The Decision to Operate and Surgery of the Small Intestine

Diagnostic Techniques

• Clinical assessment of patient (endotoxaemia?)
• Rectal examination key
• Transabdominal ultrasonography (vital in foals)
• Although haematological and blood biochemical parameters are important, as yet a simple laboratory-based “surgical test”has proved elusive
• Response to analgesia remains critical in decision process

Cardiovascular Status

• Heart rate
• Mucous membrane colour
• Capillary refill time
• Evidence of other signs of circulatory collapse (eg DIC, laminitis etc) Red cell parameters (PCV, platelets etc)

Taking Blood

• PCV
• Total protein
• RBC
• WBC
• Fibrin degradation products
• Looking for hydration status, evidence of shock, infection, or DIC (platelets very low or evidence of FDPs)
• Chronic colic (variety of biochemical tests)
• Postoperatively ....... Electrolytes

Auscultation of the Abdomen

• Simple and non-invasive
• 4 “quadrants”
• Borborygmi variable
• Unreliable for “surgical diagnosis”
• Many surgical patients have a “silent” abdomen but may be hyperactive in early stages 
• Caecal gas cap may be detectable by “ping test”

Manual Examination Per Rectum

• Clinician / handler safety
• Patient safety
• Adequate restraint (physical / chemical)
• Rectal “relaxation”
• Aim of the examination?
• To try to make a diagnosis without injury to patient or clinician!
• At the very least to attempt to differentiate the “medical” from the “surgical” patient  [...]