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Module 14 > Trauma Patient: Surgical Intervention Abdominal Surgery > Flashcards

Trauma Patient: Surgical Intervention Abdominal Surgery Flashcards

1
Q

how would you diagnose hemoabdomen

A

peripheral blood and abdominal fluid both PCV 45%

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2
Q

if there is hemoabdomen, why is the patient not anemic?

A

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

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3
Q

where could the blood in the abdomen be from

A
  1. spleen: prone to trauma
  2. liver: more protected but if damaged will bleed excessively
  3. kidney: uncommon
  4. omental vessel
  5. vena cava

others

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4
Q

what would be your next step in hemoabdomen?

A

abdominal surgery to address bleeding

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5
Q

what is a coeliotomy/laparotomy

A

an incision in the abdomen

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6
Q

what is an exploratory coeliotomy (ex lap)

A

systemic exploration of the entire abdomen

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7
Q

what is acute abdomen

A

per-acute, rapidly deteriorating abdominal condition promtoing emergency surgery

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8
Q

what are the requirements of ex lap (4)

A
  1. be systematic
  2. assess everything
  3. recognize normality
  4. recognize pathology
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9
Q

what is enterotomy

A

incision into intestional tract

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10
Q

what is an enterectomy

A

removal of portion of intestinal tract

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11
Q

what is a cystotomy

A

incision into bladder

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12
Q

what is a splenectomy

A

removal of spleen

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13
Q

what is a gastronomy

A

incision into stomach

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14
Q

what is the order of abdominal wall anatomy (7)

A
  1. external abdominal oblique
  2. transverse abdomins
  3. internal abdominal oblique
  4. rectus abdominis
  5. external rectus sheath
  6. internal rectus sheath
  7. peritoneum
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15
Q

which layer of the abdominal wall is the suture holder

A

external rectus sheath

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16
Q

what is an organ-centred incision

A

for specific procedures

ex. spay or a liver biopsy

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17
Q

when would a full abdominal incision be required

A

when ex lap is required

when smaller incisions prove indadequate exposure

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18
Q

describe how to make a ventral midline coeliotomy

A
  1. curved portion of #10 blade using a hub grip
  2. extend without underminind down to reach the linea alba
  3. using rat tooth forceps lift the linea alba and reverse the scapel blade and introduce it into the linea alba using a stab incision
  4. using mayo scissors ensuring you don’t trap abdominal organs underneath
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19
Q

describe how to make a ventral midline coeliotomy in a male dog

A
  1. make incision just before you reach the prepuce –> go to one side (if RH then go on right side)
  2. ligate the vessel and cut the muscle to push the structures and continue down to the linea alba
20
Q

how do you ensure maximal exposure of a ventral midline coeliotomy

A

excise the falciform fat

and ligate base and xiphisternum

21
Q

how do you prevent tissues from desiccating

A
  1. moistened swabs
  2. lavage saline
  3. suction
22
Q

what is the four quadrant approach

A
  1. cranial
  2. caudal
  3. left
  4. right
  5. central
23
Q

what should appear in the cranial quadrant and what should you look for in each (4)

A
  1. diaphragm: muscle and tendon components
  2. liver: size, masses, contours, shape, pull stomach back and look at bililary tree
  3. gall-bladder: gentle squeeze to see if it empties
  4. stomach: feel whole body
24
Q

what should appear in the right quadrant

A
  1. right limb pancreas
  2. kidney
  3. adrenal
  4. portal vein
  5. ureter
  6. ovary
25
Q

how do you expose the right quadrant

A

mesoduodenal sling to improve exposure –> handle intestine not the pancreas

26
Q

how do you improve access on the left quadrant

A

mesocolonic sling

27
Q

what should you see in the left quadrant

A
  1. kidney
  2. ureter
  3. ovary
  4. adrenal
28
Q

what should be seen in the caudal quadrant

A
  1. colon
  2. reproductive tract
  3. bladder
  4. urethra
  5. prostate
  6. inguinal rings
29
Q

what should you do in the central component

A
  1. palpate the entire legnth of intestines
  2. look at colour
  3. peristalsis
  4. pulses
  5. mesenteric lymph nodes
30
Q

what other organs should you inspect in the central component

A
  1. 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
  2. spleen
  3. left limb of the pancreas: lift omentum up and reflect cranially to expose left limb of pancreas in dorsal leaf
31
Q

what is shown here

A

splenic hematoma

32
Q

what is a hilar splenectomy

A

double ligation of each hilar vessel and cut between

work from tail to head isolating vessels by blunt dissection

33
Q

what are the important structures of the speen

A
  1. splenic artery and vein
  2. short gastric vessels from head of spleen to stomach
34
Q

what are indications for a hilar splenectomy

A
  1. ruptured splenic tumour: 80% of canine cases (hemangisarcoma), poor prognosis
  2. ruptured splenic hematoma: 20% of cases, spontaneous or following trauma, good prognosis
35
Q

why is it easier to work from the tail of the spleen to the head when removing it

A

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

36
Q

what is the first layer of closure

A

external recutus sheath

37
Q

do you engage the external rectus sheath in every suture bite

A

yes this is very important

38
Q

what suture pattern can you use to close the external rectus sheath

A

simple interrupted or continous closure

39
Q

if you chose continuous closure of the external rectus sheath what should you change

A

use a larger suture by one size

40
Q

how many throws at the start and are at the end of continuous closure of the external rectus sheath

A

5 to start

7 to end

41
Q

what suture material is suitable for external rectus sheath closure

A

polydioxanone

3/0 cat

1 great dane

42
Q

how do you close the subcutaneous fat layer

A

simple continuous

close the dead space and suppoty skin closure

43
Q

what suture material is suitable for closing of the subcutaneous fat layer

A

poliglecaprone 3/0 to 2/0

44
Q

how do you close the skin layer

A

any appropriate pattern and material

intradermal skin - poligecaprone

simple interrupted skin sutures - nylon

skin staples

45
Q

what are complications associated with abdominal surgery

A
  1. abdominal organs move subcutaneously
  2. skin incision dehiscence: peritonitis, evisceration, death
  3. post op bleeding

Module 14 (29 decks)

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