Miscellaneous Flashcards
(106 cards)
1
Q
What are most equine uroliths composed of?
A
Calcium carbonate or calcium phosphate
2
Q
What are three techniques for removing uroliths?
A
Laparocystotomy
Perineal urethrostomy
Cystotomy
3
Q
What are the causes of pain in the GIT
A
Stretch
Ischemia
Inflammation
4
Q
What are the indications for colic surgery?
A
Acute, unrelenting pain with no analgesic response
Silent abdomen
Progressive abdominal distention
Continuous high-volume reflux (alkaline pH)
HR >60-80 or increasing
Poor/deteriorating CV status
Increased peritoneal protean (>3g/dl) or blood tinged
Fever —> proximal enteritis or non-strangulating infarction
5
Q
What are the abdominal approaches for a celiotomy?
A
Ventral midline ***
Paramedian
Paramedian oblique
Flank
Inguinal
6
Q
What are the attachment points for the colon?
A
Colon is only fixed at the base of the cecum + transverse colon
All else is free-floating
7
Q
How many bands on the cecum?
A
4 = 2 vascular + 2 avascular
8
Q
What does the vascular lateral band of the cecum lead to?
A
Cecocolic fold - Right ventral colon - Sternal flexure
Left ventral colon - pelvic flexure
Left dorsal colon - diaphragmatic flexure
Right dorsal colon - transverse colon - small colon
9
Q
What does the avascular dorsal band of the cecum lead to?
A
Ileocolic fold - start of ileum - Jejunum - duodenocolic fold
Indicates the end of the Jejunum and beginning of duodenum
duodenum - stomach
10
Q
What are the surgical options for the large intestines?
A
Reposition
Evacuation / massage - enterotomy
Amputation / resection
Bypass (cecum)
Colopexy - colon torsions can reoccur - cannot do on performance horse, will tear and contaminate abdomen
Colostomy (small colon)
11
Q
What is the most common type of simple obstruction?
A
Colonic impactions
12
Q
What are some etiologies for colonic impactions?
A
Coarse feed
Poor dentition
Abnormal motility
Decreased water intake
13
Q
What are the signs of a colonic impaction?
A
Mild to moderate dehydration
Normal/elevated HR
Peritoneal fluid usually normal
Rectal palpation reveals mass or gas distention
14
Q
How do you treat colonic impactions?
A
IV (+/- oral) fluids
Oral laxatives
Analgesics
Surgery if necessary
15
Q
What are some etiologies for sand colic?
A
Short pasture
Insufficient roughage
Sandy soil
16
Q
What are the signs of sand impaction?
A
Intermittent colic, stretching out, diarrhea
Auscultation f abdomen
Rectal palpation may be normal or impaction felt
Sand present in feces
17
Q
How do you medically treat sand impactions?
A
Mineral oil
Magnesium sulfate
Psyllium
18
Q
How can you prevent sand colic?
A
Feeding off ground
Maintain lush pasture
Feed hay if grass too short
Chronic psyllium administration
19
Q
What is the etiology of enteroliths?
A
Precipitation of magnesium ammonium phosphate salts (struvite) around a nodes - rock, bale, nail, twine, etc.
20
Q
What are the signs of enteroliths?
A
Intermittent colic with gas distended large colon on rectal (fat)
21
Q
What are the risk factors of enteroliths?
A
Geography
California, Arizona
22
Q
How do you treat enteroliths?
A
Surgical removal by enterotomy
If stone is not a smooth ball, need to look for more - always look for more
23
Q
Where do enteroliths most commonly occur in the intestine?
A
Small colon 45%
Right dorsal colon 32%
Transverse colon 22%
DO NOT occur in small intestine
24
Q
What are the etiologies of colon tympany?
A
Fermentable feeds ( abrupt change high carb or legume/alfalfa)
Electrolyte abnormalities - low calcium and potassium
Atropine administration
25
What are the risk factors for colon tympany?
Abrupt feed changes
Feeding large amounts of carbohydrates
Very rich legumes (alfalfa)
26
What are the clinical signs of colon tympany?
Increasing severity of pain
Gas distention on rectal
Circulatory shock may occur
27
How do you treat colon tympany?
Analgesics
Fluid therapy
Mineral oil to aid removal of fermentation products
Decompression
28
What are causes of intramural lesions?
Eosinophilic granulomas
Hematoma
Fibrotic plaques —> wall of intestine thickens
29
What are clinical signs of intramural lesions?
Functional obstruction (with feed)
Peritoneal fluid may have increased protein and WBC
30
How do you treat intramural lesions?
Impaction will not resolve with medical therapy
Surgical removal of impaction
Resection of affected intestine
31
Describe a right dorsal displacement.
Mispositioning of the left colon to the right of the cecum (i.e. colon is between the cecum and the right body wall)
Most common is counterclockwise
32
What causes a right dorsal displacement?
Abnormal motility due to gas distention - larger breed horses (recurrence common)
33
What are the signs of a right dorsal displacement?
Variable amounts of pain
Gastric reflux
Rectal exam: bands of large colon palpated in transverse orientation
Peritoneal fluid: initially normal
34
How do you treat right dorsal displacements?
Surgical correction via ventral midline celiotomy
35
Describe a left dorsal displacement
Nephrosplenic entrapment
36
How can you surgically treat sand colic?
Pelvic flexure enteropathy + evacuate large colon if devitalized
37
What horses are most likely to develop left dorsal displacements?
Large warmblood geldings
38
What are the signs of a left dorsal displacement?
Variable pain
Gastric reflux
Rectal palpation of entrapment
U/S exam
Peritoneal tap may penetrate spleen
39
How do you treat a left dorsal displacement?
Surgical correction via midline celiotomy OR flank laparotomy
Systemic rolling under general anesthesia
Phenylephrine
40
Describe a displacement of the pelvic flexure and/or left colon
Cranial flexion of left colon “gas tie”
Gastrosplenic entrapment
Diaphragmatic hernia
41
What are the signs of a displacement of the pelvic flexure and/or left colon?
Duration and degree of distention determine metabolic compromise, gas distention on rectal
Just tells you large colon is involved
42
How do you treat a displacement of the pelvic flexure and/or left colon?
Surgical correction via midline celiotomy
43
What would indicate a poor prognosis for a displacement of the pelvic flexure an/or left colon?
Diaphragmatic hernia
44
What is the cause of colonic torsion/volvulus?
Etiology unknown
In mares, often related to post-foaling (first four months)
45
What are the signs of colonic torsion/volvulus?
Acute onset of severe pain
Rapid deterioration of systemic signs
Gas dissension on rectal exam
Peritoneal fluid - normal or inflammatory changes - colon dies form the inside out - the thicker the wall, the greater the delay in changes
46
How do you treat colonic torsion/volvulus?
IMMEDIATE SURGICAL CORRECTION
Volvulus at cecal base most common
Enterotomy aids with repositioning
Colon resection
Fluids, antimicrobials, anti endotoxemic therapy
Recurrence is possible - colopexy
47
What abdominal issues can cause a serosanguinous abdominocentesis?
SI volvulus
Pedunculated lipoma
Mesenteric defect
Epiploic entrapment
48
What are the risk factor s for a non-strangulating infarction (thromboembolic colic)?
Young horses, especially if not on parasite control plan
49
What are the signs of a non-strangulating infarction (thromboembolic colic)?
Depression and variable pain +/- fever
Usually still passing feces
Peritoneal fluid: inflammatory changes
Endotoxemia if large or severe infarction
Cecum commonly affected
50
How do you treat non-strangulating infarctions (thromboembolic colic)?
Analgesics and fluid therapy
Surgery if clinical deterioration
Bowel resection may be required
Antimicrobials due to peritonitis
51
What is the prognosis for non-strangulating infarctions (thromboembolic colic)?
Poor if surgery is required
52
What are the etiologies of acquired inguinal hernias?
Strenuous exercise
Breeding
Trauma
Enlarged inguinal ring
Castration complication
53
What breeds are most at risk for acquired inguinal hernias?
Standardbred
American Saddlebred
Tennessee Walker
54
What are the clinical signs of an acquire inguinal hernia?
Acute intestinal obstruction
Usually unilateral and indirect herniation
Firm, swollen testicle
Gastric reflux
Rectal: distended SI, loop of SI into inguinal canal
Peritoneal fluid: may be normal or elevated WBC and protein
55
How do you treat acquired inguinal hernias?
EMERGENCY SURGICAL CORRECTION!
Inguinal and ventral midline incision
Incarcerated bowel reduced and respected if necessary
Remove affected testicle
56
What is the most common cause of intussusception?
Tapeworms - ileum into cecum
57
What are the clinical signs of intussusception?
Acute onset of pain
Decreased GI sounds
Tachycardia
Dehydration
Reflux
Rectal - distended SI loops
Inflammatory peritoneal fluid
58
What is the risk factor for epiploic foramen herniation?
Cribbing
59
What part of the intestines involved with epiploic foramen herniation?
Ileum
60
What are clinical signs of an epiploic foramen herniation?
Pain, reflux, normal rectal, serosanguinous and inflammatory peritoneal fluid
Hole is through a vascular ring made up of caudal vena cava and portal vein —> can’t enlarge during surgery without tearing on vessels
61
What is the etiology of ileal impactions?
Vascular thrombotic dz
SE USA - coastal Bermuda hay
62
What are the signs of ileal impaction?
Mild to severe abdominal pain
Elevated HR
Decreased borborygmi
Dehydration
Gastric reflux
Rectal: distended SI, palpable impaction
Peritoneal fluid: normal or elevated protein
63
How do you treat ileal impaction?
Analgesics, IV fluids, mineral oil, surgical correction usually required
64
What is hemomelasma ilei?
Often incidental finding
Subserosal chronic bleeding thought to be the result of parasite migration
65
What causes muscular hypertrophy of the ileum?
Idiopathic or strongyle migration
66
What are the clinical signs of muscular hypertrophy of the ileum?
Depends on degree of obstruction
Usually intermittent (intraluminal obstruction)
67
What are the treatment options for muscular hypertrophy of the ileum?
Ileal Kyoto my or ileoceco-ostomy
68
What are the two reasons horses with proximal enteritis go to surgery?
1. Oops
2. You know it’s proximal enteritis but SI is so distended that you have to go in and decompress the horse so it doesn’t die
69
What might help you differentiate a proximal enteritis from a SI origin of colic?
Fever, blood - stinky reflux
70
What are secondary complications associated with proximal enteritis?
Laminitis
Septic jugular phlebitis
Nephritis
Renal failure
DIC
71
What is the most important thing to know about adhesions?
Prevention
72
How do we prevent adhesions?
Surgical adhesiolysis or resection and anastomosis or bypass
Preemptively remove omentum
Avoid surgery in foals
73
What is the prognosis associated with adhesions?
Worsens if they occur w/in 90 days of surgery
74
What is the etiology of a pedunculated lipoma?
Solid lipoma suspended on a mesenteric pedicle
Usually in horses >9 yrs old
If horse is teens or older and has serosanguinous abdominocentesis with distended SI —> strangulating lipoma until proven otherwise
75
How do you treat a pedunculated lipoma?
Often can’t see stalk; have to go in blindly and hope you are not cutting an artery
76
How do SI volvulus form?
Alterations in peristalsis from a variety of causes
77
How do you treat SI volvulus?
Surgery to reduce volvulus
If >60% devitalized, euthanize
78
What are the clinical signs of a SI volvulus?
Acute severe abdominal pain
Shock signs
Reflux
Distended SI
Serosanguinous and inflammatory peritoneal fluid
79
What suture pattern should you use for a small intestine anastomosis?
Interrupted pattern so you do not limit size of dilation
80
What species causes Ascarid impactions?
Parascaris equorum
81
What are the causes of mesenteric defects?
Commonly due to trauma; firmly attached bowel joins highly movable bowel or congenital remnants
Most common after parturition or being kicked
82
What are the five cartilages of the larynx?
Epiglottis
Arytenoid (x2)
Thyroid
Cricoid
83
What is an atheroma?
Epidermal inclusion cyst; usually develops in the horse’s “false nostril”
84
Who is disposed to wry nose (campylorrhinus lateral is) and how is it corrected?
Foals in utero or genetic (Arabs)
Surgery to correct breathing and dental alignment
Euthanasia depending on severity
85
What is the most common pharyngeal cyst?
Subepiglottic
86
What is the etiology of a subepiglottic/pharyngelal cyst?
Congenital, embryologic remnants of thyroglossal duct, or trauma and fluid filled
Laryngeal polyp is NOT fluid filled, more tissue
Dorsal pharyngeal wall = craniopharyngeal duct or Rathke’s pouch
87
What is the most common signalment for a subepiglottic pharyngeal cyst?
Young thoroughbred + standardbred racehorse
Male > female
88
What are clinical signs of a subepiglottic / pharyngeal cyst?
Result from distortion of larynx and pharynx articulation
Upper airway noise, cough, nasal discharge
Exercise intolerance, dysphagia, aspiration pneumonia
Dorsal displacement of soft palate
Problems with exercise
89
How do you diagnose a subepiglottic / pharyngeal cyst?
Endoscopic exam of nasopharyngeal and oral exam under general anesthesia
90
How do you treat a subepiglottic / pharyngeal cyst and what is the prognosis?
Remove entire lining and heal by second intention with laryngotomy or pharyngotomy via electrocautery loop or non-contact laser
Good prognosis
Do NOT hit hypoepiglotticus muscle; if nicked think hood of car is up while driving with hood being epiglottis
91
What are some differentials for epistaxis?
Progressive ethmoidal hematoma (trickle of blood)
Guttural pouch mycosis (gushing blood)
Trauma
Neoplasia
Exercise induced pulmonary hemorrhage
92
Where do most progressive ethmoidal hematomas originate?
Cribiform plate
93
How do you treat progressive ethmoidal hematomas?
Surgical correction
Frontal flap - debunk
Endoscopy - inject with formalin; shrink and slough out ideally
94
What is the etiology of guttural pouch mycosis?
Aspergillosis
Erodes through internal and external carotid arteries
Opportunistic pathogen that requires lesion to attach to mucosa
Unilateral > bilateral
95
What is the treatment for guttural pouch mycosis?
Micro-coil and ligate cardiac side of lesion
96
What clinical signs are associated with left laryngeal hemiplegia?
Laryngoplasty tie-back
Goal: stabilize left arytenoid with a non-absorbable suture from cricoid into muscular process
Most will also get ventriculocordectomy with tie back; this or ventriculectomy/sacculectomy increases ventral diameter of rima glottidis and reduces airflow turbulence and noise during exercise
Improves airflow dynamics and decreases exercise intolerance
Done on affected side as well
97
How do you grade a left laryngeal hemiplegia?
AT REST
1. Symmetric, synchronous abduction and addiction of left and right arytenoid cartilage
2. Some asynchronous movement during any phase of respiration. Full abduction of left arytenoid cartilage maintained by swallowing or nasal occlusion
3. Asynchronous movement during any phase of respiration. Full abduction of left arytenoid cartilage cannot be maintained by swallowing or nasal occlusion
4. There is no movement of left arytenoid cartilage during any phase of respiration
98
What is another differential for laryngeal hemiplegia?
Arytenoid chondritis
99
What side is arytenoid chondritis most likely to occur on?
Occurs on both sides about the same
100
How do you treat an arytenoid chondritis?
Do not tie back
Arytenoidectomy - leave the muscular process and remove the corniculate cartilage leaving mucosa intact
101
What is cricopharyngeal-laryngeal dysplasia?
AKA rostral displacement of the palatopharyngeal arch
4BAD
Abnormalities of cartilage within the larynx and a lack of development o the proximal esophageal sphincter - will see air in esophagus on rads
102
What landmarks are used for a tracheostomy?
Junction of upper middle 3rd of neck where tracheal rings are easily palpable
103
What is the process for a tracheostomy?
Prefer to do standing
Local anesthetic over skin and prep
Do not go more than 180 degrees
ESOPHAGUS ON LEFT SIDE
Change tubes a couple of times a day
Stabilize with Elastikon (can be dead in minutes if dislodged or clogged)
104
What are the signs of sinus disease?
Nasal discharge
Malodor - anaerobic smell - tooth decay or dead/necrotic tissue
Deformity - feel each nostril for symmetry
Air flow obstruction
Noice (stertor-stridor)
Draining tract
Cannot find it —> CT
105
What structures do you need to avoid when doing sinus surgery?
Lacrimal duct
Infraorbital foramen
Infraorbital canal (infraorbital nerve goes through)
106
What are the borders of the nasofrontal flap?
Caudal - between supraorbital foramen and medial canthus
Lateral - medial to nasolacrimal duct, line parallel and medial from medial canthus to nasoincisive notch
Rostral - cranial to infraorbital and nasoincisive notch
