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| − | Also known as: '''''Gastric Rupture | + | {| cellpadding="10" cellspacing="0" border="1" |
| | + | | Also known as: |
| | + | |'''Gastric Rupture''' |
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| − | ==Introduction== | + | {| cellpadding="10" cellspacing="0" border="1" |
| − | 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>
| + | | See also: |
| | + | |'''[[Colic, Gastric Causes]]''' |
| | + | |} |
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| − | See also: '''[[Colic, Gastric Causes|Gastric causes of colic]]'''
| + | ==Description== |
| | + | Gastric dilation in the horse may be primary, secondary or idiopathic.(Sanchez) |
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| | ==Aetiology== | | ==Aetiology== |
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| − | <u>'''Primary causes:'''</u> | + | *'''Primary causes:''' [[Gastric Impaction - Horse|gastric impaction]], food engorgement, excessive water intake after exercise, aerophagia and parasitism(141,146). 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> |
| | + | *'''Secondary causes:''' 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 [[Colic Diagnosis - Naso-gastric Intubation|naso-gastric reflux]]. Gastric dilation may also occur with certain colonic displacements, especially '''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> |
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| − | [[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>
| + | 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(146,148). 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.(Sanchez) Certain '''risk factors''' have been identified for gastric rupture(146, 148) including: |
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| − | <u>'''Secondary causes:'''</u>
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| − | 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>
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| − | 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 | | *Feeding grass hay |
| | *Not feeding grain | | *Not feeding grain |
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| | *Pale mucous membranes | | *Pale mucous membranes |
| | *Retching<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> | | *Retching<ref name="Merck">Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''', ''Merial''.</ref> |
| − | *Ingesta at the nares in severe cases (rare) | + | *Ingesta appears at the nares in severe cases |
| | *Gastric reflux | | *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>'''''
| + | NB: the time to development of reflux is proportional to the distance to the intestinal segment involved, (e.g. 4 hours with duodenal obstruction(147)). Furthermore, '''''nasogastric intubation does not preclude the possibility of gastric rupture(146).''''' |
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| | '''Gastric rupture''' typically results in: | | '''Gastric rupture''' typically results in: |
| | *Relief | | *Relief |
| | *Depression | | *Depression |
| − | The inevitable '''peritonitis''' and '''endotoxic shock''' will lead to: | + | The inevitable '''peritonitis''' and '''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>
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| | *Tachypnoea | | *Tachypnoea |
| | *Tachycardia | | *Tachycardia |
| | *Sweating | | *Sweating |
| | *Muscle fasciculations | | *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> | + | *Signs of '''endotoxaemia''' |
| − | ''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>
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| | ==Diagnosis== | | ==Diagnosis== |
| − | '''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> | + | '''[[Colic Diagnosis - Clinicopathologic Evaluation|Laboratory findings]]:(141)''' |
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| − | '''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.
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| − | 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>
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| − | '''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>:
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| − | *Foetid, turbid sample containing particulate matter
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| − | *White cell count >40 x 10<sup>9</sup>/l
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| − | *Protein content >30g/l.
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| − | 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>:
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| − | *A 'gritty feeling' on the serosal surfaces of intestine due to adherent food material
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| − | *An impression of 'space' in the abdomen due to gas in the peritoneal cavity.
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| − | [[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 |
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| | ==Treatment== | | ==Treatment== |
| − | '''[[Colic, Medical Treatment|Medical treatment]]:'''
| + | Surgical repair has been reported for partial thickness tears(149) and one case of a full thickness repair(150). |
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| − | 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>
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| − | '''Surgical treatment''':
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| − | 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>
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| | ==Prognosis== | | ==Prognosis== |
| − | 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. | + | 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]]. |
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| − | {{Learning
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| − | |flashcards = [[Equine Internal Medicine Q&A 01]]
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| − | |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]
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| | ==References== | | ==References== |
| | <references/> | | <references/> |
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| − | | + | [[Category:To_Do_-_Nina]] |
| − | {{review}}
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| − | ==Webinars==
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| − | <rss max="10" highlight="none">https://www.thewebinarvet.com/gastroenterology-and-nutrition/webinars/feed</rss>
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| − | [[Category:Expert_Review - Horse]] | |
| | [[Category:Surgical_Colic_in_the_Horse]] | | [[Category:Surgical_Colic_in_the_Horse]] |
| − | [[Category:Colic - Gastric Causes]]
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| − | [[Category:Medical Colic in the Horse]]
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| − | [[Category:Stomach Diseases - Horse]]
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