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Equine Medicine and Surgery > Lecture 7: Abnormal Conditions of Equine Small intestine > Flashcards

Lecture 7: Abnormal Conditions of Equine Small intestine Flashcards

1
Q

What are the two classifications of obstructions

A
  1. Simple/ nonstrangulating vs strangulating
  2. Functional vs mechanical
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2
Q

What is a simple/ nonstrangulating obstruction

A

Blood supply to intestine involved in the obstruction remains patent

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3
Q

How does peritoneal fluid in a simple/ nonstrangulating obstruction look

A

Grossly normal

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4
Q

What is a strangulating obstruction

A

Blood supply is constricted/blocked which results in mucosal ischemia injury and endotoxemia

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5
Q

What is a functional obstruction

A

Lumen of the intestine involved remains patent but motility is altered

No blockage

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5
Q

What is a mechanical obstruction

A

Lumen is blocked

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5
Q

How does peritoneal fluid look in a strangulating obstruction

A

Serosanguineous

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6
Q

What are some causes of non-strangulating/ simple obstructions

A

Ideal impaction, ascarid impaction, enteritis

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7
Q

How does the ileum appear in an ileum impaction

A

Mostly normal but enlarged- doughy to solid tubular mass that extends ileocecal junction

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8
Q

What can cause ileal impactions

A

High prevalence related to feeding costal Bermuda grass hay
Regional: southeast US

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9
Q

Risk for ileal impactions increases by recent introduction to __ or feeding ____

A

Bermuda hay or poor quality hay

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10
Q

What is the pain for ileal impactions attributed to

A

Spasmodic bowel contraction around impaction- more severe and constant pain as small intestinal distention progresses

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11
Q

What would rectal exam reveal in an ileal impaction

A

Small intestine distention in right dorsal quadrant behind cecum

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12
Q

What are some rule outs for ileal impactions

A

Strangulating obstruction, enteritis

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13
Q

What is the treatment for ileal impactions

A

IV fluids, banamine, mineral oil via NG tube

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14
Q

What is the prognosis for ileal impactions

A

Favorable if treated early

If delayed: gastric rupture, mucosal necrosis, ileal perforation

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15
Q

What is the main ascarid that affects horses

A

Parascaris equorum

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16
Q

What age are ascarid impactions common

A

Foals and young horses

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17
Q

What do ascarid have widespread resistance to

A

Ivermectins

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18
Q

What is tx for ascarid impaction

A

Surgery

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19
Q

What is post-operative mortality for ascarid impactions and why

A

92%- focal necrotizing enteritis, peritonitis, abscess formation, adhesions

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20
Q

Why do you not want to deworm a foal less than 60 days for ascarids

A
  1. Want them to develop immunity ~1yr
  2. Don’t want all worms to die then cause blockage
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21
Q

What are the best drugs to tx ascarid impaction

A

Oxibendazole> fenbendazole > pyrantel pamoate

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22
Q

What is DPJ

A

Inflammation of the proximal portion of the small intestine leads to endotoxemia and ileus and thus fluid accumulation in SI and stomach

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23
Q

What type of obstruction is DPJ

A

Functional

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24
Q

How do you diagnose DPJ

A
  1. Large NG reflux
  2. Severe pain initially then depression
  3. Tachycardia, pre renal azotemia, dehydration, hypotension, electrolyte abnormalities
  4. After NG reflux should have pain relief
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25
Q

What is the primary rule out for DPJ

A

Strangulating lesions

26
Q

What are the horses with DPJ more likely to have vs strangulating lesion

A

Fever, leukocytosis, greater volume gastric reflux

27
Q

What diagnostic can you do to differentiate between DPJ and strangulating lesion

A

Belly tap

28
Q

How is the uncleared cell count and total protein concentration in DPJ vs strangulating lesion

A

Increased to lesser extent in DPJ

29
Q

What is treatment for DPJ

A
  1. Frequent NG tube decompression
  2. Correct dehydration and electrolyte imbalances- IV fluids with calcium, potassium and magnesium
  3. Restoration of normal intestinal function
  4. Tx endotoxemia- banamine and polymixin B
  5. Ileus- prokinetics- metoclopramide or lidocaine
  6. Maybe antibiotics
  7. Laminitis prevention- ice feet, sole support, deep bedding
30
Q

What do you give horse to prevent/tx endotoxemia post DPJ

A

Banamine and polymixin B

31
Q

What do you given horse to tx ileus post DPJ

A

Prokinetics- metoclopramide and lidocaine

32
Q

What prognostic indicators associated with death in DPJ

A

Anion gap, peritoneal fluid total protein concentrations, and volume of gastric reflux in 24hrs

33
Q

What happens in small intestinal volvulus

A

Rotation in a segment of jejunum +/- ileum about the mesentery so that the intestine becomes twisted into distinct spirals

34
Q

What age group are small intestinal volvulus most prevalent in

A

Foals- most common cause of SI sx in foals

35
Q

What is the most common indication of colic surgery in foals

A

Small intestinal volvulus

36
Q

How do you diagnose small intestinal volvulus

A
  1. Degree of pain and heart rate
  2. Small intestinal distention on rectal palpation (adults) AUS in foals
37
Q

Do foals have fever or not with small intestinal volvulus

A

No fever
If fever could be enteritis

38
Q

What is the treatment for small intestinal volvulus

A

Surgery- manual correction of volvulus followed by resection and anastomosis

39
Q

What is the prognosis for small intestinal volvulus

A

Good

40
Q

What is an epiploic foramen entrapment

A

4cm wide entry into vestibule of omental bursa from peritoneal cavity- SI can become entrapped in this space

41
Q

What are the boundaries for epiploic foramen

A

Dorsal boundary is caudate process of the liver, portal vein is cranial ventral border and gastropacreatic fold is ventral border

42
Q

What are the risk factors for epiploic foramen entrapment

A

Cribbing, hx colic in last 12 months, increased time in stall, greater height

43
Q

What is treatment for epiploic foramen entrapment

A

Surgery

44
Q

What must you be cautious of when correcting epiploic foramen entrapment

A

Tearing portal vein- death

45
Q

What is a pedunculated lipoma on SI

A

Benign, smooth walled fat tumor suspended by a thin mesenteric pedicure- causes strangulating obstruction when pedicure wraps around intestine and mesentery

46
Q

What contributes to risk of strangulation for penduculated lipoma

A

Length of stalk

47
Q

What age group is typically affected by pedunculated lipomas

A

Older horses

48
Q

What breeds are at higher risk of pedunculated lipoma

A

Ponies, Arabians, saddlebreds

49
Q

What are some rule outs for a pedunculated lipoma

A

Enteritis, especially if large volume of reflux

50
Q

You have an Arabian that presents with colic, you suspect strangulating obstruction in SI, what is most likely dx

A

Pedunculated lipoma

51
Q

What are the 4 types of intussception and which is most common

A
  1. Jejunojejunal
  2. Jejunoileal
  3. Ileoileal
  4. Ileocecal-most common
52
Q

What are some predisposing factors to intussusception

A
  1. Segmental motility differences caused by enteritis
  2. Heavy ascarid burden
  3. Abrupt dietary changes
  4. Tapeworm infection
53
Q

What is a mesenteric rent

A

Hole in the mesentery due to congenital, secondary mesodiverticular bands, primary lesion, trauma, mesenteric stretching

54
Q

Who is most commonly affected by mesenteric rents

A

Mares- especially post partum

55
Q

What is prognosis for mesenteric rents

A

Not good- long segments of bowel involved, hemorrhage, inability to close entire defect

56
Q

What is the most common form of inguinal/scrotal hernias in horses

A

Indirect inguinal/scrotal hernias

57
Q

What is an indirect inguinal/ scrotal hernias

A

Short segment of SI passes through inguinal ring into vaginal tunic, mild to severe colic and strangulating lesion

58
Q

Is an indirect inguinal/ scrotal hernia acquired or congenital and nonreducible or reducible

A

Acquired and non-reducible

59
Q

What is a direct inguinal/ scrotal hernia

A

Jejunum escapes through a rent in peritoneum to lie in SQ space of scrotum

60
Q

T or F: direct inguinal/ scrotal hernias are more common in adults than foals

A

True

61
Q

Is a direct inguinal/ scrotal hernia acquired or congenital and nonreducible or reducible

A

Congenital and reducible

62
Q

What are some complications of SI strangulating obstructions

A
  1. Anastomotic obstruction
  2. Post-op pain
  3. Endotoxemia
  4. Ileus
  5. Adhesions
  6. Short bowel syndrome- leads to malabsorption
63
Q

You are looking at section of ileum- what is wrong

A

Ileal impaction

64
Q

What is wrong here? And what is a very concerning differential

A

small intestine distention- concern for intestinal volvulus

Equine Medicine and Surgery (9 decks)

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