LA Acute Abdomen Diagnosis and Plan Flashcards
describe what to do for a nonstrangulating obstruction in the field versus in sx referral hospital
small intestine:
-field: refer! fluid can’t get to LI to get absorbed, so needs IV fluid support
–fluid could also back up to need to check for reflux regularly
-surgical referral hospital: medical to start; often best response from horse, or surgery as indicated
large intestine:
-field: treat or refer
–often can respond to medical management (CARE WITH CECAL IMPACTIONS though; high incidence of rupture); refer as indicated
-referral hospital: often respond best to medical therapy, best response with horses; surgery as indicated
describe next steps for a strangulating obstruction in field versus surgical referral hospital
small intestine:
-field: refer or euthanize
–need surgery to survive
–can refer for further diagnostics if need confirmation
–if sx not an option, euthanasia
-sx referral hospital: need surgery to survive, euth if sx not an option
large intestine:
-field: refer or euthanize, same as small
-sx referral: same as small
describe next steps for an inflammatory lesiol
small intestine:
-field: REFER
–lots of reflux: frequent check
–shock, SIRS: intensive management
-sx referral:
–medical: supportive care is mainstay of treatment
–surgery if indicated: decompression
large intestine:
-field: REFER
–shock, SIRS: intensive management
–zoonotic, contagious risk
-referral hospital:
–medical: supportive care is mainstay of treatment
–surgery if indicated decompression
what goes in to making the decision to treat colic in field?
- diagnosis: confidence in the diagnosis
- PAIN:
-severity of pain
-duration/recurrence - response to treatment
- expected treatment requirements
-frequency and skill required to perform - owner:
-comfort with monitoring and treatment
-cost, convenience
what goes in to the decision to recommend surgery for colic?
- diagnosis: confidence in diagnosis that requires surgery
- PAIN:
-severity
-duration/recurrence - response to treatment
- systemic/gastrointestinal deterioration
- owner: risks of surgery vs risks without surgery
describe the types of medical treatment for colic
- non-specific, symptomatic:
-analgesics (alpha-2 agonists)
-anti-spasmodics (Buscopan)
-trocharization (relieve gas inside a GI structure; can be part of stabilization and also pain relief) - non-specific, supportive care:
-fluids, electrolytes, acid base
-nutrition - specific therapies:
-impactions: laxatives
-endotoxemia
-LDDLC
describe the types of surgical treatment
- remove contents:
-alleviate distension, remove obstruction, remove source of endotoxin
-needle decompression, move SI contents into cecum, enterotomy, high enema - correct positioning:
-alleviate obstruction of GI +/- blood supply
-for displacements and strangulating lesions - resection and anastomosis
give specifics for ileal impactions (NSO SI)
- history of coastal/Bermuda hay
- tapeworms often involved
- sometimes palpable on rectal exam
- treatment: most resolve with supportive care and analgesia
- prognosis: for survival is good for medical and surgical treatment
give specifics for ascarid impaction (NSO SI)
- 5-8 month old foals most common; weanlings
- often occur after 1st antiparasitic administration
- can sometimes visualize in SI lumen with ultrasound
-look like traintracks/double lines - less severe cases can be medically managed then give slow kill dewormer
- if unresponsive, surgery is indicated
-prognosis considered poor
describe treatment and prognosis for SI bezoars in camelids
- treatment: surgery!
- prognosis better with earlier intervention and duodenal (vs jejunal which is poor prognosis)
- rupture/leakage reported before, during, and after surgery, so DONT WAIT, refer!
describe specifics for impactions (NSO LI)
- history clues: cecal bute admin, stall rest, small colon diarrhea, sandy area
- pelvic flexure, small colon, and cecum often palpable on rectal exam
- treatment:
-medical management often includes laxatives: water, electrolyte water, MgSO4, oil, psyllium for sand
-water is better than oil! will dissolve poop, oil will not
-cecal: rupture more common than others so consider surgery more rapidly
describe specifics for enteroliths (NSO LI)
- history: california, alfalfa hay
- radiographs can be diagnostics
-except for RDC
describe specifics for displacements (NSO LI)
- LDDLC: approx 20% reflux!
-rectal findings (tightly stuck squished colon with a tight band) are diagnostic!
-can rule out with ultrasound if see spleen under kidney - RDDLC: colonic mesenteric vessel on right side and rectal transverse band suggestive on ultrasound
- treatment and prognosis:
-recurrence reported at a wide range
-RDDLC: increased incidence of recurrent colic post-op
-LDDLC: specific medical management phenlyephrine, jogging, rolling
describe general treatment and prognosis for horse NSO LI
- often resolve with medical management
- surgical prognosis good to very good
describe diagnostics, treatment, and prognosis for spiral colon bezoars in camelids (LA NSO LI)
- treat with surgery
- prognosis better with earlier intevrention and better for LI and SI
describe diagnostics, treatment, and prognosis atresia coli (LA NSO LI)
- signalment: within days of birth
- dx: contrast radiography
-enema = no fecal staining! (normal - meconium) - prognosis for productivity poor
describe diagnostics, treatment, and prognosis for cecal dilation/dislocation (LA NSO LI)
- signalment/history:
-dairy
-within 60 days of freshening
-concurrent peripartum disease - dx: rectal, ping, distension
- tx: may be able to treat with prokinetics and supportive care
- prognosis: high rate of recurrence
above also applies to torsion and volvulus (signalment, treatment)
describe working diagnosis specifics for horse strangulating obstruction in small intestine
signalment/history:
1. strangulating lipoma: older horses (10 to >15)
2. epiploic foramen entrapment: cribbers
3. inguinal hernia: stallions, recent breeding
4. intussusceptions:
-jejuno-jejunal: foals
-ileocecal: young adult or tapeworm infection
exam:
1. inguinal hernia: testicular and rectal palpation, ultrasound scrotum
- intussusceptions: ultrasound bulls-eye, abdominocentesis changes may lag (sequestered)
describe working diagnosis specifics for other LA SO SI
- intussusception:
-hx/signalment:
–calves <2 months
–Brown swiss
–other GI dz: enteritis, parasites: change motility
-dx: ultrasound bullseye - volvulus:
-hx/signalment: calves, 1wk-6mo - HBS:
-hx/signalment: >4 y/o, brown swiss in peak milk production (3-4 months)
-tarry (raspberry jam), scant feces
-C. perfringens A +/- aspergillus fumigatus
describe treatment and prognosis for SO SI
- horses:
-variable prognosis to discharge
-better without resection and anastomosis
-prognosis better for foals and older horses
-prognosis for J-J may be better than J=I and/or J-C - other LA:
-intussception: often need resection and anastomosis, reported prognosis variable
-volvulus: prognosis best if catch early and less intestine involved
-HBS: high mortality, particularly poor if require resection and anastomosis
describe working diagnosis specifics for SO LI
horse:
-LCV: hx/signalment is post-partum mare
-intussusception:
–hx/signalment: more ccommon <3 years old parasitism might play a role
–dx: can present acute or chronic, bulls-eye on US, abdominocentesis may not change as expected if sequestered
other LA:
-intussusception, mesenteric volvulus like small intestine
-cecal torsion/volvulus for dilation/doslocation
describe treatment and prognosis for SO LI
horse:
- LCV: variable prognosis, duration likely plays a role
- intussusception: prognosis 50-80%
-Ce-ce better than ce-colon
-ranked best to worse prognosis: reduce only, typhlectomy, colotomy and typhlectomy
other LA:
-like with SO SI, prognosis likely better with faster diagnosis and treatment
describe anterior enteritis/duodenal proximal jejunitis (AE/DPJ)
etiology: C. difficile, salmonella, mycotoxins, C. perfringens
signalment/hx:
-avg 5-10 yr
-mares may be more predisposed
-stress: foaling, other changes
-high concentrate diet
treatment:
-aggressive medical supportive care
-surgery: does not appear to decrease reflux volume post op
prognosis:
-good in most
describe idiopathic peritonitis
etiology: unknown; transmural parasite migration proposed
clinical signs: lethargy, inappetance, colic, depression
PE: fever
ultrasound: +/- increase echogenic fluid, often see thickened SI/LI
abdominocentesis:
-grossly discolored, cloudy
-VERY increased TP, lactate, and WBCC (avg >150,000 cells/ul)
bloodwork:
-dehydration
-WBC abnormalities common
culture: not always positive (blood culture media may be better)
-actinobacillus spp seems most common
treatment: broad spectum abx and supportive care
-prognosis to discharge and 1 year very good
-recurrent colic does not appear increased relative to other causes of colic
