Lecture 40 5/2/25 Flashcards by Danika Boltz

What are the characteristics of the horse stomach?

*located primarily on left
*cannot vomit; concerns for rupture
*adults:
-5 to 15 L capacity
-nearly inoperable; cannot exteriorize, lots of gross contamination
-disorders include impaction and rupture
*foals:
-disorders include duodenal ulcers, duodenal adhesions, and rupture

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What are the surgical treatments for stomach disorders in adult horses?

*rupture:
-euthanasia
*stomach impaction:
-lavage via NG tube, intraabdominal infusion, or intraabdominal massage

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What are the surgical treatments for stomach disorders in foals?

*gastric outflow obstruction:
-gastrojejunostomy/”gastric bypass”
*rupture:
-repair
-euthanasia

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What are the general characteristics of the horse small intestine?

-60 to 70 feet in length
-normal wall thickness of < 3mm
-not palpable on rectal exam

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What are the characteristics of the duodenum?

-starts on right side of abdomen and ends on left
-ultrasound best detects it near caudal aspect of right kidney
-short mesentery prevents exteriorization
-duodenocolic fold marks the start of jejunum

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What are the characteristics of the ileum and jejunum?

*jejunum:
-majority of small intestine
-variable ability to exteriorize
*ileum:
-2 to 3 feet in length
-less collateral blood supply

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What are the disorders of the duodenum?

-ulcers and adhesions (adults and foals)
-masses
-rupture (adults and foals)
-impaction

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What are the surgical treatments for duodenal disorders?

*adults:
-lavage and massage for impaction
-euthanasia for rupture
*foals:
-gastrojejunostomy for duodenal ulcers and adhesions
-possible repair or euthanasia for rupture

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What are the disorders of the jejunum and ileum?

-lipoma (most common)
-mesenteric rent
-epiploic foramen entrapment
-omental rent
-gastrosplenic ligament entrapment
-hernia entrapment
-impaction
-mass
-volvulus
intussusception

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Which jejunal and ileal disorders can be strangulating?

-lipoma
-mesenteric rent
-epiploic foramen entrapment
-omental rent
-gastrosplenic ligament entrapment
-hernia entrapment
-intussusception

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What are the characteristics of lipoma?

-seen in older animals
-typically arabians and ponies
-account for 89% of small intestinal colics

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What are the characteristics of mesenteric rent?

-seen in postpartum mares primarily
-can occur with trauma or unknown causes

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What are the characteristics of epiploic foramen entrapment?

-entry into vestibule of the omental bursa
-craniodorsal boundary is caudate process of liver
-caudoventral border is portal vein and gastropancreatic fold
-occurs in cribbers
-space often closes after surgery
-can close space laparoscopically
-ileum involved in majority of cases

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What are the charactersitics of gastrosplenic ligament rent/omental rent?

-rare
-presents with excessive reflux

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What are the characteristics of hernia entrapment?

-congenital hernias are unlikely to be strangulating
-acquired hernias are likely to be strangulating
-closed directly or with mesh when surgical

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How are congenital inguinal hernias in foals treated?

-reduce, pack, and bandage
-inguinal rings will close down within days
-may require surgery if not staying resolved

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How are congenital umbilical hernias in foals treated?

-3 cm hernias or small may resolve without treatment
-owners should monitor daily; surgery if not resolving

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How are congenital diaphragmatic hernias treated?

often dorsal; standing sedated laparoscopic repair

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How are acquired inguinal hernias in stallions treated?

-remove compromised testicle and any dead bowel
-close directly or with mesh

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How are acquired umbilical hernias treated?

surgery if greater than 3 cm or greater than 12 months of age

How are acquired diaphragmatic hernias repaired?

ventral midline approach; caused by trauma and typically ventral in location

What are the possible causes of impactions?

*ascarids:
-4 to 24 month old animals
-recent history of deworming
*ileal impaction
-can occur with tapeworms
-greater risk with bermuda hay

What are the characteristics of intussusception?

-can be jejunojejunal or ielocecal
-can be related to tapeworms
-often seen in foals

What are the characteristics of volvulus?

-seen in foals
-seen when horses lay on their backs
-may be associated with underlying conditions in adults

What are the general surgical goals for ileal and jejunal surgery?

-relieve obstruction -give bowel at least 15 minutes to recover after constriction -remove necrotic tissue with resection and anastomosis -close holes to prevent recurrence

What is the general resection and anastomosis procedure in a horse?

-decompress small intestine into cecum -use penrose drains to prevent refill of bowel -drape off section for R&A -close with a 1 layer Lembert or 2 layer simple cutaneous or Cushing pattern

What are the techniques for small intestine R&A?

-end to end (most common) -side to side -functional end to end

What are the characteristics of jejunocecostomy?

-used when ileum is dead and must be removed -leads to chronic colic issues post-op

What are the characteristics of the cecum?

-approximately 3 feet long -capacity of around 30 L -four teniae/bands -ileocecal fold dorsally -cecocolic fold laterally

What are the disorders of the cecum?

*impaction (50% of all cecal dz) -type 1 caused by dry, firm ingesta -type 2 caused by motility dysfunction *tympany *rupture *volvulus *infarction *tumors

What are the characteristics of cecum surgical treatment?

-typhlotomy or partial typhlectomy -2 layer closure done with patterns that do not enter lumen -abdominal drains used to lavage abdomen for at least 3 days

What is the pathway of ingesta through the colon?

-ingesta moves from larger left ventral colon -travels dorsally uphill through pelvic flexure (first narrowing) -travels from dorsal colon to transverse colon (second narrowing) -travels from transverse colon to small colon (third narrowing)

What are the characteristics of the colon?

-3 to 4 meters long -50 to 60 L capacity -20 to 25 cm diameter of the lumen -pelvic flexure narrows to 8 to 9 cm -minimal attachments

What are the disorders of the large colon?

*impaction at pelvic flexure *tympany *right dorsal displacement -variably painful -can progress to volvulus *left dorsal displacement/nephrosplenic entrapment -variably painful -may reflux -kidney and spleen not together on ultrasound -felt on rectal *volvulus -in postpartum mares -very painful and strangulating

What are the characteristics of large colon surgery?

-twisted colon should be untwisted -impacted colon requires enterotomy -necrotic colon requires resection

What are the surgical options for chronic colon displacement?

*large colon resection -used in athletic animals *colopexy -NOT used in athletes; do not tolerate the adhesions

What is the surgical treatment for chronic nephrosplenic entrapment?

nephrosplenic space ablation done via standing laparoscopy

What are the characteristics of the transverse colon?

-connected to dorsal abdomen by short mesentery -not visible or operable

What are the characteristics of the small colon?

-left caudodorsal quadrant of abdomen -7 to 10 cm diameter -3.5 meters long

What are the characteristics of the rectum?

-about a foot long -runs from pelvic inlet to anus

What are the disorders of the small colon?

-enteroliths -fecaliths -impaction -rectal tears -atresia coli/atresia ani -lethal white foal syndrome -strangulating lipoma -neoplasia -intussusception -hernia entrapment

What are the characteristics of small colon surgical treatment?

-GA or standing sedated flank approaches -enteroliths and fecaliths treated with enterotomy and/or resection and anastomosis -impaction treated with lavage or enema

What are the concerns when cutting into small colon?

-higher levels of collagenase -higher bacterial load -mechanical component that makes fecal balls

What are the characteristics of atresia ani and atresia coli?

-rare -type 1 involves membrane -type 2 involves cord -type 3 involves missing segment -can create a new membrane for types 1 and 2 -must connect segments for types 2 and 3 -atresia ani has good prognosis for life but likely abnormal anal function -atresia coli has poor prognosis

What are the grades for rectal tears?

Grade 1: mucosa/submucosa Grade 2: muscular layer only Grade 3: all but serosa Grade 4: full thickness with abdominal contamination

What typically causes rectal tears?

contraction around arm/trying to move arm out of rectum

What is the treatment for rectal tears?

*Grades 1 and 2: -laxatives -antibiotics -daily inspection -possible rectum evacuation *Grades 3 and 4: -gently remove feces -epidural -pack rectum cranial to tear -towel clamp or purse string rectum -refer for surgery

What are the surgical techniques for grade 3 and 4 rectal tears?

-blind suturing -bypass surgery (not common) -laparoscopic repair