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Clinical Studies > Abdominal Surgery > Flashcards

Abdominal Surgery Flashcards

1
Q

What is a laparotomy?

A

Flank approach to the abdomen

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2
Q

What is a coeliotomy?

A

Abdominal incision

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3
Q

What is an exploratory laparotomy?

A

Exploration of the abdomen for diagnostic and therapeutic reasons
- Used when exact cause is not known

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4
Q

What is a laparoscopy?

A

The use of fibre-optic telescope to perform minimally invasive abdominal surgery

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5
Q

How could you approach a laparotomy?

A
  1. Ventral Midline
  2. Paramedian
  3. Flank
  4. Inguinal
  5. Paracostal
  6. Vaginostomy
  7. Laparoscopic portals
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6
Q

Describe the ventral midline approach to a laparotomy…

A

Linea alba
- use the direction of the muscle fibres to guide

Advantages

  • Avascular
  • Good suture holding
  • Good visualisation in some species

Disadvantages

  • Holds the weight of the viscera which increases tension
  • Fascia is slower to heal so needs secure strong closure
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7
Q

What tissues are passed through in a ventral midline laparotomy?

A
  • Skin
  • Sub cut fat
  • Linea alba ( incise in groove between rectus muscles)
  • Falciform Ligament
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8
Q

What are the differences between bitch and dog ventral midline laparotomies?

A

Bitch can have a full xlap
- From xiphoid to pubis

Dog: need to skirt around the L/R side of the prepuce
- Cut preputialis muscle and reflect prepuce back

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9
Q

What might happen if you don’t close the preputialis muscle after a dog xlap?

A

Can get urine deviation

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10
Q

What are the most common reasons for a midline laparotomy in companion animals?

A
  1. Spey (ovariohysterectomy)
    - - Pyometra
    - - Caesarian section
  2. Foreign obstruction
    - - Gastric
    - - Small intestine
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11
Q

Describe the paramedian approach to a laparotomy…

A
  • Parallel to the midline
    • through or next to the rectus abdominis muscle

Advantages

  • Less weight
  • More vascular so good healing
  • Use in cattle for approach over specific organs

Disadvantages

  • Incision through R. abdominis may be more painful
  • Muscle not as strong as fascia

e.g. retained testicle

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12
Q

Describe the flank approach to a laparotomy…

A
  • Grid approach: split muscles in the direction of fibres
  • Modified grid: internal abdominal and transverse incised together

Advantages:

  • Less weight of viscera
  • Exposure of uy specific viscera is better

Disadvantages:

  • Incision must be placed for optimal access
  • Incision must be invisible for show cats etc.
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13
Q

What tissues are passed through with a flank incision?

A
  • Skin
  • Sub cut fat
  • EAO
  • IAO
  • Transverse abdominal m
  • Peritoneum
  • Omental fat
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14
Q

Describe the inguinal approach to a laparotomy…

A

Over the inguinal canal for reproductive organs or a reproductive hernia

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15
Q

Describe the paracostal approach to a laparotomy…

A

Approach parallel to the last rib
- To access the liver

Go through same tissue layers as for flank incision

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16
Q

Describe the vaginostomy approach to a laparotomy…

A

Through the vaginal wall

Disadvantages

  • No visualisation
  • Haemorrhage is difficult to control

e.g. cattle ovariohysterectomy

17
Q

Describe laparoscopy…

A

Utilises the principle of triangulation

Site and length of incision is based on:

  • Species
  • Reason for surgery
  • Facilities available
  • Surgeon preference
18
Q

What are some laparoscopic procedures?

A
  • Ovariectomy
  • Ovariohysterectomy
  • Cryptorchiectomy
  • Gastropexy
  • Liver biopsies etc.
19
Q

In horses, cats and dogs where should an xlap be approached from?

A

Midline

20
Q

In cattle where should an xlap be approached from?

A

Flank

21
Q

How do you perform an xlap?

A

Be methodical

  1. Start with the GIT
    - Feel oesophagus entering through diaphragm
    - Stomach, Duodenum, Jejunum, ileum, Caecum, Colon
    - Also: liver, gallbladder and pancreas
  2. Then the urogenital tract
    - Kidneys and ovaries, ureters, bladder, urethra (prostates)
    - Also: adrenals
  3. Lymphoreticular system
    - Lymph nodes of hepatic hilus, mesentery, ileocaecal valve, sublumber chain, spleen
  4. Inspect vessels and diaphragmatic surface
22
Q

What should you do if you must incise an organ?

A
  • Prevent leakage
  • Pack off with abdominal swabs
  • Empty a segment by “milking it”
  • Stay suture to hold organ up and out so it doesn’t deflate and leak contents into the abdomen
  • Use special drapes to prevent leakage
23
Q

Describe Laparotomy closure…

A
  • External rectus sheath is the most important (>90% strength)
  • Closure must be strong and secure and last long enough
  • Sub cut fat and skin must be closed separately
  • Avoid dead space
24
Q

How should Laparotomy closure sutures be placed?

A
  • 5-10mm between sutures
  • 4-10 mm from incision (first 3mm have too much inflammation
  • Full thickness or external sheath only
25
Q

What are some complications of laparotomies?

A
  1. Wound infection
  2. Peritonitis
  3. Adhesions
  4. Wound breakdown
  5. Non-retrieved swabs. instruments, drains
26
Q

Describe peritonitis from laparotomy…

A

Septic or non-septic

  • Septic: Bacteria from GIT, urinary, skin or surgeon (usually result of surgical error)
  • Non-septic: Handling e.g. pancreas, chemicals, bile etc
27
Q

How do you differentiate between septic and non-septic peritonitis?

A

Cytology

  • On the free fluid that accumulated in the abdomen
  • Is there bacteria?
28
Q

Describe wound breakdown from a laparotomy…

A

Infection, surgical error or failure of materials

Early breakdown - Eventration (eating own intestines)

Late breakdown - Usually leads to incisional hernia - abdominal contents herniate beneath healed skin

Partial Breakdown - e.g. skin suture breakdown but body wall intact vs. complete

29
Q

What is gossypiboma?

A

Non-retrieved swabs and instruments etc. from a surgery

  • Important to account for all materials and instruments used
    • set number of swabs per pack
    • count in and out
    • radiopaque swabs
    • check the abdomen properly before closing

Clinical Studies (19 decks)

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