Abnormal Conditions of the Equine Small Intestine Flashcards
what is the difference between a simple/non-strangulating and strangulating obstruction?
simple - blood supply normal to intestine involved in obstruction
strangulating - blood supply is constricted/blocked >mucosal ischemic injury > endotoxemia
what color is the peritoneal fluid of simple and strangulating obstructions?
simple - normal, yellow
strangulating - serosanguineous, red
what is the difference between a function and mechanical obstruction?
function - lumen of SI still moving but motility is altered
mechanical - lumen of SI blocked
what are the non-strangulating/simple obstructions of the SI?
ileal impaction
ascarid impaction
enteritis
where are most of the cases of ileal impaction?
southeast US
what type of hay is related to ileal impactions?
coastal bermuda grass
what causes the early pain attributed to with ileal impaction?
spasmodic bowel contraction around impaction
what is a good diagnostic for small intestine issues?
gastric reflux
Does ileal impaction always have gastric reflux?
depends on duration of obstruction
if long backs up into stomach
what can severe small intestinal distention cause and what can this in turn lead to?
severe small intestinal distension > severe pain > ileus
what can you give a horse that has an ileal impaction?
IV fluids
flunixin meglumine
mineral oil via NGT if no reflex
what are the complications of a ileal impaction if it is delayed?
gastric rupture, laminitis, mucosal necrosis, and ileal perforation
what is the prognosis for an ileal impaction?
favorable if treated early
Re-impactions rare
Matty said Ascarid impaction and parasites will be covered by Dr.B so skipped
hehe hi
Is duodenitis-proximal jejunitis (DPJ) a functional or mechanical obstruction?
functional
what is DPJ pathogenesis?
inflammation of proximal SI > endotoxemia and ileus > fluid accumulation in SI & stomach
What is a typical differentiator of DPJ?
large volume of fluid passed in nasogastric tube - Horse feels better for a while after
How do you differentiate between DPJ and a strangulating lesion?
belly tap
DPJ - rarely serosanguineous
cell count and total protein inc to a lesser extent compared to a strangulating obstruction
which has a greater SI distension - DPJ or mechanical obstruction(strangulating)?
mechanical obstruction
How do you treat DPJ?
frequent gastric decompression
correct dehydration & electrolyte imbalances
restoration of normal intestinal function
With a horse with DPJ when do you let them have food?
once ileus resolved and no more reflux
very slow food introduction
Do you give a DPJ horse antibiotics?
no - gut bacteria already messed up
what is the benefit for surgery on a DPJ suspected horse?
diagnostic procedure to rule out mechanical obstruction
what is the prognosis for DPJ?
surgery performed in few cases
25-94% survival rate - recurrence rare
what are examples of strangulating obstructions?
SI volvulus
epiploic foramen entrapment
pendunculated lipoma
intussusception
mesenteric rents
inguinal/scrotal hernia
what is a small intestinal volvulus?
rotation in a segment of jejunum +/- ileum around mesentery so that SI is twisted
what age group has a higher prevalence for SI volvulus?
foals - 2-4 months age
How do you diagnose SI volvulus?
abdominal ultrasound
severe pain alternated with periods of depression
abdominal distension
SI distended on rectal
what is a differentiator between a small intestinal volvulus and enteritis in a foal?
SI volvulus - afebrile
enteritis - febrile
what is the treatment of a SI volvulus?
surgery
what is the prognosis of a SI volvulus?
good for survival to hospital surgery discharge
what is an epiploic foramen entrapment?
SI gets traped in epiploic foramen
what happens to the tissue that gets trapped within the epiploic foramen?
everything inside foramen becomes dead
what are the risk factors for epiploic foramen entrapment?
cribbing, history of colic, increased time in a stall, tall horses
Do changes in peritoneal fluid represent the extent of intestinal damage in an epiploic foramen entrapment?
no b/c the blood collects where the strangulating region is which is in the epiploic foramen
what is the treatment of an epiploic foramen entrapment?
surgery
what is the prognosis of an epiploic foramen entrapment?
18-95% short term survival
35-70% long term survival
4 times more likely for a re-laparotomy than horses with other types of colic
what is a pedunculated lipoma?
benign, smooth-walled fat tumor suspended by a thin mesenteric pedicle of variable length
when does a pedunculated lipoma cause a strangulating obstruction?
pedicle wraps around intestine and its mesentery
what age group is pedunculated lipomas often seen in?
older horses
what breeds of horses are at higher risk of a pedunculated lipoma?
ponies, arabians, and saddlebreds
what are the four types of intussusception and which is most common?
jejunojejunal, jejunoileal, ileoileal, and ileocecal
ileocecal most common
what are the predisposing factors of intussusception?
segmental motility differences from enteritis
heavy ascarid burden
abrupt diet changes
tapeworm infection
what can cause a mesenteric rent?
congenital, secondary to mesodiverticular bands, primary lesion of unknown cayuse, trauma or mesenteric stretching from another lesion or foal
what is a mesenteric rent strangulating obstruction?
SI gets strangled in hole in mesentery
which has a better prognosis mesenteric rent strangulation or intussusception?
intusccusception
mesenteric rent worst prognosis (can’t always close hole)
what is the difference between an indirect and direct inguinal/scrotal hernia?
indirect - acquired and non reducible
direct - congenital and reducible
how do foals and adults get diaphragmatic hernias?
foals - congenital
adults - trauma
what are some post operative complications?
anastomotic obstruction, postoperative pain, endotoxemia, ileus, adhesions, short bowel syndrome
What do strangulating lesions require to correct?
SURGERY
How long can you wait on a strangulating lesion?
trick question you dont want to wait on a strangulating lesion get that horse to surgery
