Trauma Patient: Surgical Intervention Abdominal Surgery Flashcards
how would you diagnose hemoabdomen
peripheral blood and abdominal fluid both PCV 45%
if there is hemoabdomen, why is the patient not anemic?
in acute blood loss there is normally concentrated blood –> just not enough of it so blood will be redistributed to vascular space and lead to gradual hemodilation and expansion of blood volume
after fluids –> PCV should show a decrease
where could the blood in the abdomen be from
- spleen: prone to trauma
- liver: more protected but if damaged will bleed excessively
- kidney: uncommon
- omental vessel
- vena cava
others
what would be your next step in hemoabdomen?
abdominal surgery to address bleeding
what is a coeliotomy/laparotomy
an incision in the abdomen
what is an exploratory coeliotomy (ex lap)
systemic exploration of the entire abdomen
what is acute abdomen
per-acute, rapidly deteriorating abdominal condition promtoing emergency surgery
what are the requirements of ex lap (4)
- be systematic
- assess everything
- recognize normality
- recognize pathology
what is enterotomy
incision into intestional tract
what is an enterectomy
removal of portion of intestinal tract
what is a cystotomy
incision into bladder
what is a splenectomy
removal of spleen
what is a gastronomy
incision into stomach
what is the order of abdominal wall anatomy (7)
- external abdominal oblique
- transverse abdomins
- internal abdominal oblique
- rectus abdominis
- external rectus sheath
- internal rectus sheath
- peritoneum
which layer of the abdominal wall is the suture holder
external rectus sheath
what is an organ-centred incision
for specific procedures
ex. spay or a liver biopsy
when would a full abdominal incision be required
when ex lap is required
when smaller incisions prove indadequate exposure
describe how to make a ventral midline coeliotomy
- curved portion of #10 blade using a hub grip
- extend without underminind down to reach the linea alba
- using rat tooth forceps lift the linea alba and reverse the scapel blade and introduce it into the linea alba using a stab incision
- using mayo scissors ensuring you don’t trap abdominal organs underneath
describe how to make a ventral midline coeliotomy in a male dog
- make incision just before you reach the prepuce –> go to one side (if RH then go on right side)
- ligate the vessel and cut the muscle to push the structures and continue down to the linea alba
how do you ensure maximal exposure of a ventral midline coeliotomy
excise the falciform fat
and ligate base and xiphisternum
how do you prevent tissues from desiccating
- moistened swabs
- lavage saline
- suction
what is the four quadrant approach
- cranial
- caudal
- left
- right
- central
what should appear in the cranial quadrant and what should you look for in each (4)
- diaphragm: muscle and tendon components
- liver: size, masses, contours, shape, pull stomach back and look at bililary tree
- gall-bladder: gentle squeeze to see if it empties
- stomach: feel whole body
what should appear in the right quadrant
- right limb pancreas
- kidney
- adrenal
- portal vein
- ureter
- ovary
how do you expose the right quadrant
mesoduodenal sling to improve exposure –> handle intestine not the pancreas
how do you improve access on the left quadrant
mesocolonic sling
what should you see in the left quadrant
- kidney
- ureter
- ovary
- adrenal
what should be seen in the caudal quadrant
- colon
- reproductive tract
- bladder
- urethra
- prostate
- inguinal rings
what should you do in the central component
- palpate the entire legnth of intestines
- look at colour
- peristalsis
- pulses
- mesenteric lymph nodes
what other organs should you inspect in the central component
- omentum: tear a hole to look into the omental bursa –> if suspected peritonitis look at the visceral surface of the stomach to look for gastric perforation
- spleen
- left limb of the pancreas: lift omentum up and reflect cranially to expose left limb of pancreas in dorsal leaf
what is shown here
splenic hematoma
what is a hilar splenectomy
double ligation of each hilar vessel and cut between
work from tail to head isolating vessels by blunt dissection
what are the important structures of the speen
- splenic artery and vein
- short gastric vessels from head of spleen to stomach
what are indications for a hilar splenectomy
- ruptured splenic tumour: 80% of canine cases (hemangisarcoma), poor prognosis
- ruptured splenic hematoma: 20% of cases, spontaneous or following trauma, good prognosis
why is it easier to work from the tail of the spleen to the head when removing it
head of the spleen is tethered to stomach by short gastric vessels
splenic artery and vein come up in the deep leaf of omentum towards hilus and branch into 20-30 vessels
at head also run forward to supply of the fundus of stomach
what is the first layer of closure
external recutus sheath
do you engage the external rectus sheath in every suture bite
yes this is very important
what suture pattern can you use to close the external rectus sheath
simple interrupted or continous closure
if you chose continuous closure of the external rectus sheath what should you change
use a larger suture by one size
how many throws at the start and are at the end of continuous closure of the external rectus sheath
5 to start
7 to end
what suture material is suitable for external rectus sheath closure
polydioxanone
3/0 cat
1 great dane
how do you close the subcutaneous fat layer
simple continuous
close the dead space and suppoty skin closure
what suture material is suitable for closing of the subcutaneous fat layer
poliglecaprone 3/0 to 2/0
how do you close the skin layer
any appropriate pattern and material
intradermal skin - poligecaprone
simple interrupted skin sutures - nylon
skin staples
what are complications associated with abdominal surgery
- abdominal organs move subcutaneously
- skin incision dehiscence: peritonitis, evisceration, death
- post op bleeding
