Surgery Abdo Module 2 Flashcards
What are common indications for preforming surgery on blocked cats?
- Recurring obstructive FLUTS
- Poor response to medical management
- Inability to catheterise the urethra
- Urethral stricture secondary to urethral surgery
- Urethral trauma secondary to catheterisation
- Urethral trauma secondary to pelvic/perineal
trauma - Urethral neoplasia
How to catheterise a blocked cat?
- Sedation/anaesthesia
- clipping and prepping perineum
- PTFE catheter 3-5FG - end hole best for propulsion
- IV catheter minus stylet if initially difficult to get in
- Dorsal or lateral recumbency with the penis extruded from the prepuce
- Lubricate catheter
- Hydropulsion - rectal palpation of urethra and flushing to allow pressure to build and then release compression
- Flush bladder - doesnt have to be clear
Ways to relieve urinary obstruction in cats?
- Cystocentesis
- Catheterisation
- Bladder pigtail catheter
Ways to relieve ureteral obstruction?
- Nephrostomy tube: locking loop pigtail catheter - relieves the increased ureteral and renal pelvic pressure with excessive ureteral spasm and edema created by the stone
- surgical placement in cats - transcutaneously under ultrasound guidance
- loop of catheter is approx 10mm - so only in dogs and cats with a renal pelvis >10mm
- 5Fr in cats
- pyelogram to make sure no leakage
Clinical signs and diagnosis of bladder rupture/trauma
CS:
- Absence or small quantities of haematuria,
unsuccessful attempts at urination
- Abdominal distention in later cases
- Chemical peritonitis from urine- vomiting/lethargy/anorexia/dehyration/hyperkalaemia/anaemia/hypoproteinaemia/hypochloraemia/hyponatraemia
Dx:
- Absence of urine on catheterisation
- Failure to palpate bladder
- Abdominal paracentesis: creatinine fluid >
creatinine blood
- Elevated BUN
- Rads - contrast showing leakage
What is a tube cystotomy?
The placement of a tube drain through the abdominal wall into the bladder in order to maintain urinary drainage while bypassing the urethra
- helps to divert urine away from epithelial
surfaces of the urethra which are healing and
minimises the risk of scarring and stenosis
Indications for tube cystotomy?
Urinary by-pass following
- urethral trauma/surgery
- sub-total prostatectomy
- bladder atony
- severe iatrogenic cystitis
Technique for Tube Cystotomy?
- Pre-pubic position and requires a small
laparotomy wound - A s/c tunne is made by blunt dissection with
artery forceps latearl to the lap wound \ - Foley catheter is drawn through the tunnel into
the abdominal cavity - Bladder is gently exteriorised and a purse string
suture (PDS, vicryl, ethicon) is preplaced in the
bladder wall - Stab incision made within the purse string area into the bladder lumen
- Place catheter into bladder, inflate baloon and tighten suture
- Place bladder back in to abdomen
- Omentum drawn caudally and wrapped around
foley catheter - Close lap wound, the foley is then tractioned to
draw the bladder to firm contact with the
abdominal wall - Fix foley in place with chinese finger trap suture
What is the management of a tube cystotomy catheter
- Closed system attached to foley - to minimise
ascending infection - Tubes need to be left for at least 5-7 days
- Culture urine prior to cystotomy and following
tube removal - Antibiotic therapy should be instituted after drain
removal should the urine culture be positive - Urine leakage from the stoma can occur for up to
4 days post removal until granulation of the site is
complete
Outline cystotomy surgery plan
- Clean contaminated surgery - based on culture or b/s abs covering for staphylco/e.coli
- Clip and prep midline abdomen
- Pack of other tissues with moist swabs in abdomen and bladder
- Drain bladder
- Stay suture at cranial ple
- Midline ventral incision - number 11,15 blade
- Stay sutues on incision edges
- Remove stones
- Retrograde flushing
- Close in 1-2 layers - no suture material in lumen 3/0, 4/0 monofilament
- Flush abdomen
complications: dehiscence, uroperitonitis
What is the aetiology of urethral prolapse?
- Primarily young brachycephlic dogs after periods
of sexual excitement or hypersexuality - Prolapse results from chronic irritation and
inflammation of the distal penile urethra that
protrudes beyond the orifice as it becomes
swollen
Management options of urethral prolapse?
- Sedation and AI drugs - manage underlying issue
- Chronic mucosa changes - reduce under AI with urethral catheter, purse string suture 4-0/6-0 monofilament
- if devitalised may necessitate amputation of the prolapsed tissue
Indications for canine urethrostomy procedure?
- Stenosis of the urethra (iatrogenic intervention,
recurrent urolithiasis or trauma) - Prophylaxis of uroliths
- Neoplasia involving urethra
- Severe penile trauma
What are possible urethrostomy sites?
Base of os penis - unsuitable for a permanent stoma due to risk of scarring and stenosis due to narrow diameter
Scrotal - optimal site, risk of stenosis is less
Perineal - undesirable since the urethra is deep at this point - risk fo stenosis and urine flow over the perineum
Prepubic - salvage site if all others fail
Post op care and complications with canine urethrostomy?
- Mictruition related urethral haemorrhage - can
lead to anaemia - Perineal haematoma development leading to
obstruction - Excessive scarring and stenosis
- Ascending infections are uncommon and urinary
incontinence
What are the indications for feline perineal urethrostomy?
- Repeated urethral obstruction
- Obstruction that can not be relieved by
catheterisation - Severe penile trauma
- Priapism
Complications following urethrostomy?
- Stenosis at site of stoma
- Dehiscence
- Scalding
- Incontinence
- Long term UTI
Common differentials for haemoabdomen?
Surgical
- GDV
- Neoplasia: liver/splenic haemangiosarcoma
- Splenic/liver torsion
Non-surgical
- Coagulopathy
Trauma - stabilise and if no improvement then surgery
Presenting/clinical signs of haemoabdomen?
- Pale mm
- Prolonged CRT
- Severe lethargy/collapse
- Distended abdomen
- Fluid wave ballotment
- Weak peripheral pulses
- Tachycardia
- Tachypnoea
What fluid would be classed as haemoabdomen?
Serosanguineous abdominal fluid that does not readily clot and has a packed cell volume >10% is diagnostic
Investigation of haemoabdomen?
- Abdominocentesis
- Haematology - PCV, hydration status of patient -
serial monitoring every 10-30mins - 5-10% PCV decline in a 15 min time period
indicates severe ongoing haemorrhage - Serum biochemistry and urinalysis
- Coagulation panel
- Cardiac auscultation: may reveal a heart murmur :
left sided murmurs are normal with anaemia and
may have arrhythmias (Ventricular) - Ultrasonography
Management of haemoabdomen?
- Administration of crystalloids to keep MAP at
minimal of 60mmHg - Add in colloids/hypertonic saline/blood products
- Pain relief
- Oxygen
Two methods of how to do a splenectomy?
- Hilar vessel ligation
- Major vessel ligation: Splenic arteries/veins beyond pancreas, short gastric vessels, gastro-epiploic a/v
What are the indications for a total splenectomy?
- Splenic neoplasia
- Splenic rupture secondary to trauma
- Splenic torsion
- Immune mediated disease - where indicated
- Feline mastocytosis
What are the disadvantages and contraindications of splenectomy?
- Loss of reservoir
- Immune defence
- Haemopoiesis and filtration function
Contraindicated:
- Haemolytic anaemia or thrombocytopaenia unless
other forms of treatment have failed
- Bone marrow hypoplasia
- Metastasis
- Coagulopathies
What are common clinical presentations/signs of diaphragmatic ruptures/hernias?
- PE may be normal though abdomen feels tucked up and empty
- Muffled heart sounds or abnormally positioned or more intense on the contralateral side to the hernia
- Percussion may elicit dullness of there is effusion or large volume of herniated organs present
- Conversely tympani may be present if there is a gastric dilation within the thoracic cage
- Borborygmi in thorax
Confirm with radiology/US
What are factors affecting survival of diaphragmatic hernias/ruptures?
Timing of surgery has no impact on the survival, operate when the patient is stable
- Longer anaesthetic times
- Concurrent soft tissue and orthopaedic injuries
- Being oxygen depending during the hospitalisation
Surgical options for blocked cats and how are they chosen?
Surgery is determined by where the block is within bladder/urethra
- Cystotomy
- Cystotomy + urethrostomy
- Perineal urethrostomy
- Prepubic urethrostomy
- Transpelvic urethrostomy
