Exploratory Celiotomy (21) Flashcards
Dr. Thompson
What is a celiotomy?
incision into the abdominal cavity
“midline celiotomy’
What is a laparotomy?
flank incision
What is an acute abdomen?
sudden onset of signs (distention, pain, vomiting) referable to the abdomen
What is an abdominal evisceration?
herniation of peritoneal contents through the body wall with exposure of the abdominal viscera
When may hemorrhage not show up until? Biliary tract?
3-4 hours
1-2 weeks
How long should you observe trauma patients?
> 8-12 hours
What all should you communicate with a client when you take their animal for an exploratory celiotomy?
- mention the chance of post-op infection
- mention the possibility of wound dehiscence
- may not find any gross abnormalities
- chance she may not make it
- need to be available by phone during the surgery so if something is found during surgery, can call
How long is a surgery maximum that does not need antibiotics? What specification also?
1 1/2 hours - without opening a contaminated hollow viscus
What are the layers of the abdomen from superficial to deep?
- rectus sheath (rectus abdominus m.)
- external/internal abdominal oblique m.
- transversalis fascia
- transversalis abdominus m.
- peritoneum
Why is the linea alba easier to locate near the umbilicus?
because it becomes thinner back near the pubis
What is the linea alba the insertion site of?
the external abdominal oblique muscle (via the rectus sheath)
How does the linea alba differ from location to location?
- caudal to xiphoid: cm wide and a mm thick
- caudal end of the linea alba: 1 mm wide and much thicker
How do you prepare a male animal for exploratory celiotomy?
- clip hair
- flush prepuce with antiseptic solution before sterile prep
- clamp prepuce to one side with a towel clamp
How do you incise the tissue dealing with a prepuce?
just cranial to the prepuce, curve your midline incision to the side opposite the clamped prepuce
incise the SQ tissues and prepucialis m.
ligate or cauterize veins at cranial prepuce
How do you approach this abdomen for an exploratory celiotomy?
just cranial to the prepuce, curve your midline incision to the side opposite the clamped prepuce
incise the SQ tissues and prepucialis m.
ligate or cauterize veins at cranial prepuce
Once you’ve incised the skin and SQ tissues, what else do you do to get into the abdomen?
locate the linea alba - SQ tissues must be incised or undermined and muscular fascia identified before locating the linea alba
cut on white line, no matter male or female
Explain a midline celiotomy approach (steps)
- incise xiphoid to pubis
- sharp/blunt dissection of SQ tissue to fascia
- ligate and cauterize small SQ bleeders
- avoid mammary tissue in lactating patients
- identify linea alba
- tent abdominal wall & sharply incise the linea alba with a scalpel blade
How do you deal with the falciform ligament?
digitally break down one side or excise it
How should you approach an exploratory celiotomy?
use a systematic exploration
- develop a technique and stick to it
don’t stop after you found a major problem, may be more
What technique for exploratory celiotomy?
- explore cranial quadrant
- explore caudal quadrant
- explore intestinal tract
- explore the gutters
In the cranial quadrant, what should you do?
examine both pancreatic limbs
What do you explore in the caudal quadrant?
How do you explore the intestinal tract in an exploratory celiotomy?
- palpate and visually inspect from duodenum to descending colon
- observe mesenteric vasculature and nodes
- inspect entire length!
How should you explore the right gutter? **
use mesoduodenum to retract intestines - toward center and go in between body wall and mesoduodenum
- palpate the right kidney
- examine the right adrenal gland
- examine the right ureter
- examine the right ovary or stump if spayed
What do you explore in the left gutter? **
use descending colon to retract intestines toward midline
- palpate the left kidney
- examine the left adrenal gland
- examine the left ureter
- examine the left ovary or stump
How do you lavage the abdominal cavity?
- always use warm fluids - NOT room temperature
- no evidence of efficacy of antiseptics in lavage fluids
What are the Dos when closing?
What are the donts with closing?
When are sutures likely to dehisce?
3-5 days post-op
When could there be an increased rate of dehiscence?
When may delayed healing occur?
- debilitated
- very young
- very old
