Part 1. Normal Anatomy and Physiology
Chapter 1
Gross and Microscopic Anatomy of the Equine Gastrointestinal Tract
Thomas M. Krunkosky, Carla Jarrett, and James N. Moore
Esophagus 5
Esophagus-Stomach Junction 7
Stomach 7
Stomach-Small Intestine Junction 11
Small Intestine 11
Large Intestine 14
Liver 17
Spleen 18
Pancreas 19

Chapter 2 Physiology of the Digestive Tract Gastric Secretory Function – Michael J. Murray 22
Small Intestine Function – David E. Freeman 25
Digestive Physiology – Anatomy 25
Intraluminal Digestion 28
Absorption of Ions and Water 29
Absorption of Carbohydrate, Protein and Fat 32
Iron Absorption 33
Calcium and Magnesium Absorption 34
Intestinal Secretion 35
Motility 36
Control of Motility 37
Function of the Ileum 38
Large Bowel Function – Marco A.F. Lopes 41
Motility Patterns and Transit of Contents 41
Microbial Activity and Fermentation 42
Secretion and Absorption 45
Liver Function – Tim S. Mair 54
Bile Acid Metabolism and Excretion of Bile 54
Protein Metabolism 54
Carbohydrate Metabolism 55
Lipid Metabolism 55
Detoxification and Drug Metabolism 56
Storage 56

Chapter 3 Effects of Feeding on Equine Gastrointestinal Function or Physiology
Marco A.F. Lopes
Feeding Grain 58
Feeding Lush Grass 62
Replacing Grain With Fat 62
Feeding Mature Grass and Poor Quality Hay 62
Feeding Large Meals Intermittently and Fasting 62

Chapter 4 Intestinal Motility and Transit
Peter C. Rakestraw
Physiology of Normal Motility 68
Pathophysiology of Ileus 80
Treatment of Motility Disorders in the Horse 82

Part 2 Pathophysiology of Gastrointestinal Diseases
Chapter 5 Pathophysiology of Gastric Ulcer Disease
Michael J. Murray
Gastric Ulcer Disease 96

Chapter 6 Pathophysiology of Gastrointestinal Disease: Obstruction and Strangulation
Anthony T. Blikslager
Simple Obstruction 100
Strangulating Obstruction 101
Intestinal Reparative Mechanisms 107

Chapter 7 Prevention and Treatment of Postoperative Intraabdominal Adhesions in Horses
P.O. Eric Mueller
Current Concepts in Pathophysiology of Adhesion Formation 119
Diagnosis of Intraabdominal Adhesions 120
Current Concepts in Prevention of Adhesion Formation 121
Separation of Adhesiogenic Surfaces 122
Treatment of Intraabdominal Adhesions 125
Adhesion Prevention Strategies 125

Chapter 8 Pathophysiology of Peritonitis
John F. Peroni
Anatomy and Physiology of the Peritoneum 130
Etiology of Peritonitis 131
Clinical Presentation 131
Diagnostic Approach 132

Chapter 9 Pathophysiology of Enteritis and Colitis
Harold C. McKenzie
Inflammation 136
Pain 137
Ileus 137
Hypermotility 137
Hypersecretion 138
Osmotic Diarrhea 138
Decreased Absorption 138
Endothelial Dysfunction 138
Specific Diseases 138

Chapter 10 Malabsorption Syndromes
Tim S. Mair and Thomas J. Divers
Causes of Malabsorption Syndrome 148
Clinical Signs 155
Diagnosis 156
Treatment 158

Chapter 11 Liver Diseases and Liver Failure
Tim S. Mair and Thomas J. Divers
Causes of Liver Disease 162
Diagnosis of Liver Disease 165
Hyperlipemia 167
Theiler’s Disease (Serum Hepatitis) 174
Other Causes of Acute Hepatic Disease and Failure in Adult Horses 178
Pyrrolizidine Alkaloid Intoxication 178
Cholangiohepatitis and Choledocholithiasis 182
Other Biliary Conditions 185
Chronic Active Hepatitis 185
Klein Grass (Panicium Coloratum) Toxicity 186
Alsike Clover Toxicity 186
Hepatic Neoplasia 187
Hepatic Amyloidosis 187
Iron Overload, Hemochromatosis 187
Right Hepatic Lobe Atrophy 188

Chapter 12 Systemic Inflammatory Response Syndrome: Endotoxemia Reconsidered
Clare E. Bryant and James N. Moore
Responses to Pathogen-Associated Molecular Patterns 192
Receptors for Gram-Negative Bacteria and Bacterial Ligands 193
Receptors for Gram-Positive Bacteria and Bacterial Ligands 195
Systemic Inflammatory Response Syndrome 196
Inflammatory Mediators and Their Source in the Horse 197

Part 3. Intestinal Parasitism
Chapter 13 Intestinal Parasitism
Christopher J. Proudman
Principles of Iintestinal Parasitism 204
Strongylus Vulgaris 204
Cyathostomins 207
Tapeworms 208
Parascaris Equorum 210
Other Intestinal Parasites 211
Prevention 211

Part 4. Epidemiology
Chapter 14 Epidemiology of Colic
Noah D. Cohen
General Epidemiologic Considerations 218
Incidence of Colic 222
Factors that Predispose to Colic 222
Factors Indicating the Need for Surgical Management of Colic 225
Frequency of and Factors Associated with Survival from Colic and Colic Surgery 226
Study of Colic Problems in Individuals and Herds 228

Part 5. Diagnosis
Chapter 15 Diagnosis of Gastrointestinal Disease
Emma L. Rowe and Nathaniel A.White
Signalment 236
History 237
Physical Examination 238
Hematology, Blood Gases, and Serum Biochemistry 270
Ultrasonography 271
Radiographs 276
Endoscopy 278
Laparoscopy 280
Fecal Examination 280
Transit Time 281
Exploratory Laparotomy 281
False Colic 281
Decision for Surgery 282

Part 6. Medical Management
Chapter 16 Medical Management of Gastrointestinal Diseases
Tim S. Mair
Analgesia 292
Choice of Analgesics in Colic 297
Treatment of Intestinal Spasm and Spasmodic Colic 298
Treatment of Obstruction 298
Treatment of Flatulence and Tympany 302
Treatment of Ileus 303

Chapter 17 Treatment of Shock
Kevin T. T. Corley
Support of the Cardiovascular System 310
Fluid Therapy 310
Acid Base Balance 312
Types of Fluid 316
Oral Fluids 324
Delivery Systems 326
Recognition of Hypovolemia and Dehydration 327
Treatment Strategies 329

Chapter 18 Treatment of Endotoxemia
Kevin T. T. Corley and Gayle D. Hallowell
Drugs that Bind or Block Endotoxin 338
Anti-Inflammatory Agents 340
Modulation of the Coagulation System 342
Drugs Affecting Intracellular Metabolism 344

Chapter 19 Treatment of Peritonitis
John F. Peroni
Medical Treatment 352
Interventional Treatment 352
Complications and Prognosis 354

Chapter 20 Diagnosis and Treatment of Enteritis and Colitis in the Horse
Harold C. McKenzie
Diagnosis 356
Specific Syndromes 356
Treatmen 360
Supportive Therapies 360
Specific Therapies 366
Surgery 369
Specific Diseases 370

Chapter 21 Nonsurgical Management of Nephrosplenic Entrapment of the Large Colon
Joanne Hardy
Clinical Presentation 383
Diagnosis 383
Nonsurgical Correction 385
Complications and Prognosis 387
Prevention of Recurrence 387

Chapter 22 Colic in the Foal
Martin O. Furr
Abdominal Radiography 391
Gastroendoscop 393
Ultrasonography 393
Abdominocentesis 394
Case Synthesis and Management 395
Surgical Treatment 396
Gastroduodenal Ulceration 397
Small-Intestinal Obstruction 397
Large-Colon Obstruction 397
Atresia 398

Part 7. Nutritional Management
Chapter 23 Nutritional Management of the Colic Patient
Ray J. Geor
Rationale for Early Initiation of Nutritional Support after Colic and Intestinal Surgery 404
Estimating Nutrient Requirements 405
Modes of Nutritional Therapy 406
Feeding Management of Specific Gastrointestinal Conditions 412

Part 8. Anesthesia for Abdominal Surgery
Chapter 24 Anesthesia for Horses with Colic
Cynthia M. Trim
Preanesthetic Assessment 420
Anesthetic Agents 421
Induction of Anesthesia 422
Maintenance of Anesthesia 422
Anesthetic Agents in Foals 424
Monitoring 424
Cardiovascular Support 428
Hypercapnia and Hypoxemia 434
Airway Management 435
Recovery from Anesthesia 436
Anesthesia for Surgery in the Standing Horse 437

Part 9. Surgery for Acute Abdominal Disease
Chapter 25 Preparation of the Patient
David E. Freeman
Patient Preparation 444
Antiseptics Agents 445
Draping the Surgery Site 446

Chapter 26 Surgical Exploration and Manipulation
David E. Freeman
Ventral Midline Incision 452
Inguinal Approach 454
Flank Laparotomy 455
Alternative Approaches 455
Abdominal Exploration 456
Examination and Handling of Small Intestine 468
Examination and Handling of Large Intestine 469
Special Circumstances 470
Intestinal Placement 472

Chapter 27 Surgical Techniques
David E. Freeman
Surgical Team 474
Surgical Environment and Equipment 475
Gowns, Drapes and Accessories 476
Decompression and Drainage 477
Laparotomy Sponges 482
Surgical Instruments and Suture 482
Stapling Instruments 485
Miscellaneous Instruments 489
Surgical Procedures in the Small Intestine 489

Chapter 28 Intestinal Viability
David E. Freeman
Small Intestine 502
Large Colon and Cecum 509
Small Colon 510

Chapter 29 Large-Colon Enterotomy, Resection and Anastomosis
Joanne Hardy
Large-Colon Enterotomy 514
Large Colon Resection 516

Chapter 30 Small Intestinal Resection and Anastomosis
David E. Freeman
Extent of Resection 522
Resection of Mesentery 522
Decompression 522
Resection and Anastomosis 523
Stoma Size 525
End-to-End Anastomosis 527
Stapled Jejunojejunostomy 528
Everted Triangulated Stapled Anastomosis 530
Stapled versus Handsewn Anastomoses for Jejunojejunostomy 530
Jejunoileostomy 531
Jejunocecal and Ileocecal Anastomoses 532
Pelvic Flexure Colotomy 536

Chapter 31 Abdominal Closure
David E. Freeman
Closure of the Peritoneum 540
Linea Alba Closure 540
Techniques and Principles 543
Subcutaneous Closure and Skin 544
Incisional Dressing 545
Recovery Stall 545
Abdominal Bandages 545
Postoperative Care 546
Healing of the Equine Linea Alba 546
Special Circumstances 547
Secondary Closure 548

Part 10. Intensive Care and Postoperative Care

Chapter 32 Monitoring Treatment for Abdominal Disease
Tim S. Mair and Thomas J. Divers
Frequency of Examinations 554
Physical Examinations 554
Monitoring Clinical Pathology Parameters 560

Chapter 33 Postoperative Complications
Christopher J. Proudman
Postoperative Colic 564
Postoperative Ileus (POI) 565
Jugular Thrombosis and Thrombophlebitis 566
Incisional Infection 568
Incisional Hernia Formation 569
Adhesions 570
Laminitis 572

Part 11. Specific Diseases
Chapter 34 Diseases of the Stomach
Michael J. Murray
Gastric Ulcer Syndromes 578
Gastric Impaction 582
Gastric Dilation 583
Neoplasia 583

Chapter 35 Liver Diseases In Foals
Tim S. Mair and Thomas J. Divers
Portosystemic Shunts 586
Tyzzer’s Disease 586
Equine Herpes Virus 1 Hepatitis 588
Liver Failure in Foals after Neonatal Isoerythrolysis 588
Umbilical Vein Abscess Affecting the Liver 589
Portal Vein Thrombosis 589
Hyperammonemia of Morgan Foals 590
Bile Duct Obstruction 590
Toxic Hepatopathy 591

Chapter 36 Diseases Of The Small Intestine
David E. Freeman
Strangulating Obstruction 594
Nonstrangualting Obstruction 605
Inflammatory and Infiltrative Diseases 610

Chapter 37 Diseases of the Cecum; Cecocecal and cecocolic intussusception
James N. Moore and Joanne Hardy
Cecal Tympany 618
Cecal Impaction 619
Cecocecal and Cecocolic Intussusception 622

Chapter 38 Specific diseases of the large colon
Joanne Hardy
Large-Colon Tympany 628
Large Colon Impaction 628
Sand Impaction 631
Enterolithiasis 633
Large-Colon Displacement 634
Other Simple Obstructions of the Large Colon 639
Large-Colon Torsion/Volvulus 639
Right Dorsal Colitis 642
Mural Infarction (Thromboembolic Colic) 644
Other Strangulating Lesions of the Large Colon 644

Chapter 39 Disorders of the Small Colon
John F. Peroni
Surgical Considerations Affected by Anatomic Features of the Small Colon 650
Obstructive Lesions 651
Vascular and Strangulating Lesions 656

Chapter 40 Vascular and strangulating lesions
Peter C. Rakestraw
Anatomy 660
Etiology and Prevention 660
Location and Classification of Rectal Tears 660
Clinical Signs and Diagnosis 662
Emergency Management 663
Medical Management 664
Surgical Management 665
Temporary Indwelling Rectal Liner 665
Loop Colostomy 666
Primary Repair 671
Nonvisual Direct Suturing Per Rectum 671
Ventral Midline Exposure and Antimesenteric Enterotomy for Suture Repair 673
Prognosis and Recommendations 674

Chapter 41 Colic and Pregnancy
Elizabeth M. Santschi
Colic during Pregnancy 678
Colic in the Peripartum Period 683

Chapter 42 Colic From Alternative Systems – “False Colics”
Tim S. Mair
Pain Associated with the Female Reproductive Tract 689
Pain Associated with the Male Reproductive Tract 695
Pain Associated with the Urinary Tract 695
Liver Diseases 697
The Pancreas 697
The Spleen 698
Pain Associated with the Respiratory Tract 698
Pain Associated with Cardiovascular Disease 700
Pain Associated with the Musculoskeletal System 700

Chapter 43 Abdominal Injuries
John F. Peroni
Diagnostic Approach 704
Treatment 707

Chapter 44 Laminitis Associated with Acute Abdominal Disease
James K. Belknap and Andrew H. Parks
Pathogenesis 710
Clinical Presentation 716
Treatment 719

Index 731

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