Abdominal Surgery

Question 1

What are some key considerations for ruminant abdominal surgery?

Answer 1

Need to eructate
Standing easier - can eructate, less compartment syndrome, less nerve damage

Question 2

What should you do to prep for surgery?

Answer 2

Clip hair
Scrub - dish soap, iodine 3x (oval) , alcohol 3 x (top to bottom)

Question 3

What are all of the possible surgical approaches?

Answer 3

Right paralumbar, left paralumbar, right paramedian, ventral midline, oblique

Question 4

What is each surgical approach used for?

Answer 4

Right paralumbar - RDA, RTA, LDA, Explore

left paralumbar - Rumenotomy, C-section

right paramedian - Csection emphseamtous calf, DA

ventral midline - c section emphasematous

oblique c-section empaceatous

Question 5

What should you remember when cloving and gowning?

Answer 5

Drop your sterile sleeve and put it on the arm that matches the side of the cow you are on regardless of dominance

Question 6

What is critical to remember when doing and abdominal exploratory surgery?
What organs should be saved for last?

Answer 6

Clean -> Contaminated
Save Cranioventral portion last
-Abomasum (ulcers), Liver (abscess), Reticulum (TRP)

Question 7

How do you perform a right sided exploratory?

Answer 7

-Sterile sleeve on left arm
-open see duodenum and omental curtain
-Hope to not see abomasum or else displaced
-Check caudal - rumen (gas cap and pack), pelvis, bladder, sublumbar lymph nodes, uterus, ovaries, caudal intestines (empty ish)
-In sling - kidneys
-Abdominal floor
-Crainial - liver (sharp edge or fatty), gall bladder (distended if anorexic)
-Ascending duodenum
-Abomasum
-Omasum
-Reticulum
-Diaphragm (hernia)

Question 8

Describe a left side paralumbar exploratory:

Answer 8

Sterile sleeve right arm
-Same as before Right, then caudal, left, then cranial

Question 9

If you open the right side of a cow for a c-section what could happen?

Answer 9

Guts fall out

Question 10

What do you use the roll and toggle method for?

Answer 10

LDA only (omentum tight and pull back over)
-If try and RDA you create torsion since omentum not tight)

Question 11

How do you roll and toggle?

Answer 11

Xylazine tail vein (20mg)
Clip right side midline and over
Running W or cast
Go down right side
scrub again
find abomasum craniovental right - ping to ID
- trocar in ping area
-close down on trochar and dont let air out , hemostat to suture close to body wall, 2nd 2-3 inch forward, use cap of needle to run suture through and tie with surgeon knot then square on top (keep from too tight)

Question 12

When doing a DA, you should always do a what first?

Answer 12

Exploratory

Question 13

When you do a paramedian approach for DA what is it called?

Answer 13

Abomasalpexy

Question 14

How long should Iodine have contact time?

Answer 14

5 minutes

Question 15

What are the layers you go through in paralumbar approach?

Answer 15

Skin, sub Q, external abdominal oblique, Internal abdominal oblique, transversus abdominus, peritoneum

Question 16

How do you go through the transverus?

Answer 16

Drill hole with finger

Question 17

When you find peritoneum, how do you cut it?

Answer 17

Pull out with alis tissue forceps, then use upside down scaple to cut, then Metzenbaum to cut it with the transverse = easier to go back together

Question 18

What should you not do before DA surgery to help reduce the straining of the cow?

Answer 18

Dont palpate

Question 19

How do you deflate a DA?

Answer 19

Needle and tube connect well, cup needle in hand, go over to abomasum and stab into it until deflate (smell like burnt almonds)

Question 20

How do you tack the abomasum?

Answer 20

No pig ear
Tack omentum with towl clamp outisde cow to keep pylorus in place
omentopexy
tack all the way up to seal the hole
Close each layer individually - cat gut and plolyimidine, decrease dead space with tack, forward interlock skin

Question 21

When doing a rumenotomy you can tack the rument to the skin to prevent contamination?

Answer 21

Ture