Changes

==Description==

==Description==

'''Caecal impaction''' in horses occurs in two forms. In '''primary impactions''' the caecum contains dry, relatively solid ingesta which may be localised to the crainial part of the caecal base, or extend to fill the whole visera. The onset of clinical signs is typically 5-7 days and the associated signs are of low grade intermittent colic.  

'''Caecal impaction''' in horses occurs in two forms. In '''primary impactions''' the caecum contains dry, relatively solid ingesta which may be localised to the cranial part of the caecal base, or extend to fill the whole viscera. The onset of [[Colic Diagnosis - Clinical Signs|clinical signs]] is typically 5-7 days and the associated signs are of low grade intermittent colic.

 

'''Secondary impactions''' are a result of caecal dysfunction; the caecal content is fluid and the viscera is distended and immotile. This syndrome usually occurs in the post-operative period and early signs may be missed, being attributed to discomfort following surgery or the concurrent condition. The delayed diagnosis results in a serious situation where the caecum can become so distended that rupture is imminent.

==Signalment==

==Signalment==

Hospitalised horses are at greater risk, especially those with musculoskeletal conditions, often due to the reduction in activity and treatment with non-steroidal anti-inflammatory drugs.

Hospitalised horses are at greater risk, especially those with musculoskeletal conditions, often due to inadequate analgesia, the reduction in activity and treatment with non-steroidal anti-inflammatory drugs.

   

   

==Diagnosis==

==Diagnosis==

===Clinical signs===

===Clinical signs===

* Mild to moderate intermmitant colic signs

* Mild to moderate intermmitent colic signs

* Marginal increase in heart rate

* Marginal increase in heart rate

* Reduced gut sounds

* Reduced gut sounds

* Dehydration  

* Dehydration  

Diagnosis can be made on [[Rectal Examination of the Horse|rectal examintion]], the caecum is firmer and filled with ingesta and can be indented digitally. The caecal mass will be palpated in the right paralumbar area, identified by the taut ventral caecal band and the fat and blood vessels overlying the medial caecal band.   

Diagnosis can be made on [[Rectal Examination of the Horse|rectal examination]]; the caecum is firmer and filled with ingesta and can be indented digitally. The caecal mass will be palpated in the right paralumbar area, identified by the taut ventral caecal band and the fat and blood vessels overlying the medial caecal band.   

[[Dehydration - Pathology|Dehydration]] develops as the impaction becomes estabilised; in most cases the impaction is not sufficiently severe or prolonged to cause cardiovascular compromise or changes in peritoneal fluid, but if the case is chronic or progresses to rupture then the condition is serious and the horse should be closely monitored for worsening clinical signs. There will be an increase in the protein content of peritoneal fluid as well as cardiovascular signs of shock as the caecum becomes grossly distended, ischaemia of the visera occurs and toxaemia develops as the caecum eventually ruptures.     

[[Dehydration]] develops as the impaction becomes established; in most cases the impaction is not sufficiently severe or prolonged to cause cardiovascular compromise or changes in peritoneal fluid, but if the case is chronic or progresses to rupture then the condition is serious and the horse should be closely monitored for worsening clinical signs. There will be an increase in the protein content of peritoneal fluid as well as cardiovascular signs of shock as the caecum becomes grossly distended, ischemia of the viscera occurs and toxaemia develops as the caecum eventually ruptures.     

    

    

See '''[[:Category:Colic Diagnosis in the Horse|Colic Diagnosis in Horses]]'''

See '''[[:Category:Colic Diagnosis in the Horse|Colic Diagnosis in Horses]]'''

==Treatment==

==Treatment==

Treatment depends on the severity and cause of the impaction. Mild impactions which are diagnosed early can be treated effectively with IV fluid therapy, oral fluid therapy with added magnesium sulphate by stomach tube and flunixin meglumate as analgesia. Food should be witheld and the horse should be monitored very closely to avoid the caecal distension progressing. Impactions which do not improve should be refered for surgical management.  

Treatment depends on the severity and cause of the impaction. Mild impactions which are diagnosed early can be treated effectively with IV fluid therapy, oral fluid therapy with added magnesium sulphate by stomach tube and flunixin meglumate as analgesia. Food should be withheld and the horse should be monitored very closely to avoid the caecal distension progressing. Impactions which do not improve should be referred for surgical management.  

Caecal impactions can be corected under general anaesthesia by laporotomy. The caecum is decompressed and the ingesta is removed. In cases where the emptying function of the caecum as been lost, a by-pass surgery must be performed.   

Caecal impactions can be corrected under general [[Equine Anaesthesia|anaesthesia]] by laparotomy. The caecum is decompressed and the ingesta is removed. In cases where the emptying function of the caecum has been lost, a by-pass surgery must be performed.   

The risk of secondary impactions developing post-operatively can be minimised by administering adequate analgesia and close monitoring of the patient. Feed intake, faecal output and gut sounds should be recorded while the patient is hospitalised, if they become reduced the rectal palpation is indicated to make an early diagnosis.  

The risk of secondary impactions developing post-operatively can be minimised by administering adequate analgesia and close monitoring of the patient. Feed intake, faecal output and gut sounds should be recorded while the patient is hospitalised, if they become reduced then rectal palpation is indicated to make an early diagnosis.  

==Prognosis==

==Prognosis==

The prognosis for horses with caecal impactions is gaurded due to the number that progress to fatal rupture.  

The prognosis for horses with caecal impactions is guarded due to the number that progress to fatal rupture.

 

 

==References==

==References==

* Blood, D.C. and Studdert, V. P. (1999) '''Saunders Comprehensive Veterinary Dictionary (2nd Edition)''' ''Elsevier Science''

* Blood, D.C. and Studdert, V. P. (1999) '''Saunders Comprehensive Veterinary Dictionary (2nd Edition)''' ''Elsevier Science''

* Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

* Merck & Co (2008) '''The Merck Veterinary Manual (Eighth Edition)''' ''Merial''

* White, N.A., Edwards, G.B. (1999) '''Handbook of Equine Colic''' ''Reed Educational and Professional Publishing Ltd''

* White, N.A., Edwards, G.B. (1999) '''Handbook of Equine Colic''' ''Reed Educational and Professional Publishing Ltd''

[[Category:Surgical Colic in the Horse]]

[[Category:Surgical Colic in the Horse]]

[[Category:To_Do_-_lizzyk]]

[[Category:Medical Colic in the Horse]]

 

[[Category:Impaction - Horse]]

[[Category:Colic - Caecum Causes]]