Ruminants Tx + Procedures Flashcards
Local/regional anaesthetic technique
- Infiltration/inverted L
- Proximal / distal paravertebral (T13 - L2 +/- 3)
- Epidural (L6 - S1 or Co1 - Co2)
- Speed of onset = 5 - 15 min
- Procaine + adrenaline
Loco-regional anaesthetic sites - head
- Eyes
- Auriculopalpebral
- Infraorbital
- Cornual - disbudding + dehorning
- Mental
Pre-emptive NSAID
- Flunixin meglumine (Finadyne®)
- Meloxicam (Metacam® 2 0 mg/mL)
- Ketoprofen (Ketofen® 10%)
- Carprofen (Rymadyl Cattle® 50mg/ml)
- Tolfenamic acid (not sold in UK)
- IV to maximise speed of onset
Pre-op antimicrobial therapy - non-contaminated abdo Sx
- Aminopenicillins (e.g. Ampicillin or Amoxycillin)
- Penicillin and Aminoglycoside (e.g. Penicillin and Streptomycin)
- First-generation cephalosporins (e.g. Cephalexin)
- Tetracyclines (e.g. Oxytetracycline)
- Potentiated sulphonamides (e.g Trimethoprim and Sulphadiazine)
Pre-op antimicrobial therapy - anaerobic contamination likely or infection established
- Aminopenicillins (e.g. Ampicillin or Amoxycillin)
- Cephalosporins (e.g. Cephalexin)
Pre-op antimicrobial therapy - suspected or lactamase resistance
- Tetracyclines (e.g. Oxytetracycline)
- Potentiated sulphonamides (e.g. Trimethoprim and Sulphadiazine)
- Potentiated Aminopenicillins (e.g. Amoxycillin and Clavulanic acid)
- Third generation cephalosporins (e.g. Ceftiofur)
Non-contaminated abdo Sx (in theatre) min duration of antimicrobial therapy
0 d
Non-contaminated abdo Sx (on farm) min duration of antimicrobial therapy
3 - 5 d
Contaminated/infected (on farm/in theatre) min duration of antimicrobial therapy
5 - 7 d
Sx scrub
- Gloves
- Min two buckets - clean + dirty
- +/- scrubbing brush
- Chlorhexidine/povidone-iodine
- Surgical spirit
Laparotomy incisions
- Paramedian
- Ventral midline
- Paracostal
- Oblique
- Paralumbar fossa - most common, standing Sx, less forces of muscle tension - easier to suture
- Ventrolateral
- Medial approaches - better visualisation + access to organs
Laparotomy incisions - left flank incisions
- Paracostal - rumenotomy - most cranial, 18 - 25 cm
- Left flank abomasopexy - utrecht technique/ex-lap, 25 cm
- Low flank incision in recum cow/heifer for C-section when anticipated difficult to bring uterine wall to flank, 35 cm
- Standard caudal left flank, 35 - 40 cm
- Oblique flank incision - C-section in standing, 35 - 40 cm, best as greater access to uterus
Paralumbar laparotomy - abdo incision
- 15 - 40 cm dorsoventral skin incision
- Identify and incise muscle layers individually
- Individually incise cutaneous trunci m, external abdominal oblique m, internal abdo oblique m
- The transverse abdominal muscle and attached peritoneum should be tented with 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 and ventrally, using fingers to elevate the body
LDA - right flank approach
- Ping on LDA
- Incision RHS
- Deflate abdomasum - needle
- Reach around LHS + pull stomach back so won’t happen again + correct by untwisting + suture onto RHS of abdo to ensure doesn’t displace again
- Penicillin
- Suture
- Drench - fluids to ensure hydrated
Paralumbar laparotomy - abdo closure suture material + needle
Absorbable
- 2-0 Vicryl or PDS
- 5-0/6-0 Catgut
- Curved, round-bodied needle
Paralumbar laparotomy - abdo closure of peritoneum + transverse abdominis
- Simple continuous
Paralumbar laparotomy - abdo closure of internal abdominal oblique
- Simple continuous
- Cruciate
- Dependent on muscle thickness
Paralumbar laparotomy - abdo closure of external abdominal oblique
- Simple continuous
- Cruciate
- Dependent on muscle thickness
- May be closed in single layer w/ internal abdo oblique m
Paralumbar laparotomy - abdo closure of skin
- Half curved, cutting needle
- Non-absorbable 3-0 - 4-0 nylon material
- Ford interlocking
- Simple interrupted - most ventral 2 - 3 sutures to allow removal + drainage if required
Exploratory laparotomy - left-sided approach
- From left luminal wall
- 1). Parietal peritoneum -> abdo floor (fluid)
- 2). L kidney -> uterus + ovaries -> bladder -> ureters -> LNs -> inguinum
- 3). Descending colon -> body of caecum -> coils of jejunum
- 4). Rumen -> spleen -> reticulum -> diaphragm -> L lobe of liver -> cardiac impulse (apex beat)
- To access peritoneum
Exploratory laparotomy - right-sided approach
From greater omentum
- 1). Mesoduodenum -> duodenum -> pylorus -> abdomasum
From abomasum
- 2). Reticulum -> abdo wall -> diaphragm -> cardiac impulse (apex)
- 3). Visceral surface of liver -> gallbladder -> cranial surface of liver -> diaphragm
GO -> descending colon
- 4). Coils of jejunum -> body of caecum -> spiral colon -> root of mesentery + coils of jejunum -> root of mesentery
- 5). Rectum -> uterus + ovaries -> bladder
GO
- 6). Perirenal fat (right) -> perirenal fat (left) -> kidneys (L + R)
- More common - better access to organs
TRP (traumatic reticulo-pericarditis)
Conservative
- Magnet bolus
- Broad-spectrum systemic antibiotics - amoxicillin
- NSAIDs
- Oral fluid therapy and probiotics
Surgical - not rewarding, easier if performed early, at moment of exit of FB from reticulum
- Left paralumbar fossa laparotomy and rumenotomy
- Careful manual exploration of the cranioventral abdomen alongside the rumen and reticulum + removal of FB
- Adhesions palpable between the reticulum and the diaphragm
- (Pericardiocentesis)
- Px = guarded - poor, usual poor response to medical Tx
- Guarded if peritonitis generalised
- V poor if muffled heart sounds
Rumenotomy
- 1). Explore the external surface of the rumen and reticulum
- 2). Secure rumen to the skin
- Stay sutures (2-0 synthetic absorbable = vicryl)
- Rumenotomy frame and sleeve
- 3). Rumenotomy incision
- 4). Manual exploration of reticulum
- Identifying the hexagonal internal surface
- Rumen contents removed
- Rumen lavaged w/ warm water
- Intra-ruminal buffers e.g. Mg(OH)2; Al(OH)3; NaHCO3
- IVFT + correction of acid/base imbalance
- (If poisoning instead of intra-ruminal buffers, give activated charcoal)
- 5). Closure - two layers with a continuous inverting suture pattern in a 2-0 synthetic absorbable
Ruminal trochar placement
- 1). Surgical prep & LA by infiltration
- 2). Scalpel incision through skin, not on muscle
- 3). Firmly insert trochar (stab) & cannula through body wall into rumen in a single motion - paralumbar fossa, where thinnest
- 4). Screw into place - secures muscle layers to cannula, prevents it moving + rumen moving & remove cannula (deflates, removes air)
- 5). Secure with sutures
LDA - conservative management
- Casting and rolling (30 - 40% success) - hear ping on RHS successful
- +/- Analgesics and spasmolytics - Butylscopolamine + Metamizole
- +/- Oral fluid therapy - 40 - 60L isotonic fluid to ballast the rumen)
- +/- Ruminal probiotics
- +/- Treatment of concurrent medical conditions (e.g. Metritis and Ketosis)
- Dietary management (High NDF + low starch)
LDA - open Sx
Abomasopexy = suturing abomasal wall/attached omentum to abdo wall
- Secure pylorus and/or lesser omentum - right-sided paralumbar fossa (common); both-sided paralumbar fossa
- Secure fundus - right paramedian fossa (increasingly common); L-sided paralumbar fossa ‘utrecht’ (less common)
LDA - closed Sx
- Toggle pin (common)
- Blind fixation
- Laparoscopy (+/- rolling)
LDA - fixation procedures
- Right paralumbar laparotomy
- Pyloropexy
- And/or Omentopexy (pexy = fixation)
- Reach caudally to the omental sling and dorsally, then cranially over the rumen to palpate the distended abomasal fundus
- Obliquely insert a 14G needle attached to sterile tubing into the abomasum at the most dorsal point to decompress
- Reach across the ventral body wall and grasp the pylorus / lesser omentum on the midline
- Raise the pylorus to the ventral margin of the incision restoring normal abomasal position
- A pyloropexy, omentopexy or both (incorporating the peritoneum and transverse abdominal muscle) are carried out using a synthetic absorbable suture material (2-0 Vicryl)
LDA - Left paralumbar laparotomy + abomasopexy (utrecht)
Uncommon but occasionally useful
- 1 - 2 m 2-0 monofilament, nonabsorbable suture - place 5 - 8 partial-thickness continuous sutures along the greater curvature of the abomasum
- Pass straight needles (threaded onto both free ends) ventrally between rumen + body wall to right of midline caudal to sternum -> punctured through body wall to assistant w/ grasped haemostats
- As abomasum is decompressed, traction is applied to sutures to return it to its normal position
- Two ends of sutures are anchored to secure it in place
LDA - right paramedian laparotomy + abomasopexy
Increasingly common
- Cast the cow in right lateral recumbency, then roll into dorsal recumbency (sedation recommended)
- A paramedian incision is made starting approximately a hand’s breadth to the right and a hand’s breadth caudal to the xiphisternum
- Reach abomasum on LHS from RHS, once dropped ventrally, fish abomasum to RHS -> fixate to wall
- The abomasal fundus is visualised and an abomasopexy (to omentum/pylorus) is performed suturing the abomasum to the
internal layer of the rectus sheath and peritoneum (three muscle layers)
LDA - toggle-pin suture
Common - may not need to give AB
- Cast the cow in right lateral recumbency, then roll into dorsal recumbency (sedation recommended)
- Confirm the position of the abomasum must be confirmed by locating a “ping” in the right cranioventral abdomen. If this is not possible the procedure should be aborted.
- Give local anaesthesia
- Applying pressure to the caudal abdomen (e.g. by kneeling in on both sides with the help of an assistant) will help to push the abomasum cranially and ventrally
- A trochar is used to penetrate into the abomasum a hand’s breadth to the right and a hand’s breadth caudal to the xyphisternum
- The location is confirmed by the acidic smell of abomasal gas
- The first toggle is quickly inserted using the cannula, the trochar is removed before the abomasum is decompressed fully and the free end of the suture is grasped securely with haemostats
- The trochar is re-inserted approximately 5 cm caudally to the initial incision and a second toggle suture is placed
- Gas is allowed to escape before the trochar is removed
- The two sutures are secured together, leaving hand’s thickness between the tightened suture and the body wall
RDA - Sx correction
Right paralumbar fossa laparotomy, pyloro- and/or omento-pexy
- Traction on the omentum does not expose pylorus with an RVA - An anticlockwise volvulus can be corrected by clockwise rotation of abomasum using left arm placed medially
- Decompression (as for LDA) may be required before correction of the volvulus -> pyloropexy/omentopexy performed
- Correct fluid / electrolyte imbalances
RDA - conservative management
- +/- Analgesics and spasmolytics - Butylscopolamine
- +/- Oral fluid therapy - may regurg
- +/- Ruminal probiotics
- +/- Treatment of concurrent medical conditions (e.g. Metritis and Ketosis)
- Dietary management (High NDF + low starch)
- Metaclopromide illegal in FPAs
- Regular monitoring q 2 - 4 h
C-section positioning - cattle
- Standing generally preferred as it facilitates manipulation of the uterus
- Right lateral recumbency if unable to stand or requiring heavy sedation to handle
- Preventing the cow from changing position is essential
- Generally paralumbar fossa approach, most common LHS - don’t need to worry about rumen, if intestines coming out
- RHS - only if have uterine torsion that needs solving on RHS
C-section positioning - small ruminants
- Right lateral recumbency
- Tied to a table / straw bale
Caesarean section - left-sided paralumbar fossa laparotomy appraoch
- Preferred approach
- Rumen easier to manipulate than distal GIT
- Minimises egress of viscera and abdominal contamination
- Caudal third of the paralumbar fossa to facilitate exteriorisation of the uterus
- Large incision (~40 cm) to avoid trauma to the incision while manipulating the uterus
C-section - hysterecomty + calf delivery
- Determine uterine and calf position
- Identify closest HL in anterior and FL in posterior presentations
- Gently grasp a limb, apply traction and ‘rock’ the limb towards the incision
- Lock the limb in the incision - e.g. hock over the ventral aspect of the incision and the hoof pointing dorsally
- Hysterotomy incision outside the abdomen to decrease contamination
- Kruse caesarean knife can be used to safely incise within abdomen if required
- A longitudinal incision over the plantar metatarsus and hock through all layers of uterus (care to avoid damaging calf)
- The other limb can be identified and exteriorised
- The calf can then be elevated and rotated as a (non) sterile assistant
applies traction to deliver = calving ropes, pulling dorsally and caudally - During traction the uterus should be maintained extra-abdominally
- ALWAYS check for a second calf
C-section - hysterotomy closure
- Place the membranes back in the uterus (or cut off if contaminated)
- “Utrecht” Far-Near-Far-Near continuous inverting pattern in 1 or 2
layers to ensure water-tight - 2-0 synthetic absorbable suture material
- Care not incorporate foetal membranes
- Assess integrity of seal before closure
C-section - small ruminants
- Tissue much more fragile compared to cattle - cannot pull as much
C-section - alternative approaches
- Right-sided paralumbar fossa laparotomy
- Left ventrolateral laparotomy
Vaginal/cervical prolapse
- Epidural
- Clean
- Replace
- Bruhner’s suture/’Spoon’ harness
Uterine prolapse
- Protect the uterus
- +/- Intravenous Calcium Borogluconate
- Caudal epidural anaesthesia + NSAIDs
- Clean uterus + remove foetal membranes
- 2x assistants support uterus in a towel
- If recumbent, then ‘frog-leg’
- Start at the vulval margins & progressively invert using knuckles
- Make sure the uterus is fully inverted
- Bruhners suture – very controversial use (like draw-string)
- Oxytocin - encourage uterine involution
Elastrator bands
- Lambs / calves in first 7 d of life
Calf standing / restrain lamb i sitting pos - Ensure both testes present
- Place ring over tip of scrotum, grasping gently w/ fingers + push ring up to level of scrotal neck + release the pressure
- Check both testes included accessory teats are free before forceps removed
- Stops blood supply -> skin + testicles slough off due to necrosis
- Sometimes testis slips up/both not in band - requires vet intervention, Sx similar to cryptorchid
Burdizzo castration
- Bloodless castration - crush spermatic cord + blood vessels w/o penetrating skin
- Performed up to 6 m/o
- Decreasingly common
- Local anaesthesia > 2 m age
- Previous experience w/ complications of open castration
- Ensure both testes maintained in scrotum
- Apply Burdizzo proximal to testes where cord becomes narrower - cord held to lateral side + instruments applied for at least 6 - 10 s
- Second applicator made distal to first advisable
- Each cord crushed separately w/ crush lines slightly staggered to prevent interruption of bloody supply to the scortal skin
- Testes should have atrophied 4 w later, but scrotal skin remains
Surgical castration - local anaesthesia
- 1). Skin block so cannot feel twisting
- 2). Intratesticular - hub of needle straight into testicle, then as pull out - infiltrate under skin, safer for vet
- Should have some infiltration of spermatic cord
- 3). OR infiltration of spermatic cord on both sides individually + higher up but harder to access, more dangerous to perform
(Can do all three)
Surgical castration (open)
- 1). Restrain in safe standing position
- 2). Infiltrate local anaesthesia
- 3). Wash the scrotum w/ antibacterial solution
- 4). Grip scrotum firmly at neck to pull testes down
- 5). Start w/ testis furthest from you -> longitudinal bold/transverse distal incision through scrotal skin + vaginal tunic
- 6). Digitally break down attachment of vaginal tunic to testis distally
- 7). Holding testis in one hand, use other hand to free spermatic cord by stripping fascia proximally
- Push tunic back up into incision - don’t want to caught in torsion + traction of spermatic cord
- 8). Testicular removal + hemostasis = torsion + traction - twisting + pulling for hemostasis - high up to the body wall for pulling straight down / emasculator (like equine) - nut to nut - clamp above + hold for a min of 2 min + cut in the same action
Castration - ‘twist + pull’
- Detach tunic from tail of epididymis
- ‘Twist + pull’ - torsion + traction
- Leave skin open + apply topical AB
Vasectomy - pre-op considerations
- Anaesthesia - local infiltration using Procaine w/ adrenaline; Lumbosacral epidural - also immobilises hindlimbs, using Lignocaine + provides analgesia
- Analgesia - NSAID as castrate
- AB?
- Restraint - require the ram to be tipped up, sedation/GA (Xylazine)
Vasectomy
- 1). Infiltration around cord and subcutaneously at site of incision
- 2). Surgical preparation of the incision site and surgeon
- 3). Incise the medial scrotal skin over the spermatic cord - 2 cm made 1 cm off midline cranial or caudal to the scrotum
- 4). Identify and exteriorise spermatic cord
- 5). Identify vas deferens - caudomedial aspect of spermatic cord, located by palpation + firmer texture
- 6). Create small incision into vaginal tunic - avoid damaging aa, vv, nn + identify ductus deferens by blunt dissection
- 7). Exteriorise length of vas deferens (minimum 3 cm) - closed artery forceps placed beneath ductus deferens to isololate is from other structures of spermatic cord
- 8). Clamp and cut at each end of the vas deferens - 3 - 4 cm resected + removed
- 9). Anchor one end (Proximal?) to reduce the risk of re-canalisation
- 10). Close SC + skin
Urolithiasis - Sx
(Order of inc invasiveness)
- Amputation of urethral appendage - snip off
- Perineal urethrostomy
- Cystotomy
- Bladder marsupialisation (prepubic cystotomy)
- Euth = valid Tx
Omphalitis (Navel ill/umbilical abscess) Abscess - Sx approach
- Restrain calf standing or in lateral recum
- Pre-op US/FNA for Dx
- Sx prepare incision site
- Bold incision at most dependant point
- Expression of purulent material + antiseptic lavage
- +/- systemic AB - concurrent pyrexia or poor/incomplete drainage, significant fibrosis of abdominal wall
- Px - good for non-complicated abscesses
Umbilical hernia repair (herniorrhaphy)
- 1). Fusiform incision +/- preputial reflection
- 2). Blunt dissect through SC tissues to expose + free hernial sac
- 3). Invert free hernial sac into abdo - attached w/ a lot of fibrous + scar tissues around
- 4). Decide if open/closed
- Closed = uncomplicated hernia, no intestines - abdo tissues within, blunt dissection around all tissues
- Open = open sac to reduce contents of hernia back into abdo
- 5). Debride margins of hernial ring to improve adhesion
- 6). Preplace tension-relieving horizontal mattress sutures in synthetic absorbable material - mesh may be appropriate in larger hernias (polypropylene or steel), rarely used
- 7). Tie off each suture
- 8). Oversew everted abdo wall margin in simple continuous pattern
- 9). Routine closure of SC tissues + skin
- 10). Secure stent over incision to provide protection for first 24 - 72 h
Umbilical remnant disorder - abscess + hernia at same time
- Similar approach to hernia surgery - pre-operative considerations similar, AB?
- Extreme care not to puncture the abscess
- Incise cranially in urachal or umbilical abscesses
- Incise caudally in umbilical vein abscessation
- Dissect abscess out - take capsule of abscess out
- If incise whilst still attached to abdo, pus gets out
Disbudding + dehorning
- 1). Thermal cautery: 1 - 4 w/o hot iron disbudding; 1 - 6 m/o; Barnes dehorning gouge/hoof shears; > 6 m/o embryotomy wire/dehorning saw or shears
- 2). Chemical cautery (not recommended) = 48 h - 7 d/o, using NaOH/KOH
- 3). Sx by vet (VSA 1966): dehorning > 2 m/o; disbudding/dehorning of goats at any age
Goat disbudding
- Restrain
- Clip area for visualisation
- Requires larger iron head - wider horn base than calves
- Ensure iron hot
- Remove bud carefully w/ forceps, high risk of brain damage
Digit amputation - pre-op considerations
- Anaesthesia - IV regional, +/- digital nerve blocks - ring block around claw to ensure covered - cranial branch of lateral saphenous vein - tourniquet
- Analgesia - NSAIDs - sufficient for major orthopaedic Sx?
- AB - good anaerobic efficacy, distribution into purulent material
- Restraint - crush + leg elevated - foot raised from above hock
Digit amputation - areas
- Cutting straight off w/ embryotomy wire, have some cauterisation
- Stopping bleeding w/ pressure bandage, stay on for few days for haemostasis
- 1). P2 - low down - can disturb blood supply between bone, through blood supply - sequestrum of bone, stops healing of amputation, have dead bone present
- 2). In between joint, intra-articular - end up w/ synovial cartilage + fluid - cartilage associated w/ non-healing
- 3). P1 preferred! - high enough
Digit amputation
- 1). Make hemi-circumferential incision through skin, SC tissues + tendons at level approx 1 cm proximal to coronary band
- 2). Make second longitudinal incision into deep tissues of the interdigital space to meet the original incision at both ends
- 3). Place a sterile embryotomy wire into incision at level of P2 + make transverse cut
- 4). Apply pressure bandage over stump of digit + block to sound claw
Teat lacerations - surgical repair
- Ring block local anaesthesia
- Leg of affected side lifted in crush for access
- Debride necrotic/infected tissue
- Teat cannula should be inserted to identify teat canal in cases of full thickness laceration
- Three-layer closure (submucosa, intermediate layer + skin) for full-thickness laceration using 3-0/4-0 synthetic absorbable suture material
- Deeper layers - horizontal mattress pattern, avoiding penetrating the mucosa
- Routine skin closure
- NSAID/Antibiotic - risk of mastitis
- Passive drainage w/ teat cannula BID for 2 d post-op -> machine milking start on d 3
Teat amputation
- Stand in crush with hind limb of affected side lifted (preferred) or lateral recum w/ affected teat uppermost + hindlimb elevated
- Ring block - around base of teat
- Paravertebral block
- +/- Xylazine
- Cow leg raised in crush
- Tourniquet for haemostasis + prevent milk leakage
- Use burdizzo
- Clamp + cut distally
- When take off, lumen teat still there, ST structures still there, allow to drain
Enucleation - pre-op considerations
- 1). Anaesthesia
- Local infiltration
- 4-point Retrobulbar block - 4 points around globe, medial, dorsal, caudal + lateral canthus, long needle behind eye to infiltrate - thin, spinal needle, bend for infiltration around optic nerve
- Peterson block
- Deep sedation/GA
- 2). Analgesia - NSAID
- 3). Antibiotics
- 4). Restraint
- Crush, head collar, deep standing sedation
- GA
- Casting restraint
Enucleation
- 1). Suture eyelids closed (prevents production of vitreous/aq humor -> improves healing process) - simple continuous pattern
- 2). Incise close + parallel to eyelid margins
- 3). Blunt dissect through SC tissues, working circumferentially
- 4). Cut through medial + lateral canthal ligaments
- 5). Using long-handled, curved scissors, blunt dissect through adnexal tissues to free the cone of retractor bulbi
- 6). Digitally palpate optic nerve at the base of the cone of retractor bulbi, cutting through blindly w/ scissors - not much hemostasis
- 7). (Optional) - tightly pack orbit w/ single, continuous strip of iodine-soaked gauze (sterile bandage), leave gap where haven’t sutured entire eyelid back up in few days time, pull bandage out - helps for pressure on hemostasis
- 8). Suture SC tissues where possible + skin closed, leaving gauze protruding at the lateral canthus
Tail amputation
- Caudal epidural anaesthesia
- Apply tourniquet
- Curved incisions on dorsal + ventral tail
- Blunt dissection of subcutis to free skin for closure
- Disarticulate joint, transect joint w/ scalpel
- Simple interrupted closure
- Tail bandage
