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70 Cards in this Set
- Front
- Back
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What are the 3 principle indications for abdominal surgery?
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1) Identification & correction of surgical conditions of GI tract
2) Identification & correction of surgical conditions of the urogenital tract 3) Abdominal exploration |
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What are the 5 locations for abdominal incisions in horses? Which is most common?
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1) Ventral midline*****
2) Paramedian 3) Paralumbar fossa 4) Parainguinal 5) Inguinal |
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What is the difference b/w a laparotomy and a celiotomy?
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Celiotomy: ventral midline incision
Laparotomy: flank incision |
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What are 4 surgeries a ventral midline incision is routinely used for?
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1) Intestinal surgery
2) C-section 3) Cystotomy 4) Exploratory celiotomy |
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Where do you make your ventral midline incision to access the GI?
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From umbilicus cranial
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Where do you make your ventral midline incision for urogenital surgery?
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From umbilicus caudally
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What are 6 abdominal incisions used in cattle and other ruminants?
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1) Left paralumbar fossa
2) Right paralumbar fossa 3) Right paramedian 4) Caudal paramedian 5) Ventral midline 6) Ventrolateral |
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What incision do you use for a C-section on a ruminant?
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Left paralumbar fossa
Right paramedian Caudal paramedial Ventral midline Ventrolateral -any incision aside from right paralumbar fossa |
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What abdominal incision do you use when performing a rumenotomy?
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Left paralumbar fossa
-rumen takes up whole left side of abdomen |
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When do you want to use a ventrolateral incision for a ruminant C-section?
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Emphysematous fetus in cattle
Vaginal prolapse in sheep |
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What abdominal incision do you use when performing an abomasopexy to correct and LDA?
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Left paralumbar fossa
Right paramedian (always works for RDA) |
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What abdominal incision do you use when wanting to perform an omentopexy to correct an LDA, RDA or AV?
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Right paralumbar fossa
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What abdominal incision can you use to perform an abomasopexy to repair a RDA or early AV?
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Right paramedian
-also works for LDA |
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What abdominal incision should you use to perform intestinal surgery on a ruminant (cecum, small intestine)?
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Right paralumbar fossa
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Describe how to make a paralumbar fossa incision in a ruminant.
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Mutiple layer approach where cut through cutaneous tissue then body wall layers individually, make an incision then use forceps and then snip next layer until get to deepest layer then tent up with metzenbaums and snip to protect viscera
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Where do you want to start a ventral midline incision on a large animal?
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Small incision through linea alba at thickest point near umbilicus with scalpel blade
-use forceps as groove director to elevate after initial incision |
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What should you observe (be on the look out for) when performing an abdominal exploration?
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Distention, displacement, discoloration, devitalizaiton
-peritoneal fluid (quantity, color) |
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Where do you always begin in situ palpation during an exploratory in cattle?
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Caudal abdomen
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Explain the order of in situ palpation in cattle.
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Start in caudal abdomen:
-Caudal right abdomen: cecum, SI, colon, omentum -Caudal dorsal: L and R kidneys -L side of abdomen: rumen -L cranial abdomen: spleen, diaphragm -R cranial R abd: Liver, gall bladder, omasum, abomasum, reticulum *similar for horses |
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The large colon = _______ colon. The small colon= ________ colon.
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Large colon= ascending colon
Small colon= descending colon |
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How many taeniac bands does the small intestine have?
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one
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During an exploratory in horses you should exteriorize the _______.
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cecum
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Explain the order of palpating the small intestine and stomach during exteriorizaiton and systemic evaluation during an exploratory in a horse.
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Identify ileocecal fold, then ileum, to jejunum, to duodenum, to the level of the duodenocolic fold, palpate descending duodenum to pylorus, palpate stomach
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Explain the process of systemic evaluation of the colon during an exploratory in a horse.
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-identify cecocolic fold, follow to pelvic flexure, exteriorize colon, palpate transverse colon
-identify descending colon by finding rectum and going cranial, or palpating for & exteriorizing descending colon by band or fecal ball and palpating in cranial and caudal directions |
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What are 2 signs of enterolith formation/ GI obstruction in horses?
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1) Distention of intestine -occurs proximal to site of obstruction
2) Displacement from normal location in abdomen |
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What is a simple obstruction? Strangulating obstruction?
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simple obstruction: interruption of flow of ingesta w/o vascular compromise
Strangulating obstruction: simultaneous vascular occlusion and luminal obstruction |
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What is the definition of intestinal viability?
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Refers to capacity of intestine to survive an insult & function normally w/o residual changes
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Why is it so important to determine intestinal viability?
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Essential in deciding whether to resect bowel, length to resect, or to euthanize
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In order to assess intestinal vitality both _____ and tissue ______ need to be assessed.
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Perfusion & vascular integrity
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How can you clinically assess bowel viability?
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Physiological parameters
-HR, CRT, PCV, TP, MM color -may be helpful in predicting survival but not direct indicator of bowel viability |
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How does a hemorrhagic strangulating obstruction appear during abdominal surgery?
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Serosal surface is dark red to black, thick wall & mesentery due to edema and hemorrhage
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How does ischemic strangulating obstruction appear upon abdominal surgery?
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Serosal surface is cyanotic and blanched, edema but not hemorrhage in bowel wall and mesentery
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How does a non-strangulating infarction in the intestine appear during abdominal surgery?
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Wall does not thicken, becomes cyanotic, dark red, or green; w/ time becomes thin & perforations can occur
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How do you measure the severity of ischemia in bowel?
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Color of mucosa
-Thick dark red mucosa due to congestion, hemorrhage, edema, necrosis -HSO, ISO: mucosa becomes dark red to blck, eventually completely denuded |
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What is the prognosis of a horse with a large colon volvulus that had black mucosa?
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Not good-85% of these horses die
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How can you determine if blood flow is present in the damaged bowel?
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Palpation of arterial pulse
-if present not completely occluded -if absent, may not signify nonviable bowel |
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Does the presence of intestinal motility indicate the bowel is viable?
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Not necessarily, re-establishment of blood flow after ischemia is often accompanied by intestinal contractions though
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What does it mean if there's a return of normal bowel wall color to the intestine?
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Occurs after restoration of blood flow but not always reliable, but considered favorable sign
-pink serosa does not always signify viable bowel |
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What does hemorrhage from the enterotomy site suggest? Oozing of dark blood from cut surface of enterotomy?
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Hemorrhage: suggests intestinal perfusion-not necessarily viability
Oozing: indicates venous congestion & is bad prognosis |
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What are 4 ancillary methods used to determine intestinal viability?
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1) fluoroscein dye- by IV injection
2) Surface oximetry 3) Doppler ultrasound 4) Histopathology |
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How does use of IV injection of fluoroscein dye help determine intestinal viability?
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Rapidly distributed to perfused tissues, yellow-green fluorescence on serosa of normal bowel using long-wave UV light
-pattern and intensity depend on perfusion, distention, dehydration, hypovolemia, shock, etc. |
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What does a blotchy pattern of the colon mean when using fluorescein die to evaluate intestinal viability? Finer grained pattern?
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Blotchy: Necrosis
Finer grained: viability -less effective when HSO present (mural hemorrhage and edema shied dye from UV light? |
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How does surface oximetry assist in determining intestinal viability?
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Oximeter measures tissue surface oxygen and partial pressure reaching electrode
-surface oxygen tension depends on distance from nearest blood vessel, blood flow, local O2 consumption of tissue |
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What does a SpO2 <20 mmHg of surface oximetry of the intestines mean in horses with colonic volvulus? > 30 mmHg?
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<20: Horses usually die
>30: usually survive |
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How does a doppler ultrasound work?
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Detects a shift of back-scattered laser light in proportion to the velocity of RBCs in the microcirculation
-laser light penetrates to depth of ~1 mm and can detect blood flow of 1 mm/sec |
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What is a doppler ultrasound most suited to be used for when trying to determine intestinal viability?
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Identifying small areas of ischemia and for determining well-perfused margins for an anastomosis
-not practical to scan large segments of ischemic intestine |
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How can you use histopathology to determine intestinal viability?
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Frozen sections provide rapid assessment of viability during surgery
-Look at amt of hemorrhage & edema in mucosa & submucosa, % of superficial epithelial cell loss and crypt cell damage -nonviable colon= > 97% superficial cell loss, >50% crypt cell loss |
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How come the severity of intestinal injury presented in a biopsy may not reflect the status of the bowel?
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Because injury can progress postoperatively and specimen may not be representative of remaining bowel
-pretty accurate, need pathologist to be near by |
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How do you perform gas decompression on intestines? Why do we perform gas decompression?
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Using needle and suction
-to resolve distention -ascending colon, cecum, stomach in horses; rumen, abomasum in cattle |
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What do you call an incision into the intestine? cecum? stomach?
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Enterotomy
Typhlotomy Gastrotomy |
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How do you cut into the intestine, cecum or stomach? Why would you?
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Scalpel-extended w/ blade or metzenbaum
-remove impaction, foreign body |
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How do you close an enterotomy, typhlotomy or gastrotomy in a large animal?
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Closed in 2 layers:
-generally appositional followed by inverting -e.g. simple continuous (full thickness, including mucosa) followed by cushing or lembert -need fluid tight seal (continuous patterns) -Serosa-to-serosa contact |
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What is the strongest layer of the intestine and stomach?
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Submucosa
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What size suture do you want to use for an enterotomy, typhlotomy or gastrotomy in a large animal?
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2-0 or 0 size
Absorbable |
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What are 4 configurations used to perform intestinal anastamosis?
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1) End-to-end
2) Side-to-side 3) End-to-side 4) Functional end-to-end |
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What are 2 ways to anastomose the GI?
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1) Hand-sutured
-2 layer inverting (connell-cushing) OR 1st leayer appositional 2nd inverting (simple cont. then cushing or lembert), serosa to serosa contact *No exposed mucosa 2) Stapled |
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What are 6 ways to prevent abdominal contamination when performing GI anastomosis and resection?
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1) Exteriorize segment to be incised or resected
2) Use separate instruments for clean & contaminated portions of procedure 3) Isolate bowel to be resected (moistened hand towels, laparotomy pads, split sheets) 4) Clamp with noncrushing forceps to keep ingesta away from resection site 5) Lavage after anastomosis before returning viscus to abdomen 6) Change gowns, gloves, instruments for closure |
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What incision is used for a C-section in a horse? Camelid? Cattle?
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Ventral midline for horses & camelids
-most often LPLF cattle |
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After selecting the incisional approach for your C-section, explain what the next 8 steps are.
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1) Exteriorize a portion of the uterus
2) Towel off incision -prevent body wall contamination 3) Incise incision on uterine horn 4) Remove fetus 5) Check for another fetus 6) 2-layer closure w/ absorbable suture -same principles as intestinal 7) lavage uterus 8) change instruments (gowns, gloves) for closure |
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What is the incision used for bladder surgery?
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Caudal ventral midline
-w/ reflection of prepuce in males or paramedian incision |
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What are 3 examples of bladder surgery performed in LAs?
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1) Correction of bladder rupture
2) Removal of cystic calculi 3) Resection of patent urachus |
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What are 2 things to be very careful about when performing bladder surgery?
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-gentle retraction to incision
-prevent abdominal contamination |
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How do you close up after performing bladder surgery in large animals?
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2 layer closure: appositional-inverting OR 2-layer inverting
-AVOID placing sutures into lumen of bladder |
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What is the most common approach used to perform a cryptorchidectomy in large animals?
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Inguinal or parainguinal approach
-or laproscopy |
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What 3 incisions are generally used for an ovarectomy in large animals?
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1) Ventral midline
2) Parainguinal 3) Paralumbar fossa -standing or recumbent -perform bc of granulosa cell tumors or neoplasia, correct behavioral problems associated w/ estrus |
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In general how do you close up a ventral midline incision in large animals?
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Suture each layer separately
-each layer of body wall, subcutaneous tissue & skin |
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What type of suture material do you want to use for closing a ventral midline incision in large animals?
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Absorbable for layers other than skin
-#2 or #3 for holding layers such as linea alba in ventral midline or external rectus sheath in paramedian in horses & cattle -2-0 or 0 for SQ -2-0 or 0 or staples for skin |
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What suture pattern is used for closing a ventral midline incision in large animals?
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Simple interrupted, simple continuous, cruciate, inverted cruciate most common
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What suture pattern is generally used to close up the paralumbar fossa muscle layers?
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Simple continuous
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Where are the sutures placed with regards to the incision when suturing the linea alba of large animals?
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Generally 1-1.5 cm apart and 1-1.5 cm from edge in horses and cattle
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