Clinical examination in horses involves a systematic evaluation of the animal to assess its health status and identify any potential medical issues. This process typically includes a thorough physical assessment, which may cover observation of behavior and posture, palpation of body structures, auscultation of heart and lung sounds, and examination of the skin, eyes, and mucous membranes. Additional diagnostic tools such as thermography, endoscopy, or imaging techniques may be utilized to gather more detailed information. Clinical examination serves as a foundational step in veterinary diagnostics, aiding in the detection and management of diseases or injuries in horses. This page compiles peer-reviewed research studies and scholarly articles that explore methodologies, advancements, and findings related to clinical examination practices in equine medicine.
Lyashchenko KP, Greenwald R, Esfandiari J, Lecu A, Waters WR, Posthaus H, Bodmer T, Janssens JP, Aloisio F, Graubner C, Grosclaude E, Piersigilli A....A case of pulmonary tuberculosis caused by Mycobacterium tuberculosis was diagnosed in a horse. Clinical evaluation performed prior to euthanasia did not suggest tuberculosis, but postmortem examination provided pathological and bacteriological evidence of mycobacteriosis. In the lungs, multiple tuberculoid granulomas communicating with the bronchiolar lumen, pleural effusion, and a granulomatous lymphadenitis involving mediastinal and tracheobronchial lymph nodes were found. Serologic response to M. tuberculosis antigens was detected in the infected horse, but not in the group of 42 potential...
Rull-Cotrina J, Molleda JM, Gallardo J, Martín-Suárez E.To assess the refractive state of the equine eye utilizing retinoscopy. To compare the refractive state of Spanish Thoroughbred horses with the refractive state of Crossbred horses. Methods: The refractive state of 135 horses (264 eyes) was assessed utilizing streak retinoscopy. Two perpendicular meridians were examined in order to assess astigmatism at a working distance of approximately 67 cm. A group of 81 Spanish Thoroughbred horses was compared with a group of 54 Crossbred horses. Cyclopentolate ophthalmic solution was instilled in the eyes of a group of 18 horses to determine if accommod...
Mitchell JS.Lameness and performance evaluation can be one of the most rewarding aspects of equine veterinary practice. There is a misconception that it depends on new sophisticated and expensive diagnostic modalities, when the reality is that knowing where and when to use these modalities form the real art of equine lameness practice. The most expensive ultrasound machine in the world is not very diagnostic if applied to the wrong limb. The art of lameness practice is vested in knowledge of horsemanship, an understanding of anatomy and function, and inquiring senses to sort out what the horse and his han...
Canisso IF, Beltaire KA, Bedford-Guaus SJ.Premature luteal demise or luteal insufficiency is not well characterised as a cause of pregnancy loss in domestic species, including horses. In this report, a mare inseminated with cooled-transported semen at our facility returned for a routine pregnancy diagnosis at 15 days post ovulation. Ultrasonography per rectum revealed endometrial oedema and the absence of visual indication of a corpus luteum on either ovary. Nonetheless, an embryonic vesicle small for the gestational age was identified. Daily oral altrenogest treatment was implemented immediately. Serum progesterone concentration was ...
van Galen G, Saegerman C, Marcillaud Pitel C, Patarin F, Amory H, Baily JD, Cassart D, Gerber V, Hahn C, Harris P, Keen JA, Kirschvink N, Lefere L....Appropriate management of atypical myopathy (AM) requires the establishment of an accurate diagnosis and prognosis. Furthermore, preventive measures to avoid AM need to be refined. Objective: The aims of the study were as follows: 1) to improve the diagnosis of AM; 2) to identify prognostic predictors; and 3) to refine recommended preventive measures based on indicators of risk factors. Methods: An exploratory analysis of cases in Europe between 2006 and 2009 reported to the Atypical Myopathy Alert Group was conducted. Based on clinical data, reported cases were allocated into 2 groups: ...
Knottenbelt DC.A logical and thorough clinical investigation should provide the best basis for the diagnosis of skin diseases. Where no diagnosis can be reached despite a full range of investigations, the clinician can justifiably attempt symptomatic treatment, but it is always better to focus treatment on a specific condition based on properly accumulated and tested clinical evidence. Unfortunately, in equine dermatology there are few text descriptions of the majority of the conditions encountered in practice. While a few diseases are well recognized, there is still little consensus on the best treatments f...
Dwyer AE.Equine practitioners examine patient eyes on a daily basis. Indications range from inspection of normal anatomy to treatment of traumatized eyes to workups of sight threatening inflammatory or neoplastic ocular conditions. Assessment of equine eyes requires practitioners to take time to create a good "exam room" in the field and administer appropriate restraint, sedation and/or regional anesthesia to facilitate thorough examination. Accurate diagnosis and treatment of equine eye problems requires skill in ocular surface staining and cytology, and basic proficiency in standing surgery. Expertis...
Greenberg SM, Plummer CE, Brooks DE, Craft SL, Conway JA.An 8-year-old Gypsy Vanner gelding presented to the University of Florida Ophthalmology service for the evaluation of chronic, recurrent corneal ulcers behind the third eyelid of the right eye. On ophthalmic examination, a cluster of aberrant hairs was identified growing along the margin of the third eyelid. This portion of third eyelid was surgically excised, and histopathology identified the haired tissue as a dermoid. Chronic keratitis secondary to a third eyelid dermoid was diagnosed, and excision appeared curative at 6 months post-operative follow-up.
Bienert-Zeit A, Müller JM, Feige K.The article provides hands-on advice and scientific background information regarding the management of the equine acute colic patient. It summarizes essential information on the patient's history, clinical examination, and legal aspects. The scope of the history is based on the clinical appearance of the patient. In horses with violent and barely controllable signs of pain, it is limited to colic-associated information such as onset, course and severity of colic signs, and the last time of defecation, as well as prior therapeutic intervention. In these patients, the clinical examination is foc...
Straticò P, Suriano R, Sciarrini C, Varasano V, Petrizzi L.To report laparoscopic-assisted cystotomy and inguinal cystostomy for treating bladder urolithiasis in a gelding. Methods: Clinical report. Methods: Twelve-year-old Appaloosa gelding. Methods: A laparoscopic approach was used to locate and grasp the bladder, which was exteriorized through an enlarged instrument portal for cystotomy to remove the calculus. During withdrawal, the calculus fragmented into multiple pieces. To avoid urethral occlusion and facilitate elimination of these fragments, an inguinal cystostomy was created. The seromuscular layer of the bladder was circumferentially secure...
Klier J, Fuchs S, May A, Schillinger U, Plank C, Winter G, Coester C, Gehlen H.In the recent years, nanotechnology has boosted the development of potential drug delivery systems and material engineering on nanoscale basis in order to increase drug specificity and reduce side effects. A potential delivery system for immunostimulating agents such as cytosine-phosphate-guanine-oligodeoxynucleotides (CpG-ODN) needs to be developed to maximize the efficacy of immunotherapy against hypersensitivity. In this study, an aerosol formulation of biodegradable, biocompatible and nontoxic gelatin nanoparticle-bound CpG-ODN 2216 was used to treat equine recurrent airway obstruction in ...
Stokes AM, Lavie NL, Keowen ML, Gaschen L, Gaschen FP, Barthel D, Andrews FM.This study investigated the use of a wireless ambulatory capsule (WAC; SmartPill(®) pH.p GI Monitoring System) to determine WAC-gastric emptying time (GET) in ponies. Objective: To measure WAC-GET and compare it to those findings with GET assessed by nuclear scintigraphy (S-GET). Objective: WAC-GET will be slower than S-GET, but will be significantly correlated. Methods: Seven healthy adult mixed-breed pony mares were used in this study. Feed was withheld for 12 h prior to the WAC administration. After administration, a complete-feed diet was fed to allow the WAC to pass into the stomach. Lum...
Mc Brearty A, Auckburally A, Pollock PJ, Penderis J.Deafness has been reported in horses due to a variety of causes and objective auditory assessment has been performed with brainstem auditory evoked potential testing. Evoked otoacoustic emission (OAE) tests are widely used in human patients for hearing screening, detecting partial hearing loss (including frequency-specific hearing loss) and monitoring cochlear outer hair cell function over time. OAE tests are noninvasive, quick and affordable. Two types of OAE are commonly used clinically: transient evoked OAEs (TEOAEs) and distortion product OAEs (DPOAEs). Detection of OAEs has not been repor...
Nguyen JS, Tran Y, Su SW, Nguyen HT.This paper is concerned with the design and development of a semi-autonomous wheelchair system using cameras in a system configuration modeled on the vision system of a horse. This new camera configuration utilizes stereoscopic vision for 3-Dimensional (3D) depth perception and mapping ahead of the wheelchair, combined with a spherical camera system for 360-degrees of monocular vision. This unique combination allows for static components of an unknown environment to be mapped and any surrounding dynamic obstacles to be detected, during real-time autonomous navigation, minimizing blind-spots an...
Carmalt JL, Bell CD, Panizzi L, Wolker RR, Lanovaz JL, Bracamonte JL, Wilson DG.To assess the safety and efficacy of alcohol-facilitated ankylosis of the distal intertarsal (DIT) and tarsometatarsal (TMT) joints in horses with osteoarthritis (bone spavin). Methods: Prospective clinical trial. Methods: 21 horses with DIT or TMT joint-associated hind limb lameness and 5 nonlame horses. Methods: 11 horses (group 1) underwent lameness, force-plate, and radiographic examinations; following intra-articular analgesia, lameness and force-plate examinations were repeated. Nonlame horses were used for force-plate data acquisition only. Following localization of lameness to the DIT ...
Zantingh AJ, Gaughan EM, Bain FT.A 14-year-old Hanoverian gelding was evaluated after a 10-week history of occasional straining during urination and dark red urine production after exercise. Physical examination findings were within normal limits. After 2 weeks of clinical signs, ultrasonography had found no abnormalities in the kidneys or bladder. A freely voided urine sample revealed an elevated protein concentration (500 mg/dL; reference range: <100 mg/dL) and few red blood cells. Vitamin C supplementation was suggested to acidify the urine, as was provision of a salt block to encourage water intake.
Evans RG, Lowder M.Equine behavioral problems and loss of optimum performance have been associated with musculoskeletal injury and, more recently, dental disease. Injuries to a horse's tongue and bars of the mandible due to bitting have been documented. However, another point of contact of the bit, the hard palate, has thus far been virtually ignored. The objective of the study was to determine if there was a significant range associated with the depth of the equine hard palate and if this range was associated with a certain breed, age, or sex of the horse. Oral examinations were performed on 52 horses and a mea...
Menzies RA, Lewis JR, Reiter AM, Lundström TS.Equine dentistry should no longer be thought of as art over science. To be an effective equine dental clinician requires considerable investment in knowledge beyond the basic veterinary degree. It requires current scientific dental knowledge and adherence to the fundamental principles of medicine, dentistry, and surgery. Knowledge and principles will provide clinicians with the necessary information to make more evidence-based decisions as the scientific literature continues to evolve. Diagnosis and therapy should be seen as journeys with a destination, keeping in mind the values of the Hippoc...
Kotoyori Y, Yokoo N, Ito K, Murase H, Sato F, Korosue K, Nambo Y.The objective was to assess the optimal procedure for real-time, three-dimensional (3D) ultrasound (US) imaging for assessing the equine fetus during the first half of gestation and the possibility of using 3D US imaging of the equine fetus in clinical applications. Seventeen pregnant mares were examined by 3D US between Days 35 and 180 of gestation. Abdominal and endo-vaginal real-time 3D transducers used in human medicine were used for transrectal and transvaginal examinations, respectively. Images were recorded by both 3D stationary and real-time movies. In a comparison of four methods, tra...
Sherlock CE, Eggleston RB, Howerth EW.A 7-year-old Quarter Horse gelding was evaluated because of sudden onset of severe left forelimb lameness of 4 days' duration. Results: Clinical evaluation and diagnostic perineural analgesia localized the lameness to the distal portion of the left forelimb. Radiography revealed a transverse fracture of the distal phalanx of the left forelimb. Results: The horse was treated conservatively with stall rest and stabilization of the hoof with fiberglass cast material and an elevated heel support. These treatments improved the lameness considerably. Over the following 4 months, the horse was exerci...
Emmerich IU.In 2010, three new active pharmaceutical ingredients were released on the German market for horses and food-producing animals. These were gamithromycin (Zactran®), a new macrolide antibiotic, Monepantel (Zolvix®), a broad spectrum anthelmintic with a novel mechanism, and Pergolide (Prascend®), the first dopamine receptor agonist for animals. Two substances have been approved for additional species. The tetracycline antibiotic doxycycline is now also authorized for turkeys and the nonsteroidal anti-inflammatory drug firocoxib from the group of cyclo-oxygenase-2 (COX-2) inhibitors is now avai...
Lacombe VA, Mayes M, Mosseri S, Reed SM, Fenner WR, Ou HT.In contrast with reports in man and small animals, a systematic classification of seizures in horses is lacking. Objective: The purpose of this study was to classify seizures based on their aetiology and to characterise epilepsy in 104 horses presented for seizures at the Ohio State University Veterinary Medical Center between 1988 and 2009. Methods: In a retrospective observational study, seizures were classified by aetiology based on history, clinical observations, diagnostic investigations (e.g. electroencephalograms, cerebrospinal fluid and computed tomography imaging of the head) and post...
Smrkovski OA, Koo Y, Kazemi R, Lembcke LM, Fathy A, Liu Q, Phillips JC.Performance and clinical characteristics of a novel hyperthermia antenna operating at 434 MHz were evaluated for the adjuvant treatment of locally advanced superficial tumours in cats, dogs and horses. Electromagnetic simulations were performed to determine electric field characteristics and compared to simulations for a flat microwave antenna with similar dimensions. Simulation results show a reduced skin surface and backfield irradiation and improved directional irradiation (at broadside) compared to a flat antenna. Radiated power and penetration is notably increased with a penetration depth...
Hanson RR, Nixon AJ, Calderwood-Mays M, Gronwall R, Pendergast JF.Two techniques for end-to-end anastomosis of the small colon were evaluated in each of 6 horses. A simple interrupted suture pattern that excluded the mucosa and was oversewn with an inverting suture was compared with a triangulated double-row pattern of stainless steel staples. Anastomotic sites were evaluated at 2 weeks, 2 months, and 6 months for extent of abdominal adhesions, lumen diameter at anastomotic sites, bursting pressures, and healing response. Clinical postoperative complications were not associated with either technique. At postmortem examination, there was extensive adhesion fo...
Saadi A, Azizi S, Farshid AA, Yousefi A.This report describes surgical management and breeding implications of a case of penile sarcoid associated with penis laceration in a 4-year-old Kurdish stallion. A large fleshy mass on the distal end of the penis that resulted in urethral meatus deviation and dysuria was detected in a physical examination. No evidence of local extent or metastasis was detected. Under general anaesthesia, the involved distal portion of the penis was removed through partial phallectomy. Histopathological examination of the mass confirmed a fibroblastic sarcoid. Partial phallectomy was successful for management ...
Sielhorst J, Roggel-Buecker U, Neudeck KC, Kahler A, Rohn K, Luettgenau J, Bollwein H, Hollinshead F, Sieme H.The aim of this double-blinded placebo-controlled study was to investigate the effect of acetylsalicylic acid (ASA) on uterine blood flow, gestation length, placental and foal weights in pregnant mares. Sixteen Thoroughbred mares of different age (13.3 ± 4.1) and parity (7.4 ± 3.1) were randomly assigned to three treatment groups. Mares in group C (n = 4) served as controls and received 5,000 mg lactose orally once daily from D 120 (D 0 = day of ovulation) until parturition. Mares in group ASA1 (n = 7) received 5,000 mg ASA orally once daily from D 120 until parturition. Mares in group...
Matthews AG, Crispin SM, Parker J.A wide range of fundic variants are encountered during routine ophthalmoscopic examination of visually normal horses, often causing the examiner difficulty in assessing their clinical significance. Many of these are anatomical variants having no significant effect on visual function, and lie within the limits of normality in the horse. This paper illustrates this range of variants and discusses their anatomical basis and physiological consequences. Colobomata are non-progressive discontinuities in the structure of the anatomic fundus, occasionally noted as incidental findings during ophthalmos...
Chanda M, Klinphayom C, Sungsuwan T, Senarat W, Thongkham E, Kamlangdee A, Senarat N.In horses, the structures at the dorsal aspect of the carpus, including the digital extensor tendons, their related tendon sheaths, and bones, are vulnerable to injury because of their superficial location. Injuries to these structures may result in lameness of the affected limb(s) and reduce a horse's athletic performance. A 13-year-old eventing horse that routinely underwent regular exercise exhibited dorsolateral distension of the right carpus. An effusion insensitive to compression was observed in the affected area. No lameness was detected, and the horse exhibited a negative response to t...
Vasey JR.In 15 horses with acute abdominal disease, a diagnosis of incarceration of small intestine through the epiploic foramen was made, either at the time of exploratory celiotomy or at necropsy.The horses exhibited signs of moderate to severe abdominal pain and were suffering from hypovolaemic and/or endotoxic shock. Nasogastric intubation produced either gas or fluid, the pH of which was in the range of 5 to 7.2, indicating reflux of small intestinal content into the stomach. Consistent physical findings included absence of gut sounds on auscultation, dilated small intestine palpable on rectal exa...
Dart AJ, Snyder JR, Pascoe JR, Meagher DM, Wilson WD.To quantify some components of prepurchase evaluations in horses, records from 134 evaluations performed during a 2-year period were reviewed and the outcome was determined via telephone follow-up interview. Sixty-two percent of the prepurchase evaluations had been performed at the clinic and 38% had been performed in the field by the ambulatory service. All evaluations included physical and lameness examinations, whereas radiography (49%), endoscopy (15%), nerve blocking (5%), transrectal palpation (3%), hematologic analysis (2%), electrocardiography (2%), drug testing for analgesic agents (2...
Ricketts SW.The clinician may use the clinical pathology laboratory as a valuable aid to diagnosis and management, for the assessment of response to treatment, and in preventive medicine programs. Each "link in the chain," that is, sample selection, collection, handling, analysis, result reporting, and interpretation must be carefully and efficiently managed, using an informed combination of art and science, to provide a useful endpoint. This general introduction precedes more specific and detailed articles.
Sertich PL.The events surrounding parturition are well orchestrated, and normal delivery of a foal is an explosive, rapidly occurring event. Any aberration may jeopardize the pregnancy and cause clinical complications. This article discusses problems associated with the periparturient period that require immediate attention.
Proietto L, Beatty SS, Plummer CE.To compare corneal cytology samples from three common sampling techniques: cytobrush (CB), Kimura platinum spatula (KS), and the handle edge of a scalpel blade (SB). Methods: Equine patients presenting to the University of Florida College of Veterinary Medicine with ulcerative keratitis were included. Following diagnosis of corneal ulcer and sampling for microbial culture, two cytology samples per technique were collected with sterile CB, KS, and SB in a randomized order. Cytologic evaluation was performed by two observers masked to collection method. Objective measures of sample cellularity, ...
McKenzie EC.Polyuria and polydipsia provide a diagnostic challenge for the equine clinician. This article describes the various known causes of polyuria and polydipsia in horses and provides a description of a systematic diagnostic approach for assessing horses with polyuria and polydipsia to delineate the underlying cause. Treatment and management strategies for addressing polyuria and polydipsia in horses are also described.
Romero A, Rodgerson DH, Fontaine GL.A 3-year-old Thoroughbred was presented for evaluation of hematuria post exercise. On physical examination, an enlarged kidney was identified, as well as serum biochemical abnormalities such as an elevated creatine kinase (CK) and hypoalbuminemia. The kidney was removed laparoscopically and a nephroblastoma was identified. Un Thoroughbred âgé de 3 ans est présenté pour évaluation de l’hématurie après l’effort. À l’examen physique, un rein enflé est identifié ainsi que des anomalies biochimiques sériques comme une créatine kinase (CK) élevée et l’hypoalbuminémie. Le rein...
Lapjit C, Charoenchanikran P, Petchkaew P, Sukpipattanamongkol S, Yodsheewan R, Theerapan W, Chanda M.The fetlock joint is a high mobility structure that accommodates enormous loading during locomotion. An injury of the superficial constituent such as subtendinous bursitis may occur due to repeated trauma. An 8-year old school riding horse was presented with dorsomedial distension in the left hindlimb fetlock region. The lesion was noted following routine exercise. The horse demonstrated no lameness and a negative response to the fetlock flexion test. Radiographic findings revealed a smooth surface cortical thickening on the medial aspect of the distal third metatarsal bone. Furthermore, the u...
Bernard WV, Williams D, Tuttle PA, Pierce S.A Thoroughbred foal that was born after 305 days of gestation was referred 6 hours after birth. On initial examination, the foal was alert, but weak and unable to stand. Heart rate was 150 beats/min, respiratory rate was 48 breaths/min, and rectal temperature was 33 C. Leukocytosis was detected (26,000 WBC/microliters). Dysuria and passage of red urine was observed approximately 30 hours after admission. Urine collected by free catch had a 3+ reaction for blood on dipstick analysis. Examination of Warthin Starry-stained sections of allantochorion revealed organisms morphologically characterist...
Paciello O, Passantino G, Costagliola A, Papparella S, Perillo A.Histiocytic diseases in veterinary medicine have been revised in the last few decades, but these are considered relatively rare in horses. This report describes a 9-year-old female horse, Dutch Warmblood, presented for investigation of severe nasal bleeding. A multinodular bilateral mass of 5 cm, reddish to white in color, that invaded and destroyed the surrounding tissues, was observed during a clinical examination of the nostril The morphological features of the tumor cells were represented by cytologically bizarre, highly phagocytic, multinucleated giant cells. These findings, together with...
Oreff GL, Shiraki R, Kelmer G.This study describes the use of an intraoral approach for sialolith removal in horses. All horses resumed their previous activity after surgery. Sialoliths were composed mainly of calcium carbonate, containing a nidus of plant material. The removal of sialoliths via an intraoral approach results in a high success rate with minimal complications. Cette étude décrit l’utilisation d’une approche intra-orale pour l’enlèvement des sialolithes chez les chevaux. Tous les chevaux ont repris leurs activités antérieures après la chirurgie. Les sialolithes étaient principalement composés d...
Moustafa MA, Boero MJ, Baker GJ.A technique for satisfactory arthroscopic examination of the lateral and medial femorotibial joints of the horse is described. The entry portal is made between the middle and medial patellar ligaments with the horse on its back and the stifle flexed. This position allows easy access to view the intercondylar eminence of the tibia. From this reference point, examination of all but the most caudal and medial structures of the joints are possible by manipulating the sleeve and telescope and maintaining joint distention. In a series of 20 examinations, iatrogenic trauma was recognized only once.
Schott HC, Bayly WM, Reed SM, Brobst DF.Nephrogenic diabetes insipidus was diagnosed in two full sibling Thoroughbred colts. Each colt had a history of excessive urination. Extreme polydipsia (greater than 80 L per day) was documented in both colts. Inability to concentrate urine in response to water deprivation, infusion of hypertonic saline, or exogenous vasopressin administration indicated insensitivity of the collecting duct epithelial cells to vasopressin. A diagnosis of nephrogenic diabetes insipidus was further supported by a normal increase in plasma vasopressin concentration after water deprivation in the one colt in which ...
Soma LR, Beech J, Gerber NH.The effect of disodium cromoglycate (cromolyn) in preventing the pulmonary dysfunction caused by the inhalation of barn and hay dust was studied in 5 horses with confirmed chronic obstructive pulmonary disease (COPD). The horses were studied before (Con) and after exposure to hay and dust allergens (Expos) and after pretreatment with cromolyn followed by exposure (Cr-Expos). There was a significant reduction in PaO2 from 86.8 +/- 8.3 to 73.1 +/- 8.8 when the horses were exposed to hay and dust allergens. The PaO2 after pretreatment with cromolyn and exposures was 78.1 +/- 5.5. There were no si...
Davies JV, Gerring EL.The effect of acepromazine, Buscopan (Crown Chemicals), pethidine and methadone was evaluated in ponies prepared with Thiry-Vella (T-V) loops. Motility was assessed by electrophysiological means (bipolar electrodes and strain gauge transducers) and by the passage through the T-V loop of a fluid test meal. Results were obtained from 26 experiments in three ponies and compared with six control experiments, in which saline had been administered to the same ponies. Each pony acted as its own control in each experiment and pre and post treatment values for slow wave frequency, spiking activity, del...
Munsterman AS, Hanson RR.To develop a direct method for measuring intra-abdominal pressures in the standing horse, identify a reference interval for direct intra-abdominal pressures, compare these pressures to indirect intra-abdominal pressures measured from the bladder, and determine the optimal bladder infusion volume for indirect pressure measurement. Methods: Prospective, experimental study. Methods: A university-based equine research facility. Methods: Ten healthy adult horses, 5 males and 5 females. Methods: Direct intra-abdominal pressures were measured through an intraperitoneal cannula and zeroed at the heigh...