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Equine Medicine and Surgery > Lecture 8: Abnormal Conditions of Equine Large Intestine > Flashcards

Lecture 8: Abnormal Conditions of Equine Large Intestine Flashcards

1
Q

What is included in large intestine

A

Cecum, large colon, small colon, rectum

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2
Q

Where is the cecum located

A

Between small intestine and large colon on right side

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3
Q

What are the three parts of the cecum

A
  1. Base- most dorsal
  2. Body- 4 longitudinal bands
  3. Apex- narrow blinded end directed cranially
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4
Q

What are the two primary functions of the cecum

A

Water absorption, microbial digestion

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5
Q

What is the most common pathological condition of the cecum

A

Cecal impaction

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6
Q

What is the fatality rate in cecal impactions and why

A

43%, due to rupture

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7
Q

What are some causes of cecal impactions

A

Poor dentition, feeding poor quality roughage, decreased water intake, patrurition, parasite induced thromboembolism, hospitalization with GA within 5 days, use of NSAIDS and lack of exercise

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8
Q

How do you diagnose cecal impactions

A

1.Mild signs of pain
2. lying down, looking at flank, decreased appetite, depression
3. HR normal to slightly elevated
4. Borborygmi decreased with decreased fecal production
5. Rectal palpation- tension in ventral cecal band, lack of sacculations, can’t pass hand dorsal over impaction

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9
Q

What does the rectal exam reveal for cecal impaction

A
  1. Tension in ventral cecal band
  2. Lack of sacculations due to increased filling
  3. Can’t pass hand dorsally
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10
Q

Is BW normal or abnormal in cecal impactions

A

Normal

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11
Q

What are some characteristics of type 1-mechanical cecal impactions

A

Causes: Firm, dry or doughy ingesta
Location: base or body
Impaction indented with fingers
Cecal wall does not feel thickened
Normal peritoneal fluid

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12
Q

What are some characteristics of type 2 cecal dysfunction

A
  1. Cecum is tightly distended with gas and ingesta
  2. More painful
  3. Higher heart rate
  4. May be endotoxin
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13
Q

How do you tx type 1 mechanical cecal impactions

A

Soften ingesta to allow cecal contractions to empty cecal contents into right ventral colon

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14
Q

How do you tx type 2 cecal dysfunction

A

Surgical- decompression, typhlotomy and evacuation, cecal bypass- cecocolic anastomosis

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15
Q

What are the medical treatments in cecal impactions

A
  1. Withhold feed
  2. IV fluids
  3. Oral laxatives via NG tube
  4. Psyllium
  5. Walking and limited controlled grazing to stimulate motility
  6. Analagesics
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16
Q

What analgesics do you need to have caution with in cecal impactions

A

Xylazine, detomidine, butorphanol

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17
Q

When should surgery be considered for cecal impactions

A
  1. No improvement on rectal palpation for 24-36hrs
  2. Systemic deterioration (increase HR)
  3. Increase pain
  4. Cecum feels tight enough to rupture
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18
Q

What is the large colon composed of

A

Dorsal and ventral colons connected by short mesentery

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19
Q

Describe the order through the large colon

A
  1. Right ventral colon
  2. Sternal flexure
  3. Left ventral colon
  4. Pelvic flexure
  5. Left dorsal colon
  6. Diaphragmatic flexure
  7. Right dorsal colon
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20
Q

What are some abnormal conditions of large colon

A

Tympany, impaction, sand, enteroliths, nephrosplenic displacement, right dorsal displacement, volvulus

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21
Q

What is the most commonly reported colic in horses

A

Large colon tympany

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22
Q

What is large colon tympany

A

Gas colic, spasmodic colic

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23
Q

What causes large colon tympany

A

Excessive gas fermentation, resulting in distention and pain

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24
Q

What are some risk factors for large colon tympany

A

Cribbing, increased time in stall, recent change to exercise, lack of deworming, hx of travel within 24hrs, recent lameness, infrequent dentals, tapeworms, diet with lots of carbs and less fiber

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25
How do you diagnose large colon tympany
1. Acute pain +/- visible abdominal distention 2. Rectal palpation- moderate to severe gas distention of large colon
26
What are some differentials for large colon tympany
Large colon displacement, large colon torsion, ileus, impending colitis, small colon obstruction
27
What is treatment for large colon tympany
Withhold food, analgesics
28
If you suspect large colon tympany but horse does not respond to analgesics what is a more concerning differential
Large colon volvulus
29
What is the most frequent type of simple obstruction
Large colon impaction
30
What are some risk factors for large colon impaction
Cribbing, increase time in stall, lack of deworming, hx travel within 24hrs, recent changes to exercise, hx of colic, recent lameness, infrequent dentals, high grain diet, hospitalization, general anesthesia, medications (atropine and morphine)
31
What medications can cause large colon impactions
Atropine and morphine
32
What is most common site of large colon impaction
Pelvic flexure Then right dorsal colon > transverse colon
33
What are some differentials for large colon impaction
Large colon displacement +/- right dorsal colon impaction
34
What is the treatment for large colon impaction
Withhold feed, fluid therapy, NSAIDS, cathartics (magnesium sulfate, mineral oil)
35
What are some indications for referral and surgery for large colon impactions
Uncontrollable pain, deteriorating cardiovascular status, abnormal changes in peritoneal fluid
36
What is the surgical procedure for large colon impactions
Pelvic flexure enterotomy and evacuation
37
What are some complications from surgery for large colon impaction
1. Intraoperative rupture of large colon 2. Post-op diarrhea 3. Incisional drainage/infection 4. Septic peritonitis
38
What are some risk factors for large colon sand impaction
1. Insufficient roughage /fiber in diet 2. Access to sand
39
How can sand colic be determined
1. Sand ausculted in ventral abdomen caudal to xyphoid 2. Observation of sand in feces 3. AUS
40
What is medical treatment for large colon sand impaction
Remove horse from access to sand, rehydrate, laxatives, magnesium sulfate and/or psyllium
41
How is surgery performed for large colon sand impaction
Pelvic flexure enterotomy and evacuated
42
What site does sand like to sit, predisposed to rupture
Right dorsal colon
43
What is the pelvic flexure pacemaker
Contractions of longitudinal muscle layers shorten length of left colons and move pelvic flexure toward diaphragm followed by caudal movement towards pelvis during relaxation
44
What type of diet can cause large colon displacement
Increase carbs- excessive fermentation and gas distention
45
What is nephrosplenic entrapment/ left dorsal displacement
Left dorsal and left ventral colons migrate later to the spleen in dorsal direction until entrapped in nephrosplenic space
46
What age group is typically associated with nephrosplenic entrapment
Any age
47
How do you diagnose nephrosplenic entrapment
Transabdominal US- presence of gas filled colon dorsal to spleen, precludes imaging of left kidney Rectal palpation- mainstay diagnosing this
48
What is medical treatment for nephrosplenic entrapment
Withhold feed, IV, phenylephrine- causes splenic contraction, rolling under GA, trocharization then lunge, therapeutic trailer ride
49
What drug can you give to treat nephrosplenic entrapment and what does it do
Phenylephrine- causes splenic contraction, lunge after administration
50
What is the surgical procedure for nephrosplenic entrapment
Standing flank laparotomy or ventral midline celiotomy
51
What is right dorsal displacement
Retropulsive movement of pelvic flexure with subsequent migration cranial
52
What is one of the most painful and devastating causes of colic
Large colon volvulus
53
Without intervention in large colon volvulus death occurs within hours, what is death due to
Hypovolemia shock, progressive cardiovascular collapse, poor pulmonary expansion
54
What horses have a higher prevalence for large colon volvulus
Broodmares
55
What are the risk factors for broodmares getting large colon volvulus
Recent patrurition, recent dietary changes, recent access to lush pasture
56
What is tx for large colon volvulus
Surgery
57
What needs to be done pre-operatively for large colon volvulus
Stabilization measures taken- fluids!
58
What is prognosis for large colon volvulus
Not great, mortality rates between 56%-65%
59
What are the pre-operative parameters that indicate poor prognosis for large colon volvulus
PCV >50%, rectal temp>102%, heart rate >80%
60
Where does the small colon sit
Caudo-dorsal quadrant of the abdomen
61
What is function of small colon
Contractile activity and circular muscles produce fecal balls
62
What are some simple obstructions of small colon
1. Fecal impaction 2. Enterolithiasis 3. Fecaliths, phytobezoars, trichobezoars, meconium
63
What are some vascular lesions of small colon
Intramural hematoma, mesocolic rupture, nonstrangulating infarction
64
What are some strangulating lesions in small colon
Strangulating lipomas, intussception
65
What are some risk factors for enteroliths
1. Geographic- CA and FL 2. Breeds: Arabians and minis 3. Feeding alfalfa hay 4. <50% time spent outdoors
66
What is the most common site for enterolith obstruction
Small colon
67
What is prognosis for enteroliths
Excellent if no local necrosis of bowel
68
T or F: rectal tears are life threatening
True!
69
Where do most rectal tears occur
Dorsal aspect of rectum, oriented parallel to longitudinal axis of rectum
70
What are some signs indicating rectal tear
1. Sudden release of pressure 2. Direct palpation of abdominal organs 3. Large amount of blood on sleeve/glove 4. Hemorrhagic feces
71
What do you do once you suspect rectal tear
1. Assess severity 2. Inform owner 3. Apply tx 4. Contact liability insurance
72
What is the initial treatment for rectal tears
1. Reduction of rectal activity- IV sedation, caudal epidural, lidocaine enema, buscopan 2. Gentle fecal removal (after epidural) 3. Treatment of septic shock and peritonitis with banamine and broad spectrum antibiotics 4. Referral
73
What are some causes of rectal prolapse
Tenesmus from diarrhea, dystocia, intestinal parasites, colic, rectal tumor
74
What sex are rectal prolapses more common in
Females
75
What is the treatment for rectal prolapse
1. Caudal epidural to reduce straining and facilities reduction 2. Reduce mucosal enema with topical glycerin/ sugar/ magnesium sulfate / lidocaine 3. Purse string suture 4. With hold feed 12-24hrs 5. Mineral oil via NG tube
76
Label 1-7
1. Right ventral colon 2. Sternal flexure 3. Left ventral colon 4.pelvic flexure 5. Left dorsal colon 6. Diaphragmatic flexure 7. Right dorsal colon

Equine Medicine and Surgery (27 decks)

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