Lecture 10 9/5/24

Question 1

what should occur during the preparation for abdominal surgery?

Answer 1

-clip and aseptically prep the abdomen and beyond to prepare for unexpected events
-position animal so that appropriate regions are available for final prep and draping while maintaining respiration and blood flow
-review surgical checklist

Question 2

What is gossypiboma?

Answer 2

retained gauze sponge or cloth laparotomy pad

Question 3

What are the potential issues associated with a retained sponge?

Answer 3

-abscesses
-adhesions
-fistulas
-malignant transformations

Question 4

How are retained sponges prevented/identified?

Answer 4

-sponge counts prior to incision and prior to closing
-radiopaque sponges

Question 5

What are the characteristics of abdominal incisions?

Answer 5

-typically ventral, possibly flank
-may need to go around prepuce in males
-want to prep caudal half of thorax when making cranial abdominal incisions

Question 6

What are the steps to exposing the linea?

Answer 6

-incise subcutis down to linea
-avoid excessive lateral dissection of subcutis; associated with dead space, seromas, and increased trauma

Question 7

What are the steps to opening the abdomen?

Answer 7

-tent the fascia with forceps
-hold scalpel with sharp blade edge upward and handle parallel to abdominal wall
-make a stab incision into wall
-sweep fingers/scissors to feel for adhesions prior to extending incision
-extend incision slightly and verify no adhesions
-complete incision with scissors

Question 8

How are thumb forceps used when opening the linea with a blade?

Answer 8

thumb forceps are used to lift rectus sheath up and provide a guide for the blade

Question 9

What are the steps to removing the falciform ligament?

Answer 9

-transect lateral body wall attachments with scissors, cautery, or tearing
-ligate the base of the falciform ligament with absorbable suture

Question 10

What are the steps to visualizing the abdomen with retractors?

Answer 10

-place sponges along body wall; moisten sponges where they will contact tissue (optional step)
-place retractors so they hold back abdominal musculature on each side
-ensure no organs are trapped between retractor blades and body wall

Question 11

What are the four main goals of tissue excision?

Answer 11

-detach structure from fascia, peritoneum, or fibrous tissue
-ligate and transect blood vessels without damaging blood flow to remaining structures
-ligate and transect functional connections that will no longer be needed
-re-establish any critical functional connections

Question 12

What are the steps taken in hollow organ surgery?

Answer 12

-isolate organ with laparotomy pads
-set aside clean instruments; do not want to use instruments that were inside the organ
-place stay sutures as needed
-close incisions with absorbable suture
-change contaminated gloves and instruments

Question 13

What are the characteristics of lavage?

Answer 13

-used to remove contamination or warm patients
-balanced electrolyte solution warmed to body temp.
-poole suction tip used to prevent organ damage

Question 14

What are the steps of abdominal wall closure?

Answer 14

-appose rectus sheath with continuous or interrupted pattern
-appose SQ tissues to close dead space, reduce tension on skin, and potentially improve blood supply
-close skin with external or buried sutures