Lecture 22: Principles of Large Animal Soft Tissue Surgery (Exam 3) Flashcards
How is LA tissue different than SA
- Thicker tissue
- Skin doesn’t bruise
- Hemorrhage generally not a problem
What are some ways to reduce trauma
- Fingers
- Stay sutures
- Atraumatic forceps
T/F: Blood loss is not a big deal
True
What is the blood volume found in horses
8% of bwt (kg)
What is an acceptable amount of blood loss
- <15% of blood volume
- No clinical signs
At what % blood volume will there start to be clinical signs
15 to 20%
At what % of blood volume lost is there a risk of death
- > 40%
Describe the benefits of standing a horse for surgery?
- Prevents complications of being recumbent
- Prevent risk of recovering from anesthesia
- Better access for select structures (dorsal)
- Reduced cost
What is the benefits for putting a horse in a recumbent position for surgery
- Safer for the surgeon
- No movement for better control of the surgical field
- Better access for most structures
What position is better for access for most structures in bovine
Standing position
What is the primary diagnostic used in equine
URT endoscopy
Describe doing a URT endoscopy
- Not sedated @ rest
- Treadmill
- Under saddle
How wide are the spaces where most procedures are done in equine
< 3 inches
T/F: You don’t need retractors in equine surgery
False they are critical
How does mucosa heal
Rapidly
What is a potential for mucosa when healing that will later require revision
Mucosal “Webbing”
What are some common complications of URT surgery
- Excessive swelling (blocks the airways)
- Damage to nearby structures like cranial nerve
- Too large an opening = aspiration
- Too small an opening = problem not corrected
- Surgical site infection
Is respiratory surgery a clean or contaminated surgery
A clean-contaminated or contaminated surgery
What is the most serious complication & what is the least serious
- Most serious = Excessive swelling
- Least serious = surgical site infection
What are some GI diagnostics used in equine
- Limited due to the size of the abdomen & length of GIT
- Colic work up
- Gastric endoscopy (gastroscopy)
What diagnostics are used in a “colic work up”
- Rectal palpation
- Abdominal U/S
- Abdominal radiographs
- Nasogastric tube intubation
- Abdominocentesis
- Blood work
What is the most common approach for a celiotomy in horses
Ventral midline
What are some other approaches for doing a celiotomy in equine
- Paramedian (right side)
- Paralumbar fossa (uncommon)
- Laparoscopic portals
What is the most common surgery in emergency or sick horses
Exploratory laparotomy (colic surgery)
What is import in equine surgery
Speed
When is an equine surgery considered clean
If the bowel is unopened
When is an equine surgery considered clean-contaminated
When the bowl is opened
When is it considered “game over”
If ingesta enters the abdomen
What are some GI procedures done in equine
- Exploration
- De-rotation
- Enterotomy
- Resection & anastomosis
- Biobsy
What is a major cause of post op colic & death in equine
Intra-abdominal adhesions - a dysfunction of fibrinolysis
What are some ways to reduce adhesions in equine
- Gentle handling of tissues (avoid excessive handling)
- Keep tissues moist
- Use of lubricants (carboxymethylcellulose)
- Strict asepsis
- Prevent blood from entering the abdomen ( flush the abdomen if needed)
T/F: Do not use dry gauze ever
True
What complications can occur after GI surgery
- Adhesions
- Hemoabdomen
- Peritonitis
- Illeus
- Diarrhea
- Endotoxemia (associated complications)
- Incisional infection
What are some diagnostics used for the urogenital tract in equine
- Palpation
- Ultrasound
- Endoscopy
What are some common urogenital surgical procedures in male equine
- Castration
- Cryptorchid castration
- Urolithiasis
- Penile injuries & problems
- Preputial injuries & problems
- Inguinal hernia
What are some common urogenital surgical procedures in female equine
- Repair foaling injuries
- Correct vaginal conformation
- Ovariectomy
What are some common urogenital surgical procedures in foals
Bladder rupture
What are some approaches to that can be used for urogenital surgery in cryptorchid males
- Inguinal
- Parainguinal
- Laparoscopic
What are some approaches for doing urogenital sx in males
- Perineum
- Penis
What are some approaches for urogenital surgery in females
- The back end (standing sedation + epidural)
- Laparoscopy
- Flank
- Vagina
- Ventral midline celiotomy
What are some surgical considerations when doing urogenital sx in equine
- May need to catheterize the bladder
- Function is an impt outcome
- Approaches can be challenging
What can urogenital surgery approaches be challenging
- Small spaces
- Bladder is difficult to access in adult horses
Why can healing be difficult after urogenital sx in equine
- Stricture formation
- Break down of repair
T/F: The back end of a mare has a lot of contamination
T it makes repair breakdown common
How can you give the distal urethra a rest
By creating a perineal urethrostomy
What are some common complications during/after urogenital sx in equine
- Bleeding
- Loss of fxn
- Breakdown of repair
- Stricture
- Infection
What are the principles of laparoscopy
- Abdomen is insufflated w/ CO2 (~8 - 12 mmHG)
- Blind stab incision is made to place a scope portal
- Scope is introduced through the portal that maintains pressure in the abdomen
- Remaining portals are created w/ visualization from the scope
- Scope has a 0 degree lens
How many portals is there in a laparoscopy
- 1 scope
- 2 instrument portals
What are the common uses for an equine laparoscopy
- Cryptorchidectomy
- Ovariectomy
- Explore abdomen in chronic cases
Describe a cryptorchidectomy
- Usually done in dorsal recumbency but can be done standing
*Trendelenburg position
T/F: Ovariectomy & exploring of the abdomen are done in dorsal recumbency
False they are done w/ the px standing
Why should food be withheld before a laparoscopy
- Space in the abdomen
- Less weight on diaphragm if in trendelenburg position
- Increase time withheld for dorsal recumbency
- Increased risk of colitis
What NSAIDs can be given before a laparoscopy
- Flunixin meglumine
- Phenylbutazone
T/F: Antibiotics are not necessary before a laparoscopy b/c it is a minimally invasive clean procedure
True
What are some general complications that can occur during/after a laparoscopy
- SubQ emphysema
- Retroperitoneal insufflation
- Bowel perforation
- Hemorrhage from body wall incision, mesovarium/mesorchium, & ligature slippage
