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77 Cards in this Set
- Front
- Back
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Pyloric Stenosis
Dx |
rare in horses
contrast radiography: delayed outflow |
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Pyloric Stenosis
Et |
Congenital (rare)
Secondary to ulceration • healing by fibrosis >> stricture formation |
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Pyloric Stenosis
Tx |
pyloromyotomy
• cutting the sphincter muscle gastrojejunostomy • joining the jejunum to the stomach wall to bypass the duodenum and sphincter |
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Gastric surgery
Complications |
cannot exteriorise stomach
• HIGH probability of contamination adhesions form readily Spontaneous rupture of dilatation/impaction |
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Gastric impaction/dilatation
Et |
Unclear
• ingestion of unsuitable feed • primary motility problem • secondary to liver disease |
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Gastric impaction/dilatation
Dx |
very difficult
• gastroscopy can be helpful but how much is too much stomach content final Dx often made a surgery |
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Gastric impaction/dilatation
Tx |
surgical evacuation is possible but should be avoided
Sudden relief of colic symptoms indicates rupture |
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Small Intestinal surgery
complications |
Ileus!!
• especially handling damaged or distended bowel Endotoxaemia • damaged bowel becomes leaky |
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Differential list of Non-strangulating lesions of small intestine
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Ileal-jejunal impaction
Intestinal neoplasia Anterior enteritis (USA) |
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Ileal-jejunal impaction
Et |
associated with certain diets
• bermuda grass in USA Ascarid infestation in young horses • especially after Tx of severe burden with anthelmintics Tapeworm infestation |
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Ileal-jejunal impaction
Tx and Px |
decompression
via enterotomy if required Good outcomes |
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Intestinal Neoplasia
Phys |
Tumor >> thickening of intestinal wall >> complete/partial obstruction of lumen
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Intestinal neoplasia
Et |
lymphosarcoma is most common
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Ileal-jejunal impaction
Dx |
Palpation of distended loops of SI via rectal examination
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Intestinal Neoplasia
Tx and Px |
Resection possible if focal lesion
Not possible for multifocal lesions • more common to be multifocal Long term prognosis poor |
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Anterior enteritis
Et |
Unknown agent causing marked distension of SI and stomach
• salmonella • clostridia • diet |
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Anterior enteritis
Tx |
Medical
• repeated nasogastric intubation to relieve pressure Surgical • manual decompression of SI |
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Anterior enteritis
Px |
50-70% survival
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Differential list for Strangulating obstructions of the small intestine
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Pedunculated lipoma
Small intestinal volvulus Intussusception Thromboembolic colic Small Intestinal entrapment |
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Pedunculated Lipoma
Et and phys |
Most common SI strangulation
• old fat horses lipoma suspended on fibrous band attached to mesentery • encircles bowel >> strangulation |
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Small intestine volvulus
Et |
rotation of some/all of jejunum around the dorsal attachment
• stricture of the arterial root |
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Small intestine volvulus
CS and Px |
acute severe pain
sudden relief of symptoms denotes possible rupture Poor outcome due to large portion of intestine involved |
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Intussusception
Et |
ileocecal associated with tapeworm infestation
jejunal more common in foals |
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Intussusception
Phys |
proximal intestine pulled into distal intestine
• initially creates a simple obstruction strangulation occurs as arterial supply drawn into intussusception and trapped |
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Intussusception
Tx |
My need to resect portion within the intussusception if devitalized
Ileocecal may require bypass of ileocecal junction |
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Thromboembolic colic
Et |
Vascular thrombi
• strongylus vulgaris larvae migration >> vascular infarction Less common with regular anthelmintic use |
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Intussusception
Dx |
Target shaped lesions on intestinal cross-section by ultrasound
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List of possible entrapment locations
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Epiploic foramen
Inguinal/scrotal hernia Hernia through mesentery Gastro-splenic ligament Umbilica Hernia Diaphramatic hernia |
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Epiploic foramen
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foramen in the omentum between liver and pancreas
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Epiploic foramen
Dx |
difficult because too cranial to palpate by rectal
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Inguinal hernia
Foal vs Stallion |
large undeveloped inguinal rings in foal do not strangulate intestine
often strangulated in stallion |
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define direct inguinal hernia
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intestine contained within skin of scrotum
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define indirect inguinal hernia
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intestine contained within the vaginal tunic in scrotum
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Treatment of strangulating small intestinal obstruction
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Surgery required
reduce strangulation and remove ischemic portions Can only exteriorise some portions • jejunum • proximal ileum |
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Prognosis of strangulating small intestinal obstruction
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dependent on multiple variables
• length of gut affected • cardiovascular or endotoxemia • type of lesion 60-85 % survival |
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Differential for caecal colic
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Caecal impaction
Intussusception (rare) • caeco-caecal • caeco-colic Caecal infarction |
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Caecal impaction
Et |
Primary impaction
Secondary to motility disorder • common in hospitalized horses |
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Caecal impaction
Sx indications |
no response to medical treatment
• prone to spontaneous rupture |
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Caecal impaction
Sx |
evacuation via apical typholoptomy
+/- caecal bypass if primary motility problem • often recurs |
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Caecocecal intussusception
Phys |
Usually occurs at the apex
can progress to obstruct the ileocecal junction can progress to osbstruct the RVC |
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Caecocecal intussusception
Sx |
simple reduction for apical intussusception
partial typhlectomy for severe intussusception causing obstruction |
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Caecocolic intussusception
Sx |
very messy enterotomy
• resect inverted cecum in the RVC • perform jejunocolic anastamosis |
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Caecal infarction
Et Tx |
susceptable due to lack of collateral blood supply
• emboli common cause Resect ischaemic section |
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Caecal surgery
Complications |
can only exteriorise apex
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Differential for Large colon colic
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Left dorsal displacement
Right dorsal displacement Volvulus or torsion Enteroliths |
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Caecal intussusception
Dx |
Palpation of large firm mass by rectal in some cases
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Large colon displacement
Et |
gaseous distension
transient motility disorders sudden dietary changes parturition idiopathic |
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LC Left dorsal displacement
Phys |
colon trapped between dorsal tip of spleen and nephrosplenic ligament to the left kidney
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LC Left dorsal displacement
Tx and Sx indications and Px |
Surgical reduction
• severe cases with secondary impactions • no response to medical treatment Px good |
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LC Right dorsal displacement
Et |
left limbs of colon migrate around the caecal body
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LC Right dorsal displacement
Tx and Sx indications and Px |
Surgical reduction of displacement
• unrelenting pain • increasing colon distension • deteriorating Cardio status colopexy to the abdominal wall • recurring problem Px good if no volvulus |
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Right dorsal displacement surgery
complications |
weight loss
chronic colic colon rupture |
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Colon volvulus / torsion
Phys |
tosion around caeco-colic junction
• whole colon involved |
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Colon volvulus / torsion
CS |
Extremely painful
rapid deterioration due to endotoxaemia |
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Colon volvulus / torsion
Tx |
Emergency surgery
+/- resection if bowel ischemic |
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Colon volvulus / torsion
Px and complications |
prone to acute colitis and systemic effects of toxemia
prognosis is guarded |
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Enterolithiasis
Et |
mineralized contents obstruct the transverse colon
• most narrow segment rare in UK |
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Enterolithiasis
Tx and Px |
surgical removal
good prognosis |
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Differential list of small colon colics
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Atresia coli
Impaction Rectal prolapse rectal tears |
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Atresia coli
Et, Dx, Tx |
heritable condition of foals
Dx - contrast radiography Tx - can correct if segment missing is short • euthenasia for most cases |
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Small colon impaction
Et |
focal enterolith (US)
primary motility dysfunction associated with salmonella? |
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Small colon impaction
Tx and Px |
Surgical removal of the enterolith
good prognosis |
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Rectal Prolapse
Grading and prognosis |
graded 1-4
grade 3 and 4 have guarded prognosis • prone to meorectal tears |
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Rectal prolapse
Tx |
Mild
• clean and resect affected area • replace if seromuscular layer is intact >25-30 cm prolapsed • probably mesocolon tear • refer for aggressive surgery |
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Rectal tears
Et |
Palpation
Always check for blood after rectal palpation • early recognition can save horse |
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Rectal tears
Grading |
1-4 depending on depth
1 = mucosa only 2 = muscularis only 3 = mucosa and muscularis 4 = full rupture = abdominal contamination |
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Rectal tears
First aid |
sedate
epidural or large per rectum anaesthetic dose carefully evacuate rectum pack rectum to prevent further contamination broad spectrum antibiotics and NSAIDs refer to surgery center |
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Rectal tear
Sx options and Px |
Severe lesions
• temporary colostomy • temporary rectal liners • attempt primary repair Guarded but not hopeless |
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Complications of Colic surgeries
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Repeat episodes of colic
Continuing endotoxemia and dehydration Ileus (20% of cases) Incisional drainage • infection Herniation Adhesions |
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Ileus
Et |
Lack of peristalsis
• inflammation • handling intestines • distension • neuropathy (grass sickness) 20% of all surgery cases |
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Ileus
CS |
distension and pain
dehydration if SI ileus impaction if LI ileus |
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Ileus
Dx |
rectal or abdominal ultrasound
• distended loops of SI • little or no peristalsis Nasogastric tube • reflux |
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Ileus
Tx |
Reflux as necessary
supportive care • IVFT Motility stimulants • lidocaine • cisapride • metclopramide |
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Incisional drainage/infection
prevalence and complications |
10-40% of surgeries
predisposes to herniation later |
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Incisional drainage/infection
Tx |
recognize early
belly bandage bacterial culture: antibiotics lavage wound as necessary |
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Adhesions
Et and complications and CS |
Scarring post surgery
may obstruct or strangulate intestine • recurrent colic |
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Adhesion
Prevention and Tx |
Careful tissue handling
antiadhesion therapy • carboxymethylcellulose • heparin • seprafilm laprascopic or open Sx to break down adhesions |
