Presentation on theme: "Gastric and Esophageal Diverticulum Rupture in a Friesian Gelding"— Presentation transcript:
1Gastric and Esophageal Diverticulum Rupture in a Friesian Gelding Lindsay ChaseMay 7th 2014Clinical advisor: Dr. Kathleen mullenBasic science advisor: dr. Elizabeth buckles
2Signalment and History 17 year old Friesian Gelding1 day history of inappetence and lethargyApproximately 8 hour history of colic and dyspnearDVM FindingsTachycardic (80 bpm)DyspneicFebrile (102.60F)Muddy mucous membranes – CRT 3 secondsAbsent GI motilityNormal rectal palpation
3rDVM TherapyFlunixin meglumine, detomidine, ceftiofur crystalline free acidNasogastric tubeNo gastric refluxInstilled water and mineral oilHorse became uncomfortable during administrationReferred to Cornell for suspected colitis
4Physical Exam Vital Signs: Depressed BCS 7/9 T:101.7oF ( oF)P: 86 bpm (28-44 bpm)R: 52 bpm (8-16 bpm)DepressedBCS 7/9Small amount of malodorous nasal dischargeCardiovascularInjected mucous membranes with a toxic lineCRT 3 secondsGastrointestinalAbsent gut sounds in all quadrants
6Additional Diagnostics Thoracic UltrasoundNo pleural fluid or evidence of pleuritisAbdominal UltrasoundStomach of normal sizeThickened large colon and small intestinal wallsImaging was difficult because of BCSNo appreciable peritoneal fluidRectal ExamThickened but compressible loops of small intestineNasogastric IntubationUnable to pass tube beyond the cardia
7Problem List Colic Thickened SI and colon Inability to pass NG tube into stomachTachypneaEndotoxemiaDehydrationHypoproteinemiaHypochloremic metabolic alkalosisHypocalcemiaHyperlactatemiaLeukopenia
9Initial Stabilization and Treatment 1L Hypertonic saline bolus20L Plasmalyte bolusPlasmalyte CRI with electrolyte supplementationHetastarch CRILidocaine CRIAntiendotoxic dose of flunixin (0.25 mg/kg)CryotherapyOffered 3L of water – after drinking became uncomfortablePhoto courtesy of Dr. Sally Ness
10Re-evaluation No clinical improvement Thoracic ultrasound Pleural fluidAbdominal ultrasoundCopious amounts of flocculant peritoneal fluidUpper GI EndoscopyImpaction of feed material in distal esophagusAbdominocentesisSeptic peritonitis consistent with GI ruptureEuthanasia was elected and a necropsy was performedPhoto courtesy of Dr. Sally NessPhoto courtesy of Dr. Katie Mullen
11Photo courtesy of Dr. Kim Bonner Gross FindingsPhoto courtesy of Dr. Kim BonnerPeritoneal cavity contained ~60 L of peritoneal effusion with copious amounts of fibrin. No feed material was found in the fluid.
12Photos courtesy of Dr. Kim Bonner Gross FindingsPhotos courtesy of Dr. Kim BonnerLeft: 8 cm tear in impacted esophageal pulsion diverticulum caudal to the diaphragmRight: Severe smooth muscle hypertrophy of caudal esophageal wall (1.7 cm (normal thickness cm))
13Esophageal Diverticula Types of DiverticulaTractionShallow body and wide openingUsually secondary to esophageal injuryAble to transmit peristalsisNot prone to impactionPulsionFlask-like body and narrow openingMucosa protrudes through a defect in esophageal wallProne to impactionUsually located in cervical region in the horse
14Photos courtesy of Dr. Kim Bonner Gross FindingsPhotos courtesy of Dr. Kim BonnerLeft: Full thickness gastric tear (5.5 cm) located within a 10 cm partial tear (separation of tunica muscularis) along the lesser curvatureRight: Severe edema in pyloric gastric wall
15Regional Anatomy Esophagus Stomach Diaphragm Liver Left Dorsal Colon Left Ventral Colon312456Color Atlas of Veterinary Anatomy, Volume 2, The Horse. Vol. 2: Elsevier Health Sciences, Print.
16Photo courtesy of Dr. Elizabeth Buckles HistopathologyDistal EsophagusThickened tunica muscularisNo underlying condition was found that would have predisposed to either the gastric or esophageal lesionsPhoto courtesy of Dr. Elizabeth Buckles
17History of the BreedDeveloped in the Friesland province of the Netherlands1879 – Studbook was founded1913 – Only 3 approved stallions1928 – 8 approved stallions bred 358 maresCurrently 45,000 registered Friesians
18Common Anomalies and Diseases DwarfismHydrocephalusRetained placentaChronic Proliferating LymphangitisMegaesophagusAortic ruptureAortopulmonary fistulasAll photographs: Boerma, S., W. Back, and M. M. Sloet Van Oldruitenborgh-Oosterbaan. "The Friesian Horse Breed: A Clinical Challenge to the Equine Veterinarian?" Equine Veterinary Education 24.2 (2012): Web.
19Current Research Retrospective study conducted in 2013 852 horse necropsies over 6 years at Michigan State University42 horses had gross esophageal lesions, 10 were severe35.3% of Friesians submitted had severe esophageal lesions compared to 0.5% of other breedsMost common lesion was caudal esophageal smooth muscle hypertropyPrevalence in Friesians: 35% and all other breeds <3%Usually an incidental idiopathic finding in older horsesMegaesophagus was present in 6 Friesian horses, 5/6 had severe muscular hypertrophy
20Current Research Aortic Rupture Dwarfism Study published in April 2014 showed specific histological changesAccumulation of mucoid materialDisorganization and fragmentation of elastic laminaeSmooth muscle hypertrophyMedial necrosisHypothesized to be a genetic connective tissue disorder of elastin or collagenDwarfismTendons of dwarf Friesians and non-dwarf Friesians have been shown to have more elastic properties compared to control ponies
21Fenway Foundation for Friesian Horses Mission Statement“The Fenway Foundation for Friesian Horses is a not for profit corporation created to preserve and enhance the longevity and quality of life of Friesian horses by accruing pertinent equine, more specifically Friesian, information to educate the public and offering assistance regarding Friesian horses and their owners throughout North America.”ServicesRescue assistanceNecropsy assistanceHealth assistanceGenetic assistanceEducational assistanceContinuing Care Assistance Upon Incapacitation Or Death
22Necropsy AssistanceThe foundation will reimburse for necropsies on Friesians 17 years old and youngerWork in conjunction with Dr. Back at Utrecht University on the following:HydrocephalusDwarfismAortic ruptureMegaesophagusDetailed necropsy guidelines and sample information found at:
23Final Cost Emergency Colic Work-up Medications, Fluids and Supplies $768Medications, Fluids and Supplies$852.23Diagnostics$393.19Necropsy$214.40Total: $- Reimbursement from Fenway Foundation
24ReferencesBenders, N. A., J. B. Veldhuis Kroeze, and J. H. Van Der Kolk. "Idiopathic Muscular Hypertrophy of the Oesophagus in the Horse: A Retrospective Study of 31 Cases." Equine Veterinary Journal 36.1 (2004): Web.Boerma, S., W. Back, and M. M. Sloet Van Oldruitenborgh-Oosterbaan. "The Friesian Horse Breed: A Clinical Challenge to the Equine Veterinarian?" Equine Veterinary Education 24.2 (2012): Web.Fenway Foundation for Friesian Horses. N.p., n.d. Web. <http://www.fenwayfoundation.com/index.html>."Friesian Timeline." Friesian Horse Association of North America. N.p., Web. 01 May <http://www.fhana.com/timeline/>.Komine, M., I. M. Langohr, and M. Kiupel. "Megaesophagus in Friesian Horses Associated With Muscular Hypertrophy of the Caudal Esophagus." Veterinary Pathology Online (2013): n. pag. Sage Publications. Web. 1 Apr <http://vet.sagepub.com/content/early/2013/11/13/ >.Ploeg, M., V. Saey, C. Delesalle, et. al. "Thoracic Aortic Rupture and Aortopulmonary Fistulation in the Friesian Horse: Histomorphologic Characterization." Veterinary Pathology Online (2014): n. pag. Sage Publications. Web. 25 Apr <http://vet.sagepub.com/content/early/2014/04/16/ >.Yamout, S. Z., K. G. Magdesian, and D. A. Tokarz. "Intrathoracic Pulsion Diverticulum in a Horse." Canadian Veterinary Journal 53 (2012): Web.
25Questions? Thank you to: My advisors Class of 2014! Dr. Buckles Dr. MullenClass of 2014!