Surgical Treatment Of Equine Colic

Front 1

Indications for surgical colic?

Back 1

1) severe, continuous pain with little/no improvement to analgesia
2) Pulse >60
3) Progressive CV collapse (mm = injected/cyanotic w/ fluids)
4) Rectal findings = abdominal distension
5) Progressive ileus or continual gastric reflux of bile/alkaline fluid
6) Increasing abdominal distention
7) Serosanguinous peritoneal fluid w/ protein (>2.5 g/l) and wbc's (10x10^9/L)

Front 2

Approach?

Back 2

Ventral midline laparotomy

Front 3

Can you exteriorise the equine stomach at surgery?

Back 3

NO

Front 4

Surgical conditions of the equine stomach?

Back 4

Pyloric stenosis
Gastric impaction/dilatation

Front 5

What ages get pyloric stenosis?
And
And what are the types/pathogenesis?

Back 5

a) 4months or younger
b) congenital (rare) or Aquired = ulcers -> fibrotic healing -> stricture

Front 6

Dx of pyloric stenosis

Back 6

Contrast radiography looking at outflow (delayed)

Front 7

Tx of pyloric stenosis

Back 7

Pyloromyotomy
Gastrojejunostomy (bypass pylorus)

Front 8

Aetiology of gastric impaction (adult)

Back 8

RARE
Bad diet
Motility problem
2nd to liver dz

Front 9

Is there treatment

Back 9

Sx is indicated but rarely sucessful due to high complication rate eg. cannot isolate stomach

Front 10

Anatomy of small intestine

Back 10

Duodenum- attached to RD body wall (mesoduodenum)
Jejunum- free therefore can exteriorise
ileum- thicker wall and anti-mesenteric band
Cannot exteriorise the ileocecal junction

Front 11

What 2 type of lesions do you have?

Back 11

Strangulating
Non strangulating

Front 12

What are the 3 surgical strangulating lesions of SI?

Back 12

Ileal/jejunal impaction
Intestinal neoplasia
Anterior enteritis

Front 13

a) Cause of ileal/jejunal impaction
b) Tx
c) prognosis

Back 13

a) Diet or Ascarid burden (young), tapeworm burden (adults)

b) Decompression

c) Good

Front 14

Most common intestinal tumor

Back 14

Lymphosarcoma, causes complete/partial obs because of thickening of wall

Front 15

5 causes of strangulating lesions of the SI?

Back 15

Pedunculated lipoma
SI volvulus
Intussusception
Thromboembolic colic
SI entrapment

Front 16

General tx of strangulating OBS?

Back 16

Reduce strangulation then resect ischemic gut followed by anastomosis (jejuno-jejunostomy, jejuno-ileostomy, jejuno-caecostomy)

Front 17

What does prognosis depend on

Back 17

Length of gut resected
C/V status
Lesion type
(around 60%-85% success)

Front 18

Most common cause of SI stranulation

Back 18

Pedunculated lipoma

Front 19

Most common place for intussception:
a) Foal
b) Adults

Back 19

a) jejuno-jejunal

b) ileo-caecal (tapeworm infection- anoplocephala)

Front 20

Common cause of thromboembolic emboli to mesentery

Back 20

migration of strongylus vulagirs larvae
(not as common due to regular worming with aveermectins)

Front 21

6 types of SI entrapment

Back 21

Epiploic foramen
Inguinal/scrotal hernia
mesenteric rent
Gastro splenic
Umbilical hernia
Diaphragmatic hernia

Front 22

Caecal surgical anatomy

Back 22

apex and part of body are exteriorisable
ileocecal fold = dorsal band
RVC = lateral band

Front 23

Types of ceacal impaction
and
when is surgery indicated

Back 23

Types:
-Primary
-Secondary to motility disorder

Indicated: Unresponsive to medical tx

Front 24

Sx correction of caecal impaction

Back 24

evacuation via typholotomy
+/- caecal bypass

Front 25

When does a caecocaecal impaction cause a total obs

Back 25

if it obstucts the ceacocolic area

It can further progress into the RVC causing a strangulating lesion

Front 26

Sx TX of caecocaecal intussusception

Back 26

If little damage- simple reduction w/ typhylectomy

if involves colon- enterotomy into RVC and resection w/ jejunocolic anastomosis

Front 27

Order of equine colon

Back 27

Caecum --> RVC --> LVC --> LDC --> RDC --> transverse colon --> small colon

(left colons are highly movable therefore displacements/torsions occur)

Front 28

where do you perform an enterotomy to evacuate the colon?

Back 28

Pelvic flexure

Front 29

What are the usual causes of large colon displacements?

Back 29

Gas distension
Motility disorders
Sudden diet change
Parturition
Idiopathic

Front 30

Where and what get displaced in a LD displacement?

Back 30

Colon gets stuck above the nephrosplenic ligament on the left side.

Front 31

Where and what gets displaced in RD displacement?

Sx soln if recurrent?

Back 31

Left colon migrates between caecum and R body wall

sx- colopexy to abdo wall

Front 32

Where does the colon tend to torse around?

Back 32

caecocolic junction

Very painful and leads to massive endotoxemia

Front 33

What breed of horse tends to get enteroliths?

Can you simply surgically remove theses?

Back 33

Miniture

Yes

Front 34

What is the grading of rectal tears?

Back 34

1- mucosa only
2- muscularis only
3- mucosa and muscularis
4- all layers and abdo contamination

Front 35

What is the first aid for a rectal tear?

Back 35

Sedate
GIve epidural or local per rectum
Evacuate and pack the rectum
Broad spec antibiosis
NSAIDs
REFER- Sx

Front 36

What are the complications associated with colic Sx?

Back 36

Repeat colic- year after Sx

Ileus (20%)- due to inflammation, distension, deinervation

Incisional infection/hernia (10-40%)

Adhesions- weeks after sx, fibrinous-->fibrous adhesions
can cause obs or strangulation

Front 37

What does ileus predispose to?

Back 37

destension and pain --> dehydration --> Impaction

Front 38

Dx of ileus

Back 38

U/S - distended loops of SI with little movement
NG intubation - reflux