Changes

==Treatment==

==Treatment==

If gastric impaction is suspected, the horse should be trasnported with a nasogastric tube in place to a clinic with surgical facilities.(Mair)  '''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.(Mair)  Owing to the risk of gastric rupture, gastric motility stimulants shold be avoided if the extent of the impaction is undetermined.(Mair)  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.(Mair)  [[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.(Mair)  Owing to the risk of gastric rupture, gastric motility stimulants should be avoided if the extent of the impaction is undetermined.(Mair)  At surgery the following should be performed:

*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(Bliks) 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.(Mair)

*Impactions diagnosed at surgery may benefit from '''bethanechol''' at 0.2mg/kg SC every 8 hours to stimulate gastric motility.(Mair)

*The horse should be starved for 48-72 hours post-operatively

*The stomach should be lavaged by nasogastric tube post-operatively and the horse starved for 48-72 hours.

*Gastroscopy is indicated to confirm resolution of the impaction and to identify any underlying causes in stomach.(mair)

*'''Gastroscopy''' is indicated to confirm resolution of the impaction and to identify any underlying causes in the stomach.(mair)

 

'''Gastrotomy''' has been attempted to remove impacted stomach contents but this has largely been unsuccessful (Huskamp 2000 in Edwards) and carries major risk including poor gastric motility and recurrence of the impaction.(Edwards 1997)

There is also a report including the details of a pony and a horse in which a gastrotomy was performed to removethe impacted stomach contents.5 However, there are major risks with this procedure, and infusion followed up by postoperative lavage by stomach tube isusually successful. (Bliks)

In dorsal recumbency, the impacted stomach can be felt extending back to midway between the xiphisternum and the umbilicus and is therefore readily accessible via a midline celiotomy. As much as 30 - 40 kg have been removed via a gastrotomy but postoperatively normal gastric motility was not restored and impaction recurred (Edwards 1997). Reduction of stomach volume by partial resection of its flaccid wall was

similarly unsuccessful (Huskamp et al 2000). (Edwards)

==References==

==References==