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Background: Intravenous (IV) and intragastric (IG) administration of fluid therapy are commonly used in equine practice, but there are limited data on the systemic, renal, and enteric effects., Hypothesis: IV fluid administration will increase intestinal and fecal hydration in a rate-dependent manner after hypertonic dehydration, but will be associated with significant urinary water and electrolyte loss. Equivalent volumes of IG plain water will result in comparatively greater intestinal hydration with less renal loss., Animals: Six Thoroughbred geldings., Methods: Experimental study. 6 by 6 Latin square design investigating constant rate IV administration at 50, 100, and 150 mL/kg/d over 24 hours in horses dehydrated by water deprivation. Equivalent volumes of IG plain water were administered by 4 bolus doses over 24 hours., Results: Water deprivation resulted in a significant decrease in the percentage of fecal water, and increases in serum and urine osmolality. IV fluids administered at 100 and 150 mL/kg/d restored fecal hydration, but increasing the rate from 100 to 150 mL/kg/d did not confer any additional intestinal benefit, but did result in significantly greater urine production and sodium loss. Equivalent 24-hour volumes of plain water resulted in greater intestinal water and less urine output., Conclusions and Clinical Importance: IV polyionic isotonic fluids can be used to hydrate intestinal contents in situations where enteral fluids are impractical. IV fluids administered at three times maintenance are no more efficacious and might be associated with adverse physiological findings after withdrawal. Bolus dosing of IG water can be used to restore intestinal water with minimal adverse effects., (Copyright © 2013 by the American College of Veterinary Internal Medicine.)

Reasons for Performing Study: Stall housing has been suggested as a risk factor for ulcer development in the equine stomach; however, the exact pathogenesis for this has not been established., Objectives: To investigate the effect of 3 environmental situations (grass paddock, stall alone or stall with adjacent companion) on pH in the proximal and the ventral stomach., Methods: Six horses with permanently implanted gastric cannulae were used in a randomised, cross-over, block design. Each horse rotated through each of three 24 h environmental situations. Horses remained on their normal diet (grass hay ad libitum and grain b.i.d.) throughout the study. Intragastric pH was measured continuously for 72 h just inside the lower oesophageal sphincter (proximal stomach) and via a pH probe in the gastric cannula (ventral stomach)., Results: Neither proximal nor ventral 24 h gastric pH changed significantly between the 3 environmental situations. Mean hourly proximal gastric pH decreased significantly in the interval from 01.00-09.00 h compared to the interval from 13.00-20.00 h, regardless of environmental situation. Median hourly proximal pH only differed in the interval from 06.00-07.00 h compared to the interval 14.00-19.00 h. Neither mean nor median hourly ventral gastric pH varied significantly with the time of day., Conclusions: The change in housing status used in the current study did not affect acid exposure within either region of the equine stomach. The pH in the ventral stomach was uniformly stable throughout the study, while the proximal pH demonstrated a 24 h circadian pattern.

Equine gastrointestinal motility is a central issue in cases of equine colic, post operative convalescence and alimentary conditions encountered in practice. There are significant syndromes of intestinal dysmotility in the horse such as obstructive disorders and post operative ileus that are still poorly understood. This review describes the various areas of research that aim to elucidate the pathogenesis of intestinal hypo- or hypermotility by research methods, which include studies at the cellular level, and those that employ in vitro or in vivo techniques of evaluating the physiology and mechanical means of ingesta transit through the alimentary tract. The review discusses future directions for studies which will hopefully lead to better understanding and appropriate measures for diagnosis, therapy and prevention of ileus and other motility disorders.

Reasons for Performing Study: Commonly used analgesics (nonsteroidal anti-inflammatory agents, opioids and alpha2-agonists) have unwanted side effects. An effective alternative with minimal adverse effects would benefit clinical equine pain management., Objectives: To compare the effect of lidocaine or saline on duodenal and rectal distension threshold pressure and somatic thermal threshold in conscious mature horses., Hypothesis: Systemically administered lidocaine would increase somatic and visceral nociceptive thresholds., Methods: Lidocaine (2 mg/kg bwt bolus followed by 50 microg/kg bwt/min for 2 h) or saline was administered to 6 horses each carrying a permanently implanted gastric cannula, in a randomised, blinded cross-over design. Thermal threshold was measured using a probe containing a heater element placed over the withers which supplied heat until the horse responded. A barostatically controlled intraduodenal balloon was distended until a discomfort response was obtained. A rectal balloon was inflated until extruded or signs of discomfort noted., Results: Thermal threshold was increased significantly 30 and 90 mins after the start of lidocaine infusion. There was no change in duodenal distension pressure and a small but clinically insignificant change in colorectal distension pressure in the lidocaine group., Conclusions: At the dose used, systemically administered lidocaine produced thermal antinociception but minimal changes in visceral nociception., Potential Relevance: At these doses, lidocaine may play a role in somatic analgesia in horses.

Objective: To determine factors associated with development of postoperative ileus (POI) in horses undergoing surgery for colic., Design: Prospective case-control study., Animals: 251 horses undergoing colic surgery, of which 47 developed POI., Procedure: Signalment, history, clinicopathologic data, pre- and postoperative treatments, lesions, complications, costs, and outcome were recorded for all horses during hospitalization., Results: Variables associated with increased odds of POI included small intestinal lesion, high PCV, and increased duration of anesthesia. There was modest evidence that pelvic flexure enterotomy and intraoperative administration of lidocaine may have reduced the odds of developing POI., Conclusions and Clinical Relevance: Findings during the preoperative and intraoperative periods can be used to identify horses at increased risk of POI. Reducing surgical and anesthetic duration should decrease the incidence of POI.

The effect of corn oil (approximately 60% [wt/vol] linoleic acid) dietary supplementation on various components of equine gastric secretion was studied by use of a repeated-measures experimental design. Four healthy adult ponies were surgically fitted with gastric cannulas. The ponies were then fed a free-choice hay diet for 5 weeks, which was followed by 5 weeks of the same diet supplemented with 45 mL of corn oil daily. Gastric contents were analyzed under basal and pentagastrin-stimulated conditions once weekly during the latter 2 weeks on each diet. Gastric contents were collected at 30-minute intervals, and volume, hydrogen ion concentration, sodium content, and prostaglandin E2 (PGE2) content were measured. Data were analyzed by a linear fixed-effect modeling procedure. During the diet supplemented with corn oil, the ponies had, under basal and pentagastrin-stimulated conditions, significantly decreased acid output and significantly increased PGE2 and sodium outputs compared to those measured before corn oil supplementation. We conclude that corn oil supplementation may be an effective and inexpensive way to increase the protective properties of equine glandular gastric mucosa. This could be particularly helpful in reducing the chances of ulceration associated with nonsteroidal anti-inflammatory drug (NSAID) administration.

Reasons for Performing Study: Ulceration of the squamous gastric mucosa is commonly associated with intensive training programmes in horses, but only one compound ('Gastrogard') has been subjected to controlled scrutiny as to therapeutic efficacy., Objectives: To compare the gastric acid inhibitory efficacy of one manufactured ('GastroGard') and 3 generic pharmacy-compounded preparations of the proton pump inhibitor omeprazole (OME) in the mature horse., Hypothesis: All OME preparations tested would induce a clinically acceptable effect., Methods: Six healthy mature gastrically cannulated horses of various breeds, 3 mares and 3 geldings, were used. Each product was administered per os once daily (0730 h) at an equivalent dose of 4 mg OME/kg bwt, in a randomised complete repeated measures design for sequence of individual preparation treatment per horse. There was a minimum of 14 days between treatment regimens. A portable unit that recorded pH continuously was attached to a recording electrode fixed within the gastric lumen via the gastric cannula. Three 24 h recordings were made one day before and during Days 2 and 7 after commencement of a 7 day treatment with each of the 4 individual preparations. The horses were fed as usual throughout the study., Results: Only the GastroGard and one other preparation induced a significant increase over baseline in mean percentage of time that the pH was > 4.0 and mean median intragastric pH, during the first 14 and 12 h post treatment respectively, for both Days 2 and 7 post treatment. Both these products had a vehicle pH > 8.0, in contrast to the 2 less effective products, where the vehicle pH was < 6.0., Conclusions: OME at 4 mg/kg per os s.i.d. can effectively maintain intragastric pH at an accepted anti-ulcerogenic level for at least 12 h post administration in mature horses. In contrast to GastroGard, it should not be expected that all compounded preparations of OME are equally effective in achieving this performance. It appears that vehicle pH might play an important part in determining preparation efficacy., Potential Relevance: Optimal timing for daily dosing of athletic horses with an effective OME preparation, in order to suppress gastric squamous ulceration, might be 4-8 h prior to a training session.

Objective: To evaluate the reliability of a method for inducing colic via small intestinal distention in horses and to examine the analgesic potential of bilateral electroacupuncture (EAP) at the Guan-yuan-shu (similar to BL21) acupoint., Animals: 5 healthy adult horses, each with a gastric cannula., Procedure: A polyester balloon connected to an electronic barostat was introduced into the duodenum via the gastric cannula. At 2 specified intervals (before and after commencement of EAP), the balloon was inflated to a barostat-controlled pressure that induced signs of moderate colic. Each inflation was maintained for 10 minutes. Heart and respiratory rates were continuously recorded. Frequency of various clinical signs of colic was recorded by 2 trained observers during various combinations of balloon inflation and EAP. Each horse received each of 5 treatment protocols (EAP at 20 Hz, sham EAP at 20 Hz, EAP at 80: 120 Hz dense:disperse, sham EAP at 80: 120 Hz dense:disperse, no treatment). Sham EAP was at a point located 2 cm lateral to the Guan-yuan-shu acupoint., Results: Duodenal distention consistently induced a significant increase in frequency of signs of colic. None of the EAP protocols caused a significant reduction in frequency of these clinical signs during distention., Conclusions and Clinical Relevance: The method described is reproducible and highly controllable method for inducing colic that involved duodenal distention that should be useful in evaluating the efficacy of various analgesic strategies. Bilateral EAP at the Guan-yuan-shu acupoint was ineffective in reducing signs of discomfort induced by this method.

Objective: To characterize intragastric pH profiles in critically ill foals and determine whether administration of ranitidine altered pH profiles., Design: Prospective observational study., Animals: 23 hospitalized neonatal foals < or = 4 days of age., Procedure: Intragastric pH was measured continuously for up to 24 hours by use of an indwelling electrode and continuous data recording system. In 21 foals, ranitidine was administered IV., Results: 10 foals had predominantly or exclusively alkaline profiles, 10 had profiles typical of those reported for healthy foals, with periods of acidity (hourly mean pH < 5.0 at least once), and 3 had atypical profiles with periods of acidity. All 10 foals that had intragastric pH profiles typical of healthy foals survived, whereas only 2 foals with alkaline profiles survived, and none of the foals with atypical profiles survived. The effects of ranitidine administration could not be assessed in 13 foals because of a high baseline intragastric pH. In 7 of the remaining 9, ranitidine administration resulted in an alkalinizing response, but this response was often of blunted duration. Ranitidine administration did not appear to alter the intragastric pH profile in the remaining 2 foals., Conclusions and Clinical Relevance: Results suggested that hospitalized critically ill foals often have intragastric pH profiles different from those reported for healthy foals and may respond differently to ranitidine administration than do healthy foals. Many critically ill foals have continuously alkaline intragastric pH profiles, questioning the need for prophylactic administration of ranitidine in all critically ill foals.

Objective: To determine the origin of the nonacid (nonparietal) component of gastric secretions in horses induced by pentagastrin infusion., Animals: 6 horses., Procedure: A Latin square design was used, involving 6 horses, 3 treatments, and 2 duodenal intubation conditions (catheter with balloon to obstruct pylorus [B] or without balloon allowing movement of contents between stomach and duodenum [NB]). Each horse had an indwelling gastric cannula and a catheter positioned in the duodenum. Gastric and duodenal contents were collected during 15-minute periods. Each experiment consisted of serial collection periods: baseline; infusion of pyrilamine maleate (1 mg/kg of body weight, IV); not treated; and IV infusion of saline (0.9% NaCl) solution alone, saline solution containing pentagastrin (6 microg/kg x h), or saline solution containing histamine (30 microg/kg x h). Volume of samples was recorded, and electrolyte concentrations were measured., Results: Pentagastrin and histamine stimulated maximal acid output; however, during NB conditions, pentagastrin-induced concentration of hydrogen ions was significantly less than during histamine or pentagastrin infusions during B conditions. The large volume produced in response to pentagastrin during NB conditions was accompanied by increased sodium ion output that was greater than for pentagastrin during B conditions, but both values were significantly greater than values for histamine during B or NB conditions., Conclusions and Clinical Relevance: Nonparietal secretions collected during IV infusion of pentagastrin are duodenal in origin. Reflux of duodenal contents into the stomach of horses is enhanced by pentagastrin. Flow of duodenal contents into the stomach could have implications in the pathogenesis of ulcers in horses.

Ten horses were used in a crossover study to evaluate the effectiveness of eltenac against endotoxaemia. Eltenac (0.5 mg/kg bwt) or saline control was given i.v. then 15 min later, intravenous infusion of endotoxin was begun and continued for 120 min (total dose 100 ng/kg bwt). Horses were monitored for heart and respiratory rates, pulmonary and carotid arterial pressure and core body temperature. Blood was sampled at intervals for measurement of haematological variables and plasma concentrations of lactate, prostanoid metabolites, tumour necrosis factor (TNF) and stress hormones. In comparison with saline-treatment, use of eltenac significantly protected against endotoxin-induced changes in respiratory rate, core temperature, systemic arterial blood pressure (SAP), pulmonary arterial pressure, PCV, and plasma protein, 6-keto prostaglandin F1 alpha, thromboxane B2, epinephrine, and cortisol concentrations. Despite statistical effect of eltenac on SAP, values in both treatment groups remained well above baseline throughout the evaluation period. Significant protective effect of eltenac was not found for heart rate, white blood cell count, plasma lactate concentration or TNF activity. On the basis of these results, it is expected that use of eltenac will provide clinical benefit in horses with naturally occurring endotoxaemia.

A yearling Arabian filly was referred to the Veterinary Medical Teaching Hospital with a history of weight loss, profound anemia, and peritoneal effusion. At necropsy, a large, soft, mottled tan and red neoplastic mass was at the pelvic inlet replacing the left ovary. Additional tumor nodules of various sizes were disseminated throughout the mesentery, diaphragm, and serosal surfaces of the abdominal viscera. Histologically, the neoplasm had sheets of large round to polygonal cells separated into lobules by fibrous connective tissue with multifocal areas of necrosis. Tumor cells stained strongly for alkaline phosphatase. Immunohistochemically, tumor cells expressed vimentin and were negative for cytokeratin. Ultrastructurally, the neoplastic cells had a characteristic nucleolus with an elaborate reticular nucleolonema in an irregular configuration. This is the first in-depth detailed report of this very rare germ cell tumor of the ovary in horses.

To investigate the possibility that a disorder of potassium balance may have a role in the development of equine rhabdomyolysis, the potassium concentration within erythrocytes (RBC [K+]) and plasma (P [K+]) was measured in 3 groups of horses: group 1, eight 2-year-old fillies that had postexercise muscle soreness within 48 hours of sample collection; group 2, ten 2-year-old fillies subjected to identical management and training conditions (as fillies of group 1) and that did not have signs of myopathy; and group 3, 32 yearlings of both sexes on the farm of origin of groups 1 and 2 that were pastured and not in training. Creatine kinase activity in serum from horses of groups 1 and 2 was also measured. The mean P [K+] was not significantly different between groups, whereas the mean RBC [K+] was significantly (P less than 0.01) lower in group-1 fillies vs group-2 fillies and group-3 horses. Group-1 fillies also had markedly high serum creatine kinase activity. Results of the study revealed significantly lower RBC [K+] in horses that had had signs of myopathy within the preceding 48 hours. This does not prove a causal relationship between RBC potassium depletion and myopathy, but does suggest that decreased RBC [K+] may be observed in horses with exercise-related myopathy.

A 4-year-old stallion was examined because of a 2-month history of inappetance and weight loss. Diarrhoea had also developed a month before presentation. Abnormal clinical findings were emaciation, diarrhoea, ventral oedema, palpable mesenteric lymph node enlargement and a large mass in the left cranial portion of the abdomen. Significant laboratory findings were anaemia (packed cell volume 0.21 litres/litre), hypoalbuminaemia (16 g/litre) and xylose malabsorption. The horse was euthanased and at necropsy a 10.5 kg pendunculated mass composed of granulation tissue was found within and attached to the stomach. There was villous atrophy diffusely throughout the small intestine. The inciting cause of the gastric mass was not determined.

The concentrations of acetate (C2), propionate (C3), isobutyrate (iC4), butyrate (nC4), isovalerate (iC5), and valerate (nC5) were measured in the feces of 16 clinically normal horses and 44 horses with chronic diarrhea of at least 1-month's duration. The diarrheal horses were categorized diagnostically as: (1) no discernible clinical abnormalities other than diarrhea and in some cases, weight loss (open); (2) clinical evidence of strongyle larval migrans; and (3) Salmonella organisms recovered from the feces. Osmolarity of the feces of 14 of the normal and 15 of the sick horses also was measured. The mean concentration of C2 was significantly less (P < 0.05) in feces from horses of all diagnostic categories, whereas there was a significantly increased isobutyrate concentration (P < 0.01) in feces from horses in the open category. When individual volatile fatty acids (VFA) were expressed as percentage of total, only isobutyrate in feces from horses in the open category was significantly different (P < 0.01) from normal and was increased. Some horses were monitored sequentially for a number of weeks. Fecal VFA concentrations showed considerable variability, and a transient decrease of isobutyrate concentration was not necessarily coincidental with cessation of diarrhea. Horses responding to empirical therapy had a more stable reestablishment of a normal fecal VFA distribution. Correlation between total fecal VFA concentration and osmolarity was significant (P < 0.05) for diarrheal horses, but was not significant for normal horses.

Feces from 13 healthy horses and 8 horses with chronic diarrhea were subjected to an in vetro fermentation procedure that had been developed for rumen fluid. Fermentations were conducted over 6 hours in a closed system, with and without an essential amino acid (EAA) mixture being added to the basic starch-buffer medium. The addition of EAA caused no significant difference in results of fermentation of feces from healthy horses. For diarrheic animals, there was a significant (P less than 0.01) increase in gas and total volatile fatty acids production whether EAA were present or not, and alpha-amino nitrogen was utilized in significantly (P less than 0.01) greater amounts only if EAA was present. Fermentations were repeated on feces from five of the eight diarrheal horses after they had been treated with oral iodochlorhydroxyquin for 1 week, and had shown desirable clinical response. A significant difference was not shown between pre- and posttreatment fermentations, except for decreased butyrate production. The results are consistent with the hypothesis that chronic equine diarrhea is primarily a colonic disease and indicates that colonic maldigestion may, in part, be responsible for excess fecal water.

The D-xylose absorption test was applied to clinically normal horses and to horses with signs of gastrointestinal disease. A dosage of 0.5 grams of xylose per kilogram of bodyweight was useful in detecting horses that absorbed the pentose abnormally. The clinical findings were correlated with gross and microscopic findings by biopsy and at necropsy. Gastrointestinal lesions associated with abnormal xylose absorption were classified as: 1) villous atrophy; 2) edema of the lamina propria or 3) necrosis of the lamina propria.

Granulomatous enteritis was diagnosed in 9 horses between 1 and 11 years of age. The complaint in all cases was persistent weight loss. Four of the horses had chronic diarrhea. Two consistent diagnostic features were hypoalbuminemia and decreased phagocytic activity of mesothelial cells in the peritoneal fluid. In 2 cases the diagnosis was confirmed by biopsy of the rectal mucosa. Remaining cases were definitively diagnosed by exploratory laparotomy and biopsy or at necropsy.

Five clinically normal, mature horses and 11 with chronic diarrhea were given 51Cr-tagged Cohn fraction V equine albumin intravenously. All urine and feces were collected separately, and blood for plasma analysis was taken periodically for 5 to 8 days after injection of the isotope. Plasma clearance of albumin into the intestinal tract of normal horses was calculated as 0.67 +/- 0.23 (SD) ml/kg of body weight/day, with 1.33 +/- 0.69% of the 51Cr dose appearing in the feces in 5 days. Of the 11 diarrheal horses, 8 had a plasma clearance of 0.49 +/- 0.21 ml/kg/day with 1.12 +/- 0.68% of the dose of 51Cr in a 5-day fecal collection, suggesting that excessive losses of plasma protein into the bowel was not a component of their intestinal disease. The 3 other diarrheal horses had a marked protein-losing enteropathy; 1 of these horses had granulomatous enteritis due to Mycobacterium avium infection; another had severe intercellular edema of small and large intestinal mucosa, cause unknown; and intestinal biopsies were not obtained from the 3rd horse. The results suggest that: (1) as with other species that have been studied, daily loss of plasma protein into the bowel of horses is small; (2) most horses with chronic diarrhea do not have protein-losing enteropathy.

The clinical, bacteriologic and pathologic findings of three adult horses suffering from avian tuberculosis are presented. Chronic weight loss and hypoproteinemia were pertinent clinical abnormalities in all three horses. Gross pathologic lesions were characterized by chronic enterocolitis with mesenteric lymphadenopathy in two horses and hepatic granulomas in the third horse. The microscopic diagnoses were chronic, non-caseating granulomatous enterocolitis, and necrotizing, non-mineralizing granulomatous hepatitis, respectively. All three horses had granulomatous lymphadenitis of mesenteric lymph nodes with varying degrees of non-mineralizing, coagulation necrosis. Various serotypes of the Mycobacterium avium-intracellulare complex were isolated from selected tissues and feces.

Pertinent questions regarding the history of a horse with diarrhoea are listed, as are diagnostic procedures that might be included in a complete clinical work-up. For purposes of discussion, diarrhoea is regarded as "acute" or "chronic" wherein the former concerns cases where the features of the disease are severe with progressive electrolyte imbalance, dehydration, toxaemia, or other life-threatening manifestations and the latter refers to cases that have been prolonged for a month or more. Patterns of disease, including results of diagnostic techniques, are stressed. In the "acute" category, salmonellosis, haemorrhagic and oedematous colon (Colitis X), acute peritonitis, and Corynebacterium equi infection are discussed in some detail. In the "chronic" group, strongyle larval migrans, granulomatous enteritis, chronic liver disease, Corynebacterium equi infection and chronic salmonellosis are emphasized.

Gastroenterostomy was performed in 14 foals to treat gastric outflow obstruction caused by advanced gastroduodenal ulcer disease. The onset of excessive salivation and teeth grinding, without response to medical treatment, combined with endoscopic and radiographic evidence of gastric outflow obstruction, were indications for surgical intervention. Successful outcome in 5 foals was attributed to early diagnosis, patient stabilization, early surgical correction, and postoperative management including antibiotics and antiulcer medication.

Developmental changes of the gastrointestinal tract were probably responsible for the changes in faecal composition during the first week of the foals' life, which resembled small intestinal ingesta of adult horses, suggesting a minimal colonic modification. Faecal composition at the time of foal heat diarrhoea was suggestive of a secretory-type diarrhoea, in that the electrolyte concentration accounted for most of faecal osmolality and the faecal pH was alkaline. After foal heat diarrhoea faecal composition slowly approached that of adult horses. These data suggest that foal heat diarrhoea is most likely caused by hypersecretion in the small intestinal mucosa, which may overwhelm an immature colon that is unable to compensate by increased fluid and electrolyte absorption.

A base-line study of bacteria isolated from horses admitted to the Veterinary Medical Teaching Hospital during a 6-month period was performed to determine the extent of multiresistant nosocomial infections caused by gram-negative aerobic bacteria other than Salmonella spp. Results of this study indicated that 21.9% of the 105 horses from which cultures and sensitivities were available had developed nosocomial gram-negative aerobic infections, with high rates of resistance to gentamicin, kanamycin, and trimethoprim sulfadiazine, three of the most often prescribed antibiotics in this hospital. In addition, a prospective study of antibiotic-resistant bacteria of fecal origin was performed to determine whether there was a change in the degree of antibiotic resistance of a horse's intestinal flora while the horse was hospitalized. Bacterial culturing for gram-negative lactose fermenting bacteria was done on fecal specimens collected directly from the rectum on day 1 and day 7 of a horse's hospitalization. Susceptibility testing was done on each isolant. Of the 24 paired fecal specimens obtained, Escherichia coli and Klebsiella sp isolated on day 7 were resistant to a significantly higher number of antibiotics than day 1 isolants (P = 0.003, P = 0.043, respectively).