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Large Animal Surgery > Laparotomy/Celiotomy > Flashcards

Laparotomy/Celiotomy Flashcards

1
Q

Exploratory laparotomy/celiotomy indications

A
  • Exploration (diagnostic), surgical correction, or procedural (e.g. C-section)
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2
Q

Standard approaches for exploratory laparotomy/celiotomy

A
  • Paralumbar fossa
  • Midline
  • Paracostal
  • Alternative approaches
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3
Q

How tightly should you suture up a cow for surgery?

A
  • VERY TIGHT

- You do not want it to be loose

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4
Q

Casting cows

A
  • can do with a double half hitch
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5
Q

Typical recumbency for sheep abdominal surgery

A
  • Dorsal recumbency
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6
Q

Left paralumbar fossa approach indications

A
  • Left side general exploration
  • Traumatic reticuloperitonitis
  • Vagal indigestion, rumenotomy
  • LDA via abomasopexy
  • Cesarean section
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7
Q

Right paralumbar fossa approach indications

A
  • SI and LI access
  • Correct LDA by omentopexy
  • Correct RDA/abomasal volvulus
  • Cesarean section
  • Nephrectomy
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8
Q

Right paramedian approach

A
  • correct LDA, RDA, RAV
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9
Q

Right paracostal approach

A
  • Pyloric or abomasal visualization
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10
Q

Ventral midline approach

A
  • Cesarean section

- Alternate approach for hardware lesion or reticular abscess

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11
Q

Ventrolateral approach indications

A
  • Cesarian section for emphysematous fetus

- Repair of postpartum uterine tear

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12
Q

Why does Dr. Barrington prefer the left sided approach for C-section?

A
  • No need to go in on any side other than the left side on a bovine
  • if you go in on the right side, things can follow them
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13
Q

Landmarks for incision for Paralumbar approach

A
  • Midway between 13th rib and tuber coxae
  • Can go vertically or obliquely depending on anatomy
  • Start about 2” below the transverse processes
  • Extend incision about 5-6” vertically through skin and cutaneous trunci
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14
Q

General paralumbar fossa approach restraint

A
  • Chute or stocks
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15
Q

General paralumbar approach preparation of surgical area

A
  • Clip with 40 blade

- Surgical scrub and final surgical prep

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16
Q

Paravertebral block - what nerves are you blocking?

A
  • Dorsal and ventral branches of spinal nerves from T13, L1, L2
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17
Q

What are advantages of the paravertebral block vs an inverted L or line block?***

A
  • (Distal) paravertebral block you can block the peritoneum
  • Line blocks it is almost impossible to block the peritoneum
  • Also you have less lidocaine in your incision
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18
Q

Where do you block T13, L1, and L2 for the distal paravertebral block?

A
  • T13: Transverse process of L1
  • L1: Transverse process of L2
  • L2: Transverse process of L4
  • Palpate the transverse process and put a needle above and below
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19
Q

C-section overview

A
  • If you’re reaching in and finding the greater curvature of the horn of the uterus but cannot pick up the calf
  • Would have to make an incision in the uterus
  • You can use a letter opener with a guarded blade to put through
  • You will spill amniotic fluid into the abdomen, which isn’t that much of a problem
  • Want to make you incision at the end of the uterine horn and on the greater curvature of the horn, somewhere down towards the end of the horn
  • Difference between right horn and left horn presentation
  • Want to get the chain around the back legs
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20
Q

Post-op risks after C-section

A
  • LDA in the first week
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21
Q

Uterine closure and placenta exposure

A
  • You do not want any placenta protruding - has t obe a perfect closure
  • Uterus wall will contract quickly, and the placenta will come out and lead to peritonitis
  • Either do one perfect incision or do two oversewn.
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22
Q

General approach to paralumbar fossa approach

A
  • Skin incision
  • Muscles incision (grid or not)
  • Abdominal visualization on left or right side
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23
Q

Which muscles do you encounter when doing a paralumbar fossa approach?

A
  • Cutaneous trunci
  • External abdominal oblique
  • Internal abdominal oblique
  • Transverse abdominus
  • Peritoneum
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24
Q

Gridding vs sharp dissection for paralumbar fossa approach

A
  • Surgeon’s choice
  • He likes to do a sharp dissection through the skin and the external abdominal oblique (both have a sheath that can be sewn back together)
  • Internal abdominal oblique and transverse abdominus don’t have a sheath, so he pokes a hole all the way through the muscle belly and widens it
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25
Q

Viscera on the left side

A
  • Rumen
  • Spleen
  • Bladder (very caudal)
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26
Q

Viscera on the right side

A
  • Descending duodenum
  • Omentum
  • Right kidney
  • Cecum
  • Spiral colon (difficult to access)
  • Jejunum and ileum
  • Abomasum
  • Omasum
  • Liver
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27
Q

Exploration of the abdominal cavity in a standing paralumbar fossa approach

A
  • Know that there are certain things that can’t be exteriorized and things that cannot be palpated
  • Most of the jejunum can be exteriorized
  • Ascending duodenum you can’t really pull out
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28
Q

What are the three T’s of successful surgery?

A
  • Time
  • Trash
  • Trauma
29
Q

Closure suture type for paralumbar fossa approach?

A
  • Catgut or Braunamid 0 to #3
30
Q

Layers for Paralumbar fossa approach closure

A
  • Simple continuous pattern for non-skin layers generally
  • Usually three deep layers closed (transverse abdominus and peritoneum, internal oblique, external oblique)
  • Skin (ford interlocking pattern; terminal simple interrupted suture)
31
Q

LDA overview

A
  • Usually to the right of midline
  • Propagated by shifts in abdominal content
  • Comes up on the left
  • Less likely to twist on itself due to the way it is attached
  • Much more common
32
Q

RDA overview

A
  • Much less common
  • May result in an RDA and/or torsion of the abomasum (torsion would result in a twisting of the mesenteric root and vasculature)
  • Can lead to vascular impairment and poor prognosis
33
Q

What ways do RAVs tend to twist?

A
  • Right and to the rear
  • Counterclockwise from the right and the rear
  • Important so that you can untwist them the right way
34
Q

What can you not pull out?

A
  • Transverse colon

- Ascending duodenum

35
Q

What else is important with a displaced abomasum surgery?

A
  • Always perform a thorough exploration of the abdominal cavity as a high percentage of displacement have other or underlying pathology
36
Q

Culling a DA

A
  • Don’t do anything
  • Don’t make a lot of money and don’t correct a lot of things
  • He does not suggest
37
Q

Rolling

A
  • LDA only
  • 50% success
  • risk of RDA or RAV
  • Doesn’t work very long
38
Q

Rolling with a toggle

A
  • LDA only
  • 80% success rate with an experienced
  • Putting the trochar on the right side
39
Q

Steps for roll and toggle

A
  • +/- Tranquilize and sedate
  • Cast them onto the right side and roll onto back
  • Clip and scrub
  • Area of the loudest ping
  • 4-7 inches behind the xiphoid
  • Assistant places pressure on lower abdominal quadriant
  • Trocharize the abdomen 4-7 inches behind xiphoid and 3 inches right of midline
  • Remove handle and push rod from trochar
  • Place toggle suture and push through cannula, remove trochar
  • Trocharize 2nd site 2-3 inches proximally
  • Tie two toggle sutures ends together, leaving space between skin and the knots
40
Q

Advantage of Roll & Toggle

A
  • Simple, quick, inexpensive
  • Minimally invasive
  • High success rate (>60-80%) similar to surgery
41
Q

Disadvantage of roll & toggle

A
  • Blind technique - cannot see abomasum

- Dorsal recumbent position

42
Q

2 step laparoscopy what procedures for?

A
  • LDA

- You can do it standing or not

43
Q

Right paramedian approach recumbency

A
  • Dorsal recumbency
44
Q

Advantage of right paramedian

A
  • DA usually corrects itself while cow being placed
45
Q

Disadvantage of right paramedian approach

A
  • Getting cow into dorsal recumbency and a ventral surgical site
  • Okay if you have a crew
46
Q

Preparation for right paramedian

A
  • Sedate, table, or cast into dorsal recumbency

- Prepare right paramedian site

47
Q

Anesthesia for right paramedian approach

A
  • Anesthesia: line block, full thickness, lateral to incision
48
Q

Entering the abdominal cavity from right paramedian approach

A
  • Incise skin
  • Rectus sheaths and muscle belly
  • Want to make a big cut
49
Q

Procedure for correcting LDA from right paramedian approach

A
  • Explore abdomen, correct abomasal displacement if needed
50
Q

Closure for right paramedian approach

A
  • Abomasopexy (gastropexy) - abomasum to internal layers of body wall
  • Close rectus rectus abdominus sheaths
  • Skin closure
51
Q

Where can you attach the abomasopexy/gastropexy?

A
  • Attach to the transverse abdominus and peritoneum

- OR the internal rectus sheath

52
Q

Left flank paralumbar fossa abomasopexy what for?

A
  • For an LDA

- or C-section

53
Q

Left flank paralumbar fossa approach recumbency

A
  • standing
54
Q

Do you always get direct visualization with the Left flank paralumbar fossa approach?

A

+/-

  • Can see the abomasum about 30%
55
Q

Disadvantage of Left flank paralumbar fossa approach

A
  • Pexy requires reaching under the ventral sac of the rumen to the right paramedian area (arm length)
  • Limited exploration
56
Q

Description of Left flank paralumbar fossa approach

A
  1. Standard left flank anesthesia and surgical approach
  2. Limited exploration of abdomen
  3. 4-6” continuous bites are placed in greater curvature of abomasum, 2-3” off greater omentum attachment (often blind). Make sure you leave long tails
  4. Suture is placed to leave 1+ meter tails
  5. Decompress the abomasum
  6. Cranial end: ~10 cm caudal to xiphoid, right of midline (pass needle through body wall
  7. Caudal end: ~10 cm caudal to cranial end
  8. Surgeon pushes deflated abomasum ventrally as assistant pull sutures bringing abomasum to ventral abdominal wall
  9. Sutures tied together externally, fixing abomasum in position
57
Q

Post-op care for left flank abomasopexy

A
  • Tie a knot and leave it there for two weeks
58
Q

Advantages of left flank abomasopexy

A
  • Abomasal adhesions are best broken down by this approach
  • can also address problems involving the rumen
  • Fewer people needed
  • Standing procedure
59
Q

Left flank abomasopexy disadvantages

A
  • Short people + big cow makes flank incision lower
  • Viscera puncture a risk
  • Exposure of abomasum sometimes difficult
60
Q

Right flank/paralumbar fossa omentopexy what for?*

A
  • LDA, RDA, RAV
61
Q

Approach for right flank/paralumbar fossa omentopexy

A
  • Standard abdominal approach

- Standing

62
Q

Success rate of right flank/paralumbar fossa omentopexy

A
  • Redisplacements are slightly more common with this approach
  • Omental stretching or tearing
63
Q

LDA procedure for right flank/paralumbar fossa omentopexy

A
  • Decompress with a needle attached to tubing (simplex)
  • Have to reach over the top of the rumen
  • Retract to the right side
64
Q

RDA or RAV procedure for right flank/paralumbar fossa omentopexy

A
  • Easy to find

- Decompress and replace to proper position

65
Q

What appearance does the pylorus have?

A
  • “Sow’s ear”
66
Q

Omentopexy in right flank/paralumbar fossa omentopexy

A
  • Incorporate omentum adjacent to pylorus into closure of peritoneum and transverse abdominus
  • Pyloropexy done by some, but be careful
67
Q

Closing right flank/paralumbar fossa omentopexy

A
  • Tension suture to bring it together into the closure
  • Omentum into peritoneum
  • Close the internal abdominal oblique separately
  • Still a risk of RDA
68
Q

Pre-op medications for LDA/RDA

A
  • Flunixin meglumine

- +/- antibiotics

69
Q

Post-op medications for LDA/RDA

A
  • Drench with electrolytes (post)
  • Support rumen - get cow back on feed
  • Monitor site
  • Observe drug withdrawal

Large Animal Surgery (7 decks)

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