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Equine Med and Surgery > Abnormal Conditions of the Equine Large Intestine > Flashcards

Abnormal Conditions of the Equine Large Intestine Flashcards

1
Q

what comprises the “large” intestine?

A

cecum
large colon
small colon and rectum

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2
Q

what side of the horses body is the cecum on?

A

right side of the abdomen

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3
Q

what is the most common pathologic condition of the cecum?

A

cecal impaction

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4
Q

what are a large amount of fatalities from cecal impaction due to?

A

cecal rupture

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5
Q

How does hospitalization or surgery/general anesthesia within previous 5 days lead to cecal impaction?

A

NSAIDS and lack of exercise

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6
Q

what is important about clinical signs and cecal impaction?

A

clinical signs may be mild and underestimated

horse does not seem that painful but then cecum ruptures and horse dies

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7
Q

How do you diagnose a cecal impaction?

A

GI sounds decreased (borborygmi)
fecal production decreased
rectal palpation - tension in ventral cecal band, sacculations disappear, distended structure on right abdomen

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8
Q

where is the tension in a cecal impaction?

A

ventral cecal band

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9
Q

Are changes in peritoneal fluid an indicator of cecal deterioration?

A

not always

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10
Q

what are the two types of cecal impactions?

A

type 1 - mechanical obstruction
type 2 - cecal dysfunction

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11
Q

which cecal impaction can be indented with fingers, the walls do not feel thickened, and the cecum contains firm, dry, or doughy ingesta?

A

type 1 - mechanical obstruction

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12
Q

which cecal impaction does the cecum feel tightly distended with gas and ingesta of normal or fluid consistency?

A

type 2 - cecal dysfunction

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13
Q

How do you treat the two types of cecal impaction?

A

type 1 - medical treatment
type 2 - surgical treatment

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14
Q

why can a type 1 cecal impaction be managed medically?

A

ingesta can be softened to allow cecal contraction to empty cecal contents into right ventral colon

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15
Q

why does type 2 cecal impaction need to be managed surgically? (what needs to be done that is not done medically?)

A

decompression
typhlotomy and evacuation
cecal bypass (cecocolic anastomosis)

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16
Q

How is a type 1 cecal impaction managed medically?

A

withhold feed, IV fluids, oral laxatives via nasogastric tube (mineral oil, magnesium sulfate, DSS), psyllium, walked and limited controlled grazing to stimulate motility, analgesics

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17
Q

when should a cecal impaction be considered for surgery?

A

no improvement on rectal palpation during 24-36hr period
signs of systemic deterioration
increase in pain
cecum feels tight enough to rupture

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18
Q

what is the prognosis for cecal impaction?

A

57-90% survival for medical
29-90% survival for surgery

if surgery is an option refer it

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19
Q

Map out the pathway of the large colon

A

cecum > right ventral colon > sternal flexure > left ventral colon > pelvic flexure > left dorsal colon > diaphragmatic flexure > right dorsal colon

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20
Q

what are some abnormalities of the large colon?

A

tympany, impaction, sand impaction, enterolithiasis, displacement, volvulus

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21
Q

what are the two types of large colon displacement?

A

nephrosplenic entrapment/left dorsal displacement
right dorsal displacement

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22
Q

what is large colon tympany?

A

gas colic, spasmodic colic
results from excessive gas fermentation > distension and pain

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23
Q

what is the most commonly reported colic in horses?

A

large colon tympany

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24
Q

How is large colon tympany diagnosed?

A

acute pain +/- abdominal distension
rectal palpation reveals moderate to severe gas distension of large colon

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25
Q

what is a common challenge with large colon tympany?

A

hard to differentiate from more serious causes of abdominal pain

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26
Q

How is large colon tympany treated?

A

withhold food, analgesics

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27
Q

what does a lack of response to analgesics with large colon tympany indicate?

A

more serious problem
large colon volvulus primary differential diagnosis

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28
Q

what are the risk factors for large colon impaction?

A

windsucking, inc hours spent in stable, no parasite control, travel in previous 24hr, change in regular exercise program, previous colic, lameness, hospitalization, general anesthesia, medication (atropine, morphine)

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29
Q

How is a large colon impaction diagnosed?

A

pain, bloated, dec GI sounds, dec fecal production

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30
Q

what is the differential diagnoses for a large colon impaction?

A

large colon displacement +/- right dorsal colon impaction

31
Q

List the most to least common location for the large colon to get impacted

A

pelvic flexure > right dorsal colon > transverse colon

32
Q

How is a large colon impaction treated?

A

withhold feed, fluid thearpy, analgesic, cathartics (mineral oil)

33
Q

what are the indications for referral and surgery in a large colon impaction?

A

uncontrollable pain, dec VC status, abnormal changes in peritoneal fluid (indicates bowel degeneration)

34
Q

what is the prognosis for large colon impactions?

A

most respond well to medical therapy
surgical - can have rupture of colon, post-op diarrhea, incisional drainage, septic peritonitis

35
Q

what are predispositions of large colon sand impaction?

A

insufficient roughage (fiber) in diet
access to sand (regional)

36
Q

How many weeks after horses being exposed to sand have they been diagnosed with a sand impaction?

A

3-8 weeks

37
Q

How is sand impaction diagnosed?

A

clinical signs similar to large colon impaction
sand auscultated in ventral abdomen
observation of sand/gravel in feces
abdominal radiography

38
Q

How is a large colon sand impaction treated medically?

A

remove horse from access to sand, rehydrate, laxatives (magnesium sulfate, psyllium, mineral oil)

39
Q

How is a sand impaction treated surgically?

A

san evacuated through pelvic flexure enterotomy

40
Q

what do you do if you suspect/diagnose a large colon displacement?

A

refer

41
Q

what can happen with the right dorsal colon during a sand impaction surgery?

A

predisposed to rupture

42
Q

what is the prognosis for a large colon sand impaction?

A

good long-term survival
most common complication is post-op diarrhea

43
Q

How can sand impaction be prevented?

A

feed off ground, provide additional roughage, psyllium

44
Q

What are the ways the large colon can get displaced?

A

-large colon lacks mesenteric attachment to body wall
-pelvic flexure pacemaker
-diet too high in soluble carbohydrates (excessive fermentation and gas distension)

45
Q

what is a pelvic flexure pacemaker?

A

contraction of longitudinal muscle layers shorten length of left colons and move pelvic flexure forward diaphragm, followed by caudal movement towards pelvis during relaxation

46
Q

what is a nephrosplenic entrapment?

A

left dorsal and left ventral colon migrate lateral to spleen in dorsal direction until entrapped in nephrosplenic space

47
Q

Is a nephrosplenic entrapment strangulating or non-strangulating?

A

non-strangulating

48
Q

what is a nephrosplenic entrapment also called?

A

left dorsal displacement

49
Q

How is a left dorsal displacement diagnosed?

A

transabdominal ultrasound- gas-filled colon dorsal to spleen overs left kidney
rectal palpation

50
Q

what is the medical treatment for a left dorsal displacement?

A
51
Q

what is the surgical treatment for a nephrosplenic entrapment?

A
52
Q

what is the pathology?

A

large colon left dorsal displacement

53
Q

what is a right dorsal displacement?

A

retropulsive movement of pelvic flexure with subsequent migration craniad
large colon located between cecum and body wall

54
Q

what is the pathology?

A

right dorsal displacement

55
Q

what does the success of a large colon volvulus treatment rely on?

A

rapid referral and prompt surgical intervention

56
Q

where are large colon volvulus more prevalant?

A

higher prevalence in areas with a high broodmare concentration (parturition risk factor)

57
Q

How is a large colon volvulus treated?

A

SURGERY - stabilize preop

58
Q

what is the prognosis of a large colon volvulus?

A

mortality rates between 56 to 65%

59
Q

what is the small colon a continuation of?

A

transverse colon

60
Q

what is the small colon suspended by?

A

long mesocolon

61
Q

what does the anti mesenteric border of the small colon contain?

A

longitudinal teniae

62
Q

What are some abnormal conditions of the small colon?

A

Simple obstructions (fecal impaction, enterolithiasis, fecaliths, phytobezoars, trichobezoars, meconium)
Vascular lesions
(intramural hematoma, mesocolic rupture, nonstrangulating infarction)
Strangulation lesions(strangulating lipomas, intussusception)

63
Q

what are the risk factors for enterolithiasis?

A

feeding alfalfa hay

64
Q

How are enterolithiasis diagnosed?

A

acute severe luminal obstruction (severe pain), intermittent mild signs of colic, right dorsal colon discomfort, abdominal distension

65
Q

How are enterolithiasis treated?

A

large - surgical
small - pass on their own

66
Q

what is the prognosis of enterolithiasis?

A

excellent if there is no local necrosis and in a location where it can be excised

67
Q

what is the risk of malpractice claim determined by in a rectal tear?

A

standard of care applied after the tear and the circumstances that led it its occurence

68
Q

what should be done to avoid rectal tears?

A

copious lubrication and adequate restraint (sedation if necessary)

69
Q

How can you tell the rectum tore?

A

sudden release of pressure, direct palpation of abdominal organs, large amount of blood on sleeve/glove, hemorrhagic feces

70
Q

what do you do once you’ve confirmed a rectal tear?

A

assess its severity
inform owner
apply appropriate treatment, including referral
contract liability insurance

71
Q

How are rectal tears treated?

A

reduction of rectal activity (IV sedation, caudal epidural, lidocaine enema, Buscopan), gentle fecal removal, treatment of septic shock and peritonitis, refferal

72
Q

What causes a rectal prolapse?

A

tenesmus from diarrhea, dystocia, intestinal parasitism, colic, rectal tumor

73
Q

How are rectal prolapses treated?

A

Equine Med and Surgery (18 decks)

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