Equine Health Update EHU Vol 19 Issue 3 - Page 23

EQUINE | Proceedings Proceedings To Cut Or Not To Cut: Decision Making In Colic Management Michael Schramme DrMedVet, CertEO, PhD, HDR, DipECVS, DipACVS, AssocECVDI Campus Vétérinaire de Lyon, VetAgro Sup Université de Lyon, France When making the decision whether a horse with ab- dominal discomfort needs surgery to assure survival, the clinician needs to have a good understanding of the broad classification of the mechanisms of intestinal pain and the different intestinal abnormalities that can cause them. The first objective of the clinical assessment of the patient is not to make an accurate diagnosis but to es- tablish whether emergency surgery may be required to relieve a life threatening intestinal problem.It is there- fore essential to determine whether pain is caused by a non obstructive intestinal abnormality, a simple intes- tinal obstruction or a strangulating obstructive lesion. The latter typically leads to obstruction and hypoperfu- sion of the bowel and is therefore more closely associ- ated with endotoxaemia, circulatory impairment and shock. The appropriate recognition of coexisting signs of intestinal obstruction and cardiovasculuar compro- mise is the key to the decision making process. It must be remembered that irreversible shock (cardiovascular failure) may occur as early as 4 hours following onset of intestinal strangulation. The need for surgical intervention can be determined from basic clinical parameters and a few diagnostic tests. Laboratory test and diagnostic imaging can be useful in some cases where the clinical signs are con- fusing. No single decisive criterion exists. Therefore the veterinarian builds as complete a clinical picture as pos- Taken from the Colic WETLAB Proceedings South African Equine Veterinary Association Congress February 2017 sible given the available instrumentation, weighs off all the parameters and makes a preliminary decision. When the results of the initial examination are inconclusive or conflicting, an hourly monitoring programme is initiat- ed in order not to allow developing trends of clinical de- terioration to go unnoticed for some time and thereby not to miss the best window of opportunity for surgi- cal intervention. Studies of survival information clearly show that surgery is best performed in the early stages of intest W'7FVf&VBvW&R7W"ЦvW'6&RW&f&VBVFFVǒbV6W76'2&WBЧFW"7VFVBFF26&VgVF&r&6W72BV&ǐ&VfW'&2FW&Vf&RGf6&RGW&rFRV&ǒ7FvW2bFW7FW'WfFV6Pb6&Ff67V"6&֗6RVWfFVBV'B&FRFVG&F2gFV'6VBBFR&F֖fV@2g&WVVFǒ&FRǒV&ǒ6v2F6FfR`FRVVBf"7W&vW'&RV&VVFr"g&WVVFǐ&V7W'&r&F֖'6V6RbFW7FfRЦVBBFVFFfR&V7FfFw2bF76VVB F7FV6FV66F7WB&6VBFW6R6v2ǐvvWfW"VBF7F6W2vW&R&Fג0W&f&VBVV6W76&ǒF2&W7VG2fF&R67B7&V6VBWFRBFVFf"66@FW"7W&vW'&VFVB&&V2FRFW"BvFrf"6v2b66FW7FFVvVW&F"6RЧ&6wVW2W&FVfVBF&V6R'fW2FV7&V6R66W2b7W'ffV66Ɩ6FWfV27W7F֗VBGFW&bFV66rFB&W7B7VG22"W"FVW&VBB62खF2&6W72V67W&vV&6W2FR&VGV7F7W'ff66W2766FVBvFFV7W&v6FW"ЧfVFv7BFRW&VB&&FG766FVBvF( "fVR2( "6WFV&W"#r( #