Day 6 - GI 2 Flashcards
Laparoscopic Anatomy – Standing Left Side
Duodenum, dorsal spleen, stomach
Laparoscopic Anatomy – Standing Right Side
Ovary, uterus, duodenum, caecum, ventral and lateral taenia, small colon, small intestines
Flank approach
M. externus abd - internus abd - transversus
Paramedian laparotomy - approach
Linea alba - M. rectus abd - stronger outside then stronger inside layer
Suturing:
Peritoneum with contineous suture
Linea alba
Subacute, then skin
Structures of caecum
– 4 tenias
– Blood supply: lat and med tenia
– Lat.: leads to cecocolic lig.
– Dorsal tenia to lig. ileocaecale
Lesions of the intestinal wall
- Distension
– Intraluminal pressure for 2-4 hours. Hypoperfusion, edema, inflammatory cell invasion, adhesions within 10 days postop - Ischaemic mucosa
– Smal intestine: „tips of villi”: spec. blood supply
– Large intestine: no villi withstands 25% more - Vascular closure
Large bowel tenias
Reperfusion injury
What and consequences
Neutrophils
Adhesions leading to postop. ileus
Small intestine injuries
- Strangulating lesions (60-85%)
- Dilatation (prestenotic!)
- Special blood supply =>
- Ischemic wall less tolerant than large colon
(reperfusion injury)
Strangulation (9)
- Volvulus - Younger horse (Knot)
- Epiploic foramen (Left to right) Heavy colic signs.
- Pedunculated lipoma - surgery
- Mesenterial tears - Must be closed
- Intussusception: Jejunal or ileocaecal
- Inguinal hernia: Direct/Indirect
- Tear of gastrolienal lig. - internal hernia
- Umbilical hernia
- Diaphragmatic hernia
Congenital inguinal hernias
Definition:
Inguinal hernia: abdominal organ slips into the inguinal canal
Scrotal hernia: hernial content in the vaginal tunic (In general: inguinal hernia)
Clinical symptoms (indirect - foals)
▪ no colic symptoms, not painful
▪ Palpable intestines in the scrotum, soft fluctuend swelling
Treatment
▪ Continuous control
▪ Can grow out of the problem until 3-5 months!!!
▪ Immediate surgery if colic signs are present (rear)
▪ If direct: surgical treatment necessary!
Aquired indirect inguinal hernias (adults)
Hard, painful palpational finding, good visible, enlargement is not remarkable, not palpable!!!
Rectal palp.: Painful
Treatment
Peracute stage: pull out rectally, or massage back in GA and continue with castration
Surgery: gen. anesth. dors. rec.
* herniotomy, gut resection if needed
* decompress prestenotic intestines castration, closure of the ext. ing. ring,
* Collateral castration? – ask owner
* Laparoscopic closure of the vaginal process ?
Aquired direct inguinal hernias
Clinical signs
▪ Mild- to moderate colic!
▪ Adhesions and or inflammation of intest.
Treatment
▪ Do not wait long!
▪ Closure of hernial ring
Prognosis - Guarded to good
Small intestine – non-strangulating obstructions (8)
- Ileum impaction → frequent
- Muscular hypertrophy of ileum
- Ascarid impactions
- Duodenitis, prox. jejunitis
- Neoplasia
- Gastroduodenal obstruction
- Miscellaneous simple obstr
- Enteritis and fibrosis: Eosinophilic gastroenteritis. Tx w/NSAIDS
Duodenitis – proximal jejunitis (obs Tx)
Clostr., parasites, toxins
Reflux - often reddish, fever, leukocytosis
Tx:
* Decompression, electrolyte correction (K, Ca!)
* AB, Antiendotoxin and laminitis preventive treatment
Caecum disorders
- Caecum impaction (Type I and II)
- Caecocaecal invagination + ileocecal
- Caecocolonal invagination
- Caecum volvulus, torsion
- Caecum infarction
Diseases of the ascending colon
- Large colon tympany (most common cause of colic!)
- Impaction
- „Sandcolic”→ eat sand ( Pony)
- Enterolithiasis
- Large colon displacement
- Large colon torsion or volvulus
Right dorsal displacement of ascending colon
Together with displacement?
Marek trocar
Tympany
Decompression through rectum
Enterotomy at the pelvic flexure
Left Dorsal Displacement of ascending colon
Nephrosplenic entrapment
Conservative Tx: Phenylephrin for spleen contraction
Traumatic hernias
▪ Large hernial ring: Not susceptible to incarceration, but do susc. to adhesions
▪ Small hernial ring: Susceptible to incarceration– ileus
Most common area:
Aponeurosis of the int. and transv. abd. Or ext. and transv. abdom. muscle
Postoperative hernias
Cause, Predisposing factors
Following abdominal (colic) surgery at the previous surgical site Possible causes:
▪ Surgical technical error, failure of surture material
▪ Wound infection
▪ Extra abdominal pressure, foal under the mare
▪ Too early training
Predisposing factors:
▪ „Belly horse”, large wound, long operating time,
▪ Peritonitis at the time of surgery
Treatment
▪ Abdominal bandage,
▪ Reconstruction:
▪ 4-6 months post-surgery
Prepubic tendon rupture
Associated with: hydroallantois, twins, trauma,
▪ Excessive edema of the ventral abdom. Wall
Clinical signs: sudden onset
▪ progressive enlargement, edema
▪ mild to moderate discomfort
▪ stiff gait, prefer not to lie down, reluctant to move
Diagnosis:
▪ anamnesis, visual exam., palpation,
▪ rect. exam. US exam.
Differential-diagnosis:
▪ haematome, abscess, tumor
Aquired direct inguinal hernias
Clinical signs
▪ Mild- to moderate colic!
▪ Adhesions and or inflammation of intest.
Treatment
▪ Do not wait long!
▪ Closure of hernial ring Prognosis
▪ Guarded to good
Internal hernias
Displacement of an abdominal organ trough a physiological or abnormally originating space
▪ Diaphragmatic hernia
▪ For. epiploicum Winslowi
▪ Rent in the mesenterium or omentum
▪ Nephrosplenic space
▪ adhesions, wholes made by fibrous growth
