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Principles of Surgery > Ex-Lap and Biopsy > Flashcards

Ex-Lap and Biopsy Flashcards

1
Q

what is the best kind of gauze to use for a laparotomy

A

laparotomy sponge; may also be good to use sponges with radiomarking

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2
Q

what is a key thing to do with every abdominal exploration

A

make a plan and stick to it -> examine organs in the same order every time and dont interrupt if you dont have to

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3
Q

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

A

F; keep with your plan and do not interrupt unless you have to

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4
Q

how do you protect the organs during abdominal exploration

A

cover with moist towels; try not to exteriorize unless you have to; prevent contact with the skin

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5
Q

what are 6 things to look for on ex-lap

A
  • position/torsion
  • thickening/thinning
  • masses/FB
  • enlargement
  • irregularity
  • discoloration
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6
Q

T/F free fluid in the abdomen is a normal finding on ex-lap except for in young animals

A

F; may see in very young animals but it should be clear

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6
Q

what should you do if you see free fluid in the abdomen

A

take a sample, culture, cytology

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7
Q

how does peritonitis look

A

inflammed, hyperemic, fibrinous intestines

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8
Q
A
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9
Q

what should you do if you suspect peritonitis

A

take a sample and send it to lab

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10
Q

where is a good place to start your explore

A

diaphragm and serosal surfaces

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11
Q

how should you approach investigating the gall bladder

A

1) make sure biliary tree is normal
2) express gallbladder to confirm patency of bile duct

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12
Q

T/F you should never make a hole in the omentum, even if you cant visualize the pancreas

A

F; it is ok to make a hole to ensure you can see both left and right limbs of the pancreas

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13
Q

what is the name for an insulin-secreting tumor

A

insulinoma

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14
Q

what might happen to the spleen after you handle it (or if the patient is shocky)

A

may get smaller

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15
Q

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?

A

siderotic plaques; normal (they are iron deposits from RBC recycling)

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16
Q

what happens with a splenic torsion

A

veins collapse but arteries do not (thicker walled) -> blood keeps coming in -> get a ton of congestion

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17
Q

T/F splenic torsion can be acute or chronic

A

T

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18
Q

how can you tell the intestines from the ovarian horns

A

intestines are smoother and more vascular; will never see a bifurcation in intestines

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19
Q

you do an ex-lap on a cat and the intestines are coiled up like an accordion… what do you expect is going on

A

linear foreign body

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20
Q

mesenteric lymph nodes are _________ in __________ patients due to more _________ stimulation from the gut

A

bigger; younger; immune

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21
Q

where does the colon usually run

A

from pubis to cecum

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22
Q

what is the term for when the ileum and cecum are pushed into the colon

A

ileo-cecal intussusception

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23
Q

use the ___________ to retract the intestines to the ______ and examine the right gutter

A

mesoduodenum; left

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24
Q

use the _____________ to retract the intestines to the _______ and examine the left gutter

A

mesocolon; right

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25
Q

what do we see in the “gutter”

A

kidney, adrenal, ureter, ovary/horn/testis

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26
Q

basket using the ________ on LEFT

A

colon

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27
Q

basket using the __________ on RIGHT

A

duodenum

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28
Q

the adrenal glands sit ________ to the kidney

A

cranially

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29
Q

what artery crosses the adrenal gland

A

phrenicoabdominal

30
Q

for a cystotomy you can cut what ligament if needed? what ligament should you not cut

A

ventral; lateral

31
Q

why shouldnt you cut the lateral ligament

A

it contains vessels, nerves and the ureters

32
Q

it is possible to see what kinds of lesions post bladder obstruction

A

ischemic

33
Q

what structure in the caudal aspect of the abdomen do you only evaluate if you suspect an issue

A

prostate

34
Q

what are some ways to limit tissue trauma during an ex-lap

A

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)

35
Q

how do we lavage the abdomen

A

with warm sterile saline until clear and ideally using suction

36
Q

how many times do we lavage

A

1 time if nothing dirty happened
2+ if something dirty (also leave drain)

37
Q

you should begin with the _________ procedures and work your way to the ________

A

cleanest; dirtiest

38
Q

what is an important step before closing if you think you contaminated something

A

change gloves and instruments

39
Q

T/F you should always biopsy something during ex-lap, even if it was a negative explore

A

T

40
Q

what does the decision to give antibiotic therapy depend on

A
  • underlying disease
  • duration of procedure
  • type of procedure
41
Q

in general, give _______________ as antibiotic therapy and give ___________ if lower jejunum or colon

A

cefazolin; cefoxitin

42
Q

how do you give perioperative antibiotics (what time interval and what dose)

A
  • first dose at induction: 22 mg/kg
  • q90 min for duration of surgery
  • stop immediately post-op, unless contamination
43
Q

what antibiotic do we give patients that we do a liver biopsy on

A

cefazolin

44
Q

what two ways do we do a liver biopsy

A
  • guillotine if on edge of liver lobe
  • skin punch if not on edge
45
Q

how do you keep things out of the way while doing liver biopsy

A

assistant or stay sutures in the stomach and lap sponges cranial to liver

46
Q

what size and type of suture should you use for a guillotine biopsy

A

3-0 or 2-0 PDS or Monocryl

47
Q

how many throws for a guillotine biopsy

A

3 or 4

48
Q

T/F you can expect some mild oozing when you do a guillotine biopsy

A

T

49
Q

what type of suture pattern do you use for a wedge liver biopsy

A

transfixing/mattress/simple interrupted

50
Q

when would a punch biopsy of the liver be good and when would it be bad

A

focal mass on the diaphragmatic surface; less good for visceral surface

51
Q

what size biopsy should you use for a liver punch and how deep should you go

A

4-6mm; <50% thickness

52
Q

what is useful to control bleeding for a liver punch biopsy

A

gelfoam

53
Q

how many gelfoam plugs should you apply for a liver punch biopsy

A

1-3

54
Q

how do you set up for a gastric biopsy

A

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

55
Q

what are the inverting suture patterns

A

Cushing and Lembert

56
Q

what suture would you NOT use for a gastric biopsy

A

chromic gut or monocryl

57
Q

T/F it is important to ligate or cauterize bleeders when doing a gastric biopsy as they will bleed profusely if you do not

A

F; they will collapse when you suture

58
Q

what size suture should you use for a gastric biopsy

A

3-0 or 2-0

59
Q

how do you cut and close a gastric biopsy

A

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)

60
Q

what will want to fall off when doing a gastric biopsy

A

mucosa

61
Q

what are the steps for performing an intestinal biopsy

A

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

62
Q

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?

A

transverse closure; increased risk of leaks so only use when needed

63
Q

T/F you can do a punch biopsy of the intestines

A

T

64
Q

how do we close the intestines after biopsy

A
  • 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
65
Q

what are the 3 methods to do a lymph node biopsy and which is best

A

wedge, guillotine or whole node resection; guillotine is best

66
Q

what size suture do you use for guillotine biopsy on a lymph node

A

3-0 or 4-0

67
Q

what should you beware of if you are going to do a whole node resection

A

mesenteric root vasculature

68
Q

what 3 things should you do before closing the abdomen

A

1) return all organs to anatomic location
2) ensure mesenteric root not twisted
3) ask for used gauze count

69
Q

in what direction should you suture if you are right handed

A

R -> L

70
Q

what is a good option for suture type and pattern for closing the linea

A

3-0, 2-0 or 0 PDS -> simple continuous (or interrupted while learning)

71
Q

what should you include in every bite of the linea

A

external rectus fascia

72
Q

what is an ideal suture type and pattern for sub-cutaneous

A

monocryl; simple continuous

73
Q

what is an ideal suture type and pattern for skin

A

4-0 or 3-0 nylon or prolene; simple interrupted or cruciate; can also use staples

Principles of Surgery (8 decks)

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