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!Equine Medicine And Surgery > Small Intestine > Flashcards

Small Intestine Flashcards

1
Q

Predisposing conditions of the small intestine for young horses

A

Incarcerations of the mesodiverticular bands
Volvulus

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2
Q

Predisposing conditions of the small intestine for old horses

A

SI incarceration in the epiploic foramen
Strangulation by a pendunculated lipoma

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3
Q

CS of SI obstructive dz

A

Non-specific signs
Gastric reflux during nasogastric intubation
Moderate to severe abdominal pain
Distended SI on rectal exam
Inguinal hernia: swollen scrotum

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4
Q

Single factor that horses should be considered for sx?

A

All horses having distended SI (few can be treated successfully)

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5
Q

Decisions when they should get SI surgery

A

Persistent abdominal pain
HR > 80 bpm
Abnormal rectal exam
Gastric reflux
Peritoneal fluid alterations

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6
Q

T/F: if there are problems with the SI and the horse has a fever you SHOULD operate

A

FALSE- never

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7
Q

Prerequisites for resection of the SI

A

Isolate affected intestine from incision
ID viable mesentery and intestine
Correction of intestinal displacement
Decompressed the proximal intestine

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8
Q

How is viability of the SI determined?

A

Grossly: color, contractions during handling , bowel wall thickness
Iv injections of fluorescein with UV light (vasc. integrity)
Doppler assessment of blood flow

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9
Q

How is distention of the SI measured?

A

Water manometer: 15 cm water or more indicate a small prognosis (susceptible to ileus, ↑ secretion, adhesions)

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10
Q

Hand suture of the SI

A

Apposition of the intestinal layers
Slight inversion
2-0 absorbable suture
Continuous suture with interruption

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11
Q

Surgical stapling (GIA)

A

GI anastomosis is used to create a blind stump at the prox. and dist. end of the intestine
Poor with thickened tissues

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12
Q

Surgical stapling (TA-90)

A

Thoraco-abdominal stapling
Better with thickened tissues

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13
Q

SI volvulus

A

Most frequently reported dz of SI
Young horses, linked to verminous arteritis

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14
Q

CS associated with SI volvulus

A

Acute severe pain with dehydration
Distention of the SI
Reflux fluid into the stomach
Shock and bowel degeneration

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15
Q

SI volvulus tx

A

SX correction: exteriorization of the entire SI and rotation of the intestine and mesentery around the abdominal incision

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16
Q

SI volvulus prognosis

A

> 50% of intestine involved: euthanasia
<50% alive in 1 year
Guarded to poor

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17
Q

Mesenteric incarcerations

A

When the SI is subject to incarceration in mesenteric rents of its own mesentery
Lesions: lipomas, mesodiverticular bands and meckel’s diverticulum

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18
Q

Rents of the SI

A

Found in dist. jejunum as remnants of the mesodiverticular band
Seen in mesoduodenum of pregnant mares

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19
Q

TX of mesenteric incarcerations

A

Resection and anastomosis
If the ileum is involved: ileocolostomy

20
Q

Inguinal hernia

A

Passage of the abdominal contents from the abdominal cavity into the inguinal canal
Most common in adult stallions, congenital in foals

21
Q

Inguinal hernia contents

A

Omentum of SI most common
Also see colon, bladder, pelvic flexure of large colon

22
Q

Indirect hernias

A

Most common in horses
Goes into the vaginal tunic and shares the same space as testicle
Occurs with hernial sac ruptures

23
Q

Direct inguinal hernias

A

Goes through a peritoneal defect outside the vaginal tunic
Traumatic incident with peritoneal rupture

24
Q

Which breeds are prone to inguinal hernias

A

Standardbreds, TN walking horses, American saddlebreds, and warmbloods
Enlarged inguinal rings (descention of testicle post breeding)

25
Q

Which part of the SI is mostly involved in inguinal hernias?

A

Ileum: trapped by the inguinal ring dist. to the peritoneal reflection

26
Q

CS associated with inguinal hernias

A

SI obstruction
Progressive periodic abdominal pain
Swollen testicle

27
Q

Dx of inguinal hernias

A

Rectal exam
Testicular palpation
US

28
Q

Sx approaches for inguinal hernias

A

Inguinal approach: testicle and SI, reducing hernia and testicular amputation
Ventral midline: evaluation and resection of SI

29
Q

What happens if the surgeon tries to save the testical for inguinal hernias?

A

↑ risk of second hernia or cause lymphatic and venous stasis with testicular fibrosis

30
Q

Prognosis of an inguinal hernia

A

25-75% survival
Good to guarded
Prone to ileus and SI adhesions

31
Q

Inguinal hernias in the foal

A

Observed @ birth or few days of life
Unilateral or bilateral
Incurred during straining to pass meconium

32
Q

CS of inguinal hernias in foals

A

Swollen scrotum, edema of prepuce, fluid sounds in scrotum, non painful, hernia recurs after reduction

33
Q

Conservative tx in foals with inguinal hernias

A

Daily manual reduction
Support strap
Resolve by 3d-3m, good prognosis

34
Q

Surgical tx for inguinal hernias in the foal

A

For large, non-reducible hernias
No resolved by 4m
Bilateral castration, fair to good prog

35
Q

Entrapment in the epiploic foramen

A

SI incarcerated in the epiploic foramen: older horses
An enlargement of the foramen due to ↓ size of cd. lobe of the liver

36
Q

Dx of entrapment in the epiploic foramen

A

SI entrapped on the dorsal right side of the abdomen
Danger with enlargement of foramen: portal vein, cd. vena cava, resection and anastomosis

37
Q

Prognosis of Entrapment in the epiploic foramen

A

Guarded to poor
CS associated with shock, difficulty in reduction and adhesions

38
Q

Ileal impaction

A

Most common non-strangling obstruction
SE US
Bermudagrass hay associated

39
Q

Early dx of ileal impaction

A

Marked abdominal pain related to SI spasm
Rectal exam dx

40
Q

Later dx for ileal impaction

A

↓ abdominal pain
Marked SI distention on rectal
Moderate to severe SI reflux
↑ protein on abdominocentesis

41
Q

Medical tx for ileal impaction

A

If non-progressive abdominal pain, rectal confirmed impaction and norm abdominocentesis
IV fluids, nasogastric decompression, analgesics
Responds in 24-36 hrs

42
Q

When is sx tx for ileal impaction needed?

A

If progressive abdominal pain, open rectal dx or abnormal abdominocentesis

43
Q

Sx tx for ileal impaction

A

Milk impaction into cecum: inject saline/ carboxymethylcellulose into lumen, lido for spasms
Ileal bypass or enteromy last resort

44
Q

Post op care and prognosis for ileal impaction

A

Ileus heals in up to 7d and gradual return to diet over 3d
Fair to good prog, depends on ease of reduction

45
Q

What causes SI adhesions?

A

Mesenteric abscesses or previous sx

46
Q

Tx of SI adhesions

A

Resection and anastomosis
Bypass: GIA, 9.3 cm stroma and suture mesenteric rent

!Equine Medicine And Surgery (23 decks)

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