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45 Cards in this Set

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What are indications for colic surgery?
What are indications for colic surgery?

- Severe continuous pain showing no or only short duration of improvement with analgesia.




- Pulse >60 bpm, progressively rising and weakening




- Progressive CVS collapse- mm injected- cyanotic.




- Increased abdominal distension.




- Rectal findings positive with acute abdominal disease.




- Progressive reduction in intestinal motility or continuous gastric reflux.




-Serosanguinous peritoneal fluid with protein >2.5 g/l and WBC over 10x109/l



How is the horse positioned for colic surgery and what approach is used?

How is the horse positioned for colic surgery and what approach is used?

Dorsal recumbency.



Generally a ventral midline laparotomy through the linea alba.

Capacity of the equine stomach and can we exteriorise it? Indications for surgery of the stomach?

15 litres and we cannot exteriorise it.




Impactions in adults like ingesting unsuitable dry feed, a motility issue or secondary to liver disease.




Pyloric stenosis in foals- acquired secondary to gastroduodenal ulcers or congenital.

How can we treat a foal with pyloric stenosis?

Pyloromyotomy- cut the muscle to release tension.




Bypass pylorus gastrojejunostomy.

Where is the duodenum located? How long is it and can we exteriorise it?

Attached to the right dorsal body wall by a short mesoduodenum preventing exteriorisation.




1m long.

How long is the jejunum and can it be exteriorised?

Jejunum is 15-30 m long with a long 50cm mesojejunum.




It can be exteriorised.

How large is the ileum and what are features of it to tell it apart from other parts of the small intestines? Can we exteriorise it?

70-80 cm ileum with a slightly thicker wall and distinctive antimesenteric bands, ileocaecal fold--> dorsal taenia of caecum.




Cannot exteriorise the distal ileum and ileocaecal junction.

What is common complication after small intestinal surgery? How can we prevent this from happening?

What is common complication after small intestinal surgery? How can we prevent this from happening?

Ileus.




Prevent this from happening by gentle tissue handling.

What types of small intestinal lesion do not require surgical resection? Which ones need resection?

Non strangulating lesions of the small intestine.




Strangulation lesions require transection.

Aetiology of a non strangulating small intestinal lesion leading to colic?

Ascarids in young animals.



Tapeworm in the ileocaecal orifice.




Unsuitable feed.




Primary motility problem.




Muscular hypertrophy.

Treatment for a non strangulating small intestinal lesion causing a surgical colic? Prognosis?

Decompress at surgery and enterotomy only if necessary.




Prognosis: very good.

Signs of tumors leading to non strangulating SI colic? Name the most common SI tumor other symptoms that occur with it? Treat? Prognosis?

Thickening of intestinal wall leads to partial/ complete obstruction of gut wall leading to altered motility.




Lymphosarcoma accompanied by signs of weight loss.




Treatment: Resection but often multifocal leaving this impossible.




Prognosis: poor.



Aetiology of anterior enteritis? Signs? Treament?Prognosis?

Unknown: clostridia/salmonella/diet.




Get mark distension of the proximal SI and stomach which resembles a surgical colic.




Treatment: Medical- repeated nasogastric intubation.




Surgery: decompression.




Prognosis: 50-70% survival.

What is the general approach to a strangulating SI lesion? 
What is the general approach to a strangulating SI lesion?

1) Identify the cause of the strangulation such as pedunculated lipoma, intussusception, SI volvulus.




2) Reduce strangulation.




3) Assess gut viability.




4) Decompress, resect and anastomose if gut non viable.

How do we assess the viability of a portion of gut?
How do we assess the viability of a portion of gut?

Viable gut has active haemorrhage when nicked, peristalsis and pulses.




Compromised: Avulsed vessels, haemorrhagic, red.




Non viable: thin walled, black, grey or green colour.

Prognosis for SI strangulating lesion depends on?

Length of gut affected, duration of obstruction and consequence of CVS/endotoxaemic status of horse.




60-85%

What is the most common cause of SI strangulation and what animals does it usually occur in?

What is the most common cause of SI strangulation and what animals does it usually occur in?

Pedunculated lipoma which mainly occurs in mature/obese animals. 

Pedunculated lipoma which mainly occurs in mature/obese animals.

Treatment of a pedunculated lipoma SI strangulation?

Resect the lipoma, pedicle and non viable gut.
Aetiology of SI volvulus?Signs? Prognosis?

Aetiology of SI volvulus?Signs? Prognosis?

Jejunum rotates about its attachment in dorsal abdomen at cranial mesenteric arterial root.




Signs SEVERE PAIN.




Prognosis poor.

Aetiology of intussuception? Treatment?

Aetiology of intussuception? Treatment?

Young animals more common jejuno-jejunal area. 

Proximal intussusceptum into distal intusscuscipiens leading to obstruction. then strangulation as more gut entrapped and artery supply drawn in.

Treat: Reduce.

Assess viability +/- resection an...

Young animals more common jejuno-jejunal area.




Proximal intussusceptum into distal intusscuscipiens leading to obstruction. then strangulation as more gut entrapped and artery supply drawn in.




Treat: Reduce.




Assess viability +/- resection and anastomosis.

What is the cause of thromboembolic colic?

Migration of Strongylus vulgaris larvae.

Types of SI entrapment leading to colic surgery?

Epiploic foramen entrapment.




Inguinal/scrotal hernia.




Herniation through a mesenteric rent.




Gastro-splenic ligament.




Umbilical hernia.




Diaphragmatic hernia.

What part of the caecum is the only part we can exteriorise? What do we use the caecum to find?
What part of the caecum is the only part we can exteriorise? What do we use the caecum to find?
The apex.



Dorsal band--> ileocaecal fold.




Lateral band- ventral colon.

Cause of primary caecal impaction? Secondary?

Primary caecal impaction--> unsuitable food.




Secondary--> Motility disorder.


Hostipalized patient, repeated GA, sedation,painful condition, limited movement.

How do we surgically resolve caecal impaction?

Apical typholotomy +/- a caecal bypass.

Types of caecal intussuception?

Caecocaecal.




Caecocolic.

Describe the course of the large colon from the caecum to the anus?
Describe the course of the large colon from the caecum to the anus?
Caecum--> RVC--> LVC --> LDC--> RDC--> Transverse colon--> small colon.
What parts of the large colon can we not exteriorise?

RVC, RDC and caecal base as attached to the body wall!!!

Causes of large colon displacements? 
Causes of large colon displacements?
Gaseous distension.



Transient motility disorders.




Sudden diet changes.




Parturition.




Idiopathic.

What happens with a left dorsal displacement of the large colon? Treat?

What happens with a left dorsal displacement of the large colon? Treat?

Colon becomes entraped between dorsal aspect of spleen and nephrosplenic ligament adjacent to the left kidney.




Treat with surgery and reduction of displacement.

What can we do prior to colonic surgery ?

Relieve distension/impaction.




This aids manipulation, allows repositioning in abdomen, improves post operative motility.

What occurs with a right dorsal displacement?

What occurs with a right dorsal displacement?

The left colon migrates around the body of the caecum clockwise or anticlockwise.

Indications for surgery with a RDD? Treat? Prognosis?

Unremitting pain, increasing distension, deterioration in CV status.




Treat: reduce displacement, dump colon, replace.




Can do a colopexy to abdominal wall if colon displacement recurs eg in breeding mares.




Prognosis good.

Complications of RDD?

Progress to colonic volvulus/ torsion.

Signs of colonic volvulus/torsion? Treat?
Signs of colonic volvulus/torsion? Treat?

180-360 torsion around caecolic junction.




Extremely painful, rapid deterioration due to massive endotoxaemia.




Treat QUICKLY.




Colonic resection.

Where do enteroliths tend to lodge? Treatment?

Narrow transverse colon.




Treat surgically remove via enterotomy.

Aetiology of atresia coli? Diagnose? Treat?

Heritable congenital condition of foals results in atresia of segment of colon and or atresia ani.



Diagnose by contrast radiography.




Treat: surgical correction if segment not to long.

Causes of small colon impaction? Treatment?
Focal enteroliths.

Primary motility issue.


Intramural haemorrhage.




Manual decompression or enterotomy.



How do we grade rectal prolapses? Which carry worst prognosis? Treatment?

1-4




3-4 guarded prognosis as mesorectum tears.




Treat: mild: clean, resect affected muscosa and replace providing seromuscular layer is intact.




25-30 prolapse more aggressive surgery.

When do rectal tears usually occur and where? How do you diagnose?

Occur during rectal.




Usually occur in the 10 and 2 o'clock position at the attachment of mesocolon.




Blood on rectal glove to diagnose.

How do we grade rectal tears? 

How do we grade rectal tears?

1-4




1: Mucosa only involved.




Grade 2: Muscularis only




Grade 3: Mucosa and muscularis.




Grade 4 : all layers and life threatening.

Most important steps to take if you get a rectal tear?

Most important steps to take if you get a rectal tear?

1) ID early.




2) Tell owner.




3) Institute first aid.




4) Refer.

First aid for a rectal tear? 

First aid for a rectal tear?

1) Sedate.




2) Epidural or large volume of local per rectum.




3) Careful evacuation.




4) Packing rectum with lubed noted tights etc.




5) Broad spectrum A/B




6) NSAID




7) Referral for surgery if severe- colostomy to bypass the rectum or an indwelling rectal liner.

Prognosis for rectal tears?

1-2: good to fair.





3: guarded.




4: POOR

Complications of colic surgery?

1) Repeat episodes of colic.




2) Continued endotoxaemia/dehydration.




3) Ileus.




4) Incisional drainage/ infection/ herniation.




5) Adhesions.