Alteration in intestinal morphologic features associated with extensive large-colon resection in horses

Light microscopy, morphometry, and scanning electron microscopy were used to examine the mucosal morphologic features of 7 intestinal specimens (3 from the small intestine; 4 from the large intestine) from each of 8 horses 1 year after sham operation (group 1; n = 3) or extensive large-colon resection (group 2; n = 5). Qualitative light microscopic examination did not reveal differences between groups, but morphometry revealed significantly (P less than 0.05) greater intercrypt area and distance in horses with colon resection and this was most pronounced in the cecum and remaining right ventral and dorsal colon. Crypt area and depth were similar for horses with colon resection and sham operation (P greater than 0.05). Qualitative evaluation of the scanning electron micrographs revealed more prominent crypt orifices in the large intestine of horses with colon resection. The larger intercrypt distance in the colon of horses with resection was not an obvious feature of the qualitative evaluation of the surface with scanning electron microscopy. Small intestinal morphologic features were variable and significant differences were not detected between horses with sham operation and colon resection. Horses adapted to extensive large-colon resection within 1 year by increasing the absorptive (intercrypt) surface area of the remaining large intestine.     

Large intestinal capacity, retention times, and turnover rates of particulate ingesta associated with extensive large-colon resection in horses

Fecal excretion of a particulate marker, ytterbium (Yb), was evaluated in 9 horses before surgery and 3 weeks, 3 months, and 6 months (4 trials) after sham-operation (group 1; n = 3) or extensive large colon resection (group 2; n = 6). Fecal excretion curves of total Yb excretion, loge Yb excretion, % Yb excretion, loge % Yb excretion, and cumulative % Yb excretion were evaluated, and kinetic analysis was performed on the loge Yb excretion curves to detect mixing pools and to calculate the fractional rate of particulate passage, turnover rate, and pool size. Calculations were performed to determined transit time, mean overall retention time, adjusted mean retention time, peak time, and disappearance time. Values were statistically analyzed to determine differences between groups and among trials (P less than 0.05). Group-2 horses had significantly shorter transit, peak, and mean overall retention times, compared with preoperative values and with values for group-1 horses. Two mixing pools were identified: a slower emptying pool of 5.7% hour-1 (k1) and a faster emptying pool of 12.3% hour-1 (k2). The rate of passage from the first pool (k1) was not altered by colon resection, and was interpreted as being most influenced by the cecum. In further support of this interpretation, the capacity of the k1 pool approximated the capacity of the cecum (17 L). The capacity of the k1 pool significantly expanded by 6 months in the resected horses. the rate of passage from the second pool (k2) significantly increased initially after colon resection (3 weeks and 3 months), but returned to preoperative values by 6 months.(ABSTRACT TRUNCATED AT 250 WORDS)     

Fiber digestion and voluntary intake in horses after adaptation to extensive large-colon resection

Each of 3 digestion trials (3 forage diets) was performed on 2 groups of horses 6 to 12 months after sham operation (group 1; n = 3) or large-colon resection (group 2; n = 5). Diets were alfalfa pellets, alfalfa hay, and grass hay. Feed and fecal analyses were performed to determine apparent digestion of dry matter, organic matter, and crude protein and true digestion of dry matter, organic matter, crude protein, total plant cell wall, hemicellulose, cellulose, and lignin. Additional fecal and metabolic variables determined were percentage of fecal water, total fecal water, metabolic organic matter, metabolic crude protein, and metabolic nitrogen. Large-colon resection decreased the digestion of plant cell wall because of decreased digestion of cellulose in alfalfa pellet and grass hay diets, but not in alfalfa hay diet. Insufficient digestible energy and/or protein from grass hay was obtained by horses with colon resection, and significant (P less than 0.05) weight loss was observed. Voluntary intake was significantly (P less than 0.05) increased by horses with colon resection. Of the diets studied, alfalfa hay was the most appropriate forage diet, compared with average grass hay and alfalfa pellet diet, for horses after extensive large-colon resection. Additionally, horses with colon resection may have higher levels of feed intake than do horses without colon resection.     

Hepatic and pulmonary enzyme activities in horses

OBJECTIVE: To determine hepatic and pulmonary phase-I and phase-II enzyme activities in horses. SAMPLE POPULATION: Pulmonary and hepatic tissues from 22 horses that were 4 months to 32 years old. PROCEDURE: Pulmonary and hepatic tissues from horses were used to prepare cytosolic (glutathione S-transferase and soluble epoxide hydrolase) and microsomal (cytochrome P450 monooxygenases) enzymes. Rates of microsomal metabolism of ethoxyresorufin, pentoxyresorufin, and naphthalene were determined by high-performance liquid chromatography. Activities of glutathione S-transferase and soluble epoxide hydrolase were determined spectrophotometrically. Cytochrome P450 content was determined by carbon monoxide bound-difference spectrum of dithionite-reduced microsomes. Activity was expressed relative to total protein concentration. RESULTS: Microsomal protein and cytochromeP450 contents were detectable in all horses and did not vary with age. Hepatic ethoxyresorufin metabolism was detected in all horses; by comparison, pulmonary metabolism of ethoxyresorufin and hepatic and pulmonary metabolism of pentoxyresorufin were detected at lower rates. Rate of hepatic naphthalene metabolism remained constant with increasing age, whereas rate of pulmonary naphthalene metabolism was significantly lower in weanlings (ie, horses 4 to 6 months old), compared with adult horses. Hepatic glutathione S-transferase activity (cytosol) increased with age; however, these changes were not significant. Pulmonary glutathione S-transferase activity (cytosol) was significantly lower in weanlings than adult horses. Hepatic and pulmonary soluble epoxide hydrolase did not vary with age of horses. CONCLUSIONS AND CLINICAL RELEVANCE: Activity of cytochrome P450 isoforms that metabolize naphthalene and glutathione S-transferases in lungs are significantly lower in weanlings than adult horses, which suggests reduced ability of young horses to metabolize xenobiotics by this organ.     

Small intestinal biopsy and resection in standing sedated horses

Diagnostic laparotomy and laparoscopy are surgical techniques commonly used for the investigation of chronic abdominal disease and weight loss. They can both be usefully carried out in the standing sedated horse, allowing a thorough examination of the dorsal abdominal cavity and biopsies to be harvested. Small intestinal disease is an important cause of weight loss and recurrent colic. Inflammatory or neoplastic bowel disease may not always be apparent grossly and histopathological assessment of full thickness biopsies may be required to provide a definitive diagnosis. Details of cases of 15 horses that underwent small intestinal biopsy or enterectomy while sedated and standing are presented. Three incisional infections occurred causing delayed wound healing. Three horses were subjected to euthanasia before hospital discharge: two had persistent gastric reflux and one had colitis. A further six were subjected to euthanasia in the first 4 months due to their underlying inflammatory bowel condition. One horse was subjected to euthanasia for severe laminitis that was presumed to be caused by treatment with a corticosteroid 4 years later, and one died of acute colic 2.3 years after successful resection and anastomosis. Five horses were alive at the time of review, median 2.7, range 1.2–4.3 years. Overall therefore, 3 (20%) horses died during hospitalisation and 5 (33%) were still alive at the end of the study. Results from this series suggest that minimising the number of intestinal biopsies may reduce morbidity, but the underlying pathological process appears to be the most important prognostic factor for survival. Resection and anastomosis in the standing sedated horse proved feasible.     

Small intestinal obstruction associated with wood chewing in two horses

Although wood chewing by horses is recognised as a common vice, there are few reports of specific disease associated with the habit. Two cases of acute obstruction of the small intestine by solid aggregations of wood splinters are described in horses which were both habitual wood chewers. Details are presented of the clinical findings in these cases, including the surgical treatment of acute colic. Both horses returned to full working fitness. The authors review the syndrome of enterolithiasis in horses, and discuss the causes and significance of wood chewing as a stable vice.     

Factors associated with mortality and morbidity in small intestinal volvulus in horses

OBJECTIVE: To determine historical, physical, and clinical factors that may affect morbidity and mortality in horses with small intestinal volvulus unrelated to other causes (e.g., incarceration, lipoma, etc.). STUDY DESIGN: Retrospective study. ANIMALS: Client-owned horses (115), aged 1 month to 21 years. Methods: Data were obtained from medical records, identified by computer search and manual review. Continuous variables were compared between affected and non-affected horses with Mann-Whitney U-tests and non-continuous variables with Fisher's exact test (2 x 2 tables) or chi(2)-tests (larger tables). Stepwise logistic regression analysis was used to develop a multivariable model of the risk factors, taking account of confounding and interaction. RESULTS: Eighty percent of horses recovered from surgery survived to hospital discharge. Neither age, breed, nor sex was related to mortality. Survivors had a significantly lower heart rate, shorter capillary refill time, and better mucous membrane color. Variables associated with worsening cardiovascular status, increased hemoconcentration, and exudation of cells and protein into peritoneal fluid were significantly associated with non-survival. After recovery from surgery, the most serious complication was colic, which was significantly associated with non-survival (P=.028) as was a second celiotomy (P<.01). Both of these complications were associated with a jejunocecostomy during the first surgery. CONCLUSIONS: Significant differences in the clinical and clinicopathologic signs were identified between survivors and non-survivors. CLINICAL RELEVANCE: These findings can be used to make a scientific assessment of prognosis in the pre-operative, operative, and post-operative management of horses with small intestinal volvulus.     

Idiopathic focal eosinophilic enteritis associated with small intestinal obstruction in 6 horses

OBJECTIVE: To report the history, clinical findings, and outcome of horses with idiopathic focal eosinophilic enteritis associated with acute small intestinal obstruction. STUDY DESIGN: Retrospective study. ANIMALS: Six horses with idiopathic focal eosinophilic enteritis. METHODS: Retrospective review of medical records of horses with idiopathic focal eosinophilic enteritis, with acute abdominal pain and small intestinal obstruction, associated with a focal region of eosinophilic enteritis of unknown cause. Information retrieved from the medical records included signalment, physical examination, laboratory findings, surgical procedure, histologic diagnosis, and postoperative management. Outcome was determined by telephone communication with owners. RESULTS: Six horses met the selection criteria. Horses had persistent pain, distended small intestine, and nasogastric reflux. Idiopathic focal eosinophilic enteritis lesions associated with a small intestinal obstruction were treated surgically by intestinal resection and anastomosis or wedge resection. There were no observed complications associated with extension of the disease from the lesion site. Five horses were alive at follow-up 5 to 60 months after surgery. CONCLUSIONS: Although the cause of these focal eosinophilic enteritis lesions is unknown, the long-term outcome after lesion resection was favorable. CLINICAL RELEVANCE: Small intestinal obstruction associated with a focal eosinophilic enteritis lesion may be a cause of acute abdominal pain in horses. Horses apparently have a good prognosis after lesion resection.     

Digestive enzyme concentrations and activities in healthy pancreatic tissue of horses

OBJECTIVE: To measure concentrations and activities of major digestive enzymes in healthy equine pancreatic tissue. ANIMALS: 7 adult horses with normal pancreatic tissues. PROCEDURES: Small pieces of pancreatic tissue were collected immediately after euthanasia, immersed in liquid nitrogen, and maintained at -80 degrees C until analyzed. Concentrations and activities of amylase, lipase, chymotrypsin, trypsin, and elastase were determined by use of a microtiter technique. Relative pancreatic protein concentrations were determined by use of bovine serum albumin as the standard. Pancreatic DNA was extracted and con-centrations determined by use of the diphenylamine method with calf thymus DNA as the standard. RESULTS: The pancreatic cellular concentration of each enzyme, expressed as units per milligram of DNA, was consistent among horses. Cellular concentration of lipase (1,090.8 +/- 285.3 U/mg of DNA) was highest, followed by amylase (59.5 +/- 9.8 U/mg of DNA). Elastase, trypsin, and chymotrypsin were detected in small concentrations (1.9 +/- 0.6, 3.5 +/- 1.5, and 9.6 +/- 2.9 U/mg of DNA, respectively). Similar results were obtained for specific activities of the enzymes. CONCLUSIONS AND CLINICAL RELEVANCE: Results were unexpected because, under natural conditions, the predominant energy source for horses is carbohydrate. These results may indicate, in part, the reason horses seem to tolerate large amounts of fat added to their diet.     

Evaluation of peritoneal fluid following intestinal resection and anastomosis in horses.

Postoperative abdominal fluid changes were compared in 2 groups of horses; those undergoing double small-colon resection and anastomosis (n = 10) and those undergoing exploratory celiotomy alone (n = 5). Peritoneal fluid was collected before surgery and on postoperative days 1, 3, 5, and 7. Total and differential nucleated cell counts, RBC numbers, and total protein and fibrinogen concentrations were evaluated. In both groups, all values were significantly higher than normal on the first postoperative day (after small-colon resection and anastomoses, WBC = 130,350 +/- 23,310 cells/microliters, RBC = 7,389,000 +/- 6,234,000 cells/microliters, total protein = 3.63 +/- 0.16 g/dl; after exploratory celiotomy alone, WBC = 166,620 +/- 34,340 cells/microliters, RBC = 295,000 +/- 86,070 cells/microliters, total protein 4.38 +/- 0.54 g/dl). The number of total peritoneal nucleated cells and RBC significantly decreased after the first postoperative day, whereas total protein and fibrinogen concentrations, percent neutrophils, and percent mononuclear cells remained unchanged. None of the values had returned to normal by postoperative day 7 (after small-colon resection and anastomoses, WBC = 45,600 +/- 8,765 cells/microliters, RBC = 95,390 +/- 53,380 cells/microliters, total protein = 4.39 +/- 0.23 g/dl; after exploratory celiotomy alone, WBC = 43,340 +/- 7,746 cells/microliters, RBC = 12,860 +/- 11,790 cells/microliters, total protein = 3.92 +/- 2.20 g/dl.) The resection and anastomosis group had a significantly lower total protein concentration on the first postoperative day and a significantly higher mean total RBC count over the entire 7-day postoperative evaluation than did horses that underwent celiotomy alone. Other values in the 2 groups of horses did not differ significantly.(ABSTRACT TRUNCATED AT 250 WORDS)     

Accuracy of increased large-intestine wall thickness during ultrasonography for diagnosing large-colon torsion in 42 horses

Large-colon torsion is a common cause of colic in horses and has a worse prognosis and higher cost than other causes of surgical colic of the large colon. During large-colon torsion, the colon wall becomes thick due to vascular occlusion. Therefore, we hypothesized that detecting increased colon wall thickness during ultrasonography would be an accurate preoperative test for large-colon torsion. The sample population consisted of 42 horses that were admitted for surgical treatment of colic localized to the large colon. The diagnosis was confirmed at surgery or necropsy examination. Twelve (29%) of these horses were diagnosed with large-colon torsion. Duplicate ultrasonographic measurements of colon wall thickness were made at six abdominal locations and an average measurement was calculated. For four of these six sites, a significant difference (P < 0.005) was detected between horses with and without large-colon torsion. All four tests were moderately sensitive and highly specific for diagnosing large-colon torsion using five decision criteria. Using a ventral abdominal window, a colon wall thickness > or = 9 mm accurately predicted large-colon torsion in eight of the 12 horses (sensitivity, 67%; confidence interval [CI], 36-98%) and correctly predicted that large-colon torsion was absent in 28/28 horses (specificity 100%; CI, 98-100%). Intraobserver repeatability was assessed by evaluating the difference between the first and second measurements obtained, which was < or = 2 mm. Therefore, detecting increased large-colon wall thickness during ultrasonography is a reproducible and accurate preoperative test for large-colon torsion in horses with surgical colic localized to the large colon.     

Effect of age on liver enzyme activities in serum of healthy quarter horses

Serum alkaline phosphatase (ALP), gamma-glutamyl transferase (GGT), 5'nucleotidase (5'NT), sorbitol dehydrogenase (SDH), and aspartate transaminase activities were measured in 10 clinically healthy foals, 10 yearlings, and 10 two-year-old Quarter Horses. Enzyme activities in foals at 0.5 to 3 days, 2 to 3 weeks, and 5 to 7 weeks of age were compared with enzyme activities from yearling and 2-year-old horses. Multivariate analyses of variance revealed significantly higher enzyme values in foals (P less than 0.002). This increase was mainly a result of higher ALP and GGT activities, with lesser effects due to higher SDH and 5'NT activities. Standard deviations for ALP and GGT were also larger in foals than in adult horses. The wide variation of ALP and GGT activities may limit their usefulness in the diagnosis of hepatic disease in foals. Standard deviations for serum AST, SDH, and 5'NT activities were smaller. These enzymes may be indicators of hepatobiliary disease in foals. The high serum enzyme activities in healthy foals may reflect a physiologic difference between foals and adult horses. Relative hepatic mass (as a percentage of body weight) and enzyme activity per gram of hepatic tissue are high in young animals, indicating that the high serum enzyme activities in foals are due partly to a high rate of enzyme production and release.     

Pathologic changes associated with induced small intestinal strangulation obstruction and nonstrangulating infarction in horses

Arteriovenous (ischemic strangulation obstruction, ISO) or venous (hemorrhagic strangulation obstruction, HSO) occlusions were created in the jejunum of 5 anesthetized horses and were left in situ for 1-, 2-, or 3-hour intervals. Segments were evaluated grossly for color, thickness, and motility. The horses were euthanatized, and the degree of mucosal slough, edema, congestion, and hemorrhage was determined histologically. Segments subjected to ISO became dark, but did not contain edema or hemorrhage. Segments subjected to HSO were characterized by progressive congestion, edema, and hemorrhage especially in the mucosal layer. Histologically, the mucosal epithelium was affected approximately equally by ISO or HSO, although more gross changes were evident in segments subjected to HSO.     

Evaluation of a vessel-sealing device for small intestinal resection and anastomosis in normal horses

OBJECTIVES: To compare arterial bursting pressure after vessel closure using a vessel-sealing device (LigaSure Atlas Laparoscopic Sealer/Divider Instrument; Valleylab, Boulder, CO), a ligate-and-divide stapling device (LDS), and 2-0 polydioxanone suture. To evaluate the LigaSure Atlas as a method for ligation of the mesenteric vasculature during small intestinal resection in normal horses. STUDY DESIGN: Experimental study. ANIMALS: Part A: jejunal segments from 19 horses. Part B: 6 horses, aged 1 to 18 years, weighing 330 to 509 kg. METHODS: Part A: Jejunal segments with mesenteric vessels were collected from 19 horses. After closure by 1 of 3 methods (LigaSure Atlas, LDS, 2-0 polydioxanone) arteries were cannulated, and bursting pressure was measured by incrementally increasing intraluminal pressure until failure. Part B: Six horses had jejunal resection and anastomosis using a vessel-sealing device (LigaSure Atlas) to provide hemostasis of the mesenteric vasculature. Horses were monitored clinically for 4 weeks. RESULTS: Part A: Mean +/- SEM bursting pressure after 2-0 polydioxanone ligation (1,014.50 +/- 279.05 mm Hg) was significantly greater than mean bursting pressure after LigaSure (554.25 +/- 228.79 mm Hg), which was significantly greater than the mean bursting pressure after LDS (373.25 +/- 183.69). Part B: No major operative or postoperative hemorrhage occurred after application of the LigaSure Atlas for sealing and transecting mesenteric vasculature during small intestinal resection in normal horses. CONCLUSIONS: The LigaSure Atlas appears to be a safe method for hemostasis of the mesenteric vasculature during small intestinal resection in normal horses. CLINICAL RELEVANCE: Benefits of the LigaSure Atlas vessel-sealing device include reduced time required to provide hemostasis, acceptable arterial bursting pressure, no remaining foreign material, and no risk for ligature slippage. In our experience, use of the LigaSure Atlas during small intestinal resection and anastomosis in horses is safe for ligation of vessels less than or equal to 7-mm diameter.