Small Intestine

Small Intestine


Ileal Impaction



Basic Information image



Definition


Impaction of the distal-most segment of the small intestine (ileum) extending from the ileocecal papilla orally for varying lengths



Epidemiology



Species, Age, Sex




• Reported in very young and older foals


• More common in adult horses



Risk Factors




• Associated with feeding coastal Bermuda hay (CBH)


• Parasitism: Anoplocephala perfoliata (tapeworms), Strongylus vulgaris (less common)


• Poor water intake



Geography and Seasonality




• Particularly common in southeast United States


• Summer through late fall (June to November)



Associated Conditions and Disorders




• Parasitism


image Association between tapeworm infestation and ileal impactions has been made in the United States and Europe. These parasites attach to the intestinal mucosa at the ileocecal junction, causing mucosal inflammation, edema, and ulceration. Extent of injury is proportional to the number of parasites attached (>100 tapeworms)

image S. vulgaris infestation may cause changes in motility and blood supply to the ileum. Uncommon because of current deworming practices.

• Ileal hypertrophy



Clinical Presentation



History, Chief Complaint


Clinical signs are consistent with abdominal discomfort or colic. Early in the disease, pain is caused by spasmodic contraction of the ileum around the impaction. Systemic compromise is not seen at this stage. As the disease progresses, signs of colic worsen caused by the progressive distension of the small intestine with gas and sequestered fluids. Systemic signs of dehydration also start to appear. If not treated, intestinal or gastric rupture may occur. Important historical information usually includes an abrupt change in feeding practices, such as



• Change from different type of grass hay or alfalfa to CBH over an inadequate period of time


• Horse has been on CBH but recently fed a new cutting of hay.


• On a different grass or alfalfa hay and had recent unexpected exposure to CBH



Physical Exam Findings


Physical examination findings consistent with abdominal discomfort (colic)



• Tachycardia


• Tachypnea


• Normothermic


• Reduced or absent borborygmi


• Progressive signs of dehydration


• Pale, tacky mucous membranes


• Prolonged capillary refill time


• Injected sclera



Etiology and Pathophysiology




• Abrupt change in feeding practices, particularly to CBH from other grass hay or legume hay. Lignin and crude fiber content increases as hay matures as with tall stands or in late summer and early fall.


• Tapeworm infestation causes mucosal injury, resulting in changes in intestinal motility and reduction in size of the ileocecal papilla.


• Ileal hypertrophy causes changes in intestinal motility and variable reduction in size of the ileal lumen.



Diagnosis image



Differential Diagnosis


Other causes of simple obstruction of the small intestine



• Inflammatory disease


• Intussusception


• Ascarid impaction (young animals)


• Ileal hypertrophy (older animals)


• Nonstrangulating infarction

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Jul 24, 2016 | Posted by in SMALL ANIMAL | Comments Off on Small Intestine

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