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Y4 EQ - Gastrointestinal tract > Surgical management of colic > Flashcards

Surgical management of colic Flashcards

1
Q

List the indications for colic surgery

A

Severe, unrelenting pain
Recurrence of pain despite moderate – potent analgesia
HR >60bpm
Net reflux >2L
Deteriorating CV parameters
Reduced intestinal motility
Increased abdominal distension
Deteriorating peritoneal fluid values

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2
Q

Is a diagnosis needed for colic surgery?

A

No - evaluation just needs to determine if potential surgical or medical management is appropriate

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3
Q

List the common types colic requiring surgery

A
  • Small intestinal Pedunculated lipoma
  • Epiploic foramen entrapment
  • Caecum
  • Large colon displacement
  • Large colon torsion
  • Small colon
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4
Q

Describe how to initiate the referral process for colic cases

A
  • Discussion with the owner / carer
  • Start organizing transport
  • Contact the referral centre
  • Make sure owners know where they are going & how to contact the referral centre
  • Get the horse to the centre as quickly as possible
  • Contact the clinic if any delays / problems
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5
Q

What should be discussed with the owners when surgery for colic is needed

A
  • Discuss your findings and why you feel that surgery may be needed
  • Discuss the possible causes of colic and likely costs of surgery
  • In insured cases, check that the horse / pony is covered for colic surgery
  • Surgery might not be an option but owners should be provided with EVIDENCE-BASED INFORMATION ON WHICH THEY CAN MAKE AN INFORMED DECISION
  • If referral is declined at this stage, owners should be aware of the potential consequences
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6
Q

List the various factors involved in an owners decision regarding colic surgery

A
  • Financial (insurance)
  • Existing health issues (e.g. laminitis / OA)
  • Emotional (dead / ill relative)
  • Previous experience (good or bad)
  • Advice from friends / peers / you!
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7
Q

What needs to be discussed when contacting the referral contre?

A
  • Most clinics are happy to discuss colic cases and possible causes / prognosis / cost
  • Provide a succinct history and details of analgesia, results of repeat examinations etc
  • Discuss possible costs / prognoses and any deposit required with the owner first
  • Discuss analgesia and other therapies required e.g. passage of a nasogastric tube
  • Give an ETA and contact details for the owner / transporter
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8
Q

Describe the steps needed in the initial assessment of surgical colic cases

A
  • Quick and efficient: decision about whether urgent surgical intervention is needed
  • may be painful on admission and potentially dangerous to manage
  • Need to make sure examination is performed efficiently and properly (so it can be a very busy time for staff and students) and that owners may be very tired / upset at this stage (it can be quite a stressful time for all involved)
  • Some cases may be relatively normal on admission and are admitted for medical treatment / further monitoring
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9
Q

Describe initial exploration in colic cases

A
  • Midline abdominal incision in dorsal recumbency
  • Essential to do a logical and thorough exploration
  • Caecum exteriorized as the starting point
  • Tracing of dorsal caecal band to ileum & exteriorization of small intestine, palpation of duodenum & distal ileum
  • Exteriorisation of large colon: orientation correct, palpation of RVC and RDC
  • Exteriorisation of small colon: palpation of transverse colon and down to rectum
  • Palpation of non exteriorisable areas / organs: stomach, diaphragm, nephrosplenic space, spleen, liver, bladder and ovaries / uterus
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10
Q

How can you minimise trauma and inflammation when assessing the small intestine?

A

Fluids flushed on the intestine during handling, avoid drying out, trauma from swabs

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11
Q

How should you decided wether or not to resect the small intestine

A
  • Key decision as this can have important consequences for the horses short and long-term outcome
  • Early surgery helps to avoid the need for resection
  • But leaving non-viable intestine in situ will lead to POR and potential need for repeat laparotomy
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12
Q

Name 3 mistakes that can occur during SI resections

A

Leakage
Mesenteric rent
Lumen too narrow – physical obstruction and POR

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13
Q

Which types of SI resection has been associated with increased risk of post operative colic and relaparotomy?

A

Jejujuno ileal anastomoses

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14
Q

What should be suspected as the cause in cases of ileal impaction or caecal intususseption?

A

High tapeworm burdens

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15
Q

How is intussusception treated?

A

May require resection on the caecum

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16
Q

When is a surgical bypass indicated for caecal impactions?

A

When there is evidence of poor caecal motility

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17
Q

What are the 4 common sources of primary large colon lesions?

A

Impactions
Displacements
Torsion
Enteroliths/sand

18
Q

Lesions most commonly occur in which part of the large colon?

A

Pelvic flexure

19
Q

Describe a pelvic flexure enterotomy

A
  • Removal of LC contents assists correction of torsions / displacements and can confirm sand colic
  • Want to minimise reduction in the luminal diameter following closure
20
Q

How can you assess the viability of the large colon?

A
  • Colour
  • Thickness of wall
  • Motility
  • Change in the above following correction of the torsion
21
Q

How is a large colon torsion treated surgically?

A

Pexy to the body wall
Resection

22
Q

Name 4 conditions in the small colon that need to not be missed

A
  • Impaction
  • Lipoma
  • Volvulus
  • Mesocolon tears
23
Q

Describe abdominal closure following colic surgery

A
  • Various suture materials and methods of closure
  • Careful closure of the linea alba essential to minimise the chance of acute abdominal dehiscence
  • Debate over need to close subcutaneous layer and some surgeons advocate closure of the peritoneum
24
Q

How is postoperative pain assessed?

A

Pain scoring
- Subjective / objective
- Pain face
- Scoring systems

25
Q

Describe post-op analgesia following colic surgery

A
  • Flunixin meglumine most commonly used
  • Other NSAIDs may be used: meloxicam
26
Q

Describe post-op cardiovascular support following colic surgery

A

Crystalloids +/- colloids +/- plasma / whole blood
Monitoring
- PCV / TP
- Heart Rate
- Urination
- Electrolytes / acid base status
+/- Lactate
+/- SAA

27
Q

What is a critical part of post colic surgery care to prevent gastric rupture?

A

Gastric lavage/decompression

28
Q

Describe post-op nutrition following treatment for LI displacements

A
  • Offered free choice water within 3 hours
  • Offered feed within 3 hours of surgery
  • Mostly fed handfuls of forage initially
29
Q

List some post operative complications following colic surgery

A

Surgical site infection
Incisional dehiscence
Post-op colic
Post-op reflux
Adhesions
Diarrhoea
SIRS/endotoxaemia
Jugular thrombophlebitis

30
Q

When would a possible relaparotomy be discussed with the owners?

A
  • Persistent / increasing signs of pain
  • Suspicion of abdominal haemorrhage / intestinal leakage
  • Persistence of large quantities of reflux not decreasing beyond 48-72h
31
Q

How can the risk of surgical site infections be reduced?

A
  • Local wound management (e.g. cleansing around the site with hydrogen peroxide 1.5%, topical dressings)
  • Good hospital protocols re. environmental sampling & infection control e.g. hand hygiene
32
Q

What are the aims of the international colic surgery audit

A
  • To document prevalence of different lesions, duration of survival and complication rates
  • To improve the quality of care for colic patients: comparison of clinical performance with local, national and international standards = benchmarking
  • To provide data about changing trends
  • To identify areas of good practice / potential targets for improvement in care = audit cycle
33
Q

Describe what needs to be discussed with owners at post hospital discharge following colic surgery

A
  • Communication with owner and horse’s usual veterinary surgeon regarding aftercare and likely complications
  • Post operative colic
  • Incisional healing and timing of suture removal
  • Rehabilitation strategy
34
Q

Describe a suitable rehabilitation strategy following colic surgery

A
  • 6-8 weeks box rest with in-hand walking 2-3 times per day
  • 8 weeks turnout in a small yard /paddock
  • Normal turnout and gradual return to normal exercise over 6-8 weeks
35
Q

When would preventative surgical procedures for colic be considered?

A

In certain types of colic to reduce the likelihood of recurrence and performed as a scheduled preventive surgical procedure

36
Q

Same some colic types that may indicate preventative surgical treatement

A

Epiploic foramen entrapment
Left dorsal displacement
Diaphragmatic hernia / mesenteric rent
Recurrent large colon displacements

37
Q

Describe the long term prognosis following colic surgery

A
  • Survival to hospital discharge for horses recovered from general anaesthesia is around 74-85%
  • Highest rate of death in the first week
  • Lower but continued rate of mortality from 7-120 days
38
Q

Name 3 factors that contribute to the likelihood of post-op complications

A
  • Initial lesion
  • Surgical procedure performed
  • Post-op complications encountered
39
Q

Describe athletic function following colic surgery

A

There is no reason why horses cannot return to their previous function provided
Very good – excellent prognosis for return to athletic function

40
Q

What is the most significant factors in maximising a horses chance of survival following colic surgery?

A

Early referral of the horse

Y4 EQ - Gastrointestinal tract (9 decks)

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