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Large Animal Surgery > Equine Acute Abdomen, Pt. 2 > Flashcards

Equine Acute Abdomen, Pt. 2 Flashcards

1
Q

What is the blood supply to the cecum? What 4 attachments does it have?

A

ileocecal artery

  1. dorsal body wall
  2. transverse colon
  3. root of mesentery
  4. ileocecal and cecocolic folds
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2
Q

What are the 4 taeniae of the cecum like?

A
  • ileocecal = dorsal
  • cecocolic = lateral
  • medial and ventral join
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3
Q

What is the difference between primary and secondary cecal tympany?

A

PRIMARY = readily fermentable diet causes gas build up on digestion, reduced motility

SECONDARY = LI obstruction

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4
Q

When is trocharization of the cecum recommended?

A

no surgical option available or there is a surgical delay

  • cecum = R
  • colon = L
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5
Q

What materials are used for trocharization?

A
  • large bore catheter
  • local anesthetic
  • suction
  • extension set into a bottle of water - once bubbles stop, can remove
  • penicillin, gentamicin - can be injected as catheter is taken out

(stabilize colon rectally)

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6
Q

What 4 factors contribute to cecal impaction?

A
  1. dentition - fiber in diet remains coarse
  2. poor quality roughage
  3. tapeworm - Anoplocephala perfoliata at cecal valve
  4. altered motility - anesthesia/sedation, decreased exercise, ulcers
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7
Q

What are the 3 most common signs of cecal impaction?

A
  1. mild, intermittent pain
  2. scant, soft manure
  3. ventral band and enlarged base of cecum can be palpated on exam
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8
Q

What are the 2 types of cecal impactions?

A

TYPE 1 = mechanical obstruction due to firm, dry, or doughy content (feedstuffs); abdominocentesis WNL

TYPE 2 = cecal dysfunction causes the cecum to fill with gas and fluid and thickens the wall; serosanguinous abdominocentesis

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9
Q

When can medical treatment be used to treat cecal impactions? What plan is recommended?

A

Type 1 - dry feed, solid contents

  • fluid therapy - CAREFUL, overhydration can enlarge contents —> rupture
  • restrict feed
  • limited analgesics
  • monitor rectally
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10
Q

When is surgery recommended for cecal impaction? What is done? What complication is associated?

A

Type 2

  • empty via typhlotomy at apex
  • perform a bypass - cecocolostomy, jejuno/ileostomy

rupture

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11
Q

What are 2 major risk factors to developing cecal rupture?

A
  1. ulcers
  2. impactions

can occur without prior diagnosis of cecal disease!

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12
Q

What age of horse is most commonly associated with cecal intussusception? What is the most common cause?

A

< 3 y/o

altered motility - Salmonella, Eimeria, S. vulgaris, A perfolata

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13
Q

What are the most common signs associated with cecal intussusception? How is it treated?

A
  • ACUTE = extreme pain
  • CHRONIC = colic responds to therapy, but reappears

typhlectomy of compromised section + cecal bypass

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14
Q

What is the blood supply of the large colon? How many taenia are present?

A

cranial mesenteric artery

  • ventral colon = 4
  • pelvic flexure = 1
  • left dorsal colon = 1
  • right dorsal colon = 2
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15
Q

What 3 attachments does the large colon have?

A
  1. transverse colon
  2. cecocolic
  3. mesocolon
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16
Q

What are the most common clinical signs associated with colonic tympany? How is it diagnosed?

A
  • gas or spasmodic colic
  • acute, moderate pain with normal vitals and demeanor

rectal palpation - gas distention

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17
Q

What are the 3 major risk factors associated with colonic tympany?

A
  1. large colon impaction
  2. parasitism: small strongyles (cyathostomes), tapeworms
  3. recent changes in exercise, feeding, and high grain diet cause increased gas production
18
Q

What are 3 aspects of medical treatment for colonic tympany?

A
  1. analgesics - Flunixin +/- alpha2-agonist
  2. anti-spasmodic - Buscopan
  3. address primary cause
19
Q

Where is large colon impaction most common?

A
  • pelvic flexure - Bermuda grass, boredom, lack of water
  • transverse colon
20
Q

How are large colon impactions treated?

A

SURGERY - exteriorize the colon and perform a pelvic flexure enterotomy

21
Q

What 4 risk factors are associated with enterolithiasis? Where are they most commonly found?

A
  1. region - California/Southwest, Florids
  2. alfalfa hay
  3. stalled - less forage
  4. breed - Arabian, Morgan

right dorsal colon

22
Q

What is indicative of enterolithiasis? What are 2 options for diagnosis?

A

mild to moderate pain associated with recurrent colic

  1. rectal palpation - gas or ingesta
  2. radiography - radiopaque
23
Q

How is enterolithiasis treated?

A

pelvic flexure or right dorsal colon enterotomy for removal —> NOT able to be dissolved or passed through the pelvic flexure

24
Q

How can enterolithiasis be prevented?

A
  • NO alfalfa hay —> Timothy or orchard
  • Psyllium - decreases nidus
  • apple cider vinegar
25
Q

How is sand impaction treated?

A

pelvic flexure enterotomy - reduce impaction with water and use a hose as a siphon to drain sand that sunk to the bottom

  • most common at sternal flexure
26
Q

What is right dorsal displacement? What is indicative of this?

A

colon moves cranially and retroflexed to the right

variable pain depending on distention

27
Q

What is the preferred method of diagnosing right dorsal displacement? What else can be used?

A

rectal palpation

ultrasounds - may see colonic vessels next to the body wall

28
Q

What 4 things are seen on rectal palpation in cases of right dorsal displacement?

A
  1. absence of pelvic flexure
  2. left colon lateral to cecum
  3. can palpate bands of the colon
  4. gas distention
29
Q

What are 2 options for treating right dorsal displacement? How can recurrence be avoided?

A
  1. medical - pelvic flexure retroflexion
  2. surgery - exteriorize colon + pelvic flexure enterotomy if impacted

colopexy

30
Q

Where is the nephrosplenic space? How is the colon involved?

A

between left kidney, spleen, and body wall

can become entrapped when it moves between the spleen and body wall then dorsally

31
Q

What is indicative of nephrosplenic entrapment on rectal exams?

A

gas distention + colon in nephrosplenic space

32
Q

What is seen on ultrasounds in cases of nephrosplenic entrapment?

A

left kidney is deep to the spleen

  • can be used to monitor treatment
33
Q

What medical treatments are used for treating nephrosplenic entrapment?

A
  • fluid therapy
  • phenylephrine - alpha1 agonist shrinks the spleen and the horse is lunged for 15 mins to get the spleen back into normal position
  • rolling horse from right to left under general anesthesis
34
Q

How is nephrosplenic entrapment treated with surgery?

A

manual correction

35
Q

How can nephrosplenic entrapment be prevented?

A

closure of nephrosplenic space with laparoscopic mesh placement

36
Q

What is colon torsion? What are the 2 types?

A

twisting of colon along its long axis

  • NON-STRANGULATING = 90-270 degrees
  • STRANGULATING = > 360 degrees
37
Q

What are 3 risk factors associated with colon torsion?

A
  1. post-parturient mares - usually withing 4 days
  2. diet changes - increases gas production
  3. lush pasture - increases gas production
38
Q

What are the most common findings in cases of colon torsion? On rectal palpation?

A
  • moderate to severe pain with MINIMAL response to analgesics
  • tachycardia (> 80 bpm)
  • shock - injected/blue MM, blood pools into large colon

often too painful to perform (may only reach wrist), tightly gas distended colon

39
Q

How is colon torsion treated surgically? What is done if the colon in non-viable?

A
  • exteriorize the colon and correct torsion
  • pelvic flexure enterotomy to strain blood or unblock any impactions formed

R&A - up to 80% of the colon can be removed —> up to cecum and beyond cannot be reached, but should NOT be left if necrotic —> euthanasia

40
Q

What are the 2 most common causes of thromboembolic colic? How are they treated?

A
  1. S. vulgaris - R&A
  2. colitis caused by Salmonellosis or Clostridia - euthanasia
41
Q

What is the prognosis of large intestinal lesions like?

A
  • NON-STRANGULATING = 95% (enteroliths, impaction)
  • STRANGULATING = 50% (torsion)

Large Animal Surgery (32 decks)

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