Surgery Flashcards
1
Q
Is tissue under the skin supposed to be aseptic or sterile?
A
Aseptic
2
Q
T/F: Contamination is the same thing as infection.
A
F
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
4
Q
What are the signs of contamination?
A
None - can’t see bacteria
5
Q
What are the signs of infection?
A
Purulent discharge and signs of inflammation
6
Q
When confirming infection, where is the best place to collect a sample?
A
From deep tissue
7
Q
T/F: Not all wounds get contaminated.
A
F
8
Q
Which NRC wound classification includes surgical wounds, aseptic conditions, non-traumatic, non-inflamed, and no luminal structures entered?
A
Clean
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
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
11
Q
Which NRC wound classification includes infection, abscess, purulent discharge, and/or necrotic tissue?
A
Dirty
12
Q
Which NRC wound classification does a spay or castration fall under?
A
Clean
13
Q
Which NRC wound classification does a gastrotomy/gastrectomy fall under?
A
Clean-contaminated
14
Q
Which NRC wound classification does an abdominal exploratory fall under?
A
Clean
15
Q
Which NRC wound classification does a liver biopsy fall under?
A
Clean
16
Q
Which NRC wound classification does a splenectomy fall under?
A
Clean
17
Q
Which NRC wound classification does a cystotomy fall under?
A
Clean-contaminated
18
Q
Which NRC wound classification does a prophylactic gastropexy fall under?
A
Clean
19
Q
Which NRC wound classification does an enterotomy/R and A fall under?
A
Clean-contaminated
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.
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
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
23
Q
When using prophylactic antibiotics for an uncomplicated procedure, how early should you start the antibiotics prior to incision?
A
30-60 minutes
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
25
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?
Yes, continue for duration required to clear all bacteria associated with the pre-existing UTI. In this case, for one week.
26
Give 2 examples of when we would use prophylactic antibiotics.
Risk of infection is high, or consequences of infection would be disastrous, such as in cases of permanent implant
27
For which NRC classification of wounds are therapeutic antibiotics postoperatively not needed?
Clean and clean-contaminated
28
T/F: Increasing the surgery time by 1 hour approximately doubles the risk of infection.
T
29
Patients who are sent home with a course of antibiotics after surgery are being given a therapeutic/prophylactic antibiotic protocol.
Therapeutic
30
What 4 muscles make up the abdominal wall? Give their general location too.
External abdominal oblique (lateral), internal abdominal oblique (lateral, transversus abdominis (lateral), and rectus abdominis (ventral)
31
What does the aponeurosis of the lateral abdominal muscles become? 2 names.
Rectus sheath aka linea alba
32
What portion of the abdomen is external and internal rectus sheath?
Cranial 2/3 of abdomen
33
What portion of the abdomen is external rectus sheath only?
Caudal 1/3 of abdomen
34
What is the standard approach for any abdominal procedure?
Ventral midline celiotomy
35
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?
Preputial branch
36
After ligation of the branch of the caudal superficial epigastric artery, what muscle will you transect?
Preputialis muscle
37
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
B, retract the prepuce to make a midline incision
38
Give an advantage and disadvantage to dissecting the subcutaneous fat from the body wall in a ventral midline celiotomy.
Advantage - makes body wall more apparent/delineated
Disadvantage - may increase risk for seroma formation
39
What are 3 techniques when incising the body wall to avoid inadvertent organ damage?
Tent body wall, "reverse press cut", and hold blade upside-down and horizontal
40
What is the best suture material to use when closing the body wall?
PDS
41
To ensure you are engaging the linea alba when closing your ventral midline incision, how many mm of fascia should the suture engage?
5 mm or more
42
When closing a ventral midline incision, which layer is the most critical?
Abdominal wall
43
What approach is indicated for procedures involving dorsal or retroperitoneal organs?
Paracostal laparotomy
44
What is another name for a paracostal laparotomy?
Grid approach
45
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?
Paracostal laparotomy
46
For a paracostal laparotomy, how and where would you make your skin incision?
Dorsoventral incision caudal to last rib
47
T/F: For a paracostal laparotomy, each muscle is dissected in the direction of its fibers and each muscle should be closed separately.
T
48
List 3 reasons why standing procedures are easier for ruminants.
Can still eructate, avoids compartmental syndrome, and prevents nerve damage.
49
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?
Hold them off feed for 24 hours prior to surgery
50
What sedative is used for local blocks in ruminants for abdominal surgery?
Lidocaine
51
What nerves do you need to block to provide anesthesia to the region of the paralumbar fossa?
T13, L1 and L2 nerves
52
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?
1.5 to 2-inch needle and inject 20ml of lidocaine
53
When injecting lidocaine for a distal paravertebral block, why is it important to inject both above and below the tip of the transverse processes?
Because there are dorsal and ventral branches of nerves
54
When performing a distal paravertebral block, what vertebrae should you block?
L1, L2, and L4 vertebrae
55
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?
Left side = inverted L
Right side = 7
56
When performing an inverted L or 7 block, where should you inject the lidocaine?
Caudal to last rib under transverse process of lumbar vertebrae
57
Give 2 indications that tell you your patient has been anesthetized over the paralumbar region.
Will see relaxation of muscles and will feel warm sensation over PLF.
58
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.
Caudal, cranial
59
In addition to abdominal exploratory, give 3 more indications for using a paralumbar celiotomy approach in ruminants.
Abomasal surgery, intestinal surgery, or cecal surgery
60
What direction do the external abdominal oblique muscle fibers run?
Caudodorsal direction
61
What direction do the internal abdominal oblique muscle fibers run?
Cranioventral direction
62
What direction do the transversus abdominis muscle fibers run?
Horizontal direction
63
How can you confirm that you have opened the peritoneum in ruminants?
Should hear a sucking sound and see fluttering of peritoneum due to lots of negative pressure in abdomen
64
What approach is used for a displaced abomasum?
Right paramedian celiotomy
65
What position should the cow be placed in when performing a right paramedian celiotomy?
Dorsal recumbency
66
What is the indication for a ventrolateral celiotomy in ruminants?
C-section or removal of emphysematous fetus
67
Where is the incision made for a ventrolateral celiotomy?
Lateral to milk vein and extends dorsally
68
What approach is used for C-section or removal of emphysematous fetus in horses and pigs?
Ventral midline celiotomy
69
What position should the cow be placed in when performing a ventrolateral celiotomy?
Right lateral recumbency
70
What position should a horse/pig be placed in when performing a ventral midline celiotomy?
Dorsal recumbency
71
Give an indication for a left oblique celiotomy in ruminants.
C-section or removal of emphysematous fetus
72
What position should a cow be placed in for a left oblique celiotomy?
Standing position
73
What approach is often used in calves to get better exposure to the abdomen?
Right paracostal approach
74
Describe how the incision is made for a right paracostal approach?
Incision made parallel and caudal to the last rib
75
What position should the cow be placed in for a left or right paralumbar celiotomy?
Standing position
76
Which portion of the stomach is the most anchored?
Cardia
77
On which side would you approach the abdomen to place a stomach tube in the fundus?
Left
78
On which side would you approach the abdomen to perform a pexy at the pyloric antrum?
Right
79
What is the first unpaired branch of the aorta?
Celiac artery
80
What are the 3 branches of the celiac artery?
Hepatic, splenic, and left gastric arteries
81
What are the 2 branches of the splenic artery?
Left gastroepiploic artery and short gastric arteries
82
Which artery supplies the cardiac region of the stomach?
Left gastric artery
83
Which artery supplies the fundic region of the stomach?
Short gastric arteries
84
Which artery supplies the lesser curvature of the stomach?
Right gastric artery
85
Which artery supplies the majority of the greater curvature of the stomach?
Left gastroepiploic artery
86
What are the 4 layers of the stomach from outermost layer to innermost layer?
Serosa, muscularis, submucosa, mucosa
87
Which layer of the stomach is considered the holding layer?
Submucosa
88
What is an indication for a gastrotomy in dogs and cats?
Foreign body
89
What is an indication for a partial gastrectomy in dogs and cats? 3 possible answers.
Tumor, perforated ulcer, necrotic wall
90
What is an indication for a gastrostomy in dogs and cats?
To place a feeding tube
91
What is an indication for gastropexy in dogs?
Treat or prevent GDV
92
If a patient undergoing surgery has presented to you for vomiting, what are 4 preoperative considerations you need to take into account?
Dehydration status, electrolyte abnormalities, acid-base abnormalities, and prevent aspiration pneumonia
93
Give 2 examples of medications that can be given to dogs and cats to increase gastric pH and prevent gastroesophageal reflux during surgery?
Omeprazole and Famotidine
94
What type of needle should always be used for atraumatic handling during gastric surgeries?
Tapered needle
95
What is the name of the specialized forceps that may be used to promote atraumatic handling during gastric surgery?
Babcock forceps
96
How long is GI healing time on average?
2 weeks
97
What is the most common suture material chosen for small animal GI tract?
PDS (monofilament)
98
Why is Vicryl suture not used in small animal gastric closure?
Braided suture that cuts through fragile tissue
99
What suture material is often chosen for large animal GI tract?
Vicryl (multifilament)
100
What is the most common technique for closing the stomach?
Double layer patterns - second layer inverting
101
Of the inverting suture patterns, which one goes into the lumen?
Connell
102
What approach will you use for a gastrotomy in small animals?
Ventral midline celiotomy
103
What is the first step in performing a gastrotomy?
Place stay sutures
104
Describe the location of where the incision will be made in a gastrotomy in dogs and cats.
Along ventral stomach wall at pyloric antrum and/or gastric body and halfway between greater and lesser curvatures
105
Describe how you will make and extend your incision when performing a gastrotomy in dogs and cats.
Start with "press cut" aka stab incision with scalpel blade in pencil grip and extend with Metzenbaum scissors
106
What is a complication following a gastrotomy?
Septic peritonitis
107
How does a septic abdomen develop after a gastrotomy?
Dehiscence during healing period
108
When will complications from a gastrotomy occur?
3-5 days after surgery
109
What type of gastropexy is most common and most favored?
Incisional gastropexy
110
What type of gastropexy involves suturing the stomach to the midline incision and should never be done?
Incorporating gastropexy
111
To prevent GDV, what side do we perform a gastropexy?
Right
112
With incisional gastropexy, where should the incision into the stomach be made and which layers should you cut through?
Pyloric antrum area through serosa and muscularis
113
With incisional gastropexy, where should the incision into the body wall be made and what should you cut through?
Right side of body wall caudal to last rib; cut through parietal peritoneum and transversus abdominis muscle
114
How should you close both incisions in an incisional gastropexy?
Suture incisions together using long-lasting monofilament absorbable suture with 2 simple continuous patterns
