Abdominal Surgery Flashcards
what is the difference between laparotomy and celiotomy
laparotomy: refers to flank incision into the abdominal cavity
celiotomy: refers to midline incision into the abdominal cavity
when we refer to an “ex-lap”, we are technically referring to what procedure
celiotomy
what do we can acute clinical signs referable to the abdominal cavity
acute abdomen
exploration of the abdominal cavity can fall under what 3 categories? give an example of each
- diagnostic: liver biopsy
- therapeutic: GDV, tumor resection
- preventative: gastropexy, OHE
for abdominal exploration, where should you clip
few cm cranial of the xiphoid to the level of the inguinal region
T/F you should prepare and drape more than what you anticipate for an ex-lap
T
what are the 4 general principles of surgery
1) asepsis
2) gentle tissue handling
3) hemostasis
4) maintain organ function
what does it mean to count sponges “in and out”
count before and count after surgery
T/F your sponges are no longer sterile once used so they should be discarded in a garbage off of the surgical table
F: discard in your large bowl to not throw off your count (but yes, they are no longer sterile)
what should you do if you drop a sponge used during surgery
discard it under the table and remember to count it later
what are the benefits of cutting through the linea alba
1) clean incision
2) less bleeding
3) clean, secure closure
T/F in males, you have to cut off the linea alba at the level of the prepuce
F: your SKIN incision will be off midline but you still cut through the linea (just have to dissect to get there and make sure that you tack down)
what length of incision is necessary to explore the abdominal cavity
xiphoid to the pubis
what number blade should you use for a midline incision for a celiotomy? what would you use for the rest of the surgery
10 blade; 15 blade
what is an important consideration when you make your initial incision and have to dissect around the rectus fascia to find the linea
this will create dead space and can lead to a seroma if you do not tack it down; limit the amount of dissection you do
what blade do you want to use to incise the linea
15
where would you ideally make your stab incision on the linea
caudally, to extend cranially
what is an important step before extending your linea incision with mayo scissors
palpate for any adhesions along the body wall
how does the incision differ if a male dog?
1) make an incision parallel and lateral to the prepuce
2) ligate the branches of the caudal superficial epigastric vein
3) undermine prepuce and reflect it away from the surgeon to expose the linea
where is the linea easiest to locate
at level of umbilicus (widest)
why do we make our stab incision at the umbilicus
this is where the linea is the easiest to identify
where is the falciform ligament
cranial to the umbilicus
what is the best way to deal with the falciform ligament
excise it completely from the abdomen
what are the 4 steps for removing the falciform ligament
1) incise the attachments on either side of the linea
2) deal with any bleeders
3) clamp and ligate the attachment at the cranial end of the xyphoid
4) amputate distal to suture
T/F it is necessary to remove the falciform ligament to improve visualization for caudal abdominal procedures
F; only cranial abdominal procedures
what tool do we use to keep the abdomen open during a celiotomy
Balfour retractor
what structures are strong and what are weak when it comes to closing the abdomen
strong: skin and fascia
weak: muscle and fat
what is the deal with the peritoneum when it comes to closing the abdomen
it heals fast BUT does not contribute to wound strength and can increase adhesions
what is the layer of strength for closing the abdomen
rectus fascia (external rectus sheath)
how long should your suture tags be for closing the linea
~ 0.5cm
what are the advantages and disadvantages of simple interrupted for closing the linea
advantage: more secure when learning (novice surgeon)
disadvantage: more foreign material, longer sx time, more suture (cost)
what are the advantages and disadvantages of simple continuous to close the linea
advantages: fast, less foreign material, less material (cheaper)
disadvantages: can be catastrophic if it comes undone, line breaks, or gets infected
what should you NEVER use to close the linea
steel, cat gut or non-absorbable braided suture
if you incised on the linea, you should take what kind of bites? what about if you incised lateral to the linea
on the linea: 4-10mm full-thickness bites
off the linea: 5-10mm bites of external rectus fascia only
T/F you should include subq or falciform in your bites as it will help heal
F
how far apart should you space sutures when closing the linea
5-7mm
what is the main cause of wound dehiscence
tissue weakness
you should take _____ bites of the ___________ leaf of the fascia for every bite
large; external
what size suture should you use for a simple interrupted closure on the linea in the following size dogs:
2-12 kg
12-30 kg
>30 kg
2-12 kg -> 3-0
12-30 kg -> 2-0
>30 kg -> 0
what size suture should you use for a simple continuous closure on the linea in the following size dogs:
2-12 kg
12-30 kg
>30 kg
2-12 kg -> 2-0
12-30 kg -> 2-0 to 0
>30 kg -> 0
what are good suture options for the linea
PDS II, biosyn, maxon
what should you use to close subq and what type of suture
simple continuous; Monocryl
how do you tack down to prevent a seroma
take a bite of fascia every 2-4 bites
should you use absorbable or non-absorbable suture on the subq
absorbable
T/F knots for subq sutures must be buried
T
what are the 3 steps for a parapreputial closure
1) close SQ first using simple interrupted or cruciate sutures
2) re-oppose the preputial mm to re-align the prepuce using one mattress or cruciate suture
3) close the SQ in a straight line like for a female
what is the #1 complication of parapreputial incisions
seromas due to excessive dead space
how do we close the skin
1) staples (fast to place, longer to remove)
2) simple interrupted or cruciate (4-0 or 3-0)
what surgeries do NOT warrant prophylactic antibiotics
<1.5-2h with no entry into a hollow viscus or contamination
what does perioperative antibiotics mean
start giving within a half hour of cutting and stop once procedure is done or within 24h
what should you check an incision for every day
redness, swelling, pain, discharge
