Exam 1 - Exploratory Laparotomy Flashcards
what are some examples of an exploratory with both diagnostic & therapeutic components?
diagnostic & therapeutic - penetrating abdominal trauma & some abdominal tumors
what is included in patient prep before an exploratory?
medical stabilization if indicated
wide shave, drape in xyphoid & pubis
when do you recommend an exploratory surgery?
when the potential benefit outweighs the risks of anesthesia, potential complications, & financial cost
how is a basic exploratory performed?
systematic approach - start cranially
diaphragm -> liver (look at color/shape/texture/masses/location/position)
-> gallbladder -> pylorus & duodenum -> run the bowel, look at lymph nodes
what organs can you assess while retracting the duodenum toward midline?
right kidney, right limb of the pancreas, right ovary, right adrenal, part of the caudate lobe of the liver, portal vein & caudal vena cava
what organs can you assess while retracting the colon toward midline?
left kidney, left adrenal, left ovary
in which situations would you not begin with a full exploration of the abdomen?
active bleeding, GDV, colonic torsion - there is a significant problem that must be addressed first
what are some examples of needing a diagnostic exploratory?
chronic medical condition needed confirmed diagnosis - intestinal lymphoma, IBD, PLE
staging cancer - biopsy lymph nodes
what are some examples of needing a therapeutic exploratory?
hemoperitoneum, uroperitoneum, septic peritonitis, free abdominal air, intestinal obstruction
why should you have cautery available when doing an exploratory?
for blood loss - especially if the patient already is anemic
patients with coag problems
cautery is faster than ligating
what do you do for a midline incision for male dogs?
skin incision is para-preputial - will run into pudendal vessels, will need to ligate them
abdominal incision is ON MIDLINE - don’t want to cut through muscle (more bleeding & more painful)
what does the omentum attach to?
greater curvature of the stomach
how do you visualize the left limb of the pancreas in an exploratory?
lift up the spleen cranially
when would you do the guillotine method for a liver biopsy?
lesion is on the edge or if there is diffuse liver disease
other option is punch biopsy
how should you biopsy the stomach?
place stay sutures, pick a spot that is less vascular, & close in one or two layers
