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SENSITIVITY AND SPECIFICITY OF ABDOMINAL FLUID VARIABLES AS A MARKER OF INTESTINAL ISCHEMIA IN DONKEYS(EQUUS ASINUS).

Byline: H. M. M. Ibrahim, S. M. Shoieb, M. R. El-Ashker and K. S. Abouelnasr

Keywords: Obstructive colic; Intestinal ischemia; Peritoneal fluid; Donkeys(Equus asinus).

INTRODUCTION

Colic, an emergent condition encountered in equine practice, is a main cause of morbidity and mortality among horses and requires surgical intervention to resolve the main problem(Tinker et al., 1997). Approximately 50% of horses admitted in equine colic clinics required a rapid and emergent abdominal surgery(Hardy, 2004). The severity of colic case is ranged from temporary self-recovered spasmodic colic to severe strangulating obstruction with multi-organ failure and subsequent circulatory collapse(Archer and Proudman, 2006).

Acute circulatory failure secondary to intestinal ischemia and infarction is the leading cause of death as a direct result of equine colic. Therefore, quick and accurate detection of the bowel ischemic segment is necessary to prevent the complications with increasing the patient survival rate(Latson et al., 2005). Yet, there are several diagnostic tests for evaluation of horses with colic, and such tests vary in their costs, available facilities and experience level required to complete its techniques and interpreting the outcomes(Curtis et al., 2015).

Alkaline phosphatase, an enzyme present in intestinal mucosa, can be used as an indicator for strangulating versus non-strangulating intestinal lesions. Following experimental ileal ischemia, alkaline phosphatase activity in peritoneal fluid was significantly increased(Saulez et al., 2004). Moreover, horses with surgical colic are unique in having blood-stained peritoneal fluid with a high alkaline phosphatase activity. Furthermore, alkaline phosphatase activity is significantly different between survived horses and those that died, but not between horses treated surgically and those treated conservatively for the duration of colic(Kaya and Iben, 2009).

Lipase, an enzyme catalyzes the breakdown of triglycerides, found not only in pancreatic acinar cells, but also in the heart, lungs, leukocytes and gastrointestinal tract, including the esophagus, duodenum, stomach, liver and colon(Tietz and Shuey, 1993; Lott and Lu, 1991). Therefore, serum lipase level may be mildly elevated in intra-abdominal diseases arising from the stomach, bowel and hepato-biliary tract(Hameed et al., 2015). Lactate, the glycolysis end product, is usually increased because of poor tissue perfusion and anaerobic glycolysis that occurs in cases of shock(De Backer, 2003). In intestinal ischemia, the cell membrane permeability is deleteriously affected, with intracellular by-products, including the release of lactate into the peritoneal cavity(Liao et al., 1995).

Nitric oxide, a labile gas produced from the dietary amino acid L-arginine via nitric oxide synthase, exerts either cytoprotective or cytotoxic effects during intestinal ischemia and reperfusion(Moncada and Higgs, 1993; Beckman and Crow, 1993; Beckman and Koppenol, 1996). Endothelium nitric oxide synthase-derived nitric oxide facilitates microvascular patency, inhibits platelet adhesion and aggregation, decreases neutrophil adhesion, and stabilizes mast cells, and thereby preserving the mucosal barrier function(Beckman and Crow, 1993; Mirza et al., 1999). Thus, nitric oxide synthesis is essential for the maintenance of both intestinal mucosal and microvascular barrier integrity of feline small intestine, which is damaged by ischemia and reperfusion(Kubes et al., 1992; Kubes, 1993). Furthermore, early administration of nitric oxide donors or L-arginine in the ischemia-reperfusion process decreases both mucosal and microvascular injury, protecting their function(Kanwar et al., 1994).

Earlier studies described the usefulness of estimating the peritoneal fluid pH, glucose concentration, and activity of both alkaline phosphatase and lactate dehydrogenase as potential indicators of intestinal ischemia and peritonitis in horses(Latson et al., 2005; Van Hoogmoed et al., 1999; Yamout et al., 2011). However, there are no reported data on the significance of measuring the activity of lipase enzyme, and level of both nitric oxide and cardiac troponin I in peritoneal fluid in equine with obstructive colic. Thus, assessment of these biochemical markers in the peritoneal fluid may provide a clue for early detection of ischemic bowel injury in such species. In the current study, the donkey(Equus asinus), a domesticated member of the horse family, Equidae, was used as a model of equine species.

In this article, the cellular profile and certain biochemical parameters, including the activity of alkaline phosphatase and lipase, and level of lactate, nitric oxide, and cardiac troponin I were evaluated in peritoneal fluid in donkey with obstructive colic, with a focus on their diagnostic sensitivity and specificity as biomarkers for the early diagnosis of intestinal ischemia in such animal species.

MATERIALS AND METHODS

Animals: The present study was conducted on 30 donkeys(Equus asinus) admitted to Veterinary Teaching Hospital, Mansoura University, Mansoura, Egypt, for colic of intestinal origin between May, 2017 and December, 2018. Their ages ranged between 3 and 10 years, and their body weight ranged between 150 and 280 Kg. In addition, ten clinically healthy donkeys(Equus asinus) were randomly selected within the same age as a control group for this study. Organization and national rules for the utilization and care of the animals were taken as indicated by the Animal Welfare and Ethical Committee, Faculty of Veterinary Medicine, Mansoura University, Mansoura, Egypt, code No. R/9.

Clinical examination: All data related to the case history, and clinical findings of each donkey were recorded. A thorough history was taken, including age, sex, recent activity, feeding program, parasite control, fecal quality and when it was last passed, and any history of colic. Likewise, any changes in management practice, including feeding regimen, pregnancy, or medical treatments were recorded. The owners had also been asked about the time elapsed since onset of clinical signs of abdominal pain and any drugs given to the donkey, their amount, and how it is responding to analgesia. All studied donkeys were initially examined, including inspection of abdominal silhouette, abdominal auscultation, rectal examination, nasogastric intubation, abdominal paracentesis, and abdominal ultrasonography.

A special concern was given to rectal temperature, heart rate, respiratory rate, mucous membranes, peripheral perfusion, appetite, severity of abdominal pain, motility of both cecum and colon, and defecation pattern, according to the standard clinical examination methods(Constable et al., 2017).

Ultrasonographic Examination: Transcutaneous ultrasonographic examination was conducted using a high-frequency linear(6 - 11 MHz) array transducer(CHISON Digital Color Doppler Ultrasound system, iVis 60 EXPERT VET, CHISON Medical Imaging Co., Ltd., China) to examine the intestinal peristalsis. All ultrasound imaging procedures were performed using the standard protocol described previously by Gomaa et al.(2013); Ibrahim et al.(2013).

Peritoneal Fluid sampling and analysis: Peritoneal fluid samples were aseptically obtained from each standing donkey under investigation. A small stab incision was made directly to the right of midline using scalpel blade after local anesthesia, and then a sterile teat cannula was inserted(Latson et al., 2005; Constable et al., 2017) to collect two peritoneal fluid samples from each donkey. The first peritoneal fluid sample was collected in an ethylenediaminetetraacetic acid(EDTA) tube and immediately evaluated for color, turbidity, and cytological picture(total and differential cell counts) using standard method(Juzwiak et al., 1991; Hanson et al., 1992). The second peritoneal fluid sample was collected in a plain tube and immediately centrifuged(1,500 x g, 10 min), separated, and stored at - 20 AdegC until biochemical analysis.

All selected biochemical variables were quantified spectrophotometerically(Photometer 5010, Germany), using commercial test kits according to standard protocol of supplier; alkaline phosphatase activity(ELITech Group Clinical Systems Products, Russia), lactate level(Spectrum Diagnostics, Germany), lipase activity(Quimica Clinica Applicada, Spain), nitric oxide level(Bio-diagnostic, Egypt), and cardiac troponin I level(Siemens healthcare diagnostics products ltd, United Kingdom).

Statistical Analysis: Data analysis was performed using a statistical software program(SPSS for windows Version 21, SPSS Inc., Chicago, USA). For testing the normal distribution of the data, Kolmogrov-Smirnov test was used. The data were normally distributed; therefore, they were expressed as mean and standard deviation(SD). Independent sample t-test was used to determine the difference between diseased group and control group. ROC curve, sensitivity(%), specificity(%), accuracy(%), and cut-off point for both the cytological picture and certain biochemical parameters of peritoneal fluid were performed. To examine the predictors for diagnosis of intestinal ischemia in donkeys, univariate logistic regression analysis model was performed using a constructed model from identified variables(cellular profile and certain biochemical parameters of the peritoneal fluid) by our investigation.

Variables with significant association at P < 0.05(two-sided) were further subjected to multivariate logistic regression model, providing a definition of the final parameters that early predict the intestinal ischemia in the studied donkeys. Regression coefficient(B), standard error(S.E.), Wald, P-value, odds ratio(OR), and a 95% confidence interval(95% CI) were recorded for each variable. In all statistical analyses, the results were considered significant at P < 0.05.

RESULTS

Clinically, both the heart rate and the respiratory rate were increased in the studied donkeys with intestinal obstruction compared with control group without alteration in the rectal temperature. Donkeys are very stoical, and therefore did not show the obvious clinical signs of colic that are seen in horses. Close monitoring of the studied donkeys with obstructive colic revealed that donkeys' demeanour and bowel habits were very helpful in identifying when they become unwell. The observed clinical signs in the donkeys with intestinal obstructive lesion were dullness, poor response to external stimuli, increased respiratory and heart rates, congested mucosa, anorexia, shivering, muscle fasciculation, excessive sweating, pawing, sternal recumbency, abdominal distension, and absence of both peristalsis and defecation.

Rectal palpation revealed the presence of distended intestinal loops, and the rectum seemed sticky to touch and empty except for mucous and blood. At the terminal stage, the signs of hypovolemia as well as toxic shock with or without intestinal rupture and per-acute diffuse peritonitis appeared, but the pain did not worsen. There was no any fluid reflux on passage of a nasogastric tube in all studied donkeys with intestinal obstructive lesion.

Abdominal ultrasonography provided an indication about intestinal peristalsis, general condition of the intestine, and the amount of fluid in the abdominal cavity. In the studied donkeys with intestinal ischemia, the intestinal peristalsis was absent, the intestine appeared as several distended loops adjacent to each other with a thickened and edematous wall, and the amount of the fluid in the cranial abdomen increased.

The peritoneal fluid samples appeared turbid and tinged with blood in the studied donkeys with obstructive colic. There was a significant(P < 0.05) increase in the count of total nucleated cells, neutrophils, lymphocytes, and monocytes in the studied donkeys with intestinal obstruction compared to the control group(Table 1). Besides, the cytological picture of peritoneal fluid had a diagnostic sensitivity of 100% and a specificity of 100%(Tables 2).

Univariate logistic regression analysis model of the cellular profile of peritoneal fluid showed that the increased count of each of the total nucleated cells, neutrophils, lymphocytes, and monocytes was a significant predictor of intestinal ischemia in the examined donkeys(Table 3). However, multivariate logistic regression analysis model showed that the increased total nucleated cells count in peritoneal fluid appeared to be an independent predictor of intestinal ischemia(P = 0.001; OR = 0.028; 95% CI = 0.004 - 0.196)(Table 4).

There was a significant(P < 0.05) increase in the activity of both alkaline phosphatase and lipase as well as in the level of lactate, nitric oxide and cardiac troponin I in peritoneal fluid in donkeys with intestinal obstruction when compared with control group(Table 5). Moreover, the activity alkaline phosphatase, and the level of both lactate and cardiac troponin I in peritoneal fluid had a diagnostic sensitivity of 90% and a specificity of 100% for each of them. Besides, lipase activity and nitric oxide level in peritoneal fluid had a diagnostic sensitivity of 80% and a specificity of 100% for each of them(Table 6).

Univariate logistic regression analysis model of the selected biochemical parameters in peritoneal fluid indicated that the increased activity of both alkaline phosphatase and lipase and the increased level of lactate, nitric oxide, and cardiac troponin I in the peritoneal fluid were significant predictors of the intestinal ischemia in the studied donkeys(Table 7). However, multivariate logistic regression analysis model showed that the increased alkaline phosphatase activity in peritoneal fluid was a strong predictor of intestinal ischemia(P = 0.034; OR = 0.041; 95% CI = 0.002 - 0.902). Likewise, the increased lipase activity in peritoneal fluid was a significant predictor of intestinal ischemia(P = 0.030; OR = 0.056; 95% CI = 0.003 - 0.988). As well, the increased lactate level in peritoneal fluid was a substantial predictor of intestinal ischemia(P = 0.018; OR = 0.030; 95% CI = 0.002 - 0.543)(Table 8).

Table 1. Peritoneal fluid cytological picture(Mean +- SD) in clinically healthy donkeys and in those with obstructive colic.

###Total nucleated cells###Neutrophils###Lymphocytes###Monocytes

###(x 10 3 )###(x 10 3 )###(x 10 3 )###(x 10 3 )

Control(n = 10)###1.05 +- 0.05###0.69 +- 0.34###0.32 +- 0.30###0.07 +- 0.01

Obstructive colic(n = 30)###10.39 +- 0.05 *###5.39 +- 1.49 *###4.63 +- 0.28 *###0.37 +- 0.02 *

Table 2. Sensitivity and specificity of analyzing the cytological picture of the peritoneal fluid in donkeys with obstructive colic.

###Total nucleated cells###Neutrophils###Lymphocytes###Monocytes

AUC###1.000###1.000###1.000###1.000

Cut-off point(x 10 3)###1.1###1.03###0.6###0.03

Sensitivity(%)###100###100###100###100

Specificity(%)###100###100###100###100

95 % confidence interval###3.49 A 7.97###1.95 A 4.27###1.56 A 3.59###0.10 A 0.26

Significance level P(Area=0.5)###0.001###0.001###0.001###0.001

Table 3. Univariate logistic regression model of the cytological picture of the peritoneal fluid in donkeys with obstructive colic.

Variables###B###S.E.###Wald###P###OR###95 % CI

Total nucleated cells(x 10 3)###2.603###0.733###12.614###0.001###13.500###3.210 A 56.770

Neutrophil(x 10 3)###2.485###0.736###11.400###0.001###12.000###2.836 A 50.775

Lymphocytes(x 10 3)###2.398###0.739###10.541###0.001###11.000###2.587 A 46.779

Monocytes(x 10 3)###2.351###0.740###10.096###0.001###10.500###2.462 A 44.781

Table 4. Multivariate logistic regression model of the cytological picture of the peritoneal fluid in donkeys with obstructive colic.

Variables###B###S.E.###Wald###P###OR###95 % CI

Total nucleated cells(x 10 3)###- 3.584###0.998###12.901###0.001###0.028###0.004 A 0.196

Constant###2.603###0.733###12.614###0.001

Table 5. Activity of both alkaline phosphatase and lipase, and level of lactate, nitric oxide, and cardiac troponin I(Mean +- SD) in the peritoneal fluid in clinically healthy donkeys and in those with obstructive colic.

###Alkaline phosphatase###Lipase###Lactate###Nitric oxide###Cardiac troponin I

###(U/L)###(U/L)###(mmol/L)###(U/mL)###(ng/mL)

Control(n = 10)###15.08 +- 0.75###58.9 +- 11.5###3.00 +- 0.23###2.46 +- 0.31###0.02 +- 0.01

Obstructive colic(n = 30)###19.70 +- 2.26 *###85.60 +- 9.08 *###9.69 +- 2.8 *###4.99 +- 0.45 *###0.05 +- 0.01 *

Table 6. Sensitivity and specificity of analyzing the activity of both alkaline phosphatase and lipase, and the level of lactate, nitric oxide, and cardiac troponin I in peritoneal fluid in donkeys with obstructive colic.

###Alkaline Phosphatase###Lipase###Lactate###Nitric oxide###Cardiac troponin I

###(U/L)###(U/L)###(mmol/L)###(U/mL)###(ng/mL)

AUC###0.965###0.980###0.970###0.935###0.905

Cut-off point###15.83###70.4###3.23###2.77###0.03

Sensitivity(%)###90###80###90###80###90

Specificity(%)###100###100###100###100###100

95 % confidence interval###0.888 A 1.042###0.929 A 1.031###0.902 A 1.038###0.833 A 1.037###0.768 A 1.042

Significance level P(Area=0.5)###0.001###0.001###0.001###0.001###0.002

Table 7. Univariate logistic regression model of the analysis of the activity of both alkaline phosphatase and lipase, and the level of lactate, nitric oxide, and cardiac troponin I in peritoneal fluid in donkeys with obstructive colic.

Variables###B###S.E.###Wald###P###OR###95 % CI

Alkaline phosphatase(U/L)###0.073###0.021###11.713###0.001###1.075###1.032 A 1.121

Lipase(U/L)###2.485###0.736###11.400###0.001###12.000###2.836 A 50.775

Lactate(mmol/L)###2.603###0.733###12.614###0.001###13.500###3.210 A 56.770

Nitric oxide(U/mL)###2.079###0.612###11.531###0.001###8.000###2.409 A 26.567

Cardiac troponin I(ng/mL)###1.910###0.536###12.703###0.001###6.750###2.362 A 19.290

Table 8. Multivariate logistic regression model of the analysis of the activity of both alkaline phosphatase and lipase, and the level of lactate, nitric oxide, and cardiac troponin I in peritoneal fluid in donkeys with obstructive colic.

Variables###B###S.E.###Wald###P###OR###95 % CI

Alkaline phosphatase(U/L)###- 3.196###1.578###4.101###0.034###0.041###0.002 A 0.902

Lipase(U/L)###- 2.888###1.468###3.872###0.030###0.056###0.003 A 0.988

Lactate(mmol/L)###- 3.519###1.484###5.624###0.018###0.030###0.002 A 0.543

Constant###4.958###1.571###9.961###0.002

DISCUSSION

Obstructive colic is a major disease state that causes severe abdominal pain and a frequent and important cause of death in horses and donkeys. These species are prone to colic compared to others due to their unique anatomy of digestive system. Under the field condition, markers of ischemic bowel are useful for predicting, monitoring, and managing the obstructive colic in equine. To improve the diagnostic accuracy while examining a horse with colic, several studies regarding clinical and laboratory examination are needed. Therefore, the current study aimed to assess the cellular profile and certain biochemical parameters of the peritoneal fluid, highlighting their diagnostic sensitivity and specificity as biomarkers for early diagnosis of intestinal ischemia in donkeys(Equus asinus) as a model of equine.

In the existing study, peritoneal fluid analysis had remarkable cellular alterations as a consequence of intestinal strangulation. These findings were similar to those reported by Hanson and Albanese(2015). As a consequence of strangulating obstruction, the red blood cells migrate across the bowel wall into the peritoneal fluid, followed by white blood cells. Thus, the earliest sensitive indicator of intestinal strangulating lesion is the change in the color of peritoneal fluid from straw to red color. The recorded increase in the total nucleated cells count in the peritoneal fluid is mostly related to the increase in the segmented neutrophils, which was observed in the donkeys under investigation. Constable et al.(2017) stated that the total leukocyte count was ranged between 10,000 and 150,000 cell/uL in horses with peritonitis and/or intestinal infarction.

Furthermore, the results of sensitivity and specificity of the cellular profile of the peritoneal fluid demonstrated its usefulness as an aid in diagnosing intestinal ischemia in the studied donkeys as previously reported elsewhere(Faleiros et al., 2011; Duesterdieck-Zellmer et al., 2014).

With respect to the ultrasonographic imaging results, the intestinal peristalsis was absent, the intestine appeared as several distended loops adjacent to each other with a thickened and edematous wall, and the amount of the fluid in the cranial abdomen increased. These findings were similar to those reported by le Jeune and Whitcomb(2014) and Constable et al.(2017). The results of ultrasound imaging provided a diagnostic aid for evaluating horses with colic and assisting in the differentiation of medical from surgical colic.

Alkaline phosphatase activity in the peritoneal fluid increased significantly in donkeys with intestinal obstruction compared to the control group. Such increase may be attributed to the increased hepatic exposure to endotoxin, inflammatory mediators, enteric bacteria, and stretched bile ducts as a result of ileus. Consequently, measurement of alkaline phosphatase activity in the peritoneal fluid aids in diagnosis of more severe intestinal lesions requiring surgery in horses. These findings were similar to those previously reported(Saulez et al., 2004).

Lipase activity in the peritoneal fluid increased significantly in donkeys with intestinal ischemia compared to the control group. The elevated lipase activity suggests acute pancreatic injury secondary to both intestinal obstruction and shock associating acute abdominal disorders(Grulke et al., 2003; Talbot et al., 2011). In human studies, it has been reported that shock can lead to hypo-perfusion of the splanchnic area with a resultant multi-organ dysfunction, including pancreas(Venneman et al., 1993). The pancreas is mostly vulnerable to hypovolemia due to both its specific structure and the nature of the blood distribution within it(Endrich et al., 1990).

Lactate level in the peritoneal fluid was significantly greater in donkeys with intestinal obstruction compared to those in the control group. Horses suffering colic are in imminent shock and incurring an oxygen deficit. In oxygen-deficient states, hypoxic tissues undergo anaerobic glycolysis with the end result being an increased lactic acid production. Lactate accumulates in the cells and enters the circulation exacerbating metabolic acidosis(Rogatzki et al., 2015). Consequently, the high lactate level is well correlated with greater degree of bowl damage and ischemia as the horses succumbed to diffuse peritonitis 3 days later(Peloso and Cohen, 2012). Several studies discussed the clinical importance and prognostic significance of pre-operative assessment of lactate in peritoneal fluid in horses with signs of colic and intestinal ischemia(Delesalle et al., 2007; Tennent-Brown et al., 2010).

In a study conducted on adult horses with large colon volvulus, the serum lactate level at admission in non-survived horses was significantly increased compared with those of survivors. Moreover, the serum lactate level returned to its normal level in the survivors, but continued to be higher in non-survivors(Johnston et al., 2007).

The gut is considered an instigator for systemic inflammation. In the present study, intestinal obstruction and ischemia, and gut disuse may prime the body for a hyper-active inflammatory response, including increased gut inflammation and breakdown of gut barrier function, thus disturbing the intestinal microbiomes and predisposing animal to significant inflammation again(Annane, 2005). The outcome is a deleterious vasodilatation and capillary leakage, with concomitant hypovolemia and increased metabolic demand. As a result, when oxygen delivery is insufficient to meet metabolic demand, tissue hypoxia develops giving rise to production of lactate as a by-product of anaerobic cellular respiration(Ebrahim, 2011).

The cellular hypoxia is confounded due to impaired cellular oxygen extraction, which is mediated at a mitochondrial level through nitric oxide, blocking the mitochondrial electron transfer chain with subsequent increased mitochondrial derived reactive oxygen species concentration(Jeffrey Man et al., 2014).

In the existing study, there was a significant increase in the level of nitric oxide in the peritoneal fluid obtained from donkeys with obstructive colic compared to the control group. Mirza et al.(1999) found that nitric oxide level in the peritoneal fluid was significantly increased subsequent to small intestinal strangulating obstruction. Nitric oxide exerts either cytotoxic or cytoprotective effects during intestinal inflammation, including ischemia-reperfusion injury, depending upon the source, duration, magnitude, and timing of its production(Mirza et al., 2005; Granger and Kvietys, 2015). Hypoxemia and ischemia occurring as a result of intestinal strangulating volvulus cause trans-mural colonic damage with disruption of the mucosal barrier subsequent to ischemia and secondary to reperfusion injury.

Reperfusion injury is usually initiated by production of oxygen free radicals and perpetuated by neutrophils and inflammatory mediators(Granger and Kvietys, 2015). The constitutive nitric oxide protects the intestinal mucosal barrier, while the inducible isoform of nitric oxide is usually expressed in numerous cells, in response to cytokines or another stimulus, leading to sustained release of large quantities of nitric oxide(Beckman and Crow, 1993; Granger and Kvietys, 2015). The produced nitric oxide reacts with superoxide radicals to produce peroxynitrite, causing appreciable tissue damage(Nakao et al., 2009).

Cardiac troponin I level increased greatly in the peritoneal fluid collected from the studied donkeys with obstructive colic compared to control group, suggesting myocardial injury as a result of intestinal ischemia. Up to now, there are no available published data regarding the potential significance of measuring cardiac troponin I in the peritoneal fluid of equine with obstructive colic. An increase in the level of cardiac troponin I at admission was significantly associated with occurrence of ventricular arrhythmias and the outcome is surgical treatment(Radcliffe et al., 2012; Diaz et al., 2014). Furthermore, Nath et al.(2012) reported that the serum cardiac troponin I level was significantly elevated in 36% of horses suffered from strangulating lesions and 47% of horses with inflammatory lesions.

The cardiovascular system is sensitive to the effect of vasoactive substances, including nitric oxide produced during systemic inflammatory response. Nitric oxide is a vocative mediator responsible for the reduced myocardial contractility during systemic inflammatory response syndrome. Likewise, endotoxin and pro-inflammatory cytokines have been shown to induce myocardial depression, which is probably mediated through nitric oxide(Bohlen, 2015).

Conclusion: The results herein demonstrated that the increased total nucleated cells count, the increased activity of both alkaline phosphatase and lipase, and increased level of lactate are sensitive and specific predictors to assist in the early diagnosis of intestinal obstruction in donkeys(Equus asinus) with obstructive colic. Thus, it provides evidence about the ability of the assessment of cellular profile and measurement of such biochemical parameters in the peritoneal fluid to provide a diagnostic plan for early diagnosis as well as for detection of the deleterious consequences of intestinal ischemia in donkeys(Equus asinus) with an intestinal obstructive lesion. Also, along with its excellent predictive power, the peritoneal fluid is easy to obtain, making it a practical tool of potentially widespread applicability.

These non-invasive and promising tools may offer opportunities for early diagnosis of the intestinal ischemia in equine with intestinal obstruction and potentially more rational choice to differentiate between surgically and conservatively treated colic in such animals.

Conflict of interest: None of the authors of this paper has a financial or personal relationship with other people or organizations that could inappropriately influence or bias the content of the paper.

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Author:H. M. M. Ibrahim, S. M. Shoieb, M. R. El-Ashker and K. S. Abouelnasr
Publication:Journal of Animal and Plant Sciences
Date:Oct 31, 2020
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