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EXAM 2 > Colic 3: Post Op Management/complications > Flashcards

Colic 3: Post Op Management/complications Flashcards

1
Q

What is one of the most important things to manage Post op?

A

Fluid therapy

VOLUME of fluids most important
Dehydration/electrolyte imbalance
Daily maintenance 50ml/kg/day
Add losses to maintenance 
Electrolytes add to fluids
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2
Q

What 2 electrolytes imbalances are common post op (exploratory celiotomy) in a horse?

A

Hypocalcemia

Hypomagnesemia

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3
Q

What are the supplements post op that should be considered after a horse has an exploratory celiotomy?

A

K+, Ca, Mg

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4
Q

What is the Daily maintenance for a horse?

A

50ml/kg/day

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5
Q

What are the common causes of Hypokalemia in the horse?

A

1) lack of intake (only get it from their diet)
2) Diuresis
3) GI loss through diarrhea

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6
Q

When should you supplement K+ in a horse?

A

1) lack of intake >24hrs and/or IV fluids >24hrs
* **Remember not greater than 0.5meq/Kg/hr

Usually add 80mEq/5L bag!!!

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7
Q

What is the maximum K+ a horse can receive?

A

0.5mEq/kg/hr!!!!!

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8
Q

What is the goal of post op fluid therapy in a horse?

A

Maintain vascular volume to sustained cardiovascular output

Mucosal damage—> increased capillary permeability—> fluid/protein loss into interstitial = difficult to maintain vascular volume

Indicators:
HR <80, PCV <50%, TP >4.1

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9
Q

Post op monitoring: (Refluxing colic and foals)

PCV/TP
Gastric decompression
Exam
CBC/fibrinogen/lactate/electrolyte

A

PCV/TP q6hrs
Gastric decompression q2-3hrs (if needed)
Exam q1-3
CBC etc… one day post op and 3 days post op

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10
Q

Following exploratory surgery on a horse when do you discontinue meds?

A
  • EAT
  • afebrile
  • normal CBC
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11
Q

What can be given to a horse post op to manage pain and anti-endotoxins effects?

A

Banamine

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12
Q

What is lidocaine CRI prescribed for post op in horses?

A
  • Anti-inflammatory properties

- post op ileus (POI)

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13
Q

What are the clinical signs of Endotoxemia?

A
  • tachycardia
  • Abnormal mm (hyperemic, cyanotic)
  • Pain
  • edema
  • hypomotility
  • GI distention
  • NG net reflux
  • Thrombosis/coag disorders
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14
Q

How do you manage endotoxemia in a horse?

A

Maintain circulatory volume:

1)FLUIDS!!!!
2)NSAIDS (low does Banamine BID-QID)
3)Anti-endotoxin therapy:
—>Di-tri-octahedral (DTO) smectite (Biosponge)
bind endotoxins, bind clostridium enterotoxin
—>Polymyxin B (bind endotoxins, Lipid A, neutralizes endotoxin)
—>Plasma (colloidal, provides abs)

In cases of DIC —-> Heparin therapy

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15
Q

What are the 3 risks to look for with Endotoxemia?

A

1) hypovolemia/endotoxemia (GI stasis, reflux, cap. Prep.)

2) Protein loss (albumin)
—>edema formation (2ndary to protein loss)

3) laminitis

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16
Q

What are the risk factors for Post op ileus. (POI) in the horse?

A

BAsically some kinda small intestinal lesion at surgery!

-old horse
-abnormal CBC:
—-PCV>45%
—-High TP and ALbumin
—-Hypergylcemia

  • anesthesia >2.5hrs
  • Surgery >2hr
  • R/A
  • SI lesions
  • Ischemic small intestine
17
Q

What is the incidence of POI in the horse?

A

10-21%

Up to 40% of all post op deaths in horses treated for colic

18
Q

What is the most common lesion leading to POI in horses?

-What is the prognosis for POI

A

Strangulating small intestine

Prognosis = favorable but $$$$

19
Q

What are the clinical signs of a horse with POI?

A
  • Colic, depression
  • decreased/no borborygmi
  • elevated HR
  • increased PCV/TP, electrolyte derangement
20
Q

How do you diagnose POI in the horse?

A

Dx:
Rectal Palpatine
U/S
Gastric reflux 12-48hrs post op!

21
Q

How do you treat POI in the horse?

A

1) supportive therapy:
- NG decompression
- Fluids
- electrolytes
- antibiotics

2) pro kinetic agents
- Lidocaine (anti inflammatory, free radical scavenger)
- Metoclopromide
- erythromycin (we do not use this very much causes pain)

22
Q

How does Lidocaine CRI help with POI?

A

1) decreases catecholamines
2) supremes primary afforestation neuron activity
3) directly stimulates smooth muscle
4) inhibits:
- prostaglandin = decreases inflammation in gut wall
- granulocyte migration/lysosomal enzyme release
- free radical production

23
Q

What is important to remember about the administration of Lidocaine CRI?

A

Toxicity
Can cause muscle fasciculations, ataxia, SEIZURES

DO NOT BOLUS!!!!!!!!!!! Give it slow over 5 mins

24
Q

What is metoclopramide used for? And how does it work? What should you be careful of?

A

Stimulate gut motility in POI!

1) increases ACH release
2) stimulations smooth muscle in stomach and small intestine!!!

  • Toxicity/ Extrapyramidal effects ()
  • excitement, restlessness, sweating, SEIZURES
25
Q

What is the occurrence of incisional complications?

A

10-37% Not uncommon

-increases with additional surgeries

26
Q

What is the number one cause of incisional complication?

A

1) INFECTION!!

2) Hernia 13-16%
3) suture sinus formation
4) Acute incisional dehiscence 2-3%

27
Q

When would you see an incisional infection?

And what must you do?

A 
>= 3 days post op
Febrile
Pain/edema
Drainage
Culture

Needs abdominal support - minimize hernia/dehiscence

28
Q

Why would you potentially not use antibiotics in a horse presenting with incisional infection?

A

Drainage

Resistance

29
Q

What is the most common complication from incisional infection?

A

Incisional hernia????

30
Q

Should you repair an incisional hernia, secondary to incisional infection immediately?

A

No, do not repair for a minimum of 3 months:

  • Want to make sure the infection resolves first
  • allow the incision (body wall) site to heal more,because it has weak granulation tissue that wont hold sutures
  • need fibrous ring to form, so we have tissue to hold to close that up
31
Q

What type of repair should eventually be used for incisional hernia treatment?

A

Primary !!!!!

We don’t really like mesh

32
Q

How common does Acute total dehiscence of an incision site occur post op?
-What are the predisposing factors?

A

RARE

  • Violent recovery
  • severe post op pain
  • prolonged surgery time
  • continuous suture pattern!!!!
33
Q

What is the second most common reasons for repeat surgery?

-who is it more common in?

A

Adhesions

Foals > Adults

34
Q

How can you prevent Adhesions Post op?

A

1) maintain intact mesothelial layer
2) minimize trauma-good technique (wet bowel, hemostasis, minimal suture exposure)
3) decide on surgery in a timely manner
4) Peri-op NSAIDs and antibiotics

Peritoneal lavage, HA (everyone one should get a shot), CMC 3% (belly jelly, physical barrier lubricant), omentectomy, DMSO (free radical scavenger, anti edema)

35
Q

In a horse with Post op peritonitis, why is it important to do a cytological evaluation?

A

Bacteria
Neutrophilic
Degenerate

36
Q

What is a good indicator of septic peritonitis in a horse?

A

pH and Glucose

Serum: peritoneal glucose difference >50mg/dL
Or
Peritoneal pH <7.2 + peritoneal glucose <30mg/dL = septic

37
Q

What else can be used to diagnose septic peritonitis?

A

Other than glucose and ph

-culture /sensitivity. (Peritoneal fluid)
-CBC/Fibrionogen:
—->left shift
—->thrombocytopenia
—->hypoproteinemia

38
Q

How do you treat Septic peritonitis?

A 
Fluids
Electrolytes 
Plasma
NSAIDs
Antibiotics
Possible repeat laparotomy
Closed drains
39
Q

WHat is a huge post op complication of an Endotoxemia horse?

A

LAMINITIS

5x higher risk in horses with endotoxemia

EXAM 2 (19 decks)

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