Day 6 - GI 2

Question 1

Laparoscopic Anatomy – Standing Left Side

Answer 1

Duodenum, dorsal spleen, stomach

Question 2

Laparoscopic Anatomy – Standing Right Side

Answer 2

Ovary, uterus, duodenum, caecum, ventral and lateral taenia, small colon, small intestines

Question 3

Flank approach

Answer 3

M. externus abd - internus abd - transversus

Question 4

Paramedian laparotomy - approach

Answer 4

Linea alba - M. rectus abd - stronger outside then stronger inside layer

Suturing:
Peritoneum with contineous suture
Linea alba
Subacute, then skin

Question 5

Structures of caecum

Answer 5

– 4 tenias
– Blood supply: lat and med tenia
– Lat.: leads to cecocolic lig.
– Dorsal tenia to lig. ileocaecale

Question 6

Lesions of the intestinal wall

Answer 6

1. Distension
   – Intraluminal pressure for 2-4 hours. Hypoperfusion, edema, inflammatory cell invasion, adhesions within 10 days postop
2. Ischaemic mucosa
   – Smal intestine: „tips of villi”: spec. blood supply
   – Large intestine: no villi withstands 25% more
3. Vascular closure

Question 7

Large bowel tenias

Answer 7

Question 8

Reperfusion injury
What and consequences

Answer 8

Neutrophils

Adhesions leading to postop. ileus

Question 9

Small intestine injuries

Answer 9

• Strangulating lesions (60-85%)
• Dilatation (prestenotic!)
• Special blood supply =>
• Ischemic wall less tolerant than large colon
  (reperfusion injury)

Question 10

Strangulation (9)

Answer 10

• 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

Question 11

Congenital inguinal hernias

Answer 11

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!

Question 12

Aquired indirect inguinal hernias (adults)

Answer 12

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 ?

Question 13

Aquired direct inguinal hernias

Answer 13

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

Question 14

Small intestine – non-strangulating obstructions (8)

Answer 14

• 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

Question 15

Duodenitis – proximal jejunitis (obs Tx)

Answer 15

Clostr., parasites, toxins
Reflux - often reddish, fever, leukocytosis

Tx:
* Decompression, electrolyte correction (K, Ca!)
* AB, Antiendotoxin and laminitis preventive treatment

Question 16

Caecum disorders

Answer 16

• Caecum impaction (Type I and II)
• Caecocaecal invagination + ileocecal
• Caecocolonal invagination
• Caecum volvulus, torsion
• Caecum infarction

Question 17

Diseases of the ascending colon

Answer 17

• Large colon tympany (most common cause of colic!)
• Impaction
• „Sandcolic”→ eat sand ( Pony)
• Enterolithiasis
• Large colon displacement
• Large colon torsion or volvulus

Question 18

Right dorsal displacement of ascending colon

Answer 18

Together with displacement?
Marek trocar
Tympany
Decompression through rectum
Enterotomy at the pelvic flexure

Question 19

Left Dorsal Displacement of ascending colon

Answer 19

Nephrosplenic entrapment
Conservative Tx: Phenylephrin for spleen contraction

Question 20

Traumatic hernias

Answer 20

▪ 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

Question 21

Postoperative hernias

Answer 21

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

Question 22

Prepubic tendon rupture

Answer 22

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

Question 23

Aquired direct inguinal hernias

Answer 23

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

Question 24

Internal hernias

Answer 24

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