Exploratory and rumen surgery, abomasal diseases, abomasal surgery Flashcards
What are the blocks for paralumbar fossa analgesia?
Line block (local)
Inverted L
Proximal/Distal lumbar paravertebral
Caudal epidural
Local analgesia blocks _____ whereas regional analgesia blocks _______.
Local–infiltration of local analgesic
Regional–desensitization by blocking major nerves
Why is regional analgesia preferred over local?
Better incisional healing.
What nerves do you block with proximal intervertebral?
T13, L1, L2
What is the landmark for proximal intervertebral block?
Foramen located immediately caudal to corresponding vertebra. ID cranial edge of transverse process, then ID point 1.5-2 inches off midline (this is where you block).
What is the landmark for distal paravertebral block?
Distal extremity of transverse processes of L1, L2, L4
Where do you inject block for distal paravertebral?
Ventral and dorsal to transverse process, have to block ventral and dorsal rami.
When do you use a standing approach for an exploratory laparotomy?
Minimal intra-abdominal pressure
When do you use a left flank approach?
problem suspected on the left side (rumen)
When do you use a right flank approach?
problem suspected on right side (intestinal, liver)
Sleeve goes on the ____ arm for a right flank approach and the ____ arm for a left flank approach.
Left arm–right flank
Right arm–left flank
When in the abdomen, what is an indicator that there is no torsion/volvulus?
Find omasum and should palpate vessel on top, this is indicator.
What structure is “home base” when in the abdomen?
left kidney
Where do you make your incision for exploratory?
Hands width below transverse process and hands width behind last rib
What are the layers that you cut through when making an incision for exploratory?
- external abdominal oblique (thickest)–fibers run caudal ventral
- internal abdominal oblique–fibers run cranial ventral
- transverse abdominus (thinnest)–fibers run straight up and down
- peritoneum
Air should move ____ abdominal cavity upon incision.
INTO, if air comes out suspect rupture
What structures should you be conscious of when cutting through peritoneum?
Rumen or LDA in left flank approach.
Duodenum, RDA, abomasal volvulus (AV) in right flank approach.
What is the most common indication for a rumenotomy?
Hardware disease
What should be done during a rumenotomy to prevent contamination of abdomen?
Anchor rumen to incision, creates a seal.
What order should you place suture when anchoring the rumen during a rumenotomy?
External skin
Seromuscular layer of rumen
External skin
Seromuscular layer of rumen
What are your options for suture patterns for rumen closure?
Double layer inverting continuous pattern
Cushings
Guard rumen stitch works best
What steps are taken when closing a rumenotomy incision?
- rumen closure
- lavage serosa of rumen prior to removing stay sutures
- routine closure of fossa incision
What are indications for a rumenostomy?
chronic rumen tympany, enteral nutrition
What are the reasons for a permanent rumen fistula?
research, large commercial farms (transfaunation)
What is important in pathophysiology of abomasal displacement?
Atony, displacement occurs as a result
What species is abomasal dispalcement most common in?
dairy, usually older female Holsteins
Is LDA or RDA more common?
LDA
What will you find on an exam of a cow with DA?
Ping in location of displacement
What is the clinical pathology of a DA?
hypokalemia hypochloremia metabolic alkalosis ketosis hypoglycemia hypocalcemia
What is different about clin path of an AV?
hemoconcentration, hyponatremia
What causes atony of the abomasum?
high VFA concentration, concurrent diseases
Is it okay to wait till tomorrow to treat an RDA?
NO! Never sleep on an RDA, can easily turn into an AV.
What is a nonsurgical procedure to treat a DA?
cast and roll
What are differentials for a left sided ping?
LDA
Rumen void
Pneumoperitoneum or rumen tympany
What are the two right sided, off-feed pings?
proximal colon distention (spiral colon gas)
Duodendal gas
What factors predispose cattle to abomasal ulcers?
Stress and high concentrate feeds
What are the two categories of abomasal ulcers?
Perforating
Non-perforating
What signs do you see with a Type 1 ulcer? What signalment?
mild anemia, dark soft feces
early post-partum period in dairy cows, calves under stress
What signs do you see with a Type 2 ulcer?
melena, anemia, depression, acute death
What other disease are Type 3 ulcers associated with?
Lymphosarcoma
What signs do you see with a Type 3nulcer? What signalment?
Anemia, melena, enlarged LN or evidence of LSA, grave prognosis
BLV-positive cows
What signs do you see with a Type 4 ulcer?
Perforation with localized peritonitis, signs similar to hardware disease
Where in the abomasum are Type 4 ulcers typically found?
LESSER curvature
What signs do you see with a Type 5 ulcer? What signalment?
Perforation with diffuse peritonitis, severe systemic disease, signs look like shock
Where in the abomasum are Type 5 ulcers usually found?
GREATER curvature
What type of abomasal ulcer may require surgical repair?
Type 4
Abomasitis is caused by what organism?
Clostridium perfringens type A
What happens as a result of abomasitis? What is the signalment?
profound endotoxemia leads to death
young neonatal calves, usually dairy <21 days old
How does abomasitis present?
rumen/abomasal tympany
abomastitis
abomasal ulceration
What is the better approach for surgical repair of an LDA?
standing restraint–left paralumbar fossa abomasopexy on left side
What structures should you be conscious of when doing a RIGHT paralumbar omentopexy?
Duodenum, RDA, AV
What are the goals of a right paralumbar fossa omentopexy?
LDA–move back on right side of ventral abdomen
RDA/AV–lift dorsally and push cranially
Incorporate omentum into first layer of closure of peritoneum and transversus abdominus.
What are the advantages of doing a standing DA surgery?
Can do alone.
Less possibility of cuasing abomasal dysfunction.
Not necessary to have displacement upon presentation.
What structures should you be conscious of when doing a LEFT paralumbar fossa abomasopexy?
rumen, LDA
Which abomasopexy approach gives the most stable and exact fixation?
Right paramedian abomasopexy
After doing a right paramedian abomasopexy, roll patient into ____ lateral recumbency, then what?
LEFT, then sternal
What is the sequence of a “Roll and Toggle” procedure?
Animal in RIGHT lateral recumb, roll from to dorsal and ping cow, insert trocar into ping area. Place toggle, then repeat 8cm caudal to first trocar with second toggle. Tie toggles, then roll into LEFT lateral recumb.
Roll and toggle is a ______ procedure.
BLIND
It is necessary to have a _________ abomasum for roll and toggle.
Gas-filled
Which techniques are good for a “floating” LDA?
Omentopexy, pyloro-omentopexy
Which LDA surgery is best for a pregnant cow?
Left flank abomasopexy
Which LDA surgery is best for young calves?
Right paramedian abomasopexy
What kind of situation is abomasal volvulus?
SURGICAL EMERGENCY
What procedure should you NOT do with an abomasal volvulus?
Roll and toggle
What condition can lead to an abomasal volvulus?
RDA
