Changes

==Treatment==

==Treatment==

*'''[[Colic, Medical Treatment|Medical treatment]]:''' if anatomical obstructions have been ruled out, prokinetic agents may prove useful to restore gastric motility, especially in the presence of post-operative ileus.  '''Metoclopramide''' (0.10-0.25 mg/kg TID or QID) has neurological side effects.  '''Cisapride''' is currently unavailable.  '''Bethanecol''' (at 0.0025 to 0.03mg/kg SC every 4 hours then 0.3-0.75 mg/kg PO TID or QID) has been used to promote gastric emptying but it produces dose-related gastrointestinal side effects including colic, diarrhoea and salivation.<ref>Murray, M.J (1990) Gastric ulceration.  In: Smith, B.P, '''Large Animal Internal Medicine''', ''CV Mosby Publishing Company'', USA, pp 648-652.  In:</ref> These prokinetic agents should be used only when anatomical obstructions have been ruled out. Nonsteroidal anti-inflammatory drugs appear to be beneficial in equine post operative ileus, possibly by inhibiting the release of prostaglandin synthesis induced by endotoxin. Both flunixin meglumine and phenylbutazone have been used and there is some evidence to suggest that phenylbutazone may be more

*'''[[Colic, Medical Treatment|Medical treatment]]:''' if anatomical obstructions have been ruled out, '''prokinetic agents''' such as '''metoclopramide''' or '''bethanecol''' may prove useful to restore gastric motility, especially in the presence of post-operative ileus.  Bethanecol however produces dose-related gastrointestinal side effects including colic, diarrhoea and salivation.<ref>Murray, M.J (1990) Gastric ulceration.  In: Smith, B.P, '''Large Animal Internal Medicine''', ''CV Mosby Publishing Company'', USA, pp 648-652.  In:</ref> '''Nonsteroidal anti-inflammatory drugs (NSAIDs)''' such as 'flunixin meglumine''' and '''phenylbutazone''' may also be beneficial in post operative ileus to help combat the effects of endotoxin. It is crucial that '''gastric decompression''' is maintained in cases of delayed gastric emptying.  This can be achieved with an indwelling nasogastric tube, (although prolonged intubation carriesits own risk) or by repeated intubation. '''IV fluid therapy''' should be given to ensure adequate hydration.(Proudman)

In particular, in cases of delayed gastric emptying, gastric decompression must be maintained either by an indwelling nasogastric tube, with the attendant risks of prolonged intubation, or by repeated intubation. Hydration should be effectively maintained by parenteral

fluid therapy.(Proudman)

*'''Surgical treatment''': The stomach of the adult horse, by virtue of its anatomical location in the cranial abdomen, partially enclosed by diaphragm and thoracic body wall, is difficult to access surgically. Extension of a midline laparotomy incision cranially improves access marginally but also increases the probability of post operative wound problems. With such difficult access and without the possibility of mobilising the stomach to bring it closer to the incision surgical options for treating gastric disease are very

*'''Surgical treatment''': The stomach of the adult horse, by virtue of its anatomical location in the cranial abdomen, partially enclosed by diaphragm and thoracic body wall, is difficult to access surgically. Extension of a midline laparotomy incision cranially improves access marginally but also increases the probability of post operative wound problems. With such difficult access and without the possibility of mobilising the stomach to bring it closer to the incision surgical options for treating gastric disease are very