Changes

==Description==

==Description==

Gastric impaction is rare in the horse.(Edwards)  It can occur spontaneously as a primary condition but is often secondary to other disturbances in the intestinal tract of the stomach such as ucleration of fibrosis at the pylorus.(Mair)  The condition typically causes mild to moderate colic that does not resolve with routine medical treatment.(Bliks)

Gastric impaction is rare in the horse.(Edwards)  It can occur spontaneously as a primary condition but is often secondary to other disturbances in the intestinal tract of the stomach such as ucleration of fibrosis at the pylorus.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref> The condition typically causes mild to moderate colic that does not resolve with routine medical treatment.(Bliks)

==Aetiology==

==Aetiology==

===Predisposing factors===

===Predisposing factors===

*Ingestion of certain feedstuffs including sugar beet pulp, bran, straw, wheat and barley.  Beet pulp and bran can become dessicated within the stomach and may not become rehydrated by water or gastric secretions.(Mair)

*Ingestion of certain feedstuffs including sugar beet pulp, bran, straw, wheat and barley.  Beet pulp and bran can become dessicated within the stomach and may not become rehydrated by water or gastric secretions.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*Dental disorders - roughage may be only partially masticated.(Mair)

*Dental disorders - roughage may be only partially masticated.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*Feeding a horse that has signs of colic - there may be poor gastric emptying associated with generalised decreased gastrointestinal motility

*Feeding a horse that has signs of colic - there may be poor gastric emptying associated with generalised decreased gastrointestinal motility

*Rapid consumption of feedstuffs.(Sanchezz)

*Rapid consumption of feedstuffs.(Sanchezz)

==Diagnosis==

==Diagnosis==

*Gastric impaction is suspected if a [[Colic Diagnosis - Naso-gastric Intubation|'''nasogastric tube''']] cannot be passed or if poorly macerated or digested feed material is recovered from the tube when the horse has been starved for several hours.  With gastric distension, the gastoroesophageal junction can become distorted making it difficult to pass the tube.(Mair)  

*Gastric impaction is suspected if a [[Colic Diagnosis - Naso-gastric Intubation|'''nasogastric tube''']] cannot be passed or if poorly macerated or digested feed material is recovered from the tube when the horse has been starved for several hours.  With gastric distension, the gastoroesophageal junction can become distorted making it difficult to pass the tube.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*On [[Colic Diagnosis - Rectal Examination|'''rectal examination''']], the spleen may be displaced caudally and medially (but this is not specific for gastric impaction).(Mair)

*On [[Colic Diagnosis - Rectal Examination|'''rectal examination''']], the spleen may be displaced caudally and medially (but this is not specific for gastric impaction).<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*'''Endoscopy''' would be indicated in a chronic case(Mair, Blisk) and may show a full stomach after a fast of 18-24hrs.(Sanchez)  However it is not diagnostic for impaction as it is difficult to assess gastric distension by endoscopy.(MAir)

*'''Endoscopy''' would be indicated in a chronic case(Mair, Blisk) and may show a full stomach after a fast of 18-24hrs.(Sanchez)  However it is not diagnostic for impaction as it is difficult to assess gastric distension by endoscopy.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*In a small horse or pony, a lateral '''radiograph''' of the cranial abdomen may show the diaphragm displaced cranially(Mair)

*In a small horse or pony, a lateral '''radiograph''' of the cranial abdomen may show the diaphragm displaced cranially

*[[Colic Diagnosis - Abdominal Ultrasound|'''Ultrasonography''']] may reveal a markedly enlarged gastric echo extending over six or more intercostal spaces on the left side of the abdomen.  A marked increase in the thickness of the wall of the stomach may also be imaged. (Edwards)

*[[Colic Diagnosis - Abdominal Ultrasound|'''Ultrasonography''']] may reveal a markedly enlarged gastric echo extending over six or more intercostal spaces on the left side of the abdomen.  A marked increase in the thickness of the wall of the stomach may also be imaged. (Edwards)

==Treatment==

==Treatment==

If gastric impaction is suspected, the horse should be transported with a '''nasogastric tube''' in place to a clinic with surgical facilities.(Mair)  [[Colic, Medical Treatment|'''Medical treatment''']] might include gastric lavage with water(BLiks) to remove as much impacted ingesta as possible, which may take several attempts.  100-200ml of an 8% solution of '''dioctyl sodium sulfosuccinate (DSS)''' may help to hydrate the dessicated material.  IV fluid therapy and analgesia should be commenced, although IV fluids are unlikely to resolve the impaction.(Mair)  Owing to the risk of gastric rupture, gastric motility stimulants should be avoided if the extent of the impaction is undetermined.(Mair)  At surgery the following should be performed:

If gastric impaction is suspected, the horse should be transported with a '''nasogastric tube''' in place to a clinic with surgical facilities.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref> [[Colic, Medical Treatment|'''Medical treatment''']] might include gastric lavage with water(BLiks) to remove as much impacted ingesta as possible, which may take several attempts.  100-200ml of an 8% solution of '''dioctyl sodium sulfosuccinate (DSS)''' may help to hydrate the dessicated material.  IV fluid therapy and analgesia should be commenced, although IV fluids are unlikely to resolve the impaction.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref> Owing to the risk of gastric rupture, gastric motility stimulants should be avoided if the extent of the impaction is undetermined.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref> At surgery the following should be performed:

*In dorsal recumbency, the impacted stomach can be felt extending back midway between the xiphisternum and the umbilicus, so it is easily accessed via a '''midline celiotomy'''.(Bliks)

*In dorsal recumbency, the impacted stomach can be felt extending back midway between the xiphisternum and the umbilicus, so it is easily accessed via a '''midline celiotomy'''.(Bliks)

*Infusion of balanced polyionic fluids such as saline(Bliks) either directly into the impaction through the gastric wall (adjacent to the greater curvature) or via a nasogastric tube

*Infusion of balanced polyionic fluids such as saline(Bliks) either directly into the impaction through the gastric wall (adjacent to the greater curvature) or via a nasogastric tube

*Massage of the stomach to reduce the impaction and aid movement of fluid into the ingesta

*Massage of the stomach to reduce the impaction and aid movement of fluid into the ingesta

*Impactions diagnosed at surgery may benefit from '''bethanechol''' at 0.2mg/kg SC every 8 hours to stimulate gastric motility.(Mair)

*Impactions diagnosed at surgery may benefit from '''bethanechol''' at 0.2mg/kg SC every 8 hours to stimulate gastric motility.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*The stomach should be lavaged by nasogastric tube post-operatively and the horse starved for 48-72 hours.

*The stomach should be lavaged by nasogastric tube post-operatively and the horse starved for 48-72 hours.

*'''Gastroscopy''' is indicated to confirm resolution of the impaction and to identify any underlying causes in the stomach.(mair)

*'''Gastroscopy''' is indicated to confirm resolution of the impaction and to identify any underlying causes in the stomach.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

   

   

==References==

==References==

 

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