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Small Animal Surgery > Approaches to the abdominal cavity > Flashcards

Approaches to the abdominal cavity Flashcards

1
Q

Surgical incision into abdominal cavity

A

Celiotomy

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2
Q

Flank approach to abdominal cavity

A

Laparotomy

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3
Q

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

A

Ventral midline

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4
Q

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

A

Ventral midline

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5
Q

Advantages of a Ventral Midline Approach

A
  • Minimal bleeding
  • Easiest and quickest approach & closure
  • Exposure to of all abdominal organs→incisions made xiphoid to pubis
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6
Q

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

A

Paramedian

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7
Q

Advantages of Paramedian incision

A

Increased exposure to organs on one side of the abdominal cavity

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8
Q

Disadvantages of Paramedian incision

A
  • Increased bleeding
  • Increased closure time
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9
Q

Refers to “thru the rectus abdomens”

A

Transrectal

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10
Q

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

A

Pararectal

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11
Q

Lateral incsion b/w last rib & tuber coxae

A

Flank

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12
Q

Advantages of Flank incisions

A

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

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13
Q

Disadvantages of Flank incisions

A

Limited access to entire abdomen

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14
Q

Techniques used when making a flank incision

A
  1. Cut thru external & internal abdominal oblique
  2. Grid approach
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15
Q

Describe the grid approach flank incision

A
  • Separate mm. fibers by the direction they are running
  • Let mm. fibers return to normal position
  • Suture layer by layer to close
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16
Q

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

A

Paracostal

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17
Q

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

A

Paracostal

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18
Q

What are the combined approaches to the abdomen?

(2)

A
  1. Ventral midline + Paracostal
  2. Ventral midline + Medial Sternotomy
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19
Q

Advantages & Disadvantages of the

Ventral Midline + Paracostal approach

A
  • Advantages
    • Increased exposure →esp. of gall bladder & liver lobes (R)
  • Disadvantages
    • Increased bleeding & prolonged exposure/closure time
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20
Q

Advantages & Disadvantages of the

Ventral midline + Median sternotomy approach?

A
  • Advantages:
    • Increased exposure of cranial abdomen (liver and diaphragm) ​
  • Disadvantages:
    • Opens pleural cavity →requires assisted ventilation
    • Thoracic drainage required
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21
Q

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

A

Determined by the goal of surgery

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22
Q

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

A

1 cm cranial & caudal to the anticipated body wall incision

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23
Q

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

A

False

It is incised in the same line as the skin

24
Q

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

A

Tent and incise it

25
Q

What provides the holding strength for closure?

A

External rectus sheath or abdominal fascia

26
Q

Where is the linea alba most easily identified?

A

@ or cranial to the umbilicus in dogs

27
Q

Where are the CRANIAL superficial epigastric vessels located?

A

Run parallel to linea & cranial to the umbilicus

28
Q

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

A

Displace penis

29
Q

What grip is used for short, precise cutting?

A

Pencil grip

30
Q

Grip used for long incisions?

A

Fingertip grip

(Marta says violin or modified violin)

31
Q

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

A

To avoid jagged incision edges

32
Q

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

A

45°-60°

33
Q

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

A

Out of the field

34
Q

If working on a ventral midline incision in a male dog,

what should you do when you reach the prepuce?

A

Detour R or L of the prepuce

35
Q

What is a stay suture?

A
  • Stich placed thru tissues but not tied
  • Long sutrue end is left exposed
  • -Clamp end w/ hemostat to elevate tissue or tag something
36
Q

True/False: During a ventral midline incision of a male dog,

Preputial muscles must be severed in half

A

True

37
Q

During a ventral midline incision of a male dog,

what vessels must be ligated before returning to the midline?

A

Branches of the CAUDAL superficial epigastric vessels

38
Q

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

A

Hemorrhage

39
Q

What do you do if urine enters the abdominal cavity?

A
  • Flush w/ saline at end of surgery → not a major problem (Relax yo!)
  • Prophylactic antibiotics can be given
40
Q

How should you clip for a celiotomy?

A

WIDE!!!!!!

41
Q

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

A

The Omentum →displace it to visualize the intestines

42
Q

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

A

Lift the intestines to visualize

43
Q

During abdominal surgery, what structure should you avoid squeezing?

A

Pancrease

44
Q

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

A

External rectus fascia = holding layer of ventral body wall

45
Q

When closing a Ventral Midline incision, is it okay to suture the rectus muscle layer?

Why or why not?

A

Never suture thru muscle!!!!

B/c it doesn’t add strength to closure and it increases inflammation

46
Q

When closing a ventral midline incision, do you close the internal sheath?

Why or Why not?

A

Usually not closed

B/c it doesn’t add strength to closure & may increase adhesion formation

47
Q

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

A

If the incision is on the midline

48
Q

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

A

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

49
Q

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

How much tissue should be incorporated?

A

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

50
Q

What may be a consequence of suture being placed too far apart

when closing a ventral midline approach?

A

Seroma or Hernia

51
Q

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

ventral midline approach?

A

Simple Interupted

or Simple Continuous (w/ more practice)

52
Q

What is the preferred suture material for closing a ventral midline approach?

What are the sizes used for dogs? cats?

A
  • Monofilament synthetic absorbable or non-absorbable suture
    • Monocryl or PDS
  • Dogs → 3/0 to 0
  • Cats → 3/0 or 4/0
53
Q

What is a consequence of not closing properly?

A

Dehiscence

54
Q

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

A

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

55
Q

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

A

Chromic gut or Stainless steel

56
Q

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

A
  • 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
57
Q

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

A

**Opened from the xiphoid process to pubis **

**Umbilicus should be the landmark **

Small Animal Surgery (10 decks)

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