Celiotomy/Cystotmy

Question 1

Any Surgical Incision into the Abdominal Cavity

Answer 1

Celiotomy

*Celiotomy and Laparotomy are Commonly used Interchangably

Question 2

Patient Preparation for a _____ Procedure

Answer 2

Celiotomy

*Dorsal Recumbancy

Question 3

Retained Foreign Object During Surgery (Primarily Gauze)

Answer 3

Gossypiboma

*Make sure to do an Instrument and Sponge Count after every Surgery prior to Closing

Question 4

Most Common Surgical Approach when Performing a Celiotomy

Answer 4

Ventral Midline

*Most Common approach for Celiotomy Incisions- Usually extended from Xyphoid to Pubis

Question 5

Celiotomy Surgical Approach that Aims to Incise through Linea Alba

Answer 5

Ventral Midline Approach

*AVOID Rectus Abdominis muscle

Question 6

When Making the Stab Incision for a Ventral Midline Approach for an Exploratory Celiotomy:

_____ If Using Scalpel and Groove Director

_____ if using Scissors

Answer 6

Cranial- Using Scalpel And Groove Director

Caudal- Using Scissors

*If you make a Caudal Stab Incision- Use Scissors to extend the Incision Cranially

If you make a Cranial Stab incision- Follow Incision Caudally with Scalpel

Question 7

True/False: When performing an Exploratory Celiotomy you need to be Maticulous and Explore Everything/Everytime

Answer 7

True

*Start at one Quadrant to move to all other quadrants until you have Thoroughly Explored the entire Abdominal Cavity

*Even if No Gross Lesions, Biopsies are ALMOST ALWAYS Indicated

Question 8

What Structures are Found within the Cranial Quadrant during a Celiotomy

Answer 8

Diaphragm

Stomach

Gall Bladder and Liver

Pancreas

Question 9

What Structures are Found within the Right Quadrant during a Celiotomy

Answer 9

Duodenum

Right Kidney

Ureter

Right Adrenal Gland

Question 10

What Structures are Found within the Left Quadrant during a Celiotomy

Answer 10

Descending Colon

Left Adrenal Gland

Left Uterine Horn

Spleen

Question 11

What Structures are Found within the Central Quadrant during a Celiotomy

Answer 11

Cecum

Jejunum

Mesentary/Mesenteric Lymph Nodes

Ascending Colon

Question 12

What Structures are Found within the Caudal Quadrant during a Celiotomy

Answer 12

Duodenocolic Ligament

Bladder

Prostate

Uterine Body

Question 13

Best Grip used during Surgical Approach for Cystotomy

Answer 13

Fingertip Grip

*Best Accuracy and Stability for Long Incisions

Question 14

Why Do we Place Laparotomy Sponges around the Bladder when Performing a Cystotomy?

Answer 14

Prevent Urine Leakage into the Abdominal Cavity

*When we make an Incision into a Normal Bladder we will get Urine Leakage. Urine can be very Irritating to the Abdominal Wall and other Abdominal Structures

Question 15

Best Suturing Technique used on the Bladder when Performing a Cystotomy

Answer 15

First Layer- Simple Continuous

Second Layer- Inverting Pattern (Cushing or Lembert)

*Need a Watertight Closure

Question 16

True/False: Biopsies are Often Performed during Exploratory Laparotomies/Celiotomies

Answer 16

True

*Biopsies are Often Performed during Exploratory Celiotomies. Multiple Tissues are Biopsied based on Suspected Pathological Process

Question 17

Two methods for Biopsies during Exploratory Celiotomy

Answer 17

Needle Core (aka True Cut Biopsy)- Sharp Needle Placed onto the Tissue which Retracts portion of Tissue

Incisional- Cutting out a Small Piece and then Closing Defect

Question 18

Prior to Closure during Celiotomy, Perform a Sponge Count and ____ the Abdomen with Copious Amounts of Warm Sterile Saline

Answer 18

Lavage

*Use large amounts of Warm Saline and Suction the Fluid out in order to Dilute and possible Contamination

Warm Saline can Help to prevent Hypothermia in Patients

Question 19

When Closing the Abdomen after a Celiotomy we perform a ____ Layer Closure

Answer 19

Three

Question 20

Holding Layer when Closing a Celiotomy/Laparotomy

Answer 20

External Rectus Fascia

*KNOW THIS- You need to Engage the External Rectus Fascia

Question 21

Suture Types used when Closing a Celiotomy/Laparotomy

Answer 21

Monofilament Absorbable (PDS)

Multifilament Absorbable

Monofilament Non-Absorbable (Stainless Steel Wire, Nylon)

*All of these Suture Types are Acceptable to use when Closing the Abdomen after performing a Celiotomy

Question 22

Name Four Suture Types that should be AVOIDED when Closing after Celiotomy/Laparotomy

Answer 22

Chromic Gut- Very Reactive, Absorbs Rapidly

Silk- Very Reactive

Vicryl Rapid- Absorbs Rapidly

Polymerized Caprolactam

Question 23

After Performing a Celiotomy, when Closing the Fascia you want to take ____mm Bites from the cut edge and you want the Bites ___mm Apart

Answer 23

5mm

Question 24

Suture Pattern Commonly used to Close the Subcutaneous Tissue after a Celiotomy

Answer 24

Simple Continuous

Question 25

Suture Pattern that Can be used in Patients with Little Subcutaneous Tissue where the Bites are Taken Parallel at the Base of the Dermis as a Continous Pattern

Answer 25

Intradermal Pattern

*Used as an Alternative to Subcutaneous Closure in Patients with Little Subcutaneous Tissue

Question 26

Technique used when Closing the Subcutaneous Tissue after Performing a Celiotomy Described Below:

Minimizes the Chance of Suture Tags or Knots being Exposed through Skin

Answer 26

Burying the Knot

*Take first Bite Deep to Superficial, come across and go Superficial to Deep and Tie the Knot

When Ending the Pattern you want a Deep Loop (Last Bite will be from Superficial to Deep) to Tie the Knot onto

Question 27

When Placing Skin Sutures after a Celiotomy, use an Appositional Pattern taking ____mm Bites from Incision Edge and Avoiding Underlying Tissue

Answer 27

5mm

Question 28

Common Suture Types and Suture Patterns used to Close the Skin following a Celiotomy

Answer 28

Suture Patterns: Simple Interrupted, Simple Continuous, Cruciate, Ford Interlocking

Suture Types: Monofilament Absorbable or Non Absorbable