Original ResearchPeritoneal Fluid Lactate Evaluation in Horses With Nonstrangulating Versus Strangulating Small Intestinal Disease
Introduction
Duodenitis-proximal jejunitis (DPJ) (also referred to as anterior enteritis or proximal enteritis) is characterized by abdominal pain, nasogastric reflux, small intestinal ileus, and inflammation of the duodenum and jejunum [1], [2]. Clinical findings of this disease and other nonstrangulating small intestinal (NSSI) lesions (ileal impactions, ileal hypertrophy, intramural masses) can be indistinguishable from those of horses presenting with strangulating small intestinal (SSI) lesions.
Peritoneal fluid lactate (PFL) values have been used as biomarkers of ischemic bowel injury in horses with colic [3] and can be useful in determining strangulating versus nonstrangulating lesions [3], [4], [5]. Peritoneal fluid lactate in normal horses is typically <2.0 mmol/L [3], [4], [5], [6]. Horses with strangulating obstructions (of the small or large intestine) are reported to have higher PFL values (8.45 mmol/L) compared to those with nonstrangulating obstructions (2.09 mmol/L) [3]. Horses with NSSI lesions such as DPJ may have peritoneal fluid that has an elevated total protein without a concurrent increase in nucleated cell count and is yellow or cloudy in color but rarely serosanguinous [2], [7], [8]. To the author's knowledge, PFL levels in horses with DPJ or other NSSI lesions have not been specifically reported in the literature.
The aim of this study is to report the PFL and BL levels in horses diagnosed with NSSI lesions and to compare those values to horses diagnosed with SSI lesions. It has been our clinical impression that horses with NSSI can have PFL values that are as high or higher than horses with SSI. We hypothesize there would be no difference in PFL levels between horses with NSSI lesions and horses with SSI lesions and that PFL alone is not predictive of strangulation.
Section snippets
Inclusion Criteria and Case Selection
Medical records of horses admitted to Michigan State University College of Veterinary Medicine between 2005 and 2016 were reviewed. Two groups of cases were obtained. Group 1 included horses with NSSI lesions that had an abdominocentesis performed on admission. Nonstrangulating small intestinal cases were searched with keywords including: DPJ, anterior enteritis, proximal enteritis, enteritis, enterocolitis, duodenitis, or jejunitis. Horses were considered to have a NSSI lesion if DPJ (anterior
Results
Of the cases admitted between 2005 and 2016, 39 horses met our inclusion criteria for NSSI lesions. Eighteen horses with NSSI lesions were diagnosed definitively: 15 at surgery and 3 at necropsy. Twenty-one horses were diagnosed presumptively with a NSSI lesion based on clinical signs and response to medical management; 35/39 horses with NSSI lesions had small intestinal distension on transabdominal ultrasound, 16/39 also had small intestinal distension on rectal palpation, and 4 horses had
Discussion
The results of this study confirmed our clinical impression that there was no difference in BL or PFL values in horses with NSSI lesions and horses with SSI lesions, and PFL alone was not predictive of small intestinal strangulation. However, the PFL:BL ratio was different when comparing SSI to NSSI.
Peritoneal fluid lactate is typically <2.0 mmol/L in healthy horses and is consistently elevated in horses with abdominal pain [3], [4], [5], [6]. When evaluating all types of colic, horses with
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Animal welfare/ethical statement: The authors have no ethical considerations to disclose.
Conflict of interest statement: The authors declare no conflicts of interest.
All authors participated in all aspects of the study, contributed to and approved the final manuscript.