Basics of Surgery of LI

Question 1

What is involved in causing

Answer 1

non-obstructive,
migration of LDC, and LVC between spleen and kidney
rotates 180 degrees on axis

Question 2

Nephrosplenic intrapment etiology

Answer 2

1. heavy weight in colon to displace spleen
2. impaired flow in LDC –> impaction
3. obstruction

Question 3

Who is mainly afected by Nephrosplenic intrapment?

Answer 3

Horses over 9 mo
Warmbloods
Horses that have more dorsomedial space

Question 4

Clinical signs of Nephrosplenic intrapment

Answer 4

normal CV
mild-severe pain
tension on the NS lig
distention of some extent

Question 5

Dx of Nephrosplenic intrapment

Answer 5

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

Question 6

Tx for Nephrosplenic intrapment

Answer 6

trailer? vigorous exercise? (be careful with these)

1. phenylephrine -splenic contract (alpha agonist) but has side effects. Then check rectally
2. rolling under GA - use the gas to help lift
3. standing flank lapar - avoid GA, can close the space from here, direct access.
4. ventral midline celiotomy - cost, GA, but can ensure correction.

Question 7

recurrence of Nephrosplenic intrapment

Answer 7

21%, don’t do the preventative surgery at the 1st surgery

Question 8

Surgical techniques to prevent NS lig entrap

Answer 8

LC resection
colopexy
NS space obliteration *** best

Question 9

Right Dorsal Displacement definition

Answer 9

pelvic flexure goes cranial

RDC and RVC go between cecum and body wall going the other direction

Question 10

Right Dorsal Displacement CLinical signs

Answer 10

extremely variable

Question 11

Right Dorsal Displacement dX

Answer 11

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)

Question 12

Tx of Right Dorsal Displacement

Answer 12

medical management - withold feed, flunixin, trocarization

Surgical management - explore, ID, decompress, reposition

Question 13

Prognosis og Right Dorsal Displacement

Answer 13

Excellent

Question 14

Large Colon Volvulus characteristics

Answer 14

most painful and devastating

needs dealt with FAST because death in hours

Question 15

Large Colon Volvulus etiology

Answer 15

can happen anywhere but most commonly in:

1. cecocolic ligament
2. sternal flexure and diaphragmatic flexure
3. base of cecum
4. right colon cranial to cecocolic lig

Most twist clockwise from behind the horse (dorsomedial)

Question 16

CLinical signs of 90-270 Large Colon Volvulus

Answer 16

partial obstruction, mild pain
no abdom tympany
vital signs that progress in 12-24 hr

Question 17

CLinical signs of 270-360 Large Colon Volvulus

Answer 17

complete obstruction - moderate pain
tachycardia (60-80)
progressive distention
CV collapse

Question 18

Clinical signs of 360-720 Large Colon Volvulus

Answer 18

complete obstruction
endotoc, 
sequestration
blood in strangulated seg
CV compromise
Tachy DH, CRT long, MM deter
uncontrollable pain
will die of hypovolemic shock

Question 19

Who are at risk for Large Colon Volvulus?

Answer 19

older broodmares
large breed horses
diet changes

Question 20

Dx of Large Colon Volvulus?

Answer 20

rectal exam - marked colonic dist.
Abdom US - wall edema and thickening
Abdominocent - doesn’t alter decision for surgery

Question 21

Pre-surgical Tx of Large Colon Volvulus?

Answer 21

Shock fluids - hypertonic followed by colloids and cystalloids
trochar to decrease abdom pressure

Question 22

surgical Tx of Large Colon Volvulus?

Answer 22

explore on ventral midline, correct torsion, assess viability (then it is either recover after fiing, large colon resection, or euthanasia)

Question 23

Post-op Tx for Large Colon Volvulus is

Answer 23

Endotoxemia tx - fluids, AB, Neutralize endotoxins with plasma and hyperimmune serum and polymixin B

Question 24

Prognosis of Large Colon Volvulus

Answer 24

depends on rapid dx, prompt referral, and surgical correction
poor if irreversible ischemic damage