Changes

==Treatment==

==Treatment==

Prokinetic agents

Prokinetic agents

Impaired gastric motility has been treated with several

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 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 SC q. 4 h then 0.3-0.75 mg/kg bwt per 0s 3-4 times daily), but it produces dose related 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, 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

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).

efficacious (King and Gerring 1989).

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

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)

fluid therapy.(Proudman)

Surgical

*'''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

The stomach of the adult horse, by virtue of its anatomical

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

location in the cranial abdomen, partially enclosed by

passing a nasogastric tube in the anaesthetised horse in dorsal recumbency.(Proudman)

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)