Exam 1 - Urogenital Surgery (Sx) Flashcards
1
Q
indications for castration
A
behavioral
abnormal testicle
cryptorchid
2
Q
typical age of castration
A
6 mos - 2 yrs
3
Q
testicle of young horse that is hard to find often sits where?
A
inguinal location
4
Q
precautions to take when castrating
A
- correct horse
- both testes present
- overall health good
- season - NOT middle of summer (flies) or winter (cold)
5
Q
general diff btwn open, closed and modified closed?
A
how you handle vaginal tunic
note: incision is same for all 3
6
Q
describe open castration
A
- incision through vaginal tunic to expose testicle
- good visualization of cord and vessels
- entire tunic not removed but stays w skin and sub q tissues
- components of cord emasculated separately
7
Q
describe closed castration
A
incision NOT through vaginal tunic
- tunic and components emasculated separately
- strip sub q tissues of the cord
8
Q
modified closed castration:
A
testicle prolapsed thru small incision in vaginal tunic
increased removal of tunic - some of tunic is removed
can visualize some of the vessels
9
Q
benefits of standing castration
A
no anesthetic risk, no recovery and waiting around
10
Q
risks of standing castration
A
harder to isolate bleeders b/c cord will go back up and in so cannot find to stop bleeding if you need to
bad position if horse too short
harder to deal w complications
11
Q
general protocol of standing castration:
A
sedate horses, block testes, inject into cord and allow 15 mins for block to take effect
clean area well
12
Q
positives of recumbent castration
A
better exposure to allow for hemostasis and drainage
13
Q
protocol (general) for recumbent castration:
A
- sedate and anesthetize horse
- dorsal recumbency or lateral w upper leg brought forward
- rough scrup
14
Q
describe incision for castration
A
2 incisions - each 1 cm from and parallel to median raphe
15
Q
how is hemostasis achieved?
A
emasculation - with emasculators - applied in “nut to nut” fashion
occasionally ligation
16
Q
why is emasculation preferred over ligation?
A
emasculation is faster
and in old days, sutures had more reactions so avoided
17
Q
why is “nut to nut” important?
A
to get proper emasculation
if not applied this way, you cut wrong side and get bleeding
18
Q
how to apply emasculator
A
nut to nut and perpendicular to cord
do NOT stretch cord
wait about 2 mins
release slowly
19
Q
what ligament is cut in open castration?
A
lig of tail of epididymis [what attaches tail of epididymis to tunic]
20
Q
important peri operative care for castration?
A
tetanus prophylaxis
NSAID
animal confined first 24 hours then exercised after that
21
Q
T/F: type of castration affects chance of intestines coming down?
A
F - the size of the inguinal ring does - not method of castration
22
Q
most common castration complication?
A
edema
23
Q
what causes edema post castration?
A
inadeqate exercise
premature closure of incisions / seroma formation
infection of sub q tissues
24
Q
what days post castration is swelling/edema typical?
A
1 d and 3 d
25
when does swelling typically peak after castration ?
3-6 days post op
26
what is hydrocele?
closure of vaginal tunic before adequate drainage
cosmetic issue - looks like stallion
27
what is eventration?
serious complication of castration
escape of intestinal contents thru inguinal canal
28
how to repair eventration?
anesthetize horse, lavage and replace bowel
CLOSE superficial inguinal rin
29
what does incomplete castration lead to?
persistent stallion behavior - due to retained testicular tissue
may also be learned behavior
30
possible sources of hemorrhage after castration?
skin, subcutaneous, tunic
| spermatic cord
31
T/F - clostridial infections common post castration
FALSE
32
T/F: if cryptorchid testicle, remove it second
false - remove retained testicle first
33
crypdorchid definition:
failure to descend into scrotum
34
location of abdominal testicle
testicle and epididymis in body cavity
35
partial abdominan crhptorchid?
incomplete
body of testicle in abdomen and tail of epididymis descended
36
inguinal cryptorchid
testicle in inguinal canal
37
ectopic cryptorchid
testicle in odd location, sub q or near scrotal region
38
what is the proper ligament?
attaches epididymis and testicle
may be long if testicle far into abdomen
39
what is lig of tail of epididymis
attaches tail of epididymis to tunic
may be long if testicle far from inguinal region
40
clin presentation of cryptorchid:
any age - often aggressive stallion like behavior
hard to train and work with animal
variable or unknown certain history of castration
41
hormonal assay options for cryptorchid dx?
testosterone - baseline will be higher in cryptorchid
hCG stimulation - testosterone should inc by 200%+ if retained testicle
anti mullerian hormone - present in cryptorchids [and stallions]
42
u/s to dx cryptorchidism?
may be helpful to ID location especially if inguinal
43
laparoscopy use in cryptorchidism?
visualize vaginal ring
determine location of testis
remove abdominal testicle
44
tx of cryptorchid?
sx removal [always undescended side first]
45
sx approaches that are recumbent for testicle removal?
inguinal
modified parainguinal
paramedian
46
sx approaches that can be standing flank or recumbent for testicle removal?
laparoscopic
| flank
47
non invasive inguinal technique for removal of testicle?
abdominal cavity not entered
inguinal extension of gubernaculum identified and used to locate vaginal process blindly
vaginal process incised and epididymis used to exteriorize testicle
48
what structure was the gubernaculum supposed to become?
the lig of tail of epididymis
49
invasive inguinal technique to get retained testicle?
abdomen is entered w fingers or hand thru inguinal canal
search for epididymis or testicle
50
sx approach to modified parainguinal removal of testicle?
incision to side of inguinal canal - Cr to inguinal ring
aponeurosis of external abdominal oblique
51
advantages and disadvantages to laparoscopic removal of testicle?
small incisions
need experience and equipment
52
inguinal hernia etiology?
congenital (may spontaneously regress) - vaginal ring larger than normal
acquired - things that cause inc abdominal pressure
53
indirect hernia def?
hernia loc w/in vaginal tunic
54
direct hernia def?
hernia loc outside the vaginal tunic
55
inguinal hernia def?
intestines passing through body cavity via inguinal ring
56
indications for surgical repair of inguinal hernia?
non reducible
rupture into sub Q tissues
excessive edema, skin excoriation
owner preference
57
common presentation of acquired inguinal hernia?
scrotal swelling that presents as colic
58
indications for circumcision:
neoplasm
scarring
granulomas
59
sx technique for circumcision is called?
"reefing"
60
post circumcision care:
NSAIDs and mild to moderate activity
61
before circumcising the penis, do this:
biopsy lesion
62
indications for penis amputation
extensive lesions
63
post penis amputation care?
rest
abx
NSAIDs
64
complications of penile amputations?
bleeding
dehiscence
urethral stricture
65
what is welliam's approach to penis amputation?
ventral approach
| spatulate urethra - open it and close mucosa in a wider triangle fashion
66
what is vulvoplasty and why is it done?
vulvar seal made with sutures - done to decrease pneumo vagina and ascending bacT infections
67
to the level of what anatomical marker is vulvoplasty done?
ischial arch
68
suture pattern used for vulvoplaslty?
interrupted pattern to learn then more advanced - continuous pattern
69
what does a 2nd degree perineal laceration include?
the perineal body
70
what does a 3rd degree perineal laceraiton entail?
surgically repair necessary
minimal tissue on tissue shelves
evert mucosal layers to rectum and vagina
71
immediate care for perineal lacerations?
anti inflammatory
abx
debridement (light)
mineral oil to soften stool
72
what is the Aanes method to perineal repair?
to repair 3rd degree perineal lacerations
| 2 stage
73
what is the goetz methon (vaughin) method of surgical repair?
one stage repair of 3rd degree perineal lacerations
74
how to repair rectovaginal fistula?
create septum by creating 2 shelves of tissue
75
ways to repair rectovestibular fistula?
through rectum
through transected perineal body
through vestibule
converted into 3rd degree perineal laceration
76
what is perineoplasty?
to correct poor perineal conformation that Caslicks/vulvoplasty cannot do alone
repair tear of perineal body - reconstruction or transection
77
what is the perineal body?
fibromuscular septum btwn the anus and vulva
78
rectal tear MC cause?
iatrogenic
79
clin signs of rectal tear?
straining, colic, endotoxemia, peritonitis
80
dx of rectal tear?
blood on sleeve after palpation
81
grade 1 rectal tear?
| Tx?
through mucosa
soften manure, no palpation for 30 days, nsaids, abx, monitor
82
grade 2 rectal tear?
| tx?
mucosa intact but muscular layer under is torn
-almost theoretical - rare
dietary mgmt
83
grade 3 rectal tear?
| Tx?
more typical tear - through mucosa and muscularis
repeated small volumes of manual evacuation
primary repair often NOT possible
laparotomy approaches
rectal liner-laparotomy
84
grade 4 rectal tear?
| Tx?
through serosa and into peritoneal cavity
```
endotoxemia - shock Tx
abx, nsaids
abdominal lavage
euthanasia often :(
very guarded/poor prognosis
```
Sx: suture laparotomy, rectal liner laparotomy, diverting colostomy, abdominal lavage
85
initial mgmt of rectal tear?
```
inform owner
determine extent of tear
broad spec abx
reduce straining - epidural, nsaids, sedation, lidocaine enema
evacuate tear
refer!
```
86
indications for ovariectomy?
sterilize
adjust behavior
pathology - tumor
87
ovariectomy approach?
standing and general anesthesia
laparoscopic (method of choice, typically)
flank
colpotomy
88
when to use ventral approach for ovariectomy?
large tumor
89
ventral approaches for ovariectomy are?
midline
ventral paramedian
diagonal paramedian
90
ovariectomy pedicle ligation techniques?
```
ligature
ligasure
stapling instruments
ecrasuer
emasculator
cautery
```
91
how does an ecraseur work?
remove ovary blindly
| vasculature is crushed
92
post ovariectomy repair?
analgesics
abx
rest
93
complications to ovariectomy?
```
hemorrhage
abdominal pain
adhesions
peritonitis
herniation, evisceration
death
```
94
what is urovagina?
urine pooling b/c urethral orifice is pulled cranially to allow some urine to fall cranial toward vagina and cervic
result: vaginitis, cervicitis, endometritis
95
clin signs of urovagina:
dec conception
apparent incontinence
predisposing factors (poor condition and multiparous)
96
uro vagina Dx:
clin signs, vaginal exam, vaginal floor tilts Cr and ventral
| urine on Cr vaginal floor
97
uro vagina Tx:
urethroplasty - create tunnel so urine exits Cd to brim of pelvis
98
urethroplasty Monin's Sx technique:
relocation of transverse fold
| mild cases
99
urethroplasty Browns Sx technique
commonly used
| 3 layer closed
100
Caesarean section indications:
dystocia
uterine torsion
elective [rare]
101
approaches to C-section:
ventral midline
ventral paramedian
flank (vertical/modified low)
recumbent
102
prognosis for mare and foal if C-section performed during dystocia?
mare - good
| foal - poor
103
MC type of cystic / urethrarl calculi?
type 1
| speculated - cause irritation to bladder and cystitis
104
composition of cystic calculi?
calcium carbonate salts
105
cystic calculi MC in M or FM?
| why?
MC in M b/c FM have wider urethra for stones to pass better
106
clin signs of cystic/urethral calculi?
hematuria, dysuria
| urine scalding, colic
107
dx cystic calculi?
clin signs, rectal exam, catheterize, cystoscopy, U/a
endoscopy to confirm
108
dx cystic calculi with high carbonate?
NO b/c many horses have high carbonate normally
109
Tx or cystic / urethral calculi?
celiotomy and cystotomy
parainguinal or caudal ventral midline incision for better bladder access b/c hard to exteriorize bladder
110
standing procedure to remove cystic / urethral calculi?
FM - direct access through urethra
M - subischial urethrotomy approach to bladder
if gelding, can palpate rectally and find bladder, find stone in bladder and break stone into smaller pieces
111
radial shock waves to treat cystic / urethral calculi: through what procedure?
subischial urethrotomy
112
post op care for cystic / urethral calculi?
Tx cystitis
| inc salt intake to inc water intake
113
pararectal approach to cystic / urethral calculi used?
for M
retroperitoneal approach to bladder
economical, standing procedure but inc complication rate
