Exploratory Celiotomy

Question 1

Standard landmarks for preparation

Answer 1

Xyphoid to pubis

Laterally beyond mammary chains

Question 2

Exploratory celiotomy is with a ____ midline appraoch, involving the incision into these three layers…

Answer 2

• Ventral midline
• Skin, Subcutaneous layer, and linea stab incision (cranial to umbilicus)

Question 3

Important to extend incision of the linea alba from the xyphoid to the pubis using ____ scissors and ____ blade.

Answer 3

Mayo scissors, scalpel blade

Question 4

The abdominal muscles are closer together _______.

Answer 4

cranially

Question 5

We make our stab incision ____ to the umbilicus becuase our organs are further away from the body wall.

Answer 5

Cranial

Question 6

The holding layer is the strongest layer of the abdomen, it is what is needed to grab with your sutures as you are closing hte abdomen. What is this layer?

Answer 6

External sheath

Question 7

Exploratory Celiotomy: Cranial Quadrant

Answer 7

• Diaphgram
• Esophageal hiatus
• Liver
• Gall bladder
• Stomach
• Pancreas (L limb)

Question 8

When we look into the cranial quadrant of the abdomen, the most cranial aspect is the diaphragm. Upon opening up the abdomen here, we mainly see the _____ tendon of the diaphragm.

Answer 8

Central

Question 9

Guillotine technique for biopsy of the liver

Answer 9

Notches created in the liver margins

Tieing suture material in nothces and tightening it down, and excising the liver distally towards the free border. The suture in place will provide hemostasis, allowing to take a failry decent seized biopsy.

Question 10

A liver biopsy technique that punches holes in the liver to take samples, and created defect then packed with hemostatic agent such as gelfoam, is called:

Answer 10

Baker’s Biopsy Punch

Question 11

It is imporant not to squeeze or attempt to express gall bladder - instead we do the ____ ____ test, where we create a dimple to see if it can create an indentation with your finger. If you can, it won’t be obstructed.

Answer 11

Dough Boy

Question 12

Inspissated bile

Answer 12

Chunky bile

Question 13

Gall bladder removal is called ____

Answer 13

Cholycystectomy

Question 14

What is the gastric “slip”?

Answer 14

As you pinch the gastric wall between your fingers, the mucsoa and submucosa should slip away - and all that remains in your fingers is the serosa and muscularis layers.

Question 15

The ___ limb of the pancreas is assocaited with the stomach.

Answer 15

left

Question 16

To the view the left limb of the pancreas, you need to open the _____ _____.

Answer 16

Omental bursa

Question 17

Exploratory Celiotomy: Left Quadrant

Answer 17

• Spleen
• L kidney
• L adrenal
• L ovary/uterine horn
• L ureter

Question 18

In order to see the adrenal gland, kidney and ureter in the left quadrant, it is improtant to retract the ______ medially.

Answer 18

Mesocolon

Question 19

A tru-cut biopsy of the kidney is when a biopsy is taken ____ to the organ, to remain in the ____ and avoid the renal pelvis and vessels.

Answer 19

Parallel; cortex

Question 20

Kidney Biopsy Technique: wedge

Answer 20

• Incise and reflect renal capsule
• Excise wedge of cortex
• Suture capsule
• Digital pressure if bleeding
• Be prepared for hemorrhage!

Question 21

Exploratory Celiotomy: Right Quadrant

Answer 21

• Duodenum
• Pancreas (R limb)
• R adrenal
• R kidney
• R ureter
• R ovary/uterine horn

Question 22

It is important to retract the _____ to see the right quadrant.

Answer 22

Mesoduodenum

Question 23

The ___ limb of the pancreas can be seen upon retraction of the duodenum.

Answer 23

Right

Question 24

It is important to evaluate the portal vein for porotsystemic shunts. The most common place to find PSS is in the _______

Answer 24

epiploic foramen

Question 25

Portosystemic shutns are communications between the portal vein and the _____

Answer 25

vena cava

Question 26

Exploratory celiotomy - caudal quadrant

Answer 26

• Colon
• Prostate
• Urinary bladder
• Uterine body

Question 27

When biopsing the prostate, _____ biopsy technique should be done to avoid injuring the urethra.

Answer 27

Tru-cut (at an angle)

Question 28

Exploratory Celiotomy - Mid abdomen

Answer 28

Small intestines

Question 29

Identify the ileum via the ______ artery.

Answer 29

Antimesenteric

Question 30

Lymph node biopsy

Answer 30

1. Incise the mesentery over node (avoid injury to jejunal vessels)
2. Mobilize node by sharp and blunt dissection
3. Ligate or electrocoagulate vessels entering parenchyma
4. Close mesenteric defect with continuous suture pattern

Question 31

Functions of the abdomen

Answer 31

• Peritoneal defense
• High absorptive capacity
• Functions:
  
  • Blood supply
  • Lymph drainage
  • Immune response
  • Angiogenesis

Question 32

Why is it important to “follow the omentum”?

Answer 32

It will often be adhered to or walling of the region of interest.

Question 33

What to do before closure of exploratory celiotomy

Answer 33

1. Check biopsy sites for hemorrhage
2. Sponge count
3. Lavage with warm irrigation solution (1L/10kg)
   
   1. Contaminated surgeryes - like perforated bowels, use 4-5 liters minimum

Question 34

Abdominal closure is a __ or __ layer closure.

Answer 34

3 or 4

Question 35

Upon abdominal closure the suture MUST be in this layer _____, due to its strength in the abdominal wall.

Answer 35

External rectus fascia

Question 36

Avoid incorporating the _____ ____ upon when closing the abdomen.

Answer 36

Rectus Muscle

Question 37

To close the linea alba, which suture materials are acceptable:

Answer 37

• Polydiaxanone (PDS) - absorbable
• Polygloconate
• Glycomer 631

Question 38

When closing the linea alba, which suture pattern should be used and how many throws at the end of incision?

Answer 38

Simple continuous or interrupted; 6 throws

Question 39

How to prevent incisional hernias

Answer 39

• Incorporate adequate tissue in each bite
• Ensure each bite is in the external rectus sheath
• Bites ~ 5-10 mm apart
• Meticulous SQUARE knot tying!
• E-collar