Unit 2 - GI Lesions Flashcards
What are the clinical signs of peritonitis?
fever, anorexia, ileus, endotoxemia, and mild colic
How is peritonitis diagnosed?
via abdominocentesis - fluid abnormalities and culture
How is peritonitis treated?
Broad spectrum antimicrobials, abdominal lavage, manage endotoxemia, and exploratory celiotomy
What gastric lesions can horses get?
Gastric impaction, gastric dilation and rupture, pyloric stenosis and outflow obstructions, and Equine gastric ulcer syndrome (EGUS)
What are the two types of gastric impaction?
primary or secondary
What can cause gastric impaction?
overfeeding/overeating - grain overload and leaves
How is gastric impaction treated?
Gastric lavage via NG tube, coke
What is the prognosis for gastric impaction?
good
At what volume can the adult equine stomach rupture?
5 gallons (19L)
What ‘tool’ is very important to prevent gastric rupture?
an NG tube
What can cause gastric rupture?
Dilation with gas or solids - causes pressure necrosis
What privides pain relief in gastric rupture cases?
relief of pressure
Over time, what can happen if a gastric rupture is not caught?
endotoxemia and death
How is gastric rupture diagnosed?
abdominocentesis
What is the prognosis for gastric rupture?
grave
What are some non-strangulating lesions of the small intestine?
Spasmodic (gas), ileal impaction, duodenitis-proximal jejunitis, ascarid impaction, muscular hypertrophy of the ileum, gastroduodenal obstruction, intestinal inflammation and fibrosis, and neoplasia
What are some strangulating lesions of the small intestine?
Pedunculated lipoma, volvulus, epiploid foramen entrapment, gastrosplenic ligament entrapment, intussussception, mesenteric rents, inguinal/umbilical/diaphragmatic hernia, intussussception, viteline anomalies
What is the most common cause of colic?
gas/spasmodic colic
Where does gas/spasmodic colic localize?
it can be in any part of the intestine
What clinical signs are associated with gas/spasmodic colic?
mild to moderate signs of colic with few abnormalities on physical or colic examination
How is gas/spasmodic colic treated?
pain control, hand walking
What is the prognosis for gas/spasmodic colic?
good to excellent
How will a small intestinal obstruction feel on palpation?
Turgid, distended small intestine - the small intesine will also be in abnormal areas
How will small intestinal obstruction look on ultrasound?
No motility, anechoic or stratified ingesta, some normal small intestine may be visible, and intestinal wall thickness may be normal in acute cases and increase with time
What is the etiollogic cause of ileal impaction?
Coastal Bermuda grass hay
Where is Coastal Bermuda grass hay a risk factor?
in the southern US
What signs are associated with ileal impaction?
Mild to severe abdominal pain, elevated HR, decreased borborygmi, dehydreation, gastric reflux
What will ileal impaction feel like on rectal palpation?
distended SI, palpable impaction
What will the peritoneal fluid be like in cases of ileal impaction?
Normal color, normal or elevated protein
How is ileal impaction treated?
Analgesics, IV fluids, mineral oil, surgical correction may be required
What is the prognosis of ileal impaction?
guarded to good
What is duodenitis-proximal jejunitis(DPJ) also known as?
proximal enteritis or anterior enteritis
What is DPJ?
hemorrhagic necrotizing duodenitis and proximal jejunitis
What is the etiology of DPJ?
Unknown - salmonellosis, clostridia, sudden feed changes
Where is DPJ a risk factor?
Southeast, Ohio River Valley, and East Coast of the US
What are the clinical signs associated with DPJ?
Mild to severe colic, depression, blood-tinged gastric reflux, febrile, inflammatory leukogram
What will the SI feel like on rectal palpation?
mild to moderate distension of the SI
What will the peritoneal fluid be like in cases of DPJ?
elevated protein, normal WBC
What is the reatment for DPJ?
medical therapy, gastric decompression, IV fluids, analgesics, Flunixin, prokinetics, +/- antibiotics
What is the prognosis for DPJ?
guarded
What secondary complications are associated with DPJ?
Laminitis, septic jugular phlebitis, nephritis and renal failure, DIC
What ascarid causes impaction?
Parascaris equorom
What population of horses have a higher risk of getting ascarid impaction?
young horses
What clinical signs are associated with ascarid impaction?
variable amounts of pain, gastric reflux, and normal peritoneal fluid
How is ascarid impaction treated?
Medical therapy if possible - low efficacy anthelmintics to kill off slowly, intestinal lubricants and analgesics, and surgical correction via enterotomy
What is the prognosis of ascarid impaction?
guarded if surgery is necessary
What signs are associated with strangulated small intestine?
Acute and severe pain, shock, elevated HR and CRT, weak pulse, injected mm, hemoconcentration, gastric reflux, distended loops of SI
What will the peritoneal fluid look like in patients with strangulated small intestine?
Serosanguinous, elevated WBC and protein, and elevated lactate
What is a pedunculated lipoma?
a solid lipoma suspended on a mesenteric pedicle - in older horses
How does small intestinal volvulus affect the SI?
It causes alterations in peristalsis
In what scenario does sequestration happen as a result of a strangulated small intestine?
There is epiploic foramen entrapment and intussusception
What lesions commonly happen in the cecum?
Cecal impaction, cecal motility disorders, cecal torsion, cecal infarct, cecocecal/cecocolic intussusception, and intussusception of the ileum into the cecum
What is the number one lesion to be aware of in the cecum?
cecal impaction
What are the risk factors for cecal impaction?
Orthopedic surgery, anesthesia, NSAIDs
What are the clinical signs of cecal impaction?
Mild colic, ADR, decreased amount of fecal passage - may rupture before you see clinical signs
How is cecal impaction diagnosed?
rectal examination
How is cecal impaction treated?
medically (fluids, laxatives, pain medication, and psyllium) and surgical
What is the prognosis of cecal impaction?
guarded to good
What lesions can occur in the large intestine?
Impaction, enteroliths, displacements, torsion/volvulus, sand colic, thromboembolism, right dorsal colitis, and colitis
What is the etiology of large colon impaction?
coarse feed, poor dentition, abnormal motility, decreased water intake, and sand
What are the risk factors for large colon impaction?
aged horses with poor dentition, cold weather
What are the clinical signs associated with large colon impaction?
Intermittent mild colic that gradually worsens, mild to moderate dehydration, normal or elevated heart rate, normal peritoneal fluid, and mass or gas distension on rectal palpation
Where are the common locations of large colon impaction?
pelvic flexure, dorsal colon
How is large colon impaction treated?
Intravenous +/- oral fluids, oral laxitives, analgesics, and surgical intervention
What is the prognosis for large colon impaction?
good
What is the etiology of enteroliths?
Precipitation of magnesium ammonium phosphate salts around a nidus
What are the risk factors for enteroliths?
Geography (California), Breed (Arabian), and Diet (alfalfa)
What clinical signs are associated with enteroliths?
Intermittent colic, gas distension of the large colon on rectal exam
How are enteroliths treated?
Surgical removal by enterotomy
What does triangular sape of enteroliths indicate?
there are multiple stones
What is the prognosis for enteroliths?
good unless there is bowel necrosis
What is left dorsal displacement (nephrosplenic)?
The colon is stuck over the nephrosplenic ligament
What are the risk factors for left dorsal displacement?
large breed horses
What are the signs associated with left dorsal displacement?
Variable amounts of pain, +/- gastric reflux, rectal palpation of the entrapment/spleen medial, ultrasound examination, abdominocentesis
How Is left dorsal displacement treated?
Medical, phenylephrine, surgical correction via midline celiotomy, and rolling under general anesthesia
What is the prognosis for left dorsal displacement?
good
What is right dorsal displacement?
malposition of the colon between the body wall and the cecum
What is the etiology of right dorsal displacement?
abnormal motility with gas distension
What are the risk factors for right dorsal displacement?
large breed horses
What are the signs associated with right dorsal displacement?
variable amounts of pain, +/- gastric reflux, bands of large colon palpated in transverse orientation, normal peritoneal fluid, and elevated GGT
What is the treatment for right dorsal displacement?
Medical if not tightly distended and surgical if it does not resolve
What is the prognosis for right doesal displacement?
good
What are the risk factors for large colon torsion?
Broodmare just after parturition
What are the clinical signs of large colon torsion?
Acute onset of severe pain, rapid deterioration of systemic signs, shock, gas distension, abdominal distension, normal peritoneal fluid
What is the treatment for large colon torsion?
Medical treatment unsuccessful, immediate surgical correction, and fluid, anti-endotoxic therapy post op
What is the prognosis for large colon torsion?
Good if treatment within 4 hours, poor if delayed
What is the etiology of sand colic?
short pasture, insufficient roughage, and sandy soil
What are the risk factors of sand colic?
sandy soil, feeding on the ground, and poor grass cover
What clinical signs are associated with sand colic?
Intermittent colic, diarrhea, ventral auscultation of abdomen, rectal palpation often normal, sand present in the feces
How is sand colic treated?
medically with fluids and laxatives and surgical
How is sand colic prevented?
Feed off the ground, maintain in a lush pasture, feed hay if the grass is short, and chronic psyllium administration
What is the prognosis for sand colic?
good
What is the etiology of thromboembolic colic?
verminous arteritis
What are the risk factors for thromboembolic colic?
young horses and horses not on a parasite control program
What are the signs of thromboembolic colic?
Depression, variable amounts of pain, inflammatory changes in the peritoneal fluid, endotoxemia if large or severe
What regions of the GI tract are commonly affected by thromboembolic colic?
the cecum and colon
What lesions can occur in the small colon?
impaction, infarc, strangulating lipoma, enterolith, fecalith, meconium impaction, atresia ani/coli, rectal tears, rectal prolapse
What animals are commonly affected with small colon impactions?
miniature horses and ponies
What pathogen are small colon impactions associated with?
Salmonella
How do you treat small colon impactions?
treat like other impactions
What is the prognosis for small colon impactions?
good prognosis
What is the etiology of rectal tears?
Iatrogenic, breeding injury, or spontaneous
How are rectal tears classified?
Depth, distance, and circumferential location
How are rectal tears diagnosed?
Loss of resistance, fresh blood on the sleeve, sedation, epidural, careful palpation, endoscopy
What is a grade 1 rectal tear?
flap of mucosa
What is a grade 2 rectal tear?
cavity/depression with mucosal lining
What is a grade 3 rectal tear?
recess with firm ring
What is a grade 4 rectal tear?
tear to the abdominal cavity
Where is the rectal tear the most common?
25-30 cm from the anus at the junction of the rectum and small colon on the dorsal aspect
What is the medical management for grade 1 and 2 tears?
laxative diet, decreased fecal volume, mineral oil, and systemic antibiotics
What is the prognosis of a grade 1 rectal tear?
good prognosis, usually heal in a week, no rectal palpation for 8 weeks
What is the prognosis of a grade 2 rectal tear?
Usually inconsequential, occasionally resultes in recurrent impaciton, no palpation for 8 weeks
What is the prognosis of a grade 3 rectal tear?
guarded, often progress to a grade 4
What is the prognosis of a grade 4 rectal tear?
poor, septic peritonitis, euthanasia
What is the ‘first aid’ for rectal tears?
Client communication, sedation, spasmolytics, caudal epidural, fecal evacuation and rectal packing, fecal softening, antimicrobials, tetanus toxoid, and flunixin meglumine
