Page 898 - Equine Clinical Medicine, Surgery and Reproduction, 2nd Edition

Gastrointestinal system: 4.2 The lower gastrointestinal tr act 873

VetBooks.ir Surgery allows for identification of the inciting cause such as heparin has been used to decrease adhesion
formation, but its efficacy has not been proven.
as well as thorough abdominal lavage and placement of
abdominal drains.
Intravenous fluid therapy is often required. Prognosis
High fluid rates are often necessary early in the The prognosis depends on the cause of the peritoni-
disease because of dehydration and cardiovascular tis and the severity of the disease. If the underlying
compromise. Plasma transfusion may be required. cause cannot be identified and promptly corrected,
Broad-spectrum antimicrobial therapy, including the prognosis is grave. Peritonitis caused by intesti-
adequate anaerobic coverage (e.g. sodium/potassium nal rupture is almost invariably fatal. Complications
penicillin 20,000–40,000 IU/kg i/v q6 h, genta- are common and include intestinal adhesions and
micin 6.6–8.8 mg/kg i/v q24 h, and metronidazole laminitis. Treatment can be prolonged and expen-
(25 mg/kg p/o q8–12 h) is indicated. Treatment can sive. Idiopathic primary peritonitis carries a better
be changed if necessary, based on culture and sensi- prognosis with survival in >90% of cases. Long-term
tivity results. Flunixin meglumine is typically used complications are rare in cases of idiopathic primary
(1.1 mg/kg i/v q12 h). peritonitis.
Lavage of the abdomen is essential with severe
septic peritonitis. It is rarely indicated in idio- FURTHER READING
pathic primary peritonitis. Lavage can consist of Basoni V, De Busscher V, Lopez D, Verwilghen D,
a single ventral drain or a combination of dorsal Cassart D (2011) Evaluation of a protocol for fast
ingress and ventral egress drains. Drains can be localized abdominal sonography of horses (FLASH)
placed in standing sedated horses, ideally with admitted for colic. Vet J 188(1):77–82.
ultrasonographic guidance. Horses should be Blikslager AT, White NA, Moore J, Mair TS (2017) Equine
stabilised before drainage and intravenous fluid Acute Abdomen, 3rd edn. J. Wiley and Sons, Hoboken.
therapy should be administered to compensate for Nielsen MK, Reinemyer CR (2018) Handbook of
any fluid shifts that may occur. For lavage in adult Equine Parasite Control, 2nd edn. Wiley Blackwell,
Hoboken.
horses, 10–20 litres of balanced electrolyte solu- Reed SM, Bayly WM, Sellon DC (2018) Equine Internal
tion should be infused, then the drain(s) should Medicine, 5th edn. Elsevier, St. Louis.
be clamped and the horse walked for 10–20 min- Smith BP (2014) Large Animal Internal Medicine, 5th edn.
utes to distribute the fluid, after which the drain Elsevier, St Louis.
is opened. Further walking can facilitate drainage. Stumpfli H, Schoster A (2018) Recent advances in the
Intraperitoneal administration of antimicrobials is diagnosis and management of equine gastrointestinal
not usually indicated. Infusion of other substances disease. North Am Vet Clin Eq 34(1):1–180.