Basics of SI Surgery Diseases Flashcards by Cordell Young

DDx of Non-strangulating obstructions

ileal impaction
muscular hypertrophy ileum
ascarid impaction
duo-prox jejunitis
gastroduo obstruction
intestinal inflamm and fibrosis

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DDx of Strangulating obstructions

SI volvulus
EEF (epiploic)
Pedunc lipomas
intussusceptions
inguinal hernia
mesenteric rents
diaphragmatic hernia
incarceration of GP lig
vitelline anomalies

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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

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Small Intestinal Volvulus may develop because:

(mesenteric axis rotation)
primary displacement
inguinal hernia
mesodiverticular band
meckel's diverticulum

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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)

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C/S of Small Intestinal Volvulus

severe, persistent pain
distention
increase HR
decreased motility
CV compromise (CRT, hemoconc)

Foals see lots of distention

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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. !!!

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How high is high for RBC, WBC, and protein on abnormal abdominocentesis

> 2.5 g/dL in protien
foals - >1500 cells/microL
adults - >10000

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Tx of Small Intestinal Volvulus

Exploratory Celiotomy ventral midline
correct the volvulus
reserct the SI
anastomose

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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

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Lipomas found where

90% SI, 9% LI

14-19 yo horses

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Who is at risk for lipomas?

ponies, arabians, QH

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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

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Clinical signs of Lipoma

same clinical signs as SI volvulus

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DDx for spont gastric reflux >2L

proximal enteritis

the SI volvulus

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Surgical treatment of Lipomas

exploratory vnetral midline
sever the avascular pedicle
remove (blindly)
release trapped bowel
anastomosis

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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