Large Ani. Sx- Castration 3

wilsbach's version from 2015-11-08 22:39

Postop care and complications

Question Answer
how common is it to use post-op abx for castration?only routine in horses, not in any other sp
who is the only animal to get abx post-op, and which abx is it?routine in horses, Penicillin Usually Adequate
who should you be esp careful to check tetanus prophy for before you start sx?It is very important to check the vaccination status when horse is wounded or surgery is performed. (Failure to do this is to invite a lawsuit)
If a horse has not been protected previously against tetanus, what should you do? what cautions should you know about?horses should routinely be given tetanus antitoxin and or toxoid. NOte: Older horses occasionally have significant problems with tetanus antitoxin (Theiler's Disease)...This should be discussed with owners. Some veterinarians just don't give antitoxin to older horses. If horses have received tetanus toxoid previously a boosting dose of toxoid is indicated
So horses basically always need tetanus antitoxin/toxoid before areas where tetanus is common, who ELSE is given antitoxin? In areas where tetanus is quite common lambs and kids (goats) are routinely given antitoxin at 1/10 the normal dose (150 units). [It is not common to protect other species against tetanus--> ie cows and pigs]
how long after sx till horse can be returned to exercise?Horses should be given adequate exercise starting the day following castration --> Restrict for 12 Hours then force exercise
how long after sx till things that are not horses (goat/sheep/pig/cow) can be returned to exercise?Other species are usually encouraged to exercise immediately following surgery --> Encourage Exercise Immediately!!
Post operative swelling and edema is most obvious for how long? common for how long after castration?Most obvious 3 to 4 days post castration... Routinely resolves in 10 days to 2 weeks
how does Postoperative Observation differ between horses and the other animals? what is common?Horse -Check Frequently Till Bedtime. All Species -Encourage for Several Days
post-op swelling and edema is most commonly associated with?Associated with lack of ventral drainage (Inadequate size of incision is the most common reason)
what are three possible treatments for post-op swelling?(1) Open incisions or increase their size (2) NSAID (3) adequate exercise Best accomplished by riding the horse at the walk or turning the animal out to pasture with other horses --Riding is better than leading because the owner will ride for longer than they will lead
what are 2 ways for preventing post-op swelling and edema?Adequate size of incisions, Adequate exercise
signs of infection?Fever, Swelling (Scrotal or preputial), Lameness, Discharge
what are Two classical chronic infections are described post-castration?(1) Champignon (STREP) (2) Scirrhous cord (STAPH)
what is the agent usually involved in champignon infection, and where is the infection located? any other unique attributes of this infection?Caused by STREPTOcoccus, Associated by an infected end of the spermatic cord and a large amount of granulation tissue
what is the agent usually involved in Scirrhous cord infection, and where is the infection located? any other unique attributes of this infection?Caused by STAPHylococcus, Scrotal incision heals but a chronic infection involving the stump of the spermatic cord causes enlargement and eventual drainage
what is a possible result of a champignon/ scirrhous cord infection?Occasionally the entire remaining spermatic cord becomes infected and enlarged to the point that it can be palpated rectally
how common is a post-op infection?Few animals develop an infection if there is adequate drainage and adequate exercise
what type of infection is a serious problem that requires extensive therapy and support?clostridial :(
post-op infection is predisposed by... (2)(1) Lack of drainage associated with postoperative swelling and edema (2) Ligatures Non absorbable or slowly absorbed
what is the therapy for a post-op infection?(1) Adequate drainage and removal of chronically infected tissue (2) Adequate antibiotic therapy (consider C/S) (3) Forced exercise (4) The usual situation resolves within a short time with these measures
Hge: Initial bleeding is normal... what criteria will tell you that the bleeing needs attention?Bleeding with a fast drip for more than 15 minutes requires attention
what is the usual source of post-op hemorrhage? (less common sources?)Testicular artery within the spermatic cord. (less common are Vessels in the cremaster muscle, Scrotal vessels)
post-op hge is usually because of a problem with what?the emasculator
what are two diff probs there can be with the emasculinator which can lead to post op hge?(1) too sharp- New emasculators should be used to cut rope to dull them (2) Improper application- might be applied upside down (should be nut to nut ie ball thing near joint down) , Tension applied to the spermatic cord while cutting, Applied at an angle, Inclusion of scrotal skin in the emasculator (leads to laceration of the scrotal vessel resulting in inadequate crushing of testicular artery)
how should you manage post op hge?--> Attempt to identify the bleeding vessel--> if you can find it, what do?clamp and ligate, or clamp and leave clamp in place for 24 hours
how should you manage post op hge?--> Attempt to identify the bleeding vessel--> if you CANT find it, what do?Pack the scrotum with sterile gauze and suture the skin to hold the gauze in place--> Gauze is usually removed in 24 to 48 hours. (Consider drugs to decrease fibrinolysis and or decrease clotting time (these aren't very effective)---Aminocaproic acid , premarin)
what lab tests are NOT good indicators of blood loss, and why?total protein and packed cell volumes are not a good indication of blood loss (6 hrs lag period before total protein goes down, 12 to 24 hours before PCV goes down)
Animals with marked post castration hemorrhage are at greater risk for....? (What should you do about this?)greater risk for post surgical infections...Broad spectrum antibiotics prophylactically are indicated
how severe of a problem is eventration of the omentum? how do you manage this?Herniation of the omentum alone is usually not a significant problem. Management: Rectal examination to evaluate the size of the internal inguinal ring & to check to see if intestine is involved. Ligate & remove the omentum, or Consider the use of an emasculator to remove the omentum. Cross tie the horse and observe carefully for 48 hours
If herniation of the intestines is going to occur, WHEN does it usually occur? what is herniation of the intestines usually secondary to?Usually occurs within the first 3 to 4 hours following castration. Usually secondary to straining (colic, or Animal cast and extensive straining to get up)
which breeds are overrepresented for intestinal herniation?Draft Horses, Standard Bred Horses, Tennessee Walking Horses
what are 4 risk factors that inc chances for intestinal hernias?(1) breed (Draft Horses, Standard Bred Horses, Tennessee Walking Horses) (2) Pre-existing inguinal hernia (3) Inguinal hernia as a foal (4) Inguinal rings that, on rectal exam, will admit more than 2 fingers
Inguinal rings that, on rectal exam, will admit more than _________ fingers means there is a risk for post-op intestinal hernia 2
what are 2 prevevntative measures you can take against eventration/herniation?(1) Ligation of the spermatic cord prior to removal of the testicle (2) Closure of the external inguinal ring at the time of castration
does closed castration help prevent herniation?No, closed castration doesnt reduce risk, but Closed castration plus ligation of the cord reduces the risk
Closure of the external inguinal ring at the time of castration to avoid herniation is usually indicated when?Suggested in very high risk cases--> Large inguinal rings, Herniation reported by the owner, Congenital hernia that corrected with time
how do you manage eventration/hernia of intestines?Protect the bowel from contamination and damage. Clean the bowel with sterile saline (ideally) or clean water. If possible replace the bowel in the scrotum and close the scrotum with towel clamps prior to transport or anesthesia for repair/Protect the bowel with moist towels or drapes used as a sling to protect the bowel during movement to a surgical area. Use Broad spectrum antibiotics. Flunixin meglamine for analgesia and its anti endotoxic properties. Surgically replace the bowel, through the inguinal ring, into the abdomen and closure of the external inguinal ring (usually have to enlarge the inguinal ring, might also have to do a paramedian/ventral midline approach, thorough exam of bowel, and possible resection/anastomoses)
which drug has anti-endotoxic properities and can be used to help with complications of herniation/eventration?Flunixin meglamine
what are clincal signs of peritonitis? fever, depression, inc pulse rate, colic, dehydration, diarrhea, anorexia
how do you test for peritonitis?Abdominocentesis- Fluid submitted for cytology, bacterial culture and sensitivity testing (Cell numbers many times reach 100,000/ ul in horses which do not have an infectious peritonitis- Thought to be the reaction to blood in the peritoneal cavity). Should be evaluated for the presence of bacteria and degenerative neutrophils
how do you manage peritonitis?(1) Broad spectrum antibiotics prior to return of sensitivity test results then specific effective antibiotics (2) NSAIDs (3) anti-endotoxic medications (polymixin b, hyperimmune serum)(4) indwelling drains in the abdomen --> Abdominal lavage several times per day
when does damage to the penis usually happen as a complication to castration? what do you have to do?Usually occurs because an inept surgeon mistakes the penis for a testicle. Surgery must be performed to correct the problem+ NSAIDs to reduce swelling and edema... If the penis is prolapsed it must be supported until the edema reduces and the penis can be placed caudal to the preputial orifice
what is a hydrocele?An accumulation of sterile fluid in the common vaginal tunic, resulting in a non painful distention of the common vaginal tunic with peritoneal fluid
is hydrocele more common in an open or closed castration?More common in open castrations when the common vaginal tunic is not removed
which animal gets hydroceles most commonly?mules
how important is fixing a hydrocele, and how do you fix it?No treatment is necessary except to correct appearance, Surgical treatment involves surgically removing the distended common vaginal tunic
when might castration fail to elim unwantedd behavior?(1) Older stallions occasionally retain learned behavior (2) Some animals have extra testicular sources of testosterone (The adrenal gland is usually incriminated)
what is proud cut?when there is Failure to change obnoxious behavior, Indicating that all genetic tissue has not been removed (very unlikely)