Basics of Surgery of LI Flashcards Preview

Equine Medicine > Basics of Surgery of LI > Flashcards

Flashcards in Basics of Surgery of LI Deck (24):
1

What is involved in causing

non-obstructive,
migration of LDC, and LVC between spleen and kidney
rotates 180 degrees on axis

2

Nephrosplenic intrapment etiology

1. heavy weight in colon to displace spleen
2. impaired flow in LDC --> impaction
3. obstruction

3

Who is mainly afected by Nephrosplenic intrapment?

Horses over 9 mo
Warmbloods
Horses that have more dorsomedial space

4

Clinical signs of Nephrosplenic intrapment

normal CV
mild-severe pain
tension on the NS lig
distention of some extent

5

Dx of Nephrosplenic intrapment

nasogastric reflux (43%)
rectal exam - gas in LC, it goes over, etc
abdominecentesis - normal
US - 88% gas colon dorsal to spleen in front of kidney
Kidney - normally at 18th rib

6

Tx for Nephrosplenic intrapment

trailer? vigorous exercise? (be careful with these)
1. phenylephrine -splenic contract (alpha agonist) but has side effects. Then check rectally
2. rolling under GA - use the gas to help lift
3. standing flank lapar - avoid GA, can close the space from here, direct access.
4. ventral midline celiotomy - cost, GA, but can ensure correction.

7

recurrence of Nephrosplenic intrapment

21%, don't do the preventative surgery at the 1st surgery

8

Surgical techniques to prevent NS lig entrap

LC resection
colopexy
NS space obliteration *** best

9

Right Dorsal Displacement definition

pelvic flexure goes cranial
RDC and RVC go between cecum and body wall going the other direction

10

Right Dorsal Displacement CLinical signs

extremely variable

11

Right Dorsal Displacement dX

REctal exam - LC distention, no pelvic felx, RD impaction, LC lateral to cecum
Nasogastric reflux - if LC distention
Abdominocentesis - normal
Lab - high GGT (partial obstruction)

12

Tx of Right Dorsal Displacement

medical management - withold feed, flunixin, trocarization
Surgical management - explore, ID, decompress, reposition

13

Prognosis og Right Dorsal Displacement

Excellent

14

Large Colon Volvulus characteristics

most painful and devastating
needs dealt with FAST because death in hours

15

Large Colon Volvulus etiology

can happen anywhere but most commonly in:
1. cecocolic ligament
2. sternal flexure and diaphragmatic flexure
3. base of cecum
4. right colon cranial to cecocolic lig

Most twist clockwise from behind the horse (dorsomedial)

16

CLinical signs of 90-270 Large Colon Volvulus

partial obstruction, mild pain
no abdom tympany
vital signs that progress in 12-24 hr

17

CLinical signs of 270-360 Large Colon Volvulus

complete obstruction - moderate pain
tachycardia (60-80)
progressive distention
CV collapse

18

Clinical signs of 360-720 Large Colon Volvulus

complete obstruction
endotoc,
sequestration
blood in strangulated seg
CV compromise
Tachy DH, CRT long, MM deter
uncontrollable pain
will die of hypovolemic shock

19

Who are at risk for Large Colon Volvulus?

older broodmares
large breed horses
diet changes

20

Dx of Large Colon Volvulus?

rectal exam - marked colonic dist.
Abdom US - wall edema and thickening
Abdominocent - doesn't alter decision for surgery

21

Pre-surgical Tx of Large Colon Volvulus?

Shock fluids - hypertonic followed by colloids and cystalloids
trochar to decrease abdom pressure

22

surgical Tx of Large Colon Volvulus?

explore on ventral midline, correct torsion, assess viability (then it is either recover after fiing, large colon resection, or euthanasia)

23

Post-op Tx for Large Colon Volvulus is

Endotoxemia tx - fluids, AB, Neutralize endotoxins with plasma and hyperimmune serum and polymixin B

24

Prognosis of Large Colon Volvulus

depends on rapid dx, prompt referral, and surgical correction
poor if irreversible ischemic damage