Ruminant 1 & 2 Flashcards
What surgical location consideration?
- Under cover (where possible)
- Sheltered from the prevailing wind/rain
What flooring considerations?
- Non-slip
- Clean, deeply bedded straw pen
- Ideally rubber metting
Restraint considerations?
- Consider patient temperament / compliance
- Halter, tied to a secure fitting with a quick release knot
- Cattle crush, with good side access
- Small ruminants tied down on a table / straw bale in lateral recumbency
- Assistant(s)
Pre-Op Consideration - anaesthesia ?
- Local/regional anaesthetic techniques
- Speed of onset (5-15mins)
- Licensed anaesthetic agents (procaine with adrenaline)
Describe local anaesthetic options?
- Infiltration or Inverted L
- Proximal / distal paravertebral (T13-L2+3)
- Epidural (L6-S1 or C1-C2)
Pre-Op Considerations - analgesia?
- Pre-emptive. NSAID use (fluxinin, meloxicam, ketoprofen, carprofen)
- IV to maximise speed of onset
What AM Considerations?
- Infection status
- Risk of contamination (opening viscera, decompressing viscera, patient compliance
- Likely bacteria present -> G+ ; G - , anaerobic organisms from GIT
What to remember about AMs?
- ROA - Iv or IM to act quick
- Licensed products
- Milk & meat withold
What Am to use for non-contaminated abdominal surgery?
- Aminopenicillins
- Aminoglycoside
- First gen cephalosphorins
- Tetracyclines
What AMs to use for anaerobic contamination likely or infection establish?
- Aminopenicillins
- Cephalosporins
What AMs for suspected or known beta-lactamase resistance ?
- Tetracyclines
- Potentiated sulphonamides
- Potentiated Aminopenicillin
- 3rd gen cephaloS
HOw many days of AB for non-contaminated abdo surgery (theatre) ?
0 days
How many days of AMs for Non-contaminated abdo surgery (on farm) ?
3-5 days
how many days of AMs for contaminted or infected (on farm or theatre) ?
5-7 days
Fluid therapy?
- Hydration status and degree of shock
- Likelihood of electrolyte derangement
- Acid/ Base balance
PreOp Surgical prep?
- Wide clip
- Make sure La complete first
- Secure tail to cow
- Surgical scrub (two buckets + brush ; chlorexidine or providone iodine / surgial spirit )
Describe steps to Abdominal incision?
- 15-40cm dorsoventral skin incision
- Identify and incise muscle layers individually
- The transverse abdominal muscle and attached peritoneum should be tented with a forceps and a cut made into the abdomen with scissors. A sharp hiss is usually heard at as air is sucked into the peritoneal cavity under negative pressure.
- Extend the incision dorsally & ventrally using fingers to elevate the body wall
When to use Absorbable suture to close ?
With simple conitnuous, or cruciate and a curved round bodied needle
When to use Non-abdorbable suture?
Ford interlocking
Simple interrupted (most ventral 2-3 sutures to allow removal and drainage if rq)
With half-curved cutting needle
What indications for Exploratory Laparotomy?
- Severe or inc abdo pain unresponsive to analgesics
- Unresponsive or deteriorating shock
- Rectal exam findings
- chronic rumenal indigestion/tympany
- Complete absence of faecal production
- Lab findings
- To obtain a diagnosis
How would u do a left sided ex-lap?
How would u do a right sided approach?
What categories of surgical conditions of the ruminant GIT ?
Ruminal disorders
Abomasal disorders
Intestinal disorders (uncommon)
What ruminal disorders can be surgical?
- Traumatic Reitulopericarditis
- Rumental tympany
- Impaction
What abomasal disorders surgical ?
- Left displaced abomasum
- Right abosomal dilatation, displacement and volvulus
- Impaction
- Ulceration
What intestinal disorders?
- Intestinal intussusception
- Caecal dilation and torsion
- Rectal prolpase
What indiciations for Rumenotomy?
- Suspected TRP
- Ruminal Impaction
- Ruminal FB
- Grain overload and acidosis
- Ruminal tympany
- Intoxication
Describe the conservative management of Traumatic Reticulo-pericarditis ?
- Magnet bolus
- Broad spec system Antibiotics
- NSAIDs
- Oral fluid therapy and probiotics
Surgical Traumatic Reticulo-P?
- Left paralumbar fossa lapatotomy and rumentomy
- Careful manual exploration of the Cranioventral abdomen alongside the rumen and reticulum
- Adhesions palpable between the reitucum and diaphragm
Prognosis for Tramatic Reticulo-P?
- Guarded to poor
- Poor medical tx response
- Surgery if often unrewarding
- Timing of surgery is key
- Guarded if the peritonitis is generalised
- Very poor if muffled sounds
Rumenotomy - Surgical approach?
- Explore the external surface fo the rumen and reticulum
- Secure the rumen to the skin (stay suture or frame)
- Rumenotomy incision
- Manual exploration of reticulum (identify hexagonal internal surface)
- Closure (two layers with a continuous inverting suture pattern in #2 absorbable)
Indications for Ruminal Trochar placement?
- Peracute ruminal tympany unresponsive to decompression
- Management of chronic ruminal tympany
Approach to ruminal trochar placement?
- Surgical prep & LA by infiltration
- Scalpel incision through skin
- Firmly insert trochar & cannula through body wall into rumen in a single motion
- Screw into place & remove cannula
- Secure with sutures
Common & important abomasal disorders
- Left displaced
- Right displaced abomasum
- Ulceration
- Impaction
Considerations of surgical approach - Abomasal disorders
- Effective return & stabilisation of the abomasum in a normal anatomical position
- Mangement of concurrent abdominal pathology
- Minimise additional risk
- Practicality in light of available handling facilities
- Economic cost-benefit
- Surgeon experience
Left displaced abomasum - conservative management?
- casting and rollig
- +/_ analgesics & spasmolytics
- +/- oral fluid thrapy
- +/- ruminal probiotics
- +/- tx of concurrent medical conditions
- Dietary management
Describe the Open approach to surgical correction of LDA
- Secure the pylorus and/or lesser omentum -> right sided paraL fossa, both sided paraL fossa
- Secure fundus -> right paramedian & left sided paralumbar fossa
Closed approach to surgical correction of LDA?
- Toggle-pin (common)
- Blind fixation
- Laparoscopy (+/- rolling)
What intra-op complications of LDA ?
- Failure of decompression
- Failure of relocation
- Other (peritonitis, friable intra-abdo/omental fat)
Describe Failure of decompression?
- Obstrution of tubing
- Incorrect needle placement
- Inadequate reach / large abdo sie
- Incorrect diagnosis
Failure of relocation - ?
- Adhesions
- incomplete decompression
- Dorsal incision placement / deep abdomen
- Incorrect diagnosis
Advantages of open approach?
- Good visualisation
- Concurrent pathology addressed
- Suitable for most DAs
- Low risk of recurrence
- Pg 80-100%
Open Disadvantages?
- More invasive
- Time consuming
- More expensive
- Risk of generalised peritonitis
- Reasonable surgeon arm length
Closed - Advanatages?
- Lless expensive
- Rapid
- Any surgeon arm length
- Relatively low risk of recurrence
- Pg 77-91%
Disadvantages of Closed?
- Blind procedure
- Concurrent pathology not addressed
- Risk of trauma to other viscera
- Requires rolling
- Careful case selection
- Risk of local peritonitis and abomasal fistula
Indications for surgical intervention (RDA)
- PResent or deteriorating hypovol/ endotox shock
- Severe or increasing abdo pain unresponsibe to analgesics
- Regurg on passing a stomach tube
- No response to conservative management in 2-4 hrs
RDA - Surgical correciton ?
- Right paralumbar fossa laparotomy pyloro-and/or omentopexy
- Traction on the omentum does nto expose pylorus with RVA
- An anticlockwise volvulus can be corrected by clockwise rotation of abomasum
- Decompresison may be require before correction of the voluvlus
correct fluid/ electorlyte imbalances
Conservative tx for RDA?
As for LDA
NB metroclopramide illegal in food producing animals in UK
Regular monitoring
