Lecture 22: Principles of Large Animal Soft Tissue Surgery (Exam 3) Flashcards by Shelby Rainbolt

How is LA tissue different than SA

Thicker tissue
Skin doesn’t bruise
Hemorrhage generally not a problem

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What are some ways to reduce trauma

Fingers
Stay sutures
Atraumatic forceps

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T/F: Blood loss is not a big deal

True

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What is the blood volume found in horses

8% of bwt (kg)

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What is an acceptable amount of blood loss

<15% of blood volume
No clinical signs

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At what % blood volume will there start to be clinical signs

15 to 20%

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At what % of blood volume lost is there a risk of death

> 40%

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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

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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

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What position is better for access for most structures in bovine

Standing position

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What is the primary diagnostic used in equine

URT endoscopy

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Describe doing a URT endoscopy

Not sedated @ rest
Treadmill
Under saddle

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How wide are the spaces where most procedures are done in equine

< 3 inches

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T/F: You don’t need retractors in equine surgery

False they are critical

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How does mucosa heal

Rapidly

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What is a potential for mucosa when healing that will later require revision

Mucosal “Webbing”

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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

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Is respiratory surgery a clean or contaminated surgery

A clean-contaminated or contaminated surgery

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What is the most serious complication & what is the least serious

Most serious = Excessive swelling
Least serious = surgical site infection

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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)

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What diagnostics are used in a “colic work up”

Rectal palpation
Abdominal U/S
Abdominal radiographs
Nasogastric tube intubation
Abdominocentesis
Blood work

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What is the most common approach for a celiotomy in horses

Ventral midline

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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