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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
How is sand impaction treated?
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
What is right dorsal displacement? What is indicative of this?
colon moves cranially and retroflexed to the right variable pain depending on distention
27
What is the preferred method of diagnosing right dorsal displacement? What else can be used?
rectal palpation ultrasounds - may see colonic vessels next to the body wall
28
What 4 things are seen on rectal palpation in cases of right dorsal displacement?
1. absence of pelvic flexure 2. left colon lateral to cecum 3. can palpate bands of the colon 4. gas distention
29
What are 2 options for treating right dorsal displacement? How can recurrence be avoided?
1. medical - pelvic flexure retroflexion 2. surgery - exteriorize colon + pelvic flexure enterotomy if impacted colopexy
30
Where is the nephrosplenic space? How is the colon involved?
between left kidney, spleen, and body wall can become entrapped when it moves between the spleen and body wall then dorsally
31
What is indicative of nephrosplenic entrapment on rectal exams?
gas distention + colon in nephrosplenic space
32
What is seen on ultrasounds in cases of nephrosplenic entrapment?
left kidney is deep to the spleen - can be used to monitor treatment
33
What medical treatments are used for treating nephrosplenic entrapment?
- 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
How is nephrosplenic entrapment treated with surgery?
manual correction
35
How can nephrosplenic entrapment be prevented?
closure of nephrosplenic space with laparoscopic mesh placement
36
What is colon torsion? What are the 2 types?
twisting of colon along its long axis - NON-STRANGULATING = 90-270 degrees - STRANGULATING = > 360 degrees
37
What are 3 risk factors associated with colon torsion?
1. post-parturient mares - usually withing 4 days 2. diet changes - increases gas production 3. lush pasture - increases gas production
38
What are the most common findings in cases of colon torsion? On rectal palpation?
- 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
How is colon torsion treated surgically? What is done if the colon in non-viable?
- 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
What are the 2 most common causes of thromboembolic colic? How are they treated?
1. S. vulgaris - R&A 2. colitis caused by Salmonellosis or Clostridia - euthanasia
41
What is the prognosis of large intestinal lesions like?
- NON-STRANGULATING = 95% (enteroliths, impaction) - STRANGULATING = 50% (torsion)

Large Animal Surgery (32 decks)

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