Lec 22: Principles of LA Soft Tissue Surgery

Question 1

handling of large animal tissues differ from small animal tissues in that the tissue is (thicker/thinner), skin (does/does not) bruise, and hemorrhage (is/is not) generally not a problem.

Answer 1

thicker ; bruise ; hemorrhage

Question 2

we can reduce skin trauma by using our ___, placing ____ sutures, and utilizing _____ forceps.

Answer 2

fingers ; stay ; atraumatic

Question 3

true or false: blood loss seriously is not a big deal in large animal.

Answer 3

TRUE (for the most part - they have 40 L of blood!!!)

Question 4

___% blood volume lost is acceptable during surgery.

Answer 4

15! –> we see now clinical signs with this amount. it is approx 6 L in a 500kg horse.

Question 5

standing surgery in horses prevents complications of being ___. it prevents the risk of _____ from anesthesia, and provides better access for _____ structures.

Answer 5

recumbent ; recovering ; dorsal

Question 6

standing surgery is generally _____ than recumbent surgery.

Answer 6

less expensive

Question 7

recumbent surgery in horses is ____ for the surgeon, there is no movement which allows for better _____ of surgical field, and better ___ for most structures.

Answer 7

safer ; control ; access

* OPPOSITE OF BOVINE –> more access standing! *

Question 8

what is depicted by the grey arrow?

Answer 8

the epiglottis

Question 9

upper respiratory endoscopy is a _____ diagnostic tool. horses are _____ sedated, and are usually under ____ or on a treadmill.

Answer 9

primary ; not ; saddle

Question 10

what sites are depicted in A-C in the image?

Answer 10

sinus trephination sites

Question 11

when we incise the blue line depicted in the image, this procedure is called a _____.

Answer 11

pharyngotomy

Question 12

when we incise the red line depicted in the image, this procedure is called a _____.

Answer 12

laryngotomy

Question 13

what is most common, a pharyngotomy or a laryngotomy?

Answer 13

laryngotomy

Question 14

self retaining or hand held ______ are used and are critical in upper respiratory procedures.

Answer 14

retractors

Question 15

can you do both standing and recumbent surgery for URT procedures?

Answer 15

yes. easier in recumbent

Question 16

mucosa heals ______.

Answer 16

rapidly

Question 17

there is potential for mucosal “____” during the healing of URT surgery.

Answer 17

webbing –> requires later revision

Question 18

common complications of URT surgery (most serious)

• excessive swelling, ____ airway
• .> can consider a post op ____
• damage to _____ structures, like ___ nerves

Answer 18

blocks ; tracheotomy ; nearby ; cranial

Question 19

common complications of URT surgery (serious)
- surgeries that are reopening airways can create too large of an opening which can lead to _____, or create too small of an opening which leads to the problem not being _____.

Answer 19

aspiration ; corrected

Question 20

common complications of URT surgery (least serious)
- surgical site infection since respiratory surgery is _____ or _____ surgery.

Answer 20

clean contaminated ; contaminated

Question 21

diagnostics for GI surgery in horses are _____.

Answer 21

limited

Question 22

what can we do for diagnostics before GIT surgery in horses?

Answer 22

gastric endoscopy, rectal palpation, abdominal US, abdominal rads, NG tube intubation, abdominocentesis, bloodwork

Question 23

what diagnostics are considered a colic workup?

Answer 23

rectal palpation, abdominal US, abdominal rads, NG tube intubation, abdominocentesis, bloodwork

Question 24

what is the most common approach for an equine celiotomy?

Answer 24

ventral midline

Question 25

what are other approaches for a equine celiotomy?

Answer 25

paramedian (R side), paralumbar fossa, laprascopic portals

Question 26

what approach for a celiotomy in equine is uncommon?

Answer 26

paralumbar fossa

Question 27

speed is \_\_\_\_\_\_!

Answer 27

important

Question 28

a GIT surgery is clean if the bowel is \_\_\_\_\_\_

Answer 28

unopened

Question 29

a GIT surgery is clean contaminated if a bowel is \_\_\_\_\_.

Answer 29

opened (however - game over if ingesta enters the abdomen, euth)

Question 30

exploration, de-rotation, enterotomy, resection and anastomosis, biopsy are all common ______ procedures.

Answer 30

GIT

Question 31

when considering healing of the GIT, the ____ can have problems.

Answer 31

serosa

Question 32

a common serosal problem during GIT healing after surgery is ________ adhesions, a dysfunction of \_\_\_\_\_\_.

Answer 32

intrabdominal ; fibrinolysis

Question 33

what serosal healing problem is a major cause of post-operative colic and death?

Answer 33

intra-abdominal adhesions

Question 34

we can reduce adhesions by: 1. _____ handling of tissues 2. keeping tissues \_\_\_\_ 3. use of \_\_\_\_ 4. strict \_\_\_\_\_\_ 5. prevent blood from entering \_\_\_\_\_ 6. NOT using ___ gauze EVER!

Answer 34

1. gentle 2. moist 3. lubricants 4. asepsis 5. abdomen 1. dry

Question 35

complications that can arise during GIT surgery are:

Answer 35

adhesions, hemoabdomen, peritonitis, ileus, diarrhea, endotoxemia, incisional infection

Question 36

what are some diagnostics we can use for the urogenital tract?

Answer 36

palpation, US, endoscopy

Question 37

what are some common urogenital surgeries in males?

Answer 37

castration, cryptorchid castration, urolithiasis, penile injuries/problems, preputial injuries/problems, inguinal hernia

Question 38

what are some common female urogenital surgeries?

Answer 38

repair foaling injuries, correct vaginal confirmation, ovariectomy

Question 39

what is a common urogenital surgery seen in foals?

Answer 39

bladder rupture sx

Question 40

inguinal, parainguinal, and laprascipic are all approaches for a male _____ surgery.

Answer 40

cryptorchid

Question 41

we should always provide an ____ and sedation for a standing procedure of repairing the back end of a female.

Answer 41

epidural

Question 42

laparoscopym flank, vagina, ventral midline celiotomy are all approaches for this female urogenital surgical procedure

Answer 42

ovariectomy

Question 43

we may need to ______ the bladder in urogenital surgery

Answer 43

catheterize

Question 44

\_\_\_\_ is an important outcome in urogenital surgery

Answer 44

function

Question 45

small spaces and difficult access to the bladder make _____ challenging in urogenital surgery.

Answer 45

approaches

Question 46

\_\_\_\_ formation and break down of repair are both challenges in urogenital surgical healing.

Answer 46

stricture

Question 47

the back end of the mare has a lot of _____ and therefor, repair breakdown is common.

Answer 47

contamination

Question 48

we can give the distal urethra a rest by creating a perineal \_\_\_\_\_\_.

Answer 48

urethrostomy (PU surgery)

Question 49

bleeding, loss of function, breakdown of repair, stricture and infection are all common complications in _____ surgery.

Answer 49

urogenital

Question 50

in laparoscopy, the abdomen is insufflated with \_\_\_\_, to ______ mm Hg.

Answer 50

CO2, 8-12

Question 51

a ____ stab incision is made in a laparoscopy to place the scope portal

Answer 51

blind

Question 52

the scope is introduced through _____ that maintains pressure in the abdomen.

Answer 52

portal

Question 53

we generally need ___ total portals.

Answer 53

3

Question 54

out of the 3 portals, we need ___ scope and ___ instrument portals.

Answer 54

1 ; 2

Question 55

once the scope is introduced, the remaining portals are created with ______ that the scope provides.

Answer 55

visualization

Question 56

the scope has a ___ degree lens

Answer 56

zero

Question 57

what are common procedures we will use equine laparoscopy for?

Answer 57

cryptorchidectomy, ovariectomy, abdominal explore in chronic cases

Question 58

a laparoscopic _______ is usually done in dorsal recumbency, but can be done standing.

Answer 58

cyrptorchidectomy

Question 59

an laparoscopic ovariectomy is usually done \_\_\_\_\_. (standing or dorsal recumbency)

Answer 59

standing

Question 60

a laporoscopic abdominal explore is usually done\_\_\_\_\_.

Answer 60

standing

Question 61

we should always _____ before lapraoscopy, because it frees up space in the abdomen, there is less weight on the diaphragm (esp if in Trendelenburg position), and increases time withheld for dorsal recumbency,

Answer 61

withold

Question 62

it is speculated that withholding feed may increase the risk of \_\_\_\_\_.

Answer 62

colitis

Question 63

we need to know if the surgical patient was/is on _____ drugs.

Answer 63

non steroidal anti-inflammatory

Question 64

in a minimally invasive procedure that is clean like a laparoscopy, ____ are not necessary.

Answer 64

antibiotics

Question 65

subcutaneous emphysema, retroperitoneal insufflation, bowel perforation, and hemorrhage are all common general complications seen in _______ procedures.

Answer 65

laparoscopic

Question 66

hemorrhage as a complication after laparoscopic procedures can be due to…

Answer 66

body wall incisions, mesovarium or mesochium, ligature slippage