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Intro to Surgery > Lecture 17 - Equine GI Surgery > Flashcards

Lecture 17 - Equine GI Surgery Flashcards

1
Q

What is colic?

A

Abdominal pain, most commonly of GI origin (can be due to other things such as uroliths).

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2
Q

What % of colic cases require surgical intervention?

A

5-10%

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3
Q

What does a colic exam consist of?

A

The 10 P’s:

Pain, Pulse, Perfusion, Peristalsis, Pings, Paunch, Passing an NG tube, Palpation, PCV/TP, Peritoneal fluid

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4
Q

What is paunch?

A

How distended the abdomen looks

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5
Q

What is considered an elevated HR in horses?

A

>60 bpm

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6
Q

What is a “toxic line”?

A

Purple line on gums around teeth - can be a sign of endotoxemia

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7
Q

What should you listen for during abdominal auscultation?

A

Peristalsis (frequency, intensity, duration, fecal passage)

Pings

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8
Q

How frequent should peristaltic sounds be when auscultating?

A

2-3 episodes in 1-2 minutes

(Should not be continuous, should not be absent)

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9
Q

When passing an NG tube, how much fluid reflux is abnormal?

A

>2 L

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10
Q

If you get reflux (>2 L) with an NG tube, what can be causes?

A

Clostridium/Salmonella, small intestinal lesion

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11
Q

What can an NG tube be used for other than relief of gas/fluid?

A

Enteral fluid therapy (water, mineral oil (laxative))

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12
Q

What is reflux?

A

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

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13
Q

T/F: The SI is not palpable in a normal horse.

A

True

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14
Q

What is visceral distention on rectal palpation a sign of?

A

Gas, distended large colon

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15
Q

What types of abnormalities (location-wise) can you feel on rectal palpation?

A

Nephrosplenic entrapment, inguinal rings (hernias)

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16
Q

What is a risk of rectal palpation?

A

Rectal tears

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17
Q

What should the large colon feel like normally on rectal palpation?

A

should be soft and floppy

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18
Q

What is a normal PCV? TS? Lactate? WBC?

A

PVC = 28-40%

TS = 6-8 mg/dL

Lactate = <2 mmol/L

WBC = 5,000-12,000 cells/mL

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19
Q

What does a PCV >60% mean?

A

Decreased prognosis for life; shunting blood from other ogans, something severe is happening

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20
Q

What is a normal TP for peritoneal fluid?

A

<2.5 g/dL

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21
Q

What is a normal WBC for peritoneal fluid?

A

<1,000 cells/ml

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22
Q

What can be seen on cytology of peritoneal fluid?

A

peritonitis, rupture of GIT

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23
Q

What things can be evaluated with transabdominal ultrasound?

A

SI distention, intestinal wall thickness, peritoneal fluid, gastric size, SI/LI contencts, spleen and kidneys, intussusception

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24
Q

What can be diagnosed via gastroscopy?

A

Equine gastric ulcer syndrome, gastric impaction

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25
Q

What are indicators of surgical colic?

A
  1. Pain (severe, analgesia doesn’t help, horse throws itself on ground)
  2. Pulse (52-78 bpm, >80 bpm severe)
  3. Perfusion (prolonged CRT, poor pulse quality)
  4. Absence of peristalsis
  5. Pings
  6. Paunch
  7. >2 L of reflux with NG tube
  8. PCV > 60%
  9. Abnormal peritoneal fluid
  10. Enteroliths or lg amounts of sand on xray
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26
Q

What are 3 medical therapies that can be done for colic?

A
  1. Pain management (NSAIDs, lidocaine, opioids)
  2. Fluid therapy
  3. Laxatives
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27
Q

What is the most common NSAID used?

A

Banamine

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28
Q

When would you use omeprazole?

A

When ulcers are suspected

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29
Q

What are some laxatives we can use?

A

Mineral oil, water, epsom salts

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30
Q

What are some diseases of the oral cavity?

A
  1. Dental disease
  2. Dysphagia
  3. Foreign bodies
  4. Neoplasia
  5. Salivary gland conditions
  6. Infectious disease
  7. Congenital and developmental disorders
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31
Q

What are diseases of the esophagus?

A
  1. Obstruction (choke)
  2. Strictures
  3. Diverticula
  4. Rupture
32
Q

What is the primary cause of choke?

A

Impaction with feed

33
Q

What are secondary obstructions that cause choke?

A

Foreign body, neoplasia/abscess/cyst, diverticulum, stricture

34
Q

What are clinical signs of choke?

A
  1. Post-pharyngeal dysphagia
  2. Nasal regurgitation of feed/saliva
  3. Coughing/retching/extended neck carriage
35
Q

What diagnostics can be used with choke?

A

Clinical signs, endoscopy, radiography

36
Q

What can be used in the field to diagnose choke?

A

NG tube

37
Q

How can choke be treated?

A
  1. Gentle lavage via NG tube
  2. Systemic support including NSAIDs and antimicrobials
  3. Dietary restriction
  4. Occasional surgical intervention
38
Q

Why might we use antimicrobials with choke?

A

If we suspect they aspirated

39
Q

What are diseases of the stomach?

A
  1. Equine gastric ulcer syndrome (EGUS)
  2. Pyloric stenosis and delayed gastric emptying
  3. Gastric dilation and rupture
  4. Gastric impaction
40
Q

What is the most common approach to an equine abdominal exploratory?

A

Ventral midline

41
Q

What are other approaches to abdominal exploratories?

A

Paramedian, flank (standing), laparascopic

42
Q

How many feet of SI and LI do horses have?

A

SI = 60-70 feet

LI = 30-40 feet

43
Q

What is the most common long term complication of abdominal exploratory and how often does it occur?

A

Adhesions; 25% of horses

44
Q

What can we use in surgery to prevent adhesions?

A
  1. Carboxymethylcellulose (belly jelly) - lube
  2. Omentectomy
  3. Minimize trauma, ensure hemostasis, experienced surgeon
45
Q

What do we use to close the linea alba in horses?

A

3 Vicryl

46
Q

What do we use to close the SQ in horses?

A

2-0 Vicryl

47
Q

What do we use to close the skin in horses for an exploratory?

A

Skin staples

48
Q

What are the components of the horse SI?

A

Duodenum, Jejunum, Ileum, Mesentery

49
Q

What are 2 types of general diseases of the SI?

A

Non-strangulating obstructions and strangulating obstructions

50
Q

How can we tell if a SI obstruction is surgical?

A
  1. PE
  2. U/S
  3. Rectal exam
  4. Abdominocentesis
51
Q

What suture patterns can we use for a resection and anastomosis? What suture material?

A

Simple interrupted, continuous Lembert, simple continuous (interrupted at 180 deg)

Material = 2-0 poliglecaprone (Monocryl) or polyglactin 910 (Vicryl)

52
Q

Why should you close mesenteric defects?

A

To prevent the SI from getting entrapped

53
Q

What are diseases of the cecum?

A
  1. Impaction
  2. Cecocecal or cecocolic intussisception
  3. Perforation or rupture
  4. Volvulus
  5. Infarction
54
Q

What are surgical treatments that can be done for the cecum?

A
  1. Typhlotomy
  2. Cecocolic anastomosis
  3. Jejunocolic anastomosis
55
Q

What are diseases of the large colon?

A
  1. Large colon tympany
  2. Large colon impaction
  3. Sand impaction
  4. Enterolithiasis
  5. Nephrosplenic entrapment
  6. R dorsal displacement
  7. Large colon volvulus
  8. R dorsal colitis
  9. Thromboembolic colic
56
Q

What are surgical procedures that can be done with the large colon?

A
  1. Resolution of displacement/volvulus
  2. Pelvic flexure enterotomy
  3. Large colon resection
57
Q

What type of procedure is a pelvic flexure enterotomy considered to be and why?

A

Clean-contaminated;

Clean = we are not opening it over the main body cavity

Contaminated = we are going into the intestine

58
Q

What are diseases of the small colon?

A
  1. Fecal impaction
  2. Enterolithiasis
  3. Fecalith/phytobezoar
  4. Foreign body obstruction
  5. Meconium impaction
  6. Intramural hematoma
  7. Pedunculated lipoma
  8. Volvulus/herniation/intussusception
  9. Atresia coli
59
Q

What are surgical procedures that can be done in the small colon?

A
  1. Resolution of volvulus
  2. Small colon enterotomy
  3. High enema
  4. Resection and anastomosis
60
Q

What diseases of the rectum?

A

Rectal tears, rectal prolapse

61
Q

What are causes of rectal tears?

A
  1. Palpation per rectum and contraction of rectal wall
  2. Enemas
  3. Dystocia/parturition
  4. Breeding injury
62
Q

What is a grade 1 rectal tear?

A

Through mucosa

63
Q

What is a grade 2 rectal tear?

A

Through muscularis

64
Q

What is a grade 3 rectal tear?

A

Only serosa left

65
Q

What is a grade 4 rectal tear?

A

Into the abdomen

66
Q

How can we treat rectal tears?

A
  1. Reduce activity in rectum
  2. Gently remove feces from rectum
  3. Treat septic shock and peritonitis
  4. Administer epidural and pack the rectum
  5. Temporary in-dwelling rectal liner
  6. Colostomy
  7. Direct suturing
67
Q

What is a type I rectal prolapse?

A

Rectal mucosa and submucosa project thru anus

68
Q

What is a type II rectal prolapse?

A

Complete prolapse of full thickness of all or part of rectal ampulla

69
Q

What is a type III rectal prolapse?

A

Small colon intussuscepts into rectum in addition to type II prolapse

70
Q

What is a type IV rectal prolapse?

A

Peritoneal rectum and small colon form intussusception thru anus

71
Q

How can we treat types I and II rectal prolapses?

A

Apply glycerin, sugar, magnesium sulfate, lidocaine jelly;

Epidural;

Pursestrings;

Do not feed for 12-24 hours, laxative diet for >10 days

72
Q

If surgical treatment for rectal prolapse is needed, how can we do so?

A

Submucosal resection, resection and anastomosis, celiotomy if type III/IV

73
Q

When does atresia ani become apparent and what are clinical signs?

A

Shortly after birth;

Straining to defecate, colic, abdominal distention

74
Q

How can we treat atresia ani?

A

Reconstructive rectal surgery

75
Q

What is a common neoplasia of the rectum in horses?

A

Melanoma; esp in gray horses

Intro to Surgery (36 decks)

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