Reproductive Surgery of Adult Ruminant Flashcards
what are the indications of a caesarean section (5)
- calf too big
- calf too small
- deformed calf
- twisted uterus
- dead/emphysematous calf
how do you prep for a c section
Find a suitable place and restrain cow
LIGHT
Assess temperament — sedation?
0.5ml xylazine IM, then walk away
Instruct farmer to get warm/clean water, electricity, string for tail, table for kit, extra help
Clip and prepare surgical site, LEFT side
Rumen is easy to push away
Right hand side has small, large intestine in the way
Admin local and other drugs
Open and organize kit
how do you restrain for a c section
crush - if she goes down its a disaster
Halter in corner? (Safety)
calving stall?
what drugs do you need for c section
epidural cow if straining
broad spectrum antibiotics
NSAID (meloxicam)
clenbuterol
local anesthetic for flank
what broad spectrum antibiotics might you use in a c section
penicillin and streptomycin (Pen and Strep)
Amoxicillin
Clavulanic acid (Synulox)
what are the landmarks for a laparotomy
Caudal edge of last rib
Transverse process of lumbar vertebrae
Line drawn down from hook bone (tuber coxae)
what is a line block
Line block: 100-150ml
Disadvantages:
- Local anesthetic can delay wound healing
what is an inverted L block
upside down L
The local anesthetic is not on the surgical site
what are paravertebral blocks
2 options for nerves T13, L1 and L2
Distal L1, L2, L4
Proximal
90ml
before you enter the abdomen of the cow what should you do
Final scrub of cow and you
Scrub of farmer
Get suture material ready (in case of perforation of rumen)
Make sure everyone knows the plan if:
- Cow goes down
- Calf needs help
- Someone faints
- Etc
how do you perform a laparotomy on the left
muscle 3-10cm thick
what looks very similar to the rumen
peritoneum
how do you perform a c section
Locate uterus — hand in, to the right and down
Right horn = more difficult
Grasp metatarsal or hock and hoof and pull towards wound
Hook hock end of wound
Incise right over hoof (scissors) and up to hock
Incise placenta (grip)
Give farmer foot above metatarsal
Gently pull calf (+/- ropes/chains) caudal and dorsal
Watch umbilicus
Leave farmer to assist calf
Breathe
Trim placenta
Inverted closure of uterus (2 layers), clamps
Lembert, Cushing, Connell
Not into lumen and don’t trap placenta
Can result in retained fetal membrane
If friable — better to have one good layer
Scoop fluid from abdomen
how do you suture the uterus closed
Near far, far near then secure
Continue with approx. 1.5cm between each stitch and about 1.5cm from the wound edge
Tighten every 3-4 seiches
Vicryl (cat gut)
6-8 metric USP 2-4
Secure at bottom then head back up to top again
Can have bigger gap between stitches
Remember to tighten stitches
how do you close the peritoneal and transverse muscle layers
Peritoneum and transverse (3rd) simple continuous, absorbable
how do you close the external and internal abdominal oblique muscle
External and internal abdominal oblique (2nd and 1st) simple continuous, absorbable (vicryl – 6-8 metric or USP 2 to 4)
how do you close the skin
Skin, surgeons preference (ford interlocking with 2x cruciate at bottom) non-absorbable (ex. supramid 6-8 metric or USP 2)
- Variations — occasionally taking a bite of first layer when suturing the second muscle layer, subcutaneous for dead space, interrupted stitches at distal end skin wound (to allow drainage)
what would you use to reverse the clenbuterol
what are the care instructions to give the farmer
Administer meds as instructed/required
Watch for retained fetal membrane (RFM)
Watch for wound swelling (removal distal stitches)
Phone you if worried
SO 14-21 days
Normal post operative:
- Would swelling
- Emphysema
what can go wrong in the short term c section
cow goes down (can do down)
enter rumen (have your suture ready)
friable uterus and stitches tear through
stressed/acidotic calf
what can go wrong in the medium term c section (1-3 weeks)
retained fetal membrane (ideally repulsed within 24 hours)
wound infection
peritonitis (local or general)
poor fetal maternal bond
what can go wrong in the long term c section (1-3 weeks)
subsequent milk production
subsequent fertility
how is a c section in sheep done
restraint
lying down vs standing
less local 40-60ml inverted L block (don’t use too much)
what are the key differences between a sheep and a cow c section (3)
- often multiple fetuses
- thinner muscle layers (can stitch all together if really thin)
- if one hole, need to go back to cervix to enter opposite horn
how do you retrieve a lamb from the other horn
what are the indications of an episiotomy
tight vulva
prevents tear
how is an episiotomy performed
5-10cm skin incision (+/- mucosa)
10 and/or 2 o’clock
2 layer suture with vicryl or cat gut (6-8 metric USP 2 to 4)
- Continuous mucosa
- Simple interrupted skin
Tend to heal well
when is a vasectomy done
teaser
synchro and advancement of breeding season
mainly tups
what drugs would you need for a vasectomy
Pre op: 8-10 ml local around each chord (draw back!), epidural +/- sedation
Broad spectrum antibiotics
NSAIDs
how is a vasectomy done
Vertical skin incision about 4cm
Digital dissection to isolate spermatic cord
Hook cord over finger or with pair of forceps (don’t confuse with the penis)
Locate deferent duct (should be medial, feels firm, artery/vein close by)
Secure between thumb and forefinger
Make a nick in vaginal tunic to expose deferent duct (2mm, has BV)
Exteriorize at least 3cm of duct, clamp at either end and ligate at either end
Cut between forceps —> keep the bit!
Skin sutures
Repeat on other side
what can go wrong with a vasectomy
nfection, hemorrhage
Remove wrong tissue
Deferent duct re-anastomosis
Always offer histopathology (store if not running)
Always offer electroejaculation
what is a penile hematoma
end to occur at base of scrotum
More proximal the better for prognosis
Can resolve so can try conservative treatment first —> must do surgery within 10 days
May abscess/adhesion/penile prolapse
? Nerve damage
how is penile hematoma surgery done
GA
Incise over
Remove clot
Flush
Stitch
how is an internal pudendal block done
Results in penile relaxation and analgesia distal to sigmoid flexure
Local infiltration of skin in ischiorectal fossa
Rectal to wrist, place hand lateral and ventral to ID foramen on sacrosciatic ligament
Find nerve cranial and dorsal to foramen
Inject 30ml (long needle) from outside
Repeat on other side
