Exam 3: Lecture 22 - Principles of LA soft tissue sx Flashcards
How is handling large animal tissue different from small animal
thicker skin, skin does not bruise, and hemorrhage is generally not a problem
what are the 3 ways to reduce trauma in LA tissue handling
- fingers
- stay sutures
- atraumatic forceps
What happens if a horse loses <15% of their blood volume
no clinical signs, acceptable amount during surgery
What happens if a horse loses 15-20% of their blood volume
there are clinical signs
What happens if a horse loses >40% of their blood volume
there is significant risk of death
what are the benefits of having a horse stand for surgery
- prevents complications of being recumbent
- prevents risk of recovering from anesthesia
- better access for select structures
- reduced cost
what are the benefits of having a horse recumbent for surgery
- safer for the surgeon
- no movement - better control of surgical field
- better access to MOST structures
what is this structure?
Epiglottis
Why do we do upper respiratory tract endoscopy
primarily for diagnostic purposes
what are the 3 ways you can perform an upper respiratory endoscopy
- not sedated at rest
- treadmill
- under saddle
what is the most common way to access/visualize the arytenoids
laryngotomy
what is a secondary way we can access the arytenoids
pharyngotomy
what type of retractors are these (self retaining or hand held)
self retaining
what type of retractors are these
handheld
what are the considerations for healing when doing upper airway surgery in LA
mucosa heals rapidly but there is usually a lot of swelling and the potential need for a tracheotomy for relief
there is also potential for mucosal “webbing” which requires later revision
what are the common complications of upper respiratory surgery
- excessive swelling - blocks airway
- damage to nearby structures
- surgeries that are re-opening airway
- surgical site infection
What is the most serious complication of URT surgery
excessive swelling
how do we correct excessive swelling in URT surgery
post-op tracheotomy if needed
what organ is nicknamed “sparky”
cecum
what are the problems with diagnostics of GI issues in the horse
it is limited due to the size of abdomen and length of GIT
How can we diagnose issues in the GIT
- gastroscopy
- rectal palpation
- abdominal ultrasound
- abdominal radiographs
- nasogastric tube intubation
- abdominocentesis
- bloodwork
what are the things we usually do for a colic workup
- rectal palpation
- abdominal ultrasound
- abdominal radiographs
- nasogastric tube intubation
- abdominocentesis
- bloodwork
what are the approaches for a celiotomy
ventral midline - most common
paramedian - right side
paralumbar fossa - uncommon
laparoscopic portals
what is the most common surgery in LA
exploratory laparotomy (colic sx)
what are the surgical considerations for colic sx
clean if bowel is unopened and clean-contaminated if the bowel is open (but game over if ingesta enters abdomen because theres nothing we can do to prevent sepsis)
what are the 5 steps to colic sx
- exploration
- de-rotation
- enterotomy
- resection and anastomosis
- biopsy
what are some considerations for healing with abdominal sx in LA
serosa can have problems and do not EVER use dry gauze
what are the 7 complications of abdominal sx in LA
- adhesions
- hemoabdomen
- peritonitis
- ileus
- diarrhea
- endotoxemia
- incisional infection
what is a MAJOR post-operative issue of colic surgery that can lead to death
intra-abdominal adhesions
what are the ways to reduce adhesions
- gentle handling of the tissues
- keep tissues moist
- use of lubricants
- strict asepsis
- prevent blood from entering the abdomen
what are the diagnostics we can use for surgical urogenital tract
palpation, ultrasound, or endoscopy
what are common urogenital tract procedures for males
- castration
- cryptorchid castration
- urolithiasis
- penile injuries and problems
- preputial injuries and problems
- inguinal hernia
what are common urogenital tract procedures for females
- repair foaling injuries
- correct vaginal conformation
- ovariectomy
what are common urogenital tract procedures for foals
bladder rupture
what are the 3 approaches for cryptorchid surgery
inguinal, parainguinal, and laparoscopic
what are the approaches for male urogenital surgery (for non cryptorchid)
perineum and penis
what are the approaches for female urogenital tract surgery
via the back end with standing sedation and epidural
what are the 4 approaches for ovariectomy in mares
- laparoscopy
- flank
- vagina
- ventral midline celiotomy
what are some surgical considerations for urogenital tract surgery
- may need to catheterize bladder
- function is an important outcome
- approaches can be challenging (small spaces and bladder is difficult to access in adult horse)
what are some considerations for healing with urogenital tract surgery
- healing can be a challenge (stricture formation and breakdown of repair)
- back end of the mare has a lot of contamination (repair breakdown is common)
- give distal urethra a rest (create a perineal urethrostomy)
what are the most common complications of urogenital tract surgery
- bleeding
- loss of function
- breakdown of repair
- stricture
- infection
what are the principles of laparoscopy in equine medicine
- abdomen is insufflated with CO2
- blind stab incision is made to place scope portal
- scope is introduced through portal that maintains pressure in abdomen
- remaining portals are created with visualization from the scope
what 3 instruments do you usually need for laparoscopy
1 scope and 2 instrument portals
what are the common uses for equine laparoscopy
- cryptorchidectomy
- ovariectomy
- explore abdomen in chronic cases
what type of cryptorchidectomy is this picture showing
intra-abdominal testis
what type of cryptorchidectomy is this picture showing
gubernaculum but no cord
what type of cryptorchidectomy is this picture showing
It is the cord exiting normally through the internal ring…… not cryptorchidectomy
what are the 3 main preoperative considerations
- withhold feed
- NSAIDs
- Antibiotics
why do we withhold feed
- space in abdomen
- less weight on diaphragm if in trendelenburg position
- increase time withheld for dorsal recumbency
what are some general complications for equine sx
- subcutaneous emphysema
- retroperitoneal insufflation
- bowel perforation
- hemorrhage
