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3. Food Animal 2 > Bovine surgery 2 > Flashcards

Bovine surgery 2 Flashcards

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1
Q

Surgical Approaches

A

Flank
- Paralumbar fossa celiotomy
> Left
> Right
- Mid to low
> Right paracostal approach
> Left oblique celiotomy
- Ventrolateral oblique
<><>
Right paramedian celiotomy
<><>
Ventral midline

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2
Q

Flank: paralumbar fossa celiotomy
- what can we access from the left?

A
  • Left side: access rumen, reticulum, spleen, diaphragm, reproductive tract, bladder, left kidney, abomasum (LDA)
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3
Q

Flank: paralumbar fossa celiotomy
- what can we access from the right?

A
  • Right side: access pyloric part of abomasum, small & large intestine, reproductive tract, urinary bladder, kidneys
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4
Q

Flank: paralumbar fossa celiotomy
- landmarks for initial cut

A

Landmarks:
* 6-8cm ventral to transverse processes
* 4-6cm caudal to last rib
* Dorsoventral direction for approx. 25cm

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5
Q

Flank: paralumbar fossa celiotomy
- is the approach the same from R and L side? what if we anticipate a pyloropexy or c-section, how will we change our landmarks?

A
  • R & L approach the same
  • If pyloropexy anticipated (R side), go closer to last rib
  • If c-section (L side), incision more caudal and lower in flank
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6
Q

Flank: paralumbar fossa celiotomy
- Layers of incision:

A

Layers of incision:
* Skin
* Subcutaneous
* External abdominal oblique muscle ( points diagonally from head to udder)
* Internal abdominal oblique muscle (points diagonally from brisket to tailhead)
* Transversus abdominis muscle with attached peritoneum (up and down)

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7
Q

what are the muscular layers of the abdominal wall and where do they run?

A
  • External abdominal oblique (ribs > tuber coxae, prepubic tendon, linea)
  • Internal abdominal oblique (hip, lumbar vertebrae > linea, ribs)
  • External & internal abdominal oblique fuse to aponeurosis (= external sheath of rectus abdominis) > linea
  • Transversus abdominis (lumbar vertebrae, ribs > forms aponeurosis=inner sheath of rectus abdominis > linea)
  • Rectus abdominis > only ventral (sternum, ribs ®cranial pubic ligament)
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8
Q

Flank: paralumbar fossa celiotomy
- what is our strategy for closure? what layers do we close and what type of suture and patterns?

A
  • 4 layers:
  • Peritoneum & transversus abdominis
  • Internal abdominal oblique
  • External abdominal oblique
  • Skin
    ()
  • Peritoneum & transverse abdominis
  • Internal abdominal oblique
  • External abdominal oblique
    > simple continuous, #2, absorbable
    ()
  • Skin > Ford interlocking, #1, nonabsorbable, simple interrupted ventral
    <><><><><><><>
    o Peritoneum & transversus abdominis, No. 1 or 2 absorbable, simple continuous
    o Internal abdominal oblique, No. 1 or 2 absorbable, simple continuous
    o External abdominal oblique, No. 1 or 2 absorbable, simple continuous
    o Skin, non-absorbable suture, No. 1 , Ford interlocking pattern and a few simple interrupted sutures at the ventral aspect to allow for drainage if necessary
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9
Q

Flank: paralumbar fossa celiotomy
- advantages and disadvantages

A

Advantages: good for exploration, viscera in normal position

Disadvantages: not always adequate exposure eg for evaluating gravid uterus, or small intestine; cow may go down

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10
Q

what is the use of the right paracostal approach?

A
  • Good for access to abomasum in calves or adult cattle
  • More thorough examination of intestines possible through this approach in calves due to more mobile intestinal tract than adults
  • Left lateral recumbency under GA
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11
Q

Right paracostal approach - where / what do we cut?

A
  • Parallel and caudal to last rib (5-10 cm in adults)
  • Aponeurosis of external abdominal oblique
  • muscular layer of internal abdominal oblique dorsally, and aponeurotic portion ventrally
  • Transversus abdominis and peritoneum together, tented
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12
Q

Flank: Mid to Low approach
- advantages and disadvantages?

A

Advantages:
* standing or recumbent
* good access to intestines if recumbent
* good access to gravid uterus animal

Disadvantages:
* increased potential of spillage of organs
* increased tension on sutures

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13
Q

Mid flank: Left oblique celiotomy
- when is it reccomended?

A

o Recommended for cows with c section
o Extends further cranial and ventral than classic flank approaches so better for
uterus exteriorisation
o Standing or recumbent

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14
Q

Mid flank: Left oblique celiotomy
- landmarks for incision? how do we cut?

A

o Skin incision starts 10cm ventral to transverse process and angles forward to
finish at level of costochondral junction
o Abdominal oblique muscles incised in same direction as skin
o Transversus and peritoneum tented as other approaches

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15
Q

Low flank: Ventrolateral Oblique
- when would we use this approach?

A
  • C-section in recumbent animal (fetal abnormalities)
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16
Q

Low flank: Ventrolateral Oblique
- what is the surgical technique?

A
  • Lateral recumbency
    > Usually sedation & local
  • oblique incision (30-40 cm)
    > Ventral to flank fold, dorsal to udder
  • extends cranioventrally
  • Mark milk vein!
  • Incise along edge of rectus abdominis
  • External sheath is holding layer of the closure
17
Q

Flank: Ventrolateral Oblique
- advantages

A

Good access to uterus > good exteriorization > less contamination

18
Q

Flank: Ventrolateral Oblique
- disadvantages

A
  • Requires good restraint
  • Difficult to enlarge incision
  • less access to other organs
  • Tension & movement on incision
19
Q

Right paramedian celiotomy
- when do we use? what is it good for?

A
  • Cranial abdomen access
  • Mostly used for correction of abomasal
    displacement or volvulus, or access to reticulum
  • Restrained in dorsal recumbency
20
Q

Right paramedian celiotomy
- where to do the incision? how large?

A

Landmarks:
* 4-6cm lateral to ventral midline
* 6-8cm caudal to xiphoid
* 15-20cm incision

21
Q

Right paramedian celiotomy
- what layers do we cut through? what is the holding layer?

A
  • Skin, subcutaneous
  • Ext.sheathof rectus abdominis mm (holding layer), rectus abdominis mm, int. sheath of rectus abdominis mm (thumb forceps to tent)
  • Sometimes in cranial portion aponeurosis of pectoral mm is present
22
Q

Right paramedian celiotomy
- advantages and disadvantages

A

Advantages:
* good access to forestomachs, abomasum and urinary bladder in male

Disadvantages:
* requires good restraint
* dorsal recumbency!!!
* general exploration limited
* not as strong as midline

23
Q

indications for ventral misdline incision

A
  • umbilicus problems
  • calves
  • urogenital diseases
  • C-section
24
Q

Surgical technique for ventral midline incision

A
  • dorsal recumbency
  • Sedation & local or GA
  • incision through linea alba
25
Q

ventral midline closure technique

A
  • linea > simple continuous, #1 or 2, absorbable
  • subcutaneous > simple continuous, #0 or 2.0, absorbable
  • skin > simple continuous or ford interlocking, #0 or 2.0, non-absorbable
26
Q

Ventral Midline approach - advantages and disadvantages

A

Advantages:
* good exposure (young calves)

Disadvantages:
* dorsal recumbency
* gravid uterus less easily exteriorized
> Can tilt cow
* exploration may be difficult in adult
* increased tension on sutures

27
Q

Indications for rumenotomy

A
  • Metallic foreign objects traumatic reticulitis or reticuloperitonitis
  • Removal of foreign material that may obstruct reticulo- omasal orifice
  • Removal of foreign bodies lodge in distal esophagus
  • Removal of ruminal content following overload, or ingestion of toxic plants
  • Rumen impaction
  • Impaction or atony of omasum or abomasum
28
Q

Rumenotomy - where do we incise, then what do we do? what do abscesses feel like and where would we look?

A

surgical exploration in left paralumbar fossa
* Incision caudal to last rib
* Abdominal exploration before opening rumen
* Caudal & central part first
* Abscesses firm & spherical, usually right side of reticulum or cranial to omasum
* Palpate for adhesions

29
Q

Rumenotomy
- where do we anchor rumen? why? how?

A
  • Rumen is anchored to skin to prevent contamination of peritoneal cavity when abdomen opened:
  • Exteriorise as much of rumen as possible
  • Continuous inverting suture pattern to close rumen to skin over entire incision, use non- absorbable No1 or 2, cutting needle needed for skin
30
Q

when doing a rumenotomy and anchoring the rumen to the skin, what must we ensure?

A
  • Ensure rumen projects well over skin at ventral aspect to prevent contamination
31
Q

alternative to suturing rumen to skn in rumenotomy, and disadvantage

A

Alternatively, can use rumenotomy board, but is more easily displaced

32
Q

rumenotomy incision - what should we stay away from? how do we remove contents?

A
  • Good seal important
  • Stay away from anchoring
    sutures during incision
    *Remove fluid with hose, solid contents scoop out
    *Explore
33
Q

rumenotomy - how do we find the reticulum? what can we do to help find foreign bodies?

A

Follow dorsal wall (through gas cap) to reach reticulum
* To locate foreign bodies, reticulum can be gently picked up

34
Q

during rumenotomy, how do we drain an abscess?

A

Abscess can be drained into reticulum by carrying in scalpel blade attached to umbilical tape

35
Q

Rumenotomy - closure method? how to stay clean?

A
  • Closure of rumen with No. 1 or 2 absorbable material in 2 rows of continuous pattern, with second row using an inverting suture pattern
  • Following closure of first row, suture line is thoroughly lavaged
  • surgeon regowns, redrapes and uses a clean surgical kit
  • Rumen-fixation suture removed prior to closure of second row of rumen sutures
36
Q

when do we perform a rumenostomy? general strategy?

A
  • chronic vagal indigestion, space occupying lesion, idiopathic
  • commercial device or suturing rumen to skin
37
Q

muscles of flank - what is our holding layer? where is it?
- how do the fibers of each muscle run? - how do we incise?

A
  • External abdominal oblique
    o Incised in same direction as skin incision
  • Most extensive muscle of flank, ‘holding layer’
  • Originates on 4th or 5th rib, terminates on tuber coxae, prepubic tendon and linea alba
  • Fibres run in caudoventral direction
  • Aponeurosis of external abdominal oblique blends with aponeurosis of internal abdominal oblique to form external sheath of rectus abdominis muscle
  • Internal abdominal oblique
    o Incised in same manner as external abdominal oblique
  • Originates on tuber coxae, transverse processes and thoracolumbar fascia, terminates on costal cartilages or aponeurosis joining external abdominal oblique
  • Fibres run in cranioventral direction
  • Transverse abdominis
    o Tent using thumb forceps and use Mayo scissors to cut along length to prevent damage to viscera
    o Thinnest layer
    o Arises from transverse processes of lumbar vertebrae and last ribs
    o Forms aponeurosis at lateral edge of rectus abdominis muscle
    o Becomes internal sheath of rectus abdominis muscle and ultimately inserts on linea alba
    o Covered on inside by transverse fascia and peritoneum

3. Food Animal 2 (20 decks)

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