Exam 3: Lecture 21 - Exploratory Celiotomy Flashcards
what is the definition of celiotomy
incision into the abdominal cavity
what is the definition of laparotomy
flank incision
what is the definition of acute abdomen
sudden onset of signs (distention, pain, vomiting) referable to the abdomen
what is the definition of abdominal evisceration
herniation of peritoneal contents through the body wall with exposure of the abdominal viscera
what are the 2 main reasons for abdominal exploratory
diagnostic and therapeutic
what do we look for with a diagnostic abdominal exploratory
- biopsies
- visualization
why do we do therapeutic abdominal exploratory
- GDV
- severe hemorrhage
- colonic perforation
- FB removal
- evisceration
what is the #1 cause of post-op major abdominal evisceration
Ovariohysterectomy
T/F: We should make a list of the samples needed prior to the procedure, prioritize the list, discuss the list with the primary clinician, and take the list to the OR and use it
true! These are 4 things we should do
what are the 5 things in preoperative management
- history
- PE findings
- radiographic studies
- ultrasound studies
- lab findings
T/F: depressed/lethargic animals always show pain
false! they sometimes may not show any pain
why should we observe trauma patients for more than 8-12 hours
because hemorrhage may not show up for 3-4 hours
what are the 6 things we look for in our general observations
- attitude and posture of patient
- temperature
- respiratory rate and effort
- heart rate and rhythm
- abdominal auscultation, percussion, and palpation
- serial PEs
what are the things we can do for further management
IV catheters, blood samples, urine collection, radiographs, and other types of diagnostics if radiographs do not help
what things should do blood test for
hematocrit, total protein, glucose, BUN, CBC, or other tests that are indicated
how can we collect urine
cystocentesis, catheterization
what tests should we do if radiographs are nondiagnostic
abdominocentesis, diagnostic peritoneal lavage, FAST exam
why is owner communication critical
if you take time to speak with the owner about these things before surgery the owner is much more likely to deal with these situations better should they occur
what are 5 things we should consider for anesthesia
- underlying disease
- age of animal
- condition of animal
- length and type of surgical procedure
- remember pain management
what are the 4 things we should consider for the use of antibiotics
- underlying disease
- animal overall general health
- length and type of surgery
- surgical setting (OR vs field conditions)
T/F: Surgeries less than 1.5 hours without opening a contaminated hollow viscus do not usually warrant prophylactic antibiotics
true!!
what are the 5 important structures we need to remember for surgical anatomy
- rectus sheath and rectus abdominus m
- external/internal abdominal oblique m
- transversalis fascia
- transversalis abdominus m
- peritoneum
what should we always make sure we count before incision and before closing
sponges!!
what are 3 tips on prepping
- nice even shave margins
- no razor burn
- don’t cut nipples
what are 3 tips for closing
- wound edges nicely apposed
- nice, evenly spaced sutures
- no thumb forceps bruises on the skin
T/F: If it looks bad on the outside your clients will assume that whatever you did on the inside must be bad too
true!! Make it look pretty
What should we for prep if the patient is a male
clip prepuce hair, flush the prepuce with antiseptic solution prior to sterile prep, and clamp the prepuce to one side with a towel clamp
what solutions can we flush the prepuce with
diluted chlorohexidine or diluted povidone-iodine
T/F: Male or female we still enter the abdomen through the linea alba
true!
what are the steps to enter the abdomen
- incise from xyphoid to pubis
- sharp/blunt dissection of SQ tissue to fascia
- ligate and cauterize small SQ bleeders
- avoid mammary tissue in lactating patients
- ID the linea alba
- tent the abdominal wall and sharply incise the linea alba with a scalpel blade
T/F: We should use a systemic exploration
true!
T/F: you don’t need develop a technique and do not need to stick to it
false! You should develop the technique
T/F: You shouldn’t quit until the job is done… just because you found a major problem does not mean that it is the only problem present
true!!
what should we do when we explore the cranial quadrant
- examine the diaphragm and entire liver
- inspect the gall bladder & biliary tree and then express the gall bladder
- examine the stomach, pylorus, proximal duodenum, and spleen
- examine both pancreatic limbs, portal vein, hepatic arteries, and caudal vena cava
what are the 5 things we explore the caudal quadrant
- descending colon
- urinary bladder
- urethra
- uterine horns or prostate
- inguinal rings
what should we check when we explore the intestinal tract
palpate and visually inspect from duodenum to descending colon, observe mesenteric vasculature and nodes (both sides), and dont get sidetracked and forget to inspect the entire length
what should we look for when we explore the right gutter
use mesoduodenum to retract intestines, palpate the right kidney, examine the right adrenal, right ureter, and right ovary or stump
what should we look at when we explore the left gutter
use descending colon to retract intestines, palpate the left kidney, examine the left adrenal, left ureter, and left ovary or stump
what temp fluid should we lavage the abdominal cavity
warm fluids to avoid hypothermia and decrease the chances of post-op intection
T/F: Adding antiseptics/antibiotics to lavage fluids is of benefit
false! there is no evidence that there is benefit
In what order do we close the abdominal wall
- linea alba
- subcutaneous
- subcuticular
- skin
does simple continuous patters increase the risk of dehiscence in the linea alba
it does NOT
what are the Do’s when closing
- tighten suture enough to appose tissues
- incorporate full thickness bites if on midline
- use external rectus sheath if off midline
- use an absorbable suture in a simple continuous pattern in subcutaneous tissue
- reappose the prepucialis muscle fibers in males
- use nonabsorbable skin sutures/staples
what are the do nots when closing
- dont strangulate tissues with suture
- dont damage tissue with forceps
- dont incorporate falciform ligament between fascial edge
- dont include muscle when closing external rectus sheath
- dont attempt to include peritoneum
T/F: Glue is not a substitute for good technique
true!!
T/F: Absorbable suture in skin is absorbable
it is NOT absorbable in the skin
when are you most likely to see dehiscence
3-5 days post op
what 11 things increase the rate of dehiscence
- wound infection
- fluid or electrolyte imbalance
- anemia
- hypoproteinemia
- metabolic disease
- immunosuppression
- corticosteriods
- abdominal distention
- chemotherapy patients
- radiation therapy patients
- improper surgical technique
What 3 things can delay healing
- debilitated patients
- very young
- very old
