Basics of Surgery of LI Flashcards
What is involved in causing
non-obstructive,
migration of LDC, and LVC between spleen and kidney
rotates 180 degrees on axis
Nephrosplenic intrapment etiology
- heavy weight in colon to displace spleen
- impaired flow in LDC –> impaction
- obstruction
Who is mainly afected by Nephrosplenic intrapment?
Horses over 9 mo
Warmbloods
Horses that have more dorsomedial space
Clinical signs of Nephrosplenic intrapment
normal CV
mild-severe pain
tension on the NS lig
distention of some extent
Dx of Nephrosplenic intrapment
nasogastric reflux (43%)
rectal exam - gas in LC, it goes over, etc
abdominecentesis - normal
US - 88% gas colon dorsal to spleen in front of kidney
Kidney - normally at 18th rib
Tx for Nephrosplenic intrapment
trailer? vigorous exercise? (be careful with these)
- phenylephrine -splenic contract (alpha agonist) but has side effects. Then check rectally
- rolling under GA - use the gas to help lift
- standing flank lapar - avoid GA, can close the space from here, direct access.
- ventral midline celiotomy - cost, GA, but can ensure correction.
recurrence of Nephrosplenic intrapment
21%, don’t do the preventative surgery at the 1st surgery
Surgical techniques to prevent NS lig entrap
LC resection
colopexy
NS space obliteration *** best
Right Dorsal Displacement definition
pelvic flexure goes cranial
RDC and RVC go between cecum and body wall going the other direction
Right Dorsal Displacement CLinical signs
extremely variable
Right Dorsal Displacement dX
REctal exam - LC distention, no pelvic felx, RD impaction, LC lateral to cecum
Nasogastric reflux - if LC distention
Abdominocentesis - normal
Lab - high GGT (partial obstruction)
Tx of Right Dorsal Displacement
medical management - withold feed, flunixin, trocarization
Surgical management - explore, ID, decompress, reposition
Prognosis og Right Dorsal Displacement
Excellent
Large Colon Volvulus characteristics
most painful and devastating
needs dealt with FAST because death in hours
Large Colon Volvulus etiology
can happen anywhere but most commonly in:
- cecocolic ligament
- sternal flexure and diaphragmatic flexure
- base of cecum
- right colon cranial to cecocolic lig
Most twist clockwise from behind the horse (dorsomedial)
CLinical signs of 90-270 Large Colon Volvulus
partial obstruction, mild pain
no abdom tympany
vital signs that progress in 12-24 hr
CLinical signs of 270-360 Large Colon Volvulus
complete obstruction - moderate pain
tachycardia (60-80)
progressive distention
CV collapse
Clinical signs of 360-720 Large Colon Volvulus
complete obstruction endotoc, sequestration blood in strangulated seg CV compromise Tachy DH, CRT long, MM deter uncontrollable pain will die of hypovolemic shock
Who are at risk for Large Colon Volvulus?
older broodmares
large breed horses
diet changes
Dx of Large Colon Volvulus?
rectal exam - marked colonic dist.
Abdom US - wall edema and thickening
Abdominocent - doesn’t alter decision for surgery
Pre-surgical Tx of Large Colon Volvulus?
Shock fluids - hypertonic followed by colloids and cystalloids
trochar to decrease abdom pressure
surgical Tx of Large Colon Volvulus?
explore on ventral midline, correct torsion, assess viability (then it is either recover after fiing, large colon resection, or euthanasia)
Post-op Tx for Large Colon Volvulus is
Endotoxemia tx - fluids, AB, Neutralize endotoxins with plasma and hyperimmune serum and polymixin B
Prognosis of Large Colon Volvulus
depends on rapid dx, prompt referral, and surgical correction
poor if irreversible ischemic damage
