Abdominal surgery Flashcards
What part of the cow should be prepped for rumen surgery?
Paralumbar fossa from the last rib to the tuber coxae
At what point does rumen surgery become “dirty”? What should the surgeon do at this point?
When entering the rumen; surgeon should change sleeves, gloves, and drape once rumen is closed
What are the different regional anesthesia approaches for rumen surgery?
Line block, inverted L block, distal paravertebral block, proximal paravertebral block
Describe a line block for a rumen surgery
Infuse lidocaine in deep and superficial layers of the flank directly where it will be cut
Describe an inverted L block for a rumen surgery
Infuse lidocaine in a line ventral to the transverse processes and then caudal to the 13th rib
Describe a distal paravertebral block for rumen surgery
Infuse lidocaine dorsal and ventral to the transverse processes of L1, L2, and L4 (+/- L3)
Describe a proximal paravertebral block for rumen surgery
Infuse lidocaine cranial and caudal to L1 and caudal to L2
What layers will you have to cut into to get into the abdomen?
Skin, external abdominal oblique, internal abdominal oblique, transversus abdominus, peritoneum
What type of suture is usually used for closure of an abdominal surgery?
2-0 or 3-0 absorbable suture (Vicryl, chromic gut) in a simple continuous pattern for first two layers, 2-0 or 3-0 non-absorbable suture (Vetafil or Braunamid) in a Ford interlocking pattern for the third layer
What layers are closed in an abdominal surgery?
First layer- peritoneum, transversus abdominus, internal abdominal oblique
Second layer- external abdominal oblique
Third layer- skin
What measure can you take to simplify treatment of an abscess at an incision site?
Use a cruciate or simple interrupted suture for the ventral few centimeters so the sutures can easily be removed to drain the abscess
What kind of medications are indicated post-operatively for rumen surgery?
High doses of procaine penicillin (extra-label), flunixin
How would you prepare to make a rumen fistula in a calf?
Relieve any rumen distension via orogastric tube, prep and block the left paralumbar fossa
Describe the steps of creating a rumen fistula in a calf
Create a 2-3cm hole in the skin and the abdominal musculature and peritoneum, grasp the underlying rumen wall and pull some through the hole, suture the rumen to the hole in four places using 0-0 non-absorbable suture and a horizontal mattress pattern, remove the protruding rumen, use simple interrupted pattern to suture the edges of the rumen to the hole
How long does it take for a rumen fistula to close in a calf?
2-3 weeks (during which the respiratory disease usually resolves as well)
Why shouldn’t trocars be used as a long-term solution to relieve gas accumulation?
Because they have increased risk of peritonitis
Where is the location for a left flank celiotomy?
4cm caudal and parallel to the last rib, 6-8cm ventral to the transverse processes; can be moved cranially to better examine reticulum
What part of the abdomen should you explore last in a left flank celiotomy and why?
The left cranial abdomen where the spleen and reticulum are- highest risk of contamination here
What are the most common indications for a rumenotomy?
Evacuation of the rumen from grain overload, removal of wire causing TRP, removal of a foreign body causing rumen outflow obstruction
How is a rumen board used?
Enter the abdomen and pull a portion of the dorsal sac of the rumen through the incision and rumen board. Hook it ventrally and dorsally, then incise the rumen incrementally while attaching it to the hooks on either side.
What are the benefits and disadvantages of a rumen board?
It is quicker and easier than suture but allows for greater abdominal contamination
How is rumen sutured to skin in a rumenotomy?
A portion of the dorsal sac of the rumen is exteriorized and sutured dorsally and ventrally. The rumen is then sutured circumferentially using 1-0 or 2-0 non-absorbable suture and a cutting needle in a Cushing-type pattern (not full thickness). The rumen is then incised.
Once you have removed any foreign bodies with a rumenotomy, what else should you determine?
Palpate the reticulum wall and determine if there are any abscesses present
How do you figure out if there are adhesions present during a rumenotomy?
Grasp the reticular wall and attempt to invert it into the rumen. If this isn’t possible, there are likely adhesions between the serosal surface and the diaphragm, liver, or peritoneum
Where would you locate an obstruction in a rumenotomy?
In the omasal orifice
What should you do prior to closing a rumenotomy site?
Return rumen contents, remove gross contamination from the rumen wall. If sutured, close the rumen before undoing sutures. If using a board, leave the board attached and dorsal and ventral commissures and incrementally remove the rumen from the hooks as you close it. Change into sterile gloves
What do you use to close the rumen in a rumenotomy?
Either simple continuous oversewn with Cushing, or a single layer Utrecht
Use 1-0 or 2-0 absorbable suture (Vicryl or PDS)
Why might a farm keep a cannulated cow?
For rumen fluid collection and donation to other cows
Where is a rumen cannulation placed?
Incision is centered in the paralumbar fossa and 6cm below the transverse processes
How long are antibiotics needed after cannulating a cow?
5-7 days with daily monitoring and cleaning of the surgery site
What situations make it impossible to perform a fetotomy rather than a c-section?
Non-reducible uterine torsion, closed cervix
What are the advantages and disadvantages of approaching a c-section from the left flank?
Easier on the cow, requires less assistance; carries the highest risk of abdominal contamination
In what circumstances is approaching a c-section from the left flank inappropriate?
If the calf is dead or if the uterine environment is heavily contaminated
What challenge do you face performing a c-section from a low oblique or paramedian/median approach?
You need to avoid the large and tortuous mammary veins
When should you perform a c-section vs. a fetotomy?
Fetotomy if the calf is dead, C-section if it is alive or fetotomy is not possible
Where would you make a c-section incision using a flank approach?
Slightly caudal of the middle of the paralumbar fossa
How long should a c-section incision be?
Approximately 40cm
How do you avoid nicking the rumen when performing a c-section?
Tent the peritoneum to incise it
What should you try to locate once you are in the abdomen of a c-section?
The hind limb (anterior presentation) or the forelimb (posterior presentation)
Once you have located a limb in a c-section, what should you do next?
Pull the limb to exteriorize it and then incise the uterus between the toes of the calf. Extend the incision to the hock/carpus, and place a chain on the fetlock. Have an assistant gently pulls o you can locate the other limb and place a chain on it.
Once there are chains on two limbs during a c-section, what do you do?
Have the assistant pull the calf from the incision while you ensure the uterine incision does not tear, then grasp the edges of the uterus so it doesn’t fall back into the abdomen and check to see if another calf is present.
How should you close the uterus in a c-section?
Using 2-0 or 3-0 Vicryl or chromic gut in a Utrecht or a simple continuous oversewn with Cushing pattern
Do you remove the placenta during a c-section?
No, it may be trimmed if it interferes with closure, but it is firmly attached so it shouldn’t be removed
What do you do after you’ve closed the uterus in a c-section?
Lavage the exterior to remove any blood clots or contamination
How do you close the abdomen in a c-section?
Simple continuous with 2-0 to 3-0 Vicryl or chromic gut in two layers; skin closed with large non-absorbable suture in a Ford interlocking pattern
What medications should be administered post-c-section?
Oxytocin, analgesics, systemic antibiotics
What is the prognosis of a c-section and a fetotomy?
Simple c-section- good prognosis
Complicated c-section/fetotomy- worse prognosis
