large animal surgery evaluation of colic in foals rectal tears/ rectal prolapse
TRANSCRIPT
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Large Animal Surgery
Evaluation of colic in foals
Rectal Tears/ Rectal Prolapse
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What important factors in the history can help to diagnose colic in foals
• Breed• Sex• Birth circumstances (immune status, weak down
foals)• Deworming• Vaccination • Other illnesses• Pregnancy problems• Health of other mares and foals
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What is the normal temp for a foal
• 99-101.5 degrees
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What is the normal HR for a foal
• 70-100 bpm
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What do you need to evaluate in a foal with colic
• Pain
• CV status
• GI tract
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How do you evaluate for possible sepsis
• Look for hypoglycemia
• Depressed immune function
• Decreased intake
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How to you evaluate the GI tract of foals
• Observe for distention and feces
• Auscultation
• NG reflux
• Abdominal palpation
• Ancillary procedures
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What types of ancillary procedures might be done in a foal with colic
• US
• Rads
• Contrast rads
• Abdominocentesis
• CBC
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What is the TP in foals compared to adults
• Lower in foals
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What are the main differentials in a foal with colic in the neonatal period
• Meconium impaction
• Enteritis
• Ulcers
• Hernia w ruptured tunic
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What are the main differentials in a foal w colic from 2-5 days of age
• Ruptured bladder
• Atresia coli
• Enteritis
• Ulcers
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What are the main differentials in older foals w colic
• Ulcers
• Enteritis
• Gastric outflow obstruction
• Small intestinal volvulus
• Intussusception
• Hernias
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What are the general principles when treating colic in foals
• Evaluate immunity and correct w IV plasma
• Minimal use of analgesics
• Rehydrate
• Resume feeding ASAP or use TPN
• Preventative therapy for ulcers
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Meconium impaction commonly occurs in foals of what age
• <36 hours
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Which foals have an increased risk for meconium impaction
• Males
• FPT foals
• Weak foals
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What are the CS of meconium impaction
• Straining
• Absence of feces
• Abdominal distention
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What is the main ddx for meconium impaction
• Atresia
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How do you rule out atresia
• Digital palpation
• Rads
• Barium enema
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How is meconium impaction treated
• Acetylcysteine enema
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What are some causes of enteritis in foals
• C perfringens
• C difficile
• E coli
• Rotavirus
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How do you diagnose enteritis in foals
• Fever, leukopenia
• Diarrhea
• Response to fasting
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How do you treat enteritis in foals
• Check for systemic illness and give ATBS if necessary
• Decrease or discontinue milk if bloat
• NPO w TPN for a few days
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How do you diagnose ulcers in foals
• Bruxism
• Colic after nursing
• Excessive salivation in older foals
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How do you treat ulcers in foals
• Ensure hydration
• Address other problems
• Sucralfate
• If d/t NSAIDS give H2 blockers or omeprazole
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What are the CS of ruptured bladder
• Depression, decreased nursing
• Progresive abdominal distention
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What lab data is associated w a ruptured bladder
• Hyponatremia, hypochloremia, hyperkalemia
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How do you diagnose a ruptured baldder
• US, rads, contrast rads
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Is a ruptured bladder a surgical emergency
• No but it is a medical emergency
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How do you treat a ruptured bladder
• Decrease serum potassium
• Abdominal drainage
• Sx when stabilized
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What is the prognosis for uroabdomen
• Good-excellent for urachal or bladder tear
• Guarded for ureteral tear
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What are the CS of atresia coli
• Initial signs of meconium impaction
• Progressive abdominal distention
• No feces
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How do you dx atresia coli
• Confirm w barium enema
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What is the cause of gastric outflow obstruction
• Duodenal ulcers
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What are the CS of gastric outflow obstruction
• May be no hx of illness
• Bruxism
• Spontaneous reflux
• Colic after nursing
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What is the tx for gastric outflow obstruction
• Gastrojejunostomy (w or wo jejunojejunostomy)
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What are the CS of small intestinal obstruction
• Pain
• Abdominal distention
• reflux
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What types of small intestinal obstruction occur
• Congenital or acquired hernia
• Intussusception
• Volvulus
• Meckels diverticulum
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Which Cs should make you suspect intussusception or volvulus
• Pain following onset of diarrhea
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What is your diagnosis
• Meckels diverticulum
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What is a meckels diverticulum
• Embryologic remnant of the omphalomesenteric duct– Band that connects antimesenteric surface of
the ileum to the umbilicus
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What is your diagnosis
• Umbilical hernia
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What is your diagnosis
• Intestinal adhesions
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What is the prognosis for foals <14 days old w SI obstruction
• 10% survival
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What is the prognosis for foals 15-150 days old w SI obstruction
• 46% survival
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Why is the prognosis so bad for SI obstructions
• Increased risk of adhesions
• Delayed indentification
• Sepsis
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What are some examples of LC and SC obstructions
• Fecalith, bedding ingestion, hairball
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What is the main cause of rectal tears
• Iatrogenic d/t rectal palpation
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How will you first know that there is a rectal tear
• Blood on the rectal sleeve
• Feel rectum suddenly relax
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Where are most rectal tears
• Dorsally between 10 and 2 oclock
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What is a grade 1 rectal tear
• Mucosa and submucosa
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What is a grade 2 rectal tear
• Disruption of the muscular layer (mucosa and serosa still intact)
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What is a grade 3 rectal tear
• Disruption of the mucosa, submucosa and muscularis
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What is the difference between a 3a and 3b tear
• 3a the serosa remains intact
• 3b is extension into the mesocolon
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What is a grade 4 rectal tear
• Disruption of all layers of the rectal wall
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What is your dx
• Grade 4 rectal tear
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What is your dx
• Grade 1 rectal tear
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What is your dx
• Grade 2 rectal tear
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What is your dx
• Grade 3a rectal tear
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Which grades of rectal tear should be referred
• Grade 3 or 4
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What should be done prior to referring a grade 3 or 4 rectal tear
• Pack rectum cranial to tear
• Banamine
• ATBs
• Atropine (to slow intestinal motility)
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What is the tx for grade 1 or 2 rectal tear
• No palpation for a few weeks
• Banamine
• ATBs
• Diet that will cause soft feces
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What are the options for surgical repair of a grade 3 or 4 rectal tear
• Rectal liner
• Colostomy
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What surgical approach is needed to place a rectal liner
• Caudal ventral midline incision
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What is the principle behind placing a rectal liner
• Liner is placed using a PVC pipe and long plastic bag so that feces will pass through the bag and not interrupt the rectal tear
• The tear heals by second intention
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How is the rectal liner removed
• Chromic gut is used to suture it in place…breaks down in 2 weeks and the PVC pipe and plastic bag are passed in feces
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What is a complication of placing a rectal liner
• Retraction of the liner into the rectum when the horse lies down
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What can be done to prevent retraction of the liner into the rectum
• Patient should be kept standing until the ring has been passed
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What is a colostomy
• Fecal diversion to the left paralumbar fossa
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How long are colostomys left in place
• 6-7 weeks
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What is the prognosis for for a grade 1 or 2 tear
• Good
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What is the prognosis for for a grade 3 or 4 tear
• Fair-poor
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What is the etiology of rectal prolapse
• Straining to defecate
• Chronic pneumonia
• Short tail
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What is the tx for rectal prolapse
• Epidural anesthesia
• Manual reduction or sx resection
• Topical agents/astringents
• +/- purse string
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What can be done to create inflammation and adhesions around the
rectum in ruminants• Inject iodine perirectally
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What can be done to create inflammation and adhesions around the
rectum in foals or mares• Nothing you cant inject iodine in equines
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What is your diagnosis
• Grade 4 rectal prolapse; full thickness tear w omentum coming out
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What is your diagnosis
• Rectal and vaginal prolapse
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How would you treat the previous case
• Amputate the devitalized tissue
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What is the prognosis with a grade 1 or 2 rectal prolapse with reduction
• Good
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What is the prognosis with a grade 1 or 2 rectal prolapse with resection
• Guarded
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What is the prognosis with a grade 3 or 4 rectal prolapse
• Guarded-poor