Lasx Exam 3 (Wounds...)

Front 1

wounds caused by encircling material such as wire, rubber bands, and twine are diagnosed how

Back 1

the material is tight with the leg swollen, the skin sloughs, and material is buried. Lesion is completely around the leg, marked swelling, wound doesnt heal

Front 2

management of encircling material

Back 2

find wound, remove material, then normal wound management

Front 3

Wounds complicated by FB are Dx

Back 3

Digital exploration- bare, scrubbed finger most effective, always explore wounds on anterior surface and wounds that don't heal

Front 4

Besides digital exploration what other DX can be done on FB wounds

Back 4

US is helpful
RADs- R/O bone involvement, ID FB

Front 5

Treatment for FB wounds

Back 5

remove FB, US evaluation at time of Sx, Infusion of sterile Methylene Blue into tract- esp helpful if wound is wood related- see tracts/ slivers. Treat wound

Front 6

Abscess are caused by what

Back 6

localized hematogenous infection
or
2ndry to poorly draining wound

Front 7

Abscesses develop by ...

Back 7

localization of bacteria, migration of WBCs, and formation of exudate by living/dead WBCs, Bacteria and cellular debris

Front 8

Dx of abscess is based on

Back 8

Classic signs= red, swollen, hot, pain, & loss of function.
Confirmed by test puncture & or US

Front 9

Abscess management

Back 9

wait till the abscess matures (initially hard/firm, time --> fluctuant)
clip, shave, scrub, US helps ID most ventral aspect, Preform test puncture, Analgesia/local anesthesia, Incise for ventral drainage, use drains if needed
cattle- maybe use caustics to destroy abscess wall.

Front 10

what is an indolent wound

Back 10

wound that reaches a stage of healing and then doesn't improve further (doesn't get worse either)

Front 11

What are the possible etiologies for an indolent wound

Back 11

1. Poor nutritional state of animal
2. Epithelial fatigue- lrg wounds
3. Chronic infection
4. Over exuberant attempts to control granulation tissue

Front 12

Managing Indolent wounds

Back 12

correct underlying problem & stimulate epithelialization (Sx underminde the wound edges, stimulate edges with mild irritant (scarlet red), insert pinch graft, use occlussive drainage)

Front 13

Subcutaneous Air is caused by

Back 13

1. Wounds that pump air
(Axilla)
2. Wounds in Respiratory tract (Trachea)
3. Gas forming Organisms (clostriium- hematogenous, high temp, marked depression, anorexia, swelling/destruction of tissue)

Front 14

Managing Subcutaneous Air from a wound that pumps air or involves the respiratory tract

Back 14

no treatment required - air absorbed in 3-4 days

limiting movement helps

Front 15

Managing Subcutaneous Air from a wound secondary to a clostridial infection

Back 15

Establish drainage/ debride
High doses of antibiotics
(Penicillin 44k -88k units per KG q 6hrs)
Anticipate large muscle sloughing
warn owner - death is likely

Front 16

The most common skin tumor in the horse is

Back 16

the sarcoid

Front 17

Sarcoids are seen most likely when

Back 17

in Arabs, Appys, QH 3-6 years.
Incidence dec. after 15 yrs
linked to inheritance- eq. leukocyte Ag W 13
more common in donkeys
WW, benign (some malignant)

Front 18

Etiology of Sarcoids

Back 18

possible viral
bovine papilloma virus (BPV 1 &2)
viral DNA can many times be found in normal skin of horses w/ sarcoid (thus recurrence w/ excision Sx)

Front 19

Location of sarcoids in the Equine

Back 19

most- face, muzzle, ear, periocular, distal limbs, neck, ventral abdomen, areas previous injury.
US/Australia- common involvement- distal limbs& face most common
England/Switzerland- more common on trunk

Front 20

Types of sarcoids

Back 20

1. Occult
2. Verrucous or Warty sarcoids
3. Nodular
4. Fibroblasic sarcoids
5.Malevolent
all can turn malignant or aggressive- more after inury or irritation- assoc. w/ tx, Bx, or attempted removal

Front 21

Occult sarcoid

Back 21

mild cutaneous scaling & alopecia

Front 22

Verrrucous or warty sarcoids

Back 22

raised scaly with hair loss & thickened skin - cracks on the surface but rarely ulcerate

Front 23

Nodular sarcoids

Back 23

freely moveable, raised masses with normal or ulcerated skin

Front 24

Fibroblasic sarcouds

Back 24

Proliferative, ulcerated masses that many times are confused with excessive granulation tissue

Front 25

Malevolent sarcoids

Back 25

infiltrate locally along fascial planes & vessels. Grow rapidly & have a high recurrence rate following excision. These are uncommon and the most aggressive

Front 26

Approximately of the involved animals (that have sarcoids) have multiple lesions

Back 26

1/3

Front 27

Definitive Dx of Sarcoids involves

Back 27

Histopath- risk transformation to more aggressive subtype

PCR- detect BPV- superficial scrape

Front 28

Management of Sarcoids

Back 28

No completely & routinely satisfactory method available
1. cryosurgery
2. chemical cautery
3. Immmune Stimulation
4. drugs interfering with cell development (anti cancer)
5. Laser surgery
6. Sharp surgical dissection
7. Radiation

Front 29

Cryosurgery is how effective and what products are typically used to treat sarcoids

Back 29

sometimes effective
Podophyllin (50% wt./volume) in compound benzoin - apply daily - thick scabs, wait till slough then repeat.
topical formalin
tee tree oil
indian mud (bloodroot/ZnCl/ other- sparingly apply 3-4 days- slough repeat)

Front 30

Immune stimulation for sarcoids

Back 30

when cryosurgery would disfigure (eye/ear)
effective 50%
acid fast bacterial cell wall infiltrates - Regressin V, ingect -1-3 weeks max 4 times - $$$ - inflammation
BCG- smae as regressin, more severe rxn, hard get in US
Mammalian tuberculin- 50% effective, IM q 10 days

Front 31

other agents thought to cause immune reaction for treatment of sarcoids

Back 31

caprine serum immunomodulator (centaur, intralesionally)
Equi-stim- Intralesional- q 2 wks, (4-6x)
Autologous tissue implantation= Sx prep, debulk sarcoid, cut tissue into cubes, freeze w/ liquid nitrogen, insert into SQ space, regresion may take up to 6 mo, 80% sucess reported in small groups

Front 32

drugs interfering in cell development for treatment of sarcoids

Back 32

anti cancer drugs
Cisplatin- 10mg in 1ml of water & 2ml sesame oil

beads can implant in tissue

Front 33

laser surgery for treatment of sarcoids

Back 33

large study recurrence rate 38%

Front 34

sharp surgical dissection of sarcoids

Back 34

recurrence is quite common even with wide incision

Front 35

Radiation of sarcoids

Back 35

linear or local implantation of irridium (one most sucessfull Tx)

tx $$$, require special clearances

Front 36

SCC is what % of neoplasms in the horse

where is it seen

Back 36

SCC is 20% of neoplasma
-common in mucocutaneous area, can be in cutaneous
eye/adnexa 33%, prepuce 27%, glans penis 17%, perineum mare 12%, head 10%

commonly light haired animals more common

Front 37

Dx of SCC

Back 37

papillary to cauliflower like multinodular lesions with varying ulceration/inflammation

invade locally but slow to met
Histpahth is definitive

Front 38

Managing SCC

Back 38

best is wide Sx exceision
post Sx radiation reduces recurrence
other- cryosurgery, hyperthermia (eye cattle), radiation, laser

Front 39

One of the most common neoplasms of the horse with most having metastatic potential is ?

Back 39

Melanoma

Front 40

Melanoma is seen most common

Back 40

In Grey/Chestnut horses
> 10 years - older the horse the more common
assoc. w/ fading color= greys (Arabs/ Lipizzan)
perineum, tail head, anus, external genitalia, parotid salivary gland (can be anywhere)
sometimes only internal

Front 41

Prognosis of Melanoma (as a result of size)

Back 41

smaller less likely to Met
> 4cm more likely to Met
non grey are more likely to Met

Front 42

Dx of Melanoma

Back 42

gross appearance
coat color
area involved
Histology not usually necessary

Front 43

management of Melanoma

Back 43

Sx removal- when interference w. funciton or lesion is ugly
cryosurgery
Cisplatin- beads, mix with sesame oil & inject
5 - flurouracil- injection/cream
BCG
vaccine- $1k, send tissue lab makes
Cimetidine (tagamet) - stop progression, red. size, $$$

Front 44

Verrucous Dermatitis

Back 44

chronic villus proliferative growth
cancer- frog of sole
greased heal- heal skin
scratches- involves pastern
grapes- involves pastern & fetlock - lesions are more proliferative

animal is often not lame

Front 45

Etiology of verrucous dermatitis

Back 45

predisposed by but not always the result of filthy conditions

occ. seen when animals are on continuosly wet pastures

Front 46

Dx of verrucous dermatitis

Back 46

typical appearance
definitive is histopath

canker/ thrush involve the same area of the foot but thrush is erosive and canker is proliferative

Front 47

Management of Verrucous Dermatitis

Back 47

radically excise all diseased tissue, best under GA w/ eschmarch bandage, control hemorrhage w/ bandaging. Variety of topicals under bandage
-phycofixer BEST
- theabendazole/ DMSO paste
- thiabendazole, iodoform, salicylic acid
- Cloramphenicol tincture
- Tetracycline topically
- metronidazole in h20 base

Front 48

Keloid

Back 48

commonly result of improperly managed wound- overconcern of granulation tissue- chronic irritation
excessive caustics, inadequate protection from environment

Front 49

Dx of Keloids

Back 49

large raised thickened scar appearance

Front 50

Managing Keloids

Back 50

Surgically excise & close defect
keloids mostly in areas w/ minimal excess tissue, Sx more difficult in these areas
daily application of emollient to inc. pliability of the area is many times helpful in managing condition

Front 51

this usually results from the animal spending a considerable time laying down (most commonly the result of chronic laminitis)

Back 51

Pressure sores

Front 52

Dx of pressure sores

Back 52

typical lesions developing over bony prominences

Front 53

Managing pressure sores

Back 53

keep wounds as clean as possible
treat wounds with antiseptic or antibiotic ointments
a mix of malox & Zn oxide- runny paste
minimize pain so not down as often
appropriate bedding in the stall
don't use pine shavings (turpentine)
Deep straw
Peat Moss - easy on skin, but dirty

Use sheets or blankets to minimize skin irritation (if weather permits)

Front 54

Burns are usually caused by what

Back 54

usually the result of barn fires
occ. trailer bedding catches fire

Front 55

Treatment of burns in horses

Back 55

debride area as necessary to remove eschar
skin grafts are many times required
control pseudomonas w/ topicals ( silver preperations, gentamicine, dilute vinegar)

Front 56

Complications of burns

Back 56

laminitis
shock (tx w/ fluids/ plasma)
respiratory infection

Front 57

Dentigerous cysts etiology

Back 57

congenital defects
result of incomplete closure of the first banchial cleft

Front 58

Dentigerous cyst

Back 58

nussance
animal wont die
small piece of enamel on head close to ear, sinus tract develops and drains

Front 59

Clinical signs of dentigerous cysts

Back 59

swelling w/ a cystic lining that produces a mucoid discharge, intermittent drainage, usually at the base of the ear- might occur in other areas of the head

Front 60

Dx of Dentigerous Cysts

Back 60

Clinical signs
Radiographic exploration
Surgical exploration

Front 61

Management of Dentigerous Cysts

Back 61

BLemish so not necessary to remove
definitive management requires complete Sx removal
local or GA
introduce a probe to determine extent of lesion
distend the draining tract w/ fluid- ligate neck of cyst to prevent contamination
Sx prep, dissect to remove w/o opening tract
usually necessary to remove tooth remnant w/ bone chisel
suture SQ & skin

Front 62

Reasons to Castrate

Back 62

remove traits from genetic pool
reduce obnoxious behavior
reduce management problems
prevent injuries 2nd to fighting
allow better pasture mngmt
prevent unwanted preg's
meat quality- Boars & Billy's
DECREASES- rate of Gain & efficiency (bull more rapid/more efficient)
pigs- meat flavor
allow for better marbling of prime beef
Arrest scent gland development in goats

Front 63

equine male castration

Back 63

removal of testicles or actions taken to cause testicular degeneration resulting in reduction or lack of testosterone secretion

Front 64

Negative factors of castration

Back 64

decreased rate of gain & feed eff.
steers must be fed longer to have the same carcass quality
can correct w/ implants, trenbolone acetate & estradiol, inc. avg. daily gain & feed eff.

Front 65

Castration and age

Back 65

performed at any age
hemorrhage greater problem in older animals
herniation is > at younger ages

Front 66

Suggested age in the Equine

Back 66

most horsemen wait until the colt is around 2 yrs
masculine conformation has developed at this time
testicle usually in the scrotum

Front 67

Suggested age in the Bovine

Back 67

usually animals < 500 #
the younger the animal the less stress
early castration is associated w/ some increase in urethral calculi problems

Front 68

Suggested age in Ovine, Caprine, Porcine

Back 68

usually during first 2 weeks of life

Front 69

Preoperative considerations

Back 69

1. Animals should be in good physical condition
2. The general husbandry & the owner's ability to manage animals should be evaluated
- Animals shouldn't have access to spoiled sweet sweet clover (Dicumarol)
- Vet should be sure following Sx the animals will be properly managed (pigs should be clean/dry)
3. Testicles should be evaluated
4. External Inguinal ring should be of normal size
5. Elective - delay Sx if conditions not right
If owner wants to proceed- say NO

Front 70

Equine Restraint

Back 70

- Sx can be preformed w/ animal standing or recumbent

Front 71

Advantages of the colt standing

Back 71

Increase chance of injury
Restraint not as reliable
Sx complications more difficult to manage

Front 72

Disadvantages with the colt standing

Back 72

Increased chance of injury to the surgeon
Restraint is not reliable
Surgical complications, if they occur, are more difficult to manage

Front 73

Restraint for standing horse

Back 73

physical restraint
(1 person, twitch, lip chains/ war bridles, tail tie)
possible sedations
(Ace, xylazine, talwin, morphine, burphanol, detomadine, romifidine)

Front 74

Restraint for the recumbent horse

Back 74

1. Outdated methods (casting harness/ w/o anesthetic; succinylcholine Cl- paralyze animal)
2. Anesthetic Regimes
(xylazine, xylazine/diazepam, Glyseryl guaiacolate & thiopental or ketamine)- combo maintain 15-20 min.
position- dorsal recumbency hard to maintain in field, left lateral - best for right handed surgeons, right lateral for left handed.

Front 75

Bovine restraint

Back 75

larger animals are routinely castrated standing - restrained in a chute with the head in a head catch and the tail held
recumbent routinely used for small calves in a calf cradle, held on the ground (as for branding)

Front 76

Bovine Anesthesia

Back 76

not commonly used in N. America, the testicle or spermatic cord can be infused w/ local, anesthesia of the skin of the scrotum can be produced by infusing local anesthetic SQ

Front 77

Ovine & Caprine restraint & Anesthesia

Back 77

commonly held in an upright position w/ the weight born on the buttocks & the rear legs firmly flexed
Anesthetic

Front 78

Porcine restraint & Anesthesia

Back 78

Anesthesia not routinely used except for mature boars
restraint
weanlings- hold rear legs craddle body
Larger- rear legs pulled backward- knock off feet- one knee on neck, one knee behind front leg, hold both fronts. One knee in flank while castrates

Front 79

Porcine restraint/ anesthesia in mature boars

Back 79

poss. cast manually & castrate w/o anesthesia - not recommended
w/ anesthesia- restraint (hog holder, a lariat w/ the noose placed behind the canines)
Anesthesia- Na phenobarbital inj. into testicle, Pentothal or Surital

Front 80

Closed castration

Back 80

testicle is removed by deviding the entire spermatic cord including the common vaginal tunic, at one time.
usually w/ emasculator (crush proximal/ cut distal), prior to cutting the entrie cord & common vaginal tunic a ligature is sometimes placed (closes opening into peritoneal cavity as well as compressing the spermatic artery)

Front 81

open castration

Back 81

common vaginal tunic is incised, the testicle is them romoved & the common vaginal tunic left in place or removed following removal of the testicle= more effective compression of the blood supply prior to division by the emasculator

Front 82

Equine standing open castration

Back 82

sedate as previously described
held with a lead rope/ twitch
Sx preparation of the scrotum & prepuce
LA of scrotum & spermatic cord (line block ventral scrotum, into parenchyma, liberal incise scrotal skin & dartos muscle, bluntly seperate common vaginal tunic &CT, force testicle through incision, finger break mesorchium through vas deferens & testicle, cutting edge of emasculator distally (nut to nut) remove as much of common vaginal tunic as possible, allow adequate ventral drainage. wait till hemorrhage stopped before leaving premises

Front 83

Equine recumbent castration

Back 83

essentially same as standing. Lateral recumbency remove lower first. Right handed surgeon find easier in left lateral recumbency.

Front 84

Henderson castrating tool to remove testicles

Back 84

orig. for bovine castration. Henderson castrating tool is a clamp w/ the jaws at right angles to the long axis of the tool. Sx approach to the common vaginal tunic, CT stripped from spermatic cord, drill activated to twist spermatic cord until it breaks
used in place of emasculator

Front 85

Technique w/ primary closure - these are not routine but there has been greater use of them recently
General

Back 85

1. General- more time, must be sterile, wound closed post op, common in unilateral crypto to remove not retained, GA & aseptic technique req'd

Front 86

Technique w/ primary closure - these are not routine but there has been greater use of them recently
Removal of only the testicle

Back 86

most commonly used on younger animals
GA, normal Sx prep, incision made in common vaginal tunic, ligament epididymis is cut to free, vascular elements isolated, common vaginal tunic/ SQ closed w/ suture, Skin closed subcuticular

Front 87

Technique w/ primary closure - these are not routine but there has been greater use of them recently
Removal of only the testicle + major portion of scrotum

Back 87

GA + prep, elliptical skin incision centered over medium raphe (inc. skin/scrotum), SQ divided along margins of elliptical incision is removed, dead space reduced w/ dep sutures, skin closed subcuticular

Front 88

Bovine Sx techniques

Back 88

anesthesia & surgical prep are not commonly performed
access to the testicle using one of the following methods
- remove ventral 1/3 of scrotum
- vertical incision over each testicle

removal of testicles
removal excess SQ/fat to inc. drainage

Front 89

Bovine testicle removal involving ventral 1/3 of the scrotum

Back 89

most common method used in younger animals
pull downwards on most ventral aspect of the scrotum & using a knife to make a horizontal incision through the skin & median raphe. Sx drainage not as good in this method

Front 90

Bovine testicle removal- ventral incision over each testicle

Back 90

pulling distally on the skin of the scrotum- inserting knife distal/lateral testicle forcing through median raphe to exit skin on opposite side & then forcing the knife distally to produce an anterior/ posterior skin flap (newberry tool used more)more time consuming (poss. for show steers)= better look of scrotum

Front 91

bovine testicle removal by traction with common vaginal tunic intact

Back 91

animals < 500 #
grasp each testicle seperately
apply controlled traction untill cremaster m., vaginal tunic & spermatic vessels rupture/ retract. jerking thought to = peritoneal rupture & hemorrhage

Front 92

Bovine testicle removal after incision of common vaginal tunic

Back 92

> 500#s (tough vag. tunic)
grasp ea. testicle seperately/ isolate from surrounding CT
incise common vaginal tunic
prolapse testicle outside
apply controlled traction to the testicle to rupture spermatic vessels in inguinal region
apply tension to vaginal tunic removing as much excess as possible . emasculator can be used, scrape spermatic cord to divide it. Can use henderson castration tool.
remove excess Sq/ fat to improve Sx drainage

Front 93

Henderson Castration Tool

Back 93

attached to variable speed electric drill
approach to the testicle as w/ normal castration
tool applied to spermatic cord & drill engaged
cord twisted till ruptures
hemorrhage is minimal w/ normal drainage

Front 94

Other bovine castration
use emasculatome (Burdizzo)

Back 94

instrument to divide the spermatic vessels w/o incising skin, bloodless castration, 6wks for testicular atrohy
knee bracket recommended
tetanus not a problem
grap scrotum prox. to testicles, one cord forced laterally so vessels can be divided w/o affecting vessels in median raphe. Emasculatome applied/ closed to crush & divide testicular vessels. 2 cm proximal same thing

Front 95

Elastrator bands to castrate bulls

Back 95

small tough elastic band around scrotum proximal to testicle- interrupts blood supply and leads to sloughing, tetanus more common this way

Front 96

Chemically castrating bulls with an irritant

Back 96

only suggested for newborn calves, irritant injected straight into the testicle, inflamm. reaction causes atrophy of testicle

Front 97

Ovine / Caprine castration

Back 97

surgical removal of testicles- remove bottom 1/3 of the scrotum to gain access, traction of testicle contained within the common vaginal tunic

emasculators & elastrator bands can be used same as in cattle

Front 98

Castrating older goats

Back 98

sometimes go into shock if done same as cattle
best use sedation & local anesthetics
consider ligation of spermatic vessles

Front 99

Oorcine castration

Back 99

check for inguinal hernias (pressure chest/ abdomen when restraining pig)- intestines through external inguinal ring
sx removal of testicles only- closed or open

Front 100

Closed porcine castration

Back 100

free testicle form the CT remove by grasping & pulling to break supporting structures in abdomen (pull ca. prevent stretch inguinal ring & hernia)
grasp testicle scrape cord till divides
Grasp testicle & cut the cord with side cutters

Front 101

Open Porcine castration

Back 101

incise common vaginal tunic (remove testicle)
leave the tunics

Front 102

Mature boar castration

Back 102

GA, closed technique - cut entire spermatic cord including common vaginal tunic w/ an emasculator

Front 103

Postop castration treatment & care

Back 103

antibiotic therapy
tetanus prophylaxis
exercise
post surgical examination

Front 104

Antibiotic therapy post castration

Back 104

22K units procain penicillin G/kg 1x dose to horses

other spp. generally NOT

Front 105

Tetanus prophy post castration

Back 105

horse- check vax status in wounded/ Sx cases- toxoid or antitoxin
older + antitoxin can be problem - thielers disease
- if have recieved toxoid before booster with toxoid

in areas where common lambs/ kids given 1/10 antitoxin dose

not common protect other spp. against tetanus

Front 106

Exercise post castration

Back 106

horses- adequate exercise day post

other spp. encouraged exercise immediately after

Front 107

Post sx examination

Back 107

horses- check frequently 6-8 hrs post castration

all other spp. examine for several days post surgery

Front 108

Post op castration complications

Back 108

most common- post op swelling & edema
infection
hemorrhasge
eventration- herniation
peritonitis
damage to penis
hydrocele
tetanus
failure to change obnoxious behavior

Front 109

post castration swelling & edema

Back 109

mostly seen 3-4 dys post op
resolves 10-14 dys
associated lack ventral drainage- mainly inadequate incision size.
Tx- open incision, Nsaids, exercise- riding best
prevent with adequate exercise and adequate incision sixe

Front 110

Infection post castration

Back 110

can see dys to months after castration
CS= fever, swelling (scrotal/ pretputial), lameness,, discharge
few develop if adequate drainage & exercise
clostridial infections are possible and serious problem

Front 111

chamoignon infection post castration

Back 111

caused by streptococcus
assoc. bu infected end of spermatic cord & larg. amount of granulation tissue

Front 112

Scirrhous cord infection post castration

Back 112

caused by staphylococcus
scrotal incision heals but a chronic infection involving the stump of the spermatic cord causes enlargement & eventual drainage
occ. entire remaining spermatic cord becomes infected & enlarged to point that it can be palpated rectally

Front 113

infection post castration is predisposed by

Back 113

lack of drainage associated w/ post op swelling & edema
ligatures - non absorbable or slow absorbable

Front 114

Therapy for infection post castration

Back 114

adequate drainage
remove chronically infected tissue
adequate Atb Tx- sensitivity test?
forced exercise
resolves shortly

Front 115

hemorrhage post castration

Back 115

initial bleeding is normal > 15 min req attention
usually from testicular arterl
less common is cremaster m. vessels & scrotal vessels
usually bc problem w/ emasculator (faulty, impropter application)
Tx- ID vessel clamp leave 24 hrs or clamp & ligate

Front 116

If can't ID bleeders in post castration hemorrhage

Back 116

GA, pack with gause, sutuer 24-48 hrs/ Give drugs dec. fibrinolysis & clotting time (Animocaproic acid, Premarin) if continues to bleed refer. TP & PCV arent good indicators for blood loss. TP has a 6 hr lag, and PCV 24 hr ag
hemorrhage inc. risk of infection

Front 117

Eventration- herniation

Back 117

rare
herniation of omentum alone usually not significant promblem -ligate remove, monitor 24 hrs, xtie
herniation of intestines- first 3-4 hrs, up to 12 dys following sx, 2nd to straining colic, cast strugge
predisposed= drafts, STB, TWH, pre existing ing. hernia, hernia that admits > 2 fingers. Ligation spermatic cord prior to removal of testicle, closure of external inguinal ring at time of castration- protect bowel, clean, replace, broad spec antibiotics, banamine analgesia/ anti-endotoxic, close external inguinal ring
survival rates 36-87%

Front 118

Peritonitis post castration

Back 118

not common
CS= fever, depressed, inc. pulse rate, colic, dehydration, diarrhea, anorexia
DX= abdominocentesis - cell = 100k in non infectious peritonitis, rxn to blood in peritoneum. eval for bacteria + degen. neuts.
manage- broad spec Atb, nsaids, anti-endotoxin (polymixin B' hyperimmune serum), indwelling drains in abdomen (lavage mult. times per day)

Front 119

Damage to penis post castration

Back 119

unusual complication
inept surgeon mistakes penis for testicle
Sx must be performed to correct problem
NSAIDs to reduce swelling/ edema
penis is prolapsed - support until edema reduses & penis can ve placed ca. to preputial orifice

Front 120

Hydrocele

Back 120

unusual complicaition
an accumulation of sterile fluid in common vaginal tunic
common in open castrations when tunic not removed
reported more in mules
non painful distension of common vaginal tunic w/ peritoneal fluid
No treatment is necessary except to correct appearance
Sx treatment involves Sx removing the distended common vaginal tunic

Front 121

Tetanus post castration

Back 121

occurs when animals havendt been protected by antitoxin or not vaccinated with toxoid
evaluate status in any horse with wound or undergoing Sx

Front 122

Failure to change obnoxious Behaviour

Back 122

older stallions occ. retain learned behavior
some animals have extra testicular sources of testosterone- adrenal gland is usually incriminated
common vernacular is that horse has been proud cut (all genetic tissue not removed) very unlikely, effective castration is only necessary to remove testicle, studies have been done in which only the testicle have been removed and no response to HCG administration

Front 123

synonyms for retained testicle

Back 123

cryptorchid
high flanker
rig
ridgling
original

Front 124

retained testicle in ruminants

Back 124

very seldom get testicles retained in abdomen
if not in scrotum usually SQ close to external inguinal ring
skin incision over testicle - remove with emasculator

Front 125

Retained testicle in Swine

Back 125

have retained abdominal testicles
not econimcallly worth removal
meat quality not affected if slaughtered at market weight

Front 126

Equine retained testicles

Back 126

usually present in scrotum at birth
impossible to differentiate between scrotum & gubernaculum (bulb) in foal by palpation. Descend by 2 yrs.

horses w. retained testicles are more difficult to manage than stallions
most common present of crypto is difficulty to manage

Front 127

heritability of retained testicles

Back 127

considered heritable
some breed registration allowed
considered unethical to Sx repositon a testicle in scrotum

Front 128

Dx approach to retained testicle

Back 128

palpation
US examination
scars previous surgery
lab exams
estrogen levels
testosterone levels
location of testice

Front 129

palpation of retained testicel

Back 129

deep palpation of inguinal area, sedate/ tranquilize
relax cremaster muscle
rectal palpate occ. testicle in abdomen or vas deferens through inguinal ring

Front 130

LAb exams (estrogen/ testosterone)

Back 130

Estrogen - diff. find lab set up
horse > 3 yrs E2 > 400 = testicular tissue < 100 = no testicular tissue
testosterone level 10k units HCG to 450 kg horse 30/60 min sample, geldings testosterone level is essentially 0. if testicular tissue see increase in level post HCG > 7 nano mols

testosterone gas chromotography of urine

Front 131

location of retained testicle

Back 131

uni:bilateral = 13:1
most sx = 1 inguinal canal, 1 scrotal
monorchidism sometimes occurs
R and L almost equally
L larger in fetus
L more likely abdominal
R more likely inguinal canal

Front 132

Managing retained testicles

Back 132

stimulate decent of testicle (effective sometimes if close to inguinal ring- determine w/ US)
use HCG- Ab produced
GnRH- or Deslorein suggested but unless the colt is sexually mature but doesnt produce LH & result doesn't respone.

Front 133

Surgical approaches to removing retained testicle

Back 133

inguinal
parainguinal
ventral midline or paramedian approach
flank approach

Front 134

inguinal approach to testicle removal

Back 134

through inguinal canal
use approach if question about location of testicle

Front 135

Parainguinal approach to testicle removal

Back 135

4-5 cm anterior/ medial to external inguinal ring
easier repair area with suture then suture the external inguinal ring/

Front 136

Ventral midline or paramedian approach to removal of retained testicle

Back 136

maybe for bilateral (2 abdominal can be removed through single inguinal or parainguinal approach)

complicated by location of penis & prepuce. Incise lateral and reflect for ca. midline access

Front 137

Flank approach to testicular removal

Back 137

major advantage is stanging, one must make sure have testicle before this approach. can locate testicle by following mesorchium or vas deferens

technique discussed later

Front 138

Inguinal/ Parainguinal technique

Back 138

GA, dorsal recumbency, normal prep, always remove retained testicle first
skin incision anterior/medial to external inguinal ring
blunt dissection to external inguinal ring
if Hx questionable - examine for cut end of spermatic cord
explore inguinal canal to be sure that testicle or epididymis isn't present in canal
if can't locate then enter the abdomen
locate- apply tension- ligate - close abdominal fascia or inguinal ring
if less than ideal conditions may not close completely

Front 139

Suggested method for locating the testicle

Back 139

tension on inguinal extension of gubernaculum - examine anterior/medial aspect of external inguinal ring. Apply traction to deliver vaginal process & make incision in it to deliver epididymis & testicle.

Use sponge forceps to pick up vaginal process. forceps in canal open, press against peritoneum, close picking up vaginal process, apply traction, bring to level of external ring, incise vaginal process, apply traction to gubernaculum - deliver epididymis & testcle

insert fingers through ruptured vaginal process - feel in gubernaculum area

Front 140

parainguinal abdominal incision - locate vas deferens at neck of bladder ...

Back 140

always sucessful unless previous removal of epididymis & not testicle, palpate neck of bladder for ampulla, which is in genital fold. Trace ampulla distally to the vas deferens & then to the epididymis & finally the testicle

Front 141

types of inguinal hernia

Back 141

In domestic animals inguinal hernias are usually indirect hernia
(bowel through vaginal ring)
Direct hernia- bowel goes through break in peritoneum

Acute irreducible inguinal hernias

Congenital scrotal hernias of newborn

Chronic reducible inguinal hernias

Front 142

Acute irreducible Inguinal herniaas

Back 142

most commonly Breeding assoc. in stallions

rare- breeding related in other spp.
usually req. emergency Sx, anastamosis, & resection

CS= acute abdominal pain, rectal = intestine passing through inguinal ring (can be missed shortly after hernia occurs), After several hours the segment of the bowel proximal to the herniated portion is markedly distended, scrotum is usually distended & sometimes intestine can be palpated in the scrotum

Front 143

Congenital scrotal hernias of the newborn

Back 143

inherited trait - dont keep to breed
CS= palpable enlarged inguinal area, intestines can be forced back through enlarged inguinal ring

foals- many self correct bc increased muscle tone, apply truss to maintain pressure over inguinal area, if persist= Sx

Calves- uncomon
Pigs- often notice at castration, holding pressure abdomen forces intestine through, Sx correct

Front 144

Chronic Reducible Inguinal Hernia

Back 144

no immediate danger of strangulation, elective repair

Inc. testicular temp- dec. fertility stallion & bull

Sx correct
equine/ swine= heritable. Castrate when repair

bulls not heritable -fatty area to dilate inguinal canal, very rare to see right sided inguinal hernia in bull

Front 145

Differential diagnosis for chronic reducible inguinal hernia

Back 145

periorchitis
mesothelioma
Hydrocele

Front 146

Medical Tx of inguinal hernia in the Stallion

Back 146

if Dx/ Tx early
grab testicle- apply traction- cause vaginal tunic to become rigid tube- 2nd hand above testicle- pressure to force viscera proximally- following epidural rectally grab intestines proximal to inguinal ring apply pressure to free the intestine. If non Sx correction accomplished= monitor post to make sure blood supply is maintained

Front 147

Sx correction of Inguinal Hernia in the Stallion

acute hernias

Back 147

Incise over external inguinal ring
acute hernia- resect/ anastamose, inc. inguinal ring size, best = ventral midline incision, pull intestine into abdominal cavity. close external inguinal ring

Front 148

Clinical signs of chronic inguinal hernias in bulls and stallions

Back 148

Bulls- hour glass appearance of scrotum, intestines can be palpated in scrotum

Stallions- sometimes recurring digestive problems, occ. assoc. with a slight rear leg lameness

Front 149

Sx correction of Stallion chronic inguinal hernia

Back 149

same as acute
common vaginal tunic is dissected from the scrotal fascia
testicle & vaginal tunic are twisted to force the intestine into the abdomen
ligatures placed & testicle & vaginal tunic removed
External ring & skin are closed

Front 150

Sx correction of chronic inguinal hernias in bulls

Back 150

direct or abdominal approach

Front 151

direct Sx correction of chronic inguinal hernia

Back 151

involved testicle not usually removed
Sx approach made into the testicle
common vaginal tunic is incised & testicle is checked for damage. If adhesions present they are broken down so that the intestine can be placed in abdomen. Sutures through IAO m. to close canal w/o producing excessive pressure on spermatic cord
suture vag. tunic & skin

also abdominal approach

Front 152

Abdominal approach Sx correction of chronic inguinal hernia in the bull

Back 152

incision of abdominal wall in paralumbar fossa ipsilateral side. arm introduced and tension applied to herniated bowel. loop suture needle through anteriot end of inguinal ring- form larks head knot. needle through inguinal ring to partially close. Suture is cut & needle place on one end of suture passed through tissue again 2 ends tied- inscision closed

Front 153

indications for ischial urethrotomy

Back 153

removal of urethral or vesicular (bladder) calculi in the male

Front 154

position & anesthesia for ischial urethrotomy

Back 154

standing with epidural or local

Front 155

Surgical technique for ischial urethrotomy

Back 155

pass catheter to ID the urethra
midline incision just below the anal sphincter
sharply dissect between the retractor penis m. continue through the bulbospongiosus m. the corpus spongiosum & urethra. enlarge incision to remove calculi or allow passage of forceps into the pelvic urethra & bladder to remove calculi. Lithiotripsy with shock wave or laser technology can be used to break down the calculi for removal. flush bladder & urethra wound left open to heal

Front 156

Post operative management of ischial urethrotomy

Back 156

no special care required. Heal via 2nd intention

Front 157

Post operative complications of Ischial urthrotomy

Back 157

none expected

Front 158

Pararectal cystotomy

Back 158

extremely old technique
worth consideration for large calculi that are too large to remove through ischial urethrotomy
Abdominal approach- bladder difficult to get to wall incision so calculi can be removed without contamination. Pararectal approach although a crude technique is sometimes better

Front 159

Steps involved in a pararectal cystotomy

Back 159

epidural
remove feces from rectum
10 cm vertical pararectal skin incision between the rectum & semimembranous m.
careful/blunt dissection btwn semimembranosus m. & anal sphincter to avoid pudendal vein & artery & pudendal nerves
surgeon hand in rectum- force calculus back into retroperitoneal segment of bladder- incise- remove calculi- flush- heal as open wound

Front 160

Injuries to the penis - etiology

Back 160

kicks (common during breeding)
movement of mare during breeding
jumping and becoming stranded on top of fence or partition
poorly managed stallion ring

Front 161

paraphimosis

Back 161

swelling of the penis & prepuce which cause the penis to be retained outside the preputial orifice
condition in bulls & stallions

Front 162

treatment of paraphimosis

Back 162

manual support (nylon mesh laundry bag)
massage aided by ointments / lubricants
NSAIDS
diuretics
mild exercise

Antibiotics if infection present

Front 163

maintenance of penis in the prepuce in paraphimosis

Back 163

manipulate back within 24 hrs
if no laceration- keep in place with probang into preputial orifice
pad end plastic speculum w/ cotton, apply tape over cotton, rectal sleeve over, insert padded end into prepuce, hold in place w/ adhesive tape encircling abdomen, after several days penis usually stays in place

Front 164

phimosis

Back 164

swelling of the penis & prepuce which causes the penis to be retained inside the preputial orifice

common in bulls
seldom in stallions

Front 165

Penile paralysis

Back 165

animal looses the ability to retract the penis into the prepuce

Front 166

Etiology of penile paralysis

Back 166

phenothizine derived tranquilizers used in stallions

fail to properly treat paraphimosis

Front 167

Treatment of penile paralysis

Back 167

replacement of penis into the prepuce & retention as described under paraphimosis

occ. long time retention will allow return of function

Sx to retract penis is indicated if prolonged retention is not effective

Front 168

Indications for Reefing (circumcision of the penis)

stallion

Back 168

remove abnormal growths or scar tissue that don't extend deeper than the dermis

Front 169

Position & anesthesia for reefing in the stallion

Back 169

sedate + LA in standing animal when lesions are small and don't require removal of lrg. amount of tissue

GA with the animal in dorsal recumbency for extensive lesions

Front 170

Sx procedure for Reefing

Back 170

prep, pass catheter to ID urethra, tourniquet used by some, pull penis anterior- umbilical tape snare suggested, circumfrential skin incision anterior/posterior to lesion, establish dissection plane, dissect skin from deeper tissue, remove ring of diseased tissue, close in 2 layers (fascia, skin)

Front 171

Post operative management for reefing Sx

Back 171

limit erection in stallions for 3-4 weeks (apply breeding ring)
if use non resorbable on skin remove in 10 days

Front 172

Post op complications assoc. with reefing Sx

Back 172

hemostasis is less than ideal, hematoma may develop at Sx site. Drainage is indicated

Front 173

Indications for penile amputation

Back 173

carcinoma involving structures deeper than skin
penile paralysis- boltz technique better

Front 174

pre-op considerations for amputation of the penis

Back 174

prior castration is suggested

Front 175

anesthesia/ position for penile amputation

Back 175

GA, dorsal recumbency- suggested
sedate/ locals is possible

Front 176

technique for amputating the penis

Back 176

ventral abdomen, penis/prepuce prepped, catheterize urethra, gum rubber tubing tourniquet, apply umbilical tape snare caudal to gland to pull the penis anteriorly. Select site for amputaton, triangular incision 4cm side w/ base anterior continued down urethra, split urethra midline, amputate starting at vase of triangular incision cute edge at dorsal aspect of penis slightly anterior to ventral cut edge, ligate branches of dorsal artery of penis & large veinds btwn fascia & tunica albuginea, close the stump 4 bite sutures taken through the urethral wall, tunica albuginea of urethral groove, tunica albuginea of the opposite side & the skin
sutures replaced 1rst in middle, 2nd/3rd in 2 halves to divide into quarters, continue until adequate sutures have been taken to close

Front 177

post operative care in penile amputation

Back 177

hemorrhage can be a problem for several days, minor dehiscence is not unusual, dissecting hematomas can cause dehiscence, granulomas & stenosis are a result of inadequate ligation & inadequate number of skin sutures. Remove sutures in 2 weeks

Front 178

Post operative complications after penile amputation

Back 178

amputation of considerable amount of tissue is sometimes not possible for horse to extend penis when urinating

Front 179

Indications for retraction of penis (Bolz technique)

Back 179

paralysis of the penis after all efforts to stimulate spontaneous retraction have been exhausted

Front 180

presurgical considerations for retraction of the penis (Bolz)

Back 180

castration- at least 1 mo. prior
removal of granulomatous growths- if necessary

Front 181

Anesthesia / position in retraction of the penis (bolz)

Back 181

GA & dorsal recumbency

Front 182

technique for retraction of the penis (Bolz)

Back 182

surgical preperation of the prepuce, penis, inguinal region, & posterior ventral abdomen, pass catheter for urethral ID, 10cm incision on midline just caudal to the castration scar.
dissection to the penis, retract the penis so glans is just inside preputial orifice, ID preputial reflection. Insert #2 non absorbable, non capillary suture through the preputial reflection 2cm on either side of midline- avoid urethra. place sutures deep but not through the preputial cavity, pass ends 5cm on either side incision in skin tie over stomach tubing, drain may be indicated, close incision. Remove non absorbable suture in 2-3 weeks. Aim to produce firm adhesions between prepuce & skin and in this way maintain penis in retracted position

Front 183

examination of the vulva, vagina, & rectum

Back 183

1. discharges
2. rectal examination- vagina, cervix, uterus, & ovaries
3. vaginal exam- speculum, palpate + cervix
4. bimanual exam- one hand in rectum, one hand in vagina

Front 184

Uterine examination

Back 184

1. palpation
2. endoscopic
3. uterine culture
4. uterine cytology
5. uterine biopsy

Front 185

pneumovagina

Back 185

involuntary aspiration of air into the vagina

Front 186

etiology of pneumovagina

Back 186

faulty seal of the vulva bc of poor closure or abnormal position. sometimes assoc. w/ poor general condition, tipped vulva (old multiparous mares), inversion of the lips of the vulva, assoc. w/ perineal lacerations

Front 187

Treatment of pneumovagina

Back 187

correct the underlying cause of poor general condition (if part of problem)
feed, deworm, float teeth

Front 188

Indications for Caslick

Back 188

correct vaginal contamination assoc. with poor conformation of the vulva. Make a preformance mare more asthetically pleasing (stop air sucking)

Front 189

Technique of caslicks

Back 189

remove small band of skin & mucosa at mucocutaneous junction- dorsal to floor of pelvis, suture w/ simple continuous. Open to breed. Can speculum/ breed AI wo removing sutures. Open prior to foaling

Front 190

post op complications of caslick

Back 190

incompleate seal
urine pooling (too far ventrally)
suture sinus (eliminate by not going through mucosa with suture)

Front 191

Variation of caslick

Back 191

same procedure - insert sutures slightly anterior to mucocutaneous junction
doesn't compromise seal of vagina
good for the performance cause
takes more time - done less

Front 192

Gadd technique for pneumovagina

Back 192

episioplasty or perineal body reconstruction
Sx remove rt. triangle piece mucosa from dorsal aspect of vestibule- approximate raw vulva and caudal vagina. Increases size of perineal body- improves natural seal

Front 193

Etiology for perineal lacerations

Back 193

occur secondary to problems associated with delivery of a foal

Front 194

classification of perineal lacerations

Back 194

first degree- only skin & mm
2nd degree- involves perineal body
3rd degree- perineal body, dorsum vagina & rectum

Front 195

Repairing first degree lacerations of the perineum

Back 195

heal without complication dont require special care

Front 196

Repairing 2nd degree lacerations of the perineum

Back 196

repair immediately- after inflammation/ infection subsided (5-10dy), no change in diet, anesthesia by infiltration or epidural. Debride, insert multiple simple absorbable sutures to appose, insert skin sutures as in caslick

Front 197

Repairing 3rd degree lacerations of the perineum

Back 197

occur at delivery, usually foot through dorsal vagina into rectum- most often in maiden mares, Wait to repair (6wks)or if foal alive till weaned. immediate wound care - carefully determine extent of damage/ evisceration unlikely, tetanus prophy, parenteral Atb, clean for several days

Front 198

Preoperative considerations for perineal laceration repair

Back 198

manage diet to keep stool soft and unformed
lush pasture, bran w/ grain, no long stemmed hay, pelleted feed, frequent laxatives

Front 199

surgical repair for perineal laceration

Back 199

modified goetz technique
annes technique
pull back technique - for shallow 3rd degree lacerations

Front 200

post op management of perineal laceration repair

Back 200

non formed stool for 10 days
tetanus prophy
parenteral atb
remove non absorbable sutures in 10 dys

Front 201

complications of perineal laceration repair

Back 201

excessive straining to defecate
partial or complete wound breakdown

Front 202

Etiology of rectovaginal fistula

Back 202

birth related injury
foal foot through dorsal vagina through rectum
in time marked wound contractiong but fistula persists
time for repir & dietary considerations are same for 3rd deg. laceration

Front 203

technique for repair of rectovaginal fistulous

Back 203

large fistulas or those that are >6 inch anterior to the vulva are best repaired by making an incision to produce a 3rd degree laceration & then repair that laceration

Front 204

classical technique for repair of rectovaginal fistulas

Back 204

horizontal incision mid btwn anus & dorsal vulva
dissection continued 2cm cranial to cr. edge of fistula. interrupted lembert sutures- sagittal direction & simple interrupred in transveres direction/ close dorsally first. `

Front 205

etiology of vaginal injuries

Back 205

difficult birth
mare backing into projecting object - occassionaly
Perverted humans - rare

Front 206

vaginal contusions

Back 206

usually resolve without complication

Front 207

vaginal hematomas

Back 207

may occassionaly need to drain