Small Intestine Abnormalities

What will a simple/ non strangulating obstruction look like?

Blood supply to intestines remains patent, peritoneal fluid is grossly normal

What does strangulating obstruction look like?

Blood supply is blocked leading to ischemic inj and endotoxemia,

Serosangenous peritoneal fluids

What dos a functional obstruction look like?

Lumen is patent, motility altered

What is a mechanical obstruction?

Lumen will be blocked

Distension of the seromuscular leads to what?

Injury proximal/ oral to the obstructive lesion

- And adhesion

What are a few examples of Non-strangulating simple obstructions?

Ileal impaction

Ascarid impaction

Enteritis

What can cause an ileal impaction?

Bermuda hay or feeding poor quality hay

How do you DX an ileal impaction?

Rectal exam - SI distension

Gastric reflux (depending on duration)

What are TX of ileal impactions?

Sx (if its early can use medicine)

Iv fluids

Flunixin meglumine

Mineral oil if no gastric reflex

What are complication of ileal impactions if TX is delayed?

Gastric rupture

Laminitis

Mucosal necrosis

Ileal perforation

What organism is going to cause an ascarid impaction?

Parascaris equorum

Who is at risk for ascarid impaction?

Foals and young horses (ivermectin resistance and acquired immunity)

What drugs are going to be best for prevention of ascarid impaction?

Oxibendazole, fenbendazole

What is Duodenitis-proximal jejunitis pathogenesis?

Inflammation of proximal SI leading to endotoxemia and ills resulting in fluid accumulation in the SI and stomach (functional obstruction)

What are symptoms of Duodenitis-proximal jejunitis pathogenesis?

NG reflux

Sever pain then depression

Tachycardia

electrolyte abnormalities

Dehydration

How do you rule out Strangulation when you suspect Duodenitis-proximal jejunitis pathogenesis?

Fever,

leukocytosis,

belly tap (will have WBC and more protein, rarely serosanguineous)

How do you TX Duodenitis-proximal jejunitis pathogenesis?

medical tx:

NG tube

Correct dehydration and electrolyte imbalance (IV fluids spiked)

NPO till ileus is resolved then slow intro of food

Flunixin meglumie and polymyxin B

Prokinetics - for ileus

What are some types of strangulating obstructions?

SI volvulus

epiploic foramen entrapment

pdunculated lipoma

Inssusception

Mesenteric rents

Inguinal scrotal hernia

How do you dx SI volvulus?

Heart rate varies,

Rectal palpation (adults)

Abdominal US (foals) - depression - dissension - afebrile

How do you TX SI volvulus?

SX

Where is the Epiploic foramen?

Between the caudate process of the liver, portal vein and gastropancreatic fold

What are risk factors for Epiploic foramen entrapment?

Cribbing

Previous colic

Increased time in stall

Greater height of a horse

how do you DX Epiploic foramen entrapment?

Changes in peritoneal fluid (doesn't always work)

What is tx of Epiploic foramen entrapment? What do you have to be REALLY careful about when fixing?

SX

-Careful of portal vein!!!!

What is a pendunculated lipoma?

A benign smooth walled tumor suspended by a thing mesenteric pedicle. can cause strangulation

What is going to influence the risk of strangulation in a pedunculate lipoma?

The length of the stalk

pedunculate lipoma are more common in ____ horses and the breeds most suseptable are?

Older horses

-ponies, Arabians, Saddlebreds

What are the four types of intussusception?

Jejunojejunal

Jejunoileal

Ileoileal

Ileocecal (most common)

What are Predispositioning factors for Intussuception?

Segmental motility - enteritis

Heavy ascarid burden

Abrupt diet change

Tapeworm infection

What are mesenteric rents?

Congenital trauma or mesenteric stretching

What is the prognosis for Mesenteric rents?

Poor

What is an indirect scrotal hernia?

The most common form of hernia

small segment of SI will pass through inguinal ring causing sever colic and strangulation

acquired and nonreducible

What is a direct scrotal hernia?

jejunum escapes through rent in peritoneum to lie in sq space of scrotum

more common foals

congenital and reducible

What is prognosis for ascarid impaction?

post-sx mortality VERY high

prevention is key

What are some signs of a poor prognosis for DPJ?

anion gap

peritoneal fluid TP concentration

volume of NG reflux in first 24 hrs

hihg cost and prolonged tx can necessitate euthanasia

What are common complications w/ SI sx?

anastomotic obstruction

post-op pain

endotoxemia

ileus

adhesions

short bowel syndrome (malabsorption)