Surgery Flashcards
What are these?
Mayo-Hegar
- Long Moderately heavy tips
- Medium to course needles
When doing an Abdominal Exploration and you have the Abdo open what order should you explore?
- Must be systematic
- Diaphragm and Liver
- Right kidney/adrenal
- Left Kidney/adrenal
- Stomach, S. Intestine, L. Intestine
- Bladder, Repro
- Examination
- Visual
- Textile
- Odour
If we have an infected/contaminated wound what kind of dressing should we use?
Hypertonic saline
Describe Scalpel Blade numbers
10, 11, 12, 15, 20
- 12 - Stitch Cutter
- 11 - Stab Upside down
- 15 - Stab
What is the formula to overcome dehydration?
Maintenance + Deficit + Ongoing Losses
A dog has an infected laceration what do I do?
Must get rid of the infection before closing. Never close an infected wound
What are these?
Halstead (Mosquito) hemostatic forceps
- Fine tips
- Transverse grooves on entire surface of jaws
- Straight or Curved
- Use on small vessels
- Traumatic
Explain Suture Material
Nylon (Ethilon)
- What is it made from?
- What type of filament is it?
- Absorbable or Non-Absorbable? If so how and timeframe?
- Tensile Strength?
- Knot Security?
- Reactivity?
- Handling?
- Thermoplastic Polymer
- Monofilament, but also Braided (stronger)
- Non-Absorbable
- Moderate Strength Loss of 30% @ 2yrs,
- Poor to Fair
- Inert
- Poor Handling
What are these scissors used for?
Suture Removal Scissors
What are these two called?
What is the differences
What are they used for?
Osteotome/Chisel
- Cutting of Bone
- Ostemotome - bevel on both sides
- Chisel - Bevel on one side
- Ostemotome will cut in a straighter direction
What is this used for?
Needle holders
- Forceps with short, heavy, blunt tips with a cross pattern
- Specifically for holding needle
- May have groove to faciliate grasping needle
- Do not use tissue forceps for this task
What are these?
Hand-Held Retractors
- Aid exposure of tissue
- Army-Navy (largest looking one)
What are the classifications of Suture Material?
- Absorbable - degradation and rapid loss of tensile strength <60Days
- Non-Absorbable - >60 Days
They can be Natural or Synthetic
What are these?
Kelly Hemostatic Forceps
- Heavier Tips
- Transverse grooves on half of surface
- Straight or Curved
- Crile (grooved on entire surface)
- Use on moderate sized vessels
- Traumatic
- What Suture type gives the best apposition?
- What is Apposition?
- Simple Interupted
- Bringing like tissue layers together for best healing
- What size suture should you use?
- To get better hold what do you do?
- The Smallest Possible
- Put more Sutures in before going to larger Size material
Explain the differences between these suture materials
- Monofilament
- Slides Easy however knot security is decreased
- Twisted Multifilament
- Grips and Drags more, contamination can sit inbetween gaps, better knot security
- Braided Multifilament
- Passes through a little easy than Twisted, slightly less secure
Draw/Explain a graph of Wound Strength v Phases of Wound Healing/timeline
When closing a ex lap, what suture material and pattern is used for the External Rectus?
- Material
- Monofilament absorbable or nonabsorbable
- NOT CATGUT
- Polydioxanone, Polyglyconate Nylon
- 2/0-1 (35kg dog would use 0 or 1)
- Pattern
- Simple Continous
- Secure square knots at either end
- Tissue
- Must Engage external Rectus Sheath
- 5-10mm from edge, 5-10mm apart
What are these and what are they used for?
Babcock Grasping tissue forceps
- No Teeth
- Small Longitudinally grooved contact end
- Minimally traumatic
- Holding power perpendicular to line of pull
- Suitable for visceral tissue
What are these and what are they used for?
Adson (Rat Tooth) Thumb Forceps
- Single Tooth
- Opposite Interdigitation
- Very focal hold -> may damage very delicate tissue
- Atraumatic
If you have dropped the left ovarian pedicle and/or its bleeding how do you gain access bact to it?
xGrab the Mesocolon - Small Intestine to the right, which exposes :-
- Left Kidney/ureter
- Left Adrenal
- Left Ovary
- Gonadal Vessels
- Spleen
Open omental bursa to see left pancreas
- Explain the difference between Circlarge and Transfixing Sutures
- What are these used for?
- Circlarge is a ligature that goes around a small vessel, where a transfixing passes through the centre of the vessel and tie on each side.
What bacteria does Cephazolin work against?
- Wide spectrum of activity against Gram-Positive organisms
- Variable against Gram-Negative organisms
- Poor activity against Anaerobic infections
Explain Suture Material
Polyester (Mersilene, Tevdek, Dacron, PolyDek)
- What is it made from?
- What type of filament is it?
- Absorbable or Non-Absorbable? If so how and timeframe?
- Tensile Strength?
- Knot Security?
- Reactivity?
- Handling?
- Polyester
- Multifilament
- Non-Absorbable
- Excellent
- Good Knot Security
- Significant Tissue Reaction
- Good Handling
Used for replacing a tendon
Explain Suture Material
Silk
- What is it made from?
- What type of filament is it?
- Absorbable or Non-Absorbable? If so how and timeframe?
- Tensile Strength?
- Knot Security?
- Reactivity?
- Handling?
- Natural, Cocoon of silk worm
- Multifilament often coated
- Non-Absorbable but will break down over time
- Fair, 30% @ 14days, 50% @ 1year, 100% @ 2years
- Good Security
- Moderate Reaction
- Excellent Handling (Gold Standard)
What equipment should you have when planning a Coeliotomy?
- Assistance
- Suction (Poole)
- Laparotomy sponges
- Balfour Retractor
- Haemostatic Agents
- Biopsy Instruments
- Other
- Electrosurgery
- Drainage
What does this symbol represent?
What is it used for?
Reverse Cutting Needle
When lifting up the tissue less likely to cut through. Used when doing skin sutures
What is this?
Olsen-Hegar Needle Holders
- Combination of Scissors and Needle holders
- Suitable for small to medium needles
- Helpful for Lone Surgeons
What are these used for?
Doyen (Pean) intestinal forceps
- Longitudinal grooves along jaws
- Jaws do not completely compress in middle
- Suitable for use on bowel to prevent spillage.
Regarding Antimicrobials what does
MIC
MBC
Mean?
- MIC = Minimal inhibitory concentration - Lowest concentration that inhibits visible bacterial growth
- MBC = Minimal bacteriocidal concentration - Lowest concentration that kills 99.9% of the bacteria in the animals plasma or tissues
What are the pros and cons or Interrupted verses Continuous Suturing Patterns
Interrupted
- Single Sutures
- If one fails, remainder not affected
- Longer time
- More Suture Material
- More Knots -> more irritation
Continuous
- Sutures linked together
- Failure
- Less suture material
- Quicker
What influences Oncotic (Colloid-oncotic) pressure
Proteins (Main one is Albumin) are negatively charged and attract Na, usually into the vascular space, this is the osmotic drive. However when the vessels become leaky Albumin leaks into the interstitial space which then attracts Na which then drags water causing oedema
Explain Suture Material
Poliglecaprone 25 (PGC25, Monocryl)
- What is it made from?
- What type of filament is it?
- Absorbable or Non-Absorbable? If so how and timeframe?
- Tensile Strength?
- Knot Security?
- Reactivity?
- Handling?
- Polymer
- Monofilament
- Absorbtion by Hydrolysis, Complete absorbtion 90-120Days
- Strength Moderate - loss of 50% by 10days, 100% by 21days
- Good Knot security
- Minimal to no reactivity
- Good Handling, Soft, Flexible, No tissue Drag
When would you provide antimicrobial prophylaxis for an upcomming surgery?
- Based on wound classification & considerations of other factors
- Primarily recommended for “Clean-Contaminated” and selected “contaminated” wounds
- Not indicated in clean procedures
EXCEPT
- Long procedures (>90mins)
- Implant Placement
- Infection likely to be castrophic
- Immunocompromised
If you have dropped the right ovarian pedicle and/or its bleeding how do you gain access bact to it?
Use the mesoduodenum to pull the small intestine to the left. This exposes :-
- Right Limb of pancreas
- Right kidney/ureter
- Caudate process of the caudate lobe
- Adrenal
- Ovary
- Gonadal Vessels
- CVC, Aorta PV
What does this symbol mean?
What is this best used for?
Blunt Point Needle
For delicate tissue like parencema of the liver
What are these?
Gelpi Self Retaining Retractors
- Soft Tissue retractor
- Retracts Muscle, fascia
- Sharp pointed tips for minimal tissue contact and minimal trauma
There are 3 fluid compartments in the body, what are they?
- Intracellular Fluid (40% total body weight)
- Interstitial Fluid (15% total body weight)
- INtravascular Fluid (Blood 8% Total Body Weight)
We only have access to influence the blood
List in order of days for complete absorption of suture material
What are these? What are they used for?
Ewald Thumb Forceps
Grooved tips
Moderate / Poor grasping ability
Atraumatic