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Equine Surgery and Medicine 2 > Surgery of the Small Intestine > Flashcards

Surgery of the Small Intestine Flashcards

1
Q

Importance of small intestinal surgery

A

It accounts for around 25-64% of all colic disorders- strangulating mostly (60-85% are strang)

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2
Q

Assesment of intestinal viability

A

Flueorescin dye: for ischaemic stang disorder

Surface oximetry: PsO2 has specificity of 100%

Doppler US: haem strang

Histopath

Clinical assesment:

  • colour of serosa and mucosa
  • Peristalsis or changes in peristalsis
  • pulsation of mesnterial artery
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3
Q

What is unique about the small intestine?

A

The villi have a special bs therefore is less tolerant than the Large colon

Strang lesions account for 60-85%

Prestenotic dilation is a concern

Ischaemic wall could be prone to reperfusion injury

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4
Q

What are the strang obstructions of the SI

A

Volvulus

Epiploic foramen

Penunculated lipoma

Tears of the mesentery

Intussusception

Inguinal hernia

Lig gastrolienalis tear- int hernia

Umbilical hernia- Richter’s or Littre’s

Diaphragmatic hernia

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5
Q

Volvulus

A

Usually at 2-4 months of age

Mesnterium turns >180degrees

Volvulus nodosus: when the mesentery forms a know: seen btw 2-7 months of age

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6
Q

Foramen epipoicum Winslowi

A

Left to R

Ileum involvement

Crib biters and wind suckers

Usually requires reoperation

Mostly mild clinical signs, 50% have reflux

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7
Q

Itussusception

A

Jejunojejunal- all ages, long

Ileocaecal <3yrs, small

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8
Q

Abdomical hernias

A

Umbilical

Traumatic

Postop

Prepubic tendon rupture

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9
Q

Inguinal hernias

A

When abd organs found in the ing canal (usually SI loop)

Acquired: Direct vs indirect(real)

Congenital: scrotal (hernial content in the vaginal tunic)

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10
Q

Congenital indirect inguinal hernia

A

Foals

No colic symptoms

Can palpate intestines in the scrotum

Fluctuent swelling

Not painful

Treatment: can outgrow in 3-5 months! Immediate surgery if colic signs do develop

If direct: need to perform surgery!!

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11
Q

Acquired indirect inguinal hernias in adults

A

Clinical symptoms:

Early: rectal palpation of stuctures is v painful!

Indolent: no pain upon palpation- suspect necrotic intestine in this case

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12
Q

Acquired indirect intestinal hernias: Diagnosis and Differentials

A

Diagnosis: History and clinical signs

Palpation

Visual exam

Palpation upon rectal exam

Differentials

  • Twisted testicle
  • Thrombosis of testicular artery
  • Seroma or hematoma
  • Pyocele- pus in vaginal tunic
  • Orchitis
  • Teratomas of testicle or scrotum
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13
Q

Acquired indirect intestinal hernias: treatment

A

Peracute: Pull out rectally, or massage back in whilst under GA and then continue to castrate the animal

Surgical: GA Dors recumbency

  • herniotomy- resection of gut if it is necessary
  • decompression the prestenotic part of the intestine
  • Castration- close ext ing ring
  • Should probably castrate other side too
  • Laparoscopic closing of vaginal process
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14
Q

Acquired direct inguinal hernias: clinical signs, treatment and prognosis

A

Mild to moderate colic!

Adhesions and inflamm of intestines

Treatment: must act quickly to close the hernial ring

Guarded to good prognosis

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15
Q

Non-strangulating obstructions of the small intestine

A

Impaction of the ileum

Hypertrophy of muscle of ileum

Ascarids- impactions

Duodenitis, prox jejunitis

Neoplasia

Gastroduodenal obstruction

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16
Q

Ileal impaction

A

Up to 90cm

Seasonal: winter-early spring

Anoplocephala perfoliata

Mares and arabians

Enterotomy is contra!!

Jejunocecostomy not usually recommened

Reimpactions are rare

17
Q

Parascaris causing impaction

A

usually around 5 months of age

Over half after antihelminthic treatment

High mortality in serious cases

  • Toxins
  • Necrotising enteritis
  • Peritonitis, adhesions
  • Mechanical obturation etc
18
Q

Duodenitis, prox jejunitis (is this also known as prox entritis?)

A

Cause unknown- Clostr toxins, parasites?

Fever, incr WBCs, reflux!- can produce 48L in 24hrs!- has reddish discolouration

Colic signs

Decompression offers improvement (decr HR)

Peritoneal fluid normal

Rectal exam: distension

Treatment: decompression, electrolytes

AB’s and PREVENT LAMINITIS

19
Q

Enteritis and Fibrosis

A

Eosinophilic gastroenteritis: local or generalised

20
Q

Anastomosis of the SI

A

End to end using continuous Lembert

Side to side: seen with jejunocaecostomy?

21
Q

Disorders of the caecum

A
  1. Impaction
  2. Caecocaecal invagination
  3. Caecocolonal invagination
  4. Volvulus, torsion
  5. Infarction
22
Q

Caecum impactions

A

Type 1: hard: mechanical?

Type 2: semi-solid/fluid: paralytic?

23
Q

What can cause caecocolic or ileocaecal intussusception?

A

Anoplocephala perfoliata

24
Q

Diseases of the ascending colon (the L and R ventral and dorsal colon)

A

Large colon tympany- most common cause of colic!

Impaction- try to trat conservatively

Sand colic

Enterolithiasis

Large colon displacement: because the suspension is loose

Torion or volvulus

*displacement occurs more frequently than torsion

25
Q

Tympany

A

Together with displacement

Decompress:

  • through the caecum- with marek trocar or 12G IV catheter
  • or through rectum
26
Q

Pelvic flexure enterotomy

A

Requires a colon tank

Suture in 2-3 layers

*I think indicated for RDD?

27
Q

LEft dorsal displacement

A

Also known as Nephrosplenic entrapment

Conservative treatment 90% successful

Phenylephrine for splenic contration

In recurrent cases: Laparoscopic closure of the NSS

Prophylaxis:

  • ablation of the space laparoscopically
  • coloplexy
  • large colon resection
28
Q

Volvulus

A

Also known as torsion

Strang vs non-strang (90-360degrees)

Usually seens in prev colic cases (esp broodmares)

Post foaling

Sever pain

Characterised by direction and point of twist: bad if >90degress clockwise

29
Q

Treatment of Volvulus

A

Resection: must assess the viability of the colon

  • clinically: mucosa, pulse
  • Intraluminal P (by Doppler)
  • Histopath!!
  • Pre-op lactate in the plasma
  • Post-op colon wall thickness- measure on US

Colopexy

30
Q

Desc colon

A

Colon tenue

Has broad antimesenteric taenia

Long, fatty mesocolon

31
Q

Diseases of the descending colon

A

Miniature breeds esp!!

Impaction/obstipation

Tooth problems

Lesions of vessels

Lipoma pedulans

Enteroliths

32
Q

Diseases of the descending colon: complications of conseervative treatment

A

Thrombophlebitis

33
Q

Diseases of the descending colon: complications of surgery

A

Paralytic ileus

Wound infection

Colic!! because of adhesions

Thrombophlebitis

34
Q

Rectal tears and prolapse

A

Tear: I, II, IIIa and IIIb, IV

Prolapse: I-IV

35
Q

Non intestinal colic diseases

A
  1. CV: thrombus in iliac artery, pericarditis
  2. Thorax: pleuritis and pleuropneumonia
  3. Abdomen: neoplasia, abscess, peritonitis, haematoma
  4. Liver: cholelithiasis, cholangiohepatitis
  5. Spleen: abscess, splenomegaly
  6. Urinary tract: nephrolith, pyelonephritis, cystits, bladder rupture
  7. Mare genital tract:ovulation, theca or gran cell tumour, uterine torsion
  8. Stallion genital: testicle torsion, orchitis
  9. Muscle-bone: laminitis, rhabdomyolysis
  10. NS: tetanus, botulismus, EMND
36
Q

Muscle hypertrophy of the ileum

A
37
Q

Lecture notes on inguinal hernias

A

Congenital vs acquired

Indirect:

  • Intact peritoneum covering the hernial sac
  • Recurrence is frequent
  • Adult stallions: acute, aggressive colic
  • V. hard vaginal tunic
  • Won’t see SI loops in this case?

Dircect

  • Rupture of vaginal tunic - SI can come out through and this is visible under the skin OR tear just next to the inguinal canal

Equine Surgery and Medicine 2 (15 decks)

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