INTERNAL MEDICINE

At NEH we offer investigation and treatment on all types of internal medicine problems. After the diagnosis has been made, patients can either be sent home for treatment or they may need to be hospitalised in our state of the art facilities. Cases requiring high levels of care and nursing will be admitted to our intensive care unit (ICU). Some of the investigations available for common disorders are listed below:

We also offer the following services with specialist on-site facilities:

Upper Respiratory Tract Disorders (Laryngeal paralysis, Palatal displacement, Sinus disease)

We are one of the first hospitals in the UK to have an overground endoscope for the diagnosis of upper respiratory tract disorders in exercising horses. This new equipment allows us to see the larynx and pharynx during ridden exercise and assess whether they are functioning normally. The horse carries the endoscope and the images are recorded on a back pack carried by the rider and also can be viewed in real time. Horses can be exercised in our ménage or taken out on to the gallops where a galloping exercise test can be performed. This equipment has already greatly increased our ability to diagnose the cause of respiratory noises and poor performance in athletic horses.

Videoendoscopic examinations can also be performed at rest for investigation of the guttural pouches and paranasal sinuses. When required direct sinus endoscopy allows visualisation within the paranasal sinuses to identify sinus disease. Radiography of the head is available and particularly used for the investigation of sinus disease. The videoendoscopic can also be used to direct laser surgery on the upper respiratory tract. This technique has the advantage of being able to be performed in the standing animal and therefore in some cases will avoid the need for general anaesthesia.

Lower Respiratory Tract Disorders (COPD, RAO, pneumonia)

Diseases of the lungs can be investigated using a combination of clinical examination, lung auscultation and percussion, radiography of the lung fields and ultrasonography of the chest. Videoendoscopic examination allows visualisation of the trachea (windpipe) and major bronchi. Samples can be collected from the trachea and the small airways to allow cytological and bacteriological examination in our laboratory. When appropriate samples of pleural fluid or biopsies from the lung may be collected to allow further investigations.

Cardiac Evaluation (Heart murmurs, arrhythmias)

Heart abnormalities can be evaluated with a combination of auscultation, echocardiography, and colour-flow Doppler examination. Electrocardiographs (ECGs) can be obtained at rest and during exercise using a portable recorder.

Weight Loss

Following a thorough clinical examination a full range of blood tests are available in our laboratory to aid with the diagnosis of weight loss. Specific tests of liver and kidney function are available. Dynamic tests, such as sugar absorption tests, can also be performed when intestinal malabsorption is suspected. Endocrine tests are also performed when hormonal disorders are suspected. Laparoscopic examination of the abdomen can be used to allow visualisation of the abdominal cavity and when appropriate full surgical exploration of the abdomen is possible.

Liver Disorders (Toxic liver disease, ragwort poisoning, cholangitis)

Most liver diseases present insidiously and initial diagnosis is based on the laboratory results of blood samples. Liver enzyme levels can be measured and monitored. Specific tests of liver function can also be performed. When indicated ultrasonographic examination of the liver is performed and this is often done in conjunction with the collection of a liver biopsy to allow precise histopathological diagnosis of the liver disease.

Urinary Tract Disorders (cystitis, urinary calculi)

Fortunately urinary disease is uncommon in horses. However, we can perform ultrasonographic examinations of both kidneys, the bladder and the urethra and ureters. Laboratory tests can be performed on both blood and urine samples. Videoendoscopic examination of the urinary tract can allow visualisation of the inside of the urethra, bladder and also the lower part of the ureters. Laser surgery can also be performed through the endoscope to allow removal of urinary stones (calculi).

Neurological disorders (wobblers, head shakers)

Neurological diseases in the horse can be very subtle. Thorough neurological examinations are often required to determine the site of the disorder. Radiographic examination of the spinal column can be performed and this can be done in conjunction with a bone scan to identify areas of possible bone damage. Samples of fluid from around the spinal cord (CSF) can be collected for laboratory evaluation and a myelogram can be performed to identify any areas of compression within the spinal column.

Ophthalmological disorders (corneal ulcers, uveitis)

Eye disorders can be examined by routine ophthalmic examination. Where necessary ultrasonographic and tonometric evaluations will also be performed. In-dwelling catheters may be placed in to the eyelid to allow frequent treatments without causing repeated discomfort to the patient.

Intensive care unit (ICU)

Our ICU is a dedicated building where the highest levels of treatment and care may be given to those severely sick or injured horses. Six individual and self-contained boxes are available, two of which are suitable for mares and foals. These boxes each have individual heating with padded floors. They are designed to allow easy intravenous fluid administration and can be kept under 24 hour CCTV observation. When necessary there is the facility for staff to be in attendance 24/7.