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Diseases of the Small Intestine
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Small intestinal problems
Nonstrangulating obstructions include ileal impaction, ascarid impactions, duodenitis/ proximal jejunitis, gastroduodenal obstruction, neoplasia, simple impactions, and ischemic diseases. Surgical diseases of the small intestine may be either non- strangulating or strangulating obstructions. Strangulating obstructions are more common and may result from multiple causes including volvulus, epiploic foramen entrapment, intussusception, pedunculated lipoma, mesodiverticular bands, mesenteric rents, and strangulating inguinal, diaphragmatic or other hernias. Strangulating lesions result in compromised blood flow to the intestine, with resulting venous (hemorrhagic) or venous and arterial (ischemic) damage. Severe complications including hypovolemia, endotoxemia, hemorrhage, adhesions and ileus often result from such obstructions.
Non-strangulating obstruction
Ileal Impactions
Impactions of the ileum may occur primarily or secondary to diseases such as muscular ileal hypertrophy. Impactions may be soft or solid, extending up to 90 cm orally from the ileocecal junction. Ileal impaction has been associated with feeding coastal Bermuda grass hay or tapeworm infestations. Small intestinal distention is a common finding, although the impaction may be felt on rectal examination. Medical treatment is possible, although surgical decompression alone or together with resection and anastomosis is recommended for cases with persistent pain, progressive abdominal distention, physiologic deterioration or abnormal abdominal fluid.
Simple Impactions
Small intestinal obstruction may occur due to several problems including ascarid impactions, impaction with feed material such as compressed cracked corn, ingestion of persimmon fruit, foreign body ingestion such as hay nets, baling twine, or wood bedding, trichophytobezoars, and choleliths. Clinical signs are consistent with SI obstruction and include SI distention, gastric reflux and variable pain. Gastroduodenal obstruction may occur secondary to duodenal inflammation, ulcers, and stenosis. Foals younger than 4 months of age subjected to disease, NSAID’s, stress, surgery, or transportation are at increased risk. Duodenal obstruction may cause severe pain and large volumes of gastric reflux or spontaneous reflux through the nose.
Ischemic Diseases
Nonstranglating infarction and severe necrotic enteritis or enterocolitis are rare involving the small intestine and carry a poor prognosis.
Strangulating obstruction
SI Volvulus
Volvulus is the rotation of jejunum and or ileum around the root of the mesentery greater than 180 degrees. Most SI volvulus cases involve long segments of intestine rotated 360 degrees. A volvulus may be a primary lesion, or secondary to other problems including adhesions, SI herniation, mesodiverticular band, Meckel diverticulum, SI strangulation and/or distention. Two types of volvulus are described: one where the SI rotates around the mesentery forming coils of distended intestine; a second termed volvulus nodosus where the ileum and jejunum undergo torsion and knotting. Correction of a volvulus may be difficult. Rotation of the entire SI mass around the root of the mesentery usually is successful, except for volvulus nodosus, where additional manipulation and correction of the knotted intestine is necessary. [...]
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