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EXAM 2 > Colic 2: Exploratory Celiotomy > Flashcards

Colic 2: Exploratory Celiotomy Flashcards

1
Q

What are the 7 Ps of Surgery?

A

1) Proper
2) Prior
3) Planning
4) Prevents
5) Piss
6) Poor
7) Performance

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2
Q

14 yr QH Gelding, normal this am and at lunch. Severely painful this afternoon. Eats grass/ alfalfa mix, plus pellets. Current on Vax/deworming. No he of colic previously. No meds per os.

T 100.8
P80
R Painful
Muddy mm, CRT=3
Negative motility in all quadrants

Self induced trauma over head/ eyes

WHAT is your NEXT step?

A

First pass NG tube!!!
-may have to sedate and pain meds for this

Then….

  • Rectal
  • bloodwork
  • U/S
  • Abdominocentesis
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3
Q

14yo QH gelding with severe colic (no abnormal history, up to date on vax/deworm)

  • reflux’s 10L foul smelling
  • multiple loops of distended firm SI
  • U/S: stacked loops of amotile, thick SI
  • abdominocentesis: serosanguinous, TP 3.7, WBC 5000

What’s your Diagnosis?

A 
Small intestinal strangulating lesion!!!!
Ddx:
-strangulating lipoma****
-EFE (LDD)
-intestinal accident

Reason: Most likely lipoma, due to age signalmen and CS

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4
Q

14yo QH gelding with severe colic (no abnormal history, up to date on vax/deworm). Diagnose strangulating lipoma based of:
10L foul smelling reflux, multiple loops of distended firm SI and abnormal abdominocentesis.

What treatment do you recommend?
Prognosis?

A

Immediate surgical intervention
-recommend referral / Sx

Good prognosis >80% survival
-requires rapid assessment and early referral

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5
Q

If the surgical facility is <2 hrs away and the horse is showing clinical abnormalities and evidence of systemic shock. What should you consider giving it to help it on its way, explain how it works?

A

Hypertonic saline (4ml/kg) but be sure to advise referral center.

  • pulls fluid into vasculature
  • maintains cardiovascular volume->maintains circulatory volume= suspends shock!!!

Needs to be less than 2 hours away so that the patient can get follow up fluids

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6
Q

A shocky horse (suspected strangulating lipoma) is given Hypertonic saline to help it on its way to the referral clinic because it is less than 2 hours away. What must be followed up at the clinic?

A

Must follow up with Crystalloids
-because the hypertonic fluid with dehydrate all the other organs??

Make sure to hydrate the patient appropriately!!
-for every 1L hypertonic solution needs 10L of balance electrolyte /crystalloids/isotonic*****

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7
Q

What are the basics for Pre-operative surgery for a horse?

A 
1)Minimum Pre-op bloodwork:
PCV/TP
Lactate
CBC with differential
Fibrinogen
Glucose
BUN/creatinine
  • Antibiotics
  • Anti-inflammatories
  • IV fluids
  • TETANUS prophylaxis

2) organize support staff
3) organize necessary equipment

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8
Q

What is the BEST overall approach to an abdominal surgery??

A

Ventral midline

  • can exteriorize 75% of GIT
  • minimal hemorrhage
  • strong closure

Others:

1) ventral paramedical
2) inguinal
3) flank (Paralumbar and transverse)

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9
Q

With which surgical abdominal approach can you visualize the most in a horse?
-What are you unable to exteriorize?

A

Ventral midline

Cannot exteriorize:

  • stomach
  • duodenum
  • distal ileum
  • base of cecum
  • distal RDC
  • transverse colon
  • terminal small colon

But these should still be palpated!!

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10
Q

What is the lines alba?

A

Used for ventral midline approach

Aponuerosis of EAO, IAO, transverse abdominal muscle

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11
Q

When taking a ventral midline approach in a horse where do you start your incision and where do you extende to ?

A

Begin at umbilicus (Linda is thickest here), extend cranially with a blade (protecting abdominal content)

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12
Q

When performing an exploratory celiotomy in a horse what 4 things should you be cognizant of that could indicated better/worse prognosis?

A

1) loss of negative pressure - BAD
2) small- FOUL- BAD
3) excessive/abnormal fluid,SAMPLE (3cc syringe)
4) Note positioning of bowel/excessive gas

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13
Q

What is really important to do (as the student) in a colic surgery to prevent tissue adhesion

A

Copious lavage:

-warm sterile saline / LRS

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14
Q

What is important to do during celiotomy to better visualize and handle tissue?

A

Decompression!!!!

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15
Q

When performing a exploratory celiotomy in a horse, what order do you perform the exploration?

A

1) Cecum
…..follow lateral band to….
2) Cecocolic band/fold………follow to the RVC
…..follow dorsal band to…..
3) Ileocecal fold……….follow to antimesenteric band of ileum
4)…run SI from ileum to duodenum

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16
Q

What is the duodenum fixed to?

A

The dorsal body wall and transverse colon by duodenocolic ligament.

17
Q

In which direction does the Duodenum in a horse run from?

A

Runs from Left to Right behind root of mesenteric to the ascending duodenum (next to RDC)

18
Q

What can you palpate on the duodenum?

A

Palpate the cranial mesenteric artery!!!

19
Q

During an exploratory celiotomy on what side do you palpate the Liver?

A

Right

20
Q

During an exploratory celiotomy on what side do you palpate the SPLEEN?

A

LEFT

-don’t forget to palpate the gastrosplenic ligament

21
Q

Describe the process of Colonic evaluation during Exploratory celiotomy?

A

1) begin at lateral band of cecum to RVC
2) Exteriorize pelvic flexure (free end of LC)
3) **RVC from cecum cranially to eternal flexure, causally down LVC to pelvic flexure, cranially as the LDC to the diaphragmatic flexure to the RDC to the Transverse colon

22
Q

What direction does the transverse colon run when doing an exploratory celiotomy?

A

Transverse colon runs RIGHT to LEFT

23
Q

During exploratory celiotomy, when running GI, what comes just before the rectum?

A

Small colon

24
Q

What should always be palpated in addition to the GI?

A

Palpate Kidney, bladder, repro tracts

-nephrosplenic space

25
Q

You have located a strangulating lipoma in the abdomen of a 14yo QH. You want to remove it, what must be done?

A

Resection / anastomoses

  • EE* (for small intestine to small intestine)
  • Functional EE
26
Q

When hand suturing an End- End anastomoses, what side do you start at and why?

A

Mesenteric

-can be more difficult to visualize (hemorrhage, vasculature, edema)

27
Q

What is a jejunosecostomy?

A

Jejunum to cecum
-Do side to side

Using a TA90 (thoracoanastal stapler)—> staples doesnt cut, double row , staggered staples

28
Q

What suture is used to close the lines alba During an exploratory celiotomy?

A

Large synthetic absorbable

  • 3 polyglactin 910 (vicryl)
  • 3 Polydioxanone (PDS)
29
Q

How long does PDS last?

A

180days (6months) until absorbed

30
Q

How often should you check on a horse you suspect could get post op ileus, that has come out of an exploratory celiotomy?
-when do you expect post op ileus to start happening?

A

Every 2-3hours

-we have stripped the SI before surgery so should have some time for rest before SI fills up (12-24hours)

31
Q

8yr warmblood mare, foaled 8 weeks ago, foal is doing great. Current on Vax/deworming. She is put out on spring pasture. She has acute severe, onset of colic. Owner gave 10ml of Banamine PO prior to calling.

T unable
P 60
R elevated
MM brick red with toxic line
Visible distinction
Cool extremities

What is the first thing that you suspect (guilty until proven otherwise)?
What should you do next?

A

Large colon torsion

Sedation: xylazine
Antispasmolytic: buscopan
NG tube pass

32
Q

8yr warmblood mare, foaled 8 weeks ago, foal is doing great. Current on Vax/deworming. She is put out on spring pasture. She has acute severe, onset of colic. Owner gave 10ml of Banamine PO prior to calling.

  • 2L net, normal odor
  • Painful again (meds lasted <5mins)

Rectal: significant LC distention
CBC/chem unremarkable
Lactate 5
PCV/TP: 48/6

What’s the diagnosis?
Treatment?
Prognosis?

A

Diagnosis: Large colonic torsion
Treatment: surgery
Prognosis: Fair

33
Q

What broad spectrum antibiotics are typically used for celiotomy?

A
  • ssK + Pen and Gentocin

- Tetanus prophylaxis

34
Q

You have a mare on the table with Large colon torsion, during surgery what should you do?

A

-Decompress distended bowel (14g needle and suction through Taenia, pre-placed crucial suture)

35
Q

Compare and contrast Colonic obstructions, namely:

Hemorrhagic strangulating obstruction vs ischemic strangulating obstrubtion

A

Hemorrhagic strangulating obstruction

  • Edema
  • congestion
  • Prognosis better

Ischemic strangulating obstruction
-WORSE (both arterial and venous blood supply cut off)

For both be cogniscent of reperfusion injury

EXAM 2 (19 decks)

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