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Large Animal Surgery > Equine Acute Abdomen > Flashcards

Equine Acute Abdomen Flashcards

1
Q

How long is the equine small intestine? What is its major blood supply?

A

30-90 feet

cranial mesenteric artery (ileocecal) —> easy compromise with strangulation

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2
Q

In what 3 locations does the small intestine attach to the abdominal wall?

A
  1. duodenocolic fold
  2. mesentery
  3. ileocecal fold
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3
Q

What are the 2 most common causes of ileal impaction?

A
  1. coastal Bermuda grass hay - Southeast US
  2. Anoplocephala perforata (tapeworm) - ulceration, edema
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4
Q

What is the most common sign of ileal impaction? How is it diagnosed?

A

moderate pain due to intestinal spasms and distention

  • rectal palpation
  • ultrasonography (dilated loops stacked on one another)
  • reflux
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5
Q

What medical and surgical treatments are available for ileal impaction? What is prognosis like?

A

MEDICAL = IV fluids, analgesics

SX = massage contents into cecum

good

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6
Q

What is ileal hypertrophy? What 2 signs are seen?

A

thickened circular and longitudinal layers of the ileum (over a meter), resulting in luminal constriction

  1. chronic colic
  2. ileal impaction
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7
Q

What is the main option for treating ileal hypertrophy?

A

SURGICAL - ileocecostomy or jejunocecostomy to bypass ileum into cecum

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8
Q

What is the most common cause of ascarid impaction in horses? When does it most commonly occur?

A

Parascaris equorum

post-deworming - Moxidectin or Ivermectin kill ascarid, causing them to detach from the SI and obstruct the lumen

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9
Q

What horses are most commonly affected by ascarid impaction? How do they present?

A

younger horses, weanlings (4-24 months) post-deworming

  • pot-bellied
  • emaciated/unthrifty
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10
Q

How is ascarid impaction diagnosed?

A
  • history - young horse, recently dewormed
  • ascarids in reflux
  • ultrasonography
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11
Q

What medical and surgical options are available for ascarid impaction?

A

MEDICAL - fluid therapy, lubricants

SX = entero/typhloptomies + removal with forceps

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12
Q

What is prognosis like for ascarid impaction following surgical treatment? Why?

A

poor - mortality ~92%

high possibility of rupture

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13
Q

What are the 3 major causes of strangulation impactions?

A
  1. lipoma
  2. volvulus
  3. intussusception

(more common than simple obstructions)

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14
Q

What are the 4 most common signs of strangulation onstructions?

A
  1. moderate to severe pain with limited response to analgesics
  2. tachycardia - 60-80 bpm
  3. ileus - nasogastric reflux, decreased borborygmi
  4. congested MM with toxic line
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15
Q

What is felt on rectal palpation in cases of strangulation obstruction?

A
  • fluid distention
  • firm colon content - NOT intestinal wall shrinking around feed

felt in central/ventral abdomen

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16
Q

What are 2 signs of strangulation obstruction on ultrasound?

A
  1. fluid distention - third spacing of fluid into lumen
  2. decreased motility - particulate matter sings to the bottom of the intestine
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17
Q

What is seen with abdominocentesis in cases of strangulation obstruction?

A
  • serosanguinous fluid - TP > 2.5 mg/dL, WBC > 5000, elevated lactate > 2 mmol
  • third spacing of fluid into lumen AND abdomen

(red = dead bowel)

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18
Q

What is the most common cause of strangulation obstruction? In what horses is this most common?

A

lipoma - benign fatty tumor (“ball on a string”)

older geldings (15-19 y/o)

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19
Q

What surgical intervention is recommended for strangulating lipomas? What complication can be seen?

A

resection and anastomosis of affected parts of intestine

re-establishing blood flow can case reperfusion injury

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20
Q

In what 2 groups of horses is volvulus most common? What is volvulus?

A
  1. foals
  2. mature horses (lipomas more common)

rotation of the intestine around the mesentery across the bowel axis

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21
Q

At what age is intussusception most common? What causes it? Where is it most common?

A

< 3 y/o

abnormal motility - enteritis, parasites

small intestine - jejunojejunal, jejunoileal, ileoileal

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22
Q

What is the most common part of the intestine affected by intussusception? What is a unique cause?

A

ileocecal

chronic colic within a small segment of the bowel (10 cm)

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23
Q

What surgery is recommended for corrected intussusception? What acute and chronic complications are associated?

A

reduction via manipulation with R&A of unsalvageable tissue

  • ACUTE = edema
  • CHRONIC = adhesions
24
Q

Where is the epiploic foramen found? What horses are most commonly affected? At what incidence?

A

4 cm opening into the omental bursa found caudal to the liver and near the portal vein/pastropancrease

> 7 y/o

seasonal - fall/spring

25
Q

What is the most common presentation of epiploic foramen entrapment?

A

“Cribber” - horse gulps air and gnaws on fence posts as a means to release stress

26
Q

What is the preferred method of diagnosing epiploid foramen entrapment? What part of the GIT is commonly involved?

A

ultrasonography in the right paralumbar fossa

ileum

27
Q

What signalment is most commonly associated with acquired inguinal hernias? What history is seen?

A

Tennessee Walking Horse, Standardbred, American Saddlebred, and Warmblood stallions

recent exercise or breeding

28
Q

What is an acquired inguinal hernia? How is it diagnosed?

A

“scrotal hernia” - through the vaginal ring, which can include the ileum

  • palpation - rectal, scrotum
  • ultrasound - abdominal, scrotum (may see SI in scrotum or torsion)
29
Q

What approach is used for treating inguinal hernias? What 4 things are commonly done?

A

inguinal and midline incisions

  1. reduce hernia into normal positiong
  2. SI reduction of nonviable segments involved
  3. inguinal ring closure
  4. castration (vessel compression)
30
Q

In what horses are congenital inguinal hernias common? How does it occur?

A

foals 4-48 hours post-partum (L > R)

through peritoneum or fascia, possibly adjacent to the vaginal ring and into the preputial/scrotal space

31
Q

How do congenital inguinal hernias compare to acquired ones?

A

congenital inguinal hernias are rarely strangulating and can commonly preserve any bowel involved and testicles —> the canal in younger horses are short and wide

32
Q

How are congenital inguinal hernias treated? How quickly should this correct?

A

manually reduced and managed with a truss

should naturally resolve at 3-6 months

33
Q

What causes congenital inguinal hernias to be non-reducible? How is it corrected?

A

rupture of the vaginal tunic causes massive swelling and may allow intestines to lie in the SQ

surgical reduction —> inguinal incision and replace bowel + close defect

  • castration not usually needed
34
Q

What are 4 causes of mesenteric rents? How is it treated?

A
  1. idiopathic
  2. post-partum mares
  3. trauma
  4. surgical defect

surgical reduction +/- R&A of any nonviable intestines

35
Q

How do umbilical hernias compare to other hernias?

A

painful, swollen, hot, and non-reducible

  • due to size, they are commonly easy to get out, but hard to reduce
36
Q

What are the most common causes of acquired and congenital diaphragmatic hernias? What is the most common organ involved? 3 others?

A
  • ACQUIRED = trauma
  • CONGENITAL = diaphragmatic defect, rib fracture

intestines + stomach, liver, colon

37
Q

What are 3 signs of diaphragmatic hernias? How is it diagnosed?

A
  1. acute pain
  2. dyspnea with larger defects
  3. auscultation shows reduced heart/lung sounds or borborygmi
  • ultrasonography
  • radiography
38
Q

How are diaphragmatic hernias treated?

A
  • reduce intestine
  • repair diaphragm with direct suturing or mesh - will reoccur if not repaired!
39
Q

Where is the gastrosplenic ligament found? What happens when it tears? What is required for treatment?

A

between greater curvature and hilus of the spleen

intestines move cranially

surgery - reduce intestine and repair the ligament

40
Q

What is the most common cause of non-strangulating infarctions?

A

verminous arteritis - S. vulgaris migration causes mesenteric thrombarteritis of the cranial mesenteric and ileocecocolic arteries

  • thrombus at the root can compromise huge portions of the GIT, requiring euthanasia
41
Q

What 4 medications are provided prior to abdominal surgery?

A
  1. broad spectrum antibiotics - Penicillin (+), Gentocin (-), Ceftiofur
  2. anti-inflammatory - Flunixin
  3. anti-endotoxic - Polymyxin B (smaller dose binds to subunits of endotoxins)
  4. vaccination - Tetanus
42
Q

What 2 types of fluid therapy are recommended prior to abdominal surgery?

A
  1. hypertonic - 7.5% NaCl 15 mins prior to support systemic shock
  2. isotonic - bolus recommended when PCV > 50%
43
Q

How are patients physically prepared prior to abdominal surgery?

A
  • IV catheter placement
  • clean body and feet
  • clip abdomen
  • rinse mouth prior to placing ET tube to avoid aspiration pneumonia
44
Q

How are horses handled following induction?

A
  • cornered in a padded stall and encouraged to dog sit, sternal recumbency, and lateral recumbency
  • intubated
  • hobbles connected to feet and lifted into the surgery suite
  • scrubbed, draped
45
Q

Why is padding of the surgical table especially important for horses?

A

avoids myopathy and myositis

46
Q

Abdominal approaches:

A
47
Q

Surgical exploration:

A
  • lighter blue = can be exteriorized
  • darker blue = harder to visualize

cecum = R
pelvic flexure = L

48
Q

What 4 post-operative medications are recommended following abdominal surgery?

A
  1. broad spectrum antibiotics - Penicillin, Gentamycin, Ceftiofur
  2. anti-inflammatory - Flunixin
  3. anti-endotoxic - Polymyxin B
  4. gastroprotectants - Omeprazole
49
Q

What 2 post-operative fluids are recommended following abdominal surgery?

A
  1. isotonic - 1 L/hr to account for ongoing losses until there is free access to water
  2. colloidsq
50
Q

What are important aspects to post-operative monitoring following abdominal surgery?

A
  • physical exam q 4-6 hours - HR, digital pulses, temperature
  • reflux PRN
  • incision and catheter site maintenance
  • blood work: PCV/TS, electrolytes
51
Q

How is small intestine surgery performed?

A
  • exteriorize and straighten
  • correct primary lesion
52
Q

How much of the small intestine can be resected?

A

40%

  • may be able to tolerate 50-70%, but debatable
53
Q

What are the 3 most common ways of anastomizing the small intestine?

A
  1. jejunojejunostomy
  2. jejunoileostomy
  3. jejunocecostomy - when the ileum is not viable
54
Q

What should be minimized during small intestinal surgery?

A
  • surgery time - quick pre-op prep
  • trauma - decreased handling and friction + lavage
55
Q

What is the prognosis of small intestinal surgery like?

A
  • non-strangulating = 90%
  • strangulating = 85% short-term, 70% long-term (adhesions tend to develop), 76% jejunocecostomy

Large Animal Surgery (32 decks)

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