Sarah S. le Jeune

Prevalence of gastric ulcers in Thoroughbred broodmares in pasture: A preliminary report

Gastroscopic examinations were performed in 62 Thoroughbred broodmares (33 pregnant, 29 non-pregnant) at one breeding farm to investigate the prevalence of gastric ulceration. Age, pregnancy status, race earnings, last race start, herd size, medical history, number of live foals, breeding years, feed type and number of feedings were recorded, plus coat condition and body condition score were determined. Twenty-one mares were re-evaluated after foaling, and the foaling date, foal weight at birth and placenta weight were recorded. The overall prevalence of gastric ulcers was 70.9%, with a median ulcer score of 3.0 (range: 2-5). Most ulcers were present on the squamous portion of the stomach, while two mares had glandular ulcers. There were no differences in the presence, location and severity of gastric ulcers between pregnant and non-pregnant mares. Furthermore, there were no significant associations between the variables measured and the presence of gastric ulceration. The prevalence of gastric ulceration in this specific population of horses was higher than expected and further investigation is warranted to determine the factors that contributed to this finding.

Ultrasound of the equine acute abdomen.

Abdominal ultrasound is an invaluable aid in the evaluation of the colic patient but can be heavily influenced by patient preparation, individual horse-to-horse variation, availability of ultrasound transducers, technique, experience level of the examiner, and complexity of the abdominal disorder. This article describes ultrasonographic anatomy of the normal equine abdomen and technique for examination of the equine colic patient. Common abnormalities of the stomach, small intestine, large intestine, and peritoneal cavity are described along with other abnormalities that may be discovered with abdominal ultrasonography of the colic patient, such as masses, urolithiasis, cholelithiasis, and thoracic or cardiac lesions.

Use of Physiologic and Arterial Blood Gas Variables to Predict Short‐Term Survival in Horses with Large Colon Volvulus

Objective To determine if preoperative physical examination and blood work values, intraoperative physiologic variables, and intraoperative treatments can be correlated with survival to anesthetic recovery and short-term survival to hospital discharge in horses that undergo exploratory celiotomy for large colon volvulus (LCV) with and without colon resection. Study Design Retrospective case series. Animals Horses (n = 156) undergoing exploratory celiotomy for correction of LCV ≥ 360ο. Methods Medical records (January 2000–December 2009) of horses that had surgical correction of LCV ≥ 360ο were reviewed. Data collection included signalment, preoperative physical examination variables and hematologic values as well as intraoperative physiologic variables, intraoperative treatments, and arterial blood gas values. Risk factors for survival to anesthetic recovery and hospital discharge were determined using exact logistic regression. Results High preoperative heart rate and packed cell volume were associated with not surviving to anesthetic recovery or hospital discharge. A low intraoperative total serum protein concentration was associated with not surviving to anesthetic recovery or to hospital discharge. Intraoperative tachycardia and hypercapnia were associated with not surviving to hospital discharge. Intraoperative hypotension was a negative predictor of survival to anesthetic recovery. There was no increase in death for horses in which a resection and anastomosis was performed compared with those having manual correction. Conclusions Several hematologic and cardiorespiratory variables that are easily measured preoperatively and intraoperatively show good correlation with postanesthetic survival in horses undergoing surgical correction of LCV. These measurements might be useful for prognosticating survival in horses admitted for correction of LCV ≥ 360ο.OBJECTIVE To determine if preoperative physical examination and blood work values, intraoperative physiologic variables, and intraoperative treatments can be correlated with survival to anesthetic recovery and short-term survival to hospital discharge in horses that undergo exploratory celiotomy for large colon volvulus (LCV) with and without colon resection. STUDY DESIGN Retrospective case series. ANIMALS Horses (n = 156) undergoing exploratory celiotomy for correction of LCV ≥ 360(ο) . METHODS Medical records (January 2000-December 2009) of horses that had surgical correction of LCV ≥ 360(ο) were reviewed. Data collection included signalment, preoperative physical examination variables and hematologic values as well as intraoperative physiologic variables, intraoperative treatments, and arterial blood gas values. Risk factors for survival to anesthetic recovery and hospital discharge were determined using exact logistic regression. RESULTS High preoperative heart rate and packed cell volume were associated with not surviving to anesthetic recovery or hospital discharge. A low intraoperative total serum protein concentration was associated with not surviving to anesthetic recovery or to hospital discharge. Intraoperative tachycardia and hypercapnia were associated with not surviving to hospital discharge. Intraoperative hypotension was a negative predictor of survival to anesthetic recovery. There was no increase in death for horses in which a resection and anastomosis was performed compared with those having manual correction. CONCLUSIONS Several hematologic and cardiorespiratory variables that are easily measured preoperatively and intraoperatively show good correlation with postanesthetic survival in horses undergoing surgical correction of LCV. These measurements might be useful for prognosticating survival in horses admitted for correction of LCV ≥ 360(ο) .

Use of Pelvic Flexure Biopsy Scores to Predict Short‐Term Survival after Large Colon Volvulus

OBJECTIVE To (1) determine if histologic scores of pelvic flexure biopsies can predict short-term survival in horses with large colon volvulus (LCV) and (2) identify clinical variables predictive of short-term survival. STUDY DESIGN Case series. ANIMALS Horses (n = 28) with LCV (≥ 360°). METHODS Medical records (January 2000-February 2008) of 28 horses were reviewed and clinical data recorded. Pelvic flexure biopsies were reviewed by 2 board-certified veterinary pathologists, unaware of clinical history and outcome, using 2 scoring systems. Exact logistic regression analysis was used to determine the relationship between histopathology scores (tissue viability), clinical data, and short-term survival (hospital discharge). RESULTS Twenty-four horses (86%) survived to hospital discharge. Using a similar cutoff, neither scoring system was capable of predicting short-term survival. One scoring system failed to correctly predict clinical outcome in 5/25 horses (20%) and the other failed in 6/28 horses (22.4%). Heart rate (at admission and 24 hours after surgery) and packed cell volume 24 hours after surgery were significantly associated with short-term survival. CONCLUSION Histopathologic evaluation of pelvic flexure biopsies did not accurately predict short-term survival in a significant proportion of horses with LCV in this study.Objective To (1) determine if histologic scores of pelvic flexure biopsies can predict short-term survival in horses with large colon volvulus (LCV) and (2) identify clinical variables predictive of short-term survival. Study Design Case series. Animals Horses (n = 28) with LCV (≥360°). Methods Medical records (January 2000–February 2008) of 28 horses were reviewed and clinical data recorded. Pelvic flexure biopsies were reviewed by 2 board-certified veterinary pathologists, unaware of clinical history and outcome, using 2 scoring systems. Exact logistic regression analysis was used to determine the relationship between histopathology scores (tissue viability), clinical data, and short-term survival (hospital discharge). Results Twenty-four horses (86%) survived to hospital discharge. Using a similar cutoff, neither scoring system was capable of predicting short-term survival. One scoring system failed to correctly predict clinical outcome in 5/25 horses (20%) and the other failed in 6/28 horses (22.4%). Heart rate (at admission and 24 hours after surgery) and packed cell volume 24 hours after surgery were significantly associated with short-term survival. Conclusion Histopathologic evaluation of pelvic flexure biopsies did not accurately predict short-term survival in a significant proportion of horses with LCV in this study.

Evaluation of 3 handheld portable analyzers for measurement of L-lactate concentrations in blood and peritoneal fluid of horses with colic.

Objective To compare 3 portable handheld analyzers with a bench top blood gas analyzer for measurement of blood and peritoneal fluid L-lactate concentrations in horses admitted with signs of colic. Study Design Prospective clinical study. Sample Population Blood and peritoneal fluid from horses with colic. Methods L-lactate concentrations in heparinized blood and peritoneal fluid were measured serially on 10 occasions to evaluate repeatability of the portable analyzers. Blood and peritoneal fluid L-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. L-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 had good intra-analyzer reliability for peritoneal fluid. Two portable analyzers had poor intra-analyzer reliability for mid concentrations of L-lactate in blood. L-lactate measurements from portable analyzers were closer to the bench top analyzer at low concentrations of L-lactate than at higher concentrations. Compared with the bench top analyzer, the Lactate Pro and Lactate Plus have the highest intraclass correlation coefficient and the smallest bias for peritoneal fluid and blood L-lactate, respectively. The bench top analyzer and the Lactate Pro had the highest level of agreement for peritoneal fluid compared with the chromogenic assay. Conclusions Although portable analyzers are alternatives for the measurement of L-lactate concentration in field situations, clinicians need to be aware of the variable results between analyzers, especially when extrapolating means or cutoff values from studies using different lactate analyzers.OBJECTIVE To compare 3 portable handheld analyzers with a bench top blood gas analyzer for measurement of blood and peritoneal fluid L-lactate concentrations in horses admitted with signs of colic. STUDY DESIGN Prospective clinical study. SAMPLE POPULATION Blood and peritoneal fluid from horses with colic. METHODS L-lactate concentrations in heparinized blood and peritoneal fluid were measured serially on 10 occasions to evaluate repeatability of the portable analyzers. Blood and peritoneal fluid L-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. L-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 had good intra-analyzer reliability for peritoneal fluid. Two portable analyzers had poor intra-analyzer reliability for mid concentrations of L-lactate in blood. L-lactate measurements from portable analyzers were closer to the bench top analyzer at low concentrations of L-lactate than at higher concentrations. Compared with the bench top analyzer, the Lactate Pro and Lactate Plus have the highest intraclass correlation coefficient and the smallest bias for peritoneal fluid and blood L-lactate, respectively. The bench top analyzer and the Lactate Pro had the highest level of agreement for peritoneal fluid compared with the chromogenic assay. CONCLUSIONS Although portable analyzers are alternatives for the measurement of L-lactate concentration in field situations, clinicians need to be aware of the variable results between analyzers, especially when extrapolating means or cutoff values from studies using different lactate analyzers.

Abdominal computed radiography for the diagnosis of enterolithiasis in horses: 142 cases (2003-2007)

OBJECTIVE To evaluate the sensitivity and specificity of abdominal computed radiography (CR) for the diagnosis of enterolithiasis in horses and to examine how these parameters are affected by the number and anatomic location of enteroliths and by gas distension of the gastrointestinal tract. DESIGN Retrospective case series. ANIMALS Horses ? 1 year old that underwent abdominal CR and subsequent exploratory laparotomy or postmortem examination. PROCEDURES 3 reviewers blinded to signalment, history, clinical signs, and diagnoses separately evaluated abdominal computed radiographs of horses included in the study. Each set of radiographs was evaluated for the presence or absence of enteroliths, the amount of gas distention, and the image quality. Signalment, definitive diagnosis on the basis of findings on exploratory laparotomy or postmortem examination, and the number and location of enteroliths were obtained from medical records. RESULTS Of the 142 cases reviewed, 58.4% (83/142) had confirmed enterolithiasis. For the 3 reviewers, overall sensitivity was 85% and specificity was 93%. Sensitivity was lower for small colon enteroliths than for large colon enteroliths (50% and 94.5%, respectively) and was significantly affected by gas distention. Sensitivity was not significantly affected by the number of enteroliths. CONCLUSIONS AND CLINICAL RELEVANCE Computed radiography provided high sensitivity and high specificity for the diagnosis of enterolithiasis in horses. Caution should be exercised when the radiographic results are negative, as the sensitivity for small colon enterolithiasis was relatively low and gas distension negatively affected detection of enteroliths. Abdominal CR is indicated as a diagnostic test in horses examined for colic in geographic regions in which enterolithiasis is endemic.

Use of digital abdominal radiography for the diagnosis of enterolithiasis in equids: 238 cases (2008–2011)

OBJECTIVE To evaluate the sensitivity and specificity of direct digital abdominal radiography for the diagnosis of enterolithiasis in equids and to assess the effect of the number and anatomic location of enteroliths and gas distention of the gastrointestinal tract on diagnostic sensitivity of the technique. DESIGN Retrospective case series. SAMPLE POPULATION 238 horses and ponies ≥ 1 year old that underwent digital abdominal radiography with subsequent exploratory celiotomy or postmortem examination. PROCEDURES For each case, 3 reviewers independently evaluated radiographic views. Radiographic images were evaluated for presence or absence and location of enteroliths and the degree of gas distention. Signalment, definitive diagnosis based on exploratory celiotomy or postmortem examination findings, and number and anatomic location of enteroliths were obtained from the medical records. RESULTS 70 of the 238 (29.4%) equids had confirmed enterolithiasis. With regard to diagnosis of enterolithiasis via digital radiography, overall sensitivity and specificity for the 3 reviewers were 84% and 96%, respectively. Sensitivity was lower for small colon enteroliths (61.5%) than for large colon enteroliths (88.9%) and was negatively affected by gas distention of the gastrointestinal tract. Sensitivity was not affected by the number of enteroliths. CONCLUSIONS AND CLINICAL RELEVANCE Sensitivity and specificity of digital radiography for the diagnosis of large colon enterolithiasis in equids was high. Sensitivity of digital radiography for detection of small colon enteroliths was lower than that for large colon enteroliths, but was higher than that typically associated with computed radiography. In geographic regions in which enterolithiasis in equids is endemic, digital abdominal radiography could be used as a diagnostic test for equids with colic.

Myenteric ganglionitis as a cause of recurrent colic in an adult horse

CASE DESCRIPTION A 10-year-old Lipizzaner stallion was evaluated over the course of 1.5 years because of intermittent, recurrent colic. CLINICAL FINDINGS The horse was initially treated medically for gastric ulcers; dietary changes were made, and a deworming protocol was instituted, without resolution of colic episodes. Subsequently, the horse underwent exploratory celiotomy and a large colon volvulus was identified with diffuse colonic wall thickening. A pelvic flexure biopsy sample was submitted for histologic examination, which revealed lymphocytic (CD3-positive T cells) myenteric ganglionitis (MG). The horse developed a cecal impaction after surgery, which did not resolve, despite aggressive medical management; subsequently a complete cecal bypass was performed. Cecal and colonic wall biopsy samples were evaluated histologically and confirmed the diagnosis of MG. After surgery, the horse developed a large colon impaction, which initially responded to aggressive medical treatment, and the horse was discharged. TREATMENT AND OUTCOME Despite rigorous feed restrictions and prokinetic and corticosteroid treatment, the horse continued to have signs of colic and was euthanized 3 weeks after discharge from the hospital because of a recurrent large colon impaction. Intestinal biopsy samples obtained at the time of death revealed chronic changes in intramural ganglia consistent with generalized MG. CLINICAL RELEVANCE MG is a rare disease in horses, causing gastrointestinal motility dysfunction and signs of colic, which is challenging to diagnose and treat successfully. Further studies are needed to identify the etiology of this disease and to explore treatment options.

Investigation of perioperative and anesthetic variables affecting short-term survival of horses with small intestinal strangulating lesions

Objective: To determine if preoperative and intraoperative physiologic variables, and surgical factors correlate with survival to anesthetic recovery or hospital discharge, repeat celiotomy, and postoperative nasogastric intubation (NGT) in horses undergoing exploratory celiotomy for small intestinal (SI) strangulating lesions. Study Design: Retrospective case series. Animals: Horses that had surgical correction of SI strangulating lesions (n = 258). Methods: Medical records (January 2000‐December 2014) of horses that had surgical correction of SI strangulating lesions were reviewed. Data collection included signalment, preoperative physical examination variables, hematologic values, presence of gastric reflux, peritoneal fluid analysis, intraoperative physiologic variables, intraoperative findings/treatments, and arterial blood gas values. Risk factors for survival to anesthetic recovery and hospital discharge were determined using exact logistic regression. Results: Survival to anesthetic recovery was 76% and survival to discharge after anesthetic recovery was 79%. The difference between abdominal and peripheral lactate concentrations and intraoperative tachycardia were associated with not surviving to anesthetic recovery or hospital discharge. Intraoperative hypotension, hypocapnia, and low intraoperative packed cell volume (PCV) were negative predictors of survival to anesthetic recovery. Low intraoperative PCV was also associated with NGT postoperatively. Performing resection‐anastomosis and jejunocecostomy were associated with repeat celiotomy and with not surviving to hospital discharge. Conclusion: Several hematological and cardiorespiratory variables show good correlation with short‐term survival in horses undergoing surgery for SI strangulating lesions. These variables are easily measured and could be useful for prognosticating survival in horses presenting with SI strangulating lesions.

Acupuncture and Equine Rehabilitation

Acupuncture is one of the most common veterinary integrative medicine modalities. Acupuncture can greatly contribute to a rehabilitation protocol by promoting analgesia, tissue healing, and muscle strength. Acupuncture is safe, has minimal detrimental side effects, and is well tolerated by most horses.