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Gastric Dilation and Intestinal Obstruction – Rabbit (view source)
Revision as of 17:55, 25 August 2015
, 17:55, 25 August 2015→References
===Introduction: gastric dilation and gut stasis===
===The difference between gastric dilation and gut stasis===
Gastric stasis must be differentiated from gastric dilation which is usually associated with intestinal obstruction. Gastric dilation develops rapidly, suddenly and unexpectedly, whereas gut stasis develops slowly and insidiously, usually followed by a painful or stressful episode. Note that a moving foreign body could mimic gut stasis except that the stomach is not impacted (stomach may or may not be impacted).
Gastric stasis must be differentiated from gastric dilation which is usually associated with intestinal obstruction. Gastric dilation develops rapidly, suddenly and unexpectedly, whereas gut stasis develops slowly and insidiously, usually followed by a painful or stressful episode. Note that a moving foreign body could mimic gut stasis except that the stomach is not impacted (stomach may or may not be impacted).
*Harcourt Brown F M (2007), Gastric dilation and intestinal obstruction in 76 rabbits. Veterinary Record, 161, 409 – 414, and
*Harcourt Brown F M (2007), Gastric dilation and intestinal obstruction in 76 rabbits. Veterinary Record, 161, 409 – 414, and
*Harcourt Brown T R (2007) Management of Acute Gastric Dilation in Rabbits. Journal of Exotic Pet Medicine, 16, (3) 168 – 174
*Harcourt Brown T R (2007) Management of Acute Gastric Dilation in Rabbits. Journal of Exotic Pet Medicine, 16, (3) 168 – 174
===Pathophysiology===
===Pathophysiology===
**note dilation of gut proximal to obstruction
**note dilation of gut proximal to obstruction
*Non-passage of the blockage leads to devitalisation and necrosis of intestine
*Non-passage of the blockage leads to devitalisation and necrosis of intestine
===Clinical Signs of Gastric Dilation===
===Clinical Signs of Gastric Dilation===
*Distended stomach palpable in left epigastric area caudomedial to left last rib and confirmed radiographically
*Distended stomach palpable in left epigastric area caudomedial to left last rib and confirmed radiographically
*Abdominal pain or flaccidity
*Abdominal pain or flaccidity
===Causes of intestinal obstruction===
===Causes of intestinal obstruction===
*Tapeworm cysts
*Tapeworm cysts
*Diverticulosis
*Diverticulosis
===Pellets of compressed hair===
===Pellets of compressed hair===
*Ingestion of hair in caecotrophs
*Ingestion of hair in caecotrophs
*Predisposed by low-fibre diets
*Predisposed by low-fibre diets
===Sites and causes of obstruction===
===Sites and causes of obstruction===
*Pylorus (Deeb 2000 Jenkins 2003)
*Pylorus (Deeb 2000; Jenkins 2003)
*Proximal duodenum
*Proximal duodenum
**foreign bodies
**foreign bodies
'''NB: Severity of prognosis is directly proportional to closeness of site of obstruction to pylorus.'''
'''NB: Severity of prognosis is directly proportional to closeness of site of obstruction to pylorus.'''
===Case assessment===
===Case assessment===
Serial radiographs (every 30 – 90 minutes) looking for gas in hindgut. If gas in hind gut this indicates that the obstruction is moving - administer NSAIDs (carprofen or meloxicam) if not already administered (see above) - followed by prokinetics if still anorectic after 2-3 hours.
Serial radiographs (every 30 – 90 minutes) looking for gas in hindgut. If gas in hind gut this indicates that the obstruction is moving - administer NSAIDs (carprofen or meloxicam) if not already administered (see above) - followed by prokinetics if still anorectic after 2-3 hours.
Fluid accumulation in stomach leads to deficit in intra- and extra-cellular compartments. Parenteral fluids required. Give Hartmann’s IV.
Fluid accumulation in stomach leads to deficit in intra- and extra-cellular compartments. Parenteral fluids required. Give Hartmann’s/kg /hr IV.
Exploratory surgery may be attempted. Decision of whether to embark on surgery or conservative treatment depends on the time of presentation and on financial considerations:
Exploratory surgery may be attempted. Decision of whether to embark on surgery or conservative treatment depends on the time of presentation and on financial considerations:
*Day => conservative treatment
*Day => conservative treatment
*Night => surgery more likely
*Night => surgery more likely
===Surgical Procedure===
===Surgical Procedure===
*Insert stomach tube to decompress: if it blocks, remove, flush and replace
*Insert stomach tube to decompress: if it blocks, remove, flush and replace
**Procedure of gastric decompression
***+/- sedation
***mouth to last rib
***gentle gastric massage
***patience
***minimal suction
***intermittent retropulsion
***if tube is placed inadvertently endotracheally there will be
*a change in breathing pattern
*the presence of breath sounds at the free end of the tube
*intraluminal condensation
*Gastric rupture => euthanasia
*Intestinal rupture => euthanasia
*Intestinal neoplasm => euthanasia
*Intestinal FB milked through ileocaecocolic junction into the hind gut or perform an enterotomy.
enterotomy.
*Note small omentum so omentalisation may not be possible
*Postoperatively give antibiotics, prokinetics, food (force fed with Oxbow Critical Care Formula and baby cereal)
===Practical approach to exploratory laparotomy in rabbits with intestinal obstruction===
#Opiate premedication, oxygenation, gastric and tracheal intubation and isoflurane maintenance.
#Incision midline, sternum to umbilicus
#Inspect retroperitoneum for fluid/ingesta
#Palpate stomach and descending duodenum
#Palpate ascending duodenum (under caecum)
#Palpate jejunum cranially and caudally
#Look for flattened intestine caudal to obstruction
#Examine site of obstruction for contributive or subsequent pathology: cytology/biopsy?
#Milk obstruction to hindgut or stomach
#Gastrotomy/enterotomy/ectomy???
#Closure with Vicryl (not catgut)
===Complications of rabbit intestinal surgery===
*Insufficient omentum for omentalisation
*Intestine small and thin-walled
*Food cannot be withheld during post-operative period
**danger of hepatic lipidosis
===Practical approach to exploratory laparotomy in rabbits with intestinal obstruction===
===Postoperative care===
*Warmth, quiet
*Fluid therapy
*Analgesia
*Antibiotics
*Prokinetics
*Food (grass, dandelions)
*Gavage with Oxbow CCF and Baby cereal
{{Learning
|Vetstream = [https://staging.vetstream.com/lapis/Content/Freeform/fre00011#section2 Gastric dilation and stasis]
}}
===Complications of rabbit intestinal surgery===
==References==
*Deeb, B. (2000) Digestive System and Disorders in '''Manual of Rabbit Medicine and Surgery''', ed. Paul Flecknell pub BSAVA Cheltenham Glos Pages 39 - 46
*Harcourt Brown, F. M. (2007) '''Gastric dilation and intestinal obstruction in 76 rabbits'''. Veterinary Record, 161, 409 – 414
*Harcourt Brown, T. R. (2007) '''Management of Acute Gastric Dilation in Rabbits'''. Journal of Exotic Pet Medicine, 16, (3) 168 – 174
[[Category:Rabbit Digestion]]
[[Category:Digestive_Disorders_-_Rabbit]]