Equine Emergency Surgery Flashcards
What are the most common emergency surgeries?
Colic
Dystocia
Trauma
Synovial sepsis
Fracture repair
Define colic.
Broad term for abdominal discomfort in horses
Body systems potentially involved: GI tract, liver, urinary tract, reproductive organs
What equipment is needed for a colic assessment?
Drugs - sedation, NSAIDs, Buscopan
Clippers
Sterile prep solution
Catheters
Blood tubes
Lactate reader
NG tube
Rectal gloves and lubricant
Fluids (isotonic / hypertonic)
Ultrasound machine
What does a colic work-up entail?
Physical exam - demeanour/signs of pain, TPR GI borborygmi, CVS status, abdo distension
Rectal exam
Pass NG tube
Bloods - PCV, TP, lactate
Abdo ultrasound
Abdominocentesis - TNCC, TP, lactate
What signs indicate surgical colic over medical colic?
Congested MMs, CRT >3s, HR >60-80bpm, poor pulse quality
Uncontrollable pain
Distension/displacement of small/large intestine
>2L reflux on nasogastric intubation
Amotile, distended loops of small intestine on u/s
High blood/peritoneal fluid lactate
How do we prepare a horse for colic surgery?
Ensure IV catheter present and patent
Ensure stomach decompressed/NG tube left in
Start clipping abdomen/remove shoes if safe!
Place urinary catheter
Surgical prep and scrub
What equipment is needed for colic surgery?
Warmed fluids
Carboxymethylcellulose (CMC) - lubricant to prevent adhesions post-op
2x surgical kit
Fresh gloves/gowns in case of contamination/enterotomy/resection
Lots of drapes
Hose
Colon table and dump drum
How is colic surgery carried out?
Ventral midline incision (>20cm long)
Whole GI tract assessed for distension, thickening, viability, displacement
Any non-viable intestine needs to be resected and anastomosed
Displacements of large intestine - do not require resection, contents dumped via enterotomy
What general post-op care can we provide to colic patients?
IVFT +/- lidocaine CRI
Analgesia
Antimicrobials
Incision care
Nutrition
How do we reintroduce food to different colic patients?
Large intestinal displacements - can gradually refeed once awake/alert
Small intestinal resections/anastomosis - no food for 48hrs
Usually start with small amounts of fibre nuts +/- handfuls of grass (hay last to be added in)
What possible post-op complications can we see with colic patients?
Endotoxaemia
Ileus
Colitis
Jugular thrombophlebitis
Peritonitis
Incisional infection
Describe endotoxaemia in colic patients.
Caused by bacteria leakage from gut/contamination during surgery
IVFT
Flunixin +/- Polymixin B +/- hyperimmune plasma
Can cause laminitis so pre-empt - ice boots, deep bed, frog supports
Describe ileus in colic patients.
NG tube intubation regularly - gastric decompression
Pro-motility drugs - lidocaine, erythromycin, metoclopramide
IV fluids
Nil by mouth
Monitor by ultrasound
Describe colitis in colic patients.
Can be fatal in itself
IVFT!
Isolation - can shed salmonella
Gastroprotectants e.g. misoprostol, sucralfate
Describe jugular thrombophlebitis in colic patients.
Not uncommon
Remove catheter
Local anti-inflammatory treatment
Consider anti-thrombolytics - do not want to risk bleeding from other sites
Describe peritonitis in colic patients.
Diagnosed by abdominocentesis
Broad spectrum antimicrobials e.g. penicillin, gentamycin, metronidazole
Describe incisional infection in colic patients.
Not uncommon - painful!
Often develop marked oedema/cellulitis
Antimicrobials if horse is systemically unwell
Swab for culture and sensitivity, encourage drainage
What should we monitor post-op for colic patients?
Complete clinical exam every 2-4hrs
Demeanour
GI borborygmi, faecal output/consistency, appetite
Jugular vein (heat, swelling, pain, patency)
Feet (comfort, digital pulses)
Incision (oedema, discharge)
Ensure geldings not urinating on belly bandage
How can we begin to rehabilitate colic surgery patients?
Gradual reduction of analgesia
Gradual refeeding
Box rest 4-6 weeks + walks to grass
Paddock rest 1 month
Turn out 1 month
Then gradual return to previous work
What is red bag delivery?
Premature separation of placenta (placenta provides foal with oxygen)
Instead of amnion appearing at vulva - chorioallantois appears first (deep red colour)
Chorioallantois must be ruptured immediately and assisted delivery of foal
What can cause dystocia?
Incidence 1-10%
Usually foal malposition
Occasionally due to foal abnormalities e.g. limb deformities
How is a caesarean section carried out?
Ventral midline incision
Uterine horn located and exteriorised
Hysterotomy incision 35-40cm (allow for feet and hocks)
Umbilical cord clamped and transected
Foal lifted out (two person job!)
Foal transferred to separate team
What is the role of ‘team mare’ during a C-section?
Two people scrubbed in
One person running the room
One anaesthetist
What is the role of ‘team foal’ during a C-section?
Two people min. to resuscitate foal
Is foal normal/abnormal?
O2 supplementation, IV catheter placement, umbilicus management etc.
What are some possible dystocia complications?
Reproductive tract trauma - perineal lacerations, uterine rupture
Retained placenta
Delayed uterine involution
Metritis
Peritonitis
Uterine/bladder prolapse
Arterial haemorrhage
