Evaluation of Fecal Sand Clearance in Horses With Naturally Acquired Colonic Sand Accumulation With a Product Containing Probiotics,Prebiotics, and Psyllium

Consumption of sand and dirt in horses can cause chronic diarrhea and colic because of irritation and obstruction of the gastrointestinal tract of horses. Prevention has primarily focused on changes in management to reduce the intake of sand and feeding of psyllium products. The purpose of this study was to evaluate the efficacy of a product containing probiotics, prebiotics, and psyllium in the clearance of colonic sand in horses with naturally acquired sand accumulation using a randomized, placebo-controlled, blinded clinical trial format. After identification of 10 horses with sand accumulation as determined by both auscultation and abdominal radiography, quantitative assessment of changes in colonic sand content in response to management changes combined with treatment with the probiotic/psyllium product or no treatment was assessed by blinded observers. Fecal sand output was monitored in both groups via sand sedimentation analysis of fecal samples every 3 days for 35 days and with pre- and post-treatment abdominal radiography. There was a significant reduction in sand accumulation in both treatment and control groups, but there were no significant differences between treatment and control groups in clearance of colonic sand as measured by both fecal sand sedimentation and quantitative radiography.     

Radiographic parameters for diagnosing sand colic in horses

Background

Ingestion of sand can cause colic, diarrhoea and weight loss in horses, but these signs are unspecific and can have many other causes. The amount of sand that induces disease may vary between individuals. To avoid over-diagnosing, it is important to determine the amount of sand that can be found in horses without clinical signs of gastrointestinal disease. The aim of this study was to use previously suggested parameters for establishing a radiographic diagnosis of sand colic, and compare these findings between a sand colic group and a control group.

Methods

Abdominal radiographs were obtained in 30 horses with a complaint unrelated to the gastrointestinal tract. In addition, archived abdominal radiographs of 37 clinical cases diagnosed with sand impaction were investigated. The size of the mineral opacity indicative of sand in the abdomen was measured and graded according to a previously published protocol based on height and length. Location, homogeneity, opacity and number of sand accumulations were also recorded.

Results

Twenty out of 30 control horses (66%) had one or more sand accumulations. In the present study; height, length and homogeneity of the accumulations were useful parameters for establishing a diagnosis of sand colic. Radiographically defined intestinal sand accumulation grades of up to 2 was a common finding in horses with no clinical signs from the gastrointestinal tract whereas most of the clinical cases had much larger grades, indicating larger sand accumulations.

Conclusion

Further work to establish a reliable grading system for intestinal sand content is warranted, but a previously proposed grading system based on measurements of height and length may be an alternative for easy assessment of sand accumulations in the meantime. The present study indicates that a grade 1 – 2 sand accumulation in the intestine is a frequent finding in horses. When working up a case with clinical signs from the gastrointestinal tract, one or more accumulations of this grade should not be considered the cause until other possibilities have been ruled out.     

Surgical treatment of sand colic in equids: 48 cases (1978-1985)

Medical records of 48 equids (47 horses, 1 pony) with surgical sand colic were reviewed. The diagnosis of sand colic was made if a sand impaction(s) was palpated during exploratory abdominal surgery or if a large quantity of sand was found during colotomy. Most equids did not experience a previous episode of sand diarrhea or sand colic. Clinical findings and results of clinicopathologic determinations were not diagnostic. Rectal palpation findings in 40 of 46 horses were compatible with large-colon and/or cecal distention. Impactions were palpable per rectum in only 7 horses, but emergency abdominal surgery revealed one or more impactions in 46 of 48 equids. Single impaction most commonly was observed at the pelvic flexure. Twenty-six horses had concurrent large-colon torsion or displacement. Pelvic flexure colotomy was performed in 44 horses. Of 48 equids, 44 survived and were discharged.     

INTEROBSERVER AGREEMENT ON THE ASSESSABILITY OF STANDARD VENTRODORSAL HIP-EXTENDED RADIOGRAPHS AND ITS EFFECT ON AGREEMENT IN THE DIAGNOSIS OF CANINE HIP DYSPLASIA AND ON ROUTINE FCI SCORING

Insufficient agreement on scoring hip quality might be caused by differences in the assessability of a radiograph (exposure, contrast, positioning, and diagnostic quality). We studied the agreement in assessability of standard ventrodorsal hip-extended radiographs by experienced (nine) and inexperienced (21) observers, using the standard subjective method of quality control, currently applied in screening programs. The effect of assessability on the agreement of scoring hip quality [dysplastic vs. nondysplastic and the final Federation Cinologique International (FCI) score] was also investigated. There was a significant difference ( P <0.0001) in agreement on assessability between the experienced and inexperienced observers. In 68% of evaluations, experienced observers stated that the radiograph was assessable. Inexperienced observers evaluated the radiographs as being assessable in only 46.5% of evaluations. Increased interobserver agreement on assessability of a radiograph did not increase the overall interobserver agreement in the diagnosis of hip dysplasia, nor did it result in consistent scoring of the hip status from that radiograph, despite a significant ( P <0.05) increase in agreement of FCI scoring with an increasing agreement on assessability at a one to five ratio in the experienced group. The inconsistent evaluation of radiographic quality, as well as the inconsistent evaluation of the hip quality, caused differences in diagnosing hip dysplasia and FCI scoring in the same dog ranging from excellent hips to moderate hip dysplasia. Therefore, the credibility of the FCI screening method for canine hip dysplasia, using the standard hip-extended radiographic view, as currently applied in most European countries, is questionable.     

Radiographic scoring lacks predictive value in inflammatory airway disease

REASONS FOR PERFORMING STUDY: Diagnosis of inflammatory airway disease (IAD) currently rests upon the results of bronchoalveolar lavage (BAL) cytology, lung function testing and histamine bronchoprovocation (HBP), none of which provides direct information about structural change in the lung. HYPOTHESIS: That thoracic radiography might better portray structural change in the lungs and therefore offer a good clinical assessment of IAD. METHODS: A radiographic scoring system was developed to assess the extent of bronchial and interstitial pattern on thoracic radiographs in the dorsocaudal, dorsocranial and caudoventral regions in 16 control horses and 33 horses with IAD. Mean scores were compared to ascertain whether thoracic radiographs could distinguish between the 2 groups. In order to determine whether independent observers reliably scored radiographs similarly, an inter-rater reliability score was employed for each radiographic observation. Correlations between radiographic scores, BAL cytology, lung function testing using the forced oscillatory technique and HBP were examined. RESULTS: Inter-rater reliability was only moderate. Radiographic scoring demonstrated no differences between the 2 groups. There were no correlations among BAL cytology, lung function testing, HBP and radiographic scores. CONCLUSIONS AND POTENTIAL RELEVANCE: Thoracic radiographs are a low-yield diagnostic modality in horses with a clinical history compatible with IAD. In the absence of clinical evidence of more extensive, infectious disease, thoracic radiographs neither refine nor improve diagnosis of IAD, but increase diagnostic costs.     

Alternative diagnoses in the colic patient

Despite clinical signs compatible with obstruction or ischemia of the gastrointestinal tract, the clinician occasionally is unable to identify a gastrointestinal cause for colic. In this article, disorders not originating from obstruction or ischemia of the gastrointestinal tract but causing real or apparent abdominal pain are presented as alternative causes of colic. In addition, colic of gastrointestinal origin may be the primary inciting factor or a secondary complication of an alternative disorder, causing colic-like signs. Recognition of alternative diagnoses relies on a thorough and consistent approach to the clinical assessment of the equine colic patient and helps to ensure appropriate patient management.     

RADIOGRAPHIC DIAGNOSIS OF GASTROINTESTINAL DISORDERS IN THE FOAL

Abdominal discomfort in the foal presents a diagnostic challenge, because the small size of the foal precludes rectal palpation. Standing lateral horizontal beam abdominal radiographs using conventional techniques were evaluated as a diagnostic aid to identify the presence and location of gastrointestinal disorders in foals presented with colic. Forty foals were radiographed prior to surgery (20 foals), necropsy (7 foals), or clinical diagnosis (13 foals). Clinical, surgical, or necropsy findings were then correlated to radiographic findings. Gastrointestinal disease was accurately identified on radiographs as the source of colic in 25 of 26 foals that had surgical or postmortem confirmation. The site of disease, whether gastric, small intestinal, large intestinal, or a combination, was accurately determined from radiographs. Standing lateral abdominal radiographs were determined to be a valuable diagnostic aid in the foal presented with colic.     

Surgical management of sand colic impactions in horses: a retrospective study of 41 cases

OBJECTIVE: A retrospective review of the medical records of 41 horses requiring abdominal surgery for sand colic. RESULTS: The diagnosis of sand colic was made when sand was found to be the cause of impaction of the gastrointestinal tract during surgical exploration. The most common clinical signs at presentation were abdominal pain, abdominal distension and diarrhoea. A statistically significant association was found between the respiratory rate on arrival and short-term survival. Sand impaction at multiple locations was detected in one-third of the horses. Concurrent pathology was detected in half of the horses. Four horses were euthanased during surgery; of those that recovered from surgery, 35/37 (95%) were discharged from hospital. Short- and long-term complications were similar to those previously reported. Long-term (1 year) survival of the horses discharged was 100%. CONCLUSION: The good prognosis for horses undergoing surgery for the treatment of sand impaction supports early surgical intervention in cases where large amounts of sand are suspected.     

Interobserver agreement in the diagnosis of canine hip dysplasia using the standard ventrodorsal hip-extended radiographic method

OBJECTIVES: To determine the agreement between observers and to investigate the effect of observer experience in diagnosing canine hip dysplasia and providing final scoring of hips using the standard ventrodorsal hip-extended radiographic method. The agreement of the final scoring, with a presumed correct assessment based on the Norberg angle, is also investigated. METHODS: Thirty observers were requested to read 50 ventrodorsal hip-extended radiographs of 25 dogs according to Federation Cynologique International criteria. Groups of experienced (nine members) and inexperienced (21 members) observers were used. RESULTS: For providing the distinction between dysplastic versus non-dysplastic dogs, the average interobserver agreement was 72 per cent and was significantly higher (P<0.0001) than the score that could be expected by chance without any agreement between observers. For providing the final score (A, B, C, D or E), an average interobserver agreement of 43.6 per cent was found. In the experienced group, an agreement score of 76 per cent was found for the distinction between AB versus non-AB and an agreement score of 81 per cent was found for the distinction between C versus non-C. The agreement score was significantly higher (P<0.0001) for the experienced group than for the inexperienced group in all cases. Agreement between the presumed correct assessment based on the Norberg angle and the observer's evaluation was low (P=0.35), irrespective of whether the observers were experienced (71.8 per cent correct assessments) or inexperienced (69 per cent correct assessments). CLINICAL SIGNIFICANCE: Although interobserver agreement is low, observer experience increases agreement.     

THE EFFECT OF A TECHNICAL QUALITY ASSESSMENT OF HIP‐EXTENDED RADIOGRAPHS ON INTEROBSERVER AGREEMENT IN THE DIAGNOSIS OF CANINE HIP DYSPLASIA

Experienced and inexperienced observers evaluated the assessability of 50 radiographs (25 dogs) and determined the hip status (dysplasia/nondysplasia and final scoring according Fédération Cynologique Internationale [FCI]‐criteria) individually. A radiographic technical quality assessment was performed in a separate reading session. Interobserver agreement in determining dysplasia/nondysplasia and FCI‐scoring did not significantly increase with the increasing quality of a radiograph, irrespective whether these observers are experienced or not. There was a significant agreement between the technical quality assessment and assessability (P<0.0005). Despite the effort to objectify radiographic quality and to present high‐quality radiographs to observers, interobserver agreement on dysplasia/nondysplasia and final scoring, remains low, even in the experienced group. Although increased radiographic quality narrows the range of scoring, the range remains unacceptably high.     

Assessment of survey radiography as a method for diagnosis of congenital cardiac disease in dogs.

In order to assess the diagnostic accuracy of survey radiography for canine congenital cardiac anomalies, thoracic radiographs of 57 dogs with congenital cardiac anomalies, 31 normal dogs and 27 dogs with acquired cardiac disease were mixed, and reviewed by two independent observers, who were blinded to any patient information. The congenital anomalies were aortic stenosis (n=25), pulmonic stenosis (n=10), patent ductus arteriosus (n=9), ventricular septal defect (n=8), tricuspid dysplasia (n=3) and mitral dysplasia (n=2). Both observers were moderately accurate at identifying dogs with cardiac disease. Their ability to distinguish dogs with congenital versus acquired cardiac disease was poorer and this assessment was probably influenced by the recognition of patients that were skeletally immature, which biased observers towards a diagnosis of congenital cardiac anomaly. The diagnosis rate for specific congenital anomalies was also poor (the differential list included a correct diagnosis in only 40 and 37 per cent of cases). Radiographic signs of specific cardiac chamber enlargement or pulmonary vascular abnormalities were recognised by both observers in only 20 per cent of instances in which they might be expected. They were, however, recognised more frequently in dogs with anomalies that imposed a volume load on the heart than in dogs with anomalies that induced a pressure load on the organ. It is concluded that survey radiography is an inaccurate method for diagnosis of canine congenital cardiac anomalies because of the difficulty of recognising radiographic signs, which are not present in many cases.     

Equine colic: clinical epidemiology and associated risk factors in and around Debre Zeit

A prospective study was conducted to describe clinical epidemiology of equine colic in the Society for Protection of Animal Abroad and Donkey Sanctuary Project Clinic, at Debre Zeit, Ethiopia, from November 2014 to April 2015. The objectives were to describe clinical epidemiology of equine colic, to characterize the main types of equine colic, and to determine the major risk factors associated with equine colic. The method which was used in the study was attending clinical case of equine and assessing physiological parameters, fecal egg count, abdominal sounds, and rectal examination as well as questioner interviewing of the owners. The data were collected and analyzed using Statistical Package for Social Science. The incidence of colic was 10.3% in the study period. Colicky were typed as unknown, flatulent, impaction, spasmodic, and enterolithiasis. The proportion of case incidence were 63.1 (41/65), 33.8 (22/65), and 3.1% (2/65), in donkey, horse, and mule, respectively. The total mean (±SD) of temperature 37.80 ± 1.003, heart rate 57.54 ± 10.098, fecal egg count 236.922 ± 67.990, respiratory rate 30.92 ± 7.315, and packed cell volume 41.40 ± 10.221 were recorded. The case fatality rate of equine colic was 15.38% (10/65). There were statistically highly significant (p < 0.01) differences in impaction colic in relation to species. Interview with 183 equine owners revealed incidence of equine colic as the sixth major disease condition affecting equine. A long-term epidemiological study of the true representative population should be carried out to determine the incidence rate and associated risk factors of equine colic in the study area.     

ACCURACY OF SURVEY RADIOGRAPHIC DIAGNOSIS OF INTERVERTEBRAL DISC PROTRUSION IN DOGS

To assess the diagnostic accuracy of survey radiography for canine thoracolumbar intervertebral disc protrusion, survey radiographs (lateral and ventrodorsal) of 64 dogs with surgically-confirmed thoracolumbar intervertebral disc protrusion, 51 dogs with negative myelograms and 29 dogs with various spinal conditions other than disc protrusion were reviewed by three independent observers who were unaware of any clinical information. There were marked differences in observer performance for diagnosis of intervertebral disc protrusion, although there were no significant differences in intraobserver diagnostic accuracy for small vs. large dogs. Accuracy of observers for determining sites of intervertebral disc protrusion using survey radiography was in the range 51-61%. All observers had low accuracy for identification of second sites of intervertebral disc protrusion. The most useful radiographic sign, narrowed intervertebral space, had only moderate sensitivity (range 64-69%) and moderate predictive value (range 63-71%) for intervertebral disc protrusion. Vacuum phenomenon was an infrequent but accurate sign of intervertebral disc protrusion. Recognition of multiple radiographic signs of intervertebral disc protrusion at one site was associated with increased accuracy of diagnosis. No observer was accurate enough to justify attempting targeted surgical treatment of intervertebral disc protrusion without myelography.     

Abdominal abscess involving a metallic foreign body removed via thoracotomy in a horse

Reports of alimentary tract foreign bodies have been rarely reported in the equine literature. This Case Report concerns a mare who presented persistent fever and mild signs of colic. A metallic foreign body was found near to the diaphragm on radiographic and ultrasonographic examinations. A thoracotomy was subsequently performed by means of a 7th rib resection and a diaphragmatic incision made in order to remove the intra‐abdominal abscess containing a metallic foreign body. Peritonitis was the major complication and was managed during hospitalisation by multiple lavage‐drainage procedure of the abdominal cavity. Long‐term outcome (3 years) was good.     

COMPARISON OF VISUAL ANALOG AND NUMERIC SCORING SCALES FOR ASSESSING INTRAOPERATIVE MESENTERIC PORTOVENOGRAPHY

A visual analog scale and a numeric scoring scale were designed for the assessment of dynamic intraoperative mesenteric portovenography in the dog and cat. Two independent observers evaluated both scoring scales for reproducibility (differences between observers) and repeatability (within-observer differences) in the assessment of 60 trial portovenograms. Agreement (interchangeability) of both scales was evaluated by comparing the scores obtained in the assessment of 200 portovenograms obtained from 100 dogs and cats. There was no statistical difference between the two observers when scoring the same portovenogram for either the visual analog scale (p = .730, reproducibility coefficient = 17.85 units) or the numeric scoring scale (scores identical, reproducibility coefficient = 0). There was no statistical difference, for either of the observers, when the same portovenogram was assessed on two separate occasions using the visual analog scale (observer 1, p = .35, repeatability coefficient = 17.93 units; observer 2, p = .42, repeatability coefficient = 8.27 units) or the numeric scoring scale (scores given by both observers were identical, repeatability coefficient = 0 for both observers). The results of comparison between the visual analog scale and numeric scoring scale confirmed that the two scoring systems were not directly interchangeable. Although both scoring systems demonstrated good reproducibility and repeatability, the numeric scoring scale possessed a number of inherent deficiencies that suggested it was not the method of choice for the assessment of the subjective data obtained from dynamic intraoperative mesenteric portovenography.     

Comparison between radiography and computed tomography for diagnosis of equine skull fractures

The equine head is a complex structure prone to traumatic injuries. To determine the value and limitations of radiography and (CT) for the diagnosis of skull fracture, the differences between the two modalities were described. Two observers retrospectively reviewed the radiographic and CT images of 18 horses with a skull fracture. To allow direct comparison between the two modalities, a simplified fracture classification system was used. In 3/18 cases the evaluation of the radiographic examination concluded no injuries visible. In 2/15 cases soft tissue involvement was not detected and in 7/15 cases the extension of the fracture was underestimated with radiography. Radiography classified 4/10 multiple fractures incorrectly as single fracture and 5/15 comminuted fractures on CT were diagnosed as simple fracture with radiography. The number of fragments was underestimated with radiography in 14/15 cases. In conclusion, radiography is able to diagnose a skull fracture in most cases. Skull fractures however are not similarly classified after radiographic and CT evaluation, which causes a difference in interpretation and perception of the fractures. Therefore, CT should be the modality of choice for surgical planning and prognosis.     

Causes of gastrointestinal colic in horses in western Canada: 604 cases (1992 to 2002)

The medical records of equine gastrointestinal colic cases presented to the Western College of Veterinary Medicine between 1992 and 2002 are reviewed. There was no breed predisposition to colic. Geldings were more prone to colic than females and stallions. Overall, the 3 most common causes of colic were large colon impaction (20.8%), large colon displacement (16.5%), and spasmodic colic (11.7%), after excluding the 13% of cases in which the diagnosis was undetermined. Of the medical cases, large colon impaction (38.4%) and spasmodic colic (22.5%) were the most common. Of the surgical cases, large colon displacement (24.5%), large colon torsion (14.3%), and strangulating lipoma (13.5%) were the most common. Recovery rate for the medical cases was 93.6%. Recovery rate for surgical cases was 73.5%. In conclusion, most of the equine colic cases were medical, and the recovery rates for both surgical and medical cases were comparable with those of other studies.     

Prevalence of Gastric Ulcerations in Horses with Colic

The goal of this study was to determine the prevalence of gastric ulcers in horses with acute abdominal crisis (colic) and to examine the temporal effect of hospitalization on ulcer development in equine patients treated for colic. In addition, other factors that may be associated with gastric ulceration were also explored. The study design was a prospective original study incorporating 169 horses that presented to the George D. Widener Hospital for examination. One hundred and twelve horses presenting with the chief complaint of colic were included in the study group, and 57 horses that presented for non-colic or nonemergency complaints were evaluated and included as case controls. Gastroscopy was performed on equine patients presenting with the chief complaint of colic or horses presenting for reasons other than colic (control); mucosal changes were scored 0 to 3. Additionally, horses presenting for colic were gastroscopically evaluated twice during a 5-day period. Medical records were reviewed for history, clinical findings, laboratory results, and treatment. Seventy-six of 112 horses presenting with the chief complaint of colic had gastric ulceration compared with 41 of 57 horses in the control group. There was a significant association between age of the patient and chief complaint (ie, colic vs control) and between breed and chief complaint. There was no association between gastric ulcer score and chief complaint (colic vs control). Thirty-eight of the 112 horses presenting with colic deteriorated in ulcer score while hospitalized. Using a Pearson chi-squared test, there was no statistically significant association between gastric ulceration with age, breed, or sex. Horses with gastric ulceration in the colic group had lower packed cell volumes compared with horses presenting with colic without gastric ulcers, and this was statistically significant (P < .001). The high incidence of gastric ulceration in the study and control groups supports the reports of other investigators that gastric ulcers in horses, no matter the presenting complaint, are widespread. There was a significant association between breed and chief complaint (P = .005); however, breed and outcome of gastric ulceration were not related (Thoroughbreds were the least likely breed to present for colic). Although a trend in increasing gastric ulceration was seen in hospitalized colic patients, it was not statistically significant. This suggests that horses that are hospitalized may be at increased risk for developing gastric ulcers because of stress, feed deprivation, and administration of treatment. Thus, horses that present for colic should be gastroscopically evaluated if clinical signs raise the index of suspicion for gastric ulceration.     

Demographics and costs of colic in Swedish horses

BACKGROUND: Colic is an important cause of morbidity and mortality in horses. In Sweden, an insurance database with diagnostic medical information is maintained on >30% of the nation's horse population. HYPOTHESIS: The objective was to describe the occurrence of colic, defined by costly veterinary care and life claims, in horses at 1 insurance company during 1997-2002. HORSES: All horses (<21 years of age) with complete insurance for veterinary care and life during the period 1997-2002 were included. METHODS: Colic was defined as conditions where the main clinical sign was abdominal pain and the problem was related to the gastrointestinal system. The analyses included measures of incidence by sex, breed group, age categories, geographical location (urban/other), survival to and survival after colic, medical cost for colic, and multivariable modeling of risk factors related to the event of colic. RESULTS: In all, 116,288 horses contributed to 341,564 horse years at risk (HYAR). There were 3,100 horses with a colic diagnosis, of which 27% were settled for life insurance. The median gross cost for veterinary care was 4,729 Swedish Kronor (SEK). The overall occurrence and mortality rate of colic was 91 and 24 events per 10,000 HYAR. Survival after colic at 1 month was 76% (95% confidence interval: 75-78%). CONCLUSIONS AND CLINICAL IMPORTANCE: The occurrence of colic varied with breed group, age, and season. The mortality rates probably reflected the true mortality of colic. The veterinary care rates most likely underestimated of the risk colic because they represent relatively costly events.