Exam 2 Flashcards
What are the clinical signs of pyloric obstruction?
Projectile vomiting Undigested mucus and bile Rapid fluid loss Electrolyte loss (H+, Cl-, Na+, K+) Hyponatremia, hypochloremia, alkalosis
What are treatment options for gastric foreign bodies?
Spontaneous passage
Induction of vomiting
Endoscopy
Surgery
What are the two layer closures you would use for a gastrotomy?
Cushing- submucosa
Lembert- seromuscular- submucosa
Use absorbable suture
What are the breed incidences for GDV?
Large/giant breeds: Great Dane St. Bernard Weimeraner Irish setter Gordeon setter
What are the proposed etiologies for GDV?
Diet Overeating Post-prandial exercise Anatomic factors Delayed gastric filling Bacterial fermentation (clostridia) Aerophagia Hypergastrinemia Gastric myoelectric dysrhythmias
What are the clinical signs for GDV?
Restlessness, discomfort, pain Hypersalivation Nonproductive vomiting/retching Abdominal distention Hyperpnea (>30rpm) Shock
What is the pathophysiology of GDV?
Dilation precedes volvulus
Angulation of gastroesophageal junction
Volvulus - 270 degree clockwise rotation
Dilation alone - 90 degree counterclockwise
Does ability to pass a stomach tube distinguish between GD and GDV?
No
What percent of dogs with GDV end up in DIC?
40%
What is the initial management of GDV?
Decompression (orogastric intubation or trocharization)
T/F? In all cases of GDV, surgical intervention should be recommended even if distention is relieved and the stomach is shown to be in a normal position
TRUE
Is it okay to medically manage a GDV and then take to surgery 24-48 hours later?
NO
What are the objectives of GDV surgery?
Reposition stomach
Evaluate GI tract
Prevent recurrence
How can you assess gastric wall viability?
Color Temperature Peristalsis- pinch test* Thickness Fluorescien Surface oximetry
What are the advantages of tube gastrostomy?
Rapid, easy procedure
Creates a permanent adhesion
Allows for gastric decompression
Allows tube feeding
What are the advantages and disadvantages of incisional gastropexy?
Advantages:
Rapid, easy procedure
Does not enter stomach lumen
Disadvantages:
No post-op alimentation
No good clinical follow up
What characterizes a simple complete obstruction?
Ischemia and devitalization -> decreased fluid absorption
Bowel wall edema -> fluid accumulation
What are the 3 types of mechanical intestinal obstruction and what commonly causes them?
- Luminal: foreign body, polypoid mass
- Intramural: neoplasia, fungal granuloma
- Extramural: adhesions, strangulated hernia
What type of obstruction results in rapid dehydration?
Duodenal
Loss of salivary, gastric, pancreatic duodenal secretions
What type of obstruction will result in more chronic signs?
Low jejunal obstruction
What is the size of a normal dog, cat, and ferret intestine?
Dog: 1.6 x the height of the body of L5
Cat: 12mm
Ferret: 5-7mm
What do you see on radiographs with linear foreign body?
Pleated bowl/accordion pattern
How can you diagnose foreign body on ultrasound?
Dilated, fluid-filled SI loops
What is the pinch test?
Tests viability of intestine
See if pinch incites peristalsis
What are the advantages and disadvantages of enterotomy?
Advantages:
Less risk of surgical dehiscence
Retain absorptive capacity
Disadvantages:
Wrong guess- perforation and peritonitis
Where do you make incision in foreign body enterotomy?
Aboral side of foreign body
Foreign body may have partially or fully eroded through mucosa. Making incision over foreign body may impede healing.
What suture type and pattern do you use for enterotomy?
4-0 PDS
Simple interrupted or continuous
May want to use cushing for animals with pre-existing peritonitis
What are the two enterotomy techniques used for linear foreign body removal?
Multiple enterotomy technique
Catheter passage technique
What are the advantages and disadvantages of intestinal anastamoses?
Advantage: removes all questionable tissue
Disadvantages: Longer surgical time Greater risk of leakage Greater potential for stricture Potentil weightloss and diarrhea
What suture would you use on intestinal anastamoses?
Moncryl
Maxon
PDS
What should you always do after suturing an intestinal resection and anastamoses?
SEAL WITH OMENTUM
What animals most commonly get intussusception?
Young dogs and cats
Most often associated with worms
What is the most common part of intestinal for intussusception?
Ileo cecal colic
What are the clinical signs of intussusception?
Inappetence
Vomiting
Tenesmus
Melena
How do you diagnose intussusception on ultrasound?
Bulls-eye/target sign
What surgical techniques are used to prevent recurrence of intussusception?
Enteropexy- (Most of the time this is not done, no good data to show that this will prevent recurrence)
Enteroplication
What is the prognosis of intestinal volvulus?
Grave
95% mortality rate
Survivors may have short bowel syndrome
Must retain >20% bowel
What are the clinical signs of megacolon?
Constipation Obstipation Tenesmus Dyschezia Hematodyschezia
What is idiopathic megacolon in cats and how do you medically manage it?
Mid to older age cats
No sex predilection
Inability of smooth muscle to contract
Give lactulose and cisapride
What is peritonitis?
Inflammation of peritoneum
Aseptic or septic
Primary or secondary
When is the most common time of dehiscence of GI surgery?
3-5 days post-op
What is septic peritonitis?
Bacterial contamination -> influx of protein rich fluids
What is the difference between bacteremia and septicemia?
Bacteremia: bacteria in bloodstream
Septicemia: body’s response to bacteremia
What is the criteria for systemic inflammatory response syndrome?
Dogs (2 or more of criteria): Temp >104 or <100.4 HR >120 RR >20 WBC > 18000 or <5000
Cats (3 or more criteria): Temp >103.5 or <100 HR >225 or <140 RR >40 WBC >19500 or <5000 Bands >5%
Does a lack of superficial infectious rule out septic peritonitis?
NO
What is the best way to diagnose septic peritonitis?
Abdominocentesis
4 quadrant technique
Needs to be done sterily
How do you treat septic peritonitis?
Antimicrobials: based on C + S, give ASAP! Debride Lavage Omental/serosal patching Drains (open or closed)
What is the prognosis for peritonitis?
Ultimately depends on underlying cause
High mortality rate
What is MIS?
Minimally invasive surgery
Any surgery that is less invasive and/or results in less tissue trauma compared to open surgery
Endoscopy, laparoscopy, thoracoscopy
What are the different methods of peritoneal access in laprascopic ove/ohe?
Veress needle
Modified hasson
Mini-laparotomy
What is the safest laparoscopy technique and why?
Modified Hasson
Make incision first and then insert camera
What is the Veress laparoscopy technique?
Has blunt, spring-loaded obturator that can retract to expose cutting needle
Protects from lacerating viscera
What is a threaded cannula?
Used in laparoscopic surgery to make a port for instruments
Prevents slipping in/out
Screw-in, rubber reducer valves, +/- insufflation
What are the 3 components of the tower in laparoscopic surgery?
- Light: xenon
- Video control unit
- Insufflator
What is used for insufflation in laparoscopic surgery and why?
CO2
Soluble, not flammable, no emboli
What is triangulation in laparoscopic surgery?
The orientation of instruments and self with monitor
What are different curves in instruments used for in laparoscopic surgery?
Looking around corners, getting different views
What are the indications for laparoscopy?
Elective procedures
Client requests
Decreases patient morbidity
Hospital reputation
What are contraindications of laparoscopy?
Lack of experience or comfort in surgeon or staff
Instrumentation missing
Advanced/exploratory procedures
What is the goal insufflation pressure for cats and dogs during laparoscopy?
Cats: <8 mmHg
Dogs: <12mm Hg
What are the physiologic effects of insufflation?
Pressure against diaphragm and vena cava ->
Decrease in thoracic compliance and venous return ->
Decreased cardiac output and tidal volume ->
Hypoventilation, hypoxemia, acidemia
What are the sources of pain during laparoscopy?
Incisions
Peritoneal CO2 (acidosis, desiccation)
Stretching of diaphragm
How can you decrease pain from laparoscopy?
NSAIDs Local nerve blocks Evacuate residual CO2 Humidify gas Limit insufflation pressure Limit duration of surgery
When do pyometras typically occur?
High progesterone
Low estrogen, LH
(Diestrus)
What is the best method for laparoscopic OVE
2 port lap
What type pf table do you use for laparoscopic procedures?
Tilt table
Use gravity to help move viscera
What local analgesia is used in laparoscopic OVE prior to port placement?
Bupivicaine 1mg/kg prior to port placement
Where do the ports go for laparoscopic OVE and OHE?
OVE:
Camera 1cm caudal to umbilicus
Instruments 2-4cm cranial to umbilicus
OHE:
Camera 1cm caudal to umbilicus
Instruments 2-4cm cranial to umbilicus or 1/3 distance fro umbilicus to pubis
What is ligasure?
Bipolar electrosurgery that compresses and denatures tissue to create a seal
Good for >7mm vessels
Can hold up to 3x systolic pressure
What are specimen bags used for in laparoscopic procedures?
Neoplastic tissue to prevent seeding elsewhere when removing tissue
What layers do you close close in the port incisions in laparoscopic OVE?
5 mm incision: SQ and skin
10mm incision: linea, SQ, skin
What are possible complications of laparoscopic OVE?
Splenic laceration/hemorrhage Pedicle hemorrhage SQ emphysema Loss of insufflation Dropped ovary or pedicle
What are indications for prophylactic gastropexy?
At-risk dogs:
Relative with GDV, large breed, deep chest
Great danes, Irish wolfhound, standard poodle
What side is the lap-gastropexy done on?
Right
What are possible complications of lap gastropexy?
Seroma (very common) Splenic laceration/hemorrhage Serosal tearing Loss of insufflation Dropped stomach
Conversion to keyhole technique is possible
What are the benefits of MIS?
Less pain Less tissue trauma Less analgesics Less infection Precision and safety Reputation
What are the advantages/disadvantages of standing castration (equine)?
Advantages: inexpensive, fast, avoids anesthesia
Disadvantages: dangerous, uncomfortable
Not recommended for mules, donkeys, ponies, AMH
What are the advantages/disadvantages of recumbent castration (equine)?
Advantages: IV anesthesia, better access, safe for surgeon
Disadvantages: Time consuming
What is a closed castration and what are the advantages/disadvantages?
Skin incision only
Advantages: removes a lot of tunic (reduces swelling)
Disadvantages: Need careful dissection not to cut into tunic
What are the two types of emasculators for equine castration and what is “the rule”?
Serra: 2 handles
Reimer: 3 handles
Rule: “nut to nut”- puts crushing edge on top and cutting edge on bottom
What is included in the aftercare of equine castration?
Walking exercise at least 2x daily (reduces swelling)
Hydrotherapy
NSAIDs
Antibiotics rarely used
Digital opening of incision (rarely needed)
What are possible complications following equine castration?
Swelling (edema Infection Hemorrhage (testicular a. Or pampiniform plexus- mostly seen in donkeys/mules) Evisceration (bowel or omentum) Severe pain Unaltered behavior Hydrocele Urethral transection Peritonitis
In a unilateral cryptorchid stallion, why would you not want to remove the descended testicle only?
Cryptorchid testicle will still produce testosterone
Will behave like stallion but look like gelding
What species have intra-abdominal testicles?
Elephant
Rock hyrax
What are common penile diseases of horses?
Squamous cell carcinoma
Penile paralysis
What is a common site of metastasis of equine penile squamous cell carcinomas?
Lungs
What is penile reefing?
Segmental posthetomy used to removed neoplastic lesions using two parallel circumfrential incisions
What is penile amputation (equine)?
Amputation to sib-ischial area where urethra is cut open and exteriorized
What is an episioplasty (caslick’s operation) (equine)?
Procedure done for mare that have age-related, poor peritoneal conformation
Prone to pmeunovagina (“wind sucking”)
Combined with other treatments for urine pooling and perineal injuries
Creates better seal and prevents air/feces from being pulled into vagaina
What is urethral extension (mares)?
Procedure done for mare that have age-related, poor peritoneal conformation
Poor conformation leads to incomplete emptying or urine
Urine can flow back into uterus and predispose mare to infections
What are types of 3rd degree perineal lacerations mares can experience, what are the risk factors, and how are they treated?
Rectovaginal laceration
Rectovaginal fistula
Foals feet push straight up and break through vaginal and into rectum
Risk factors- first foal, unassisted delivery
Tx: not considered an emergency. Clean, give analgesics and antibiotics. Wait 30 days to surgically close.
What is the purpose of ovariectomy in mares and what surgical techniques are used?
To remove granulose cell tumor or make a “jump” mare
laparoscopy, flank, oblique paramedian, ventral midline
All approaches: HEMORRHAGE
When is cesarean section indicated in mares?
After other approaches have been considered (assisted vaginal delivery, controlled vaginal delivery, fetotomy)
Usually to save mare, foal is usually dead
Time (<90 min to save foal)
Hemorrhage from uterine incision
What is controlled vaginal delivery (mares)?
Delivery of foal under general anesthesia
How do you diagnose a lesion as neoplastic?
FNA Tru-cut biopsy Incisional biopsy: take a fragment of mass out Excisional biopsy: remove entire mass Presumptive diagnosis
When would you take an incisional biopsy and what techniques are used?
FNA non-diagnostic
Easy to access mass
Diagnosis will change surgery done
Needle-core biopsy (Tru-cut or Jamshidi)
Wedge biopsy
Punch biopsy
Principle: the structure of the tumor remains intact, no seeding go the tumor or disruption of fascial planes around tumor
Where would you want to get a biopsy of a bone lesion?
Center of bone, endosteum
What are the margins for mass cell tumors? Vaccine tumors (sarcomas)?
Mass cell tumor: 3 cm margin, 1 fascial plane
Vaccine tumor: 5 cm margin, 2 fascial planes
When should biopsy be done?
For diagnosis of neoplastic vs non-neoplastic disease
Results will change treatment
Results may lead to -/+ aggressive treatment
Results may change what owners want to do
When should you not biopsy?
Diagnosis is certain
Emergency situations
High risk/complex location
Results will not change treatment
What are the two methods of bone biopsy?
Jamshidi needle
Michel trephine
What dictates where you should get your sample from when getting a biopsy?
Type of tumor-
Large soft tissue masses: center may be necrotic
Bone masses: periphery may be necrotic
(Where the blood supply comes from)
What are principles of oncologic surgery?
Excise all biopsy and fistulous tracts
Early vascular ligation
Wide margins
Gentle manipulation
Avoid contamination of healthy areas
Avoid (if possible) use of grafts/flaps
Pre-treat animals with diphenhydramine (MCT)
Avoid using drains
What are the different prognoses when only surgery is used for tumor removal?
Spleen hemangiosarc: 1-2 months
Osteosarc: 3-5 months
Oral melanoma: 7-8 months
Oral squam cell: 7-11 months
AGASACA: 18 months
What animals are predisposed to needing airway surgery?
Brachycephalic breeds
Beagles
Cocker spaniels
Poodles
What is the common presenting complaint of animals needing airway surgery?
Episodic or continuous respiratory distress/strenuous breathing
Gagging/regurgitation
Cyanosis or collapse
What are the components of brachycephalic airway disease?
Stenotic nares elongated soft palate Everted laryngeal saccules Laryngeal collapse/stenosis Hypoplastic trachea Enlarged tonsils
What diagnostic should always be included in work up of airway disease?
Radiographs
What are pre-surgical considerations for airway surgery?
Tracheostomy site preparation
Reduce swelling- pre-op steroids?
What is the goal of the caudal wedge technique in airway surgery?
Lifts and lateralizes nares
What suture pattern would you use for ellongated palate resection and why?
Simple continuous
Compresses vessels
What is the Co2 laser used for in airway surgery?
Hemostasis
What is a folding flap palatoplasty?
Soft palate surgery used to opens choanal area
Removes 50-60% of palatine muscle using electrocautery
Brings free caudal edge of palate cranial and suture to open wound bed
Keeps suture line away from tip of epiglottis
Increased diameter of nasophharynx and reduces snoring
Good for dogs with thickened palates: nose breathers (french bulldogs)
Good for revisions (pugs)
What causes laryngeal paralysis and what is the treatment?
Heriditary or idioiopathic (most common)
Older, large breed dogs (labs, st bernard, irish setter)
Bilateral paralysis
Tx: arytenoid lateralization (tieback)
Causes increased risk of aspiration pneumonia
What are indications for temporary tracheostomy?
Trauma to larynx Laryngeal collapse Post surgery for brachiocephalic airway syndrome Laryngeal paralyisis To allow surgical access to oral cavity
Where is a tracheostomy done?
Between 3rd and 4th cartilaginous ring of trachea
Transverse incision
What is required for post-op management of tracheostomy surgery?
Observation
Oxygen
Suction q2-4 hrs with whistle tip catheter
Tracheostomy tub kit ready
What causes collapsing trachea?
Miniature or toy breeds
~7 years old
Etiology unknown
Cartilage is hypocellular and deficient in glycoprotein and GAG content
Often concurrent main stem bronchus collapse occurs
What is a classic clinical sign for tracheal collapse and what diagnostic procedures would you use to diagnose it?
“Goosehonk” cough, severe respiratory distress, and cyanosis
Radiographs, fluoroscopy (best), tracheoscopy, transtracheal wash and culture
How do you treat tracheal collapse?
Medical- antitussives, sedatives, anabolic steroids
Surgical- external rings (cervicotracheal collapse) or intraluminal stents (thoracic collapse, most common)
What is the #1 need in thoracic surgery?
Ventilation
What are common sutures used in thoracisc surgery and what are they used for?
Prolene for tiebacks (non-absorbable)
PDS or Maxon for rib approximation
Silk- vessel ligation
What are hemoclips commonly used for?
Bleeding vessels
PDA
Lung lobectomy (cats)
Thoracic duct ligation
What are the two surgical approaches to the thoracic cavity and when would each be used?
Lateral/intercostal thoracotomy (PDA surgery) Median sternotomy (removal of large masses)
What is an important landmark to remember with thoracic surgeries?
Scalenius m. Inserts on 5th rib
What suture material do you use to close lateral thoracotomy? Midline sternotomy?
Lateral- PDS/ Maxon
Midline- need to close sternum
Dogs >10kg: 22-24 ga wire
Cats/dogs <10kg: 1 or 2 polypropylene suture
What vessels do you have to ligate and what suture pattern do you use to close lunglobectomy?
Pulmonary a. followed by pulmonary v. (Non-absorbable suture)
Horizontal mattress (prolene, PDS)
How do you handle traumatic pneumothorax vs spontaneous pneumothoax?
Traumatic: can put chest tube
Spontaneous: need to figure out cause- median sternotomy allows for exploration of entire chest
What are the functions of upper airway vs lower airway?
Upper: Conduct for airflow Olfaction Phonation Thermoregulation Filters and conditions air Protects lower airway
Lower: gas exchange
What are the primary structures of resistance in upper airway?
oral cavity
Nasal valve
Rostral nasopharynx
Larynx
In upper airway dysfunction, what results from increased resistance? Increased turbulence?
Incesed resistance -> decreased ventilation -> poor performance
Increased turbulence -> increased noise
What types of endoscopy is performed on horses when assessing airway?
ALWAYS DO UNSEDATED
Resting or exercising (gold standard)
Oral endoscopy or sinoscopy
What are important structures seen on radiographs of horse head and what is important to remember?
Paranasal sinuses
Dental arcades
Beware of superimposition
When using ultrasound for assessing a horse’s airways, what is a limiting factor?
Bone
What is a main advantage of CT or MRI when assessing a horse’s airways/head?
No superimposition
CT is method of choice
What are problems of nasal passage (horses)?
Epidermal inclusion cysts (atheromas) Redundant alar folds nasal lacerations nasal septal disease Engorgement of nasal mucosa (Horner's) Wry nose
Which of the horses sinuses are paired?
Frontal Caudal maxillary Rostral maxillary Dorsal conchal Ventral conchal Sphenopalatine
What are common diseases of the paranasal sinuses in horses?
Sinusitis Sinus cyst Ethmoid hematoma Neoplasia Trauma
What are the different kinds of sinusitis seen in horses and how are they treated?
Primary: strep; lavage (trphine), abx +/- sx debridement
Secondary: dental dz; address underlying cause!
Diagnose with endoscopy and rads
Sinocentesis for culture and sensitivity
What are the landmarks for trephination of the frontal sinus (horses)?
Draw a line from midline to medial canthus
60% of distance from midline along this line and 0.5 cm caudal to the line
What are the landmarks for trephination of the caudal maxillary sinus (horses)?
2 cm ventral to the medial canthus
What are the landmarks for trephination of the rostral maxillary sinus (horses)?
Draw a line from medial canthus to infraorbital foramen
1cm ventral to this line and midway between canthus and rostral extent of facial crest
What is the most common type of sinus neoplasia in horses and what is the prognosis?
Squamous cell carcinoma
Poor; often dx late in disease process
What is a progressive ethmoid hematoma?
Mass arising from ethmoids or sinus of horses
Results in mild, intermittent epistaxis or facial deformation/airway obstruction (rarely)
Dx by endoscopy
Tx: intralesionsal formalin, laser photoablation, sx
T/F? The pharynx has no rigid support?
True
What are common diseases of the pharynx in horses?
Lymphoid hyperplasia Dorsal displacement of soft palate Pharyngeal collapse Palatal instability Pharyngeal cicatrix
Foals:
Cleft palate
Choanal atresia
Nasopharyngeal dysfunction
What is the common clinical sign of dorsal displacemtn of the soft palate in horses and how is it diagnosed and treated?
CS: noise during expiration
Dx: exercising endoscopy
Tx: laryngeal tie forward
What is recurrently laryngeal neuropathy n horses and how is it diagnosed and treated?
Demyelination and axonopathy of the RLN
Paresis leads to paralysis of intrinsic laryngleal muscles
Inspiratory obstruction and noise at exercise (commonly left side)
Affects large horses (TB, draft)
Dx: resting endoscopy, laryngeal u/s/
Tx: prosthetic larygnoplasty (tie back)
What is the difference between lateral vs medial compartments of gutteral pouches in horses?
Lateral: smaller, contains ex.carotid a., maxillary a., facial n.
Medial: larger, contains int. Carotid, cranial cervical ganglion, sympathetic trunk, CN 9-12, ventral straight muscles
What is gutteral pouch mycosis (cause, dx, tx)?
Rare but life-threatening fungal infection of gutteral pouch in horses
Commonly caused by Aspergillus spp.
Dx: endoscopy
Tx: Medical tx fungus, NSAIDs, nutritional support
What are common diseases of the trachea in horses?
Collapse
Stenosis
Perforation
Foreign body
Where do you perform tracheotomy and tracheostomy in horses?
Tracheotomy:
longitudinal incision at level of junction of prox and mid 1/3 of neck
Transverse incision between rings, <50% circumference
Tracheostomy: 2-5 tracheal rings
What are indications for thoracic surgery in horses?
Pleuritis Pleuropneumonia Pulmonary abscess Trauma Diaphragmatic hernia
What are common thoracic surgical procedures done in horses?
Rib fracture repair (foals)
Rib resection and thoracotomy
Thoracoscopy
What are clinical signs of urethral obstruction and rupture in cattle?
Urethral obstruction: abdominal pain, distended bladder on rectal
Rupture urethra: distended bladder on rectal, ventral swelling, cellulitis, uremic smell
What is the main difference in clinical signs between ruptured urethra and ruptured bladder?
Ruptured bladder will have no abdominal pain and abdominal distention
What are the goals of treatment of urolithiasis?
Steers: Perineal urethostomy with epidural anesthesia (dissect down to penis and transect)- salvage for market
Pet goats/pigs: treat with surgery
What is the cause of urolithiasis?
Concentrated diets
Imbalance in Ca:P ratio
Lack of water
high urine pH
Why are males more prone to urolithiasis?
Sigmoid flexure and vermiform appendage (urethral process) Narrowed urethra (early castration)
What are the clinical signs of urethral obstruction in goats?
Early signs:
Restlessness or anxiety
Tail twitching
Progressive: Excessive vocalization Stretching/arched back Forceful urination Reduced urine flow Bloody urine Crystals on preputial hairs
Advanced: Swelling/pain of urethra Ventral edema Sudden cessation of clinical signs Abdominal distention Anorexia Anorexia Depression Weakness Death
What is the best way to diagnose urolithiasis in goats?
CT!
What is the initial management for urolithiasis in goats?
Massage or manipulation of urethral process Exteriorization of penis Sedate with diazepam Removal of urethral process Passage of catheter
How do you medically manage urolithiasis in goats?
Promotion of urethral relaxation (diazepam, ace, AVOID xylazine)
Ammonium chloride, walpoles solution: acidify urine
How can you surgically manage urolithiasis in goats?
Urethral process amputation Percutaneous catheter placement Tube cystotomy Bladder marsupialization Perineal urethrostomy
Fluid of choice: NaCl
What is the most common surgical procedure for urolithiasis in goats?
Tube cystotomy
Allows urethra to rest and complete recovery can occur in a ew months
Allows administration of urinary acidifiers
MUST change dieet!
What are common complications of tube cystotomy?
Blockage of tube
Failure of balloon
Continued straining
Premature removal of tube
What is bladder marsupialization?
Surgical management of urolithiasis in ruminants
“Permanent” solution after failed tube cystotomy
Minimally invasive technique, two inch incision
Approximately 4cm stoma is created for urine to drip out
What are possible complications of bladder marsupialization?
Cystitis Pyelonephritis Premature closure Bladder prolapse Urine scalding
What is a perineal urethrostomy?
Salvage procedure for urolithiasis in ruminants
High rate of stricture
Incision ventral to anus, penile body freed from ischium, urethral mucosa spatulated
What is the most common type of urolith in horses and where is it commonly found?
Calcium carbonate
Neck of bladder
How can you surgically manage urolithiasis in horses?
Subischial urethrostomy
Lithotripsy
Laparocytotomy
What is a patent urachus? How is it surgically and medically managed?
Persistent urachus (carrier urine from bladder to allantois) in foals
Not life-threatening
Can resolve without treatment
Medically managed with silver nitrate cautery
Surgically managed with umbilical resection
What do the urachus, umbilical artery, and umbilical vein become in developed animal?
Urachus- scar at apex of bladder
Artery- round lig of bladder
Vein- falciform lig
What is omphalophlebitis?
Infected umbilical remnants
Outward signs of infection -> need to do U/S
What is uroperitoneum and what can cause it?
Urine in peritoneal cavity
Can be caused by ruptured bladder, urachus, or ureter
What are clinical signs of uroperitoneum and how is it diagnosed?
CS: History and age (<6 days) Males > females Depression Abdominal distention Abnormal urination
Dx: Abdominocentesis Electrolytes- increased K+, creatinine, BUN*** Ultrasonography Dye studies Contrast studies
What are electrolyte abnormalities for uroperitoneum and how do you medically manage it?
Increased K+, BUN, creatinine
Fluid therapy (0.9% NaCl)
Dextrose
Crystalline insulin
Sodium bicarb if acidotic
What is the major concern when doing surgery/biopsy of kidneys?
Hemorrage
What part of the kidney do you biopsy from and why?
Cortex
Only want glomeruli
How do you manage a proximal uretal injury vs a distal uretal injury?
Proximal: CANNOT be re-routed to bladder. Need to remove.
Distal: CAN be re-routed to different spot on bladder
What do you have to be careful about when manipulating lateral ligaments of bladder?
Large arteries and ureters
DON’T LIGATE UNLESS YOU HAVE TO
What suture pattern do you use to close bladder?
Simple interrupted
How long does it take the urethral mucosa to regenerate?
7 days
How do you manage a minor urethral injury vs major urethral injury?
Minor: conservative management (indwelling catheter)
Major: requires surgery (anastomosis, urethrotomy, urethrostomy)
What surgical techniques are used for ureteral obstruction?
Resection and preimplantation
Ureterotomy
Ureteral stenting
SUB subcutaneous ureteral bypass
What is ureteral ectopia?
Ureter attaches to bladder at abnormal spot
How long does it take for bladder mucosa to heal?
5 days
Full strength/thickness: 14-21 days
What are the most common methods/procedure of small animal gonadectomy in US?
Ovariohysterectomy
Castration
What are indications for gonadectomy in small animals?
Pet overpopulation Sex-based aggression Mammary neoplasia Pyometra Uterine/ovarian neoplasia Prostatic disease Perineal herniation Prostatic neoplasia Testicular neoplasia
When is the risk of mammary neoplasia reduced with gonadectomy?
If done before 1st or 2nd heat cycle in dog
If before 6 months of age in cats
What percent of female dogs have a pyometra by 10 years of age?
25%
What percent of male dogs experience bph by 5 years of age?
50%
What are friction knots used for the vascular pedicles?
Strangle
Miller’s
Surgeon’s (less secure)
Modified miller’s (less secure)
What are the terminal knots used on vascular pedicles?
Used for continuous subcuticular/intradermal patterns
Aberdeen
Square throws- 10x larger volumes
What are possible complications of castration and ovariectomy?
Castration: Hemorrhage Urethral/ureteral ligation Prostatic ligation SSI
Ovariectomy: hemorrhage Ureteral ligation Ovarian remnant syndrome Sphincter mechanism incontinence
What are risk factors for ureteral/urethral ligation during small animal castration?
Urethral ligation:
Stray dissection, deep bites when closing
ureteral ligation:
Poor visualization/exposure
What is the preferred approach to prostatic ligation?
Caudal midline celiotomy
Which side is more common to have ovarian remnant syndrome?
Right
What effects does castration have on a dog’s urethral sphincter mechanism?
Increased collagen
Decreased smooth muscle
(Especially in proximal urethra)
What percent of spayed female dogs experience incontinence?
Up to 75%
Literature says ~12-20%
In gonadectomy of small animals, what contributes to surgical site infection?
Traumatic tissue handling
Excessive dissection
Poor tissue apposition
What is the best sterilization method for laparoscopic equipment?
Gas sterilization
