Adhesions, Abdominal

Adhesions, Abdominal



Basic Information image



Definition


Fibrous connection between intraabdominal organs or intraabdominal organs and the body wall



Epidemiology



Species, Age, Sex


Foals are predisposed; however, adhesions are also seen in adult horses.



Genetics and Breed Predisposition


Anecdotally, miniature horses are predisposed.



Risk Factors




• Foals


• Peritoneal inflammation


• Ischemic bowel


• Distended bowel


• Surgical manipulation


• Drying of the bowel during surgery


• Abrasion of the bowel during surgery


• Hemorrhage


• Peritonitis


• Presence of foreign material


• Bowel puncture



Clinical Presentation



History, Chief Complaint




• Horses with adhesions may be asymptomatic.


• Horses with adhesions may also present with inappetence, lethargy, and signs of colic.


• A high index of suspicion is necessary if the horse has a history of exploratory celiotomy.



Physical Exam Findings




• The heart rate is variable depending on the severity of the colic signs.


• The temperature is generally normal.


• Borborygmi are often reduced.


• The mucous membranes are generally pink and moist, but they may become tacky.


• Hydration is variable depending on the severity of colic.



Etiology and Pathophysiology




• Damage to the parietal or visceral peritoneum increases adhesion formation in two ways:


image Increase in fibrin formation and deposition

image Decrease in fibrinolytic activity

• Mechanism: disruption of the mesothelial cells leads to exposure of underlying connective tissue, blood vessels, collagen, lymphocytes, fibroblasts, mast cells, macrophages, and plasma cells.


image Release of vasoactive substances (prostaglandin E2, serotonin, bradykinin, and histamine) from the exposed submesothelial tissue leads to increased vascular permeability and extravasation of a fibrinogen-rich inflammatory exudate.

image Release of thromboplastin (tissue factor) and exposure of subendothelial collagen activate the intrinsic and extrinsic clotting cascade, leading to thrombin-mediated conversion of fibrinogen to fibrin.
image Normally, fibrin tags are lysed by plasmin in 2 to 5 days and the mesothelial layer repairs, but inadequate fibrinolysis allows fibroblasts to produce collagen by day 4, leading to fibrous adhesions.

image Increased production of plasminogen activator inhibitor reduces the conversion of plasminogen to plasmin.
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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Adhesions, Abdominal

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