Unit 3 - Obstructive GI Disease Flashcards
What are the predisposing factors for duodenal outflow obstruction?
Ulcers, penetrating foreign bodies, intraluminal/extraluminal masses, adhesions adjacent to sigmoid flexure, duodenal sigmoid flexure volvulus
How do cows with duodenal outflow obstructions typically present?
Anorexia, decreased milk and fecal production, tachycardia, depression, decreased rumen contractions, ruminal/abdominal distention, and signs of colic
What electrolyte derangements are associated with duodenal outflow obstructions?
Hyponatremia, hypokalemia, hypochloremia, and hyperphosphatemia; metabolic alkalosis
What supportive/stabilization care should be given to patients with duodenal outflow obstruction?
Fluid therapy, correct electrolyte imbalance, NSAIDs (after stabilization), and broad-spectrum antimicrobials perioperatively
What is the surgical approach to correcting a duodenal outflow obstruction?
Right paralumbar fossa either standing or left lateral recumbency (GA)
How is the definitive diagnosis of a duodenal outflow obstruction made?
Through abdominal exploration
How do you treat duodenal outflow obstructions?
Remove the obstruction via surgery
If the obstructive duodenal lesion cannot be removed, what surgical procedure is done?
A duodenal bypass - side-to-side duodenoduodenostomy
The (inside/outside) intestinal portion of the intussusception is known as the intussuscipens, and the (inside/outside) portion of the intussusception is knwon as the intussusceptum.
outside; inside
What are the predisposing factors for intussusception?
Enteritis, intestinal parasitism, mural granuloma, abscess or hematoma, neoplasia, sudden diet changes, and medications
What age of calves are at a greater risk for intussusception?
1-2 month old calves
Intussusception has an increased prevalence in ______ _____ and a decreased risk in _______.
Brown Swiss; Hereford
What are the most common locations for intussusception?
Small intestine - 84%
Colocolic - 11%
Ileocolic - 2%
How do cattle with intussusception typically present?
Mild to moderate abdominal pain Anorectic Lethargic Reluctant to walk Tachycardic Sucussable fluid wave
What will fecal material be like in patients with intussusception?
Scant, with mucus or melena
What will you feel on rectal palpation in a patient with intussusception?
Dilated loops of intestine
How do you stabilize patients with intussusception?
Fluid therapy, NSAIDs, and perioperative broad-spectrum antimicrobials
What is the surgical approach for intussusception?
Right paralumbar fossa either standing or left lateral recumbency
What will an intussusception feel like on palpation (during sx)?
The proximal end will be distended and friable and the distal end will be empty
It will be firm and congested
T/F: Reduction is the preferred surgical treatment for intussusception.
False
What is the preferred surgical treatment for intussusception?
Resection and anastomosis
What are the general steps to a resection and anastomosis of an intussusception?
- Isolate the region of intussusception with moist laparotomy sponges.
- Clamp off the boundaries of the resection
- Resect bowel
- Perform a one or two (one is better if you can) layer inverting closure with absorbable suture and a taper needle
What is intestinal volvulus?
Twisting of the intestines along the mesenteric axis either causing an obstruction or vascular strangulation
What is intestinal volvulus secondary to?
ileus
What locations are predisposed to intestinal volvulus?
Distal jejunum and ileum
What clinical signs are associated with intestinal volvulus?
Moderate to severe abdominal pain Abdominal distention Feces scant, mucoid Tachycardic, tachypneic Dehydration
What electrolyte imbalance is associated with intestinal volvulus?
Hypochloremic metabolic alkalosis
What does hypochloremic metabolic alkalaosis caused by intestinal volvulus progress to with bowl ischemia?
Metabolic acidosis
What will you see on US in patients with intestinal volvulus?
distended intestines
How do you stabilize patients with intestinal volvulus?
Fluid therapy, chloride, NSAIDs, and perioperative broad-spectrum antimicrobials
What is the surgical approach to an intestinal volvulus?
Right paralumbar fossa either standing or left lateral recumbency
What will an intestinal volvulus look like? Feel like?
It will be firm and congested
The proximal end will be distended and friable, and the distal end will be empty
What is the goal of surgery for an intestinal volvulus?
Reduce the volvulus and assess the viability of the intestine
What is torsion of the mesenteric root?
Volvulus of the entire small intestinal tract
How do cattle with torsion of the mesenteric root present?
Severe abdominal pain
Bilateral abdominal distention
Tachycardia, tachypnea
Dehydration
What should be given for stabilization of patients with mesenteric root torsion?
Fluid therapy, calcium, chloride, NSAIDs, and perioperative broad-spectrum antimicrobials
What is the surgical approach for tx if mesenteric root torsion?
Right paralumbar fossa either standing or left lateral recumbency
What is the goal of surgery for torsion of the mesenteric root? What do you need to be aware of?
Reduce the torsion - beware of endotoxin release
What is cecal dilation?
Distention of the cecum without a twist
What is cecal torsion?
Rotation along the long axis of the cecum
What is cecal volvulus?
Rotation at the ileo-ceco-colic junction or proximal ascending colon
What are some potential causes of cecal dilation or dislocation?
Potentially caused by motility disturbances such as hypocalcemia, elevated VFA concentrations, and masses
How do cattle with cecal dilation or dislocation present?
Decreased milk yield Decrease appetite, feces Poor rumen motility Mild abdominal pain Right flank ping, succussion
T/F: Cattle with cecal dilation or dislocation may have hematologic and serum biochemical parameters within normal limits.
True
What medical management is recommended for cecal dilation, dislocation?
Fluids - IV preferred with KCL
NSAIDs
Prokinetic - bethanechol, neostigmine
Withold feed for 24 hours, then slow return
When is an exploratory celiotomy indicated in patients with cecal dilation, dislocation?
If there is no improvement within 24 hours
What is the approach for correction of cecal dilation, dislocation?
Right paralumbar fossa either standing or left lateral recumbency
What is the goal of surgery for cecal dilation, dislocation?
Decompression of gas filled viscus
Gently correct dislocation
What is a typhlotomy?
Incision into the ventral location of the cecum, empty, and flush the cecum
What is a typhlotomy closed with?
Absorbable suture in an inverting pattern
When should you evaluate your typhlotomy closure?
Evaluate fill after 10 minutes and repeat if needed
T/F: You should oversew your typhlotomy closure with an inverting pattern
True
How do you perform a cecal amputation?
Ligate cecal branches of cecal artery and vein close to ICC ligament
Transect ICC ligament
Place two intestinal clamps, one from mesenteric side and one from antimesenteric side
Transect cecum
Stump is closed with a double layer, inverting pattern using absorbable, monofilament suture
What is a type I rectal prolapse?
Rectal mucosa only
What is a type II rectal prolapse?
All layers of the rectum
What is a type III rectal prolapse?
The descending colon intussuscepts into the rectum in addition to type II prolapse
What is a type IV rectal prolapse?
When the peritoneal rectum and/or descending colon form intussusception, anal sphincter causes constriction
What types of rectal prolapses are common? Rare?
Common - type I or II
Rare - type III or IV
What are the predisposing factors for rectal prolapses?
Increased abdominal pressure - respiratory disease, coughing, high feed intake, increased abdominal fill, diarrhea, scours, colitis, cystitis, and tenesmus from dystocia
How are rectal prolapses managed?
Resolve prolapse
Eliminate straining
Address predisposing factors
What steps are best to evaluate a rectal prolapse?
Administer (lidocaine) caudal epidural
Clean prolapsed tissue with mild antiseptic
Evaluate for necrosis and tears
In cases of no necrosis or tears present with a rectal prolapse, what is the protocol for replacement?
Gentle reduction and placement of a purse-string suture
In cases of severe edema with a rectal prolapse, what is the protocol for replacement?
Place hyperosmotic solution on the prolapse and wrap it in a moist towel to reduce it. Then, place the purse-string suture
To replace a rectal prolapse a purse-string suture should be placed with _______ _____. The rectal opening should be ____ to _____ fingers width. The suture should be removed in __ ______.
umbilical tape
two to three fingers
1 week
When is amputation of a rectal prolapse indicated?
If there is necrotic mucosa or tears present
Explain the procedure of amputating a rectal prolapse.
Insert tubing into the rectum
Cross-pin near the anus with spinal needles
Circumferential incision proximal to necrotic tissue
Suture inner mucosa to outer mucosa with monofilament absorbable suture
Routine purse-string for 1 week
