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Flashcards

GI surgery 1

Rachael Jones 4. Gastrointestinal English 48 cards

Cards in this deck (48)

  1. 1What underpins the learning objectives for equine GI surgery?Day One competences from RCVS
  2. 2What is GI surgery in equine practice related to?Signs of abdominal pain ie Colic
  3. 3What is Colic?Abdominal pain - set of behaviours that are caused by the pain
  4. 4What are the occasional other equine surgeries that take place?Exploratory laparotomy (or laparoscopy) for other subacute or chronic conditions or signs eg weight loss, suspected masses, peritonitis
  5. 5What is most abdominal pain due to?GI tract disturbances - very occasionally due to reproductive or urinary tract disease
  6. 6What may cause overlapping signs that are sources of pain and systemic disturbance not emanating from the abdomen?- Laminitis
    - Myopathies
    - Respiratory conditions: pleuropneumonia, acute "asthma"
  7. 7What is the series of events for investigating a colic?- History
    - Observation without restraint in box – is it colicy ?
    - Clinical examination
    - Rectal examination
    - Nasogastric intubation – is there significant net reflux of fluid ?
    - Abdominocentesis
    - Blood sample - PCV/Total protein & Lactate
    - Ultrasonography
  8. 8What aged cat is predisposed to pedunculated lipomas?Middle ages to older - especially is fat
  9. 9What are important things to ask about the history for colic?- Signalment & Use
    - BIOP (“Been In Owners Possession”)
    - Background management – feeding, worming, exercise
    - Previous colic ?
    - Current episode – when started (last seen normal?) ? signs ?
    - Faecal production ?
    - Veterinary findings where relevant – temp, pulse, mm, ausc, rectal, ST
    - Treatment – what ? How much ? when ? response ?
  10. 10What are the behavioural signs with colic?- Reduced faecal output – sometimes a precursor sign
    - Anorexia
    - Dull, uninterested, standing at back of box
    - Lying down – (bedding in coat)
    - Pawing at the ground
    - Flank watching
    - Kicking at abdomen
    - Rolling
  11. 11What are the 2 main systems that have to be clinically assessed with colic?1. Cardiovascular system
    2. Gastrointestinal system
  12. 12How should the cardiovascular system be assessed when in colic?For indicators of the severity of systemic disturbance produced by the GI tract problem eg
    - Heart rate
    - Pulse quality
    - Mm colour
    - PCV/TP
    - Lactate
  13. 13How should the GI system be assessed when in colic?For indicators of the nature and site of the problem:
    - Auscultation of gut sounds
    - Nasogastric reflux on passage of stomach tube
    - Rectal examination
    - Abdominal ultrasound
  14. 14What are systemic disturbances associated with colic?- Tachycardia - heart rate above normal (30-40)
    * > 60 potentially surgical
    * > 100 potentially dying
    * Pulse may feel “weak” (reduced volume)
    * Driven principally by pain but also dehydration and endotoxaemia
    - Discoloured mucous membranes – from pink to red to purple - slow CRT
    - Reduced to absent gut sounds on abdominal auscultation
    - Abdominal distention
  15. 15What is essential with the numbers associated with tachycardia in colic?Taken with the patient and other clinical findings as they're not specific
  16. 16When my horses regurgitate/vomit when having a nasogastric tube placed?If there is obstruction or oleus of SI
  17. 17What are the considerations for the passage of the nasogastric tube?- Horse restrained – stocks ? twitch ? sedation (xylazine) ?
    - Tube passed into ventral nasal meatus
    - Head flexed to encourage passage into oesophagus rather than trachea
    - Horse swallows as tube is advanced
    - Observe left hand side of neck for end of tube advancing in oesophagus to confirm correct placement (CRITICAL)
  18. 18What should be done once the nasogastric tube is in the stomach?- Pass down into stomach – if no spontaneous reflux establish syphon by attaching funnel to end of tube and pouring in measured amount of water from jug and then lowering end of tube into bucket to collect and measure what comes out.
    - Suck/blow end of tube to encourage flow and repeat attempts to syphon as necessary
  19. 19What is the essential thing with rectal examination?Human safety
  20. 20What are the considerations and process of performing a rectal examination?- Restraint
    * Sedation with xylazine +/- spasmolyics eg hyoscine (Buscopan)
    * Stocks
    * Twitch
    - Tail bandaged
    - Copious lubricant on hand and arm
    - Elevate tail and gently introduce arm.
    - Remove faeces from rectum
    - Do NOT resist contractions – allow hand to be pushed back
    - Gentle systematic exploration of the caudal abdomen
  21. 21What is a common cause of rectal tears?Resisting the contractions when performing a rectal examination
  22. 22What is it important to look at with the faeces?- Consistency
    - How much is there?
  23. 23What can you feel on the left side when performing a rectal exam?- Left dorsal colon
    - Left ventral colon
    - Pelvic flexure
    - Sharp caudal border of spleen
    - Caudal pole of kidney at top of spleen
    - Small colon (faecal balls)
  24. 24What can be felt on the right side of the horse from rectal exam?Caecum
  25. 25What are rectal examination potentially palpable abnormalities?- Impaction of intestine – esp pelvic flexure of large colon
    * Where LVC becomes LDC
    * Down & to Left of midline
    - Distension of small intestinal loops – obstruction (or ileus)
    - Distension of Large intestine
    - Displacement of Large Intestine
  26. 26What are the first line analgesics for colic?- NSAIDs – eg Phenylbutazone
    - Spasmolytics – eg Hyoscine butylbromide/Butylscopolamine (Buscopan)
    - Sedatives – eg Xylazine (short acting alpha agonist)
  27. 27How can the response to analgesia be used for the treatment of colic?- Whether it's good/ poor?
    - Short lived? Protracted?
  28. 28What can abdominal ultrasound be used to detect?- SI distention – may be visible in places hard to reach on rectal
    - Intestinal wall thickening – suggesting possible strangulating obstruction
    - Free abdominal fluid – possible peritonitis
    - Nephrosplenic entrapment – colon between spleen and L kidney
  29. 29What can abdominal paracentesis provide information about?- Presence of inflammation or devitalised bowel.
    - Ideally check for amount and distribution of fluid ultrasonographically first
  30. 30When is abdominal paracentesis not indicated?- Where severe large intestinal distension/ impaction
  31. 31What types of restraint can be used for abdominal paracentesis?Stocks/ twitch/ sedate
  32. 32How is abdominal paracentesis performed?- Aseptic preparation of ventral abdomen – clip, antiseptic scrub, sterile gloves, sterile equipment
    - Ventral midline at most dependant point through linea alba
    - 1ml local anaesthetic
    - Use 2” needle or #11 scalpel and teat canula
    - Cloudy reddish fluid suggests intestinal compromise
  33. 33What are the likely lab test results for colic?- Blood – PCV – normal 30-40%
    * Total Protein – normal 60-80 g/L
    Lactate – normal < 3 mmol/L ?
    - Peritoneal Fluid – cytology – WBC 0-5 x 109/L
    - lactate < 2 x Blood lactate
  34. 34What are the "good" findings related to?Probably a medical case
  35. 35What are findings suggesting medical colic?- Only mild/intermittent behavioural signs
    - Heart rate < 50
    - Good pulse volume, colour and CRT
    - Gut sounds present on auscultation
    - Rectal – NAD or palpable impaction
    - Normal blood results – PCV, protein, lactate
    - No reflux with nasogastric tubing
    - Ultrasound – normal, no distended SI
    - Normal peritoneal fluid on paracentesis
  36. 36What may management of medical colics include?- Starvation
    - Analgesia
    - Rehydration: drinking, by nasogastric tube, intravenously
    - Electrolyte replacement
    - Spasmolytics
    - Lubricants (by NG tube)
    - Gentle walking exercise
    - Re-appraisal every 2-4h
  37. 37What do the "bad" findings link to?Possible surgical cases
  38. 38What are the findings that can relate to surgical findings?- Moderate to severe and persistent behavioural signs despite analgesia
    - Absence of faeces
    - Heart rate >60
    - Poor mm colour
    - Reduced or no gut sounds present on auscultation
    - Rectal – distention +/- displacement of intestine (SI or LI)
    - Increased – PCV, protein, lactate
    - Positive reflux with nasogastric tubing – more than 5L net
    - Ultrasound – distended SI or displaced LI
    - Discoloured and turbid peritoneal fluid on paracentesis
  39. 39What is the likely cost of surgery for colic?Likely to be in the region of £4,000 - £8,000
    - surgical centre may require substantial payment up front
    - the unsuccessful case not infrequently at the top end
    - DEAD HORSE + BIG BILL often = unhappiness
  40. 40What are the issue with transport and the surgery for colic?- Where will it be done and how is the owner going to get the horse there?
  41. 41What affects the prognosis of surgery?Often hard to be sure pre-surgery
    - duration of signs critical
    - severity of systemic disturbance will also give clues
  42. 42What should owners be aware of if they're putting their horse through colic surgery?- Many and common complications
  43. 43How do you prepare the horse for surgery?- Decompress stomach with nasogastric tube
    - Jugular Intravenous catheter placement
    - Administration of analgesia/ antimicrobials
    - IV fluids to support circulation
    - Shoe removal
    - Clipping of abdomen
  44. 44What are the principles of surgical treatment?- Opening and exploration of the abdomen by palpation and exteriorisation of intestine where that is anatomically possible
    - Identification of the lesion
    - Correction of displaced/entrapped intestine
    - Decompression of distended viscera
    -Resection of devitalised tissue and restoration of intestinal continuity (anastomosis)
    - Closure of abdomen
    - Recovery from anaesthesia
  45. 45Give 3 main types of intestinal obstruction.1. Simple
    2. Functional
    3. Stangulating
  46. 46What is a simple intestinal obstruction?Lumen only obstructed- usually food. Vasculature OK so intestine minimally compromised. Prognosis usually good. eg pelvic flexure impaction
  47. 47What is a functional intestinal obstruction?Peristalsis fails to propel ingesta (ie “ileus”) leading to distension. eg grass sickness, post-operative ileus secondary to distention
  48. 48What is a strangulating intestinal obstruction?- Compromise of vasculature resulting in ischaemia of intestine – eg pedunculated lipoma, large colon volvulus. Veins obstructed first causing oedematous thickening of gut wall
    - Release of endotoxins into circulation (“endotoxaemia”) – systemic compromise & shock. Prognosis increasingly poor after 6-8 hours.
    - Later secondary problems eg laminitis – further worsen prognosis

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4. Gastrointestinal (Equine Gastrointestinal Surgery - Alistair Barr) Flashcards on GI surgery 1, created by Rachael Jones on 24/10/2018.
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