Abdominal Exploratory Notes Flashcards
Exploratory Laparotomy / Celiotomy
an abdominal surgery in which the organs of hte abdominal cavity are systemically examined for signs of injury or disease
-otomy
incision into an organ or cavity
-ectomy
removal of an organ or strucuter
-ostomy
surgical creation of a new opening
Diagnostic
an exploratory laparotomy in which the purpose is to identify, but not always treat, a medical condition
Obtaining biopsies for animals with hepatobiliary, renal, or GI dysfunction; evaluating an animla with clinical signs of pain referable to the abdominal cavity
Therapeutic
An exploratory laparotomy in which the purpose is to correct the underlying cause of abdominal disease
Tumor removal, herniorrhaphy (hernia repair), enterotomy or gastrotomy to remove intestinal foreign body, correction of traumatic injury to abdominal organ
Emergent
Surgery needs to occur imminently after appropriate diagnostics and therapeutics are performed
Gastrointestinal foreign bodies
Penetrating abdominal trauma
Septic peritonitis of any cause
bilioabdomen
Undiagnosed acute adbominal pain
Urgent
Surgery need to occur soon, but can wait < 24 hours
Elective
Surgery can be scheduled at a time that is convenient for the veterinarian and owners
Muscles that compse the abdominal wall
Outer most muscle:
External abdominal oblique
Internal abdominal oblique
Transversus abdominus
Rectus Abdominus
Inner most muscle
Linea alba
A white band directly on ventral midline
Incisions through this structure will have less hemorrhage and inflammation compared to incisions through the muscle layers
Rectus Sheath
The external rectus sheath is the HOLDING LAYER onf the abdomen in regards to suturing
Median Raphe
Dogs have it, Cats Do NOT
Ventral Midline Laparotomy Landmarks
- Xiphoid Process of the sternum - cranial extent of a complete celiotomy incision
- Pubic bone - Caudal extent of a complete celiotomy incision
- Umbilicus
- Mammary chain
- Prepuce - in a male dog the prepuse lies directly on midline. Complete celiotomy incisions must avoid this structure
What side of the patient does a right handed surgeon stand on?
Right side
What side of the patient does a Left Handed surgeon stand on?
Left side
What is the first thing you see in the cranial abdomen after completing the incision?
Falciform ligament
Procedures that do NOT warrant a compele abdominal exploratory
prophylactic gastropexy
Ovariohysterectomy/Ovariectomy on a healthy animal
Cryptorchid castration on a healthy animal
Cesarean section on an otherwise healthy animal
Liver biopsies on an otherwise healthy animal with elevated ALT/AST and no imaging abnormaliites
Splenectomy for an animal with IMHA
Cystotomy for urolith retrieval on an otherwise healthy animal
Condition that almost ALWAYS warrant a complete abdominal exploratory
Septic abdomen
Abdominal organ neoplasia
Gastrointestinal foreing body
Hemoabdomen
Uroabdomen
Gastric Dilation and Volvulus
Exploratory Celiotomy / Abdominal Exploratory Technique:
The goal of an abdominal exploration is to use a consistent pattern to assess the entire abdominal cavity
What do you assess in the Cranial Abdomen
Diaphragm
Esophagus
Liver
Gallbladder
Stomach
What acts as a physiologic retractor of the right abdominal gutter
Duodenum and its mesentery (mesoduodenum)
What structures can you assess in the Right abdominal Gutter?
right limb of the pancrease
right kidney
right ureter
vena cava
Portal vein
common hepatic artery
Right ovary and right uterine horn / right testicular artery
What structure prevents the exteriorization of the Duodenum?
duodenocolic ligament
What is the physiologic retractor for the Left Abdominal Gutter?
Descending Colon
What structures can you assess in the LEFT abdominal gutter
spleen
left kidney
left ovary
left uterine horn / left testicular artery
Left adrenal gland (ventrally overlying phrenicoabdominal vein)
left ureter
order of procedures
most critical first
clean, clean-contaminated, contaminated, dirty
Most important before addtional
Abdominal Closure
Typically done in 3 layers
body wall
Subcutaneous tissues
skin
Body wall closure
holding layer is the External Rectus Sheath
Avoid inclusion of significant amounts of subcutaneous fat in body wall closure, as it can be difficult to determine that the suture bite went deep enough to engage the correct layer
Think SQ tissue or preputialis muscle can look like body wall. Accidentally closing the wrong layer will result in a body wall hernia
Body wall closure
suture pattern
Simple interupted with four throws per knot
Body wall closure
suture type
Prolonged absorbable monofilament suture (PDS)
Suture size
small cats (interrupted pattern only)
3-0
Suture size
Dogs <10kg or large cats
2-0
Suture size
11-25kg dog
0
Suture size
>25kg dog
1
Subcutaneous Tissue Closure
SQ layer closed to eliminate dead space and relieve tension from the skin
Take deep tacking bites of hte body wall ever 2-3 bites
Subcutaneous Tissue Closure
Suture pattern
Simple continuous pattern with buried knots
4 throws to start and 4+ throws to end
Subcutaneous tissue closure
suture type
Rapidly absorbable monofilament surture (monocryl)
PDS is acceptable for dogs
Subcutaneous tissue closure
Suture size
3-0 or 4-0 suture
Skin closure
may be closed with a buried or external sutures or staples
Subcuticular pattern will be used in lab
Skin closure
suture type
Rapid absorbable monofilament (monocryl)
Skin closure
suture size
3-0 or 4-0 suture
