Surgery

Question 1

What does contamination mean?

Answer 1

(Bacteria are on the surface of a tissue that usually does not have bacteria related to it)

Question 2

What are the three very basic possible outcomes of bacterial contamination?

Answer 2

(Bacteria die, bacteria leave, or bacteria infect)

Question 3

(T/F) Only pathogenic bacteria can cause infection such as Staph. pseudintermedius, E. coli, and P. aeruginosa.

Answer 3

(T)

Question 4

(T/F) There are no clinical signs related to contamination.

Answer 4

(T)

Question 5

What are the two typical signs of infection?

Answer 5

(Purulent discharge and signs of inflammation)

Question 6

What is the risk of contamination leading to infection based on? Three answers.

Answer 6

(Number of bacteria present, virulence of the bacteria present, and the resistance of the tissue the bacteria is trying to infect)

Question 7

What are the four NRC wound classifications?

Answer 7

(Clean, clean-contaminated, contaminated, and dirty)

Question 8

Described a clean wound as per the NRC wound classification.

Answer 8

(Surgical wound, maintained aseptic conditions throughout, non-traumatic, non-inflamed, and no luminal structures were entered)

Question 9

What NRC wound classification is described as any traumatic wound with or w/o signs of infection, a surgical wound with gross spillage of contaminating contents, and/or a surgical wound with a major break in asepsis?

Answer 9

(Contaminated)

Question 10

Describe a clean-contaminated wound as per the NRC wound classification.

Answer 10

(Surgical wound where a luminal structure is entered in a controlled manner or a clean wound with a drain (since you’re exposing a wound to the environment))

Question 11

What NRC classification is an ovariectomy?

Answer 11

(Clean)

Question 12

What NRC classification is a cystotomy?

Answer 12

(Clean-contaminated)

Question 13

In what two ways can you reduce the number of bacteria present as a strategy for preventing infection?

Answer 13

(Aseptic technique and using perioperative antibiotics)

Question 14

How do you increase/maintain tissue health as a way to prevent infection?

Answer 14

(Support the patients’ health primarily by reducing surgery/anesthesia time)

Question 15

What is the prophylactic antibiotic protocol?

Answer 15

(Start abx 30-60 minutes before incision and stop within 24 hours of surgery)

Question 16

What kind of cases, two specifically, are prophylactic antibiotics used for?

Answer 16

(Cases with a high risk of infection and cases in which consequences of infection would be disastrous (permanent implant))

Question 17

(T/F) Increasing surgery time by 1 hour approximately doubles the risk of infection.

Answer 17

(T)

Question 18

What are Halsted’s 6 principles of surgery?

Answer 18

(Gentle tissue handling, preserve blood supply, control hemorrhage, eliminate dead space, appose tissues accurately, and practice aseptic technique)

Question 19

What are the three lateral muscles of the abdominal wall?

Answer 19

(External and internal abdominal obliques and the transversus abdominis)

Question 20

What is the ventral muscle of the abdominal wall?

Answer 20

(Rectus abdominis)

Question 21

What is the dorsal muscle of the abdominal wall?

Answer 21

(Quadratus lumborum)

Question 22

What structures do the lateral muscles’ aponeuroses become? Two answers.

Answer 22

(Linea alba and rectus abdominis muscle sheath)

Question 23

Is the cranial 2/3rd or caudal 1/3rd of the rectus abdominis associated with only an external rectus sheath?

Answer 23

(Caudal 1/3rd, cranial 2/3rd has both external and internal))

Question 24

What does dissection of the SQ fat from the body wall in your ventral midline celiotomy increase the risk of?

Answer 24

(The formation of a seroma)

Question 25

What is the purpose of tenting the body wall and using a reverse press cut (where the blade is upside down and horizontal) when you are initiating your body wall incision in a ventral midline celiotomy?

Answer 25

(To avoid inadvertent organ damage)

Question 26

What is the purpose of inserting your fingers into the initial hole you made in the body wall before extending your incision?

Answer 26

(To feel for adhesions)

Question 27

If you are using an absorbable suture to close the body wall of a ventral midline celiotomy, how long does the tension need to last?

Answer 27

(At least 4 weeks)

Question 28

Should you use a monofilament or a braided suture for closing the body wall of a ventral midline celiotomy?

Answer 28

(Monofilament)

Question 29

What is the holding layer that you should be sure to engage when closing a body wall incision?

Answer 29

(The linea)

Question 30

What type of approach is indicated in procedures involving dorsal or retroperitoneal organs?

Answer 30

(‘Grid approach’ → paracostal laparotomy)

Question 31

(T/F) In a paracostal laparotomy, because you are incising into three different muscles, they should each be closed separately at the conclusion of the procedure.

Answer 31

(T)

Question 32

What are the three muscles that you will encounter in a paracostal laparotomy from outermost to innermost?

Answer 32

(External abdominal oblique, internal abdominal oblique, and transversus abdominis)

Question 33

What can result if ruminants cannot eructate during a surgical procedure? Two general answers.

Answer 33

(Respiratory and cardiovascular compromise)

Question 34

In what two ways can you minimize the issue of eructation in ruminant surgeries?

Answer 34

(Hold off feed for 24 hours and performing standing procedures when able)

Question 35

What three nerves are specifically blocked for a paralumbar fossa approach for a ruminant?

Answer 35

(Last thoracic nerve and the first two lumbar nerves)

Question 36

What three vertebrae should be your guides for where to perform your injections for paralumbar fossa approaches to a ruminant abdomen?

Answer 36

(L1, L2, and L4)

Question 37

Is the 7/inverted L block a local line block or specific nerve block?

Answer 37

(Local line)

Question 38

How far should you be from the transverse processes and the last rib when performing your paralumbar fossa incision in a cow?

Answer 38

(2-3 inches)

Question 39

How long should your paralumbar fossa incision be in inches in a cow?

Answer 39

(8-10 inches)

Question 40

What are the five layers that you are incising through in the paralumbar fossa approach to the cow abdomen from outermost to innermost?

Answer 40

(Skin, external oblique, internal oblique, transversus abdominis, peritoneum)

Question 41

What is the indication for a right paramedian celiotomy approach in a cow?

Answer 41

(Abomasal displacement)

Question 42

What are the five layers that you are incising through in the right paramedian celiotomy approach to a cow abdomen from outermost to innermost?

Answer 42

(Skin, external linea alba, rectus abdominis, internal linea alba, peritoneum)

Question 43

What approach allows for better exposure of the abdomen in calves and in general, good access to the abomasum?

Answer 43

(Right paracostal approach)

Question 44

What approach is typically used in horses and pigs when you want to gain access to their abdomen?

Answer 44

(Ventral midline celiotomy)

Question 45

What is the holding layer of the GI tract?

Answer 45

(Submucosa)

Question 46

What layer(s) of the stomach do you ONLY cut through in a gastropexy?

Answer 46

(Seromuscular layer → serosa + muscularis)

Question 47

If your word ends in -otomy, what does that mean?

Answer 47

(To cut into (and typically close it at the end))

Question 48

If your word ends in -ostomy, what does that mean?

Answer 48

(To create an artificial opening)

Question 49

If your word ends in -ectomy, what does that mean?

Answer 49

(To remove part or all of something)

Question 50

If your word ends in -plasty, what does that mean?

Answer 50

(To change the shape of something)

Question 51

If your word ends in -pexy, what does that mean?

Answer 51

(Surgical fixation of an organ)

Question 52

If your word ends in -rrhaphy, what does that mean?

Answer 52

(To suture together)

Question 53

What are three ways to atraumatically handle stomach tissue?

Answer 53

(Your fingies, stay sutures, specialized forceps → Babcock)

Question 54

The GI healing time is about what time period?

Answer 54

(Two weeks)

Question 55

Why do surgeons avoid using multifilament suture in small animal GI tracts?

Answer 55

(Braided suture can cut through fragile tissue)

Question 56

What are cutting needles used for? Two answers.

Answer 56

(Skin or linea alba)

Question 57

How is the stomach isolated and held in the large animal flank approach to the stomach?

Answer 57

(By suturing the edges of the rumen to the body wall incision)

Question 58

How can a septic abdomen result from a gastrotomy?

Answer 58

(Dehiscence of the incision during the healing period)

Question 59

In what time period does dehiscence typically occur after a gastrotomy?

Answer 59

(3-5 days)

Question 60

What region of the stomach should you make your incision on when performing an incisional gastropexy?

Answer 60

(The pyloric antrum area)

Question 61

Through what layers of the body wall should you make your incision in an incisional gastropexy procedure?

Answer 61

(Through the parietal peritoneum and the transversus abdominis)