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JR SX > Written Exam - Post-Op Considerations > Flashcards

Written Exam - Post-Op Considerations Flashcards

1
Q

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

A

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

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2
Q

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

A

fever, endotoxemia, laminitis, ileus, diarrhea

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3
Q

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

A

hernia, laminitis, adhesions, & repeat colic

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4
Q

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

A

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

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5
Q

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

A

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

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6
Q

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

A

indicate bigger problem - colitis, peritonitis, thrombophlebitis, endotoxemia

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7
Q

what is endotoxemia?

A

disruption of the mucosal barrier resulting in systemic absorption of endotoxin

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8
Q

what are some clinical signs of endotoxemia?

A

tachycardia, fever, hyperemic mucus membranes, & laminitis

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9
Q

what are some treatment options for endotoxemia?

A

iv fluids, appropriate antimicrobial therapy, NSAIDs

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10
Q

what are some treatment options for laminitis?

A

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

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11
Q

what is post-op ileus?

A

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

occurs in 50-60% of small intestinal cases

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12
Q

what defines post-op ileus?

A

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

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13
Q

what are some risk factors of post-op ileus?

A

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

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14
Q

what is the treatment for post-op ileus?

A

decompress stomach with nasogastric tube frequently

supportive therapy - iv fluids, anti-inflammatories, analgesics

pro-kinetic therapy

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15
Q

when may you have to repeat a laparotomy?

A

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

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16
Q

what is the standard incisional care?

A

stent for recovery & abdominal bandage upon return to the stall

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17
Q

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

A

true

18
Q

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

A

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

19
Q

what does an incisional infection look like?

A

preceded by edema, serosanguinous discharge, & fever

happens 5-10 days post-op

20
Q

how do you treat incisional infections?

A

drain areas of focal fluid accumulation

flush incision

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

support incision with a belly band

21
Q

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

A

true

22
Q

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

A

immediate surgical repair - associated with poor recoveries

23
Q

what increases the risk of hernia by 62.5x?

A

incisional drainage/infection

24
Q

why is repair required for post-op hernias?

A

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

25
Q

when do you repair a post-op hernia?

A

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

26
Q

what can cause post-op septic peritonitis?

A

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

27
Q

what are some clinical signs associated with septic peritonitis?

A

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

28
Q

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

A

nucleated cell count & TP elevated due to recent surgery

degenerate neutrophils, bacteria, low pH, & low glucose

29
Q

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

A

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

30
Q

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

A

monitor progress via repeat ultrasound, cytology, & culture

remove the drain & suture skin

31
Q

what is thrombophlebitis?

A

inflammation of the jugular vein - can also be septic

32
Q

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

A

emergent nature may preclude aseptic prep

recovery

hypercoagulable states

33
Q

what is the clinical appearance of thrombophlebitis?

A

perivascular swelling, firm, ropy jugular vein, & fever

34
Q

what does thrombophlebitis look like on ultrasound?

A

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

35
Q

what is the treatment for thrombophlebitis?

A

remove the catheter & don’t use for venipuncture

hot-packing, diclofenac, local drainage for culture & sensitivity, & surgical removal

36
Q

what is recurrent colic?

A

repeat episodes that occur in about 30% of post-op patients

can be immediate, from re-feeding, & or chronic intermittent

37
Q

what is re-feeding colic?

A

feeding after colic surgery leading to recurrent episode of colic

38
Q

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

A

surgical pain was not adequately addressed - give analgesics

if colic pain is significant - horse may require repeat surgery

39
Q

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

A

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

40
Q

how is post-op colitis treated?

A

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

JR SX (17 decks)

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