Soft tissue surgery Flashcards
What is laparotomy
Incision through muscle into abdomen, generally flank incision
What is celiotomy?
Any incision into abdominal cavity.
What structures can you access from a paracostal laparotomy?
Liver, stomach, adrenal glands.
How do you prevent tissues from desiccating in ventral midline coelitomy?
Moistened swabs, lavage saline, suction.
What is in the cranial quadrant of the abdomen?
Diaphragm, liver, gall bladder, stomach. The right gutter - right limb pancreas, kidney, adrenal, portal vein, vena cava, ureter, ovary. Left gutter - kidney, ureter, ovary, adrenal.
What is found in the caudal quadrant of the abdomen?
Colon, reproductive tract, bladder, urethra, prostate, inguinal rings. Assess colour, palpate entire length and check mesenteric lymph nodes of intestinal tract.
What can be found in the central abdomen?
Omentum, spleen, left limb of pancreas.
Describe Coeliotomy closure?
Layer 1 - linea alba - external rectus sheath - the main holding layer. simple interrupted or continuous patterns. Mono filament synthetic suture material. 7 Throws to start and finish.
Layer 2 - Subcutaneous tissues - close dead space, supports skin closure. Layer 3 - skin apposition.
What is an incisional hernia?
The abdominal organs move subcutaneously. The skin incision dehisces, causing peritonitis, evisceration and death.
What is peritonitis?
Inflammation of the peritoneum. Primary generalised peritonitis - spontaneous, no pre existing abdominal disease e.g viral peritonitis - FIP. Secondary generalised peritonitis - secondary to pre existing abdominal pathology. Examples - rupture of GIT, urine leakage, penetrating trauma, bile leakage following trauma. Infectious - bacterial in origin, leakage from GIT, often iatrogenic. Non infectious causes are urine, bile, foreign body, pancreatitis. There will be a history of intestinal surgery or foreign body, dullness, abdominal distension, abdominal pain, fluid thrill
What is a hernia?
Protrusion of a structure through a defect in the wall of its normal anatomical cavity.
What types of hernia are possible?
Umbilica, inguinal, scrotal, femoral, perineal. - often congenital or acquired degenerative.
Internal abdominal hernias, external abdominal hernias - often traumatic.
What is an external abdominal hernia?
Usually traumatic. Herniation of organ out of abdomen through a defect in the abdominal wall. e.g paracostal hernia.
What are internal abdominal hernias?
Usually traumatic lesions. Herniation of abdominal organs through a ring/defect confined within the abdomen or thorax. eg diaphragmatic hernia.
What is a true hernia?
A congenital or acquired degenerative herniia. Contents are within an outpouching of peritoneum - the hernial sac.
What is a false hernia?
Usually traumatic - contents not restrained by hernia sac.
Which hernias herniate through a normal body cavity opening?
Umbilical, internal abdominal, external abdominal - do not herniate through normal body cavity opening. Inguinal, scrotal, femoral, all herniate through a natural abdominal opening - vital structures run through these.
What is a prepubic hernia?
Avulsion of cranial (prepubic) tendon. Usually RTA. Often associated pelvic fractures.
What is an umbilical hernia?
Usually congenital. OFten closed during elective neutering. Foetal umbilical ring fails to close. a true hernia.
In external abdominal hernias the hernia contents may be in different health - such as;
reducible, non reducible, incarcerated, strangulated. Strangulated contents - the organ blood supply is compromised - distension, torsion and constriction.
If a repair is too difficult what may be used?
Surgical meshes - polypropylene mesh. Because tension free repair must be achieved. Tension leads to dehiscence, large defects lead to tension on suture line.
What are inguinal hernias?
Herniation through the inguinal canal. Contents adjacent to vaginal process. May be congenital or acquired. May be unilateral or bilateral. Sex hormones, pregnancy and obesity may play a role in acquired hernias. Do midline incision and dissect over hernia. Consider coeliotomy if cannot reduce easily. Avoid damaging external pudendal vessels. Advise neutering. Makes repair in male dogs easier.
What is a scrotal hernia?
Rare, unilateral. Organs herniate beside testicular vessels and ductus deferens into scrotum. Organ strangulation is common. Castrate - repair in a similar fashion to inguinal hernia.
What is a femoral hernia?
Usually traumatic. Herniation of organs through the femoral canal. Femoral artery, vein and nerve. Repair very difficult. Usually misdiagnosed as inguinal hernias. Refer for repair.
What is a perineal hernia?
Pelvic diaphragm degenerates. Rectum, prostate and abdominal organs herniate. Acquired degeneration of the pelvic diaphragm - levator ani muscle. Unknown aetiology - androgens, straining, neurogenic muscle atrophy. Occurs in male, entire dogs, mature. Occassionally in male neutered and female dogs. Right > left. The rectum deviates + dilates. Abdominal fat, prostate, retroflexed bladder (20%). presentation - faecal tenesmus - straining to defecate, perianal swelling, constipation. Retroflexed baldder presentation - dysuria, systemic collapse/acute renal failure. If retroflexed bladder - cystocentesis or urinary catheterisation - reduce hernia with digital pressure. Repair with simple herniorrhaphy. Internal obturator muscle transposition flap. Castration reduces risk of recurrence. Complications include rectal eversion, suture penetrating rectal mucosa, fecal incontinence, sciatic nerve injury.
Describe oral neoplasia?
Common. Lesions may be proliferative, erosive. Prognosis ay be good. clinical signs include drooling + blood. Halitosis, oral facial pain, dysphagia.
What is a melignant melanoma?
Commonest canine oral tumour. Melanotic or amelanotic. Behave aggresively. They have a high metastatic rate > 80%, high post op recurrence. poor prognosis.
What is a squamous cell carcinoma?
commonest feline tumour, low metastatic rate, high local recurrence rate, prognosis guarded due to high rate of regrowth. Rostral have a low metastatic rate and tonsillar are highly aggressive - 73% have metastasised to a distant site. Good prognosis for non metastatic lesions providing achieve wide surgical excision. Alternative therapies include radiotherapy.
What is a fibrosarcoma?
Dog - upper carnassial region, proliferative, non ulcerated. Cat - no predilection site. Complete excision - low metastatic potential. recurrence rates - 40% maxilla. Require large margins.
What is epulis?
Of periodontal origin. May be fibromatous - pedunculated or acanthomatous - bone destruction. Excellent prognosis with wide excision & radiotherapy.
What are ameloblastomas?
Benign tumours, very uncommon, originate from dental laminae, good prognosis with wide excision.
What are oral papillomas?
Seen in young dogs, viral aetiology: papillomavirus, papovavirus. Spontaneously regress.
What is a sialocoele or salivary mucocoele?
Submucosal or Subcutaneous collection of saliva, leakage of saliva from gland or duct. May be submandibular, cervical, sublingual (rannula). Most cases are idiopathic. May be caused by trauma,inflamation, neoplasia, sialolithiasis, foreign body, sublingual gland duct most common. The signs are fluctuating swelling, dysphagia, oral bleeding, hypersalivation, respiratory obstruction.
What is a sialogram?
Diagnosis for sialocoele. 2 to 3 mls of non ionic contrast agent, inserted through a lacrimal cannula or intravenous catheter.
What is the treatment of sialocoele?
Subcutaneous sialocoele - sialoadenectomy, submandibular salivary gland complex. Rannula - marsupialisation/sialoadenectomy.
What is an oronasal fistula?
May cause Chronic rhinitis, nasal regurgitation of food, aspiration pneumonia, malnutrition.May be caused by dental disease, trauma, neoplasia. Must repair surgically - high failure rates.
What is a cleft soft or hard palate?
May be acquired following trauma, which is more amenable to repair. Stabilise maxillary fractures. Close in 2 or 3 layers. Congenital: refer for repair.
What are the advantages of an oesophagostomy tube?
Well tolerated allowing early oral feeding. Bypasses the nasomaxillary area. Does not obstruct the pharynx, can be removed immediately. It is contraindicated in oesophageal disease, vomiting, neck injuries. Secure with roman sandal suture.
