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Principles of Surgery > Abdominal Surgery > Flashcards

Abdominal Surgery Flashcards

1
Q

what is the difference between laparotomy and celiotomy

A

laparotomy: refers to flank incision into the abdominal cavity

celiotomy: refers to midline incision into the abdominal cavity

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2
Q

when we refer to an “ex-lap”, we are technically referring to what procedure

A

celiotomy

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3
Q

what do we can acute clinical signs referable to the abdominal cavity

A

acute abdomen

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4
Q

exploration of the abdominal cavity can fall under what 3 categories? give an example of each

A
  • diagnostic: liver biopsy
  • therapeutic: GDV, tumor resection
  • preventative: gastropexy, OHE
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5
Q

for abdominal exploration, where should you clip

A

few cm cranial of the xiphoid to the level of the inguinal region

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6
Q

T/F you should prepare and drape more than what you anticipate for an ex-lap

A

T

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7
Q

what are the 4 general principles of surgery

A

1) asepsis
2) gentle tissue handling
3) hemostasis
4) maintain organ function

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8
Q

what does it mean to count sponges “in and out”

A

count before and count after surgery

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9
Q

T/F your sponges are no longer sterile once used so they should be discarded in a garbage off of the surgical table

A

F: discard in your large bowl to not throw off your count (but yes, they are no longer sterile)

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10
Q

what should you do if you drop a sponge used during surgery

A

discard it under the table and remember to count it later

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11
Q

what are the benefits of cutting through the linea alba

A

1) clean incision
2) less bleeding
3) clean, secure closure

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12
Q

T/F in males, you have to cut off the linea alba at the level of the prepuce

A

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)

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13
Q

what length of incision is necessary to explore the abdominal cavity

A

xiphoid to the pubis

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14
Q

what number blade should you use for a midline incision for a celiotomy? what would you use for the rest of the surgery

A

10 blade; 15 blade

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15
Q

what is an important consideration when you make your initial incision and have to dissect around the rectus fascia to find the linea

A

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

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16
Q

what blade do you want to use to incise the linea

A

15

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17
Q

where would you ideally make your stab incision on the linea

A

caudally, to extend cranially

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18
Q

what is an important step before extending your linea incision with mayo scissors

A

palpate for any adhesions along the body wall

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19
Q

how does the incision differ if a male dog?

A

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

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20
Q

where is the linea easiest to locate

A

at level of umbilicus (widest)

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21
Q

why do we make our stab incision at the umbilicus

A

this is where the linea is the easiest to identify

22
Q

where is the falciform ligament

A

cranial to the umbilicus

23
Q

what is the best way to deal with the falciform ligament

A

excise it completely from the abdomen

24
Q

what are the 4 steps for removing the falciform ligament

A

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

25
Q

T/F it is necessary to remove the falciform ligament to improve visualization for caudal abdominal procedures

A

F; only cranial abdominal procedures

26
Q

what tool do we use to keep the abdomen open during a celiotomy

A

Balfour retractor

27
Q

what structures are strong and what are weak when it comes to closing the abdomen

A

strong: skin and fascia
weak: muscle and fat

28
Q

what is the deal with the peritoneum when it comes to closing the abdomen

A

it heals fast BUT does not contribute to wound strength and can increase adhesions

29
Q

what is the layer of strength for closing the abdomen

A

rectus fascia (external rectus sheath)

30
Q

how long should your suture tags be for closing the linea

A

~ 0.5cm

31
Q

what are the advantages and disadvantages of simple interrupted for closing the linea

A

advantage: more secure when learning (novice surgeon)

disadvantage: more foreign material, longer sx time, more suture (cost)

32
Q

what are the advantages and disadvantages of simple continuous to close the linea

A

advantages: fast, less foreign material, less material (cheaper)

disadvantages: can be catastrophic if it comes undone, line breaks, or gets infected

33
Q

what should you NEVER use to close the linea

A

steel, cat gut or non-absorbable braided suture

34
Q

if you incised on the linea, you should take what kind of bites? what about if you incised lateral to the linea

A

on the linea: 4-10mm full-thickness bites

off the linea: 5-10mm bites of external rectus fascia only

35
Q

T/F you should include subq or falciform in your bites as it will help heal

A

F

36
Q

how far apart should you space sutures when closing the linea

A

5-7mm

37
Q

what is the main cause of wound dehiscence

A

tissue weakness

38
Q

you should take _____ bites of the ___________ leaf of the fascia for every bite

A

large; external

39
Q

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

A

2-12 kg -> 3-0
12-30 kg -> 2-0
>30 kg -> 0

40
Q

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

A

2-12 kg -> 2-0
12-30 kg -> 2-0 to 0
>30 kg -> 0

41
Q

what are good suture options for the linea

A

PDS II, biosyn, maxon

42
Q

what should you use to close subq and what type of suture

A

simple continuous; Monocryl

43
Q

how do you tack down to prevent a seroma

A

take a bite of fascia every 2-4 bites

44
Q

should you use absorbable or non-absorbable suture on the subq

A

absorbable

45
Q

T/F knots for subq sutures must be buried

A

T

46
Q

what are the 3 steps for a parapreputial closure

A

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

47
Q

what is the #1 complication of parapreputial incisions

A

seromas due to excessive dead space

48
Q

how do we close the skin

A

1) staples (fast to place, longer to remove)
2) simple interrupted or cruciate (4-0 or 3-0)

49
Q

what surgeries do NOT warrant prophylactic antibiotics

A

<1.5-2h with no entry into a hollow viscus or contamination

50
Q

what does perioperative antibiotics mean

A

start giving within a half hour of cutting and stop once procedure is done or within 24h

51
Q

what should you check an incision for every day

A

redness, swelling, pain, discharge

Principles of Surgery (8 decks)

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