Written Exam - Post-Op Considerations Flashcards
what immediate (1-5 days) clinical signs may be seen in a post-op colic patient that are very bad?
failure of anastomosis/enterotomy - body wall dehiscence, & recovery issues
what intermediate (2-14 days) clinical signs may be seen in a post-op colic patient that are very bad?
fever, endotoxemia, laminitis, ileus, diarrhea
what chronic (14 days to months) clinical signs may be seen in a post-op colic patient that are very bad?
hernia, laminitis, adhesions, & repeat colic
in the immediate post-op period, what are some uncommon catastrophic complications?
fracture, myopathy, neuropathy, acute body wall dehiscence, & failure of anastomosis site
T/F: fever is not unusual in the 1st 48 hours post-op for horses
true - large and small bowel problems, result of transient inflammation/endotoxemia, & horse is typically clinically stable
why are sustained, progressive fevers that develop 48 hours after surgery worrisome?
indicate bigger problem - colitis, peritonitis, thrombophlebitis, endotoxemia
what is endotoxemia?
disruption of the mucosal barrier resulting in systemic absorption of endotoxin
what are some clinical signs of endotoxemia?
tachycardia, fever, hyperemic mucus membranes, & laminitis
what are some treatment options for endotoxemia?
iv fluids, appropriate antimicrobial therapy, NSAIDs
what are some treatment options for laminitis?
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
what is post-op ileus?
loss of motility in the small intestines, distension of the stomach/small intestine with fluid & ingesta
occurs in 50-60% of small intestinal cases
what defines post-op ileus?
greater than 20L reflux/day or > 8L at any one time
what are some risk factors of post-op ileus?
small intestinal lesion, large length resected, increased time under anesthesia, intestinal ischemia/distension, endotoxemia
what is the treatment for post-op ileus?
decompress stomach with nasogastric tube frequently
supportive therapy - iv fluids, anti-inflammatories, analgesics
pro-kinetic therapy
when may you have to repeat a laparotomy?
functional problem with anastomosis site, adhesion, or post-op ileus
what is the standard incisional care?
stent for recovery & abdominal bandage upon return to the stall
T/F: incision infections occurs in 7-34% of post-op colics
true
what are some risk factors of incisional infections in a post-op colic?
repeat celiotomy, leukopenia, weight >300kg, increased surgery time, & > 1 year old
what does an incisional infection look like?
preceded by edema, serosanguinous discharge, & fever
happens 5-10 days post-op
how do you treat incisional infections?
drain areas of focal fluid accumulation
flush incision
submit fluid for bacterial identification & sensitivity (local antibiotic therapy)
support incision with a belly band
T/F: acute, catastrophic hernias after abdominal surgery are rare
true
what is the treatment & prognosis for acute, catastrophic hernias after abdominal surgery?
immediate surgical repair - associated with poor recoveries
what increases the risk of hernia by 62.5x?
incisional drainage/infection
why is repair required for post-op hernias?
small hernias have the potential to trap bowel - athletic horses & breeding stallions
when do you repair a post-op hernia?
months after initial surgery - ensure infection has resolved & that you have a good fibrous hernia ring
what can cause post-op septic peritonitis?
non-viable intestines, anastomosis site leakage, pre-existing peritonitis from damaged bowel, colitis, & severe incisional infection
what are some clinical signs associated with septic peritonitis?
fever, depression, tachycardia, colic, & colitis - very red intestines & a lot of fibrin
what may you see in peritoneal fluid in a horse with septic peritonitis?
nucleated cell count & TP elevated due to recent surgery
degenerate neutrophils, bacteria, low pH, & low glucose
what is the treatment for septic peritonitis in a post-op horse?
repeat laparotomy to correct it, abdominal lavage, antimicrobial therapy, anti-endotoxemia treatment, & NSAIDs
how do you monitor a post-op septic peritonitis horse?
monitor progress via repeat ultrasound, cytology, & culture
remove the drain & suture skin
what is thrombophlebitis?
inflammation of the jugular vein - can also be septic
what are some reasons that colic patients may be predisposed to developing thrombophlebitis?
emergent nature may preclude aseptic prep
recovery
hypercoagulable states
what is the clinical appearance of thrombophlebitis?
perivascular swelling, firm, ropy jugular vein, & fever
what does thrombophlebitis look like on ultrasound?
thickened wall, clot or hyperechoic material in the lumen, & patency
what is the treatment for thrombophlebitis?
remove the catheter & don’t use for venipuncture
hot-packing, diclofenac, local drainage for culture & sensitivity, & surgical removal
what is recurrent colic?
repeat episodes that occur in about 30% of post-op patients
can be immediate, from re-feeding, & or chronic intermittent
what is re-feeding colic?
feeding after colic surgery leading to recurrent episode of colic
what do you do if you have a post-op colic patient that is showing signs of immediate colic?
surgical pain was not adequately addressed - give analgesics
if colic pain is significant - horse may require repeat surgery
what is colitis in regards to a post-op patient?
post-op diarrhea - large colon impaction treated with aggressive fluids
how is post-op colitis treated?
fluids, address protein loss & endotoxemia, nutritional support, & re-establish normal colonic microbiota through probiotics & transfaunation
