Chapter 32 - Spleen and Liver Flashcards
1
Q
What shape is the spleen described as in the text?
A
Falciform or sickle-shaped.
2
Q
How many ligaments suspend the spleen within the peritoneal cavity?
A
Three ligaments: phrenicosplenic, nephrosplenic, and gastrosplenic.
3
Q
What is the anatomical position of the spleen relative to the last ribs?
A
The base generally corresponds to the last three or four ribs, exceeding the 18th rib by 2 to 3 cm.
4
Q
Where is the hilus of the spleen located?
A
On the visceral surface, where vessels, nerves, and lymphatic structures are present.
5
Q
What type of blood vessel supplies the spleen?
A
The splenic artery, a branch of the celiac artery.
6
Q
What is the color of the spleen as described in the text?
A
Bluish red to purple.
7
Q
What is the role of the trabeculae in the spleen’s structure?
A
They extend into the substance of the spleen, supporting its structure
8
Q
What characterizes the majority of splenic pulp in horses?
A
Red pulp, which is lobulated and lacks venous sinuses.
9
Q
What is the primary function of the white pulp in the spleen?
A
It serves as the lymphatic tissue, involved in immune responses.
10
Q
What cells are primarily found in the white pulp?
A
Lymphocytes, antigen-presenting cells, and macrophages.
11
Q
What significant feature is noted about the splenic vein?
A
It is an affluent of the portal vein and lies caudal to the splenic artery at the hilus.
12
Q
What anatomical structure provides sympathetic and parasympathetic innervation to the spleen?
A
The splenic plexus, branching from the celiac plexus.
13
Q
What type of muscle fibers are found in the splenic capsule?
A
Smooth muscle cells.
14
Q
How is the red pulp of the spleen organized in terms of blood flow?
A
It consists of arterial capillaries, pulp veins, and a reticular meshwork filled with macrophages and blood.
15
Q
What is the function of the reticular meshwork in the spleen?
A
It supports lymphatic tissue and facilitates immune function.
16
Q
What anatomical structure is found cranial to the hilus?
A
The facies gastrica, in contact with the left side of the greater curvature of the stomach.
17
Q
What is the anatomical significance of the caudodorsal angle of the spleen?
A
It can be palpated per rectum.
18
Q
What does the white pulp of the spleen contain that aids in its immune function?
A
Deep efferent lymphatic vessels and is organized around arterial vessels.
19
Q
What percentage of the circulating erythrocyte mass can the equine spleen store?
A
Up to 50%.
20
Q
What is the maximum splenic contraction reported with phenylephrine administration?
A
Up to 83% of the original splenic mass.
21
Q
By what percentage does epinephrine reduce splenic length when administered as a bolus?
A
Approximately 68%.
22
Q
What is the typical thickness of the spleen that indicates splenomegaly on ultrasonography?
A
Greater than 15 cm at midbody.
23
Q
What specific type of immunoglobulin is produced in the spleen?
A
Immunoglobulin M (IgM).
24
Q
What role does the spleen play in the removal of aged erythrocytes?
A
It phagocytoses old or abnormal erythrocytes using macrophages.
25
How is splenomegaly detected during a physical examination?
By rectal palpation revealing thickening and rounded caudal margins.
26
What diagnostic procedure uses ultrasound guidance for histologic evaluation of splenomegaly?
Percutaneous biopsy.
27
What gas is used for abdominal insufflation during laparoscopic procedures?
Carbon dioxide.
28
What is the typical insufflation pressure used during laparoscopy?
8 to 10 mm Hg.
29
What instruments are commonly used for laparoscopic biopsy of the spleen?
Laparoscopic scissors and uterine biopsy forceps.
30
What are the possible complications associated with splenic biopsy?
Bleeding, intestinal puncture, and exudate leakage.
31
What primary neoplastic diseases are reported involving the equine spleen?
Lymphosarcoma, metastatic melanoma, hemangiosarcoma, and extraadrenal paraganglioma.
32
What common clinical signs indicate splenic pathology in horses?
Recurrent abdominal pain, lethargy, poor performance, anemia, and weight loss.
33
What is the main purpose of splenectomy in horses?
Research purposes and treatment of various splenic diseases
34
What are some etiologies for secondary splenomegaly?
Neoplasia, hematoma, vascular infarction, splenic abscesses, and immune-mediated hemolytic anemia.
35
What specific infectious diseases can cause splenomegaly?
Babesiosis, theileriosis, ehrlichiosis, borreliosis, and equine infectious anemia.
36
What is the significance of splenic infarction in horses?
It can occur concurrently with splenomegaly due to venous thrombosis.
37
Which cells are responsible for phagocytosing debris in the spleen?
Macrophages (reticuloendothelial cells).
38
What is the common clinical manifestation of splenic abscessation?
Anorexia, weight loss, depression, fever, and abdominal pain.
39
What anatomical structures can be identified when using a laparoscope to examine the spleen?
Head of the spleen, left kidney, and nephrosplenic ligament.
40
What does an abdominal ultrasound help determine regarding the spleen?
The cause of splenic abnormalities.
41
How does the spleen's structure contribute to its function in filtering blood?
Blood circulates through highly porous capillaries, allowing for the removal of old erythrocytes.
42
What is the term for the process by which the spleen recycles iron?
Iron recycling.
43
What is the role of the spleen in the immune response?
It affects antibody response and serves as a reservoir for lymphocytes.
44
What is the function of the splenic plexus?
It supplies the spleen with sympathetic and parasympathetic fibers.
45
How does splenectomy affect a horse's resistance to blood protozoa?
It significantly reduces resistance, allowing subclinical infections to become patent.
46
What complication is associated with an enlarged spleen in terms of surgery?
It may complicate the surgical exploration due to increased volume of ingesta.
47
What diagnostic test is indicated for equine infectious anemia?
Coggins test (agar gel immunodiffusion test).
48
How might the body condition of a horse affect laparoscopic visibility?
Obesity can thicken the body wall, interfering with laparoscope movement.
49
What is the significance of identifying hypoechoic masses during an ultrasound of the spleen?
They may indicate conditions such as hematomas or splenic tumors.
50
What are some indications for performing a splenectomy?
Trauma, primary splenomegaly, neoplasia, and autoimmune disease.
51
What potential effects do autoimmune diseases have on the spleen?
They can lead to erythrocyte destruction.
52
What type of neoplastic condition is lymphosarcoma classified as?
A neoplastic disease of lymphoid cells.
53
What is the role of splenic lymph nodes in relation to the spleen?
They drain lymph to the celiac lymphocenter.
54
What clinical signs are associated with splenic infarction?
Symptoms of systemic disease, which may include abdominal pain and anemia.
55
What happens to the spleen during severe stress or exercise?
It contracts to release stored erythrocytes into circulation.
56
What type of test is recommended before performing a splenic biopsy?
A complete coagulation profile to ensure normal function.
57
What specific type of fluid appearance on ultrasound suggests a hemoabdomen?
A swirling cellular appearance in hypoechoic effusion.
58
What is the relationship between splenic disease and recurrent colic in horses?
Both primary and idiopathic splenomegaly have been attributed to recurrent colic.
59
What is the primary cause of splenic rupture in horses?
Often attributed to direct, severe trauma to the spleen.
60
What are the common clinical signs of splenic rupture in horses?
Signs include pale mucous membranes, anemia, tachycardia, dyspnea, and abdominal pain.
61
How many cases of nonfatal subcapsular hematoma have been reported?
Four cases.
62
What imaging techniques can differentiate between hematoma and rupture?
Laparoscopy and ultrasonography.
63
What are the key preoperative considerations for a horse undergoing splenectomy?
Assessment of hydration, electrolyte and acid-base status, and coagulation parameters.
-Blood donor crossmatch perfomed
-Starving for 24-48h to improve visualization
-Screen piroplasmosis if endemic zone
64
What is the recommended fasting period before elective splenectomy?
24 to 48 hours.
65
What is the most common approach for performing splenectomy in horses?
An open approach from the left side.
66
What rib resection techniques have been described for accessing the spleen?
Resection of the 16th, 17th, or 18th ribs, and modifications of the paralumbar incision.
67
What percentage of the pleural cavity may be entered during rib resection?
Entering the pleural cavity is almost always expected when ribs are resected.
68
What is the purpose of administering phenylephrine prior to vessel ligation?
To induce transient splenic contraction and improve access to splenic vessels.
69
What technique can be used to perform a partial splenectomy?
Use of a TA-90 stapling device.
70
What type of sutures are recommended for minor spleen lacerations?
Absorbable sutures placed across the defect. Take large bites to avoid tension on suture line
Use swaged needle
71
How long should horses be hand-walked post-splenectomy?
For the first 7 to 10 days.
72
What should be monitored daily in the surgical incision after splenectomy?
Signs of heat, swelling, drainage, seroma formation, or infection.
73
What are the main aftercare considerations for a horse post-splenectomy?
Monitoring vital signs and the incision site, and administering antibiotics if needed.
74
What is the role of laparoscopic techniques in splenectomy?
To assist in ligation of splenic vessels and improve visualization.
75
What are the two ligation techniques mentioned for splenic vessels?
Triple ligation and using a polyamide cable for vascular occlusion.
76
What medication may be used to assist with hemorrhage control during surgery?
**Antifibrinolytic agents**. Antifibrinolytic agents such as **aminocaproic acid** or **tranexamic acid** can also be used to promote hemostasis
77
What complications are more likely to develop in obese horses post-splenectomy?
Incisional complications such as seromas.
78
What is the risk associated with the entrance of the pleural cavity during splenectomy?
Pneumothorax.
79
Which ligaments are transected during splenectomy?
The nephrosplenic, phrenicosplenic, and gastrosplenic ligaments.
80
What type of drains may be utilized post-splenectomy?
Active or passive drains.
81
What is the significance of crossmatching blood before splenectomy?
To ensure compatibility for potential blood transfusions due to acute blood loss.
82
What is a common clinical sign of splenic abscessation?
Anorexia.
83
Which surgical device is mentioned for managing hemorrhage during splenectomy?
LigaSure (coagulating hemostatic device).
84
What is the general method of closure for the abdominal wall after splenectomy?
In three layers: peritoneum, subcutaneous tissues, and skin.
85
What anesthetic position is used for the 17th rib resection technique?
Right lateral recumbency.
86
What is the role of systemic epinephrine in splenectomy?
To reduce the weight of the spleen by inducing contraction.
87
What can be expected if the pleural cavity is entered during surgery?
Assistance with ventilation may be required.
88
How is the splenic vein located in relation to the splenic artery?
The vein is more superficial or lateral than the artery.
89
What specific anesthetic monitoring is suggested for horses post-splenectomy?
Breathing assistance may be required if the pleural cavity is entered.
90
What types of cultures are recommended for guiding antimicrobial therapy in cases of infection?
Bacterial culture and sensitivity testing.
91
What does a splenic abscess require in terms of surgical technique?
Overlapping mattress sutures and ligation of splenic vessels for hemostasis.
92
What is the potential risk of using phenylephrine in older horses?
Life-threatening hemorrhage.
93
What incision method can expose the spleen for surgery?
Vertical incision over the 17th rib.
94
What type of fluid may be observed in the abdomen of a horse with splenic rupture?
Serosanguinous or sanguineous peritoneal fluid.
95
What condition may require splenectomy due to immune-mediated issues?
Autoimmune disease affecting erythrocyte destruction.
96
What post-surgical complication may necessitate drainage or lavage of the incision site?
Seroma formation or infection.
97
What percentage of body weight does the liver constitute in horses?
Approximately 1.5%
98
What is the typical weight range of the liver in horses?
Between 5 kg (light-breed) and 10 kg (draft breed).
99
How many lobes does the equine liver have?
Five lobes. The right lobe, left medial lobe, left lateral lobe, quadrate lobe, and caudate lobe.
100
What is the surgical incision approach for splenectomy?
A paralumbar incision (caudal to the last rib).
101
Which ribs may be resected to improve access to the spleen?
16th, 17th, or 18th ribs.
102
What are the two surfaces on which splenic rupture may occur?
Visceral and parietal surfaces.
103
What are the main ligaments suspending the liver?
Right triangular, left triangular, coronary, and falciform ligaments.
Round lig does not suspend
104
What complications can arise from incisions that invade the pleural space?
Pyothorax, pneumonia, pneumothorax, and pleuritis.
105
What is the most serious complication post-splenectomy?
Intraabdominal hemorrhage.
106
How many lobes comprise the right liver lobe in horses?
The right lobe is undivided.
107
What condition can cause atrophy of the right liver lobe?
Compression by chronic atony and distention of the right dorsal colon.
108
What is the typical anatomical location of the liver in horses?
From the 6th to the 15th intercostal space.
109
What is the role of Kupffer cells in the liver?
They form part of the reticuloendothelial system.
110
What is the function of the common hepatic duct?
To transport bile from the liver to the duodenum.
111
What surgical techniques can be used for partial splenectomy?
Stapling devices, hemostatic agents, or absorbable mesh
112
What is the risk associated with splenectomy in terms of infection?
Overwhelming postsplenectomy infection syndrome.
113
What complication can result from inadequate closure of the nephrosplenic space?
Left dorsal displacement of the colon.
114
What is the primary role of the liver in metabolism?
Filtration and storage of blood, and metabolism of carbohydrates, proteins, and fats.
115
How much of the liver's weight does the right lobe comprise?
Approximately 50%.
116
What physiological role does the liver play in blood glucose levels?
It maintains normal blood glucose levels.
117
How many factors essential for coagulation does the liver produce?
At least 13 factors (II, V, VII-XIII, fibrinogen).
118
What type of incision is performed during the 17th rib resection technique?
A vertical incision.
119
What medication can induce splenic contracture during nephrosplenic space closure?
Etilefrine (Effortil).
120
What are the risks of adhesions post-surgery?
Can lead to complications like recurrent colic.
121
hat is the common bile duct's length in horses?
Approximately 5 cm.
122
What is the site of bilirubin metabolism in horses?
The liver.
123
What surgical technique uses absorbable sutures for minor splenic tears?
Splenorrhaphy.
124
What happens if the pleural cavity is entered during splenectomy?
Mechanical ventilation may be required.
125
What are the four major lobes of the liver?
Right, left (medial, lateral) quadrate, and caudate lobes.
126
What structure is absent in horses that typically aids in bile storage?
Gall bladder.
127
What is a common aftercare procedure following splenectomy?
Regular monitoring of body temperature, pulse, and respiratory rate.
128
What component is primarily stored in the liver and involved in blood formation?
Iron, in the form of ferritin.
129
What surgical technique is recommended for abdominal wall closure?
Three-layer closure, per surgeon’s preference.
130
The liver is storage beside iron of which vitamins?
The liver is the site of storage of vitamins including A, D, and B12,
131
Bile, which contains bile acids, bilirubin, cholesterol, lecithin, and various electrolytes required for digestion, is produced by the
liver
132
The majority of bile is comprised of bile acids that facilitate _________ and __________ excretion and absorption of ______ and _________ vitamins from the intestinal tract
The majority of bile is comprised of bile acids that facilitate **cholesterol** and **phospholipid** excretion and absorption of **lipids** and **fat-soluble** vitamins from the intestinal tract.
133
Because horses lack a gall bladder, plasma bile acid concentration is altered by fasting or meals - TRUE or FALSE
FALSE Because horses lack a gall bladder, plasma bile acid concentration is NOTaltered by fasting or meals
134
Bilirubin in bile is derived mainly from
hemoglobin metabolism
135
Unconjugated bilirubin is carried by
plasma proteins and transported by the cytosol of hepatocytes
136
Figure 32-6. Intraoperative view showing elevation of the dorsal part of the spleen into the incision. The nephrosplenic ligament prevents complete elevation of the spleen.
137
Figure 32-2. Left view of the (A) spleen, (B) stomach, and (C) left kidney with pertinent vascular supply. Retractors are placed along the greater curvature of the stomach to reveal the short gastric arteries and veins and along the dorsal extremity of the spleen to show the left kidney. Parts of the stomach are identified with special labels.
138
Figure 32-9. Relative topography of the abdominal viscera as viewed from the right side. The lateral and ventral walls are removed. The proximal one-third of the last nine ribs shows the relative position of the liver protected by the rib cage (18th rib defines the ventral and caudal border of the rib cage). A, Right liver lobe; B, quadrate liver lobe; C, right dorsal colon; D, cecum; E, right kidney; F, descending duodenum; G, diaphragm.
139
Figure 32-1. Relative topography of the abdominal viscera as viewed from the left side. The lateral and ventral walls are removed. The proximal one-third of the ribs show the relative position of the spleen and liver protected by the rib cage (the 18th rib defines the ventral and caudal border of the rib cage). A, Spleen; B, left dorsal colon; C, left ventral colon; D, left liver lobe; E, stomach; F, diaphragm; G, jejunum
140
What percentage of functioning liver mass loss typically leads to hepatic insufficiency?
50% to 80%.
141
Which clinical signs of hepatic disease are considered nonspecific?
Depression, anorexia, fever, tachycardia, and polypnea.
142
What common gastrointestinal signs may indicate hepatic disease?
Weight loss, abdominal pain, diarrhea, and lack of borborygmi.
143
What is the primary purpose of diagnostic procedures in hepatic disease?
To differentiate between hepatocellular and biliary tract diseases.
144
What diagnostic tests are included in serum biochemistry for hepatic assessment?
Total and conjugated bilirubin, GGT, ALP, AST, and lactate dehydrogenase.
145
What can urinalysis show in cases of obstructive cholestasis?
Bilirubinuria.
146
What imaging technique may help visualize the distal common bile duct?
Endoscopy of the upper gastrointestinal tract.
147
What is the typical location of the liver in horses?
From the 4th to the 11th intercostal space on the left side.
148
How many intercostal spaces can the liver be seen extending on the right side?
Between the 5th and 16th intercostal spaces.
149
What is a normal liver's echogenicity compared to the spleen?
The liver is hypoechoic compared to the spleen.
150
What diameter of vessels indicates congestion in the liver?
Exceeding 8 mm in diameter.
151
What complication can arise from blind biopsy techniques?
Sampling lung, kidney, or intestinal contents.
152
What is the recommended biopsy technique for the liver?
ercutaneous biopsy guided by ultrasound.
153
What type of needle is typically used for liver biopsies?
A 14-gauge, 15-cm biopsy needle.
154
What is the average sample size obtained from liver biopsies?
Between 20 and 30 mg.
155
What scoring system is used for evaluating liver biopsy samples?
A system rating fibrosis, cytopathology, inflammatory infiltrates, hemosiderin, and biliary hyperplasia.
156
What factor is most useful for prognosis in diffuse liver disease?
Hepatic fibrosis.
157
What are potential complications of liver biopsy?
Pneumothorax, hemorrhage, colic, renal damage, cellulitis, and peritonitis.
158
What coagulation parameters should be evaluated prior to liver biopsy?
Prothrombin time, thrombin clotting time, and activated partial thromboplastin time.
159
How is the liver positioned relative to the diaphragm during biopsy?
Caudal to the heart and diaphragm, cranial to the spleen and stomach.
160
What may indicate hepatomegaly during ultrasound examination?
Liver extending past the costochondral junction.
161
What must be confirmed if icterus is present?
Rule out other causes like hemolytic anemia or toxins.
162
What is a key sign of hepatic dysfunction that may also affect the upper airway?
Laryngeal hemiplegia.
163
What diagnostic approach is indicated for cases with suspected hepatoencephalopathy?
Endoscopy of the upper airway.
164
What does increased echogenicity in the liver indicate?
Possible hepatic fibrosis, lipidosis, or hemosiderosis.
165
What factor may necessitate administering fresh-frozen plasma before biopsy?
Abnormal coagulation tests indicating increased hemorrhage risk.
166
What is the definition of cholestasis?
Disruption of the formation or flow of bile.
167
What are the two types of cholestasis?
Intrahepatic and extrahepatic.
168
What term refers specifically to calculi found in the intrahepatic bile ducts?
Hepatolith.
168
What is the composition of most biliary calculi in horses?
Monomeric calcium bilirubinate with low cholesterol.
169
At what age are most horses diagnosed with biliary calculi?
Older than 9 years.
169
What percentage of total bilirubin indicates suspected cholestasis?
Direct bilirubin exceeding 30%.
170
hich bacterial species are associated with septic cholangiohepatitis in horses?
Salmonella spp., E. coli, Aeromonas spp., and others.
170
What are the clinical signs of biliary obstruction?
Depression, icterus, weight loss, and abdominal pain.
171
How often do biliary calculi occur in horses compared to other domestic animals?
Rare in horses but more frequent than in other species.
172
What are common findings in bloodwork for horses with biliary obstruction?
Leukocytosis, hyperfibrinogenemia, and increased clotting times.
173
What imaging technique is typically used to show hepatomegaly and increased echogenicity?
Transabdominal ultrasonography.
174
What position should the horse be placed in for surgical access to the cranial abdomen?
Dorsal recumbency with a reverse Trendelenburg position.
174
What is the typical incision length for surgery addressing biliary obstruction?
30 to 40 cm.
175
What is the purpose of lavage after removal of a choledolith?
To flush smaller calculi and inspissated bile from the duct.
176
What type of suture pattern is recommended for oversewing the hepatic duct?
Inverting suture pattern in the final two layers.
177
What is the risk if complete obstruction of the common bile duct is left untreated?
It is almost always fatal.
177
How long should antibiotics be administered postoperatively?
At least 4 to 8 weeks.
178
What can be used to provide better exposure during biliary surgery?
Burford, Balfour, or Finochietto retractors.
179
What percentage of horses show signs of hepatic encephalopathy in cases of biliary obstruction?
Less frequently observed; specific percentage not provided.
180
What is the significance of the parallel channel sign on ultrasound?
Indicates dilation of intrahepatic biliary ducts adjacent to the portal vein.
181
What postoperative care is recommended regarding the incision site?
Monitor for infection signs like heat, swelling, or drainage.
182
What diagnostic technique may help identify choledoliths in the duodenum?
Duodenoscopy.
183
What should be done if contamination of the surgical field occurs?
Perform lavage and suction to decontaminate.
184
What is the common location for biliary calculi seen on ultrasound?
Cranioventral aspect of the right liver lobe in the 6th to 9th intercostal space.
185
What additional materials may be found within choleliths?
Foreign bodies, ascarid eggs, or feed material.
186
What are some signs of possible peritonitis after biliary surgery?
Increased abdominal pain, fever, or changes in vital signs.
187
What is choledocholithotomy, and what complication is associated with it?
Surgical removal of a choledolith; can result in bile-induced peritonitis.
188
How can histopathologic examination support a diagnosis of biliary obstruction?
By identifying changes like periportal fibrosis and bile duct proliferation.
189
What is the primary cause of biliary calculi formation proposed in horses?
Increased secretion of unconjugated bilirubin or bacterial deconjugation.
190
What type of drugs may be administered for postoperative pain control?
Nonsteroidal anti-inflammatory medications or butorphanol.
191
What potential outcome is guarded in cases of biliary obstruction associated with hepatic failure?
Poor prognosis.
192
What is the significance of biliary hyperplasia in the context of biliary obstruction?
Indicates adaptive changes due to chronic obstruction.
193
What should be evaluated preoperatively if biliary obstruction is suspected?
Blood work for hepatic enzyme levels and clinical signs.
194
What are the potential complications of surgical removal of biliary calculi?
Septic peritonitis, hemorrhage, and recurrent obstruction.
194
What is the purpose of closing the epiploic foramen?
To prevent recurrence of epiploic foramen entrapment of the small intestine.
195
What is the reported recurrence rate range for epiploic foramen entrapment?
Between 1.9% and 14.3%.
196
What laparoscopic device is used to attach the gastropancreatic fold to the liver?
Protack 5-mm Fixation Device.
196
What technique can also be used to obliterate the epiploic foramen?
Insertion of a mesh.
197
In what position is the horse during the closure procedure?
Standing and sedated.
198
What level is the right flank prepared to for the laparoscopic approach?
To the level of the 12th intercostal space.
199
What is the recommended insufflation pressure for the abdominal cavity during the procedure?
15 mm Hg.
200
How far below the diaphragmatic reflection is the first instrument portal placed?
Just below it in the 15th intercostal space.
201
How many coils are typically used to secure the gastropancreatic fold with the tacking device?
Four to five coils.
202
What tool is used to grasp the gastropancreatic fold?
Laparoscopic Babcock forceps.
203
What is the next step after closing the epiploic foramen?
Decompressing the abdomen.
204
What closure method is used for the skin after the procedure?
Sutures or staples.
205
What is the recommended duration of stall rest post-surgery?
2 weeks.
206
What type of activity is allowed after the initial stall rest?
Small paddock turnout for 2 weeks.
207
How long should antiinflammatory medications be administered postoperatively?
For 24 hours.
208
Are antimicrobials necessary if a sterile technique is used?
No, they are not necessary.
209
What anatomical structure is the gastropancreatic fold attached to during the procedure?
The caudate lobe of the liver.
210
What specific part of the abdominal wall is targeted for the laparoscopic portal for epiploic foramen closure?
Right flank, level with the tuber coxae.
211
What is the significance of the crus of the internal abdominal oblique muscle in this procedure?
It serves as a landmark for portal placement.
212
What is the role of the tacking device in the closure process?
To secure the gastropancreatic fold and close the epiploic foramen.
213
What should be monitored postoperatively in the horse?
Signs of recovery and any complications.
214
What potential benefits does a mesh closure offer compared to tacking?
It may provide more extensive coverage and support.
215
What anatomical structures are avoided during the laparoscopic approach?
The intercostal vessels and nerves (rostral part)
216
Description of the laparoscopy for epiploic closure
laparoscopic portal centered in the right flank, level with the tuber coxae at the crus of the internal abdominal oblique muscle. The laparoscope is introduced into the abdomen, and the abdominal cavity insufflated to 15 mm Hg to visualize the epiploic foramen (Video 32-1). An instrument portal is placed in the 15th intercostal space, just below the diaphragmatic reflection, and a second instrument portal placed 4 cm below in the same intercostal space. The gastropancreatic fold is grasped with laparoscopic Babcock forceps and held against the caudate liver lobe (Video 32-2) until secured by four to five coils by the tacking device over the opening of the epiploic foramen The laparoscopic cannula may need to be removed, and the tacking device directly inserted through the skin to improve access in larger horses. Alternatively, a folded mesh can be inserted into the foramen. After closure of the epiploic foramen, the abdomen is decompressed and the skin closed with sutures or staples.
217
How does the technique reduce the risk of infection?
By maintaining a sterile field throughout the procedure.
218
What physiological response is expected from the horse during the laparoscopic procedure?
Increased heart rate due to sedation and stress.
219
What factors may influence the choice between mesh and tacking closure?
Size of the horse and complexity of the entrapment.
