Changes

==Clinical signs==

==Clinical signs==

The colic associated with gastric impaction varies from mild and chronic to acute and severe.(Bliks)  Other signs reported include (Bliks):

The colic associated with gastric impaction varies from mild and chronic to acute and severe.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref> Other signs reported include:

*Anorexia

*Anorexia

*Lethargy

*Lethargy

==Treatment==

==Treatment==

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:

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<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref> 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'''.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref>

*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<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref> 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.<ref name="Mair">Mair, T.S, Divers, T.J, Ducharme, N.G (2002) '''Manual of Equine Gastroenterology''', ''WB Saunders''.</ref>

*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>

==Prognosis==

==Prognosis==

Infusion followed by postoperative gastric lavage by stomach tube is usually successful.(Bliks)  Chronic cases carry a poorer prognosis.

Infusion followed by postoperative gastric lavage by stomach tube is usually successful.<ref name="Bliks">Blikslager, A.T (2005) Treatment of Gastrointestinal Obstruction - Stomach Impaction, Ileal Impaction and Caecal Impaction, ''American Association of Equine Practitioners (AAEP)'', reproduced at www.ivis.org.</ref> Chronic cases carry a poorer prognosis.

==References==

==References==