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Veterinary Equines Finals > Colic > Flashcards

Colic Flashcards

Types of colic Rectal exam Ulcers & diarrhoea Foal colic Choke Rectal tear grading

1
Q

List possible caecal colics

A

Caecal impaction

Caecal intussusception

Caecal tympany

Caecal volvulus

Non-strangulating infarction

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2
Q

Breed and age predilection for caecal impaction colic

A

Arabians

Appaloosa

> 15 years

(this might be different in hospitalised horses)

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3
Q

Risk factors for caecal impaction colic

A
  • Poor quality, coarse roughage
  • Poor dentition
  • Parasites: Anaplocephala perfoliata
  • Lack of exercise while using NSAID’s (hospital)
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4
Q

Two groups of cecal impactions

A

Mechanical obstruction - hard ingesta

Motility dysfunction - fluid ingesta with distention

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5
Q

Most likely diagnosis:

Decreased appetite and faecal output. Mild colic signs for days to weeks.

A

Cecal impaction colic

NOTE: cecal perforation can occur with little to no signs of colic

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6
Q

Rectal examination findings in suspect cecal impaction colic

A
  • Early in the course - tight (could be thickened) ventral band of cecum from right caudo-dorsal to cranio-ventral
  • Round cecal base may be palpable in the right caudo-dorsal abdomen
  • As it progresses the colon will empy and cecum gets heavier - not able to diagnose the impaction per rectum = abdomenl US
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7
Q

Factors that are important to note when performing an abdominal US on a suspect cecal impaction colic

A

Thickness of cecal wall

Texture of content

Will differentiate between mechanical obstruction and motility dysfunction

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8
Q

How to differentiate cecum from colon during rectal examination with suspect cecal impaction

A

If the distended structure is the cecum the examiner will not be able to pass a hand over the impaction dorsally because the cecum is attached to the dorsal body wall

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9
Q

Average thickness of equine cecal wall

A

18mm (0.18cm)

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10
Q

Average thickness of the equine duodenum

A

19.5mm (0.195cm)

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11
Q

Average thickness of the equine jejunum

A

18mm (0.18cm)

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12
Q

Average size of the equine stomach

(transcutaneous abdominal US)

A

5 intercostal spaces

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13
Q

Differential diagnoses for mild abdominal pain

A
  • Simple / nonstrangulating obstruction of the GI tract
    • Feed / sand impaction of large colon
    • Enterolithiasis
    • Large colon displacement
    • Tympany
    • Small colon impaction
    • Ileal impaction
    • Non-strangulatin infarction of the cecum (A. perfoliata)
    • Cecocecal / cecocolic intussesception
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14
Q

Medical management of cecal impaction

A
  • Keep off feed
  • IV and oral fluids
  • Laxatives / cathartics - MgSO4, psyllium
  • Analgesics - Flunixin meglumin (1.1mg/kg IV Q12)
  • Careful monitoring: repeated physical and rectal exams
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15
Q

Most important complications of cecal impaction colic

A

Cecal perforation - 25% - 57%

Recurrence - 13% - 29%

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16
Q

Name the 2 types of cecal intussesceptions

A

Cecocecal intussusception - apex invert into cecal body

Cecocolic intussusception - into the right ventral colon

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17
Q

Breed and age predisposition for cecal intussesception

A

Young horses: < 3 years

Standardbreds

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18
Q

Risk factors for cecal intussusception

A

Infectious factors:

  • Salmonella - abscessation of cecal wall
  • Strongylus vulgaris
  • Cyathostomins
  • Anaplocephala perfoliata

Dietary changes

Use of organophosphates

Use of parasympathomimetic drugs

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19
Q

Most likely diagnosis:

Mild, intermittent abdominal pain, scant feces, weight loss

Physical examination:

Normal with mild to moderate tachycardia and prolonged CRT

A

Chronic cecal intussusception

  • might alos have a fever
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20
Q

DD’s for a firm viscus in the right dorsal abdomen

A
  • Feed / sand impaction in the large colon
  • Right dorsal colon impaction with right dorsal displacement
  • Non-strangulating infarction of the cecum
  • Cecal impaction
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21
Q

DD’s for change in faecal output and character

A
  • Infectious colitis
  • Sand colitis
  • Cecal impaction
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22
Q

DD’s for abdominal pain associated with fever

A

Infectious colitis

Sand colitis

Small colon impaction

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23
Q

Treatment for both forms of cecal intussusception

A

Surgery

Prognosis is good if resection of compromised cecum is possible

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24
Q

Risk factors for cecal perforation

A
  • Brood mares at parturition
  • Cecal impactions
  • Infection with Anaplicephala perfoliata
  • Use of NSAID’s in hospitalised patients (for non GI problems)
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25
**Most likely diagnosis:** Broodmare post parturition showing signs of endotoxic shock (toxic MM's), muscle fasiculations, tachycardia, tachypnoea, cold extremities, prolonges CRT
Cecal perforation during parturition
26
**Pathophysiology for the following causes of cecal perforation:** **- Broodmare postpartum** **- NSAID's** **- A. perfoliata infection** **(don't forget cecal impaction)**
* Cecal distension cause by altered motility that rutpures due to increased abdominal pressure * Related to ulceration and masking signs of fluid / motility dysfunction cecal impaction * Unknown
27
**DD's for endotoxaemia**
Colitis Typhlitis Enteritis Large colon volvulus Non-strangulatin infarction of large colon and cecum
28
## Footnote **DD's for septic peritonitis**
Cecal perforation Gastric rupture Idiopathic peritonitis
29
## Footnote **Rectal palpation findings in suspect cecal perforation**
Pneumoperitoneum - floating sensation Roughening of the surfaces of intestines - ingesta and fibrin formation Crepitus over the cecum - associated with perforation
30
## Footnote **T/F: There is no nasogastric reflux with cecal perforation**
False: Nasogastric reflux may occur due to ileus secondary to endotoxaemia and peritonitis
31
## Footnote **Most likely blood work results in the case of cecal perforation**
Blood work will be consistent with endotoxemic shock * Haemoconcentration (increased Ht) * Leukopaenia due to Neutropaenia with a left shift * Azotaemia * Increased lactate
32
## Footnote **Expected findings on abdomintocentesis in a suspect cecal perforation case**
Mixed population of intracellular bacteria and plant material
33
## Footnote **Expected findings of abdominal US in a suspect cecal perforation case**
Increased abdominal fluid with a mixed echogenicity with hyperechoic, shadowing gas bubbles
34
**Expected findings on a colic work-up for a suspect cecal perforation**
Rectal palpation: Pneumoperitoneum Rough surface of intestines - food and fibrin Nasogastric reflux: Present due to ileus secondary to endotoxaemia CBC: Decreased Ht, leukopaenia (neutropania), Azotaemia, high lactate Abdominocentesis: Mixed population of intracellular bacteria Abdominal US: Increased abdominal fluid with mixed echogenicity
35
**Treatment options for cecal perforation**
None Humane euthanasia
36
## Footnote **Causes of cecal tympany**
Usualy secondary to large colon obstruction: * Feed / sand impaction * Large colon displacement * Large colon tympany * Large colon intraluminal obstruction
37
**Causes of cecal volvulus**
Congenital abnormalities of cecocolic fold and dorsal body wall attachment - increased movement of caecum Secondary to large colon volvulus
38
**Explain nonstrangulating infarction of the caecum**
Loss of blood supply to the caecum not associated with strangulations
39
## Footnote **Risk factors of non-strangulating infarction of the equine caecum**
High parasite load: Strongylus vulgaris Cyathostomin larvae
40
**Etiology and pathophysiology of non-strangulating infarction of the caecum**
Strongylus vulgaris - verminous arteritis (mesenteric artery and its branches) Larval Cyathostomins - multifocal infarctions secondary to infestation with larval cyathostomins
41
## Footnote **Causes of Gastric dilation**
Primary: After consumption of highly fermentable material (grain, grass clippings, apples) Secondary: Reflux of SI fluid retrograde into the stomach due to SI obstruction / SI dysfunction with proximal duodenitis, jejunitis, post-op ileus
42
## Footnote **Physical findings:** **Tachycardia, tachypnea** **Decreased GI sounds** **Depressed with colic signs, fever, dehydration**
Gastric dilation
43
**Diagnose suspected gastric dilation**
US - Stomach is normally 5 intercostal spaces (primary) (SI hypomotility and distention (secondary)) Nasogastric tube - reflux of 10-20L
44
## Footnote **When having trouble passing the NGT through the cardia**
Administer 20 - 40mL 2% Lidocaine down the NGT - promote cardiac sphincter relaxation
45
## Footnote **DD's and possible complications of gastric dilation**
DD's: Gastric impaction Complication: Gastric rupture
46
**Definition of gastric impaction**
Distension of the stomach with feed or a phytobezoar or trichobezoar
47
## Footnote **Which age group is most susceptible to trochobezoar**
Foals: Indiscriminate hair ingestion
48
**Risk factors for gastric impaction**
Poor quality roughage Beet pulp, wheat bran Poor dentition Dehydration Concurrent GI disease resulting in generalised poor GI motility Pyloric outflow obstruction Actue / Chronic hepatic disease
49
50
## Footnote **Expected findings when passing a NGT in a suspect gastric impaction**
Difficult to pass the NGT through the cardia - horse shows signs of pain No significant reflux - feed is hard, dry and fibrous Stale, fermented smell
51
## Footnote **Therapeutic goals for gastric impaction**
Prevent gastric rupture Hydrate gastric content to promote gastric emptying Resolve inciting, concurrent intestinal obstruction (if present)
52
## Footnote **Risk factors for gastric rutpure**
Any mechanical or functional lesion resulting in gastric outflow obstruction: Gastric dilation / impaction Gastric outflow obstruction Grain overload Gastric ulcerations (adult and foals)
53
**Exepcted findings during a colic workup of a suspect gastric rupture:**
**Physical exam**: Profuse sweating with tachypnea Depressed with injected MM's (purple to grey) with increase CRT Decreased to absent gut sounds **Rectal palpation**: Serosal surfaces feel "gritty" with pneumoperitoneum **CBC**: Polycythemia due to haemoconcentration Leukopaenic Hyperlactatemia \>5mmol/L **Abdominal US**: Evaluation of dorsal abdomen obscured due to pneumoperitoneum Increased free fluid with mixed echogenicity **Abdominocentesis**: Green/brown to haemorrhagic fluid - foul smelling
54
**Racehorses and performance horses in active training are predisposed to which GI related condition**
Gastric ulcers
55
## Footnote **Risk factors for gastric ulcers in horses**
High concentrate diet Stress: Shipping, showing, racing, training Anorexia NSAID's and corticosteroid therapy GI disease
56
## Footnote **Conditions associated with gastric ulcers in horses**
Inflammatory bowel disease (IBD: idiopathic or autoimmune) Gastric outflow obstruction
57
## Footnote **Most likely dagnosis:** **Inappetence and depressed** **Bruxism and hypersalivation** **Weight loss** **Discomfort when girthing or mounting** **Hypersensitive to leg aids** **Decreased performance (acute / chronic)**
Gastric ulcers
58
## Footnote **List the mechanisms responsible for protecting the gastric mucosa from the extremely acidic gastric contents in horses**
Mucus-Bicarbonate barrier Gastric mucosal blood flow - Supported by prostaglandins like Prostaglandin E2 Eating, stimulating secretion of alkaline saliva Absorption of gastric secretions by roughage
59
## Footnote **Confirmatory test for gastric ulcers**
Gastroscopy
60
**Therapeutic goals for gastric ulcers**
Eliminate predisposing disease, stress, dietary cause Increase gastric pH - limit further mucosa damage Promote mucosal blood flow and support healing
61
**Treatment of gastric ulcers**
Disconitnue any NSAID's Decrease dietary concentrated and permit access to pasture Proton pump inhibitors: Omeprazole (4 mg/kg PO Q24) Mucosal protectants: Sucralfate (20mg/kg PO Q12) Continue acid suppression therapy for 3-4 weeks to ensure complete mucosal healing
62
## Footnote **Possible drug interactions when treating gastric ulcers**
Sucralfate may prevent absorption of other drugs thus should not be given within 1-2 hours of other medications. **Especially H2 receptor antagonists** (Cimetidin, Ranitidine)
63
## Footnote **Foals with gastric ulcers are usualy diagnosed with which GI disorder**
Gastroduodenal ulcer disease (GDUD)
64
**Most likely diagnosis:** **Foals with mild colic** **Bruxism and hypersalivation** **Inappetence and diarrhoea with poor condition**
Gastroduodenal ulcer disease (GDUD)
65
## Footnote **DD's for GDUD in foals**
Infectious enterocolitis Pyloric stenosis (congenital) Small intestinal obstructive lesions
66
## Footnote **Confirmatory test for GDUD in foals**
Gastroduodenoscopy
67
## Footnote **Risk factors for large colon impaction colic**
* High grain diet * Change in exercise - increased stabling * Cribbing / windsucking * Parasites * Dental abnormalities * Medication: Amitraz, atropine, general anaesthesia * Cold weather and cold water = decreased intake
68
**Types of large colon impaction colic**
Primary large colon impaction Secondary large colon impaction
69
## Footnote **Cause of secondary large colon impaction**
* Right dorsal colon displacement * Enteroliths * Fecaliths * Bezoars * Dehydration of ingesta in large colon secondary to SI obstruction (not a true impaction)
70
## Footnote **History and chief complaint:** **Horse presented with mild - moderate colic with decreased to absent faecal production** **Most likely diagnosis**
Large colon impaction
71
## Footnote **Most common intestinal sites for impaction**
Pelvic flexure Transverse colon Right dorsal colon - ileocecal valve
72
73
74
## Footnote **Therapeutic goals for large colon impaction colic**
Hydrating ingesta Pain management Monitoring: Be aware of any GI or cardiovascular compromise
75
## Footnote **Acute general treatment of large colon impaction**
1. Withhold all feed!! 2. Enteral fluid: Iso / Hypotonic fluid, 3-6L every 2-3 hours 3. IV fluid: replace fluid deficits especially if nasogastric reflux is present (2x maintenance: 120ml/kg/d) 4. Cathartics / laxatives: MgSO4 5. Analgesics: Flunixin meglumine @ 1.1mg/kg IV Q12
76
## Footnote **Chronic treatment of large colon impaction colic**
Dietary modification: grass and complete pelleted food Stimulate water intake Make any changes gradually: amount of stabling time
77
## Footnote **Recommended monitoring for large colon impaction colic**
Unrelenting pain Nasogastric reflux Progressive abdominal distension Systemic deterioration: increase HR, Poor pulse quality cold extremeties, increased CRT GI deterioration: Abdomincentesis to evaluate
78
## Footnote **Causes of large colon intraluminal obstructions**
Fecalith Trichobezoar Phytobezoar Combinations of above
79
## Footnote **Predisposition for fecalith**
Miniature horse
80
## Footnote **Predisposition for trichophytobezoar**
Miniature horse foals
81
## Footnote **Risk factors for fecaliths**
Poor quality roughage Poor dentition Decreased water consumption
82
## Footnote **Risk factors for trichophytobezoar**
Foals chewing on the mare's tail Access to foreign material in conjunction with inadequate exercise (boredom)
83
**Possible complications of fecaliths / thrichophytobezoar (large colon intraluminal obstructions)**
Postoperative complications: Diarrhoea, inappetence, impaction at surgical site
84
## Footnote **Acute general treatment of large colon intraluminal obstructions (fecalith / trichophytobezoar)**
Surgical exploration and removal
85
## Footnote **Chronic treatment for large colon intraluminal obstruction (fecalith / thrichophytobezoar)**
Provide good quality roughage Fresh water Apptopriate dental care
86
**What is large colon intussusception**
One segment of the colon telescoping into an adjacent segment of the colon - Colo-colic intussusception
87
## Footnote **Predisposition for large colon intussusception**
Young horses \< 3 years - same as for other forms of intussusception
88
**History:** **Mild, recurrent colic with soft feces** **Mild tachycardia, increased temperature and variable borborygmi** **2 yr old horse**
Large colon intussusception
89
## Footnote **Cause of large colon intussusception**
Hypermotility - could also be associated with intraluminal mass in the leading edge of the intussusceptum
90
## Footnote **Most common sites for colo-colic intussusception**
Left ventral colon Left dorsal colon Pelvic flexure
91
## Footnote **Expected findings during a colic work-up for a suspected colo-colic intussusception**
**Rectal palpation:** Distended parge colon and cecum - most consistent finding If palpable the intussusception will feel like a doughy mass **NGT:** Reflux is not expected **CBC:** Leukocytosis, hyperfibrinoginemia **Abdominocentesis:** Increased fluid with nucleated cells and variable protein
92
## Footnote **Acute general treatment of colo-colic intussuscpetion**
Surgical reduction / resection
93
## Footnote **Predisposition for left dorsal displacement of the large colon** **(Nephrosplenic entrapment)**
Large breed horses
94
## Footnote **Risk factor left dorsal displacement of the large colon (neprhosplenic entrapment)**
Deep nephrosplenic space - Possibly why large breed horses are predisposed to LDDLC
95
96
**History:** **Horse showing mild to moderate colic signs, with no fecal production and a slight abdominal distension in the left paralumbar fossa** **Most likely diagnosis**
Left dorsal displacement with large colon tympany (Nephrosplenic entrapment)
97
## Footnote **Pathophysiolocy of nephrosplenic entrapment**
Changes in motility and gas distension = abnormal migration of the pevlic flexure Abnormal migration: 1. Left large colon can migrate lateral to the spleen and dorssaly until it reaches the nephrosplenic space 2. Pelvic flexure migrate cranially then caudally and pass through the nephrosplenic space from cranial to caudal 3. Left colon rotates 180 so that left dorsal colon is ventral to the left ventral colon
98
## Footnote **Expected findings during a colic work-up for a suspect left dorsal displacement (neprhosplenic entrapment)**
**Rectal palpation:** Distended large colon caudal to neprhosplenic space and compressed within the nephrosplenic space Ventro-medial displacement of the spleen Can't palpate the nephrosplenic space / ligament **NGT:** Present in 43% - almost half the cases: pressure on the duodenum of tenstion of the mesentery **CBC:** Normal **Abdomincentesis:** Splenic blood **Abdomnial US:** Can't visualise the left kidney adjacent to the spleen
99
## Footnote **Acute general treatment of a neprhosplenic entrapment**
**If pain and distension is not severe:** Phenylephrine @ 3-6ug/kg/min for 15 min = Splenic contraction (Monitor for reflex bradycardia) Then walk / trot / lunge **If pain and distension is severe:** Surgical exploration
100
## Footnote **Possible complications of medical management of neprhosplenic entrapment**
Rupture Displacment Volvulus (All of the large colon)
101
## Footnote **Recommended monitoring of medically managed nephrosplenic entrapment**
Unrelenting pain Nasogastric reflux Progressive abdominal distension Systemic deterioration: increased HR, prolonged CRT, poor pulse quality, cold extremeties
102
**Risk factors for large colon nonstrangulating infarctions**
High parasite load - Strongylus vulgaris Coagulopathies associated with severe GI disease and sepsis = predispose to thromboembolic disease
103
## Footnote **How does Strongylus vulgaris cause large colon nonstrangulating infarction**
Verminous arteritis of the cranial mesenteric artery: larval migration
104
**Predisposition for right dorsal colon displacement**
Large breed horses
105
## Footnote **Pathophysiology of right dorsal displacement**
106
## Footnote **Expected findings during a colic work-up of a suspect right dorsal displacement colic**
**Rectal palpation:** Distended large colon with bands coursing transversely across the abdomen Can't palpate the ventral band of the cecum Can't palpate the pelvic flexure **NGT:** May be present due to pressure on the duodenum **Blood work:** Normal or similar to mild dehydration (prerenal azotemia, elevated packed cells, elevated total protein)
107
## Footnote **Acute general treatment of right dorsal displacmenet**
Surgical explortionis recommended: can't be diagnosed otherwise
108
**What is large colon tynpany**
Commonly known as gas / spasmodic colic Accumulation of gas in the large colon secondary to excessive fermentation or functional obstruction (ileus)
109
**Risk factors for gas / spasmodic colic (large colon tympany)**
Highly fermentable diet (high carbohydrate) Roughage with high surface area (cut grass) Tapeworm infestation (A. perfoliata) History of colic Recent travel Poor dentition
110
## Footnote **Acute general treatment of gas / spasmodic colic (large colon tympany)**
1. Withhold feed 2. Analgesics: Flunixin meglumine, a2 agonists, butorphanol 3. IV fluids - support cardiovascular function & treat dehydration 4. Gentle exercise - walking: may stimulate GI motility = natural evacuation of gas
111
## Footnote **What is colonic volvulus**
Rotation of the colon around the mesenteric axis (same as the long axis of the large colon)
112
## Footnote **Predisposition to large colon volvulus**
Postpartum mares Recent diet change: exposure to lush pastures
113
## Footnote **Most common location for large colon volvulus**
At the level of the ceco-colic ligament - Less commonly at the level of the sternal-diaphragmatic flexure
114
## Footnote **DD's for severe colic**
Large colon volvulus (morethan 270 degrees is strangulating) Strangulating lesions of the SI: 1. SI volvulus 2. Epiploic foramen entrapment 3. Strangulating lipome 4. Severe colitis
115
**DD's for large intestinal distention on recta palpation**
Feed / sand impaction Enterolithiasis Large colon tympany Large colon displacement Intraluminal obstructions
116
## Footnote **DD's for endotoxaemia (Colic related)**
Large colon volvulus (more than 270 degrees is strangulating) Colitis Nonstrangulating infarction of the large colon
117
## Footnote **Expected findings during a colic work-up for a suspect large conlon volvulus**
**Rectal palpation:** Normal or sever gas distension of colon and cecum **NGT:** Reflux is unlikely **CBC:** Normal or Leukopaenia due to Neurtopaenia with a left shift = increased severity of systemic compromise **VBG:** Hyperlactatemia = poor perfusion and ischemia of strangulated area **Abdominocentesis:** Normal (evennin sever cases) or Increased TP (decreased prognosis) **Abdominal US:** Thickening of large colon wall (patient is usually to painful for abdominal US)
118
**Acute general treatment of large colon volvulus**
Preoperative stabilization - rapid fluid resuscitation Surgical correction of large colon volvulus During surgery: asses viability of the large colon Post-op care: Fluid therapy, colloid support, antiendotoxic treatment, antimicrobials and pain management
119
## Footnote **Cause of small colon impaction**
Fecal impaction: physical obstruction of the small colon with feces
120
## Footnote **Predisposition for small colon impaction**
Young horses Elderly horses \>15yrs Miniature / ponies Mares
121
## Footnote **Risk factors of small colon impaction**
Ingesting bedding Poor quality roughage Poor dentition Inadequate hydration Parasitiv damage Motility issues IBD
122
## Footnote **Etiology of small colon impaction (Fecal impaction)**
Idiopathic Salmonella infection Poor dentition
123
## Footnote **DD's for small colon non-strangulating lesions (early stages)**
Small colon enterolith Small colon fecaliht Small colon bezoar Small colon neoplasia Small colon foreign body
124
## Footnote **DD's for small colon nonstrangulating lesions (later stages)**
Small colon lipoma Small colon intussusception Small colon volvulus Small colon herniation
125
## Footnote **Expected findings during a colic work-up of a suspect small colon impaction**
**Rectal palpation:** Cylindrycal, firm, sausage shaped small colon Distended large colon Occasionally distended small intestines **CBC:** Leukopaenia / leukocytosis with left shift **Adbdominocentesis:** Normal or Increased protein and WCC, serosanguineous fluid **Abdominal US:** Gas distended large colon
126
**Acute general treatment of small colon impaction**
1. Withhold feed 2. Analgesics: Flunixin meglumine (1.1mg/kg IV Q12) 3. Fluid therapy: IV and oral (if no reflux) 4. Laxatives: MgSO4 (1g/kg PO Q24) 5. Butylscopolamine (0.3mg/kg IV) (Buscopan)
127
## Footnote **Possible complications of small colon impaction**
Peritonitis Endotoxaemia Laminitis Adhesions Reobstruction Jugular thrombophlebitis Diarrhoea Pyrexia Incisional infection / hernia Recurrent colic
128
## Footnote **IMPORTANT NOTE for horses with small colon impaction**
43% are diagnosed with Salmonella infection = FECAL CULTURE / PCR
129
## Footnote **Chronic treatment of small colon impaction**
Nutrition NB Low-residue diet = prevent trauma to the small colon for 5 - 7 days
130
## Footnote **Which small colon colic commonly presents as a rectal prolapse?**
Small colon intussusception
131
## Footnote **DDs for small colon intussusception (commonly presents as rectal prolapse)**
SC lipoma SC volvulus / impaction SC enterolith / fecalith / bezoar SC neoplasia
132
## Footnote **Acute general treatment of small colon intussusception**
Analgesics: Flunixin meglumine 1.1mg/kg IV Q12 Fluid therapy: dependent on hydration status Surgery
133
## Footnote **Possible complications of small colon intussusception and treatment**
Peritonitis Enteritis Adhesions Incisional infection / herniation Pyrexia Diarrhoea Jugular thrombophlebitis Laminitis Reobstruction Recurrent colic
134
## Footnote **Recommende monitoring after treating small colon intussusception**
Pain management Reflux Abdominal distension Fecal output PVC / TP
135
## Footnote **Predisposition for strangulatin lipoma**
Fat horses Geldings \>15 yrs (no younger than 9 yrs) Ponies / Quarter horses / Standardbreds
136
## Footnote **DD's for strangulating lipoma**
SC enterolith / fecalith / bezoar SC impaction / volvulus / intussusception SC neoplasia / foreign body
137
## Footnote **Expected findings during a colic work-up of a suspect strangulating lipoma**
**Rectal palpation:** Difficult to enter abdomen Gas distended large colon / SI (secondary) **CBC:** Leukopenia / leukocytosis / normal **Abdominocentesis:** Increased protein and WCC with serosanguineous appearance **Abdominal US** Gas distende large colon / SI distension
138
## Footnote **Acute general treatment of strangulating lipoma**
Analgesics: Flunixin meglumine 1.1mg/kg IV Q12 Fluid therapy Exploratory celiotomy if unresponsive to analgesics
139
## Footnote **Possible complications of strangulating lipoma and treatment**
Peritonitis / Enteritis Laminitis Adhesions Reobstruction / recurrent colic Diarrhoea Pyrexia Jugular thrombophlebitis Incisional infection / hernia
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## Footnote **Recommended monitoring after treating strangulating lipoma**
Pain management Progressive abdominal distension Fecal output Reflux PCV / TP
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**Cause of Ascarid impaction in the SI**
Parascaris equorum
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**Predisposition for SI Ascarid impaction**
Young horses (5 months): foals, weanlings, yearlings
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## Footnote **Risk factors for SI Ascarid impaction**
Poor parasite control Deworming foals with paralytinc dewormers: - Ivermectin (ML) - Pyrantel (Pyrimidine) - Piperazine
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## Footnote **What is the epiploic foramen**
The epoploic foramen is the opening to the omental bursa
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## Footnote **Which parts of the SI are involved in epiploic foramen entrapment colic**
Ileum - 70% Jejunum - 40 - 60%
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## Footnote **Predisposition for epiploic foramen entrapment colic**
Males (geldings / stallions) Thoroughbreds Thoroughbred crosses Crib biters Wind sucking
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**DD's for epiploic foramen entrapment**
Small intestinal volvulus Gastrosplenic entrapment Strangulation through mesenteric defect Strangulating lipoma
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## Footnote **Confirmatory test of epiploic foramen entrapment**
Transcutaneous abdominal US - Multiple loops of small intestine in the right ventral paralumbar fossa with low to no motility and mural thickening
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## Footnote **Acute general treatment of epiploic foramen entrapment**
Surgical reduction of entrapment (Surgical emergency)
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**Possible complications after surgical reduction of epiploic foramen entrapment**
Ileus Intra-abdominal adhesions Complications at the anastomosis site Incision site infection / hernia
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## Footnote **Recommended monitoring after surgical reduction of epiploic foramen entrapment**
Cardiovascular system (endotoxaemia) Nasogastric reflux (ileus) Recurring signs of colic (intra-abdominal adhesions) Incisional complications Slow return to oral intake
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Veterinary Equines Finals (8 decks)

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