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38 Cards in this Set
- Front
- Back
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what is successful recovery of a colic horse dependent on
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surgical technique, good anesthesia, maintenance of fluid and electrolytes, management of pain and nutritional considerations
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what happens if you do sx and they get worse
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start over, PE work up the problem, make a POA
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post of PE
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more than a TPR (many exams throughout the day)
GI auscultation (passage of manure/consistency) evaluation of hoof-laminitis inspection of catheter site inspection of bandage/incision site monitor water consumption/ appetite evaluate tx sheets from overnight |
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post op fluid administration
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maintain hydration/ volume repletion
maintanance fluid rate 50 ml/kg/day system of checks and balances (monitor amount delivered vs. amount prescirbed) |
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when do you stop fluids
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when patient is eating > 80% normal diet before d/c
water consumption= periprandial drinking |
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why do you say after the horses are eating a good amount of normal intake you can decrease fluids
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becuase when they eat is when they are going to drink
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balanced electrolyes, so what are anorectic horses depleted in
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potassium and calcium
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what do you have to monitor everyday if you patient is on fluids
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monitor electrolyes q 12-24 hours
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when do you start referring the horse after sx
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begins within 24 hours of GA recovery
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if there is a small intestinal sx how long do you wait until you feed them
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about 6-8 hours a very small amount of food could feed earlier for a lg int. sx
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when you are re feeding how much food are you goign to give
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handfuls, not flakes
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what do you feed for a recovering horse
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pellets, pasture, soft hay
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post op BW
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daily PCV/TP (minimum)
electolyes lactate CBC WBC is expected to be abnormal following GI surgery (neutropenia is common) they are inflamed you just cut them fecal cultures (salmonella biosecurity protocol) |
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post op drugs
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abx broad spectrum 24-96 hours
beta lactam + aminoglycoside most common combo anti-inflammatory NSAIDs 2% lidocaine therapy (SI/LI horses) +/- antiendotoxemic therapy therapies for the laminitc patient |
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complications of post op colic patient
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post op ileum (POI)
peritonitis equine gastric ulcer syndrome (EGUS) mechanical obstru tion adhesions |
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who will lay down after sx
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foals not adults
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POI
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most commonly occurs following SI surgery from handling the bowel, distention of bowel proximal to obstruction
functional ileus- development of gastric reflx |
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how common is it for horses to get POI after sx
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~30% of horses following SI surgery depends on
length of resection age PVC at admission duration of anesthesia ` |
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dx of POI
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positive gastric reflux
>20 L in 24 hours >8 L at any one time volume of reflux should begin to taper over days increasing among can indicate Sx recurrence serial US exam should show improving motility |
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treatment of poi
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gastric decompression indwelling NG tube
monitor fluid ins and outs critical to mnitor fluid/e-lyte balance anti-inflammatory tx pro kinetic tx |
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post op colic d/dx
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periotonitis
EGUS mechanical obstruction adhesion formation |
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risk of peritonitis
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celiotomy procedure (expect sterile inflammation)
leakage of reception and anastomosis site (septic peritoneal fluid expected) |
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post op dx peritonitis
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abdominocentesis
recent sx creates confusion cause you flushed the hell out of the abdomen completes the dx WBC > 200.000 cells and TP > 6.0 gnot uncommon up to 6 days post p |
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what can you do to evaluate the peritoneal fluid if you have no idea
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do a fluid blood gas compare peritoneal fluid to serum blood gas results
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what should peritoneal fluid look like compared to serum blood gas
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glucose < 50 points lower than that of serum BG
elevated lactate very low pH |
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post op colic EGUS
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diagnosis - endoscopy
response to tx treatment - PPI- omeprazole effective tx and prevention manage discomfort (avoid NSAIDs) alpha 2 agonists temp. relief: maalox., sulcrafate |
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mecahnical obstruction post op
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constipation lg. colon feed impaction. returning to feed and not having them drink enough. need to monitor water consumption
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mechanical obstruction at site of resection/ anastomossi
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clinical signs of POI
reflux that plateaus/ increases- suspect diagnosis via re-laparotomy/necropsy unlikely to visualize via US exam may be related to surgical procedure may be related to adhesions |
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adheions
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scar tissue within the abdomen
SI> LI patients up to 22% of SI develop adhesions 2nd most common cause of re-lapartomy cause of chronic colic following surgery |
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how can you try to px adhesions
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abx + anti-inflammatory tx
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when do fibrin tags become fibrous
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~ 5 days post op
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what potentiates adhesion formation
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POI, peritonitis
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what is another post op issue with horses
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laminits
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prophylaxis
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cryotherpay, nsaids, good bedding
closely monitor hoof comfort, digita pulses, hoof capsule temperature be proactive |
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what can cause fever post op
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catheter site
monitor T visual insection of catheter site signs of heat, swelling, pain at site palpate of site only with sterile glove evaluate jugular v. avoid multiple drug resistant infsn (MRSA) most common remove of catheter may be necessary culture! |
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another differential for fever post op
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incision site
change site dressing always wear gloves excess drainage/ discharge may indicate infection (plaque of ventral edema ~ normal) heat, swelling, pain, inc. body temp submit culture/ abx sensitivity px hernia formation |
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post op complications GI inflammatio colitis
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nosocomial infection (salmonella/ c. difficle)
abx-induced infxn NSAID sensitivity hypoproteinemia, neutropenia development of endotox +/- colic pain decreased attitude/ appetite decreased fecal output/ change in consistency |
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most important thing about postop complication
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go back to the basics, PE, BW, US, good nursing care and good observational skills are very important recovery proces
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