Exam 1 Flashcards
Drugs For Pain Relief in Ruminants
- Lidocaine only thing approved for intraop (All others are ELDU)
- Banamine is used for foot rot but can be used post op ELDU
- Use FARAD
Preparing Ruminant Surgical Site
- Clip hair (don’t shave)
- Tie tail
Rough
o Remove dirt and debris
o Mild soap & brush
Sterile
o Chlorhex or povidine
o Contact time important
Draping
o Use water impermeable
Post-op Feeding of Ruminants
- Usually on 60:40 roughage to grain
- Post-op give full roughage and slow intro to grain
- Return neonates to regular feed (milk) & monitor weight
Fluids for Ruminants
- Adults: 60ml/kg/day
- Neonates: 90 ml/kg/d
Disbudding Goats; When, Nerve Supply, Issues
o Look for two twists of hair
o Bucks at 3d
o Does at 5-7d
o Tetanus prophylaxis
Nerve Supply
* Corneal nerve beneath temporal line
* Infratrochlear nerve above rim of orbit
* Block 4 nerves w/ 1ml lidocaine
* Careful w/ lidocaine in small goats
Issues
* No frontal sinus to protect brain
* Burns
* Hemorrhage from not stopping bleeders
* Don’t give too much xylazine
Disbudding Cows; When, procedure
o Before 3 wks
o Give 3 tabs meloxicam
o 4-6ml lidocaine in each corneal nerve
o don’t keep dehorner on longer than 10secs
o if done in adults -> frontal sinus exposed
Docking Sheep; Purpose, When, Issues
o Eliminate manure buildup & fly strike
o w/in first 48hrs of life (to a few days)
Issues
* Too short -> prolapse
Castration; Precautions, Analgesia options
o Use tetanus antitoxin
o testicular block
o ring block
Repair Nose Ring Tear
o Older than 6hrs? -> treat as second intension
o Sedate w/ xylazine & acepromazine
o Infuse nose or bilateral infraorbital nerve block w/ lidocaine
o Place 2-3 horizontal mattress sutures
o Place simple interrupted between mattress as needed
o Never remove sutures
Sinusitis; Treatment
- Lavage w/ “weak tea” diluted betadine
- Trephination?
How to: Trephination
- Goal is to establish drainage
- Clip and prep w/ Betadine/povidine
- Local infusion of lidocaine
- Small (~2cm) circular incision thru skin down to bone
- Galt trephine thru bone into sinus
Llama Lullaby
o 10ml ketamine
o 1ml xylazine
o 1ml butorphanol
Mandibular Tooth Root Abcsess; Diagnosis, Treatment; Surgical Approaches
Diagnosis
* Oral exam
* imaging
* Check PCV pre-surgery
Treatment
* Ceftiofur or florenicol for 4-6wks
* Meloxicam or Banamine for 1-2wks
Surgical Approach
* Performed under general anasthesia
* Ventrolateral buccal approach (recommended)
* Retropulsion of tooth (Not in mandibular cheek teeth)
* Oral extraction (Only for extremely loose teeth)
* Post-op, Flush incision with warm water/dilute betadine until no longer communicating with mouth/hole closes & give antibiotics 1-2 weeks
Squamous Cell Carcinoma; Locations, Diagnosis, Treatment
Locations
* 3rd eyelid
* limbus
* lower lid
* conjunctiva
Diagnosis
* Ocular exam
* Fluorescein stain
* Manual palpation of orbit
Treatment
* Cryosurgery
* 3rd eyelid removal
* enucleation (if invading eye)
How to: 3rd Eyelid Removal
- Auriculopalpebral block, topical on cornea & 3rd, or lidocaine injected into 3rd
- Light sedation
- Place hemostats on dorsal & ventral edge of 3rd eyelid
- Sharp dissection w/ scalpel
- Leave hemostats in place for 2-3mins
How to: Enucleation
- Ring block
- Retrobulbar infusion
- 3(4) point block OR Petersen block (technically challenging)
- Suture or clamp eyelids shut ->
- Use scalpel to make elliptical incision ->
- Dissect tissue out w/o entering eyeball
Corneal Ulcer; Causes, Treatment
Cause
* Pink eye
* Trauma
* entropion
* Other bacteria
Treatment
* Medical management
* 3rd eyelid flap
* enucleation
* entropion repair
How to: Emergency Tracheotomy
o Junction of cranial and middle third of neck
o Head restrained vertically
o Line block with lidocaine
o Sternohyoideus and sternothyroideus muscles split on midline
o Incise between tracheal ring
o Use of stylet to introduce largest tube that will fit
o Cuffed tubes are NOT inflated
o Changed / cleaned 2-3 times daily
o Antibiotics & NSAIDs
Left Displaced Abomasum; Basics, Clinical Signs, Diagnosis, Treatment
o Goes under rumen and stays between rumen and left body wall
o No severe occlusion or vascular compromise
o Not an emergency
Clinical Signs
* Sunken eyes & elevated ribs on L
* Ketotic, hypocalcemic, hypochloremic
* Dry feces maybe
Diagnosis
* Ping
* Tube test
* Endoscopy, ultrasound, or exploratory sx
Treatment
* Toggle
* Right paralumbar omentopexy/pyloropexy
* Left paralumbar abomasopexy
* Paramedian abomasopexy
R Abomasal Volvulus; Clnical Signs, Diagnosis, Treatment
Clinical Signs
* Increased HR & RR
* Sunken eyes
* Maybe down
Diagnosis
* Ping
* Tube test
* Endoscopy, ultrasound, or exploratory sx
Treatment
* Right paralumbar omentopexy/pyloropexy
* Paramedian abomasopexy
Pros & Cons of a Toggle
Pros
* Cheap
* Easy
* Good prognosis/rapid return to normal
* Pexy abomasum @ anatomical location
Cons
* Need multiple people
* Potentially toggle wrong organ
* Roll complications
* Can’t use on RDA, RAV, heavy or pregnant cows
Pros & Cons of R Side Approach Surgery for Displaced Abomasum
Pros
* Good prognosis/rapid return to normal
* Can do alone
* Can perform prophylaxis pexy
* Good for LDA, RDA, RAV
Cons
* LDA harder to reach
* Difficult to break adhesions on L
* Not goof for heavy/[regnant cows w/ LDA
* Pexy not at anatomical location
Pros & Cons of L Side Approach Surgery for Displaced Abomasum
Pros
* Good prognosis
* Rapid return to normal
* Pexy at anatomical position
* Good for heavy pregnant cow with LDA
Cons
* Only for LDA
* Cannot do anything if no DA
* Difficult to pull needle
* Size difficulties
Pros & Cons of Paramedian Approach for Displaced Abomasum
Pros
* Good prognosis
* Rapid return to normal
* Can be used for LDA, RDA or RAV
* Pexy at anatomical position
Cons
* Have to put cow on dorsal and keep the cow there
How to: Toggle
o Administer oral fluids
->
o Be aware of milk veins on the abdomen.
->
o Cast cow onto right side and roll cow onto her back.
->
o Rock the cow & push knee into side of abdomen to allow abomasum to ‘float’ up to anatomical location ->
o Determine location of abomasum by pinging.
->
o Place two toggle sutures to pexy abomasum to ventral wall.
->
o Let air out and use something to break pressure of suture on skin.
->
o Roll the cow onto left side and let cow up
How To: R Approach for LDA
o Flunixin meglumine IV
->
o Make incision on right paralumbar fossa.
->
o Determine if there is LDA.
->
o Deflate LDA using needle and tube as much as possible.
->
o Return abomasum to anatomical location
o Grab greater omentum and pull pylorus to incision.
->
o Find the sow’s ear.
->
o Pexy pylorus (partial thickness) to body wall
(full body wall thickness) as low as possible.
->
o Close first layer with omentum.
->
o Close rest of layers and skin
Choices for Flank Anesthesia
o Proximal paravertebral block
o Distal paravertebral block
o Inverted L block
o Line block
C-section; Reasons, Pain Management, Approaches, Post-op care
Reasons
* Muscular hypertrophy
* Prolonged gestation
* Inappropriate crossbreeding or premature breeding of heifers
* Cow- narrow birth canal (relatively oversized calf)
* An irreducible uterine torsion
* An incomplete cervical dilatation
Pain Management
* Epidural 6 ml 2% Lidocaine
* IV flunixin meglumine
* Distal paravertebral +line block behind the last rib
Approaches
* Standing paralumbar
* Recumbent ventral midline
* Ventorlateral
* Standing L oblique
Post-op care
* Systemic & intra abdominal antibiotics
* IV fluids
* Oral fluids
* Meloxicam
How to: C-section
o Incise ->
o The uterus may be manipulated up to the incision and exteriorized. ->
o Incise into the uterine horn using an envelope opener ->
o Expose one or two legs of calf and place chains ->
o Gently pull the calf
->
o Extend the incision as needed ->
o Check calf is doing well once on ground ->
o First layer- simple continuous-#2 catgut ->
o Second layer-inverting pattern without penetration of the wall (Modified Cushing suture pattern)
Umbilical Stump Evaluation & Diagnostics
Umbilical stump evaluation
o Reducible, heat, painful, red skin?
o Leaking urine = most likely patent urachus
o Fever, off feed, signs of colic, straining to urinate
Diagnostics
* Ultrasound to look for loops of bowel (hernia)
* OR hyperechoic debris (abscess)
Hernia Repair, How to Belly Band, Post-op care
Hernia Repair
* 1 to 3 cm (1 finger) manual stimulation belly band
* 4 to 5 cm (2 finger) belly band, irritant injection, surgery
* > 5 cm (3 finger) surgical
Belly Band
* Wrap brown gauze, vet wrap, or elastikon around waist
* Check every 10 days
Post-op Care
* Confine 10-14 days
* Antibiotics if field surgery or open abdomen
* Flunixin or meloxicam
* Belly band if severe
Scrotal/Inguinal Hernias Direct Vs Indirect
Direct
* through facia of abdominal wall
Indirect
* through inguinal ring, within vaginal tunic
Scrotal/Inguinal Hernias Treatment
Taping Method
* 1” Elastikon “Figure 8” around legs
after castration
* Puts pressure on inguinal rings
* Remove tape in 4-5 days
Surgery
* Performed prior to castration
* Incision over external inguinal ring ->
* Blunt dissection down to testis and spermatic cord ->
* Visualize intestines in vaginal tunic ->
* Twist spermatic cord and milk intestines back into abdomen ->
* Transfixation ligature around spermatic cord ->
* Close inguinal ring
Rectal Prolapse; Cause, Treatment, Repair for “Short tail” prolapse, When to amputate & anestamose
o Caused by straining due to many underlying causes
Treatment
* Caudal epidural then ->
* Replace & purse string (cattle) OR
* Peri-rectal counterirritant & purse string (small Rs & camelids) OR
* (Sub)mucosal Resection & purse string (only if needed) OR
* amputation (avoid!)
* maintain soft feces w/ MgOH or mineral oil
* flunixin
* remove purse string in 5-10d
Short Tail Rectal Prolapse Repair
o Ram – 1 ml oxytetracycline injected around rectum at 12, 3, 6, 9 o’clock
o Ewe – 12, 3, 9 o’clock
Rectal prolapse amputation & anastomosis
o Prolapse out for too long, unable to replace, or damaged tissue
Which Claws of a Cow Bear the most Weight Bearing
Front
* Most
* Medial claw most
Hind
* Less than front
* Lateral claw most
Deep Digital Sepsis Surgical Options
Amputation
* Cheaper
* Short recovery time
* Shorter lifespan
* Moderate skill
Arthrodesis
* Expensive
* Recovery 2-3mo
* Drainage dependent on aftercare
* High technical skill needed
How to: Claw Amputation; Post-op Concerns
o Clip & scrub
o Bier block
o Disarticulate between PI & PII
OR
o Cut through with wire at distal PI or proximal PII
o Place wooden block on other foot to keep from weight bearing
Post-op Concerns
* Septic tendon sheath
* Poor granulation tissue
* Breakdown of other claw
How to: Arthrodesis; Post-op Concerns
o Clip/scrub
o Bier block
o Drill through distal navicular/coffin joint
o Currette out dead bone
o Flush & pack (every 2-3 days)
o +/- cast
Post-op Concerns
* Persistent sepsis
* Pain
* Wound management
* Eventual immobilization of coffin joint
Interdigital Hyperplasia (Corn) Removal
o Clip, scrub, block
o Hemostasis VERY important
General Post-op Management
Pain
* Flunixin IV Q12
* Meloxicam PO Q24
* Gabapentin PO 8-12
Antibiotics
* Nuflor – good bone penetration
* Excede – labeled for foot rot
* Oxytetracycline - labeled for foot rot
Urolithiasis; Signalment, Clinical Signs, Diagnosis
Signalment
o Male, castrated
o High grain diet
o High alfalfa diet
Clinical Signs
o General
o Straining
o Vocalization
Diagnosis
o imaging
Urolithiasis; Treatment
Clip urethral process
o avoid sx
Tube cystostomy
* gold standard
* Fully removes stones & don’t damage anatomy
Percutaneous Tube cystostomy
* cheaper, high risk/less reward
* Trochar into body wall & bladder
Perineal Urethrostomy
* permanent, high risk/reward
o Bladder marsupalization (last resort)
o Vescicular Preputial Anastamosis (last resort)
o Permanent Tube Cystostomy (last resort)
Mastectomy in Small Ruminants; Reasons, Vessels to be aware of
Reasons
* Mastitis
* Neoplasia/hyperplasia
* CAE
* Precocious Udder (hormone related)
Vessels
* Pudendal
* Caudal mammary
Mastectomy in Small Ruminants; Radical Vs Physiologic
Radical
* More expensive
* Time consuming
* Constant hemostasis
* No more udder
* Completely scoop out mammaries
* 4 leaf clover closure w/ drains
Physiologic
* Cheaper
* Quick
* Less traumatic
* find vessels & put zip ties around them -> 6-8wks tissue atrophy
