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E&E Exam 3 > Surgery > Flashcards

Surgery Flashcards

1
Q

Is tissue under the skin supposed to be aseptic or sterile?

A

Aseptic

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2
Q

T/F: Contamination is the same thing as infection.

A

F

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3
Q

When bacteria recognize the tissue, invade and proliferate in it, resulting in the stimulation of inflammation within the tissue, is this considered contamination or infection?

A

Infection

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4
Q

What are the signs of contamination?

A

None - can’t see bacteria

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5
Q

What are the signs of infection?

A

Purulent discharge and signs of inflammation

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6
Q

When confirming infection, where is the best place to collect a sample?

A

From deep tissue

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7
Q

T/F: Not all wounds get contaminated.

A

F

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8
Q

Which NRC wound classification includes surgical wounds, aseptic conditions, non-traumatic, non-inflamed, and no luminal structures entered?

A

Clean

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9
Q

Which NRC wound classification includes any traumatic wound with or without signs of infection, a surgical wound with gross spillage of contaminating contents, or a surgical wound with major break in asepsis?

A

Contaminated

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10
Q

Which NRC wound classification includes surgical wound where a luminal structure is entered in a controlled manner or otherwise a clean wound but with a drain?

A

Clean-contaminated

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11
Q

Which NRC wound classification includes infection, abscess, purulent discharge, and/or necrotic tissue?

A

Dirty

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12
Q

Which NRC wound classification does a spay or castration fall under?

A

Clean

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13
Q

Which NRC wound classification does a gastrotomy/gastrectomy fall under?

A

Clean-contaminated

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14
Q

Which NRC wound classification does an abdominal exploratory fall under?

A

Clean

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15
Q

Which NRC wound classification does a liver biopsy fall under?

A

Clean

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16
Q

Which NRC wound classification does a splenectomy fall under?

A

Clean

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17
Q

Which NRC wound classification does a cystotomy fall under?

A

Clean-contaminated

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18
Q

Which NRC wound classification does a prophylactic gastropexy fall under?

A

Clean

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19
Q

Which NRC wound classification does an enterotomy/R and A fall under?

A

Clean-contaminated

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20
Q

Give 4 examples of bad wound factors that can contribute to the risk of infection.

A

Ischemic tissue, dead space/fluid pockets, foreign material, blood clots.

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21
Q

In addition to perioperative antibiotics and Halsted’s principles, what else can be done to maintain tissue health to reduce the risk for infection?

A

Reduce surgery/anesthesia time

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22
Q

Contamination increases the further orad/aborad you go down the GI tract, so the colon (for example) would have the least/most contamination.

A

Aborad, most

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23
Q

When using prophylactic antibiotics for an uncomplicated procedure, how early should you start the antibiotics prior to incision?

A

30-60 minutes

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24
Q

Your patient is having an uncomplicated gastrotomy to remove a foreign body. You administer Cefazolin 30 minutes before incision, and continue it every 90 minutes during surgery. You stop the Cefazolin once the last skin suture is placed. Everything in surgery went well and you used aseptic techniques. Are you going to prescribe postoperative antibiotics? If so, how long are you prescribing them for?

A

Not necessary

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25
Q

Your patient with a UTI is having a cystotomy. The patient has been on antibiotics prior to surgery to treat the infection, and these antibiotics are continued during surgery. Are you going to prescribe postoperative antibiotics? If so, how long are you prescribing them for?

A

Yes, continue for duration required to clear all bacteria associated with the pre-existing UTI. In this case, for one week.

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26
Q

Give 2 examples of when we would use prophylactic antibiotics.

A

Risk of infection is high, or consequences of infection would be disastrous, such as in cases of permanent implant

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27
Q

For which NRC classification of wounds are therapeutic antibiotics postoperatively not needed?

A

Clean and clean-contaminated

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28
Q

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

A

T

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29
Q

Patients who are sent home with a course of antibiotics after surgery are being given a therapeutic/prophylactic antibiotic protocol.

A

Therapeutic

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30
Q

What 4 muscles make up the abdominal wall? Give their general location too.

A

External abdominal oblique (lateral), internal abdominal oblique (lateral, transversus abdominis (lateral), and rectus abdominis (ventral)

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31
Q

What does the aponeurosis of the lateral abdominal muscles become? 2 names.

A

Rectus sheath aka linea alba

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32
Q

What portion of the abdomen is external and internal rectus sheath?

A

Cranial 2/3 of abdomen

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33
Q

What portion of the abdomen is external rectus sheath only?

A

Caudal 1/3 of abdomen

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34
Q

What is the standard approach for any abdominal procedure?

A

Ventral midline celiotomy

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35
Q

When performing a ventral midline celiotomy in a male dog, you will have to do a parapreputial continuation when incising the skin, which takes 3 additional steps. Which branch of the caudal superficial epigastric artery must you first ligate?

A

Preputial branch

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36
Q

After ligation of the branch of the caudal superficial epigastric artery, what muscle will you transect?

A

Preputialis muscle

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37
Q

After you have incised the skin in a ventral midline celiotomy, you must incise the subcutaneous tissue to reach the abdominal wall musculature. In a male dog, the prepuce is in your way. Choose the correct answer on how to proceed in this situation.
A. Make incision lateral to prepuce
B. Retract the prepuce to make a midline incision
C. Cut through prepuce
D. None because you don’t need to extend the incision that far

A

B, retract the prepuce to make a midline incision

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38
Q

Give an advantage and disadvantage to dissecting the subcutaneous fat from the body wall in a ventral midline celiotomy.

A

Advantage - makes body wall more apparent/delineated

Disadvantage - may increase risk for seroma formation

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39
Q

What are 3 techniques when incising the body wall to avoid inadvertent organ damage?

A

Tent body wall, “reverse press cut”, and hold blade upside-down and horizontal

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40
Q

What is the best suture material to use when closing the body wall?

A

PDS

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41
Q

To ensure you are engaging the linea alba when closing your ventral midline incision, how many mm of fascia should the suture engage?

A

5 mm or more

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42
Q

When closing a ventral midline incision, which layer is the most critical?

A

Abdominal wall

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43
Q

What approach is indicated for procedures involving dorsal or retroperitoneal organs?

A

Paracostal laparotomy

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44
Q

What is another name for a paracostal laparotomy?

A

Grid approach

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45
Q

If you were to perform a prophylactic gastropexy on a deep-chested, large breed dog who is at risk for developing GDV, what type of approach would you use?

A

Paracostal laparotomy

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46
Q

For a paracostal laparotomy, how and where would you make your skin incision?

A

Dorsoventral incision caudal to last rib

47
Q

T/F: For a paracostal laparotomy, each muscle is dissected in the direction of its fibers and each muscle should be closed separately.

A

T

48
Q

List 3 reasons why standing procedures are easier for ruminants.

A

Can still eructate, avoids compartmental syndrome, and prevents nerve damage.

49
Q

What can you do prior to surgery to reduce rumen fill and gas production to prevent them from eructating as much as possible during surgery?

A

Hold them off feed for 24 hours prior to surgery

50
Q

What sedative is used for local blocks in ruminants for abdominal surgery?

A

Lidocaine

51
Q

What nerves do you need to block to provide anesthesia to the region of the paralumbar fossa?

A

T13, L1 and L2 nerves

52
Q

We use a distal paravertebral block to anesthetize the paralumbar fossa in ruminants. What size needle should be used and how much lidocaine should be injected?

A

1.5 to 2-inch needle and inject 20ml of lidocaine

53
Q

When injecting lidocaine for a distal paravertebral block, why is it important to inject both above and below the tip of the transverse processes?

A

Because there are dorsal and ventral branches of nerves

54
Q

When performing a distal paravertebral block, what vertebrae should you block?

A

L1, L2, and L4 vertebrae

55
Q

For a non-specific nerve block (aka diffusion block) of the paralumbar fossa, what is this block called when it is on the left side vs. the right side?

A

Left side = inverted L
Right side = 7

56
Q

When performing an inverted L or 7 block, where should you inject the lidocaine?

A

Caudal to last rib under transverse process of lumbar vertebrae

57
Q

Give 2 indications that tell you your patient has been anesthetized over the paralumbar region.

A

Will see relaxation of muscles and will feel warm sensation over PLF.

58
Q

When performing a left or right paralumbar celiotomy for abdominal exploratory, you should always examine the cranial/caudal abdomen first, then the cranial/caudal abdomen.

A

Caudal, cranial

59
Q

In addition to abdominal exploratory, give 3 more indications for using a paralumbar celiotomy approach in ruminants.

A

Abomasal surgery, intestinal surgery, or cecal surgery

60
Q

What direction do the external abdominal oblique muscle fibers run?

A

Caudodorsal direction

61
Q

What direction do the internal abdominal oblique muscle fibers run?

A

Cranioventral direction

62
Q

What direction do the transversus abdominis muscle fibers run?

A

Horizontal direction

63
Q

How can you confirm that you have opened the peritoneum in ruminants?

A

Should hear a sucking sound and see fluttering of peritoneum due to lots of negative pressure in abdomen

64
Q

What approach is used for a displaced abomasum?

A

Right paramedian celiotomy

65
Q

What position should the cow be placed in when performing a right paramedian celiotomy?

A

Dorsal recumbency

66
Q

What is the indication for a ventrolateral celiotomy in ruminants?

A

C-section or removal of emphysematous fetus

67
Q

Where is the incision made for a ventrolateral celiotomy?

A

Lateral to milk vein and extends dorsally

68
Q

What approach is used for C-section or removal of emphysematous fetus in horses and pigs?

A

Ventral midline celiotomy

69
Q

What position should the cow be placed in when performing a ventrolateral celiotomy?

A

Right lateral recumbency

70
Q

What position should a horse/pig be placed in when performing a ventral midline celiotomy?

A

Dorsal recumbency

71
Q

Give an indication for a left oblique celiotomy in ruminants.

A

C-section or removal of emphysematous fetus

72
Q

What position should a cow be placed in for a left oblique celiotomy?

A

Standing position

73
Q

What approach is often used in calves to get better exposure to the abdomen?

A

Right paracostal approach

74
Q

Describe how the incision is made for a right paracostal approach?

A

Incision made parallel and caudal to the last rib

75
Q

What position should the cow be placed in for a left or right paralumbar celiotomy?

A

Standing position

76
Q

Which portion of the stomach is the most anchored?

A

Cardia

77
Q

On which side would you approach the abdomen to place a stomach tube in the fundus?

A

Left

78
Q

On which side would you approach the abdomen to perform a pexy at the pyloric antrum?

A

Right

79
Q

What is the first unpaired branch of the aorta?

A

Celiac artery

80
Q

What are the 3 branches of the celiac artery?

A

Hepatic, splenic, and left gastric arteries

81
Q

What are the 2 branches of the splenic artery?

A

Left gastroepiploic artery and short gastric arteries

82
Q

Which artery supplies the cardiac region of the stomach?

A

Left gastric artery

83
Q

Which artery supplies the fundic region of the stomach?

A

Short gastric arteries

84
Q

Which artery supplies the lesser curvature of the stomach?

A

Right gastric artery

85
Q

Which artery supplies the majority of the greater curvature of the stomach?

A

Left gastroepiploic artery

86
Q

What are the 4 layers of the stomach from outermost layer to innermost layer?

A

Serosa, muscularis, submucosa, mucosa

87
Q

Which layer of the stomach is considered the holding layer?

A

Submucosa

88
Q

What is an indication for a gastrotomy in dogs and cats?

A

Foreign body

89
Q

What is an indication for a partial gastrectomy in dogs and cats? 3 possible answers.

A

Tumor, perforated ulcer, necrotic wall

90
Q

What is an indication for a gastrostomy in dogs and cats?

A

To place a feeding tube

91
Q

What is an indication for gastropexy in dogs?

A

Treat or prevent GDV

92
Q

If a patient undergoing surgery has presented to you for vomiting, what are 4 preoperative considerations you need to take into account?

A

Dehydration status, electrolyte abnormalities, acid-base abnormalities, and prevent aspiration pneumonia

93
Q

Give 2 examples of medications that can be given to dogs and cats to increase gastric pH and prevent gastroesophageal reflux during surgery?

A

Omeprazole and Famotidine

94
Q

What type of needle should always be used for atraumatic handling during gastric surgeries?

A

Tapered needle

95
Q

What is the name of the specialized forceps that may be used to promote atraumatic handling during gastric surgery?

A

Babcock forceps

96
Q

How long is GI healing time on average?

A

2 weeks

97
Q

What is the most common suture material chosen for small animal GI tract?

A

PDS (monofilament)

98
Q

Why is Vicryl suture not used in small animal gastric closure?

A

Braided suture that cuts through fragile tissue

99
Q

What suture material is often chosen for large animal GI tract?

A

Vicryl (multifilament)

100
Q

What is the most common technique for closing the stomach?

A

Double layer patterns - second layer inverting

101
Q

Of the inverting suture patterns, which one goes into the lumen?

A

Connell

102
Q

What approach will you use for a gastrotomy in small animals?

A

Ventral midline celiotomy

103
Q

What is the first step in performing a gastrotomy?

A

Place stay sutures

104
Q

Describe the location of where the incision will be made in a gastrotomy in dogs and cats.

A

Along ventral stomach wall at pyloric antrum and/or gastric body and halfway between greater and lesser curvatures

105
Q

Describe how you will make and extend your incision when performing a gastrotomy in dogs and cats.

A

Start with “press cut” aka stab incision with scalpel blade in pencil grip and extend with Metzenbaum scissors

106
Q

What is a complication following a gastrotomy?

A

Septic peritonitis

107
Q

How does a septic abdomen develop after a gastrotomy?

A

Dehiscence during healing period

108
Q

When will complications from a gastrotomy occur?

A

3-5 days after surgery

109
Q

What type of gastropexy is most common and most favored?

A

Incisional gastropexy

110
Q

What type of gastropexy involves suturing the stomach to the midline incision and should never be done?

A

Incorporating gastropexy

111
Q

To prevent GDV, what side do we perform a gastropexy?

A

Right

112
Q

With incisional gastropexy, where should the incision into the stomach be made and which layers should you cut through?

A

Pyloric antrum area through serosa and muscularis

113
Q

With incisional gastropexy, where should the incision into the body wall be made and what should you cut through?

A

Right side of body wall caudal to last rib; cut through parietal peritoneum and transversus abdominis muscle

114
Q

How should you close both incisions in an incisional gastropexy?

A

Suture incisions together using long-lasting monofilament absorbable suture with 2 simple continuous patterns

E&E Exam 3 (7 decks)

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