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LAS - RUSS > Colic II - Exploratory Celiotomy and Post-Op Complications > Flashcards

Colic II - Exploratory Celiotomy and Post-Op Complications Flashcards

1
Q

Two forms you’d want completed before the surgery?

A
  1. Written / Signed consent from owner/agent

2. Signed estimate

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2
Q

Minimum Pre-Op Bloodwork:

1. \_\_/\_\_\_
2.
3.
4.
5.
6. \_\_\_/\_\_\_
A
  1. PCV/TP
  2. Lactate
  3. CBC with differential
  4. Fibrinogen
  5. Glucose
  6. BUN / Creatinine
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3
Q

4 surgical approach options?well

1.
2.
3.
4.

Which one is the best? Why?

A
  1. Ventral Paramedian
  2. Inguinal
  3. Ventral Midline
  4. Flank (paralumbar and transverse)

Ventral Midline is the best because you can exteriorize 75% of the GIT with minimal hemorrhage, and close

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4
Q

Things you are unable to exteriorize during a ventral midline approach?

1.
2.
3.
4.
5.
6.
7.
A
  1. Stomach
  2. Duodenum
  3. Distal ileum
  4. Base of cecum
  5. Distal RDC
  6. Transverse colon
  7. Terminal small colon
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5
Q

Ventral Midline Approach:

  1. Incision through the linea alba cuts through what three layers?
  2. Average length of incision?
  3. Begin incision where? Why?
A
  1. EAO, IAO, and transverse abdominal muscle
  2. 30 cm+
  3. Umbilicus - linea is thickest here
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6
Q

A bad sign during exploratory celiotomy is loss of (negative/positive) pressure

A

Negative

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7
Q

Describe the step-by-step exploration:

  1. Begins at ____
  2. Follow ___ to the ____
  3. Follow ___ to the ____
  4. Run ___ from __ to ___
A
  1. Cecum
  2. Follow lateral band to the cecocolic band to the RVC
  3. Follow dorsal band to the ileocecal fold to the antimesenteric band of ileum
  4. Run SI from Ileum to duodenum
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8
Q

How can you decompress the SI during exploration?

A

Manually milk contents to the cecum

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9
Q

Duodenum Exploration:

  1. Fixed to ____ + ____ by the ____
  2. How it runs in the body?
  3. Be sure to palpate what closely associated structure?
A
  1. Dorsal body wall and Transverse colon by the duodenocolic ligament
  2. from L to R behind the root of mesentery to the ascending duodenum
  3. Cranial mesenteric artery
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10
Q

What is the next step of an Exploratory Celiotomy after the initial exploration?

A

Colonic evaluation

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11
Q

Where do you begin the colonic evaluation stage of the exporatory celiotomy?

A

at the lateral band of the cecum to the RVC

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12
Q

Describe the steps of the colonic evaluation:

Starting from the RVC:

  1. from ___ to ____

3.

6.

A
  1. From cecum cranially to the sternal flexure
  2. Caudally down the LVC to the pelvic flexure
  3. Cranially as the LDC
  4. To the diaphragmatic flexure
  5. To the RDC
  6. To the Transverse colon
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13
Q

If a horse in desperate need of a correcting surgery for a small intestine colic is <2 from surgical facility, you can consider giving _____

A

hypertonic saline

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14
Q

Methods to determine tissue viability:

  1. ____ - Gold Standard!

2.

3.

4.

5.

6.

A
  1. Histopathology
  2. Gross clinical assessment
  3. Fluorescein Dye given IV
  4. Doppler U/S
  5. Luminal Pressure
  6. Surface Oximetry
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15
Q

Post-Op Supportive Care Includes:

1.
2.
3.
4.
5.
6.
A
  1. CV support
  2. Pain Management
  3. Anti-Endotoxin therapy
  4. Prevent/treat infection
  5. Restore GI function
  6. Manage complications
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16
Q

Post-Op Fluid Therapy:

  1. Most important aspect is the (volume/rate) of fluids given
  2. Daily maintenance = ___ ml/kg/day
  3. Common electrolyte imbalances you’d try to correct?
A
  1. Volume
  2. 50 ml/kg/day
  3. Hypocalcemia, hypomagnesemia
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17
Q

Causes of Hypokalemia Post-op?

A
  1. Lack of intake
  2. Diuresis
  3. GI loss through diarrhea
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18
Q

Potassium Supplementation:

  1. When to supplement?
  2. No greater than __mEq/kg/hr **
  3. Usually add ___mEd/5L bag
A

1, lack of intake > 24 hours or when youve given IV fluids > 24 hours

  1. .5 mEq/kg/hr
  2. 80mEq/5L bag
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19
Q

Why is it difficult to maintain vascular volume post therapy?

A

Because increased capillary permeability d/t mucosal damage creates fluid and protein loss into interstitum

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20
Q
  1. Goal of Post Op Fluid Therapy?

2. Reasonable indicators that you are successful?

A
  1. Maintain enough vasc. volume to sustain CO

2. HR < 80, PCV < 50%, TP > 4.1

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21
Q

Post Op-Monitoring:

How often should you:

  1. Take a PCV/TP?
  2. Perform gastric decompression?
  3. Complete PE?
  4. Take a CBC/Fibrinogen/Lactate/Electrolytes?
A
  1. Q6 HRs
  2. Q2-3 Hr
  3. Q1-3 Hrs
  4. One day post op, and 3 days post op
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22
Q

Post op medications:

1.
2.
3.
4.
5.
\+/-
6.
7.
A
  1. Fluids
  2. Antibiotics (broad spectrum)
  3. NSAIDs
  4. Gastric protectants
  5. Anti-endotoxin drugs

+/-

  1. Colloids
  2. Prokinetics
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23
Q

When to discontinue Post-op Meds?

1.
2.
3.

A
  1. Eating
  2. Afebrile
  3. Normal CBC
24
Q

Post-Op Pain Management:

Etiology?

1.
2.
3.

A
  1. Peritoneal inflammation
  2. Abdominal incision
  3. Intestinal distension
25
Q

Post-Op Pain Management Options:

  1. ____ - Beneficial effects?
  2. _____ - Dosage regimen?
A
  1. Pain + Anti-Endotoxin

2. Loading dose followed by CRI

26
Q

Post-Op Endotoxemia:

  1. (common/rare)?
  2. Describe some clinical signs
A
  1. common!

2. tachycardia, abnormal mm, pain, edema, hypomotility, GI distension, NG net reflux, thrombosis/coag disorders

27
Q

Post-Op Endotoxemia Management:

1.
2.
3.
4.
5.
6.
A
  1. FLUIDS! FLUIIIIIDDDDSSS

2 Flunixin meglumine low dose

  1. Meds to chelate endotoxins like DTO
  2. Drugs to bind endotoxin like POlymyxin B
  3. Plasma
  4. Heparin therapy (if DIC)
28
Q

Post-Op Ileus (POI)

  1. (Common/rare)?
  2. Some risk factors (there are a lot!)
A
  1. common
2. 
> 10 years old,
PCV > 45% at presentation,
Hight TP and alb,
Hyperglycemia,
Anesthesia > 2.5 hr,
Surgery > 2 hours,
R/A,
SI lesions,
Ischemic small intestine
29
Q

Post-Op Ileus (POI)

  1. Incidence rate: __-__%
  2. Most common lesion that leads to POI?
  3. Prognosis?
A
  1. 10-21%
  2. Strangulating SI
  3. Favorable
30
Q

Clinical Signs of POI:

  1. Behavior?
  2. 3.
  3. Lab results?
A
  1. Colicky, depressed
  2. Decreased/no borborygmi
  3. Elevated Hr
  4. Increased PCV/TP, electrolyte derangement
31
Q

Dx of POI:

1.
2.
3.

A
  1. Rectal exam
  2. U/S
  3. Gastric reflux 12-48 hours post op
32
Q

T/F: The best way to treat POI is via supportive therapy

A

T

33
Q

Supportive therapy options for POI:

1.
2.
3.
4.

A
  1. NG decompression
  2. FLUIDS
  3. Address any electrolyte imbalances
  4. +/- Antibiotics
34
Q

Prokinetic options for POI:

1.
2.
3.

A
  1. Lidocaine
  2. Metoclopramide
  3. Erythromycin
35
Q

Lidocaine CRI :

  1. Decreases _____
  2. Suppresses _____ activity
  3. Directly stimulates ____
  4. Inhibits: a) b) c)
A
  1. catecholamines
  2. 1st degree afferent neuron activity
  3. smooth muscle

4.

a) prostaglandin = decreased inflam in gut wall
b) granulocyte migration/lysosomal enzyme release
c) free radical production

36
Q

Lidocaine CRI:

  1. Loading Dose?
  2. CRI dose?
A
  1. 1.3ml/kg IV

2. .05mg/kg/min in fluids

37
Q

Lidocaine CRI:

  1. Toxicity can cause: ___, ___, ____
  2. DO NOT GIVE AS ____
A
  1. muscle fasiculation, ataxia, SEIZURE

2. Bolus

38
Q

Metoclopramide: Effects:

  1. Mechanism?
  2. End result?
A
  1. Increases ACH release via Da1 and DA2 antagonism, and serotonin modification
  2. Stimulates smooth muscle in stomach and small intestine
39
Q

Toxic effects of Metoclopramide?

1.
2.
3.
4.

A
  1. Excitement
  2. Restlessness
  3. Sweating
  4. Seizure
40
Q

Erythromycin:

  1. Mechanism?
  2. Effect?
  3. Reports of ____ with use, can also have what two side effects?
A
  1. Motilin agonist
  2. Stimulates stomach and small intestine motility
  3. Severe colitis,
    Cramping, colic
41
Q

Possible incisional complications:

1.
2.
3.
4.

A
  1. Infection
  2. Hernia
  3. Suture sinus formation
  4. Acute incisional dehiscence
42
Q

Incisional Infection:

  1. Usually occurs how long post-op?
  2. CxS?
A
  1. > 3 days

2. Febrile, pain, edema

43
Q

Incisional Infection:

Treatment options:

1.
2.
3.
4.

A
  1. Drainage
  2. Culture
  3. Antibiotics (depending)
  4. Abdominal support to minimize hernia / dehiscence
44
Q

Incidence of incisional infection can be decreased by:

1.
2.
3.
4.

A
  1. Rapid surgery
  2. Appropriate draping
  3. Isolating enterotomy incision
  4. Good technique
45
Q

Most common complication from incisional infection?

Factors that increase likelihood of this complication?

A

Incisional Hernia

Violent recovery, severe post-op pain, prolonged surgery time

46
Q

Acute Total Dehiscence:

  1. (common/rare)?
  2. (mild/severe)?
A
  1. rare

2. Severe, often fatal

47
Q

Acute Total Dehiscence: Predisposing factors:

1.
2.
3.
4.

A
  1. Violent recovery
  2. Severe post-op pain
  3. Prolonged surgery time
  4. Continuous suture pattern
48
Q

2nd most common reason for a repeat surgery?

More common in (foals/adults)?

A
  1. Adhesions

2. Foals > adults

49
Q

Ways to prevent post-op adhesions (pre/intra-op)

1.
2.
3.
4.

A
  1. Maintain intact mesothelial layer
  2. Minimize trauma via good technique (keep bowel moist, remove talc from gloves, hemostasis, minimal exposure of suture)
  3. Decide on surgery in a timely manner
  4. Peri-op NSAIDs and antibiotics
50
Q

Adhesion Prevention (post-op)

1.
2.
3.
4.
5.
6.
A
  1. DMSO
  2. Heparin
  3. CMC 3%
  4. HA
  5. NSAIDs / Antibiotics
  6. Omentectomy
  7. Peritoneal Lavage
51
Q

Peritonitis:

  1. Mortality rate - __%
  2. Damage via: a) b) c)
A
  1. 56%
  2. a) Bowel necrosis

b) Anastomotic / enterotomy leakage
c) contamination

52
Q

Clinical Signs of Peritonitis:

1.
2.
3.
4.
5.
6.
A
  1. Colic, depression
  2. Anorexia
  3. Ileus
  4. Diarrhea
  5. Fever
  6. Elevated HR and Rr
53
Q

T/F: 200,000 cells/uL, TP 6 g/dL is normal after a colic surgery

A

T

54
Q

What would you look for on cytologic eval of of abdominal fluid to dx peritonitis?

A

Toxic PMNs, bacteria

55
Q

Peritonitis Dx:

  1. pH?
  2. Glucose?
A
  1. Serum peritoneal glucose difference > 50 mg/dL

2. Peritoneal pH < 7.2 with peritoneal glucose < 30 mg/dL

56
Q

Treatment of Perionitits:

1.
2.
3.
4.
5.
A
  1. Stabilize with fluids/electrolytes/plasma
  2. NSAIDs
  3. Antibiotics
  4. Possible repeat laparotomy
  5. Closed drains
57
Q

What is the best way to prevent post-op laminitis?

A

By minimizing risk of post-op endotoxemia

LAS - RUSS (32 decks)

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