Ex-Lap and Biopsy Flashcards
what is the best kind of gauze to use for a laparotomy
laparotomy sponge; may also be good to use sponges with radiomarking
what is a key thing to do with every abdominal exploration
make a plan and stick to it -> examine organs in the same order every time and dont interrupt if you dont have to
T/F if you are performing an ex-lap and see an abnormal finding, it is important to stop what you are doing and investigate that abnormality to ensure that you do not forget to go back to it
F; keep with your plan and do not interrupt unless you have to
how do you protect the organs during abdominal exploration
cover with moist towels; try not to exteriorize unless you have to; prevent contact with the skin
what are 6 things to look for on ex-lap
- position/torsion
- thickening/thinning
- masses/FB
- enlargement
- irregularity
- discoloration
T/F free fluid in the abdomen is a normal finding on ex-lap except for in young animals
F; may see in very young animals but it should be clear
what should you do if you see free fluid in the abdomen
take a sample, culture, cytology
how does peritonitis look
inflammed, hyperemic, fibrinous intestines
what should you do if you suspect peritonitis
take a sample and send it to lab
where is a good place to start your explore
diaphragm and serosal surfaces
how should you approach investigating the gall bladder
1) make sure biliary tree is normal
2) express gallbladder to confirm patency of bile duct
T/F you should never make a hole in the omentum, even if you cant visualize the pancreas
F; it is ok to make a hole to ensure you can see both left and right limbs of the pancreas
what is the name for an insulin-secreting tumor
insulinoma
what might happen to the spleen after you handle it (or if the patient is shocky)
may get smaller
while you evaluate the spleen you see small white spots that form a bit of a sheet in some areas…
what is this?
are you concerned?
siderotic plaques; normal (they are iron deposits from RBC recycling)
what happens with a splenic torsion
veins collapse but arteries do not (thicker walled) -> blood keeps coming in -> get a ton of congestion
T/F splenic torsion can be acute or chronic
T
how can you tell the intestines from the ovarian horns
intestines are smoother and more vascular; will never see a bifurcation in intestines
you do an ex-lap on a cat and the intestines are coiled up like an accordion… what do you expect is going on
linear foreign body
mesenteric lymph nodes are _________ in __________ patients due to more _________ stimulation from the gut
bigger; younger; immune
where does the colon usually run
from pubis to cecum
what is the term for when the ileum and cecum are pushed into the colon
ileo-cecal intussusception
use the ___________ to retract the intestines to the ______ and examine the right gutter
mesoduodenum; left
use the _____________ to retract the intestines to the _______ and examine the left gutter
mesocolon; right
what do we see in the “gutter”
kidney, adrenal, ureter, ovary/horn/testis
basket using the ________ on LEFT
colon
basket using the __________ on RIGHT
duodenum
the adrenal glands sit ________ to the kidney
cranially
what artery crosses the adrenal gland
phrenicoabdominal
for a cystotomy you can cut what ligament if needed? what ligament should you not cut
ventral; lateral
why shouldnt you cut the lateral ligament
it contains vessels, nerves and the ureters
it is possible to see what kinds of lesions post bladder obstruction
ischemic
what structure in the caudal aspect of the abdomen do you only evaluate if you suspect an issue
prostate
what are some ways to limit tissue trauma during an ex-lap
1) keep organs moist
2) prevent contact with skin
3) use less traumatic instruments (ex. debakey)
4) use stay sutures (instead of holding with hands or forceps for long time)
how do we lavage the abdomen
with warm sterile saline until clear and ideally using suction
how many times do we lavage
1 time if nothing dirty happened
2+ if something dirty (also leave drain)
you should begin with the _________ procedures and work your way to the ________
cleanest; dirtiest
what is an important step before closing if you think you contaminated something
change gloves and instruments
T/F you should always biopsy something during ex-lap, even if it was a negative explore
T
what does the decision to give antibiotic therapy depend on
- underlying disease
- duration of procedure
- type of procedure
in general, give _______________ as antibiotic therapy and give ___________ if lower jejunum or colon
cefazolin; cefoxitin
how do you give perioperative antibiotics (what time interval and what dose)
- first dose at induction: 22 mg/kg
- q90 min for duration of surgery
- stop immediately post-op, unless contamination
what antibiotic do we give patients that we do a liver biopsy on
cefazolin
what two ways do we do a liver biopsy
- guillotine if on edge of liver lobe
- skin punch if not on edge
how do you keep things out of the way while doing liver biopsy
assistant or stay sutures in the stomach and lap sponges cranial to liver
what size and type of suture should you use for a guillotine biopsy
3-0 or 2-0 PDS or Monocryl
how many throws for a guillotine biopsy
3 or 4
T/F you can expect some mild oozing when you do a guillotine biopsy
T
what type of suture pattern do you use for a wedge liver biopsy
transfixing/mattress/simple interrupted
when would a punch biopsy of the liver be good and when would it be bad
focal mass on the diaphragmatic surface; less good for visceral surface
what size biopsy should you use for a liver punch and how deep should you go
4-6mm; <50% thickness
what is useful to control bleeding for a liver punch biopsy
gelfoam
how many gelfoam plugs should you apply for a liver punch biopsy
1-3
how do you set up for a gastric biopsy
1) isolate with moist lap sponges
2) stay sutures (being sure to include submucosa)
3) aim for less vascular region between greater and lesser curvatures
what are the inverting suture patterns
Cushing and Lembert
what suture would you NOT use for a gastric biopsy
chromic gut or monocryl
T/F it is important to ligate or cauterize bleeders when doing a gastric biopsy as they will bleed profusely if you do not
F; they will collapse when you suture
what size suture should you use for a gastric biopsy
3-0 or 2-0
how do you cut and close a gastric biopsy
stab and extend scissors approx 2 cm; do elipse of full-thickness bites
close in 2 layers (simple continuous for inner and inverting for outer)
what will want to fall off when doing a gastric biopsy
mucosa
what are the steps for performing an intestinal biopsy
1) isolate with moist lap sponges
2) stop intestinal flow with boyan clamp or fingers
3) stab antimesenteric border with blade
4) extend 1cm with metzembaum
5) take 2-3mm edge full thickness
how can we close the intestines in a way that prevents luminal structure in the cases of a small intestinal lumen? what is a consequence?
transverse closure; increased risk of leaks so only use when needed
T/F you can do a punch biopsy of the intestines
T
how do we close the intestines after biopsy
- single layer closure using absorbable monofilament size 3-0 or 4-0
- no monocryl or chromic gut
- single layer closure using simple interrupted or continuous
- can be longitudinal or transverse
- omentalize and do leak test
what are the 3 methods to do a lymph node biopsy and which is best
wedge, guillotine or whole node resection; guillotine is best
what size suture do you use for guillotine biopsy on a lymph node
3-0 or 4-0
what should you beware of if you are going to do a whole node resection
mesenteric root vasculature
what 3 things should you do before closing the abdomen
1) return all organs to anatomic location
2) ensure mesenteric root not twisted
3) ask for used gauze count
in what direction should you suture if you are right handed
R -> L
what is a good option for suture type and pattern for closing the linea
3-0, 2-0 or 0 PDS -> simple continuous (or interrupted while learning)
what should you include in every bite of the linea
external rectus fascia
what is an ideal suture type and pattern for sub-cutaneous
monocryl; simple continuous
what is an ideal suture type and pattern for skin
4-0 or 3-0 nylon or prolene; simple interrupted or cruciate; can also use staples
