Chapter 33 - Colic diagnosis

Question 1

Why is knowledge of analgesics and sedatives crucial in interpreting signs of pain and physical examination findings in colic patients?

Answer 1

These medications may alter clinical signs, affecting the accuracy of pain assessment.

Question 2

How is the heart rate useful in determining prognosis in colic patients with large and small intestinal disease?

Answer 2

It serves as an indicator of the physiologic response to pain, dehydration, and endotoxemia

Question 3

What conditions are associated with pyrexia in colic patients, and why may they not require immediate surgical intervention?

Answer 3

Conditions like anterior enteritis, colitis, septic peritonitis, and pleuropneumonia; they may not require surgery immediately.

Question 4

How does capillary refill time aid in the determination of hydration status and diagnosis of endotoxemia in colic patients?

Answer 4

Prolonged capillary refill time and brick-red or purple mucous membranes indicate endotoxemia.

Question 5

What is the significance of auscultating abdominal borborygmi in colic patients, and how does it help in diagnosis?

Answer 5

It subjectively assesses large intestinal motility, helping diagnose conditions affecting intestinal movement.

Question 6

How can abdominal sounds similar to a paper bag with sand be used in diagnosing sand impaction in colic patients?

Answer 6

These sounds, heard just caudal to the xiphoid process, suggest sand impaction, contributing to a tentative diagnosis.

Question 7

What are signs of pain in horses presented for colic, and how is the severity of pain related to the need for surgical intervention?

Answer 7

Signs include pawing, flank-looking, and rolling; severe pain may indicate the need for immediate surgery.

Question 8

Why is placing an intravenous jugular catheter and beginning fluid therapy prudent during colic examination?

Answer 8

It allows for fluid therapy while further diagnostic procedures are performed.

Question 9

What is the normal appearance of peritoneal fluid, and how does abnormal fluid appearance aid in diagnosing colic conditions?

Answer 9

Normal fluid is clear to light yellow; turbid and serosanguinous fluid indicates strangulating lesions.

Question 10

What information can be obtained from the measurement of blood packed cell volume (PCV) and total protein (TP) in colic patients?

Answer 10

It helps quickly assess hydration status and prognosis, with high PCV associated with poor prognosis.

Question 11

Why are acute-phase proteins like serum amyloid A (SAA) useful in distinguishing between different categories of colic?

Answer 11

Elevated levels, especially SAA, can indicate the need for surgical management.

Question 12

What is the significance of peritoneal fluid examination in colic patients, and what conditions can be diagnosed using this method?

Answer 12

It aids in diagnosis and prognosis, detecting conditions like strangulating lesions and septic peritonitis.

Question 13

Why is prompt surgical intervention critical in maximizing the probability of a successful outcome in colic patients?

Answer 13

Delayed exploratory celiotomy may result in visceral rupture or deterioration, reducing the chance of a successful outcome

Question 14

What is the purpose of administering antimicrobial prophylaxis in colic patients undergoing surgery?

Answer 14

Antimicrobial prophylaxis is administered to reduce the risk of incisional infection, septic peritonitis, and adhesion formation.

Question 15

What is the prevalence range of incisional surgical site infection (SSI) in colic patients?

Answer 15

The prevalence of incisional SSI has been estimated to be between 3% and 20%.

Question 16

Which bacterial isolates are commonly associated with incisional infections in colic patients?

Answer 16

Escherichia coli, Streptococcus, and Staphylococcus spp. are commonly associated with incisional infections.

Question 17

What antimicrobial is considered a suitable first-choice for gram-negative bacteria such as E. coli?

Answer 17

Gentamicin, a bactericidal aminoglycoside, is considered a suitable first-choice antimicrobial for gram-negative bacteria.

Question 18

How is the effectiveness of gentamicin dependent?

Answer 18

The effectiveness of gentamicin is dependent on the peak concentration achieved, with a recommended dose of 6.6 mg/kg IV.

Question 19

Why are penicillin and gentamicin frequently administered together?

Answer 19

Penicillin and gentamicin are administered together for both prophylaxis and treatment due to their synergistic actions.

Question 20

Which antimicrobial is generally sensitive to gram-positive bacteria like Streptococcus and Staphylococcus spp.?what is the dose?

Answer 20

Penicillin, a bactericidal β-lactam, is generally sensitive to gram-positive bacteria.A dose of 22,000 IU/kg administered intravenously or intramuscularly is recommended for penicillin to achieve effective serum concentration.

Question 21

What antimicrobials should not be administered for surgical prophylaxis to prevent antimicrobial resistance?

Answer 21

Enrofloxacin and third- and fourth-generation cephalosporins such as ceftiofur and cefquinome should not be administered for surgical prophylaxis.

Question 22

According to evidence from human surgery, when should antimicrobial administration occur for effective prophylaxis?

Answer 22

Antimicrobial administration should occur within 60 minutes of clean-contaminated surgery

Question 23

What should be done if antimicrobials are administered under general anesthesia, considering potential adverse effects?

Answer 23

Potential adverse effects, such as a decrease in blood pressure, should be anticipated and managed as necessary.

Question 23

Why is preoperative administration of antimicrobials recommended in all colic surgeries?

Question 24

What NSAID is recommended for preoperative administration to colic patients who have not received one?

Answer 24

Flunixin meglumine (0.25–1.1 mg/kg IV) should be administered preoperatively to treat surgical pain and endotoxemia.

Question 25

Why is a nasogastric tube placed before surgery in colic patients?

Answer 25

A nasogastric tube is placed to allow stomach decompression during surgery as necessary.

Question 26

How is the horse prepared for surgery regarding its hair coat and oral cavity?

Answer 26

The horse’s hair coat is clipped, and the mouth is rinsed to prevent aspiration of feed material during intubation.

Question 27

What position is the horse placed in after induction of anesthesia for abdominal surgery?

Answer 27

The horse is positioned and secured in dorsal recumbency after induction of anesthesia.

Question 28

What are the common surgical approaches to the abdomen in colic patients?

Answer 28

1. ventral midline celiotomy,
2. ventral paramedian approach
3. flank laparotomy
4. inguinal approach are common surgical approaches.

Question 29

How is the closure of the linea alba performed in adult horses, and what suture materials are commonly used?

Answer 29

Closure of the linea alba is performed with large absorbable suture material in a simple continuous pattern, commonly using polyglactin 910 or polydioxanone.

Question 30

ventral midline celiotomy allows the surgeonto exteriorize approximately …% of the GI tract. What are the exceptions?

Answer 30

75%. Exceptions: stomach, duodenum, distal ileum,dorsal body and base of the cecum, distal right dorsal colon,transverse colon, and terminal descending colon

Question 31

Close to umbilicus the linea alba is thick. How much thick?

Answer 31

10 mm thick

Question 32

When do you use ventral paramedian approach?

Answer 32

when it is necessary to perform a repeat celiotomy in a horse with a surgical site infection, dehiscence or other wound complication. It is typically performed by makingan incision 8 to 12 cm to the right of midline through the skin, subcutaneous tissues, and rectus abdominus muscles.
Hemorrhageis significantly greater and more difficult to control than with a ventral midline approach.

Question 33

Which vessels should you be careful in this approach in teh paramedian area?

Answer 33

superficial and deep epigastric vessels.

Question 34

When do you use the flank laparotomy?

Answer 34

When is to access the small colon in cases of impaction or rectal tear

Question 35

Describe the landmarks and access to flank laparotomy

Answer 35

A skin incision is then made centeredbetween the tuber coxae and last rib, just proximal to the palpabledorsal edge of the internal abdominal oblique muscle. The externalabdominal oblique muscle is then sharply divided vertically,whereas the internal abdominal oblique and transverse abdominalmuscles are bluntly divided parallel to their fiber directions,usually with the surgeon’s hand or a pair of Mayo scissors. The peritoneum is bluntly perforated with finger or scissors.

Question 36

In which situation do you use the inguinal approach?

Answer 36

When performing surgery on a stallion with an inguinal hernia, an inguinal approach is used in conjunction with a ventral midlineincision. The inguinal approach allows access to the incarcerated intestine while the ventral midline approach allows complete exploration and decompression of the prestenotic and post stenotic intestine.

Question 37

What are the landmarks for inguinal approach

Answer 37

skin incision is made over the superficial inguinal ring and blunt dissection of the soft tissues is performed to expose the parietal tunic, which is sharply incised to reveal th eherniated intestine.
**Closure of the external inguinal ring is performed with USB size 2 or 3 (metric size 5 or 6) absorbable suture material in a simple-interrupted or simple-continuous pattern with sutures placed 1.5 cm apart**.
Closure of the inguinal ring is also performed following correction of eventration of the intestines following castration

Question 38

Parainguinal approach is used in which situation?

Answer 38

The parainguinal approach may be used to gain access to very aboral lesions of the smallcolon and is described