Diagnostics

Radiography is the principle imaging modality for bone. When an x-ray beam hits a patient, some of the x-rays are scattered, some are absorbed and some pass through unchanged. The appearance of the radiograph produced is dependent on the number of x-rays that pass through the patient and strike the x-ray plate. The more x-rays that strike the x-ray plate, the blacker the image appears.

We know that different tissues in the body absorb x-rays to differing degrees. Of all the tissues in the body, bone absorbs the most x-rays. This is the reason that bone appears white on a radiograph. Soft tissues absorb some but not all of the x-rays, so soft tissues appear on a radiograph in different shades of grey.

Oakham Veterinary Hospital uses a digital computer radiography system which produces radiographic images of excellent quality. The pictures are viewed on a computer screen and areas of particular interest can be enlarged to achieve more detail. The digital system also allows radiographs to be sent via email, for example to referring vets or farriers.

Oakham Veterinary Hospital also has a portable Eklin digital radiography system that affords our ambulatory vets the ability to obtain images of the highest diagnostic quality.

Ultrasonography is a versatile imaging modality for assessing soft tissue structures such as tendons and ligaments. Damage to tendons and ligaments can be seen on ultrasound as changes to the fibre pattern and cross sectional area of the structure.

The practice has six ultrasound scanners in total. Two large scanners are situated permanently in the hospital and an additional four scanners are portable and can be used on visits out of the hospital. The degree of portability and outstanding image quality afforded by these machines allows our veterinarians to effectively employ the use of ultrasound as a diagnostic imaging tool, anywhere, under any circumstances.

Endoscopy facilitates the visualisation of otherwise inaccessible areas of the equine respiratory tract. The pharynx, larynx, guttural pouches and trachea can be visualised using a portable fibre optic endoscope. Using an endoscope, we can visualise these regions of the horse in great detail and take biopsy samples for on site laboratory diagnosis.

In the hospital we have two videoendoscopes that allow the image to be displayed on a TV screen, enabling the client and vet to observe and discuss the case at the same time. In addition, we have 3 portable endoscopes that allow horses to be examined by our ambulatory team without the need for a hospital visit.

Endoscopy is an essential part of the evaluation of horses with upper airway obstructions and abnormal respiratory noises, lung diseases, gastric (stomach) ulcers and many urinary tract diseases.

Gastroscopy is used to assess the stomach of horses to diagnose disorders such as equine gastric ulcer syndrome. At Oakham Veterinary Hospital, we have the latest mobile video endoscopes that are 3.5 metres in length meaning our vets can assess the oesophagus (gullet), the stomach and the first part of the small intestine (duodenum) to undertake a complete assessment of your horse.

Equine Gastric Ulcer Syndrome 

Equine Gastric Ulcer Syndrome (EGUS) is a complex condition, of which our medicine specialists are at the cutting edge of research. A list of some of their published work is shown at the bottom of this page. We now know that EGUS represents multiple different conditions causing different signs in different horse types. Broadly the disease is divided based on location to Equine Squamous Gastric Disease (ESGD), affecting the upper part of the stomach and Equine Glandular Gastric Disease (EGGD) affecting the lower part of the stomach where it empties into the small intestine. Some confuse EGGD with diseases of the ‘hind-gut’ or colon which are entirely different conditions. In fact, hind gut ulceration is usually associated with parasites or the use of painkiller medications (e.g Bute)

How do I know if my horse has gastric ulcers? 

A range of signs can be associated with diseases of different parts of the stomach or intestines as shown in the table below. None of these signs are specific to gastric disease and the only way to definitively diagnose gastric disease is to have your horse gastroscoped. Hind gut ‘ulcers’ can only be documented by ultrasound imaging of the colon. To undertake ultrasound assessment of the colon it is normally necessary to clip your horse.

What does gastroscopy involve? 

In order to assess the entirety of the stomach your horse will have to be starved overnight (from 6pm) and water removed from the stable 2 hours before the examination. We will happily hospitalise your horse to do this, but you are also welcome to do this at home. Remember to be strict or the examination will have to be repeated! If you do bring your horse in the morning of the examination remember not to feed them en-route, it is very easy to slip into auto-pilot and hang a haynet in the horsebox.

Your horse will need to be sedated to have the gastroscope passed up your horse’s nostril, to the back of its throat and down the oesophagus into the stomach. The scope is then steered around the stomach to assess it within its entirety. Horses may also need to be twitched to prevent them moving their head during the procedure, which can result in a nose-bleed. If this happens it always stops, and looks worse than it is.

How do I treat my horse with gastric ulcers? 

True gastric ulceration occurs in the squamous (upper) portion of the stomach (ESGD) and can be effectively managed in almost all cases with oral omeprazole paste (Peptizole, Gastroguard, Ulcer Gold), which reduces the production of acid in the stomach. The drug is most effective if administered on an empty stomach in the morning, one hour before feeding. Horses will typically improve clinically within a week of treatment, although stopping medication early can result in a return of signs. Once healed, it is possible to prevent recurrence by removing risk factors and changing the diet. A range of supplements can be purchased, but please discuss these with your vet as some will have no effect on the health of your horse’s stomach. Ocassionally horses may require ongoing low dose ‘maintenance therapy’ using omeprazole.

Disease of the glandular stomach (EGGD) are not, in fact, ulcers. Research carried out by our team has shown that these are an inflammatory condition that are rarely associated with gastric ulceration. Although omeprazole can be helpful to lower the acidity of the stomach to encourage healing, we no longer believe that acid injury is the cause of this condition. Indeed, EGGD rarely heals with the use of oral omeprazole alone. Other medicines, that are not authorised for use in horses, are frequently used and we have extensive experience in using these medicines. If you have any questions about this you can discuss them with anyone in the medicine team. EGGD often takes longer for complete healing but stopping treatment early often results in an immediate return of signs and disease. Specific supplements can be useful, but the choice of active ingredient is very important.

Can I treat my horse without it having a gastroscope? 

Although treatment without the results of gastroscopy used to be the norm, this is no longer recommended since different diseases require different medicines and treatment periods. Although horses will improve clinically with untargeted treatment while receiving medication, the underlying disease is not changed if the wrong treatment is selected. As such, signs usually recur and attempts to ‘save-money’ can often be counter-productive. We offer a discounted ‘all-in’ gastroscopy fee to ensure this procedure remains cost effective.

Does my horse need rescoping at the end of treatment? 

We strongly recommend that all horses are re-scoped at the end of treatment to ensure complete healing. This is particularly important for EGGD where disease will recur if complete healing is not achieved. We offer a discounted re-scoping fee in recognition of the benefit this has to your horse’s health.