Equine Icc Surgery: Colic 1

Front 1

Pyloric Stenosis
Dx

Back 1

rare in horses
contrast radiography: delayed outflow

Front 2

Pyloric Stenosis
Et

Back 2

Congenital (rare)

Secondary to ulceration
• healing by fibrosis >> stricture formation

Front 3

Pyloric Stenosis
Tx

Back 3

pyloromyotomy
• cutting the sphincter muscle

gastrojejunostomy
• joining the jejunum to the stomach wall to bypass the duodenum and sphincter

Front 4

Gastric surgery
Complications

Back 4

cannot exteriorise stomach
• HIGH probability of contamination
adhesions form readily
Spontaneous rupture of dilatation/impaction

Front 5

Gastric impaction/dilatation
Et

Back 5

Unclear
• ingestion of unsuitable feed
• primary motility problem
• secondary to liver disease

Front 6

Gastric impaction/dilatation
Dx

Back 6

very difficult
• gastroscopy can be helpful but how much is too much stomach content

final Dx often made a surgery

Front 7

Gastric impaction/dilatation
Tx

Back 7

surgical evacuation is possible but should be avoided
Sudden relief of colic symptoms indicates rupture

Front 8

Small Intestinal surgery
complications

Back 8

Ileus!!
• especially handling damaged or distended bowel
Endotoxaemia
• damaged bowel becomes leaky

Front 9

Differential list of Non-strangulating lesions of small intestine

Back 9

Ileal-jejunal impaction
Intestinal neoplasia
Anterior enteritis (USA)

Front 10

Ileal-jejunal impaction
Et

Back 10

associated with certain diets
• bermuda grass in USA
Ascarid infestation in young horses
• especially after Tx of severe burden with anthelmintics
Tapeworm infestation

Front 11

Ileal-jejunal impaction
Tx and Px

Back 11

decompression
via enterotomy if required

Good outcomes

Front 12

Intestinal Neoplasia
Phys

Back 12

Tumor >> thickening of intestinal wall >> complete/partial obstruction of lumen

Front 13

Intestinal neoplasia
Et

Back 13

lymphosarcoma is most common

Front 14

Ileal-jejunal impaction
Dx

Back 14

Palpation of distended loops of SI via rectal examination

Front 15

Intestinal Neoplasia
Tx and Px

Back 15

Resection possible if focal lesion
Not possible for multifocal lesions
• more common to be multifocal

Long term prognosis poor

Front 16

Anterior enteritis
Et

Back 16

Unknown agent causing marked distension of SI and stomach
• salmonella
• clostridia
• diet

Front 17

Anterior enteritis
Tx

Back 17

Medical
• repeated nasogastric intubation to relieve pressure

Surgical
• manual decompression of SI

Front 18

Anterior enteritis
Px

Back 18

50-70% survival

Front 19

Differential list for Strangulating obstructions of the small intestine

Back 19

Pedunculated lipoma
Small intestinal volvulus
Intussusception
Thromboembolic colic
Small Intestinal entrapment

Front 20

Pedunculated Lipoma
Et and phys

Back 20

Most common SI strangulation
• old fat horses
lipoma suspended on fibrous band attached to mesentery
• encircles bowel >> strangulation

Front 21

Small intestine volvulus
Et

Back 21

rotation of some/all of jejunum around the dorsal attachment
• stricture of the arterial root

Front 22

Small intestine volvulus
CS and Px

Back 22

acute severe pain
sudden relief of symptoms denotes possible rupture

Poor outcome due to large portion of intestine involved

Front 23

Intussusception
Et

Back 23

ileocecal associated with tapeworm infestation

jejunal more common in foals

Front 24

Intussusception
Phys

Back 24

proximal intestine pulled into distal intestine
• initially creates a simple obstruction
strangulation occurs as arterial supply drawn into intussusception and trapped

Front 25

Intussusception
Tx

Back 25

My need to resect portion within the intussusception if devitalized

Ileocecal may require bypass of ileocecal junction

Front 26

Thromboembolic colic
Et

Back 26

Vascular thrombi
• strongylus vulgaris larvae migration >> vascular infarction
Less common with regular anthelmintic use

Front 27

Intussusception
Dx

Back 27

Target shaped lesions on intestinal cross-section by ultrasound

Front 28

List of possible entrapment locations

Back 28

Epiploic foramen
Inguinal/scrotal hernia
Hernia through mesentery
Gastro-splenic ligament
Umbilica Hernia
Diaphramatic hernia

Front 29

Epiploic foramen

Back 29

foramen in the omentum between liver and pancreas

Front 30

Epiploic foramen
Dx

Back 30

difficult because too cranial to palpate by rectal

Front 31

Inguinal hernia
Foal vs Stallion

Back 31

large undeveloped inguinal rings in foal do not strangulate intestine

often strangulated in stallion

Front 32

define direct inguinal hernia

Back 32

intestine contained within skin of scrotum

Front 33

define indirect inguinal hernia

Back 33

intestine contained within the vaginal tunic in scrotum

Front 34

Treatment of strangulating small intestinal obstruction

Back 34

Surgery required
reduce strangulation and remove ischemic portions

Can only exteriorise some portions
• jejunum
• proximal ileum

Front 35

Prognosis of strangulating small intestinal obstruction

Back 35

dependent on multiple variables
• length of gut affected
• cardiovascular or endotoxemia
• type of lesion

60-85 % survival

Front 36

Differential for caecal colic

Back 36

Caecal impaction
Intussusception (rare)
• caeco-caecal
• caeco-colic
Caecal infarction

Front 37

Caecal impaction
Et

Back 37

Primary impaction
Secondary to motility disorder
• common in hospitalized horses

Front 38

Caecal impaction
Sx indications

Back 38

no response to medical treatment
• prone to spontaneous rupture

Front 39

Caecal impaction
Sx

Back 39

evacuation via apical typholoptomy

+/- caecal bypass if primary motility problem
• often recurs