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38 Cards in this Set
- Front
- Back
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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 |
