Equine Med- Managing the Post-Op Colic Patient

wilsbach's version from 2016-02-22 21:43


Question Answer
#1 indication for colic sx is? what are some other parameters to consider?#1=uncontrollable pain. Other parameters include: CV deterioration, SI distention, Changes in bloodwork, Abnormal peritoneal fluid
what kinda sx environment will you need for colic sx?you will need General anaesthesia (GA) and a Sterile OR + equipment (sterile procedure!!)
what pre-op meds can you consider for colic sx?NSAIDs and antimicrobials
what is the recumbency and approach for colic sx?Dorsal recumbency, Ventral midline incision
what things should you be monitoring in the post-op pt? Physical exam: serial examinations/day, Monitor water consumption / appetite, Passage of manure / consistency, Evaluation of the hoof……laminitis, Inspection of catheter site(s), Inspection of bandage/ incision site
what do you need to consider in your fluid therapy plan? Volume repletion, Hydration, Maintenance, Ongoing losses
so you just did colic on your pt. IT will eventually need to eat again, so you need to do what?make a refeeding plan
What medication needs to be given post-op? (4 types to consider)(1) Broad spectrum antimicrobials (prophylactic) (24-96hrs depending on type of surgery) (2) NSAIDs / pain medication (Usually flunixine meglumine (judicious use) ) (3) Prokinetics if indicated (SI surgery) (2% lidocaine therapy) (4) Anti-endotoxic therapies
what is the most commonly used post-op pain medication given?flunixin meglumine (better for visceral pain-- bute is better for orthopedic pain)
when might you want to give a prokinetic post-op? what is a prokinetic we give?usually indicated with SI sx. 2% lidocaine therapy
when you start refeeding-- which sx requires SLOWER refeeding... small or large intestine? what kinda meals should you be giving?Feed small frequent meals (SI patient slower then LI)
when do you usually start refeeding? when do you usually have them return to their normal, full diet?Refeeding usually starts within 24h of recovery. Resume normal diet over several days (monitor closely)
what do you look at to decide when you can stop giving fluid therapy? why is this so?you can stop fluid therapy when Patient should be eating > 80% normal diet... This is bc horses are post-prandial drinkers so their fluid consumption depends on their food intake (Transition period is a critical period!)
what is the bare minimum post-op bloodwork/dx tests you need to do?Daily PCV / TP= minimum
which electrolytes should you be monitoring closely post-op? K+, Ca++ and Mg++ !!!!
what chemical parameter should you monitor post-op?lactate
what is a common post-op irregularity of the CBC?neutropenia is common
Why do you want to do post-op fecal cultures?Salmonella biosecurity protocol (they shed when they are stressed-- need to know if you have a shedder)
6 common complications you should expect after colic sx(1) Post-operative ileus (2) Peritonitis (3) Equine gastric ulcer syndrome (4) Mechanical obstruction (constipation, or site of resection and anastomosis) (5) Adhesion formation (6) colitis
if the horse has a FEVER post-op, what other complications might you want to consider? (6) Peritonitis, Colitis, Incisional infection, Catheter site infection, Post-op pneumonia, Laminitis!!!!
6 DDX for COLIC POST-OP FROM COLIC SURGERYPost-operative ileus******, Peritonitis, Equine gastric ulcer syndrome, Mechanical obstruction (constipation, or site of resection and anastomosis), Adhesion formation, colitis
after what surgery is post-op ileus most common? and WHY does the ileus happen? Most common after SI surgery (30%)! usually because of Handling of bowl during surgery, Distention of bowel proximal to obstruction. If it was a Resection: length of resection + GA length (can determine if there will be ileus). PCV at admission also plays a role in predicting this
if it is functional ileus, you will see...development of gastric reflux
why does ileus suck so much?Increases morbidity / mortality and has Huge financial consequences
what are clinical signs of post-op ileus? Colic, HR↑ / RR↑, Gastric reflux, Manure production↓, GI sounds decreased, Distended small intestines (RE / Ultrasound)
how do you treat post-op ileus?Similar to DPJ treatment (Duodenitis proximal jejunitis, inflammation and edema of the duodenum and proximal jejunum, a type of IBD)... Gastric decompression, Fluid / electrolyte therapy, Anti inflammatory tx ( NSAIDs / Lidocaine 2% CRI), Prokinetics (Metoclopramide)
what are 3 major risk factors for Post-OP Peritonitis?Contamination during Surgery, Leakage at R&A site (septic peritoneal fluid), More devitalized bowl (did not take enough out)
why is post-op peritonitis particularly difficult to accurately dx?because Normal post-op inflammation complicates Dx! (Abdominocentesis results hard to interpret)
how can you differentiate septic versus non-septic peritoneal fluid? septic= Glucose conc. much lower then serum, Lactate higher then serum, Acidic pH, Bacteria present (determine via cytology/culture+sensitivity)
picture of what septic peritoneal fluid will look like on cytology, and what the lab results would look like for it
what are the risk factors to getting equine gastric ulcers post-op?STRESS, NSaiD USE, stall confinement
how can you dx post op equine gastric ulcers?dx ulcers with gastroscopy as only definitive dx (response to tx can be useful)
how can you treat post-op gastric ulcers?(management, but bc after sx, can't really change what's going on) Proton pump blockers (omeprazole), Histamine Type-2 Receptor Antagonists (Ranitidine / Cimetidine), Coating agents (sucralfate)
how can you manage the discomfort of a horse with post-op gastric ulcers?can use Alpha-2 agonists (like xylazine) -- Avoid NSAIDs!!!!
Post-OP Mechanical Obstruction-->What is the kind of obstruction that usually forms? what are the two areas/reasons this occurs?luminal obstruction! (1) Easily constipated during refeeding due to resolving dysmotility (Pelvic Flexure) (2) Site of R&A (stricture)
if they are obstructed because they are constipated during refeeding due to resolving dysmotility...where does this usually occur and what should you do?Pelvic Flexure, Monitor hydration / water consumption
what sign might make you suspect there is a resection and anastomosis stricture causing an obstruction? How do you dx? Continuous reflux (if SI)= suspect. Diagnose via re-laparotomy / necropsy
what are Post-Op Adhesions?Scar tissue within abdomen
is it more common for pts with large intestinal sx or small intestinal sx to get adhesions? SI> LI patients (up to 22% of SI patients)
how common are post-op adhesions? 2nd most common cause of re-laparotomy
what kinda problems can post-op adhesions cause?Cause of chronic colic after surgery
post-op colitis is most often seen when/ after what sx? what other cause must you consider??Often seen after large colon volvolus (torsion) (Damaged and inflamed colonic wall)... NEED TO REMEMBER IT COULD BE a nosocomial infection--> THINK salmonellosis/biosecurity
how do you identify a catheter site infection?Daily visual inspection, Evaluate jugular vein (ultrasound), Removal may be necessary! be sure to culture tip of cath
Post-Op incisional infection is usually due to what??Contamination in recovery & stall
cs of a post-op incisional infection?Sx: heat, swelling, pain, higher T°, excess discharge / drainage
how can you help reduce/prevent post-op incisional infection? Use a stent during recovery (uh i think like a drain)- Reduces infection incidence by up to 22% Remove once horse is back in the stall
what bug are we worried about with post-op incisional infections? MRSA (Methicillin-resistant Staphylococcus aureus)
post-op incisional infections predispose to what complication?hernia
how do you treat an incisional infection? Culture discharge!! Allow for good drainage, Topical + systemic ABX (Topical is often sufficient), Use a belly band (keeps it clean and helps prevent hernia formation)
Post-op pneumonia usually occurs because why? how do you tx?sec to prolonged GA, Treat like other pneumonia
Good nursing care and good observation skills are an important part of a successful recovery process...what 3 things should you monitor closely/doRepeated Physical exams! Repeated Bloodwork, Ultrasound + other additional diagnostic tools

clicker questions

Question Answer
order of colon oral to aboral(cecum) RVC, sternal flex, LVC, pelvic flex, LDC, diaphragmatic flex, RDC---> transverse colon
what percentage of the diet should be fiber?1.5-2% of bodyweight a day fiber. (1% is absolute min, 1.5%-2% is best) *****DONT MIX UP KG/LBS of the weight of the horse versus the feed etc
know how to calculate fluids. know what factors to account out for all units, make sure you consider maintenance+ongoing loss+deficit (resuscitation if need a shock dose)
horse shock dose? 50-80ml/kg (bolus a quarter at a time)
horse maintenance fluid rate?50ml/kg/day
limit for potassium being given?DO NOT EXCEED 0.5mEq/kg/hr!!!
what kills strongylus vulgaris eggs?Ivermectin!!! (praziquantel is to kill tapeworms)
DO NOT GIVE THESE DRUGS WITH A LAMINITIC HORSEsteroids (like prednisolone sodium succinate)
you dont pump the stomach if...its been a while since they ate the thing. Put oil/charcoal down there instead
what problem is associated with NSAID admin?right dorsal colitis
what happens if you give epsom salts to a horse?diarrhea
pass a NG tube if HR is more than..80
eso obstructions in horse usually because of...ingestion of inadequately moistened feed stuff
consider AGE when looking at questionspedunculated lipoma= old. ascarids= young.
consider severity of colicsuper severe generally indicating a strangulating lesion or sthing. know what the severe colics are
what part of eso is sm mm?lower 1/3