Lecture 17 - Equine GI Surgery Flashcards
What is colic?
Abdominal pain, most commonly of GI origin (can be due to other things such as uroliths).
What % of colic cases require surgical intervention?
5-10%
What does a colic exam consist of?
The 10 P’s:
Pain, Pulse, Perfusion, Peristalsis, Pings, Paunch, Passing an NG tube, Palpation, PCV/TP, Peritoneal fluid
What is paunch?
How distended the abdomen looks
What is considered an elevated HR in horses?
>60 bpm
What is a “toxic line”?
Purple line on gums around teeth - can be a sign of endotoxemia
What should you listen for during abdominal auscultation?
Peristalsis (frequency, intensity, duration, fecal passage)
Pings
How frequent should peristaltic sounds be when auscultating?
2-3 episodes in 1-2 minutes
(Should not be continuous, should not be absent)
When passing an NG tube, how much fluid reflux is abnormal?
>2 L
If you get reflux (>2 L) with an NG tube, what can be causes?
Clostridium/Salmonella, small intestinal lesion
What can an NG tube be used for other than relief of gas/fluid?
Enteral fluid therapy (water, mineral oil (laxative))
What is reflux?
Difference bt amount of fluid you put in the stomach to get a siphon going and what comes out that you didn’t put in
T/F: The SI is not palpable in a normal horse.
True
What is visceral distention on rectal palpation a sign of?
Gas, distended large colon
What types of abnormalities (location-wise) can you feel on rectal palpation?
Nephrosplenic entrapment, inguinal rings (hernias)
What is a risk of rectal palpation?
Rectal tears
What should the large colon feel like normally on rectal palpation?
should be soft and floppy
What is a normal PCV? TS? Lactate? WBC?
PVC = 28-40%
TS = 6-8 mg/dL
Lactate = <2 mmol/L
WBC = 5,000-12,000 cells/mL
What does a PCV >60% mean?
Decreased prognosis for life; shunting blood from other ogans, something severe is happening
What is a normal TP for peritoneal fluid?
<2.5 g/dL
What is a normal WBC for peritoneal fluid?
<1,000 cells/ml
What can be seen on cytology of peritoneal fluid?
peritonitis, rupture of GIT
What things can be evaluated with transabdominal ultrasound?
SI distention, intestinal wall thickness, peritoneal fluid, gastric size, SI/LI contencts, spleen and kidneys, intussusception
What can be diagnosed via gastroscopy?
Equine gastric ulcer syndrome, gastric impaction
What are indicators of surgical colic?
- Pain (severe, analgesia doesn’t help, horse throws itself on ground)
- Pulse (52-78 bpm, >80 bpm severe)
- Perfusion (prolonged CRT, poor pulse quality)
- Absence of peristalsis
- Pings
- Paunch
- >2 L of reflux with NG tube
- PCV > 60%
- Abnormal peritoneal fluid
- Enteroliths or lg amounts of sand on xray
What are 3 medical therapies that can be done for colic?
- Pain management (NSAIDs, lidocaine, opioids)
- Fluid therapy
- Laxatives
What is the most common NSAID used?
Banamine
When would you use omeprazole?
When ulcers are suspected
What are some laxatives we can use?
Mineral oil, water, epsom salts
What are some diseases of the oral cavity?
- Dental disease
- Dysphagia
- Foreign bodies
- Neoplasia
- Salivary gland conditions
- Infectious disease
- Congenital and developmental disorders
What are diseases of the esophagus?
- Obstruction (choke)
- Strictures
- Diverticula
- Rupture
What is the primary cause of choke?
Impaction with feed
What are secondary obstructions that cause choke?
Foreign body, neoplasia/abscess/cyst, diverticulum, stricture
What are clinical signs of choke?
- Post-pharyngeal dysphagia
- Nasal regurgitation of feed/saliva
- Coughing/retching/extended neck carriage
What diagnostics can be used with choke?
Clinical signs, endoscopy, radiography
What can be used in the field to diagnose choke?
NG tube
How can choke be treated?
- Gentle lavage via NG tube
- Systemic support including NSAIDs and antimicrobials
- Dietary restriction
- Occasional surgical intervention
Why might we use antimicrobials with choke?
If we suspect they aspirated
What are diseases of the stomach?
- Equine gastric ulcer syndrome (EGUS)
- Pyloric stenosis and delayed gastric emptying
- Gastric dilation and rupture
- Gastric impaction
What is the most common approach to an equine abdominal exploratory?
Ventral midline
What are other approaches to abdominal exploratories?
Paramedian, flank (standing), laparascopic
How many feet of SI and LI do horses have?
SI = 60-70 feet
LI = 30-40 feet
What is the most common long term complication of abdominal exploratory and how often does it occur?
Adhesions; 25% of horses
What can we use in surgery to prevent adhesions?
- Carboxymethylcellulose (belly jelly) - lube
- Omentectomy
- Minimize trauma, ensure hemostasis, experienced surgeon
What do we use to close the linea alba in horses?
3 Vicryl
What do we use to close the SQ in horses?
2-0 Vicryl
What do we use to close the skin in horses for an exploratory?
Skin staples
What are the components of the horse SI?
Duodenum, Jejunum, Ileum, Mesentery
What are 2 types of general diseases of the SI?
Non-strangulating obstructions and strangulating obstructions
How can we tell if a SI obstruction is surgical?
- PE
- U/S
- Rectal exam
- Abdominocentesis
What suture patterns can we use for a resection and anastomosis? What suture material?
Simple interrupted, continuous Lembert, simple continuous (interrupted at 180 deg)
Material = 2-0 poliglecaprone (Monocryl) or polyglactin 910 (Vicryl)
Why should you close mesenteric defects?
To prevent the SI from getting entrapped
What are diseases of the cecum?
- Impaction
- Cecocecal or cecocolic intussisception
- Perforation or rupture
- Volvulus
- Infarction
What are surgical treatments that can be done for the cecum?
- Typhlotomy
- Cecocolic anastomosis
- Jejunocolic anastomosis
What are diseases of the large colon?
- Large colon tympany
- Large colon impaction
- Sand impaction
- Enterolithiasis
- Nephrosplenic entrapment
- R dorsal displacement
- Large colon volvulus
- R dorsal colitis
- Thromboembolic colic
What are surgical procedures that can be done with the large colon?
- Resolution of displacement/volvulus
- Pelvic flexure enterotomy
- Large colon resection
What type of procedure is a pelvic flexure enterotomy considered to be and why?
Clean-contaminated;
Clean = we are not opening it over the main body cavity
Contaminated = we are going into the intestine
What are diseases of the small colon?
- Fecal impaction
- Enterolithiasis
- Fecalith/phytobezoar
- Foreign body obstruction
- Meconium impaction
- Intramural hematoma
- Pedunculated lipoma
- Volvulus/herniation/intussusception
- Atresia coli
What are surgical procedures that can be done in the small colon?
- Resolution of volvulus
- Small colon enterotomy
- High enema
- Resection and anastomosis
What diseases of the rectum?
Rectal tears, rectal prolapse
What are causes of rectal tears?
- Palpation per rectum and contraction of rectal wall
- Enemas
- Dystocia/parturition
- Breeding injury
What is a grade 1 rectal tear?
Through mucosa
What is a grade 2 rectal tear?
Through muscularis
What is a grade 3 rectal tear?
Only serosa left
What is a grade 4 rectal tear?
Into the abdomen
How can we treat rectal tears?
- Reduce activity in rectum
- Gently remove feces from rectum
- Treat septic shock and peritonitis
- Administer epidural and pack the rectum
- Temporary in-dwelling rectal liner
- Colostomy
- Direct suturing
What is a type I rectal prolapse?
Rectal mucosa and submucosa project thru anus
What is a type II rectal prolapse?
Complete prolapse of full thickness of all or part of rectal ampulla
What is a type III rectal prolapse?
Small colon intussuscepts into rectum in addition to type II prolapse
What is a type IV rectal prolapse?
Peritoneal rectum and small colon form intussusception thru anus
How can we treat types I and II rectal prolapses?
Apply glycerin, sugar, magnesium sulfate, lidocaine jelly;
Epidural;
Pursestrings;
Do not feed for 12-24 hours, laxative diet for >10 days
If surgical treatment for rectal prolapse is needed, how can we do so?
Submucosal resection, resection and anastomosis, celiotomy if type III/IV
When does atresia ani become apparent and what are clinical signs?
Shortly after birth;
Straining to defecate, colic, abdominal distention
How can we treat atresia ani?
Reconstructive rectal surgery
What is a common neoplasia of the rectum in horses?
Melanoma; esp in gray horses
