An update on equine post-operative ileus: Definitions, pathophysiology and management.

Post-operative ileus (POI) is a serious condition which any horse undergoing abdominal surgery is at risk of developing, leading to increased hospitalisation time and resulting costs. Advances in the understanding of the development of equine POI are mainly based on human and rodent literature, where manipulation-induced inflammation has been identified as a trigger, with activation of resident muscularis externa macrophages playing a crucial role in the pathophysiology. Despite many pharmacological trials in all species, there is no single completely successful treatment for POI, highlighting that the condition is multifactorial in cause and requires a multimodal approach to minimise its incidence.

The effect of temperature changes on in vitro slow wave activity in the equine ileum.

REASONS FOR PERFORMING STUDY: Slow waves are rhythmic pacemaker currents generated by the gastrointestinal pacemaker cells, the interstitial cells of Cajal, and represent the rate-limiting step for small intestinal smooth muscle contractions. Therefore, factors that affect slow wave activity may also influence contractile activity. It is not known how temperature changes may influence slow wave activity in the horse. This could be of relevance during colic surgery if cooling of exposed intestine resulted in reduced slow wave activity potentially exacerbating post operative ileus. OBJECTIVES: To evaluate the effect of temperature changes on in vitro slow wave activity of normal equine ileum using intracellular recording techniques. STUDY DESIGN: In vitro experimental study. METHODS: A segment of ileum was collected immediately following euthanasia from 9 horses for reasons unrelated to the gastrointestinal tract. Intracellular recordings of membrane potentials were made from individual smooth muscle cells. The temperature of the tissue bath was altered during the course of each experiment across a range of 27-41°C. All data were recorded and stored using a computer-interfaced acquisition system. A software package was used to analyse slow wave frequency, duration, amplitude and resting membrane potential. RESULTS: In all 9 horses, slow wave frequency was highly temperature sensitive and approximately linearly related to the temperature over the range studied, increasing by 0.5 cycles/min for each 1°C increase in temperature (P<0.001). The initial slow wave frequency resumed when the temperature was returned to 37°C. The recovery time appeared to be directly related to the duration for which the temperature had been changed. CONCLUSIONS: Slow wave frequency in the equine ileum is highly temperature sensitive. As post operative ileus is a major cause of morbidity and mortality in the horse, the negative effect of lower temperatures on slow waves, and therefore contractile activity, should be considered.

Clinical features and management of equine post operative ileus (POI): Survey of Diplomates of the American Colleges of Veterinary Internal Medicine (ACVIM), Veterinary Surgeons (ACVS) and Veterinary Emergency and Critical Care (ACVECC).

REASONS FOR PERFORMING STUDY: A recent survey of European Colleges (European College of Equine Internal Medicine [ECEIM] and European College of Veterinary Surgeons [ECVS]) revealed the different strategies implemented by, and some of the challenges facing, European clinicians presented with cases of post operative ileus (POI). It was concluded that further comparative analysis of opinions, canvassed from additional colleges of equine veterinary specialism worldwide, would provide valuable additional insight into current POI knowledge on a more global scale. OBJECTIVES: To report and compare the current strategies favoured by American veterinary specialists when managing POI in horses that underwent emergency colic surgery. STUDY DESIGN: Cross-sectional survey. METHODS: Electronic invitations were sent to 814 Large Animal specialists, including 3 colleges: the American College of Veterinary Internal Medicine (ACVIM), American College of Veterinary Surgeons (ACVS) and the American College of Veterinary Emergency and Critical Care (ACVECC). RESULTS: The response rate was 14% (115/814). The majority of respondents (68%) reported an estimated prevalence range of POI of 0-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. A lesion involving the small intestine was considered the main risk factor for POI. Anti-inflammatory drugs, intravenous (i.v.) fluids and antimicrobial drugs were the primary strategies used when managing POI. Flunixin meglumine and i.v. lidocaine were the drugs most commonly used in the treatment of horses with POI. Supplementary management strategies targeted mainly the prevention of post operative adhesions, infection and inflammation. CONCLUSIONS: There is a lack of consensus on the clinical definition of POI. Prospective and objective clinical assessment of the effectiveness of the different strategies contained within this and the European survey is necessary in order to identify a standardised approach to the management of equine POI.

Clinical features and management of equine post operative ileus: Survey of diplomates of the European Colleges of Equine Internal Medicine (ECEIM) and Veterinary Surgeons (ECVS).

REASONS FOR PERFORMING STUDY: There is a need for an improved understanding of equine post operative ileus (POI), in terms of both clinical definition and optimal management. Although the pharmacological strategies that are used to treat POI continue to evolve, little is known about the supplementary strategies used to prevent and manage this condition. OBJECTIVES: To report the current strategies used to diagnose, prevent and manage POI following emergency abdominal surgeries. STUDY DESIGN: Cross-sectional survey. METHODS: An electronic survey invitation was sent by email to 306 European college diplomates (European Colleges of Equine Internal Medicine, ECEIM n = 120, and Veterinary Surgeons, ECVS n = 186). RESULTS: The response rate was 33% (100 of 306). The median reported estimated incidence of POI was 10-20%. The presence of reflux on nasogastric intubation was the main criterion used to define POI. Lesions involving the small intestine were thought to be the leading risk factors for developing POI. Anti-inflammatory drugs, antimicrobial drugs and i.v. fluids were the primary preventative strategies when managing cases at high risk for POI. Flunixin meglumine and lidocaine were the drugs most commonly used to treat horses with POI. Supplementary preventative and treatment strategies for POI included control of endotoxaemia, fluid therapy, early ambulation and judicious timing of post operative feeding. CONCLUSIONS: Appreciation of the potential risk factors associated with the development of POI appeared to have an impact on the choice of management strategies that are implemented. The majority of ECEIM and ECVS Diplomates in the survey used flunixin meglumine and lidocaine, often in combination, to treat horses with POI, which is likely to reflect the contributory role of inflammation in its pathophysiology. Various supplementary strategies were used to prevent and manage POI risk factors intraoperatively and post operatively.

Equine grass sickness.

Equine grass sickness (EGS; equine dysautonomia) is a polyneuronopathy affecting both the central and the peripheral nervous systems of horses. As the name implies, EGS almost exclusively affects grazing horses, resulting in the development of a characteristic array of clinical signs, most of which can be attributed to neuronal degeneration in the autonomic and enteric nervous systems. Varying disease severities occur, largely determined by the extent of neuronal degeneration in the myenteric and submucous plexuses of the enteric nervous system. Extensive neuronal degeneration, as seen in acute and subacute forms of EGS, results in intestinal dysmotility, the severity of which is incompatible with survival. In comparison, a proportion of chronic forms of EGS, characterised by less severe neuronal degeneration, will survive. Despite extensive research efforts since EGS was first reported over 100 years ago, the precise aetiology remains elusive. This article reviews much of the scientific literature on EGS, covering epidemiology, pathology, diagnosis, treatment and aetiological hypotheses.

Expression of PGP 9.5 by enteric neurons in horses and donkeys with and without intestinal disease.

Intestinal motility disorders are an important problem in horses and donkeys and this study was carried out in order to evaluate the enteric neurons in animals with and without intestinal disease. Surplus intestinal tissue samples were collected from 28 horses undergoing exploratory laparotomy for colic. In addition, surplus intestinal samples from 17 control horses were collected immediately following humane destruction for clinical conditions not relating to the intestinal tract. Similar samples were also collected during routine post-mortem examinations from 12 aged donkeys; six animals were humanely destroyed for conditions related to the intestinal tract, while the remaining six were humanely destroyed for other reasons including dental and orthopaedic diseases. Tissue samples were fixed in formalin and immunohistochemical labelling was performed targeting the enteric neurons using a polyclonal antibody specific for the neuronal marker PGP 9.5. The distribution and density of neuronal networks were assessed qualitatively and semiquantitatively. There was strong PGP 9.5 expression in both the horse and donkey samples and labelling was detected throughout the tissue sections. In both species, PGP 9.5-immunoreactive nerve fibres were detected in all layers of the intestinal tract, both in large and small intestinal samples. Networks of enteric neurons were present in the donkey with a similar distribution to that seen in the horse. There was no demonstrable difference in enteric neuronal density and distribution in the groups of animals with intestinal disease compared with those without, apart from two (out of 28) horses with intestinal disease that showed a marked reduction in PGP 9.5 immunoreactivity. Apart from these two animals, this total cohort analysis differs from some previously observed findings in horses with intestinal disease and may therefore reflect the different pathophysiological processes occurring in varying intestinal conditions resulting in colic both in the donkey and the horse.

The influence of interview on decision making and selection of prospective veterinary undergraduate students.

Interviews form part of the selection process in many veterinary programmes worldwide. This study aimed to evaluate the influence of the interview on veterinary selection decisions. An admissions cycle of interviews of 181 shortlisted school-leaving applicants to veterinary medicine was investigated. Selection panel pairs (from cohorts of 5 chairs and 11 cointerviewers) independently evaluated applicants before interview on the basis of their written application. Applicants were then interviewed and selectors repeated their evaluations, both independently and after joint discussion. Results of the preinterview and postinterview evaluations of the applicants were analysed statistically. There was slight to moderate agreement between the chair and cointerviewer on selection decisions/rankings taken before interview, but substantial agreement after interview. Agreement between postinterview decisions/rankings and consensus decisions/rankings postinterview was extremely high. Applicant attributes that had the most influence on selection decisions were: 'communication skills', 'overall knowledge gained from work experience' and 'ability to think on their feet'. There was significantly more agreement possible between interviewers with regard to selection decisions based on interview assessment compared with preinterview assessment of written applications. This study suggests that interviews may be a useful and important aid in decision making for selecting the candidates perceived as most suitable for this veterinary programme.

In vitro electrical activity of the equine pelvic flexure.

REASONS FOR PERFORMING STUDY: The generation and maintenance of intestinal motility patterns involve the complex interactions of several components including the gastrointestinal pacemaker cells (interstitial cells of Cajal, ICC). Central to ICC function is the generation of rhythmic pacemaker currents, namely slow waves, which represent the rate limiting step for intestinal smooth muscle contractions. Currently, intracellular slow wave activity has not been demonstrated in the equine colon. OBJECTIVES: To characterise the in vitro myoelectrical activity of the equine pelvic flexure using intracellular recording techniques. METHODS: Intestinal samples were collected immediately following euthanasia from 14 normal horses. One millimetre thick tissue sections were pinned and superfused with warmed, oxygenated Krebs solution. Intracellular recordings were made from smooth muscle cells close to the submucosal border of the circular muscle layer. The L-type Ca(2+) channel blocker nifedipine was added to the superfusion fluid in 9 experiments while the Na(+) channel blocker tetrodotoxin was added to the superfusion fluid in 4 experiments. The data were recorded and stored using an acquisition system and a software package used to analyse the recordings. RESULTS: In 10 of the 14 horses, electrical events consistent with slow wave patterns were recorded from individual smooth muscle cells. Surprisingly, adding nifedipine to the superfusion fluid abolished all electrical activity. In contrast, tetrodotoxin had no apparent effect on the electrical activity. CONCLUSIONS: Assuming that the electrical events were slow waves, the blockade by nifedipine suggests significant and potentially important differences in the ionic mechanisms responsible for slow waves in the different regions of the equine intestinal tract, which deserve further evaluation.

Perceptions of clients and veterinarians on what attributes constitute 'a good vet'.

The perceptions of veterinarians and small animal (SA) clients on what attributes constitute 'a good veterinarian' were examined by a questionnaire survey. The respondents were asked to record how important they considered 20 attributes for a veterinary surgeon to have on a five-point scale from 'not at all important' to 'very important'. In addition, they were asked to list which attributes they considered to be the three most important attributes in a veterinary surgeon; finally, they were asked whether there were any additional attributes that they considered to be highly desirable in a veterinary surgeon. In total, 407 SA clients, 243 SA veterinarians and 61 non-SA veterinarians completed the questionnaire. There were significant differences in the proportion of clients who considered an attribute to be 'very important' compared with SA veterinarians for 12 of the 20 attributes (P<0.005). A larger proportion of clients considered 'confidence', 'knowledge about veterinary medicine and surgery', 'cleanliness', 'good at explaining technical terms', 'patience', 'clear about cost of treatment', 'ability to work in a team', 'honesty', 'politeness', 'decisiveness', 'good with animals' and 'good practical skills' to be 'very important' attributes than the SA veterinarians; a larger proportion of SA veterinarians considered 'good communication skills' to be a 'very important' attribute than the clients.

The interstitial cells of Cajal of the equine gastrointestinal tract: what we know so far.

Gastrointestinal motility disorders are a serious problem in both veterinary and human medicine and may represent a dysfunction of the neural, muscular or pacemaker components (interstitial cells of Cajal) of bowel control. The interstitial cells of Cajal are considered to be the pacemakers and mediators of certain forms of neurotransmission in the gastrointestinal tract. These cells have been implicated, either primarily or secondarily, in the pathogenesis of gastrointestinal disease processes in which there is a prominent element of disturbance to intestinal motility. In the horse, their involvement has been implicated in large intestinal obstructive colic and grass sickness (equine dysautonomia). This review highlights the properties of the interstitial cells of Cajal and the role these cells play in orchestrating gastrointestinal motility patterns. In addition, it examines their role in intestinal motility disorders and summarises our current understanding of their importance in the equine gastrointestinal tract.

Evaluation of suicide awareness programmes delivered to veterinary undergraduates and academic staff.

In an effort to increase suicide awareness skills among veterinary undergraduates, a three-hour suicide awareness workshop (safeTALK) was delivered to third-year Royal (Dick) School of Veterinary Studies undergraduates as part of their professional development curriculum. Students were able to opt out of the session by contacting the course organisers. A total of 26 of 151 (17 per cent) third-year students attended the workshop, and 17 completed a feedback questionnaire. The vast majority of the students reported that after completing the workshop they were more likely or much more likely to recognise the signs of a person at risk of suicide, approach a person at risk of suicide, ask a person about suicide, and connect a person at risk of suicide with help. Five veterinary academics attended a two-day Applied Suicide Intervention Skills Training (ASIST) course, and all reported that the course was effective in improving suicide awareness and intervention skills.

A study of the interstitial cells of Cajal in aged donkeys with and without intestinal disease.

Intestinal tissue samples were collected during routine post-mortem examinations from 12 aged donkeys. Six animals were euthanised due to impaction of the pelvic flexure of the large colon, while the remaining six were euthanised for non-enteric reasons such as dental or orthopaedic disease. Immunohistochemical labelling was performed to demonstrate the gastrointestinal pacemaker cells, the interstitial cells of Cajal (ICC), with polyclonal c-Kit antibodies. The distribution and density of the cellular networks were assessed qualitatively and semi-quantitatively. ICC networks are present in the donkey, with distribution similar to that of the horse, and they remain strongly immunoreactive in the older animal. There was no difference in the density and distribution of ICC in animals with or without intestinal disease.

Admissions processes at the seven United Kingdom veterinary schools: a review.

The major challenge in veterinary undergraduate admissions is to select those students with most suitability for veterinary training and careers from a large and diverse pool of applicants with very high academic ability. This paper describes a review of the admissions processes of the seven veterinary schools in the UK. There was significant commonality in the entry requirements and the criteria upon which the schools made decisions on candidates. There was some variation in the procedures used by individual schools to select candidates, but common themes existed within these processes. All of the schools evaluated both academic and non-academic factors for individual applicants, and all used interviews in some format as a selection tool after an initial short-listing process. The procedures and approaches to selection processes are compared and discussed.

Equine gastrointestinal motility research: where we are and where we need to go.

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.

Interstitial cells of Cajal and electrical activity of smooth muscle in porcine ileum.

AIM: To identify the interstitial cells of Cajal in the porcine ileum for the first time immunohistochemically and to examine the electrical properties of intestinal smooth muscle in the same region. METHODS: In vitro intracellular microelectrode recordings were made from smooth muscle cells in cross-sectional preparations from abattoir-derived healthy porcine ileum. Immunohistochemical labelling of interstitial cells of Cajal was performed using an anti-Kit antibody. RESULTS: Slow waves were recorded in the circular muscle layer of all ileal preparations. The mean resting membrane potential of smooth muscle cells was -61.0 +/- 1.3 mV. Slow waves had a mean amplitude of 8.5 +/- 0.5 mV, a frequency of 9.9 +/- 0.1 cycles per minute and a duration of 5.6 +/- 0.1 s. A waxing and waning pattern of slow wave activity was occasionally observed. In addition, higher frequency spiking activity associated with contractions was observed in some recordings. The L-type calcium channel blocker nifedipine abolished both the spiking activity and the contractions, but had no significant effect on slow wave characteristics. Current-injection manipulation of the resting membrane potential had no effect on slow wave amplitude, frequency or duration. Kit-immunoreactive interstitial cells of Cajal were identified in the ileal samples and were present in the region of the myenteric plexus and in the circular and longitudinal muscle layers. CONCLUSION: This study recorded slow waves in vitro and demonstrated immunohistochemically the presence of interstitial cells of Cajal in the normal porcine ileum. This study forms a basis for future physiological and pathophysiological comparative studies of intestinal motility.

Investigation and management of a cluster of cases of equine retained fetal membranes in Highland ponies.

Four at-risk Highland ponies on the same premises all retained their fetal membranes in the same breeding season. The ponies were treated with a combination of oxytocin, infusion and distension of the allantochorionic sac with fluid, gentle traction in one case, and supportive therapy. The possible causes of the condition were investigated with clinicopathological tests and analyses of the herbage for its species composition and fungal contamination. No obvious possible causative abnormalities were identified apart from a low total serum calcium level in one case. No fescue grass was found and no pathogenic fungi were detected.

Observations on the interstitial cells of Cajal and neurons in a recovered case of equine dysautonomia (grass sickness).

This paper describes the histopathological and immunohistochemical changes in the central, autonomic and enteric nervous systems in a well-documented case of equine dysautonomia (ED), after the animal had recovered without significant residual clinical signs. Evidence of neuronal degeneration, such as neuronal chromatolysis, glial scars or a decrease in density of neurons, was not observed in the midbrain, pons, medulla oblongata or spinal cord, including the nuclei of cranial nerves III, V, VII, X and XII. In addition, no evidence of muscle denervation or re-innervation, such as group atrophy of clusters of cells or grouping of cells of similar size in the triceps muscle, was observed. These findings support the hypothesis that the chromatolytic motor neurons may not progress to cell death in ED. The autonomic ganglia showed evidence of previous neuronal loss. In the myenteric and submucosal plexuses of the ileum there was significant loss of enteric neurons. However, in the ileum, a continuous network of interstitial cells of Cajal (ICC) was observed by means of immunohistochemical techniques. It is possible that recovery without significant residual clinical signs was associated with lack of damage to, or more likely recovery of, the ICC, which have a pacemaker function in the intestinal tract.

Interstitial cells of Cajal (ICC) in equine colic: an immunohistochemical study of horses with obstructive disorders of the small and large intestines.

REASONS FOR PERFORMING STUDY: The gastrointestinal pacemaker cells, the interstitial cells of Cajal (ICC), have been implicated in several human gastrointestinal dysmotility syndromes. Recently, the involvement of these cells in equine gastrointestinal diseases has been investigated in cases of equine grass sickness where a significant reduction in ICC density was observed. OBJECTIVE: To investigate ICC density in equine obstructive gastrointestinal disorders using immunohistochemical labelling methods. METHODS: Intestinal samples were analysed from 44 horses undergoing exploratory surgery for colic and from 11 control animals subjected to euthanasia for conditions not related to the gastrointestinal tract. Immunohistochemical labelling of ICC was carried out using an anti-c-Kit antibody. Two independent observers assessed ICC density using a semiquantitative grading system. RESULTS: There was a significant reduction in ICC density in horses with large colon disorders compared to the controls (P<0.01). Horses with strangulating lesions of the small intestine showed no difference when compared to the controls. CONCLUSIONS: There was a reduction in ICC density in horses with large intestinal disorders. POTENTIAL RELEVANCE: The reduction in ICC density may be associated with the clinical findings as well as recurrent colic episodes observed in a number of these cases. This immunohistochemical study provides a basis for future functional electrophysiological investigations to determine the precise effect of ICC reduction on equine intestinal motility.