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Equine GI Surgery Flashcards

(73 cards)

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1
Q

which condition is the most likely to be a cause for GI surgery in horses?

A

colic (abdominal pain)

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2
Q

what reasons other than colic might a horse need GI surgery?

A

exploratory laparotomy/laparoscopy

other subacute/chronic conditions e.g. weight loss, suspected masses, peritonitis

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3
Q

how might you establish whether the horse requires emergency surgery?

A 
pain 
clinical exam findings 
rectal exam 
NGT reflux 
peritoneal fluid analysis 
blood work 
ultrasound findings
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4
Q

how might behaviour change in a horse with colic?

A

moderate/severe and persistent behavioural signs despite analgesia

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5
Q

how might faecal output change in a horse with colic?

A

horses with colic can usually produce no faeces

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6
Q

what heart rate is found in horses with colic?

A

> 60 bpm

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7
Q

what colour might mm be in horses with colic?

A

poor

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8
Q

what might happen to the rectum/intestines in horses with colic?

A

distension +/- displacement (SI or LI)

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9
Q

what might be found in blood testing in horses with colic?

A

Increased PCV/protein/lactate (indicative of dehydration)

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10
Q

what should happen when you NG tube a horse with colic?

A

positive reflux of more than 5L

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11
Q

what will an ultrasound show with colic?

A

distended SI or displaced LI

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12
Q

what is the fluid like on paracentesis if a horse has colic?

A

discoloured and turbid peritoneal fluid

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13
Q

where should a catheter be placed for colic surgery?

A

jugular intravenous for admin of medication, IV fluids, anaesthesia

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14
Q

what size catheter is usually used for an adult horse?

A

14G

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15
Q

how do you decompress the stomach?

A

passing a nasogastric tube (refluxing) - should be done before anaesthesia induction

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16
Q

how do you confirm correct placement of the NG reflux tube?

A

observe left hand side of the neck for end of tube advancing in oesophagus (critical!)

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17
Q

how do you insert the NG tube?

A

tube is passed into ventral nasal meatus
flex head to encourage passage into oesophagus rather than trachea
horse swallows as tube is advanced

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18
Q

what should you do if no spontaneous reflux establishes after passing the NG tube into the stomach?

A

create a syphon by attaching a funnel to end of tube and pouring in a measured amount of water from jug - lower end of tube into bucket to collect and measure what comes out

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19
Q

which medications might be administered to prepare a horse for colic surgery?

A

analgesia and antimicrobials

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20
Q

why are IV fluids administered during prep for colic surgery?

A

support circulation - stabilise cardiovascular system

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21
Q

how is the abdomen prepped for colic surgery?

A

clipping - may be started before induction but consider safety (horse is likely to be in a lot of pain)

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22
Q

what are the overall steps in preparing a horse for colic surgery?

A

jugular IV catheter placement

decompression of stomach with NG tube

administration of analgesia/antimicrobials

IV fluid to support circulation

clip abdomen

shoe removal/tape feet

wash out mouth

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23
Q

what steps should be taken to prepare the horse after induction?

A

move to table

place urinary catheter (suture prepuce in males)

clip abdomen/second fine clip

cover legs and feet

drape

sterile skin prep

ensure all instruments are in surgical colic kit

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24
Q

what are the main principles of surgical treatment?

A

opening and exploration of the abdomen by palpation and exteriorisation of intestine

identification of the lesion

correction of displaced/entrapped intestine

decompression of distended viscera

resection of devitalised tissue and restoration of intestinal continuity

closure of abdomen

recovery from anaesthesia

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25
what are the 3 types of intestinal obstruction?
simple (lumen only obstructed) functional strangulating
26
what is a functional obstruction of the intestines?
peristalsis fails to propel ingesta, leading to distension
27
what is a strangulating intestinal obstruction?
compromise of vasculature resulting in ischaemia of intestine - veins obstructed leading to oedematous thickening of gut wall
28
what does a strangulating obstruction lead to?
release of endotoxins into circulation --> systemic compromise and shock (endotoxaemia)
29
what colour is a strangulating obstruction?
section does maroon to purple to black
30
how does the intestine distal to an obstruction look?
appears relatively normal
31
what specific conditions can cause strangulating obstruction?
pedunculated lipomas herniation - epiploic foramen, inguinal, mesenteric defects intusussceptions
32
how is small intestinal resection achieved?
isolation of affected segment with two bowel clamps at either end ligation of blood vessels supplying affected segment resection of affected segment
33
how are simple/functional obstructions treated?
decompression of SI and/or enterotomy to remove obstruction | blood supply not compromised so no resection or anastomosis required
34
what is the prognosis for simple/functional obstructions?
usually good once resolved
35
what is the prognosis for strangulating lesions involving resection/anastomosis?
survival to 1 year approx 50%
36
what are the risks involved in treating strangulating lesions?
contamination and peritonitis endotoxic shock ileus post-operative adhesions
37
what are the most common conditions affecting the large intestine?
displacements large colon torsion enteroliths (not common in UK)
38
what is involved in surgical management of colonic displacement?
decompression of distended bowel evacuation of colon via pelvic flexure enterotomy (not always) correction of displacement colopexy occasionally performed
39
what is a colopexy?
anchoring the colon by suturing (usually to body wall)
40
what type of obstruction does a large colon volvulus tend to be?
strangulating obstruction with ischaemia of a huge section of GI tract
41
where does a large colon volvulus occur?
at sternal flexure or close to attachment of the right ventral colon to the caecum
42
what is the cause of large colon volvulus?
unknown
43
which horses are most commonly affected by large colon volvulus?
usually affects larger horses, particularly brood mares 90 days after foaling
44
what are the specific signs of large colon volvulus?
sudden onset severe abdominal pain extremely enlarged colon marked abdominal distension endotoxaemia - systemic status deteriorates rapidly tachycardia poor peripheral perfusion
45
what is the prognosis for large colon volvulus?
directly related to the time that elapses between onset of condition and surgery 90% near brood mare farms but much lower when horse must be transported large distances
46
what is involved in post-operative care?
exam every 2-4 hours analgesia, antimicrobials IV fluid therapy belly bandage monitoring for complications regular blood sampling NG tubing as required
47
what are the potential post-operative complications?
endotoxaemia (esp post strangulating obstructions) ileus jugular thrombophlebitis incisional infection further obstruction anastomosis leakage peritonitis adhesions
48
what parameters should be monitored post-op?
``` pain levels temperature GI signs CVS signs incision site catheter feet respiratory system ```
49
how can post-op pain be monitored?
behavioural signs of colic heart rate (tachycardia) specific - peritoneal, incisional infection, musculoskeletal (laminitis)
50
how can pyrexia be monitored for post-op?
rectal temperature
51
how can you measure GI function post-op?
``` reflux through NG tube faecal output gut sounds on auscultation appetite ultrasound ```
52
how can cardiovascular function be assessed post-op?
heart rate mm colour and CRT PCV, protein, lactate, electrolytes
53
what should you be looking for when checking an abdominal incision site?
swelling (some oedema is normal) pain discharge
54
what should you be looking for when checking a catheter post-op?
swelling pain jugular patency
55
why is it important to check the feet/mobility post-op?
laminitis can be secondary to endotoxaemia
56
how can you monitor the respiratory system post-op?
auscultation increased rate? nasal discharge/cough?
57
can you feed a horse who has post-op reflux on passing a NG tube?
no - nil by mouth, IV fluid therapy, may need to muzzle to prevent horse eating bedding
58
what should be involved in post-op feeding?
start with small volumes of water and gradually increase grass is good first solid food small wet mashes of concentrates hay introduced as handfuls and gradually increased return to normal volumes over 3 days (ish)
59
how should post-op exercise be managed?
box rest for 6 weeks with short walks to promote GI motility check no incisional problems which may require prolonged exercise restriction turn out into small paddock at 6 weeks ridden exercise may resume 3 months if abdominal repair is sound
60
what are the potential immediate complications of GI surgery?
endotoxaemia | ileus
61
what are the potential short-term complications of colic surgery?
laminitis | jugular thrombophlebitis
62
what is the potential longer term complication of colic surgery?
adhesions
63
what are the signs of endotoxaemia?
tachycardia and tachypnoea pyrexia --> hypothermia hyperaemic mucous membranes, turning dark over time colic signs, dullness
64
how is endotoxaemia treated?
IV fluid therapy flunixin polymixin B hyperimmune plasma
65
how is ileus managed?
nasogastric intubation for gastric decompression IV fluids (maintenance + dehydration + ongoing losses) reassess 2-4 hourly supplement with electrolytes if needed
66
how is laminitis treated?
frog support/deep bedding | analgesia
67
how is jugular thrombophlebitis treated?
``` remove catheter local anti-inflammatory treatment consider thrombolytics e.g. aspirin antibiotics? don't place catheter in other jugular - alternative site if venous access still required ```
68
how is peritonitis treated?
antibiotics - broad spectrum (often penicillin/gentamycin/metranidozole) abdominal drainage +/- lavage?
69
what are the signs of colitis?
pyrexia, colic, diarrhoea
70
what can cause colitis?
can occur after colon torsion/displacement, where colon wall has been compromised antibiotic and NSAID usage plus sudden change in management
71
how do you treat colitis?
``` can require intensive nursing IV fluid therapy analgesia (avoid NSAIDs) prostaglandin analogues probiotics ```
72
what are the signs of incisional infection?
excessive local oedema pain on palpation drainage of purulent material
73
how do you treat incisional infection?
antibiotics if horse systemically affected culture for sensitivity encourage drainage tends to persist until suture material resorbs (6 weeks ish)

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