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Large Animal Surgery > Equine Acute Abdomen > Flashcards

Equine Acute Abdomen Flashcards

1
Q

How long is the equine small intestine? What is its major blood supply?

A

30-90 feet

cranial mesenteric artery (ileocecal) —> easy compromise with strangulation

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2
Q

In what 3 locations does the small intestine attach to the abdominal wall?

A
  1. duodenocolic fold
  2. mesentery
  3. ileocecal fold
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3
Q

What are the 2 most common causes of ileal impaction?

A
  1. coastal Bermuda grass hay - Southeast US
  2. Anoplocephala perforata (tapeworm) - ulceration, edema
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4
Q

What is the most common sign of ileal impaction? How is it diagnosed?

A

moderate pain due to intestinal spasms and distention

  • rectal palpation
  • ultrasonography (dilated loops stacked on one another)
  • reflux
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5
Q

What medical and surgical treatments are available for ileal impaction? What is prognosis like?

A

MEDICAL = IV fluids, analgesics

SX = massage contents into cecum

good

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6
Q

What is ileal hypertrophy? What 2 signs are seen?

A

thickened circular and longitudinal layers of the ileum (over a meter), resulting in luminal constriction

  1. chronic colic
  2. ileal impaction
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7
Q

What is the main option for treating ileal hypertrophy?

A

SURGICAL - ileocecostomy or jejunocecostomy to bypass ileum into cecum

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8
Q

What is the most common cause of ascarid impaction in horses? When does it most commonly occur?

A

Parascaris equorum

post-deworming - Moxidectin or Ivermectin kill ascarid, causing them to detach from the SI and obstruct the lumen

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9
Q

What horses are most commonly affected by ascarid impaction? How do they present?

A

younger horses, weanlings (4-24 months) post-deworming

  • pot-bellied
  • emaciated/unthrifty
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10
Q

How is ascarid impaction diagnosed?

A
  • history - young horse, recently dewormed
  • ascarids in reflux
  • ultrasonography
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11
Q

What medical and surgical options are available for ascarid impaction?

A

MEDICAL - fluid therapy, lubricants

SX = entero/typhloptomies + removal with forceps

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12
Q

What is prognosis like for ascarid impaction following surgical treatment? Why?

A

poor - mortality ~92%

high possibility of rupture

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13
Q

What are the 3 major causes of strangulation impactions?

A
  1. lipoma
  2. volvulus
  3. intussusception

(more common than simple obstructions)

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14
Q

What are the 4 most common signs of strangulation onstructions?

A
  1. moderate to severe pain with limited response to analgesics
  2. tachycardia - 60-80 bpm
  3. ileus - nasogastric reflux, decreased borborygmi
  4. congested MM with toxic line
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15
Q

What is felt on rectal palpation in cases of strangulation obstruction?

A
  • fluid distention
  • firm colon content - NOT intestinal wall shrinking around feed

felt in central/ventral abdomen

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16
Q

What are 2 signs of strangulation obstruction on ultrasound?

A
  1. fluid distention - third spacing of fluid into lumen
  2. decreased motility - particulate matter sings to the bottom of the intestine
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17
Q

What is seen with abdominocentesis in cases of strangulation obstruction?

A
  • serosanguinous fluid - TP > 2.5 mg/dL, WBC > 5000, elevated lactate > 2 mmol
  • third spacing of fluid into lumen AND abdomen

(red = dead bowel)

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18
Q

What is the most common cause of strangulation obstruction? In what horses is this most common?

A

lipoma - benign fatty tumor (“ball on a string”)

older geldings (15-19 y/o)

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19
Q

What surgical intervention is recommended for strangulating lipomas? What complication can be seen?

A

resection and anastomosis of affected parts of intestine

re-establishing blood flow can case reperfusion injury

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20
Q

In what 2 groups of horses is volvulus most common? What is volvulus?

A
  1. foals
  2. mature horses (lipomas more common)

rotation of the intestine around the mesentery across the bowel axis

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21
Q

At what age is intussusception most common? What causes it? Where is it most common?

A

< 3 y/o

abnormal motility - enteritis, parasites

small intestine - jejunojejunal, jejunoileal, ileoileal

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22
Q

What is the most common part of the intestine affected by intussusception? What is a unique cause?

A

ileocecal

chronic colic within a small segment of the bowel (10 cm)

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23
Q

What surgery is recommended for corrected intussusception? What acute and chronic complications are associated?

A

reduction via manipulation with R&A of unsalvageable tissue

  • ACUTE = edema
  • CHRONIC = adhesions
24
Q

Where is the epiploic foramen found? What horses are most commonly affected? At what incidence?

A

4 cm opening into the omental bursa found caudal to the liver and near the portal vein/pastropancrease

> 7 y/o

seasonal - fall/spring

25
What is the most common presentation of epiploic foramen entrapment?
"Cribber" - horse gulps air and gnaws on fence posts as a means to release stress
26
What is the preferred method of diagnosing epiploid foramen entrapment? What part of the GIT is commonly involved?
ultrasonography in the right paralumbar fossa ileum
27
What signalment is most commonly associated with acquired inguinal hernias? What history is seen?
Tennessee Walking Horse, Standardbred, American Saddlebred, and Warmblood stallions recent exercise or breeding
28
What is an acquired inguinal hernia? How is it diagnosed?
"scrotal hernia" - through the vaginal ring, which can include the ileum - palpation - rectal, scrotum - ultrasound - abdominal, scrotum (may see SI in scrotum or torsion)
29
What approach is used for treating inguinal hernias? What 4 things are commonly done?
inguinal and midline incisions 1. reduce hernia into normal positiong 2. SI reduction of nonviable segments involved 3. inguinal ring closure 4. castration (vessel compression)
30
In what horses are congenital inguinal hernias common? How does it occur?
foals 4-48 hours post-partum (L > R) through peritoneum or fascia, possibly adjacent to the vaginal ring and into the preputial/scrotal space
31
How do congenital inguinal hernias compare to acquired ones?
congenital inguinal hernias are rarely strangulating and can commonly preserve any bowel involved and testicles ---> the canal in younger horses are short and wide
32
How are congenital inguinal hernias treated? How quickly should this correct?
manually reduced and managed with a truss should naturally resolve at 3-6 months
33
What causes congenital inguinal hernias to be non-reducible? How is it corrected?
rupture of the vaginal tunic causes massive swelling and may allow intestines to lie in the SQ surgical reduction ---> inguinal incision and replace bowel + close defect - castration not usually needed
34
What are 4 causes of mesenteric rents? How is it treated?
1. idiopathic 2. post-partum mares 3. trauma 4. surgical defect surgical reduction +/- R&A of any nonviable intestines
35
How do umbilical hernias compare to other hernias?
painful, swollen, hot, and non-reducible - due to size, they are commonly easy to get out, but hard to reduce
36
What are the most common causes of acquired and congenital diaphragmatic hernias? What is the most common organ involved? 3 others?
- ACQUIRED = trauma - CONGENITAL = diaphragmatic defect, rib fracture intestines + stomach, liver, colon
37
What are 3 signs of diaphragmatic hernias? How is it diagnosed?
1. acute pain 2. dyspnea with larger defects 3. auscultation shows reduced heart/lung sounds or borborygmi - ultrasonography - radiography
38
How are diaphragmatic hernias treated?
- reduce intestine - repair diaphragm with direct suturing or mesh - will reoccur if not repaired!
39
Where is the gastrosplenic ligament found? What happens when it tears? What is required for treatment?
between greater curvature and hilus of the spleen intestines move cranially surgery - reduce intestine and repair the ligament
40
What is the most common cause of non-strangulating infarctions?
verminous arteritis - S. vulgaris migration causes mesenteric thrombarteritis of the cranial mesenteric and ileocecocolic arteries - thrombus at the root can compromise huge portions of the GIT, requiring euthanasia
41
What 4 medications are provided prior to abdominal surgery?
1. broad spectrum antibiotics - Penicillin (+), Gentocin (-), Ceftiofur 2. anti-inflammatory - Flunixin 3. anti-endotoxic - Polymyxin B (smaller dose binds to subunits of endotoxins) 4. vaccination - Tetanus
42
What 2 types of fluid therapy are recommended prior to abdominal surgery?
1. hypertonic - 7.5% NaCl 15 mins prior to support systemic shock 2. isotonic - bolus recommended when PCV > 50%
43
How are patients physically prepared prior to abdominal surgery?
- IV catheter placement - clean body and feet - clip abdomen - rinse mouth prior to placing ET tube to avoid aspiration pneumonia
44
How are horses handled following induction?
- cornered in a padded stall and encouraged to dog sit, sternal recumbency, and lateral recumbency - intubated - hobbles connected to feet and lifted into the surgery suite - scrubbed, draped
45
Why is padding of the surgical table especially important for horses?
avoids myopathy and myositis
46
Abdominal approaches:
47
Surgical exploration:
- lighter blue = can be exteriorized - darker blue = harder to visualize cecum = R pelvic flexure = L
48
What 4 post-operative medications are recommended following abdominal surgery?
1. broad spectrum antibiotics - Penicillin, Gentamycin, Ceftiofur 2. anti-inflammatory - Flunixin 3. anti-endotoxic - Polymyxin B 4. gastroprotectants - Omeprazole
49
What 2 post-operative fluids are recommended following abdominal surgery?
1. isotonic - 1 L/hr to account for ongoing losses until there is free access to water 2. colloidsq
50
What are important aspects to post-operative monitoring following abdominal surgery?
- physical exam q 4-6 hours - HR, digital pulses, temperature - reflux PRN - incision and catheter site maintenance - blood work: PCV/TS, electrolytes
51
How is small intestine surgery performed?
- exteriorize and straighten - correct primary lesion
52
How much of the small intestine can be resected?
40% - may be able to tolerate 50-70%, but debatable
53
What are the 3 most common ways of anastomizing the small intestine?
1. jejunojejunostomy 2. jejunoileostomy 3. jejunocecostomy - when the ileum is not viable
54
What should be minimized during small intestinal surgery?
- surgery time - quick pre-op prep - trauma - decreased handling and friction + lavage
55
What is the prognosis of small intestinal surgery like?
- non-strangulating = 90% - strangulating = 85% short-term, 70% long-term (adhesions tend to develop), 76% jejunocecostomy

Large Animal Surgery (32 decks)

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