abdominal cavity Flashcards
surgicasl incison into the abdominal cavity
celiotomy
flank approach incision to the abdominal cavity
laparatomy
incision through the linea alba
ventral midline approach
what are the advantages of ventral incision
- most commonly used in small animals
- easiest and quickest approach and closure
- minimal bleeding
- exposure of all abdominal organs
ventral abdominal incision parallel; to the midline
paramedian
discuss exposure of organs in paramedian incision
increase exposure to organs on one side of the abdominal cavity
what are the disadvantages of paramedian incision
- increased bleeding
- increased closure time
describe flank incision
lateral incision between last rib and tube rcoxae
what are the advantages of flank approach
- excellent exposure of the kidney,one adrenal gland,one ovary
what are the disadvantages of flank incision
limited excess to entire abdomen
how is the paracostal incision made
caudal and parallel to the last rib
what are the disadvantages of paracostal incision
- very limited exposure
- rarely used alone
what are the advantages of combining ventral midline and paracostal incision
increased exposure, espercially of gall bladder and liver lobes(right)
what are the disadvantages of combining ventral midline and paracostal incision
- increased bleeding
- prolonged closure
what are the advantages of combining ventral midline and median sternotomy
- increeased exposure of cranial abdomen (liver and abdomen)
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what are the disadvantages of combining ventral midline and median sternotomy
- opens pleural cavity–assisted ventilation is required
- sternum must be closed
- thoracic drainage is required
explain the margins of opening the abdomen in exploratory celiotomy using the ventral midline approach
- from the xyphoid to the pubis
- the umblicus should be included in the surgical field as a landmark.
- the skin incision should be extended 1 cm cranial and caudal to the anticipated body wall incision
- the subQ layer is incised in the same line as the skin
- the linea alba is identified,tented and incised.
discuss the ventral midline approach in male dogs
- the preputial orifice is draped out of the field
- the skin incision detours lateral (right or left) to the prepuse
- the preputialis mm. must be severed in half,ends are tagged for later reattachement
- the incision returns to midline after branches of caudal superficial epigastric vessels are ligated
which layer is required for closing the abdomen with ventral midline approach
- the external rectus fascia
- the internal sheath is not usually closed
- suturing the rectus mm. layer should be avoided because it doesnot add streng of closure and
- also increases inflamation
explain suturing of midline incision vs when the muscles are exposed
- if the incision is in the midline,full thickness bites may be placed
- if muscle is exposed, sutures are places in the rectus sheath(fascia) only
- sutures are placed 5-10 mm apart and incooperate 5-10 mm of tissue
explain the type of suture and needle used in simple interupted closure of ventral midline
- monofilament absobable or non absobable suture
- dogs= size 3/0 to 0
- cats=3/0 or 4/0
explain the type of suture and needle used in simple continuous closure of ventral midline
- monofilament synthetic absobable or non absobable suture
- dogs=3/0 to 0
- cats=3/0 or 4/0
- do not use chronic gut or stainless steel suture in continuous pattern in linear alba
- stsart at one end and close at the other end of the incision or
- start at each end and close towards the centre of the incision. tie 2 sutures together at centre of incision
discuss how the subQ and skin are closed (suture pattern,size of needle)
- subQ tissue= simple continuous or simple interupted pattern, using 2/0 to 4/0 synthetic absobable suture
- in the male dog the preputialis mm. mustrbe accurately apposed
- skin=closed with 3/0 or 4/0 nylon
indications for exploratory celiotomy biopsy
- fluid accumulation–ascites
- organ dysruption
- biopsy
- non responsive pain
- non responsive dystocia
- abnormal discharge
- content evaluation by inspection or palpation
- microbiological sampling
what should you tell your anesthetian when using the trendelemburg positioning
the patient breathing is going to be impaired due to abdominal organs pressing on the diaphragm.
list the equipment required for celiotomy
- balfour or gosst retractors
- gelpi retractors
- lap sponges
- sunction
- doyen interstinal forceps wlwctroscapel
- delicate thumb forceps
discuss the surgical technique for celiotomy
- essentially the same
- after entering the peritoneal cavity,obtain sample of free fluid
- ignore the obvious lesions unless they are life threatening eg haemorrhagesor leakage
- thorough exploration, evaluate color,size,shape location,consistency
- begin cranially with diaphragm
- four quadrants
- always use the same technique,be consistent, effecient
- use anatomical retractors
which type of biopsy takes the whole of the mass
excisional
type of biopsy which makes a wedge of the mass and include the part of the healthy tissue
incisional biopsy
organs commonly biopsied
- liver
- prostate
- interstine
- lnn
- kidney
organs less commonly biopsied
- stomach
- spleen
- pancreas
- urinary blader
- greater omentum
list all the techniques you can perform for biopsying the liver
- finger crushing–be careful with bleeding and bile peritonitis
- ligature fracture technique (guillotine)
- instrument fragmentation
- wedge resection
- biopsy punch
- tru-cut
- hemostasis is achieved with surgicel,vetspon or omentum
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how much of the intestine can be biopsied and which closure suture technique should be deployed
- do not exceed 20% of interstinal circumference
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which lnn are commonly biopsied
- mesenteric
- external iliac
- colic
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why is excisional biopsy of lnn prefered over FNA
- provides morphological info
- preserve regional blood supply
- minimal handling
- ligate blood supply
which method is used to biopse the kidney
needle aspiration
which suturing techniques are used to suture kidneys after biopsy
mattress or continuous pattern using omentum or oxidized cellulose
methods of biopsy of stomach
- endoscopy
- exploratory cellotomy allows full thickness biopsy
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methods of biopsy in spleen
- partial spleenoctomyor wedge resection
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methods of biopsy in pancrease
partial pancreactomy,distal aspect
method of biopsy of UB
- full thickness
- one or two layer closure
