Trauma patient : surgical intervention

Question 1

Define coeliotomy/laparotomy

Answer 1

an incision into the abdomen

Question 2

What are the requirements of ex lap?

Answer 2

1. be systematic
2. assess everything
3. recognise normality
4. recognise pathology
5. take appropriate action- core abdominal surgical procedures, enterotomy, gastromy, liver biopsy

Question 3

Where should the incision be made for an exlap and what else do you need to do in a male dog?

Answer 3

ventral midline from the xiphisternum to close to the pubis

1. as you reach the base of the prepuce you divert incision towards yourself and carry on caudally on the inside edge of the prepuce behind the nipples.
2. need to ligate the cranial preputial vessel and cut through the cranial preputial muscle and then the penis can be pushed away.

Question 4

When is hilar splenectomy indicated?

Answer 4

indicated during haemoabdomen due to rupture splenic haematoma

Question 5

Describe the 4 quadrant approach to explore the abdomen

Answer 5

1. cranial quadrant- left xiphisternum to maximise exposure. diaphragm, liver, galbladder, stomach
2. right quadrant- mesoduodenal sling to improve exposure. right limb pancreas, kidney, adrenal, portal vein, vena cava, ureter etc
3. left quadrant- mesocolonic sling to improve access- kidney, ureter, ovary, adrenal
4. central compartment- palpate entire length of intestines (colour, peristalsis, pulses). mesenteric lymph nodes. omentum, spleen, left limb of pancreas etc

Question 6

what is the blood supply to the spleen?

Answer 6

splenic vein and artery

Question 7

how is a hilar splenectomy carried out?

Answer 7

• spleen needs to be exteriosed and the omentum dissected away
• start fom tail towards head, isolate each hilar vessel and double ligate it close to the hilus and cut between the ligatures.
• when last vessel is cute spleen can be lifted out abdomen