Final: Little 2 - Colic 2, Hernias

Question 1

What are the 7 P’s of exploratory ceilotomy (and life in general)?

Answer 1

Proper Prior Planning Prevents Piss Poor Performance

Question 2

A 14 year old QH gelding presents for severely painful colic this afternoon after having been normal at lunch. The history is unremarkable, the HR is elevated (80bpm), the RR in not obtainable, the mm’s are muddy, and the CRT is prolonged. The abdomen is silent. There is evidence of trauma over the head and eyes.

What procedure should you perform next?

Answer 2

NG tube

Question 3

A 14 year old QH gelding presents for severely painful colic this afternoon after having been normal at lunch. The history is unremarkable, the HR is elevated (80bpm), the RR in not obtainable, the mm’s are muddy, and the CRT is prolonged. The abdomen is silent. There is evidence of trauma over the head and eyes.

NG: 10L foul smelling net reflux

Rectal: multiple distended firm loops of SI

US: Stacked loops of amotile SI

Abdominocentesis: serosanguinous, TP 3.7, cells 5000

Diagnosis?

a. Colon torsion
b. Strangulating lipoma
c. RDD
d. Small colon impaction

Answer 3

b. Strangulating lipoma

Question 4

What is the normal thickness of the SI on US?

Answer 4

<2mm

Question 5

What is indicated for a 14 yo QH gelding with severe clinical signs due to a stangulating lipoma?

Answer 5

Immediate surgical intervention

Question 6

What should you request from the owner before performing a colic surgery on their horse?

Answer 6

At least half of the upper estimate as a deposit

Question 7

You decided to initially administer hypertonic saline when stabilizing a patient for colic surgery. How many liters of isotonic fluid must you give before induction if you gave 2L of hypertonic saline?

Answer 7

20L

Question 8

What is the best approach to the abdomen in a horse? Why?

Answer 8

Ventral midline

Can exteriorize 75% of the GIT, minimal hemorrhage, strong closure

Question 9

Which of the following structures CAN be exteriorized when performing an abdominal exploratory via ventral midline approach?

a. Stomach
b. Duodenum
c. Pelvic flexure
d. Base of cecum
e. Transverse colon
f. Terminal small colon

Answer 9

c. Pelvic flexure

Question 10

The linea alba is the aboneurosis of the ____, ____, and ______ muscles.

Answer 10

EAO

IAO

Transverse abdominal

Question 11

What does it indicate if there is a loss of negative pressure when you open the abdomen?

Answer 11

Perforation

Question 12

What viscera should be seen first when making a ventral midline incision into the abdomen if nothing is displaced?

Answer 12

Cecum

Question 13

When exploring the abdomen, you begin at the _____. You follow the _____ band to _____ to the __________ colon. You then follow the _____ band to the _____ fold to the ______ band of the ileum.

Answer 13

When exploring the abdomen, you begin at the CECUM. You follow the LATERAL band to the CECOCOLIC band to the RIGHT VENTRALcolon. You then follow the DORSAL band to the ILEOCECAL fold to the ANTIMESENTERIC band of the ileum.

Question 14

The duodenum is fixed to the dorsal body wall and the tranverse colon by the _________.

Answer 14

Duodenocolic ligament

Question 15

In which direction does the duodenum run behind the root of the mesentary next to the RDC?

Answer 15

Left to right

Question 16

In which direction does the transverse colon run?

Answer 16

Right to left

Question 17

What type of staples would you use for a resection and anastomosis of the jejunum to the cecum?

Answer 17

GIA

Question 18

Which forceps (picutred) do you use when closing the linea alba?

Answer 18

Russian thumb forceps (“Clams”)

Question 19

What type of suture and pattern do you use to close the abdomen? How many throws do you use for your knots?

Answer 19

Large, synthetic, absorbable #3

In short burst simple continuous pattern

8-10 throws per knott

Question 20

Why should you place an indwelling NG tube post-abdominal surgery?

Answer 20

Almost all horses get post-op ileus which results in reflux

Use tube to maintain decompression

Question 21

A 8yo Warmblood mare presents for a violent colic. She foaled her third baby 8 weeks ago. Both are being kept on a spring pasture. What is the most likely diagnosis?

a. Strangulating SI
b. RDD
c. LDD
d. Colon torsion

Answer 21

d. Colon torsion

Question 22

How long should xylazine last?

Answer 22

15 min

Question 23

Which of the following is not incuded in a pre-op drug protocol for a horse with a colonic torsion?

a. K+Pen
b. Meloxicam
c. Banamine
d. Tetanus toxoid
e. IVF (LRS)
f. Gentocin

Answer 23

b. Meloxicam

Question 24

How is tissue viability evaluated during surgery? What is the gold standard?

Answer 24

Flick it

IV Fluorosceine dye

Suface oximetry

Doppler US

Luminal pressure

Gold standard: Histopathology Not reasonable choice in surgery

Question 25

Which 2 parameters are most important to monitor during abdominal surgery?

Answer 25

HR BP

Question 26

What is the daily maintenance fluid rate for a horse?

Answer 26

50 mL/kg/day

Question 27

Which e-lyte derrangement is common post-abdominal op?

Answer 27

Hypocalcemia Hypomagnesemia *Also add K+ to fluids*

Question 28

What is the maximum amount of K+ that can be given per kg per hour?

Answer 28

0.5mEq

Question 29

What is the threshold for TP before you start seeing peripheral edema?

Answer 29

4.1

Question 30

What 3 things indicate you can discontinue post-colic surgery tx?

Answer 30

Eating Afebrile Normal CBC

Question 31

What can be done to manage protein loss?

Answer 31

Give **plasma**

Question 32

What is the most important therapy for endotoxemia?

Answer 32

Fluids

Question 33

How does Polymyxin B treat endotoxemia?

Answer 33

Binds lipid A and thus neutralized the endotoxin ## Footnote *6000 IU/kg IV*

Question 34

Which of the following is NOT a risk factor for POI (post-op ileus)? a. \>10 yo b. Presenting with a PCV \<45% c. Presenting with hyperglycemia d. Anesthesia \>2.5 hrs e. Surgery \>2 hrs f. Ischemic SI or SI lesions g. Presenting with high TP and ALB

Answer 34

b. Presenting with a PCV \<45% ## Footnote *\>45%*

Question 35

What is the most common lesion leading to POI?

Answer 35

Strangulating SI

Question 36

Which prokinetic agents are used for POI treatment? Which one is not indicated because it causes cramping?

Answer 36

Lidocaine and Metoclopramide C/O'd: Erythromycin

Question 37

What is the most common complication from a post-op incisional infection?

Answer 37

Incisional hernia

Question 38

When do you repair an incisional hernia?

Answer 38

At least 3 months after surgery ## Footnote *To allow for granulation tissue (which has poor holding power) to heal into scar tissue*

Question 39

Are adhesions more common in foals or adults?

Answer 39

Foals

Question 40

What should all colicky stallions be checked for?

Answer 40

Inguinal hernia

Question 41

Which of these is not given to prevent adhesion formation? a. Heparin b. NSAIDs c. Antibiotics d. Lidocaine e. HA f. 3% CMC (carboxymethylcellulose)

Answer 41

d. Lidocaine

Question 42

What pH and peritoneal glucose levels indicate septic peritonitis?

Answer 42

pH \<7.2 GLU \<30mg/dL (Serum to peritoneal glucose difference \>50mg/dL)

Question 43

Which post-op condition is 5x more likely in horses with endotoxemia?

Answer 43

Laminitis

Question 44

What are the 3 portions of a hernia?

Answer 44

Ring Sac Contents

Question 45

What is a true or indirect hernia?

Answer 45

Opening through normal aperture, containing a complete peritoneal sac

Question 46

What is a false, or direct, hernia?

Answer 46

Hernia that does not contain a complete peritoneal sac, usually created by trauma or after breakdown of surgical entry

Question 47

Whhy is the size of the external inguinal ring irrelevant to the development of an inguinal hernia?

Answer 47

The internal ring is the limiting area

Question 48

T/F: Inguinal hernias are common in geldings due to the space that the removed testes have left behind.

Answer 48

False

Question 49

T/F: Congenital inguinal hernias usually resolve spontaneously in 3-6 months.

Answer 49

True

Question 50

Why do mature bulls usually get indirect inguinal hernias on the left side?

Answer 50

Rumen pressure

Question 51

Do beef or dairy cows get inguinal hernias more often?

Answer 51

Beef esp Hereford

Question 52

What position do you put a bull in under GA to repair an inguinal hernia?

Answer 52

Lateral recumbency

Question 53

Why is surgical repair of a congenital inguinal hernia in a bull not recommended unless a bilateral castration is also performed?

Answer 53

Strong evidence that hernias are hereditary

Question 54

What is the most common hernia in the horse?

Answer 54

Umbilical

Question 55

What is incarcerated in a parietal or Richter hernia? What findings make you think that this type of hernia is present?

Answer 55

Antimesenteric wall of the ileum Hernia is firm, non-reducible, and painful

Question 56

You are palpating an umbilical hernia in a horse. Is the prognosis better if the hernia ring is firm and thickened or thin and indistinct?

Answer 56

Firm and thickened (better prognosis for successful repair)

Question 57

What parameters must be met for conservative treatment to be an option for an umbilical hernia?

Answer 57

\<5cm diameter Reducible Foal

Question 58

What indicates the surgery is warrented for an umbilical hernia?

Answer 58

Didn't spontaneously close by 4 months of age \>10 cm / 4in diameter

Question 59

Is an open or closed surgical technique preferred for umbilical hernias?

Answer 59

Open

Question 60

What are the 5 categories of umbilical hernias in claves?

Answer 60

Uncomplicated + SQ infection/abscessation + infection of umbilical remnant Umbilical abscesses/ chronic ophalitis Urachal cysts/ruptures

Question 61

Are uncomplicated umbilical hernias more common in dairy or beef cattle? What is most commonly contained in the hernial sac?

Answer 61

Dairy (esp. Holstein-Friesian) Abomasum

Question 62

T/F: Umbilical hernias in foals and calves usually spontaneously close by 4 months of age as long as they are uncomplicated.

Answer 62

False, in calves they don't usually close - simple repair indicated

Question 63

In what species are hernia bands and elastrator bands used to repair uncomplicated hernias?

Answer 63

Bovine

Question 64

Are post-op complications after a herniorrhaphy more common in calves or foals? Why?

Answer 64

Calves More commonly have concurrent infections

Question 65

What surgery is indicated if you have a hernia with an umbilical infection? What vessels must be ligated? What portion of which organ is removed?

Answer 65

Open herniorrhapthy with en bloc removal of umbilical remnants Umbilical arteries and vein Apex of urinary bladder

Question 66

Why would a calf require marsupialization due to omphalophlebitis?

Answer 66

If the infection extended cranially to involve the liver