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CVNT2 > Equine GI Surgery > Flashcards

Equine GI Surgery Flashcards

1
Q

which condition is the most likely to be a cause for GI surgery in horses?

A

colic (abdominal pain)

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2
Q

what reasons other than colic might a horse need GI surgery?

A

exploratory laparotomy/laparoscopy

other subacute/chronic conditions e.g. weight loss, suspected masses, peritonitis

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3
Q

how might you establish whether the horse requires emergency surgery?

A 
pain 
clinical exam findings 
rectal exam 
NGT reflux 
peritoneal fluid analysis 
blood work 
ultrasound findings
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4
Q

how might behaviour change in a horse with colic?

A

moderate/severe and persistent behavioural signs despite analgesia

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5
Q

how might faecal output change in a horse with colic?

A

horses with colic can usually produce no faeces

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6
Q

what heart rate is found in horses with colic?

A

> 60 bpm

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7
Q

what colour might mm be in horses with colic?

A

poor

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8
Q

what might happen to the rectum/intestines in horses with colic?

A

distension +/- displacement (SI or LI)

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9
Q

what might be found in blood testing in horses with colic?

A

Increased PCV/protein/lactate (indicative of dehydration)

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10
Q

what should happen when you NG tube a horse with colic?

A

positive reflux of more than 5L

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11
Q

what will an ultrasound show with colic?

A

distended SI or displaced LI

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12
Q

what is the fluid like on paracentesis if a horse has colic?

A

discoloured and turbid peritoneal fluid

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13
Q

where should a catheter be placed for colic surgery?

A

jugular intravenous for admin of medication, IV fluids, anaesthesia

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14
Q

what size catheter is usually used for an adult horse?

A

14G

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15
Q

how do you decompress the stomach?

A

passing a nasogastric tube (refluxing) - should be done before anaesthesia induction

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16
Q

how do you confirm correct placement of the NG reflux tube?

A

observe left hand side of the neck for end of tube advancing in oesophagus (critical!)

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17
Q

how do you insert the NG tube?

A

tube is passed into ventral nasal meatus
flex head to encourage passage into oesophagus rather than trachea
horse swallows as tube is advanced

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18
Q

what should you do if no spontaneous reflux establishes after passing the NG tube into the stomach?

A

create a syphon by attaching a funnel to end of tube and pouring in a measured amount of water from jug - lower end of tube into bucket to collect and measure what comes out

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19
Q

which medications might be administered to prepare a horse for colic surgery?

A

analgesia and antimicrobials

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20
Q

why are IV fluids administered during prep for colic surgery?

A

support circulation - stabilise cardiovascular system

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21
Q

how is the abdomen prepped for colic surgery?

A

clipping - may be started before induction but consider safety (horse is likely to be in a lot of pain)

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22
Q

what are the overall steps in preparing a horse for colic surgery?

A

jugular IV catheter placement

decompression of stomach with NG tube

administration of analgesia/antimicrobials

IV fluid to support circulation

clip abdomen

shoe removal/tape feet

wash out mouth

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23
Q

what steps should be taken to prepare the horse after induction?

A

move to table

place urinary catheter (suture prepuce in males)

clip abdomen/second fine clip

cover legs and feet

drape

sterile skin prep

ensure all instruments are in surgical colic kit

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24
Q

what are the main principles of surgical treatment?

A

opening and exploration of the abdomen by palpation and exteriorisation of intestine

identification of the lesion

correction of displaced/entrapped intestine

decompression of distended viscera

resection of devitalised tissue and restoration of intestinal continuity

closure of abdomen

recovery from anaesthesia

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25
Q

what are the 3 types of intestinal obstruction?

A

simple (lumen only obstructed)
functional
strangulating

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26
Q

what is a functional obstruction of the intestines?

A

peristalsis fails to propel ingesta, leading to distension

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27
Q

what is a strangulating intestinal obstruction?

A

compromise of vasculature resulting in ischaemia of intestine - veins obstructed leading to oedematous thickening of gut wall

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28
Q

what does a strangulating obstruction lead to?

A

release of endotoxins into circulation –> systemic compromise and shock (endotoxaemia)

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29
Q

what colour is a strangulating obstruction?

A

section does maroon to purple to black

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30
Q

how does the intestine distal to an obstruction look?

A

appears relatively normal

31
Q

what specific conditions can cause strangulating obstruction?

A

pedunculated lipomas
herniation - epiploic foramen, inguinal, mesenteric defects
intusussceptions

32
Q

how is small intestinal resection achieved?

A

isolation of affected segment with two bowel clamps at either end
ligation of blood vessels supplying affected segment
resection of affected segment

33
Q

how are simple/functional obstructions treated?

A

decompression of SI and/or enterotomy to remove obstruction

blood supply not compromised so no resection or anastomosis required

34
Q

what is the prognosis for simple/functional obstructions?

A

usually good once resolved

35
Q

what is the prognosis for strangulating lesions involving resection/anastomosis?

A

survival to 1 year approx 50%

36
Q

what are the risks involved in treating strangulating lesions?

A

contamination and peritonitis
endotoxic shock
ileus
post-operative adhesions

37
Q

what are the most common conditions affecting the large intestine?

A

displacements
large colon torsion
enteroliths (not common in UK)

38
Q

what is involved in surgical management of colonic displacement?

A

decompression of distended bowel

evacuation of colon via pelvic flexure

enterotomy (not always)

correction of displacement

colopexy occasionally performed

39
Q

what is a colopexy?

A

anchoring the colon by suturing (usually to body wall)

40
Q

what type of obstruction does a large colon volvulus tend to be?

A

strangulating obstruction with ischaemia of a huge section of GI tract

41
Q

where does a large colon volvulus occur?

A

at sternal flexure or close to attachment of the right ventral colon to the caecum

42
Q

what is the cause of large colon volvulus?

A

unknown

43
Q

which horses are most commonly affected by large colon volvulus?

A

usually affects larger horses, particularly brood mares 90 days after foaling

44
Q

what are the specific signs of large colon volvulus?

A

sudden onset severe abdominal pain

extremely enlarged colon

marked abdominal distension

endotoxaemia - systemic status deteriorates rapidly

tachycardia

poor peripheral perfusion

45
Q

what is the prognosis for large colon volvulus?

A

directly related to the time that elapses between onset of condition and surgery
90% near brood mare farms but much lower when horse must be transported large distances

46
Q

what is involved in post-operative care?

A

exam every 2-4 hours

analgesia, antimicrobials

IV fluid therapy

belly bandage

monitoring for complications

regular blood sampling

NG tubing as required

47
Q

what are the potential post-operative complications?

A

endotoxaemia (esp post strangulating obstructions)

ileus

jugular thrombophlebitis
incisional infection

further obstruction

anastomosis leakage

peritonitis
adhesions

48
Q

what parameters should be monitored post-op?

A 
pain levels 
temperature 
GI signs 
CVS signs 
incision site
catheter 
feet
respiratory system
49
Q

how can post-op pain be monitored?

A

behavioural signs of colic
heart rate (tachycardia)
specific - peritoneal, incisional infection, musculoskeletal (laminitis)

50
Q

how can pyrexia be monitored for post-op?

A

rectal temperature

51
Q

how can you measure GI function post-op?

A 
reflux through NG tube 
faecal output 
gut sounds on auscultation 
appetite 
ultrasound
52
Q

how can cardiovascular function be assessed post-op?

A

heart rate
mm colour and CRT
PCV, protein, lactate, electrolytes

53
Q

what should you be looking for when checking an abdominal incision site?

A

swelling (some oedema is normal)
pain
discharge

54
Q

what should you be looking for when checking a catheter post-op?

A

swelling
pain
jugular patency

55
Q

why is it important to check the feet/mobility post-op?

A

laminitis can be secondary to endotoxaemia

56
Q

how can you monitor the respiratory system post-op?

A

auscultation
increased rate?
nasal discharge/cough?

57
Q

can you feed a horse who has post-op reflux on passing a NG tube?

A

no - nil by mouth, IV fluid therapy, may need to muzzle to prevent horse eating bedding

58
Q

what should be involved in post-op feeding?

A

start with small volumes of water and gradually increase

grass is good first solid food

small wet mashes of concentrates

hay introduced as handfuls and gradually increased

return to normal volumes over 3 days (ish)

59
Q

how should post-op exercise be managed?

A

box rest for 6 weeks with short walks to promote GI motility

check no incisional problems which may require prolonged exercise restriction

turn out into small paddock at 6 weeks

ridden exercise may resume 3 months if abdominal repair is sound

60
Q

what are the potential immediate complications of GI surgery?

A

endotoxaemia

ileus

61
Q

what are the potential short-term complications of colic surgery?

A

laminitis

jugular thrombophlebitis

62
Q

what is the potential longer term complication of colic surgery?

A

adhesions

63
Q

what are the signs of endotoxaemia?

A

tachycardia and tachypnoea

pyrexia –> hypothermia

hyperaemic mucous membranes, turning dark over time

colic signs, dullness

64
Q

how is endotoxaemia treated?

A

IV fluid therapy
flunixin
polymixin B
hyperimmune plasma

65
Q

how is ileus managed?

A

nasogastric intubation for gastric decompression

IV fluids (maintenance + dehydration + ongoing losses)

reassess 2-4 hourly

supplement with electrolytes if needed

66
Q

how is laminitis treated?

A

frog support/deep bedding

analgesia

67
Q

how is jugular thrombophlebitis treated?

A 
remove catheter 
local anti-inflammatory treatment 
consider thrombolytics e.g. aspirin 
antibiotics?
don't place catheter in other jugular - alternative site if venous access still required
68
Q

how is peritonitis treated?

A

antibiotics - broad spectrum (often penicillin/gentamycin/metranidozole)
abdominal drainage +/- lavage?

69
Q

what are the signs of colitis?

A

pyrexia, colic, diarrhoea

70
Q

what can cause colitis?

A

can occur after colon torsion/displacement, where colon wall has been compromised

antibiotic and NSAID usage plus sudden change in management

71
Q

how do you treat colitis?

A 
can require intensive nursing 
IV fluid therapy 
analgesia (avoid NSAIDs) 
prostaglandin analogues 
probiotics
72
Q

what are the signs of incisional infection?

A

excessive local oedema
pain on palpation
drainage of purulent material

73
Q

how do you treat incisional infection?

A

antibiotics if horse systemically affected
culture for sensitivity
encourage drainage
tends to persist until suture material resorbs (6 weeks ish)

CVNT2 (47 decks)

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