WikiVet English

Changes

Gastric Dilation and Rupture - Horse (view source)

Revision as of 17:35, 6 January 2023

10,085 bytes added ,  17:35, 6 January 2023
no edit summary
Line 1: Line 1: −
{{unfinished}}
     −
{| cellpadding="10" cellspacing="0" border="1"
+
Also known as: '''''Gastric Rupture
−
| Also known as:
  −
|'''Gastric Rupture'''
  −
|}
     −
{| cellpadding="10" cellspacing="0" border="1"  
+
==Introduction==
−
| See also:
+
Gastric dilation in the horse may be primary, secondary or idiopathic.<ref name="Sanchez">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>
−
|'''[[Colic, Gastric Causes]]'''
+
 
−
|}
+
See also: '''[[Colic, Gastric Causes|Gastric causes of colic]]'''
   −
==Description==
   
==Aetiology==
 
==Aetiology==
−
The most common cause of gastric dilatation in horses is excessive gas or intestinal obstruction. Gastric dilatation may be associated with overeating fermentable feedstuffs such as grains, lush grass, and beet pulp. Presumably the large increase in production of volatile fatty acids inhibits gastric emptying. If untreated, gastric dilatation associated with overeating can rapidly lead to gastric rupture. If intestinal obstruction is the cause, the obstruction most often involves the small intestine. The fluid from the obstructed small intestine accumulates in the lumen of the stomach, causing dilatation of the stomach and retrieval of gastric reflux on passage of the nasogastric tube. Gastric dilatation also may develop in some horses with certain colonic displacements, most notably right dorsal displacement of the colon around the cecum. It is presumed that the displaced colon obstructs duodenal outflow. Gastric dilatation with fluid also is a characteristic of proximal enteritis-jejunitis. 
  −
Rupture of the stomach is a fatal complication of gastric dilatation. The stomach generally tears along its greater curvature. About two-thirds of all gastric ruptures occur secondary to mechanical obstruction, ileus, and trauma; the remaining cases are due to overload or to idiopathic causes.  (Merck)
  −
      +
<u>'''Primary causes:'''</u>
 +
 +
[[Gastric Impaction - Horse|Gastric impaction]], food engorgement, excessive water intake after exercise, aerophagia, ''[[Gasterophilus spp.|Gasterophilus]]'' infestation and [[Habronema and Draschia spp.|habrenomiasis]].<ref name="Camp">Campbell-Thompson, M.L, Merritt, A.M (1999) Alimentary system: diseases of the stomach.  In Colahan, P.T, Mayhew, I.G, Merritt, A.M, Moore, J.N ''Equine medicine and surgery'', St Louis, Mosby, pp 699-715.  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><ref name="Todhunter">Todhunter, R.J, Erb, H.N, Roth, L (1986) Gastric rupture in horses: a review of 54 cases. ''Equine Vet J'', 30:344-348.</ref>  Excessive consumption of fermentable feeds (grains, lush grass, and beet pulp) causes a large increase in the production of volatile fatty acids which is thought to delay gastric emptying.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>
 +
 +
<u>'''Secondary causes:'''</u>
 +
 +
Primary intestinal ileus or small or large intestinal obstruction. Dilation resulting from small intestinal obstruction is the most common cause.  Fluid from the obstructed small intestine accumulates in the stomach, causing nasogastric reflux. Gastric dilation may also occur with certain colonic displacements, especially [[Large Colon, Right Dorsal Displacement - Horse|right dorsal displacement of the colon]] around the caecum. It is hypothesised that the displaced colon obstructs duodenal outflow. Gastric fluid accumulation is also characteristic of '''proximal enteritis-jejunitis'''.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>
 +
 +
Untreated, gastric dilation can rapidly lead to '''gastric rupture''' whereby the stomach usually tears along its greater curvature.  It has been proposed that the '''seromuscularis''' weakens and tears before the gastric mucosa.<ref name="Todhunter">Todhunter, R.J, Erb, H.N, Roth, L (1986) Gastric rupture in horses: a review of 54 cases. ''Equine Vet J'', 30:344-348.</ref><ref name="Kiper">Kiper, M.L, Traub-Dargatz, J, Curtis, C.R (1990) Gastric rupture in horses: 50 cases (1979-1987), ''J Am Vet Med Assoc'', 196:333-336.  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>  Most cases of rupture occur secondary to mechanical obstruction, ileus, and trauma.  The rest are due to overload or idiopathic causes.<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>  Rupture can occur secondary to [[Gastric Ulceration - Horse|gastric ulceration]], in which case full-thickness tearing usually occurs in all layers of the gastric wall.<ref name="Sanchez">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>  Certain '''risk factors''' have been identified for gastric rupture<ref name="Todhunter">Todhunter, R.J, Erb, H.N, Roth, L (1986) Gastric rupture in horses: a review of 54 cases. ''Equine Vet J'', 30:344-348.</ref><ref name="Kiper">Kiper, M.L, Traub-Dargatz, J, Curtis, C.R (1990) Gastric rupture in horses: 50 cases (1979-1987), ''J Am Vet Med Assoc'', 196:333-336.  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> including:
 +
*Feeding grass hay
 +
*Not feeding grain
 +
*Gelding
 +
*Non-automatic water sources
 +
 +
==Clinical signs==
 +
'''Gastric dilation''' usually produces:
 +
*Acute, severe [[Colic Diagnosis - Clinical Signs|colic]]
 +
*Tachycardia
 +
*Pale mucous membranes
 +
*Retching<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref>
 +
*Ingesta at the nares in severe cases (rare)
 +
*Gastric reflux
 +
''NB: the time to development of reflux is proportional to the distance to the intestinal segment involved, (e.g. 4 hours with duodenal obstruction<ref>Puotunen-Reinert, A, Huskamp, B (1986) Experimental duodenal obstruction in the horse.  ''Vet Surg'', 15:420-428.  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>).  Furthermore, '''nasogastric intubation does not preclude the possibility of gastric rupture.<ref name="Todhunter">Todhunter, R.J, Erb, H.N, Roth, L (1986) Gastric rupture in horses: a review of 54 cases. ''Equine Vet J'', 30:344-348.</ref>'''''
 +
 +
'''Gastric rupture''' typically results in:
 +
*Relief
 +
*Depression
 +
The inevitable '''peritonitis''' and '''endotoxic shock''' will lead to:
 +
*Reluctance to move<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>
 +
*Tachypnoea
 +
*Tachycardia
 +
*Sweating
 +
*Muscle fasciculations
 +
*Blue or purple mucous membranes<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>
 +
''NB: rupture of a stomach containing dry, fibrous material may produce a more insidious onset of clinical signs of peritonitis than rupture of a fluid distended viscus. This is probably because it takes longer for the dry gastric contents to disperse around the peritoneum.''<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>
   −
Dilation is primary, secondary or idiopathic.  Causes of primary: gastric impaction, grain engorgement, excessive water intake after exercise, aerophagia and parasitism(141, 146).  Secondary more common and can result from primary intestinal ileus or small or large intestinal obstruction.   
+
==Diagnosis==
−
==Clinical signs of gastric dilation==
+
'''Primary gastric dilation''' should be suspected if there are copious amounts of [[Colic Diagnosis - Naso-gastric Intubation|gastric reflux]] in the absence of small intestinal distension on [[Colic Diagnosis - Rectal Examination|rectal examination]] and the absence of endotoxaemia.<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref> A retrospective diagnosis of '''primary gastric dilation''' can be made if colic signs cease following decompression, and other clinical parameters return to normal.  Primary gastric dilation does not cause any significant change in peritoneal fluid parameters until rupture occurs.<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>
−
*Acute colic
+
 
−
*Ingesta appears at nares in severe cases
+
'''Secondary gastric dilation''' should be considered if there is persistent [[Colic Diagnosis - Clinical Signs|colic]], repeated retrieval of [[Colic Diagnosis - Naso-gastric Intubation|nasogastric reflux]], intestinal distension on [[Colic Diagnosis - Rectal Examination|rectal examination]] and clinical signs of endotoxaemia.<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref> These are all indications for '''exploratory laparotomy''' to look for an intestinal obstruction.   
−
When rupture occurs, horses may exibit signs of relief.  Tachypnea, tachycardia, sweating and muscle fasciculations are consistent with peritonitis and shock.
+
 
−
Time to development of gastric reflux is proportional to the distance to the intestinal segment involved, with duodenal obstruction resulting in reflux within 4 hours(147).
+
NB: ''excessive fluid within the stomach is not always detected by nasogastric intubation, despite repeated attempts with frequent repositioning of the tube. Furthermore, gastric impaction with solid food material may be too firm to be retrieved by this method.''<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref> 
−
Clinical signs associated with gastric dilatation include severe abdominal pain, tachycardia, and retching. The mucous membranes may be pale. Classically, these acute signs are replaced by relief, depression, and toxemia after the stomach has ruptured. (Merck)
+
 
−
==Lab abnormalities(141)==
+
'''Gastric rupture''' results in septic peritonitis which will be reflected in the [[Colic - Peritoneal Fluid Analysis|nature of fluid collected by abdominocentesis]]<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>:
 +
*Foetid, turbid sample containing particulate matter
 +
*White cell count >40 x 10<sup>9</sup>/l
 +
*Protein content >30g/l.
 +
Findings on [[Colic Diagnosis - Rectal Examination|rectal examination]] may include<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>:
 +
*A 'gritty feeling' on the serosal surfaces of intestine due to adherent food material
 +
*An impression of 'space' in the abdomen due to gas in the peritoneal cavity.
 +
[[Colic Diagnosis - Clinicopathologic Evaluation|Laboratory findings]]<ref name="Camp">Campbell-Thompson, M.L, Merritt, A.M (1999) Alimentary system: diseases of the stomach. In Colahan, P.T, Mayhew, I.G, Merritt, A.M, Moore, J.N ''Equine medicine and surgery'', St Louis, Mosby, pp 699-715. 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> may include:
 
*Haemoconcentration
 
*Haemoconcentration
 
*Hypokalaemia
 
*Hypokalaemia
 
*Hypochloraemia
 
*Hypochloraemia
−
==Aetiology of gastric rupture==
+
 
−
*Secondary to small intestinal obstruction
  −
*Primary gastric dilation
  −
*Idiopathic gastric dilation
  −
'''Risk factors for gastric rupture(146, 148)'''
  −
*Feeding grass hay
  −
*Not feeding grain
  −
*Gelding
  −
*Non-automatic water source
  −
Nasogastric intubation does not preclude the possibility of gastric rupture, and the amount of reflux obtained before rupture is highly variable(146)
  −
Usually occurs along the greater curvature.  In horse with rupture due to gastric dilation, the seromuscualris likely wekaens and tears before the mucosa(146,148).  In rupture secondary to gastric ulceration, there is usally full-thicknees tearing of equal size in all layers.
   
==Treatment==
 
==Treatment==
−
Surgical repair has been reported for partial thickness tears(149) and one case of a full thickness repair(150).
+
'''[[Colic, Medical Treatment|Medical treatment]]:'''
 +
 
 +
If anatomical obstructions have been ruled out, '''prokinetic agents''' such as '''metoclopramide''' or '''bethanecol''' may prove useful to restore gastric motility, especially in the presence of post-operative ileus.  Unfortunately, metaclopramide causes neurological side effects and bethanecol produces dose-related gastrointestinal problems including colic, diarrhoea and salivation.<ref>Murray, M.J (1990) Gastric ulceration.  In: Smith, B.P, '''Large Animal Internal Medicine''', ''CV Mosby Publishing Company'', USA, pp 648-652.  In: Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>  '''Nonsteroidal anti-inflammatory drugs (NSAIDs)''' such as '''flunixin meglumine''' and '''phenylbutazone''' may also be beneficial in post operative ileus to help combat the effects of endotoxin.  It is crucial that '''gastric decompression''' is maintained in cases of delayed gastric emptying.  This can be achieved with an indwelling nasogastric tube, (although prolonged intubation carries its own risk) or by repeated intubation.  '''IV fluid therapy''' should be given to ensure adequate hydration.<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>
 +
 
 +
'''Surgical treatment''':
 +
 
 +
The surgical options for managing gastric disease are limited since the equine stomach is difficult to access surgically.  Extending the midline laparotomy incision cranially may improve access slightly but also increases the risk of post operative wound problems.<ref name="Proudman">Proudman, C.J, Baker, S.J (1994) Satellite Article: Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref>  Gastrotomy and removal of impacted food material has been reported<ref>Clayton-Jones, D.G, Greatorex, J.C, Stockman, M.J.R, Harris, C.P.J (1972) Gastric impaction in a pony: Relief via laparotomy.  ''Equine Vet J'', 4:98-99.  In: Proudman, C.J, Baker, S.J (1994) ''Satellite Article'': Gastric disease in the adult horse: a clinical perspective.  ''Equine Vet Educ'', 6(4):178-184.</ref> but carries a high risk of gross peritoneal contamination. For gastric rupture, surgical success has been reported for repairing 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 also in one case of a full thickness rupture.<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>
 +
 
 
==Prognosis==
 
==Prognosis==
−
Gastric rupture is usually fatal because of widespread contamination of the peritoneal cavity, septic peritonitis, and septic shock.
+
The prognosis for survival may be excellent in most cases of gastric dilation<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> but gastric rupture is usually '''fatal''' because of widespread contamination of the peritoneal cavity, septic peritonitis, and septic shock. '''Food engorgement''' also carries the risk of secondary laminitis.
−
'''Food Engorgement:''' also carries the risk of secondary [[laminitis]].
+
 
−
The prognosis for survival may be excellent in most cases of gastric dilatation, but gastric rupture is fatal.(Merck)
+
{{Learning
−
[[Category:To_Do_-_Nina]]
+
|flashcards = [[Equine Internal Medicine Q&A 01]]
 +
|literature search = [http://www.cabdirect.org/search.html?q=title:(gastric)+AND+(title:(dilat*)+OR+title:(ruptur*))+AND+od:(horses) Gastric Dilatation or Rupture in horses publications]
 +
}}
 +
 
 +
==References==
 +
<references/>
 +
 
 +
 
 +
{{review}}
 +
 
 +
==Webinars==
 +
<rss max="10" highlight="none">https://www.thewebinarvet.com/gastroenterology-and-nutrition/webinars/feed</rss>
 +
 
 +
[[Category:Expert_Review - Horse]]
 
[[Category:Surgical_Colic_in_the_Horse]]
 
[[Category:Surgical_Colic_in_the_Horse]]
 +
[[Category:Colic - Gastric Causes]]
 +
[[Category:Medical Colic in the Horse]]
 +
[[Category:Stomach Diseases - Horse]]
Retrieved from "https://en.wikivet.net/Special:MobileDiff/83350...208233"