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EXAM 3 FINAL > Rectal tear and Prolapse HORSE > Flashcards

Rectal tear and Prolapse HORSE Flashcards

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1
Q

Where do rectal tears in horses most commonly appear? WHY?

A
  • Dorsal aspect of the rectum and longitudinally
  • right at the peritoneal reflection

*that is where the circular muscle layer becomes thinner

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2
Q

If related to dystocia, where are rectal tears most commonly seen in horses?

A

-Ventrally

1-30 cm long

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3
Q

What are the predisposing factors for rectal tears in horses?

A
  • Arabian and Miniature horses
  • Mares
  • older >9yo
  • other: Fractious horses and previous tears
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4
Q

What is the most common cause for rectal tears in horses?

A

Transrectal palpation

For:

  • colic
  • reproductive purposes

Tears as wall contrast around hand

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5
Q

T/F: the increasing use of US has decreased the incidence of rectal tears

A

TRUE

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6
Q

How can you prevent rectal tears?

A
  • Copious lubrication
  • cleaning out rectum of all feces
  • relax arm when horse strains/peristalsis
  • sedation and antispasmodic
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7
Q

What can be used to chemical and physically restrain a horses for a rectal exam?

A
  • xylazine

- butorphanol

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8
Q

What drug can be used to decrease rectal pressure in a horse?

A

BUSCOPAN
(N-butylscopolammonium bromide)

  • 0.3mg/kg IV
  • decreases rectal pressure by 70%
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9
Q

T/F: lidocaine enemas can decrease rectal pressure

A

False they cannot

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10
Q

Why should a parasympatholytic drug not be given before doing a PE?
-example

A

It can increase HR

BUSCOPAN
-decreases rectal pressure

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11
Q

How are Rectal tears classified?

A

Grade 1 (mucosa and sub mucosa torn)

Grade 2. (Muscle layer torn)

  • mucosa and sub mucosa intact
  • rare/incidental finding/impaction
Grade 3 (Mucosa, submucosa, muscularis torn)
-serosa intact

Grade 4 (complete tear)

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12
Q

How do you distinguish between grade 3A and grade 3B rectal tears?

A

3A - only serosa intact

3B - mesorectum invovled, more dorsal (12oclock),

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13
Q

What are the clinical signs or a horse with a rectal tear?

A

1) On palpation:
- sudden release of resistance
- FRESH blood (except grade 2)
- direct palpation of viscera (grade 4)

2) Straining to deficate

3) Peritonitis
-grade 3 and 4
-abdominocentesis
——-WBC >50 000 within 30 min
-Retroperitoneal abscess if caudal to reflection

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14
Q

Why do you not see blood on palpation of a grade 2 rectal tear?

A

Because MUCOSA and SUBMUCSA are still intact

Only the muscularis is torn!!!!

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15
Q

Why would you get peritonitis with grade 3 rectal tear?

A

You only have the serosa

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16
Q

What is the normal value for WBC within the peritoneal cavity?

A

between 5 and 10 000 WBC

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17
Q

Why do some horses get depressed with rectal tears?

A

Endotoxemia (within 2 hours)

-Horses are extremely sensitive to LPS in the blood stream

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18
Q

What are the clinical signs of endotoxemia?

A
  • lucopenia
  • increased HR
  • toxic line
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19
Q

T/F: Endotoxemia will happen with all rectal tears except grade 2

A

True

  • all rectal tears that bleed
  • grade 2 doesn’t bleed because only the muscularis is torn
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20
Q

Why do you not get endotoxemia with grade 2 rectal tears?

A

Because grade 2 have an INTACT mucosal barrier

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21
Q

T/F: wait and see may be deemed as negligence?

A

TRUE

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22
Q

What can be used to STOP straining in a horse rectal tear case?

Study These Flashcards
A
  • assess severity (1,3,4 grade)
  • Xylazine (0.17mg/kg) + lidocaine (0.2mg/kg)
  • Onset 5’ duration 5 hrs
  • epidural (between c1 and c2)
  • Hanging drop technique
23
Q

What can diagnostic tools can be done to assess the Severeity of a rectal tear in a horse?

Study These Flashcards
A
  • speculum
  • endoscopy
  • ABDOMINOCENTESIS (for presence of peritonitis)
  • CBC (ET)
  • CHEM (ET)
24
Q

What first aid measures should be taken for a horse with a rectal tear?

Study These Flashcards
A
  • sedation and severity examination
  • Braod spectrum Abx + NSAIDs
  • Fluid therapy (ET)
  • Rectal tampon
  • Prompt referral**
25
How far oral should a rectal tampon be placed?
At least 10cm oral to the lesion -insert partially filled and then fill the rest once inside *refer with purse string or towel clamp
26
how would you treat a rectal tear in a horse CONSERVATIVELY?
1) Antibiotics + NSAIDs 2) Fluid replacement (PO,IV) as needed 3) Laxatives + low bulk Diet (pellets/ mash etc..) —-Oral fluids + MgSO4 (1g/kg) —-Mineral oil 4) Daily removal of feces from rectum —Q1-2hrs for 5 days —Q6 then until healed (9-21 days) PREVENT impaction of feces onto the tear!!!!
27
What broad spectrum antibiotics would you consider for treating a rectal tear conservatively?
1) Penicillin for: —Gram + —Anaerobes 2) Gentamycin: —GRAM - 3)Metronidozole: —anaerobes (betalactamase producing/resistant) -apparently not good for Cali horses (raging colitis)
28
How would you treat a Grade 1 rectal tear in a HORSe?
CONSERVATIVE management - rarely require Sx - heals from remaining SM (~10days) - Good prognosis with CM 90% survival
29
How would you treat a grade 2 rectal tear in a horse?
CONSERVATIVE management - incidental finding - dietary changes aimed to soften feces Unless there is chronic impaction in diverticulum, these horses need to be euthanized
30
How would you treat a grade 3 rectal tear in a horse?
1) Conservative management (40-70% survival rate) - labor intensive (epidural catheter, regular manual evacuation, abdominal lavage) PREVENT progression to grade 4
31
When do you consider surgical management for rectal tears in horses?
GRADE 3/4 -combine with abdominal lavage and drain (standing, ventral and midline celiotomy) - Different techniques depending on: 1) tear location 2) settings and finances 3) Case-based
32
What is the survival rate of a horse with peritonitis?
50%
33
What surgical technique would you use for a rectal tear that is close to the anus ?
Direct suture repair -epidural—>Pneumorectum—>+ room -clean lumen and tear with moistened gauze -debride -Externl anal sphincter can be incised @ dorsal comminuted -retraction with stay sutures —@12,3,6,9 o’clock Not reachable through midline -EASY and INEXPENSIVE - close in direction of less tension (TRANSVERSLY) - bites <1.5cm - sutures placed subserosally
34
How would you close a direct suture repair of a rectal tear (close to anus)?
``` Close in direction of LESS tension -usually TRANSVERSLY -suture bites <1.5cm (To avoid lumen reduction -Subserosal suture placement ```
35
What are the 3 ways to repair a rectal tear close to the anus?
1) speculum + long handle instrubments 2) Non-visual direct suturing 3) Prolapse tear through anus Any of these can be combined with bypass procedure
36
T/F: in a direct suture repair of a rectal tear near the anus, you want to use gloves
FaLSE | -want to have bear hand for better feeling
37
What surgical repair would you recommend for a post foaling mare with a rectal tear?
PRolapse tear through the anus | -due to laxity of perirectal tissues
38
When should you use a Prolapse tear through the anus repair for a rectal tear in horses?
1) Post partuirent mares 2) Grade 4 tears - pneumoperitoneum
39
What stapler can be used to prolapse a rectal tear through the anus?
TA 90 or SI | -overseen
40
What surgical approach would you use for a rectal tear that is not accessible through the anus?
1) Laparoscopy - hand assisted per rectum 2) Ventral midline celiotomy - more commonly done if grade 4 with eviservation (to assess blood supply)
41
You have a grade 4 rectal tear with evisceration what surgical approach is best? Why?
VENTRAL midline celiotomy *We need to assess the viability of the intestine
42
T/F: most rectal tears occur 15-20cm cranial to the anus
TRUE
43
How many bypass rectal tear procedures are there and what are they?
1) Temporary indwelling rectal liner (TIRIL) | 2) Colostomy
44
How do bypass rectal tear procedures work?
Divert feces away from tear - with/without direct repair of tear - prevent progression of 3 to 4 grade - protect suture line - prevents impaction of feces in tear - decreases fecal contamination
45
For the TIRIL (temporary indwelling rectal liner) repair, what surgical approach should be taken? -describe the positioning of the TIRIL
CAUDAL midline celiotomy + assistant per rectum TIRIL is positioned: 10cm cranial from tear 10cm protruding from rectum
46
T/F: Loop colostomy is preferred over End colostomy?
TRUE | -easier to perform and to revert
47
T/F: Colostomy should be performed in lateral recumbancy
FALSE It should be done standing -shifting of muscle layers —>inaccurate placement -risk of traumatizing stoma upon recovery
48
What are the advantages of colostomy over TIRIL?
- Better control of feces diversion for longer time - better for large tears or those too far cranial *TIRIL only lasts 9-12 days
49
Why are 2 incisions required for the loop colostomy?
High flank incision -to find and prepare colon loop Low flank incision (~10cm) -Stoma placement
50
What are the land marks for stoma placement (low flank incision) of a loop colostomy?
1) midway betweeen flank fold and last rib 2) @ level of flank fold 3) parallel to last rib
51
T/F: Ventral edema develops and resolves spontaneously with loop colostomy
TRUE
52
How long do you have to wait to reverse colostomy?
6 weeks or more usually
53
What does the colostomy reversal involve?
1) lateral recumbency 2) “en bloc” resection of stoma - flank laparotomy 3) small colon anastomoses - SC + Lemberg
54
T/F: Initial management of rectal tears affects survival and liability
TRUE

EXAM 3 FINAL (19 decks)

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