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Gastric Dilation and Rupture - Horse (view source)
Revision as of 17:33, 11 August 2010
, 17:33, 11 August 2010→Treatment
==Treatment==
==Treatment==
Prokinetic agents
Impaired gastric motility has been treated with several
drugs, especially in the context of treatment for postoperative
ileus. Metoclopramide (0.10-0.25 mg/kg bwt
3-4 times daily) has been used, but the frequent
occurrence of neurological side effects limits its utility.
Cisapride, a 5-HT4 agonist, has received some
attention. It has been given per 0s and i.v. but
commercially only an oral formulation is available. A
suggested dose is 0.1 mg/kg bwt q. 8 h (Gerring et a/.
1991). However, its therapeutic benefits have been found
to be equivocal.
Bethanecol. a muscarinic agonist, has also been used to
promote gastric emptying (0.00250.03 mg/kg bwt sub cut.
q. 4 h then 0.3-0.75 mg/kg bwt per 0s 3-4 times daily), but it
produces doserelated gastrointestinal side effects including
colic, diarrhoea and salivation (Murray 1990).
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, possiblyby 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
efficacious (King and Gerring 1989).
Supportive therapy
Because of the uncertain benefits of drug treatment for
equine gastric diseases, considerable care must taken
with non-specific supportive measures. 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
The stomach of the adult horse, by virtue of its anatomical
location in the cranial abdomen, partially enclosed by
C. J. Proudman and S. J. Baker 183
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
limited. Gastrotomy and evacuation of impacted food
material has been reported (Clayton-Jones et a/. 1972)
but is extremely difficult to achieve without causing gross
peritoneal contamination. Softening of gastric impactions
can be successfully achieved during surgery by instillation
of fluid into the stomach by stomach tube, or by
transmural injection from the peritoneal side; and by
manual mixing of the fluid and impacted food material
by the surgeon massaging the stomach wall. The latter
technique is often used because of the difficulty of
passing a nasogastric tube in the anaesthetised horse in
dorsal recumbency.(Proudman)
Surgical repair has been reported for partial thickness tears<ref>Steenhaut, M, Vlaminck, K, Gasthuys, F (1986) Surgical repair of a partial gastric rupture in a horse. ''Equine Vet J'', 18:331-332. In: Sanchez, L.C (2010) ''Other Disorders of the Stomach'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 15.</ref> and one case of a full thickness repair<ref>Hogan, P.M, Bramlage, L.R, Pierce, S.W (1995) Repair of a full-thickness gastric rupture in a horse. ''J Am Vet Med Assoc'', 207:338-340. In: Sanchez, L.C (2010) ''Other Disorders of the Stomach'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 15.</ref>
Surgical repair has been reported for partial thickness tears<ref>Steenhaut, M, Vlaminck, K, Gasthuys, F (1986) Surgical repair of a partial gastric rupture in a horse. ''Equine Vet J'', 18:331-332. In: Sanchez, L.C (2010) ''Other Disorders of the Stomach'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 15.</ref> and one case of a full thickness repair<ref>Hogan, P.M, Bramlage, L.R, Pierce, S.W (1995) Repair of a full-thickness gastric rupture in a horse. ''J Am Vet Med Assoc'', 207:338-340. In: Sanchez, L.C (2010) ''Other Disorders of the Stomach'' in Reed, S.M, Bayly, W.M. and Sellon, D.C (2010) '''Equine Internal Medicine''' (Third Edition), ''Saunders'', Chapter 15.</ref>