Approaches to the abdominal cavity

Question 1

Surgical incision into abdominal cavity

Answer 1

Celiotomy

Question 2

Flank approach to abdominal cavity

Answer 2

Laparotomy

Question 3

What is the most common approach into the abdomen used in SAM?

Answer 3

Ventral midline

Question 4

Incision that goes thru the SQ tissue and the linea alba?

Answer 4

Ventral midline

Question 5

Advantages of a Ventral Midline Approach

Answer 5

• Minimal bleeding
• Easiest and quickest approach & closure
• Exposure to of all abdominal organs→incisions made xiphoid to pubis

Question 6

Venral abdomial incision parallel to midline (R or L) is called

Answer 6

Paramedian

Question 7

Advantages of Paramedian incision

Answer 7

Increased exposure to organs on one side of the abdominal cavity

Question 8

Disadvantages of Paramedian incision

Answer 8

• Increased bleeding
• Increased closure time

Question 9

Refers to “thru the rectus abdomens”

Answer 9

Transrectal

Question 10

Refers to “rectus abdominus muscle pulled to one side before incision”

Answer 10

Pararectal

Question 11

Lateral incsion b/w last rib & tuber coxae

Answer 11

Flank

Question 12

Advantages of Flank incisions

Answer 12

Excellent exposure to 1 kidney, 1 adrenal gland, & 1 ovary

Question 13

Disadvantages of Flank incisions

Answer 13

Limited access to entire abdomen

Question 14

Techniques used when making a flank incision

Answer 14

1. Cut thru external & internal abdominal oblique
2. Grid approach

Question 15

Describe the grid approach flank incision

Answer 15

• Separate mm. fibers by the direction they are running
• Let mm. fibers return to normal position
• Suture layer by layer to close

Question 16

Incision caudal or parallel to last rib (1 or 2 fingers behind last rib)

Answer 16

Paracostal

Question 17

Which incision gives very little exposure and is rarely used alone?

Answer 17

Paracostal

Question 18

What are the combined approaches to the abdomen?

(2)

Answer 18

1. Ventral midline + Paracostal
2. Ventral midline + Medial Sternotomy

Question 19

Advantages & Disadvantages of the

Ventral Midline + Paracostal approach

Answer 19

• Advantages
  
  • Increased exposure →esp. of gall bladder & liver lobes (R)
• Disadvantages
  
  • Increased bleeding & prolonged exposure/closure time

Question 20

Advantages & Disadvantages of the

Ventral midline + Median sternotomy approach?

Answer 20

• Advantages:
  
  • Increased exposure of cranial abdomen (liver and diaphragm) ​
• Disadvantages:
  
  • Opens pleural cavity →requires assisted ventilation
  • Thoracic drainage required

Question 21

With the midline approach, what determines the location and length of the incision?

Answer 21

Determined by the goal of surgery

Question 22

How far is the skin incision extended past the anticipated body wall incision?

Answer 22

1 cm cranial & caudal to the anticipated body wall incision

Question 23

True/False: The SQ layer is not incised in the same line as the skin

Answer 23

False

It is incised in the same line as the skin

Question 24

What do you do to the linea alba after you identify it?

Answer 24

Tent and incise it

Question 25

**What provides the holding strength for closure?**

Answer 25

**External rectus sheath or abdominal fascia**

Question 26

Where is the linea alba most easily identified?

Answer 26

@ or cranial to the umbilicus in dogs

Question 27

Where are the CRANIAL superficial epigastric vessels located?

Answer 27

Run parallel to linea & cranial to the umbilicus

Question 28

What must be done in males to complete the ventral midline incision?

Answer 28

Displace penis

Question 29

What grip is used for short, precise cutting?

Answer 29

Pencil grip

Question 30

Grip used for long incisions?

Answer 30

Fingertip grip | (Marta says violin or modified violin)

Question 31

Why do you need to apply tension while making an incision?

Answer 31

To avoid jagged incision edges

Question 32

What degree angle should you use when stabbing the linea alba?

Answer 32

45°-60°

Question 33

In male dogs, is the preputial orifice draped in or out of the surgical field?

Answer 33

Out of the field

Question 34

If working on a ventral midline incision in a male dog, what should you do when you reach the prepuce?

Answer 34

Detour R or L of the prepuce

Question 35

What is a stay suture?

Answer 35

* Stich placed thru tissues but not tied * Long sutrue end is left exposed * -Clamp end w/ hemostat to elevate tissue or tag something

Question 36

**True/False**: During a ventral midline incision of a male dog, Preputial muscles must be severed in half

Answer 36

True

Question 37

During a ventral midline incision of a male dog, what vessels must be ligated before returning to the midline?

Answer 37

Branches of the CAUDAL superficial epigastric vessels

Question 38

What may happen if you grab the penis with the hemostats when draping?

Answer 38

Hemorrhage

Question 39

What do you do if urine enters the abdominal cavity?

Answer 39

* Flush w/ saline at end of surgery → not a major problem (Relax yo!) * Prophylactic antibiotics can be given

Question 40

How should you clip for a celiotomy?

Answer 40

WIDE!!!!!!

Question 41

What is the first thing visualized when opeing during a celiotomy?

Answer 41

The Omentum →displace it to visualize the intestines

Question 42

If you lose your ovarian pedicle, what do you do?

Answer 42

Lift the intestines to visualize

Question 43

During abdominal surgery, what structure should you avoid squeezing?

Answer 43

Pancrease

Question 44

What is the holding layer during closure of ventral midline incision?

Answer 44

External rectus fascia = holding layer of ventral body wall

Question 45

When closing a Ventral Midline incision, is it okay to suture the rectus muscle layer? Why or why not?

Answer 45

**Never suture thru muscle**!!!! B/c it doesn't add strength to closure and it increases inflammation

Question 46

When closing a ventral midline incision, do you close the internal sheath? Why or Why not?

Answer 46

Usually not closed B/c it doesn't add strength to closure & may increase adhesion formation

Question 47

You are closing an incision..... when may you place full thickness bites?

Answer 47

If the incision is on the midline

Question 48

Where do you place your sutures if the muscles are exposed during the closure of a ventral midline approach?

Answer 48

Sutures are placed in the external rectus sheath (fascia) only

Question 49

When closing a ventral midline approach, how far apart should your sutures be placed? How much tissue should be incorporated?

Answer 49

Place 5-10mm apart & incorporate 5-10mm of tissue

Question 50

What may be a consequence of suture being placed too far apart when closing a ventral midline approach?

Answer 50

Seroma or Hernia

Question 51

What is the preferred suture pattern(s) to use when closing the linea alba during a ventral midline approach?

Answer 51

Simple Interupted or Simple Continuous (w/ more practice)

Question 52

What is the preferred suture material for closing a ventral midline approach? What are the sizes used for dogs? cats?

Answer 52

* Monofilament synthetic absorbable or non-absorbable suture * Monocryl or PDS * Dogs → 3/0 to 0 * Cats → 3/0 or 4/0

Question 53

What is a consequence of not closing properly?

Answer 53

Dehiscence

Question 54

What does Dr. Bruhl-Day say about the size of the suture when closing a ventral midline approach?

Answer 54

It is not the size of the suture that matters, but the technique you apply with it Use the minimum size to do the job

Question 55

What type of suture material should you NOT use in a continuous pattern to close the linea alba?

Answer 55

Chromic gut or Stainless steel

Question 56

What is the technique for suturing a ventral midline approach closed?

Answer 56

* One end to the other ***_OR_*** Each end to the middle (tie 2 sutures together at center) * **SQ tissue is closed in simple continuous pattern or simple interrupted ** * ​2/0 or 4/0 synthetic absorbable suture * **Preputialis mm. must be correctly apposed in male dog - pull 2 stay sutures ** * Skin is closed in simple interrupted or cruciate pattern * 3/0 or 4/0 nylon * **Dead space should be properly closed - accumulation of serosanguineous fluid or serum leads to hematoma or seroma formation**

Question 57

**With a celiotomy, you use the ventral midline approach. The abdomen is opened from _____ to \_\_\_\_\_, and what is the landmark?**

Answer 57

**Opened from the xiphoid process to pubis ** **Umbilicus should be the landmark **