Cecum

Question 1

Cecal impaction

Answer 1

Type1: dry ingesta (constipation)
Type2: fluid, impaired cecal outflow, cecal rupture

Question 2

What can cause a cecal impaction?

Answer 2

Anecdotal associations: chronic pain, poor dentition, ↓ water intake and poor quality roughage

Question 3

Cecal rupture is associated with _________

Answer 3

Musculoskeletal pain

Question 4

CS of cecal impaction

Answer 4

Masked by nonsteroidal anti-inflammatories
Reduced appetite
Low grade abdominal pain
Change in fecal quantity and quality

Question 5

Type 1 impaction

Answer 5

Chronic condition (fair to good prog)
Mild to moderate intermittent pain
Gas and fluid can pass beyond mass
Pain more evident as cecum distends

Question 6

Type 2 impaction

Answer 6

Progressive abdominal pain
HR elevates as cecum distends
Ping right paralumbar fossa
Endotoxemia
Guarded due to motility dysfunction

Question 7

Dx Type 1 cecal impaction

Answer 7

Cecum in normal postion
Dry feed in base and body of cecum are full
Ventral band cecum evident
Signs unchanged for days

Question 8

Dx of type 2 cecal impaction

Answer 8

Ingesta and fluid pull cecum forward
Worsening abdominal fluid

Question 9

When is medical tx for cecal impaction needed?

Answer 9

If cecum is small or moderate size
Goal: empty cecum and return to normal motility

Question 10

Medical tx for cecal impaction

Answer 10

Mineral oil, oral fluids, IV fluids
Flunixin meglumine
No feed, motility stimulators (erythromycin lactobionate, bethanechol, neostigme)- type 1

Question 11

Post cecal impaction

Answer 11

Off feed 2-3d to allow cecum to empty
Additional 2 w: pelleted feed and small amounts of green grass

Question 12

Sx indications for cecal impaction

Answer 12

No medical improvement for 3d
Extremely large cecum, recurrence of impaction, systemic deterioration, constant progressive abdominal pain

Question 13

Sx for cecal impaction

Answer 13

Commone for type 2 impactions
Sudden rupture
Typhlotomy (type 1), ileo or jejunocolic anastomosis (type2), or cecocolic anastomosis

Question 14

Ileocecal and cecocolic intussusceptions

Answer 14

Irritation or partial obstructions
Tapeworm infestations

Question 15

Ileocecal intussusceptions

Answer 15

Acute to chronic colic
Acute signs: SI signs, false neg abdominocentesis
Chr.: SI distention and 2x normal size, nasogastric reflux

Question 16

Cecocolic intussusceptions

Answer 16

Pain related to severity of lesion

Question 17

Reducible ileum tx

Answer 17

Correction of intussusception
Healthy ileum: ileocecal bypass
Unhealthy ileum: jejunocecostomy

Question 18

Non-reducible ileum tx

Answer 18

Small and chr: ileocecal bypass
Long and irreducible: reset within cecum, typhlotomy, exteriorize and resect ileum

Question 19

Reducible cecolic tx

Answer 19

Cecal resection
Ligation of lateral and medial vessels
2 double inverting layers
Stapling is difficult

Question 20

Nonreducible cecocolic tx

Answer 20

Reset cecum through r. ventral colon
Reduce intussusception
Reset balance of necrotic tissue

Question 21

Complications of Ileocecal and cecocolic intussusceptions

Answer 21

Difficult procedure
Avulsion of cecal vessels > hemorrhage
Necrosis of ileocecal orifice
Cecocolic orifice obstruction by ileocecal stump
Inoperative contamination

Question 22

Cecal infarction

Answer 22

Uncommon
Occurs in strangulating and non infacrtion, cecocecal or cecocolic intussusceptions

Question 23

Cecal infarction tx

Answer 23

Resection of diseased cecum
Ventral midline: cecal apex and body
Flank laparatomy: cecal base
Closure: double inverting or TA-90 stapling