The Equine Acute Abdomen

Transcription

1 The Equine Acute Abdomen Third Edition Edited by Anthony T. Blikslager, DVM, PhD, DACVS Professor of Equine Surgery and Gastroenterology Department of Clinical Sciences North Carolina State University Raleigh, North Carolina Nathaniel A. White II, DVM, MS, DACVS Professor Emeritus of Equine Surgery Marion dupont Scott Equine Medical Center Virginia Maryland Virginia Tech, Leesburg, Virginia James N. Moore, DVM, PhD, DACVS Josiah Meigs Distinguished Teaching Professor Director, Educational Resources Tim S. Mair, BVSc, PhD, DEIM, DESTS, DECEIM, Assoc. ECVDI, FRCVS Director Bell Equine Veterinary Clinic Mereworth, Kent

2 This edition first published John Wiley & Sons, Inc. Edition History Second edition published 2009 by Teton NewMedia First edition published 1990 by Lea & Febiger All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted, in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, except as permitted by law. Advice on how to obtain permission to reuse material from this title is available at The right of Anthony T. Blikslager, Nathaniel A. White II, James N. Moore, and Tim S. Mair to be identified as the authors of the editorial material in this work has been asserted in accordance with law. Registered Office John Wiley & Sons, Inc., 111 River Street, Hoboken, NJ 07030, Editorial Office 111 River Street, Hoboken, NJ 07030, For details of our global editorial offices, customer services, and more information about Wiley products visit us at Wiley also publishes its books in a variety of electronic formats and by print on demand. Some content that appears in standard print versions of this book may not be available in other formats. Limit of Liability/Disclaimer of Warranty The contents of this work are intended to further general scientific research, understanding, and discussion only and are not intended and should not be relied upon as recommending or promoting scientific method, diagnosis, or treatment by physicians for any particular patient. In view of ongoing research, equipment modifications, changes in governmental regulations, and the constant flow of information relating to the use of medicines, equipment, and devices, the reader is urged to review and evaluate the information provided in the package insert or instructions for each medicine, equipment, or device for, among other things, any changes in the instructions or indication of usage and for added warnings and precautions. While the publisher and authors have used their best efforts in preparing this work, they make no representations or warranties with respect to the accuracy or completeness of the contents of this work and specifically disclaim all warranties, including without limitation any implied warranties of merchantability or fitness for a particular purpose. No warranty may be created or extended by sales representatives, written sales materials or promotional statements for this work. The fact that an organization, website, or product is referred to in this work as a citation and/or potential source of further information does not mean that the publisher and authors endorse the information or services the organization, website, or product may provide or recommendations it may make. This work is sold with the understanding that the publisher is not engaged in rendering professional services. The advice and strategies contained herein may not be suitable for your situation. You should consult with a specialist where appropriate. Further, readers should be aware that websites listed in this work may have changed or disappeared between when this work was written and when it is read. Neither the publisher nor authors shall be liable for any loss of profit or any other commercial damages, including but not limited to special, incidental, consequential, or other damages. Library of Congress Cataloging in Publication Data Names: Blikslager, Anthony T., editor White, N. A. (Nathaniel A.), editor. Moore, James N. (James Neil), editor. Mair, Tim S., editor. Title: The Equine Acute Abdomen/ edited by Anthony T. Blikslager, Nathaniel A. White II, James N. Moore, Tim S. Mair. Description: Third edition. Hoboken, NJ : Wiley, Preceded by Equine acute abdomen / [edited by] Nathaniel A. White, James N. Moore, Tim S. Mair Includes bibliographical references and index. Identifiers: LCCN (print) LCCN (ebook) ISBN (pdf) ISBN (epub) ISBN (cloth) Subjects: LCSH: Colic in horses. MESH: Colic veterinary Horse Diseases Classification: LCC SF959.C6 (ebook) LCC SF959.C6 E (print) NLM SF 959.C6 DDC 636.1/ dc23 LC record available at Cover image: Brad Gilleland Cover design by Wiley Set in 10/12pt Warnock by SPi Global, Pondicherry, India

3 iii Contents Editors viii List of Contributors ix Preface and Dedication xiii About the Companion Website xiv Part I Normal Anatomy and Physiology 1 1 Gross and Microscopic Anatomy of the Equine Gastrointestinal Tract 3 Thomas M. Krunkosky, Carla L. Jarrett, and James N. Moore 2 Intestinal Epithelial Stem Cells 19 Liara M. Gonzalez 3 Gastric Secretory Function 24 Michael J. Murray 4 Small Intestinal Function 27 Anthony T. Blikslager 5 Large Intestine Function 41 Marco A. F. Lopes and Philip J. Johnson 6 Liver Function 55 Tim S. Mair 7 The Equine Intestinal Microbiota 58 J. Scott Weese 8 Effects of Feeding on Equine Gastrointestinal Function or Physiology 66 Marco A. F. Lopes and Philip J. Johnson 9 Intestinal Motility and Transit 78 Jorge E. Nieto and Peter C. Rakestraw Part II Pathophysiology of Gastrointestinal Diseases Pathophysiology of Gastric Ulcer Disease 99 Michael J. Murray 11 Pathophysiology of Gastrointestinal Obstruction and Strangulation 102 Anthony T. Blikslager

4 iv Contents 12 Pathophysiology of Pain 119 Casper Lindegaard, Karina B. Gleerup, and Pia Haubro Andersen 13 Pathophysiology and Treatment of Postoperative Ileus 140 Jorge E. Nieto and Peter C. Rakestraw 14 Pathophysiology, Prevention, and Treatment of Adhesions 153 P. O. Eric Mueller 15 Pathophysiology of Enteritis and Colitis 166 Harold C. McKenzie III 16 Pathophysiology of Systemic Inflammatory Response Syndrome 183 Clare E. Bryant and James N. Moore Part III Intestinal Parasitism Intestinal Parasitism 195 Christopher J. Proudman Part IV Epidemiology of Colic Epidemiology of Colic: Principles for Practice 207 Noah D. Cohen 19 Epidemiology of Colic: Risk Factors 215 Noah D. Cohen Part V Diagnosis of Gastrointestinal Disease Diagnostic Approach to Colic 223 Anne Desrochers and Nathaniel A. White II 21 Investigations of Chronic and Recurrent Colic 263 Nathaniel A. White II 22 Alternative Diagnostic Techniques 266 Nathaniel A. White II and Anne Desrochers 23 Imaging of the Abdomen 271 Anne Desrochers 24 Decision for Surgery and Referral 285 Nathaniel A. White II 25 Prognosticating Equine Colic 289 Nathaniel A. White II 26 Biosecurity in the Management of Equine Gastrointestinal Disease 301 Harold C. McKenzie III

5 Contents v Part VI Medical Management Medical Management of Gastrointestinal Diseases 313 Tim S. Mair 28 Treatment of Shock 331 Kevin Corley 29 Diagnosis and Treatment of Peritonitis and Hemoperitoneum 361 John F. Peroni 30 Diagnosis of Enteritis and Colitis in the Horse 376 Harold C. McKenzie III Part VII Colic in the Foal Diagnosis of Colic in the Foal 413 Martin Furr 32 Imaging of the Foal with Colic and Abdominal Distention 418 Martin Furr 33 Medical Management of Colic in the Foal 422 Martin Furr 34 Surgical Management of Colic in the Foal 426 Sarah M. Khatibzadeh and James A. Brown 35 Anesthesia of Foals with Colic 437 Cynthia M. Trim 36 Specific Diseases of the Foal 452 Martin Furr 37 Liver Diseases in Foals 459 Tim S. Mair and Thomas J. Divers Part VIII Colic in the Donkey Colic in the Donkey 471 Alexandra K. Thiemann, Karen J. Rickards, Mulugeta Getachew, and Georgios Paraschou Part IX Nutritional Management Nutritional Management of the Colic Patient 491 Shannon E. Pratt Phillips and Raymond J. Geor Part X Anesthesia for Abdominal Surgery Anesthesia for Horses with Colic 511 Cynthia M. Trim

6 vi Contents Part XI Surgery for Acute Abdominal Disease Preparation of the Patient for Abdominal Surgery 541 Anna K. Rötting 42 Surgical Exploration and Manipulation 549 Anna K. Rötting 43 Intestinal Viability 570 Liara M. Gonzalez 44 Small Intestinal Resection and Anastomosis 581 Anna K. Rötting 45 Large Colon Enterotomy, Resection, and Anastomosis 597 Joanne Hardy 46 Abdominal Closure 604 Vanessa L. Cook Part XII Intensive Care and Postoperative Care Monitoring Treatment for Abdominal Disease 613 Tim S. Mair 48 Postoperative Complications 624 Diana M. Hassel 49 Laminitis Associated with Acute Abdominal Disease 639 James K. Belknap and Andrew H. Parks Part XIII Specific Diseases of Horses Diseases of the Stomach 665 Michael J. Murray 51 Diseases of the Liver and Liver Failure 673 Tim S. Mair and Thomas J. Divers 52 Diseases of the Small Intestine 704 Debra C. Archer 53 Diseases of the Cecum 737 James N. Moore and Joanne Hardy 54 Specific Diseases of the Ascending Colon 748 Joanne Hardy 55 Diseases of the Descending Colon 775 John F. Peroni

7 Contents vii 56 Equine Grass Sickness 783 Tim S. Mair 57 Rectal Tears 790 Canaan M. Whitfield Cargile and Peter C. Rakestraw 58 Malabsorption Syndromes 804 Tim S. Mair and Thomas J. Divers 59 Colic and Pregnant Mares 819 Elizabeth M. Santschi 60 Colic from Alternative Systems: False Colics 831 Tim S. Mair 61 Abdominal Trauma 843 John F. Peroni 62 Abdominal Abscesses and Neoplasia 848 Jan F. Hawkins Index 855

8 viii Editors Anthony T. Blikslager, DVM, PhD, DACVS Professor of Equine Surgery and Gastroenterology Department of Clinical Sciences North Carolina State University Raleigh, North Carolina Nathaniel A. White II, DVM, MS, DACVS Professor Emeritus of Equine Surgery Marion dupont Scott Equine Medical Center Virginia Maryland Virginia Tech Leesburg, Virginia James N. Moore, DVM, PhD, DACVS Josiah Meigs Distinguished Teaching Professor Director, Educational Resources Tim S. Mair, BVSc, PhD, DEIM, DESTS, DECEIM, Assoc. ECVDI, FRCVS Director Bell Equine Veterinary Clinic Mereworth, Kent

9 ix List of Contributors Pia Haubro Andersen, DVM, PhD, DVSci Professor of Large Animal Surgery Department of Clinical Sciences, Equine Section Faculty of Veterinary and Agricultural Sciences Swedish University of Agricultural Sciences Uppsala Sweden Debra C. Archer, BVMS, PhD, CertES, DECVS, MRCVS Professor of Equine Surgery Institute of Veterinary Science University of Liverpool Neston, The Wirral James K. Belknap, DVM, PhD, DACVS Professor of Equine Surgery Department of Veterinary Clinical Sciences Ohio State University Columbus, Ohio Anthony T. Blikslager, DVM, PhD, DACVS Professor of Equine Surgery and Gastroenterology Department of Clinical Sciences North Carolina State University Raleigh, North Carolina James A. Brown, BVSc, MS, DACVS, ACT Clinical Assistant Professor in Equine Surgery & Emergency Care Marion dupont Scott Equine Medical Center Virginia Tech Leesburg, Virginia Clare E. Bryant, BSc(Hons), BVetMed, PhD, Cert VA, DECVPT, MRCVS Professor of Innate Immunity Department of Veterinary Medicine University of Cambridge Cambridge Noah D. Cohen, VMD, MPH, PhD, DACVIM Professor of Large Animal Internal Medicine Department of Large Animal Clinical Sciences and Biomedical Sciences Texas A&M University College Station, Texas Vanessa L. Cook, VetMB, PhD, DACVS, DACVECC Associate Professor Department of Large Animal Clinical Sciences Michigan State University East Lansing, Michigan Kevin Corley, BVM&S, PhD, DECEIM, DACVIM, DACVECC, MRCVS Specialist (Equine Medicine and Critical Care) Veterinary Advances Ltd The Curragh, Co. Kildare Ireland Anne Desrochers, DMV, DACVIM, cvma Leesburg, Virginia Thomas J. Divers, DVM, DACVIM, DACVECC Professor of Medicine Department of Clinical Sciences Cornell University Ithaca, New York Martin Furr, DVM, PhD, MA Ed, DACVS Professor and Head Department of Physiological Sciences Center for Veterinary Health Sciences Oklahoma State University Stillwater, Oklahoma

10 x List of Contributors Raymond J. Geor, BVSc, MVSc, PhD, DACVIM, DACVSMR, DACVN(Hon) Professor and Pro Vice Chancellor College of Sciences Massey University New Zealand Mulugeta Getachew, DVM, MVM, PhD Researcher and International Research Advisor Department of Research and Pathology The Donkey Sanctuary Sidmouth, Devon Brad Gilleland, BFA, MS Medical Illustrator Educational Resources Karina B. Gleerup, DVM, PhD Assistant Professor Department of Large Animal Science University of Copenhagen Copenhagen Denmark Liara M. Gonzalez, DVM, PhD, DACVS Assistant Professor of Gastroenterology and Equine Surgery Department of Clinical Sciences North Carolina State University Raleigh, North Carolina Joanne Hardy, DVM, PhD, DACVS, DACVECC Clinical Associate Professor Department of Large Animal Clinical Sciences Texas A&M University College Station, Texas Diana M. Hassel, DVM, PhD, DACVS, DACVECC Associate Professor of Equine Emergency Surgery and Critical Care Department of Clinical Sciences Colorado State University Fort Collins, Colorado Jan F. Hawkins, DVM, DACVS Professor and Section Chief of Large Animal Surgery Department of Veterinary Clinical Sciences Purdue University West Lafayette, Indiana Carla L. Jarrett, DVM, MS Senior Lecturer Department of Veterinary Biosciences and Diagnostic Imaging Philip J. Johnson, BVSc(hons), MS, DACVIM LAIM, DECEIM, MRCVS Professor of Internal Medicine Department of Veterinary Medicine and Surgery University of Missouri Columbia, Missouri Sarah M. Khatibzadeh, DVM Resident in Surgery Department of Veterinary Clinical Sciences Virginia Maryland Virginia Tech Blacksburg, Virginia Thomas M. Krunkosky, MS, DVM, PhD Associate Professor Department of Veterinary Biosciences and Diagnostic Imaging Casper Lindegaard, DVM, PhD, DECVS Head of Equine Surgery Evidensia Equine Specialist Hospital Helsingborg Helsingborg Sweden Marco A. F. Lopes, MV, MS, PhD Associate Professor of Equine Surgery Equine Health and Performance Centre School of Animal and Veterinary Sciences University of Adelaide Roseworthy, South Australia Australia

11 List of Contributors xi Tim S. Mair, BVSc, PhD, DEIM, DESTS, DECEIM, Assoc. ECVDI, FRCVS Director Bell Equine Veterinary Clinic Mereworth, Kent Harold C. McKenzie III, DVM, MS, PGCert (Vet Ed), FHEA, DACVIM (LAIM) Associate Professor of Large Animal Medicine Chief, Equine Section Department of Veterinary Clinical Sciences Virginia Maryland Virginia Tech Blacksburg, Virginia James N. Moore, DVM, PhD, DACVS Josiah Meigs Distinguished Teaching Professor Director, Educational Resources P. O. Eric Mueller, DVM, PhD, DACVS Director of Equine Programs Professor of Surgery Department of Large Animal Medicine Michael J. Murray, DVM, MS, DACVIM Technical Marketing Director US Pets Parasiticides, Merial Inc. Duluth, Georgia Jorge E. Nieto, MVZ, PhD, DACVS, DACVSMR Chief, Equine Surgical Emergency and Critical Care Service Veterinary Medical Teaching Hospital University of California, Davis Davis, California Georgios Paraschou, DVM, MRCVS Anatomical Veterinary Pathologist Pathology Laboratory The Donkey Sanctuary Honiton, Devon Andrew H. Parks, MA, Vet MB, DACVS Olive K. Britt & Paul E. Hoffman Professor Department Head, Large Animal Medicine John F. Peroni, DVM, MS, DACVS Associate Professor Department of Large Animal Medicine Veterinary Medical Center Shannon E. Pratt Phillips, MS, PhD, PAS Associate Professor Department of Animal Science North Carolina State University Raleigh, North Carolina Christopher J. Proudman, MA, Vet MB, PhD, Cert EO, FRCVS Specialist in Equine Gastroenterology Head of School School of Veterinary Medicine University of Surrey Guildford, Surrey Peter C. Rakestraw, MA, VMD, DACVS Consultant, Veterinary Surgeon Korean Racing Association Seoul South Korea Karen J. Rickards, PhD, BVSc, MRCVS Principal Veterinary Surgeon Veterinary Department The Donkey Sanctuary Sidmouth, Devon Anna K. Rötting, DrMedVet, PhD, DACVS, DECVS German Specialist for Horses (Surgery and Orthopedics) Section Head Equine Surgery Clinic for Horses University of Veterinary Medicine Hanover Germany

12 xii List of Contributors Elizabeth M. Santschi, DVM, DACVS Professor of Equine Surgery Department of Clinical Sciences Kansas State University Manhattan, Kansas Alexandra K. Thiemann, MA, Vet MB, Cert EP, MSc, Assoc Vet Ed, MRCVS Senior Veterinary Surgeon Veterinary Department The Donkey Sanctuary Sidmouth, Devon Cynthia M. Trim, BVSc, DVA, DACVAA, DECVAA, MRCVS Emeritus Professor of Anesthesiology Department of Large Animal Medicine J. Scott Weese, DVM, DVSc, DACVIM Professor Department of Pathobiology Ontario Veterinary College University of Guelph Guelph, Ontario Canada Nathaniel A. White II, DVM, MS, DACVS Professor Emeritus of Equine Surgery Marion dupont Scott Equine Medical Center Virginia Maryland College of Veterinary Medicine Virginia Tech Leesburg, Virginia Canaan M. Whitfield Cargile, DVM, DACVS, DACVSMR Assistant Professor of Large Animal Surgery Department of Large Animal Clinical Sciences and Biomedical Sciences Texas A&M University College Station, Texas

13 xiii Preface Colic is a clinical syndrome that has frustrated horse owners and veterinarians for centuries, and that remains the same today. In fact, colic continues to be at or near the top of the list of causes of death in horses. Advances made over the past three decades in recognition of colic as well as medical, anesthetic, and surgical techniques have significantly improved the prognosis for any horse presented with colic. For example, horses with even the most devastating forms of colic, such as large colon volvulus, can have an excellent prognosis for survival if they are treated early in the disease process. This edition of The Equine Acute Abdomen details further advances in early recognition of colic, including recognition of pain using subtle behavioral signs, evaluation of biomarkers indicative of ensuing severe disease, advances in imaging the abdomen, and approaches to determining the prognosis. An area of equine practice that has changed the most since the previous edition of this book is critical care, with many hospitals now employing criticalists. Consequently, several chapters in this edition detail important advances in areas such as fluid therapy, nutrition, and the appropriate use of antimicrobial, anti inflammatory, and prokinetic agents. There is also a comprehensive new section on colic in foals. This edition of The Equine Acute Abdomen explores discoveries in exciting new areas related to colic, such as the role of intestinal stem cells and the microbiome. We expect that advances in these and other areas will likely have a vital role in our future understanding of the pathogenesis and consequences of colic. This edition additionally includes up to date information on the epidemiology, pathophysiology, and treatment of specific diseases that cause colic, as well as important topics that often receive less attention, such as colic in the donkey, grass sickness, and biosecurity. Given the breadth of information covered in this edition, we hope that the reader will be better prepared to intervene when horses are presented with colic. It also is our hope that this edition will inform veterinarians about the latest advancements in critical care, introduce them to some of the current trends in equine colic research, and help them improve their ability to pre empt or ameliorate colic. Dedication Dedicated to the horses we ve learned from throughout our careers, including the ones we ve treated on the clinic floor, worked with in the research laboratory, and partnered with to teach veterinary students.

14 xiv About the Companion Website This book is accompanied by a companion website: The website includes: Animations Figures from the book as PowerPoint slides, to download