Urinary Tract and Umbilical Surgery in the Horse

Can do endoscopy-> provides evaluation of the urine outflow from ureters  which should void every 20-45 seconds. Can catheterise the ureters which may provide evidence of uni/bilateral disease.

-Transrectal ultrasound for adults bladder.
-Transcutaneous ultrasound for foal bladder, kidneys and umbilicus.

Radiography may provide information about the proximal urinary tract in foals/yearlings.
Scintigraphy can be used to assess renal function.

Bladder Rupture

Usually seen in 1-5 day old foals. COLTS. Depressed, abdominal distension, colic, increased frequency, urination and small volumes of urine passed. 

Diagnosis-> HYPERK, hypochloride, sodium, metabolic acidosis and dehydration. 
With peritoneal fluid, there will be increased creatinine when compared against serum. Normal= clear fluid with a low SG. 
Stabilise-> get K+ below 5.5 before anaesthesia due to risk of arrhythmias. Rule out concurrent sepsis. Fluid therapy- IV saline/hartmanns +/- sodium bicarbonate to correct the metabolic acidosis/insulin. Use a slow abdominal drain, and check IgG statuus.

Tx- surgical repair via midline laporotomy +/- umbilicus/urachus resection. 

Urolithiasis 

Uncommon, adult male. Cystitis and obstruction. 
Can also use electrohydraulic/laster lithostripsy to remove. 

Umbilicus 

Assess if moist >24h (urine), swelling/pain or fever.

1. Patent urachus- fails to close/reopens with sepsis. Concurrent sepsis/septic arthritis/physitis. Moisture/urine dripping.
Tx- abs, topic cautery or surgical resection.
2. Sepsis- foal 1-2 weeks old. Swollen and painful. Tx- assess IgG, and concurrent conditions. Blood culture/haem etc. Surgical resect if no response to systemic abs.
3. Umbilical hernia- common. Most= small and resolve with time. Repair if LARGE or persists for >6 months, enlarges or has associated colic signs.

Renal Disease in Horses

To help me revise my university work, I am trying to make it more fun. Here is a blog about renal disease in the horse.

Disease in the horse may present with dysuria (abnormal urination), which can refer to a variety of urine signs- pollakiuria (frequent voiding of small amounts), stranguria (straining to urinate). These signs may also be confused with a mare in oestrus 'winking' behaviour, as urine dribbles in some specific urine diseases which is known as 'scald.' A mare in heat will also urinate frequently. 

Some urinal disease of the horses are:

Diseases which affect geldings primarily are urethritis, uroliths and calculi.

 In the older horse, urethritis presents with a malodorous and swelled sheath. This is generically due to the build up of concretions 'beans' of smegma in the urethral fossa. Treatment of this comprises topical antibiotics and cleaning the sheath. 

Uroliths are uncommon which are stones in the BLADDER of the horse. Stones in the kidney and ureter are even rarer (and are generally due to infection, and necrosis from NSAID toxicity in the medulla). Stones come in TWO forms- and are principally made up of calcium carbonate in the horse. They are either yellow green or white (more phosphate). Sabulous stones also exist, which are secondary to bladder paralysis due to calcium sludge.

Cystic and urethral calculi are more common. They can also be found in the mare. Clinical signs include 'posturing' to urinate, possible colic signs, urine scald and weight loss. Stones are probably painful I imagine! Diagnosis is by palpation of the stone or endoscopically. They are generally removed surgically are medical dissolution such as in the dog is a lot harder in the horse to get enough ration in the diet. With males the surgical removal technique is perineal urethrotomy, or laparotomy. With females, it is a lot simpler. An epidural and removal by hands is generally a more amenable approach. The problem with such stones, and with it being hard to change the diet, recurrence is common. Give antibiotics post  removal, and avoid alfalfa hay which is higher in calcium content. Salt will increase water consumption and aid diuresis. 

Polyuria and Polydipsia is a very frustrating clinical sign that can be associated with a whole range of clinical issues. Normal water intake is 20Litres/day rising to 90L if hot weather/vigorous exercise. The main differentials for PU/PD are:

1. Renal failure/disease.
2. Cushing's disease (PPID)- induces a glycosuria and osmotic diuresis, with ADH antagonism by cortisol, and possible decreased ADH from pituitary adenoma impingement. 
3. Psychogenic (a lot of the polydipsia in dogs is psychogenic). 

The different differentials must be differentiated between.

1. Is the horse azotaemic? Azotaemia is generally a clinical sign of renal disease, but pre-renal causes may include hypovolaemia, endotoxaemia,volume redistribution etc. Isosthenuric urine indicates renal disease (1.008-1.012 SG). A very dilute urine rules out renal disease.

2. Not azotaemic= water deprivation test to test the integrity of ADH. Withold water and monitor 12 hourly, stop if the SG >1.025, >12-15% body weight loss or increase TP (dehydration) or azotaemia occurs. If the horse can concentrate normally- suspect psychogenic causes or cushings disease. 

3. Rule out cushings- low dose dexamethosone suppression, resting ACTH, and TRH responsive ACTH. 

Tier 1- low dose dexamethosone (overnight) or resting ACTH. Low dose dex suppression has a associated risk of laminitis as exacerbates insulin resistance (insulin resistance via excess glucocorticoids antagonistic effect). Test cortisol with this test 20 hours later. Abnormal if >40 post dexamethosone left, or <70% suppression. Resting ACTH levels will be increased in resting ACTH but glucocorticoid levels will generally be normal as ACTH is mainly biologically inactive in the horse. 

Tier 2- ACTH response to TRH stimulation- unstressed horse, needs freezing within 3 hours, lab correction for seasonal levels (PPID horse has increased levels of ACTH in autumn but normal horses also have this increased level so needs lab correction). ACTH >100= positive for PPID. This is due to decreased receptor sensitivity to normal hypothalamic releasing hormones and increased sensitivity to pituitary stimulated by TRH.

4. If doesn't concentrate can use a modified water deprivation test.

5. ADH response. Response= central diabetes insipidus. No response= nephrogenic diabetes insipidus. 

Red Urine 

Red urine is a common finding in the horse associated with a variety of different conditions.

1. Haematuria. Associated with cystitis, pyelonephritis or uroliths, neoplasia and nSAID toxicity. Ischial arch/terminal urethral defect in males. Idiopathic renal causes are common with haemorrhage, and blood clots seen, can be severe and unilateral in cause. In such instances a unilateral nephrectomy may be performed. 

2. Pigmenturia- myoglobin- myopathy exercise associated. Increased muscle enzymes CK and AST will be seen. Pasture associated atypical myoglobinuria- ill, high CK with VPCs on ECG. Poor prognosis. 

3. Haemaglobinuria- IMHA, secondary to penicillin/strep equi. Can also be neonatal isoerythrolysis, EIA, oxidative injury, end stage kidney or iatrogenic. 

Update :)

I know, I know. My blog post is getting longer between times. Again, I blame this on my laptop as I don't know the login information offhand! Since I last posted, a few things.

Rally training with Pippa is progressing really well. She entered the clubs inter club match in December and came away winning her two classes! Little superstar :). She is doing well at the club and I'm really pleased with her, she picks up things so fast. I'm aiming to enter rally shows in april and may- local ones. The first one for her will be Anglesey. Hoping she can qualify up the rounds quickly! :). We shall see. Hopefully this will fit easily enough around rotations.

I did a bit of EMS at christmas, at the butchers :). Was really interesting to remind myself of the different bits of anatomy and also the significance and roots of public health. I've got some placements at the PDSA and at a laboratory coming up soon, which should be really interesting :). This is after exams in march. 

Exams, eurgh. Don't even get me started. You probably all realise how much I stress about this by now anyway haha. |Exams are about five and a half weeks away and I'm drowning in revision notes literally. I feel like I'll never have all the information in my head to walk out into practice in a year and a bit time and diagnose something that comes through the door! Scary times. Did a dentistry practical the other day which was really interesting, I have NO hand strength for extracting even the smallest incisor, took me 40 minutes for only one.. in addition to the elevator being a bit too big for my teeny hands (one of the cons of being quite small). I've got a whiteboard I'm using at the moment which has the novely effect- for the time being of course. 

I go to nottingham AVS congress this weekend, really excited. I've signed up for cardiac ultrasound practicals/abdominal and antimicrobial resistance. There is also a pub crawl and a ball, so that should be really fun :D. 

I really want to adopt another dog for a companion for Pippa- looking for a rescue cavalier once I graduate I think, something around the age of four/five so I can train it to do some obedience or rally which should be fun :). I do prefer girls but maybe I'd get a boy.

I've started watching criminal minds which I'll again quote as amazing, because it is! I really watch too many tv shows and I now have netflix.. which is not a good combination for exams! 

Kind of Krazy

Hello People, 

 :). Sorry I haven't been around for a while. I got a new computer and then lost my login, which is never entirely helpful. I haven't got around to finding it yet either until today. New puppy at my parents chewed through my new laptop cable.. unamused to say the least, but hey, puppies...

Things have been kind of crazy. A spiral between stress and managing and more stress. The vet course is to be only described as, a challenge. On other words, my dog is progressing well in rally. She went to our obedience club competition for obedience (not rally) and won two of the classes she entered in. It was a very proud moment for me, I do love my little girl :). Light of my life much? She is not liking the new puppy, and she turned 7 the other day! Can't believe how times fly. She is and can only be named as that once in a lifetime dog. 

The vet course, what you're interested in? Booked all of my EMS mainly, apart from a few odd weeks, and there is barely any time to turn around again. Holidays? They don't exist really. On the other hand, the information I'm learning is pretty exhilarating, and it'll be really cool once I get to put some of it into practice. I have perhaps, idealistic expectations, but I really hope I enjoy my job once I graduate, and some speakers recently have reinspired me from some of my lows about the cons of the profession as a whole. 

Currently on holiday- well. Not quite. In the local butchers helping out at the back and observing for my public health placement. They are all really nice and it is interesting to see some of the anatomy that is a tad rusty to say the least again. Kidneys, scapulas etc. I'm there for a week which is good. Other things I have planned this week are going out with some old friends, and I really want to see the hobbit at some point. Of course, spending time with my dog is always a priority too. :)

A new series I started to watch recently called Agents of SHIELD is really really good, and also another one witches of east end. Both are good, not as good as some of things I watch, but I really like them and I recommend anyone to try them. I also saw Thor recently which was really good (2), and the hunger games 2 which was also pretty amazing. 

There are probably a lot of gaps, but I'll try to blog a bit more after the holidays. I only have seven weeks and then two weeks off until exams when I get back though so I'm a bit in revision mode, which is turning out to not be quite as bad as I anticipated after all. Right, now I'm going to go find a book to read as my old laptop is depressingly slow. 

I haven't said maybe, but I'm a bit of a mills and boon fan. Especially their historical romance books!

So you graduate in 20 months....

20 months may seem like a long time, certainly for a normal degree it isn't even halfway through yet. However, on a five year course which is going FAST- it is really going to be here in no time- what a scary but exhilarating thought. It doesn't seem two minutes since I was walking through the door to the University of Liverpool campus as a fresher- now look where I am... 

I haven't blogged for a while because things have been well- hectic. The other day I celebrated three years with my boyfriend who is also a vet student- I met him in freshers week, and we now live together with my dog near Leahurst Campus. A lot has happened in the last few weeks so I'll try to give you a snippet of my mish mash thoughts at the moment. 

I start my equine buddy weeks next week. We get paired with a fifth year to find our way around for a week so we have some clue before our rotations start in April (yes my last EVER lecture is in March, and I have exams on my BIRTHDAY, how mean is that). I'm a bit scared as equine is my weakest topic and I'm scared of what I'm expected to know. I'm a bit relieved that we get to go in stables in pairs- makes me a bit more confident about the situation knowing I'm not out there on my own. I also have small animal for a week and a farm buddy thing for 2 days. We go at 8am for an hour before lectures and again an hour after lectures. Quite a good system I hope. I have been watching some introductory tour videos- but for those things my memory is really quite a sieve! 

I am also back training my dog BIG HAPPY DANCE at rally training which is a new emerging sport. I've really missed being able to train her and compete with her in competition obedience these past three years as being a student no houses in the Liverpool Centre would allow pets (although I would have actually had more time). She is really good at it, its a fun sport where you follow signs, and a bit more relaxed than Competition Obedience. My heart will always be with competitive obedience but for her, rally is good. She is a little superstar (yes I go on about her a lot sometimes but hey!). I'm a bit worried that when rotations start I won't get a lunchbreak at all to pop home and let her home (5 minute drive away)- nightmare situation really, and one of the major cons of being a vet, or vet student.

I've had lecture weeks in respiratory and cardiology so far. The really interesting ones have been cardiology-the lectures for small animal are intense (15 or so hours worth!), and the ones for farm have been a bit more minimalist. I'm slightly more worried about farm as I don't have the time to do extra reading really. I'll burn out if I try. To give you an idea of my workload so far this year- I go dog training on Tuesday nights (but do an hour or so of work anyway), and generally do about three hours of work every other evening. At weekends I'm still doing about six + hours of work just to keep up with and understand the lecture notes. To do any extra reading is going to be, well, impossible really! I do like farm so maybe it'll just soak into my brain if I can get a bit of reading done sometime. Although I was a bit cheeky this week, I finished at 3 from uni on Thursday and went to Nandos for my anniversary meal! I do like cardiology. Respiratory was interesting too, but didn't leave me with as much knowledge! ECGS for the record, are damned hard (and echo is much better a mon avis). 

I probably have more to write- such as my flat tyre in the first week of university.. but I have more pressing things- like watching Grey's anatomy. Work is done for tonight,  so now it is time to relax and chill. I also bought a gamecube to play Harvest Moon AWL and all the Zelda old games. Not sure when I might have time at the moment though with everything else I try to do.. 

:) 

Farm Practice Memoirs

This week I've done a bit of mixed practice and saw some interesting things. The first thing to note before I forget, is the talk I had on synoquin EFA. Interesting talk about the building blocks  of chondroitin sulphate and glucosamine, the different types there are out there, what is best and the addition of dexahan which is krill oil into the product. The krill oil has better anti-inflammatory and analgesic properties than before (apparently), and this joint supplement sounds like something to try in osteoarthritis management. Problem is the cost. For large breed dogs you're looking about £80 for 120 tablets, and with the 'overload' initial phase to get the drug working into the body for around 40 days, the price is a bit high for the average dog owner I think! Sounds interesting as a supplement though but to get a better idea I'd really have to see the effects in practice, and the clinical trial evidence. They come in a sprinkle capsule (handy for cats) or chewy palatable tablets (the small breed dog chewy can also be given to cats which are amiable to tablets, but the tablets are quite big so the cat really has to chew it rather than it being shoved down). :). 

I saw a range of things, the most notable being a stitch up we did one evening (didn't get back until 10pm which is late for me!), on a pony which had a massive open wound down the rump area which had been opened again by rolling. A few mattress sutures, a lot of flushing, some wound debriding (getting rid of the granulation tissue) and some hibiscrub cleaning and sedation later, the wound looked a lot better. The sutures used were a mixture of nylon and vicryl, with tension being the reason they had been pulled out- the nylon was a bit weaker in this instance. They also used a pink ointment at the end to pack in the wound which I can't remember the name of, but it had some sort of additive to keep flies away- maybe chamomile (if anyone has any ideas please leave a comment with the answer)!

Mattress sutures were a newer thing I encountered in this practice. They are mainly used for x-laps, bitch speys or surgery where things need to be held together a bit tighter. They are apparently a bit more secure than cruciate stitches I described before, so here's another one to add to my list of things to learn! 

I also encountered a mare with lameness- she had a foot abscess which is one of the top diagnoses where the horse is really lame (alongside fractures). They normally burst out on their own with the aid of a poultice and antibiotics. She also seemed to have some laminitis with her stance and so she was also given bute for the pain relief, and told to have reduced food and soaked hay etc just in case for the time being. 

Today I encountered a puppy farm- although the dogs were all healthy which was a bonus (they had about 50 dogs though!), and three cows- one which was lame on one side which was given some antibiotics, one which had an LDA (a toggle was done to see if this would change things, to be monitored for a day), and a cow which was down after a calving with presumed nerve/muscle/pain damage in the hindquarter/pelvic region- she was given some antibiotics and told to be lifted onto her feet with a tractor to promote better healing of the nerve. We also had a dog which had passed away due to suspect parvo in the area, and a dog which had to have a wound debraded and cleaned, and tetanus antitoxin after cutting the leg to the tendon on some rusty barbed wire!

Other interesting things I saw were a possible splenectomy on a weimaraner that presented with vomiting and quite a bit of weight loss and a poor condition score. The tumour was really big on ex-lap exploration unfortunately- so it was a kinder decision for the dog to be euthanised as it had metastasied to the stomach wall. The tumour was a multilobulated 20cm large mass, about the size of a mini-rugby ball! I think I'm going to do this as my case report for university. 

I got to administer some routine vaccinations (one which leaked out the other side whoops, but practice makes perfect and it won't happen again!), and got to do two of my own consultations today which was pretty brill (although I forgot basic things for vaccs- such as diahorrea, vomiting, and general concerns, I was too busy trying to do a clinical exam :(, too many things happening at once). Grateful to the vets who let me assist in these! 

We had a dog with possible rat poisoning- where the treatment is activated charcoal for the stomach after making the dog sick, and dependent on a few factors e.g. time length, possibility of poisoning this may be followed by aggressive vitamin K1 therapy. 

Also found out my boyfriend passed his resits- YAY. Not that I've had a chance to talk to him about those today.. but hey, what are boys like.... 

SO interesting times, and I move back to Liverpool on sunday. I need to pack tomorrow, and for definate I have too much stuff! 

Adios for now :)