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Large Animal Surgery > Exam 1 > Flashcards

Exam 1 Flashcards

1
Q

Drugs For Pain Relief in Ruminants

A
  • 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
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2
Q

Preparing Ruminant Surgical Site

A
  • 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

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3
Q

Post-op Feeding of Ruminants

A
  • 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
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4
Q

Fluids for Ruminants

A
  • Adults: 60ml/kg/day
  • Neonates: 90 ml/kg/d
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5
Q

Disbudding Goats; When, Nerve Supply, Issues

A

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

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6
Q

Disbudding Cows; When, procedure

A

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

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7
Q

Docking Sheep; Purpose, When, Issues

A

o Eliminate manure buildup & fly strike
o w/in first 48hrs of life (to a few days)

Issues
* Too short -> prolapse

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8
Q

Castration; Precautions, Analgesia options

A

o Use tetanus antitoxin
o testicular block
o ring block

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9
Q

Repair Nose Ring Tear

A

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

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10
Q

Sinusitis; Treatment

A
  • Lavage w/ “weak tea” diluted betadine
  • Trephination?
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11
Q

How to: Trephination

A
  • 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
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12
Q

Llama Lullaby

A

o 10ml ketamine
o 1ml xylazine
o 1ml butorphanol

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13
Q

Mandibular Tooth Root Abcsess; Diagnosis, Treatment; Surgical Approaches

A

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

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14
Q

Squamous Cell Carcinoma; Locations, Diagnosis, Treatment

A

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)

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15
Q

How to: 3rd Eyelid Removal

A
  • 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
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16
Q

How to: Enucleation

A
  • 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
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17
Q

Corneal Ulcer; Causes, Treatment

A

Cause
* Pink eye
* Trauma
* entropion
* Other bacteria

Treatment
* Medical management
* 3rd eyelid flap
* enucleation
* entropion repair

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18
Q

How to: Emergency Tracheotomy

A

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

19
Q

Left Displaced Abomasum; Basics, Clinical Signs, Diagnosis, Treatment

A

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

20
Q

R Abomasal Volvulus; Clnical Signs, Diagnosis, Treatment

A

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

21
Q

Pros & Cons of a Toggle

A

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

22
Q

Pros & Cons of R Side Approach Surgery for Displaced Abomasum

A

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

23
Q

Pros & Cons of L Side Approach Surgery for Displaced Abomasum

A

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

24
Q

Pros & Cons of Paramedian Approach for Displaced Abomasum

A

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

25
Q

How to: Toggle

A

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

26
Q

How To: R Approach for LDA

A

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

27
Q

Choices for Flank Anesthesia

A

o Proximal paravertebral block 

o Distal paravertebral block 

o Inverted L block 

o Line block 


28
Q

C-section; Reasons, Pain Management, Approaches, Post-op care

A

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

29
Q

How to: C-section

A

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)

30
Q

Umbilical Stump Evaluation & Diagnostics

A

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)

31
Q

Hernia Repair, How to Belly Band, Post-op care

A

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

32
Q

Scrotal/Inguinal Hernias Direct Vs Indirect

A

Direct
* through facia of abdominal wall

Indirect
* through inguinal ring, within vaginal tunic

33
Q

Scrotal/Inguinal Hernias Treatment

A

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

34
Q

Rectal Prolapse; Cause, Treatment, Repair for “Short tail” prolapse, When to amputate & anestamose

A

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

35
Q

Which Claws of a Cow Bear the most Weight Bearing

A

Front
* Most
* Medial claw most

Hind
* Less than front
* Lateral claw most

36
Q

Deep Digital Sepsis Surgical Options

A

Amputation
* Cheaper
* Short recovery time
* Shorter lifespan
* Moderate skill

Arthrodesis
* Expensive
* Recovery 2-3mo
* Drainage dependent on aftercare
* High technical skill needed

37
Q

How to: Claw Amputation; Post-op Concerns

A

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

38
Q

How to: Arthrodesis; Post-op Concerns

A

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

39
Q

Interdigital Hyperplasia (Corn) Removal

A

o Clip, scrub, block
o Hemostasis VERY important

40
Q

General Post-op Management

A

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

41
Q

Urolithiasis; Signalment, Clinical Signs, Diagnosis

A

Signalment
o Male, castrated
o High grain diet
o High alfalfa diet

Clinical Signs
o General
o Straining
o Vocalization

Diagnosis
o imaging

42
Q

Urolithiasis; Treatment

A

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)

43
Q

Mastectomy in Small Ruminants; Reasons, Vessels to be aware of

A

Reasons
* Mastitis
* Neoplasia/hyperplasia
* CAE
* Precocious Udder (hormone related)

Vessels
* Pudendal
* Caudal mammary

44
Q

Mastectomy in Small Ruminants; Radical Vs Physiologic

A

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

Large Animal Surgery (3 decks)

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