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Equine Medicine and Surgery > Lecture 7: Abnormal Conditions of Equine Small intestine > Flashcards

Lecture 7: Abnormal Conditions of Equine Small intestine Flashcards

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1
Q

What are the two classifications of obstructions

A
  1. Simple/ nonstrangulating vs strangulating
  2. Functional vs mechanical
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2
Q

What is a simple/ nonstrangulating obstruction

A

Blood supply to intestine involved in the obstruction remains patent

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3
Q

How does peritoneal fluid in a simple/ nonstrangulating obstruction look

A

Grossly normal

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4
Q

What is a strangulating obstruction

A

Blood supply is constricted/blocked which results in mucosal ischemia injury and endotoxemia

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5
Q

What is a functional obstruction

A

Lumen of the intestine involved remains patent but motility is altered

No blockage

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5
Q

What is a mechanical obstruction

A

Lumen is blocked

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5
Q

How does peritoneal fluid look in a strangulating obstruction

A

Serosanguineous

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6
Q

What are some causes of non-strangulating/ simple obstructions

A

Ideal impaction, ascarid impaction, enteritis

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7
Q

How does the ileum appear in an ileum impaction

A

Mostly normal but enlarged- doughy to solid tubular mass that extends ileocecal junction

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8
Q

What can cause ileal impactions

A

High prevalence related to feeding costal Bermuda grass hay
Regional: southeast US

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9
Q

Risk for ileal impactions increases by recent introduction to __ or feeding ____

A

Bermuda hay or poor quality hay

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10
Q

What is the pain for ileal impactions attributed to

A

Spasmodic bowel contraction around impaction- more severe and constant pain as small intestinal distention progresses

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11
Q

What would rectal exam reveal in an ileal impaction

A

Small intestine distention in right dorsal quadrant behind cecum

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12
Q

What are some rule outs for ileal impactions

A

Strangulating obstruction, enteritis

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13
Q

What is the treatment for ileal impactions

A

IV fluids, banamine, mineral oil via NG tube

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14
Q

What is the prognosis for ileal impactions

A

Favorable if treated early

If delayed: gastric rupture, mucosal necrosis, ileal perforation

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15
Q

What is the main ascarid that affects horses

A

Parascaris equorum

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16
Q

What age are ascarid impactions common

A

Foals and young horses

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17
Q

What do ascarid have widespread resistance to

A

Ivermectins

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18
Q

What is tx for ascarid impaction

A

Surgery

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19
Q

What is post-operative mortality for ascarid impactions and why

A

92%- focal necrotizing enteritis, peritonitis, abscess formation, adhesions

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20
Q

Why do you not want to deworm a foal less than 60 days for ascarids

A
  1. Want them to develop immunity ~1yr
  2. Don’t want all worms to die then cause blockage
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21
Q

What are the best drugs to tx ascarid impaction

A

Oxibendazole> fenbendazole > pyrantel pamoate

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22
Q

What is DPJ

A

Inflammation of the proximal portion of the small intestine leads to endotoxemia and ileus and thus fluid accumulation in SI and stomach

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23
What type of obstruction is DPJ
Functional
24
How do you diagnose DPJ
1. Large NG reflux 2. Severe pain initially then depression 3. Tachycardia, pre renal azotemia, dehydration, hypotension, electrolyte abnormalities 4. After NG reflux should have pain relief
25
What is the primary rule out for DPJ
Strangulating lesions
26
What are the horses with DPJ more likely to have vs strangulating lesion
Fever, leukocytosis, greater volume gastric reflux
27
What diagnostic can you do to differentiate between DPJ and strangulating lesion
Belly tap
28
How is the uncleared cell count and total protein concentration in DPJ vs strangulating lesion
Increased to lesser extent in DPJ
29
What is treatment for DPJ
1. Frequent NG tube decompression 2. Correct dehydration and electrolyte imbalances- IV fluids with calcium, potassium and magnesium 3. Restoration of normal intestinal function 4. Tx endotoxemia- banamine and polymixin B 5. Ileus- prokinetics- metoclopramide or lidocaine 6. Maybe antibiotics 7. Laminitis prevention- ice feet, sole support, deep bedding
30
What do you give horse to prevent/tx endotoxemia post DPJ
Banamine and polymixin B
31
What do you given horse to tx ileus post DPJ
Prokinetics- metoclopramide and lidocaine
32
What prognostic indicators associated with death in DPJ
Anion gap, peritoneal fluid total protein concentrations, and volume of gastric reflux in 24hrs
33
What happens in small intestinal volvulus
Rotation in a segment of jejunum +/- ileum about the mesentery so that the intestine becomes twisted into distinct spirals
34
What age group are small intestinal volvulus most prevalent in
Foals- most common cause of SI sx in foals
35
What is the most common indication of colic surgery in foals
Small intestinal volvulus
36
How do you diagnose small intestinal volvulus
1. Degree of pain and heart rate 2. Small intestinal distention on rectal palpation (adults) AUS in foals
37
Do foals have fever or not with small intestinal volvulus
No fever If fever could be enteritis
38
What is the treatment for small intestinal volvulus
Surgery- manual correction of volvulus followed by resection and anastomosis
39
What is the prognosis for small intestinal volvulus
Good
40
What is an epiploic foramen entrapment
4cm wide entry into vestibule of omental bursa from peritoneal cavity- SI can become entrapped in this space
41
What are the boundaries for epiploic foramen
Dorsal boundary is caudate process of the liver, portal vein is cranial ventral border and gastropacreatic fold is ventral border
42
What are the risk factors for epiploic foramen entrapment
Cribbing, hx colic in last 12 months, increased time in stall, greater height
43
What is treatment for epiploic foramen entrapment
Surgery
44
What must you be cautious of when correcting epiploic foramen entrapment
Tearing portal vein- death
45
What is a pedunculated lipoma on SI
Benign, smooth walled fat tumor suspended by a thin mesenteric pedicure- causes strangulating obstruction when pedicure wraps around intestine and mesentery
46
What contributes to risk of strangulation for penduculated lipoma
Length of stalk
47
What age group is typically affected by pedunculated lipomas
Older horses
48
What breeds are at higher risk of pedunculated lipoma
Ponies, Arabians, saddlebreds
49
What are some rule outs for a pedunculated lipoma
Enteritis, especially if large volume of reflux
50
You have an Arabian that presents with colic, you suspect strangulating obstruction in SI, what is most likely dx
Pedunculated lipoma
51
What are the 4 types of intussception and which is most common
1. Jejunojejunal 2. Jejunoileal 3. Ileoileal 4. Ileocecal-most common
52
What are some predisposing factors to intussusception
1. Segmental motility differences caused by enteritis 2. Heavy ascarid burden 3. Abrupt dietary changes 4. Tapeworm infection
53
What is a mesenteric rent
Hole in the mesentery due to congenital, secondary mesodiverticular bands, primary lesion, trauma, mesenteric stretching
54
Who is most commonly affected by mesenteric rents
Mares- especially post partum
55
What is prognosis for mesenteric rents
Not good- long segments of bowel involved, hemorrhage, inability to close entire defect
56
What is the most common form of inguinal/scrotal hernias in horses
Indirect inguinal/scrotal hernias
57
What is an indirect inguinal/ scrotal hernias
Short segment of SI passes through inguinal ring into vaginal tunic, mild to severe colic and strangulating lesion
58
Is an indirect inguinal/ scrotal hernia acquired or congenital and nonreducible or reducible
Acquired and non-reducible
59
What is a direct inguinal/ scrotal hernia
Jejunum escapes through a rent in peritoneum to lie in SQ space of scrotum
60
T or F: direct inguinal/ scrotal hernias are more common in adults than foals
True
61
Is a direct inguinal/ scrotal hernia acquired or congenital and nonreducible or reducible
Congenital and reducible
62
What are some complications of SI strangulating obstructions
1. Anastomotic obstruction 2. Post-op pain 3. Endotoxemia 4. Ileus 5. Adhesions 6. Short bowel syndrome- leads to malabsorption
63
You are looking at section of ileum- what is wrong
Ileal impaction
64
What is wrong here? And what is a very concerning differential
small intestine distention- concern for intestinal volvulus

Equine Medicine and Surgery (27 decks)

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