Abnormal Conditions of the Equine Small Intestine

Question 1

what is the difference between a simple/non-strangulating and strangulating obstruction?

Answer 1

simple - blood supply normal to intestine involved in obstruction
strangulating - blood supply is constricted/blocked >mucosal ischemic injury > endotoxemia

Question 2

what color is the peritoneal fluid of simple and strangulating obstructions?

Answer 2

simple - normal, yellow
strangulating - serosanguineous, red

Question 3

what is the difference between a function and mechanical obstruction?

Answer 3

function - lumen of SI still moving but motility is altered
mechanical - lumen of SI blocked

Question 4

what are the non-strangulating/simple obstructions of the SI?

Answer 4

ileal impaction
ascarid impaction
enteritis

Question 5

where are most of the cases of ileal impaction?

Answer 5

southeast US

Question 6

what type of hay is related to ileal impactions?

Answer 6

coastal bermuda grass

Question 7

what causes the early pain attributed to with ileal impaction?

Answer 7

spasmodic bowel contraction around impaction

Question 8

what is a good diagnostic for small intestine issues?

Answer 8

gastric reflux

Question 9

Does ileal impaction always have gastric reflux?

Answer 9

depends on duration of obstruction
if long backs up into stomach

Question 10

what can severe small intestinal distention cause and what can this in turn lead to?

Answer 10

severe small intestinal distension > severe pain > ileus

Question 11

what can you give a horse that has an ileal impaction?

Answer 11

IV fluids
flunixin meglumine
mineral oil via NGT if no reflex

Question 12

what are the complications of a ileal impaction if it is delayed?

Answer 12

gastric rupture, laminitis, mucosal necrosis, and ileal perforation

Question 13

what is the prognosis for an ileal impaction?

Answer 13

favorable if treated early
Re-impactions rare

Question 14

Matty said Ascarid impaction and parasites will be covered by Dr.B so skipped

Answer 14

hehe hi

Question 15

Is duodenitis-proximal jejunitis (DPJ) a functional or mechanical obstruction?

Answer 15

functional

Question 16

what is DPJ pathogenesis?

Answer 16

inflammation of proximal SI > endotoxemia and ileus > fluid accumulation in SI & stomach

Question 17

What is a typical differentiator of DPJ?

Answer 17

large volume of fluid passed in nasogastric tube - Horse feels better for a while after

Question 18

How do you differentiate between DPJ and a strangulating lesion?

Answer 18

belly tap
DPJ - rarely serosanguineous
cell count and total protein inc to a lesser extent compared to a strangulating obstruction

Question 19

which has a greater SI distension - DPJ or mechanical obstruction(strangulating)?

Answer 19

mechanical obstruction

Question 20

How do you treat DPJ?

Answer 20

frequent gastric decompression
correct dehydration & electrolyte imbalances
restoration of normal intestinal function

Question 21

With a horse with DPJ when do you let them have food?

Answer 21

once ileus resolved and no more reflux
very slow food introduction

Question 22

Do you give a DPJ horse antibiotics?

Answer 22

no - gut bacteria already messed up

Question 23

what is the benefit for surgery on a DPJ suspected horse?

Answer 23

diagnostic procedure to rule out mechanical obstruction

Question 24

what is the prognosis for DPJ?

Answer 24

surgery performed in few cases
25-94% survival rate - recurrence rare

Question 25

what are examples of strangulating obstructions?

Answer 25

SI volvulus epiploic foramen entrapment pendunculated lipoma intussusception mesenteric rents inguinal/scrotal hernia

Question 26

what is a small intestinal volvulus?

Answer 26

rotation in a segment of jejunum +/- ileum around mesentery so that SI is twisted

Question 27

what age group has a higher prevalence for SI volvulus?

Answer 27

foals - 2-4 months age

Question 28

How do you diagnose SI volvulus?

Answer 28

abdominal ultrasound severe pain alternated with periods of depression abdominal distension SI distended on rectal

Question 29

what is a differentiator between a small intestinal volvulus and enteritis in a foal?

Answer 29

SI volvulus - afebrile enteritis - febrile

Question 30

what is the treatment of a SI volvulus?

Answer 30

surgery

Question 31

what is the prognosis of a SI volvulus?

Answer 31

good for survival to hospital surgery discharge

Question 32

what is an epiploic foramen entrapment?

Answer 32

SI gets traped in epiploic foramen

Question 33

what happens to the tissue that gets trapped within the epiploic foramen?

Answer 33

everything inside foramen becomes dead

Question 34

what are the risk factors for epiploic foramen entrapment?

Answer 34

cribbing, history of colic, increased time in a stall, tall horses

Question 35

Do changes in peritoneal fluid represent the extent of intestinal damage in an epiploic foramen entrapment?

Answer 35

no b/c the blood collects where the strangulating region is which is in the epiploic foramen

Question 36

what is the treatment of an epiploic foramen entrapment?

Answer 36

surgery

Question 37

what is the prognosis of an epiploic foramen entrapment?

Answer 37

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

Question 38

what is a pedunculated lipoma?

Answer 38

benign, smooth-walled fat tumor suspended by a thin mesenteric pedicle of variable length

Question 39

when does a pedunculated lipoma cause a strangulating obstruction?

Answer 39

pedicle wraps around intestine and its mesentery

Question 40

what age group is pedunculated lipomas often seen in?

Answer 40

older horses

Question 41

what breeds of horses are at higher risk of a pedunculated lipoma?

Answer 41

ponies, arabians, and saddlebreds

Question 42

what are the four types of intussusception and which is most common?

Answer 42

jejunojejunal, jejunoileal, ileoileal, and ileocecal ileocecal most common

Question 43

what are the predisposing factors of intussusception?

Answer 43

segmental motility differences from enteritis heavy ascarid burden abrupt diet changes tapeworm infection

Question 44

what can cause a mesenteric rent?

Answer 44

congenital, secondary to mesodiverticular bands, primary lesion of unknown cayuse, trauma or mesenteric stretching from another lesion or foal

Question 45

what is a mesenteric rent strangulating obstruction?

Answer 45

SI gets strangled in hole in mesentery

Question 46

which has a better prognosis mesenteric rent strangulation or intussusception?

Answer 46

intusccusception mesenteric rent worst prognosis (can't always close hole)

Question 47

what is the difference between an indirect and direct inguinal/scrotal hernia?

Answer 47

indirect - acquired and non reducible direct - congenital and reducible

Question 48

how do foals and adults get diaphragmatic hernias?

Answer 48

foals - congenital adults - trauma

Question 49

what are some post operative complications?

Answer 49

anastomotic obstruction, postoperative pain, endotoxemia, ileus, adhesions, short bowel syndrome

Question 50

What do strangulating lesions require to correct?

Answer 50

SURGERY

Question 51

How long can you wait on a strangulating lesion?

Answer 51

trick question you dont want to wait on a strangulating lesion get that horse to surgery