5 Management of Ileus

Transcript

A warm Greetings! to all,

We have been seeing about Intestinal Ileus in cattle and in the previous lesson we have seen about Ultrasonography features of the thorax as well as the abdominal cavity.

In this lesson we are going to see the Ultrasonic features of Pregnancy and more important is the ultrasonic features of the Intestine and the Management of the Ileus.

Ultrasonography of pregnancy: here we need to appreciate the fetal heart movement and movements of the fetus and we have to recognition of the gestation sac, fetal parts, and heartbeat.

(Showing pictures in the slide) this ultrasonic feature depicts the chest cage of the fetus, where we can see the central part, and the heartbeat is also noticed.

Pregnancy:(Showing pictures in the slide) On the left side we can see the live fetus, where the heartbeat is also seen, and the fetal also actively moves as indicated by the arrow. On the right side, there is another fetus with the movement of the fetus.

Pregnancy ultrasonographic examination: here we can see the fetal head and the active movement of the fetal head, this is a frozen image that is used for assessment of the fetal age. Ultrasonic feature of an early fetus: So, where you can see the entire thoracic cavity and the movement of the heart.

(Showing pictures in the slide) this slide shows where we are going to place the probe for ultrasonic investigation of the intestine, here we are going to investigate from tuber coxae to the 8th intercostal space, transverse process of the vertebrae to the linear album on the right side, so the usual diameter is usually 2-4 centimeter.

Normal small intestine: now we can see the cross-sections of a healthy small intestine, where you can see sacculations with echogenic content. So, the loops are in cross-section mostly in cross-section, occasionally we see it in longitudinal sections.

(Showing pictures in the slide) These are ultrasonic features of the small intestine where there is a beautiful cross-sectional image of the Intestine with echogenic content.

Dilated Caecum: it is usually with gas and the wall of the large intestine- the outer part is visualized as a thick echogenic line. Sometimes as echogenic semicircular lines, the internal content is usually not visualized.

This is the Ileus: where the concentration has to be done on Diameter, Motility, and Evidence of peritonitis. Here the diameter is usually increased by more than 4 centimeters and there will be hypermotility and usually, there will be an accumulation of fluid or peritoneal diffusion in case of delayed cases.

Ultrasonic examination of the Intestine: In this case, we can appreciate dilated intestine and the diameter is more than 4 centimeters. Here ultrasonic features of the intestine in the case of Ileus in addition to the increase in the diameter we can see anechoic fluid in between the Intestine.

Intussusception: Intussusception in the future has to be identified by the target lesion, as we see as round concentric rings of anechoic and hyperechoic lines.

(Showing video in the slide) the left side shows a rectal examination of an intussusception, there is an echogenic lumen, that is intestine and in the caudal or ventral part, we can see concentric anechoic and hyperechoic lines indicative of intussusception.

(Showing pictures in the slide) This case is shown by anechoic intestinal loops and echogenic intestinal loops on the ventral part. So anechoic intestinal loops are with fluid, and echogenic is with the intestinal content. so, this indicates Intestinal obstruction.

Ileus: after having identified functional Ileus, by excluding mechanical Ileus and elimination by individual disease or disorder, a functional Ileus diagnosis is made. Once the diagnosis is made the important part is fluid therapy, the fluid has to be calculated based upon the dehydration as well as the maintenance requirement and it has to be given by rapid intravenous fluid administration set, to achieve the effective circulating volume. Usually, this will be supplemented with Calcium Potassium, and Phosphorus, the various dose are Calcium at 1gram/45 kg BW Potassium at 0.5 milliequivalent/kg BW, Phosphorus usually 4 (Dimethylamino)- 2(Methylphenyl phosphonic acid) is administered at the rate of 10 milligram/kg BW IV, all these have to be diluted in a normal Saline.

Management of Ileus can be done with the 3 drugs namely:

• the Neostigmine
• Metoclopramide and
• Erythromycin Neostigmine- the dosage is 0.02 gram/kg BW and it has to be diluted in normal saline and can be given.

Another drug for the management of a functional Ileus is Metoclopramide at the dosage of 0.1 milligrams/kg BW essentially needs to be diluted in normal saline and administered. The effective drug when compared to the Metoclopramide and Neostigmine is Erythromycin, so at 1.1 milligrams to 8.8 milligrams per kg IV is very effective in producing the normal motility from 20 hours to 24 hours.

We have been discussing the various Etiology and how to Differentiate the Mechanical and Functional Ileus, the Ultrasonography features of various disease conditions, and how to Manage the Intestinal Ileus.

This has to be followed to avoid the mortality in the animal because the loss of animals is a reduction in the economy of the farmer.

Thank you very much.