Equine gastric ulcer syndrome (EGUS) is a highly prevalent and presumptively painful condition, although the amount of pain horses might experience is currently unknown. The aims of this study were to determine if the Horse Grimace Scale (HGS) could identify pain behaviours in horses with and without EGUS and if severity would be positively associated with the HGS score. Horse grimace scale scores were assessed blindly using facial photographs by seven observers and involved evaluation of 6 facial action units as 0 (not present), 1 (moderately present) and 2 (obviously present). Lameness examination, serum amyloid A (SAA) measurement and gastroscopy evaluation were performed on all horses. Horses (n = 61) were divided into two and three groups based on the presence (yes, no) and severity (none, mild, moderate-severe) of EGUS, respectively. Presence of lameness and elevated SAA (≥50 µg/mL) were used as exclusion criteria. Inter-observer reliability was analyzed by intra-class correlation coefficients (ICC). HGS scores between groups were compared using Welch’s and Brown Forsythe tests (p < 0.05). Overall, HGS ICC was “excellent” (0.75). No significant differences (p = 0.566) were observed in HGS scores between horses with and without gastric lesions (mean, 95% CI; 3.36, 2.76–3.95 and 3, 1.79–4.20, respectively). HGS was not influenced by the presence or severity of EGUS in this current study. Further studies investigating the use of different pain scales in horses with EGUS are needed.

Effective clinical reasoning is essential for veterinary medical education, particularly in managing complex cases. This review explores strategies for learning clinical reasoning by veterinary medical learners, using a case example of mastitis to illustrate key concepts. Clinical reasoning encompasses cognitive, metacognitive, social, and situational activities, yet the literature on practical applications in veterinary education remains limited. The review discusses various stages of clinical reasoning, including data collection, problem representation, differential diagnosis, and management planning. It emphasizes the importance of integrating client-centered care and iterative evaluation into the clinical decision-making process. Key learning strategies include facilitation in using the domains of clinical reasoning—concepts, data collection, and analysis, taking action, and reflection on encounters. This review highlights best practices such as forward and backward reasoning, reflective practice, and the use of practical examples to enhance learners’ diagnostic accuracy and patient outcomes. The insights provided aim to enhance the training of veterinary learners, ensuring they can navigate day 1 as well as complex cases with improved diagnostic accuracy and patient outcomes.

Clinical reasoning is an essential competence of veterinary graduands. It is a complex competence with cognitive, metacognitive, social, and situational activities. The literature on clinical reasoning in veterinary medical education is relatively scarce or focused on theoretical rather than practical applications. In this review, we address the practicality of teaching clinical reasoning to veterinary learners utilizing a practical example of a cow with allergic rhinitis. Learners should be guided through all the domains of clinical reasoning, including concepts, data collection and analysis, take action, and reflection on an encounter. Each of these domains needs to be clearly but concisely explained and practiced repeatedly by learners throughout the veterinary curricula. The teaching of clinical reasoning should start as early in the curriculum as possible, preferably in the pre-clinical years, with a gradual scaffolding and building of complexity before work-based learning begins, with an increase in demanding for advanced clinical reasoning competence. The teaching of clinical reasoning is best performed in specialized sessions and continued as a horizontally and vertically integrated activity.

Background Diuretic treatment is the mainstay for management of congestive heart failure in horses, and its use has been restricted to injectable medications because no currently data supports the use of PO administered loop diuretics. Objectives To determine the pharmacokinetic and pharmacodynamic properties of PO administered torsemide and, determine if PO administered torsemide, could be used as an alternative to injectable diuretics in the horse. Animals Six healthy adult mares. Methods A 2‐phase, prospective study, that consisted of pharmacokinetic profiling of a single dose (6 mg/kg PO) and pharmacodynamic effects of long‐term torsemide administration (2 mg/kg PO q12h) for 6 days in healthy horses. Results Pharmacokinetic analysis identified a peak concentration (C_max) of 10.14 µg/mL (range, 6.79–14.69 µg/mL) and elimination half‐life (T_1/2) 9.2 hours (range, 8.4–10.4 hours). The area under the plasma drug concentration over time curve (AUC) was 80.7 µg × h/mL (range, 56.5–117.2 µg × h/mL). A statistically significant increase in urine volume and decrease in urine specific gravity were found from day 0 (baseline) to day 6 (P < .0001). Significant alterations in biochemical variables included hyponatremia, hypokalemia, hypochloremia, and increased serum creatinine concentration. Mean arterial blood pressure significantly decreased on day 6 (57.7 ± 8.8 mm Hg, P = .001) as compared with baseline (78 ± 6.1 mm Hg). Serum aldosterone concentrations significantly increased after 6 days of torsemide administration (P = .0006). Conclusions and Clinical Importance PO administered torsemide (4 mg/kg/day) successfully reached therapeutic concentrations in blood, induced clinically relevant diuresis, and resulted in moderate pre‐renal azotemia and electrolyte disturbances.

Background: Right dorsal colitis (RDC) is a nonsteroidal anti-inflammatory drug (NSAID) induced, protein losing enteropathy in horses associated with a high case fatality rate. Objectives: To describe signalment, NSAID usage, clinical presentations, clinical pathology, ultrasonographic findings, treatments, outcomes, and factors associated with survival in horses diagnosed with RDC. Animals: Thirty-five horses from 7 Australian equine hospitals diagnosed with RDC. Methods: Retrospective case series. Clinical records of cases were accepted if definitively or presumptively diagnosed by an internist with RDC and had ≥3 of: hypoproteinemia or hypoalbuminemia; diarrhea with negative test results for infectious diseases; colic for which other diseases were excluded or right dorsal colon thickening on ultrasound. Descriptive data analysis was performed for categorical and continuous variables. Univariate binominal logistic regressions were used to assess factors associated with survival. Results: An overdose of NSAIDs occurred in 84% (21/25) cases where dose was known. Common clinical presentations included diarrhea (69%; 22/32), colic (61%; 20/33), and tachycardia (53%, 17/32). Common clinicopathological findings included hypoalbuminemia (83%; 26/31), hypocalcaemia (79%, 23/29), and hyperlactatemia (77%, 14/18). The right dorsal colon wall appeared subjectively thickened in 77% (24/31) cases using ultrasonography. Case fatality rate was 43% (15/35). Odds of survival significantly decreased with increasing heart rate (odds 0.84, 95% CI = 0.71-0.92, P = .01), packed cell volume (odds 0.91, 95% CI 0.82-0.98, P = .05) and abnormal appearance of mucous membranes (odds 0.05, 95% CI 0.005-0.28, P = .001) on hospital presentation. Conclusions and Clinical Importance: An overdose of NSAIDs is common in horses diagnosed with RDC. Serum albumin concentrations should be monitored in horses receiving a prolonged course of NSAIDs. Overall prognosis for RDC remains fair.