Bovine surgery: intro and laparotomy Flashcards
What is the norwegian method is regard to suturing shut a laparotomy?
suturing all layers together in one go (muscles and skin) to get one layer of sutures.
- Nonabsorbable material,
- Use thick material
- Tighten properly!
- Not recommendable if really thick muscle layers (hard to tighten)
How would you close the abdominal wall after LDA operation?
How many layers and what type of suture pattern?
2 layers: muscles in one layer with continuous simple suture, skin with continuous Ford-interlocking suture
In which case is cesarean section contraindicated?
twins
emphysemic fetus
unopened uterine cervix
emphysemic fetus
would prob cause peritonitis if you tried. do fetotomy instead.
Name two main side effects associated with xylazine use in cattle?
lowered gastro-intestinal motility & respiratory depression
Name the top 5 most common surgeries performed in ruminants.
LDA
cesarean section
rumenotomy
diagnostic laparotomy
RDA
When it comes to cattle, what specific questions should you include in anamnesis? (3)
- Free stall/ tie stall?
- Beef cow/dairy cow?
(beef are less prone to needing surgical intervention but c-sections are not uncommon in them)
*lactation, parity, production
First step of cattle clinical exam. (3)
Observe from a distance!
- BCS
- dehydration
- rumination
Blood samples: most common values to assess in cattle. (8)
- Ca 8,5 – 10 mg/dl (2 – 3 mmol/l)
- K 3,9 – 6,4 mmol/l (< 3,5 mmol/l problem!)
- Na 138 – 155 mmol/l
- Cl 96 – 116 mmol/l
- AST 43 – 127 IU/L (aspartate, liver damage marker)
- CK 105 – 409 IU/L (creatine kinase, muscle enzyme)
- Creatinine 1,0 – 2,0 mg/dl (byproduct from protein breakdown)
- Fibrinogen 2 – 5 g/l
After clinical exam and blood sampling…
You come up with your care plan that you present to the owner.
Pets cows are more likely to be treated.
Production animals are more likely to be sent to slaughter.
Sunken eyeball 7mm =
12% dehydration
probably also has skin turgor >3s & CRT >4s
Hypertonic saline effect on the heart
Will cause an increase in heart rate so monitor it while administering the hypertonic fluids.
Remember to always offer water by mouth, or tube into the rumen if they won’t drink.
Adult cow rehydration options. (3)
How much fluid?
Fluids in Liters = body weight kg X dehydration %
e.g. 600 kg x 8% = 4.8 L
- 7,2 % hypertonic NaCl (4-5 ml/kg) (600 kg cow 2400 – 3000 ml i.v.) -> The cow needs to drink OR stomach tube (30l of water).
- Isotonic NaCl / Ringer minimum 15L
- Per os 30l of water + salts mixed in.
Blood sample values we want to see:
BHB
glucose
fibrinogen
Ca
K
BHB (0,7 mmol/l;1,4 mmol/l),
glucose (2 - 4 mmol/l),
fibrinogen (<5 g/l),
Ca (>8,5 mg/dl),
K (>3,8 mmol/l)
Describe Abdominocentesis
- usa an EDTA tube (small)
- Use a Teat cannula if avail.
- Normal amount of fluid 200 ml, increases in late pregnancy.
- Electrolyte concentration same as in blood.
- Leucocytes should be < 10,000 cells/µl
- Transudate: clear, transparent, low protein content < 3,0 g/l
- Exudate: cloudy, high protein content >3,0 g/l (peritonitis)
Preparation of a calf for surgery.
Ideally,
* No feed for 12h, no water for 6h
* Newborn calves -> ideally don’t restrict feeding at all, risk of hypoglycemia.
Preparation of adult cattle for surgery.
Ideally,
No feed for 18-24h, no water for 6h.
But in field settings doesn’t always happen.
Catheter can be used in jugular vein (12-14G) but isn’t so common to place them with cows, like it is in horses.
- Flush catheter with heparin solution after 4 hours, you can leave it in for three days.
Prep of the tail for surgery.
Tie to the leg closest to your surgery site so it wont flick and if it gets loose itll flick away.
Surgical wash in cattle.
x 3, then 70% alcohol then infiltration anesthesia and then another x 3 wash followed with alcohol
Local anesthesia in cattle. (4)
usually blocking T13-L2(L3)
most common: distal paravertebral block
proximal paravertebral block needs a little more skill
inverted L block
(common in beef cattle in whom you can’t feel the transverse processes cause they so thick)
infiltration anesthesia often combined with one of the above
Advantages of different Local anesthesia techniques.
distal paravertebral block
- smaller needles
- not so bleedy
- won’t cause scoliosis
proximal paravertebral block
- smaller LA dose
- wide analgetic area
- no LA near incision site
inverted L block
- easy
- no LA at incision site
infiltration anesthesia
- easy
Disadvantages of different Local anesthesia techniques.
distal paravertebral block
- larger doses of LA than proximal block
- not always reliable due to anatomic variation
proximal paravertebral block
- increased skill needed
- scoliosis can make closure hard
- poss. ataxia
- hemorrhage risk
inverted L block
- incomplete analgesia/ less efficient
- large LA doses (cost)
infiltration anesthesia
- LA at incision site
- incomplete analgesia (cost)
- less efficient
Local anesthesia – distal paravertebral anesthesia
We usually start from…
the cranial aspect of the 4th lumbar vertebra as the others are more painful, then you move cranial. Next to L2 you inject just under the process. Next to L1, you aim cranial of the process.
20ml of 2% procaine / site (procaine as 0 withdrawal time but lidocaine has approx. 2 weeks)
We only do lower part of the processes, fan out. 5ml straight under the process, 5ml cranially, 5ml caudally and 5 ml upon exit of the needle.
Incision site is infiltrated as well, usually (regional block may not always be sufficient).
Local anesthesia– distal paravertebral anesthesia: what nerves are being anesthetized next to what vertebrae?
Spinal nerves
* T13
* L1
* L2
Next to Transverse processes
* L1
* L2
* L4
see image for anatomy
Local anesthesia– proximal paravertebral anesthesia.
Aims for spinal nerves T13, L1 and L2 but at the body of the vertebrae, not at the transverse processes like distal does.
See image.
Local anesthesia – inverted L- anesthesia
Easier than vertebral anesthesia but not always efficient for analgesia.
Each site may require up to 10 ml of local anesthetic (so 8 x 10 ml according to the photo). Large volumes.
What surgery would you do at each line?
Left to right.
Left to right.
LDA, rumenotomy, cesarean
Organs you can feel from the left side of a cow:
- Rumen
- Spleen
- Reticulum
- Diaphragm
- Tip of the heart
- Liver’s left lobe
- Omasum
- Abomasum
- Left kidney (more caudal than right)
- Ovaries
- Uterus
- Bladder
- Intestines
Basically everything except the right kidney, some intestines.
what is a spring eye needle
This type of needle is sometimes called spring eye, French eye or split eye.
These needles facilitate suturing. There is a V-shaped notch at the end of the needle. The thread is pulled through the sprinkler groove into the eyelet.
The slit in the needle allows the surgeon to quickly load the suture by simply snapping the thread into place rather than passing it through a small hole.
Body wall structure, name the layers from outside in. (6)
- Skin (cutis) + subcutis
- Three muscle layers
- M. obliquus externus abdominis
- M. obliquus internus abdominis
- M. transversus abdominis
Further ventral, - (M. rectus abdominis on both sides of the white line)
- Peritoneum
Jejunal Hemorrhage Syndrome
a severe, often fatal intestinal disorder characterized by acute hemorrhage and the formation of clots within the jejunum, a part of the small intestine, leading to intestinal blockage, tissue necrosis, and in many cases, sudden death.
Clostridium perfringens Type A is frequently implicated in JHS.
- Usually dairy cows are affected 3-5 months after calving (median 3. lactation)
- Rarely bulls, dry cows or beef cattle
- Sudden anorexia, loss of milk yield, RR and HR ↑, white mucosa, dehydration, anemia, colic, blood in the rectum, feces
are absent or a few clumps can be seen. - Hypokalemia, hypochloremia, serum L-lactate >5 mmol/L
- 24-48 h later peritonitis, will die usually within 48 h
Urolithiasis - treatment in rams (and other ruminants)
Sigmoid flexure in ruminants means you can’t insert a catheter via urethra.
Tube cystotomy:
* Purse string suture on the bladder -> big needle through the middle
* Foley catheter nr 22 (goat, sheep) goes into the bladder through the abdominal wall.
* The catheter is sutured to the abdominal wall, a gloves fingertip attached to the end.
* a week later the patient should start urinating through the urethra
Use slightly acidic solutions (ph 4,5 – 5,5) to lower the urine ph.
* dissolves any crystals/stones
Prevention – Ca:P ratio 2:1
