. Each observer reviewed the videos three times, with a minimum seven day interval between each
review. Reviewers were blinded to their previous scores as well as other observers’ SFS throughout the process.
Intraobserver and interobserver agreement scores were performed using both weighted and simple Kappa (ĸ)
statistics. Agreement was considered good if ĸ > 0.81, substantial if ĸ 0.61 to 0.8, moderate if ĸ 0.41 to 6.0, fair if ĸ
0.21 to 0.4, and poor if ĸ < 0.2. Data are presented as weighted ĸ statistics and mean ± standard deviation.
Results
Intraobserver agreement was good for all four observers over the three time points. Observer 1 ĸ = 0.96 ± 0.02,
Observer 2 ĸ = 0.97 ± 0.02, Observer 3 ĸ = 0.92 ± 0.05, and Observer 4 ĸ = 0.94 ± 0.01.
The interobserver agreement was also considered to be good between all observers at each of the three reviewed
time points. First review ĸ = 0.92 ± 0.01, Second review ĸ = 0.93 ± 0.04, and Third review ĸ = 0.92 ± 0.04. The overall
interobserver agreement for all time points was ĸ = 0.92 ± 0.01.
Conclusions
These data show that with appropriate training in determining SFS, observers show good or strong agreement when
visually assessing DFM video loops of colonic serosal blood flow from horses with primary lesions of the large colon.
Further study assessing the correlation between SFS and calculated microvascular perfusion indices is needed if DFM
is to be a more practical tool in the operating room in evaluating colonic viability.
Acknowledgement
Supported by a grant from the Morris Animal Foundation.
References
Hurcombe, S.D.A., Welch, B.R., Williams, J.M., Cooper, E.S., Russell, D., and Mudge, M.C. (2014) Dark-field
microscopy in the assessment of large colon microperfusion and mucosal injury in naturally occurring surgical
disease of the equine large colon. Equine Vet. J. doi:10.1111/evj.12202 (online)
Menzies-Gow, N.J., Stevens, K.B., Sepulveda, M.F., Jarvis, N., Marr, C.M. (2010) Repeatability and reproducibility of
the Obel grading system for equine laminitis. Vet. Rec. 167, 52-55
Perkins, J.D., Salz, R.O., Schumacher, J., Livesey, L. Piercy, R.J., and Barakzai, S.Z. (2009) Variability of resting
endoscopic grading for assessment of recurrent laryngeal neuropathy in horses. Equine Vet. J. 41, 342-346
2.2 Evaluation of handheld lactate portable analyzers in blood and peritoneal fluid.
Nieto, J.E., Dechant, J.E., le Jeune, S.S., Snyder, J.R.
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis . Tel
(530) 752-0290. Email: [email protected]
Background
Blood and peritoneal lactate are commonly used for the diagnosis and prognosis of horses with colic. Mean and
predictive values to differentiate strangulating and non-strangulating obstructions have been published. Increase of
1 mmol/L of lactate in blood or peritoneal fluid increases the odds for need for surgery, intestinal resection, and fatal
outcome.
Objective
To evaluate and compare 3 portable pocket-sized lactate analyzers with a bench top blood gas and electrolyte
analyzer for the measurement of lactate concentrations in blood and peritoneal fluid of horses with colic.
Methods
Lactate concentrations were evaluated serially on 10 occasions to evaluate repeatability of the portable analyzers.
Blood and peritoneal fluid lactate concentrations were simultaneously evaluated by a bench top and 3 portable
analyzers and the results compared by intraclass correlation coefficients and Bland Altman plots. Lactate
concentrations in a subgroup of peritoneal fluid samples were evaluated by a chromogenic laboratory assay and
compared with the bench top and the handheld analyzers.
Results
Portable lactate analyzers showed good intra-analyzer reliability for peritoneal fluid. Two portable analyzers showed
poor intra-analyzer reliability in blood. Lactate measurements from portable analyzers were closer to the bench top
analyzer at low concentrations of lactate than at higher concentrations.
Conclusions
Although portable analyzers are alternatives for the measurement of lactate concentration in field situations,
clinicians need to be aware of the variable results between analyzers specially when extrapolating means or cutoff
values from studies using different lactate analyzers.
2.3 Evaluation of peritoneal fluid parameters for prediction of intestinal ischemia lesions in
horses with abdominal disease.
Dechant, J.E., Williams, C., Nieto, J.E.
Department of Surgical and Radiological Science, School of Veterinary Medicine, 1 Shields Avenue, University of
California-Davis, Davis, California, 95616, USA and Rocky Bay Equine, P.O. Box 452, Vaughn, Washington, 98394,
USA. Tel: (530) 752-0290, Fax: (530) 752-9815, Email: [email protected]
Background
Intestinal ischemia is a severe cause of colic in horses that must be quickly corrected by surgery to minimize
morbidity and mortality.
Objectives
The purpose of this study was to compare the diagnostic performance of several peritoneal fluid parameters in
predicting the presence of intestinal ischemia.
Methods
Seven hundred thirty eight horses having peritoneal fluid collected and analyzed for evaluation of various abdominal
diseases between December 2007 and April 2011 were included in this study. Recorded information included
signalment, presenting examination findings, blood lactate, peritoneal fluid parameters, clinical diagnosis,
treatment, and outcome. ANOVA and receiver operating characteristic curves were used to compare diagnostic
tests for the identification of intestinal ischemia.
Results
There were 169 intestinal ischemia diagnoses (126 small intestine, 38 large intestine, 5 small colon) and 569 nonischemic diagnoses (including 34 rupture or septic peritonitis). Ischemia prediction index, peritoneal lactate, and
peritoneal-blood lactate difference were significantly better than peritoneal fluid pH, peritoneal-blood lactate ratio,
peritoneal total protein, and peritoneal nucleated cell count for predicting intestinal ischemia, if rupture and septic
peritonitis cases were excluded. Peritoneal fluid parameters had moderate specificity and peritoneal fluid
appearance had moderate sensitivity for the detection of intestinal ischemia.
Conclusions
Measurement of peritoneal fluid lactate, either alone or as part of the ischemia prediction index and peritonealblood lactate difference, can be helpful in the identification of intestinal ischemia. However, these values should not
be used in isolation and are confounded by the location of the ischemic lesion or the presence of septic peritonitis.
2.4 Alcohol dehydrogenase in colic horses with strangulation obstruction.
Schusser, G.F., Koller, G., Breitenstein, M., Thuess, T.
Department of Large Animal Medicine, Institute of Pathology, Faculty of Veterinary Medicine, University of Leipzig,
An den Tierkliniken 11, 04103 Leipzig, Germany, Tel: (+49) 341 9738320, Fax: (+49) 341 9738349.
Email: [email protected]
Background
The decision for surgery or euthanasia of a horse with colic is based on clinical and clinico-pathological diagnostic
findings. A previous study showed that the increase of alcohol dehydrogenase (ADH) activity above 80 U/L in the
serum of horses with strangulation obstruction indicated a poor prognosis (Gomaa et al. 2011).
Objective
To determine whether patho-morphological changes of the strangulated gut associated with the duration of colic,
increase ADH activity in horses with severe colic.
Methods
Fifty three horses with a small intestine strangulation obstruction and 8 horses with large colon torsion from seven
equine medical centers in Germany were included in this prospective study. Breed and age of colic horses, colic
duration, length and mucosal color of the strangulated small or large intestine were recorded. A serum sample was
also collected for ADH-measurement, before surgery. During surgery, tissue sample of the involved gut were taken
and fixed in 4% neutral buffered formalin. ADH-activity was measured photometrically based on the conversion of
ethanol to acetaldehyde, with simultaneous reduction of NAD+ to NADH. The formalin fixed tissue samples were
processed routinely and sections of 2 to 4 µm were stained with H&E. Out of 33 determined histopathological
variables 3 were selected, namely (i) changes in the gut wall thickness due to edema and/or hemorrhage, (ii) loss of
epithelial cells of the villi (grade 1-6; grade 1 no epithelial damage; 6 marked epithelial damage); (iii) mucosal,
submucosal, muscular and subserosal hemorrhages (grade 1 with no hemorrhage; 5 with hemorrhage seen in all the
layers of the gut wall). Horses with a strangulated small intestine were divided into two groups, i.e. those with a
black colored necrotic mucosa (group 1, n = 27) or a non-necrotic mucosa (group 2, n = 26) based on the
macroscopic appearance during surgery. Data were tested for normal distribution using the Shapiro-Wilk-test.
Nonparametric descriptive statistic results are presented as median with the 25th and 75th percentiles. For
comparison of these two groups, the Wilcoxon rank test was performed. A multivariable analysis, with different
combinations of the 33 descriptive histopathological variables, length and mucosal color of the strangulated small
intestine, was also performed to obtain those parameters that are of significant value compared with an increase in
the ADH activity. The probability of strangulated infarction, using ADH activity, in the horse with colic was calculated
using a logistic regression model. The level of significance was set at p≤0.05.
Results
The median age of the horses with small intestine strangulation obstruction was 17.5 years (25th/75th percentile:
11/20 years), while in horses with large colon torsion it was 15.5 years (9.5/20 years). The duration of colic in group
1 horses was 6 hours (4.5/10 h) and 11 hours (5/27 h) in group 2. The length of the strangulated gut was 290 cm
(135/550 cm) and 200 cm (80/350cm) in group 1 and 2 respectively. The mucosa was necrotic in 27/53 horses with a
small intestine strangulation obstruction, as well as in all the horses with a large colon torsion evaluated at surgery.
A significantly higher ADH activity of 41.5 U/L (32.0/60.0 U/L) was detected in group 1, compared to 27.5 U/L
(23.0/34.5 U/L) in group 2. However, horses with large colon torsion had a wider range of ADH activity (median 32,
25/83 U/L). The combined morphological findings: increased thickness of the intestinal wall, moderate to severe
hemorrhages and massive loss of villous epithelium, taking the length of the involved gut segment into
consideration, correlated significantly with an increase in ADH activity. An ADH-activity ≥74 U/L together with
palpable loops of small intestine per rectum in a horse with severe colic, indicated venous infarction of the
strangulated small intestine, with a probability of over 90 % in comparison to Gomaa et al. (2011).
Conclusion
Based on our results, ADH activity can be a prognostic indicator of a strangulated infarction of the small intestine in
horses with colic.
References
Gomaa NAM, Köller G, Schusser GF. Clinical evaluation of serum alcohol dehydrogenase activity in horses with acute
intestinal obstruction. Journal of Veterinary Emergency and Critical Care, 2011, 21: 242–52.
2.5 Variations in eosinophilic infiltration within the rectal mucosa of clinically healthy
horses.
Sloet van Oldruitenborgh-Oosterbaan, M.M., Grinwis, G.C.M.
Department of Equine Sciences and Department of Pathobiology, Faculty of Veterinary Medicine, Utrecht University,
Yalelaan 114, 3584CM, Utrecht, The Netherlands. Tel: (+31)0302531350 Email: [email protected]
Background
Histopathological examination of rectal biopsies has been used in the horse as an aid to the diagnosis of intestinal
disease with variable success over many years (Lindberg et al. 1996; Mair et al. 2006; Schumacher et al. 2000). In
horses with eosinophilic gastroenteritis microscopic lesions with diffuse eosinophilic infiltration of the lamina propria
and submucosa are often more widespread than the gross lesions (Pass and Bolton 1982). However, eosinophils are
commonly found in the rectal mucosa and submucosa of horses without any clinical symptoms deriving from the
digestive tract and their presence in rectal biopsies is not necessarily proof of MEED or idiopathic eosinophilic
enterocolitis (Mair et al. 2006).
The extent of eosinophilic infiltration observed before a diagnosis of eosinophilic enterocolitis can be applied varies
between pathologists (Schumacher et al. 2000). There are no ‘reference values’ for the number of eosinophils in
histology sections of the gastro-intestinal tract in clinically healthy horses, and there may be a misleadingly high
prevalence of intestinal eosinophilic infiltration in clinically healthy horses.
Objectives
The objective of this study was to evaluate the extent of eosinophilic infiltration in rectal biopsies from clinically
healthy horses and to establish the repeatability of these findings.
Methods
Seven clinically healthy adult Dutch Warmblood horses were biopsied twice on Day-1 and twice on Day-15 to
compare the results between samples taken on the same day and samples taken after a 14-day interval (with
Utrecht Animal Ethical Committee approval).
Biopsy specimens were collected 30-35 cm proximal to the anal sphincter at 10:00 and 2:00 o’clock from a minimally
restrained horse in stocks using a standard uterine biopsy instrument.
After fixation in 10% phosphate buffered formalin biopsies were processed using paraffin wax. Sections (5 μm) were
stained with haematoxylin and eosin and quantitatively evaluated for eosinophilic infiltration by counting the
eosinophils in the lamina propria mucosae and in the submucosa in as many crypts as possible to estimate the mean
number of eosinophils per crypt both in the lamina propria and in the submucosa.
IBM SPPS 22 computer software was used for statistical evaluation.
Results
In three of the seven horses the histologic slides of the four biopsies were of sufficient quality to be evaluated. One
of the samples in three horses and two biopsy samples in one horse could not be evaluated because these were too
small or were damaged during collection or preparation.
The mean number of crypts that could be evaluated per slide was 50±18 (range 26-104 crypts/slide). The intraindividual correlation of the eosinophils/crypt ratio of the horses was only significant for the data of the lamina
propria mucosae of the second sample on Day-1 and on Day-15 (0.93; p=0.022)
Eosinophils were consistently found in all samples to varying extents and their presence was considered to be high in
some horses (Figure 1).
Repeated rectal biopsies in 7 clinically healthy horses
eosinophils per crypt in submucosa
3.5
3
2.5
horse 1
horse 2
2
horse 3
1.5
horse 4
horse 5
1
horse 6
horse 7
0.5
0
0
0.5
1
1.5
2
2.5
3
3.5
4
eosinophils per crypt in lamina propria
Figure 1: Variation in number of eosinophils per crypt in the lamina propria and in the submucosa in different rectal
biopsy samples of seven horses.
Conclusions
Earlier studies identified the specific inflammatory cell types in rectal biopsies semi-quantitatively as a percentage of
the total cell infiltrate (Mäkinen et al. 2008). In the present study the mean eosinophil count per crypt was used to
provide an objective assessment of the eosinophilic infiltration.
Our findings demonstrated that there is a marked variation in the number of eosinophils in both the rectal mucosa
and submucosa of clinically healthy horses. This finding, in combination with the small size of rectal biopsies
compared to the total length of the equine large bowel, may decrease the sensitivity of rectal biopsies in establishing
a definitive diagnosis.
Acknowledgement
The authors thank Lutz Goehring, DVM, PhD and Angelique Jongbloets, DVM for help in obtaining the samples, and
Ted van den Ingh, DVM, PhD for histological evaluation.
References
Lindberg, R., Nygren, A. and Persson, S.G.B. (1996). Rectal biopsy diagnosis in horses with clinical signs of intestinal
disorders: a retrospective study of 11 6 cases. Equine vet. J. 28,275-284.
Mair, T.S. Pearson, G.R. and Divers, T.J. (2006) Malabsorption syndromes in the horse. Equine vet. Educ. 18,299-308.
Mäkinen, P.E., Archer, D.C., Baptiste, K.E. et al. (2008) Characterisation of the inflammatory reaction in equine
idiopathic focal eosinophilic enteritis and diffuse eosinophilic enteritis. Equine vet. J. 40,386-392
Pass, D. A. and Bolton, J. R. (1982) Chronic eosinophilic gastroenteritis in the horse. Vet. Pathol. 19,486-496.
Schumacher, J., Edwards, J.F. and Cohen, N.D. (2000) Chronic idiopathic inflammatory bowel diseases of the horse. J.
vet. intern. Med. 14,258–265.
3. Epidemiology
3.1 Trends in management of horses referred for evaluation of colic: 2004-2013.
Blikslager, A.T., Mair, T.S.
Department of Clinical Sciences, North Carolina State University, Raleigh, North Carolina 27607, USA. Tel: (+1) 919513-7725; Fax: (+1) 919-513-6336 Email: [email protected]
Bell Equine Clinic, Mereworth, Maidstone, Kent, ME18 5GS, UK. Tel: (+44) 1622 813700; FAX (+44) 1622 812233;
Email: [email protected]
Background
Ever since the economic turmoil of 2008, equine veterinarians have been concerned about the subsequent financial
hardship of equine practice, including reduced caseloads and a perceived reduced willingness for owners to give
permission for expensive medical or surgical procedures (Ramey 2012). During the British Equine Veterinary
Association Congress 2013, these issues were discussed during a colic panel, prompting the present study.
Objectives
We aimed to document the numbers of horses with colic being referred to two equine hospitals over the last ten
years, and to record the numbers undergoing surgery and numbers being euthanased.
Methods
Caseload numbers were compared between a university practice in the United States (NC State) and a private
referral practice in the United Kingdom (Bell Equine). The total number of cases referred for evaluation of colic was
recorded on a calendar year basis from 2004-2013. Within the population of colic referrals, horses were assigned to
one of four groups depending upon the course of treatment following initial assessment: medical colic, surgical
exploration with recovery from anesthesia, surgical exploration with intraoperative euthanasia or euthanasia
without additional medical or surgical procedures. The caseload within each of the four categories was expressed as
a percentage of the total colic caseload for the purposes of comparison.
Results
In 2004, Bell Equine received 150 horses for evaluation of colic, whereas NC State received 266 horses. In 2013, the
number of horses referred for evaluation of colic at Bell Equine was 173, representing a 15.3% increase, whereas NC
State received 220 horses, representing a 17.3% decline in colic caseload. The most remarkable trends, which were
similar between the two practices, were the decline in the number of horses going to surgery for exploration of the
abdomen, and the increase in the number of horses that were euthanased as a proportion of the total colic caseload.
For example, at Bell Equine in 2004, 56.0% of the colic caseload underwent surgical exploration with recovery from
anesthesia, as compared to 31.2% of the colic caseload in 2013. At NC State in 2004, 28.2% of the colic caseload
underwent surgical exploration with recovery from anesthesia, whereas only 19.5% of the caseload were treated
similarly in 2013. These reductions in surgical caseload were accompanied by increasing numbers of horses that
were euthanased, but euthanasia tended to occur at different time points. For instance, at Bell Equine, 2.7% of the
colic referral population was euthanased without further medical or surgical treatment in 2004, as compared to 9.2%
in 2013. Alternatively at NC State, the population of horses euthanased following initial workup was 11.3% of the
caseload in 2004 and 8.2% in 2013. However, the number of horses euthanased at surgery increased markedly from
7.5% of the colic caseload in 2004 to 17.7% in 2013 at NC State. The percentage of colic patients being euthanased at
surgery at Bell Equine varied very little over the 10-year period, accounting for 6.7% of the caseload in 2004 and
6.4% of the caseload in 2013. One positive trend that was noted since 2011 was that the percentage of horses taken
to surgery appears to be going up at both practices, with a notable reduction in euthanasia following evaluation at
Bell Equine in 2013 and a similar but smaller drop in euthanasia at NC State. One factor that may contribute to
decisions with colic patients is the cost of treatment. From available financial data from both practices (2008-2013),
the average bill at discharge following colic surgery at Bell Equine increased by 10.5%, whereas the NC State bills
increased by 10.3% over the same 5-year time period.
Conclusions
This study revealed a trend at two equine practices toward a decreasing proportion of colic patients going to
surgery, which was accompanied by a trend toward increased euthanasia prior to surgery (Bell Equine) or an
increasing number of horses being euthanased at surgery (NC State). Over the latter half of the study period, the
cost of surgery rose by approximately 10% at both practices, suggesting that factors other than fee increases may
have accounted for an increasing trend toward euthanasia of horses with surgical colic. However, evaluation of these
data at NC State have prompted tentative plans for a reduction in colic fees for the first time in the institution’s
history. In addition, specific trends, such as increasing euthanasias following initial evaluation or during surgery
should be evaluated to understand the driving forces for these decisions. References
Ramey, D. W. (2012). Equine ambulatory practice: challenges and opportunities. Vet. Clin. North Am. Equine Pract.
28, 1-9.
3.2 Prospective study of primary assessment of equine colic: Part 1: Study population and
case presentation.
Curtis, L., Curran, M.L., Bayes, T.C., England, G.C.W., Burford, J.H., Freeman, S.L.
School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington,
Loughborough, Leicestershire. LE12 5RD, UK. Tel: (+44) 01159 516422 Fax: (+44) 01159 516440.
Email: [email protected]
Background
Colic is one of the most common emergency problems and causes of mortality in the horse (Traub-Dargatz et al.,
1991; Tinker et al., 1997; Ireland et al., 2011). It has many different causes and clinical presentations. Current
literature is mainly focused on critical/ referral cases, which represent a small selective population with the data
based on their presentation to the referral hospital rather than the primary assessment by a practitioner. Evidence
about first-opinion colic assessment is required to provide information on current veterinary practice.
Objectives
The aim of this study was to describe the primary assessment of colic cases by veterinary surgeons.
The objectives of the study were:


To collect information from veterinary surgeons in general practice who are involved in the primary
assessment of horses with colic.
To describe the clinical presentation of colic cases on primary assessment by a veterinary surgeon.
Methods
A prospective 13 month study (September 2012-October 2013) was designed to collect data from veterinarians
involved in the primary assessment of horses with colic. All UK equine practices listed in the Royal College of
Veterinary Surgeons register were invited to participate. Colic was defined as ‘An incidence of any condition signified
by one or more indicators of acute abdominal pain’ (Tinker et al., 1997), and seven days free of colic was required for
a case to be considered unrelated to a previous episode (Hillyer et al., 2001). Participating veterinary surgeons
completed a case report form describing clinical history, initial presentation, physical examination, diagnostic tests,
treatment and outcome. A behavioural severity scale combined individual severity scores based on behaviour and
demeanour into a scoring system (score 0-17). A total gut sounds score was calculated as the sum of scores for
sounds heard on auscultation from all four quadrants (score 0-12). Descriptive analysis was used to represent the
data. Diagnostic approach and differences between cases with varying outcomes are described in a separate study
(Curtis et al., 2014).
Results
1064 case report forms were submitted (of which 1023 were first opinion only) from 167 veterinary surgeons
working at 108 different practices. The type of practices were equine first and second opinion (30%), equine firstopinion (24%), mixed practice – mainly small animal (21%), mixed practice – mainly large animal (19%) and mixed
practice – mainly equine (6%). The equine population consisted of 55.2% geldings, 41.5% mares and 3.4% stallions
with a mean age of 13.5 (range 0 - 42) years. Over 49 breeds/ types of equine were represented. Management
history was provided in 763 case forms and a recent change in management was reported in 47.3% (361/763) of
those cases; changes in diet/bedding and turnout were the most stated changes (21% (77/361) and 19% (75/361)
respectively). Mucous membranes were pink in 92% (917/1000) of cases, red in 5% (50/1000) and cyanotic in 3%
(33/1000) of cases. Capillary refill time was <2.5 seconds in 92% (911/991) of cases and >2.5 seconds in 8% (80/991)
of cases. The median total gut score was 5 (range 0-12). Mean heart rate was 47 beats/min (range 18 - 125bpm),
mean respiratory rate was 20 breaths/min (range 6-100) and mean rectal temperature was 37.7°C (range 33.0 –
40.3). On a colic behavioural severity scale of 0-17, 70.4% (720/1023) scored 0-6 and 29.6% (271/1023) scored 7-12.
Spasmodic colic (35.9% (338/941)) and presentations which can be collectively termed “simple colonic obstruction
and distension” (18.5% (174/941)) were the most common initial diagnoses, and 16.2% (152/941) of cases were
classified as ‘undiagnosed’.
Conclusions
This is the first multi-centric study to report the clinical features identified at the primary presentation of colic cases
to veterinary surgeons. Evidence has been gathered across a range of practices providing an overview of case
assessment in general practice. The findings illustrate the range of conditions and presentations seen by veterinary
surgeons in practice.
Acknowledgments
Supported by a grant from Petplan Charitable Trust, and by survey promotion from Boehringer Ingelheim
References
Curtis, L., Curran, M.L., Bayes, T.C., G.C.W., Burford, J. and Freeman, S. (2014) Prospective study of primary
assessment of equine colic: Part 2: Diagnostic approach, decision-making and outcomes. Submitted as an abstract to
this symposium
Hillyer, M. H., Taylor, F. G. R. and French, N. P. (2001). A cross-sectional study of colic in horses on Thoroughbred
training premises in the British Isles in 1997. Equine Veterinary Journal, 33: 380-385.
Ireland, J. L., Clegg, P. D., Mcgowan, C. M., Platt, L. and Pinchbeck, G. L. (2011). Factors associated with mortality of
geriatric horses in the United Kingdom. Prev. Vet. Med., 101: 204-218.
Tinker, M. K., White, N. A., Lessard, P., Thatcher, C. D., Pelzer, K. D., et al. (1997). Prospective study of equine colic
incidence and mortality. Equine Vet. J., 29: 448-453.
Traub-Dargatz, J. L., Salman, M. D. and Voss, J. L. (1991). Medical problems of adult horses, as ranked by equine
practitioners. J. Am. Vet. Med. Assoc., 198: 1745-1747.
3.3 Prospective study of primary assessment of equine colic: Part 2: Diagnostic approach,
decision-making and outcomes.
Curtis, L., Thomas, J.S.M., England, G.C.W., Freeman, S.L., Burford, J.H.
School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington,
Loughborough, Leicestershire. LE12 5RD, UK. Tel: (+44) 01159 516422 Fax: (+44) 01159 516440.
Email: [email protected]
Background
There is a wide range of diseases which cause colic, with prognosis varying greatly (Proudman et al., 2002). Critical
cases need to be diagnosed and treated as rapidly as possible to optimise the outcome. Most of the current
literature on the diagnosis of colic is derived from referral populations and does not always discuss suitability of a
diagnostic test for the initial stages of a colic episode and its value for making decisions on critical cases. There is
currently a lack of research on the main diagnostic tests widely used by the first-opinion veterinary practitioner.
Objectives
The aim of this study was to determine how the primary presentation of colic cases related to diagnosis and
outcome.
The objectives of the study were:


To describe the diagnostic approach used by veterinary surgeons on primary assessment of colic cases
To determine which aspects of the clinical presentation of cases were significantly associated with critical
cases and euthanasia.
Methods
Data was collected from veterinary surgeons involved in the primary assessment of horses with colic during a 13
month prospective study (Curtis et al. 2014). Case data included clinical presentation, diagnostic approach,
treatment and outcome using both open and closed questions. Open text responses were reviewed and grouped
into categories. Descriptive analysis was used to evaluate trends in the data.
Outcomes were grouped into two categories: mild-medical cases and critical cases. Inclusion criteria for mildmedical cases were cases that resolved with medical treatment on a single visit. Inclusion criteria for critical cases
were horses that died, were euthanased, had surgery, or required intensive care. Univariable chi-squared analysis
was used to investigate the association between categorical variables and outcomes
Results
Clinical features of 1032 colic cases collected during a 13 month study were evaluated
(Curtis et al., 2014). At initial examination, heart rate was recorded in 98.9% (1012/1023) of cases and rectal
temperature in 81.1% of cases. A rectal examination was performed in 73.96% (749/1014) of cases, 35.5% (350/985)
underwent nasogastric intubation, 18.0% (176/975) had a blood sample taken for various haematological and
biochemical measurements and abdominocentesis was carried out in 7.2% (70/973) of cases. Additional diagnostic
tests included ultrasound, faecal sedimentation test and faecal worm egg count which were performed in 3.4%
(35/1023), 2.5% (26/1023) and 2.1% (21/1023) of cases respectively. In terms of outcome, 8.6% (86/1003) of cases
resolved before the veterinarian’s visit, 50.3% (505/1003) resolved with treatment at the first visit, 12.3% (123/1003)
required further visits, 15.3% (153/1003) died or were euthanased, and 13.6% (136/1003) were referred. Of the
latter cases which were referred, 1.9% (19/1003) were surgical, 1.4% (14/1003) euthanased, 4.9% (49/1003) medical
and 5.4% (54/1003) ongoing/unknown. Mean heart rate was significantly lower (P=0.000) for cases that resolved
than for cases that were euthanased.
535 mild-medical cases and 240 critical cases met the inclusion criteria. Cardiovascular variables (capillary refill time,
mucous membrane colour and heart rate), signs of pain and abdominal borborygmi were significantly different
(P<0.05) between mild-medical and critical cases. There was evidence of a significant difference (P=0.000) in the
utilisation of diagnostic tests between the groups, with veterinarians utilising additional resources in critical cases.
Rectal examination and nasogastric intubation were not performed in 17.5% and 52.6% of critical cases, respectively.
Conclusions
The majority of cases were diagnosed based on clinical presentation and rectal examination, and further diagnostic
tests were infrequently used. Most cases resolved with simple medical or no treatment. Clinical parameters such as
heart rate, pain and gastrointestinal borborygmi were significantly different between cases which resolved with
minimal intervention, and those that required surgery / euthanasia, and therefore can be useful prognostic
indicators even at this early stage in case evaluation.
Acknowledgments
Supported by a grant from Petplan Charitable Trust, and by survey promotion from Boehringer Ingelheim
References
Curtis, L., Curran, M.L., Bayes, T.C., G.C.W., Burford, J. and Freeman, S. (2014) Prospective study of primary
assessment of equine colic: Part 1: Study population and case presentation. Submitted as an abstract to this
symposium
Proudman, C. J., Smith, J. E., Edwards, G. B. and French, N. P. (2002). Long-term survival of equine surgical colic
cases. Part 2: Modelling postoperative survival. Equine Veterinary Journal, 34, 438-443.
3.4 Could it be colic? Horse-owner decision making and practices in response to equine
colic.
Scantlebury, C.E., Perkins, E., Pinchbeck, G.L., Archer, D.C., Christley, R.M.
Department of Epidemiology and Population Health, Institute of Infection and Global Health, University of Liverpool,
Leahurst Campus, CH64 7TE, UK Tel: (+44) 0151 795 6011 Email: [email protected]
Health Services Research Department, Institute of Psychology Health and Society, University of Liverpool.
Background
Little is known about lay understanding of colic and how this contributes to decision making in response to colic.
Horse-owners/carers are key to identifying colic and initiating veterinary intervention. Understanding how owners
think and act in relation to colic could assist veterinary surgeons in tailoring colic information and advice with the
aim of improving colic outcome.
Objectives
The study use mixed research methodology to describe lay understanding of colic. By exploring owners’ views,
knowledge and decision making relating to colic, the study aimed to examine the horse-owner approaches to colic
management,
Methods
The study comprised both qualitative in-depth interviews and a cross-sectional postal questionnaire mailed to 1000
horse-owners in the North-West of the UK. Horse-owners for both phases of the study were selected from a
common sampling frame devised from 4 sources; horse-owners from a previous study of geriatric horses (Ireland et
al.2011), owners of horses that underwent colic surgery and were discharged from the Philip Leverhulme Equine
Hospital between Jan 2008 and September 2010 (n=311), owners of horses that had been treated for medical colic
by Leahurst first opinion equine practice between Jan 2007 and September 2010 (n=109), horse-owners from a
previous recurrent colic study (Scantlebury et al. 2011) total n= 1,841. Horse-owners were purposefully sampled
based upon colic experience for the qualitative study. One thousand horse-owners were randomly selected to
receive the postal questionnaire. Qualitative data were analysed using grounded theory which aided
conceptualisation of processes involved in horse-owner management of colic. Data saturation was considered to
occur when no new hierarchical concepts were emerging from the data (Charmaz 2006). The cross-sectional
questionnaire was designed subsequent to the interview analysis in order to explore the hypothesised concepts
among a larger population. Cluster analysis based on Euclidian distance and Ward’s agglomeration method aided
examination of the role of the human-horse relationship upon colic management strategies. Clusters developed
from this analysis were tested against responses to questionnaire items on the management of colic using chi-square
statistics.
Results
Fifteen horse-owners with a range of colic experience and including both professional and hobbyist horse-owners
participated in in-depth qualitative interviews. A grounded theory of the data generated hypotheses of how horseowners recognised, assessed and responded to colic. Three main management strategies were identified including
‘wait and see’, ‘lay treatments’ and ‘seek veterinary assistance’. Actions in response to colic were moderated by
owners’ experience of colic and interpretation of the severity of colic signs.
A postal questionnaire gathered data from 673 horse-owners from the north-west of UK (70.8% useable response
rate). Four hundred and nineteen respondents stated they had owned a horse with a history of colic. The majority
(605, 89.9%) of respondents were female with a modal age of 41-50 years (51-60 years among male respondents).
Cluster analysis revealed 5 meaningful groups of horse-owners based upon assessment of questionnaire items on
the human-horse relationship. These groups included 2 professional and 3 amateur owner typologies. Responses
among these groups of horse-owners varied in relation to their approaches to the management of colic. For
example, there were significant differences between the owner typology groups and their decisions about seeking
veterinary assistance. These included; how the horse responded to the owners actions (p=0.007), the owners current
financial status (p=0.03), if the horse was insured (p=0.006) and, for decisions surrounding colic surgery, included if
the horse was insured (p=0.02), retired (p<0.001), well adapted for its use (p=0.001) or financially valuable (p<0.001).
Conclusions
This study describes lay understanding and management of colic among a population of horse-owners from the
North-West of the UK. The resulting information may serve as a basis upon which to tailor existing programmes
designed to educate owners about colic management strategies and timely veterinary interventions for colic.
Acknowledgements
The authors gratefully acknowledge all participants of the study along with the project funders; the RCVS Charitable
Trust and the University of Liverpool, Philip Leverhulme Equine Hospital.
References
Charmaz, K. (2006) Constructing Grounded Theory A practical guide through qualitative analysis Sage publications.
Ireland, J. L., Clegg, P.D., McGowan, C.M., McKane, S.A. & Pinchbeck, G.L. (2011) A cross sectional study of geriatric
horses in the United Kingdom Part 1: Demographic and management practices Equine Vet J. 43 (1) 30-36.
Scantlebury, C.E., Archer, D.C., Proudman, C.J. & Pinchbeck, G.L. (2011) Recurrent colic in the horse: Incidence and
risk factors for recurrence in the general practice population. Equine Vet J. 43, 81-88.
3.5 Prospective survey of veterinary practitioners' primary assessment of equine colic:
Clinical signs, diagnoses, and treatment of 120 cases of large colon impaction.
Curtis, L., Jennings, K.M., Burford, J.H., Freeman, S.L.
School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington,
Loughborough, Leicestershire. LE12 5RD Tel: (+44) 01159 516422 Fax: 01159 516412
Email: [email protected]
Background
Large colon impactions are a common cause of colic in the horse (Proudman 1992; Dabareiner and White, 1995;
Reeves et al. 1996). The current published evidence on risk factors, clinical presentation and decision making in large
colon impaction cases, is based on referral hospital populations (Dabareiner and White, 1995, Newton, 1998; Hillyer
et al. 2002), which represent a particular section of the case population. There is a lack of evidence from first opinion
practice on the wider population, and on how large colon impaction cases initially present to the veterinary surgeon.
The aim of this study was to describe the initial clinical presentation, and the diagnostic tests and treatments used by
veterinary practitioners on the primary assessment of horses with large colon impactions.
Objectives
The study objectives were:

To describe the history and signalment of large colon impaction cases in a prospective study of the primary
presentation of horses with colic to veterinary practitioners.

To characterise the clinical findings of large colon impaction cases at initial presentation in a prospective
study of horses with colic

To determine how clinical findings of large colon impaction cases relate to case outcome

To describe the diagnostic tests and treatments used by veterinary practitioners on the primary assessment
of large colon impaction cases.
Methods
Data was collected prospectively from veterinary practitioners on the primary presentation of equine colic cases
over a 12 month period. An impaction was defined as any case that involved partial or complete obstruction of the
intestinal tract by ingested material (including ingesta and sand impactions). Inclusion criteria were a diagnosis of
primary large colon impaction and positive findings on rectal examination. Data recorded for each case included
history, signalment, clinical and diagnostic findings and treatment on the first assessment by the veterinary surgeon,
and the final case outcome. Case outcomes were categorised into three groups: mild medical (resolved with single
treatment), complicated medical (resolved with multiple medical treatments) and critical (required surgery, were
euthanased or died). Mean, range and standard deviation were calculated for continuous variables and percentage
frequencies for categorical data. One way ANOVA, Kruskal Wallis and Chi squared analysis were used to compare
between different outcome categories.
Results
1032 colic cases were submitted by veterinary practitioners: 216 cases were recorded as impactions affecting a
range of different sites. 120 cases met the inclusion criteria for primary impactions affecting the large colon. Cases
with primary large colon impactions consisted of 60 mares and 60 geldings, aged between 3-41 years, and with an
estimated bodyweight of 200-750kg. 53% cases were categorised as simple medical, 36.6% as complicated medical,
and 9.2% as critical. Most cases (42.1%) occurred during the winter. 59% of horses had had a recent change in
management, 43% of horses were not ridden, and 12.5% had a recent / current musculoskeletal injury. Most horses
showed mild signs of pain and there were no significant differences in the pain scores between the different
outcome categories. Mean heart rate was 43bpm (range 26-88), most cases showed mild signs of pain (67.5%), and
reduced gut sounds (76%). There were significant differences in heart rate, mucous membrane colour, capillary refill
time and gut sounds between critical cases compared to mild and complicated medical cases (p<0.05). Most cases
(99/120) had nasogastric intubation, and other tests (blood samples, sand test, abdominocentesis and ultrasound
examination) were used infrequently on this first assessment. 50 different treatment combinations were used, with
NSAIDs (93%) and oral fluids (71%) being administered most often.
Conclusions
This is the first study of primary presentation of large colon impactions in the UK. It provides the first evidence on
how cases present and are initially assessed and treated by veterinary practitioners. The study confirms evidence
from previous research on history and management factors, but also raises new questions regarding the association
between exercise and impaction colic. Heart rate and gut sounds were the most useful clinical parameters to identify
critical cases on the initial presentation. Rectal examination and nasogastric intubation were commonly used by
practitioners; other diagnostic tests were used infrequently and provided limited additional information in most
cases. The most common treatments used were NSAIDs and oral fluids, consistent with current evidence. The study
highlighted a wide variation in specific treatments by practitioners, and the need for further research on the efficacy
of different treatment options outside of the referral hospital environment.
Acknowledgements
This study was supported by a grant from the Pet Plan Charitable Trust. Boehringer Ingelheim provided support with
dissemination of the national survey. Laila Curtis is funded by the School of Veterinary Medicine and Science.
References
Dabareiner. R.M., White. N.A. (1995) Large colon impaction in horses: 147 cases (1985-1991). J Am Vet Med Assoc
206: 679-85
Hillyer, M.H., Taylor, F.G., Proudman, C.J., Edwards, G.B., Smith, J.E., French, N.P. (2002) Case control study to
identify risk factors for simple colonic obstruction and distension colic in horses. Eq Vet J 34: 455-463
Newton, S.A. (1998) Three cases of pelvic flexure impaction in the horse. Eq Vet Ed 10: 284-290
Proudman, C. (1992) A two year, prospective survey of equine colic in general practice. Eq Vet J 24: 90-93
Reeves, M.J., Salman, M.D., Smith, G. (1996) Risk factors for equine acute abdominal disease (colic): Results from a
multi-center case-control study. Prev Vet Med 26: 285-301
3.6 Big data and equine colic.
Duz, M., Marshall, J.F., Parkin, T.D.H.
Boyd Orr Centre for Population and Ecosystem Health and Weipers Centre Equine Hospital, School of Veterinary
Medicine, College of Medical, Veterinary and Life Sciences, University of Glasgow, 464 Bearsden Road, Glasgow, G61
1QH, Scotland, United Kingdom. Tel.+44(0)1413305999 Fax:+44(0)1413306025.
Email: [email protected]
Background
The morbidity and mortality associated with equine colic has previously been described using populations of less
than 500 cases, usually from restricted geographical locations and attended by a limited number of veterinary
surgeons (Mair and Smith 2005, Muñoz et al. 2008). Electronic medical records (EMR) are widely used by veterinary
practices and offer a potential goldmine to epidemiological research. Techniques for text-mining clinical records
from large equine populations have been applied to determine the reason for retirement in the Hong-Kong
racehorse population (Lam et al. 2007) or to determine the prevalence of cervical vertebral stenotic myelopathy in a
stud farm population (Oswald et al. 2010). However, these techniques have not previously been applied to
determine the prevalence or survival of equine colic cases.
Objectives
We performed this retrospective multicentre study with 3 main objectives: (1) describe the overall prevalence of
colic in a large population under veterinary care; (2) describe the proportion of colic cases undergoing exploratory
laparotomy since 2007; (3) to determine the effect of colic and laparotomy on survival.
Methods
Anonymous digital clinical records were obtained from a convenience sample of 9 equine private practices in North
America (U.S.A. and Canada). Text mining and data extraction were performed using the content analysis software
SimStat-WordStat v.6 (Provalis research). Medical records of those horses diagnosed with at least one episode of
colic were retrieved using a dictionary of colic-related keywords and included in the “colic” group. Horses with a
medical record of >1-year duration and no diagnosis of colic were grouped as “control”. The sub-group of horses in
the colic group that underwent an exploratory laparotomy were identified and designated as the “laparotomy”
group. Data manipulation and analysis was performed using R v3.0.0 (R Development Core Team). The earliest
episode of colic for each affected horse was identified. The prevalence of colic and laparotomy was determined
stratified by year. Median survival was calculated for control, colic and laparotomy groups. The number of
laparotomies as a proportion of the number of colic cases per year was compared using chi-square analysis. This
study was approved of the Ethics and Welfare Committee of the School of Veterinary Medicine at the University of
Glasgow.
Results
The clinical records of 312,636 horses from 27 branches of first opinion only (n=3) and first opinion and referral (n=6)
private practices employing 309 veterinarians between 1994 and 2013 were analysed. Medical records of >1-year
duration were extracted for 71,186 horses. A total of 21,386 horses suffered at least one episode of colic. The mean
yearly prevalence of colic between 2007 and 2012 was 5.2% (range: 4.5-5.7%) of all cases under veterinary care in
each year. Among all colic cases, 1799 underwent laparotomy (8.5%). Between 2007-2012, the mean proportion of
colic cases undergoing laparotomy was 8.9% (n=1575 of 17738 colic episodes). The proportion of colic cases
undergoing exploratory laparotomy was significantly greater in 2008 (8.7%), 2009 (9.6%), 2010 (10.5%), 2011
(11.4%) and 2012 (12.2%) than in 2007 (6.0%) (p < 0.001). A significantly greater proportion of colic cases underwent
exploratory laparotomy in 2011 (11.4%) and 2012 (12.2%) than in 2008 (8.7%) and 2009 (9.6%) (p<0.05).
Colic-to-death interval was available in 4019 horses of the colic group, of which 52.1% (n=2055) died within the first
24 hours following the initial veterinary evaluation of abdominal pain. Excluding horses that died within 24 hours,
the median survival was 54 days (range: 1 day to 7.6 years). One year after the first colic episode 72.5% of 10,588
horses for which follow-up data was available were still alive. For each of the following five years survival was >90%.
For non-survivors in the laparotomy group, the median survival was two days (eight days after excluding those dead
within 24 hours). Horses in the colic group were significantly more likely to die during any of the five years follow-up
than the control population (p<0.0001).
Conclusions
We have demonstrated the use of text mining and data extraction from EMRs for investigating the prevalence of
colic in a large equine population. The average proportion of colic cases undergoing surgery in the database was
8.9%. Interestingly, a significantly greater proportion of colic cases underwent surgery in the most recent two years
of data (2011-2012) when compared to 2007-2009.The results of this study have demonstrated the significant
negative effect of colic overall on equine survival. Potential limitations of this study include the effects of case
definition and completeness of records e.g. horse movement, data input errors. Nevertheless, further analyses of
these data and others like them to identify prevalence of specific diseases, risk factors for colic and death are likely
to provide significant insight in the next few years.
Acknowledgments
Supported by the John Crawford Endowment Fund, University of Glasgow and a RCVS Knowledge Target Grant.
References
Lam, K., Parkin, T., Riggs, C., Morgan, K. (2007) Use of free text clinical records in identifying syndromes and
analysing health data. The Veterinary Record 161, 547–551
Mair, T.S., Smith, L.J. (2005) Survival and complication rates in 300 horses undergoing surgical treatment of colic.
Part 3: Long-term complications and survival. Equine veterinary journal 37, 310–314
Muñoz, E., Argüelles, D., Areste, L., Miguel, L.S., Prades, M. (2008) Retrospective analysis of exploratory laparotomies
in 192 Andalusian horses and 276 horses of other breeds. The Veterinary record 162, 303–306
Oswald, J., Love, S., Parkin, T.D.H., Hughes, K.J. (2010) Prevalence of cervical vertebral stenotic myelopathy in a
population of thoroughbred horses. Veterinary Record 166, 82–83
3.7 Risk factors for colic in horses that display crib-biting behaviour.
Archer, D.C., Escalona, E.E.
Institute of Infection and Global Health, University of Liverpool, Leahurst Campus, Neston, Wirral. CH64 7TE Tel:
(+44) 0151 794 6041, Fax: (+44) 0151 794 6034 Email: [email protected]; Section Computational and Systems
Medicine, Division of Surgery and Cancer, Faculty of Medicine, Imperial College London, Sir Alexander Fleming
Building, London SW7 2AZ, United Kingdom.
Email: [email protected]
Background
Crib-biting and windsucking (CBWS) are two common forms of equine stereotypic behaviour. Horses that display
CBWS behaviour have been shown to be at increased risk of a history of colic (Malamed et al. 2010) and recurrence
of colic (Scantlebury et al. 2011). CBWS behaviour has also been identified to increase the risk of two specific forms
of colic; simple colonic obstruction distension colic (Hillyer et al. 2002) and epiploic foramen entrapment (Archer et
al 2004, Archer et al. 2008). However, at present there is no information about the prevalence of colic in horses
within a general (managed) population of horses that display CBWS behaviour nor about factors that place these
horses at altered risk of colic.
Objectives
The aims of the present study were to determine the prevalence of colic within a general population of horses in the
UK that display CBWS behaviour and to identify horse- and management-level risk factors for history of colic.
Methods
Owners /carers of horses/ponies in the UK that display CBWS behaviour were invited to participate in a
questionnaire-based survey about the management and health of these horses. Participants were recruited via
adverts placed in the equine lay press, online equestrian forums and the via the Philip Leverhulme Equine Hospital
website. Adverts were also emailed to yards and clubs affiliated with the British Horse Society and were given to
local farriers, livery yards, veterinary surgeons and riding instructors. These adverts contained a clear description of
CBWS behaviour and no reference was made to any potential relationship between these forms of behaviour and
colic. A questionnaire was mailed to volunteers that asked owners / carers to provide information about the
following: horse / pony signalment, use and duration of ownership; behaviour; stabling and turnout management
routine; nutritional management; history of colic; routine health care; medical history; owner / carer comments on
crib-biting and windsucking behaviour. The study was approved by the University of Liverpool Veterinary Research
Ethics Committee. Data from returned questionnaires were entered onto a computer database. Variables considered
a priori as possible risk factors for colic based on previous epidemiological studies investigating colic and CBWS
behaviour were screened for univariable association with outcome using a Chi-squared test for categorical variables
and a univariable logistic regression model for continuous variables. Two outcomes were investigated: a known
history of colic during ownership / care of the horse (colic ever) and a history of colic in the previous 12 months.
Multivariable logistic regression was used to identify associations between horse- and management-level variables
and these outcomes.
Results
Data were obtained for 367 horses. One or more episodes of colic had been observed in 130 horses (35.4% of horses
in the study). A total of 672 colic episodes were reported by the owners / carers of these horses (range 1-50 colic
episodes; mean 5.25). Thirteen colic episodes were reported to have required surgical intervention in 12 horses
(1.9% of all colic episodes); it was not possible to determine reliably from the owner / carer the specific cause of colic
in these cases. Where the horse / pony had been in that persons care over the previous 12 months (n=331), colic had
been observed in 67 horses (20.2%) during that time. A total of 126 colic episodes were reported in the preceeding
12 months (range 1-8, mean 1.88) of which veterinary attendance was required in 69 (54.8%) episodes. Increased
duration of ownership (OR 1.02, 95%CI 1.01-1.02, P<0.001), increased duration of stabling in the Autumn months
(September-November, OR 1.04, 95%CI 1.003-1.08, P=0.035), CBWS behaviour associated with eating forage (OR
2.17, 95%CI 1.25-3.74, P=0.006) and horses fed haylage (OR 2.08, 95%CI 1.20-3.60, P=0.008) were associated with
increased risk of a history of colic (ever). Increasing severity (frequency) of CBWS behaviour as perceived by the
owner / carer (OR 1.24, 95%CI 1.10-1.40) and increased duration of stabling in the Autumn months (OR 1.05, 95%CI
1.01-1.10, P=0.016) were associated with increased risk of colic in the previous 12 months.
Conclusions
This study has demonstrated a higher prevalence of colic in a population of horses that display CBWS than would be
expected in the general (managed) horse population. The results of this study can be used to identify horses that
display CBWS who may be at increased risk of colic. In addition risk of colic might be reduced by modifying stabling
and feeding practices.
Acknowledgements
We are very grateful to Claire Okell for assistance with preliminary analysis of the data. This study was funded by the
Department of Epidemiology and Population Health, University of Liverpool. EE is currently funded by the Horserace
Betting Levy Board. We are also very grateful to the horse owners and carers who kindly participated in this study
and to colleagues at the University of Liverpool for their support.
References
Archer, D.C., Freeman, D.E., Doyle, A.J., Proudman, C.J., Edwards, G.B. (2004) Association between cribbing and
entrapment of the small intestine in the epiploic foramen in horses: 68 cases (1991-2002). Journal of the American
Vet. Med. Assoc. 224, 562-564.
Archer, D.C., Pinchbeck, G.L., French, N.P., Proudman, C.J. (2008) Risk factors for epiploic foramen entrapment colic
in a UK horse population: A prospective case-control study. Equine vet. J. 40, 405-410.
Hillyer, M.H., Taylor, F.G.R., Proudman, C.J., Edwards, G.B., Smith, J.E., French, N.P. (2002) Case control study to
identify risk factors for simple colonic obstruction and distension colic in horses. Equine vet. J. 34,455-463.
Malamed, R., Berger, J., Bain, M.J., Kass, P., Spier, S.J. (201) Retrospective evaluation of crib-biting and windsucking
behaviours and owner-perceived behavioural traits as risk factors for colic in horses. Equine vet. J. 42, 686-692.
Scantlebury, C.E., Archer, D.C., Proudman, C.J., Pinchbeck, G.L. (2011) Recurrent colic in the horse: Incidence and risk
factors for recurrence in the general practice population. Equine vet. J., 43,81-88.
3.8 Patient characteristics, diagnostic findings and short term survival of horses with
gastrosplenic or epiploic foramen entrapments.
Kilcoyne, I., Dechant, J.E., Nieto, J.E.
William R. Pritchard Veterinary Medical Teaching Hospital, University of California-Davis, Davis, California 95616.
Deparment of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis,
California 95616. Tel: (001) 530 752 0290.
Email: [email protected]
Background
Few studies regarding the prevalence, predisposing factors, and clinical findings of horses presenting with
entrapment of small intestine within the gastrosplenic ligament have been reported in the literature.
Objective
To review cases presenting with entrapment of intestine in the gastrosplenic ligament and compare the signalment,
diagnostic findings, complications following surgery and short-term outcome with epiploic foramen entrapments of
the small intestine.
Methods
Records were reviewed for horses presenting to the Veterinary Medical Teaching Hospital between 1994 and 2012
for colic. Horses were included if a definitive diagnosis of a gastrosplenic ligament entrapment or epiploic foramen
entrapment was diagnosed at surgery or at post-mortem examination. Signalment was compared to the total
hospital colic population, and clinical findings were compared between gastrosplenic and epiploic foramen
entrapments using t-tests or chi-square tests, as appropriate. Significance was p<0.05.
Results
Forty-three horses with intestinal herniation through the gastrosplenic ligament and 73 horses with herniation
through the epiploic foramen were included in the study. Geldings were over-represented in both groups. Mean
presenting heart rate and systemic and peritoneal lactate were significantly higher for horses with epiploic foramen
entrapment than those with gastrosplenic entrapment. Survival to discharge was similar for horses following surgical
correction of gastrosplenic ligament or epiploic foramen entrapment.
Conclusions
Horses with gastrosplenic ligament entrapments are similar to epiploic foramen entrapments in regards to age and
gender predisposition. Despite differences in admission parameters, survival to discharge is comparable between
groups following surgical correction.
3.9 Establishing clinical guidelines for the treatment of equine colic in developing
countries.
Curran, M.L., Stringer, A.P., Harry, J., Freeman, S.L., Burford, J.H.
School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington, Leicestershire
LE12 5RD Tel: (+44) 115 951 6640
Email: [email protected]
Background
Colic is a major cause of mortality and morbidity amongst the estimated 15.5 million equids within the developed
world; however, no data is available for the prevalence or impact of this disease amongst the 110 million working
equids (Food and Agricultural Organisation, 2013). Furthermore, the numbers of working animals are increasing as
their importance is elevated amongst rising human population and an ever changing environment (Pritchard 2010).
Current colic literature generally involves referral cases seen by European and American veterinary hospitals. This
research has little direct relevance to the equine population in the developing world where treatment is constrained
by a lack of facilities and drug availability combined with differing cultural values and financial concerns of these
animal’s owners. In addition it is likely that the causes of colic will differ significantly. The high numbers of working
equids worldwide mean that the largest positive impact on equine welfare may be through targeted research and
application of evidence-based medicine within this population.
Objectives
This pilot study was performed with two primary objectives:

To identify the factors associated with the presentation, diagnosis and treatment of colic in developing
countries that may not have been anticipated from current colic literature.

To develop a practical and relevant recording system to allow data collection on cases of colic in working
equids.
These data will be used to develop a larger prospective study which can be used to develop recommendations for
Standard Operating Procedures (SOPs) for diagnostic tests and treatments in relevant countries and to identify risk
factors for colic in working equids which can be used in owner education programmes by equine charities. Together
these may bring about a reduction in the incidence of colic, and a more rapid resolution of the condition.
Methods
The pilot colic assessment was completed in two Moroccan clinics (Marrakech and Chemaia) run by the Society for
the Protection of Animals Abroad (SPANA) between 27th July and 31st August 2013. This form was completed for
every case presenting with clinical signs consistent with colic. The methodology reported by Curtis et al. (2014) was
used as the basis for the recording forms which were translated into French.
A focus group was also conducted during a yearly North African regional congress organised by SPANA. In total 24
participants representing Morocco, Tunisia, Mauritania, Senegal and Mali were involved in open discussion about
the project.
Results
A total of 22 working animals (12 horses, 7 mules and 3 donkeys) were presented for colic during the study period.
The majority were presented with vague and undetailed histories and had commonly been suffering colic for several
days before veterinary attention was sought. Owners were also rarely able to provide an accurate age or estimate
when or if dental and anthelmintic treatment had been performed. Rectal examination was carried out in the
majority of cases (17/22) with nasogastric intubation for both diagnostic and therapeutic reasons (12/22), faecal egg
count (10/22), basic haematology (PCV/TP; 10/22) and abdominal paracentesis (1/22) being performed less
frequently. Eighteen animals received flunixin meglumine, and seven were treated with ivermectin. Five cases were
hospitalised in order to administer intravenous fluid therapy. No diagnosis was given in 50% of cases (11/22) with
intestinal parasitism being the most common clinical diagnosis reported (6/22).
The focus group identified that the most common causes of colic in the population of animals that they treated was
intestinal parasitism (11/24) and impaction (7/24); however, cases of impaction, in their experience, were almost
always due to ingestion of foreign or plastic material
Conclusions
This study has identified several key differences between the aetiology of colic in the developed world and in the
working equine population. A wide-ranging prospective study incorporating these factors is essential to develop our
understanding of the epidemiology of colic in the developing world. The clinical approach and therapeutics available
are constrained by a multitude of factors including resources available, economic pressures, and the standards of
education and cultural values of the animal’s owners. Consequently focused research and local knowledge is
essential to deliver improved standards of welfare.
Acknowledgements
Supported by a grant from the BVA Overseas Travel Group and by The Society for the Protection of Animals Abroad.
References
Curtis, L., Curran, M.L., Bayes, T.C., England, G.C.W., Burford, J.H. and Freeman, S.L. (2014) Prospective study of
primary assessment of equine colic: Part 1: Study population and case presentation. Submitted as an abstract to The
Eleventh Equine Colic Research Symposium.
Food and Agricultural Organisation (2013) [Online] available from: http://www.fao.org/statistics/en/ [Accessed
14/11/2013]
Pritchard JC. (2010) Animal traction and transport in the 21st century: getting the priorities right. Vet J. 186(3): 271-4
3.10 Retrospective evaluations of medical and surgical treatment of colic cases in a
veterinary teaching hospital over a period of 15 years.
Van den Boom, R., Sloet van Oldruitenborgh-Oosterbaan, M.M.
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 114, 3584CM, Utrecht,
The Netherlands. Tel: (+31)030 2531350 Fax: (+31)030 2537979.
Email: [email protected]
Background
Colic is a common reason for veterinary consultation and the most common reason for equine admission to the
Veterinary Teaching Hospital (VTH) at Utrecht University. In order to provide owners with prognostic advice on
admission it is important have evidence from previous cases. For example, the short-term survival of surgical
treatment of strangulating small intestinal cases at our hospital at the end of the 20th century was shown to be 50%
(Van den Boom and Van der Velden 2000). Furthermore, it is important to know whether clinical and/or biochemical
parameters (such as results of blood examination) can help to guide the prognostic decision making process in colic
cases.
Objectives
The objectives of this study were to compare, in three different one-year periods, over the last 15 years:

the number of colic cases (total and as a percentage of total patient numbers) admitted to the internal
medicine section of the VTH at Utrecht University

the percentage of horses treated medically and surgically

the short-term outcome of medically and surgically treated cases

prognostic parameters for survival
Methods
The patient records of all colic patients admitted between November 1st 2012 and October 31st 2013 (period A) were
reviewed. Breed, age, heart rate, plasma lactate concentration, packed cell volume (PCV), white blood cell (WBC)
count and blood pH at admission, diagnosis, treatment (none, medical or surgical) and outcome were recorded. The
number of colic cases was recorded per month and compared to the total number of horses admitted to the hospital
in the same month. The percentages of horses treated medically and surgically, or not treated were calculated. For
each category of treatment statistical analysis was performed to determine whether there was a significant
difference between survivors and non-survivors in age, heart rate or biochemical parameters. Results for period A
were compared to those obtained at our VTH during 2006-2007 (period B, Sloet van Oldruitenborgh-Oosterbaan
2008) and during 1999-2000 (period C, Van der Linden et al. 2003)
Results
During the study period 867 horses were admitted; 311 (36%) of these were admitted for colic treatment (table 1).
Twenty–two percent of these horses were cases treated surgically and 12% were not treated at all. The short-term
survival for surgically treated colic cases was 60%, while the survival in medically treated cases was 86%. In the
category of medically treated colic cases the heart rate (44±14 vs 58±22 bpm, p=0.001) and plasma lactate
concentration (1.2±0.7 vs 2.3±2.6 mmol/l, p=0.001) differed significantly between survivors and non-survivors (table
2).
Conclusion
The number of horses admitted has fallen considerably since 1999-2000 but has remained more or less constant
since then, as has the percentage of colic horses (table 1). The percentage of colic cases treated surgically has
decreased slightly and the percentage of horses not treated increased slightly; both effects could be a result of the
economic crisis. The plasma lactate concentration proved to be useful as a prognostic indicator, which is in
accordance with findings during period B (table 2) and those reported by Delesalle et al (2007). During period C only
the heart rate (of the parameters recorded in the present study) was significantly associated with survival, as was
the case during the present study period.
References
Delesalle, C. et al. (2007) Determination od lactate concentrations in blood plasma and peritoneal fluid in horses
with colic by an Accusport analyser. J. Vet. Int. Med. 21, 293-301.
Sloet van Oldruitenborgh-Oosterbaan, M.M. (2008) Blood-lactate concentration and prognosis in equine gastrointestinal colic. Proceedings International Veterinary Congress Voorjaarsdagen, Amsterdam, NL, p.328.
Van den Boom, R. and Van der Velden, M.A. (2000) Short and long-term evaluation of strangulating small intestinal
colic in the horse. Vet. Quarterly 23, 109-115.
Van der Linden, M.A., Laffont, C.M. and Sloet van Oldruitenborgh-Oosterbaan, M.M. (2003) Prognosis in Equine
Medical and Surgical Colic. J. Vet. Int. Med. 17, 343-348.
Wednesday 9th July
4. Microbiome and Physiology
4.1 Microbiome of the Thoroughbred racehorse and response to dietary amylase
supplementation.
Proudman, C.J., Hunter, J., Turner, C., Escalona, E., Darby, A.
School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey. Gastroenterology
Research Unit, Addenbrooke’s Hospital. Department of Life, Health and Chemical Sciences, Open University. Section
of Computational and Systems Medicine, Division of Surgery and Cancer, Faculty of Medicine, Imperial College
London. School of Biological Sciences, University of Liverpool.
Email: [email protected]
Background
The horse is a hindgut fermenter that has evolved to survive on a low-energy, high-fibre diet. Caecal and colonic
microbiota are critical to the digestion of structural carbohydrate and production of short chain fatty acids as an
energy source. The intestinal ecosystem that has evolved to support the horse’s nutritional requirements has been
usurped by racehorse trainers who require energy expenditure far in excess of that provided by fibre digestion. The
addition of starch, in the form of cereals, to the diet of racehorses satisfies the high energy demands of extreme
exercise but has been identified as a risk factor for intestinal dysfunction. Endogenous amylase production is low in
horse relative to other species; it is hypothesized that this is a “bottleneck” in equine carbohydrate digestion. In this
study we use 454 pyrosequencing of 16S rRNA genes to characterize the microbiome of 8 Thoroughbred (Tb)
racehorses and study the response to dietary supplementation with exogenous amylase.
Methods
Faecal samples were collected from 8 castrated, Tb racehorses in full training. A second sample was collected from
all 8 horses six weeks after commencement of twice daily dietary supplementation with an amylase-rich malt
extract, designed to enhance pre-caecal digestion. Amplicons for the V1-V3 region of the 16S rDNA gene were
multiplexed and sequenced on the 454 resulting in ~25,000 reads per sample.
Results
The communities were composed of an equal balance between Bacteroidetes, and Firmicutes with a ~5%
contribution from other bacterial phyla. The number of observed OTUs sharing ≥97% nucleotide sequence identity in
human faeces has an upper range of 2000 OTUs [1], in our racehorse population the observed range [methodology
used in 1] was between 6000 – 8000 OTUs. This difference in diversity in the horse gut was driven by the large
number of singleton and doublet OTUs present in the horse gut communities. Horses showed no significant change
in the number of OTUs observed after diet supplementation, but significant changes in the relative abundance of
both Bacteroidetes and Firmicutes families, such as Prevotellaceae and Veillonellaceae, were observed.
Conclusions
We demonstrate a highly diverse and complex faecal microbial community in Tb racehorses, and we characterize
significant shifts in community profile following dietary supplementation with amylase. These changes may be
beneficial to intestinal health. Factors influencing the large number of rare taxa identified may include: i) large intake
of food borne microbiota (~15 kg of food per day), ii) large niche diversity in the horse’s voluminous hindgut (>150l)
and iii) functional requirements of hindgut fermentation.
Acknowledegments
Sequencing work was funded by a Bluesky Research grant from the Royal College of Veterinary Surgeons Charitable
Trust. Ebony Escalona is in receipt of a Horserace Betting Levy Board Research Training Scholarship.
References
Yatsunenko, T. et al., 2012. Human gut microbiome viewed across age and geography. Nature 486, 222-227.
4.2 Metabonomic characterisation of the Thoroughbred racehorse.
Escalona, E.E., Merrifield, C.A., Leng, J., Swann, J.R., Dona, A.C., Produman, C.J.,
Holmes, E.
Section of Computational and Systems Medicine, Division of Surgery and Cancer, Faculty of Medicine, Imperial
College London, Sir Alexander Fleming Building, London SW7 2AZ, UK
School of Veterinary Medicine, Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey, GU2
7TE, UK
Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, Berkshire, RG6 6AH, UK
Background
Colic is a complex condition with multiple aetiological components, one of which is thought to relate to diet and the
microbiome. This is a complex system to study in vivo, however new technology is starting to permit this. Gut
microbial co-metabolites are present in a number of biological samples and their metabolic profiles provide a
window into this largely unknown yet essential second genome. Metabonomics is the study of low-weight metabolic
products from biological fluids and tissues using high-resolution spectroscopic techniques, such as 1H Nuclear
Magnetic Resonance (1H-NMR). The resultant metabolic profiles can be interpreted along with metadata to aid the
discovery of biomarkers associated with disease or intervention. However, the use of this technology within equine
research is limited and there is paucity in baseline, ‘normal’ data.
Objectives
Before assessing abnormal conditions such as colic we must first understand the normal variability of metabolic
phenotypes amongst healthy populations. Our primary objective was to 1) create a metabolite atlas for common
biofluids (plasma, urine and faeces) and assess metabolite variability within biofluids. 2) Evaluation of major sources
of metabolic variation within a normal in-training racehorse population including: management, medication, age,
exercise and behaviour was also explored and 3) a pilot study was conducted to investigate the metabolite
correlation with equine oral stereotypies (EOS), a known risk factor for colic.
Methods
Metabolite assignment was achieved using samples from a pilot study of 7 racehorses via a range of 1D and 2D
experiments. In-house and online databases, reference to published literature and statistical total correlation
spectroscopy (STOCSY) was also used to aid assignment. A longitudinal study was conducted with 32 in-training
racehorses from 4 yards weekly. Urine and faecal samples were collected weekly and plasma fortnightly. Biofluids
were analysed using 1H-NMR spectroscopy and metabolic variation was explored using unsupervised (PCA) and
supervised multivariate analysis (MVA).
Results
Metabolite atlas: 102 metabolites were identified across three biofluids using an array of 2D NMR spectroscopy
techniques. Urine was the most metabolite abundant biofluid, with 65 assigned metabolites, and provided a window
into gut microbial co-metabolism with metabolites such as hippurate, p-cresol glucuronide and phenylacetylglycine
(PAG).
Longitudinal metabolic variation: Yard, treatment, exercise and behaviour were all sources of metabolic variation
amongst samples. For example, relative levels of urinary hippurate clustered samples into yard type and a horse that
had received oral antibiotics deviated away from the ‘normal’ population visualised by urinary and faecal PCA. This
was due to changes in gut microbial co-metabolites. Interestingly this horse returned to its baseline metabolic
coordinate within 2 weeks of cessation of treatment.
Pilot EOS study: Biomarker discovery with regards to behaviour was explored in a pilot study investigating one yard
from which 8 horses were serially sampled. Orthogonal partial least squares discriminant analysis (O-PLS-DA) models
demonstrated good separation and predictive ability (R2Y 88% and Q2Y 61%) and links to gut microbial co-
metabolism was evident, namely quinate, which was relatively increased in EOS. Faecal and plasma samples from
the same horses also revealed metabolic differences between EOS and controls.
Conclusions
Despite variation in age, location and training regime, this study provides good evidence that the Thoroughbred
racehorse population provides a robust platform for future interventional and mechanistic studies of colic. The study
also demonstrates the utility and sensitivity of ‘omic approaches in investigating equine intestinal microbiota. It
provides essential data on normal variation in the equine metabonome and suggests differential levels of microbial
metabolites and bacterial abundances in horses that demonstrate EOS, which is a novel finding in this field. This
baseline information can now be used to compare colic-related variation and has the potential to provide
mechanistic information that will better inform treatment.
Acknowledgments
Supported by a grant from the Horserace Betting Levy Board
References
Nicholson, J.K., Lindon, J.C. Holmes, E. (1999) ‘Metabonomics’: understanding the metabolic response of living
system to pathophysiology stimuli via multivariate statistical analysis of biological NMR spectroscopic data.
Xenobiotica 29, 1181-1189.
4.3 Identification of a core bacterial community in the large intestine of the horse,
including different diets and stability over time.
Dougal, K., Harris, P.A., Girdwood, S., Pinloche, E., de la Fuente, G., Geor, R.J., Nielsen,
B.D., Schott II, H.C., Elzinga, S., Argo, C., Curtis, C.G., Newbold, C.J.
Institute of Biological Environmental and Rural Sciences, Aberystwyth University, Penglais, Aberystwyth,Ceredigion.
SY23 3DA
Waltham Centre for Pet Nutrition, Melton Mowbray, Leicestershire. LE14 4RT.
Michigan State University, Department of Animal Science, East Lansing, Michigan. USA
University of Liverpool, Department of Obesity and Endocrinology, Faculty of Health and Life Sciences, Leahurst
Campus, Chester High Road, Neston, Wirral CH64 7TE
Email: [email protected]
Background
The presence of a core microbiome in the gut (i.e. key microbes that are present in all or the majority of individuals
within a population) has been much debated in human literature. However little attention, has been given to the
question of whether horses have a core gut microbiome. It has been suggested that if a core community could be
identified acrossall healthy members of a species this may provide a basis for disease diagnosis, prevention and
possibly provide therapeutic targets (1,2). Here we summarise two published studies and one unpublished study to
define both the size and nature of the core population within the equine gut microbiome.
Methods
DNA was extracted from freeze dried samples using QIAGEN QIAamp® DNA stool mini kits (Qiagen Ltd.,UK.). 454pyrosequencing amplification of the V1-V2 regions of 16SrDNA was performed. The CD-HIT-OTU pipeline was used
to remove low quality sequences and cluster into OTUs. Taxonomic classification of OTU’s was carried out using the
Ribosomal Database Project (RDP) Classifier.
Study 1: Samples were taken from the terminal ileum and 7 regions of the large intestine of 5 Thoroughbred horses
and 5 New Forest ponies euthanised for non-research purposes.
Study 2: Faecal samples for microbiological investigation were collected as part of a wider nutritional study carried
out at Michigan State University (USA) (3). Seventeen horses (8 adult, 9 elderly > 19 years) each underwent 3 dietary
treatments (high fibre, fibre plus starch supplement and fibre plus oil supplement) as part of a modified Latin Square
design.
Study 3: Faecal samples were obtained as part of a research trial undertaken at the University of Liverpool veterinary
department (4). Samples were obtained from twelve ponies and horses during week 10 and week 16 of the trial
providing two distinct time points on a standardised diet.
Results
Study 1: A core community (OTUs found in all animals) was identified in every gut region. The core in the large
intestine was made up of around 30 OTUs (5-15% of the total number of sequences) and showed a different pattern
to that in the ileum where a much smaller number of OTUs (7 OTUs) were present (32% of sequences). In the large
intestine each individual OTU making up the core was present in low abundance (less than 1% of the total).
Study 2: A reduction in diversity was found in the elderly horse group but no OTUs were significantly different
between age groups. Significant differences between diets were found at an OTU level (52 OTUs). For the forage
diet we found a core of 30/2934 OTUs (15.9% of all sequences) present in all horses. However the core associated
with the oil supplemented diet was smaller (25/3029 OTUs, 10.3%) and the core associated with the starch
supplemented diet was even smaller (15/2884 OTUs, 5.4%). The core associated with samples across all three diets
was extremely small (6/5689 OTUs, 2.3% of sequences) and dominated by the order Clostridiales, with the most
abundant family being Lachnospiraceae.
Study 3: A core community was identified and compared for both sampling periods. The size of the core identified
was 79 OTUs accounting for 30.2% of the total sequences in period 1, and 56 OTUs accounting for 20.3% of the total
sequences in period 2.
Conclusions
We have shown for the first time that a phylogenetic core bacterial community exists in all regions of the large
intestine of healthy horses. This core community is smaller than found in the rumen of the cow (5) and unlike most
other core communities that have been identified from other environments (6) is not dominated by any particular
OTUs. In conclusion, the presence of a core bacterial community in the intestine of the horse that is made up of
many low abundance OTUs may explain in part the susceptibility of horses to digestive upset.
Acknowledgements
This project is funded by a BBSRC CASE studentship
References
1. Jalanka-Tuovinen J, Salonen A, Nikkilä J, Immonen O, Kekkonen R et al. (2011) Intestinal microbiota in healthy
adults: Temporal analysis reveals individual and common core and relation to intestinal symptoms. PLOS ONE
6(7): e23035.
2. Shade A, Handelsman J (2012) Beyond the venn diagram: the hunt for a core microbiome. Environ Microbiol
14(1): 4-12.
3. Elzinga S, Nielsen B, Scott H et al.(2011) Effect of age on digestibility of various feedstuffs in horses. J Equine Vet
Sci 31: 268-269.
4. Argo C.McG., Curtis G.C., Grove-White D. et al. (2012) Weight loss resistance: A further consideration for the
nutritional management of obese Equidae. The Veterinary Journal. 194:179-188.
5. Jami E, Mizrahi I (2012) Composition and similarity of bovine rumen microbiota across individual animals. PLOS
ONE 7(3): e33306.
6. Zaura E, Keijser BJF, Huse SM et al. (2009) Defining the healthy "core microbiome" of oral microbial
communities. BMC Microbiol 9: 259.
4.4 Comparison of the faecal bacteria population of equine grass sickness and matched
controls by next generation sequencing of bacterial DNA.
Leng, J., Escalona, E., Blow, F., Darby, A., Proudman, C., Swann, J.
Department of Food and Nutritional Sciences, University of Reading, Whiteknights, Reading, RG6 6AP. Tel:
01183786649
Email: [email protected]
Section of Computational and Systems Medicine, Division of Surgery and Cancer, Faculty of Medicine, Imperial
College London, London, SQ7 2AZ
School of Biological Sciences, University of Liverpool, Crown Street, Liverpool, L69 7ZB
School of Veterinary Medicine, Faculty of Health and Medical Sciences, Guildford, Surrey, GU2 7TE
Background
Equine grass sickness remains one of the few equine diseases where aetiology is not fully defined, definitive
diagnosis is invasive and the disease carries a poor prognosis. Whilst Clostridium botulinum has been associated with
the disease the impact of grass sickness on the overall structure of the gut microbiome is currently unknown. Here, a
metagenomic approach has been used to characterise the faecal microbiome of horses suffering from grass sickness.
This approach uses non-culture dependent methods to profile the whole faecal bacterial population allowing for
comparisons between discrete bacterial populations to be made. Using this approach the bacterial signatures of
horses suffering from grass sickness have been compared to those from matched controls and hospital controls. This
also allows for an insight on how this disease affects the equine gut bacterial ecosystem. Identification of an
abnormal microbiome structure in horses suffering from grass sickness may open new strategies for manipulating
specific bacterial populations to prevent disease onsent.
Methods
Faeces were collected from 13 horses with a positive histological diagnosis of equine grass sickness on admission to
the Philip Leverhulme Equine Hospital. These were matched with 14 samples collected from healthy, co-grazing
horses, and 6 hospital controls (horses later diagnosed with another form of colic). Faecal bacterial DNA was
extracted from all 33 faecal samples collected and the v4 region of the bacterial 16S rRNA gene was amplified by
PCR. DNA samples were cleaned and size selected before undergoing sequencing by MiSeq platform at the Centre
for Genome Research, University of Liverpool. Analysis of sequencing data was carried out using the QIIME analysis
software package and linear discriminant analysis effect size (Lefse) method.
Results
Bacterial diversity was found to be lower in the grass sickness horses compared to the matched controls and hospital
controls. The composition of the grass sickness faecal bacteria populations were also found clustering away from
hospital control and matched control gut bacterial populations (seen in PCA beta diversity plots). Visualisation of the
bacterial communities from individual horses highlighted the homogeneity of the matched control profiles, but
larger intergroup variation across grass sickness horses. Phylum-level comparisons between the three groups
identified notable differences. These included an increase in Fusobacteria, Proteobacteria and Bacteroidetes, and a
decrease in Firmicutes, Spirochaetes and Fibrobacteres in grass sickness faecal bacteria populations when compared
to healthy controls. These differences were explored at a deeper level of taxonomic classification using discriminant
analysis. The order Bacteroidia, bacterial species Veillonella parvula and the genus Aggregatibacter were seen to be
significantly higher in the group of grass sickness horses. In contrast, the microbiome of healthy horses was more
abundant in the bacterial family Spirochaetaceae, the genus Coprococcus and the genus Fibrobacter.
Conclusions
The faecal microbiome of horses with grass sickness significantly is different to that of non-affected cog-grazers both
in composition and diversity. These changes were unique to grass sickness, being significantly different to hospital
controls, suffering from other forms of colic. Interestingly Bacteroidia and Aggregatibacter have known pathogenic
capabilities and were significantly higher in grass sickness horses. These pathogenic groups of bacteria could
potentially have a role in the aetiology of grass sickness. There were some universal trends when looking at
differences at phylum level; including an increase in Bacteriodes and decrease in Firmicutes. Further exploration of
the changes in gut microbiome associated with this disease is indicated.
Acknowledgements
This research is funded by the Equine Grass Sickness Fund and The University of Reading.
4.5 Investigation of clostridium difficile toxins to experimentally induced duodenitis
proximal-jejunitis in horses.
Arroyo, L.G., Costa, M.C., Guest, B.B., Beaudoin-Kimble, M., Lillie, B., Weese, J.S.
Department of Clinical Studies (Arroyo, Guest, Beaudoin-Kimble) and Pathobiology (Costa, Lillie, Weese), Ontario
Veterinary College, University of Guelph, Guelph, Ontario, Canada N1G 2W1. Tel: 1+ 519-8238840 Fax: 1+ 519-7639544.
Email: [email protected]
Background
Duodenitis proximal-jejunitis (DPJ) is an acute sporadic disease in horses.1 Clinical signs include colic, depression,
fluid accumulation in the small intestine (SI) and stomach, ileus, and endotoxemia.1 The cause remains unknown;
however, a clostridial cause had been proposed because a large number of Gram-positive rods have been observed
on Gram stains of gastric reflux samples. Toxigenic strains of C. difficile have been isolated from the gastric contents
of 10/10 horses with DPJ versus 1/16 of controls2, suggesting that this organism may be a potential etiological
candidate for this disease. We hypothesized that C. difficile toxins can disturb the SI motility in horses leading to
ileus, and the development of the clinical signs of DPJ.
Methods
A toxigenic C. difficile strain (A+B+CDT+) isolated from the gastric reflux of a horse diagnosed with DPJ was grown in
brain-heart infusion broth for 37°C for 5-7 days using the dialysis bag method. The presence of toxins (A and B) in
the inoculum was confirmed using a commercial EIA (TOX A/B. TechLab; Blacksburg, VA, USA) and cell cytotoxicity
assay for toxin B. Six mature horses with normal clinical and clinico-pathological parameters were inoculated with
crude C. difficile toxins as follows. After a least 16h fasting, a 300 cm video endoscope was advanced into the
proximal segment of the duodenum. Horses 1 and 2 were inoculated with 0.5 L and 3 L of toxins, respectively. Horse
3,4,5 and 6 were administered 3L of concentrated toxins. Six litres of toxins were concentrated to 3L by
lyophilization. All horses were closely monitored for up to 48 hours or until euthanasia.
Physical examination were performed at -24, -1, 1, 2, 3, 4, 5, 6, 8, 10, and 12 hours, then every 4 hours for a total of
48 hours post-inoculation. Horses were monitored for changes in general demeanor, heart rate, respiratory rate,
rectal temperature, hydration status, gastrointestinal sounds and signs of pain. Blood for complete blood count,
biochemistry profile, plasma fibrinogen assay and abdominal fluid were collected before inoculation and euthanasia.
A trans-abdominal ultrasonography of the abdomen was performed in each horse prior to toxin administration, then
at 1, 3, 6, 12, 18 and 24 hours after challenge. Small intestine was identified at three sites and the number of
intestinal contractions was recorded at each site for a period of 2 minutes. Scanning was performed on the right side
of the abdomen in order to assess motility of the duodenum, and over the ventral abdomen to assess motility of the
jejunum and/or ileum in at least two different locations.
Tissue samples were collected from stomach, duodenum, jejunum, ileum, cecum and ventral colon, formalin fixed,
paraffin embedded and processed for routine histological analysis. This project was approved by the Animal Care
Committee of the University of Guelph and conformed to the standards of the Canadian Council on Animal Care.
Results
Clinically, horse 1, 4 and 6 remained normal throughout the observation period, while Horse 2 showed mild signs of
colic and ultrasonographically, a transient distention of the small intestine.
Horse 3 and 5 became depressed, tachycardic, tachypneic, pyrexic, and developed mild signs of colic within 6 hours
of inoculation and were euthanized at 9 and 12 hours respectively due the severity of clinical signs including
depression, tachycardia, tachypnea, dehydration and ileus. Distended (5-6 cm), amotile loops of small intestine
were observed 6 hours post-inoculation. Clinico-pathological changes included leukopenia and hemoconcentration.
Histologically horse 1 had no changes, consistent with the lack of clinical abnormalities. In horse 2, 4 and 6 the
changes were mild and the most consistent finding was vascular congestion, particularly prominent in the
duodenum, but also present in other sections of gut; neutrophils were noted occasionally. Horse 3 and 5 were the
most severely affected with significant vascular congestion, hemorrhage and edema with occasional neutrophils,
especially in the stomach and duodenal mucosa, but also to a lesser degree in the more distal small intestine. In
some sections small intestinal mucosa was flattened and/or mildly dysplastic and rarely fibrin was present in the
superficial villi.
Conclusions
Some of the clinical signs and histological lesions similar to those described for naturally occurring cases of DPJ were
observed in two of the horses inoculated with crude C. difficile toxins. A dose dependent response or individual
animal variation may play a role in the response to C. difficile toxins administration. The classic clinical syndrome of
DPJ was not reproduced by administering crude C. difficile toxins to horses; and the role of C. difficile as a potential
cause of DPJ remains elusive.
Acknowledgements
Supported by a grant from Equine Guelph.
References
1. White, N. A., II, Tyler, D. E., Blackwell, R. B, et al. (1987) Hemorrhagic fibrinonecrotic duodenitis-proximal jejunitis
in horses: 20 cases (1977–1984). J Am Vet Med Assoc. 190, 311–315
2. Arroyo LG, Stämpfli HR, Weese JS. (2006) Potential role of Clostridium difficile as a cause of duodenitis-proximal
jejunitis in horses. J Med Microbiol. 55, 605-608.
3. Tyler, D. E., White, N. A., Blackwell, R. B., et al. (1985) Pathology of equine duodenitis-proximal jejunitis (anterior
enteritis). In Proceedings of the Equine Colic Research Symposium, vol. 2. Lawrenceville, NJ: Veterinary Learning
Systems.
4.6 Microbiota transplantation for equine colitis: revisiting an old treatment with new
technology.
Mullen, K.R., Yasuda, Hitchener, G.R., K., Divers, T.J., Bicalho, R.C.
Department of Clinical Sciences, College of Veterinary Medicine, Cornell University, Ithaca, NY 14853 USA.
Harvard School of Public Health, Harvard University, Boston, MA 02115 USA. 3Department of Population Medicine
and Diagnostic Sciences, College of Veterinary Medicine, Cornell University, Ithaca NY 14853 USA. Tel: (+1) 607 253
3100 Fax: (+1) 607 253 3787
Email: [email protected]
Background
The equine large intestinal core microbiome is made up numerous low abundance bacterial families that provide
tremendous diversity and complexity (Dougal et al, 2013). Undifferentiated colitis in horses is associated with a
change in the fecal microbiota (Costa et al, 2012). Additionally, antibiotic administration is associated with a
decrease in cellulolytic bacteria in feces during administration and for at least one week post-treatment (Harlow et
al, 2013). Fecal microbiota transplantation (FMT) has gained widespread acceptance for treatment of recurrent
Clostridium difficile infection (CDI) in humans and was more successful than standard antimicrobial therapy (van
Nood et al, 2013). In humans with CDI, following FMT with frozen fecal bacteria from a healthy donor, similar fecal
bacterial taxa were found in donor and recipient samples (Hamilton et al, 2013). Anecdotally, veterinarians have had
success using FMT for acute and chronic diarrhea in horses. However, to the authors’ knowledge, posttransplantation fecal microbiota has not been investigated using next generation sequencing technology.
Objectives
We performed microbiota transplantation on adult horses with acute colitis with the primary objectives of (1)
determining the effects of transplantation on fecal consistency and clinical outcome and (2) comparing the
recipients’ pre and post-transplantation fecal microbiota to that of the donor.
Methods
Adult horses presenting to the Cornell University Equine Hospital for acute colitis and those that developed colitis
during hospitalization between December 2012 and June 2013 were eligible for inclusion. Horses were administered,
via gavage, a slurry of strained feces from a healthy donor or strained cecal contents from a healthy donor
euthanized for reasons unrelated to this study. All donor samples were Salmonella culture negative. Bacterial DNA
was isolated from donor samples and rectal swabs of the recipients collected daily until discharge, and 16s rRNA
genes were amplified and pyrosequenced.
Results
Four horses were included in the study. Two had histories of antimicrobial administration. All had negative
Salmonella fecal cultures and Clostridium difficile and C. perfringens toxin assays. Duration of diarrhea posttransplantation in the survivors ranged from 1 to 4 days. The bacterial abundances in all four recipient adult horses
were dominated (60-95%) by Ruminococcaceae, Lachnospiraceae, unclassified Bacteroidales, Lactobacillaceae and
Enterobactericeae both pre- and post-transplantation. The abundances of these five bacterial families were low (2030%) in both the cecal and fecal donor samples. The alpha diversities (uniqueness of bacterial species within sample)
were consistently lower in all four recipient horse samples compared to those of the donor samples.
Conclusions
Although the clinical response was favorable in 3 of the 4 sick horses, microbiota transplantation did not cause the
sick horses to adapt the microbiome of healthy donors as reported in humans following microbiota transplantation.
The failure of the recipients to establish the fecal microbiome of the donor does not rule out the potential clinical
benefit of the procedure. A large, randomized clinical trial is needed to better understand the impact of microbiota
transplantation on equine health and the gastrointestinal tract microbiome.
References
Costa M.C., Arroyo L.G., Allen-Vercoe E., et al. (2012) Comparison of the fecal microbiota of healthy horses and
horses with colitis by high throughput sequencing of the V3-V5 region of the 16S rRNA Gene. PLoS ONE 7(7): e41484.
Dougal K., de la Fuente G., Harris P.A., et al. (2013) Identification of a core bacterial community within the large
intestine of the horse. PLoS ONE 8(10): e77660.
Hamilton, M.J., Weingarden, A.R., Unno, T., et al. (2013) High-throughput DNA sequence analysis reveals stable
engraftment of gut microbiota following transplantation of previously frozen fecal bacteria. Gut Microbes 4:(2), 125135.
Harlow, B.E., Lawrence, L.M and Flythe, M.D. (2013) Diarrhea-associated pathogens, lactobacilli and cellulolytic
bacteria in equine feces: Responses to antibiotic challenge. Vet Microbiol 166(1-2), 225-232.
van Nood E, Vrieze A, Nieuwdorp M, et al. (2013) Duodenal infusion of donor feces for recurrent Clostridium difficile.
N Engl J Med, 368(5):407-15.
4.7 Transport of calcium and phosphate along the intestinal axis is affected by channel
inhibitors and a blocker of the paracellular pathway in horses.
Cehak, A., Schroder, B., Feige, K., Breves, G.
Department of Physiology, University of Veterinary Medicine Hannover, Bischofsholer Damm 15, 30173 Hannover,
Germany and Clinic for Horses, University of Veterinary Medicine Hannover, Bünteweg 9, 30559 Hannover,
Germany. Tel: (+49) 511 856 7628 Fax: (+49) 511 856 7687
Email: [email protected]
Background
Calcium and phosphate homoeostasis in horses has some unique characteristics compared to other species with the
intestinal absorption playing an important role in regard to calcium and phosphate balance in this species.
Dysregulated calcium and phosphate homoeostasis is often associated with diseases, particularly with acute
gastrointestinal disorders. So far the underlying mechanisms and regulation of calcium and phosphate transport
across the equine intestine have not been elucidated.
Objectives
The aim of the present study was to identify functional characteristics of the intestinal calcium and phosphate
transport by determining the effect of specific channel inhibitors and a blocker of the paracellular pathway on the
transport of radiolabelled calcium and phosphate across different intestinal segments in healthy horses using the
radioisotope tracer technique in Ussing chambers.
Methods
Six adult horses, four Warmblood Horses, one Thoroughbred Horse and one Crossbred Horse, four mares, one
gelding and one stallion (minimum age of 3 years, maximum age of 21 years) were included in the study. All horses
were free of intestinal diseases, had normal laboratory profiles, and were dewormed prior to the study. Tissue
samples of the duodenum, jejunum, cecum and dorsal colon were harvested within five minutes post mortem and
the stripped epithelium was placed in Ussing chambers and bathed in modified Krebs-Henseleit buffer solution (pH
7.4, 38°C, gassed with carbogen). Unidirectional flux rates of calcium and phosphate were calculated from tracer
fluxes in the presence and absence of the following inhibitors: triaminopyrimidine (TAP), a blocker of the paracellular
pathway, ruthenium red, a blocker of the intestinal calcium channel TRPV6, and phosphonoformic acid (PFA), a
blocker of the intestinal phosphate channel NaPiIIb. Mannitol flux rates were simultaneously determined in all
experiments for assessment of paracellular transport. Tissue viability was confirmed by continuously monitoring
tissue conductances (Gt) and short circuit currents (Isc) during the experimental period.
Results
The calcium channel inhibitor ruthenium red reduced calcium net flux rates across the duodenum and across the
cecum (p<0.05). Blocking the paracellular pathway by the addition of TAP resulted in decreased calcium net flux
rates across the jejunum (p<0.05). Basal calcium net flux rates differed between intestinal segments (p<0.001) with
calcium net flux rates being highest in the duodenum. In the jejunum, basal calcium flux rates varied depending on
preceding duodenal flux rates with high duodenal flux rates resulting in low jejunal flux rates. Net flux rates of
mannitol which is solely transported via the paracellular pathway were significantly lower than calcium net flux rates
across the duodenum, the cecum and the colon (p<0.05) indicating the existence of both paracellular and
transcellular calcium transport mechanisms in these segments.
Regarding phosphate transport, TAP significantly affected phosphate net flux rates across the jejunum and the
across the cecum (p<0.05 and p<0.01). PFA did not affect basal negative phosphate net flux rates. Basal net flux rates
were different along the intestinal axis (p<0.01) with no significant net flux rates across the duodenum, but with
negative net flux rate across the jejunal mucosa indicating capacity for phosphate secretion across the jejunum.
Mannitol net flux rates were different than phosphate net flux rates across the jejunum (p<0.001) and the colon
(p<0.05).
Conclusions
This study identified active and passive calcium and phosphate transport along the intestinal axis in horses. There
were distinct differences between intestinal segments in respective to absorptive and secretory capacities of the
intestinal mucosa. Furthermore the intestinal transport of calcium and phosphate was effectively modulated by the
addition of channel inhibitors and a paracellular blocker in vitro.
Acknowledgments
Supported by the German Research Foundation (DFG).
References
Cehak A. et al. (2009) Electrophysiological characterization of electrolyte and nutrient transport across the small
intestine in horses. J Anim Physiol Anim Nutr (Berl). 93:287-94.
Cehak A. et al. (2012) In vitro studies on intestinal calcium and phosphate transport in horses. Comp Biochem Physiol
A Mol Integr Physiol. 161:259-64.
Sprekeler N. et al. (2011). Expression patterns of intestinal calcium transport factors and ex-vivo absorption of
calcium in horses. BMC Vet Res.7:65.
Rourke KM. et al. (2010). Cloning, comparative sequence analysis and mRNA expression of calcium-transporting
genes in horses. Gen Comp Endocrinol. 167:6-10
Hwang I. et al. (2011). Tissue-specific expression of the calcium transporter genes TRPV5, TRPV6, NCX1, and PMCA1b
in the duodenum, kidney and heart of Equus caballus. J Vet Med Sci. 73:1437-44.
4.8 Effect of food deprivation on daily water requirements in healthy horses.
Freeman, D.E., Mooney, A., Giguere, S., Giskant, P., Burrow, J., Evetts, C.
University of Florida, College of Veterinary Medicine, Department of Large Animal Clinical Sciences, Box 100136,
Gainesville, FL 32610-0136, USA. Tel: (01) 352-258-5201, Fax: (01) 352-392-8289.
Email: [email protected].
Background
The current recommendation for fluid therapy in horses is to provide crystalloid fluids in multiples of a widely
accepted maintenance requirement (Boscan et al. 2007; Lester et al. 2013). This approach is flawed because: 1)
maintenance requirements were derived from fed animals, whereas many horses on fluids are not fed; 2)
overhydration can increase the risk of postoperative ileus, intraabdominal hypertension, and disturbed water and
electrolyte balance (Raftery et al. 2011; Lester et al. 2013).
Objectives
To determine the effects of food deprivation on voluntary water consumption, as a measure of maintenance water
requirements, and to correlate this with indices of dehydration.
Methods
Water intake, body weight, physical examination findings, and vital signs were recorded daily in 8 healthy horses
assigned 4 days of feeding and 4 days of food deprivation in a randomized crossover design. PCV, TP, electrolytes,
osmolality and triglycerides were measured daily in the trial periods and plasma and extracellular fluid volumes were
measured in the last 8 hours. Appropriately transformed data were analyzed with a two-way analysis of variance
(ANOVA) with repeated measures with time and feeding status as factors. Statistical significance was P<0.05.
Results
Food deprivation immediately and persistently reduced water consumption by ~13% of fed values. The most
significant indicator of dehydration was a mild elevation in TP in 3 horses that had diarrhea on the last day of food
deprivation.
Conclusions
These findings underscore the potential for overhydrating unfed horses when fluid therapy is guided by current
recommendations for maintenance needs.
Acknowledgements
Supported by the University of Florida, College of Veterinary Medicine, and Island Whirl Equine Colic Research
Laboratory.
References
1. Boscan, P., Steffey, EP. (2007) Plasma colloid osmotic pressure and total protein in horses during colic surgery.
Veterinary Anaesthesia and Analgesia 34, 408–415.
2. Lester, G.D., Merritt, A.M., Kuck, H.V., Burrow, J.A. (2013) Systemic, renal, and colonic effects of intravenous and
enteral rehydration in horses. J. Vet. Intern. Med. 27,554-566.
3. Raftery, A.G., Morgan, R.A., MacFarlane. P. Description of perioperative trends in plasma colloid osmotic
pressure in colic surgery with particular reference to lesion specific changes. Proc. 10th Equine Colic Research
Symposium, 2011, p. 121.
4.9 The effect of temperature changes on in vitro slow wave activity in the equine ileum.
Fintl, C., Hudson, N.P.H., Handel, I., Pearson G.T.
Norwegian School of Veterinary Science, Department of Companion Animal Clinical Sciences, PO Box 8146 Dep, 0033
Oslo, Norway (Fintl); Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Easter Bush
Veterinary Centre, Easter Bush, Roslin, Midlothian, EH25 9RG, UK (Pearson, Handel and Hudson).
Email: [email protected].
Background
Phasic contractions of intestinal smooth muscle cells are initiated and timed by the interstitial cells of Cajal (ICC)
through the generation of slow waves (Sanders 1996). Slow waves are rhythmic membrane potential fluctuations
which may result in a muscle contraction if the electrical threshold of the cell is exceeded (Sanders 1996). Various
inputs, including neuronal, mechanical and endocrine factors can condition the smooth muscle cell response to the
slow wave currents to either facilitate or reduce the possibility of these resulting in a muscle contraction (Horowitz
et al. 1999). Nevertheless, it is the frequency of slow waves that will determine the potential rate of intestinal
smooth muscle contractions. Factors that affect slow wave frequency may therefore also influence the contractile
activity of the intestinal tract. Kito and Suzuki (2007) demonstrated that temperature alterations significantly affect
in vitro slow wave frequency in mice small intestine. The effect of temperature on slow wave activity has not been
previously assessed in the horse. This may be of some clinical relevance during abdominal surgery where often
lengthy extra-abdominal gut exposure may result in significant cooling of intestinal segments. If this cooling has a
negative effect on slow wave activity, and consequently contractile activity, this may increase the risk of developing
post-operative ileus.
Objectives
To evaluate the effect of temperature changes on the in vitro slow wave activity of normal equine ileum using
intracellular microelectrode recording techniques.
Methods
A segment of ileum was collected immediately following euthanasia from 9 normal horses euthanased for clinical
reasons unrelated to the gastrointestinal tract. All samples were collected with the owners’ consent. Intestinal tissue
samples were cut into 1mm thick sections, pinned out on a Sylgard plate and superfused with warmed, oxygenated
Krebs solution. Intracellular recordings of smooth muscle cell membrane potential were made using glass
microelectrodes and all experiments were performed in the presence of a calcium channel blocker (1µM nifedipine)
to ensure stable impalements. The temperature of the tissue bath was altered during the course of the experiment
across a range of 27-41ºC and was continuously recorded using a temperature probe kept in the bath throughout all
experiments. All data were recorded and stored using a computer interfaced acquisition system (Power Lab 8SP). A
software package (LabChart Pro) was used to analyse the resting membrane potentials (RMP), amplitude and
frequency of slow waves.
Results
In all 9 horses slow wave frequency appeared to be approximately linearly related to the temperature over the range
studied increasing by 0.5 cycles/min for each 1 degree increase in temperature (p<0.001). The initial slow wave
frequency resumed when the temperature was returned to 37ºC. The recovery time appeared to be directly related
to the duration over which the temperature had been changed. There was no significant effect of temperature
change on RMP or slow wave amplitude, except for a negative correlation with slow wave amplitude in one case
Conclusions
In vitro slow wave frequency in the equine ileum is highly temperature sensitive. As post-operative ileus is a major
cause of morbidity and mortality in the horse, the negative effect of lower temperatures on slow wave, and
therefore contractile activity, should be considered. Minimising extra-abdominal gut exposure time and keeping the
temperature of the intestinal and abdominal lavage fluids at body temperature during colic surgery may facilitate
preservation or recovery of slow wave activity.
Acknowledgements
The Agricultural Agreement Research Fund, Norsk Rikstoto and the Research Council of Norway as part of the
Norwegian/Swedish research collaboration.
References
Horowitz, B., Ward, S.M. and Sanders, K.M. (1999) Cellular and molecular basis for electrical rhythmicity in
gastrointestinal muscles. Annu. Rev. Physiol. 61, 19-43.
Kito, Y. and Suzuki, H. (2007) Effect of temperature on pacemaker potentials in the mouse small intestine. Pflugers
Arch. Eur. J. Physiol. 454, 263-275.
Sanders, K.M. (1996) A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the
gastrointestinal tract. Gastroenterol. 111, 492-515.
4.10 Effects of ischaemia and reperfusion and effects of selective and nonselective
nonsteroidal anti-inflammatory drugs on the muscular inflammatory reaction in equine
jejunum.
Roetting, A.K., Franz, S., Hopster, K., Brehm, R.
Equine Clinic (A. K. Rötting, S. Franz, K. Hopster), Institute of Anatomy (R. Brehm), University of Veterinary Medicine
Hannover, Foundation, Bünteweg 9, 30559 Hanover, Germany, Tel: (+49) 511 9536500; Fax: (+49) 511 9536510.
Email: [email protected]
Background
Ischemia and reperfusion is a common type of injury in equine colic patients (Mair and Smith 2005). Cyclooxygenase
(COX)- inhibitors are routinely used in colic patients but non-selective COX-inhibitors can have negative effects on
mucosal healing (Campbell et al. 2000).
Objectives
Evaluation of effects of ischaemia and reperfusion and of selective and non-selective COX-inhibitors on jejunal
muscular inflammation.
Methods
In 12 horses experimental jejunal ischemia and reperfusion were induced twice in adjacent segments. During the
second ischaemia horses received either flunixin or firocoxib intravenously. Biopsy samples were taken before and
after each ischaemia and after each reperfusion. Histopathological evaluation focused on neutrophils and
eosinophils and on immunohistochemical identification of COX-1 and COX-2.
Results
Reperfusion resulted in neutrophilic infiltration more pronounced in the longitudinal muscle (p<0.0001) and included
adjacent un-manipulated jejunal segments (p<0.0001). COX-1 was identified in the circular muscle and did not
change after ischaemia and reperfusion. Flunixin reduced COX-1 after ischemia and reperfusion, firocoxib decreased
COX-1 after ischemia but not after reperfusion. COX-2 was not identified in the initial control sample. COX-2
increased in the longitudinal muscle after ischemia and reperfusion in both injured and adjacent un-manipulated
segments. No effects of COX-inhibitors on COX-2 were identified.
Conclusions
Muscular inflammation after ischemia and reperfusion included adjacent uninjured apparently healthy jejunum and
involved both neutrophilic infiltration and upregulation of COX-2 in the longitudinal muscle. This inflammation may
increase post-operative morbidity even when injured jejunal segments are resected. COX-inhibitors had little or no
measurable effects in our model.
Acknowledgements
Supported by K. Rhon (statistical analysis)
References
Campbell NB, Blikslager AT. The role of cyclooxygenase inhibitors in repair of ischaemic.injured jejunal mucosa in the
horse. Equine Vet. J. 2000; 332, 59-64.
Mair T, Smith L. Survival and complication rates in 300 horses undergoing surgical treatment of colic. Part 1: Shortterm survival following single laparotomy. Equine Vet. J. 2005; 37, 296-302.
4.11 Stem cells are retained in reduced numbers in equine strangulated small intestine.
Kinnin, L.S., Gonzalez, L.M., Blikslager, A.T.
North Carolina State University, College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA.
Tel: (919) 513-7726
Email: [email protected]
Background
Small intestinal strangulating obstruction results in progressive destruction of mucosal architecture, progressing
from the villi toward the base of the crypts where stem cells are thought to reside. Identification of stem cells
following injury may provide clues to the regenerative potential of ischemic-injured tissues.
Objective
To characterize (1) epithelial cell types within normal equine mucosa and, (2) changes to the stem cell zone in
ischemic-injured small intestine.
Methods
Mucosal biopsies were collected from healthy horses (n=10) and from resected small intestine from horses with
strangulating obstruction (n=6). Histomorphometry and immunofluorescence using antibodies against select cellular
markers were performed. Proliferating cells were labeled using an antibody against Proliferating Cell Nuclear Antigen
(PCNA), and stem cells were labeled with an antibody against Sex Determining region Y-box 9 (SOX9). Statistical
comparisons were performed using one way ANOVA (P<0.05 considered significant).
Results
All lineages of epithelial cells were identified in normal tissues, including stem cells and post-mitotic cell types.
Evaluation of strangulated tissue revealed severe injury to the mucosa, although proliferating (PCNA+) and stem cells
(SOX9+) were retained within the crypts. The margins of resected intestine appeared histologically normal, but there
was a significant decrease in the number proliferating cells (PCNA+) and stem cells (SOX9+) (P<0.05) as compared to
normal tissue.
Conclusions
The retention of proliferating and stem cells within strangulated tissue indicate marked resistance of these cells to
ischemia. Nonetheless, the significant reduction in stem cells within the resection margins suggest injured bowel
may benefit from therapies aimed at increasing activity of remaining stem cells following strangulation obstruction.
Acknowledgements
This work was funded by a generous grant from the North Carolina Horse Council. Additional support was provided
by the NIH T32 NIH/NCSU Comparative Medicine and Translational Research Training Program (CMTRTP)
T32RR024394. The authors would also like to thank the histopathology laboratory at NCSU College of Veterinary
medicine for their processing of all biopsy specimens.
4.12 Analysis of Soluble CD14 in Clinical Equine Cases Presented to a Referral Hospital.
Fogle, C., Blikslager, A., Jacobs, M., Edwards, A., Wagner, B., Fogle, J.
Department of Clinical Sciences and Department of Public Health and Pathobiology, 1052 William Moore Drive,
North Carolina State University, College of Veterinary Medicine, Raleigh, NC 27607. Tel: (919) 513-6315
Email: [email protected]
Department of Population Medicine and Diagnostic Sciences, College of Veterinary Medicine, Cornell University,
Ithaca, NY 14853
Background
The systemic release of bacterial lipopolysaccharide (LPS), known clinically as endotoxemia, is a major cause of
morbidity and mortality in horses suffering from gastrointestinal disease (Senior et al, 2011). Soluble CD14 (sCD14)
is released by activated macrophages in response to LPS-induced signaling through TLR4 and magnifies the early
inflammatory response to bacterial LPS.
Objective
We asked if sCD14 measurement could serve as a more reliable marker of endotoxemia when compared to
measuring LPS alone.
Methods
Twenty horses were classified as clinically endotoxic, and thirty-one horses were classified as clinically nonendotoxic. Horses were classified as clinically endotoxic if they had a heart rate >70, packed cell volume >45, and/or
a lesion likely to result in endotoxemia. sCD14 was measured using a cytometric bead assay and LPS was measured
using a Limulus amoebocyte lysate assay, both validated for the horse (Wagner et al, 2013; Senior et al, 2011).
Results
Using a receiver operator curve, a sCD14 value of ≥997 ng/mL was 70% sensitive and 71% specific for identifying a
clinically endotoxic horse. An LPS value of ≥17.1 EU/mL was 56% sensitive and 100% specific for identifying a
clinically endotoxic horse. These results suggest sCD14 may be a useful biomarker for the early detection of
endotoxemia in horses.
References
Senior J, Proudman C, Leuwer M, Carter S. (2011) Plasma endotoxin in horses presented to an equine referral
hospital: Correlation to selected clinical parameters and outcome. Eq. vet. J. 43, 585-591.
Wagner B, Ainsworth D, Freer H. (2013) Analysis of Soluble CD14 and its use as a biomarker in neonatal foals with
septicemia and horses with recurrent airway obstruction. Vet. Immunol. and Immunopath. 155, 124-128.
4.13 Clinical and Intestinal Histologic Features of Horses with Recurrent Colic.
Stewart, H.L., Engiles, J., Southwood, L.
New Bolton Center, University of Pennsylvania, 382 West Street Road, Kennett Square, PA 19348. Tel: (610) 4445800
Email: [email protected]
Background
The majority of horses diagnosed with colic have a good to excellent prognosis for short-term survival. It is generally
accepted that horses with a history of colic are more likely to suffer further episodes. Recurrent colic is emerging as
an important problem in the equine population; with the most recent report indicating a recurrence rate of 50 colic
events/100 horse years at risk (Scantlebury et al. 2011). In some cases, the cause of recurrent colic is apparent;
however, in the majority of horses the cause is not identified. Most of the studies completed to date have focused
on management practices that predispose horses to colic. There has been little work done investigating the clinical
and histologic features of horses with recurrent colic.
Objectives
The current study is a preliminary analysis of horses undergoing gastrointestinal (GI) biopsy at a referral hospital. The
objectives of this study were to compare the clinical features and histological findings of horses with recurrent colic,
acute/chronic colic, non-colic GI signs, or non-GI signs with systemic disease. Our hypotheses were that there would
be a higher proportion of horses with recurrent colic with histological evidence of inflammatory or infiltrative bowel
disease compared to horses with acute colic and that rectal biopsy would not be particularly useful for diagnosis of
the cause of recurrent colic.
Methods
The Pennsylvania Animal Diagnostic Laboratory Service (PADLS) database was reviewed for all adult (> 1 year old)
equine GI biopsies obtained between December 2006 and December 2013. Based on the historical information,
horses were classified as having (1) recurrent colic (at least one episode in the 6 months prior to the episode
prompting the GI biopsy); (2) acute (<3 days duration) or chronic (>3 days duration) colic; (3) non-colic GI signs (i.e.
weight loss, diarrhea, inappetence); or (4) non-GI signs with systemic disease (i.e. ventral edema, dull demeanor,
lymphadenopathy). The final gross and histological diagnosis was obtained as well as any other diagnoses. Diagnoses
were categorized as inflammatory, ischemic, neoplastic, other, or were undiagnosed. Abdominal sonographic and
gastroscopic findings were described. GI samples were categorized as being obtained via
gastroscopy/duodenoscopy, per rectum, during laparotomy, or at necropsy. Data were analyzed using a Fisher’s
exact test. Level of significance was p<0.05. Only significant data are presented.
Results
There were 136 intestinal biopsies submitted during the study period from 85 adult horses. Horses with recurrent
colic (n=25) had a diagnosis of inflammatory/infiltrative disease (~50%), neoplasia (~10%), other (~10%), or ischemic
disease (~5%), and ~25% were undiagnosed. Acute/chronic colic (n=21) was associated with inflammatory/infiltrative
disease (~30%), ischemic disease (~30%), neoplasia (~25%), or other (~5%), and ~10% were undiagnosed. Horses
with non-colic GI signs (n=35) had inflammatory/infiltrative disease (~40%), neoplasia (~20%), and ~40% were
undiagnosed. All horses with non-GI signs with systemic disease (n=4) had neoplasia.
Gastroscopy revealed ulceration in ~50% of the horses with recurrent colic, ~50% the horses with non-colic GI signs,
and ~50% the horses with a diagnosis of inflammatory/infiltrative disease. Thickened bowel was the most common
sonographic finding and most of these horses had either inflammatory/infiltrative disease or were undiagnosed.
Rectal biopsy was non diagnostic or followed up with laparotomy or necropsy in the majority (>60%) of horses.
Biopsies obtained with laparotomy were diagnostic in all cases.
Conclusions
In this preliminary study, inflammatory/infiltrative disease was a common finding in horses with various
manifestations of GI disease, particularly in horses with recurrent colic or non-colic GI disease. Only horses with
intestinal biopsies were included in this study; therefore, the proportion of horses with acute/chronic colic
diagnosed with inflammatory disease is likely overestimated because biopsies are not routinely taken in these
horses. Gastric ulceration was common in horses with recurrent colic and inflammatory/infiltrative disease and the
relationship between gastric ulceration and inflammatory/infiltrative disease warrants further investigation. Rectal
biopsies were typically not diagnostic in cases of recurrent colic. Laparotomy (or laparoscopy) with intestinal biopsy
is recommended in horses with recurrent colic, particularly with sonographic evidence of intestinal thickening.
Horses diagnosed with inflammatory/infiltrative disease are typically treated with systemic corticosteroids and longterm follow up of horses from this study surviving to hospital discharge is needed.
References
Scantlebury CE, Archer DC et al. Recurrent colic in the horse: incidence and risk factors of recurrence in the general
practice population. Equine Vet J 2011; 43:81/88.
5. Surgical Techniques
5.1 Operative Factors Associated with Short-Term Outcome in Horses with Large Colon
Volvulus: 47 cases from 2006 to 2013.
Gonzalez, L.M., Fogle, C.A., Baker, W.T., Hughes, F.E., Law, J.M., Motsinger-Reif, A.A.,
Blikslager, A.T.
North Carolina State University, College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA.
Tel: (919) 513-7726. Email: [email protected].
Woodford Equine Hospital 3550 Lexington Rd, Versailles, KY 40383, USA.
Peterson and Smith Equine Hospital 4747 Southwest 60th Avenue, Ocala, FL 34474, USA.
North Carolina State University, Statistics Department, 2311 Stinson Drive, Raleigh, NC 27695, USA.
Background
Large colon volvulus (LCV) is an acute, severe form of colic that accounts for 10-20% of horses that undergo
exploratory laparotomy. Reported short term survival rates range from 35-86%. There is an important need for
objective parameters that accurately predict outcome of horses with LCV.
Objectives
The objectives were to evaluate: (1) the predictive value of a series of histomorphometric parameters on short-term
outcome, and (2) the impact of colonic resection on horses with LCV.
Methods
Adult horses admitted to the North Carolina State University and Peterson & Smith Equine Hospitals between 2006
and 2013 diagnosed with LCV, where a pelvic flexure biopsy was obtained, and that recovered from general
anesthesia, were selected for inclusion in the study. Associations between signalment, histomorphometric
measurements of interstitial: crypt ratio (I:C), degree of haemorrhage, percentage loss of luminal and glandular
epithelium, as well as colonic resection with short-term outcome were determined with logistic regression. P<0.05
was considered significant.
Results
Pelvic flexure biopsies from LCV cases (n=47) were evaluated. Factors that were significantly associated with shortterm outcome on univariate logistic regression were Thoroughbred breed, I:C >1 and haemorrhage score ≥3.
Resection did not significantly impact short-term outcome. No combined factors increased the likelihood of death. A
digitally quantified haemorrhage area measurement strengthened the association of haemorrhage with nonsurvival.
Conclusions
Histomorphometric measurements of I:C ratio and degree of haemorrhage predict short-term outcome in cases of
LCV. Accurate quantification of mucosal haemorrhage at the time of surgery may improve veterinary surgeons’
prognostic capabilities in horses with LCV.
Acknowledgements
This work was funded by a generous grant from the North Carolina Horse Council. Additional support was provided
by the NIH T32 NIH/NCSU Comparative Medicine and Translational Research Training Program (CMTRTP)
T32RR024394. We thank Chino Valley Equine Hospital for the contribution of a biopsy sample. The authors would
also like to thank the histopathology laboratory at NCSU College of Veterinary medicine for their processing of all
biopsy specimens.
References
Driscoll, N., P. Baia, A. T. Fischer, T. Brauer, and A. Klohnen. 2008. "Large Colon Resection and Anastomosis in Horses:
52 Cases (1996-2006)." Equine Veterinary Journal 40 (4): 342-347.
Ellis, C. M., T. M. Lynch, D. E. Slone, F. E. Hughes, and C. K. Clark. 2008. "Survival and Complications After Large Colon
Resection and End-to-End Anastomosis for Strangulating Large Colon Volvulus in Seventy-Three Horses." Veterinary
Surgery : VS 37 (8): 786-790.
Suthers, J. M., G. L. Pinchbeck, C. J. Proudman, and D. C. Archer. 2013. "Survival of Horses Following Strangulating
Large Colon Volvulus." Equine Veterinary Journal 45 (2): 219-223.
Van Hoogmoed, L., J. R. Snyder, J. R. Pascoe, and H. Olander. 2000. "Use of Pelvic Flexure Biopsies to Predict Survival
After Large Colon Torsion in Horses." Veterinary Surgery : VS 29 (6): 572-577.
5.2 Small intestinal biopsy and resection in standing sedated horses.
Coomer, R., McKane, S., Roberts, V., Gorvy, D., Mair, T.
Cotts Equine Hospital, Robeston Wathen, Narberth, Pembrokeshire, SA67 8EY, Wales. Tel. +44 1834 860871. Email:
[email protected]
Department of Clinical Veterinary Science, University of Bristol, Langford, North Somerset BS40 5DU. Tel. +44 117
9289621
Mälaren Equine Clinic, Sigtuna, 193 91, Sweden. Tel. +46 8592 540 10
Bell Equine Veterinary Clinic, Mereworth, Maidstone, Kent, ME18 5GS. Tel. +44 1622 813700
Background
Chronic weight loss and recurrent colic are commonly encountered signs of abdominal disease. Diagnostic
investigations can be complex; obtaining a definitive diagnosis in some cases requires surgical abdominal
assessment, either by laparotomy or laparoscopy. Diagnostic laparoscopy in the standing horse has become
increasingly popular as it combines all of the advantages of minimally invasive surgery and provides unique
visualisation of the dorsal abdominal cavity. However, it is a specialist procedure with relatively poor specificity
(Walmsley 1999). Although diagnostic information can be invaluable, owners can be wary of the procedure because
of the difficulty in treating any problems identified.
Whether or not gross abnormalities are noted, obtaining intestinal biopsy samples for subsequent histopathology
can provide an otherwise elusive definitive diagnosis, prognosis and treatment plan. Although intra-abdominal
intestinal biopsy techniques have been described (Schambourg & Marcoux 2006; Bracamonte et al. 2008), extraabdominal full thickness biopsy via small flank laparotomy is more secure in our experience, minimising suturing
time and risk of peritoneal contamination. Intestinal resection and anastomosis has also been carried out
successfully by this method.
Objectives
The aim of this study was to review the technique, complications and outcome of a small series of horses that
underwent extra-abdominal small intestinal surgery under standing sedation, including full-thickness intestinal
biopsies and jejunal resection.
Methods
Horses were starved for 36 hours prior to surgery, where possible. They were restrained and sedated in stocks using
a routine alpha-two opiate combination. Prophylactic antibiotics and anti-inflammatory drugs were supplied. In 7
horses both paralumbar fossae were clipped and prepared for aseptic laparoscopic surgery; in a further 6 horses
only the left paralumbar fossa was prepared for standing laparotomy. Skin and muscle layers were anaesthetised by
local infiltration with mepivicaine at the proposed incision sites.
Where it was carried out, routine diagnostic laparoscopy was first carried out on both sides of the abdomen. A 7 to
12 cm long gridiron laparotomy was then carried out using standard technique, either on the left or right paralumbar
fossa. Occasionally the surgeon’s arm was introduced into the abdominal cavity to identify small intestine, either
blindly following a general exploratory palpation, or under laparoscopic visualisation. No local anaesthetic was
applied to intestine before biopsy or resection. Intestine was exteriorised and a routine antimesenteric full-thickness
biopsy obtained using conventional instrumentation; the defect was repaired using a continuous single layer
inverting suture pattern. After lavage this was replaced and further biopsies obtained in the same way as required.
Intestinal resection was carried out via the same laparotomy. The portion to be resected was exteriorised and
supported by an assistant surgeon. The technique used for resection and 2-layer hand sewn end-to-end anastomosis
was standard (McIllwraith & Robertson 1998), utilising a continuous mucosal closure followed by a continuous
inverting Cushing incorporating the submucosa.
Results
Thirteen horses were identified: 5 mares and 8 geldings aged 6 to 25 years, mean and median 15 years. There were 6
Thoroughbred & crosses, 3 ponies, 2 warmbloods and 2 cobs. Eleven horses were presented for weight loss, 1 for
acute and 1 recurrent colic.
Six horses underwent initial diagnostic laparoscopy; the subsequent laparotomy was carried out in the left flank (3
cases) and right flank (3 cases). Seven horses underwent blind unilateral left flank diagnostic laparotomy. Median
number of biopsies taken was 3, range 1 to 4. In 2 horses jejunal resection and end-to-end anastomosis was carried
out, removing 20 cm and 1 metre respectively. Diagnosis in these cases was infiltrating adenocarcinoma and jejunal
strangulation by pedunculated lipoma.
Post-operatively, 3 horses developed wound infections with partial breakdown (these subsequently healed), one
horse developed fatal diarrhoea, and two horses developed postoperative ileus, including one following intestinal
biopsy and the acute colic case; 3 more were euthanased before hospital discharge due to underlying disease. One
horse developed transient laminitis, which was receiving oral prednisolone postoperatively. Seven horses survived
long term with follow up median 29, range 3 – 49 months.
Conclusion
Obtaining small intestinal biopsies in standing sedated horses using the extra-abdominal technique described herein
proved expedient from either flank, with or without laparoscopic assistance. Additional topical local anaesthesia was
not needed for intestinal surgery in conscious sedated horses. Laparoscopy allowed a more thorough diagnostic
examination and manipulation of bowel before laparotomy, potentially increasing the diagnostic value of the
biopsies obtained.
Incisional complications afflicted 3 horses and should be recognised as a risk when performing flank laparotomy in
horses. Postoperative ileus was rare following standing abdominal surgery; it seems most likely to be related to the
underlying condition, as opposed to being caused by surgical technique.
Indications for standing small intestinal resection and end-to-end anastomosis are rarely encountered; acute colic
appears to be the main contra-indication. In the other case it proved successful, with surmountable difficulties when
suturing a moving bowel, supporting the intestine and preventing exteriorisation of healthy adjacent bowel.
References
Walmsley JP: Review of equine laparoscopy and an analysis of 158 laparoscopies in the horse. Equine Vet J 1999. 31,
456 – 464.
Schambourg M and Marcoux MM: Laparoscopic intestinal exploration and full-thickness intestinal biopsy in standing
horses: a pilot study. Vet Surg 2006. 35, 689 – 696.
Bracamonte JL, Bouré LP, Geor RJ, et al: Evaluation of a laparoscopic technique for collection of serial full-thickness
small intestinal biopsy specimens in standing sedated horses. Am J Vet Res 2008. 69, 431 – 439.
McIllwraith CW and Robertson JT (1998): Resection and end to end anastomosis of small intestine, In: McIllwraith &
Turners Equine Surgery advanced techniques 2nd Edition, Williams & Wilkins Baltimore, pp 327 - 333.
5.3 In vitro description of a new technique for stapled side-to-side jejuno(ileo)cecal
anastomosis in horses and CT scan anatomical comparison with other techniques.
Gandini, M., Giusto, G., Iotti, B., Valazza, A., Sammartano, F.
Dipartimento di Scienze Veterinarie, Università degli Studi di Torino (Italy)
Via L. da Vinci 44, 10095 Grugliasco (Torino), Italy
Email: [email protected]
Background
Stapled jejunocecal anastomoses are commonly performed in equine abdominal surgery. The technique has been
fully described (Freeman 2009) and has not changed significantly in the last 20 years, despite presence of know
complications. According to many authors it carries higher complication rates compared to handsewn techniques
(Freeman 2009; Freeman and Schaeffer, 2010) the causes of this higher complication rates have not been fully
evaluated. In human surgery various causes likely to lead to failure of stapled techniques have been evaluated and
include staple line failure, stricture and anastomotic leakage (Neutzling, 2012; Davis and Rivadeneira, 2013). All
these events could also occur in horses, alone or in association with the formation of a blind end pouch, a
complication of either handsewn or stapled side-to-side anastomoses. Only recently did Freeman propose a new
technique to perform a stapled jejunocecal anastomosis in horses while avoiding blind end pouch formation
although the main focus of his work was to avoid complications caused by the stapler insertion sites (Freeman and
Schaeffer, 2010).
Objectives
To describe a new method for stapled side-to-side jejuno(ileo)cecal anastomosis in horses and to compare it with
other stapled techniques with the use of CT scan in terms of stomal area, stomal shape and blind end pouch size.
Methods
Intestinal specimens comprising the cecum, ileum and three meters of jejunum from 18 horses (mean age 24
months, range 18-30 months, mean weight 450 kg, range 420-480) were collected immediately after death at an
abattoir. Bowel segments were divided into three groups. In Group S a standard stapled side-to-side jejunocecal
anastomosis was performed. In Group F a stapled side-to-side jejunocecal anastomosis was performed using a
modified technique proposed by Freeman (Freeman and Schaeffer, 2010). In Group G a stapled side-to-side
jejunocecal anastomosis was performed with a modified technique proposed by the authors. All anastomoses were
performed using an Autosuture Multifire GIA 80 linear cutting stapler. Inflated bowel segments were CT scanned to
obtain a MultiPlanar Reconstruction of the stoma and afferent small intestine before calculating the area of each of
these features. The ratio of the measured areas was compared between the three techniques. The volume of the
blind end pouch was measured and its ratio with the intestinal area compared between techniques. The cecum was
opened and the effective length of the stoma measured with a caliper and compared to the intended initial length.
Results
The stomal/intestinal area ratio was not significantly different between techniques.
No statistically significant difference was found in the stomal ideal/real perimeter ratio, although there was a trend
towards a more circular shape in Group S.
There was no statistically significant difference in the intended/real stomal length ratio, and all techniques featured
an increase in stomal length ranging from 2 to 12 %. Only two cases in Group F presented a decrease in stomal
length.
Blind end pouch formation was a consistent finding in Group S and was virtually absent in Groups F and G.
Conclusions
Both the Freeman and the G technique resulted comparable to the standard technique in terms of stomal area,
stomal shape and difference in stomal elongation. They consistently produced a smaller blind end pouch and
allowed easier placement of the staplers.
References
Davis, B., Rivadeneira, D.E. (2013) Complications of colorectal anastomoses: leaks, strictures, and bleeding. Surg.
Clin. North. Am. 93, 61-87.
Freeman, D.E. (2009) Surgical Techniques. In White NA, Mair TS, Moore JN eds, The Equine Acute Abdomen, Teton
Newmedia, Jackson WY.
Freeman, D.E. and Schaeffer, D.J. (2010) Comparison of complications and long-term survival rates following handsewn versus stapled side-to-side jejunocecostomy in horses with colic. J. Am. Vet. Med. Assoc., 237, 1060-1067.
Neutzling, C.B., Lustosa, S.A., Proenca, I.M., et al (2012) Stapled versus handsewn methods for colorectal
anastomosis surgery. Cochrane Database Syst. Rev. 15, 2.
5.4 The "GR" trocar : an alternative to laparoscopy for the closure of the nephrosplenic
space in the standing horse.
Bussy, C.P.
Clinique Veterinaire du Grand Renaud 72650 St Saturnin France. Tel : (+33)608699928 Fax :(+33)243253477
Email :[email protected]
Introduction
Horses with recurrent nephrosplenic entrapment have been treated preventatively by closing the nephrosplenic
space laparoscopically ( Tom Marïen, 2000). This technique requires expensive equipment, laparoscopic experience
and trained personnel. In certain circumstances this procedure can be time-consuming. The results of a three year
investigation into developing a specialty trocar instrument which greatly simplify this procedure are presented.
Methods
The instrument is an ovoid (4 cm by 6 cm) plastic conical tube, composed of two intertwined 20 cm long elements
(chamber and trocar). Illumination is provided by a ring of LEDs incorporated into the end of the chamber (Fig1).
Control and batteries are located in the handle. Light or camera extension cords are not required. All the
components can be sterilized.
Procedure: The horse is fasted 48hr prior to surgery, and restrained in stocks using Detomidine 0.02mg/Kg and
Butorphanol 0.01mg/kg, IV. Sedation during the procedure is maintained by an IV infusion of Detomidine. The left
flank is clipped over a wide area, followed by surgical preparation of the site and sterile draping (Fig2). A
subcutaneous and intramuscular infiltration with 20 ml of lidocaine is performed in the left paralumbar fossa,
halfway between the last rib and the tuber coxae at the site of the trocar insertion. A vertical 6 to 8 cm skin and
external oblique muscle incision is performed in the left paralumbar fossa, followed by blunt dissection of the
internal oblique and abdominal transverse muscles along their fibers direction. Once the peritoneum is visualized a
tissue forceps is used to make a small puncture that is enlarged manually, allowing the introduction of the trocar by
simultaneous inward pressure and rotational movement until the abdomen is entered. The trocar is then removed
from the chamber. An anatomical assessment of the area is initially performed, by direct visualization through the
trocar chamber, the LEDs providing a sufficiently bright but cool illumination of the interior of the abdominal cavity.
The chamber is then directed between the spleen and left kidney into the nephrosplenic space for appropriate
visualization of the abdomen (Fig3). A long purpose-made needle holder is directed through the chamber and a
simple continuous suture pattern of resorbable poly-filament polyglactine 910 (Polysorb ND, loop No. 2) on a 65mm
half-curve atraumatic needle is placed between the dorsal edge of the spleen and the dorso-lateral part of the peri
renal facia. The suture pattern is started cranially, ending at the caudal pole of the left kidney. The chamber is then
removed and the muscles and subcutaneous layers are closed with simple continuous patterns. The skin incision is
closed with staples. Antimicrobials and anti-inflammatories drugs are administered immediately prior to surgery and
continued for 5 days.
Fig: 1 LEDs light up when the trocar is removed from the chamber
Fig: 2 Incision (red line) is done in the left paralumbar fossa, halfway between the last rib (white arrow) and the
lower part of the tuber coxae (yellow arrow).
Fig: 3 In direct vision through the trocar, visualization of the spleen and peri renal facia.
Results
The procedure has been performed on 30 horses, with no major complications. The appearance of a subcutaneous
seroma was noted occasionally but quickly resolved within 3 or 4 days, when drained after removing a few staples at
the bottom of the incision.
Three horses were reviewed by laparoscopy a month later, confirming that the nephrosplenic space was closed.
Discussion
Advantages of this technique and instrumentation include: no requirement for intra-abdominal insufflation, a single
portal site, and absence of cable connections cluttering the surgical field.
The use of a loop wire greatly facilitates the procedure by avoiding having to perform an extracorporeal knot at the
most cranial part of the suture. With a chamber of this size and shape, it was possible to use the widest needle that
could be mounted correctly on the needle holder and then allow passing between the renal facia and the dorsal
edge of the spleen with only one bite and consequently not needing the use of an additional instrument, therefore
reducing the surgery time by approximately 50%. This technique is easily learned, relatively inexpensive. It is also
presumably less risky than the alternative techniques of nephrosplenic space closure because only one incision is
needed and the entire procedure is made under direct visualization, thus avoiding risks of visceral puncture and
insufflation accidents. Horses returned to full activity after four weeks of rest as prescribed for the traditional
technic, with no complications noted.
References
Farstvedt E, Hendrickson D. Laparoscopic closure of the nephrosplenic space for prevention of recurrent
nephrosplenic entrapment of the ascending colon. Vet Surg. 2005 Nov-Dec;34(6):642-5.
Röcken M, Schubert C, Mosel G, Litzke LF. Indications, surgical technique, and long-term experience with
laparoscopic closure of the nephrosplenic space in standing horses. Vet Surg. 2005 Nov-Dec;34(6):637-41.
5.5 Survival in horses with strangulation of the small intestine managed by surgical
correction without resection.
Cleary, O.B., Freeman, D.E., Schaeffer, D.J.
University of Florida, College of Veterinary Medicine, Department of Large Animal Clinical Sciences, PO Box 100136,
Gainesville, FL 32610-0136, USA; University of Illinois, College of Veterinary Medicine, 1008 West Hazelwood Dr.
Urbana, IL 61802, USA; Milton Equine Hospital, 10207 Guelph Line, Campbellville, Ontario, CA. Tel: (01) 352-258-
5201 Fax: (01) 352-392-8289.
Email: [email protected]
Background
Strangulating lesions of the small intestine can lead to a high rate of mortality and lower survival than in horses with
non-strangulating lesions (Mair et al. 2005). Accurate assessment of small intestinal viability could reduce the need
for small intestinal resection and thereby improve survival rates.
Objectives
The objective of this study was to determine the outcome in horses with small intestinal strangulating lesions that
were assessed as viable based on an intraoperative clinical grading system, and were therefore not resected
(Freeman et al. 2013).
Methods
Medical records were obtained from two referral hospitals spanning a period from 1996 to 2011 in which clinical
criteria for grading small intestinal viability were developed by one of the authors (Freeman et al. 2013). Horses
were included in the study that recovered from anesthesia without resection of a strangulating small intestinal
lesion. The criteria used were based on serosal color, motility, and wall thickness, and especially in improvements in
these over 15 minutes after correction of the lesion. The effects of viability grade, length of intestine involved, and
viability index (product of viability grade and length of intestine affected) on survival were documented to determine
if the severity of injury affected survival.
Results
During the period of study, 35 horses met the inclusion criteria. Two horses had brief episodes of reflux after surgery
and 3 horses required a repeat celiotomy. All horses were discharged from the hospital and were followed for ≤192
months. The median survival time from surgery was 10 years for all postoperative deaths. Postoperative colic was
rare after discharge and owner satisfaction was good. The severity of viability grade did not appear to affect
complication rates.
Conclusions
All 35 horses in the study survived to discharge from the hospital and their long-term survival and progress were
considered to be good. Most horses in this study would have required a jejunocecostomy if a resection were
performed, and this could have reduced survival rates. Although the method for assessing viability proved to be
suitable for clinical use in horses with small intestinal strangulation, additional studies are required to determine the
most severe grade compatible with survival.
References
Mair,T.S. and Smith, L.J. (2005) Survival and complication rates in 300 horses undergoing surgical treatment of colic.
Part 1: Short-term survival following a single laparotomy. Equine vet. J. 37,296-302.
Freeman, D.E., Schaeffer, D.J., Cleary, O.B. (2013) Long-term survival in horses with strangulating obstruction of the
small intestine managed without resection. Equine vet. J. Nov 18. doi: 10.1111/evj.12216. [Epub ahead of print].
5.6 Surgical and Non-surgical Management of Cecal Impaction in 150 Horses (1991-2011).
Aitken, M.R., Southwood, L.L., Ross. B.M., Ross, M.W.
Department of Clinical Studies, New Bolton Center, University of Pennsylvania, 382 W Street Rd, Kennett Square, PA
19348. Tel: (1) 610 444 5800 Fax: (1) 610 925 6802 Email: [email protected]
Background
Impaction is the most common cecal disease in horses. The pathogenesis is likely multifactorial and often associated
with coarse roughage intake, poor dentition, sand ingestion, fasting, insufficient water consumption, and
Anaplocephala perfoliata infestation. Cecal impaction has also been identified in horses hospitalized for diseases
unrelated to the gastrointestinal tract. These horses may also have associated risks of recent general anesthesia or
treatment with non-steroidal anti-inflammatory drugs (Dart, Hodgson, Snyder 1997). In horses that develop cecal
impactions associated with concurrent disease, cecal dysfunction secondary to abnormal motility is thought to play a
role. Perforation of the cecum secondary to impaction has been reported in up to 57% of horses and may occur with
minimal prodromal signs, making the decision with regard to type of treatment to pursue critical (Dart, Hodgson,
Snyder 1997). Non-surgical treatment has been reported to yield success rates of up to 90% (Dart, Hodgson, Snyder
1997; Plummer et al 2007). Surgical treatments that have been described include typhlotomy alone and typhlotomy
followed by a bypass jejuno- or ileo-colostomy (J-IC) procedure. For horses undergoing typhlotomy alone, short
term survival has been reported anywhere between 20% and 90%, with long term survival up to 100%. However, in
early reports, continued cecal filling leading to cecal perforation post-operatively was reported in as high as 80% of
horses (Plummer et al 2007; Roberts and Slone 2000; Smith et al. 2010). Due to risk of re-impaction, J-IC to bypass
the cecum has been performed in horses with presumed cecal dysfunction. Short term survival following J-IC is
between 50 and 100% and long term survival 80% to 100% (Plummer et al 2007; Gerard et al 1996). Recently,
Plummer et al. reported a favorable outcome with either medical management or typhlotomy alone. Most
impactions (90%) were associated with feeding coarse roughage (Plummer et al 2007). Cecal impactions in our
hospital population are commonly seen in horses as a complication of concurrent disease and the conclusions from
the study by Plummer et al. may not apply to our population.
Objectives
The objectives of this study were to evaluate short- and long-term outcome of non-surgical and surgical
management strategies for horses with a cecal impaction and to determine factors affecting survival. Our
hypotheses were that (1) horses managed non-surgically would have a high occurrence of cecal perforation during
treatment and (2) there would be no difference in short and long term survival between horses managed with a
typhlotomy alone versus J-IC in our population.
Methods
Data were collected from the medical records of horses with a diagnosis of cecal impaction from January 1991 to
December 2011. Diagnosis was made on the basis of palpation per rectum, exploratory celiotomy or post-mortem
examination. Medical records were examined for the following information: signalment, history, concurrent disease,
admission clinical and laboratory data, treatment (non-surgical, typhlotomy alone, J-IC), medications, post-operative
re-feeding, and complications. Horses that had perforated prior to initiation of treatment or those that had
perforation confirmed on admission exploratory celiotomy were considered separately. Short-term survival (to
discharge) and long-term survival (≥1yr) were outcome variables determined by telephone conversations with
owners, trainers or referring veterinarians. Data were analyzed using a Chi-square or Fisher’s Exact test.
Results
There were 150 cases that met the inclusion criteria. Of the 150 cases, 102 horses (68%) had a history of previous
disease or surgical procedure. Of the total cases admitted, 38 (25%) horses had cecal perforation on admission and 3
(2%) were euthanized without treatment at the owner’s request. Therefore, 109 cases were treated, 59 (39%) with
non-surgical and 50 (33%) with surgical management. Of the surgical procedures, 26 horses had a typhlotomy and 24
had a J-IC. Short term survival for horses treated with medical management was 64% (38/59) and long term survival
57% (34/59). Short term survival for typhlotomy alone was 77% (20/26) and J-IC 88% (21/24) (p=0.47). Re-impaction
(n=2) and typhlocolitis (4) were the reasons for euthanasia post-typhlotomy and fracture repair failure (1), reimpaction (1), and typhlocolitis (1) following J-IC. Long term survival was 73% for horses having a typhlotomy alone
and 70% for horses undergoing a J-IC (p=0.86).
Conclusions
A high proportion of horses with cecal impaction managed non-surgically had cecal rupture (17/59, 29%), which is
higher than that reported by Plummer et al. (13%) The decision to pursue non-surgical management in these cases
was made on the basis of mild clinical signs, palpation per rectum findings, as well as owner decision, which may
introduce a bias. While non-surgical management can have a favorable outcome, it was less successful in our
population than previously reported.2 There was no significant difference in survival of horses managed surgically
with a typhlotomy alone versus J-IC. Overall, our survival rates are lower than those reported by Plummer et al. (95%
short term, 89% long term) which may be a reflection of our different population of horses that are susceptible to
cecal dysfunction secondary to concurrent disease.
References
Dart AJ, Hodgson DR, Snyder JR: Caecal disease in equids. Aust Vet J 1997;75(8):552-557.
Gerard MP, Bowman KF, Blikslager AT, et al: Jejunocolostomy or ileocolostomy for treatment of cecal impaction in
horses: Nine cases (1985-1995). J Am Vet Med Assoc 1996;209(7):1287-1290.
Plummer AE, Rakestraw PC, Hardy J, et al: Outcome of medical and surgical treatment of cecal impaction in horses:
114 cases (1994-2004). J Am Vet Med Assoc 2007;231(9):1378-1385.
Roberts CT and Slone DE: Caecal impactions managed surgically by typhlotomy in 10 cases (1988-1998). Equine vet J,
Suppl 2000;32:74-76.
Smith LC, Payne RJ, Boys Smith SJ, et al: Outcome and long-term follow-up of 20 horses undergoing surgery for cecal
impaction: A retrospective study (2000-2008). Equine vet J 2010;42(5):388-392.
5.7 Percutaneous caecal decompression in 100 horses with colic.
Witte, S., Schnider, D., Witte, T.H.
Department of Large Animal Sciences, Faculty of Medical and Health Sciences, University of Copenhagen,
Højbakkegård Allé 5, 2630 Tåstrup, Denmark, Tel: +45 22 629325, Fax: +45353 32880.
Email:[email protected]
Background
The effect and safety of percutaneous caecal decompression is often debated, as no comprehensive studies have
been published.
Objectives
Objectives were to investigate effect and complications of percutanous caecal decompression.
Methods
Retrospective review of clinical records (January 2006 and December 2012), at the University of Copenhagen to
identify horses where caecal decompression was performed. Clinical data (diagnosis, pain-score, temperature, heartand respiratory-rate, steel-band, rectal findings and use of analgesics) before and after caecal decompression,
treatment (medical or surgical), complications (fever, peritonitis, diarrhoea, haematoma and local inflammation at
the decompression site) and short-term survival were retrieved. Chi-square and paired t-tests were used to compare
clinical variables before and after caecal decompression. P<0.05 was considered significant.
Results
Of the 1422 horses treated for colic in the period, 147 horses (10.3%) had one or several caecal decompressions
performed. Two horses were excluded due to missing data. Death, due to caecal decompression was not observed.
Complications were observed in 23 (15.9%) horses with the following incidence: Fever (9.7%), diarrhoea (9.0%),
peritonitis (5.5%), local inflammation (4.1%) and haematoma (2.1%).
Following caecal decompression, a significant decrease in both heart-rate (p<0.0001) and use of strong analgesics
(p=0.003) and an increase in number of horses with normal rectal findings were observed (p<0.0001). Multiple
caecal decompressions were not associated with increased risk of complications or euthanasia.
Conclusions
Percutaneus caecal decompression is effective in reducing pain and improving rectal findings in horses with caecal
tympany. Short-term complications such as fever were observed but were not life threatening.
5.8 Diagnosis and prognosis of caecal intussusception. A retrospective study (2009-2013).
Broux, B., Lefere, L., De Clercq, D., Deprez, P., van Loon, G.
Department of Large Animal Internal Medicine, Faculty of Veterinary Medicine, Ghent University, Salisburylaan 133,
9820 Merelbeke, Belgium. Tel: (+32) 092647590 Fax: (+32) 092647796.
Email: [email protected]
Background
Parasitic infestations, such as Anoplocephala perfoliata, are known risk factors for caecal intussusception1. Since
caecocaecal intussusception (CeCeI) presumably has a better prognosis than caecocolic intussusception (CeCoI), an
accurate diagnosis pre-surgery is important2. Diagnosis of caecal intussusception can be challenging. Transabdominal
ultrasound has been suggested as a useful diagnostic tool.
Objective
The aims were (1) to assess the usefulness of ultrasound for diagnosis and differentiation between CeCeI and CeCoI,
(2) to evaluate the parasitic burden through coprological analysis and (3) to determine short term outcome after
surgery.
Methods
A retrospective study(2009-2013) of all colic horses with caecal intussusception (n=60) was performed.
Results
In all horses, caecal intussusception was diagnosed with transabdominal ultrasound. Correct differentiation between
CeCeI or CeCoI could be made in 91,7% of cases. 10 out of 15 horses diagnosed with CeCeI underwent surgery, of
which 7 were discharged; 2 were euthanized during and 1 after surgery. 28 out of 45 horses diagnosed with CeCoI
underwent surgery: 17 survived to discharge while 7 and 4 were euthanized during and after surgery, respectively.
Coprological analysis was available in 37 horses. Seven horses tested negative, all other horses were infested with
strongyles (cyathostominae larvae (n=21) and/or egg counts (n=8)), A. perfoliata (n=7) and/or Parascaris equorum
(n=2).
Conclusions
In all horses the intussusception was diagnosed on ultrasound and in 91,7% a correct differentiation between CeCeI
or CeCoI could be made. Small strongyles were commonly found on faecal exam. Short term survival after surgery
was 70 and 60% for CeCeI and CeCoI, respectively.
References
Gasser RB., Williamson RM, Beveridge I. (2005). Anoplocephala perfoliata of horses- significant scope for further
research, improved diagnosis and control. Parasitology 131, 1-13.
Edwards GB. (1986). Surgical management of intussusceptions in the horse. Equine Vet. J. 18 (4), 313-321.
5.9 Evaluation of acid-base and electrolyte disturbances using a Fencl-Stewart approach
and correlates to survival in horses with colic.
Hallowell, G.D., Berrym K.A., Bowen, I.M.
School of Veterinary Medicine and Science, University of Nottingham, Sutton Bonington, LE12 5RD, UK.
Tel:01159516590 Fax:01159516424
Email: [email protected]
Background
Severe acid-base and electrolyte derangements are often seen in horses with acute disorders of the abdomen. The
ability to highlight the complexity of acid-base and electrolyte derangements is useful to tailor the most appropriate
therapy to the individual animal and in some cases will provide information regarding prognosis. Traditionally, the
Henderson-Hasselbalch approach is used to assess acid-base derangements, which identifies the presence of acidbase derangements but cannot elucidate the complex mechanisms that underlie them, making the most appropriate
therapy hard to identify. In other species, the Fencl-Stewart approach has been used to provide additional useful
information in critically ill patients, allowing detailed quantitative assessment of complex metabolic acid-base
abnormalities. This approach combines the practical use of base excess with the Stewart principle. The magnitude
and contribution of changes in sodium, chloride, phosphate, albumin, lactate and unmeasured anions to metabolic
acid-base derangements can be determined allowing therapy to be more appropriately selected. The added
advantage is that the calculations are easy to perform.
Objectives
The purpose of this study was to develop and apply the quantitative Fencl-Stewart equations to horses, to evaluate
Fencl-Stewart derangements seen in horses with colic at admission and over time and to evaluate how findings at
admission compared with those identified using a traditional Henderson-Hasselbalch approach.
Methods
A calculated reference range for blood gas parameters was used to define the Fencl-Stewart equations relevant for
horses. The normal value for each effect should be zero and a value of >1.5 was deemed significant. Basic history,
major body system assessment, PCV, total solids and venous blood gas and electrolyte concentrations were
evaluated at admission and at 12 hour intervals from horses (n=94) admitted with signs of colic until discharge.
Horses were grouped based on type of colic, which included those that were managed both medically and surgically.
Outcome was defined by survival at 100 days following discharge.
Normality was evaluated using a Shapiro-Wilk normality test. Data was expressed as mean +/- standard deviation
(SD) when normally distributed and as median and inter-quartile ranges (IQR) if not. A Kruskal-Wallis or Freidman
Test, ANOVA or Repeated Measures ANOVA with appropriate post-hoc tests were used to evaluate differences
between groups or at different time points. A Mann-Whitney U or unpaired T-Test was used to evaluate differences
between survivors and non-survivors. Significance was determined when p<0.05.
Results
Fencl-Stewart equations were successfully developed for the horse:
1) Free water effect=0.3([Na+]–138)
2) Chloride effect=100.4-[Cl-]x([138]/[Na+])
3) Albumin effect=0.37(32.5–[Alb])
4) Lactate effect=-1x[lactate]
5) Unmeasured anions= Standardised Base Excess (10.1) – Sum of effects
6)
Sum of effects=Free water effect + chloride effect + phosphate effect +
albumin effect + lactate effect
It was not possible to predict the complex acid-base derangements in horses with colic, even within sub-groups
(Table 1). Albumin, lactate, chloride and unmeasured anion effects contributed to the metabolic acid-base
derangements. With abnormal albumin concentrations, traditional and quantitative approaches yielded different
interpretations of the acid-base abnormalities. Differences in chloride (p=0.008), lactate (p=0.02), calcium (p=0.001)
and unmeasured anion concentrations (p=0.0007) were observed between survivors and non-survivors in horses
with surgical lesions.
Effect
Medical
(n=39)
Surgical
(n=55)
Strangulating LI Surgical LI
lesions (n=9)
displacements
(n=16)
Strangulating
SI lesions
(n=30)
Albumin
-1.5 ± 1.2
-1.6 ± 2.2
-0.8 ± 2.4
-1.9 ± 1.5
-1.6 ± 2.4
Lactate
-1.7 ± 1.2
-2.8 ± 2.4
-3.1 ± 2.2
-1.9 ± 1.6
-3.1 ± 2.7
Free water
-0.2 ± 0.8
-0.4 ± 0.9
-0.3 ± 1.0
-0.7 ± 0.6
-0.2 ± 1.0
Chloride
-2.8 ± 3.0
-0.5 ± 3.2
-2.0 ± 1.9
-0.7 ± 3.4
0.1 ± 3.1
Sum
-6.1 ± 4.2
-5.6 ± 4.8
-7.7 ± 4.0
-5.5 ± 5.1
-5.2 ± 4.9
Unmeasured
anions
-2.7 ± 3.0
-3.6 ± 3.9
-2.9 ± 2.3
-4.4 ± 3.3
-3.4 ± 4.4
Table 1. Results (mean±SD) displaying the relative effects calculated using the Fencl-Stewart approach using
admission data for sub-groups of horses presenting with colic.
Conclusions
The Fencl-Stewart approach is a mathematically simple method adapted for use in the horse to identify how
albumin, free water (sodium), chloride, lactate and unmeasured anions contribute to metabolic acid-base
derangements in the horse with abdominal pain. Assessment of metabolic acid-base derangements should be made
on a case-by-case basis as they vary significantly even between sub-groups of horses with colic. Albumin, chloride
and lactate are shown to be the greatest contributors to the Fencl-Stewart effect, with calcium and potassium
derangements as the most prevalent electrolyte abnormalities. Specific assessment of these derangements should
allow for more tailored interventions that may contribute to improved outcomes in horses with acute abdominal
pain.
5.10 Amelioration of sodium sulphate induced hypokalemia in patients with large colon
and/or caecal impactions.
T. Latki, Gembicki N, K. Failing, K. Fey
Equine Clinic, Internal Medicine, Department of Veterinary Clinical Sciences, Justus-Liebig-University
Giessen/Germany. Tel: (+49) 641 9938660 Fax: (+49) 641 9938647 Email: [email protected]
Unit for Biomathematics and Data Processing, Faculty of Veterinary Medicine, Justus-Liebig-University, Giessen,
Germany.
Background
Primary impactions of the large colon and caecum are treated traditionally with osmotic laxatives like sodium
sulphate or magnesium sulphate (“Epsom salt”). In Germany, sodium sulphate is the preferred laxative and is used
routinely (Huskamp et al. 2006). However, about 45% of impacted patients show a decrease in potassium blood
levels and alkalosis within six to eight hours. After receiving sodium sulphate decahydrate (“salt of Glauber”, 1 g/kg
via stomach tube), a mean decrease in potassium blood levels of about 0.7 mmol/l is documented (Gembicki 2011),
which might impair muscular contractility of the intestine.
Objectives
The primary aim of this study was to avoid the decrease of potassium blood levels in equine patients with large colon
and/or caecal impactions, which are treated with sodium sulphate intragastrally. This purpose should be achieved by
adding potassium chloride to the laxative solution.
Methods
A prospective, randomised, controlled and blinded trial (RCT) was pursued. Included were patients with slight to
moderate primary impactions in their large intestines, diagnosed rectally by experienced examiners. Excluded were
severely impacted horses as well as patients with signs of dehydration, hypokalemia or acid-base disturbances in the
initial exam. All included patients were medicated with desiccated sodium sulphate (0.44 g/kg bw) via stomach tube.
They were randomised into one of three groups: a control group (K0) did not receive additional potassium, whereas
animals in therapeutic groups either got 25 mg/kg (K25) or 50 mg/kg (K50) potassium chloride intragastrally,
combined with the sodium sulphate. All salts were solved in 1.225 l water per 100 kg body weight. The clinician (TL)
was blinded to the possible addition of potassium. Clinical and laboratory parameters were evaluated every 2 hours
for the next 24 hours.
For biometrical planning of the study, it was assumed that the mean potassium blood level should not fall in at least
one of the substituted groups. Defining an error type I probability of α = 0.05 and an error type II probability of β =
0.10, a sample size of n = 10 per group was calculated with the program BiAS (Ackermann, 2006). For statistical
analysis of the results, a two-way ANOVA with repeated measures over time was used.
Results
Within 26 months, 22 warmbloods and 11 ponies were included. Impactions were located in the large colon (n=15),
cecum (n=12) or large colon and caecum simultaneously (n=6). All horses could be discharged from the clinic.
Potassium levels (mean ± standard deviation) decreased in all groups with minimal values 8 hours after treatment:
K0 decreased from 3.5 ± 0.4 to 2.9 ± 0.3,
K25 from 3.8 ± 0.3 to 3.1 ± 0.4 and
K50 from 3.7±0.3 to 3.2 ± 0.4 mmol/l.
Over the next 8 hours, in the substituted groups, the potassium levels increased nearly to their initial values. In K0
even 24 hours after the sodium sulphate application, the mean potassium value was 3.2 ± 0.4, which is 0.3 mmol/l
less than the starting value. Statistically significant differences were seen between groups (p=0.04) and over time
(p<0.001).
The number of patients which showed hypokalemia (< 2.8 mmol/l) 2-8 hours, 10-16 hours and 18-24 hours after
laxative treatment in K0 was 13, 13 and 7; in K25 6, 4 and 1 and in K50 2, 1 and 1 respectively.
Conclusions
Hypokalemia (< 2.8 mmol/l) could not be prevented in every case, but - dependent on the dose of the added
potassium chloride - the number and duration of hypokalemic states was highly reduced. However, even with
concurrent potassium application, sodium sulphate caused a decrease in potassium levels for about 8 hours. With
potassium supplementation, initial levels were reached faster and with the addition of 50 mg/kg KCl only very few
hypokalemic states were seen. Therefore we recommend to add at least 50 mg/kg KCl to every sodium sulphate
therapy. It remains to be evaluated if higher doses or increased dosing frequency may be useful.
References
Ackermann H (2006): BiAS: Biometrische Analyse von Stichproben, Version 8.2. Epsilon Verlag, Hochheim Darmstadt
Gembicki N (2011): Effects of intragastral sodium or magnesium sulphate in equines with primary impactions of the
large colon and / or caecum. Thesis, Justus-Liebig-Universität Giessen, Germany. ISBN 978-3-8359-5734-3
http://geb.uni-giessen.de/geb/volltexte/2011/8076/
Huskamp N, Kopf N, Scheidemann W: Obstipation. In: Dietz O, Huskamp N: Handbuch Pferdepraxis, 3rd ed. 2006,
Enke, Stuttgart, 461-472
Thursday 10th July
6. Post-operative Management
6.1 Effects of a continuous rate infusion of lidocaine on ischemic injury, hematological
changes, and inflammation in equine large colon.
Morton, A.J., Grosche, A., Graham, A.S., Bauck, A.G., de Cassia Seudo Lopes, M.,
Freeman, D.E.
Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary
Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA. Tel: (01) 352-294-4345, Fax: (01) 352392-8289.
Email: [email protected].
Background
Ischemic injury of the equine colon can be exacerbated by activation of neutrophils and other inflammatory cells.
The novel anti-inflammatory effects of lidocaine could prevent these complications (Cook and Blikslager 2008).
Objectives
To examine effects of lidocaine on mucosal injury and barrier function, transmural inflammation, and hematological
changes after ischemia and reperfusion in equine colon.
Methods
In 12 anesthetized horses, two colon segments were subjected to 1h ischemia. Horses were randomly assigned a CRI
of lidocaine (n=6) or saline (n=6) throughout anesthesia. After ischemia, one segment was removed for Ussing
chamber studies on mucosal barrier integrity. This was repeated in the remaining segment after 4h reperfusion.
Biopsies were taken before and after ischemia, and after 1h and 4h reperfusion for histologic assessment of
inflammation and morphometric changes. Jugular and colonic venous blood (CB) were sampled simultaneously for
hematological analyses.
Results
Colonic mucosa displayed mild morphometric changes and impaired barrier function after ischemia. Ischemia caused
lactic acidosis, electrolyte imbalances and hypoglycemia in CB. The ischemic injured mucosa recovered
morphologically and functionally despite a massive influx of neutrophils into mucosa, muscle layers, and serosa
during reperfusion. Eosinophils migrated towards the epithelium, and were released into the lumen during
reperfusion. All biochemical values but lactate returned to normal after reperfusion. Lidocaine reduced number and
migration pattern of eosinophils, but did not affect morphometric and functional changes or repair after colonic
ischemia.
Conclusions
The major antiinflammatory effect of lidocaine was mediated through reduced eosinophilic response in the colon
after ischemia and reperfusion.
Acknowledgements
Funded by the Morris Animal Foundation and by the Faculty Research Development Fund, University of Florida,
College of Veterinary Medicine.
References
Cook, V.L. and Blikslager, A.T. (2008) Use of systemically administered lidocaine in horses with gastrointestinal tract
disease. J Am Vet Med Assoc 232,1144-1148.
6.2 Effects of a continuous rate infusion of lidocaine on ischemic injury, hematological
changes, and inflammation in equine jejunum.
Grosche, A., Morton, A.J., Graham, A.S., Bauck, A.G., Lopes, M., Freeman, D.E.
Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary
Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA. Tel: (01) 352-294-4345, Fax: (01) 352392-8289.
Email: [email protected].
Background
Ischemic injury of the equine colon can be exacerbated by activation of neutrophils and other inflammatory cells.
The novel anti-inflammatory effects of lidocaine could prevent these complications (Cook and Blikslager 2008).
Objectives
To examine effects of lidocaine on mucosal injury and barrier function, transmural inflammation, and hematological
changes after ischemia and reperfusion in equine colon.
Methods
In 12 anesthetized horses, two colon segments were subjected to 1h ischemia. Horses were randomly assigned a CRI
of lidocaine (n=6) or saline (n=6) throughout anesthesia. After ischemia, one segment was removed for Ussing
chamber studies on mucosal barrier integrity. This was repeated in the remaining segment after 4h reperfusion.
Biopsies were taken before and after ischemia, and after 1h and 4h reperfusion for histologic assessment of
inflammation and morphometric changes. Jugular and colonic venous blood (CB) were sampled simultaneously for
hematological analyses.
Results
Colonic mucosa displayed mild morphometric changes and impaired barrier function after ischemia. Ischemia caused
lactic acidosis, electrolyte imbalances and hypoglycemia in CB. The ischemic injured mucosa recovered
morphologically and functionally despite a massive influx of neutrophils into mucosa, muscle layers, and serosa
during reperfusion. Eosinophils migrated towards the epithelium, and were released into the lumen during
reperfusion. All biochemical values but lactate returned to normal after reperfusion. Lidocaine reduced number and
migration pattern of eosinophils, but did not affect morphometric and functional changes or repair after colonic
ischemia.
Conclusions
The major antiinflammatory effect of lidocaine was mediated through reduced eosinophilic response in the colon
after ischemia and reperfusion.
Acknowledgements
Funded by the Morris Animal Foundation and by the Faculty Research Development Fund, University of Florida,
College of Veterinary Medicine.
References
Cook, V.L. and Blikslager, A.T. (2008) Use of systemically administered lidocaine in horses with gastrointestinal tract
disease. J Am Vet Med Assoc 232,1144-1148.
6.3 Systemic and anti-nociceptive effects of prolonged lidocaine, ketamine, and
butorphanol infusions alone and in combination in healthy horses.
Sanchez, L.C., Elfenbein, J.R., Robertson, S.A., MacKay, R.J., KuKanich, B.
Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, University of Florida
College of Veterinary Medicine, Gainesville, FL, 32608, USA and Department of Anatomy & Physiology, Kansas State
University, Manhattan, KS, 66506, USA. Tel: (+1) 352 392 2229 Fax: (+1) 352 392 8289.
Email: [email protected]
Background
Drug infusions, used to treat horses with severe signs of pain, can be associated with altered gastrointestinal transit.
The purpose of this study was to determine the effects of prolonged constant rate infusions (CRI) of lidocaine (L),
butorphanol (B), and ketamine (K) alone and in combination on gastrointestinal transit, behavior, and thermal
nociceptive threshold in healthy horses.
Methods
Eight healthy adult horses were used in a randomized, cross-over, blinded, prospective trial. Interventions were
saline, L, K, B, LK, LB, BK, and LBK as an intravenous CRI for 96 hours. Drug doses (mg/kg bolus then mg/kg/hr CRI)
were: L – 1.3 then 3; B – 0.018 then 0.013; K – 0.55 then 0.5. Two-hundred plastic beads were administered by
nasogastric tube immediately prior to the bolus. Feces were collected, weighed, and beads manually retrieved.
Behavior score, vital parameters, thermal nociceptive threshold, and LPS-stimulated concentrations of IL-6 and TNF (whole blood) were evaluated. Each drug concentration in the combined (LBK) solution was tested out to 72 hours.
Results
Four of 64 trials (3 LBK, 1 BK) were discontinued due to signs of colic. Transit time was delayed and fecal weight
decreased for LB and LBK. Significant changes in behavior scores, vital parameters, cytokines, or thermal threshold
were not observed. The concentration of each drug in the combined solution declined by <31% over 72h.
Conclusions
Drug combinations containing butorphanol caused an apparent delay in gastrointestinal transit without substantially
affecting somatic nociception at the doses studied. Combinations of lidocaine and ketamine, without butorphanol,
may have less impact on gastrointestinal transit, but further work is needed in clinical patients.
Acknowledgements
Supported by a grant from the Grayson-Jockey Club Research Foundation.
6.4 Transabdominal ultrasonography of the duodenum in the early diagnosis of paralytic
ileus in postoperative horses.
Belz, J.P., Stroth, C., Tessman, L., Willman, C.
Pferdeklinik Tappendorf, Holnweg 7, 24594 Tappendorf , Germany
(+49)04871 46080
Email: [email protected]
Background
Paralytic Ileus of the small intestine is one of the most serious complications in horses that underwent colic surgery.
Reflux of fluids from the small intestine into the stomach may cause its massive dilatation and even lead to gastric
rupture (Klohnen 2012). As the horses usually are under pain controlling medication immediately after surgery the
clinical signs of a secondary gastric dilatation may well be jeopardized. It is therefore common practice to repeatedly
pass a nasogastric tube or let the tube stay in place for days. Most horses do not tolerate the procedure very well
and the nasogastric tube often causes necrosis of the nasal and esophageal mucosa. We tried to early diagnose small
intestinal paralysis and gastric distention by means of using ultrasound examinations of different parts of the
abdomen. The only part that met our criteria (easy access, high sensitivity, no transrectal examination necessary)
was the duodenum.
Objectives
Does the repeated ultrasonographic examination of the duodenum in postoperative colic patients prove to be save
enough in the early diagnosis of paralytic ileus? Does this method at least partially avoid the necessity to repeatedly
pass a nasogastric tube?
Methods
The case records of all horses that underwent colic surgery in the Pferdeklinik Tappendorf between 1st September
2012 and 13th January 2014 and survived the immediate postoperative period (5 days) were reviewed. Ultrasound
examinations of the duodenum were performed every 6 hours over a period of 5 days postoperatively. We scanned
the duodenum ventral of the right kidney in the intercostal spaces 15 to 17 (Epstein et al. 2008) with a 3.5 MHz
curved array transducer (3.5 MHz, Noveko Int. Inc.). The ultrasonic appearance of the duodenum was classified into
the following groups: 1. Empty with repeated passage of contents, 2. Fluid filled with repeated contractions, 3. Fluid
filled without visible signs of contractions.
A nasogastric tube was inserted to control the filling status of the stomach if either there were signs of colic or the
duodenum showed fluid filling. Group 2 and 3 examinations were always followed by inserting a nasogastric tube.
We defined gastric reflux as gastric filling with more than 3 l of fluid with pH8 or higher.
Results
During this period 278 horses with acute colic were submitted to the clinic. 57 postoperative periods of 50 horses
were treated surgically (7 horses underwent a relaparotomia) and met the criteria above. In 15 postoperative
periods we detected signs of paralytic ileus and in 42 we did not. We performed 913 ultrasonographic examinations
of the duodenum following these 57 colic surgeries. 807 examinations showed an empty and contractile duodenum
(Group 1). In these cases we did not usually insert the tube as we did not get other signs of paralytic ileus in any of
these horses. 41 ultrasound examinations without signs of dilatation of the duodenum were followed by a
nasogastric intubation as other signs suggestive for paralytic ileus were observed (elevated heart and respiratory
rate, rising hematocrit value, loss of appetite). We could not find gastric reflux in any of these cases. 40 examinations
showed a moderate dilatation of the duodenum (Group 2). This was followed by gastric intubation in each case. In
25 of these cases we did find gastric reflux of 3 – 15 liters. In 25 examinations we found a massive dilatation of the
duodenum without visible signs of contractions (Group 3). We detected gastric reflux in all of these cases (3 – 24
liters).
Conclusions
The duodenum does physiologically not show a permanent filling. Permanent filling of the duodenum is a sign of
reflux of small intestinal contents. Ultrasonographic examination of the duodenum in postoperative colic patients
can partially replace the repeated use of nasogastric intubation to detect gastric reflux and paralytic ileus. In all cases
were the duodenum appears to be at least partially fluid filled we recommend the nasogastric intubation to
definitely rule out a secondary gastric dilatation.
References
Epstein K et al., Gastrointestinal ultrasonography in normal adult ponies. Veterinary Radiologiy & Ultrasound, Vol.
49, No. 3, 2008, pp 282-286
Klohnen A. Abdominal ultrasonography in the equine patient with acute signs of colic, AAEP Proceedings, Vol. 58,
2012
6.5 Nutritional management of hospitalized horses for colic according to their risk
category.
Valle, E., Bergero, D., Gandini, M.
Department of Veterinary science, University of Torino, Via L. da Vinci 44, Grugliasco (To) Italy. Tel: (+39)
0116708856 Fax: (+39) 0116709240
Email: [email protected]
Background
Nutritional support of the critically ill horses hospitalizes after colic surgery, is not longer seen as an additional care
but is essential for the recovery of the animals. The main goals of nutritional support in surgical patients are reducing
consumption of self energy stores, minimize negative protein balance to obtain the best organ rehabilitation and
healing (Giannotti and Braga 2011). However in equine medicine recommendations for nutritional support are
limited and often based on practice. This report proposes guidelines for nutritional support for equine patient after
colic surgery based on specific protocol used at the veterinary hospital of Turin.
Objectives
Using a standardized protocol for all patients scheduled for elective abdominal surgery. Horses were divided in four
risk classes (RC) based on the type of surgery: 1) low (uncomplicated colic); 2) moderate (colon-cecum enterotomy,
small colon anastomosis, with no ischemia and low distension; 3) high (ischemia-anastomosis of the small intestine,
heavy intestinal distension, proximal jejunitis); 4) very high (ischemia of large colon-cecum, anastomosis of the large
colon). For each RC a specific nutritional protocol is used in standardized in order to facilitate the management
during the hospitalization.
Methods
Horses were assigned to one RC according to their surgery. Feed used were first cut meadow hay of good quality
(medium composition on feed basis CP 7%, Ash 7%, CF 0,1%, CFb 32%, 3.5 MJ of net energy) wet in water; pelleted
fibre mix soaked in warm water to obtain a sludge (composition on feed basis CP 11%, Ash 9%, CF 4%, CFb 22%, 5.7
MJ of net energy); vitamin and mineral balancer. Before the starting of the feeding plan each horse underwent to an
accurate visit to evaluate BCS, BW, teeth and previous feed used before the colic.
The feeding schedule, the proportion of hay to pellet and the daily energy provided was establish based on the
category of risk. For each horse the requirement were calculated based on net energy requirement for rest
according to their body weight at the moment of the admission.
The feeding plan was scheduled according to the following table:
CR
Nasogastric Water Beginning Day
tube
of the
1
feeding
plan
Day
2
Day
3
Day
4
Low
No
6h
12 h
25
%
50
%
70
%
Medium No
6h
12 h
25
%
50
%
70
%
Day 5
and
for 10
days
Hay
to
pellet
ratio
Nr of
meal
Fresh
grass
90 % 90 %
80:20
5
4
time
day
for 20
min
90 % 90 %
40:60
5
4
time
day
for 20
min
High
q4h-2h-2h;
if<2lt q4h
24 h
or 8h
after
reflux
36 h or
8h after
reflux
25
%
40
%
60
%
70%
90%
20:80
8 every
3 h for
the
first
4th
days
4
time
day
for 20
min
Very
high
q4h-2h-2h;
if<2lt q4h
12 h
or 8h
after
reflux
24 h or
8h after
reflux
25
%
50
%
50
%
70%
90%
20:80
8 every
3 h for
the
first
4th
days
4
time
day
for 20
min
Results
The beginning of feeding plan was decided or postponed until postoperative ileus or gastric reflux was excluded. The
number of meals and the proportion of hay to pellet was decided based on the fact that high bulk feeds, such as
long-stem hay, in the early postoperative period could increase distension at the site of enterotomy/anastomosis
(Geor, 2007). At the moment 10 horses underwent to the described protocol and for 9 horses no complication were
recorded related to the feeding plan. For one horse a second surgery was required and a site with accumulation of
the pellet diet was identified. From this point was decided to grounding the pellet hay that has an hard consistency
and was difficult to soak in water. The mean body weight lost by the animals at the moment of admission is 20 kg
and no apparent influence were recorded on BCS.
Conclusions
The actual data on the benefits and problems linked with different modes of nutritional support in horses recovering
from colic is limited; the present reports on the feeding management is based on the present knowledge on horse
nutrition and specific request of the surgeon. In general, nevertheless, the form of nutritional support depends on
the horse’s appetite and the underlying cause of colic or complications that occur during convalescence; however
this reports should represent a first tentative to standardize the feeding schedule according to horse problem in
order to facilitate the operation during the hospitalization and guarantee the best recovery of the animals.
References
Gianotti L. and Braga M. (2011). Revising concepts of artificial nutrition in contemporary surgery: from energy and
nitrogen to immuno-metabolic support. Nutr Hosp. 26, 56-67.
Geor R. (2007). Nutritional Considerations for the Colic Patient. Compendium Eq. 344-355.
6.6 Indications, complications and short and long term outcome of 95 horses undergoing
repeat celiotomy within 14 days after colic surgery.
Mair, T., Dunkel, B., Marr, C.M., Sherlock, C., Carnwath, J., Bolt, D.M.
Dept of Clinical Science and Services, The Royal Veterinary College, North Mymms, Herts, AL9 7TA, UK; Bell Equine
Veterinary Clinic, Butchers Lane, Mereworth, Maidstone ME18 5GS, UK Rossdales Equine Hospital and Diagnostic
Centre, Cotton End Road, Exning, Newmarket, Suffolk CB8 7NN, UK
Tel: (++44) 01707 666 008 Fax: (++44) 01707 666 304
Email: [email protected]
Background
Exploratory celiotomy for colic has been extensively investigated. However, little information is available about
horses requiring a second abdominal exploration shortly after the first procedure.
Objectives
This study aimed to describe indications, findings, complications and prognosis for horses undergoing two abdominal
surgeries within 14 days. Data from short- and long term survivors and non-survivors were compared.
Methods
Records (Jan 2005 - Nov 2013) of three large equine referral hospitals were reviewed to identify horses that had
undergone two abdominal surgeries within 14 days, either due to complications arising from the first surgery or due
to newly developed problems. Signalment, historical, clinical, laboratory and surgical parameters were compared
between horses surviving to discharge (short term), horses surviving to 3 and 6 months (long term) and nonsurviving horses by chi square test or Mann–Whitney U test.
Results
Ninety-five horses met the inclusion criteria for the study; hospitals 1, 2 and 3 contributed 27, 28 and 40 cases,
respectively. Strangulating small intestinal lesions were the most common finding during the first surgery (60/95;
63.1%) and persistent nasogastric reflux was the most common reason for a second celiotomy (56/95; 58.9%),
followed by recurrent or persisting abdominal pain with/without reflux (44/95; 46.3%) and incisional complications
(8/95; 8.4%). The most common finding during the second surgery was paralytic ileus (34/95; 35.8%) while problems
with an anastomosis site were noted in 17/95 horses (17.9%). The median time between the two surgeries was 3
days (range 0.5-13 days).
Seventy five horses (78.9%) were recovered from the second surgery, but 37 animals were euthanased in the
immediate postoperative period due to continued or recurrent ileus and/or colic (n=24), subacute grass sickness
(n=2), collapse (n=4), toxaemia (n=3), peritonitis (n=2), poor long term prognosis (n=1) and incision dehiscence (n=1).
Thirty eight (40%) survived to discharge and follow up was available for all but 2 horses. Twenty seven (27/93; 29%)
survived longer than 3 months and 22/92 (23.9%) survived longer than 6 months after discharge. All deaths within
the first 6 months were associated with recurring colic, with the exception of one horse that had experienced
incisional dehiscence on the day of being discharged from the hospital. One horse had a third laparotomy due to
colic 5 months after the first procedure and subsequently developed an incisional hernia but continued to survive
long term. This horse and 17 other horses were still alive at the time of writing (median follow up time 3.25 years;
range 111 days to 7.1 years). The remaining 4 horses surviving > 6 months lived to 3, 4.25, 5 and 5.42 years after
discharge, respectively. None of the admission parameters (age, weight, heart and respiratory rates, rectal
temperature, packed cell volume, lactate concentrations, peritoneal fluid protein concentration and nucleated cell
count, nasogastric reflux volume, duration of first and second anaesthesia) and parameters between the first and
second surgery (respiratory rates, temperature and reflux volume on first and second day after the first and on the
day of the second surgery) were different between survivors to discharge, 3 months or 6 months and non-survivors.
However, heart rate on the 2nd day after the first surgery (p=0.041. p=0.013 and p=0.044, respectively) and first
(p=0.02, p=0.01 and p=0.006) and 2nd day after the 2nd surgery (p=0.003, p<0.001 and p<0.001) were significantly
lower in survivors to discharge and 3 and 6 months, respectively, compared to non-survivors. Reflux volume on day
1, 2 and 3 after the second surgery was significantly higher in non-survivors (p=0.005, p=0.002 and p=0.001,
respectively) than horses surviving to discharge and duration of hospitalisation was shorter (p<0.001). Survival to
discharge was not influenced by the type of the primary lesion (small versus large intestinal, strangulating versus
non-strangulating and strangulating small intestinal versus other lesions) or the reason for repeat celiotomy (reflux,
colic with/without reflux and incisional dehiscence). Incisional infections were noted in the records of 46 of all horses
and in 26/38 horses (68.4%) surviving to discharge; 12/38 (31.5%) of these developed incisional hernias/dehiscence.
There were no differences in survival to discharge or number of incisional infections between hospitals.
Conclusions
The prognosis for horse requiring repeat celiotomy within 14 days of the first is guarded and 42.1% of horses
surviving to discharge die or are euthanased within 6 months of discharge. The likelihood of incisional complications
is high and incisional hernias develop in close to a third of short term survivors.
6.7 Peri-operative factors associated with incisional surgical site infection following
exploratory laparotomy in horses.
Darnaud, S.J.M., Southwood, L.L., Aceto, H.W., Tomassone, L., Zarucco, L.
Department of Clinical Studies, New Bolton Center, University of Pennsylvania, 382 W. Street Rd, Kennett Square,
PA, USA. Tel: +1 610 444-5800
Email: [email protected]
Dipartimento di Scienze Veterinarie, Università degli Studi di Torino, Grugliasco (TO), Italy. Tel: +33 (0) 607 89 83 72 /
+39 348 662 39 70
Email: [email protected]
Background
Incisional surgical site infections (SSI) are one of the most common complications after exploratory laparotomy in
horses. The reported occurrence varies from 2.7% (Tnibar et al. 2013) to 37% (Phillips and Walmsley 1993). SSI may
increase animal discomfort, length of hospital stay, and expenses associated with treatment as well as delay return
to work and may lead to hernia formation. Information in the literature pertaining to factors associated with SSI is
somewhat conflicting.
Objectives
The objective of the study was to examine peri-operative factors associated with SSI following exploratory
laparotomy in horses admitted for colic.
Methods
Information on 78 peri-operative variables was collected. Demographic and admission data were recorded.
Information on surgical preparation, surgery duration, lesion, surgical procedures, body wall and skin closure, perioperative incisional protection, antimicrobial prophylaxis, and quality and duration of general anesthesia recovery
was included in the analysis. Post-operative complications, blood work abnormalities, and length of hospital stay
were noted.
SSI was defined as drainage from the incision following the initial 48 hours post-surgery that persisted for at least 36
hours. Horses were classified as having (a) normal wound healing or (b) SSI. Horses were required to have at least 12
days without signs of infection to be classified as normal wound healing.
Univariable descriptive statistics of each variable and its association with SSI were evaluated with 2x2 tables and chisquared or Fisher exact test. A multivariable model was applied on selected variables to simultaneously estimate the
effect of more than one variable on SSI. Variables that did not contribute to the model were eliminated, by
comparing the fit of the reduced models to the complete model through a likelihood ratio test.
Results
Of the 236 animals admitted, 185 horses matched the inclusion criteria and 36 had a SSI. Univariable analysis
revealed seven variables that were significantly associated with SSI. A lower proportion of young horses (≤4years)
had an SSI than older animals (>12 years) and the combination of potassium penicillin and gentamicin reduced SSI
(vs only potassium penicillin or gentamicin). A higher proportion of horses with a skin incision > 24 cm had a SSI (vs ≤
24cm). A higher proportion of horses with hyperfibrinogenemia and first febrile episode within 7 hours of surgery
had a SSI. Length of hospital stay and incisional hernia formation were also associated with SSI.
Age, final preparation with iodine-impregnated incise drape, skin incision length, duration of recumbency in the
recovery stall, postoperative diarrhea, and hyperfibrinogenemia were included in the multivariable analysis. Skin
incision > 24 cm and hyperfibrinogenemia remained significantly associated with SSI.
Conclusion
Multiple logistic regression demonstrated that odds of developing a SSI were higher for horses with an incision
length > 24 cm. Based on these findings, surgeons should carefully consider their approach to a ventral midline
laparotomy. A small incision is not recommended for exteriorizing a distended or compromised colon because of the
risks associated with colonic rupture; however, clients may be advised that the horse may develop a SSI. Results
from the univariable analysis indicated the importance of antimicrobial prophylaxis, and suggested that horses > 12
years old are more likely to develop a SSI than younger horses (< 4 years old). This study confirmed that SSI is
associated with hernia formation and that horses with a SSI have a longer hospital stay leading to increased expense
for the client.
References
Tnibar A, Grubbe Lin K, Thurøe Nielsen K, et al. Effect of a stent bandage on the likelihood of incisional infection
following exploratory coeliotomy for colic in horses: A comparative retrospective study. Equine Vet J 2013; 45:564569
Phillips TJ, Walmsley JP. Retrospective analysis of the results of 151 exploratory laparotomies in horses with
gastrointestinal disease. Equine Vet J 1993; 25:427-431
6.8 Heart rate variability in horses that undergo exploratory laparotomy for acute GI
disease: evidence for transient myocardial dysfunction.
McConachie, E.L., Giguere, S., Rapoport, G., Barton, M.H.
Departments of Large Animal Medicine and Small Animal Medicine and Surgery. College of Veterinary Medicine.
University of Georgia. 501 DW Brooks Drive Athens, GA 30602. Tel: (01) 706 542 3223.
Email: [email protected]
Background
Heart rate variability (HRV) data quantifies beat to beat variations that occur due to changes in neurohormonal
activity, thus providing an indication of cardiovascular health independent of heart rate (Marr and Bowen 2010). The
development of multiple organ dysfunction syndrome and subsequent mortality has been shown to be accurately
predicted by HRV indices in septic human patients (Pontet et al. 2003). Previous studies have demonstrated that
horses with acute ischemic intestinal disease have increased serum cardiac troponin I (cTnI) concentrations and an
increased risk of mortality (Radcliffe et al. 2012). However, there are no studies that have simultaneously evaluated
a serum cardiac biomarker with measures of autonomic balance in horses with acute colic.
Objectives
To evaluate the relationship between serum cTnI concentration, HRV, and survival to discharge in horses undergoing
surgical exploratory laparotomy for acute colic.
Methods
Adult (>1 year of age) horses presenting for acute colic requiring laparotomy (n=55) or elective surgical procedures
(control; n=10) were enrolled. Blood was collected at admission, 24, and 48 hours post-operatively for cTnI
measurement. Continuous telemetry was recorded for 48 hours beginning approximately 1 hour post-operatively.
Thirty minute ECG recordings, free of artifact and arrhythmias, were selected at 12 hour intervals for HRV
measurements including standard deviation of normal intervals (SDNN) and vasovagal tonus index (VVTI). Data were
stratified by group (elective healthy control, simple obstruction, strangulating obstruction), collection time, and
survival to discharge. Paired treatment group comparisons were made with the Mann Whitney U test or Spearman R
correlation, with significance set at p < 0.05. Receiver operative curve analysis and logistic regression were used to
identify relative risk of nonsurvival (P <0.05).
Results
Serum cTnI concentrations were significantly greater for horses with strangulating obstructions of the intestine, as
compared to horses with simple obstructions and healthy elective surgical cases 48 hours post-operatively. Horses
with strangulating obstructions had significantly lower SDNN and VVTI values during the first 24 hours, as compared
to the other treatment groups. cTnI and SDNN values were significantly correlated (p=0.0001; R= -0.46). Horses that
did not survive to discharge had significantly greater peak cTnI values (OR 37.3; 95% CI = 4.1 to 341; P = 0.0013 when
cTnI >0.22 ng/ml) and significantly lower SDNN values (OR 14.8; 95% CI = 1.69 to 129; P = 0.015 when SDNN < 27.6
msec).
Conclusions
Lower SDNN values reflect reduced HRV which is indicative of the loss of normal cardiovascular autonomic balance.
The significant correlation of SDNN with cTnI, a specific biomarker of cardiomyocyte damage, as well as its significant
association with nonsurvival suggests that HRV monitoring may be a useful stall side test of cardiovascular health in
horses with acute gastrointestinal disease requiring surgery.
Acknowledgements
This study was funded by the American Quarter Horse Association and the Grayson Jockey Club Foundation.
References
Marr CM, Bowen IM. Cardiology of the Horse. 2nd Edition. Ambulatory Electrocardiography and Heart Rate
Variability. Saunders New York 2010;10:130-133.
Pontet J, Contreras P, Curbelo A, et al. Heart Rate Variability as Early Marker of Multiple Organ Dysfunction
Syndrome in Septic Patients. J Crit Care 2003;18(3):156-63.
Radcliffe RM, Divers TJ, Fletcher DJ, et al. Evaluation of L-lactate and cardiac troponin I in horses undergoing
emergency abdominal surgery. J Vet Emerg Crit Care (San Antonio) 2012;22:313-319.
6.9 Prospective randomized clinical trial evaluating the use of absorbable skin staples for
abdominal closure in horses.
Biedrzycki, A.H., Brounts, S.H.
Department of Surgical Sciences, University of Wisconsin
Madison, WI, USA
Tel: +1 608 265 8510
Email: [email protected]
Background
Complications, such as surgical site infections (SSIs) can develop in the ventral midline incision in up to 35% of horses
after intestinal surgery (Ingle-Fehr 1997). Problems associated with suture tract infections led to the development of
a subcuticular suture placement technique in the human field and subsequently in veterinary surgery. Horses with
metallic skin staples (MS) have also been shown to be at increased risk of developing SSI’s (Torfs, 2010). Recently,
absorbable staples designed for subcuticular placement (SAS) have become commercially available1. It has been
shown in equine tissue that SAS are superior to MS in terms of resisting wound gap formation and are of comparable
biomechanical strength (Biedrzycki 2013).
Objectives
The objectives of this study were to evaluate the following hypotheses; 1) SAS can be used in equine abdominal
incisions without complication and placed in a similar time period to MS, and 2) SAS are associated with fewer SSI’s
compared to MS.
Methods
Horses undergoing a ventral midline celiotomy during December 2011-2012 were included in this prospective
randomized trial study after consent of the owner. Horses were subjected to similar perioperative antibiotic and
analgesic therapy. Data recorded included history, physical examination, surgical lesion, surgical and anesthetic
duration, postoperative complications and serial macroscopic evaluations of the incision. Once the surgical lesion
was identified, horses were randomly assigned to receive either SAS or MS, blocking on lesions type (small intestine
vs. other) and requirement for enterotomy/resection (yes/no). An Ioban was placed over the wound for 24 hours
post surgery. Recovery was graded using a scoring system. The incisions were photographed at serial time points
from ventral and lateral angles. Images were assessed for the presence of surgical site complications and evaluated
using a wound scoring system (0-10; 10 being no edema/redness/complications). SSI’s were defined using criteria
previously established, such as, incisional pain, discharge, purulent drainage, fever and isolation of organisms from
the site. Clients provided photographic images of the incision post discharge and a verbal assessment was recorded.
Categorical data was evaluated using Fishers Exact Test with significance set at p<0.05.
Results
Fifteen horses underwent a ventral midline celiotomy utilizing the SAS and 27 with MS (41 for emergency colic
surgery, 1 for elective ovariectomy). The horses were between 4 and 27 years of age and included 25 geldings and 16
mares and 1 stallion. The breeds of the horses were 11 Arabians, 14 Quarter Horses, 8 Thoroughbreds and 9 others.
For the horses presenting for abdominal surgery, the lesions identified during surgery involved the small intestine
(13 small intestinal lipomas requiring resection and anastomoses, 9 small intestinal lesions not requiring small
intestinal resection), the large colon (17 right dorsal displacements, 1 non-strangulating colonic torsion), small colon
(1 small colon resection and anastomosis) and ovaries (1 elective ovariectomy procedure). Although there was an
initial increase in time to close with the SAS due to novelty, once experience was gained, there was no significant
difference in wound closure times. All horses recovered from anesthesia without incident, although in 3 cases the
recovery period was prolonged and in 5 cases a high recovery score was recorded. For the SAS at the time of
bandage removal (24 hours after surgery), 13/15 horses were noted to have discharge, varying from mild to
moderate, serosanguineous to hemorrhagic. Discharge resolved by 48 hours post operatively in 8 horses, by 3 days
in 3 horses and 2 horses had evidence of discharge up to 5 days postoperatively. In all cases, the drainage resolved
without incident. All cases (SAS and MS) developed some degree of postoperative incisional edema formation; the
amount and duration of edema formation for the SAS (wound score) was significantly less than the MS. No horse in
the small case series developed any evidence of a surgical site infection. All wounds healed as expected. No evidence
of wound edge dehiscence or staple failure was noted in any case. During follow-up contact with the owners 30 days
postoperatively, all reported satisfaction with the incision for both groups and associated a positive experience with
the use of SAS.
Conclusions
Despite widespread use of this device in a plethora of human surgeries, this is the first study that evaluates the use
of this stapler in a clinical setting in the veterinary field. We demonstrated that SAS could be placed in similar time to
MS and without complication. Due to the limitation of the small group sizes, we had insufficient power to evaluate
an effect on SSI development. However, we present this as evidence that SAS can be used for skin closure after
exploratory celiotomy surgeries and provide the surgeon with a rapid and cosmetic closure. The interrupted and
appositional placement of the staple placement permits natural wound drainage, which may contribute to lower SSI
rates.
References
Ingle-Fehr JE, Baxter GM, Howard RD, et al (1997). Bacterial culturing of ventral midline celiotomies for prediction of
postoperative incisional complications in horses. Vet Surg 26:7–13
Torfs, S., Levet, T., Delesalle, C, et al. (2010). Risk factors for incisional complications after exploratory celiotomy in
horses: do skin staples increase the risk?. Vet Surg, 39(5), 616-620.
Biedrzycki, A., Brounts, S., Markel M. (2013) Biomechanical evaluation of a novel subcuticular skin stapling device for
equine abdominal skin closure. Vet Surg (In Press).
6.10 A prospective study of antimicrobial resistance in bacterial isolates from equine
celiotomy incisions.
Smith, L.J., Mair, T.S., Rycroft, A., Witte, T.H., Perkins, J.D.
Equine Referral Hospital, Department of Veterinary Clinical Sciences, Royal Veterinary College, Hawkshead Lane,
North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
Bell Equine Veterinary Clinic, Butchers Lane, Mereworth, Kent, ME18 5GS, United Kingdom
Pathology and Infectious Diseases, Department of Veterinary Basic Sciences, Royal Veterinary College, Hawkshead
Lane, North Mymms, Hatfield, Hertfordshire, AL9 7TA, United Kingdom
Current address: The Horse Clinic, House and Jackson, Rookery Road, Blackmore,
Essex, CM4 0LE, United Kingdom. Tel (+44) 1277 823808
E-mail address: [email protected] (L. Smith)
Background
Wound complications, including surgical site infection (SSI), are important and common following exploratory
celiotomy for colic in horses. Reported rates of SSI following exploratory celiotomy have ranged from 4 to 27%
(Honnas and Cohen 1997; Ingle-Fehr et al 1997; Mair and Smith 2005), but studies detailing pathogen identification
and in vitro susceptibility results are limited.
Objectives
This study set out to evaluate the results of bacterial cultures and antibiotic susceptibility testing of equine celiotomy
incisions at two equine referral hospitals, with and without evidence of SSI.
Methods
SSI was defined by the criteria of the U.S. Centers for Disease Control and Prevention. Clinical data were collected on
perioperative prophylactic antimicrobials, organisms isolated, and resistance profiles.
Results
A total of 52 surgeries in 52 patients were included. There were 25 sites with positive bacterial cultures from which
35 organisms were isolated. Staphylococci were the organisms isolated most commonly (21/35; 60%); 14 other
isolates (40%) included gram-negative bacilli and anaerobes. Susceptibility testing was performed on 16 (76%) of the
staphylococcal isolates. Ten (63%) exhibited drug resistance; five were multi-drug resistant. Six of eight nonstaphylococcal isolates tested (75%) exhibited antibiotic resistance; two were multi-drug resistant.
Conclusions
Although the usual empiric treatment of SSI after celiotomy targets staphylococci, culture and susceptibility profiles
should be obtained because non-staphylococcal bacteria were commonly identified, and drug resistance was seen in
more than 66% of the isolates. Further study is needed to define the optimal empiric antibiotic therapy for SSI after
equine celiotomy.
References
Honnas, C.M. and Cohen, N.D. (1997) Risk factors for wound infection following celiotomy in horses. Journal of the
American Veterinary Medical Association. 210 78
Ingle-Fehr, J.E., Baxter, G.M., Howard, R.D., et al (1997) Bacterial culturing of ventral median celiotomies for
prediction of postoperative incisional complications in horses. Veterinary Surgery. 26 7-13
Mair, T.S. and Smith, L.J. (2005) Survival and complications rates of 300 horses undergoing surgical treatment of
colic. Part 1: Short-term survival. Equine Veterinary Journal 37 296 – 302.
6.11 Intra-abdominal adhesions in horses undergoing primary and repeat celiotomies for
colic.
Mair, T., Sinclair, D.R., Barr, E.D., Sherlock, C.E.
Bell Equine Veterinary Clinic, Mereworth, Kent. ME18 5GS. UK. Tel: (+44) 1622 813700. Fax: (+44) 1622 812233.
Email: [email protected]
Background
Several epidemiological studies have identified previous abdominal surgery as an important risk factor for the
development of colic (Cohen et al. 1996 and 1999). One cause of such episodes of colic is thought to be intraabdominal adhesions, but few studies have been able to quantify adhesions following surgery. In a previous study
performed at this hospital, the rate of confirmed adhesions (confirmed by repeat exploratory celiotomy or post
mortem examination) in 190 surgical colic patients was 8.9% (Mair and Smith 2005), however this number almost
certainly underestimates the true adhesion rate since many horses that develop colic are not evaluated by repeat
surgery or post mortem examination, and clinically quiescent adhesions may also develop. Another study reported
on 99 cases of repeat celiotomies; adhesions were not identified at the primary surgery, but pathological adhesions
were the commonest diagnosis at repeat celiotomy (28%). However, adhesions were not associated with the site of
the primary lesion or resection, suggesting that surgical trauma is the most important stimulus in adhesion
formation (Gorvy et al. 2008). In our hospital, we have recognised intra-abdominal adhesions in some horses at their
initial abdominal surgery where there is no history or evidence of previous abdominal surgery; this observation does
not appear to have been reported previously.
Objectives
The aims of this study were to document the prevalence and sites of intra-abdominal adhesions in horses
undergoing exploratory celiotomy, both at their primary surgery and at repeat celiotomies.
Methods
The case records of horses undergoing exploratory celiotomy at Bell Equine Veterinary Clinic between 2005 and
2013 were reviewed. Data were retrieved from the surgical reports. Details of adhesions identified at surgery were
recorded regardless of whether the horse recovered from anaesthesia or not. No specific anti-adhesion therapies
were used other than abdominal lavage with sterile isotonic crystalloid solutions with added heparin at the
termination of surgery in approximately 50% of horses, and the routine administration of non-steroidal antiinflammatory drugs post-operatively.
Results
Surgical reports were available for 638 horses undergoing exploratory celiotomy over the study period. Of these, 75
(11.7%) were repeat surgeries. The interval between celiotomies ranged from less than one day to 12 years in 64
horses; in 11 horses the exact date of the primary surgery was unknown (in all of these cases evidence of previous
midline celiotomy was found at surgery but the owners were unaware that the horse had undergone a previous
celiotomy). In these 64 horses where the interval between celiotomies was known, the repeat surgery was
performed within 14 days in 41 cases (64.0%).
Adhesions were identified at the first surgery in 32 of 563 horses (5.7%). The most common forms of adhesions
included omental adhesions to mesenteric lipomas (10), intestinal adhesions to the body wall (6), omental adhesions
to intestine (5), intestinal adhesions to mesenteric abscesses or tumours (5) and intestinal adhesions associated with
peritonitis (2).
Adhesions were identified in 25 of 75 horses undergoing repeat celiotomy (33.3%); none of these horses had
adhesions at their initial surgery where this surgery was documented. These included adhesions to an anastomosis
site only in 2 (2.7%), adhesions to an anastomosis and to more distant intestine in 3 (4.0%), adhesions to intestine
distant to an anastomosis (without involvement of the anastomosis) in 2 (2.7%), intestinal adhesions in horses with
no anastomosis in 8 (10.7%) and adhesions to the body wall / celiotomy wound in 7 (9.3%).
Conclusions
Spontaneous intra-abdominal adhesions not associated with previous surgery occur in a small number of horses,
most commonly involving the omentum, and adhesions to tumours / abscesses and body wall. Adhesions are
identified in about a third of horses undergoing repeat celiotomy; these adhesions may involve the anastomosis site
or region of the original intestinal disease, but more frequently involve distant areas of the intestine. These
observations support previous studies suggesting that surgical trauma (and the abdominal wound) or other factors
are important in precipitating adhesion formation.
References
Cohen, N.D. and Peloso, J.G. (1996) Risk factors for history of previous colic and for chronic, intermittent colic in a
population of horses. J.Am.Vet.Med.Ass. 208 697-703
Cohen, N.D., Gibbs, P.G. and Woods, A.M. (1999) Dietary and other management factors associated with colic in
horses. J.Am.Vet.Med.Ass. 215 53-60
Gorvy, D.A., Edwards, G.B. and Proudman, C.J. (2008) Intra-abdominal adhesions in horses: a retrospective
evaluation of repeat laparotomy in 99 horses with acute gastrointestinal disease. Vet.J. 175 194-201
Mair, T.S. and Smith, L.J. (2005) Survival and complication rates in 300 horses undergoing surgical treatment of colic.
Part 3: Long-term complications and survival. Equine Vet.J. 37 310-314
6.12 Macrocyclic Lactone efficacy in clien.t owned horses: a retrospective study 20082011.
Daniels, S.P., Proudman, C.J.
Centre for Performance In Equestrian Sport, UWE Hartpury, Hartpury, Gloucester, GL19 3BE, UK. Tel: (+44) 01452 60
239.
School of Veterinary Medicine and Science, University of Surrey, Guildford, Surrey, GU2 7TE
Email: [email protected]
Background
The macrocyclic lactones (ML) ivermectin and moxidectin are both licensed for treatment of equine nematodes.
Borgsteede, et al. (1993) and DiPietro, et al. (1997) both reported high efficacy and long egg reappearance periods
(ERP) post dosing when these anthelmintics were first marketed. Anthelmintic resistance is of growing concern
worldwide and a recent UK study reported high reliance on the ML class of anthelmintics for equine parasite control
(Ireland et al. 2013). Lyons et al. (2011) reported early ERP to ivermectin and moxidectin on horse farms in Kentucky
USA. Sangster (1999) suggested that early ERP is the first step towards anthelmintic resistance which is inevitable in
the ML class of anthelmintics.
Objectives
We performed this retrospective study with 2 primary objectives: (1) to determining the efficacy of ivermectin and
moxidectin in UK pleasure horses. (2) To determine the current egg reappearance period for ivermectin and
moxidectin in UK pleasure horses.
Methods
The parasite control records of all horses that had been tested for ML efficacy between 1st January 2008 and 29th
August 2011 by a commercial provider were reviewed. Data were compiled from the parasite control programmes
and entered into a Microsoft Excel® 2007 database. Efficacy tests were sorted into faecal egg count reduction test
(FECRT) within the licensed ERP for the product: FECRT (%) = (Pre-treatment FEC – Post treatment FEC) / Pretreatment FEC *100 and early ERP tests. Following the World Association for the Advancement of Veterinary
Parasitology (WAAVP) guidelines (Coles et al. 1992) initial faecal egg counts <150epg were rejected from the data
set. The data were subject to FECRT analysis according to WAAVP guidelines for arithmetic means (Coles et al. 1992).
Following this data was subject to non-parametric bootstrap analysis used to sample with replacement from the
observed FECRT, upper and lower 2.5 percentiles of 10 000 simulations were taken as the 95% confidence limits.
Results
Of the 200 horses tested for ML efficacy, 154 met the required criteria. Observation were categorised into
moxidectin (n=96) or ivermectin (n=57) FECRT. Moxidectin mean FECRT was 82%, when bootstrapped the LCL was
73% reduction. Ivermectin displayed mean FECRT of 60% with an LCL of 35% reduction. In moxidectin treated
animals (n=96) 61% displayed expected efficacy (≥95% reduction), 39% displayed suspected reduced efficacy (>95%
reduction) and 18% displayed reduced efficacy falling below the LCL. In ivermectin treated animals (n=57) 46%
displayed expected efficacy (≥95% reduction), 53% displayed suspected reduced efficacy (>95% reduction) and 18%
displayed reduced efficacy below the LCL.
Conclusions
We report reduced efficacy of the macrocyclic lactones ivermectin and moxidectin to in horse strongyles in the UK.
Macrocyclic lactone resistance has not previously been reported in cyathostomins in UK horses, this work indicates a
reduction in the efficacy particularly of ivermectin demonstrated by early ERP.
Acknowledgements
EPLA Ltd provided the data for this study.
References
Borgsteede, F.H.M., Boersma, J.H., Gaasenbeek, C.P. and van der Burg, W.P. (1993). The reappearance of eggs in
feaces of horses after treatment with ivermectin. Vet.Quat. 15: 24-26
Coles, G. C., Bauer, C., Borgsteede, F. H. M., Geerts, S., Klei, T. R., Taylor, M. A. and Waller, P. J. (1992). World
Association for the Advancement of Veterinary Parasitology (W.A.A.V.P.) methods for the detection of anthelmintic
resistance in nematodes of veterinary importance. Vet. Parasitol.44 (1-2): 35-44.
DiPietro, J.A., Hutchens, D.E., Lock, T.F., Walker, K., Paul, A.J., Shipley, C. and Rulli, D. (1997). Clinical trial of
moxidectin oral gel in horses. Vet.Parasitol. 72 (2): 167-177
Ireland, J.L., Wylie, C.E., Collins, S.N., Verheyen, K.L.P. and Newton, J.R. (2013). Preventative health care and ownerreported disease prevelance of horses and ponies in Great Britian. Res.Vet.Sci. 95: 418-424
Lyons, E. T., Tolliver, S. C. and Collins, S. S. (2011). Reduced activity of moxidectin and ivermectin on small strongyles
in young horses on a farm (BC) in Central Kentucky in two field tests with notes on variable counts of eggs per gram
of feces (EPGs). Parasitol Res. 108(5): 1315-1319.
Sangster, N. C. (1999). Pharmacology of anthelmintic resistance in cyathastomes: will it occur with the
avermectins/milbemycins? Vet. Parasitol .85: 189-204.
Poster presentations
Monday 7th July
7.1
Ventral intra-abdominal pressures in horses with colic: Does intra-abdominal
hypertension exist?
V.H.L. Scott, S. D. Hurcombe, M. Mudge, and R. Toribio
Cambridge Equine Hospital, Department of Veterinary Medicine, University of Cambridge, Madingley Road,
Cambridge, England, CB3 0ES. Tel: (+44) 01223 760535 Fax: (+44) 01223 337 672 Email: [email protected]
Galbreath Equine Center, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State
University, 601 Vernon L Tharp Street, Columbus, Ohio, USA, 43210. Tel: (+1) 614 292 6661 Fax: (+1) 614 688 5642
Background
Intra-abdominal hypertension (IAH) is a common cause of morbidity and mortality in the human intensive care
setting. If IAH is untreated, organ failure due to abdominal compartment syndrome may ensue (Malbrain et al.
2013). Abdominal pain is the most common reason for emergency evaluation of horses and despite the high
frequency of equine colic, IAH has been poorly documented. Recent studies have focused on intra-abdominal
pressure (IAP) measurement techniques (Hurcombe and Scott, 2012), effects of gastric fill on IAP (Barrett et al. 2013)
and effects of cribbing on IAP (Albanese et al. 2013), yet the effect of colic on IAP is lacking. We sought to determine
whether IAH exists in horses with colic by measuring direct ventrum IAP and associate these pressures with clinical
findings and outcome.
Objectives
To measure and characterize ventral IAP in horses with acute abdominal pain presenting to a tertiary care facility.
Methods
Ventral abdominocentesis using a 10cm sterile metal teat cannula was performed under aseptic conditions in 53
horses presenting to The Ohio State University for acute abdominal pain. A saline primed line with electronic
manometer was connected to the cannula and direct IAP measured in triplicate at end expiration. Nine healthy
adult horses without abdominal disease were used as controls. Intra-abdominal hypertension (IAH) cut-off IAP was
determined from the mean + two standard deviations IAP from control subjects and was 32 mmHg. Horses were
characterized based on lesion type (strangulating, non-strangulating, simple), location (large intestine (LI), small
intestine (SI), other (non-LI-SI) and treatment type (medical or surgical) and outcome. Differences in IAP between
groups evaluated were performed via unpaired t-tests (2 groups), one-way-ANOVA (≥ 3 groups) or non-parametric
equivalents. Odds ratios (95% confidence intervals) for management type and survival were performed using Fishers
exact test. Data are presented as proportions (%) and medians (mmHg). P<0.05 was significant.
Results
IAP was significantly higher in colic cases (29mmHg) than controls (25mmHg; P=0.025). 15/53(28.3%) colic cases
have IAP > 32mmHg and considered to have IAH (8/15 with LI lesion and 7/15 with SI lesion). There was no
difference in IAP between survivors (28mmHg) and non-survivors (29 mmHg; P=0.87). Horses with LI medical
(36mmHg) lesions had highest IAP of any colic group including SI medical (25mmHg) or LI surgical (28mmHg; P<0.01).
Horses with IAP > 32mmHg were not more likely to need surgery (OR 0.99, 0.31-3.2; P=0.1). Horses diagnosed with a
medical lesion and who had IAH (IAP>32mmHg) were 15 times more likely to live than horses with surgical lesions
and IAH (OR 15, 0.68-332; P=0.04).
Conclusions
These data suggest that ventral IAP in horses with colic is increased compared with healthy controls. Moreover, IAH,
as defined above, does exist in horses with colic and is associated with non-survival in horses that require surgery.
References
Albanese, V., Munsterman, A.S., DeGraves, F.J., Hanson, R.R. (2013) Evaluation of intra-abdominal pressure in horses
that crib. Vet. Surg. 42, 658-662
Barrett, E.J, Munsterman, A.S., and Hanson, R.R. (2013) Effects of gastric distension on intraabdominal pressures in
horses. J. Vet. Emerg. Crit. Care. 23, 423-428
Hurcombe, S.D.A and Scott, V.H.L. (2012) Direct intra-abdominal pressures and abdominal perfusion pressures in
unsedated normal horses. J. Vet. Emerg. Crit. Care. 22, 441-446
Malbrain, M.L., De Laet, I.E., De Waele, J.J., Kirkpatrick, A.W. (2013) Intra-abdominal hypertension: definitions,
monitoring, interpretation and management. Best Pract. Res. Clin. Anaesthesiol. 27, 249-270
7.2
Blood concentrations of ghrelin, leptin, motilin and cortisol in horses with colic: pilot
study
S. D. Hurcombe, M. Larberg, M. Mudge, and R. Toribio
Galbreath Equine Center, Department of Veterinary Clinical Sciences, College of Veterinary Medicine, The Ohio State
University, 601 Vernon L Tharp Street, Columbus, Ohio, USA, 43210. Tel: (+1) 614 292 6661 Fax: (+1) 614 688 5642
Email: [email protected]
Background
Various hormones (ghrelin, leptin and motilin) are known to regulate hunger and gastrointestinal motility (De Smet
et al. 2009). As such, clinicians exploit their effects in the management of dysmotility i.e. in horses, erythromycin
(motilin analogue) used for post-operative ileus (Van Hoogmoed et al. 2004) and more recently ghrelin analogues for
people with dysmotility and gastrointestinal disorders (Fujitsuka et al. 2012).
Abdominal pain is associated with hypomotility, increased sympathoadrenal responses and reduced borborygmi.
Abdominal pain may therefore affect various endocrine pathways that regulate motility and feeding. Excluding
cortisol concentrations (Hinchcliff et al. 2005), limited information exists detailing the effects of abdominal pain on
blood ghrelin, leptin and motilin concentrations in horses.
Objectives
The main objective of this study was to measure ghrelin, leptin, motilin, and cortisol concentrations in horses with
colic at admission and discharge, euthanasia or death and to associate these endocrine variables with clinical
findings.
Methods
Jugular venous blood was collected from adult horses presenting to The Ohio State University for acute abdominal
pain during June and July 2013. Clinical examination findings, clinicopathologic findings, and outcome were recorded
for all cases. A gut sound score (GSS; unvalidated) was used to associate hormone concentrations with magnitude of
borborygmi. Briefly, each quadrant was given a score 0-2 with a maximum score of 8 (present and regular sounds)
and minimum score of 0 (absent sounds). Blood was collected again at the time of discharge or euthanasia/death. A
control group of horses (n=16) from the university teaching herd were examined and blood drawn for clinical and
endocrine testing. Blood was collected into EDTA-aprotinin tubes and serum clot tubes. Serum and plasma were
harvested within 6 hours and frozen at -80°C until assayed. Hormones were measured using validated
immunoassays. Horses with colic were classified into medical versus surgical disease, large (LI) versus small intestine
(SI), lived versus died/euthanized. Differences between groups were compared using a Mann-Whitney U test or
Kruskal-Wallis test. Differences between admission and discharge were compared using a Wilcoxon test. P<0.05 was
significant.
Results
Twenty horses presented for colic; 9/20 had medical lesions, 11/20 had surgical lesions, and there were equal
numbers of LI and SI lesions.
Among horses with colic, there were no differences in ghrelin, leptin and motilin concentrations between admission
and discharge (P>0.1). Cortisol was higher in all colic cases at admission compared to discharge (P = 0.004) including
medical (P=0.015) and surgical cases (P=0.009). Horses with LI lesions had lower cortisol concentrations at discharge
compared to admission (P=0.0024) but this was not observed for SI lesions (P=0.25). There were no significant
differences in any endocrine variable between SI admit versus LI admit, SI discharge versus LI discharge, or
strangulating lesions versus non-strangulating lesions (P>0.05). Non-survivors had higher motilinadmission
concentrations compared with survivors (P=0.037).
Horses with a GSS >4 had significantly lower motilinadmission concentrations than horses with a GSS ≤ 4 (P=0.04).
Significance was even greater when a GSS cut-off of ≤ 1 was used indicating a virtual absence of borborygmi.
Motilinadmission concentrations were highest in horses with poorer auscultable borborygmi (P=0.01).
Conclusions
Ghrelin and leptin concentrations did not change in horses with colic. Hypermotilinemia at admission was associated
with non-survival and with lower GSS. These data may suggest motilin receptor dysregulation rather than hormone
deficiency as a cause of dysmotility (Koenig et al, 2006). Hypercortisolemia at admission that decreased over time
was associated with survival. These data were corroborated, in part, by Hinchcliff et al. 2005 and indicate that stress,
pain and increased sympathoadrenal output are associated with clinical and endocrine dysregulation during colic.
Acknowledgements
Dr K. Dembek for her assistance with laboratory techniques.
References
De Smet, B., Mitselos, A. and Depoortere, I. (2009) Motilin and ghrelin as prokinetic drug targets. Pharmacol.
Therapeutics. 123, 207-223
Fukitsuka, N., Asakawa, A., Amitani, H., Fujimiya, M. and Inui, A. (2012) Ghrelin and gastrointestinal movement.
Methods in Enzymology. 514, 289-301
Hinchcliff, K.W., Rush, B.R. and Farris, J.W. (2005) Evaluation of plasma catecholamine and serum cortisol
concentrations in horses with colic. J. Am. Vet. Med. Assoc. 227, 276-280
Koenig, J., Sukhminder, S., Cote, N., and LaMarre, J. (2006) Effect of intraluminal distension or ischemic strangulation
obstruction of the equine jejunum on jejunal motilin receptors and binding of erythromycin lactobionate. Am. J. Vet.
Res. 67, 815-820
Van Hoogmoed, L.M., Nieto, J.E., Snyder, J.R. and Harmon, F.A. (2004) Survey of prokinetic use in horses with
gastrointestinal injury. Vet. Surg. 33, 279-285.
7.3
The effects of bit chewing on right upper quadrant intestinal sounds frequency in adult
horses
Pagliara, E., Giusto, G., Gandini, M.
Dipartimento di Scienze Veterinarie, Università degli Studi di Torino (Italy).
Via L. da Vinci 44, 10095 Grugliasco (Torino), Italy
Email: [email protected]
Background
Many therapies have been proposed to prevent and treat postoperative ileus (POI) in horses (Freeman, 2000;
Morton and Blinkslager, 2002; Blikslager, 1994) but to date none is considered fully effective. Various methods have
been considered in the prevention of POI in humans (Basse, 2003) too and among these gum chewing is gaining a
role, reducing time from surgery to first fecal passage and hospitalization time.
Objectives
To consistently induce healthy horse at chewing without ingesting food and to evaluate its effects on right upper
quadrant gut sounds.
Methods
Ten healthy horses (6 standarbred, 4 warmblood) of both genders (2 intact male, 4 gelding, 4 mares, age 3-6 yo and
mean weight 500±34 kg) were included in the study. All subjects underwent a clinical examination to exclude
intestinal or other pathologies.
As previously described (Naylor, 2006), a digital phonendoscope held by an operator was positioned in the area on
the right upper flank between the tuber coxae and the last rib, dorsal to the crux of the oblique external abdominal
muscle. Evaluation was confined to right upper quadrant because preliminary results showed an increase of gut
sounds only in this area.
A first registration was started and lasted for five consecutive minutes. Then a snaffle bit with toggles was applied to
the horse and a second registration started soon after and lasting 18 minutes.
Recording sessions were cut in 5-minutes sub-sessions then randomly numerated and assessed blindly by two
operators that counted the total number of borborigmi for each session. Borborigmi were classified in two
categories, ones lasting less and ones lasting more than 3 seconds. For each period of 5 minutes in each session the
number of borborigmi per minute was then obtained and compared number of borborigmi per minutes between the
5 minute pre-chewing with 5, 10 and 15-minutes post chewing sessions.
Results
Application of a bit produced consistent mastication and swallowing in all horses that started soon after and lasted
for a period of 20 minutes or more. We noted a significantly different increase in short (< 3 sec) gut sounds in the
first 5 min of registration. After this period the frequency leveled but maintained values significantly different from
the period pre-chewing. Longer sounds (> 3 sec) didn’t differed significantly in frequency between periods.
Conclusion
Mastication of a bit consistently caused an increase in gut sounds on the right upper quadrant. Bit chewing can be
easily obtained in horses at rest and further evaluation as an adjunctive element in the management of POI is
warranted.
References
Basse, L. et al. (2003) Gastrointestinal transit after laparoscopic vs open colonic resection. Surg. Endosc. 17, 19191922
Blikslager, A.T. et al (1994): Evaluation of factor associated with postoperative ileus in horses: 31 cases (1990-1992).
J. Am. Vet. Med. Ass. 205, 1748-1752.
Freeman, D.E. et al. (2000) Short-and long-term survival and prevalence of postoperative ileus after small intestinal
surgery in the horse. Equine Vet. J. Suppl. 32, 42-51.
Morton, A.J. and Blinkslager, A.T. (2002) Surgical and postoperative factors influencing short-term survival of horses
following small intestinal resection: 92 cases (1994-2001). Equine Vet. J. 34, 450– 454.
Naylor, J.M., Poirier, K.L., Hamilton, D.L., Dowling, P.M. (2006) The effects of feeding and fasting on gastrointestinal
sounds in adult horses. J. Vet. Intern. Med. 20, 1408-1413.
7.4
Small intestinal perforation caused by metallic wires in horse beddings
Caramello, V., Giusto, G., Pagliara, E., Gandini, M.
Dipartimento di Scienze Veterinarie, Università degli studi di Torino, Grugliasco (To), Via Leonardo da Vinci 44,
10095, Italy. Tel: +39 0116709058.
Email: [email protected]
Background
There are limited reports of horses suffering from colic caused by foreign bodies. Horses are animals that carefully
select the food before eating it. Among foreign bodies retrieved in horses, the most common are wooden splinters,
while metal ones are less present (Farr et al, 2010; Lohman 2012). Even less frequent are cases of penetration of
wires at the level of the small intestine (Saulez et al, 2009). This report describes two cases of colic syndrome caused
by the ingestion of wires and their migration throughout the small intestine and, for the first time, clearly defines the
origin of these foreign bodies.
Methods
Case 1: Anglo Arab horse, 17 y.o., female. Referred to the Hospital for abdominal pain started the morning of the
recovery. At the admission heart rate was 70 bpm, oral mucous membranes were pale with increased capillary refill
time. Borborygmi were absent in all four quadrant. Rectal examination revealed presence of distented small
intestine. No reflux was obtained from nasogastric intubation. Based upon these findings explorarory laparotomy
was elected. During surgery several metallic wires were noted exiting from intramural abscess in the jejunum. Due to
the number of lesions and extension of intrabdominal adhesions, euthanasia was performed.
Case 2: Argentinian horse, 13 years, gelding. Referred to the Hospital for abdominal pain started two days prior to
referral. At the admission heart rate was 54 bpm, mucous membranes were normal, capillary refill time was less
than 2 seconds . Borborygmi were present only in the ventral right quadrant. Rectal examination revealed presence
of a solid mass approximately 10 cm in diameter in the ventral right quadrant, painful during traction. Exploratory
laparotomy was elected. During surgery a intramural mass containing a single metallic wire at the level of proximal
jejunum was found. A total of 40 cm of jejunum were resected.
All the wires had a variable length of 5-7 cm and a wavy aspect. According to the medical anamnesis, the bedding
used in both cases was made of wood chip purchased in bulk from local carpenters and that the daily ration of hay
was given to the horses on the ground. A survey with three manufacturers confirmed that shavings produced and
packaged specifically for horses’ bedding are thoroughly examined for foreign bodies, which does not happen for
those sold loose by local sawmills.
In recent years a wood processing called “brushing” has become common in sawmills to highlight the grain of the
wood. This operation is performed by motorized steel brushes which can lose some filaments during the process.
These filaments have been identified as those detected in the intestine of the horses described above. The doubt
was already disclosed in previous cases (Lohman, 2012; Rosso et al, 2012) , but without confirmation.
Conclusion
This is the first report in which it is demonstrated that the use of wood shavings not for horse beddings increase the
risk of metal foreign bodies ingestion in horses. Horse fed on the ground are at higher risk and obviously the
selective behavior of this animal is not always able to avoid ingestion. Probably, the size of the wires found in our
cases was similar to the size of the stems of grass and maybe that more voluminous foreign bodies could be
detected and avoided. Veterinarians should discourage owners to use loose beddings or highly recommend an
accurate check.
References
Farr, A.C., Hawkins, J.F., Baird, D.K. and Moore, G.E. (2010) Wooden, metallic, hair, bone, and plant foreign bodies in
horse: 37 cases (1990-2005). J.Am. Vet. Med .Assoc. 237, 1173-1179.
Lohmann, K., (2012) Foreign body-associated splenic abscess in a horse. Equine Vet. Educ. 24 (6) 291-293.
A. Rosso, M. Bullone, E. Gillono, M. C. Greppi and A. Bertuglia (2012)Splenic abscesses due to migrant metallic wires
from small intestine in a horse. Equine vet. Educ. 24 (6) 286-290
Saulez, M.N., Burton, A., Steyl, J.C.A., Williams, J.H. and Clift, S.J. (2009) Perforation of the gastrointestinal tracts of
four horses by metallic wires. Vet. Rec. 164, 86-89.
7.5
Geographic disparities in clinical characteristics of duodenitis/proximal jejunitis in
horses in the United States
Hassel,D.M., Doddman, C., Steiler, A.L., Elzer, E.J., Hess, A., Southwood, L., TennantBrown, B.
Department of Clinical Sciences, 1678 Campus Delivery, Colorado State University, Fort Collins CO 80523 USA Tel:
(970)297-4271 Fax: (970)297-1275
Email: [email protected]
Background
Duodenitis-proximal jejunitis (DPJ) is an idiopathic disease of horses characterized by abdominal pain, dysfunction of
the proximal small intestine and subsequent development of profuse nasogastric reflux. Anecdotal evidence notes
that prevalence of DPJ is highest in the southeastern United States and that clinical features of DPJ differ among
regions through the USA, but no study has investigated the role of geographical location and associated causative
factors.
Objectives
The objectives of this retrospective study were to determine whether clinical characteristics of DPJ differ depending
on geographic region, to characterize these differences and reveal potential causes.
Methods
Case records were compared from veterinary referral hospitals in 3 different geographic locations in the United
States from the years 1997 through 2011 to determine if significant differences in clinical, clinicopathologic and
prognostic characteristics exist among horses with DPJ. Data was reported as means and standard errors for each
variable and hospital. One-way ANOVA F-tests were performed for each variable and pairwise comparisons of
means were performed for each variable to compare pairs of hospitals. A P value of <0.05 was considered
significant.
Results
The three University veterinary hospitals compared were Colorado State University (West), University of Georgia
(SE), and University of Pennsylvania (NE). Significant differences between hospitals were observed in heart rate at
presentation, maximum body temperature, mucous membrane color, character of reflux, peripheral blood total
protein, peritoneal fluid total protein, neutrophil count, days of hospitalization, albumin, sodium, chloride, GGT, AST,
and creatinine. This study confirmed anecdotal reports of geographical differences in clinical presentation of DPJ.
Horses from the University of Georgia and University of Pennysylvania had more severe clinical signs and more
severe biochemical abnormalities than horses presenting with DPJ at Colorado State University, with a trend toward
the most severe abnormalities from University of Georgia horses.
Conclusions
This study has validated anecdotal reports of differences in clinical characteristics of horses with DPJ in various
geographic regions. The mechanisms by which these differences occur have yet to be elucidated but may be related
to differences in bacterial or fungal pathogens.
Acknowledgements
Supported by a Young Investigatory Grant from the Center for Companion Animal Studies at Colorado State
University.
7.6
Displacement and volvulus of the large colon associated with concurrent gastric
impaction in seven adult horses
McGovern, K.F., Suthers, J.M., James, F.M., O'Meara, B.J., Parker, R.A., Bladon, B.M.
Donnington Grove Veterinary Group, Oxford Road, Newbury, Berks, RG14 2JB1. Tel: (+44) 01635 39039. Fax: (+44)
01635 39040.
Email: [email protected].
B & W Equine Group Ltd, Breadstone Clinic, Breadstone, Berkeley, Glos, GL13 9HG2. The Liphook Equine Hospital,
Forest Mere, Liphook, Hants, GU30 7JG3.
Background
Large colon volvulus (LCV) is one of the most painful and devastating gastrointestinal conditions in the horse. Colonic
weight and length combined with the lack of extensive mesenteric attachments to the body wall may play a role in
the development of mal-position of the colon (Johnston and Freeman 1997). Alterations in colonic motility patterns
have been proposed to lead to displacement and volvulus of the large colon (Sellars and Lowe 1986) and alterations
in colonic microbiota have been demonstrated in horses with simple colonic obstruction and distension colic (Daly et
al 2012). Gastric impaction is uncommon in horses (Freeman 2011, Parker et al 2011) and forms a space-occupying
lesion in the cranial abdomen. In the acute form, gastric impaction can present with severe abdominal pain. A
chronic form of gastric impaction is recognised which is likely to be caused by a failure of intrinsic gastric motility and
carries a poor prognosis (Edwards 2003). An association between gastric impaction and LCV has not previously been
described in horses. A large mass in the cranial abdomen, such as a gastric impaction may disrupt the normal
anatomical alignment of the large colon or may cause an alteration in colonic motility or microbiota and therefore
increase the risk of large colon displacement and volvulus.
Objective
To review and describe cases of adult horses with concurrent gastric impaction and LCV.
Methods
Case records from 3 different clinics were reviewed of adult horses diagnosed with a gastric impaction and
concurrent LCV, as confirmed by exploratory laparotomy.
Results
Gastric impaction with concurrent LCV was identified in 7 horses. Six horses presented for signs of acute, severe colic
and exploratory laparotomy was performed shortly after admission. There were no pre-monitory signs in any case
that might be consistent with a gastric impaction. The seventh horse had been hospitalised for 3 days and was being
treated for a gastric impaction when severe signs of colic developed and it became necessary to perform an
exploratory laparotomy, where LCV was identified and corrected. Right dorsal displacement of the large colon and
suspected nephrosplenic entrapment was identified in 2 horses as well as LCV with concurrent gastric impaction. No
horses survived. Two horses died in recovery and 2 horses were subjected to euthanasia intra-operatively due to a
likely poor prognosis. One horse was subjected to euthanasia after a protracted period in recovery and inability to
stand. A further horse suffered from persistent gastric reflux following resolution of the gastric impaction and was
subjected to euthanasia following lack of response to treatment. One horse suffered a suspected gastric rupture
post-operatively, which was confirmed at a second exploratory laparotomy and the horse subjected to euthanasia
whilst under general anaesthesia.
Conclusions
It should be considered that horses with large gastric impactions may be predisposed to subsequent large colon
displacement or volvulus, with a resulting very poor prognosis. The extensive size of the gastric impactions described
in this case series would perhaps suggest a chronic condition is associated with LCV, although there was no history of
chronic colic or pre-monitory signs suggestive of a gastric impaction, prior to sudden onset of severe colic, highly
likely to have been caused by LCV. The cause of death in the horses that died whilst recovering from surgery was
unclear. Overwhelming endotoxaemia is a possibility, and likely to be a contributory factor in all cases, based on
clinical and laboratory parameters. A large gastric impaction is likely to reduce space for normal lung expansion and
increase pressure on the thoracic cavity, which may result in respiratory embarrassment. If it is necessary for a horse
with a gastric impaction to undergo surgery because of another condition (i.e. LCV), treatment of the impaction at
surgery, either through transmural infusion of fluids and lavage or possibly gastrotomy could be considered to
reduce the risk of respiratory embarrassment in recovery. However this is likely to lengthen surgery time significantly
which may outweigh the possible benefit. This case series identifies that the prognosis appears to be poor when
gastric impactions of a significant size and LCV occur concurrently.
Acknowledgement
The authors thank the University of Liverpool and University of Glasgow for contribution of cases.
References
Daly, K., Proudman, C.J., Duncan, S.H. et al (2012). Alterations in microbiota and fermentation products in equine
large intestine in response to dietary variation and intestinal disease. Br. J. Nut. 107, 989-995.
Edwards, G.B. (2003). Gastric Pathology. 8th Congress on Equine Medicine and Surgery, New York.
Freeman, D.E. (2011) Gastric impaction. Equine Vet. Educ. 23, 174-176.
Johnston, J.K. and Freeman, D.E. (1997). Diseases and Surgery of the Large Colon. Vet. Clin. N. Am: Equine Prac. 2,
317-339.
Parker, R.A., Barr, E.D. and Dixon, P.M. (2011). Treatment of equine gastric impaction by gastrotomy. Equine Vet.
Educ. 23:169-173.
Sellars, A.F. and Lowe, J.E. (1986). Review of large intestinal motility and mechanisms of impaction in the horse.
Equine Vet. J. 18, 261-263.
7.7
Endoscopic and histologic observations in gastritis of horses
Schusser, G.F., May, M., Rechnagel, S.T.
Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11,
04103 Leipzig, Germany, Tel: (+49) 341 9738320, Fax: (+49) 341 9738349.
Email: [email protected]
Background
Endoscopic classifications exist, as established by MacAllister and Murray, which describe the grading of lesions on
the surface of the squamous and glandular mucosa of the stomach of horses.
Objective
However, the comparative histo-pathologic observations are lacking, and these are now described.
Methods
Sixty horses were examined endoscopically and graded, using the MacAllister system. Biopsy samples were also
collected from the glandular mucosa, for comparison using the Sydney system applied in humans. The endoscopic
and histologic observations were then analyzed statistically using the Chi-Square test (p≤0.05).
Results
Sixteen out of 60 (16/60) horses had lesions in the glandular region, ranging from grade 0-4. Most of these (13/60)
only had lesions (grade 2-3) around the pyloric area of the stomach. However, 44/60 horses had histo-pathological
changes. A mild gastritis was diagnosed in 25/60 (42%), moderate gastritis in 11/60 (18%) and severe gastritis in 8/60
(13%) horses. Meanwhile, 16/60 (27%) horses had a normal gastric mucosa. On the basis of histo-pathological
criteria, 20/60 horses had chronic active gastritis characterized by infiltration with lymphocytes, plasma cells and a
few neutrophils. In contrast, 21/60 horses had chronic gastritis as shown by lymphocytic and plasma cell infiltration
alone. In addition, 2/60 horses had chronic eosinophilic gastritis with eosinophil and lymphocyte plasma cell
infiltration. Only one horse had an acute gastritis with neutrophil infiltration alone. The etiology could not, however,
be determined from these observations. On the basis of the Pearson Chi-Square test, the number of horses with
endoscopic (16/60) and histo-pathological (44/60) changes were significantly different (p<0.05).
Conclusion
The complete examination of the stomach of horses with gastric disorders should, therefore, include both
endoscopy and histo-pathology. In this way one has a view of both the mucosal surface and the internal wall of the
stomach.
7.8
Effect of pectin, lecithin, and antacid feed supplements (Egusin®) on gastric ulcer
scores, gastric fluid pH and blood gas values in horses
Woodward, M.C., Huff, N.K., Garza, N.K., Keowen, M.L., Kearney, M.T., Andrews, F.M.
Veterinary Clinical Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton
Rouge, LA, 70803, USA. Tel: (+1) 225 578 9600 Fax: (+1) 225 578 9559 Email: [email protected]
Pathobiological Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton
Rouge, LA. 70803, USA
Background
Nonglandular (NG) gastric ulcers, as part of the equine gastric ulcer syndrome (EGUS), are common in performance
horses and the current pharmaceutical agent, omeprazole is effective in treatment (Andrews et al. 1999). However,
pharmaceutical agents are expensive, require a prescription, and must be administered orally. Development of a less
expensive and natural alternative that could be added to the feed would be desirable. Egusin 250® (E-250) and
Egusin SLH® (E-SLH) are commercially available as aids in promoting a healthy stomach and preventing the
destruction of the stomach lining (Centaur Animal Health,
http://www.centauranimalhealth.com/egusin/Egusin.htm). These products contain dried apple pectin pulp and
other fruit products, lecithin, sodium bicarbonate, calcium bicarbonate, dehydrated alfalfa meal, insoluble oat fiber
(ß-glucan), polar lipids, and natural antioxidants.
Objectives
The purpose of this study was to evaluate the effect of E-SLH and E-250 on NG gastric ulcer scores, gastric juice pH,
and blood gas values in stall-confined horses undergoing feed-deprivation. We hypothesize that E-SLH- and E-250treated horses will have less severe NG gastric ulcers, higher gastric juice pH, and similar blood gas values compared
to untreated control horses.
Methods
All procedures were approved by the Louisiana State University (LSU) Institutional Animal Care and Use Committee
(LSU IACUC Protocol #10-078). Nine Thoroughbred and Thoroughbred-cross horses were used in a three-period
crossover study. E-250 (125 g) or E-SLH (50 g) was mixed with sweet feed and fed twice daily. Horses were treated
for 35 days. After 21 days, the horses underwent an alternating feed-deprivation model to induce or worsen ulcers
(Murray and Eichorn 1996). In the last two periods, horses (n=6) were treated for an additional 7 days after feeddeprivation. Gastroscopies were performed on the horses on day -1 (n=9), day 21 (n=9), day 28 (n=9) and day 35
(n=6). Gastric juice pH was measured and gastric ulcer scores were assigned at each gastroscopy. Venous blood gas
values were also measured during the first two days of periods 1 and 3.
Results
E-250, a pelleted formulation, was readily consumed by all horses when mixed with sweet feed. E-SLH, a powder
formulation was consumed by all horses when mixed with sweet feed, but took some horses several hours to
consume as it sifted to the bottom of the grain bucket.
Mean NG gastric ulcer scores decreased in control horses from day -1 to day 21. Then, NG gastric ulcer scores
significantly increased in E-250-treated and control horses on day 28 compared to day 21 as a result of intermittent
feed-deprivation, but no treatment effect was observed. However, E-SLH horses did not demonstrate an increase in
NG gastric ulcer scores during the feed deprivation period. E-SLH- and E-250-treated horses had significantly lower
NG ulcer scores at day 35, seven days after feed-deprivation, when compared to day 28 scores and when compared
to untreated horses over the same time period. Gastric juice pH values were low and variable throughout the trial
and no treatment effect was observed. Mean blood partial pressure of carbon dioxide (pCO2) values were
significantly increased two hours after feeding in treated horses compared to controls, but otherwise there were no
significantly difference. Mean blood total carbon dioxide (TCO2) values increased in the 24-hour sample of both
treatment groups, but did not exceed 38 mmol/l and did not differ significantly from control values.
Conclusions
The Egusin® products, when mixed with sweet feed, were consumed by all horses. Gastric fluid pH did not
significantly vary throughout the study or between treatment groups. Although TCO2 did increase in both treatment
groups at 24 hours, these values were never different from those of control horses and the TCO2 did not exceed 38
mmol/L (the threshold for bicarbonate doping). NG gastric ulcer scores decreased in control horses during the first
21 days of the study. This decrease might be due to the management changes of stall confinement leading to
decreased stress due to less competition for food and better quality hay (round bales in the pasture vs. square bales
fed in stalls). The feed-deprivation model increased NG gastric ulcer severity in the control and E-250-treated horses,
but E-SLH blunted the increase in severity of gastric ulcers during feed-deprivation, but on day 28 there was no
significant treatment effect between groups. However, by day 35, Egusin SLH® and Egusin 250® treated horses had
less severe NG gastric ulcers when compared to untreated control horses and was likely due to the pectin, lecithin,
antacids and other ingredients found in the products. Egusin SLH® and 250® products tested here ameliorated
severity of gastric ulcers in stall-confined horses undergoing feed stress after 35 days.
Acknowledgement
The study was funded by a grant from the Equine Health Studies Program, Equine Foundation, Louisiana State
University School of Veterinary Medicine. The Egusin SLH® and 250® were supplied by the Centaur Corporation.
References
Andrews FM, Sifferman RL, Bernard W, et al. Efficacy of omeprazole paste in the treatment and prevention of gastric
ulcers in horses. Equine Veterinary Journal Supplement 1999:81-86.
Centaur Animal Health [http://www.centauranimalhealth.com/egusin/Egusin.htm]
Murray MJ, Eichorn ES: Effects of intermittent feed deprivation, intermittent feed deprivation with ranitidine
administration, and stall confinement with ad libitum access to hay on gastric ulceration in horses. American journal
of veterinary research 1996, 57:1599-1603.
7.9
Equine emergencies: Opinions of yard owners
Bowden, A., Brennan, M.L., Burford, J.H., England, G.C.W., Freeman, S.L.
School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington,
Loughborough, Leicestershire. LE12 5RD, UK. Tel: (+44) 01159 516422 Fax: (+44) 01159 516440
Email: [email protected]
Background
There is no current published data outlining owner’s opinions or experiences of equine emergency conditions. Data
for the variety of equine emergencies that are encountered in veterinary practice is limited to a small number of
studies. Two of these are hospital based, whilst the other is veterinary opinion (Traub-Dargatz et al. 1991,
Southwood et al. 2009, Viljoen et al. 2009). Previous owner related studies have focused on owner reporting of
disease prevalence and quality of life in geriatric horses (Ireland et al. 2011, Ireland et al. 2013).
Objectives
The aim of this study was to evaluate yard owners’ opinions on the important equine emergency conditions in the
United Kingdom.
The objectives of the study were to:

Survey yard owners’ opinions on the most common reasons vets were called to horses (excluding routine
vaccination and dental treatment)

Determine what yard owners ranked as the most important equine emergencies

Evaluate what conditions are most concerning for yard owners

Record the emergency conditions most commonly experienced as nominated by yard owners
Methods
A questionnaire was designed for yard owners to detail their own experiences and opinions with regards to equine
emergency situations. All yards registered as approved by the British Horse Society were invited to participate in an
online questionnaire. The rationale for including this subset of the horse owner population was that they were likely
to have greatest experience of a diverse range of conditions in different horses. The study consisted of open free
text questions, and closed questions, with both single and multiple response options. Areas covered included
participants’ opinions of the most common problems (excluding preventative treatments) and the most common
emergencies, conditions of most concern to them individually, their personal experiences and ranking of different
factors in decision making. Responses to open questions were reviewed and grouped into categories. Descriptive
analysis of the study population was performed.
Results
There were 104 questionnaires in total completed online. The median age range of participants was between 45 54. The majority (58%) had kept horses for more than thirty years. 89% of participants were female. When asked to
list the top three reasons a vet is called excluding preventative treatment, participants identified colic most
frequently (83%), followed by lameness (75%) and wounds (54%). Responses to the same question specifically
referring to emergency conditions found colic to be most frequently recorded (98%) followed by wounds (49%) and
fractures (22%). Colic was also considered to be the most concerning condition (94%) followed by lameness (36%)
and wounds (21%). When asked about their personal experiences of emergency problems in horses, yard owners’
identified colic (96%), wounds (92%) and laminitis (66%) as the most common emergencies encountered.
Conclusions
Colic is overwhelmingly important to the equine yard owner population. Not only did 'colic' clearly emerge from the
free text responses as the most common emergency and non-routine condition, it was also identified as the most
concerning disease for those involved in the study. The results are likely to be subject to a degree of recall bias as
colic is often a stressful and traumatic experience. It should also be noted the majority of participants had personal
experience of horses’ with colic. These data have highlighted concerns and opinions of yard owners’ and will now
influence a survey of the more general horse owner population in relation to colic awareness.
References
Ireland, J. L., et al. (2011). "Owners' perceptions of quality of life in geriatric horses: A cross-sectional study." Animal
Welfare 20(4): 483-495.
Ireland, J. L., et al. (2013). "Preventive health care and owner-reported disease prevalence of horses and ponies in
Great Britain." Research in Veterinary Science 95(2): 418-424.
Southwood, L. L., et al. (2009). "Short-term outcome of equine emergency admissions at a university referral
hospital." Equine Veterinary Journal 41(5): 459-464.
Traub-Dargatz, J. L., et al. (1991). "Medical problems of adult horses, as ranked by equine practitioners." J Am Vet
Med Assoc 198(10): 1745-1747.
Viljoen, A., et al. (2009). "After-hours equine emergency admissions at a university referral hospital (1998-2007):
Causes and interventions." Journal of the South African Veterinary Association 80(3): 169-173.
7.10 Prospective Evaluation of a colic prediction model
Mirza, M.H., Cruz-Sanabria, Groue, A., Pescosolido, K., Kearney, M.T., Andrews, F.M.
Equine Health Studies Program, Department of Veterinary Clinical Sciences and Department of Pathobiological
Sciences, School of Veterinary Medicine, Louisiana State University, Baton Rouge, LA, USA; Ecole Nationale
Veterinaire de Toulouse, Toulouse, France
Background
Colic is common in horses. Establishing a diagnosis is challenging, but is necessary to determine the indication of
surgery. In addition, accurate interpretation of clinical and laboratory data might be helpful to determine survival. A
retrospective surgical colic and prognosis model using a multivariable analysis was evaluated over 20 years ago and
was validated using a subpopulation of horses (Reeves et al, 1989; Reeves et al, 1990). However, this model was
never validated in a prospective population of horses with acute colic.
Objectives
We aimed to prospectively validate surgical and prognosis colic prediction models that were reported in 1989 and
1990 (Reeves et al, 1989; Reeves et al, 1990). We hypothesized that the previously developed surgical and prognosis
colic model will accurately predict the probability of surgery and survival in horses presented to Louisiana State
University Veterinary Teaching Hospital (LSU-VTH) with an acute abdominal crisis.
Methods
Horses presenting to the LSU-VTH with acute colic from 8-20-12 to 7-13-13 were studied. Clinical parameters
including age, sex, breed, and rectal exam (normal or abnormal), frequency of pain (none, intermittent, or
continuous), peripheral pulse character (normal or abnormal) and frequency of abdominal sounds (normal,
decreased, absent, increased) were used to validate the surgical model, whereas peripheral pulse character, packed
cell volume, heart rate, capillary refill time and medical vs. surgical treatment were used to validate the survival
(prognosis) model. Horses that were euthanatized due to financial constraints were not included in the survival
model. Survival was considered when a horse was discharged. Bayes theorem was utilized that calculated the posttest probability of both surgery and survival. The hosmer-Lemeshow goodness of fit chi square (GOFCS; formula
below was used to assess if each model fit the data. A chi square value of >15.51
10
G
2
HL

j=1
(O j  E j ) 2
E j (1  E j / n j )
~ X 82
using 8 degrees of freedom was considered significant if it yielded a P<0.05.
Results
Of the 71 horses evaluated for acute colic 25/71 ((35%) had surgery and 46/71 (65%) were treated medically. 17/71
(24%) of horses were humanely euthanatized and or 1/25 (4%) died after surgery. 53/65 horses (82%) survived to
discharge from the hospital. The model accurately estimated surgery (5.18; P<0.05), however, the model did not
accurately estimate of the probability of survival (15.88; P>0.05), because only one horse in the study died.
Conclusions
Parameters, including an abnormal rectal examination, continuous or intermittent abdominal pain, decreased or
absent abdominal sounds and weak peripheral pulse character, used in the surgical model successful in identified
horses needing surgery in this population of horses. Whereas, the parameters used for survival failed to survival.
Using clinical parameters are helpful in determining surgical treatment in horses with acute colic.
Acknowledgement
Supported by funds from the Equine Health Studies Program
References
Reeves MJ, Curtis CR, Salman MD, et al Prognosis in equine colic patients using multivariable analysis. Can Vet J Res
1989; 53:87-94
Reeves, M.J., Curtis C.R., Salman, M.D., et al. (1990) A Multivariable prognostic model for equine colic patients.
Preventative Veterinary Medicine 9:241-257
7.11 Evaluation of a replacement of supplemental inorganic minerals and performance
minerals on equine gastric ulcers
Andrews, F.M., Camacho, P., Loftin, P., Bidot, W.A., Zoccarato, S., Woodward, M., Garza
Jr., F., Keowen, M.L., Kearney, M.T., Larson, C.
Equine Health Studies Program, Department of Veterinary Clinical Sciences and Department of Pathobiological
Sciences, School of Veterinary Medicine, Louisiana State University, Skip Bertman Drive, Baton Rouge, LA, 70803,
USA. Tel: (1) 225-578-9580 Fax: (1) 225-578-9605
Email: [email protected]
Zinpro Corporation 10400 Viking Drive, Suite 240 Eden Prairie, MN, USA
Background
Gastric ulcers are common in horses. Current pharmaceutical agents are effective in healing gastric ulcers but they
are expensive and alter gastric juice pH (Andrews et al. 1999). Zinc and other minerals are essential in maintaining
mucosal integrity and have been used to treat peptic ulcers in people (Escolar and Bulbena 1997) and in other
species (Joseph et al. 1999). However, there are no studies evaluating the effect of mineral supplements containing
zinc on gastric ulcer disease in horses.
Objectives
The objectives of the study were to determine the effect of an organic mineral supplement containing zinc
methionine, copper lysine, manganese methionine and cobalt glucoheptonate on gastric ulcer scores in stallconfined horses after omeprazole treatment. We hypothesize that an organic mineral supplement when fed to
horses will result in fewer and less severe gastric ulcers than horses fed an inorganic mineral supplement.
Methods
Thirty-six horses (18 geldings and 18 females), ranging in age from 2 to12 years, were used in a randomized 2-period
non-crossover study. Horses were stratified by non-glandular (NG) gastric ulcer number score (McAllister et al. 1997)
and divided into two treatment groups, inorganic minerals (n=18) or organic minerals (n=18; Zinpro Performance
Minerals, Eden Prairie, MN). In addition to the supplements, horses received omeprazole (GastroGard®, Merial
Limited, Duluth, GA) 4.0 mg/kg BW, orally from day 0 to day 14. Beginning day 42 through 49, horses underwent a
feed-deprivation model (Murray and Eichorn 1996). Gastroscopy was performed in all horses on days -1, 14, 42, 49
and 56 using a 3-m endoscope (Karl Storz, El Segundo, CA). The evaluator (FMA) was masked to the treatments.
Results
Statistical analysis showed a period effect, so data was not pooled. During both periods, mean gastric ulcer scores
were not different between treatment groups at the beginning of the study. In addition, after omeprazole
treatment, mean NG gastric ulcer scores on day 14 decreased (P < 0.05) in both treatment groups compared to those
on day -1 and ulcer scores were similar between treatments. During period 1, there was no treatment effect on
gastric ulcer scores or gastric juice pH at any time point. Also, during this period, horses had difficulty maintaining
body weight due to under-estimation of the nutritional quality of the hay. However, during period 2, by day 42,
mean NG gastric ulcer scores were lower (P < 0.05) in horses fed the organic mineral compared to those fed the
inorganic mineral. After the feed deprivation model on day 49, mean NG gastric ulcer scores increased (P < 0.05) in
the inorganic mineral treatment group but not in the organic mineral treatment group, when compared to day 42.
Only a few horses had glandular gastric ulcers and there was no treatment effect at any time during the study.
Conclusions
Omeprazole treatment effectively decreased gastric ulcer scores after 14 days of treatment in horses fed either
mineral supplement. Results from period 2 suggest that, supplementing organic minerals appeared to be more
effective in preventing gastric ulcers from worsening after omeprazole treatment was discontinued (day 42) and
during the feed deprivation period (day 49), than supplementing inorganic mineral. The lack of difference between
treatments during period 1 may have been due the poor hay quality and nutritional status of the horses, as weight
loss and loss of body condition was seen. This study shows that Zinpro Performance minerals are effective in
preventing NG gastric ulcers in horse after omeprazole providing that the horses are fed adequate quality feed.
Acknowledgement
Supported by a grant from the Zinpro Corporation, Eden Prairie, MN, USA and the Equine Health Studies Program
References
Andrews FM, Sifferman RL, Bernard W, et al. Efficacy of omeprazole paste in the treatment and prevention of gastric
ulcers in horses. Eq Vet J, Suppl. 1999:81-86.
Escolar, G and Bulbena, O. Zinc compounds, a new treatment in peptic ulcers. Drugs Under Experimental and Clinical
Research. 1989;15:83-89.
Joseph, R. M., Varela, V., Kanji, V. K. et al. Protective effects of zinc in indomethacin-induced gastric mucosal injury:
evidence for a dual mechanism involving lipid peroxidation and nitric oxide. Alimentary Pharm and Therapeutics
1999;13:203-208.
MacAllister CG, Andrews FM, Deegan F, et al. A scoring system for gastric ulcers in the horse. Equine Vet J
1997;29:430–433.
Murray, M. J. and Eichorn, E. S. Effects of intermittent feed deprivation, with ranitidine administration, and stall
confinement with ad libitum access to hay and gastric ulceration in horses. Am J Vet Res 1996;57:1599-1603.
Incidence of equine gastric ulceration in horses with enteroliths compared to horses
with other simple surgical large intestinal obstructions
Klohnen, A.
7.12
Chino Valley Equine Hospital, 2945 English Place, Chino Hills, CA 91709, USA. Tel: 909 628 5545
Email: [email protected]
Valeria Albanese, DVM, Department of Clinical Sciences, College of Veterinary Medicine, Auburn University, Auburn,
AL
Background
Enterolithiasis is a recognized cause of acute and chronic colic in horses, due to partial or complete obstruction of
the large intestine. While gastric ulcers have been diagnosed in horses with colic, including horses with
enterolithiasis, it is unknown if these two diseases are statistically associated. It is also not known the incidence of
gastric ulceration in horses with other simple surgical large intestinal obstructions
Hypothesis
We hypothesized that horses affected by enterolithiasis have a higher prevalence of gastric ulceration on
presentation to the hospital (first 24 hours of hospitalization) when compared to horses with other, simple, large
intestinal simple obstructions. To confirm this hypothesis, we compared the prevalence of gastric ulceration in
horses with enterolithiasis to horses with other types of large intestinal simple obstruction within the first 24 hours
of presentation to the hospital.
Methods
A retrospective case (enterolith group) vs control (other surgical large intestinal problems) group study was
designed, and medical records from 1999 to 2011 were examined. Horses that had surgery for removal of one or
more enteroliths were included as “case horses”. Horses that had surgery for simple large intestinal, nonstrangulating obstructions other than enterolithiasis were identified as “control horses” and were matched to case
horses for age, sex and breed. Every horse admitted to the hospital for signs of colic had a gastroscopy performed
either on presentation to the hospital (during the initial colic work-up) or during the first 24 hours after
hospitalization.
Results
148 horses were identified as “case horses”. 101 out of 148 horses (68%) had gastric ulcers diagnosed during the
first 24 hours of hospitalization, while 46 of 148 matched control horses (31%) had gastric ulcers. There was a
significant association between enterolithiasis and gastric ulceration (odds ratio 4.76, P<0.0001) and a greater
prevalence in Thoroughbreds as compared to other breeds (odds ratio 22.6, P<0.0001), indicating a breed
predilection in the horses included in this study.
Conclusions
A much higher percentage of horses with enteroliths compared to other simple, surgical, large intestinal lesion were
diagnosed with gastric ulceration during the first 24 hours after presentation to the hospital. Based on the positive
association noted in this study, a gastroscopy would be indicated for all horses diagnosed with enterolithiasis.
7.13 Large colon sand impactions in horses: 1996-2008
Klohnen, A.
Chino Valley Equine Hospital, 2945 English Place, Chino Hills, CA 91709, USA. Tel: 909 628 5545.
Email: [email protected]. [email protected]
Background
Horses may ingest sand either by eating from the ground in a sandy environment or because the sand is included in
the hay. Horses usually show intermittent and mild to moderate signs of abdominal pain associated with sand
impactions in the large colon. Clinical signs of horses with a primary diagnosis of sand impaction will vary with the
amount of sand accumulated.
Objective
The purpose of this retrospective study was to describe the outcome of 632 sand colic horses, which had presented
to the Chino Valley Equine hospital. It was our hypothesis that horses, which did not require an exploratory
celiotomy to relieve the sand impaction, would respond to medical therapy.
Methods
Medical records from May of 1996 to December 2008 were reviewed and 632 horses were identified to have sand in
their intestinal tract. Once every horse was evaluated (complete colic work-up), a decision was made to pursue
either surgical treatment, medical treatment at home or at the hospital or humane euthanasia. A Chino Valley
Equine Hospital treatment protocol for sand colic treatment was established. Medical treatment at the hospital
included IV-fluid therapy, administration of sedatives and analgesic medication as needed and administration of
mineral oil via naso-gastric tube. Starting on the second day of hospitalization (or after the mineral oil had passed)
all horses were administered 1.0 g/kg of psyllium mucilloid powder in 4-6 liters of water or 2 liters of mineral oil via
naso-gastric tube twice daily.
Results
312 out of 632 sand colic horses (49.4%) were included in the medical treatment group. None of the observed signs
of abdominal pain in 125 out of 312 horses were specific to sand accumulation in the colon and all horses responded
to the administration of sedatives and analgesic medication.
Abdominal auscultation of the horses in this group revealed decreased abdominal sounds. Auscultation of the
ventral abdomen (just caudal and to the left of the xyphoid region) on presentation revealed sand sounds in 200 out
of 312 horses (64.1%). Repeat auscultation of the ventral abdomen on the second day of hospitalization revealed
sand sounds in 305 out of 312 (97.7%).
149 out of 312 horses (47.8%) were diagnosed with gastric ulcers. The gastric ulcers ranged from mild (grade 1) to
severe (grade 3).
In all 312 horses, abdominal radiographs were taken and were interpreted to show varying amounts of sand in the
colon. The sand accumulation in the large colon was graded from small amount of large colon sand to an extensive
sand impaction in the colon. Typically 3 to 4 radiographic views of the abdominal cavity were obtained including a
cranial-ventral view, the caudal-ventral view and the mid-abdominal view). The radiographs were taken from the
left lateral aspect of the abdomen. 53 out of 312 horses (17%) evaluated radiographically had a small amount of
sand visualized in the large colon (cranial-ventral view). 108 out of 312 horses (34.6%) had a moderate amount of
sand visualized in the large colon (the most cranial-ventral view and the caudal-ventral view). 151 out of 312 horses
(48.4%) had a large or extensive amount of sand visualized in the large colon. The sand could be visualized in the all
three views.
In 88 out of 312 horses (28.2%), the initial fecal floatation revealed a small mount of sand. In 144 out of 312 horses
(46.2%), the initial fecal flotation did not reveal any sand.
The horses were administered psyllium powder until auscultation of the ventral abdomen did not reveal any sand
borborygmi and the fecal material did not show any further sand. At that time, repeat abdominal radiographs were
taken and interpreted to show a resolution of the previous sand accumulation in the colon. The treatment length
depended on the initial amount of sand accumulated in the colon and ranged from 5 days to 37 days. Most horses
were treated for 7 to 14 days.
Overall, horses encountered minimal secondary complications associated with the treatment for sand accumulation
as a cause for the presenting colic signs. 19 out of 312 horses had varying degrees of jugular vein thrombosis. 112
out of 312 horses spiked a fever of 102 and higher. Many of the fever spikes were associated with signs of
secondary hindlimb edema/cellulites due to the excessive passing of mineral oil. 32 out of the 112 horses had to be
treated with antimicrobials.
Conclusion
The results of this retrospective study are in contrast to reports in the literature that treatment with psyllium will not
resolve sand impactions in the large intestine. All 312 horses in our study responded to medical therapy and the
sand impaction was cleared with the administration of psyllium powder in either water or mineral oil via naso-gastric
tube and horses eating large amounts of psyllium powder mixed with equine senior.
7.14 An investigation into the association between changes in air temperature and
barometric pressure on the incidence of colic in horses
Dechant, J.E., Davidson, Z., Kass, P.H.
Animal Biology, College of Biological Sciences, Department of Surgical and Radiological Science, School of Veterinary
Medicine, Department of Population Health and Reproduction, School of Veterinary Medicine, 1 Shields Avenue,
University of California-Davis, Davis, California, 95616, USA. Tel: (530) 752-0290, Fax: (530) 752-9815.
Email: [email protected]
Background
Weather-associated triggers have been anecdotally associated with colic, but limited research has not consistently
identified a link between colic and weather.
Objectives
The objective of this study was to determine if colic episodes were associated with changes in air temperature and
barometric pressure.
Materials and Methods
The population was horses presenting to the UC Davis Equine Field Services for colic between November 2008 and
October 2010. Weather data was retrieved from the UC Davis Department of Atmospheric Science archive for the
day of colic and the preceding three days. Control weather data was obtained for the same four days of the week in
the other weeks of the same month that the colic episode occurred. An exact conditional multivariate logistic
regression compared differences in air temperature and barometric pressure during each of the preceding days and
day of colic. Significance was p<0.05.
Results
A total of 248 colic episodes in 213 horses were used for this study. There were 101 female, 105 castrated male, and
7 intact male horses with a mean age of 17.4 years. There were 205 medical colics, 26 strangulating lesions, 15 other
diagnoses, and 2 enterolithiasis. A decrease in barometric pressure in the three days prior to colic and an increase in
temperature in the day prior to colic were associated with colic.
Conclusions
An increase in mean air temperature and a decrease in mean barometric pressure were associated with colic. Since
weather changes are not modifiable, owners should be careful to control other modifiable risk factors of colic during
weather change.
7.15 Retrospective study of confirmed fecalith obstructions in horses: 119 cases (20012013)
Dechant, J.E., Nieto, J.E.
Department of Surgical and Radiological Sciences, 1 Shields Avenue, School of Veterinary Medicine, University of
California-Davis, Davis, CA, 95616. Tel: 530-752-0290; Fax: 530-752-9815;
Email: [email protected]
Background
Fecalith obstruction is described as primarily a problem of the small colon in American Miniature horses and pony
breeds. Age- and diet-related risk factors have been suggested as contributing factors.
Objectives
The purpose was to evaluate the history, signalment, and clinical findings associated with a confirmed diagnosis of
fecalith obstruction.
Methods
The medical records of horses diagnosed with fecalith obstruction, as confirmed by surgical or necropsy
examination, were analyzed. Information obtained included history, signalment, clinical findings, diagnostic test
results, and outcome.
Results
One hundred nineteen cases of fecalith obstruction were identified. There were 46 (39%) miniature horses, 12
(10%) pony breeds, and 61 (51%) horse breeds. There 38 (32%) horses < 1 year of age and 36 (30%) horses > 15
years of age. Mean duration of colic was 25 + 25 hours. Presenting colic signs varied from mild (35%), moderate
(24%), severe (14%), or obtunded (26%). Mean heart rate was 70+24 bpm and mean respiratory rate was 29+14
bpm. Location of the obstruction included 44% large colon and 56% small colon. There was no association between
breed and location of obstruction. Of the 100 horses having a surgical option, 93% survived to discharge.
Postoperative complications included loose feces (60%) and fever (26%).
Conclusions
Fecalith obstruction is prevalent in the miniature horse, but may occur in any horse breed. Location of obstruction is
approximately equally distributed between the large and small colons. Outcome is favorable despite protracted
duration of signs and evidence of cardiopulmonary compromise at admission.
7.16 Focal idiopathic eosinophilic colitis lesions of the equine small (descending) colon
de Bont, M.P., Malbon, A.J., Blundell, R., Archer, D.C.
The Philip Leverhulme Equine Hospital, University of Liverpool, Leahurst Campus, Chester High Road, Neston, Wirral,
CH64 7TE, UK
Tel: (+44) 0151 794 6041 Fax: (+44) 0151 794 6034
Email: [email protected]
Introduction
Relatively few cases of focal or multifocal idiopathic eosinophilic lesions have been reported in the horse. Intramural
eosinophilic lesions have been previously described in the large colon as segmental eosinophilic colitis lesions
(Edwards et al. 2000), as idiopathic focal eosinophilic enteritis (IFEE) lesions of the small intestine (Southwood et al.
2000; Archer et al. 2006; Perez Olmos et al. 2006) and as diffuse eosinophilic enteritis (DEE) lesions of the small
intestine (Mäkinen et al. 2008). Focal eosinophilic infiltration of the small colon has been briefly reported in the
literature (Mäkinen et al. 2008; de Bont et al. 2012), but there have not been any detailed reports of the clinical and
histopathological features, nor of the outcome in these cases. The aim of this study was therefore to detail the
features of focal, idiopathic eosinophilic colitis of the small colon.
Methods
Five horses with a surgical and histopathological diagnosis of focal eosinophilic colitis of the small colon, were
identified in case records at the Philip Leverhulme Equine Hospital, from December 2000 - December 2010. There
were four geldings and one mare, with a mean age of 12.8 (7-21) years. There was no evidence of age, breed or
gender predisposition when compared to the general horse population. Clinical parameters on presentation included
heart rate 48-88beats/min (mean 62 beats/min), PCV 27-40% (mean 34%) and systemic total protein 62-78g/L (mean
69g/L). Rectal temperature was within normal limits for all horses. Abdominal distention was noted in 2 horses and
none had a history of pre-operative diarrhoea. The decision to perform an exploratory laparotomy was based on
abnormal rectal and ultrasonographic findings, clinical parameters and/or persistent pain despite the administration
of analgesics.
At exploratory laparotomy the lesions were characterised by a visibly striking, hyperaemic, focal lesion of the small
colon, which was considered to be the primary cause of abdominal pain. There was evidence of oedema and marked
thickening of the intestinal wall at the site. Other findings included gaseous distention of the small colon, oedema of
the mesocolon and impaction of ingesta proximal to the lesion. Due the degree of mural thickening and concerns
about focal necrosis already developing at the site, leaving the affected portion of colon in situ was considered likely
to result in a poor prognosis for survival. Resection was therefore undertaken in four horses and an end-to-end
anastomosis was performed. Examination of the resected portions of intestine revealed a green appearance to the
mucosa and submucosa, suspicious of tissue necrosis. The length of resection ranged from 15cm to 180cm. One
animal (Horse 5) was euthanased on the table due to the extent of the lesion and an inability to sufficiently
exteriorise the affected portions in order to expose healthy tissue margins.
he lesions represented a focal severe eosinophilic and granulomatous colitis. Mucosal regions were characterised by
intense hyperaemia and moderate multifocal haemorrhage, with moderate mixed cellular infiltration of plasma cells,
lymphocytes, macrophages and fewer eosinophils. The submucosa was markedly hyperaemic, with multifocal
haemorrhage and severe diffuse oedema with lymphangectasis and fibrin exudation. Severe multifocal to coalescing
primarily perivascular macrophages and eosinophils dominated the diffuse cellular infiltration. The muscularis was
characterised by focal central accumulation of eosinophilic debris, surrounded by macrophage and multinucleated
giant cells (eosinophilic granuloma) with an outer lymphocyte rim, focally associated with tracts extending between
muscle layers, composed of follicle like lymphocyte aggregates. Serosal regions were intensely hyperaemic, with
moderate diffuse eosinophil dominated cellular infiltrate and fibroblast activation. There was no gross evidence of
an aetiologic agent on examination of these portions of small colon.
Results
Horse 1 progressed well initially but then deteriorated rapidly 11 days post-operatively. The owner was unwilling to
pursue a repeat laparotomy and the gelding was euthanased on day 12. Post mortem examination revealed multiple
adhesions between the small intestine and small colon anastomosis site resulting in a small intestinal obstruction.
Horses 2, 3 and 4 were discharged from the hospital following an uncomplicated post-operative period. Horse 2 was
euthanased 184 days post surgery due to further colic episodes where the owner declined referral. Horse 3 was still
alive at the time of writing and doing well, with no further signs of colic observed. Horse 4 was euthanased 257 days
post-operatively following an acute injury and fracture associated with the cubital joint.
Conclusion
The histological features of focal eosinophilic infiltrate of the small colon are similar to that previously described in
both the large colon (Edwards et al. 2000) and the small intestine (Archer et al. 2006). The exact cause of these
lesions has not yet been established and it is unknown whether a similar pathogenesis is involved in these
anatomically distinct lesions.
References
Archer, D.C., Edwards, G.B., Donald, F.K., French, N.P. and Proudman, C.J. (2006) Obstruction of equine small
intestine associated with focal idiopathic eosinophilic enteritis: An emerging disease? The Vet J. 171, 505-512.
de Bont, M.P., Proudman, C.J. and Archer, D.C. (2013) Surgical lesions of the small colon and post-operative survival
in a UK hospital population. Equine vet. J. 45, 460-464.
Edwards, G.B., Kelly, D.F., Proudman, C.J. (2000) Segmental eosinophilic colitis: a review of 22 cases. Equine vet. J.
Suppl. 32, 86-93.
Mäkinen, P.E., Archer, D.C., Baptiste, K.E., Malbon, A., Proudman, C.J. and Kipar, A. (2008) Characterisation of the
inflammatory reaction in equine idiopathic focal eosinophilic enteritis and diffuse eosinophilic enteritis. Equine Vet.
J. 40, 386-392.
Perez Olmos, J.F., Schofield, W.L., Dillon, H., Sadlier, M. and Fogarty, U. (2006) Descriptive case series of
circumferential mural band in the small intestine causing a simple obstructive colic. Equine vet. J. 38, 354-359.
Southwood, L.L., Kawcak, C.E., Trotter, G.W., Stashak, T.S. and Frisbie, D.D. (2000) Idiopathic focal eosinophilic
enteritis associated with small intestinal obstruction in 6 horses. Vet. Surg. 29, 415-419.
7.17 The effect of parasite burden on faecally excreted albumin
Kerbyson, N., Parkin, T.D.H., Knottenbelt, D.C.
University of Glasgow, School of Veterinary Medicine, 464 Bearsden Rd, Glasgow G61 1QH Tel: (+44) 0141 330 5741
Fax: (+44) 0141 330 5602
Email: [email protected]
Background
The diagnosis of intestinal disease in horses is currently limited due to inaccessibility and inability to perform
colonoscopy. Faecal markers of intestinal disease are frequently used in human medicine and are routinely
performed in screening for colorectal cancer (Faivre et al., 2012). Similar markers have previously had limited use in
equine medicine due to poor sensitivity (Pearson et al., 1987). However, a new combined faecal haemoglobin and
albumin test using lateral flow immunoassay technology has been developed, but has not been validated in a clinical
setting. Protein losing enteropathy is associated with parasitic disease in horses and faecal albumin has been used as
a marker of intestinal protein loss in human medicine (Saitoh et al., 1995) so it is postulated that faecal albumin may
be detectable when a parasite burden is present.
Objectives
The aim of this study was to establish if faecally excreted albumin, measured using a commercially available test kit,
was related to the parasite burden of otherwise healthy horses, in order to establish whether it may indicate
intestinal inflammation or protein losing enteropathy.
Methods
Twenty horses were included in the study. They were aged from six to 26 years (mean age 15, median 16 years),
there were six mares and fourteen geldings, breeds included various draught breeds and ponies. The parasite
management programme prior to the study included irregular faecal worm egg counts (FWECs), the last of which
had been performed five months prior to the study.
A fresh (<1hr old) faecal sample was collected from each horse and divided into two sub-samples. Half of the faecal
sample was submitted for FWEC and half was tested using the commercially available qualitative faecal occult blood
detection kit (Succeed ™). This test uses lateral flow immunoassay technology to detect haemoglobin and albumin in
equine faeces and expresses the result as a colour change, the result being qualitative rather than quantitative.
Blood samples were collected for tapeworm ELISA from all horses. FWECs ranged from 0epg-1000epg (mean 135epg,
median 100epg), optical density of tapeworm ELISA ranged from 0.113 to 1.913 (mean 0.466, median 0.335).
Anthelmintics were administered to the horses one week after sample collection; all horses received moxidectin as a
larvicidal treatment due to the time of year, praziquantel was administered to those with a tapeworm optical density
of >0.2.
Results
The faecal occult blood test was repeated two weeks after anthelmintic administration. Of the 20 horses tested five
were positive for albumin both prior to and following the administration of the anthelmintic; eleven were positive
prior to anthelmintic use and negative after, one was negative prior to anthelmintic use and positive after and three
were negative on both occasions. With respect to haemoglobin: ten horses were positive on both occasions; two
were positive and then negative; six were negative and then positive and two were negative on both occasions.
McNemar’s tests were conducted to identify significant changes in the proportion of albumin and haemoglobin
positive horses prior to and following administration of the anthelmintic. Faecal albumin was significantly more likely
to be detected prior to administration of the anthelmintic than after (P = 0.004). However, there was no statistically
significant association between faecal haemoglobin status and time of testing (P = 0.16). Mann-Whitney tests failed
to identify a significant difference in tapeworm ELISA optical density or FWEC between horses with different faecal
haemoglobin (P = 0.30 and P = 0.34, respectively) or albumin status (P = 0.35 and P = 0.64)
Conclusion
This work indicates that parasite burden is associated with the likelihood of being positive for faecal albumin using
the faecal occult blood detection kit (Succeed ™). It is likely that greater numbers of horses are required to identify
associations between the specific parasite burden of an individual horse and the detection of faecal albumin.
Acknowledgement
Study funded by Freedom Health LLC.
References
Faivre, J., Dancourt, V., Lejeune, C., 2012. Screening for colorectal cancer with immunochemical faecal occult blood
tests. Dig. Liver Dis. 44, 967–973.
Pearson, E., Smith, B., McKim, J., 1987. Fecal blood determination and interpretation, in: American Association of
Equine Practitioners. Presented at the American Association of Equine Practitioners, pp. 77–81.
Saitoh, O., Matsumoto, H., Sugimori, K., Sugi, K., Nakagawa, K., Miyoshi, H., Hirata, I., Matsuse, R., Uchida, K.,
Ohshiba, S., 1995. Intestinal protein loss and bleeding assessed by fecal hemoglobin, transferrin, albumin, and alpha1-antitrypsin levels in patients with colorectal diseases. Digestion 56, 67–75.
7.18 Systematic review of risk factors for equine colic
Bayes, T.C., Curtis, L., Burford, J.H., Freeman, S.L.
School of Veterinary Medicine and Science, University of Nottingham, College Road, Sutton Bonington,
Loughborough, Leicestershire. LE12 5RD Tel: (+44) 01159 516422 Fax: 01159 516412
Email: [email protected]
Background
A systematic review comprises a methodical and standardised search of the current literature to identify, critically
appraise and consolidate the evidence on a chosen topic (Sarasin, 1999). The outcome is a document identifying the
best-evidence available, and highlighting gaps in the current research (The Cochrane Collaboration, 2013). There are
several epidemiological studies that have reported on risk factors for colic, and although there have been a number
of reviews in this area, there are currently no systematic reviews. Evidence on risk factors can contribute to the
veterinary surgeon’s clinical approach and inform strategies on management and prevention of disease. The aim of
this study was to systematically review the current evidence on risk factors for colic in the horse.
Objectives
The study objectives were:

To identify current literature on risk factors for equine colic through a systematic search of databases

To evaluate the quality of current published research on risk factors for equine colic

To compare findings from the highest scoring research studies to identify evidence for different risk factors
Methods
The study was performed in compliance with PRISMA guidelines (Liberati et al., 2009).
The primary literature search was conducted in CAB Abstracts (1910-2012), WEB of Science (1950-2012) and
MEDLINE (1946-2012) (between 23-26/11/2012), using the following terms: (horses OR horse OR equine OR equines
OR equus OR equidae OR equids OR equid) AND colic. The results of each search were downloaded into bibliological
software EndNote X6 (Thomson Reuters), duplicates removed, and publications were included if the title or abstract
referred to risk, risk factors, causes, indicators, aetiology or predictors of colic or its associated diseases. All
remaining abstracts were then assessed independently by two researchers (LC and SF) for agreement with
inclusion/exclusion criteria. Studies were excluded if they were of non-gastrointestinal colic, contained less than
three cases, were not available in English, or were reviews or textbook chapters. Articles were then categorised as
‘specific’ colic which described risk factors for specific conditions, or ‘general’ colic, which related to clinical signs of
colic in general or across different conditions. ‘General’ colic articles were selected for further analysis. The
publications that met the inclusion criteria were reviewed using a quality assessment criteria scoring system with
nine criteria, developed specifically for this topic, based on published medical and veterinary systematic reviews of
risk factors (Furlan et al., 2009; Wylie et al., 2012). Articles were ranked according to the quality assessment criteria
with those scoring greater than a specific critical threshold considered to be of the highest level of evidence.
Results
The initial search identified 1385 publications on colic in the horse; 90 publications related to risk factors – 46 related
to specific diseases and 44 related to ‘general’ colic. Thirty-six publications relating to ‘general’ colic met the
inclusion criteria and were assessed using the quality assessment criteria. The upper quartile of nine publications
scored more than 74% (78%-95%) and were selected for final evaluation. Eight of these nine studies were based in
the USA, and one was multi-national, based in Europe.
Five of the nine publications (56%) were designed to investigate specific risk factors (dietary and other management
factors, crib-biting and wind-sucking and owner-perceived behavioural traits, and intestinal parasitism). The other
four publications (44%) investigated risk factors in general.
Individual papers identified a variety of risk factors pertaining to signalment, use of horse, clinical history, diet and
other management details; however, there was inconclusive agreement amongst the papers for the majority of risk
factors investigated. Consistent consensus (agreement between ≥3 of the best evidence studies) identified
increasing age, Arab and Thoroughbred breeds, recent change in diet or housing and a previous history of colic as
significant risk factors for colic.
Conclusions
Despite the plethora of available literature, there are still significant gaps in the current evidence. There are no
published multi-centre studies spanning different continents, and the highest ranking publications are currently
heavily weighted towards the USA. The level of evidence for many risk factors is weak and inconsistent, reporting a
range of different factors as significant risks for colic. In addition, due to varying methodologies there are a variety of
confounders and interactions for each risk factor across the studies. Despite this, there is strong evidence that age,
breed, management changes and recent clinical history are risk factors for colic.
Acknowledgements
Laila Curtis is funded by the School of Veterinary Medicine and Science.
References
The Cochrane Collaboration. (2013). [Online]. Available: http://www.cochrane.org [Accessed 10/06 2013].
Furlan, A. D., Pennick, V., Bombardier, C. and Van Tulder, M. (2009). 2009 updated method guidelines for systematic
reviews in the Cochrane Back Review Group. Spine (Phila Pa 1976), 34: 1929-41.
Liberati, A., Altman, D. G., Tetzlaff, J., Mulrow, C. D., Gotzsche, P. C., et al. (2009). The PRISMA statement for
reporting systematic reviews and meta-analyses of studies that evaluate healthcare interventions: explanation and
elaboration. Brit Med J [Online], 339.
Sarasin, F. P. (1999). Decision analysis and the implementation of evidence-based medicine. Q J Med, 92: 669-671.
Wylie, C. E., Collins, S. N., Verheyen, K. L. P. and Newton, J. R. (2012). Risk factors for equine laminitis: a systematic
review with quality appraisal of published evidence. Vet J, 193: 58-66.
7.19 Incidence and prevention of gastric ulcers in horses undergoing general anesthesia
Scicluna, C.
Equ’Institut, Clinique du Plessis, 60300 Chamant, France, tel (+33) 03 44 32 21 25, fax (+33) 03 44 32 21 26,
Email [email protected]
Background
The stress associated to surgery and anesthesia may contribute to the observation of gastric ulcers during the
postanesthetic period in horses. This prospective study evaluated the incidence, treatment and prevention of gastric
ulcers in horses undergoing general anesthesia.
Methods
Eighty four horses (age 3.52.1 years, weight 420.3849.52 kg) undergoing several elective surgical procedures were
kept off of food for 20 hours prior to anesthesia. On the day before anesthesia, a preoperative gastroscopy
(baseline) was performed under sedation by a blinded assessor. Gastric ulcers were globally scored (0: no ulcers - 20:
worst degree of ulceration), considering the sum of 5 regional scores (0 to 4 EGUS scores for non glandular,
glandular, margo plicatus, small curvature, pylorus areas). Horses randomly received one of 4 treatments (n=21 per
treatment group): control (placebo) or omeprazole administered orally at 1, 2 and 4 mg/kg SID to groups OM1, OM2,
and OM4, respectively. Treatment started after the preoperative gastroscopy and continued for 2 days after
anesthesia. Animals were premedicated with acepromazine and romifidine. Anesthesia was induced with ketamine
and maintained with halothane in oxygen during controlled ventilation. A second gastroscopy was performed on day
2 after anesthesia. A Mann Whitney test compared scores and weight loss between groups. Pre and postoperative
scores were compared by a Wilcoxon signed rank test (P<0.05). Values are presented as median (range).
Results
Age, weight, and anesthesia time did not differ between groups. Preoperative gastroscopy global scores were 5(1-8),
5(0-12), 7(0-13), and 6(0-9) in the control, OM1, OM2 and OM4 groups, respectively. Only 2 horses were “ulcer free”
prior to surgery. Postoperatively, global scores were 5(1-10), 5(0-8), and 3(0-8) in the OM1, OM2 and OM4 groups,
respectively. These scores were significantly lower than values observed in the control group [7(3-12)] at the same
time. At the postoperative gastroscopy, global scores increased significantly from baseline in the control group, did
not change in OM1 group and were reduced significantly in the OM2 and OM4 groups. All horses lost weight, but no
group differences were observed.
Conclusions
Gastric ulcers are observed in most horses undergoing surgery. While anesthesia and surgery may worsen the extent
of these ulcers, omeprazole (2-4 mg/kg) may stop or reduce the extent of gastric ulcers during the immediate
postoperative period.
7.20 Colic in the British Military Working Horse Population - A Retrospective Analysis
Tannahill, V.J., Witte, T.H., Cardwell, J.M.
Equine Referral Hospital, Royal Veterinary College, Hawkshead Lane, North Mymms, Hatfield, Hertfordshire AL9 7TA.
Tel: (+44) 1707 666 297. Fax: (+44) 1707 666 304.
Email: [email protected]
Background
Numerous epidemiological studies have described the signalment, incidence, prevalence and mortality rate of horses
suffering from colic, often using a sample of the general population.
The British military working horse population represents a unique cohort of horses that are managed in a strictly
controlled environment yet there are few studies investigating their veterinary problems.
The aims of this retrospective cohort study were to describe the signalment, prevalence, incidence and mortality
rate of colic within the British military working horse population.
Methods
Data from the veterinary records of horses in British military work between 01 January 2008 and 31 December 2012
were accessed. Records of horses that remained in military work were available from the veterinary clinics of the
three military horse populations – the Defence Animal Centre, the King’s Troop Royal Horse Artillery and the
Household Cavalry Mounted Regiment. Records of horses that concluded their military work during the study period
were available from archived records. Data were collated in Microsoft Excel 2010 and imported into SPSS software
version 21 for analysis.
Results
Of 766 horses eligible for inclusion in the study, the records of 49 (6.4%) were inaccessible, leaving a total of 717
horses. Of these, 506 (70.6%) were male and 211 (29.4%) were female. Just over half (52.7%; n=378) were from
population A, 22.7% (n=163) from population B and 24.6% (n=176) from population C. Thirty-five different breeds
were recorded but breed was not recorded for 493 horses (68.8%). The total time at risk was 2395.83 horse-years.
In total, 164 horses (22.9%; 95% CI: 19.8-26.1) had had colic at least once during the study period, giving an
incidence rate of 11.1 episodes/100 horse-years. There were 267 episodes of colic, but the majority of horses
(65.2%; 107/164) suffered only a single episode. The maximum number of episodes suffered by any horse was 12.
There was no significant difference in the overall colic occurrence between male (23.3%; 118/506) and female
(21.8%; 46/211) horses (p=0.6). There was some significant variation in colic occurrence across populations A (26.5%;
100/378), B (18.4%; 30/163) and C (19.3%; 34/176) (p=0.05).
The overall colic-related mortality rate was low (1.95%; 14/717), with a case mortality rate of 8.5% (14/164) and an
incidence rate of 0.58 deaths/100 horse-years. There was no significant difference in mortality rate by sex (p=0.9) or
population (p=0.1).
Conclusions
Due to the type of veterinary records kept, the aim of describing the signalment of colic within this population was
not easily achieved. However it was possible to ascertain that, similar to other studies (Proudman, 1991; Tinker et al,
1997; Traub-Dargatz et al, 2001), there was a lack of association between colic and sex of the horse.
The period prevalence in this study (22.9%) is considerably higher than the prevalence of 5.8% described by Hillyer et
al (2001) in UK racehorses. This may be attributed to the fact that all cases of colic in military working horses receive
veterinary attention, resulting in increased recording. Tinker et al (1997) reported that 32% of colic cases in the USA
general horse population did not receive veterinary attention. Alternatively, it may be that some factors particular to
military working horse management, despite being strictly controlled, contribute to an increased risk of colic.
However, the overall colic incidence in this study (11.1 episodes/100 horse-years) is similar to incidences of 3.5 to 19
episodes/100 horse-years reported elsewhere (Uhlinger, 1992; Kaneene et al, 1997). In addition, the colic mortality
rates reported from this study (0.58 deaths/100 horse-years and 8.5% of cases) are also similar to rates of 0.45 to 0.7
deaths/100 horse-years (Tinker et al, 1997; Hillyer et al, 2001) and 3.9 to 13% (Kaneene et al, 1997; Hillyer et al,
2001) reported in the UK and USA horse populations.
The study is limited by the retrospective collection of data and the reliance upon accurate contemporaneous record
keeping. Also, entire male horses are under-represented within the study population. Further studies of this unique
population of horses are required in order to describe the clinical variety of colic episodes and to quantify the risk
factors for colic within the military working horse population.
References
Hillyer, M.H., Taylor, F.G.R. and French, N.P. A cross-sectional study of colic in horses on Thoroughbred training
premises in the British Isles in 1997. Equine vet. J. (2001) 33, 380-385.
Kaneene, J.B., Miller, R., Ross, W.A., Gallagher, K., Marteniuk, J. and Rook, J. Risk factors for colic in the Michigan
(USA) equine population. Prev. vet. Med. (1997) 30, 23-36.
Proudman, C.J. A two-year prospective survey of equine colic in general practice. Equine vet J. (1991) 24, 90-93.
Tinker, M.K., White, N.A., Lessard, P., Thatcher, C.D., Pelzer, K.D., Davis, B. and Carmel, D.K. Prospective study of
equine colic incidence and mortality. Equine vet. J. (1997) 29, 448-453.
Traub-Dargatz, J.L., Kopral, C.A., Seitzinger, A.H., Garber, L.P., Forde, K. and White, N.A. Estimate of the national
incidence of and operational-level risk factors for colic among horses in the United States, spring 1998 to spring
1999. J. Am. vet. med. Ass. (2001) 219, 67-71.
Uhlinger, C. Investigations into the incidence of field colic. Equine vet. J. Suppl. (1992) 13, 16-18.
7.21 Prevalence of different types of colic in broodmares and short-term survival in a UK
equine referral hospital population: 146 cases (2000-2012)
Suthers, J.M., Vale, L., Archer, D.C.
Philip Leverhulme Equine Hospital, School of Veterinary Science / Institute of Infection and Global Health, University
of Liverpool, Leahurst Campus, Neston, Wirral. CH64 7TE Tel: (+44) 0151 794 6041, Fax: (+44) 0151 794 6034
Email: [email protected]
Background
Certain types of colic have been identified to be more common in pregnant mares and those in the peri-parturient
period (Suthers et al. 2013). There are several published case reports and a limited number of case series detailing
causes of colic in pregnant or post-partum mares (Boening and Leendertse 1993, Steel and Gibson 2001). To our
knowledge, there is no published work documenting different colic types, their relative frequency and posttreatment survival rates in a population of broodmares referred for investigation of colic in the UK.
Objectives
The objective of this study was to report the frequency of different types of colic and short-term survival rates in
broodmares admitted to a UK referral hospital. We also aimed to investigate whether these varied according to
stage of gestation or time since foaling.
Methods
Case records of broodmares presented to the PLEH for assessment of signs of colic over a 12 year period (January
2000-December 2012) were reviewed. Criteria for selection included being classified as having a use of ‘breeding’ on
the colic admission form, as well as mares that were in foal or had a foal at foot at the time of admission. Data
extracted from hospital records included breed, age, management, colic history, whether the mare was in foal at the
time of the colic episode and stage of pregnancy (Trimester one = 0-120 days, trimester two =121-240 days and
trimester three = 241 days and above) as well as clinical data from the initial colic examination. Treatment, diagnosis
and survival to discharge was also recorded. Mares that were not in foal but were classified as broodmares with
regards to their use were still included in the study (due to the assumption that they were managed as broodmares
which could be an important factor).
Results
A total of 146 broodmares were identified; at the time of admission 98 mares (67%) were in foal, 29 (20%) were not
in foal, and for 19 (13%) data for pregnancy status was not recorded. Most were Thoroughbred mares (43%) and the
mean age was 11 years (range 3-24 years). A prior history of colic was reported in 35% of the mares. Surgical
treatment for colic was undertaken in 85 mares (58%) and 53 (36%) were treated medically (the remainder were
euthanased on financial / welfare grounds). The most frequent surgical diagnoses were: large colon displacement
(n=13; 15%), large colon torsion (n=12; 14%), epiploic foramen entrapment (n=8; 9%), other small intestinal
strangulating lesions (n=11; 13%) and ileal impaction (n=5, 6%). Uterine torsion (n=3; 4%) and lesions of the small
colon or associated mesocolon (n=4; 5%) were relatively uncommon. Where mares presented in the peri-parturient
period, this was a mean of 79 days post-foaling (1-730 days). Overall short-term survival for all mares treated
medically or surgically was 70%; 96% of mares treated medially survived to hospital discharge and 57% of all mares
taken to surgery survived to hospital discharge. Survival rates for mares according to the trimester of pregnancy
were 63% for those in the first trimester, 71% for the second trimester and 50% for the third trimester.
Conclusions
This is the first study, to our knowledge, that has reported the relative frequency of different types of colic in
broodmares in a UK referral hospital population. Knowledge of the relative frequency of different types of lesions in
these mares, short term survival rates in mares at different stages of gestation in addition to rates of survival for
specific lesion types can assist informed decision making by veterinary surgeons and horse owners. There is a need
for a prospective study investigating horse- and management-level risk factors for colic in a population of
broodmares.
Acknowledgements
Joanna Suther’s Clinical Training Scholarship was funded by the Horserace Betting Levy Board. We are grateful to the
Horse Trust (formerly Home of Rest for Horses) and the Petplan Charitable Trust who funded the colic survival study
from which some of this data was obtained. We also thank our colleagues at the Philip Leverhulme Equine Hospital.
References
Boening, K.J., Leendertse, I.P (1993) Review of 115 cases of colic in the pregnant mare Equine vet. J. 25, 518-521
Steel, C.M., Gibson, K.T. (2001) Colic in the pregnant and periparturient mare Equine vet. Educ. 13, 94-104
Suthers, J.M., Pinchbeck, G.L., Proudman, C.J., Archer, D.C. (2013) Risk factors for large colon volvulus in the UK.
Equine Vet. J. 45, 558-563.
7.22 Causes of radial lesions in the pylorus region of horses
Schusser, G.F., Koller, G., Snyder, A.
Department of Large Animal Medicine, Faculty of Veterinary Medicine, University of Leipzig, An den Tierkliniken 11,
04103 Leipzig, Germany, Tel: (+49) 341 9738320, Fax: (+49) 341 9738349, Email: [email protected]
Background
During gastroscopy of horses with colic due to gastric and intestinal pathology, radial lesions in the pylorus region
were observed. Some of these horses had a reflux of duodenal fluid into the stomach. It has been reported, that bile
acids within the duodenal fluid contributes to the development of gastric ulcers.
Objective
To determine the composition of duodenal reflux fluid as a possible cause of radial lesions in the pyloric region of the
stomach.
Methods
Gastroscopy was performed in 20 horses, 7 of which were clinically normal, while 13 were admitted with colic due to
gastric or intestinal disorders. Biopsy samples were taken from pylorus region. With the aid of this procedure, fluid
was collected both from the duodenum and the stomach into a 50 ml syringe. The fluid pH was first determined and
when it was above pH 7 it was analyzed immediately. If the stomach fluid pH was below pH 7 the samples were
alkalinized to pH 7 using a solution of 0.1% sodium hydroxide. Thereafter the fluid was analyzed using an in-house
standardized profile.
Results
The pyloric lesions of 13/20 horses appeared radial with redness, large (rugal) radial wrinkles, radial hemorrhages or
radial erosions (grading 1-3 according to M. J. Murray, Merial 2001). Duodenal reflux was seen during gastroscopy
regularly. The histo-pathologic changes of the glandular mucosa were bleeding in the lamina propria mucosa and
infiltration of lymphocytes and plasma cells. The pH of the gastric fluid in horses with duodenal reflux was 3.41
(median, 1. quartile 2.56, 3. quartile 7.18) compared to horses without endoscopically observed reflux 2.09 median
(1. quartile 1.83, 3. quartile 2.78). The concentration of cholesterol in the gastric juice in horses with duodenal reflux
was higher (0.13 mmol/L median, 1.quartile 0.05, 3. quartile 0.18) than in horses without (0.01 mmol/L, 1. quartile
0.0, 3. quartile 0.1). We measured the highest concentrations of bile acids in horses with duodenal reflux up to 380
µmol/L compared to gastric fluid of horses without (218 µmol/L).
Conclusion
The pyloric radial lesions could be caused by reduced gastric emptying and/or impaired duodenal propulsive motility.
Gastritis in the pyloric region could be risk factor too.
7.23 Use of Micro-Lightguide Spectrophotometry (O2C®) in the equine intestine
Reichert, C., Hopster, K., Franz, S., Wogatzki, A., Rotting, A.K.
Equine Clinic, University of Veterinary Medicine, Hannover, Foundation, Bünteweg 9, 30559 Hannover, Germany.
Tel: (+49) 0511– 953 6500 Fax: (+49) 0511– 953 6510 Email: [email protected]
Background
Lightguide tissue spectrophotometry is a non-invasive method to determine tissue microperfusion and oxygen
saturation (Germann et al. 1994; Beckert et al. 2004).
Objectives
Evaluation of the O2C®-micro-lightguide tissue spectrophotometer in equine small and large intestine. We
hypothesized that this system is easy to use and can quickly provide a reproducible evaluation of the
microcirculation.
Methods
In 13 horses the O2C® was used to determine oxygen saturation, relative amount of haemoglobin (rHb), and tissue
blood flow in the equine small and large intestine. Measurements were performed under different measuring
conditions that were considered to have a potential effect on the accuracy of the measurements.
Results
Use of the O2C® was easy and measured parameters were displayed almost immediately on a monitor. Most
measurement errors occurred when surgical lights were pointing at the measuring site, with the probe covered by
the surgeon’s hand or not. No measurement errors were observed when the probe was positioned on the intestinal
wall with room light, at the mesenteric side or between the mesenteric and antimesenteric side, with the surgical
lights switched off or being abducted. Placement of the probe on the mesenteric side of the intestine resulted in
higher rHb values.
Conclusions
The O2C® provided a quick and reproducible evaluation of intestinal microcirculation. We have used the O2C®
successfully in an experimental setting documenting jejunal ischaemia and reperfusion. We recommend positioning
the probe between the mesenteric and antimesenteric intestinal side with surgical lights switched off or being
abducted.
References
Beckert, S., Witte, M.B., Königsrainer, A. et al. The impact of the Micro-Lightguide O2C for the quantification of tissue
ischemia in diabetic foot ulcers. Diabetes Care, 2004, 27, 2863-2867.
Germann, R., Haisjackl, M., Hasibeder, W. et al. Dopamine and mucosal oxygenation in the porcine jejunum. J Appl
Physiol , 1994, 77, 2845-2852.
7.24 Detomidine and gut motility in horses: clinical data
Scicluna, C.
Equ’Institut, Clinique du Plessis, Chamant, France.
+33344322125
+33344322126
Email: [email protected]
Background
Use of detomidine, potent a2-agonist equine sedative and analgesic is still controversial in colic horses, especially
regarding to gut motility or re-administration.
Methods
In order to learn more about induced ileus and re-administration effects, 10 healthy adult horses were administered
nasogastric charcoal (1g/kg) prior to one of 4 sedation protocols, alternatively given to all of them: S1=no sedation,
S2=0,02 mg/kg IV detomidine, S3=0,04 mg/kg sublingual detomidine, S4=S2+S3 ,t0+45 min later. HR, sedation and
head position (0 to 2), as well as gut motility (abdominal sounds, 0 to 3 ; auscultation) were recorded every 5 then 15
mins during 210 mins. Time for dark feces (hours) and side effects were also controlled. Statistics used t-test and
Wilcoxon signed rank test with p<0,05 for significance.
Results
Tested protocols were equivalent for bradycardia. S2, S3 and S4 provided similar profound sedation. S4 induced a
significant longer max-sedation time (200 mins vs 110 mins/S2, 140 mins/S3) and more sweating. Head raised back
to nearly normal position at t210. Gut sounds decreased with all protocols, without any statistical difference, but
never disappeared. Gut motility increased back after t80, up to normal after t120/S2 and t200/S3,S4. Time for dark
feces was not statistically different (21-23h). Detomidine didn’t induce ileus, even with re-administration. Sublingual
top-up 45 mins after IV injection allowed to prolonge sedation and muscle relaxation for almost 100 mins without
side effect. Use of detomidine and re-administrations can be considered safe, regarding gut motility, for practical use
in colic horses.
7.25 Detomidine prolonged analgesia for colic in horses
Scicluna, C.
Equ’Institut, Clinique du Plessis, 60300 Chamant, France
Tel +33 344 32 21 25
Fax +33 344 32 21 26
Email [email protected]
Background
Till now, use of detomidine in colic horses is controversial because of its potent and long analgesic effects and its
even though not proven “ileus risk”. Nevertheless, its effects and benefits in practice should be underlined and rules
for a safe use explained.
Methods
In order to study clinical effects of detomidine in colic horses, especially gut motility and duration of analgesia, and
to propose a safe prolonged analgesia (PA) protocol, 20 adult horses presented for pain related to medical colic were
included in a clinical trial. After complete clinical examination at t0, in which HR, RR, CRT, MMC, abdominal
auscultation for gut motility were evaluated and naso-gastric tubing and rectal palpation were performed, all horses
received randomly a 0,01 mg/kg IV detomidine bolus prior to either 0,02 mg/kg IV detomidine injection at t90 (group
PA1, 10 horses) or 0,04 mg/kg sublingual detomidine gel dose at t45 (group PA2, 10 horses). Level of sedation (0 to
2), heart rate (beats/min), respiratory rate, mucous membrane colour, muscle relaxation and gut sounds for
intestinal motility (left and right sides, upper and lower regions, score 0 – no sound for 60s, to 3 – no silence longer
than 20s) were recorded every 5 mins from t0 to t30, every 15 mins from t30 to t190 then every 30 mins from t220
and t310. Except fluids given IV when needed to manage dehydration, no other drug was administered during the
observation period of time. No bad evolution susceptible to exclude the case from the study occurred. Statistical
analysis was performed depending on quantitative or non quantitative parameters and p<0,05 made a difference
significant.
Results
Left colon displacement was the most frequent problem (50%) to be treated in both groups (40% PA1, 60% PA2).
Colon impaction and “single pain” represented 25% in PA1 and PA2 (3 and 2 horses respectively). PA1 provided good
analgesia (score>1) for 220 mins and PA2 for 240 mins. IV bolus of detomidine induced a decrease of 50% in heart
rate 5 mins after injection. Heart rate was back to initial value after 180 mins. Bradycardia after detomidine gel
administration in PA2 was lower and delayed : -30% t75 vs -50% t5 and t50. After IV detomidine initial bolus, ileus
(no abdominal sound for 60s) occurred in PA1 and PA2 (46 and 4 horses) and lasted 10 mins between t10 and t20.
This was repeatable after the t45 IV top up in PA1. Ileus following detomidine gel top up occured in 1 horse at t75
(30mins after administration). Gut sounds were increasing to be considered as normal at t200 in both groups.
Decreased transit, without ileus, was nevertheless observed for 15 mins in 4/10 horses between t75 and t90 in PA2.
Sweating was observed in 8/10 horses in both groups, was repeatable after the IV top up, started at t30 with PA2 but
decreased in intensity to disappear at t90, despite detomidine gel top up.
PA1 horses recovered from muscle relaxation at t80, then were prolonged up to t200. Less muscle relaxation started
to be noticed at t140 in PA2. Body shivering, in relation with back to normal gut activity and positioning, occurred in
5/10 horses between t190 to t220 with PA1 and 3/10 horses from t200 with PA2. Abdominal tensions and
distensions found by rectal palpation were decreased in all cases during and after the observation period. No
adverse effects were observed. No deleterious definitive ileus occurred at any time. Moreover, horses without gut
motility at their arrival recovered well in this study.
Detomidine prolonged analgesia protocols using initial 0,01 mg/kg IV bolus and then a top up with 0,02mg/kg IV
bolus or 0,04 mg/kg sublingual gel should be considered for safe prolonged analgesia up to 220 or 300 mins, in colic
horses with left colon displacement or impactions undergoing close medical care
7.26 Detomidine prolonged analgesia with detomidine in colic horses: retrospective study
Scicluna, C.
C Scicluna
Equ’Institut, Clinique du Plessis, 60300 Chamant, France
Tel +33 344 32 21 25
Fax +33 344 32 21 26
Email [email protected]
Objectives
In order to add a clinical experience of the use of detomidine in colic horses and its benefits, a retrospective study
took out cases which received detomidine for colic analgesia in 209 colic horses.
Methods
108 horses examined in first intention in the field received 1 single bolus of IV detomidine (0,01 or 0,02mg/kg) either
to facilitate manipulation (tubing and rectal palpation) or manage immediate pain.
No other drug was administered except dipyrone in 75% and nasogastric oil. One single bolus detomidine was
considered good enough to allow complete and safe examination, manage pain, horse excitement, abdominal
distension and transit without any side effect.
101 horses arrived at the clinic after being referred or for intensive care and were treated with a prolonged analgesia
protocol with repeated administrations of IV detomidine + fluidotherapy for rehydration.
Results
Main colic observed were left colon displacements (31) and colon impactions (16).
Classical colic clinical parameters were observed up to 5 days maximum. Depending on the first examination and
according to the early diagnosis, horses received from 1 (38/101 horses) to 12 (1/101 horses) repeated injections of
detomidine during the observation period (6 mins to 72h).
36/101 horses underwent surgical procedures because of insufficient therapeutic evolution :
-
-
-
10/36 after 1 injection
o 1 epiploïc foramen, survived
o 3 right colon displacement, 2 survived
o 1 colon torsion, euthanized
o 1 caecum torsion, survived
o 4 small intestine volvulus, 2 survived
8/36 after 2 injections
o 3 colon volvulus (2 tops up every 6 or 10 mins), 1 survived
o 3 colon torsion (2 tops up every 10 mins) , 3 euthanized
o 1 small intestine volvulus, euthanized
o 1 right colon displacement, survived
5/36 after 3 injections
o 1 colon torsion (3 tops up every 30 mins), euthanized
o 1 inguinal hernia, survived
o 1 colon adhesion, survived
o 1 small intestine torsion (lipoma), survived
o 1 small ileo-caecal intussuception, survived
- 7/36 after 4 injections
o 5 right colon displacement (4 tops up every 2h, up to 8h), 5 survived
o 2 colon torsion (4 tops up every 6 mins), 2 euthanized
o 1 small intestine intussuception, survived
- 3/36 after 6 injections
o 1 right colon displacement, euthanized
o 1 small intestine torsion, survived
o 1 small ileo-caecal intussuception, survived
- 1/36 after 8 injections
o 1 colon adhesion, survived
- 1/36 after 12 injections
o 1 left colon displacement + NE (12 tops up every 2 or 3h for 36h), survived
1 horse received 10 repeated dosages for a left colon displacement with nephrosplenic entrapment and was
euthanized for financial reasons. 1 horse responded very well to a single bolus of IV detomidine concerning early
pain but couldn’t recover medically from its diaphragmatic hernia, surgery not accepted by the client.
76/101 horses (75%) received 0,02mg/kg as first dosage and top up.
Delay of detomidine re-administration, based essentially on analgesia, horse’s attitude, bowel positioning and
transit, varied from 6 mins (large colon torsion) to 3 hours (left colon displacement), median = 2 h. The shortest the
delay between 2 injections (less analgesic effect), the severe the colic was, potentially survival depending on surgery.
Duration of analgesia below 60 mins implies new clinical evaluation of the case and its vital prognosis. At this stage,
surgery might be seriously considered. First 0,01 or 0,02mg/kg IV detomidine bolus in a colic horse inducing sedation
and analgesia for at least 120 mins and decreasing heart rate for 50% within the 3 to 5 mins is likely to be good
prognosis. Prolonged analgesia by repeated doses of 0,01 to 0,02mg/kg detomidine is a good technique for the
treatment of medical colics that can be managed by careful and close clinical observations in intensive or semiintensive conditions. Besides analgesia for pain, detomidine provides also good sedation that allows calm and quiet
time to set up more or less intensive additional treatments for the medical management of the colic. The needed
resuscitation on shocked patients undergoing general anesthesia can also be achieved this way in order to enhance
the vital prognosis of the surgery. Clinical re-evaluation and diagnostic at regular intervals of 2 hours maximum allow
not to mask bad evolution of severe cases and to change therapeutic decisions.
Non responsive colic horses after 2 detomidine IV injections and/or within 6 hours must be taken into serious
consideration, especially considering a potential surgical option. Furthermore, the use of such prolonged analgesia
protocol with detomidine could be an alternative effective therapy for pain management in colic horses with no
surgical option. Although the cost of it, it never reaches the amount of combined surgery + rehabilitation cost of the
surgical option!
7.27 Objective evaluation of peritoneal fluid color in horses with colic
Nieto, J.E., Beldomenica, P., Dechant, J.E., Snyder, J.R.
Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California, Davis.
Tel (530) 752-0290.
Email: [email protected]
Background
The most common cause of death in horses with colic is acute circulatory failure secondary to intestinal ischemia.
Early and accurate recognition of ischemic bowel is essential to decrease complications and increase survival.
Previous studies have identified gross appearance of peritoneal fluid as a strong indicator of strangulating
obstructions.
Objective
To compare gross appearance and objective evaluation of peritoneal fluid in control horses and clinical cases with
colic.
Methods
Peritoneal fluid was collected and immediately centrifuged in 10 control and 63 horses with colic. Gross appearance
and objective evaluation of peritoneal fluid was performed before and after centrifugation. Objective evaluation of
peritoneal fluid was performed by using an UV-Vis spectrophotometer and specific color software. Information
regarding diagnosis, treatment and outcome was retrieved from the medical records.
Results
There was a difference on gross evaluation of peritoneal fluid between controls and clinical cases on plain but not in
centrifuged samples. Most of the objective variables were different between controls and clinical cases in both plain
and centrifuged samples. There was a difference on gross evaluation of fluid between plain and centrifuged samples
in clinical cases but not in controls. Objective evaluation of peritoneal fluid is a better predictor of ischemia, need of
surgery and resection, and survival than gross appearance of peritoneal fluid.
Conclusion
Objective evaluation of peritoneal fluid is fast to perform and can be used in the diagnosis and prognosis of horses
with colic.
7.28 Prevalence of gastric ulceration in free-ranging non-domesticated Equidae (Equus
quagga): A post-mortem study
Hillyer, M.H., Wilsher, S., Allen, W.R., Stansfield, F.
Newmarket Equine Hospital, Cambridge Road, Newmarket, Suffolk. CB8 0FG, UK. Tel: +44 (0) 1638 782020 Fax: +44
(0) 1638 782021
Email: [email protected]
Paul Mellon Laboratory of Equine Reproduction, Brunswick, Woodditton Road, Newmarket, Suffolk CB8 9BJ, UK.
Email: [email protected]
The Elephant Conservation and Research Unit, Savé Valley Conservancy, Chiredzi, Zimbabwe.
Email: [email protected]
Background
Equine Gastric Ulcer Syndrome (EGUS) remains a frustrating conundrum for horse owners, trainers and veterinary
surgeons. Increasing awareness has undoubtedly led to increased diagnosis and reporting of the condition in
domesticated equids. Original reports showed a high level of gastric squamous ulceration in performance horses
with a trend to the highest levels of ulceration in horses performing the highest intensity work. This has been largely
attributed to the feeding, exercise and stable management requirements that are placed on these high performance
athletes. In particular a high grain (carbohydrate) diet and a low forage diet, together with reduced grazing have
been implicated as risk factors. More recent reports have identified high levels of gastric squamous ulceration in
more sedentary horses kept under less artificial environments and with greater access to grazing.
Objectives
To determine the extent of EGUS in a group of free-ranging non-domesticated equidae in a method so as to most
reliably record the EGUS status of these individuals in their natural environment.
Methods
Distal oesophagus, stomach and proximal duodenum were collected and labelled immediately after death from 36
animals. These individuals were part of a managed cull of Plains zebra (Equus quagga) from free-living herds in
southern Zimbabwe. Small groups of animals were herded into a boma prior to road transport to a local abbatoir and
immediate slaughter. The stomachs were examined intact and then opened along the greater curvature. Contents
were carefully removed and the mucosa gently rinsed. The mucosa was then examined and photographed. The
mucosa was scored and recorded according to the presence of gastric ulcers. Composite scores were recorded for
each of four areas of the stomach – squamous mucosa of greater curvature of oesophageal region, squamous
mucosa of lesser curvature of oesophageal region, glandular mucosa of fundic region and glandular mucosa of
pyloric region. The presence of Gastrophilus sp larvae and any other lesions was also recorded. The sex and an
estimate of age of each individual were made from further inspection of the carcass and dentition.
Results
Squamous ulceration (other than that associated with active Gastrophilus sp attachment) was not observed in any
animal. Mild hyperkeratosis of the squamous mucosa was seen on the greater curvature adjacent to the margo
plicatus in two individuals. Glandular ulceration of the fundic region was identified in 22 individuals (seven with
Grade 1, nine with grade 2, three with grade 3 and three with grade 4). Glandular ulceration (Grade 2) was identified
in the pyloric region in one individual.
Conclusions
By definition these equidae were not habituated to humans and were unhandled. The sampling protocol was
designed to attempt to minimise stress and any alteration from normal behaviour prior to death. Invariably this
could not be achieved and these individuals will have undergone a stressful period immediately prior to death. It is
reasonable therefore to assume that this study would represent an overestimate of the prevalence of gastric ulcers
compared to the normal pre-handling state.
These results show a minimal level of squamous ulceration or hyperkeratosis to be present in this group of freeliving equidae. It is therefore proposed that these equidae would not be expected to show any squamous ulceration
in their normal environment. There may be species differences between zebra and the domesticated horse, but in
light of the prevalence of squamous ulcers in the latter group it is proposed that the high incidence of squamous
ulceration is an abnormal consequence of domestication.
Acknowledgement
The authors acknowledge the help and support of Mr Blondie Latham and staff of The Bubye Conservancy,
Zimbabwe.
References
Dionne, R.M., Vrins, A., Doucet, M.Y. and Pare, J. (2003) Gastric ulcers in standardbred racehorses: prevalence, lesion
description, and risk factors. J. Vet. Intern. Med. 17, 218-222.
Nadeau, J.A. and Andrews, F.M. (2009) Equine gastric ulcer syndrome: the continuing conundrum. Equine Vet. J. 41,
611-615.
Le Jeune, S.S., Nieto, J.E., Dechant, J.E. and Snyder, J.R. (2006) Prevalence of gastric ulcers in Thoroughbred
broodmares in pasture. In: Proc. Am. Ass. equine Practnrs. p 264.
Luthersson, N., Nielsen, K.H., Harris, P. and Parkin, T.D. (2009) The prevalence and anatomical distribution of equine
gastric ulceration syndrome (EGUS) in 201 horses in Denmark. Equine Vet. J. 41, 619-624.
7.29 Caecocaecal-caecocolic intussusception in three horses from a single farm, with
Anoplocephala perfoliata infestation
Tremaine, W.H., Roberts, V.L.H., Grabski, M., Ottridge, R.
Department of Clinical Veterinary Sciences
University of Bristol. Langford Bristol, BS405DU, tel. 0117 928 9621, Fx. 0117 928 9622,
Email: [email protected]
Background
Caecocolic intussusception is an uncommon cause of colic in horses. It can have a high morbidity and can
necessitate technically complicated surgery with significant costs and low survival outcomes. Epidemiological studies
have not identified Anoplocephala infestation as a risk factor for this lesion, although infestation has been identified
as a risk factor for spasmodic and ileocaecal disease (1, 2). Larval cyathastomiasis has been described in conjunction
with caecocolic intussusception. (3) Anecdotally many cases of caecocolic disease show tapeworm infestation, and
caecal intussusceptions with tapeworm infestations have been described (4, 5). We describe three cases from a single
unit which presented with progressive colic diagnosed to be due to a caecocolic intussusception, which underwent
surgical correction all of which were infested with Anoplocephala perfoliata, despite previous pyrantel treatment.
Objective
This is a retrospective case series which demonstrates co-incidental infestion of Anoplocephala despite anti-cestodal
therapy, in three horses from a single unit undergoing surgical correction of intussusception. Statistically significant
association between the lesion and the parasite infestation is not revealed from such a small sample size, but the
coincidence of data is noteworthy.
Methods
Case records of horses on a single farm that showed colic from 2009-1013 were retrieved.
Results
Eleven horses from a single farm (age range 7m-7y) experienced signs of colic, 6 of which were referred for further
investigation. Of these a single horse was treated medically, and five underwent surgical treatment. Three of these
were diagnosed with caecal intussusception, one of which was caecocaecal and two caecocolic intussusceptions. All
three were corrected surgically, two of which were manually reduced and on which was reduced via a colotomy.
Both horses with caecocolic intussusception underwent typhylectomy. The age range of these three animals was 712 months. One other (2y) horse was diagnosed with serosal peteciation during surgery and the other (7yo) had a
segment of devitalised jejunum that was resected. In two of the three cases with caecal intussusception a diagnosis
ultrasonographically was possible preoperatively, in the third horse violent colic interrupted this examination. Four
of the five horses that underwent surgery had elevated serum levels for antibodies to Anoplocephala perfoliata, and
the three that underwent correction of the caecocolic intussusceptions had adult parasites in the caecum or faeces.
All five horses survived surgery, were discharged from the hospital and were alive 3 months after. One of these was
euthanased subsequently for an unrelated orthopaedic injury >12m post operatively. All animals that underwent
surgery had been treated previously with pyrantel at a dose estimated to be 38 mg/kg, 10-24 weeks before clinical
signs. The presence of parasites identified at surgery and the high serology indicates that horses were exposed to
Anoplocephala on this farm and treatments with pyrantel at the doses used were not effective in controlling the
parasite in the animals which subsequently developed colic.
Conclusions
Caecocolic intussceception may be predisposed by high infestations of Anoplocephala parasites. Although the
lesion cannot be attributed directly to the tapeworm infestation from these data, the suspicion of an association
between caecocolic intussusception and this parasite infestation is raised. Pre-surgical diagnosis is possible
ultrasonographically with confidence in some cases enabling an expedient decision to operate, which enables a more
straightforward surgery. Surgical correction involving eversion, with or without caecal body resection is a viable
option for a successful outcome although jejunocaecostomy and has also been described (6). In these cases dosing
with pyrantel was not effective to eliminate the parasite, that was identified as Anoplocephala perfoliata. The
possible role of other parasites in a high prevalence of colic on this farm is inconclusive from these numbers, but it
appears that failure to control parasites could have been a risk factor in colic caused by a range of lesions at this
farm.
References
Proudman CJ, Edwards GB. (1993) Are tapeworms associated with equine colic? A case control study. Equine Vet
J. 25: 224-6
Proudman, C.J. French, N.P. Trees, A.J. (1998) Tapeworm infection is a significant risk factor for spasmodic colic and
ileal impaction colic in the horse. Equine Vet. J., 30, 194–199.
Mair TS, Sutton DG, Love S. (1989) Caecocaecal and caecocolic intussusceptions associated with larval
cyathostomosis in four young horses. Veterinary Record ; 124:34-37.
W.P. Barclay, T.N. Phillips, J.J. Foerner (1982) Intussusception associated with Anoplocephala perfoliata infection in
five horses J. Am. Vet. Med. Assoc., 180,. 752–753
Owen R, Jagger, D.W, Quan Taylor, R. (1989) Caecal intussusceptions in horses and the significance of Anoplocephala
perfoliata. Veterinary Record ;124: 34-37.
Boussauw BH, Domingo R, Wilderjans H, Picavet T. (2001) Treatment of irreducible caecocolic intussusception in
horses by jejuno(ileo)colostomy. Vet Rec. 149(1):16-8.
7.30 The development of a web-based audit and database of equine colic surgery
Mair, T.S., Sherlock, C.E., White II, N.A.
Bell Equine Veterinary Clinic, Mereworth, Kent. ME18 5GS. UK. Tel: (+44) 1622 813700. Fax: (+44) 1622 812233.
Email: [email protected]
Marion duPont Scott Equine Medical Center, P.O. Box 1938, Leesburg, Virginia 20177 Tel: 703-771-6800 Fax: 703771-6810
Email: [email protected]
Background
Over the past thirty-five years, advances in our understanding of the pathophysiologic mechanisms in equine colic,
as well as advances in anaesthetic techniques and post-operative care have all contributed to an impressive
improvement in survival rates of horses undergoing colic surgery. This has been aided by many other factors such as
the development of residency training programmes in medicine, surgery and anaesthesia, and the open sharing of
findings from research and clinical case studies via forums such as the Equine Colic Research Symposia (Moore
2005). Despite the considerable improvements in the management of surgical colic, the procedure still carries
relatively high mortality and complication rates. In part, this can be explained by wide variations in the type and
severity of the underlying disease and the seriousness of the resultant insult to the intestines, the time delay
between onset of disease and surgical treatment, as well as extra-intestinal effects of hypovolaemia, endotoxaemia,
etc. However, variations in surgical techniques and complementary treatments will almost certainly affect these
rates as well. Careful monitoring and analysis of the survival and complication rates of colic surgery not only provide
insights into risk factors for the development of negative outcomes, but also identify areas where individual
surgeons or clinics can improve their success rates (Mair and White 2005). Databases have been effectively
developed in various areas of human surgery for many years, and have been shown to be effective tools for
improving success rates of surgery and defining best practices. Compelling arguments for performing such
systematic audits in equine colic surgery have been documented.
Objectives
The purpose of this project was to develop a web-based database of colic surgery to which equine surgeons and
hospitals can contribute information from their own cases. Comparison of outcomes of colic surgery from different
hospitals should improve our understanding of surgical results and help to develop ways to improve outcomes. Until
now, most of the published results of colic surgery have been based on the caseload of individual hospitals, and it is
difficult to compare the results from different studies due to variations in the way that the data is collected and
analysed. The clinical audit database will also allow direct comparisons between different hospitals and geographical
areas, and should provide relevant information about current trends in abdominal surgery.
Methods
We aimed to develop a web-based database to collect and tabulate data from colic cases. Data from surgeries
performed at one equine hospital were entered, and problems with the data collection system were identified and
resolved.
Results
The design of the database necessitated a balance of how much detailed information is collected against the
willingness of participating clinic to spend the necessary time entering the data. The use of yes/no questions, radio
buttons and dropdown lists were included where possible. The website contains information for equine surgeons,
equine veterinary practitioners and horse owners. Each equine surgeon will be provided with their own unique
username and password and will be able to access only their own personal data and summary statistics of their
hospital, although anonymised descriptive statistics from all participating hospitals and surgeons will be made
available regularly. In this way, benchmarking of data will be possible, thereby enabling individual surgeons to
compare their own caseload and results with those of the other participating surgeons.
The data collection area of the database has six main sections, entitled “case details”, “preop details”, “intraop
details”, “postop care”, “postop complications” and “outcome”. Once each case is completed, a PDF of the page can
be generated if required to place in the patient’s medical notes. When all details of the case have been entered, the
surgeon is asked to “close this case”, at which time no further changes to the dataset can be made, and the case is
added to the main database.
Conclusions
We believe that we have created a database that is practical and easy to use, but at the same time will accumulate
important data about colic surgeries that will be valuable to individual surgeons and hospitals, as well as providing
an on-going overview of trends in colic surgery. The next challenge will be enrolling individual hospitals and
surgeons, and assisting in their initial use of the database.
Acknowledgements
The financial assistance of the RCVS Trust is gratefully acknowledged. Thanks to David Sherlock for technical
development.
References
Mair, T.S. and White, N.A. Improving quality of care in colic surgery: time for international audit? Equine Vet.J.2005;
37: 287-288
Moore, J.N. Five decades of colic: a view from thirty-five years on. Equine Vet.J. 2005; 37: 285-286
7.31 Retrospective study of survival rates between medical and surgical treatments in 103
cases of colic at Aracatuba – Brazil
Mendes, L.C.N., Baptista, R.S., Vicarivento, N.B., Pereira, M.A.A.J.S., Chaves, A.A.,
Bovino, F., Rodrigues, C.A., Feitosa, F.L.F., Lucas, F.A., Peiro, J.R.
Univ Estadual Paulista Julio de Mesquita Filho, FMVA, Rua Clovis Pestana 793, Aracatuba, SP, Brazil. Tel (+55)
1836361439
Email: [email protected]
Dr. Rodrigues present address: Univ Estadual Paulista Julio de Mesquita Filho, FMVZ, Botucatu, SP, Brazil.
Background
Colic is the most common reason for equine emergency treatment and a major cause of mortality in managed horse
populations (Southwood, 2006; Proudman et al. 2002) . Treatment was found to have a significant effect on the
outcome of colic, and medical treatment was associated with a better prognosis then surgical treatment (van der
Linden et al. 2003).
Objectives
The aim of this retrospective study was to compare survival rates between medical and surgical treatments in cases
of referred colic.
Methods
Medical records of 103 horses admitted to the “Hospital Veterinario Luis Quintiliano de Oliveira – Univ Estadual
Paulista Julio de Mesquita Filho – Aracatuba campus” between 2005 and 2013 were evaluated. Information
obtained included treatment (medical or surgical), outcome (discharged, died, euthanized or unknown) and the
diagnosis. The survival rate was calculated for both groups (medical or surgical treatments)
Results
Out of 103 horses, 71% received medical treatment and 29% received surgical treatment. In medical treated horses,
68% were discharged, 15% died, 8% were euthanized and 8% had the outcome unknown. In surgical treated horses
37% discharged, 33% died, 23% were euthanized and 7% had the outcome unknown. The overall survival rate was
59%, the survival rate in medical treated horses was 68% and the survival rate in surgical treated horses was 37%.
Diagnosis was achieved in 62% of the cases. The mainly diagnosis was large colon impactation (34%).
Conclusions
The survival rate was much higher in horses treated medically than surgically treated, but smaller than those
reported by other studies. This can be explained by the delay in referring the horses to the teaching hospital, leaving
evolved lesions without treatment prior to the arrival to the facility. The higher survival rate in horses treated
medically emphasizes the importance of early treatment to be carried out and the decision to refer the horse to a
referral center should be performed rapidly after the onset of clinical signs. The higher survival rate of the animals
treated clinically is also due to the slow progress of diseases in this group. The most prevalent disease was the large
colon impactation, which treatment is mostly clinical and easy to perform. Veterinarians, trainers and owners should
be better educated about the importance of a fast referral in our region.
References
Van der Linden, M.A., Laffont, C.M., van Oldruitenborgh-Ooterbaan, M.M.S. (2003) Prognosis in equine medical and
surgical colic. J. Vet. Intern. Med. 17, 343-348.
Proudman, C.J., Smith, J.E., Edwards, G.B. and French, N.P. (2002) Long-term survival of equine surgical colic cases.
Part 1: Patterns of mortality and morbidity. Equine Vet. J. 34, 432-437.
Southwood, L.L. (2006) Acute abdomen. Clin. Tech. Equine Pract. 5, 112-126.
7.32 Medical and surgical intervention for nephrosplenic colonic entrapment
Hackett, E.S., Nelson, B.B., Ruple-Czerniak, A.A., Hendrickson, D.A.
Department of Clincial Sciences, Colorado State University, Fort Collins, CO, 80523, USA. Tel: (00) 1 970 297 5000
Fax: (00) 1 970 297 1275
Email: [email protected]
Background
Nephrosplenic entrapment (NSE) is a commonl etiology of colic in horses. The objectives of this study were to
perform long-term follow up on horses admitted for NSE and document success of nephrosplenic ablation in
preventing NSE.
Objectives
We performed this study (1) to evaluate the long-term follow-up of horses with NSE, (2) to specifically evaluate
horses that have undergone the nephrosplenic ablation procedure and determine their long-term follow-up
recurrence rates, and (3) to identify parameters associated with increased risk of surgical intervention for correction
of NSE.
Methods
Retrospective data was collected from the medical records of 219 horses with NSE from January 1, 1999 to January
1, 2012. Records were evaluated for signalment, physical examination parameters, laboratory results,
ultrasonography, medical and surgical treatments and long-term outcomes. Horses that received a nephrosplenic
ablation were evaluated separately and the incidence of colic calculated following the procedure.
Results
NSE was identified 234 times in 219 horses, which were largely Quarter Horses. Forty-one out of 234 (18%) were
previously diagnosed with NSE at the time of admission. Survival to hospital discharge regardless of NSE treatment
was 82% (190/234). Long-term follow-up of >10 months after hospital discharge was available for 175 horses. In
horses that underwent an ablation procedure, the incidence of colic and NSE was significantly decreased following
the ablation (P<0.01).
Conclusions
Nephrosplenic colonic entrapment has low morbidity and the majority of cases resolve without surgical treatment.
Preventative laparoscopic nephrosplenic ablation is associated with a decrease in colic episodes and high client
satisfaction.
Acknowledgement
Funding for this study was provided by the Colorado State University Advances in Equine Health Fund.
7.33 Strategies to overcome increased endotoxin concentrations in the equine gut Jul
Reisinger, N., Schaumberger, S., Schatzmayr, G.
Biomin Research Center, Biomin Holding GmbH, Technopark 1, Tulln, Austria, Tel: +43 2272 81166 13434, Fax: +43
2272 81166 488,
Email: [email protected]
Background
Endotoxins play an important role during the development of many equine diseases. During colic events, endotoxin
concentration in plasma can increase (Senior et al. 2011) and in worst case lead to endotoxemia or even death.
Endotoxins also seem to play a role during development of laminitis (Bailey et al. 2009). Minimal amounts of
endotoxins are continuously released in the equine gastrointestinal tract. If the intestinal environment is disturbed,
increased amounts of endotoxins can pass the impaired gut barrier. Endotoxin can therefore activate an immune
cascade, and lead to increased oxidative stress and increased production of pro-inflammatory cytokines. To prevent
endotoxaemia in horses, polymyxin B (PMB) is used (Barton et al. 2004) as it effectively inactivates endotoxins. PMB
is known to be nephrotoxic and neurotoxic. Therefore, it is of importance to find alternatives for acute treatment.
Plant extracts are often discussed as bioprotective ingredients. Thus they could be used as a reliable alternative to
prevent different endotoxin related diseases in horses.
Objectives
We tested the effect of different plant extracts on mouse macrophages activated by LPS. These tests were done to
find plant extracts, which have the potential to inhibit LPS induced effects like oxidative stress and cytokine
production.
Methods
A mouse macrophage cell line (J774A-1) was incubated with DMEM medium with 10% heat-inactivated FBS at 37°C
and 5% CO2. Cells were seeded in 24 well plates at a density of 5x105 cells/ml. LPS [200 ng/ml] alone and combined
with 0.01%, 0.025%, and 0.05% PMB, or plant extracts (milk thistle, algae, yarrow, and echinacea purpurea extract)
were tested at a concentration of 0.02% and 0.1%. After 48 hours of incubation, cell viability was tested with the
WST-1 assay. Nitric oxide (NO) response was tested with the Griess reagent. Additionally, released pro-inflammatory
cytokines (IL-6, TNF-alpha) and the anti-inflammatory cytokine IL-10 were measured with ELISA in the cell
supernatants. Cells with medium served as negative control. An analysis of variances was performed with Dunett’s
test as post-hoc test to determine statistical differences.
Results
Cell viability was neither affected by LPS nor by any plant extracts. Highest PMB concentration [0.05%] decreased cell
viability and was therefore not used for NO and cytokine determination. LPS significantly increased NO production
compared to control cells. PMB [0.01 and 0.025%] significantly decreased the NO production by 98 and 99%. Extracts
of algae [0.02, 0.1%], yarrow [0.1%], and echinacea purpurea [0.02, 0.1%] were also able to significantly decrease
LPS induced NO response by 39%, 94%, 16%, 30% and 28%, respectively. Both tested PBM concentrations decreased
TNF-alpha and IL-6 production by 100%. 0.1% algae extract decreased the TNF-alpha production by 75% and the IL-6
production by 91%. Moreover, the echinacea purpurea extract reduced the IL-6 production by 66% compared to the
cells incubated with LPS. PBM was also able to increase the IL-10 concentration by a factor of 6 [0.01%] and 10
[0.025%] compared to LPS treated cells. No effect of the plant extracts on the IL-10 production was detected.
Conclusion
Results of the study suggest that plant extracts can positively influence the immune response of macrophages similar
to PMB. Plant extracts were able to reduce nitric oxide production and pro-inflammatory cytokine response. A
combination of plant extracts with endotoxin binders (e.g. clay minerals) might help horses to deal with increased
endotoxin concentrations in the gut during intestinal disturbance and reduce overwhelming immune response.
References
Bailey, S.R., Adair H.S., Reinemeyer, C.R., Morgan, S.J., Brooks, A.C., Longhofer, S.L. and Elliott, J. (2009) Plasma
concentrations of endotoxin and platelet activation in the developmental stage of oligofructose-induced laminitis.
Vet Immunol Immunopathol. 129(3-4):167-73.
Barton, M. H., A. Parviainen, A. and Norton, N. (2004) Polymyxin B protects horses against induced endotoxaemia in
vivo. Equine vet. J. 36 (5) 397-401.
Senior, J.M. Proudman, C.J., Leuwer, M. and Carter, S. D. (2011) Plasma endotoxin in horses presented to an equine
referral hospital: Correlation to selected clinical parameters and outcomes. Equine vet. J. 43 (5) 585-591.
Tuesday 8th July
8.1 Preliminary evaluation of an early suturing technique for laparotomy incisional infection
Gandini, M., Giusto, G.
Dipartimento di Scienze Veterinarie, Università degli Studi di Torino (Italy)
Via L. da Vinci 44, 10095 Grugliasco (Torino), Italy
Email: [email protected]
Background
Following exploratory laparotomy in horses is reported an higher incidence of abdominal wound dehiscence
compared to other species (Smith, 2007). Abdominal incision dehiscence can be caused by suture material, knot or
tissue failure (Freeman, 2002).
In horses undergoing exporatory laparotomy abdominal wound healing is conditioned by suture pattern, suture
material used and by postoperative management (Corley, 2008).
In literature are reported techniques to prevent or treat abdominal wound dehiscence in horses, such as “belly
bandages” that provide protection from contamination and support to tissues and suture line (Smith LJ, 2007). To
treat abdominal wound dehiscence Tulleners (Tullerners, 1983) suggested to re-suture the abdominal wall under
general anaesthesia.
Most of reported dehiscence involve initially only the cutaneous and subcutaneous layers and are often caused by
wound infection. A frequent sequela of these complications is the formation of an incisional hernia.
Objective
Aim of this work is to describe a technique of debriding and suturing a infected, dehisced abdominal wound in
standing horses to reduce complications and postoperative hospital stay and to report its initial clinical use.
Methods
Six horses (4 geldings, 2 female, age 8-15 y.o., weight 450-600 kg) that underwent exploratory laparotomy and
developed incisional infection in the postoperative period (7-15 days) were included in the study.
Laparotomy wounds were closed at initial surgery with a two layer technique (Polysorb 2 USP loop for the fascia and
1 USP Nylon for the skin). No belly bandages but only a stent was applied over the wound and removed after two
days.
Three horses were treated conservatively with wound cleaning and debridement and application of a belly bandage.
Remaining three horses were treated with early re-suturing of the skin and application of a belly bandage. Horses
were restrained in stocks and sedated if needed. The wound was thoroughly debrided and cleaned. Loose skin
sutures were removed. Local anaesthesia was provided along the perimeter of the wound with 2% lidocaine. The
skin was bluntly dissected from subcutaneous tissue and horizontal mattress suture with 2 nylon or 1 polypropylene
suture material applied. To avoid excessive pressure on tissues, the suture was passed through plastic tubing.
In one case, because the wound edges were distant the operation has been repeated twice at 5 days interval to
achieve proper approximation of the skin.
Number of days from wound dehiscence to healing was recorded and compared. Wound was considered healed
when skin closure was completed
Postoperative complications were recorded.
Results
For horses treaded conservatively number of days from wound dehiscence to healing was higher (median 32, range
30-45)) than for those treated with early suturing (median 15, range 12-15)
Two out of three horses in the conservatively treated group developed incisional hernia while none of horses treated
with early suturing did.
Conclusions
Following laparotomy the linea alba became self-supporting between 7 and 21 days postoperative (Tulleners, 1983).
During this period the best possible conditions must be maintained to avoid future complications and early suturing
after incisional infection seems to improve healing of the abdominal wound. The number of cases in this report is
low but early suturing seems to be a valid method to reduce complications after incisional infection, although further
studies are needed.
References
Corley, K. (2008) Monitoring and treating the gastrointestinal system In: Corley K. and Stephen J., eds The equine
hospital manual. Wiley-Blackwell. P. 484-499
Freeman, D., Rotting, A.K., Inoue, O. J. (2002) Abdominal closure and complications. Clinical Tech. in Equine Practice,
1(3), 174-187
Smith, L.J., Mellor, D.J., Marr, C.M., Reid, S.W.J., Mair, T.S. (2007) Incisional complications following exploratory
celiotomy: does an abdominal celiotomy bandage reduce risk? Equine Vet. J. 39, 277-283.
Tulleners, E.P., Donawick, W.J., (1983) Secondary closure of infected abdominal incisions in cattle and horses. J Am
Vet Med Assoc. 182(12), 1377-1379
8.2 Ex-vivo computed tomography scan and anatomical characterization of jejuno(ileo)cecal
anastomoses in horses
Gandini, M., Giusto, G., Iotti, B., Valazza, A., Sammartano, F.
Dipartimento di Scienze Veterinarie, Università degli Studi di Torino (Italy)
Via L. da Vinci 44, 10095 Grugliasco (Torino), Italy
Email: [email protected]
Background
Jejuno(ileo)cecal side-to-side anastomoses with resection are commonly performed in equine abdominal surgery
whenever the ileum is damaged to such an extent that will not allow performing an end-to-end anastomosis.
Nevertheless, the complication rates of these techniques are still high while survival rates are lower when compared
to other types of anastomosis both for handsewn and stapled techniques (Freeman and Schaeffer, 2010).
Possible explanations have been proposed mostly from a functional point of view, related to the peculiarity that this
anastomosis forcedly joins two segments with very specific and different physiology and motility patterns. The
overcoming of intracecal pressure by the jejunum (Huskamp, 1973) without the coordination normally produced by
the ileocecal valve (Freeman and Schaeffer, 2010) and the fact that most of the proximal jejunum has already been
distended and possibly damaged by the primary pathology are all factors that could explain the poor functionality of
this type of anastomosis, both handsewn and stapled. Furthermore, it is still being debated whether a handsewn or
stapled technique should be preferred in order to reduce complications and improve survival rates (Proudman,
2007). There is a strong emphasis on finding ways of improving the technique, but in the last 30 years not much has
been done towards this goal either for handsewn or stapled anastomoses. Although considered more technically
demanding and involving more procedures when compared to other types of anastomosis (Freeman, 1997) this
technique could also be more sensitive to minor changes (Freeman and Schaeffer, 2010).
Previous literature (Freeman and Schaeffer, 2010) suggested that stomal dimensions can play a role in the
development of postoperative complications. This and other factors could give some mechanical contribution to
proposed functional problems.
Objectives
The aim of the study is to evaluate how the initial stomal dimensions influence the area and shape of the
anastomosis in handsewn and stapled side-to-side jejuno(ileo)cecal anastomoses in horses.
Methods
Intestines from 24 equine cadavers, comprising jejunum and caecum were harvested immediately after death.
Bowel segments in group 1 underwent a two-layer handsewn jejunocecal side-to-side anastomosis (HS), while group
2 received a stapled jejunocecal side-to-side anastomosis (GIA). Each group was divided into two subgroups, (HS80
and HS100, GIA80 and GIA100), on the basis of the proposed length of the initial stoma or the length of the staple
line (for the stapled techniques), set at 80 or 100 mm respectively. Bowel segments were then inflated to a pressure
of 8 mmHg. They were
CT scanned and the stomal perimeter and area were calculated. Following ratios were calculated and compared:
stomal/jejunal area, stomal perimeter/perimeter of a perfect circle of the same area and blind end pouch
volume/area. Effective length of the stoma was measured with a caliper and compared with intended initial length.
Results
Stoma/jejunum area ratio was close to 1.2 for both 80 techniques, to 1.6 for the SP 100 and to 1.9 for the 100 HS
technique. There was no statistically significant difference in ideal/real circle perimeter ratio or in variation of stomal
length between groups. Both HS and GIA techniques produced a blind end pouch and exhibited a mean increase of
the final stomal length ranging from 6 up to 11%.
Conclusions
Any technique will exhibit an increase between 6 and 11% of the final stomal length, with a consequent increase in
stomal area. A stomal length of 80 mm produced a stoma wider than jejunum proximal to the anastomosis and could
be deemed sufficient to allow free flow of ingesta. A 100 mm long stoma could produce too wide a stoma, possibly
allowing cecal reflux.
References
Freeman, D.E. (1997) Surgery of the small intestine. Vet. Clin. North. Am. Equine Pract. 13(2), 261-301.
Freeman, D.E. and Schaeffer, D.J. (2010) Comparison of complications and long-term survival rates following
handsewn versus stapled side-to-side jejunocecostomy in horses with colic. J. Am. Vet. Med. Ass. 237(9), 1060-1067.
Huskamp, B. (1973) Ileum resection and jejunocecostomy in the horse. Berl Munch Tierarztl Wochenschr 86(9), 161163.
Proudman, C.J., Edwards, G.B., Barnes, J. (2007) Differential survival in horses requiring end-to-end jejunojejunal
anastomosis compared to those requiring side-to-side jejunocaecal anastomosis. Equine Vet J., 39(2), 181-185
8.3 The effect of staple dimension, tissue thickness and precompression time on staple
formation in stapled side-to-side jejunocecal anastomosis in horses
Giusto, G., Amedeo, S., Gandini, M.
Dipartimento di Scienze Veterinarie, Università degli Studi di Torino (Italy)
Via L. da Vinci 44, 10095 Grugliasco (Torino), Italy
Email: [email protected]
Background
In equine abdominal surgery stapled side-to-side jejunocecal anastomoses are commonly performed although carry
higher risk of complications compared to handsewn techniques.
Staple formation is essential to produce an effective anastomosis, to reduce haemorrhage and to avoid leakage. It
depends from tissue thickness, to staple dimensions and to precompression time (Nakayama 2011).
There is common recommendation to use the larger staples in horses (4.8 mm) unregarding of horse breed,
dimension and intestinal health condition (Van der Velden and van der Gaag 1987; Latimer 1998; Tobias 2007).
Objective
Hypothesis of this study is that 3.8 mm staples can achieve optimal shape and height whilst producing good tissue
approximation thus being effective for equine stapled side-to-side jejunocecal anastomosis.
Methods
Intestinal specimens comprising the cecum, ileum and jejunum from 17 horses (weight 450±32 kg) were collected at
an abattoir. Specimens were divided into two groups. In group 4.8 stapled anastomoses were performed with a
Linear Cutting Stapler loaded with 4.8 mm staples, while in group 3.8 staplers were loaded with 3.8 mm staples.
Precompression time of 15 seconds was applied in both groups. Wall thickness of intestines was measured with a
tissue micrometer. Staple lines were harvested, cut in three parts (proximal, middle, distal) and tissue digested.
Measures and shape definition were performed by a blinded observer. Number of optimally formed staples and
staple height were compared between portions and between groups.
Results
We evaluated 17 jejunocecal stapled anastomosis with no episodes of broken devices or firing failure. The retrieval
rate of useful staples was 88%.
On macroscopic appearance, 4.8 mm staples resulted in poor approximation of tissues in the distal part of the
anastomosis. Overall percentage of optimally formed staples exceeded 97% in both groups, without statistically
significant difference between groups. There were a statistically significant lower number of optimally formed
staples in the distal compared to proximal and middle sections of each group. Mean staples height was not
statistically different between sections of each groups.
Conclusions
Macroscopically 4.8 mm staples resulted “loose” on the distal part of the anastomosis, and this could possibly lead
to anastomotic leakage or hemorrhage.
When performing jejunocecal anastomosis in horses with 4.8 mm staples, particular care must be taken after
completion of the anastomosis to check for leakage or hemorrhage.
Our study provided the first evidence that with adequate precompression time also 3.8 mm staples can be applied to
jejunocecal anastomosis in horses obtaining proper staple formation.
References
Freeman D. and Schaeffer D.J. (2010) Comparison of complications and long- term survival rates following hand –
sewn versus stapled side-to-side jejunocecostomy in horses with colic. J. Am. Vet. Med. Assoc. 237, 1060-1067.
Latimer F.G., Blackford J.T., Valk N., Wan P. and Patton S. (1998) Closed one-stage functional end-to-end
jejunojejunostomy in horses with use of linear stapling equipment. Vet. Surg. 27, 17-28.
Morita, K., Maeda, N., Kawaoka, T., Hiraki, S., Kudo, A., Fukuda, S., Oka, M. (2008) Effects of the time interval
between clamping and linear stapling for resection of porcine small intestine. Surg. Endosc. 22, 750-756.
Nakayama, S., Hasegawa, S., Nagayama, S., Kato, S., Hida, K., Tanaka, E., Itami, A., Kubo, H. and Sakai, Y. (2011) The
importance of precompression time for secure stapling with a linear stapler. Surg. Endosc. 25, 2382-2386.
Tobias, K.M. (2007) Surgical stapling devices in veterinary medicine: A review. Vet. Surg. 36, 341-347.
Van der Velden, M.A. and van der Gaag, I. (1987) The use of staplers in equine intestinal surgery. Vet. Rec. 120, 2012004.
8.4 Slip knots are effective for mesenteric arteries ligation during jejunal small intestinal
resection and anastomosis in horses
Giusto, G., Gandini, M., Comino, F., Pagliara, E.
Dipartimento di Scienze Veterinarie, Università degli studi di Torino, Grugliasco (To),Via Leonardo da Vinci 44
10095,Italy. Tel: +390116709058 Email : [email protected]
Background
Although resection and anastomosis are commonly performed in equine abdominal surgery, in the existing literature
only one article describes and compare methods of providing hemostasis on mesenteric arteries during jejunal
resection and anastomosis (Rumbaugh et al 2003).
Extending the search on textbook there is lack of description of hemostatic ligatures to use on mesenteric vessels
and a trend to favor ligating-dividing mechanical devices (Freeman 2012). In our experience this method is not
widely used, not last because quite expensive and in some cases even contra-indicated.
Other type of knots, such as slip knots, are widely used to provide hemostasis in laparoscopy (Jaffaer 2009 ; Meng et
al 2002 )
Objective
The objective of this study is to compare a triple ligature composed by three slip knots with a triple ligature
composed by a modified transfixing and two surgeon’s knots in term of leaking pressure and construction time.
Materials and method
Portions of small intestine with mesenteric vessel were collected by 12 horses slaughtered at a local abattoir soon
after death; the intestine with mesentery were divided in specimen comprising five mesenteric arteries each. Each
artery was closed with a triple ligature. In group A Surgeon’s knot was used to tie the ligatures (two encircling and
one modified transfixing) while in group B all ligatures (three encircling) were tied with a Slip knot. Both groups were
divided in two subgroups (6 specimens each) depending on suture material used (subgroup P-multifilament suture
material, Subgroup M-monofilament suture material). Time to perform ligatures for every specimen were recorded
and compared between groups.
After closure, arteries were incanulated and intraluminal pressure were increased until ligature failure. Leaking
pressures were recorded and compared between groups and subgroups.
Results were compared with ANOVA test with Turkey-Kramer Multiple Comparison post test (p>0.05).
Results
Triple ligature of five mesenteric arteries was significantly faster to perform with Slip knots than with Surgeon’s
knots both with monofilament (mean 6.38 minutes ± 0.14 compared with mean 8.12 minutes ± 0.86) and
multifilament suture (mean 7.17 minutes ± 0.80 compared with mean 8.27 minutes ± 0.71)
With multifilament suture the bursting pressure of Slip knot ligatures (median 1012 mmHg ; range: 300-1500) was
significantly higher than that of surgeon’s knot ligature (median 468 mmHg ; range: 150-1050).
With monofilament suture there weren’t differences statistically significant on bursting pressure for both ligature
methods (median 1050 mmHg ; range 750-1050 ).
Conclusions
Unregarding of the ligature used, monofilament should be preferred on multifilament sutures to realize hemostatic
knots ; independently from suture materials the Slip knot is equal or better than Surgeon’s knot in providing
hemostasis and is faster to perform .
References
Rumbaugh, M.L., Burba, D. J., Natalini, C., Hosgood, G. and Moore, R.M. (2003) Evaluation of a Vessel-Sealing Device
for Small Intestinal Resection and Anastomosis in Normal Horses. Veterinary Surgery 32:574-579.
Freeman, D.E. (2012) Small intestine, in: Equine Surgery (4th edition ) Edited by Auer JA and Stick JA, Elsevier
Saunders, 416-453.
Usman, J. (2009) Forming an intracorporeal slip-knot in laparoscopic suturing. Can J Surg April. 52 (2):E23-4
Meng, M.V. and Stoller, M.L. (2002) Laparoscopic Intracorporeal Square-to-Slip Knot. Urology 59 : 932-933
8.5 A continuous single-layer extramucosal appositional suture pattern for end-to-end
jejunojejunostomy in horses. In vitro study
Comino, F., Caramello, V., Giusto, G., Pagliara, E., Gandini, M.
Dipartimento di Scienze Veterinarie, Università degli studi di Torino, Grugliasco (To),Via Leonardo da Vinci 44
10095,Italy. Tel: +390116709058, Email:[email protected]
Background
Double layer suture pattern techniques are the most popular in equine surgery for end-to-end jejunojejunostomies,
although recently single layer suture pattern techniques have been evaluated.
Single layer techniques are faster to perform, produce less inflammation and bursting strength is not significantly
different from a double-layer techniques ( Nieto et al, 2006 )
An extramucosal appositional single layer technique has been used with success in humans (Rygl et al,2009)
Objective
The objective of this study is to compare differences in terms of bursting pressure, construction time and
anastomotic index between three different techniques of single layer continuous suture patterns (Lembert ,
Gambee and Extramucosal appositional) for end-to-end jejunojejunostomies in horses.
Methods
Six jejunal segments with mesentery were collected from three slaughtered horses at local abattoir and each
segment divided into three 50 cm long specimens.
On each specimen was createdan end-to-end jejuno-jejunal anastomosis with single layer hand-sewn continuous
suture pattern.
Specimens were divided in three groups: E, G and L.In group E anastomoses were performed with a Extramucosal
appositional suture pattern, in group G with a Gambee suture patternand in group L with a Lembert suture pattern.
All suture were performed by the same surgeon(MG) using a2-0 monofilament suture.
Anastomosis construction time was recorded and compared between groups.
Bursting pressure was defined with a modified tank inflation test (Gandini, 2006).
Anastomotic index was calculated with a radiographic method (Gandini, 2006).
Results were compared between groups with a ANOVA test (p>0.05).
Results
Total time to perform an end-to-endjejunojejunostomy with a single layer Lembert pattern or with a Extramucosal
pattern (median11.75 minutes; range: 10.08-12.59)was significantly less than for the Gambee pattern (median 15.30
minutes; range: 14,12-16.25). The difference between groups in terms of bursting pressure and anastomotic index
was statistically not significant.
Conclusion
These three suture pattern presented minimal differences in term of construction time. Lambert suture had the
lowest anastomotic index, but the highest bursting strength. Extramucosal and Gambee suture pattern had a higher
anastomotic index and bursting strenght was largely over values encountered in vivo. Our results with the Gambee
pattern differ significantly in terms of construction time and bursting pressure from those obtained by Auletta
(Auletta et al, 2011) although methods were similar. The appositional Extramucosal suture pattern could prove
effective in horses, in particular were little inversion is crucial. Further in vivo studies are needed before advising the
use of this pattern in clinical cases.
References
Nieto,J.E., Dechant J.E. and Snyder J.R. (2006) Comparison of one- layer (Continuos Lembert) versus two-layer
(Simple Continuos/ Cushing) hand-Sewn end-to-end anastomosis in equine jejunum.Veterinary Surgery35, 669-673.
Rygl, M.,Novotna, J.,Herget, J., Skaba, R., Snajdauf.J.( 2009 ) Parameters of healing in
approximativeintestinalanastomosis.Eur J Pediatr Surg.19,(1) 25-9.
Gandini, M. (2006) In vitro evaluation of a closed-bowel technique for one-layer hand-sewn inverting end-to-end
jejunojejunostomy in the horse. Veterinary Surgery35, 683-688.
Auletta L., Lamagna, F., Uccello, V. , Lamagna, B. and Pasolini, MP.( 2011 ) In vitro comparison of three suture
techniques for anastomosis of the equine small intestine. Equine VetJ.43,( Suppl. 40 ) 46-50.
8.6 Altered Neutrophil Apoptosis in Horses with Acute Abdominal Disease
White, N.A., Krista, K.M., Barrett, J.G., Furr, M.O., Buechner-Maxwell, V.A.
Marion duPont Scott Equine Medical Center (Krista, Barrett, Furr, White), 17690 Old Waterford Road, Leesburg, VA
20176; and the Department of Large Animal Clinical Sciences (Buechner-Maxwell), Virginia-Maryland Regional
College of Veterinary Medicine, Virginia Tech, 245 Duck Pond Drive, Blacksburg, VA 24061, USA. Tel: (703) 771-6800
Fax: 703-771-6901
Email: [email protected]
Background
Morphological and physiologic abnormalities detected in the intestines of horses in response to ischemia and
reperfusion injury include cytokine production, alterations in endothelial cells, and neutrophil activation and
migration (Weiss and Evanson 2003). The resulting intestinal inflammation has been associated with loss of motility,
systemic shock, and development of intestinal adhesions (Gerard et al. 1999). Neutrophil apoptosis helps maintain
neutrophil homeostasis whereas apoptosis inhibition in peripheral blood prolongs neutrophil function (Fox et al.
2010). Although prolonged functionality of neutrophils may be beneficial to promote an inflammatory response, this
may also contribute to excessive inflammation, increasing the risk of complications and death.
Objective
To determine whether horses requiring general anesthesia for surgical lesions of the large and small intestine have a
lower proportion of circulating apoptoic neutrophils than horses undergoing elective arthroscopic surgery.
Methods
Peripheral blood from 20 adult horses undergoing surgery for acute abdominal disease (N=10) and elective
arthroscopic surgery (control) (N=10) was collected preoperatively and 24 hours postoperatively. Neutrophils were
counted, isolated using a Percoll gradient and cultured for 24 hours. The proportion of circulating neutrophils in
early apoptosis was detected using Annexin V binding and flow cytometry (Annexin V-PE Apoptosis Detection Kit I,
BD Pharmingen™)( Krista KA, et al. 2013). The Mann-Whitney U test was used to compare the percentage of
apoptotic neutrophils between horses having arthroscopic surgery and those having surgery for colic and to compare
the percentage of apoptotic neutrophils after surgery in horses with strangulating vs. nonstrangulating intestinal
obstructions. Values of P < 0.05 were accepted as significant.
Results
No significant differences in the percentages of apoptotic neutrophils between the two groups of horses were
detected before or after surgery. A significantly smaller number of neutrophils were recovered in preoperative blood
samples from the colic group compared to the arthroscopy group (P=0.037), but there was no significant difference
in the postoperative samples. Within the group of horses with abdominal disease, there was a significantly lower
median percentage of circulating apoptotic neutrophils in horses with strangulating intestinal lesions (5 horses)
compared to horses with non-strangulating lesions (5 horses)(P=0.047).
Conclusions
Although all horses requiring surgery for colic did not have a difference in circulating apoptotic neutrophils
compared to horses that had elective arthroscopic surgery, horses with strangulating intestinal lesions had a
significantly lower proportion of circulating apoptoic neutrophils compared with horses with non-strangulating
lesions. Inflammatory events in human patients with burns, trauma and inflammatory bowel disease can cause
suppression of apoptosis in response to cytokines (Paunel-Gorgulu et al. 2012), which are known to increase in
horses with endotoxemia and experimental ischemia-reperfusion in horses. Inflammation created by intestinal
strangulation may delay neutrophil apoptosis in horses thereby prolonging inflammatory response in the affected
and peripheral intestine.
Acknowledgement
Supported by the Stuart Equine Research Fund, Virginia Maryland Regional College of Veterinary Medicine
References
Weiss DJ, Evanson OA. (2003) Evaluation of activated neutrophils in the blood of horses with colic. Am J Vet Res. 64,
1329-1456.
Gerard MP, Blikslager AT, Roberts MC, et al. (1999) The characteristics of intestinal injury peripheral to strangulating
lesions in the equine small intestine. Equine Vet J. 31, 331-5.
Fox S, Leitch AE, Duffin R, et al. (2010) Neutrophil apoptosis: relevance to the innate immune response and
inflammatory disease. J Innate Immun. 2, 216-27.
Krista KA, White NA, Barrett JG et al. (2013) Altered Neutrophil Apoptosis in Horses with Acute Abdominal Disease
Am J Vet Res. 74, 999-1004
Paunel-Gorgulu A, Kirichevska T, Logters T, et al. (2012) Molecular mechanisms underlying delayed apoptosis in
neutrophils from multiple trauma patients with and without sepsis. Mol Med. 18, 325-335
8.7 How To Manage Large Intestinal Tympany In Non Surgical Colic Case Using An
Improved Pneumatic Transrectal Decompression Device
Magri, M., Scotti, G.B., De Zani, D., Zani, D.D.
1 Clinica Veterinaria Spirano, sp. Francesca 24050 Spirano (BG) Italy tel: (+39) 3391266360 Fax: (+39) 035876506
Email: [email protected]
2 Clinica Veterinaria Maggiora, via F.lli Rosselli, Maggiora (NO) Italy. Tel: (+39) 3492605246
3 Radiology Dept. Az. "Polo Veterinario di Lodi", via dell’Università n° 6, 26900 Lodi (LO), Università degli Studi di
Milano, Italy tel: (+39) 0250331120
Background
A transrectal technique for decompressing severe distention of the large intestine permits, in some colic cases,
resolution of the distension, allowing re-establishing of intestinal motility and subsequent repositioning of the
viscus, if a displacement has occurred (Scotti et al. 2013, Dallap Schaer and Orsini 2014). The first report of this
technique described the use of a special cylinder with a manual spring activation needle (Scotti et al.2013) and this
presentation will discuss further modification of that technique.
Objectives
The purpose of this study was to describe and evaluate transrectal decompression (TD) of colonic and caecal
tympany in equine colic patients, by using an improved Transrectal Decompression Device with pneumatic activation
needle (TDDp).
Methods
Horses referred for colic were included in the study, if they showed abnormal visceral distension of the caecum
and/or the colon on transrectal palpation and the presence of gas, during an abdominal and transrectal
ultrasonographic examination. For this population of horses surgical exploration and correction was not an option.
Patients were confined in stocks, sedated if very painful and hyoscine n-butylbromide was administered to all
horses, to treat rectal straining. Transrectal ultrasound was used to confirm the presence/location of the gas and to
select the location for needle placement, in order to avoid vascular structures. The rectum was evacuated to
correctly perform the rectal exam; no other special preparation of the rectum was used for the transrectal
decompression technique.
In order to perform transrectal decompression safely and more easily, an improved transrectal decompression
device with pneumatic activation (TDDp) was created, which was modified from the one previously used (Scotti et al.
2013) (Fig 1). The position of the needle was constantly monitored by the operator by a "position screw" that moved
forward and backwards in accordance to the needle advancement/retraction. The TDDp was introduced into the
rectum and placed well adjacent to the gas distended organ. The 18G needle was inserted into the bowel by a
mechanism driven by a new pneumatic unit (fig 2) and the aspiration started. Once aspiration was completed, the
needle was automatically retracted into the cylinder and safely removed from the rectum. In the case of tympany
recurrence, aspiration was repeated as needed.
Figure. 1
Figure.2
Results
Thirty-nine horses were included in the study. Four of 39 horses (10%) presented with large colon tympany as a
primary entity, while 35 (90%) presented with secondary tympany. A total of 49 TD were performed (mean
decompression of 1,25 per horse); a minimum of one and maximum of 3 decompressions were performed in a single
case. Normally, each decompression was accomplished in a range of time between 20 second and 7 minutes
(median time 1 minute 29 seconds). The unit decompresses at a volume of 5 L/minute with an 18G needle, so a
median volume of 9 L was aspirated from the patients. In the first month follow-up post treatment, 31 out of 39
horses were alive (79,5%), while 8 (20,5%) died from diseases not related to the transrectal decompression
technique.
Conclusions
No significant divergence of the results with the previous study (Scotti et al. 2013) was observed using this new
pneumatic device. By using the improved TDDp, the procedure was easier due to the automatic needle’s
forward/backward movement, which fires automatically and does not require direct activation of the needle sprung
mechanism by the operator's finger. Moreover, the pneumatic needle movement allows the automatic retraction of
the needle when the aspiration is finished. As previously described by Scotti et al. (2013), in this series, no horses
developed any complication related to decompression, in the first month follow-up post treatment. When surgery is
not an option, in horses affected by tympany, transrectal decompression improves the likelihood of restoring a
normal peristalsis and relieving pain from distention of the large bowel. In cases with a displacement of the large
bowel, decompression can additionally facilitate correction of the displacement non-surgically.
Dallap Schaer, B. and Orsini, J.A. (2014) Gastrointestinal system. Transrectal trocarization of the large colon. In:
Equine emergencies: Treatment and procedures. Eds. Orsini, J.A. and Divers T.J, Saunders, London, p. 161
Scotti, G.B., Lazzaretti, S.S., Zani, D.D., Magri M. (2013) Transrectal decompression as a new approach for treatment
of large intestinal tympany in horses with colic: Preliminary results. Equine Vet. Educ. 25, 184-188.
8.8 Piroplasmosis as differential diagnosis of post operative pyrexia in surgical colic
patients
Lotto, E., Cercone, M., Dante, S., Beccati, F., Nannarone, S., Pepe, M., Gialletti, R.
Centro di Studi del Cavallo Sportivo, Dipartimento di Medicina Veterinaria, Università degli Studi di Perugia, Via San
Costanzo 4, 06126, Perugia, Italy. Tel: (+39) 075 585 7713 Fax: (+39) 075 585 7710 Email: [email protected]
Background
Pyrexia may be a clinical sign of many surgical and non surgical complications in the early period following colic
surgery in horse. Presence of pyrexia is not necessarily associated with bacterial infection, especially if mild pyrexia is
detected in the early post operative period (Freeman et al. 2012). Moreover, in endemic areas, horses that are
unapparent carriers of piroplasmosis, after stressful condition, can develop the clinical disease that manifests mostly
as pyrexia (Zobba et al. 2008).
Objectives
The purpose of this study was 1) to investigate the piroplasmosis as a differential diagnosis for pyrexia in the post
operative period and 2) to identify differences in clinical and laboratory findings between horses with piroplasmosis
and horses with bacterial infections following colic surgery.
Methods
Medical records of patients undergoing surgical treatment for colic between August 2011 and December 2013 were
reviewed. Horses recovering from surgery and survived to discharge were included. Horses were divided in: group
without bacterial infection or piroplasmosis (Group W), horses with bacterial infection (Group I) and horses with
piroplasmosis (Group P). Group I included horses with pneumonia, septic peritonitis, intra-venous catheter site or
incisional bacterial infection. Group P included horses without bacterial infection and with a definitive diagnosis of
Babesia/Theileria infection obtained through positive serology. Data relating to case details, temperature trend
(recorded every 4 h) and laboratory findings (at the time of peak of pyrexia [red and white blood cells count,
haemoglobin, total protein and indirect bilirubin]) were recorded. Shapiro-Wilk and Levene tests were performed to
verify homoscedasticity of numerical variables. Temperature trends were compared among groups using two-way
Kruskal-Wallis ANOVA and differences were identified with Student-Newman-Keuls test. Laboratory findings were
compared between Group I and P using Student’s t test. Values of P<0.05 were considered significant.
Results
Ninety-nine horses were included in the final analysis, 31 (31.3%) of which were diagnosed with a post operative
bacterial infection and 15 (15.2%) with piroplasmosis. Piroplasmosis was identified as definitive causative agent of
pyrexia in 15/46 (32.6%) of horses with pyrexia. For analysis purpose, time 0 was defined as the time of the first post
operative physical exam, performed 4 hours after recovery from general anaesthesia. Compared to temperature at
time 0 all groups had a significant increase in temperature in the early 12 hours post surgery (Group W:
38.06±0.66°C [mean ± sd]; Group I: 38.14±0.72°C; Group P: 38.26±0.59°C). The temperature was not significantly
different between groups until 24 h. However, Group P had significant higher mean temperature than Group W
(P<0.01) from 36 hours to 7 days post-surgery, and Group I had a significant higher mean temperature than Group W
(P<0.01) from 3.5 days to 7 days post-surgery. Group P had a significant higher temperature than Group I from 48
hours to 4 days (P<0.01), with some fluctuating trends. The highest febrile peak was recorded at 92 hours (3.8 days;
mean: 38.6°C) after surgery for Group P and 124 hours (5.1 days; mean: 38.4) for Group I. A statistical tendency was
identified with respect to white blood cells count, that resulted higher in Group I (mean 9,400 cells/μL) than Group P
(mean 6,485 cells/μL) (P=0.07). Conversely, haemoglobin, bilirubin and red blood cells count values did not show a
statistically significant difference between Group P and I (P>0.3).
Conclusions
This study analysed the characteristics of piroplasmosis as a differential diagnosis for pyrexia in the post operative
period following colic surgery. Among the horse population taken into account, piroplasmosis proved to be a notable
cause for post operative fever and showed statistically significant distinctive features that could help in the
diagnostic process. Compared to bacterial infection, piroplasmosis resulted associated to an earlier increase in mean
body temperature, higher temperature values and febrile peaks manifesting already 2 to 4 days after surgery.
Surprisingly, no significant difference was found in the typical markers of hemolysis, suggesting that piroplasmosis
should be taken into account even if obvious signs of haemolysis are lacking. In consideration of the nowadays
frequent and long distance transport of sport horse, we suggest that piroplasmosis should be investigated as
differential diagnosis for early post-operative fever in horses from endemic areas.
References
Freeman, K.D., Southwood, L.L., Lane, J. et al. (2012) Post operative infection, pyrexia and perioperative
antimicrobial drug use in surgical colic patients. Equine vet. J. 44, 476-481.
Zobba, R., Ardu, M., Niccolini, S. et al. (2008) Clinical and laboratory findings in equine piroplasmosis. J. Equine Vet.
Scien. 28, 301-309.
8.9 The effect of flunixin, indomethacin and prostaglandin E2 on in vitro slow wave activity
in the equine ileum
Fintl, C., Hudson, N.P.H., Handel, I., Pearson G.T.
Norwegian School of Veterinary Science, Department of Companion Animal Clinical Sciences, PO Box 8146 Dep, 0033
Oslo, Norway (Fintl); Royal (Dick) School of Veterinary Studies & Roslin Institute, University of Edinburgh, Easter Bush
Veterinary Centre, Easter Bush, Roslin, Midlothian, EH25 9RG, UK (Pearson, Handel and Hudson);
Email: [email protected].
Background
Non-steroidal anti-inflammatory drugs (NSAIDs) are commonly used in equine practice. The effect of some NSAIDs
on intestinal contractile patterns in vitro has previously been reported in the horse (e.g. Van Hoogmoed et al. 2002;
Menozzi et al. 2009). Sanders (1984) investigated how both indomethacin as well as prostaglandins affected in vitro
slow wave activity in the canine jejunum. Slow waves are rhythmic membrane potential fluctuations of
gastrointestinal smooth muscle cells generated by the interstitial cells of Cajal (ICC) which may result in a muscle
contraction if the electrical threshold is exceeded (Sanders 1996). Various factors can condition the smooth muscle
cell response to the ICC currents to either facilitate or reduce the possibility of the electrical threshold being reached
(Horowitz et al. 1999). These factors may therefore also influence the contractile activity of the intestinal tract. The
effect of both NSAIDs and prostaglandins on slow wave activity has not been previously assessed in the horse. This
may be of importance in order to further explain the previously reported effect these substances have on equine in
vitro contractile activity.
Objectives
To evaluate the effect of flunixin, indomethacin and prostaglandin E2 (PGE2) on in vitro slow wave activity in the
equine ileum horses using intracellular recording techniques.
Methods
A short segment of ileum was collected immediately following euthanasia from 14 normal horses euthanized for
reasons not relating to the intestinal tract. All samples were collected with the owners’ consent and to the best of
our knowledge none of the horses had received prior NSAID therapy. Intestinal tissue samples were cut into 1mm
thick sections, pinned out on a Sylgard plate and superfused with warmed, oxygenated Krebs solution. Intracellular
recordings of smooth muscle cell membrane potential were made using glass microelectrodes and all experiments
were performed in the presence of a calcium channel blocker (1µM nifedipine) to ensure stable impalements.
Prostaglandin E2 (1μM) was added to the superfusion fluid in separate experiments (n=8) to that of flunixin (2.7x105) and indomethacin (0.5x10-5) (n=6) which were added sequentially following a prolonged wash-out period. All data
were recorded and stored using a computer interfaced acquisition system (Power Lab 8SP). A software package
(LabChart Pro) was used to analyse the effect of indomethacin, flunixin and PGE2 respectively on resting membrane
potentials (RMP), amplitude, frequency and duration of slow waves. The data were assessed using a linear
regression model including fixed terms for each individual horse and drug. An error correlation structure was
included in the model to accommodate the autocorrelation with time of the response variables. A p-value of <0.05
was considered significant.
Results
Slow wave frequency was significantly increased when adding PGE2 (+0.37, p=0.01) as well as indomethacin (+0.68,
p=0.001) to the superfusion fluid. In contrast, flunixin significantly decreased slow wave frequency (-40, p=0.01). No
other significant findings were observed apart from an increased slow wave amplitude (+2.04, p<0.001) when adding
indomethacin to the superfusion fluid.
Conclusion
Slow wave frequency was influenced by the drugs tested. This may help explain some of the previously reported
effects they have on equine in vitro contractile activity. Further studies are needed to determine if this effect varies
at different anatomical locations of the equine intestinal tract and also with different drug concentrations.
Acknowledgements
The Agricultural Agreement Research Fund, Norsk Rikstoto and the Research Council of Norway as part of the
Norwegian/Swedish research collaboration.
References
Horowitz, B., Ward, S.M. and Sanders K.M. (1999) Cellular and molecular basis for electrical rhythmicity in
gastrointestinal muscles. Annu. Rev. Phy. 61, 19-43.
Menozzi, A., Pozzoli, C., Poli, E., et al. (2009) Effects of nonselective and selective cyclooxygenase inhibitors on small
intestinal motility in the horse. Res. Vet. Sci. 86, 129-135.
Sanders, K.M. (1984) Evidence that prostaglandins are local regulatory agents in canine ileal circular muscle. Am. J.
Physiol. 246, G361-71.
Sanders, K.M. (1996) A case for interstitial cells of Cajal as pacemakers and mediators of neurotransmission in the
gastrointestinal tract. Gastroenterol. 111, 492-515.
Van Hoogmoed, L.M., Snyder, J.R. and Harmon, F. (2000) In vitro investigation of the effect of prostaglandins and
nonsteroidal anti-inflammatory drugs on contractile activity of the equine smooth muscle of the dorsal colon, ventral
colon, and pelvic flexure. Am. J. Vet. Res. 61, 1259-1266.
8.10 Mesenteric strangulation caused by pedunculated lipoma without intestinal
involvement
Graham, A.S., Bauck, A.G., Grosche, A., Morton, A.J., Suedo-Lopes, M., Freeman, D.E.
Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary
Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA (Graham, Freeman). Tel: (01) 352-3922212, Fax: (01) 352-392-8289,
Email: [email protected].
Background
Small intestinal strangulation by pedunculated lipoma is a common cause of colic in old horses (Garcia-Seco et al.
2005). The most common pathologic change associated with this disease is hemorrhagic ischemia of a variable
length of small intestine and associated mesentery strangulated in the mesenteric stalk.
Objectives
Purpose of this presentation is to describe an unusual form of strangulation by pedunculated lipoma with mesenteric
involvement but without any evidence of intestinal strangulation.
Methods
The medical records of 4 horses admitted to 2 veterinary hospitals with colic were reviewed to determine clinical
signs, pathological findings, and outcome after mesenteric strangulation by a pedunculated lipoma, without
intestinal involvement.
Results
Four horses were presented with moderate to severe colic in which the cause was identified as a variable sized patch
of hemorrhagic mesentery that surrounded the origin of a mesenteric lipoma. Intestine associated with the affected
segment was not strangulated. One horse was euthanized at the owner’s request and the remaining 3 had surgery
from which they made a complete recovery after removal of the involved lipoma. Intestinal resection was not
performed. The small intestinal mesentery was involved in 3 horses and the small colon mesentery in the 4th horse.
Conclusions
Isolated mesenteric strangulation by lipoma is an uncommon cause of colic in older horses, clinically
indistinguishable from the typical presentation of horses with strangulating lipomas (Garcia-Seco et al. 2005).
Removal of the involved lipoma without mesenteric or intestinal resection can be associated with complete
recovery.
References
Garcia-Seco, E., Wilson, D.A., Kramer, J., Keegan, K.G., Branson, K.R., Johnson, P.J. and Tyler, J.W. (2005) Prevalence
and risk factors associated with outcome of surgical removal of pedunculated lipomas in horses: 102 cases (19872002). J. Am. vet. Med. Assoc. 226,1529-1537.
8.11 Effects of a continuous rate infusion of lidocaine on mucosal injury and intramural
inflammation after mechanical manipulation of equine jejunum
Graham, A.S., Freeman, D.E., Rapp, H.J.
Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary
Medicine, University of Florida, 2015 SW 16th Ave., Gainesville, FL 32610, USA. Tel: (01) 352-745-1512, Fax: (01) 352392-8289,
Email: [email protected].
Background
Postoperative complications in horses, such as ileus and adhesions, have been attributed to mechanical
manipulation during corrective surgery. Lidocaine is widely used to prevent these complications based on its
putative anti-inflammatory effects.
Objectives
To examine effects of lidocaine on mucosal injury and intramural accumulation of neutrophils and eosinophils after
mechanical manipulation of the equine jejunum.
Methods
In 11 anesthetized horses, a one-meter segment of jejunum was closed at each end with umbilical tape, and
mechanically manipulated by stripping the intestinal contents back and forth 10 times between the ligatures. This
procedure simulated the intestinal handling required to decompress small intestine during surgery. Horses were
randomly assigned to receive lidocaine (n=6) or saline (n=5) throughout anesthesia. The umbilical tapes were
removed, and the jejunal segment placed in the abdomen between tissue sampling. Full thickness biopsies were
taken before, 1h and 4h after manipulation for assessment of neutrophil and eosinophil influx, and morphometric
changes.
Results
Mechanical manipulation did not cause morphologic changes in the mucosa, but induced an influx of neutrophils
into longitudinal muscle and serosa in manipulated and adjacent control segments 4h after manipulation. The
number of mucosal eosinophils increased within the manipulated segment, and lidocaine tended to change their
accumulation and migration pattern. Lidocaine did not affect neutrophil infiltration.
Conclusions
Lidocaine may affect mucosal activity of eosinophils, but without affecting neutrophil influx in manipulated small
intestine.
Acknowledgement
Funded by the Morris Animal Foundation, and Faculty Develoopment Fund, University of Florida, College of
Veterinary Medicine.
References
Little, D., Tomlinson, J.E. and Blikslager, A.T. (2005) Postoperative neutrophilic inflammation in equine small intestine
after manipulation and ischaemia. Equine vet. J. 37,329–335.
8.12 Construction of an Early Warning Index for Post-Colic Surgery
Sutton, G.A., Saar, M.
Koret School of Veterinary Medicine, Hebrew University of Jerusalem, P.O.B.12, Rehovot, Israel, 76100 Tel: (972-3)
968-8507 Fax: (972-3) 960-4079 E-mail: [email protected]
Background
Early detection of deterioration in horses recovering from colic surgery is vital for evaluating prognosis and initiating
appropriate, timely intervention. In human medicine, early warning scores (EWS) have been developed to quickly
determine the severity of illness in a patient. In an earlier, retrospective study, we determined risk factors for
deterioration in horses that had undergone colic surgery (Sutton et al. 2012). The first two days following colic
surgery were the most critical. The heart rates were significantly higher on both days in deteriorating horses in
comparison to recovering horses. On the first day post surgery, the frequency of occurrence of gastrointestinal
reflux and clinical signs of shock, such as mucous membrane (mm) color, gingival toxic line and capillary refill time
(CRT), were associated with deterioration. The horses that deteriorated remained relatively quiet on the second day
and the level of pain recorded was significantly higher.
Objectives
The purpose of the study was to design an early warning index (EWS) for post-colic surgery cases in horses.
Methods
Horses over 6 months old that underwent colic surgery at the Koret School of Veterinary Medicine Veterinary
Teaching Hospital between the years 2011-2012 and survived at least 48 hours post surgery were included in the
study. Data was collected from the hospital records. The outcome of interest was death. The parameters included
heart rate measured every 4-6 hours for 48 hours, attitude (BAR, QAR, depressed or recumbent), mm color (normal,
hyperemic or pale, with or without a toxic line), CRT, time to passage of first feces post-op (hours), pain (yes/no),
and reflux greater than 2 liters (yes/no). Association between the clinical parameters and death were evaluated by
Chi-square or Fisher’s Exact Test and T-test or Mann-Whitney, as appropriate. Cutoff values for heart rate and Time
to First Feces to predict death were determined by ROC curve for the highest positive likelihood ratio. Factor
analysis identified overlap between parameters. Measures of performance were calculated in Excel.
Results
Forty horses were included in the study. The mean age was 9.4 years [95% confidence interval (CI): 7.6, 11.1], 24
(60%) were female and the predominant breeds were Quarter Horses (32.5%) and Arabians (30%). Five horses died
[12.5% CI (4, 27)].
Parameters with p-values less than 0.1 for association with death were chosen for continued evaluation. They
included; mm color (p=0.01) and toxic line (p=0.04) on Day 1 post-surgery, lowest or minimum heart rate (Min HR)
on day 1 (p= 0.049), Min HR on day 2 (p=0.097) and Time to First Feces (p=0.02). Age, breed and sex were ruled out
as potential confounding variables.
The cutoff for Min HR day one was 58 beats per minute (bpm) and for day two was 52 bpm. The two parameters
were each associated significantly with death when divided into two categories based on the cutoff value (p<0.05).
The cutoff for Time to First Feces was 52 hours.
Factors analysis identified two factors: Min HR Days one and two together on one factor and mm color and toxic line
on the second. Time to First Feces did not factor highly.
Two indexes were constructed; Day 1 and Day 2 and their performance assessed. For Day 1, the three parameters,
Min HR, hyperemic mm and the presence of a toxic line performed better together than any of the parameters
alone, so if any one of them was positive, then the test was considered positive. The sensitivity was 100%, specificity
was 91%, Positive Predictive Value (PPV) 63% and Negative Predictive Value (NPV) 100% for predicting death.
For Day 2, the two parameters, MinHR and Time to First Feces did not complement each other. The best
performance was for MinHR alone, which had a sensitivity of 80%, specificity of 91%, PPV of 57% and NPV of 97%.
Conclusions
Two early warning indexes were constructed; one for Day 1 post surgery and one for Day 2. The Day 1 scoring index
contains the daily minimal heart rate over 58 bpm, hyperemic mucous membrane color and the presence of a
gingival toxic line. The scoring index for Day 2 contains only the daily minimal heart rate of over 52 bpm, but may, in
the future, demonstrate improved validity if the time until passage of the first feces is included.
Further studies require a larger data set (traditionally 100 cases) and the scoring indexes should be used
prospectively and tested for reliability.
Reference
Sutton, GA et al. Early detection of deterioration in horses recovering from colic surgery. Abstract presented at the
5th Congress of the ECEIM, Edinburgh, UK. 2012.
8.13 Non Strangulating Intestinal Infarction: Retrospective review of 10 cases
Mair, T.S., Sherlock, C.E.
Bell Equine Veterinary Clinic, Mereworth, Kent. ME18 5GS. UK. Tel: (+44) 1622 813700. Fax: (+44) 1622 812233.
Email: [email protected]
Background
Non-strangulating intestinal infarction (NSII) has been described in association with thromboembolism secondary to
Strongylus vulgaris larval migration, severe colitis and coagulopathies (White 1981, Martin-Cuevro et al. 2013).
Anecdotal reports suggest that modern parasite control methods have decreased the prevalence of this condition
(Hardy 2008) supported by a paucity of recent reports of NSII.
Objectives
The objectives of this study were to retrospectively review and describe cases of NSII diagnosed at our hospital
between 2005 and 2013.
Methods
A retrospective review of all horses diagnosed with NSII at exploratory celiotomy or post mortem examination
between 2005 and 2013 was performed. NSII was diagnosed on the basis of one or more well-defined focal areas of
intestinal necrosis not associated with strangulation of the mesenteric vasculature. Medical records of all horses
diagnosed with NSII were reviewed and details of signalment, history, clinical findings, treatment and outcomes
were recorded. Where available, results of gross mortem examination and histopathological examination were
documented.
Results
Ten horses with NSII were identified during the study period. These included 5 cobs, 2 Thoroughbred or
Thoroughbred crosses, 2 Irish sport horses and 1 Arabian. The ages ranged from 5 to24 years (mean 13.8 +/- s.d. 6.8
years). There were 6 mares and 4 geldings. Nine of the ten horses demonstrated signs of colic at some stage during
their illness, including 6 with acute onset colic of less than 12 hours duration, 2 with chronic colic of more than 24
hours duration and one that developed colic terminally 36 hours after the onset of other clinical signs.
Three horses demonstrated severe diarrhoea. Peritonitis was diagnosed on the basis of abnormal peritoneal fluid
analysis in 4 horses. One horse had serosanguinoous peritoneal fluid. Exploratory celiotomy for the investigation of
the cause of colic was performed in 7 horses. One or more areas of NSII were identified at exploratory celiotomy in 4
horses (including 3 affecting the large colon and one affecting the jejunum) and strangulating small intestinal
ischaemia was identified in 3 horses (2 cases of strangulation by a pedunculated lipoma and 1 case of epiploic
foramen entrapment). Two horses with strangulating small intestinal ischaemia were treated by resection and end
to end anastomosis and in one case, no resection was performed; all of these 3 horses developed colic and ileus post
operatively and at subsequent repeat exploratory celiotomy or post mortem examination, focal areas of NSII distant
to the original strangulated lesion were identified. Only one horse treated surgically (partial resection of large colon
affected by segmental eosinophilic colitis) survived to discharge for the hospital. Three horses were treated
medically all of which died or were euthanized.
Regions affected by NSII included the jejunum in 6 cases and the large intestine in 4 cases. Histopathological
examinations were undertaken in 7 cases confirming intestinal necrosis in all cases. Additionally, there was evidence
of eosinophilic colitis in 2 cases, necrotising typhylocolitis in 1 case and intestinal vascular thrombosis in 1 case.
Conclusions
NSII is an unusual cause of intestinal ischaemia in adult horses and has a poor prognosis for survival. NSII may occur
in association with severe enterocolitis or following surgical treatment for strangulating intestinal obstructions. The
underlying mechanisms remain undetermined in most affected horses and no cases of NSII were diagnosed in
conjunction with Strongylus vulgaris infestation.
Acknowledgements
We thank colleagues at Bell Equine Veterinary Clinic. Histopathological examinations were undertaken at the
Department of Veterinary Pathology, University of Bristol.
References
Hardy, J. (2008) Mural Infarction (Thromboembolic Colic). In: The Equine Acute Abdomen. Eds. N.A. White, J.N.
Moore and T.S. Mair. Teton NewMedia, Jackson, WY. 646
Martin-Cuervo, M., Gracia, L.A., Vietitez, V. et al. (2013) Postsurgical segmental mesenteric ischemic thrombosis in a
horse. Can. Vet. J. 54 83-84
White, N.A. 2nd (1981) Intestinal infarction associated with mesenteric vascular thrombolic disease in the horse. J.
Am. Vet. Med. Assoc. 178, 259-262
8.14 Treatment of Ulceration of the Gastric Glandular Mucosa: Retrospective evaluation
of omeprazole and sucralfate combination therapy in 204 sport and leisure horses
Hepburn, R.
B&W Equine Hospital, Breadstone, Berkeley, Gloucestershire, GL13 9HG
Faculty of Health & Medical Sciences, School of Veterinary Medicine, University of Surrey, Guildford GU2 7TE
Email: [email protected]
Background
Ulceration of the gastric glandular mucosa of the horse (primary glandular disease) is considered a separate
condition to ulceration of the squamous mucosa (primary squamous disease) (Merritt 2009). The importance of acid
suppression in healing squamous disease is well understood (Johnson 2001), but there is minimal data reporting
treatment of glandular ulceration. A single prospective study reported glandular healing in 5/10 horses treated with
omeprazole alone at 4mg/kg po q24h for 28-35days (Sykes 2013), this effect is poor when compared to the reported
healing rates of 70-90% in primary squamous disease. The treatment of clinical cases of primary glandular disease
has not been reported. Sucralfate has multiple effects that can enhance ulcer healing in man by improving mucosal
blood flow and cellular restitution (Szabo 1991).
Objectives
There were 2 primary objectives of this retrospective study: (1) to describe the clinical efficacy of 28 days of
combination omeprazole (4mg/kg po q24h) and sucralfate (12mg/kg po q12h) therapy on the healing of naturally
occurring primary glandular gastric disease in sport and leisure horses; (2) to further classify efficacy by the pretreatment lesion location (cardia, antrum, pylorus).
Methods
Medical records and endoscopic images were reviewed for all horses undergoing routine gastroscopy found to have
significant gastric glandular ulceration, which subsequently received 28 days of combination therapy and then repeat
gastroscopy. All cases presented between 1st January 2005 and 31st December 2011. Significant glandular lesions
were defined as EGUS GL≥2, with or without concurrent SQ disease; endoscopic healing was defined as EGUS GL≤1.
Wilcoxon paired tests were used to assess change in ulcer scores with treatment, with data for the antrum, pylorus
and cardia analysed separately.
Results
204 horses were identified, comprising 135 geldings, 64 mares and 5 stallions with a mean age of 9.6 years (range 423 years). 74.1% were classified as sport horses (showjumpers, eventers, dressage and endurance horses), the
remainder were leisure horses (general riding, hunting) The commonest breeds were Warmblood (45.4%) and
Thoroughbred (22.9%). Significant glandular lesions (GL≥2) were found in the antrum in 157 cases (GL2 - 116, GL3 32, GL4 - 9), the pylorus in 83 cases (GL2 – 52, GL3 – 25, GL4- 6) and the cardia in 28 cases (GL2 – 21, GL3 – 7).
Overall glandular healing (GL≤1) occurred in 129/204 (63.2%) horses. Healing occurred in the antrum in 106/157
(67.5%), pylorus in 51/83 (61.4%) and cardia in 27/28 (96.4%). A significant change in ulcer score occurred with
treatment at all locations (P<0.0001), with ≥1 grade improvement seen in 127/157 (80.8%) antral, 67/83 (80.7%)
pyloric and all cardia cases.
Conclusions
The use of omeprazole and sucralfate is an effective treatment for clinically occurring glandular gastric ulceration,
with the combination giving healing rates closer to that reported in primary squamous disease. There is no
difference in healing or improvement between antral and pyloric lesions, however cardia lesions are most responsive
to combination therapy. Further work is required to define the optimum treatment duration for antral and pyloric
lesions, and to define the potential role of other treatments such as antibiotics and management change.
References
Johnson, J.H., Vatistas, N., Castro, L., et al. (2001) Field survey of the prevalence of gastric ulcers in Thoroughbred
racehorses and on response to treatment of affected horses with omeprazole paste. Equine vet. Educ. 13, 221-224
Merritt, A.M. (2009) Appeal for the proper usage of the term “EGUS”: Equine gastric ulcer syndrome. Equine vet. J.
41, 616
Sykes, B.W., Sykes, K.M. and Hallowell, G.D. (2013) A comparison of two doses of omeprazole in the treatment of
equine gastric ulcer syndrome: A blinded, randomised, clinical trial. Equine vet. J. 34, 432-437.
Szabo, S. (1991) The mode of action of Sucralfate: the 1x1x1 mechanism of action. Scand J. Gastroenterol Suppl 185,
7-12
8.15 Serial venous lactate measurement following gastrointestinal surgery in horses
Hackett, E.S., Moser, D.K., Ruple-Czerniak, A.A., Perry, K.L.
Department of Clincial Sciences, Colorado State University, Fort Collins, CO, 80523, USA. Tel: (00) 1 970 297 5000
Fax: (00) 1 970 297 1275
Email: [email protected]
Background
Colic is a leading cause of mortality in horses aside from old age. Following colic surgery, serious complications can
arise, contributing to increased morbidity and mortality. Pre-operative peritoneal and venous lactate concentrations
have been used in equine medicine as an indicator of intestinal ischemia and prognosis. Predictive value of venous
lactate and serial lactate concentration of horses in the post-operative period is unknown.
Objectives
We performed this study (1) to evaluate venous lactate measurements in post operative colic horses immediately
following anesthetic recovery and daily throughout hospitalization, and (2) to determine if lactate concentrations
were significantly higher in horses that developed post operative complications or did not survive to hospital
discharge.
Methods
Horses aged >1 year undergoing surgery for gastrointestinal disease were enrolled with owner permission. A
portable lactate meter (Accutrend, Roche Diagnostics) was used to analyze venous samples immediately following
anesthetic recovery and daily throughout hospitalization. Complications arising during hospitalization and survival to
hospital discharge were recorded.
Results
Fifty horses were enrolled, ranging in age from 2 to 29 years. Lactate concentration immediately following
anesthetic recovery was significantly higher in horses that developed complications during hospitalization (p=0.046).
The odds of developing complications post-operatively was doubled for horses with a venous lactate concentration
>5mmol/L. Lactate concentration tended to be higher in non-survivors 24 hours following gastrointestinal surgery
(p=0.063).
Conclusions
Elevations in lactate in the post-operative colic period were associated with increased risk of complications and
death. Association of post-operative venous lactate and outcomes in horses undergoing surgery for gastrointestinal
disease warrants further investigation.
Acknowledgement
Funding for this study was provided by the Colorado State University Advances in Equine Health Fund.
8.16 Surgical correction of Nephrosplenic Entrapment of the Large Colon via Standing
Left Flank Laparotomy: Case Series
Krueger, C.R., Klohnen, A.
Department of Clinical Sciences, Colorado State University, Fort Collins, CO 80523 USA. Tel: (00) 1 970 297 5000 Fax:
(00) 1 970 297 1275
Email: [email protected]
Background
Medical resolution of nephrosplenic entrapment is highly variable with a success rate of 50 – 96.5% (Lindegaard et al.
2011, Boenig & von Saldern 1986). Surgical correction through a standard ventral midline celiotomy is well
described, but a report providing details of surgical correction via a left paralumbar fossa laparotomy in standing
horses is not currently available.
Objective
To describe the technique, complications, and long-term outcome of a left paralumbar fossa laparotomy for
correction of nephrosplenic colonic entrapment in 3 horses.
Methods
Nephrosplenic entrapment was diagnosed by abdominal palpation per rectum in 3 horses and confirmed by
transcutaneous abdominal ultrasound in 2 horses. Standing left paralumbar fossa laparotomy using a modified grid
approach was performed with sedation and infiltration of local anesthetic. Follow-up information was obtained by
telephone communication with trainers or owners.
Results
All horses underwent surgical correction of a nephrosplenic entrapment. Intra-operative complications such as
incisional hemorrhage in one horse, and identification of additional gastrointestinal lesions were encountered in 2
horses. Postoperative fever occurred in one horse and resolved within 24 hours of surgery. Horses were discharged
48-72 hours postoperatively and returned to routine exercise within 30 days. Long- term follow up revealed all three
horses returned to their intended and expected level of use.
Conclusions
Standing left paralumbar fossa laparotomy is an alternative for horses with nephrosplenic entrapment unresponsive
to medical therapy. This approach leads to a favorable outcome, avoidance of general anesthesia, reduced hospital
stay and associated costs and leads to a rapid return to function.
Acknowledgement
The authors would like to thank Dr. Bobby Lewis and Dr. Andrew Lewis for their technical assistance in this study.
References
Lindegaard C, Ekstrøm CT, Wulf SB, et al: Nephrosplenic entrapment of the large colon in 142 horses (2000-2009):
Analysis of factors associated with decision of treatment and short-term survival. Equine vet J. 2011;43:63-68
Boenig KJ, von Saldern FC: Nonsurgical treatment of left dorsal displacement of the large colon of horses under
anesthesia. Second Equine Colic Research Symposium 1986:325-328
8.17 Experiences (5 horses) using tissue adhesive (GLUture) for skin closure after ventral
midline celiotomy
Klohnen, A.
Chino Valley Equine Hospital, 2945 English Place, Chino Hills, CA, 91709, United States, Tel: 909 628 5545, Fax: 909
627 8658
Email: [email protected], [email protected]
Background
Incisional complications belong to the most common complications following ventral midline celiotomy for
abdominal pain in horses.
Equine surgeons have used skin staples, skin sutures and subcuticular sutures after ventral midline celiotomies for
signs of abdominal pain, in order to reduce the risk of incisional infections. Soft tissue glue has been used
extensively in small animal surgery and human surgery for the purpose of aposing skin edges.
Objectives
To determine the clinical effects (soft tissue edema formation, pain upon soft tissue palpation) of tissue adhesive
(GLUture) and possible rate of incisional infections following ventral midline exploratory celiotomies in horses.
Methods
5 horses that underwent ventral midline exploratory celiotomy for signs abdominal pain at Chino Valley Equine
Hospital and were alive 60 days after discharge from the hospital were included in the study. The surgical diagnosis
included a large colon resection and anastomosis, transverse colon enterolith with right dorsal colon enterotomy
and pelvic flexure enterotmy, 2 mid jejunal small intestinal resections and anastomises and one right dorsal colon
displacement with a pelvic flexure enterotomy, in order to evacaue the large colon content. In all cases the linea
alba was closed with #3 vicryl in a reversed cruciate pattern and the subcutaneous layer was closed with 2-0 vicryl in
a simple continuous pattern. The skin edges were aposed with tissue adhesive (GLUture).
GLUture is a topical tissue adhesive (60% 2-octyl and 40% N-butyl cyanoacrylate) and is used as a tissue bridge. Each
tube of tissue adhesive contains 1.5 mls of material. An applicator tip had been gas sterilized prior to use. Once the
subcutaneous layer was closed, the abdominal wall around the ventral midline incision was dried with sterile gauzes.
Once the skin was dried, a new pair of sterile gloves was opened for the application of the tissue adhesive. The
sterile applicator tip was placed on the tube of tissue adhesive and a thin layer of tissue adhesive was placed over
the aposed skin edges starting at the cranial end of the incision. In order to hold the skin edges in apposition, soft
tissue forceps were used to approximate both sides of the skin. Several layers (3) of tissue adhesive were applied.
As a result of the semi liquid nature of the tissue adhesive, the liquid tends to “run away” from the aposed skin
edges and another layer of tissue adhesive needed to be applied or “spot” glueing needed to be performed, in order
to seal the skin edges. The layers of tissue adhesive took on average 10 minutes to dry. Once the tissue adhesive
was completely “dry” to the touch, a sterile abdominal bandage was placed for recovery from general anesthesia.
After successful recovery from general anesthesia, the elastikon abdominal bandage removed and the incisions were
inspected in regards to the closure of the skin edges with tissue glue. The abdominal bandage was changed again
24-36 hours post operatively and removed on day 6.
Results
In 5 horses the skin edges were closed with tissue adhesive (GLUture) and none of the horse had evidence of a
ventral midline drainage. After abdominal bandage removal (day 6), the 5 horses demonstrated minimal to no soft
tissue edema around the ventral midline incision. And none of the horses developed any noticable sheath or udder
edema. There was also no evidence of soft tisse tenderness or soreness to soft tissue palpation. The ventral midline
incisions appeared to be “flat” to visual inspection. Recheck examination 60 days after surgery did not demonstrate
any adverse effects from the GLUture.
Conclusions
The results of this observational study indicate that the use of tissue adhesive for skin closure for ventral midline
celiotomy incision after colic surgery is a viable option. There did not appear to be any adverse effects to the skin or
skin edges after the use of the tissue adhesive (GLUture). A future study is indicated comparing the use of tissue
adhesive vs skin staples for the closure of the skin edges after ventral midline celiotomy incision after colic surgeries.
References
Mair, T. S. and L. J. Smith (2005). "Survival and complication rates in 300 horses undergoing surgical treatment of
colic. Part 2: Short-term complications." Equine Vet J 37(4): 303-9.
Ong J, etal. Prospective randomized study to evaluate the use of DERMABOND ProPen (2-octylcyanoacrylate) in the
closure of abdominal wounds versus closure with skin staples in patients undergoing elective colectomy. Int J
Colorectal Dis. 2010 Jul;25(7):899-905.
Pope JF, Knowles T. The efficacy of n-butyl-cyanoacrylate tissue adhesive for closure of canine laparoscopic
ovariectomy port site incisions. J Small Anim Pract. 2013 Apr;54(4):190-4.
8.18 Incisional complications following colic surgeries in horses: Does GLUture reduce
the incidence of incisional infection compared to skin staples?
Klohnen, A.
Chino Valley Equine Hospital, 2945 English Placel, Chino Hills, CA, 91709, United States
Tel: 909 628 5545
Email: [email protected]
Backround
Incisional complications belong to the most common complications following ventral midline celiotomy for
abdominal pain in horses..
Equine surgeons have used skin staples, skin sutures and subcuticular sutures after ventral midline celiotomies for
signs of abdominal pain, in order to reduce the risk of incisional infections. A previous pilot study using the tissue
adesive (GLUture) in 5 horses for skin closure after an exploratory celiotomy for signs of abdominal pain did not
demonsyrate any complications.
Objectives
To determine the clinical effect of skin glue (Gluture) on the likelihood of incisional infections following ventral
midline exploratory celiotomies in horses with abdominal pain. As a result of the non-skin penetration of the skin
glue, it was hypothized that the tissue adhesive may decrease the likelihood of incisional infections after ventral
midline exploratory celiotomy.
Methods
164 horses that underwent ventral midline exploratory celiotomy for abdominal pain at Chino Valley Equine Hospital
from October 2007 - November 2011 were included in the study, if they were discharged from the hospital. Intraoperatively data regarding duration of general anesthesia, anatomical location of primary lesion, performance of an
enterotomy or resection and surgical incision length were recorded. In all cases the linea alba was closed with #3
vicryl in a reversed cruciate pattern and the subcutaneous layer was closed with 2-0 vicryl in a simple continuous
pattern.
The medical records in the skin staple group was evaluated retrospectively, whereas the tissue adhesive group was a
prospective study. In 82 horses the skin edges were closed with tissue adhesive. A routine hospital abdominal
bandage protocol for recovery and the post-operative period has been established. If there were no post operative
incisional complication the skin staples were removed 10 days after surgery and the horse was discharged. The
horses in the tissue adhesive group were also discharged on post-operative day 10. Post operatively, horses were
evaluated for incisional edema, pain upon soft tisue plapation, sheath /udder edema and incisional drainage.
Results
In 82 horses the skin edges were closed with tissue adhesive (GLUture) and in 82 horses skin staples were used to
appose the skin edges. One horse in the tissue adhesive group (1.2%) developed an incisional infection in the cranial
aspect of the incision after having a very proximal small colon enterolith removed. 30 days after surgery, the horse
represented to the hospital for what appeared to be a foreign body reaction to tissue adhesive that “had lodged” in
the deeper layers of the subcutaneous tissue. 5 out of 82 horses (6.1%) in the skin staples group developed signs of
an incisonal infection. The horses included a small intestial resection and anastomosis for a strangulating lipoma,
bermuda grass hay ileal impaction that was resolved via a small intestinal enterotomy, a right dorsal colon enterolith
that had a pelvic flexure enterotomy and right sorsal colon enterotomy performed and two right dorsal colon
displacements with extensive colon impactions that were resolved via a pelvic flexure enterotomy. None of those
horses had any incisional contamination during surgery.
The horses in the tissue adhesive group developed no to minimal soft tissue edema after the abdominal bandage
was removed on postoperative day 6. The horses in the skin staple group developed minimal to a large amount of
soft tissue edema around the ventral midline incision after bandage removal. Horses in the tissue adhesive group
demonstrated no to very minimal soft tissue edema around the sheath or udder, where 25 horses in the skin staple
group had evidence of increased sheath edema and 10 horses had increased udder edema. 80 horses in the tissue
adhesive group appeared to be not painful to soft tissue palpation around the incision after bandage removal. 2 out
of the 82 horses appeared to experience pain to soft tissue palpation around the incision. One of the horses
developed an incisional infection. 35 out of the 82 horses in the skin staple group appeared to be painful or tender
to soft tissue palpation after bandage removal. The tissue adhesive “dislodged” itself from the healed skin incision
between post-operative days 8 and 21.
Conclusions
The results of this study indicate that the use of tissue adhesive (GLUture) for skin closure may reduce the incidence
of post-operative incisional infections after ventral midline celiotomy in horses compared to skin staples. Overall,
horses with tissue adhesive closure had less incisional edema and pain upon soft tissue palpation. The ventral
midline incisions appeared to be “flatter” to visual inspection.
References
Mair, T. S. and L. J. Smith (2005). "Survival and complication rates in 300 horses undergoing surgical treatment of
colic. Part 2: Short-term complications." Equine Vet J 37(4): 303-9.
Klohnen A. Experiences (5 horses) using tissue glue (GLUture) for skin closure after ventral midline celiotomy, 2014
paper in progress, submitted to 2014 colic symposium.
8.19 A new approach to identify the incisional site infections time point in horses after
colic surgery
Klohnen, A.
Chino Valley Equine Hospital, 2945 English Place, Chino Hills, CA, 91709, United States, Tel: 909 628 5545, Fax: 909
627 8658.
Email: [email protected]
Background
Abdominal exploratory celiotomies are one of the most commonly performed surgeries in equine practice. Despite
improvements in survival after these procedures in recent years, incisional complications are still prevalent. Surgical
site infections can be a substantial cause of morbidity and mortality and occasionally, death, in the post surgical
period in horses that have undergone an exploratory celiotomy. The financial implications associated with an
extended period of hospitalization and the use of a CM hernia belt can significantly contribute to hospital charges.
The exact time frame when these abdominal incision infections are contracted is currently unknown and the
bacteria, whether acquired from the horse or being nosocomial in origin, is yet to be determined.
The majority of studies have identified risk factors in humans, in particular for colorectal resections and in small
animals, but few have analyzed ventral celiotomy and paramedian celiotomy surgical site infections in horses.
Furthermore, the association between bacteria cultured on the skin, whether as a commensal or as a contaminant
and post operative infections is uncertain.
Objective
We hypothesized that horses which had significant culture growth would be at greater risk for developing surgical
site infections.
Methods
50 horses that underwent exploratory celiotomy procedures for a variety of colic conditions, which included
pathologies requiring enterotomies and colon resections, were analyzed. A routine ventral midline closure was
performed using No 3 polyglactin 910 in an inverting cruciate pattern. The subcutaneous layers were closed with 2-0
polyglactin 910. Staples were then placed to appose the skin. A 3M Ioban was applied to the incision to protect it
during recovery and once the horse was standing, an elasticon bandage was applied for the first 24 hours. The
surgical site was subsequently inspected 24 hours after surgery and a new elasticon bandage was applied and left on
the horse for a further 9 days
Swabs were aseptically taken from the ventral midline before and during surgery, after recovery from general
anesthesia and 24 hours post surgery. If the horse developed a surgical site infection, the discharge was also
cultured. Samples were submitted to the in house laboratory for culture and sensitivity. The identity of the bacteria
and number of colony forming units cultured was determined. The type of surgery was classified as clean if no
enterotomy was performed or clean-contaminated if an intestinal lumen was exposed.
Results
10/50 (20%) of horses developed surgical site infections, defined as any type of discharge from the surgical site,
which required the subsequent use of a hernia belt. This is comparable to other studies where frequencies range
from 10%-37%. Infections were classified as peri-incisional edema with serous drainage, subcutaneous infection with
wound dehiscence and drainage or infections in the muscular layer. Pre-surgical and intra-surgical cultures rarely
yielded any significant growth indicating appropriate abdominal preparation and maintenance of aseptic technique
during surgery. However, infections tended to occur in horses which had significant bacterial growth after recovery
and 24 hours post surgery, which tended to be staphylococcus species or beta hemolytic streptococcus. This
suggests that the period for acquiring infections occurs after abdominal closure. The gram positive bacteria cultured
during recovery and post operatively were also identified as being the predominant organism in the drainage fluid in
horse which subsequently required a hernia belt. Gram negative organisms were rarely determined to be the cause
of surgical site infections, even if they were cultured from the skin in the post operative samples. Furthermore,
horses which had a prolonged and more violent recovery were more likely to develop edema or discharge from the
surgical site. This may have been due to the displacement of the protective Ioban drape, which permitted the
contact of the surgical site with the recovery room floor, or from the gravity assisted drainage of sweat down the
abdominal wall whilst the horse was standing and contaminating the incision.
Conclusions
This study indicates the need for the continuation of appropriate asepsis and protection of the surgical site in the
immediate post surgical period. It would appear that routine Ioban application is not sufficient in preventing
contamination of the surgical site during recovery. A smooth recovery with minimal disruption to the surgical site
will assist in preventing bacterial colonization of the surgical wound. However, the duration of protection post
operatively required to significantly reduce surgical site infections is uncertain, but it seems prudent to maintain
sterility in the area for the 24 hour period
8.20 Does a standardized lidocaine treatment protocol result in therapeutic
concentrations in horses following gastrointestinal surgery?
Hackett, E.S., Rowland, A.L., Wittenburg, L.A., Sonis, J.M., Goehring, L.S., Gustafson,
D.L.
Department of Clincial Sciences, Colorado State University, Fort Collins, CO, 80523, USA. Tel: (00) 1 970 297 5000
Fax: (00) 1 970 297 1275
Email: [email protected]
Background
Lidocaine is a common treatment in horses following gastrointestinal surgery. It is unclear if currently accepted
lidocaine treatment protocols result in therapeutic and predictable plasma levels in horses following colic surgery
undergoing prolonged infusions and concurrent therapy with highly protein bound medications.
Objectives
The objectives of this study were to determine if a standardized lidocaine protocol resulted in therapeutic plasma
concentrations in horses following gastrointestinal surgery and to identify the infusion time necessary to reach
therapeutic lidocaine plasma concentrations in these cases.
Methods
Horses were consecutively enrolled following gastrointestinal surgery. Signalment, gastrointestinal lesion
characteristics, clinicopathologic data, and concurrent medications were recorded. Each horse received an
intravenous loading dose of 1.3 mg/kg lidocaine over 15 minutes, followed by a CRI of 0.05 mg/kg/min. Plasma
samples were collected at time 0, 1, 2, 3 hours following loading dose and daily throughout infusion. Total plasma
lidocaine concentration and unbound fraction was measured by LC/MS/MS.
Results
Nineteen horses undergoing 20 lidocaine treatment periods were enrolled, aged 5 to 23 years. Median plasma
lidocaine during treatment ranged between 0.95 µg/mL at 1 hour to 1.46 µg/mL after 96 hours of infusion and did
not exceed 1.85 µg/mL. Unbound lidocaine fraction was a median of 56% of total plasma drug level. When
considering a target concentration of 0.98 µg/mL, 44% of horses met or exceeded this concentration at 1 hour of
treatment and 69% of horses at 2 hours of treatment.
Conclusions
Lidocaine concentrations associated with toxicity were not observed, despite disease, prolonged infusion and other
therapeutic interventions.
Acknowledgement
Funding for this study was provided by the Colorado State University Center for Companion Animal Studies.
8.21 Effect of hypoproteinemia on lidocaine plasma concentration in horses
Hackett, E.S., Sonis, J., Wittenburg, L.A., Slovis, N.M., MacGillivray, K.C., Frazer, M.L.,
David, J.B., Gustafson, D.L.
Department of Clincial Sciences, Colorado State University, Fort Collins, CO, 80523, USA. Tel: (00) 1 970 297 5000
Fax: (00) 1 970 297 1275
Hagyard Equine Medical Institute, Lexington, KY, 40511, USA.
Email: [email protected]
Background
Lidocaine is a common treatment in horses following gastrointestinal surgery, with analgesic, anti-inflammatory,
and prokinetic properties. The effects of hypoproteinemia on kinetics of lidocaine infusion are unknown.
Objectives
The objective of this study was to determine if a standardized lidocaine treatment protocol resulted in therapeutic
plasma concentrations in horses with hypoproteinemia.
Methods
Horses aged >1 year undergoing treatment for critical illness with total protein concentrations <50 g/L were
consecutively enrolled. Signalment, clinical data, and concurrent medications were recorded. Each horse received
an intravenous loading dose of 1.3 mg/kg lidocaine over 15 minutes, followed by a constant rate infusion of 0.05
mg/kg/min. Samples for lidocaine measurement were collected at time 0, 1, 2, 3 hours following loading dose and
daily throughout infusion. Lidocaine concentration was measured by LC/MS/MS. Clinical outcomes of requirement
of dose adjustment during infusion, in hospital complications, length of hospitalization, and survival to hospital
discharge were evaluated.
Results
Twenty-three horses were enrolled, aged 1 to 28 years, with the majority developing hypoproteinemia following
gastrointestinal surgery. Five horses required dose adjustment following onset of signs of toxicity. Median plasma
lidocaine during treatment ranged between 1.1 µg/mL to 1.4 µg/mL during 96 hours of infusion and exceeded 1.85
µg/mL in 7% of samples despite dose adjustment.
Conclusions
Plasma lidocaine levels and risk of toxicity may be higher in horses with hypoproteinemia using standard infusion
protocols. Further study is indicated to determine appropriate dose adjustment recommendations in horses with
hypoproteinemia associated with critical illness.
Acknowledgement
Funding for this study was provided by the Colorado State University Advances in Equine Health Fund and Hagyard
Equine Medical Institute.
8.22 Influence of experimental mechanical manipulations on the local inflammatory
reaction in the equine jejunum
Hopster-Iversen, C., Hopster, K., Staszyk, C., Freeman, D.E., Rotting, A.K.
Equine Clinic, University of Veterinary Medicine Hannover, Bünteweg 9, 30559 Hannover, Germany, Tel: (49)
05119536632, Fax: (49) 05119536510.
Institute of Veterinary-Anatomy, -Histology and -Embryology, Justus-Liebig-University of Giessen, Germany, c The
Island Whirl Equine Colic Research Laboratory, Department of Large Animal Clinical Sciences, College of Veterinary
Medicine, University of Florida.
Email: [email protected]
Background
Two life-threatening complications after colic surgery are post-operative ileus (POI) and adhesion formation.
Mechanical manipulations of the intestine are unavoidable during colic surgery, but can result in an intestinal
inflammation that has been associated with the occurrence of POI and adhesion formation in several species (Kalff et
al. 1998, 2003).
Objectives
We aimed to evaluate the jejunal inflammatory reaction in response to mechanical manipulations that may occur
during colic surgery.
Methods
In 12 horses, 5 segments of the jejunum were subjected to one of the following manipulations: manual emptying,
placement of doyen forceps, enterotomy alone, enterotomy with mucosal irritation, and serosal irritation.
Specimens were collected before, immediately after and 30 minutes after the end of manipulations for histological
examination.
Results
A neutrophilic infiltration was observed in the serosa (after all manipulation types, p < 0.001-0.042), the circular
muscle layer (after manual emptying, p < 0.031), the submucosa (after placement of Doyen forceps, mucosal
abrasion, p < 0.016-0.043), and the mucosa (all manipulations except enterotomy alone, p < 0.001-0.04). An
increased eosinophilic infiltration of the submucosa was observed after mechanical irritation of the serosa and after
manual emptying of the bowel (p < 0.029-0.031).
Conclusions
Results of this study indicated a rapid inflammatory response involving predominantly neutrophilic granulocytes
after mechanical manipulations of jejunum. This response could contribute to postoperative complications in horses
with colic and may explain why factors resulting in increased intestinal handling are associated with an increase in
postoperative morbidity.
References
Kalff, J. C., Schraut, W. H, Simmons, R. L. et al. Surgical manipulation of the gut elicits an intestinal muscularis
inflammatory response resulting in postsurgical ileus. Annals of surgery, 1998: 228(5), 652-663
Kalff, J. C., Türler, A., Schwarz, N. T. et al. Intra-abdominal activation of a local inflammatory response within the
human muscularis externa during laparotomy. Annals of surgery, 2003: 237(3), 301-315
8.23 Percutaneous caecal decompression in the horse: Effect and complications
Pihl, T.H., Winsborg, Y., Olsen, S.N.
Department of Large Animal Sciences, Faculty of Medical and Health Sciences, University of Copenhagen,
Højbakkegård Allé 5, 2630 Tåstrup, Denmark, Tel: +45 22 629325, Fax: +45353 32880.
Email: [email protected]
Background
The effect and safety of percutaneous caecal decompression is often debated, as no comprehensive studies have
been published.
Objectives
Objectives were to investigate effect and complications of percutanous caecal decompression.
Methods
Retrospective review of clinical records (January 2006 and December 2012), at the University of Copenhagen to
identify horses where caecal decompression was performed. Clinical data (diagnosis, pain-score, temperature, heartand respiratory-rate, steel-band, rectal findings and use of analgesics) before and after caecal decompression,
treatment (medical or surgical), complications (fever, peritonitis, diarrhoea, haematoma and local inflammation at
the decompression site) and short-term survival were retrieved. Chi-square and paired t-tests were used to compare
clinical variables before and after caecal decompression. P<0.05 was considered significant.
Results
Of the 1422 horses treated for colic in the period, 147 horses (10.3%) had one or several caecal decompressions
performed. Two horses were excluded due to missing data. Death, due to caecal decompression was not observed.
Complications were observed in 23 (15.9%) horses with the following incidence: Fever (9.7%), diarrhoea (9.0%),
peritonitis (5.5%), local inflammation (4.1%) and haematoma (2.1%).
Following caecal decompression, a significant decrease in both heart-rate (p<0.0001) and use of strong analgesics
(p=0.003) and an increase in number of horses with normal rectal findings were observed (p<0.0001). Multiple
caecal decompressions were not associated with increased risk of complications or euthanasia.
Conclusions
Percutaneus caecal decompression is effective in reducing pain and improving rectal findings in horses with caecal
tympany. Short-term complications such as fever were observed but were not life threatening.
8.24 Investigation of the short chain fatty acid sensors GPR41 and GPR43 in equine large
colon
Archer, D., Jones, D., Tew, S.
Institute of Infection and Global Health and *Institute of Ageing and Chronic Disease, University of Liverpool,
Leahurst Campus, Neston, Wirral. CH64 7TE Tel: (+44) 0151 794 6041, Fax: (+44) 0151 794 6034
Email: [email protected]
Background
Short-chain fatty acids (SCFA) such as acetate, proprionate and butyrate are produced by bacterial fermentation of
dietary fibre. Research in several species has shown that luminal SCFA are absorbed as nutrients across the intestinal
epithelium and that they have a role in regulation of ion transport and motility of the small and large intestines
(Karaki et al. 2006). Work in mice, rats and humans has demonstrated that SCFA activate two orphan G proteincoupled receptors, GPR41 and GPR43 (Tazoe et al. 2009). SCFA act as signalling molecules at the cell-surface level
and have a potential role in a variety of metabolic and immune disorders (Covington et al. 2006). To date, there is no
published information about whether GPR41 and GPR43 receptors are expressed in the equine large colon.
There is evidence that altered large intestinal motility may play a role in the development of simple colonic
obstruction/distension colic (SCOD; Hillyer et al. 2002). In addition crib-biting / windsucking (CBWS) behaviour has
been shown to be increased when horses that display these forms of behaviour are placed on a low forage diet
(Hothersall and Nicol 2009) and altered intestinal physiology may play a role in development of these behaviours
(Wickens and Heleski 2010). We hypothesised that if receptors GPR41 and GPR43 are expressed in the equine colon
that their expression may differ in these two groups of horses compared to ‘normal’ horses.
Objectives
The aims of this project were 1. to confirm the expression of the GPR41 and GPR43 receptors in the equine large
colon in normal horses 2. to explore whether expression of these receptors was altered in horses undergoing surgery
for colic that display CBWS behaviour and those undergoing surgery for treatment of SCOD.
Methods
Samples of mucosa (10x10mm) were taken from the pelvic flexure of the large colon in horses being euthanased for
non-gastrointestinal reasons immediately following death (Normal group, n=10). Samples of mucosa were also
taken from the pelvic flexure of horses undergoing surgery for colic that were undergoing a pelvic flexure
enterotomy as part of their surgical management. These were divided into the following groups: horses undergoing
surgery for SCOD colic who did not display CBWS behaviour (SCPD group, n=10), horses undergoing surgery for colic
other than SCOD who exhibited CBWS behaviour (CBWS group, n=10). To control for potential alteration in intestinal
physiology due to undergoing surgery for colic, samples were also collected from horses that did not exhibit CBWS
behaviour nor had SCOD colic (Surgery group, n=10). Samples were obtained under University of Liverpool Ethics and
Welfare Committee approval. Samples of mucosa were immediately wrapped in aluminium foil which was then
immersed in liquid nitrogen prior to storage at -800C. RNA was extracted from the samples and cDNA was
synthesised prior to performing real-time PCR. Primers were obtained for GPR41 and GPR43 genes based on the
predicted sequences from the horse genome and GAPDH was used as the housekeeping gene. All samples were run
in duplicate for both housekeeping and target genes. Relative expression levels were normalised to GAPDH and
calculated using the 2-ΔCt method using Excel (Microsoft Corporation). Levels were compared between four groups
using a t-test. Results were considered significant if P<0.05.
Results
Both GPR41 and GPR43 were shown to be expressed in normal equine large colon. GPR41 expression was
significantly different between the Normal and CBWS group and between the Normal and SCOD group after removal
of one obvious outlier. Mean GPR41 expression was 3.6 times higher in the CBWS group compared to the Normal
group and 2.6 times higher in the SCOD group compared to the normal group. However, there was no significant
difference in expression of GPR 41 between the Surgery, CBWS and SCOD groups. GPR43 expression was (mean vs
mean) 2.3 times higher in the CBWS group and 2.5 times higher in SCOD group compared to the Normal group.
However, there was no statistically significant difference in expression of GPR43 between groups.
Conclusions
Work performed in this study has demonstrated that GPR41 and GPR43 are expressed in the large colon of normal
horses. These findings add to the relatively limited information that currently exists about intestinal receptors
expressed in equine large intestine when compared to other species. Expression of GRP41 was significantly increased
in horses undergoing surgery for colic that display CBWS behaviour and for treatment of SCOD compared to normal
horses, but there was no significant difference in expression of GPR41 and GPR43 between the other groups. Further
work is ongoing, including identification the location of these receptors along the crypt-surface axis using
immunohistology.
Acknowledgements
We are very grateful to the Petplan Charitable Trust and the RCVS Trust for funding this study and to Prof. Soraya
Shirazi-Beechey and Prof. Peter Clegg for helping to initiate this work.
References
Covington, D.K., Briscoe, C.A., Brown, A.J., Jayawickreme, C.K. (2006) The G-protein-coupled receptor 40 family
(GPR40-GPR43) and its role in nutrient sensing Biochemical Soc. Trans. 34, 770-773
Hillyer, M.H., Taylor, F.G.R., Proudman. C.J., Edwards, G.B., Smith, J.E., French, N.P. (2002) Case control study to
identify risk factors for simple colonic obstruction and distension colic in horses. Equine vet. J. 34, 455-463.
Hothersall, B., Nicol, C. (2009) Role of diet and feeding in normal and stereotypic behaviours in horses Vet. Clin. N.
Am. Eq. Prac. 25, 167-181
Karaki, S., Tazoe, H., Hayashi, H., Kashiwabara, H., Tooyama, K., Suzuki, Y. & Kuwahara, A. (2008) Expression of the
short-chain fatty acid receptor, GPR43, in the human colon. J. Mol. Histol. 39, 135-142
Tazoe, H., Otomo, Y., Kaji, I., Tanaka, R., Karaki, S. I. & Kuwahara, A. (2008) Roles of short-chain fatty acids receptors,
GPR41 and GPR43 on colonic functions. J. Physiol. Pharmacol. 59, 251-262
Wickens CL, Heleski CR (2010) Crib-biting behavior in horses: A review. Applied Animal Behaviour Science 128, 1-9.
8.25 Effects of selective and nonselective nonsteroidal anti-inflammatory drugs on in vitro
contractility of ischaemia and reperfusion injured equine jejunum
Wogatzki, A., Hopster, K., Tappenbeck, K., Huber, K., Rotting, A.K.
Clinic for Horses (A. Wogatzki, K. Hopster, A. K. Rötting), Department of Physiology (K. Tappenbeck, K. Huber),
University of Veterinary Medicine Hannover, Foundation, Bünteweg 9, 30559 Hanover, Germany, Tel: (+49) 0511
9536500
Current address of A.Wogatzki: Clinic for Equine Surgery, Justus-Liebig University, Frankfurterstrasse 108, 35392
Gießen, Germany, Tel: (+49) 0176 20719574,
Email: [email protected]
Background
Post-operative ileus is a life-threatening complication after colic surgery. Cyclooxygenase (COX)- inhibitors are
routinely used in colic patients but may influence gastrointestinal motility, and effects of non-selective and selective
COX-inhibitors may differ.
(Van Hoogmoed et al. 1999, 2000, 2002; Menozzi et al. 2009).
Objectives
Evaluation of the effects of a selective and a non-selective COX-inhibitor on in vitro contractility of ischemic injured
equine jejunum.
Methods
In 12 horses experimental jejunal ischemia and reperfusion were induced. In vitro contractility of longitudinal and
circular muscle was measured with and without in vitro application of increasing concentrations of flunixin or
firocoxib. In a second part of the study horses then received flunixin or firocoxib intravenously, another jejunal
segment was submitted to ischemia and reperfusion and in vitro contractility was evaluated.
Results
Ischemia/reperfusion increased in vitro contractility (frequency, amplitude and mean active force) (P<0.0001). In
vitro application of flunixin reduced contractility at high concentrations (all parameters; P= 0.032-0.041). In vivo
medication with flunixin increased the mean active force (P= 0.048) of the circular muscle and the frequency (P=
0.049) of the longitudinal muscle when compared to firocoxib.
Conclusions
The selective COX2-inhibitor firocoxib and the non-selective COX-inhibitor flunixin had different effects on in vitro
jejunal contractility, and after in vivo application flunixin compared favourably to firocoxib. This study cannot
evaluate effects on in vivo motility. Research comparing the effects of selective and non-selective COX-inhibitors on
intestinal motility seems necessary before recommendations regarding the best COX-inhibitor for the treatment of
equine colic patients should be made.
Acknowledgements
Supported by K. Rhon (statistical analysis) and S. Hoppe (technical assistance).
References
Menozzi, Pozzoli, Poli, Dacasto, Giantin, Lopparelli,Passeri, Zullian, Gobetti, Bertini (2009). Effects of nonselective
and selective
cyclooxygenase inhibitors on small intestinal motility in the horses. Res Vet Sci. 2009 Feb;86(1):129-35.
Van Hoogmoed, Rakestraw, Snyder, Harmon. (1999). In vitro effects of nonsteroidal antiinflammatory agents and
prostaglandins I2, E2,F2a, on contractility of taenia of the large colon of horses . Am J Vet Res. 1999 Aug;60(8):10049.
Van Hoogmoed, Snyder, Harmon. (2000) in vitro investigation of the effect of prostaglandins and nonsteroidal
antiinflammatory drugs
on contracile activity of equine smooth muscle of dorsal colon, ventral colon, pelvic flexure. Am J Vet Res. 2000
Oct;61(10):1259-66.
Van Hoogmoed, Snyder, Harmon. (2002) in vitro investigation of effects of cyclooxygenase-2 inhibitors on contractile
activity of
equine dorsal and ventral colon. Am J Vet Res. 2002 Nov;63(11):1496-500.
8.26 Development of an in-vitro three-dimensional culture system for equine
gastrointestinal crypts
Jacobs, C.C., Southwood, L.L., Lindborg, S.
New Bolton Center, University of Pennsylvania, 382 West Street Rd, Kennett Square, PA, 19348. Tel: 610-444-5800,
Email: [email protected]
Background
Gastrointestinal disease, particularly associated with colic, is an important cause of morbidity and mortality in the
equine population. With increasing concerns for animal welfare and decreasing funds available for equine research,
developing in vitro techniques for equine intestinal research is imperative. Recently, murine and human intestinal
crypt culture models have been developed which maintain crypt physiology and function.1,2 Application of this
technology to the equine species could prove invaluable for future gastrointestinal research in the horse.
Objectives
The purpose of this study was to describe our findings with equine intestinal crypt isolation and three-dimensional
crypt culture using the techniques that have been applied in murine and human intestine. Our hypothesis was that
using modifications of the techniques described in murine models, equine intestinal crypts could be isolated and
grown in three-dimensional culture.
Methods
All procedures were approved by the Institutional Animal Care and Use Committee. Techniques used were a
modification of the described by Sato et al for isolation and culture of murine crypts (John Lynch, MD, PhD, personal
communication). Full-thickness sections (1 cm x 10 cm) of distal jejunum and ascending colon (pelvic flexure) were
collected from 10 horses euthanized for reasons unrelated to gastrointestinal disease. All samples were kept on ice
during the isolation procedure. The sections were placed in ice-cold phosphate-buffered saline (PBSO) containing
penicillin/streptomycin and amphotericin-B (PBS-Anti-Anti). The gross debris was removed and the sections placed in
a fresh ice-cold PBS-Anti-Anti rinse. The mucosa was separated from the seromuscular layer and the villi were
scraped from the mucosa using the back of a scalpel blade (jejunum only). The mucosal sections were rinsed one
more time. The mucosa was sectioned into smaller pieces (approximately 0.5 cm x 5 cm) and incubated in PBSO with
30 mM EDTA, dithiothreitol (DTT), and an apoptosis inhibitor (dissociation reagent #1) on ice for 30 minutes. The
samples were then transferred to a sample with PBSO, 30 mM EDTA, and the apoptosis inhibitor (dissociation
reagent #2) and incubated at 37oC for 15 minutes. The samples were agitated to release dissociated crypts from the
mucosa. Samples were centrifuged and the supernatant discarded. The crypts (as well as villi and single cells) were
rinsed in PBSO with fetal bovine serum (FBS) and centrifuged. This was repeated. The final re-suspension was passed
through a 100 um cell strainer to remove the villi and then centrifuged at 800 rpm for 5 minutes to remove at least
some of the single cells. Following multiple rinses in Complete Advanced PMEM/F12 culture media, the isolated
crypts were resuspended in Matrigel Matrix (BD Biosciences). Fifty uL of the crypt-Matrigel suspension was placed
into each well. The Matrigel was allowed to become firm and 500 uL of the Complete Advanced PMEM/F12 culture
media with growth factors was placed in each well. Epidermal growth factor, noggin, and r-spondin (ENR) were
added to each well. The samples were incubated at 37ºC and 5% carbon dioxide. At 24, 48, and 168 hours, crypt
proliferation, organization, and viability was evaluated. The addition of growth factors to the media and their effect
on crypt proliferation, expansion, and longevity in culture was also evaluated.
Results
Viable crypts were successfully isolated from equine small intestine and large colon using variations of protocols
developed for murine crypt isolation. Some of the key modifications that were made from the initial murine isolation
protocol included: multiple rinses in PBSO-Anti-Anti, sectioning the mucosa into smaller pieces to increase exposure
to the dissociation reagents, longer incubation period in the dissociation reagents with frequent agitation during
incubation in dissociation reagent #2, and use of a larger pore-size for the cell strainer (70 vs. 100 um).
Following isolation, these crypts were identified using microscopy. The jejunal crypts tended to maintain crypt
formation whereas the colonic crypts did not. When no ENR was used, the jejunal crypt formation was lost and the
cells proliferated to cover the well. No bacterial or fungal contamination of our samples occurred.
Conclusions
Equine jejunal and colonic crypts could be isolated using modifications of a murine crypt isolation protocol. The cells
survived in culture; however, specific growth factors (i.e. ENR) are required in order to maintain crypt formation.
Colonic crypts did not maintain their formation even with the addition of ENR. Future studies are planned to further
evaluate the isolated and cultured crypts using histological techniques and optimization of the system by evaluating
the impact of different growth factors is planned.
Acknowledgement
Supported by Grant from Raymond Firestone Trust Research Grant
References
Sato et al. Long-term expansion of epithelial organoids from human colon, adenoma, adenocarcinoma, and Barrett’s
epithelium. Gastroenterology 2011; 141:1762-1772.
Sato T, et al. Single Lgr5 stem cells build crypt-villus structures in vitro without a mesenchymal niche. Nature 2009;
459:262-265.
8.27 MPXI as an indicator of post operative inflammation in horses after colic surgery
de Graaf-Roelfsema, E., van Mourik, S.F., van Leeuwen, M.W., Teske, E.
Department of Equine Sciences, Faculty of Veterinary Medicine, Utrecht University, Yalelaan 112-114, 3584 CM
Utrecht, The Netherlands. Tel: (+31) 30-2531350; Fax: (+31) 30 537970
Email: [email protected]; [email protected]
Department of Clinical Sciences of Companion Animals, Faculty of Veterinary Medicine, Utrecht University, Yalelaan
108, 3584 CM Utrecht, The Netherlands. Tel: (+31) 30-2531592; Fax: (+31) 30 2518126
Email: [email protected]; [email protected]
Background
The myeloperoxidase index (MPXI) is a blood parameter related to neutrophil activation and standard measured by
the Advia 2120, a haematology analyser. MPXI decreases in conditions which lead to neutrophil activation, including
ischemic disorders and bacterial sepsis.
Objectives
Evaluation of MPXI as diagnostic parameter in post-operative colic cases for development of post-operative
inflammation or recovery.
Methods
Complete blood count data from 154 horses (one year and older) that underwent colic surgery in the period
between January 2009-September 2013 were retrospectively analysed for differences in MPXI, leucocytes, band
cells, neutrophils, haemoglobin and haematocrit concentrations. Blood samples were collected between 24 and 72
hours post-surgery. For this group the medical records were reviewed for diagnosis, operation date, fever, survival
and possible resection of intestine. The association between MPXI, leucocytes and survival was evaluated using the
chi-square test. A student t-test and one way ANOVA were used for comparisons between groups. A P<0.05 was
considered significant.
Results
In 148 healthy horses a reference interval of 4.02 – 19.69 was established for the MPXI with a mean of 11.86 SD
4.00. In the horses that underwent laparotomy no significant effects were found on MPXI or leucocyte count of small
intestinal resection, small versus large intestine surgery and survival. Horses suffering from fever postoperative had
significant lower WBC counts compared to horses without fever (P=0.03) and healthy controls (P<0.001). MPXI was
significantly lower in horses with and without fever postoperative compared to healthy control horses.
In blood samples collected between 24-72 hours post-surgery haematocrit of non-survivors (n=127) was significantly
higher (P= 0.017) compared to survivors (n=32), 0.340.06 vs. 0.370.07, resp.
Conclusion
From our study no added value for a single determination of MPXI together with leucocytes could be found in
determination of development of postoperative inflammation. Further studies into the use of pre-operative or
consecutive measurements of MPXI are recommended.
8.28 Surgical site infection following laparotomy; effect of month and anaesthesia-related
variables and reporting of bacterial isolates in 299 horses
Isgren, C.M., Salem, S.E., Archer, D.C., Worsman, F.C.F., Townsend, N.B.
Philip Leverhulme Equine Hospital, School of Veterinary Science / Institute of Infection and Global Health, University
of Liverpool, Leahurst Campus, Neston, Wirral, CH64 7TE, UK. Tel: (+44) 0151 794 6041 Fax: (+44) 0151 794 6034
Email: [email protected]
Background
Surgical site infection (SSI) is a relatively common cause of morbidity following laparotomy, occurring in around 1037% of horses (Hardy and Rakestraw 2012). Incisional hernia formation is 4 - 8.93 times more likely to develop
following SSI at the site (French et al. 2002, Mair et al. 2005) and these horses are significantly less likely to return to
previous use than those without hernias (Davis et al. 2013). Several studies have investigated risk factors for
incisional infection (Hardy and Rakestraw 2012) but the effect of specific anaesthetic related variables and factors
such as surgery being performed outwith normal working hours does not appear to have been investigated. In
human medicine, seasonality of SSI has been reported following spinal surgery (Gruskay et al. 2013). To the authors’
knowledge this has not been investigated in horses that develop SSI following laparotomy.
Objectives
The aims of the study were to 1. Investigate the effect of cardiopulmonary parameters such as mean arterial
pressure under general anaesthesia, anaesthetic recovery scores following general anaesthesia and the effect of
surgery being performed outside normal working hours on likelihood of horses developing SSI during hospitalisation
2. Explore any seasonal (month) effect on risk of SSI and 3. Report bacterial isolates and antimicrobial sensitivities in
our hospital population.
Methods
The records of all horses that underwent exploratory laparotomy at the Philip Leverhulme Equine Hospital (PLEH)
over a 3-year period (July 2010-July 2013) were reviewed and data obtained from case records were entered onto a
computer database. Horses were only included in the study if they survived to hospital discharge. SSI was defined as
any discharge from the laparotomy incision of greater than 24hrs duration. Out of hours (OOH) was defined as
surgery performed between the hours of 5pm-9am Monday – Friday and at anytime over the days of Saturday or
Sunday. SSI during hospitalisation was the outcome of interest (yes / no). Variables of interest were tested for
association with SSI using a Chi-squared test for categorical variables and a univariable logistic regression model for
continuous variables. P<0.05 was considered statistically significant. Incisions that develop a SSI during
hospitalisation at the PLEH are routinely swabbed and submitted for culture and sensitivity testing. The results of
these were reviewed to determine what bacterial isolates had been identified and their antimicrobial resistance
patterns.
Results
Over the 3 year period, 511 horses underwent explorative laparotomy. A total of 212 horses were excluded from the
study, as they were either euthanased or died during surgery or hospitalisation. Out of the 299 horses that were
discharged from the hospital, 77 (25.8%) developed an SSI during hospitalisation. Over the 36 month period, horses
undergoing laparotomy during the month of July had the highest rate of infection (16/27 horses; 59.2 %) and rates of
SSI were lowest during the month of April (3/25; 7.1%). Month was significantly associated with risk of SSI (P=0.006)
but only the month of April was significantly associated with altered risk of SSI (OR 0.23, 95% CI 0.53-0.96, P=0.04).
There was no effect of a variety of cardiopulmonary parameters under general anaesthesia (e.g. mean arterial
pressure), anaesthetic recovery score (P=0.35) or surgery being performed OOH (P=0.60) on likelihood of SSI
occurring during hospitalization. Of the 77 horses that developed a SSI, samples were submitted in all but 13 horses.
Bacteria were cultured in 62 (96.9%); no bacteria were cultured in two horses. A total of 124 bacterial isolates were
cultured, with 71/124 (57%) being Gram negative and 53/124 (43%) being Gram positive. A mixed growth of bacteria
was found in 54% of SSI swabbed compared with 46% in which only a single bacterial species was cultured.
Antimicrobial sensitivity revealed a predominance of penicillin resistant isolates (100/108; 93%) with 19% of
bacterial isolates (23/124) found to be resistant to gentamicin. Nineteen isolates (19/108; 17.6%) were resistant to
both penicillin and gentamicin including 3 methicillin-resistant Staphylococcus aureus (MRSA) species.
Conclusions
The rates of SSI in the present study were within previously reported rates of SSI in other hospital populations. In
addition there was some evidence of a possible temporal effect with horses undergoing laparotomy during the
month of April being significantly less likely to develop an SSI. Further analysis of data is being undertaken to explore
a true seasonal or clustering effect. Specific anaesthetic related variables and laparotomy performed OOH had no
effect of risk of SSI during hospitalisation. Knowledge of bacterial isolates from SSI are an important part of clinical
audit and can be used to assist informed decision making regarding antimicrobial use in hospitals and in order to
identify altered patterns of microbial resistance.
Acknowledgements
We are very grateful to Janet Smith for help with data collection and to our colleagues at the hospital for their
assistance.
References
Davis, W., Fogle, C.A., Gerard, M.P., Levine, J.F. and Blikslager, A.T. (2013). Return to use and performance following
exploratory celiotomy for colic in horses: 195 cases (2003–2010). Equine Veterinary Journal, 45: 224–228
French, N.P., Smith, J., Edwards, G.B. and Proudman, C.J. (2002). Equine surgical colic: risk factors for post operative
complications. Equine Veterinary Journal, 34: 444-449
Gruskay, J., Smith, J., Kepler, C.K., Radcliff, K., Harrop, J., Albert, T. and Vaccaro, A. (2013). The seasonality of
postoperative infection in spine surgery: Clinical article. Journal of Neurosurgery: Spine, 18: 57-62.
Hardy, J. and Rakestraw, P.C. (2012). Post-operative care, complications and re-operation. In J.A Auer, J.A. Stick (eds),
Equine Surgery 4th Edition, Elsevier Ltd. pp514-529
Mair, T. S. and Smith, L. J. (2005): Survival and complication rates in 300 horses undergoing surgical treatment of
colic. Part 2: Short-term complications. Equine Veterinary Journal, 37: 303– 309
8.29 Comparison of three linea alba suture techniques; clinical and ultrasonographic
Wiemer, P., Ugahary, F., Harlaar, J.J.
Equine section, Lingehoeve Diergeneeskunde, Veldstraat 3a, 4033 AK, Lienden, The Netherlands. Tel: (+31) 0488
482900 Fax: (+31) 0488 481355
Email: [email protected]
Ziekenhuis Rivierenland, department of surgery, President Kennedylaan 1, 4002 WP, Tiel, The Netherlands. Tel:
(+31) 0344-674911 Fax: (+31)0344-674419
Email: [email protected]
Erasmus MC University of Rotterdam, department of surgery, Wytemaweg 80, 3015 CN, Rotterdam, The
Netherlands. Tel: (+31) 010-704 0 704
Email: [email protected]
Background
In the horse incisional hernia and burst abdomen are relevant complications of midline incisions. The incidence of
incisional hernia is 16% (Gibson et al. 1989). Surgical technique plays an important role in these complications,
especially in the endotoxaemic patient that suffers from impaired wound healing due to leucopenia and katabolic
status. Besides, postoperative painful episodes lead to increased mechanical strain(Gibson et al. 1989). The
recommended conventional technique was a continuous pattern with a bit size of 1.5 cm and an interval of 1.5 cm.
(Trostle et al. 1994 and Hassan et al.2006). In human surgery there is evidence that a continuous closure with small
stitches reduces complications and increased strength of the suture (Harlaar et al. 2009 and Millbourn et al. 2011).
The optimal closure technique of the linea alba is important to prevent complications.
Objectives
The objective of this study is to compare the results of three different closure techniques of the linea alba;
conventional continuous, continuous small bites and the UX technique. The rate of wound infection and acute failure
were evaluated in the first week and the quality of the linea alba healing was determined at 7 weeks.
Methods
Horses with a midline incision for acute abdominal intestinal disease were randomized just before surgery in three
groups. 1 Conventional continuous with bite size of 1.5 cm and interval of 1.5 cm PDS USP2 (Hassan et al.2006), 2
continuous small stitches with bite size of 0.6 cm and interval of 0.6 cm PDS USP2 (principle of Israelsson),(Millbourn
et al. 2011) and 3 the UX technique (reinforcement of the linea alba by the placement of a tape PDS 5 mm in the
rectus sheet, designed by Ugahary),(Wiemer et al. 2008). Wound length (WL) and suture length (SL) were measured.
Age, sex, type of surgery and duration of surgery were recorded. All patients were older than 3 years, not pregnant,
without previous laparotomy, no other disease and over 500 kg of bodyweight.
The postoperative care was performed according to the needs of the patients.
Wound healing was clinically checked daily until day 7 post operatively. At 7 weeks post operative the healing of the
linea alba was ultrasonographically evaluated. The width of the linea alba was measured at the center of the incision,
the scar was evaluated for micro herniations and homogeneity of the fibrous tissue.
Data were statistically analyzed with the Anova and significance was set at P0.05.
Results
Included were 73 patients, 11 were euthanized during surgery, 10 were euthanized before 7 days after surgery for
other reasons than wound complications and 9 were lost for follow up. Results were obtained for 14 patients in
group 1 and 2 and for 15 patients in group 3.
Between the 3 groups there was no significant difference in age, sex, type of surgery and duration of surgery.
In the conventional group the mean incision length was 19.5 cm, ranged from 14–30 cm, the stitch interval was 1.6
cm and the SL:WL ratio was 4.5:1. The small stitch group had a mean incision length of 19.9 cm with a range from 1429 cm, the stitch interval was 0.6 cm and the SL:WL ratio was 5.6:1. In the UX group the mean incision length was
22.3 cm ranged from 16-31 cm and the stitch interval was 1.56 cm.
In the first week post operative there was no difference in wound discharge and edema between groups. In the
conventional group one patient had an acute failure because of a rupture of the suture. This patient was re-operated
and excluded for the US control at 7 weeks.
At the control 7 weeks after surgery 2 patients had a complete herniation in the conventional group and one patient
had a herniation of the cranial third of the incision in the small stitch group. In the UX group no herniation occurred.
On ultrasonography at 7 weeks the width of the linea alba was 6.0 1.0 cm in the conventional group with exclusion
of the herniated patients . In the small stitch group and in the UX group the width of the linea alba was significant
smaller with respectively 2.5 0.3 cm and 3.0 0.1 cm.
Conclusion
This study showed that the use of the small stitch and UX technique result in a significant better scar formation of
the linea alba with less complications compared to the conventional continuous closure. This can improve the results
of colic surgery and reduce costs of medication and hernia repair.
References
Gibson K.T., Curtis C.R., Turner A.S., McIlwraith C.W., Aanes W.A. and Stashak T.S. (1989) Incisional hernia in the
horse. Incidence and predisposing factors. Vet. Surg. 18, 360-366.
Harlaar J.J., van Ramshorst G.H., Nieuwenhuizen J., ten Brinke J.G., Hop W.C., Kleinrenserink G.J., Jeekel H. and Lange
J.F. (2009) Small stitches with small suture distances increase laparotomy closure strenght. Am. J. Surg. 98, 392-395.
Hassan K.A., Galuppo L.D. and van Hoogmoed L.M. (2006) An in vitro comparison of two suture intervals using
braided absorbable loop suture in the equine linea alba. Vet. Surg. 35, 310-314.
Milbourn D., Cengiz Y. and Israelsson L.A. (2011) Risk factors for wound complications in midline abdominal incisions
related to the size of stitches. Hernia 15, 261-266.
Trostle S.S., Wilson D.G., Stone W.C. and Markel M.D. (1994) A study of the biomechanical properties of the adult
equine linea alba: relationship of tissue bite size and suture material to breaking strength. Vet. Surg. 23, 435-441.
Wiemer P. and Ugahary F. (2008) UX closure of the linea alba; acute bursting strength study in fresh equine cadavers
and preliminary clinical results. Proceedings European Hernia Society, Sevilla. 183.
8.30 Use of butorphanol tartrate as a continuous rate infusion (CRI) in the immediate
postoperative period for signs of abdominal pain in the management of large colon
resection and anastomosis
Klohnen, A., Krueger, C.R.
Chino Valley Equine Hospital, 2945 English Place, Chino Hills, CA 91709
USA. Tel: 909 628 5545
Email: [email protected]
Background
Possible postoperative complications after colic surgery are well documented in the literature and one of the most
undesirable complications might be repeated signs of postoperative abdominal pain.
Objective
To compare two groups of horses for possible signs of postoperative abdominal pain after undergoing large colon
resection and anastomosis. One group of horses was treated with butorphanol as a CRI and a second group of
horses was treated with butorphanol (IV and IM) on an as needed basis for pain relief in the immediate postoperative period. It was our hypothesis that horses treated with a butorphanol CRI in the postoperative period may
have a decreased incidence of postoperative ileus and would show less signs of abdominal pain compared to the
group receiving butorphanol (IV and IM).
Methods
Medical records were reviewed from October 2007 to February 2013 and horses were included in the study if they
had a large colon resection and anastomosis performed and survived to postoperative day 8. Among many other
parameters, medical records were reviewed in regards to heart rates, signs of postoperative abdominal pain and
development of postoperative ileus diagnosed via abdominal ultrasonography.
A private practice postoperative abdominal pain score system was developed after modification of the abdominal
pain score system devised by Pritchett. The postoperative pain score system was divided into three main categories
and included heart rate, signs of ileus and signs of abdominal pain. Patient monitoring was started after recovery
and continued every 12 hours thereafter until day 8.
The highest heart rate score a horse could be assigned would be 8 in a 48 hour time period. The highest POI score a
horse can be assigned during the observation period would be 15. At each postoperative time point, all horses were
evaluated for possible signs of abdominal pain and the scores were added. The highest score a horse could be
assigned for time periods, 0 hours, 12 hours and 24 hours would be 15 and 21 thereafter.
Medical records were evaluated in regards to a particular day a horse developed postoperative ileus, how many days
a horse was treated with lidocaine CRI for resolution of POI and if a horse was treated with IV-lidocaine CRI for
postoperative pain management or signs of POI.
Horses were divided into two groups: Group 1 (non CRI) horses included horses that were administered 10 mg of
butorphanol IV and IM every 4 hours or as needed for the first 36 hours after surgery. Group 2 (CRI group) received
13μg/kg/hr butorphanol CRI for a 24 – 36 hour time period. Horses in each treatment group received a lidocaine CRI
on a case-by-case basis in addition to their current regimen as needed for intestinal ileus or signs of abdominal pain.
Results
In the study period, 24 out of the 350 colic surgeries were included in the study. 13 horses were included in group 1
(nonCRI) and 11 horses were included in group 2 (CRI group).
In group 1, 9 out of 13 horses (69.2%) were treated with lidocaine CRI for signs of postoperative abdominal pain. In
all 9 horses, the treatment with lidocaine CRI was started within the first 12 hours after surgery in addition to the
treatment with 10 mg of butorphanol IV and IM every 4 hours (first dose was given after surgery). 11 out of 13
horses (84.6%) did not develop signs of postoperative ileus diagnosed with abdominal ultrasonography (48-72 hours
after surgery).
In group 2, all horses were started on butorphanol CRI after recovery from general anesthesia. In group 2, 8 out of
11 horses (72.7%) were treated with lidocaine CRI for signs of postoperative ileus (started after 48 hrs after surgery)
and not for signs of postoperative abdominal pain.
The average pain score for the horses in group 1 was 31, whereas the average pain score for horses in group 2 was
10.
Conclusion
Results of the present study of horses undergoing large colon resection and anastomosis and being treated with
butorphanol CRI in the postoperative period indicated to have a lower postoperative pain score (less signs of
postoperative abdominal pain) compared to horses treated with butorphanol IV and IM on an as needed basis.
Horses in group 2 appeared to develop signs of POI after 48 hours after surgery, but responded to treatment with
lidocaine CRI.
References
Pritchett LC, etal: Identification of potential physiological and behavioral indicators of postoperative pain in horses
after exploratory celiotomy for colic. App An Beh Science 2003.80;31-43
8.31 Impact of general anaesthesia on intestinal motility in horses undergoing nonabdominal surgery
Salciccia, A., Gougnard, A., Sandersen, C., de la Rebiere, G., Cerri, S., Grulke, S.,
Serteyn, D.
Equine Clinic, Faculty of Veterinary Medicine, University of Liège, Liège, Belgium. Blvd de Colonster 20, B41. Tel:
+3243664103, Fax: +3243664108.
Email: [email protected]
Background
Morbidity and mortality related to general anaesthesia is higher in horses than in most other domestic animal
species (Johnston et al. 2002). A multi-centre study showed that colic is the most common post-anaesthetic
complication in horses (Senior et al. 2007). However, the reason for this has not been investigated. Many drugs used
in equine anaesthesia may have an impact on intestinal motility, which may explain the high incidence of colic after
non-abdominal surgery.
Objectives
The aim of the study was (1) to evaluate the impact of general anaesthesia on the motility of the gastrointestinal
tract in horses undergoing non abdominal surgery and (2) to assess the feasibility of ultrasound as a simple tool for
the evaluation of gastrointestinal motility.
Methods
Twenty-five horses hospitalized for elective procedures were studied before and after general anaesthesia consisting
of acepromazine and xylazine premedication, and midazolam and ketamine induction followed by gaseous or total
intravenous anaesthesia. Post-operative time points for ultrasonography and auscultation were immediately after
the recovery, 2 to 4 h, 12 to 18 h and 24 h after it. Ultrasound imaging based on a previously established protocol
(Busoni et al. 2011) was used to assess the size of the stomach, the diameter and the contractility of the duodenum,
the diameter and the visibility of the jejunum and the presence or absence of peritoneal fluid. Abdominal
auscultation in the post-operative period was also recorded. Statistical analysis was carried by ANOVA and ChiSquare tests.
Results
None of the horses showed signs of colic in the post-operative period. There was a significant decrease of gut sounds
in the immediate postoperative period compared to pre-anaesthetic evaluation. Ultrasound analysis in the postoperative period revealed a smaller stomach, less duodenal contractions, more visualisation of the small intestine
which had a greater diameter than pre-operatively. These values returned to normal towards the end of the 24h
period.
Conclusions
The study showed that abdominal ultrasonography is a useful tool for the real-time evaluation of gastric and small
intestinal dimensions and motility in the postoperative period. Smaller stomach, larger small intestinal diameter, and
less small intestinal contractions suggest a reduced small intestinal motility after non-abdominal surgery in horses.
Further studies should evaluate the sensitivity of the method, investigate the impact of different anaesthetic
protocols and include a population of horses suffering from post-anaesthetic colic.
References
Johnston, G.M., Eastment, J.K., Wood, J.L.N., Taylor, P.M. (2002) The confidential enquiry into perioperative equine
fatalities (CEPEF): mortality results of phases 1 and 2. Vet. Anaesth. Analg. 29, 159-170.
Senior, J.M., Pinchbeck G.L., Allister R., Dugdale A.H.A.,Clark L., Clutton R.E., Coumbe K., Dyson S., Clegg P.D. (2007)
Reported morbidities following 861 anaesthetics given at four equine hospitals. Vet Rec., 160, 407-408.
Busoni, V., De Busscher, V., Lopez, D., Verwhilgen, D., Cassart, D. (2011) Evaluation of a protocol for fast localised
abdominal sonography of horses (FLASH) admitted for colic. Vet Journal, 188, 77-82.
8.32 Temporal stability of the bacterial community in the large intestine of the horse
Dougal, K., Harris, P.A., Girdwood, S., Pinloche, E., de la Fuente, G., Argo, C., Curtis,
C.G., Newbold, C.J.
Institute of Biological Environmental and Rural Sciences, Aberystwyth University, Penglais, Aberystwyth,Ceredigion.
SY23 3DA
Waltham Centre for Pet Nutrition, Melton Mowbray, Leicestershire. LE14 4RT.
University of Liverpool, Department of Obesity and Endocrinology, Faculty of Health and Life Sciences, Leahurst
Campus, Chester High Road, Neston, Wirral CH64 7TE.
Email: [email protected]
Background
To date studies on the bacterial community in the large intestine of the horse have mainly involved samples from
single time points. To the authors’ knowledge only two studies have investigated the temporal stability of the
bacterial community in the equine hindgut, whilst on a uniform diet, using culture independent methods (1, 2).
These studies have, however, used community comparison methods that lack sufficient resolution to identify which
components of the bacterial community are stable. In humans, the gut bacterial population has been shown to be
relatively stable over time in individual adults regardless of diet with 70% of bacterial strains being retained in an
individual after 1 year with relatively little additional change over a subsequent 4 year period (3). Similarly work in
other species has also found a stable bacterial community over time (4).
Objectives
In the horse it is not known if the changes in the bacterial community over time, as demonstrated by Blackmore and
colleagues (2), reflect changes in the core bacterial community shared between all animals or variability within the
individual animal’s host specific profile. The aims of this study were to investigate temporal stability of both the core
(ie the same OTU present in all animals) and variable bacterial community in the hindgut of the horse.
Methods
Faecal samples were obtained as part of a trial undertaken at the University of Liverpool veterinary department (5).
Samples were obtained from twelve ponies and horses during week 10 and week 16 of this trial providing two
distinct time points. DNA was extracted from freeze dried samples using QIAGEN QIAamp® DNA stool mini kits
(Qiagen Ltd.,UK.). 454-pyrosequencing amplification of the V1-V2 regions of 16SrDNA was performed using the
primer pair 27F and 357R. Data were denoised; low quality sequences, pyrosequencing errors and chimeras were
removed then sequences were clustered into operational taxonomic units (OTUs) at 97% identity using the CD-HITOTU pipeline. Taxonomic classification of OTU’s was carried out using the Ribosomal Database Project (RDP)
Classifier.
Results
The presence of a core community was identified and compared for both sampling periods. The identified core was
79 OTUs accounting for 30.2% of the total sequences in period 1, and 56 OTUs accounting for 20.3% of the total
sequences for period 2. There was no significant difference in the percentage of either the core or the total bacterial
population present in both sampling periods (69 vs 65 % respectively).Thus the core community was neither more
nor less stable than the total faecal community.
Conclusions
As in previous trials the core bacterial population identified in equine faeces was relatively small but both it and the
general population was fairly (65-70% similarity) stable over time suggesting that future studies should focus on
linking the bacterial microbiome to digestive function and malfunction (6).
Acknowledgements
This project is funded by a BBSRC CASE studentship
References
Willing B., Vӧrӧs A., Roos S., Jones C., Jansson A. & Lindberg J.E. (2009) Changes in faecal bacteria associated with
concentrate and forage-only diets fed to horses in training. Equine Vet J. 41(9):904-914.
Blackmore T.M., Dugdale A., Argo C.McG., Curtis G., Pinloche E., Harris P.A., Worgan H.J., Girdwood S.E., Dougal K.,
Newbold C.J.& McEwan N.R. (2013) Strong stability and host specific bacterial community in faeces of ponies. PLoS
ONE. 8(9):e75079.
Faith J.J., Guruge J.L., Charbonneau M., Subramanian S., Seedorf H., Goodman A.L., Clemente J.C., Knight R., Heath
A.C., Leibel R.L., Rosenbaum M. & Gordon J.I. (2013) The long-term stability of the human gut microbiota. Science.
340:44-54.
Schloss P.D., Schubert A.M., Zackular J.P., Iverson K.D., Young V.B. & Petrosino J.F. (2012) Stabilization of the murine
gut microbiome following weaning. Gut Microbes. 3(4):383-393
Argo C.McG., Curtis G.C., Grove-White D. et al. (2012) Weight loss resistance: A further consideration for the
nutritional management of obese Equidae. The Veterinary Journal. 194:179-188.
Dougal K, de la Fuente G, Harris PA et al (2013) Identification of a core bacterial community within the large intestine
of the horse. PLoS ONE 8(10): e77660
8.33 The proliferative pool of stem cells are decreased by large colon volvulus in horses
Gonzalez, L.M., Stranahan, L.W., Blikslager, A.T.
North Carolina State University, College of Veterinary Medicine, 1060 William Moore Drive, Raleigh, NC 27607, USA.
Tel: (919) 513-7726
Email: [email protected]
Background
Mucosal regeneration following large colon volvulus (LCV) likely depends on stem cells that reside in the crypts.
However, the impact of ischemic injury on crypt stem cells has not been studied.
Objectives
To determine (1) the impact of ischemic injury from LCV on mucosal stem cells and (2) if an association exists
between stem/progenitor cell number and survival.
Methods
Pelvic flexure biopsies from horses with LCV and horses with non-strangulating colonic lesions (controls) were
collected. Antibodies against biomarkers specific to stem/ progenitor cells including: Sex Determining region Y- box 9
(SOX9), Proliferating Cell Nuclear Antigen (PCNA), and Phosphohistone 3 (PH3), were used for immunohistochemical
analyses. Statistical comparisons were performed using one way ANOVA. A receiver operator curve was created to
determine a cutoff value for stem cell number associated with survival.
Results
There was a significant reduction in the number of stem/progenitor cells (SOX9+, PCNA+, PH3+) in the crypts of horses
with LCV (P<0.05). Among LCV cases, there were significantly fewer stem/progenitor cells in horses undergoing
resection (P<0.001). Based on the receiver operator curve, a cutoff value of >36 SOX9+ crypt cells predicted survival
with a sensitivity and specificity of 63% (95% CI; 38%-84%) and 62% (95% CI; 24%-91%), respectively.
Conclusions
LCV significantly reduces stem/progenitor cell numbers in the crypt. Interestingly, the number of stem cells was
particularly low in horses undergoing resection, suggesting clinicians are resecting more severe cases. Collection of
additional cases may lead to identification of a critical number of stem cells associated with survival in LCV.
Acknowledgement
This work was funded by the North Carolina Horse Council. Additional support was provided by the NIH T32
NIH/NCSU Comparative Medicine and Translational Research Training Program (CMTRTP) T32RR024394 (L.M.G.) and
the NIH/T35 Interdisciplinary Biomedical Research Program (L.W.S). The authors would also like to thank the
histopathology laboratory at NCSU College of Veterinary medicine for their processing of all biopsy specimens.
References
1. Lin, S.A. and Barker, N. (2011) Gastrointestinal stem cells in self-renewal and cancer. J. Gastroenterol. 46, 10391055.
2. Van Hoogmoed, L., Snyder, J.R., Pascoe, J.R. and Olander, H. (2000) Use of pelvic flexure biopsies to predict
survival after large colon torsion in horses. Vet. Surg. 29, 572-577.
8.34 Evaluation of gene expression in leukocytes of horses: analysis of the microarray
technique in an ex vivo model of endotoxemia
Peiro, J.R., Dalmago, P., Mendes, L.C.N., Aoki, S.M., Feitosa, F.L.F., da Silva, G.N.,
Moreira, Y., Mendonca, V.H.
Department of Clinics, Surgery and Animal Reproduction, School of Veterinary Medicine, Univ Estadual Paulista
(UNESP), Araçatuba, SP 16050-680, Brazil. Tel: (+55) 18 3636 1438.
DNApta-Biotechnology innovation Ltda, São José do Rio Preto, SP 15035-470, Brazil. Tel: (+55) 17 3234-5852, Ramal
226, Email: [email protected] .
Departament of Clinical Analysis, School of Pharmacy, Univ Federal of Ouro Preto (UFOP), Ouro Preto, MG 35400000, Brazil. Tel: (+55) 31 3559-1097. Email: [email protected].
Agilent Technologies Brasil Ltd., Barueri , SP 06460-040, Brazil. Tel: (+55) 11 98513-1873. Email:
[email protected]
Email: [email protected] / alternative email: [email protected]
Background
Endotoxemia is associated with diseases of high mortality rates in horses (MORRIS, MOORE 1989). It is a disorder
originated from the systemic host response to LPS of Gram-negative bacteria. Monocytes recognize LPS via Toll-like
receptors (TAKEDA et al. 2005), generating a cascade of pro- and anti-inflammatory cytokines (NOMURA et al. 2000).
Objectives
This study aimed to: 1) investigate the changes in gene expression in leukocytes from horses exposed to LPS using
microarray technique, 2) evaluate the global expression of genes involved in metabolic pathways and the efficiency
of the ex vivo model by microrarray technique, 3) identify potential targets for new therapies.
Methods
Whole blood (35 mL) from six adult Quarter Horse mares was collected by jugular venipuncture. Blood of each
animal was divided into 3 fractions, each of which received a different treatment. The control group received 500 µL
of PBS-Phosphate buffered saline (0.01 M, pH 7.2) and the experimental groups were treated with 500 µL of a
solution containing 1 or 10 ng of LPS/mL derivative of E. coli (O55:B5, Sigma). At 0, 2, and 4 hours aliquots of each
experimental condition/animal were collected for RNA extraction.
RNA was extracted (RNeasy® Mini Kit (Qiagen), treated with DNAse (RNAse-free DNase Set, Qiagen), and stored at 80°C. Pools of samples were maden from the total RNA according to the time incubation (0, 2, 4 hours) and LPS
concentrations (0, 1, 10 ng/mL).
The pools (25 ng of RNA/pool), in duplicate, were hybridized in 4x44K slides (G2519F Agilent Technologies) with the
equine genome sequences using the Quick Amp labeling kit (Agilent Technologies) of one color (Cy3). The
hybridization signals were captured by the G2565CA Microarray Scanner (Agilent Technologies, USA). The generated
data were normalized using the 75th percentile value according to the Low Input Quick Amp Labeling Protocol.
After normalization, data were exported to the software Ingenuity® Pathways (IPA Ingenuity Systems®,
http://www.ingenuity.com/products/ pathways_analysis-html) to search for genes and metabolic pathways, using a
fold change of genes 30 times more or less expressed.
Results
Statistical analysis revealed that genes were differentially expressed between the control (0 ng LPS/mL) and LPS 10
ng/mL concentration (p<0.05) when compared times 4 and 2 hours after LPS stimulus. The relative expression of
Toll-like 2 receptor, IL-1, IL-8, IL-10, TNF-α, and TNF-β genes was increased. The genes SLA, PCDH17, PI3K, BTLA, and
CK were also found.
Conclusions
These results demonstrated the efficiency of microarray technique to evaluate the gene expression in an ex vivo
model of endotoxemia. Genes related to immune response such as Toll-like 2 and cytokine genes were identified, as
well as genes whose role in this disease are still not well understood like PI3K, SLA, PCDH17, BTLA, and CK.
References
Morris, D.D., Morre, J.N. (1989). The effect of immunity to core lipopolysaccharides (LPS) on the production of
thromboxane and prostacyclin by equine peritoneal macrophages. Cornell Vet., 79, 231-247.
Nomura, F., Akashi, S., Sakao,Y., et al. (2000). Endotoxin tolerance in mouse peritoneal macrophages correlates whit
down-regulation of surface toll-like receptor 4 expression. J. Immunol., 164, 3476-3479.
Takdea, K. (2005). Evolution and integration of innate immune recognition systems: The Toll-like receptors. J.
Endotoxin Res., 11, 51-55.
8.35 Comparison of two in-vitro technique for cultivation of equine hoof explants
Valle, E., Vercelli, C., Tursi, M., Barbero, R., Giusto, G., Gandini, M.
Department of Veterinary science, University of Torino, Via L. da Vinci 44, Grugliasco (To) Italy. Tel: (+39)
0116708856
Email: [email protected]
Background
Hoof tissue explants (HE) culture possibly offers an interesting tool for study tissues and cells for the evaluation of
laminitis. HE culture require simply of fresh tissue obtained immediately post mortem and instruments for
dissection to obtain the HE. However at present few studies have used this methods that could represent an
interesting technique if well conducted.
Objectives
We performed a pilot study to investigate which culture medium could be better in the cultivation of HE evaluating
the use of Dulbecco’s Modified Eagle Medium (DMEM) (with 4.5mg/L glucose without L-glutamine adding 2% of
antibiotic/antimycotic solution, 2% of L-glutamine) vs DMEM+ (4.5mg/L glucose without L-glutamine, adding 2% of
antibiotic/antimycotic solution, 2% of L-glutamine and 10% of Fetal Bovine Serum-FBS). The HE were incubated with
the two different mediums and was evaluated the force required to separate epidermal from dermal lamella and
histological sections at 24 and 48 hour of incubation.
Methods
Distal limbs were collected at a commercial abattoir from horses designated for the meat production. The animals
were sound at the moment of the visit and only animals without signs of previous laminitis and with an age between
18-24 months were choosen. The limbs were brought to the laboratory of the Department of Veterinary Sciences of
Turin in ice in less than 30 minutes. Hoofs were cleaned using a hoof-knife and scrubbed with an brushes with
clorexidine. Sections were trimmed removing the lateral and medial walls and cutting 4-5 sagittal slices of the digits.
In this way was possible to obtain hoof wall strips 0.8x1.5 cm in thickness, consisting of 10-12 lamellae consisting of
the inner part of the hoof wall epidermal laminae, dermal laminae and the outer part of the bone. All instruments
were cleaned with clorexidine and sterile saline and ice were used to avoid heating. The HE sections were
maintained in sterile saline and washed with Phosphate Buffered Saline (PBS). After they were incubated in 6 wellplates with 5ml of the two different mediums. All the plates were incubated at 5% CO2 and 95% O2 atmosphere and
37°C for 24 and 48 hours. Only for the plates dedicated to the experimental time of 48 hours, the medium was
changed after 24 hours of incubation.
At 24 and 48 hours the structural integrity of the HE were assessed by a strain gauge measurement as follows: one
end was fixed and the other was attached to a digital force trasducer until a maximum force of 4000 g. Separation
force were averaged over three experiment for each time point.
Specimens of HE were sampled for light microscopy, formalin-fixed and embedded in paraffin wax. Sections of 3-µm
thickness were stained with hematoxylin and eosin (H&E) and Periodic-Acid Schiff (PAS).
Results
Basement membrane pathology were analyzed according to Pollit, 1996. At 24 h histological sections of explants
cultured in DMEM+ reveal firm adhesion between epidermal basal cell and the basal membrane with intact cells. In
the explants treated with DMEM alone the junction was less tight and the cells presented postmortem alterations.
At 48 hours histological sections of DMEM+ reveal still a firm adhesion between epidermal basal cell and the basal
membrane. The explants treated with DMEM alone revealed a separation between the basement membrane and
the basal cells. At 24 hours the mean load to failure was 0.7 g for the HE cultured in DMEM. For in DMEM+ the HE
were virtually impossible to separate. At 48 h for HE in DMEM the separation force was 0.6 and more than 1000 g
for DMEM+.
Conclusions
HE culture offers an attractive in vitro model to study laminitis trigger factors. In the present study we were able to
establish a test for analyze the separation force between the dermal and epidermal lamellae. Stained sections could
be an useful method to study the event that occurs at tissue level during laminitis. However it must be borne in mind
that the use of the best culture medium is the basis of the entire procedure, in order to maintain the cells viable. In
our study, we demonstrate that DMEM+ could be usefull to maintain HE cells viable and stable, as confirmed by the
Force Test and by histologic examination.
References
Pollitt, C.C. (1996) Basement membrane pathology: a feature of acute equine laminitis. Equine vet. J. 28, 38-46.

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