Ruminants Tx + Procedures Flashcards

Question

LDA - conservative management

Answer 1

- 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)

Answer 2

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)

Answer 3

- Toggle pin (common) - Blind fixation - Laparoscopy (+/- rolling)

Answer 4

- 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)

Answer 5

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

Answer 6

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)

Answer 7

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

Answer 8

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

Answer 9

- +/- 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

Answer 10

- 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

Answer 11

- Right lateral recumbency - Tied to a table / straw bale

Answer 12

- 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

Answer 13

- 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

Answer 14

- 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

Answer 15

- Tissue much more fragile compared to cattle - cannot pull as much

Answer 16

- Right-sided paralumbar fossa laparotomy - Left ventrolateral laparotomy

Answer 17

- Exteriorisation of uterus prior to uterotomy - Scrub in an assistant - Ventral extension of abdo incision - Ventral paracostal incision in cases of foetal maceration - Maintain cow in either standing/recum position - Plan to manage intra-op recum - Use sterile calving ropes to manipulate limbs - Use uterine holding forceps

Answer 18

- Epidural anaesthesia - Surgical preparation - Dorsolateral incision 2 - 3 cm from dorsal vulval commissure (10 or 2 ‘o’ clock position) - Extend incision through skin, SC tissues and vestibular mucosa (up to 10 cm) - Delivery of foetus - Closure of successive layers (synthetic absorbable) - AB given to prevent infection

Answer 19

- Epidural - Clean - Replace - Bruhner's suture/'Spoon' harness

Answer 20

- 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

Answer 21

- Surgically recreating an opening - A vertical incision is made over anal sphincter, the blind end of the rectum is dissected - The perirectal tissue sutured to the dermis, the blind end of rectum incised, and the rectal mucosa sutured to the skin - Prognosis with surgical correction is good

Answer 22

- Poor Px - Euth

Answer 23

- Animal restraint + make environment safe

Answer 24

- Anaesthesia not legally required, but encouraged - Elastrator ring - Burdizzo crush - By trained stockperson/vet

Answer 25

- Anaesthesia not legally required, but encouraged - Open castration - Burdizzo crush - By trained stockperson/vet

Answer 26

- Anaesthesia legally required - Open castration - Burdizzo crush - By vet only

Answer 27

- 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

Answer 28

- 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

Answer 29

- Method choice - Local anaesthesia - procaine - spermatic cord/scrotal skin/testes, 5 - 40 mL - intra-testicular - Analgesia NSAID - meloxicam - 48 h - AB? - Restrained - crush, farmer restraint, tail held directly up - Sedation - mature bulls, aggressive/difficult to handle animals - Xylazine IV/IM

Answer 30

- 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)

Answer 31

- 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

Answer 32

- Detach tunic from tail of epididymis - 'Twist + pull' - torsion + traction - Leave skin open + apply topical AB

Answer 33

- Anaesthesia - local procaine infiltration - Analgesia - little/no licenced product, meloxicam 1 mL/20 kg (twice cattle dose) - Restraint - young animals are easier to hold, older animals require sedation/GA

Answer 34

- Hygiene - Fly control - avoid doing in height of summer if turned out - Monitor for H+, bleeding ◦ Tap = vessel needs attention ◦ Drops usually okay - may knock each other - Lethargy/inappetence - sign of pyrexia - Swelling, discharge - abscesses ◦ First sign = well animal but big swelling of testicles ◦ Can be several weeks down line - usually iatrogenic - surgeon not as clean w/ Sx at least w/ hibiscrub before

Answer 35

- 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)

Answer 36

- 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

Answer 37

- Rehydration - Smooth muscle relaxants - Buscopan, Metamizole + hyoscine butylbromide (Spasmium) - Epidural +/- sedation - NSAIDs - Urinary acidification - orally - Nutrition management - dec conc + inc forage

Answer 38

(Order of inc invasiveness) - Amputation of urethral appendage - snip off - Perineal urethrostomy - Cystotomy - Bladder marsupialisation (prepubic cystotomy) - Euth = valid Tx

Answer 39

- Remove + flush out bladder - Foley catheter into bladder -> urinates out catheter - Absorb overtime stones that are stuck within the urethra

Answer 40

- Cut just under rectum to make opening for urethra to urinate - Good salvage procedure - Temporary solution if fattening Stear for meat - Once cut sphincter, gone - not option for lifelong in pets, will have constant urethral scalding + UTIs

Answer 41

- Varies w/ Tx option - High rate of recurrence - High-intensity nursing care, long term hospitalisation - Care of skin/prevention of urine scalding - Diet control

Answer 42

- Preventable w/ iodine application at birth - Confirm abscess before incision - by US/FNA - Sx - drain + flush through ventral incision - cross incision aids draining + stays patent then allow farmer to flush for few days - AB - penicillins/cephalosporins

Answer 43

- 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

Answer 44

- 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

Answer 45

- 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

Answer 46

- Case selection - cost implication - If rectum not attached to anal sphincter -> incontinence - euth - Anaesthesia - epidural - Analgesia - meloxicam - AB - dirty procedure

Answer 47

- 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

Answer 48

- Cornual nerve block + NSAID - Sedation increasingly common - Allow 5 - 10 min to work - Test w/ gauge needle

Answer 49

- GA / deep sedation + NSAID - must not be conscious - +/- Cornual nerve block

Answer 50

- Cornual + accessory nerve block + NSAIDs

Answer 51

- Vet-only procedure in UK - Case selection - invasive procedure with high risk of complications - Age - horn growth and attachment to frontal bones (under 10 days old) - Anaesthesia - goats sensitive to local anaesthetic, very low toxic dose 5 - 6 mg/ml (0.4 - 0.5 ml Adrenacaine in 4 kg goat kid) - GA required - not enough local dose to provide adequate anaesthesia, ketamine (horses, under cascade), butorphanol + xylazine bolus (licensed in FPAs) - Analgesia - NSAID (not licenced) - AB - not required

Answer 52

- 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

Answer 53

- En-bloc resection - +/- Amputation of bladder apex

Answer 54

- Ligation + resection

Answer 55

- En-bloc resection +/- marsupialisation (suture abscess open so drains) + post-op lavage

Answer 56

- En-bloc resection

Answer 57

- Abdo bandaging - Elastrator rings

Answer 58

- 1). Systemic AB - G+ anaerobes e.g. Trueperella pyogenes - Occasional beta-lactamase producers present - Amino-penicillins +/- Clavulanic acid recommended - 2). NSAIDs for cases of pyrexia, pain or marked inflam - Px - good for omphalitis, extensive scarring + fibrosis -> recurrence, but poor response in complicated cases

Answer 59

- Initially as for umbilical herniorrhaphy - Extreme care should be taken to avoid rupturing abscesses and releasing purulent material - Once the umbilical mass is free from the surrounding tissues, the abdominal wall is tented and incised either cranially (in cases of urachal abscessation and omphaloarteritis) or caudally (in cases of umbilical vein abscessation) - Umbilical mass is then carefully resected free from the abdominal wall - If umbilical remnants are present, the incision is extended along the midline to improve exposure - Urachal abscessation - the proximal urachus is ligated or the bladder tip amputated if there is patent communication - Umbilical vein abscessation - the proximal umbilical vein is ligated, or if it extends into the liver tissue, it should be marsupialised at a separate site cranial to the primary incision (such cases carry a poor prognosis due to the risk of embolism and septicaemia) - Closure is as for umbilical herniorrhaphy - Post-operative antibiotic therapy should be continued for a minimum of 5 - 7 d

Answer 60

- 1). External coaptation (common) - casting/splinting, goats don't respond well - 2). Internal fixation - rare in UK, expensive, high failure rate - 3). Applying cast - re-alignment, padding to prevent sores, conforming dressing + tape at bottom to prevent bacterial/dirt access, casting, include wire to remove, cast joints either side of Fx

Answer 61

- 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

Answer 62

- 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

Answer 63

- 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

Answer 64

- Change bandages every 48 hours - Complete healthy granulation tissue has formed - Antibiotic therapy for minimum 5 days - Repeat NSAIDs as required - Keep inside to careful monitoring - Clean environment

Answer 65

- Teat cannular (kept in for patency) & break from milking - Second intention healing - Antibiotic

Answer 66

- 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

Answer 67

- 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

Answer 68

- 1). Roll eyelid - 2). Injection into eyelid - 3). Sx excision of strip of skin - only when other Tx unsuccessful: take 'D' shape + roll back - Local anaesthesia +/- sedation - local will separate tissues, cornual block will cover part but not all of area - Analgesia = NSAID - AB - AB topical eye ointment

Answer 69

- 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

Answer 70

- 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

Answer 71

- Bandage removal after 48 h - Slowly remove the iodine-soaked gauze over a period of 7 days, removing it quickly may dislodge clot - Antibiotics

Answer 72

- 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

Answer 73

- 1). Medical - prolonged systemic course w/ AB w/ good anaerobic efficacy + distributes well in purulent material + necrotic tissue e.g. Penicllinis - Macrolides - tylosin (mainly aerobic) but distribute well into purulent material necrotic tissue - pH trap into acidic solutions - NSAIDs - 2). Sx Tx - tigit sparing procedures e.g. Coring / Wedge resection / Drilling + flushing - Digit amputation - Px = generally guarded, better for conditions that don't involve the pedal joint e.g. retroarticular abscess

Answer 74

- Resection of severe sole ulcers, extensive WLD lesions and necrotic toes represents foot surgery rather than foot trimming and should be considered an act of veterinary surgery - Regional anaesthesia and systemic NSAIDs should be considered in all cases

Answer 75

- Infiltration of local anaesthetic beneath teat base - Young calves - sharp resection w/ scissors + healing by 2nd intention - Older heifers - sharp resection w/ scalpel + routine skin closure

Answer 76

- Local anaesthesia - insertion into teat canal, ring paravertebral block - Endoscopy may be used to evaluate + Tx - Via teat canal - various instruments available - Sharp dissection through teat wall