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Fourth Year > Surgery > Flashcards

Surgery Flashcards

1
Q

4 diseases requiring castration as treatment

A

Testicular neoplasia
Orchitis
Testicular torsion
Cryptorchidism

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2
Q

6 complications of castration

A

Scrotal bruising and oedema
Swelling
Seroma
Haemorrhage
Haematoma
Infection

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3
Q

1 advantage and disadvantage of open castration

A

Better ligature security
More bleeding

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4
Q

Steps for open castration

A
  1. Prescrotal incision made and advance testes by applying pressure through drape
  2. Scrotal ligament (remnant of gubernaculum) removed by gripping tail of epididymis with fingers and thumb, grasping ligament with haemostats and shear force
  3. 3 ligatures made around vasculature using rochester carmalts
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5
Q

Closed castration process

A

Ensure no abdominal contents in vaginal canal
Palpate cremaster muscle and anchor stitch through it, continue around the cord (vascular plexus and vas deferens)

A transfixing ligature is used

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6
Q

5 reasons for scrotal ablation

A

Neoplasia (sometimes with urethrostomy) -> Remove the good testicle first, closed for neoplastic testicle

Trauma

Abscess

Ischaemia

Pendulous (appearance)

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7
Q

Process of scrotal ablation

A
  • Elevate scrotum & testes from wall
  • Elliptical incision around the scrotum, being mindful of leaving skin for closure
  • Can be open or closed
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8
Q

What is cryptorchidism?

A

Failure of one or both testes to descend into the scrotum

Inherited defect

Spermatogenesis is absent

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9
Q

Treatment of cryptorchidism

A

Castration - inguinal approach, laparotomy

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10
Q

What causes testicular torsion?

A

Mobility of vesskes
Often abdominal when they torse

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11
Q

3 types of testicular neoplasia and prognosis

A

Seminoma
Interstitial cell
Sertoli cell

Often same numbers and may cause feminising signs

Good prognosis <10% metastases prior to detection

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12
Q

What can testicular trauma cause?

A
  • Significant bleeding (castrate)
  • Sperm granuloma
  • Fibrosis
  • Possible infertility
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13
Q

What is hypospadias?

A

Developmental abnormality

Failure of fusion of the genital folds

If severe perform a urethrostomy (persistant open stoma)

Common in Boston terriers

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14
Q

What is persistent penile frenulum and how is it treated?

A

Fibrous band from the central penis to the prepuce

Usually ruptures at puberty

If persistent – resect

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15
Q

What is a bifid penis? What is the treatment?

A

Congenital abnormality

The smaller organ often does not contain a urethra

Treatment = amputate and suture the defect formed in the
urethra, tunica albuginea and mucosa

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16
Q

What are some examples of penile trauma?

A
  • Stick injuries
  • Wire fences
  • Mating injuries
  • Kicks
  • Bite wounds
  • Strangulation
  • Severe haemorrhage
  • Fracture of os penis
  • Urethral prolapse
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17
Q

Treatment of penile trauma

A

Suture fresh lacerations

Antibiotics – topical and systemic

Amputation if severe

Urethrostomy

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18
Q

8 steps of penile amputation**

A
  1. Catheterise urethra
  2. Apply tourniquet
  3. Incise penis as bilateral flaps
  4. Remove catheter and transect the urethra
  5. Ligate the major vessels
  6. Incise urethra and spatulate
  7. Suture to penile mucosa using 4/0 absorbable suture material
  8. May need to shorten urethra
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19
Q

What is phismosis?

A

inability to protrude the penis beyond the preputial opening (restricted by
exteriorisation)

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20
Q

Causes of phismosis

A

Persistent frenulum
Hypoplasia of preputial opening
Trauma with secondary scarring

Often distended prepuce and don’t urinate with a normal steady stream

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21
Q

Treatment of phismosis

A
  1. Resect fibrous tissue
  2. Widen preputial opening - Wedge resection from the dorsal prepuce then suture preputial mucosa to the skin
  3. Circumferential excision and suture
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22
Q

What is paraphimosis?

A

permanent protrusion of the flaccid penis

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23
Q

4 causes of paraphimosis

A

Small preputial opening
Matted preputial hair
Congenitally short prepuce
May have self-trauma to the penile tip

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24
Q

treatment of paraphimosis

A

Surgically enlarge preputial opening
Amputate distal end of penis (small fluffies)
Preputial advancement

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25
Q

Structure of the prostate gland - blood supply and nervous supply

A
  • Bi-lobed gland
  • Vasa deferentia enter dorso-caudally
  • Blood supply – dorsolateral capsule
  • Hypogastric nerve (sympathetic)
  • Pelvic nerve (parasympathetic)
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26
Q

Benign prostatic hyperplasia signalment and clinical signs

A

Benign enlargement of
the prostate
* Intact male
* 60% incidence in
dogs > 5 years

Constipation, tenesmus, haematuria, urethral bleeding, may have prostatic cysts, ribbon like stool

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27
Q

BPH DDx

A

Squamous metaplasia
Prostatic cyst or paraprostatic cyst
Prostatitis or abscess
Neoplasia

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28
Q

Diagnosis of BPH

A

Rectal examination: nonpainful, smooth, symmetrical enlargement of the prostate

Radiographs, Ultrasound, CT

Histopathology

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29
Q

Treatment of BPH

A

Castration
Faecal softeners
Oestrogen therapy
Anti-androgens

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30
Q

Prostatitis/abscessation signalment and clinical signs

A

Intact males
Depression, pain, vomiting, polyuria, polydipsia, haematuria, incontinence, stragnurai, UTA, pyuria, tenesmus, irregular bowel movement

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31
Q

Prostatitis/abscessation diagnosis

A

Rectal palpation (enlarged, painful)
* Radiology
* Prostatic wash
* FNA
* Ultrasonography

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32
Q

Treatment of prostatitis/abscessation

A

Castration
Antibiotics 4-6wks
Drainage = evacuate cavities, breakdown septae within gland, get samples for bacteriology, histology

Types of drains = penrose, foley, mushroom

Subtotal or total prostatectomy

Omentalisation - omentum provides drainage, adhesions, induces neovascularisation, functions in presence of infection

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33
Q

Signalment of prostatic neoplasia - population and types of cancers

A

Rare - older dogs and cats, entire and neutered

Mostly adenocarcinoma
Can be poorly differentiated, SCCs, transitional cell carcinomas

Early metastases to lymph nodes, bladder, lungs, rectum , bone

Early diagnosis hard, prognosis 3 months

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34
Q

Clinical signs of prostatic neoplasia

A

Tenesmus
Dysuria
Stranguria
Urethral bleeding
Lumbar pain
Lameness
Emaciation

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35
Q

Treatment of prostatic neoplasia

A

Total prostatectomy
Inoperative radiotherapy
Permanent tube cystostomy
Castration
Oestrogen therapy

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36
Q

Parenchymal Prostatic cysts Signalment

A

May be associated with BPH
Common
Fluid filled, non-septic, within or communicate with the prostate

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37
Q

Paraprostatic cyst signalement

A

Unknown aetiology
Adjacent and attached to prostate
Entire males
Large breeds

Calcified walls, fluid colourless-brown

Pyrexia

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38
Q

Diagnosis and treatment of paraprostatic cysts

A

Ultrasound, FNA, Rectal

Castration, drainage, excision, marsupialisation (create a pouch to allow draining outside abdomen following surgery), omentalisation

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39
Q

4 reasons for elective desexing

A

Reduction of mammary neoplasia risk
Treatment of behavioural conditions
Treatment of other medical conditions
Council registration

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40
Q

7 diseases prevented by OH

A

Pyometra
Metritis, subinvolution of placental sites
Uterine torsion
Uterine prolapse
Uterine rupture
Uterine neoplasia
Persistent pseudopregnancy

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41
Q

Best time to desex a female

A

Standard 6 months or before first or second oestrus
Shelters 8-12 weeks

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42
Q

Considerations for spaying a female

A

Decreased stress and operative time
Assurance animal is desexed when rehomed
Anaesthetic risk
Decreased maturation of external genitalia
Increased incidence of oestrogen responsive urinary incontinence
Increased risk of bony neoplasia in giant breeds?

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43
Q

Reasons a spay should be avoided on in season dogs

How long after a litter should be left for mammary involution?

A
  1. Uterus is more friable and increased blood supply
  2. Oestrogen can have detrimental effect on haemostatic mechanisms
  3. Delay for 4 weeks after the onset of pro-oestrus
  4. Desexing an early pregnant bitch is easier than in season

After a litter, wait 3 weeks after weaning to allow mammary involution

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44
Q

Risk of mammary neoplasia if spayed before first oestrus or after first and second

A

Before first = 0.5%
After first = 8%
After second = 26%

No decrease if spayed after 4th cycle

Entire cats have 7x the risk of mammary tumours

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45
Q

What are the broad ligaments?

A

Double folds of peritoneum that suspend the uterus and ovary

  1. The mesovarium - suspends ovaries
  2. The mesosalpinx - suspends oviducts
  3. The mesometrium - majority of broad ligament
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46
Q

What is the suspensory ligament?

A

Cranial continuation of broad ligament from the ovary that comes together in a distinct band which inserts on the middle and ventral thirds of the last two ribs

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47
Q

What is the proper ligament?

A

Continuation of suspensory caudally

Attaches the ovary to the uterine body/horn - continuous caudally as the round ligament that goes within the broad ligament, through the inguinal canal and ends subcutaneously near the vulva

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48
Q

Where is the ovarian arteriovenous complex?

A

Medial to the broad ligament and caudal to the suspensory

Convuluted - especially closer to the ovary

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49
Q

What is the ovarian artery? What does it supply?

A

A branch of the aorta - supplies the ovary and cranial aspect of the uterus

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50
Q

What does the right ovarian vein drain into?

A

Caudal vena cava

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51
Q

What does the left ovarian vein drain into?

A

Left renal vein

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52
Q

What is the uterine artery a branch of? Where is it located?

A

The internal pudendal artery

Positioned at the lateral aspect of the uterine body bilaterally

Enters the mesometrium at the level of the cervix

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53
Q

Where do the lymphatics of the uterus drain to?

A

Hypogastric and lumbar lymph nodes

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54
Q

Innervation of the female repro tract

A

Hypogastric plexus - sympathetic and visceral

Pelvic nerves - parasympathetic and visceral

55
Q

Which ovary is more difficult to exteriorise?

A

Right

56
Q

Steps for spay to removing the ovaries

A
  1. Exteriorise right ovary
  2. Break suspensory
  3. Ligate pedicle - make window in mesovarium caudal to ovarian vessels and triple clamp with carmalt rochester proximal to ovary
  4. Tie into crush of most proximal (PDS 0-3/0 for dogs)
  5. Transect the ovarian pedicle and hold in forceps without tension before releasing
  6. broad ligament broken or cut avoiding uterine vessels
57
Q

Steps for spay from exposing uterine body

A
  1. Expose uterine body
  2. Single clamp cranial to cervix
  3. Remove as much uterine tissue as possible to avoid stump pyometra
  4. Single encircling ligature or transfixing if enlarged uterus
  5. Uterine vessels can be ligated independent to uterus
  6. Check abdominal cavity for haemorrhage
  7. close linea alba
  8. Close skin or do intradermal
58
Q

What is used for linea alba closure?

A

Independent or continuous monofilament absorbable (1-3/0)

59
Q

Complications of spay

A

Haemorrhage

Wound healing - suture reactions, seroma, fistulous tracts

Stump pyometra -> progesterone from remnants cause inflammation or granuloma from non-absorbable material or poor asepctic technique

Ureteral ligation, ovarian remnant syndrome, incontinence (11-20% desexed females)

Weight gain

60
Q

Laparoscopic advantages in spay

A

Minimally invasive - maximises post op comfort
Great visualisation of structures

61
Q

Laparoscopic disadvantages in spay

A

Cost of equipment and processing
Learning curve

62
Q

Indications for caesarean

A

> 70d gestation (should be 63+/-2

Primary or secondary uterine inertia

Maternal pelvic abnormalities
Foetus oversized
Small litter - large foetuses and primary inertia from lack of hormonal initiation from foetus

Foetal malpresentation
Foetal death - ultrasound to detect if unresponsive to oxytocin and supportive care

63
Q

Preop considerations for caesarean

A

If emergency compromised pateint, consider circulatory status and sepsis

Crystalloid replacement
Desex or not - controversy as prolonges anaesthesia but saves a procedure

Risk of aspiration pneumonia as food rarely withheld - careful ET tube cuff inflation and removal and prokinetic metoclopramide to increase lower oesophageal tone

Make induction to delivery as fast as possible

64
Q

Where is initial incision for caesarean?

A

Ventral midline
2-3cm cranial and 5-6cm caudal to umbilicus

Large enough for uterus to be out quickly

65
Q

What needs to be done prior to removing the uterus in a caesar?

A

Take care not to damage abdominal contents and gravid uterus
Pack off uterus from abdominal cavity with laparotomy sponges
Take care not to tear uterine vessels or uterus

66
Q

Where should the uterus be incised for caesarean?

A

Avascular area within the body that allows for the removal of foetuses from both horns

Sometimes will need multiple incisions

67
Q

Process of removing puppies in caesarean

A

Milk each foetus to uterine incision

Break through foetal membranes and clamp the umbilicus 2-3cm from the base

Rub vigorously to stimulate breathing - avoid swinging in an arc (brain damage)

Give sublingual dopram 0.2-1mg and check all pups are removed

68
Q

Process of closing the uterus after a caesar

A

Single or double layer uterine closure - simple continuous inner of submucosa and not into the lumen

Continuous inverting outer such as cushing

3/0 or 4/0 monofilament absorbable taper-point needle

Uterus thoroughly lavaged before returning to abdomen, change gloves and instruments to close abdomen

69
Q

Complications of caesar

A

Haemorrhage - intrauterine (oxytocin or OH) or peritoneal (ligature failure)

Infection - long or contamination

Foetal or maternal death

70
Q

What is a pyometra a disease of?

A

the dioestrus phase of ovarian cycle while the CL is actively secreting progesterone

Ovarian or exogenous progesterone is required for it to exist

71
Q

Pathophysiology of pyometra

A

Progesterone increases secretions of the uterine glands, inhibits myometrial contraction and closes the cervix - this causes cystic endometrial hyperplasia and inhibits leukocyte response, facilitating bacterial colonisation

72
Q

Signalment of pyometra

A

Older entire bitches >6yo
Within 8-12wks of previous season - 4wks in cats

Increased risk with exogenous progesterone being given (oestrogen increases sensitivity of uterus to progesterone)

73
Q

Is infection the primary cause of pyometra? What bacteria is most common?

A

No - usually present secondarily
E.coli with strep, staph, enterococci, klebsiella, proteus and psuedomonas

Anaerobes like clostridium with secondary toxaemia have been reported

74
Q

Clinical signs of pyometra

A

Normothermic
Anorexia/depression
Vomiting/diarrhoea
PU/PD (e.coli affecting tubular function)
Vaginal discharge maybe
Poorly contaminated urine <1.030

75
Q

Clin path of pyometra

A

Leukocytosis
Left shift and toxic change
Anaemia masked by dehydration
Azotaemia
Low USG

76
Q

Diagnostic imaging for pyometra

A

Abdominal palpation
Rads - soft tissue density, displacement of GI structures

U/S most sensitive - uterine size, thickness of wall and fluid presence in peritoneal cavity

77
Q

Medical treatment for pyometra

A

PGF2a luteolysis and BS antibiotics
Lower progesterone to open cervix and allow drainage
Re-infection likely so breed on following cycle

78
Q

Surgical treatment for pyometra

A

OVH
Don’t rupture uterus

Remove all infected tissue and stabilise pre-op and AB

Omentalise stump and lavage

79
Q

What is vaginal oedema and when does it occur?

A

Formerly vaginal hyperplasia
During oestrus and proestrus

Vaginal mucosa swells allowing transverse fold (arising from floor of vagina cranial to urethral orifice) to rupture through vulva - large mass protruding out

Mass exposed - ulceration, trauma,

80
Q

When does vaginal hyperplasia regress?

A

Luteal phase - but will keep recurring and interfere with breeding and can recur in partruition causing dystocia

81
Q

Other treatments of vaginal hyperplasia than OVH

A

Excision of prolapse
Lubrication and protection
Pharmacologic induction of ovulation using GnRH and hCG

Megestrol acetate -> Synthetic progesterone inhibits oestrogen in target tissue but also prevents ovulation

82
Q

Vaginal prolapse - what is it similar to, when does it occur and treatment

A

Differentiate from vaginal hyperplasia by circumferential prolapse of vagina, also differentiate from tumour with biopsy adn exam

OCcurs after forced separation of mating or in advanced stages of parturition due to excess straining

Recognise early - reduce prolapse, or amputate

83
Q

When is episioplasty used?

A

Treating perivulvular dermatitis
Changes in anatomy of perivulvar region

84
Q

Neoplasia of the vulva/vagina

A

70-80% benig - Most common - leiomyoma, fibroma, lipoma

Malignant -> leiomyosarcoma

Surgical excision
Exposure can be improved by episiotomy

85
Q

What is the definition of aseptic technique?

A

A set of techniques and practices designed to prevent or minimise microbiological contamination of the surgical wound

86
Q

Factors associated with infection

A

Bacterial numbers >10^5
Bacterial type
Host resistance
Presence of foreign bodies
Interaction between host and bacteria

87
Q

Sepsis definition

A

Presence of pathogens or their toxic products in tissues of patient

88
Q

Asepsis definition

A

The absence of pathogenic microbes in living tissue

89
Q

Sterilisation definition

A

Destruction of all microbes and living organisms, including spores (inanimate objects only) by physical or chemical means

90
Q

Antisepsis definition

A

Use of antimicrobial chemicals on living tissues

91
Q

Surgical infection time period

A

30d-2 months
12 months for orthopaedic

92
Q

Goal of aspetic technique

A

Prevent surgical infection and encourage wound healing

93
Q

Sources of bacterial contamination

A

Surgical personnel
patient
Theatre
Instrumentas and biomaterials
Aseptic technique -> surgical site, faciliates and environment

94
Q

Prevention fo surgical infections factors:

A

Selection and prep of patient:
History, physical exam, CBC and biochem,, urine SG, treat underlying disease or remote infection

95
Q

Factors increasing surgical risk

A

BCS
Age - old or young
Brachycephalic
Type of surgery
Hypoalbuminaemia
Anaemia

96
Q

Ideal antiseptic agent should be:

A

Non-irritant
Bactericidal
Broad spectrum
Long residual activity
Not inactivated in the face of organic material
Economical

97
Q

MoA iodophors, action time

A

eg Povidone-iodine

Penetrates cell wall and displaces molecules with free iodine

Broad spectrum, bactericidal

4-6h action

98
Q

Toxicity of iodophores

A

thyroid dysfunction, acute contact dermatitis
Activity decreased by organic material

99
Q

Bisbiguanide moA, spectrum, immediate action and persistent action

A

eg Chlorhex
Increase cell wall permeability, precipitates cellular contents

Broad spectrum, bactericidal or static depending on conc.

Persistnet action >6h and residual 1-2d

100
Q

Chlorhex toxicity

A

Ototoxic, corneal toxic, neurotoxic

101
Q

Alcohols moA, spectrum, action

A

Cell lysis, protein denaturation, metabolic interruption
Broad spectrum
Bactericidal rapid

No residual action

Corneal and neurotoxic

102
Q

Bacteria found on skin and hair

A

Staph, micrococcus, strep, clostridium and bacillus

103
Q

Clipping protocol

A

good area each side of incision
Nicks and grazes are focus for bacterial contamination
Clipping day before increases risk of infection 3x
Water soluble gel like ky jelly placed in open wounds prior to clipping

104
Q

Initial, second and tertiary scrub agents

A

Initial - antiseptic/detergent mix
Second - alcohol wipe
Tertiary - antiseptic agent

105
Q

Prep of surgeons skin principles

A

Mechanical removal of dirt

Reduction in transient microbial count to as close to 0 as possible

Prolonged depressant effect on resident microflora of hands and arms

106
Q

Purpose of scrub suit

A

Not impermeable to bacteria, reduces particulate shedding in theatre

Scrub cap - hair bacteria

Shoe covers - external bacteria and hair being tracked in to surgery then out to clinic

Mask - aerosol drops directed to the side

107
Q

Advantages and disadvantages of disposable scrub suit

A

Water repellent
Always in good condition
Less laundry
Resterilised

But expensive, less conforming, large stock required

108
Q

Advantages and disadvantages of resuable scrubs

A

Cheaper, less waste

But poor barrier properties, labour intensive, threads can detach and lint into wound, reduced quality with repeated washing

109
Q

Patient draping - four quadrant method

A

Keep hands covered
Do side closest to surgeon, adjacent quadrant, opposite quadrant then final quadrant placed by opposite surgeion and secured with towel clamp

110
Q

how many organisms fall int site in an hour?

A

75,000

111
Q

Theatre parameters

A

should be out of high traffic area
only necessary people enter and attired correcrtly
Not used for examinations
Mild pos pressure laminar air flow
Clean operations first

Damp dust all surfaces and disinfect surfaces and equipment, once weekly scrub of floors and walls

112
Q

Methods of sterilisation

A

Physical - heat, filtration, radiation
Chemical - ethylene oxide, alcohols

113
Q

Indicators of sterilisation

A

Chemical indicators - colour at temperature but does not show time of exposure or if items are sterile

chemical indicators - tape (class 1) and bowie dick indicator strips (class 2)

Then biological indicators

114
Q

Consequences of post surgical wound infection

A

Wound breakdown or delayed healing - sepsis from implants, haemorrage from lysis around infected ligatures, evisceration, hernia repair failure

Septicaemia
Pain
Increased hospitalisation
All wounds become contaminated

115
Q

Antibiotic prophylaxis - when to give

A

Perioperative antibotics buttress immune defence
More efficacious given prior to surgery - IV 20-30mins before first cut and repeated at 60-90min intervals

Post op indicated when: comorbidites, excess time in surgery, trauma, risk like orthopaedics

116
Q

Duration of antibiotic therapy depends on:

A

Wound classification and individual patient

117
Q

When are host tissues most susceptible to bacterial lodgement?

A

within first 3 hours of contamination

118
Q

Class 1 surgical wound classification

A

Clean -> uninfected operative wound which no inflammation encountered and respiratory, alimentary, genital or uninfected urinary tract is not entered

Primarily closed or if needed drained with closed drainage.

Incisional wounds which follow non-penetrating trauma can be included here

119
Q

Class 2 wounds

A

Clean - contaminated

Resp, alimentary or urinary tracts entered under controlled conditions and without usual contamination

Operations with biliary tract, appendix, vagina, and oropharynx included provided no evidence of infection

120
Q

Class 3 wounds

A

Contaminated
Open, fresh, accidental wounds
Operations with major breaks in sterile technique or gross spillage from GIT, and incisions where acute, non-purulent inflammation is encountered

121
Q

Class IV

A

Dirty-infected

Old traumatic wounds with retained devitalised tissue and those with existing clinical infection or perforated viscera
Organisms causing post op infection present in operative field before operation

122
Q

Affect of wound ischaemia on infection

A

potentiate by 10,000 fold

123
Q

Low tissue oxygen affect

A

predispose infection

124
Q

Halsteds principles

A
  1. aseptic technique
  2. sharp anatomic dissection
  3. Gentle tissue handling
  4. Careful haemostasis
  5. Avoid tension
  6. Obliterate dead space

A Sharp Gentle Cut Avoids Obstacles

125
Q

4 layers of the abdominal wall

A

From exterior to interior, they are:

  1. external abdominal oblique (fibers run caudoventrally)
  2. internal abdominal oblique (fibers run cranioventrally)
  3. rectus abdominis (fibers run parallel to the linea alba)
    - surrounded by fibrous sheath made up of aponeuroses from other abdominal muscles
  4. transversus abdominis (fibers run transverse to linea)
126
Q

What is the rectus abdominis layer surrounded by?

A

Internal and external rectus sheath.

127
Q

Which layer of the abdomen holds sutures?

A

External rectus sheath of the rectus abdominis muscle

128
Q

What structures are included in the spermatic cord?

A

Ductus deferens + its artery
Testicular artery
Pampiniform plexus of testicular veins
Cremaster artery and nerves

129
Q

What is the pampiniform plexus?

A

Network of veins draining the testis located in the spermatic cord

Wraps around testicular artery

130
Q

What is the vas deferens?

A

Takes sperm from epidiymis to external

131
Q

Process of opening for a spey

A
  1. Cranial to caudal incision
    1. 10 blade through skin
    2. 15 blade through rest subcut (change blades, decrease staph infection)
    3. Get to abdominal wall and identify linea alba, pick it up with adson tissue forceps
    4. Reverse blade and stab into it to make a hole
    5. Switch to mayo scissors, gently lift and curt cranial then cut caudal
    6. Then in abdomen to find ovaries
    7. Tie off ligatures
    8. Do uterine body check for bleeders
    9. Close by linea alba to linea alba
      a. But mostly we wont cut it straight
132
Q

Strength holding layer of the muscle

A

Strength holding layer of muscle -> external layer
- Pointless grabbing internal layer and can enhance scar tissue
- Only need to get external sheath to external sheath together - exam
○ This is the holding layer

  • Greyhounds that bleed -> we can get internal sheath and sandwich close to stop bleeding but very rare
133
Q

How to search for a haemorrhage

A

Alert the anethetist and nurse and then move on to identify the source of the
bleeding
- Examine each pedicle first then move to the stump
- Incision extension may be necessary cranially and caudally to allow for better visualisation

  • LEFT – identify the descending colon and grab the mesocolon to form a basket of the intestine and
    move across to the right and visualise the dorsal abdomen, left ovarian pedicle and kidney. Inspect
    for bleeding
  • RIGHT – identify the proximal or descending duodenum and create a basket with the mesoduodenum and lift intestines to the left and visualise the dorsal abdomen inspect the right
    pedicle and kidney
  • The uterine stump is between the neck of the bladder and rectum so retrofex the bladder externally
    to visualise the stump
  • once a region of interest is exposed then use suction or swabs to gently remove the excess blood
    from the field.
  • Once located apply pressure with gauze for several minutes (up to 5 minutes) to reduce the rate of
    haemorrhage and assist in maximising visualisation – correct the haemorrhage as necessary –
    clamp and ligate
  • ALWAYS check for a secondary source of haemorrhage once fixed

Fourth Year (8 decks)

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