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Post-op care of the colic patient - Coggle Diagram
Post-op care of the colic patient
Baseline requirements
Monitor C/V status: HR, PCV, TP, membranes
Manage I/V catheters: nidus for thrombus formation, remove as soon as not needed
Analgesia: Flunixin
Protect surgical site: belly bandage
Gut motility: don't feed until normal
Fluid therapy: isotonic fluids but continuous infusion
Restore gut motility
Monitor for signs of gut motility
Gastric reflex (every 3-4hrs) - fails to empty properly causing gastric distension
Auscultation
Heart rate and PCV (increased = dehydration)
Faeces (not reliable)
Ultrasound - caudal abdomen (distended with fluid = reduced motility)
Movement, gentle walking
Average time of onset of ileus is 24 hours
Oral fluids and food
Fluid by mouth after 12 hours
Offer small amounts of feed early (12-24hrs post-op)
Long-term prevention
Horse likely to colic again
Maintain regular feeding and management practices
Minimise amount of CHO fed
Monitor gut parasite status and treat as necessary
Maintain good dental care
Long term post-op management
Once gut motility has returned
Monitor for signs of colic and clinical signs twice daily
Maintain belly bandage
Small volumes of feed regularly
Frequent walks 'in hand'
Re-introduce oral fluids and feed
Remove catheters
Following discharge
Maintain belly bandage for first 2-3 weeks
Low energy diet
Remove skin suture/ stable at 10 days post-op
Monitor for signs of colic
8 weeks box rest then 8 weeks paddock turnout before exercise
Post-op complications
Post-op colic
Failure of adaptation
Increased risk following large colon volvulus
Causes: intestinal obstruction
Ileus - build up of fluid or gas leading to colic
Adhesions
Blockage at anastomosis
Displacement
Re-laparotomy is an option
Most common cause of post-op death or reason for euthanasia
Surgical site wound infection
Tends to be dull, off food and swelling around incision
Resolve quickly when skin breaks down and pus can drain
Increased risk of hernia formation and prolonged hospitalisation
Painful
Incisional hernia
Elevated heart rate increases risk (relates to endotoxaemia and ability for midline incision to heal)
Cosmetic blemish - don't tend to cause mechanical or physiological problems
Wound suppuration (infection)
Avoidance
Avoid wound infection
Box rest 8 weeks, paddock rest 8 weeks
Use belly band or hernia belt
Post-op Ileus
Risk factors
Elevated PCV
Endotoxaemia fluid into SI leading to distension
Pedunculated lipoma strangulation
Management of ileus
IV fluids
Walk out in-hand
Decompress with stomach tube to prevent bursting
Prokinetic drugs - Metoclopramide
If signs of toxicity, stop CRI and horse usually recovers in 30 minutes
Lidocaine can reduce inflammation related to ileus but weak evidence
Clinical signs
Increasing HR, PCV, TP - dehydration
Gastric reflux - more than 2L
Dull and depressed
U/S of small intestine