Lec 23: Exploratory Celiotomy

Question 1

an incision into the abdominal cavity is called a ____.

Answer 1

celiotomy

Question 2

a flank incision is called a ____.

Answer 2

laparotomy

Question 3

a patient having a sudden onset of signs like distention, pain, vomiting, referable to the abdomen, is called ____ _____.

Answer 3

acute abdomen

Question 4

herination of the _____ contents through the body wall with exposure of the abdominal viscera is called abdominal evisceration.

Answer 4

peritoneal

Question 5

diagnostic reasons for doing an abdominal exploratory include ______ & _______.

Answer 5

biopsies ; visualization

Question 6

therapeutic reasons for doing an abdominal exploratory include

1. gastric dilation and _____
2. severe ______
3. colonic ______
4. ____ _____removal
5. ________

Answer 6

1. volvulus
2. hemorrhage
3. perforation
4. foreign body
5. evisceration

Question 7

what type of abdominal procedure is the #1 cause of postoperative major abdominal evisceration?

Answer 7

OHE - ovariohysterectomy (bc its one of the most frequently performed abdominal procedures in small animal)

Question 8

we should always make a ___ of the samples desired from IM and the diagnostic procedures that must be performed in the OR.

Answer 8

list

Question 9

take the list to the ___ and use it.

Answer 9

OR

Question 10

to cut or not to cut depends on patient _____, ______ findings, radiographs, AUS, and _____.

Answer 10

history ; PE ; labwork

Question 11

realize that depressed/lethargic animals may not show ____.

Answer 11

pain

Question 12

hemorrhage may not show up for ____ hours due to shock.

Answer 12

3-4

Question 13

always observe trauma patients for more than ____ hours.

Answer 13

8-12

Question 14

considering pre-operative management, we should take x-rays and be aware of any _____ fluid & accumulation of ___.

Answer 14

peritoneal fluid (blood, urine, periotnitis) ; air

Question 15

if radiographs are non diagnostic, we can perform an ________, diagnostic peritoneal _____, or a ____ exam.

Answer 15

abdominocentesis ; lavage ; FAST

Question 16

‘FAST’ in fast exam stands for

Answer 16

focused assessment with sonography in trauma

Question 17

critical owner communication

1. mention chance of post-op _____
2. mention possibility of wound _______
3. that there is a chance we may not find any ___ _______ in surgery
4. that there is a chance that the patient could ____ during surgery
5. that we could find something ____ that I will need to ____ with you during surgery

Answer 17

1. infection
2. dehiscence
3. gross abnormalities
4. die
5. so bad ; speak

Question 18

highlight of owner communication is that if you are willing to take the time before surgery to speak to the owner about these difficult things, the owner is much more ____ to deal with these situations better should they occur.

Answer 18

likely

Question 19

surgeries less than ____ hours without opening a contaminated hollow viscus, ____ warrant prophylactic antibiotics.

Answer 19

1 ½ hours ; DO NOT

Question 20

identify the following important structures for surgical anatomy (1-7)

Answer 20

1. external leaf
2. internal leaf
3. rectus sheath
4. external abdominal oblique muscle
5. internal abdominal oblique muscle
6. transversalis fascia
7. peritoneum

Question 21

identify the following important structures for surgical anatomy (1-2)

Answer 21

1. linea alba (midline)
2. external leaf

Question 22

always count _____ before incision and before closing

Answer 22

sponges

Question 23

it is the ______ job to count sponges

Answer 23

surgeon’s

Question 24

we should always “go ___ or go home” when making our incisons for an exploratory celiotomy.

Answer 24

BIG

Question 25

the incision for an exploratory celiotomy should start from the ____ and extend down to the \_\_\_\_.

Answer 25

xyphoid ; pubis

Question 26

if your incision looks bad on the outside, clients will assume that whatever you did on the inside must be ____ too.

Answer 26

bad

Question 27

when our patient is a boy, we must ____ the prepuce with antiseptic solution ____ sterile prep.

Answer 27

flush ; before

Question 28

prepuce should be ____ and ____ out of the surgical field

Answer 28

clamped ; draped

Question 29

when our patient is male, just cranial to the prepuce, we should ____ our midline incision to the ___ opposite of the clamped prepuce.

Answer 29

curve ; side

Question 30

male or female, you will enter the abdomen through the ___ \_\_\_.

Answer 30

linea alba

Question 31

when we are done incising from xyphoid to pubis, sharp incision of SQ tissue to fascia and cauterizing small bleeders, we should always ____ the abdominal wall and sharply incise the ____ with a scalpel blade.

Answer 31

tent ; linea alba

Question 32

once in the abdomen, ____ for adhesions.

Answer 32

palpate

Question 33

if we have to extend our incision, what scissors will we use?

Answer 33

mayo

Question 34

digitally break down one side of the _____ ligament or excise it.

Answer 34

falciform

Question 35

\_\_\_\_\_ works well to remove the falciform ligament

Answer 35

electrocautery

Question 36

when you can't see anything… remember to check if: 1. ___ adjusted? 2. ____ ligament removed? 3. ____ retractors in place? 4. excess ____ suctioned out of field? 5. ______ adequate?

Answer 36

1. lights 2. falciform 3. balfour 4. fluid 5. hemostasis

Question 37

develop a ____ and stick to it, unless the clinical situation dictates otherwise.

Answer 37

technique

Question 38

don't quit exploring until you have explored \_\_\_\_\_.

Answer 38

everything

Question 39

just because you found a major problem, doesn't mean that it is the only \_\_\_.

Answer 39

one

Question 40

technique to exploring the abdomen 1. ____ quadrant 2. ____ quadrant 3. _____ tract 4. \_\_\_\_\_

Answer 40

1. cranial 2. caudal 3. intestinal 4. gutters

Question 41

when we examine the diaphragm, liver, gall bladder + biliary tree, stomach, pylorus, proximal duodenum, spleen, **BOTH pancreatic limbs**, portal vein, hepatic arteries and caudal vena cava, we are exploring the ____ quadrant.

Answer 41

cranial

Question 42

when we examine the descending colon, urinary bladder, urethra, uterine horns or prostate, and inguinal rings, we are exploring the ____ quadrant.

Answer 42

caudal

Question 43

when exploring the intestinal tract, palpate and visually inspect from the ____ to the ____ colon.

Answer 43

duodenum ; descending

Question 44

always inspect the ____ length of the intestines

Answer 44

ENTIRE

Question 45

when we are exploring the ___ gutter, we use the mesoduodenum to retract \_\_\_\_. from here we can also palpate the ____ kidney, examine the ____ adrenal gland, ____ ureter, ____ ovary or stump.

Answer 45

RIGHT ; intestines ; right ; right ; right ; right

Question 46

when exploring the ___ gutter, we use the _____ colon to retract intestines. from there we can palpate the ___ kidney, examine the ___ adrenal gland, ___ ureter, ___ ovary or stump.

Answer 46

LEFT ; descending left ; left; left ; left

Question 47

always use ____ lavage fluids.

Answer 47

WARM

Question 48

there is __ evidence that adding antiseptics to lavage fluids is of any benefit.

Answer 48

NO

Question 49

there is __ evidence that adding antibiotics to lavage fluids is of any benefit.

Answer 49

NO

Question 50

what suture patterns can we use to close the linea alba?

Answer 50

simple continuous or simple interrupted

Question 51

simple continues _____ increase the risk of dehiscence.

Answer 51

DOES NOT!

Question 52

use secure knots of ____ at each end when closing the linea alba with a simple continuous pattern.

Answer 52

6-8

Question 53

\_\_\_\_ is not a substitute for good technique of skin closure.

Answer 53

GLUE

Question 54

absorbable suture in skin is ____ absorbable

Answer 54

NOT

Question 55

when is an incision most likely to dehisce?

Answer 55

3-5 days post op