Basics of SI Surgery Diseases Flashcards
DDx of Non-strangulating obstructions
ileal impaction muscular hypertrophy ileum ascarid impaction duo-prox jejunitis gastroduo obstruction intestinal inflamm and fibrosis
DDx of Strangulating obstructions
SI volvulus EEF (epiploic) Pedunc lipomas intussusceptions inguinal hernia mesenteric rents diaphragmatic hernia incarceration of GP lig vitelline anomalies
CLinical signs of a Strangulating obstruction
acute and severe pain no response to analgesics acute/severe fever high HR mm congested high PCV/TP, CRT, RR
Small Intestinal Volvulus may develop because:
(mesenteric axis rotation) primary displacement inguinal hernia mesodiverticular band meckel's diverticulum
Small Intestinal primary volvulus usually happens in and because
often foals 2-4 mo
a distinct spiral of intestine is made, entwined into a knot (nodosus)
C/S of Small Intestinal Volvulus
severe, persistent pain distention increase HR decreased motility CV compromise (CRT, hemoconc)
Foals see lots of distention
Dx of Small Intestinal Volvulus
Rectal exam looking for distended SI US - wall edema, dist, fluid in intestines, hypomotile Nasogastric tube (spont reflux of more than 2 L) Abdominocentesis - changes in 1-2 hours of strangulation --> leaking protein and RBCs and WBCs (serousanguinous)
US is more accurate than rectal. !!!
How high is high for RBC, WBC, and protein on abnormal abdominocentesis
> 2.5 g/dL in protien
foals - >1500 cells/microL
adults - >10000
Tx of Small Intestinal Volvulus
Exploratory Celiotomy ventral midline
correct the volvulus
reserct the SI
anastomose
Prognosis of Small Intestinal Volvulus
High complication rate - more foals than adults
things like gastric reflux, abdominal pain, incisional infection, pyrexia, diarrhea, laminitis, and pneumonia
Lipomas found where
90% SI, 9% LI
14-19 yo horses
Who is at risk for lipomas?
ponies, arabians, QH
Dx of Lipoma
Old horse
distended loops of SI on rectal
US - > 3cm diameter distention and hypomotile
Abdominocentesis depending on devitalization
nasgastric tube - spont reflux
Clinical signs of Lipoma
same clinical signs as SI volvulus
DDx for spont gastric reflux >2L
proximal enteritis
the SI volvulus
Surgical treatment of Lipomas
exploratory vnetral midline sever the avascular pedicle remove (blindly) release trapped bowel anastomosis
Complications of Lipoma surgery
Post-op ileus
Prog of Lipoma
favorable if done early.
poor once there is CV deterioration, intestinal necrosis and peritonitis
risks of blindly removing the pedicle
risk creating a mesenteric rent
mesenteric bleeding
classification of inguinal hernias
(counter-intuitive)
indirect - through vaginal tunic, so in scrotum
direct - rent near, but not through vaginal ring, so intestine lies in the SQ space
Indirect hernias are/in and involve
more common short amount of intestine Adult aquired non-reduceable unilateral
Acquired hernias are/in and involve
more common in foals longer lengths of intestine adults - stallions strenuous exercise breeding
What are some breed dispositions to Acquired hernias?
STB, Am Saddlebreds, tennessee walkers
Process that predisposes to herniation (inguinal)
increased abdominal pressure –> enlarges the inguinal ring
CLinical signs of an acqired inguinal hernia
colds, swollen, firm testicles, moderate pain increased HR, CRT, TP/PCV decreased motility nasogastric reflux
Pathogenesis of acquired inguinal hernia
hernia –> strangulation –> intestine compresses testicular vessels –> testicles go cold, firm, swollen
CLinical signs of non-strangulating inguinal hernias
abnormally large vaginal and internal rings
swelling of inguinal area
Dx of acquired inguinal hernias
palpation, rectal exam (important in males)
US - si distention, fluid in SI, si hypomotile
Tx of reducible (direct) inguinal hernias
spont fixes after dorsal recumbency GA
per rectum gentle traction
But you can’t assess the viability of the bowel then
Tx of non-reducible inguinal hernia
make inguinal incision along spermatic cord
go in by ventral midline and pull from there, after
assess bowel for viability
resect and anastomose
Unilateral castration, which allows
closure of the external inguinal ring
Prognosis for acquired inguinal hernias
worse the longer, so refer early
reproductive soundness will still even be sound most likely
EFE - Epliploic foramen entrapment borders what structures
CVC, portal vein
liver and pancreas
RDA
EFE hits
all ages of horse
horses that crib
EFE happens because
SI (Ileum) passes to the left side of the abdomen –> through the epiploic foramen
Clinical signs of EFE
not the same as typical entrapment slight pain gastric reflux normal rectal even these signs aren't always diagnostic
Dx of EFE
US - edematous SI wall > 3mm distention over 3cm see this in the ventral rt paralumbar fossa caudal ventral abdomen and middle right paralumber fossa
EFE REquire
Surgery
how much of the SI can be resected?
up to 70%
How to tell if the intstine is viable or not?
flick - if there is movement, feel pulses on vessels of mesentery, color, then good.
If non-viable, reperfusion injury
What types of Jejunojejunostomy surgeries can be done for EFE?
2 layer or single layer closure, stapled side to side closed, stapled, one-stage end-to-end stapled side-to-side hand sewn end-to-side
Post-op care for EFE
fluids AM NSAIDs take 2 days to start onto feed hand-walking out in 7-10 days
What do we worry about post-operatively? what is the rule of 1s
1 - surgery
day 10 - adhesions and fibrosis maybe
day 100 - clinical signs from adhesions or jjostomy
1 year - just about out of the woods
