Written Exam - Post-Op Considerations

Question 1

what immediate (1-5 days) clinical signs may be seen in a post-op colic patient that are very bad?

Answer 1

failure of anastomosis/enterotomy - body wall dehiscence, & recovery issues

Question 2

what intermediate (2-14 days) clinical signs may be seen in a post-op colic patient that are very bad?

Answer 2

fever, endotoxemia, laminitis, ileus, diarrhea

Question 3

what chronic (14 days to months) clinical signs may be seen in a post-op colic patient that are very bad?

Answer 3

hernia, laminitis, adhesions, & repeat colic

Question 4

in the immediate post-op period, what are some uncommon catastrophic complications?

Answer 4

fracture, myopathy, neuropathy, acute body wall dehiscence, & failure of anastomosis site

Question 5

T/F: fever is not unusual in the 1st 48 hours post-op for horses

Answer 5

true - large and small bowel problems, result of transient inflammation/endotoxemia, & horse is typically clinically stable

Question 6

why are sustained, progressive fevers that develop 48 hours after surgery worrisome?

Answer 6

indicate bigger problem - colitis, peritonitis, thrombophlebitis, endotoxemia

Question 7

what is endotoxemia?

Answer 7

disruption of the mucosal barrier resulting in systemic absorption of endotoxin

Question 8

what are some clinical signs of endotoxemia?

Answer 8

tachycardia, fever, hyperemic mucus membranes, & laminitis

Question 9

what are some treatment options for endotoxemia?

Answer 9

iv fluids, appropriate antimicrobial therapy, NSAIDs

Question 10

what are some treatment options for laminitis?

Answer 10

control endotoxemia

cryotherapy for the hoof - maintain temp at 5-7 C for 48 hours (ice in 5L bags), decreases development of laminitis in colitis patients by 10x

mechanical support to the hoof - limit laminar damage & displacement of the coffin bone

Question 11

what is post-op ileus?

Answer 11

loss of motility in the small intestines, distension of the stomach/small intestine with fluid & ingesta

occurs in 50-60% of small intestinal cases

Question 12

what defines post-op ileus?

Answer 12

greater than 20L reflux/day or > 8L at any one time

Question 13

what are some risk factors of post-op ileus?

Answer 13

small intestinal lesion, large length resected, increased time under anesthesia, intestinal ischemia/distension, endotoxemia

Question 14

what is the treatment for post-op ileus?

Answer 14

decompress stomach with nasogastric tube frequently

supportive therapy - iv fluids, anti-inflammatories, analgesics

pro-kinetic therapy

Question 15

when may you have to repeat a laparotomy?

Answer 15

functional problem with anastomosis site, adhesion, or post-op ileus

Question 16

what is the standard incisional care?

Answer 16

stent for recovery & abdominal bandage upon return to the stall

Question 17

T/F: incision infections occurs in 7-34% of post-op colics

Answer 17

true

Question 18

what are some risk factors of incisional infections in a post-op colic?

Answer 18

repeat celiotomy, leukopenia, weight >300kg, increased surgery time, & > 1 year old

Question 19

what does an incisional infection look like?

Answer 19

preceded by edema, serosanguinous discharge, & fever

happens 5-10 days post-op

Question 20

how do you treat incisional infections?

Answer 20

drain areas of focal fluid accumulation

flush incision

submit fluid for bacterial identification & sensitivity (local antibiotic therapy)

support incision with a belly band

Question 21

T/F: acute, catastrophic hernias after abdominal surgery are rare

Answer 21

true

Question 22

what is the treatment & prognosis for acute, catastrophic hernias after abdominal surgery?

Answer 22

immediate surgical repair - associated with poor recoveries

Question 23

what increases the risk of hernia by 62.5x?

Answer 23

incisional drainage/infection

Question 24

why is repair required for post-op hernias?

Answer 24

small hernias have the potential to trap bowel - athletic horses & breeding stallions

Question 25

when do you repair a post-op hernia?

Answer 25

months after initial surgery - ensure infection has resolved & that you have a good fibrous hernia ring

Question 26

what can cause post-op septic peritonitis?

Answer 26

non-viable intestines, anastomosis site leakage, pre-existing peritonitis from damaged bowel, colitis, & severe incisional infection

Question 27

what are some clinical signs associated with septic peritonitis?

Answer 27

fever, depression, tachycardia, colic, & colitis - very red intestines & a lot of fibrin

Question 28

what may you see in peritoneal fluid in a horse with septic peritonitis?

Answer 28

nucleated cell count & TP elevated due to recent surgery degenerate neutrophils, bacteria, low pH, & low glucose

Question 29

what is the treatment for septic peritonitis in a post-op horse?

Answer 29

repeat laparotomy to correct it, abdominal lavage, antimicrobial therapy, anti-endotoxemia treatment, & NSAIDs

Question 30

how do you monitor a post-op septic peritonitis horse?

Answer 30

monitor progress via repeat ultrasound, cytology, & culture remove the drain & suture skin

Question 31

what is thrombophlebitis?

Answer 31

inflammation of the jugular vein - can also be septic

Question 32

what are some reasons that colic patients may be predisposed to developing thrombophlebitis?

Answer 32

emergent nature may preclude aseptic prep recovery hypercoagulable states

Question 33

what is the clinical appearance of thrombophlebitis?

Answer 33

perivascular swelling, firm, ropy jugular vein, & fever

Question 34

what does thrombophlebitis look like on ultrasound?

Answer 34

thickened wall, clot or hyperechoic material in the lumen, & patency

Question 35

what is the treatment for thrombophlebitis?

Answer 35

remove the catheter & don't use for venipuncture hot-packing, diclofenac, local drainage for culture & sensitivity, & surgical removal

Question 36

what is recurrent colic?

Answer 36

repeat episodes that occur in about 30% of post-op patients can be immediate, from re-feeding, & or chronic intermittent

Question 37

what is re-feeding colic?

Answer 37

feeding after colic surgery leading to recurrent episode of colic

Question 38

what do you do if you have a post-op colic patient that is showing signs of immediate colic?

Answer 38

surgical pain was not adequately addressed - give analgesics if colic pain is significant - horse may require repeat surgery

Question 39

what is colitis in regards to a post-op patient?

Answer 39

post-op diarrhea - large colon impaction treated with aggressive fluids

Question 40

how is post-op colitis treated?

Answer 40

fluids, address protein loss & endotoxemia, nutritional support, & re-establish normal colonic microbiota through probiotics & transfaunation