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Large Animal Surgery > Left Displaced Abomasum, AED, and Abomasal-Cecal Dilation-Dislocation > Flashcards

Left Displaced Abomasum, AED, and Abomasal-Cecal Dilation-Dislocation Flashcards

1
Q

Besides the rumen and abomasum, what 4 structures should you be able to palpate from a right flank celiotomy?

A

Left and right kidney
Liver
Urinary bladder

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2
Q

What are 3 causes of a left displaced abomasum?

A

Abomasal atony
Decreased rumen volume
Calving

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3
Q

What are 4 causes of abomasal atony?

A

Increased VFAs
Hypocalcemia
Metritis
Mastitis

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4
Q

When do we see marked changes in abomasal dimensions, position and volume?

A

Last 3 months of gestation and first 3 months of lactation

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5
Q

Why do we see marked changes in abomasal dimensions, position and volume?

A

Response to cranial expansion of the gravid uterus

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6
Q

What position do the gravid uterus push the abomasum into?

A

More transverse and leftward position on ventral abdominal wall.

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7
Q

What are some basic clinical signs of a LDA?

A

Refuse grain
Normal temp and still passing feces
Tympany in left flank

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8
Q

With surgery of an LDA, RDA or abomasal volvulus, what is the main goal?

A

Replace the abomasum to the normal position and stabilize it there.

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9
Q

What are the 4 different procedures for LDA?

A

Right flank omentopexy
Left flank abomasopexy
Right paramediam abomasopexy
Closed suture or bar technique

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10
Q

What are 4 big considerations to choosing an approach to an LDA?

A

Time required
Man-power needed
Complications
Success rate

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11
Q

What is “pinging”?

A

Listening to the flank with your stethoscope and flicking to hear if there is a gas distended structure right there.

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12
Q

Why do we have increased urine ketones in a cow with a LDA?

A

Because they are in a high energy demand state, and should be getting 1lb of grain per 3-4lbs of milk produced, but with an LDA they refuse grain and so they switch to metabolizing fat which releases ketones.

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13
Q

A cow with LDA and diarrhea is usually..?

A

…toxic, leukopenic and a poor surgical risk.

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14
Q

What do we often see in the chem profile of a cow with a LDA?

A

Hypocalcemia.

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15
Q

Before surgery on a cow with LDA, what 3 things do you need to consider and treat?

A

Metritis (lutalyse and tetracycline)
Hypocalcemia (calicium IV)
Ketosis (Dextrose IV)

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16
Q

How would you treat metritis in a cow with LDA?

A

Lutalyse and tetracycline

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17
Q

How would you treat hypocalcemia in a cow with LDA?

A

Hypocalcemia

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18
Q

How would you treat ketosis in a cow with LDA?

A

Dextrose IV

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19
Q

For a right flank omentopexy, what 4 nerve block options do you have?

A

Proximal paravertebral
Distal paravertebral
Inverted L
Line block

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20
Q

For a right flank omentopexy, where do you make your incision?

A

Halfway between the tuber coxae and the last rib, right in the middle of the paralumbaar fossa.

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21
Q

Roughly how long should you make your incision for a right flank omentopexy?

A

At least 6 inches.

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22
Q

When correcting a LDA, what is the purpose of going into the abdomen with a needle and sterile tubing?

A

To vent the gas off the abomasum.

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23
Q

Where do you place the suture in an omentopexy?

A

Place it through the abdominal wall, through the omentum and back through the abdominal wall.

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24
Q

Where is the omentum that you will use for an omentopexy attached?

A

At the pylorus.

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25
Q

When performing an omentopexy, what 3 things do you include in your sutures to complete it?

A

The omentum, the peritoneum and the transverse abdominal muscles.

NOTE: Use a simple continuous suture pattern.

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26
Q

Why do you suture the omentopexy from ventral to dorsal?

A

Because you want to prevent things from falling out.

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27
Q

What suture pattern do you use to close the oblique muscles after an omentopexy?

A

Simple continuous.

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28
Q

What suture material should you use for the omentopexy and muscle apposition?

A

Absorbable 2 or 3 in cows, 00 for the sheep.

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29
Q

What suture pattern do you use to close the subcutaneous layer in the celiotomy in a sheep?

A

00

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30
Q

When closing the skin in a celiotomy, what suture do you use?

A

Non-absorbable suture, 2 or 3 in the cow, and 00 or 0 in the sheep.

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31
Q

What are 5 advantages of the right paralumbar omentopexy?

A 
Cow in standing
One person can do it
Can use for LDA, RDA and RTA
Less traumatic
Gives good exploration
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32
Q

What are 4 disadvantages to the right paralumbar omentopexy?

A

Needs more skill/experience
Difficult if omentum is friable
Surgeon size can cause problems
Not easy in 3rd trimester

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33
Q

When performing an left flank abomasopexy, what structure do you need to be careful of with your incision?

A

The abomasum because it’s distended with fluid and gas.

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34
Q

What special piece of equipment do you need when performing a left flank abomasopexy?

A

Two straight intestinal needles with 3 feet of suture in between.

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35
Q

Describe simply how to perform a left flank abomasopexy.

A

Place a simple continuous pattern on the greater curvature of the abomasum, pass each needle through the right paramedian area with the second needle roughly 6 inches caudal and tie.

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36
Q

What do you need to be careful of when performing a left flank abomasopexy?

A

Make sure no viscera gets caught between the abomasum and body wall.

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37
Q

When passing the straight intestinal needles through the body wall during a left flank abomasopexy, what structure do you need to be careful not to hit?

A

The milk vein.

38
Q

What are 5 advantages of performing a left flank abomasopexy?

A 
Cow standing
Advanced pregnancies
Visual inspection
Ulcers can be oversewn
Rumenotomy

NOTE: This is the procedure of choice for cows during gestation.

39
Q

What are 3 disadvantages of performing a left flank abomasopexy?

A

Not to be used to RDA or RTA
Assistant needed
Size of the surgeon can be restrictive

40
Q

Where is the incision made when performaing a right paramedian abomasopexy?

A

Between midline and the right sq abdominal vein, starting 8cm behind the xyphoid.

41
Q

When performing a right paramediam abomasopexy, what is the preferred location for abomasopexy?

A

20 cm caudal to the xypohid and 5-10 cm to the right of ventral midline.

42
Q

What is an advantage of performing a right paramediam abomasopexy?

A

The size of the surgeon doesn’t matter.

43
Q

What are 3 disadvantages of performing a right paramediam abomasopexy?

A

Inability to visualize and cut adhesions
Cow is in dorsal recumbency
Risk of infection and dehiscence

44
Q

What are the 2 minimally invasive procedure for a LDA?

A

Closed suture

Toggle pin technique

45
Q

What do we see when a cow is roughly 10% dehydrated?

A

Sunken orbit

46
Q

What percentage of cows will redevelop an LDA following rolling and medical treatment?

A

75%

47
Q

How is the closed suture technique for correcting a LDA performed?

A

Cow is cast, and the surgeon kneels on the cow to “shake” the abomasum back into place, then with the cow in dorsal, a curved needle is pushed through the body wall into the abomasal lumen and back out through the body wall.

48
Q

How do you place a toggle pin to correct a LDA?

A

Shake the abomasum as per the closed suture technique, then use the trocar to help introduce the toggle.

49
Q

When correcting an LDA, when should you stop the procedure?

A

If a distinct ping cannot be identified at the appropriate location.

50
Q

What are 3 advantages to the closed suture and toggle pin procedures?

A

Quick
Inexpensive
Simple

51
Q

What are 4 disadvantages to the closed suture and toggle pin procedures?

A

Can’t visualize abomasum
Must be absolutely sure of diagnosis
Fistula possible
Potential for catastrophic complications

52
Q

How can you eliminate the lack of abomasal visualization from the closed suture and toggle pin technique?

A

Laparoscopy

53
Q

What is a fistula?

A

A communication between a hollow or tubular organ and the body surface.

54
Q

What is something that you often find in a fistula?

A

Non-absorbable suture material.

NOTE: Suture went into lumen of the abomasum.

55
Q

How do you repair an abomasal fistula?

A

En bloc resection, suture the abomasum with a double inverting pattern and repeat abomasopexy.

56
Q

What suture is very inert allowing it to be used in inflamed/infected tissue?

A

Stainless steel

57
Q

What are some differentials for a right sided ping? (Name as many as you can, 8 total)

A 
RDA
Abomasal volvulus
Cecal dilation/volvulus
Intussusception
Pneumorectum
Gas in the uterus
Gas in the spiral colon
Penumoperitoneum
58
Q

How can you treat a simple RDA medically (3 ways)?

A

Calcium
Dextrose
Exercise

59
Q

Where do you expect to find a ping with an RDA?

A

Paralumbar fossa to rib 8.

60
Q

What organ should you be thinking about if there is a ping auscultated in the right parlumbar fossa more caudally?

A

Cecum

61
Q

In an abomasal volvulus, how does the abomasum twist?

A

Counterclockwise from behind and counterclockwise from the right side.

62
Q

Why would you expect to see a tachycardia with an RDA?

A

Because of endotoxic shock, pain and hypovolemia.

63
Q

What 2 surgical options do you have to repair an abomasal volvulus?

A

Right flank omentopexy**

Right paramedian abomasopexy

64
Q

What are 2 things that can go wrong with performing fluid decompression on a chronic abomasal volvulus?

A

Peritonitis from leakage

Loss of HCl leading to alkalosis

65
Q

Once the abomasal volvulus has been corrected, pull the omentum until you see what structure to know the volvulus has been corrected?

A

The pylorus.

66
Q

When are abx indicated in an abomasal volvulus?

A

Anytime there is a strangulating obstruction.

67
Q

What is the prognosis of an RDA post surgery?

A

Good.

68
Q

In a case of abomasal volvulus, what are 2 causes of immediate death?

A

Hemodynamic/metabolic derangement

Circulatory collapse

69
Q

In a case of abomasal volvulus, what are 2 causes of delayed death?

A

Abnormal abomasal transport

Damage to the abomasal vasculature, nerves and muscle

70
Q

What are 5 causes of death from abomasal volvulus?

A 
Abomasal ulceration
Luminal hemorrhage
Venous thrombosis
Necrosis of the abomasum
Peritonitis
71
Q

What are 3 good prognosticators post-abomasal volvulus surgery?

A

Sternal
Good appetite
Feces on the wall

72
Q

If a cow stops eating, how much weight can she lose in 24 hours?

A

10kgs

73
Q

What are 3 common clin path changes seen in cattle with upper GI obstructions?

A

Hypochloremia
Hypokalemia
Metabolic alkalosis **different from monogastric species who go right to metabolic acidosis

74
Q

In a chronic case of abomasal volvulus, what is the development of an acidosis due to?

A

Due to the release of lactic acid due to shock.

75
Q

What hormone is secreted during dehydration to cause increase in sodium reabsorption?

A

Aldosterone.

76
Q

What happens in the face of metabolic alkalosis?

A

Paradoxical aciduria

77
Q

What is a major prognostic indicator with cases of abomasal volvulus?

A

Heart rate, the higher it is, the worse things are.

78
Q

What do we see in sheep instead of LDA, RDA and abomasal volvulus (because we don’t see those)?

A

Abomasal emptying defect.

79
Q

What 4 clinical signs do you see in a sheep with abomasal emptying defect?

A

BAR, but poor appetite.
Elevated HR and RR, normal rumen contractions
Decreased fecal output
Abdominal distention in the right ventral quadrant

80
Q

What sheep are commonly affect by abomasal emptying defect?

A

Pregnant sheep on a high concentrate diet.

81
Q

In a sheep with abomasal emptying defect, what would you see on ultrasound?

A

A large viscus against the body wall.

82
Q

How do you treat abomasal emptying defect medically?

A

IV fluid with electrolytes
Mineral oil
Cholinergic drugs

83
Q

How do you treat abomasal emptying defect surgically?

A

Abomasotomy using a right paracostal approach or a right paramedian approach.

84
Q

What 2 breeds of sheep are predisposed to abomasal emptying defect?

A

Suffolk

Dorset

85
Q

What is the prognosis for a sheep with abomasal emptying defect?

A

Guarded to poor.

86
Q

What are 3 causes of cecal dilatation, displacement/volvulus?

A

Accumulation of VFAs in the cecum after heavy grain feeding
Ileus from concurrent dz
Advanced pregnancy

87
Q

How can you repair a cecal dilatation, displacement/volvulus?

A

Right flank approach with a typhlotomy at the apex of the cecum to drain the contents, two inverting layers on the cecum with 00 absorbable suture.

88
Q

Post-typhlotomy, what 3 things do you treat the animal with?

A

Abx
Flunixin
Calcium

89
Q

What is the recurrence rate of cecal dilatation, displacement/volvulus?

A

10%

90
Q

If there is recurrence of cecal dilatation, displacement/volvulus, what is done next?

A

Removal of the apex and body of the cecum.

Large Animal Surgery (30 decks)

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