exam 3 - Small Intestine Flashcards
(112 cards)
1
Q
what is the MC sign of SI dz?
A
obstruction ===> pain and colic
2
Q
pain in SI may occur d/t:
A
acute inflammation
simple obstruction
strangulating obstruction
3
Q
what is a simple versus strangulating obstruction?
A
simple: obstructs flow w/in the lumen, NOT blood flow so NO devitalization occurs
strangulating: effected with loss of blood supply AND blocks the lumen
4
Q
how common is neoplasia of the bowel?
A
UNCOMMON
5
Q
signs of chronic inflammation or neoplasia?
A
poor performance
wt loss
recurrent episodes of colic
6
Q
why does subcutaneous edema occur in many SI dzz?
A
protein losing enteropathy (PLE)
inflammation in bowel -> inc permeability -> leak albumin -> hypoalbuminemia -> loss of plasama oncotic pressure -> subQ edema if severe
7
Q
t//f
SI dz does NOT usually cause diarrhea in adult horses
A
true
SI dz may cause diarrhea in foals - rotavirus enteritis and Lawsonia intracellularis
8
Q
what pathogen may cause diarrhea in both foals and adult horses?
A
equine coronavirus
9
Q
what is a great biomarker in the blood for tissue perfusion?
also is a good prognostic indicator.
A
lactate
high lactate => poor prognosis
10
Q
diagnostic tests for SI dz?
A
- routine CBC, plasma biochemistry
- rectal palpation
- check for reflux
- u/s
- abdominocentesis
- etiological tests on feces
- laparoscopy
11
Q
what are c/s of complete SI obstruction?
A
- severe pain, possibly refractory to analgesia
- high HR
- cardiovascular deterioration and endotoxemia
- reflux positive
- rectal palpation -> distended loops of small intestine
12
Q
dx of complete SI obstruction?
A
- u/s evidence
- abdominocentesis: serosanguineous peritoneal fluid
13
Q
what is the best method to detect SI distension?
A
u/s
14
Q
hyperemia of gums and a toxic line along the tooth/gum interface suggests what illness?
A
endotoxemia - SIRS - cardiovascular compromise
15
Q
dry digesta in the large intestine suggests what?
A
an obstruction in the SI
16
Q
if SI obstruction is suspected, what is the FIRST STEP for initiating immediate Tx?
A
pass stomach tube - check for reflux
note: must create a siphon to help get the tube going
17
Q
what does a serosanguineous tap suggest?
A
devitalized intestine
iatrogenic
18
Q
t/f
SI obstruction is considered an emergency and often warrants referral to hospital
A
true
19
Q
what treatments are instituted immediately for SI colic?
A
- analgesia
- decompress stomach - NG intubation
- fluid therapy
20
Q
what is a common cause of acute inflammation that leads to SI obstruction?
A
proximal enteritis
21
Q
what are 2 common causes of simple obstruction that leads to SI obstruction?
A
ileal impaction
ascarid impaction
22
Q
what are 2 common causes of strangulating obstruction (StO)
A
lipoma anatomical excursions (mis adventures)
23
Q
what is proximal enteritis?
A
- acute inflammation
- edema
- hemorrhage
- necrosis
24
Q
what are common names for proximal enteritis?
A
duodenitis / proximal jejunitis
“anterior enteritis”
25
what does inflammation of a segment of the intestine lead to?
- dysperistalsis: paralytic ileus, functional obstruction
| - inc fluid secretion, dec fluid absorption
26
proximal enteritis often effects what types of horses?
well managed horses - dz of luxury
higher grain diet
confined
27
etiologic agent of proximal enteritis?
unknown
maybe:
Clostridium perfringens / difficile
salmonella
28
c/s of proximal enteritis:
colic
lots of reflux
lethargy
fever s/t
CBC - inflammation, hemoconcentration
PBP: azotemia, elevated lactate, hyperproteinemia
29
classic presentation for what dz:
animal painful w colic, you place stomach tube, drain stomach so pain goes away then animal becomes profoundly depressed / lethargic
proximal enteritis
30
CBC and PBP in proximal enteritis?
CBC: inflammation and hemoconcentration
PBP: azotemia, elevated lactate, hyperproteinemia
31
dx of prox enteritis?
- compressible loops of SI on palpation
- thickened loops of SI on U/s
- yellow / orange peritoneal fluid
32
t/f
protein levels in peritoneal fluid suggests prognosis of animal
true
higher protein => poorer prognosis
33
prox enteritis vs Strangulation:
bowel loop distension
loops of distended SI are less tight in PE
34
what does a bloody reflux duriing prox enteritis suggest?
assoc w less favorable outcome
inc risk of laminitis
35
prox enteritis vs Strangulation:
blood work?
CBC inflammatory in PE
stress changes in StO
36
prox enteritis vs Strangulation:
after draining, what c/s about animal's attitude is most noteworthy ?
lethargy MOST noteworthy in PE
37
prox enteritis vs Strangulation:
quantity of refulx?
higher quantity - substantial - during PE
38
prox enteritis vs Strangulation:
peritoneal fluids
yellow orange in PE
also fluid protein is high w normal TNCC
serosanguineous in StO
often elevated protein and TNCC
39
prox enteritis vs Strangulation:
GGT levels
GGT elevated in StO
40
prox enteritis vs Strangulation:
response to medical tx?
PE responds well to medical Tx typically
w/o Sx, StO condition will deteriorate
41
PE tx:
```
gastric decompression - stomach tube***
hold NPO
fluids
anti endotoxemia tx
abx [controversial]
prokinetic drugs
celiotomy
```
42
prognosis of PE?
survival = 66-87%
68% developed gastric ulcers w/in 24 hours
risk aspiration pneumonia and phlebitis
risk of laminitis high: 7.5-28.4% and higher if reflux is bloody
43
where does ileal impaction commonly occur?
at the ileum - where the ileum joins the LgI
44
MC geographic loc of ileal impaction?
SE USA
45
what type of obstruction occurs in ileal impaction?
simple luminal obstruction
46
1* ileal impaction occurs d/t:
coarse ingesta - poor quality forage
47
2* ileal impaction occurs d/t:
ileocecal jxn dysfxn
ileal hypertrophy
damage / occlusion by tapeworms
48
what type of tapeworms often cause ileal impaction in horses?
anoplocephala perfoliata
49
older animals may acquire ileal impaction 2* to what idiopathic muscular condition?
idiopathic thickening of muscularis layer of the ileum ==> dec luminal diameter at the end orad to the ileocecal junction
50
c/s of ileal impaction?
moderate pain - tachycardia, diminished borborygmi
later stages:
positive reflux
SI distension
51
rectal palpation of ileal impaction?
early = doughy to solid tubular mass extending proximad from ileocecal jxn
later = extensive SI distension
52
early case of ileal impaction Tx:
- hold NPO
- analgesia
- drain stomach
- laxative [mineral oil or DSS]
- fluid therapy
53
late case of ileal impaction Tx:
surgical reduction
| jejunocecostomy
54
px of ileal impaction?
deworm for tapeworms - praziquantel
do not feed course roughage
55
MC ascarid to cause impaction in equine?
parascaris equorum
56
t/f
parascaris equorum is ubiquitous in the horse environment
true
57
route of infection of ascarids and life cycle / pathogenesis?
fecal oral transmission
all young exposed
parasite larvae migrate out of gut and into liver -> milk spots on liver -> migrate to lungs -> respiratory signs -> couging and discarge -> re swallow -> adults enter SI
58
t/f
equine often develop a self cure from ascarid infection
true
develop natural immunity
59
ascarid parasitism issues MC seen in what age animals?
young foals
60
why should foals with a high ascarid load NOT be given high doses of de worming agents?
be cautious during what age range
worms become stunned and die -> form physical foreign body obstruction -> often occurs near duodenum and jejunum
foals 3-12 mos old
61
c/s of ascarid impaction:
```
colic signs after de worming
severe SI obstruction
abdominal distension
positive reflux
may see worms in reflux and/or feces
```
62
dx ascarid impaction?
circumstances, c/s
PE
u/s
63
how to manage an incomplete ascarid impaction:
relieve pain
decompress stomach
laxative
fluids
64
how to manage a complete obstruction?
decompression surgery
| resection / anastomosis surgery
65
how to px ascarid impaction:
use benzimidazole de wormers
worms are resistant to macrocyclic lactones [ivermectin] and pyrimidine derivatives
66
what 2 intestinal issues may complicate ascarid impaction patients?
jejunal intussusception or perforation
67
what is SI strangulation?
obstruction accompanied and complicated by loss of blood supply to affected segment
68
Tx of SI strangulation:
SURGERY
resection and anastomosis
remove strangulated segment
remove part of pre stenotic segment
69
prognosis of SI strangulation?
guarded
post op ileus likely, peritonitis and adhesions, anastomotic site dysfunction
70
in SI strangulation, why is the pre stenotic segment removed?
b/c it is damaged d/t distension
71
what does high lactate in the peritoneal fluid suggest?
intestinal de vitalization
72
t/f
lactate conc in peritoneal fluid may be elevated to a greater extent than that of the blood
true
73
some types of SI strangulation?
pedunculated mesenteric lipoma
herniation
volvulus
intussusception
74
in SI strangulation d/t hernia, what 2 locations commonly herinate?
epiploic foramen
| gastro splenic lig
75
MC strangulation type in MO?
pedunculated mesenteric lipoma
76
common presentation of horse with mesenteric lipoma:
mature or older horse - often over 15 yo
obesity is a risk factor
MC cause of critical SI colic in MO *****
77
how do mesenteric lipomas cause colic?
what region of intestines?
as a result of their mass impingement on the intestinal lumen [mild]
MC SI but can affect descending colon
78
dx of mesenteric lipoma?
at surgery
79
how do hernias cause colic?
section of intestine is obstructed after moving through an aperture => strangulation is a common sequela
80
what is the anatomy of the epiploic foramen?
a slit, 4-6 cm wide
dorsal: Cd love of liver, Cd vena cava
ventral: R lobe of pancreas, gastro splenic fold, hepatic portal vein
81
risk factors of epiploic foramen entrapment?
thoroughbred breed
winter months
cribbing and wind sucking - d/t altered / abnormal abdominal pressures
82
what configuration of epiploic forament entrapment is most common?
Left to Right
83
c/s of epiploic foramen entrapment?
- abdominal pain
- SI obstruction [MC jejunum and ileum, rare colon]
- rectal palpation findings equivocal in early stages
- reflux - later stages
- abnormal peritoneal fluid
84
dx epiploic foramen entrapment?
u/s obstructed SI - R Cr abdomen
85
what type of hernia should be considered especially when a stallion presents with colic?
inguinal hernia
86
how to check for inguinal hernia during PE?
palpate scrotum
rectal palpation
u/s
87
what age is commonly found to have inguinal hernias?
common management?
neonates
reducible scrotal swelling
managed by repeated manual reduction - wait for tissue to becomes stronger as animal grows/develops
obstruction and strangulation are still a risk
88
what is volvulus?
twisting of intestine about its mesenteric axis?
89
a volvulus of the root of the mesentery can affect ___ % of the SI
80%
90
what age group MC gets volvulus?
foals and young adults
91
1* volvulus:
consequence of abnormal motility - dysperistalsis
92
2* volvulus:
abnormal motility consequent to entrapment or other obstruction [herniated jejunum, for example]
93
what region MC for volvulus in equine?
SI
94
c/s volvulus?
severe SI obstruction and strangulation
95
tx volvulus?
resection and anastomosis
| jejunocecostomy
96
prognosis of volvulus?
only 58% survival - high inter operative attrition
80% survival if survives anesthesisa
48% post operative complication rate
97
partial obstruction d/t intussusception typically presents as :
chronic recurrent colic
```
dec feces and appetite
fever
wt loss
post prandial colic
failure to thrive
```
98
risk factors for intussusception:
MC in foals and horses less than 3 yo
enteritis [dysmotility]
parasites
abrupt diet change
prior anastomosis
presence of focal mass along intestinal wall [granuloma, neoplasia]
99
what is the pathognomonic sign on u/s for intussusception?
target sign
100
what is ileo cecal intussusception?
ileum into cecum thru ileocecal jxn
```
intussusceptum = ileum
intussuscipiens = cecum
```
101
clinical presentation of ileo cecal intussusception?
| risk factor?
young horse, intermittent colic responds to Tx
risk: Anoplocephala perfoliata parasitism
102
what is Meckel's diverticulum?
remnant of primitive yolk sac
incomplete atrophy of the embryonic vitellointestinal duct
103
where is Meckel's diverticulum loc?
loc at anti mesenteric border
distal jejunum
ileum
may be connected to umbilicus via mesenteric band
104
what issues arise at Meckel's diverticulum?
- bacT overgrowth -> risk of acute intestinal inflammation
- distends w ingesta: painful -> necrosis and possible rupture
- facilitates volvulus and intussusception
- can loop around and strangulate adjacent gut like pedunculated lipoma
105
SI adhesions predispose animal to what issues?
obstruction
herniatioin
volvulus
106
what is the nature of chronic infiltrative SI dz?
chronic inflammation
granulomatous enteritis
lymphocytic plasmacytic enteritis
eosinophilic enteritis
107
what kind of neoplasia my manifest as chronic infiltrative SI dz?
alimentary LSA
108
clin presentation of chronic infiltration dz?
wt loss and ill thrift
hypoalbuminemia / ventral subQ edema
recurrent colic
109
Dx of chronic infiltration dz?
Tx?
Prognosis?
oral glucose absorption study
biopsy
tx - corticosteroid?
prog - unfavorable
110
what is etiologic agent of proliferative enteropathy (EPE)?
proliferative ileitis
Lawsonia intracellularis infection
111
MC presentation and sings of EPE?
young horse MC than mature horse
hemorrhagic diarrhea and colic => hypoalbuminemia
112
dx EPE?
| Tx?
dx: PCR of feces, Aby titer
Tx: abx
erythromycin
chloramphenicol
tetracycline
