EqMed, Q2, III
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How do clinical signs of pain and response to pain meds compare in strangulating and non-strangulating obstruction of small bowel?
- stang: mil-mod-severe pain w/little relief from pain meds
- non-strang: mild-mod pain; good response to analgesia
How do cardiovascular parameters and peritoneal fluids compare in strangulating vs. nonstrangulating obstructions?
- strang: CV deterioration + abnormal fluid (hi WBC/TP; serosanginous)
- non-strang: minimal CV compromise + normal fluid
what are some common places for abdominal incarceration of intestines?
- epiploic foramen
- mesenteric rent
- gastrosplenic ligament
- inguinal ring hernia
what is signalment/history of horse with ascarid impaction?
- <1 year (horses 18-24 develop resistance)
- 3-6 month old recently dewormed who was not properly dewormed at 8 wks
- (hx of resp. infection dt worm's life cycle)
what is the ascarid associated with equine impaction? what is the prepatency period?
- Parascaris equorum
- PPP 8-12 weeks
life cycle/transmission of ascarids?
ingest - travel from SI to liver to lungs - up trachea - cough/swallow - mature in intestines - you deworm - massive die off/impaction
what CS are associated with ascarid obstruction?
- depression, endotoxemia, tachycardia, tachypnea, fever
- gastric reflux +/-with worms!
what is treatment for ascarid impaction?
- gastric decompression/lavage
- +/- surgery if worms have devitalized/ruptured bowel
- (foals don't usu. get laminitis so don't have to tx for this)
what is prognosis for foal with ascarid obstruction?
guarded; more favorable outcome if can resolve with medical not sx
when should foals be first dewormed to avoid ascarid obstruction? what is the most appropriate dewormer to use?
- begin at 60 days and repeat 2-4 months thereafter
- Benzimidazoles (resistance to Ivermectin reported)
- -base decision on the farms FECs
- -use less effective dewormer if suspect high worm burden to slow die off process
what are two causes of ileal impaction?
- coastal bermuda grass hay
- tapeworms irritating ileocecal junction (Anaplocephal perfoliata)
what age horse is associated with ileal impaction? what will rectal palpation reveal?
- any age, adults
- early in disease can feel enlarged ileum; as progresses SI loops distend and you only feel that
is gastric reflux associated with ileal impaction? what will peritoneal fluid analysis reveal?
- ileum later in SI so may not see reflux; only if impacted long enough to back up (>8-10 hrs);
- normal peritoneal fluid (non-strangulating lesion)
what is recommended treatment for ileal impaction?
- early (pain manageable and normal peritoneal fluid) = medical tx: mineral oil, IV fluids, analgesia
- later (pain escalates, deteriorating peritoneal fluid) = surgery
what is prognosis for ileal impaction?
good (may have to address post-ob ileus)
what is the most common place for intussusception? at what age?
- ileocecal most common - young; <3yr
- (jejuno-jejunal also common)
what are inciting causes of intussusception?
- deworming, abrupt dietary changes
- GI parasites (ascarids -jejunal, tapeworms-ileocecal, cecocolic)
is intussusception usually acute or chronic presention? what does rectal palpation reveal?
- acute (rarely intermittent)
- enlarged loops of bowel
what will US show with intussusception? what about peritoneal fluid evaluation?
- target/bulls-eye lesions
- abnormal fluid - devitalized gut = sersanguinous, hi WBC/TP
what is treatment for intussesception? what is prognosis?
- surgery - resection/anasthamosis
- simple obstruction = good
- ileocecal = guarded (jejunocecostomy; necrosis of ileocecal stump)
what is the tapeworm with affinity for ileocecal junction? what is PPP? what is recommended tx for deworming?
- Anaplocephala perfoliata
- Tx: praziquantel
when small intestine volvulus twists around root of mesentery, is arterial or venous supply obstructed first?
venous drainage occluded - engorged and thickened
what age is volvulus usually seen? what causes volvulus?
- one of most common causes of colic in foals
- unknown cause (parasites? changing feeding habits?)
what is treatment for volvulus? what is prognosis?
- surgical resection/anasthamosis
- good if only short section involved; euthanize if >50% involved - short bowel syndrome
what fluids should be used when treating volvulus patient? should you treat for laminitis?
- aggressive therapy warranted - hypertonic saline (4ml/kg) then balanced IV fluids
- -yes, prophy for laminitis; NSAIDs, cryotherapy
what are the landmarks for the epiploic foramen? does bowel usually pass from L to R or R to L?
- caudate lobe of liver
- caudal vena cava dorsally
- portal vein, pancreas
- Left to Right
how old are horses with epiploic entrapment?
older than 8 years
presenting signs of intestinal incarceration are consistent with any form of strangulating lesion, so how do you know which type you have?
all strangulating lesions require surgical correction - determine which type at surgery
what signalment is associated with strangulating lipomas?
what is treatment and prognosis for strangulating lipomas?
- surgical resection/anasthamosis
- good if addressed early
both lipomas and large colon feed impaction present with dessicated feed in the colon. How do you determine which is the cause?
aged horses rarely get feed impactions; more likely lipoma if older
feed impactions usu. do not cause CV deterioration;
strangulating lipomas: CV deterioration & abnormal peritoneal fluid
what is the cardinal sign of colitis in adult horses?
diarrhea (considered an emergency)
what are clinical signs of colitis?
- fever, endotoxemia
- diarrhea - PLE - edema
- colic pain that can mimic strangulating/surgical pain
- +/-gastric reflux
what are expected lab parameters with colitis?
- neutro*penia* w/left shift
- toxic neutrophils
- hypOkalemia, *hypOnatremia*
- metabolic acidosis; azotemia
what would US show with colitis patient?
thickened colon or cecal wall with fluid swirling within colon/cecum
what would peritoneal fluid show with colitis?
nonseptic peritonitis: normal nucleated cell count and normal to mildly increased protein concentration
what are some common causes of acute colitis/diarrhea?
- potomac horse fever
- grain overload
- cantharid toxicity
what are some common causes of chronic colitis/diarrhea
- sand enteropathy
- right dorsal colitis (NSAIDs)
Regardless the cause of colitis, what is treatment plan?
- fluids (crystalloid + colloids bc severe hypoproteinemia)
- NO hypertonic saline (bc hypOnatremic >24hr)
- NSAIDs + lidocaine CRI
- polymyxin B + cryotherapy + plasma (for endotoxemia)
- +/- anti diarrheal agents (bismuth salts, psyllium, probiotic)
- +/- Abs
- parenteral nutrition
Usually antibiotics are not indicated in treatment of colitis except in which circumstances?
- foals less than 3 mo
- secondary infections; concurrent disease
- severe, persistent neutropenia
what are common complications associated with colitis?
- coagulopathy (later)
- prolapsed rectum, infarcted bowel
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