Medical management of large colonic impactions

Medical treatment of sand enteropathy with psyllium, magnesium sulphate and paraffin oil in 54 Western Australian equids

BACKGROUND

Sand enteropathy describes the clinical signs attributed to accumulation of sand in the gastrointestinal tract. Psyllium combined with magnesium sulphate has been recommended for clearing intestinal sand, but this has only been evaluated in one population. The combination of these two agents with paraffin oil has not been investigated.

OBJECTIVES

To investigate the effectiveness of paraffin oil, psyllium and magnesium sulphate combined in clearing intestinal sand in horses diagnosed with sand enteropathy.

STUDY DESIGN

Retrospective case series.

METHODS

Medical records of horses presenting for sand enteropathy that underwent treatment with psyllium, paraffin oil and magnesium sulphate were reviewed. Area of sand was calculated from abdominal radiographs. Treatment was deemed a success if more than 75% of the sand area was cleared.

RESULTS

There were 52 horses and 2 donkeys included in the study. Daily treatment with psyllium at 1 g/kg, 6-8 mL/kg of paraffin oil, and magnesium sulphate at 1 g/kg by nasogastric intubation, was successful in clearing intestinal sand accumulation in 81% of equids over a median of 4 days (interquartile range 3-5 days). Success rate was lower in Miniatures Ponies (44%). Complications were common (30%) but were generally mild or self-limiting.

MAIN LIMITATIONS

Retrospective nature of study design. Limited to cases that consented to sand clearance treatment.

CONCLUSIONS

The combination of psyllium, magnesium sulphate and paraffin oil was effective at clearing intestinal sand in most cases. Miniature Ponies had a poorer response to treatment compared with other breeds and may be at increased risk of treatment failure.

Owners' Knowledge and Approaches to Colic in Working Equids in Honduras

In Honduras, many families are reliant on working equids in their daily life. The aim of this study was to evaluate knowledge about, and approaches to colic used by owners of working equids in Choluteca, Honduras using a phenomenological approach. Semi-structured, verbal questionnaires were conducted with ninety-three owners from eleven different communities in the Choluteca region on equid horse owners' knowledge of colic and treatments. Additional context was gained through observations and verbal questionnaires with three veterinary practitioners and eight agricultural pharmacy (agrovet) store owners. Working equids were commonly used for firewood collection 31% (40/126), transportation 24% (30/126), and carrying crops 13% (17/126). Thirty-eight percent of owners (35/92) said they did not know what colic was, 27% (24/89) could not name any clinical signs, and 46% (42/92) could not name any causes. Most owners with previous experience of colic had treated it themselves 79% (53/67), typically using herbal remedies. Colic was a major concern for owners of working equids who had prior experience or knowledge of the condition. Knowledge and understanding of colic varied, and access to evidence-based treatments was very limited. The findings will be used to inform the development of educational resources on colic in working equids.

How Can Nutrition Help with Gastrointestinal Tract-Based Issues?

Many horses are fed differently than their wild ancestors. They often have limited access to pasture and are fed conserved forage and concentrates rich in starch and sugars, in only 2 meals per day. Feeding practices in contrast to natural feeding behavior can lead to gastrointestinal issues. Standard nutritional evaluation is warranted because of its important role in prevention and in treatment and management of diseases. When medical and nutritional treatments are combined, success rates are higher. New techniques to characterize equine microbiota have been used, allowing for microbiota manipulation to prevent and treat intestinal diseases.

Hook-shaped enterolith and secondary cachexia in a free-living grey nurse shark (Carcharias taurus, Rafinesque 1810)

The carcass of a critically endangered, juvenile female grey nurse shark (Carcharias taurus, Rafinesque 1810) was recovered from a south‐eastern Australian beach and subjected to necropsy. The 1.98‐m‐long shark exhibited advanced cachexia with its total weight (19.0 kg) and liver weight (0.37 kg) reduced by 60% and 89%, respectively, compared with a healthy individual of the same length. Marked tissue decomposition was evident preventing histopathology and identification of a definitive cause of death. At necropsy, the abdominal organs were abnormally displaced and showed marked reductions in size compared with a healthy individual of the same size. Importantly, a hook‐shaped enterolith (HSE), with a rough surface and cream in colour, was found within the spiral valve of the intestine and is to the authors’ knowledge, the first description of such in any marine animal. X‐ray diffractometry showed that the HSE comprised the minerals monohydrocalcite (Ca[CO₃].H₂O; ~70 wt%) and struvite (Mg [NH₄] [PO₄]. [H₂O]₆; ~30 wt%). A CT scan showed concentric lamellate concretions around a 7/o offset J‐hook that formed the nidus of the HSE. Nylon fishing line attached to the hook exited the HSE and was evident in the abdominal cavity through a perforation in the intestinal wall where the posterior intestinal artery merges. The most parsimonious reconstruction of events leading to enterolithiasis and secondary cachexia in this shark was the consumption of a hooked fish and subsequent hook migration causing perforations of the cardiac stomach wall followed by the thin, muscular wall of the apposed, sub‐adjacent intestine.

Nasogastric Intubation as Health and Safety Risk in Equine Practice-A Questionnaire

Placing a nasogastric tube can be a life-saving act for a horse but is considered an occupational hazard for veterinarians. An online questionnaire was performed to assess and specify potential risks. 123 equine veterinarians completed the survey, and the majority admitted using the mouth to handle the end of the nasogastric tube (sucking or blowing air) and having accidentally swallowed or aspirated stomach content or medications. This can potentially lead to aspiration pneumonia or pneumonitis. Mineral oil seems to be especially dangerous as aspiration may be asymptomatic at the beginning and lipoid pneumonitis may develop. Furthermore, 60% of responders would also handle the tube with their mouth if the horse was presented with fever and diarrhea or reflux formation, which might be affected by Salmonella sp. or Clostridium difficile producing toxins. The fact that nasogastric tubes are rarely being disinfected increases the risk of infection. 50% of veterinarians would use their mouth to suck or blow air into the tube during nasogastric intubation, even if the patient was presented with suspected poisoning. Rodenticide zinc phosphide is particularly dangerous as its breakdown product is a highly toxic gas. Inhalation leads to serious symptoms in humans, including pulmonary edema and neurological signs. Alternatives to mouth use (lavage, big syringe, or suction pump) when passing a tube should be considered, especially if a patient is presented with duodenitis-proximal jejunitis, diarrhea, or suspected poisoning. Awareness needs to be raised among veterinarians that nasogastric intubation is an extremely hazardous occupational practice.