Large Animal Surgery

1. Large Animal Surgery Intussusception and Intestinal Volvulus December 2005 Amy Fayette

2. What is this bull doing • Stretching his belly because of pain

3. What are some CS of peracute severe abdominal pain • Kicking at the abdomen • Rolling • Frequent lying down • Getting up frequently • Grunting • Arching back • Expiratory grunt • Reluctant to move • Paddling in lateral recumbency • Abdominal distension

4. What are some signs of acute severe abdominal pain (>12 horus) • Depression • Recumbency • Poor response to stimuli • Abdominal distention • Dyspnea

5. What do you find on rectal exam in a cow w intussusception • Gas filled loops • Firm mass • Tight mesentery • No feces • Mucus and clotted blood

6. Why do you find mucus and clotted blood • From straining to defecate and intestinal blockage

7. What changes are expected in your lab data in a case of intestinal volvulus • Azotemia • Hypocalcemia • Hyperglycemia • Leukocytosis w a mild left shift

8. What is the initial acid base disturbance with intestinal volvulus • Alkalemia and normal serum K

9. When cattle shift to this acid base disturbance the prognosis becomes poor • Acidosis w hyperkalemia

10. What fluids do you want to use if there is a metabolic acidosis • LRS w or wo HCO3

11. What fluids do you want do use if there is a met alkalosis • LRS or NaCl

12. Is surgical exploration done earlier in the cow or the hrose • Cow because you don’t need GA, can do it standing under local and less post op complications

13. What is the tx for intussuscpetion • Surgical resection • R paralumbar fossa laparotomy

14. What needs to be done before doing an intestinal resection • Give ATBs

15. Are young or old animals more susceptible to intussusception • Young

16. Why are young animals more likely to get intussusception • Increased motility and more active

17. What are some predisposing factors to intussusception • Sudden dietary change • Heavy ascarid infection • Intestinal polyps • Foreign bodies • Tumors • Tapeworm infestation

18. What part of the intestine is most likely to form an intussusception in cattle • Distal jejunum • Proximal ileum

19. What part of the intestine is most likely to form an intussusception in horses • Mid- jejunum • Ileo-cecal • Ceco-colic

20. What is another name for the inner portion of an intussusception • Intussusceptum

21. What is another name for the outer portion of an intussusception • Intussuscipiens

22. What surgical approach is typically used to resect an intussusception • Right sided flank approach

23. What are the two techniques to performing a resection and anastamosis • End to end • Side to side

24. When would you choose to do a side to side anastamosis • When you want to create a larger lumen • With segments of different diameters

25. What are the 10 commandments for successful bowel sx • 1. Inverting suture pattern • 2. Serosa to serosa seal • 3. Divide at an angle • 4. Leave adequate blood supply • 5. Remove sufficient bowel • 6. Control hemorrhage • 7. Close mesenteric angle • 8. No leaks • 9. Minimize contamination • 10. Close mesentery

26. What species did this come from • Cow- increased fat in the mesentery

27. What do you expect on abdominoscentesis with an intussusception • Normal because the necrotic segment is contained inside the normal segment

28. What makes intestinal anastamosis more difficult in cattle vs horses • Short mesentery • Fat filled mesentery • Close vessel pattern • No serosa at the mesenteric angle

29. What ATBs would you use in horses after an anastamosis • Pen, gen

30. What ATBs would you use in cow after an anastamosis • Ceftiofur

31. What is your diagnosis • Perforated abomasal ulcer

32. That cow had gone into surgery for an intestinal resection and anastamosis…what probably caused the ulcer • Stress or NSAIDS

33. What is the post op survival rate for an intussusception in cattle • 43%

34. What is the post op survival rate for a cecocecal or cecocolic intussusception in horses • 27-45%

35. What is the post op survival rate for a SI intussusception in horses • Guarded

36. What is the greatest influence on survival • Time • To get patient • To get dx • To prepare patient • To perform sx

37. The prognosis for survival in intestinal volvulus depends on ___ • The duration of the obstruction • The viability of the bowel

38. What are the CS of hemorrhagic bowel syndrome in cattle • Depression and intestinal obstruction • Abdominal distention, colic, bloody feces, dehydration, shock, sudden death

39. What is the prognosis for a cow with hemorrhagic bowel syndrome in cattle after medical or surgical tx • Poor px: 70% death rate

40. What is usually found on necropsy for a cow w hemorrhagic bowel syndrome • Segmental necrohemorrhagic enteritis of the SI and large intraluminal clots that obstruct the intestine

41. What is the most likely cause of hemorrhagic bowel syndrome in cattle • C perfringens type A

42. What factors are associated w the occurrence of HBS • Large herd size • Administration of BST • Consumption of a high energy diet

43. What is your diagnosis • Fat necrosis in the mesentery