SURGERY AND DENTISTRY


following limitations must be fully understood when interpreting abdominal fluid:


• Gross appearance, packed cell volume (PCV), and total protein (TP) in peritoneal fluid can be mis- leading or equivocal and time for laboratory analy- ses can delay decision-making.


• The following surgical lesions might not develop diagnostic peritoneal fluid changes:


 Large colon volvulus.


 Diaphragmatic hernia (strangulated segment in the thorax).


consequences for recovery of intestinal function. This can be mediated through damage to the vascular endothelium that exacerbates trans- capillary fluid leakage and tissue edema.24


• In a clinical study in horses with small intestinal strangulation, a more restricted goal-directed approach to fluid therapy had similar survival


• Fluids given IV at the surgical facility are suffi- cient to prepare the horse for surgery.


and complication rates as the traditional liberal fluid therapy.25


 Ruptured viscus. This can produce fluid with a normal gross appearance, white blood cells


(WBC), and TP (need a cytological exami- nation).21


 Early pressure necrosis in the site of an entero- lith, fecalith, or foreign body impaction.


 Lipoma strangulation by wrapping of the lip- oma around a segment of intestine rather than


strangulating a loop and its vasculature. 8. Reassessment of Intravenous Fluid Therapy


Although intravenous (IV) fluid therapy is a necessary and life-saving treatment for horses in cardiovascular shock,many horses with signs of severe colic are not in cardiovascular shock. In horses with ischemic lesions, delays, complications, and costs associated with fluid therapy on the farmare harmfulwhen balanced against the benefits of early referral. Similar concerns apply to continuous rate infusions on the farm(e.g., lidocaine). In the authors' opinion, instituting IV fluids for


9. Treatments and Diagnostic Procedures Repeated at the Hospital


This can become a contentious issue withmany owners. Although applying diagnostics and treatments on the farm is well intentioned, many of the same procedures have to be repeated at the surgical facility to justify the decision for the next option–surgery or euthanasia. Owners regard this as an unnecessary additional cost, arguing that their veterinarian already did the same. Unfortunately, some information might be missing or some indicators could have changed during the interim. Possibly, warning owners of this beforehand might pre- pare them to accept this necessity.


10. Teamwork


horses with surgical colic at a hospital is sufficient and minimizes some of the risks of aggressive fluid therapy before referral, such as:


• High-volume fluid therapy can actually produce a misleading degree of improvement that only confuses owners and delays referral.


• Time required for administration of fluids and to monitor responses is time that allows progression of the disease and tissue injury. Consequently, the ischemic changes can become irreversible, and the more proximal distended segments will probably fill with much of the fluid-infused IV. This only adds to proximal intestinal distention and mural edema, critical factors that increase pain and delay recovery.23


• High-volume fluid therapy can create electrolyte imbalances through sodium diuresis that creates other electrolyte abnormalities (calcium, magne- sium).22 Some of these changes can delay postop- erative recovery and reduce survival.


• There is a growing awareness that aggres- sive fluid therapy can actually cause adverse


474 2022 / Vol. 68 / AAEP PROCEEDINGS


Decision-making about colic referral is complicated for owners,13 and therefore a teamapproach is recom- mended, which starts with the owner, trainer (or manager), and referring/primary veterinarian. If clini- cal signs in any way suggest a surgical treatment is indicated, but owner reluctance persists, a surgeon at the hospital that would receive the referral should be consulted to provide a reasonable overview of cost and prognosis. The decision that surgery is or is not an option should be based on solid facts that could be pro- duced by frank discussion with all involved. The goal is not to change the owner’s mind but to prevent a fatal change of course when the window for a success- ful surgery has passed.


11. Recommendations


The referral process could be regarded on the most ba- sic clinical level as needing a second opinion for a horse that does not fit within the typical colic that will respond on the farm. The decision for or against surgery when indicated is the owner’sprerogative and, in most cases, the decision they make is the correct one for them. The problem situations are those in which the surgery option is rejected, only to be selected later when the nonsurgical approach is clearly failing. Again, this decision is the owner’s prerogative, but should be based on a realistic understanding of cost and prognosis and with guidance from all involved in case management. The cost of surgical treatment is substantial, and hospi- tals should review their surgical pricing system to


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