Intra-abdominal adhesions Flashcards Preview

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Flashcards in Intra-abdominal adhesions Deck (71)
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1

What are adhesions?

a type of scar tissue that forms between organs and tissue after abdominal surgery

2

That are the steps of adhesion?

1. tissue injury
2. inflammatory response
3. fibrin deposition
4. adhesion

3

What species are most likely to get adhesions?

horses
humans

4

What is the second most common cause for repeat celiotomy in horses after abdominal surgery?

adhesions

5

What is the most common reason for death after surgery in horses with intestinal lesions?

adhesions

6

What are risk factors associated with adhesions in horse?

1. small intestinal lesions (handling!)
2. prolonged post-op ileus
3. repeated exploratory celiotomy
4. age (higher in foal esp

7

What two things predispose to adhesion formation?

1. inflammation
2. ischemia

8

What are examples of inflammation in the abdominal cavity?

1. peritoneal trauma
2. infection
3. bacterial contamination
4. foreign materia

9

What are examples of ischemia in the abdominal cavity?

1. strangulating lesion
2. vascular compromise
3. intestinal distention
4. tight sutures

10

What occurs with inflammation and necrosis in the pathogenesis of adhesion formation?

1. increased fibrin deposition
2. decreased fibrinolysis

11

What are the two key activators to get from plasminogen to plasmin? REMEMER

1. tissue plasminogen activator
2. urokinase plasminogen activator (uPA)

12

What pathways result in fibrin deposition?

intrinsic/extrinsic/common

13

What pathways result in fibrin deposition?

intrinsic/extrinsic/common

14

Under normal conditions, what happens to fibrin?

peritoneal fibrinolytic activity causes lysis of fibrin and adhesions within 48-72 hours

15

What balance is disrupted when adhesions occur?

coagulation/inflammation and fibrinolysis.

Thus fibrin deposition exeeds fibrinolysis

16

What occurs to fibrinous adhesions?

there is maturation and inadequate adhesions, that leads to inadequate permanent fibrous adhesions

17

When do permanent fibrous adhesions occur?

7-14 days after surgery

18

What are consequences of the formation of fibrous adhesions?

1. compression or distortion of intestines, narrowing of lumen
2. impedement of of normal passage of ingestion

19

Are fibrinous adhesions an issue?

no, they undergo fibrinolysis in 48-72hrs

20

Are omental adhesions a problem?

no, they can even be helpful to increase vascular supply in other species but maybe not horse.
rarely cause clinical problems--may entrap small intestine

21

How do fibrous adhesions form?

1. Due to inadequate fibrinolysis
2. result from ingrowth of fibroblasts and endothelium

22

Where can focal fibrous adhesions occur?

1. intestine to mesentery
2. intestine to incision
3. intestine to peritoneum

23

What are the two key activators to get from plasminogen to plasmin? REMEMER

1. tissue plasminogen activator
2. urokinase plasminogen activator (uPA)

24

What is the most common cause of recurrent abdominal pain in horses after small intestinal surgery

adhesions

25

What is the 2nd most common cause of performing a repeat celiotomy after abdominal surgery?

dhesions

26

What is one of the most common reasons for euthanasia after surgery in horses with small intestinal lesions

adhesions

27

What is the most consistent clinical sign associated with abdominal adhesions in horse?

recurrent colic

28

What are risk factors for post-op intra-abdominal adhesions in horses?

1. small intestinal lesions
2. intestinal resection and anastomosis
3. prolonged post-op ileus
4. repeated exploratory laparotomy (celiotomy)
5. age (higher incidence in foals and miniature horses than adults)
6. peritonitis and abdominal abscesses

29

What foals are the most likely to get adhesions?

30 days old

30

What are the two theories of adhesion formation?

1. adhesion forms in response to ischemia to supply vascular and cellular support to damaged ischemic intestine and facilitate healing
2. adhesions are a detrimental process caused by inflammation and ischemia which results in depression of fibrinolysis (especially depression of tissue plasminogen activator)