Principles of LA Soft Tissue Surgery (22) Flashcards
Dr. Devine
How does large animal skin differ from small?
- thicker tissue
- skin does not bruise
- hemorrhage generally not a problem
How much blood can LA lose during surgery?
<15 %
starts to show clinical signs 15-20%
What percent blood loss in LA is there a risk of death?
> 40%
What are the characteristics to LA standing surgery?
- prevents complications of being recumbent
- prevents risk of recovering from anesthesia
- better access for select structures - dorsal
- reduced cost
What are the characteristics to LA recumbent surgery?
- safer for surgeon
- no movement
- better access for most structures
What is this structure?
epiglottis
What method do you use to visualize this structure?
URT endoscopy
What are the characteristics of URT endoscopy?
- NOT sedated at rest
- treadmill
- under a saddle
What are the approaches to LA URT surgery?
TIGHT spaces; most procedures are done in <3 in wide spaces
What instrument is critical to URT surgeries?
retractors: self-retaining, hand held
What are URT considerations for healing?
mucosa heals rapidly
potential for mucosal “webbing”
What are complications of URT surgery?
- excessive swelling - blocks airway
- damage to nearby structures
- surgeries that are re-opening airway
- surgical site infection
What are diagnostics for GI surgery?
limited due to size of abdomen and length of GIT
What is part of a colic work up?
- rectal palpation
- abdominal u/s
- nasogastric tube intubation
- abdominocentesis
- bloodwork
What is a paramedian incision?
right side
What are the approaches to celiotomy for LA?
- ventral midline - most common
- paramedian
- paralumbar fossa
- laparoscopic portals
What is the most common surgery in equine GI?
exploratory laparotomy (colic surgery)
If the bowel is closed, the surgery is considered _____. If the bowel is open, the surgery is considered ______
clean
clean-contaminated
What are considerations for healing of the equine GI tract?
serosa can have problems
- intra-abdominal adhesions - a dysfunction of fibrinolysis
DO NOT USE DRY GAUZE EVER
How do you reduce adhesions for GI surgery?
- gentle handling of tissues
- keeps tissues moist
- use of lubricants
- strict asepsis
- prevent blood from enters abdomen
What are potential complications of equine GI surgeries?
What is wrong in this picture?
intra-abdominal testes
Look at common surgical procedures LA for urogenital tract
Where do you enter for a cryptorchid surgery?
- inguinal
- parainguinal
- laparoscopic
What are approaches to female urogenital system LA?
the back end —> standing sedation and epidural
ovariectomy —> laparoscopy, flank, vagina, ventral midline celiotomy
What are surgical considerations for LA urogenital tract?
- may need to catheterize bladder
- function is an important outcome
- approaches can be challenging - small spaces, accessibility
What are considerations for LA urogenital surgeries?
- healing can be a challenge
- back end of mare has a lot of contamination
- give distal urethra a rest
What are common complications for LA urogenital tract surgeries?
- bleeding
- loss of function
- breakdown of repair
- stricture
- infection
How does laparoscopy work?
- abdomen is insufflated with CO2
- blind stab incision made to place scope portal
- scope introduced through portal that maintains pressure in abdomen
What are the common laparoscopic surgeries?
cryptorchidectomy
ovariectomy
exploring abdomen in chronic cases
How do you prepare equine pre-operatively?
withhold feed overnight
NSAIDs
antibiotics for clean-contaminated
What are general complications for equine surgery?
- subcutaneous emphysema
- retroperitoneal insufflation
- bowel perforation
- hemorrhage
