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IP 11 Equine Medicine > Exam 1 - Urogenital Surgery (Sx) > Flashcards

Exam 1 - Urogenital Surgery (Sx) Flashcards

1
Q

indications for castration

A

behavioral
abnormal testicle
cryptorchid

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2
Q

typical age of castration

A

6 mos - 2 yrs

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3
Q

testicle of young horse that is hard to find often sits where?

A

inguinal location

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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)
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5
Q

general diff btwn open, closed and modified closed?

A

how you handle vaginal tunic

note: incision is same for all 3

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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
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7
Q

describe closed castration

A

incision NOT through vaginal tunic

  • tunic and components emasculated separately
  • strip sub q tissues of the cord
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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

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9
Q

benefits of standing castration

A

no anesthetic risk, no recovery and waiting around

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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

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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

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12
Q

positives of recumbent castration

A

better exposure to allow for hemostasis and drainage

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13
Q

protocol (general) for recumbent castration:

A
  • sedate and anesthetize horse
  • dorsal recumbency or lateral w upper leg brought forward
  • rough scrup
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14
Q

describe incision for castration

A

2 incisions - each 1 cm from and parallel to median raphe

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15
Q

how is hemostasis achieved?

A

emasculation - with emasculators - applied in “nut to nut” fashion

occasionally ligation

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16
Q

why is emasculation preferred over ligation?

A

emasculation is faster

and in old days, sutures had more reactions so avoided

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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

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18
Q

how to apply emasculator

A

nut to nut and perpendicular to cord

do NOT stretch cord

wait about 2 mins

release slowly

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19
Q

what ligament is cut in open castration?

A

lig of tail of epididymis [what attaches tail of epididymis to tunic]

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20
Q

important peri operative care for castration?

A

tetanus prophylaxis
NSAID
animal confined first 24 hours then exercised after that

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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

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22
Q

most common castration complication?

A

edema

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23
Q

what causes edema post castration?

A

inadeqate exercise
premature closure of incisions / seroma formation
infection of sub q tissues

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24
Q

what days post castration is swelling/edema typical?

A

1 d and 3 d

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25
Q

when does swelling typically peak after castration ?

A

3-6 days post op

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26
Q

what is hydrocele?

A

closure of vaginal tunic before adequate drainage

cosmetic issue - looks like stallion

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27
Q

what is eventration?

A

serious complication of castration

escape of intestinal contents thru inguinal canal

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28
Q

how to repair eventration?

A

anesthetize horse, lavage and replace bowel

CLOSE superficial inguinal rin

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29
Q

what does incomplete castration lead to?

A

persistent stallion behavior - due to retained testicular tissue

may also be learned behavior

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30
Q

possible sources of hemorrhage after castration?

A

skin, subcutaneous, tunic

spermatic cord

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31
Q

T/F - clostridial infections common post castration

A

FALSE

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32
Q

T/F: if cryptorchid testicle, remove it second

A

false - remove retained testicle first

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33
Q

crypdorchid definition:

A

failure to descend into scrotum

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34
Q

location of abdominal testicle

A

testicle and epididymis in body cavity

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35
Q

partial abdominan crhptorchid?

A

incomplete

body of testicle in abdomen and tail of epididymis descended

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36
Q

inguinal cryptorchid

A

testicle in inguinal canal

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37
Q

ectopic cryptorchid

A

testicle in odd location, sub q or near scrotal region

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38
Q

what is the proper ligament?

A

attaches epididymis and testicle

may be long if testicle far into abdomen

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39
Q

what is lig of tail of epididymis

A

attaches tail of epididymis to tunic

may be long if testicle far from inguinal region

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40
Q

clin presentation of cryptorchid:

A

any age - often aggressive stallion like behavior

hard to train and work with animal

variable or unknown certain history of castration

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41
Q

hormonal assay options for cryptorchid dx?

A

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]

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42
Q

u/s to dx cryptorchidism?

A

may be helpful to ID location especially if inguinal

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43
Q

laparoscopy use in cryptorchidism?

A

visualize vaginal ring

determine location of testis

remove abdominal testicle

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44
Q

tx of cryptorchid?

A

sx removal [always undescended side first]

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45
Q

sx approaches that are recumbent for testicle removal?

A

inguinal
modified parainguinal
paramedian

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46
Q

sx approaches that can be standing flank or recumbent for testicle removal?

A

laparoscopic

flank

47
Q

non invasive inguinal technique for removal of testicle?

A

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
Q

what structure was the gubernaculum supposed to become?

A

the lig of tail of epididymis

49
Q

invasive inguinal technique to get retained testicle?

A

abdomen is entered w fingers or hand thru inguinal canal

search for epididymis or testicle

50
Q

sx approach to modified parainguinal removal of testicle?

A

incision to side of inguinal canal - Cr to inguinal ring

aponeurosis of external abdominal oblique

51
Q

advantages and disadvantages to laparoscopic removal of testicle?

A

small incisions

need experience and equipment

52
Q

inguinal hernia etiology?

A

congenital (may spontaneously regress) - vaginal ring larger than normal
acquired - things that cause inc abdominal pressure

53
Q

indirect hernia def?

A

hernia loc w/in vaginal tunic

54
Q

direct hernia def?

A

hernia loc outside the vaginal tunic

55
Q

inguinal hernia def?

A

intestines passing through body cavity via inguinal ring

56
Q

indications for surgical repair of inguinal hernia?

A

non reducible
rupture into sub Q tissues
excessive edema, skin excoriation
owner preference

57
Q

common presentation of acquired inguinal hernia?

A

scrotal swelling that presents as colic

58
Q

indications for circumcision:

A

neoplasm
scarring
granulomas

59
Q

sx technique for circumcision is called?

A

“reefing”

60
Q

post circumcision care:

A

NSAIDs and mild to moderate activity

61
Q

before circumcising the penis, do this:

A

biopsy lesion

62
Q

indications for penis amputation

A

extensive lesions

63
Q

post penis amputation care?

A

rest
abx
NSAIDs

64
Q

complications of penile amputations?

A

bleeding
dehiscence
urethral stricture

65
Q

what is welliam’s approach to penis amputation?

A

ventral approach

spatulate urethra - open it and close mucosa in a wider triangle fashion

66
Q

what is vulvoplasty and why is it done?

A

vulvar seal made with sutures - done to decrease pneumo vagina and ascending bacT infections

67
Q

to the level of what anatomical marker is vulvoplasty done?

A

ischial arch

68
Q

suture pattern used for vulvoplaslty?

A

interrupted pattern to learn then more advanced - continuous pattern

69
Q

what does a 2nd degree perineal laceration include?

A

the perineal body

70
Q

what does a 3rd degree perineal laceraiton entail?

A

surgically repair necessary
minimal tissue on tissue shelves

evert mucosal layers to rectum and vagina

71
Q

immediate care for perineal lacerations?

A

anti inflammatory
abx
debridement (light)
mineral oil to soften stool

72
Q

what is the Aanes method to perineal repair?

A

to repair 3rd degree perineal lacerations

2 stage

73
Q

what is the goetz methon (vaughin) method of surgical repair?

A

one stage repair of 3rd degree perineal lacerations

74
Q

how to repair rectovaginal fistula?

A

create septum by creating 2 shelves of tissue

75
Q

ways to repair rectovestibular fistula?

A

through rectum
through transected perineal body
through vestibule
converted into 3rd degree perineal laceration

76
Q

what is perineoplasty?

A

to correct poor perineal conformation that Caslicks/vulvoplasty cannot do alone

repair tear of perineal body - reconstruction or transection

77
Q

what is the perineal body?

A

fibromuscular septum btwn the anus and vulva

78
Q

rectal tear MC cause?

A

iatrogenic

79
Q

clin signs of rectal tear?

A

straining, colic, endotoxemia, peritonitis

80
Q

dx of rectal tear?

A

blood on sleeve after palpation

81
Q

grade 1 rectal tear?

Tx?

A

through mucosa

soften manure, no palpation for 30 days, nsaids, abx, monitor

82
Q

grade 2 rectal tear?

tx?

A

mucosa intact but muscular layer under is torn
-almost theoretical - rare

dietary mgmt

83
Q

grade 3 rectal tear?

Tx?

A

more typical tear - through mucosa and muscularis

repeated small volumes of manual evacuation
primary repair often NOT possible
laparotomy approaches
rectal liner-laparotomy

84
Q

grade 4 rectal tear?

Tx?

A

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
Q

initial mgmt of rectal tear?

A 
inform owner
determine extent of tear
broad spec abx
reduce straining - epidural, nsaids, sedation, lidocaine enema
evacuate tear
refer!
86
Q

indications for ovariectomy?

A

sterilize
adjust behavior
pathology - tumor

87
Q

ovariectomy approach?

A

standing and general anesthesia

laparoscopic (method of choice, typically)
flank
colpotomy

88
Q

when to use ventral approach for ovariectomy?

A

large tumor

89
Q

ventral approaches for ovariectomy are?

A

midline
ventral paramedian
diagonal paramedian

90
Q

ovariectomy pedicle ligation techniques?

A 
ligature
ligasure
stapling instruments
ecrasuer
emasculator
cautery
91
Q

how does an ecraseur work?

A

remove ovary blindly

vasculature is crushed

92
Q

post ovariectomy repair?

A

analgesics
abx
rest

93
Q

complications to ovariectomy?

A 
hemorrhage
abdominal pain
adhesions
peritonitis
herniation, evisceration
death
94
Q

what is urovagina?

A

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
Q

clin signs of urovagina:

A

dec conception
apparent incontinence
predisposing factors (poor condition and multiparous)

96
Q

uro vagina Dx:

A

clin signs, vaginal exam, vaginal floor tilts Cr and ventral

urine on Cr vaginal floor

97
Q

uro vagina Tx:

A

urethroplasty - create tunnel so urine exits Cd to brim of pelvis

98
Q

urethroplasty Monin’s Sx technique:

A

relocation of transverse fold

mild cases

99
Q

urethroplasty Browns Sx technique

A

commonly used

3 layer closed

100
Q

Caesarean section indications:

A

dystocia
uterine torsion
elective [rare]

101
Q

approaches to C-section:

A

ventral midline
ventral paramedian
flank (vertical/modified low)
recumbent

102
Q

prognosis for mare and foal if C-section performed during dystocia?

A

mare - good

foal - poor

103
Q

MC type of cystic / urethrarl calculi?

A

type 1

speculated - cause irritation to bladder and cystitis

104
Q

composition of cystic calculi?

A

calcium carbonate salts

105
Q

cystic calculi MC in M or FM?

why?

A

MC in M b/c FM have wider urethra for stones to pass better

106
Q

clin signs of cystic/urethral calculi?

A

hematuria, dysuria

urine scalding, colic

107
Q

dx cystic calculi?

A

clin signs, rectal exam, catheterize, cystoscopy, U/a

endoscopy to confirm

108
Q

dx cystic calculi with high carbonate?

A

NO b/c many horses have high carbonate normally

109
Q

Tx or cystic / urethral calculi?

A

celiotomy and cystotomy

parainguinal or caudal ventral midline incision for better bladder access b/c hard to exteriorize bladder

110
Q

standing procedure to remove cystic / urethral calculi?

A

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
Q

radial shock waves to treat cystic / urethral calculi: through what procedure?

A

subischial urethrotomy

112
Q

post op care for cystic / urethral calculi?

A

Tx cystitis

inc salt intake to inc water intake

113
Q

pararectal approach to cystic / urethral calculi used?

A

for M
retroperitoneal approach to bladder

economical, standing procedure but inc complication rate

IP 11 Equine Medicine (10 decks)

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