Lecture 21: Exploratory Celiotomy (Exam 3) Flashcards
Define celiotomy
Incision into the abdominal cavity
Define Laparotomy
Flank incision
Define acute abdomen
Sudden onset signs (distention, pain, vomiting) referable to the abdomen
Define Abdominal evisceration
Herniation of peritoneal contents through the body wall w/ exposure of the abdominal viscera
What are the diagnostic reasons for an abdominal exploratory surgery
- Biopsies
- Visualization
What are the therapeutic reasons for an abdominal exploratory
- GDV
- Severe hemorrhage
- Colonic perforation
- Foreign body removal
- Evisceration
What is the number one cause of post op major abdominal evisceration in a recent study
Ovariohysterectomy (OHE)
T/F: Surgery can always be delayed until one is certain that the px will benefit from it
False it cannot always be delayed
What should be done in pre op
- Hx
- PE findings
- Radiographic studies
- Ultrasonic studies
- Lab findings
Will depressed/lethargic animals always so pain
No
How long should you observe trauma px for & why
- > or equal to 8 to 12 h
- B/c hemorrhage may not show up for 3 to 4 hours
What are some general observations that need to be observed
- Attitude & posture of px
- Temperature
- Respiratory rate & effort
- HR & rhythm
- Abdominal auscultation, percussion, & palpation
- Serial PE
What blood samples should be taken
- Hematocrit
- Total protein
- Glucose
- Blood urea nitrogen
- Complete blood count
- Other tests as indicated
How can urine collection been taken
- Cystocentesis (Ultrasound, palpation, blind stick)
- Catheterization
- Indwelling catheter to measure urine output
What critical communication should be said to the owner
- Mention the chance of post op infection
- Mention the possibility of wound dehiscence
- “There is a chance that we may not find any gross abnorms in surgery”
- ” There is a chance that he/she won’t make it through the sx”
- “There is a chance that we could find something so bad that I will need to speak to you during surgery”
If you speak to the owner about these things before surgery what is more likely to happen
The owner is more likely to deal w/ these situation better should they occur
What are some things that need to be considered before anesthetic
- Underlying disease
- Age of animal
- Condition of animal
- Length & type of surgical procedure
- Remember pain management
What type of surgeries usually don’t warrant prophylactic antibiotic
Surgeries less than 1 & 1/2 hours long
What does the white line mean
“Cut here”
Why is the linea alba easier to locate near the umbilicus
Becomes thinner back near the pubis
Describe the canine linea alba
- Site of insertion for the external abdominal oblique muscle via the rectus sheath
- ~ 1 cm wide & 1 mm thick @ the cranial location but @ the caudal end it is ~ 1 mm wide & much thicker
what should be done before incision & after closing
Always count sponges
Where should the incision be made
From the xyphoid to pubis to explore all abdominal organs (can be adjusted by the case)
If it looks bad on the outside what will the client assume
That whatever you did on the inside must be bad too
What should be done to prep a male for sx
- Clip that hair
- Flush the prepuce w/ antiseptic solution before sterile prep
- Clamp the prepuce to one side with a towel clamp (drape the tip of the prepuce & clamp outside of the surgical field)
How should the incision be made in a male px
- Just cranial to the prepuce curve the midline incision to the side opposite of the clamped prepuce
- Incise the SQ tissue & prepucialis m.
- Ligate or cauterize veins @ the cranial prepuce
What should be done after the initial incision
- Retract the incised skin & SQ tissues & locate the linea alba
- SQ tissues must be incised or undermined & muscular fascia identified before locating the linea alba
No matter male or female where do you enter the abdomen
Through the linea alba
What should be done after incising from the xyphoid to the pubis
- Sharp/blunt dissection of SQ tissue to fascia
- Ligate & cauterize small SQ bleeders
- Avoid mammary tissue in lactating px
- Identify the linea alba
- Tent the abdominal wall & sharply incise the linea alba w/ a scalpel blade
What should occur after making an incision to the linea alba
- Palpate for adhesions
- Extend incision w/ mayo scissors
- Digitally break down one side of the falciform ligament or excise it (cautery works well but may need to ligate @ cranial end)
How should the abdomen be explored
- Use a systematic exploration
- Dev a tech & stick to it (unless the clinical situation dictates otherwise)
- Don’t quit until the job is done
T/F: Just b/c you found a major problem doesn’t mean that it is the only problem
True
List the steps of exploring the abdominal tech mentioned in lecture
- Explore the cranial quadrant
- Explore the caudal quadrant
- Explore the intestinal tract
- Explore the gutters
What should be done when exploring the cranial quadrant
- Examine the diaphragm, esophageal hiatus, & palpate the entire liver
- Inspect the gal bladder & biliary tree then express the bladder
- Examine the stomach, pylorus, proximal duodenum, & spleen
- Examine both pancreatic limbs, portal vein, hepatic arteries, & caudal vena cava
What should be explored in the caudal quadrant
- Descending colon
- Urinary bladder
- Urethra
- Uterine horns or prostate
- Inguinal rings
How should the intestinal tract be explored
- Palpate & visually inspect from the duodenum to descending colon
- Observe mesenteric vasculature & nodes (both sides)
- Don’t forget to inspect the entire length
What should be explored when exploring the right gutter
- Use the mesoduodenum to retract the intestines
- Palpate the right kidney
- Examine the right adrenal gland
- Examine the right ureter
- Examine the right ovary or stump
What should be explored when exploring the left gutter
- Use the descending colon to retract intestines
- Palpate the left kidney
- Examine the left adrenal gland
- Examine the left ureter
- Examine the left ovary or stump
Why should you always use warm lavage fluids & not room temp
To avoid hypothermia & decrease the chances of post op infection
Is there evidence that adding antiseptics to lavage fluids is beneficial
No it may actually be harmful in the case of povidone-iodine w/ peritonitis (inhibits macrophage chemotaxis)
What pattern can be used to close the linea alba
- Simple continuous
- Interrupted
Explain using a simple continuous pattern to close the linea alba
- Does not increase the risk of dehiscence
- Secure knots (6 to 8 @ each end)
- Rapid closure
- Less suture material
What are the “Dos” when closing
- Tighten suture enough to appose tissues
- Incorporate full thickness bites if on midline
- Use external rectus sheath if off midline
- Use an absorbable suture in a simple continuous pattern in sub Q tissue
- Reappose the prepucialis muscle fibers in males (if you can)
- Use nonabsorbable skin sutures or staples
What are the “don’ts” when closing
- Don’t strangulate tissues w/ suture
- Don’t damage tissues w/ forceps
- Don’t incorporate falciform ligament btw/ fascial edges
- Don’t include muscle when closing the external rectus sheath
- Don’t attempt to include peritoneum
What is not a substitute for good tech
Glue
T/F: Absorbable suture in the skin is absorbable
False
List some complications post op
- Dehiscence
- Suture breakage
- Knot slippage
- Pull-through
When is the incision area most likely to dehisce
3 to 5 days post-op
What can cause an increased rate of dehiscence
- Wound infection
- Fluid or electrolyte imbalances
- Anemia
- Hypoproteinemia
- Metabolic disease
- Immunosuppression
- Corticosteroids
- Abdominal distention
- Chemotherapy
- Radiation therapy
- Improper surgical tech
Which px may have delayed healing
- Debilitated
- Very young
- Very old
