Final: Little 2 - Colic 2, Hernias Flashcards
What are the 7 P’s of exploratory ceilotomy (and life in general)?
Proper Prior Planning Prevents Piss Poor Performance
A 14 year old QH gelding presents for severely painful colic this afternoon after having been normal at lunch. The history is unremarkable, the HR is elevated (80bpm), the RR in not obtainable, the mm’s are muddy, and the CRT is prolonged. The abdomen is silent. There is evidence of trauma over the head and eyes.
What procedure should you perform next?
NG tube
A 14 year old QH gelding presents for severely painful colic this afternoon after having been normal at lunch. The history is unremarkable, the HR is elevated (80bpm), the RR in not obtainable, the mm’s are muddy, and the CRT is prolonged. The abdomen is silent. There is evidence of trauma over the head and eyes.
NG: 10L foul smelling net reflux
Rectal: multiple distended firm loops of SI
US: Stacked loops of amotile SI
Abdominocentesis: serosanguinous, TP 3.7, cells 5000
Diagnosis?
a. Colon torsion
b. Strangulating lipoma
c. RDD
d. Small colon impaction
b. Strangulating lipoma
What is the normal thickness of the SI on US?
<2mm
What is indicated for a 14 yo QH gelding with severe clinical signs due to a stangulating lipoma?
Immediate surgical intervention
What should you request from the owner before performing a colic surgery on their horse?
At least half of the upper estimate as a deposit
You decided to initially administer hypertonic saline when stabilizing a patient for colic surgery. How many liters of isotonic fluid must you give before induction if you gave 2L of hypertonic saline?
20L
What is the best approach to the abdomen in a horse? Why?
Ventral midline
Can exteriorize 75% of the GIT, minimal hemorrhage, strong closure
Which of the following structures CAN be exteriorized when performing an abdominal exploratory via ventral midline approach?
a. Stomach
b. Duodenum
c. Pelvic flexure
d. Base of cecum
e. Transverse colon
f. Terminal small colon
c. Pelvic flexure
The linea alba is the aboneurosis of the ____, ____, and ______ muscles.
EAO
IAO
Transverse abdominal
What does it indicate if there is a loss of negative pressure when you open the abdomen?
Perforation
What viscera should be seen first when making a ventral midline incision into the abdomen if nothing is displaced?
Cecum
When exploring the abdomen, you begin at the _____. You follow the _____ band to _____ to the __________ colon. You then follow the _____ band to the _____ fold to the ______ band of the ileum.
When exploring the abdomen, you begin at the CECUM. You follow the LATERAL band to the CECOCOLIC band to the RIGHT VENTRALcolon. You then follow the DORSAL band to the ILEOCECAL fold to the ANTIMESENTERIC band of the ileum.
The duodenum is fixed to the dorsal body wall and the tranverse colon by the _________.
Duodenocolic ligament
In which direction does the duodenum run behind the root of the mesentary next to the RDC?
Left to right
In which direction does the transverse colon run?
Right to left
What type of staples would you use for a resection and anastomosis of the jejunum to the cecum?
GIA
Which forceps (picutred) do you use when closing the linea alba?
Russian thumb forceps (“Clams”)
What type of suture and pattern do you use to close the abdomen? How many throws do you use for your knots?
Large, synthetic, absorbable #3
In short burst simple continuous pattern
8-10 throws per knott
Why should you place an indwelling NG tube post-abdominal surgery?
Almost all horses get post-op ileus which results in reflux
Use tube to maintain decompression
A 8yo Warmblood mare presents for a violent colic. She foaled her third baby 8 weeks ago. Both are being kept on a spring pasture. What is the most likely diagnosis?
a. Strangulating SI
b. RDD
c. LDD
d. Colon torsion
d. Colon torsion
How long should xylazine last?
15 min
Which of the following is not incuded in a pre-op drug protocol for a horse with a colonic torsion?
a. K+Pen
b. Meloxicam
c. Banamine
d. Tetanus toxoid
e. IVF (LRS)
f. Gentocin
b. Meloxicam
How is tissue viability evaluated during surgery? What is the gold standard?
Flick it
IV Fluorosceine dye
Suface oximetry
Doppler US
Luminal pressure
Gold standard: Histopathology Not reasonable choice in surgery
Which 2 parameters are most important to monitor during abdominal surgery?
HR
BP
What is the daily maintenance fluid rate for a horse?
50 mL/kg/day
Which e-lyte derrangement is common post-abdominal op?
Hypocalcemia
Hypomagnesemia
Also add K+ to fluids
What is the maximum amount of K+ that can be given per kg per hour?
0.5mEq
What is the threshold for TP before you start seeing peripheral edema?
4.1
What 3 things indicate you can discontinue post-colic surgery tx?
Eating
Afebrile
Normal CBC
What can be done to manage protein loss?
Give plasma
What is the most important therapy for endotoxemia?
Fluids
How does Polymyxin B treat endotoxemia?
Binds lipid A and thus neutralized the endotoxin
6000 IU/kg IV
Which of the following is NOT a risk factor for POI (post-op ileus)?
a. >10 yo
b. Presenting with a PCV <45%
c. Presenting with hyperglycemia
d. Anesthesia >2.5 hrs
e. Surgery >2 hrs
f. Ischemic SI or SI lesions
g. Presenting with high TP and ALB
b. Presenting with a PCV <45%
>45%
What is the most common lesion leading to POI?
Strangulating SI
Which prokinetic agents are used for POI treatment? Which one is not indicated because it causes cramping?
Lidocaine and Metoclopramide
C/O’d: Erythromycin
What is the most common complication from a post-op incisional infection?
Incisional hernia
When do you repair an incisional hernia?
At least 3 months after surgery
To allow for granulation tissue (which has poor holding power) to heal into scar tissue
Are adhesions more common in foals or adults?
Foals
What should all colicky stallions be checked for?
Inguinal hernia
Which of these is not given to prevent adhesion formation?
a. Heparin
b. NSAIDs
c. Antibiotics
d. Lidocaine
e. HA
f. 3% CMC (carboxymethylcellulose)
d. Lidocaine
What pH and peritoneal glucose levels indicate septic peritonitis?
pH <7.2
GLU <30mg/dL
(Serum to peritoneal glucose difference >50mg/dL)
Which post-op condition is 5x more likely in horses with endotoxemia?
Laminitis
What are the 3 portions of a hernia?
Ring
Sac
Contents
What is a true or indirect hernia?
Opening through normal aperture, containing a complete peritoneal sac
What is a false, or direct, hernia?
Hernia that does not contain a complete peritoneal sac, usually created by trauma or after breakdown of surgical entry
Whhy is the size of the external inguinal ring irrelevant to the development of an inguinal hernia?
The internal ring is the limiting area
T/F: Inguinal hernias are common in geldings due to the space that the removed testes have left behind.
False
T/F: Congenital inguinal hernias usually resolve spontaneously in 3-6 months.
True
Why do mature bulls usually get indirect inguinal hernias on the left side?
Rumen pressure
Do beef or dairy cows get inguinal hernias more often?
Beef
esp Hereford
What position do you put a bull in under GA to repair an inguinal hernia?
Lateral recumbency
Why is surgical repair of a congenital inguinal hernia in a bull not recommended unless a bilateral castration is also performed?
Strong evidence that hernias are hereditary
What is the most common hernia in the horse?
Umbilical
What is incarcerated in a parietal or Richter hernia? What findings make you think that this type of hernia is present?
Antimesenteric wall of the ileum
Hernia is firm, non-reducible, and painful
You are palpating an umbilical hernia in a horse. Is the prognosis better if the hernia ring is firm and thickened or thin and indistinct?
Firm and thickened (better prognosis for successful repair)
What parameters must be met for conservative treatment to be an option for an umbilical hernia?
<5cm diameter
Reducible
Foal
What indicates the surgery is warrented for an umbilical hernia?
Didn’t spontaneously close by 4 months of age
>10 cm / 4in diameter
Is an open or closed surgical technique preferred for umbilical hernias?
Open
What are the 5 categories of umbilical hernias in claves?
Uncomplicated
+ SQ infection/abscessation
+ infection of umbilical remnant
Umbilical abscesses/ chronic ophalitis
Urachal cysts/ruptures
Are uncomplicated umbilical hernias more common in dairy or beef cattle? What is most commonly contained in the hernial sac?
Dairy (esp. Holstein-Friesian)
Abomasum
T/F: Umbilical hernias in foals and calves usually spontaneously close by 4 months of age as long as they are uncomplicated.
False, in calves they don’t usually close - simple repair indicated
In what species are hernia bands and elastrator bands used to repair uncomplicated hernias?
Bovine
Are post-op complications after a herniorrhaphy more common in calves or foals? Why?
Calves
More commonly have concurrent infections
What surgery is indicated if you have a hernia with an umbilical infection? What vessels must be ligated? What portion of which organ is removed?
Open herniorrhapthy with en bloc removal of umbilical remnants
Umbilical arteries and vein
Apex of urinary bladder
Why would a calf require marsupialization due to omphalophlebitis?
If the infection extended cranially to involve the liver
