Celiotomy and Typhlotomy (Lab) Flashcards
How far should you clip for the C/T lab>
Clip from mid-thorax to tuber coxae and ventrally to the ventral midline
Due on R flank –> left lateral recumbency
Where do you make your initial incision?
R paralumbar fossa
Caudal to last rib, ventral to transverse processes of lumbar vertbrae, cranial to tuber coxae
What are you cutting through in order
Skin
Sub Q
Cutaneous trunci
External abdominal oblique (fairly thick) –> will see vessels
Paralumbar nerve (may or may not be in incision line –> can cut through)
Internal abdominal oblique muscles (not as thick as external)
Transverse abdominus muscle (varies but about 3-4 mm in thickness) –> peritoneum adheres to this muscle (very thin) Abdomen is a vacuum, so opening up even a tiny whole will cause organs to drop
What should you do you once you have made a small dissection into the abdomen?
Make a larger incision and place your entire HAND inside
DON’T CUT INTO THE RUMEN
Why do you not want instruments or gauze when placing hands into the abdominal cavity?
They could possibly fall in to the abdomen
What is the first thing you want to palpate?
The liver with left hand –> right ventral cranial abdomen
feels like liver
What is the second structure you palpate?
The kidney with left hand –> dorsal near the transverse process of the vertebrae
About 2-3 inches in length
What is the third structure you palpate?
Urinary bladder with right hand –> palpate the bony pelvic inlet, will find a round soft structure = bladder (varies in size)
What is the fourth structure you palpate?
Cecum –> quite large structure. Exteriorize the apex of the cecum. Omentum gets in the way sometimes when trying to find the cecum
What should you do once you exteriorize the apex of the cecum?
With two fingers, milk the contents of the cecum ~ 5 inches away towards the base –> take a Doyen clamp and place 2 clicks proximal to prevent refilling –> place 2 stay sutures approximately 4 cm apart and suspended with mosquito hemostats –> take lap sponges, soak in sterile saline, and wrap around Doyen and mosquito clamps
How do you enter the lumen of the cecum?
Between the two stay sutures, make a stab incision with a scalpel blade, thus creating a clean contaminated wound
How do you want to close the cecum?
Two layers:
- Using absorbable suture, place a simple continuous pattern or Cushing on the first layer of closure
- Place a continuous inverting pattern (Cushing or Lambert’s)
What should you do after you perform two closures of the cecum?
Change gloves
How should you begin closing the abdominal cavity?
Starting away from yourself, do a simple continuous pattern through the peritoeum and transverse abdominus mm WITHOUT BURYING THE KNOTS!!!!!
What is your second layer of closure?
Suture the int. abd. obl. muscle and ext. abd. obl. muscle separately or together with continuous suture pattern–> your choice
