Exploratory Celiotomy Flashcards
Standard landmarks for preparation
Xyphoid to pubis
Laterally beyond mammary chains
Exploratory celiotomy is with a ____ midline appraoch, involving the incision into these three layers…
- Ventral midline
- Skin, Subcutaneous layer, and linea stab incision (cranial to umbilicus)
Important to extend incision of the linea alba from the xyphoid to the pubis using ____ scissors and ____ blade.
Mayo scissors, scalpel blade
The abdominal muscles are closer together _______.
cranially
We make our stab incision ____ to the umbilicus becuase our organs are further away from the body wall.
Cranial
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?
External sheath
Exploratory Celiotomy: Cranial Quadrant
- Diaphgram
- Esophageal hiatus
- Liver
- Gall bladder
- Stomach
- Pancreas (L limb)
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.
Central
Guillotine technique for biopsy of the liver
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.
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:
Baker’s Biopsy Punch
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.
Dough Boy
Inspissated bile
Chunky bile
Gall bladder removal is called ____
Cholycystectomy
What is the gastric “slip”?
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.
The ___ limb of the pancreas is assocaited with the stomach.
left
To the view the left limb of the pancreas, you need to open the _____ _____.
Omental bursa
Exploratory Celiotomy: Left Quadrant
- Spleen
- L kidney
- L adrenal
- L ovary/uterine horn
- L ureter
In order to see the adrenal gland, kidney and ureter in the left quadrant, it is improtant to retract the ______ medially.
Mesocolon
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.
Parallel; cortex
Kidney Biopsy Technique: wedge
- Incise and reflect renal capsule
- Excise wedge of cortex
- Suture capsule
- Digital pressure if bleeding
- Be prepared for hemorrhage!
Exploratory Celiotomy: Right Quadrant
- Duodenum
- Pancreas (R limb)
- R adrenal
- R kidney
- R ureter
- R ovary/uterine horn
It is important to retract the _____ to see the right quadrant.
Mesoduodenum
The ___ limb of the pancreas can be seen upon retraction of the duodenum.
Right
It is important to evaluate the portal vein for porotsystemic shunts. The most common place to find PSS is in the _______
epiploic foramen
Portosystemic shutns are communications between the portal vein and the _____
vena cava
Exploratory celiotomy - caudal quadrant
- Colon
- Prostate
- Urinary bladder
- Uterine body
When biopsing the prostate, _____ biopsy technique should be done to avoid injuring the urethra.
Tru-cut (at an angle)
Exploratory Celiotomy - Mid abdomen
Small intestines
Identify the ileum via the ______ artery.
Antimesenteric
Lymph node biopsy
- Incise the mesentery over node (avoid injury to jejunal vessels)
- Mobilize node by sharp and blunt dissection
- Ligate or electrocoagulate vessels entering parenchyma
- Close mesenteric defect with continuous suture pattern
Functions of the abdomen
- Peritoneal defense
- High absorptive capacity
- Functions:
- Blood supply
- Lymph drainage
- Immune response
- Angiogenesis
Why is it important to “follow the omentum”?
It will often be adhered to or walling of the region of interest.
What to do before closure of exploratory celiotomy
- Check biopsy sites for hemorrhage
- Sponge count
- Lavage with warm irrigation solution (1L/10kg)
- Contaminated surgeryes - like perforated bowels, use 4-5 liters minimum
Abdominal closure is a __ or __ layer closure.
3 or 4
Upon abdominal closure the suture MUST be in this layer _____, due to its strength in the abdominal wall.
External rectus fascia
Avoid incorporating the _____ ____ upon when closing the abdomen.
Rectus Muscle
To close the linea alba, which suture materials are acceptable:
- Polydiaxanone (PDS) - absorbable
- Polygloconate
- Glycomer 631
When closing the linea alba, which suture pattern should be used and how many throws at the end of incision?
Simple continuous or interrupted; 6 throws
How to prevent incisional hernias
- 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
