Approach to the acute abdomen

Acute abdominal pain is a clinical sign associated with several underlying disease processes, many of which can be life threatening. Abdominal pain requires efficient diagnostic evaluation to determine the appropriate course of treatment. Definitive treatment involves medical and/or surgical management. The emergency clinician must be well versed in the diagnostic approach to these patients to facilitate appropriate therapy.     

Indices of renal function: values in eight normal foals from birth to 56 days

A series of blood and urine samples was collected from each of eight normal foals between birth and eight weeks. Blood chemistry relating to renal function was evaluated as well as physical and chemical characteristics of urine. During the first 4d of life it was impractical to suggest meaningful normal values due to wide variation among foals and with time. Serum urea and plasma creatinine fell markedly to levels less than those previously reported for normal adult horses, while urine, mildly hypersthenuric at birth, rapidly became hyposthenuric. There was also a marked proteinuria during the first 48h. After 4d clinicopathological values stabilised. Urea and creatinine remained at subadult levels and hyposthenuria was maintained. While there was some variation with time, generally the urinary activity of gamma-glutamyl transpeptidase (GGT) and alkaline phosphatase (AP) was greater in foals than in adults; plasma potassium, the creatinine clearance ratio of potassium (% Cr K), serum inorganic phosphate and the creatinine clearance ratio of phosphate (% Cr PO4) were greater than in adults while plasma chloride and the creatinine clearance ratio of chloride (% Cr Cl) were lower in foals than in adults. Urinary pH was acidic and epithelial cells and calcium oxalate crystals more prevalent in the urine of foals than in that of adults. The information presented here will be useful in the diagnosis and management of renal disease and azotaemia in foals.     

Evaluation of d,l-ethionine as a mechanism for pancreatic islet regeneration in dogs

Objective To determine whether induction of pancreatic necrosis and islet proliferation by d,l‐ethionine has potential for treating dogs with b ‐cell insufficiency. Design Eighteen mixed breed dogs of both sexes were given d,l‐ethionine at 100 mg/kg three times weekly for 2 weeks; 6 dogs were euthanased at 2, 14 and 28 d after the last dose. Methods Clinical signs during administration and recovery were assessed. Routine biochemical analyses were performed before each ethionine dose and then once weekly. Faecal samples were examined weekly for malassimilated nutrients and blood. Blood coagulation screening tests (OSPT and APTT) were determined on four dogs after ethionine administration. Intravenous glucose tolerance tests were conducted before the first and after the last ethionine dose and then fortnightly. All dogs were necropsied and pancreas, liver, kidney and jejunum were examined microscopically. Results During ethionine administration all animals displayed vomiting, inappetence, diarrhoea (often with blood), weight loss and depression. Three dogs were euthanased prematurely due to severe illness, but those allowed to recover were eating and brighter 7 d after cessation of ethio‐nine administration. Serum concentrations of TLI, amylase and lipase increased initially, then decreased, during administration but returned to normal during recovery. Concentrations of ALT, ALP, unconjugated and conjugated bilirubin increased during administration then decreased slowly. Histological examination revealed hepatic lipidosis and necrosis, but no renal or jejunal lesions. In most dogs, faecal examination demonstrated increased undigested starch and muscle, as well as increased digested and undigested fat, during ethio‐nine administration or early during the recovery period, suggesting transient malassimilation. APTT was unchanged but OSPT was prolonged in all dogs. There was no impairment of insulin secretion or glucose intolerance and C‐peptide concentrations were unaffected. Immediately after ethionine administration there was delayed insulin degradation and by day 43 there was evidence of increased insulin sensitivity. Conclusion d,l‐ethionine administration in dogs appeared not to interfere with insulin secretion, but caused clinical signs and laboratory changes indicative of pancreatic exocrine necrosis, severe hepatobiliary disease and transient malas‐similation. Pancreatic and hepatic dysfunction was severe but clinical recovery occurred after ethionine administration ceased. The severe side‐effects observed with d,l‐ethionine should preclude its potential use for treating diabetes mellitus in dogs.     

Efficacy of metoclopramide for treatment of ileus in horses following small intestinal surgery: 70 cases (1989–1992)

Summary: In this retrospective study, postoperative ileus was studied in horses having resection of the small intestine followed by a jejunojejunal (n=35) or a jejunocaecal (n=35) anastomosis. Twenty-six horses received no metoclopramide, 27 received metoclopramide as an intermittent intravenous infusion and 17 horses received metoclopramide as a continuous intravenous infusion (0.04 mg/kg/hour). Horses receiving a continuous infusion of metoclopramide had a reduced total volume (P< 0.001), shorter duration (P< 0.001), and a slower rate (P< 0.001) of postoperative gastric reflux, and a shorter postoperative hospital stay (P< 0.01) when compared to horses receiving no metoclopramide and horses receiving metoclopramide as an intermittent infusion. Horses having jejunocaecostomy performed had a larger volume (P< 0.05), longer duration (P< 0.05), and a greater rate (P< 0.05) of postoperative gastric reflux, and a longer postoperative hospital stay (P< 0.001) than horses undergoing jejunojejunostomy. Horses that had an abdominal drain placed during surgery had a longer length of intestine resected (P< 0.05) and a longer postoperative hospital stay (P< 0.05) than horses without an abdominal drain. Horses that died or were euthanased during the postoperative period had a greater total volume (P< 0.05), longer duration (P< 0.05), and greater rate of postoperative gastric reflux (P< 0.01), a longer length of small intestine resected (P< 0.01), and a shorter postoperative hospital stay (P< 0.05) than horses that survived until discharge from the hospital. In a multivariate regression analysis the continuous infusion of metoclopramide was the only variable that contributed significantly to predicting the total volume (P< 0.001; r²= 0.24), duration (P< 0.001; r²= 0.24) and rate (P< 0.001; r²= 0.25) of postoperative gastric reflux. We concluded that metoclopramide given as a continuous intravenous infusion decreased the incidence and severity of ileus following small intestinal resection and anastomosis in horses.