Exam 3

Question 1

Guttural Pouch Tympany; Signalment, Causes, Clinical Signs, Diagnosis

Answer 1

Signalment
 Foals
 Fillies>Colts

Causes
 Idiopathic
 Upper airway infection
 Persistent coughing
 Muscle dysfunction

Clinical Signs
 Air swelling of parotid region
 Unilateral > Bilateral
 Respiratory noise
 Nasal discharge
 Dyspnea, pneumonia, dysphagia

Diagnosis
 Endoscopy
 Rads
 Needle decompression

Question 2

Guttural Pouch Tympany; Treatment

Answer 2

Surgical septum fenestration
* Makes 2 pouches into 1

AND

Surgical resection of inner mucosal flap of guttural pouch opening
* Gets rid of 1-way valve so that things can come in and out

Transendoscopic laser
* may cut more than you want
* less favored

Question 3

What’s Included in Viborg’s Triangle

Answer 3

 angle of mandible
 linguofacial vein
 tendon of the sternocephalicus

Question 4

What do urachus, umbilical arteries, & umbilical vein develop into?

Answer 4

Urachus
 Middle ligament of bladder

Umbillical Arteries
 Round ligaments of bladder

Umbilical Vein
 Falciform/round ligament of liver

Question 5

Patent Urachus Vs infected Umbilical Remnants

Answer 5

Patent Urachus
 Leaking urine at <2wks

Infected
 Leaking urine at 2-4wks
 Warm, painful swelling
 Sepsis, pneumonia, septic joints, Ds
 Heat & pitting edema = surgical emergency

Question 6

Infected Umbilical Remnants; diagnosis, Surgical Options

Answer 6

Diagnosis
 Ultrasound
 Vein >1cm
 Artery >1.3cm
 All > 2.5cm

Surgical Options
 Resection of umbilical portion
 Marsupialization of hepatic portion
 Inform owners of possible hernia

Question 7

Uroperitoneum; Timing & Most Likely Cause

Answer 7

Ruptured bladder
* 3-4d

Urachal perforation
* 1-2wks

Ureteral defects
* 3-4d

Question 8

Uroperitoneum; Signalment, Clinical Signs, Diagnosis, Presurgical Management

Answer 8

Signalment
 Foals
 Males>Females

Clinical Signs
 Straining
 Depression
 Fluid in abdomen, scrotum, thorax

Diagnosis
 Abdominocentesis
 >2:1 peritoneal creatinine:serum ratio
 Ultrasound
 Contrast rads
 Hyponatremia, hypochloremia, HYPERKALEMIA

Pre-surgical Management
 Slow peritoneal drainage
 IV NaCl
 Dextrose or insulin to reduce K below 6meq/l

Surgery
 Appositional
 Followed by inverting

Question 9

Umbilical Hernia; Treatment

Answer 9

Treatment
 Herniorrhaphy
 Hernia clamp
 Elastrator bands
 Irritant injection
 Benign neglect

Question 10

Strangulated Umbilical Hernias; Basics, Clinical Signs

Answer 10

 Omentum, jejunum, ileum, cecum, or ventral colon in hernial sack

Clinical Signs
* Firm warm hernial sac
* Edema
* Colic
* Richter’s hernia (intestine opens)
* Enterocutaneous fistula

Question 11

Inguinal/Scrotal Hernias; Signalment, Types, Treatment, Herniorrhaphy

Answer 11

Signalment
 Males&raquo_space; females
 Standardbreds, draft horses, Tennesee Walkers, Saddlebreds

Types
 Indirect – thru vaginal ring most common
 Direct – thru rent near vaginal ring
 Ruptured – most challenging

Treatment
 Repeated manual reduction
 Inguinal herniorrhaphy
 Support bandage
 If you don’t do sx you must be cautious at castration

Inguinal herniorrhaphy
 Reduction and transfixation ligature
 Closure of external inguinal ring
 Tilt of operating table may ease repair

Question 12

Foal Colic; Causes, Diagnosis

Answer 12

Causes
 Meconium impaction
 Small Intestine volvulus
 Gastroduodenal obstruction
 Ascarid impaction
 Sand impaction
 Congenital defects

Diagnosis
 Rads – plain & contrast
 abdominocentesis

Question 13

Castration; When & What Position is Best

Answer 13

When
 Before weaning, ~4mo

How
 Dorsal recumbancy

Question 14

Anatomy of the testicles & scrotum

Answer 14

o Go look at testical picture and review anatomy

Question 15

Tools for Castration; What do these look like: Kocher Oschner, Serra Curved Handles, Reimer, Modified White Hausmann, Henderson Castrating Tool, Ferguson Angiotribe Forceps

Answer 15

Kocher Oschner
* Look like hemostats w/ rat teeth & alligator teeth

Serra Curved Handles
* Emasculator
* Curved handles
* 2 rounded grabbers

Reimer
* Emasculator
* 3 handles
* Several curved grabbers

Modified White Hausmann
* One strait grabber and one curved

Henderson castrating tool
* Attaches to power drill
* Twists testicle off

Ferguson Angiotribe Forceps
* Curved tip
* Looks like thinning shears

Question 16

Ragle’s 13 Steps to Castration

Answer 16

 Wipe scrotal injection site w/ alcohol prior to surgical prep
 Inject each testicle until full w/ lidocaine
 Aseptic prep of sx site & surgeon
 2 parallel scrotal incisions 2cm from median raphe
 Incise into cranial portion of vaginal tunic of one testicle, place index finger into tunic & place kocher forceps firmly over tunic & tail of epididymis
 Apply firm tension to tunic/testicle & w/ the other hand strip away connective tissue & fat covering tunic & cremaster
 Divide cremaster from vaginal tunic & clamp w/ angiotribe & section w/ electrocautery
 Expose pedicle from inside tunic blunt puncture mesochorium to separate into vascular & non-vascular segments of pedicle
 Clamp & ligate vascular portion & section w/ electrocautery
 Replace ligated vascular portion inside tunic
 Clamp & ligate tunic & section w/ electrocautery
 Repeat steps 5-11 on remaining testicle
 SQ closure of scrotal incision and/or invert scrotum & glue

Question 17

Castration AfterCare

Answer 17

 2hrs quiet
 Exercise 20 mins 2x per day for 2wks
 If doing Ragle method, no aftercare

Question 18

Risks of Castrating NOT the Ragle Way

Answer 18

 Hemorrhage
 Scirrhous cord
 Eventration or evisceration
 No such thing as premature closure only excessive drainage

Question 19

Preventing Hemorrhage After Castration, what to do if hemorrhage starts

Answer 19

 Make sure not stressed or high BP
 Ligate cord on mules, donkeys, mature stallions
 Crush cord for 6 mins prior to removal of emasculator on draft horses

If Hemorrhage begins
 Cross clamp cord for 24hr w/ R angle clamp
 Limit dissection w/in inguinal canal

Question 20

Visceral Prolapse; Signalment, Prevention, Treatment

Answer 20

Signalment
* Draft horses
* Some Standardbred lines
* Gaited Horse-TW

Prevention
* Ligate cord excluding the cremaster muscle
* Ligate cord in all horses with predisposition to inguinal hernias and/or large vaginal rings and horses with history of inguinal swelling
* Close inguinal rings

Treatment
* Anesthetize horse, replace bowel and suture superficial ring and skin

OR
* Anesthetize horse, suture skin incision

OR
* Pack canal and close skin

OR
* Pack canal and wrap groin -> REFER

Question 21

Cryptorchid; Types, Stats, Surgical Options

Answer 21

 Inguinal
OR
 Abdominal
* Testicle in abdomen & epidydimus outside
* Both testicle & epidydimus in abdomen

Stats
* Unilateral > bilateral
* L – usually abdominal
* R – usually inguinal
* Bilateral abdominal > bilateral inguinal

Options for Cryptorchidectomy
* Inguinal
* Parainguinal
* Flank
* Ventral midline
* Laparascopic standing flank or ventral umbilical

Question 22

Why do Laparascopic Cryptorchidectomy

Answer 22

• Allows thorough examination
• Eliminates chance of evisceration
• Earlier return to normal function
• “Close all the holes”

Question 23

Partial Phallectomy; Indications, William’s Technique

Answer 23

Indications
 Intractable paraphimosis
 Traumatic penile injury
 Squamous cell carcinoma

William’s Technique
 Need supreme hemostasis
 ID urethra w/ catheter ->
 Cut patch out of skin ->
 Dissect down into urethra ->
 Suture urethra to skin ->
 Remove end of penis

Question 24

What is Preputial Resection for

Answer 24

o avoid penis amputation
o Remove lesion on penis

Question 25

Ovariectomy; Indications, Surgical Approaches

Answer 25

Indications
 Neoplasia/Hematoma
 Genetic control
 Prevention of estrus

Surgical Approaches
 Colpotomy (ratchet/crushing ovary)
 Paramedian Oblique/Flank/ Ventral Midline
 Laparoscopy (recumbent)

Question 26

Perineal Lacerations; Types, Repair

Answer 26

1st Degree
 Skin + mucus membranes

2nd Degree
 Skin + mucus membranes + constrictor vulvae muscle

3rd Degree
 Complete disruption of perineal body

Rectovaginal Fistula
 Full thickness
 Does not involve vulvar cleft

Repair
 Caudal epidural w/ xylazine & mepivacaine btwn 1st 2 coccygeal vertebrae
 Rectal mucosa -> perineal body -> vaginal mucosa

Question 27

Urine Pooling; Signalment, Options for Sx

Answer 27

Signalment
 Skinny body condition (try top increase BW)
 Cranioventral tipping of pelvis
 Multiparous older females

Options for Surgical Repair
 Vaginoplasty for mild issue
 Perineoplasty
 Urethral extension (best)

Question 28

Pneumovagina; what, Signalment, Sx

Answer 28

Involuntary aspiration of air into the vagina -> chronically distended vagina

Signalment
 COMMON in race horses
 Usually seen in older, multiparous mares

Surgical Repair
 Vulvoplasty
 reduction of the mucocutaneous junction of the vulva to prevent aspiration of air

Question 29

Options for Surgical Removal of Uroliths

Answer 29

o Laparocystotomy
o Perineal urethrostomy
o Cystotomy (difficult)
o Lithotripsy (best)

Question 30

Causes for Pain in GI Tract

Answer 30

o Stretch
o Ischemia
o Inflammation

Question 31

Indications for Surgical Treatment of Colic

Answer 31

o Acute, unrelenting pain, poor response to analgesics
o Progressive abdominal distension
o Silent abdomen
o Continuous high volume gastric reflux, alkaline pH
o HR > 60-80 bpm, or rising
o Poor or deteriorating cardiovascular status
o Peritoneal fluid with increased protein (>3.0 g/dL), blood-tinged

Question 32

Abdominal Sx Approaches

Answer 32

o Ventral midline (most accessible)
o Paramedian
o Paramedian oblique
o Flank
o Inguinal

Question 33

Land Marks for the Equine GI

Answer 33

Cecum
 4 bands

Ileum, Jejunum, Duodenum, Stomach
 Dorsal band

Colon
 Lateral Band

Dorsal band
 ileocolic fold

Duodenocolic Fold
 Junction of jejunum & duodenum

Question 34

Colonic Impactions; Causes, Signs, Treatment

Answer 34

o Cause
 Coarse feed
 Poor dentition
 Abnormal motility
 Decreased H2O intake

Signs
 intermittent colic that gradually worsens
 Mild to moderate dehydration,
 normal or elevated heart rate
 Peritoneal fluid usually normal
 Rectal palpation reveals mass or gas distension

Treatment
 Intravenous +/- oral fluids
 Oral laxatives; mineral oil, DSS, magnesium sulfate, psyllium
 Analgesics
 Surgical intervention if necessary

Question 35

Sand Colic; Causes, Signs, Treatment

Answer 35

Cause
 Short pasture
 Insufficient roughage
 Sandy soil

Signs
 First Ds
 Intermittent colic
 “beach” sound on auscultation
 Sand present in feces

Treatment
 mineral oil,
 magnesium sulfate,
 psyllium

Question 36

Enteroliths; Causes, Signs, Treatment

Answer 36

Causes
 precipitation of magnesium ammonium phosphate salts (struvite) around a nidus
 more prevalent in Ca, In, Fl

Signs
 Intermittent colic
 Gas distension of large colon on rectal exam

Treatment
 Removal through enterotomy
 If you find a round one, probably only one
 Triangles have many

Question 37

Colon Tympany; Causes, Signs, Treatment

Answer 37

Causes
 Fermentable feeds (carbs, alfalfa)
 Hypocalcemia & hypokalemia
 Atropine administration

Signs
 Increasing severity of pain
 Gas distension on rectal exam
 Circulatory shock may occur

Treatment
 Analgesics
 Fluid therapy
 Mineral oil to aid removal of fermented products
 Decompression

Question 38

Intramural Lesions; Causes, Signs, Treatment

Answer 38

Causes
 Eosinophilic granulomas,
 hematomas,
 fibrotic plaques

Signs
 Functional obstruction
 Impaction of feed
 High cell & protein peritoneal fluid

Treatment
 MUST surgically remove impaction
 Resection of affected intestine

Question 39

Right Dorsal Displacement; What, Causes, Signs, Treatment

Answer 39

o Colon between cecum & R body wall

Causes
 Abnormal motility w/ gas distension
 Large breed horses

Signs
 variable amounts of pain
 Gastric reflux
 Bands of large colon palpated in transverse orientation on rectal

Treatment
 Surgical correction through ventral midline celiotomy

Question 40

Left Dorsal Displacement; Causes, Signs, Diagnosis, Treatment

Answer 40

Cause
 Unknown

Signs
 variable amounts of pain
 Gastric reflux

Diagnosis
 Rectal palpation of the entrapment
 Ultrasound

Treatment
 Surgical correction via midline celiotomy
 Surgical correction via flank laparotomy
 Systematic rolling under general anesthesia
 Phenylephrine

Question 41

Displacement of the Pelvic Flexure &/or Left Colon; What, Signs, Treatment

Answer 41

o Cranial flexion of left colons, “gut tie”,
o gastrosplenic entrapment,
o diaphragmatic hernia

Signs
 variable amounts of pain
 Metabolic compromise dependent on duration and degree of distension
 Gas distension on rectal examination

Treatment
 Midline celiotomy

Question 42

Colonic Torsion/Volvulus; Signalment, Signs, Treatment

Answer 42

o Often older brood mare post foaling

Signs
 acute onset of severe pain
 Rapid deterioration of systemic signs
 Gas distension on rectal exam
 Normal or inflammatory peritoneal fluid changes

Treatment
 Surgery immediately
 Volvulus at cecal base most common
 Enterotomy aids with repositioning
 Colon resection
 Fluids, antimicrobials, antiendotoxemic therapy
 Colopexy to avoid recurrence

Question 43

Non-strangulating Infarction; Cause, Signalment, Signs, Treatment

Answer 43

Cause
 Verminous arteritis

Signalment
 Young horses
 Horse not on parasite control

Signs
 depression and variable amounts of pain
 fever +/-
 Inflammatory Peritoneal fluid
 Endotoxemia if large or severe infarction
 Cecum commonly affected

Treatment
 analgesics and fluid therapy
 Surgery if clinical deterioration
 Bowel resection may be required
 Antimicrobials due to peritonitis

Question 44

Intussusception; Cause, Signalment, Signs, Treatment

Answer 44

Cause
 Altered peristalsis (often tapeworm)

Signalment
 Young horse

Signs
 acute onset of pain
 Decreased borborygmi,
 elevated HR,
 dehydration
 Gastric reflux
 Distended loops of small intestine on rectal exam
 Peritoneal fluid w/ elevated WBC and protein
 Characteristic “doughnut” shape on ultrasound

Treatment
 Manual reduction if possible
 Resection and anastamosis if necessary
 jejunostomy or jejunocecostomy

Question 45

Acquired Inguinal Hernia; Cause, Signalment, Signs, Treatment

Answer 45

Causes
 strenuous exercise,
 breeding,
 trauma
 Enlarged internal inguinal ring
 Complication of castration

Signalment
 Standardbred,
 American Saddlebred,
 Tennessee Walking Horse stallions

Signs
 acute intestinal obstruction
 Usually unilateral & indirect herniation
 Firm, swollen testicle
 Gastric reflux
 distended SI, loop of SI into inguinal canal on rectal exam
 Peritoneal fluid may be normal or elevated WBC and protein

Treatment
 emergency surgical correction
 Inguinal & ventral midline incision
 Incarcerated bowel reduced and resected if necessary
 Remove affected testicle

Question 46

Ileal Impaction; Cause, Signs, Treatment

Answer 46

Cause
 vascular thrombotic disease
 associated w/ coastal Bermuda hay
 often in SE US

Signs
 mild to severe abdominal pain
 Elevated HR
 decreased borborygmi
 dehydration
 Gastric reflux
 distended SI, palpable impaction on rectal exam
 Peritoneal fluid normal or elevated protein

Treatment
 analgesics
 IV fluids,
 mineral oil
 Surgical correction is usually required

Question 47

Muscular Hypertophy of the Ileum; Cause, Signs, Treatment

Answer 47

Cause
 Idiopathic
 Secondary to strongyle larval migration

Signs
 Usually intermittent
 distended SI on rectal exam
 SI may be hypermotile

Treatment
 Ileal myotomy
 Ileocecostomy

Question 48

Proximal Enteritis; Signs, Treatment

Answer 48

o In the SE US

Signs
 mild to severe colic initially
 Depression
 blood-tinged gastric reflux
 Febrile
 inflammatory leukogram
 mild to moderate distended SI on rectal
 Peritoneal fluid elevated protein, normal WBC

Treatment
 Not surgical
 Gastric decompression
 IV fluids, analgesics
 flunixin, penicillin, intestinal stimulants

Question 49

Adhesions; Cause, Signs, Treatment

Answer 49

Cause
 response to tissue anoxia/hypoxia, infection, foreign material

Signs
 variable amounts of pain
 Gastric reflux
 Distended SI on rectal exam
 may have peritonitis
 Can occur 1-2 weeks postoperatively

Treatment
 prevention is most important
 Surgical adhesiolysis
 Resection and anastamosis or bypass

Question 50

Epiploic Foramen Herniation; Signs, Treatment

Answer 50

o L to R > R to L

Signs
 variable amounts of pain
 Gastric reflux
 Peritoneal fluid serosanguinous, elevated WBC & protein

Treatment
 surgical correction
 Decompression & reduction if possible
 Resection & anastamosis
 Fatal rupture of CVC or portal vein can occur
 Closure of epiploic foramen not possible

Question 51

Mesenteric Defects; Cause, Signs, Treatment

Answer 51

Cause
 Usually result of trauma

Signs
 acute and severe pain
 Distended SI on rectal exam
 Peritoneal fluid serosanguinous, elevated WBC and protein

Treatment
 Surgical reduction of hernia
 Resection of involved bowel
 Closure of mesenteric defects

Question 52

Ascarid Impaction; Signs, Treatment

Answer 52

Signs
 variable amounts of pain
 Obstruction may be partial or complete
 Gastric reflux w/ ascarids may be present

Treatment
 medical therapy if possible
 Low efficacy anthelmintics - thiabendazole, fenbendazole
 Intestinal lubricants and analgesics
 Surgical correction via enterotomies

Question 53

Small Intestinal Volvulus; Signs, Treatment

Answer 53

Signs
 acute and severe pain
 shock - elevated HR & CRT, weak pulse, injected mm, hemoconcentration
 Gastric reflux
 Distended loops of SI on rectal exam
 Peritoneal fluid—serosanguinous, elevated WBC & protein

Treatment
 Surgical reduction of the volvulus
 Resection & anastamosis if necessary
 Euthanasia if 60% or greater devitalized

Question 54

Pedunculated Lipomas; Signalment, Signs, Treatment

Answer 54

Signalment
 Older horses

Signs
 acute and severe pain
 Shock - elevated HR & CRT, weak pulse, injected mm, hemoconcentration
 Gastric reflux
 Distended SI, rarely feel lipoma on rectal exam
 Peritoneal fluid—serosanguinous***, elevated WBC & protein

Treatment
 surgical correction
 Sever avascular pedicle & remove lipoma
 Resection & anastamosis of affected intestine

Question 55

Pharyngeal Cysts; Locations, Signalment, Clinical Signs, Diagnosis

Answer 55

Locations
 subepiglottic region,
 dorsal pharyngeal wall
 soft palate

Signalment
 Young thoroughbred & standardbred racehorses
 Males > females

Clinical Signs
 result from distortion of the larynx and pharynx articulation
 upper airway noise, cough, nasal discharge
 exercise intolerance
 dysphagia
 aspiration pneumonia
 dorsal displacement of soft palate

Diagnosis
 Endoscopic exam of the nasopharynx
 +/- oral exam under general anesthesia
 Contrast rads

Question 56

Pharyngeal Cysts; Treatment

Answer 56

 Complete removal of the secretory lining of the cyst is necessary

Surgical resection
* ventral laryngotomy or pharyngotomy incision
* preservation of the mucosa surrounding the cyst
* may decrease scar formation and secondary epiglottic dysfunction

Endoscopic-guided snare excision
* difficult if a wide base attachment

Laser ablation

Intralesional formalin injection (new)
* Minimally invasive, low-cost treatment
* desiccation and coagulation of the tissue

Question 57

Intermittent Dosally Displaced Soft Palate Treatment

Answer 57

 Tie forward

Question 58

Left Laryngeal Hemiplegia; Signs, Reason, Treatment

Answer 58

Signs
 Roaring (abnormal respiratory sounds)
 Exercise intolerance

Reason
 Paralysis of left recurrent laryngeal nerve

Treatment
 Laryngoplasty – “tie back”
 +/- ventriculocordectomy

Question 59

Arytenoid Chondritis; What, Diagnosis, Treatment

Answer 59

o Progressive infection of the arytenoid cartilages
o Often confused for left recurrent hemiplegia

Diagnosis
 Endoscopy
 kissing lesions on opposite normal arytenoid
 increased granulation tissue
 lack of abduction

Treatment
 Arytenodectomy

Question 60

Sinus Disease; Signs, Treatment

Answer 60

Signs
 Odorous nasal discharge
 Nose deformity
 Air flow obstruction
 Stertor / stridor
 Draining tract

Treatment
 nasofrontal flap

Question 61

Landmarks for Nasofrontal Flap

Answer 61

Caudal
 btwn supraorbital foramen & medial canthus

Rostral
 cranial to infraorbital foramen & nasoincisive notch

Lateral
 medial to nasolacrimal duct
 parallel & medial from medial canthus to nasoincisive notch