Diagnostics

Ultrasonography is an invaluable diagnostic imaging modality utilised mainly for assessing soft tissue structures, joints and bone surfaces.

Ultrasonographic examination of tendons and ligaments is commonplace in equine practice, allowing us to diagnose injury in these structures and monitor healing.

Additional uses for ultrasonography in the orthopaedic assessment of our equine patients are to assess bone surfaces and cartilage within joints. Ultrasonography can also be used to enable accurate injection of therapeutic substances into joints or areas of injury.

Our team is able to perform ultrasonography both on-site at your premises or at the clinic.

Ultrasonography is also used to assist reproduction; to evaluate brood mares’ reproductive cycles, pregnancy detection and twinning.

Ultrasonographic assessment of internal organs also forms part of the diagnostic process of many medical and colic cases, being useful for detecting abscesses, cysts or tumours in the abdomen and evaluating gut wall thickness. Cardiac ultrasonography can be performed to assess heart valves, size and blood flow dynamics.

Radiography is an invaluable diagnostic technique used for a range of cases, from lameness and dental problems to pre-purchase examinations and more. It is often one of the first imaging techniques used in cases, and allows our vets to make a quick assessment of the bones and joints of your horse.

We have three mobile x-ray machines available to our vets out on the road visiting clients, plus an in-house x-ray machine at our clinic.

Images are available to be viewed instantly at your premises and are stored electronically for easy access in the future. At the clinic we have a high-resolution image viewing station, where the vets can discuss their findings in detail with you. Images can also be forwarded on to owners, other vets, farriers or insurance companies.

X-rays are often used alongside other imaging techniques such as ultrasound, MRI and scintigraphy to gather more information about your horse’s problem, guide treatment plans and monitor healing progress. It can also be used in our surgical theatre, to guide our surgeons when performing surgeries such as fracture repairs.

Scintigraphy, or bone scans, allows a full body assessment of the horses’ bones to image areas which aren’t accessible with an x-ray machine. Bone scans detect areas of bone inflammation, or increased bone activity.

Bone scan involves injecting the horse into the bloodstream with an isotope (technetium 99) and taking images of the horse two hours later with a gamma camera. The isotope attaches to bone building blocks and emits a louder signal in areas of high bone turnover (such as in arthritis or fracture repair). These louder signals appear as ‘hot spots’ when imaged with the gamma camera.

Bone scans are generally used in lameness investigations when the problem is thought to originate in the back, pelvis or upper limbs.  Other diagnostic tools such as nerve blocks are not appropriate in these cases.

Horses are booked in for a bone scan in advance, at the request of the vet who has been examining the horse. The horse will need to arrive the afternoon before the procedure to ensure that it is on site and ready for when the isotope is delivered, and will need to stay for a minimum of 48 hours after the procedure until the radioactive isotope has decayed.

Gastroscopy is the only reliable diagnostic tool for stomach ulcers in the horse, and this is the main reason for performing gastroscopy in horses.

The most common signs of gastric ulceration vary depending on what discipline the horse is working in.

In horses in training:

• Slow eating or poor appetite.
• Failure to maintain adequate body condition when in work.
• Poor performance (especially with increasing workload).

In sport and pleasure horses:

• Resentment of placing the saddle and especially tightening the girth.
• Placing and adjusting rugs.
• Kicking out when eating.
• Resentment of grooming chest and abdomen.
• Temperament changes.
• Sour, poor jumping performance.
• Aggression toward handlers.
• Resistance to leg aids and unwillingness to go forward under saddle.
• Bucking, rearing, bolting.
• Low grade recurrent colic, although this is rare.

Gastroscopy may also be used in the investigation of problems of the gullet, such as recurring cases of ‘choke’ or problems of the upper small intestine, such as inflammatory bowel disease (IBD). Biopsies can be harvested from the bowel lining to assist diagnosis.

Gastroscopy can be performed either at our clinic or at your home yard.

We also run monthly gastroscopy clinics where you can bring your horse in for gastroscopy examination at a reduced fee.

Our video gastroscopes are some 3.3m long, allowing examination of both the stomach and upper small intestine of even the largest horses.

The stomach is composed of two very distinct regions; the upper cream-coloured squamous lining and the lower glandular lining, which extends down to the level where the stomach empties out into the small intestine.

Prior to gastroscopy a period of approximately 15 hours of starvation whilst stabled on a bed that the horse will not eat is required. Ideally water should be withdrawn one to two hours prior to gastroscopy, but this is not critical.

The horse is sedated and the gastroscope passed via the nostril. This procedure is most easily achieved with three people.

Gastroscopy will determine which part(s) of the stomach are ulcerated and the extent and severity of any ulcers. These findings will guide the nature, dose and duration of treatment. It is very important to correlate the presenting clinical signs and gastroscopic findings.

Ulcer severity is graded on a scale of zero to four (grade zero: normal, grade one: minor inflammation and thickening due to wear and tear, grades two, three or four mild, moderate or severe depending on the number size, depth and extent of the ulcers). However, it should be noted that all horses are individuals and vary hugely as to the severity of the clinical signs that they may show when suffering from a particular grade of ulceration.

The acid suppressant drug omeprazole is used in treatment of gastric ulceration, but in some cases other treatments are used, such as coating agents (sucralfate), antacid gastroprotectants and antibiotics. Some cases require several weeks of therapy, others many months to resolve and control the ulcers. We can also look to reduce the cause of problems, through diet control and environment modification, in the hope of preventing further recurrences.

We were proud to install a Hallmarq magnetic resonance imaging unit in 2017. The MRI unit enables imaging of the distal limb under standing sedation; anything from the knee, and hock, downwards can be imaged.

Magnetic resonance imaging is indicated for cases of lameness following the performance of diagnostic nerve blocks. Frequently, once lameness is localised to the distal limb, radiographs and/or ultrasonography are performed and yield limited information.

In this case, an MRI is an excellent ‘next step’ in being able to precisely and quickly localise damage to a particular soft tissue or bony structure. This can enable more specific, targeted treatment therapies and rehabilitation regimes.

A standing MRI will take on average two to three hours and is a non-invasive procedure. Generally, your horse will remain with us at the clinic for the day whilst the MRI is performed, images are interpreted and an appropriate treatment plan formulated and discussed.