abdominal cavity

Question 1

surgicasl incison into the abdominal cavity

Answer 1

celiotomy

Question 2

flank approach incision to the abdominal cavity

Answer 2

laparatomy

Question 3

incision through the linea alba

Answer 3

ventral midline approach

Question 4

what are the advantages of ventral incision

Answer 4

• most commonly used in small animals
• easiest and quickest approach and closure
• minimal bleeding
• exposure of all abdominal organs

Question 5

ventral abdominal incision parallel; to the midline

Answer 5

paramedian

Question 6

discuss exposure of organs in paramedian incision

Answer 6

increase exposure to organs on one side of the abdominal cavity

Question 7

what are the disadvantages of paramedian incision

Answer 7

• increased bleeding
• increased closure time

Question 8

describe flank incision

Answer 8

lateral incision between last rib and tube rcoxae

Question 9

what are the advantages of flank approach

Answer 9

• excellent exposure of the kidney,one adrenal gland,one ovary

Question 10

what are the disadvantages of flank incision

Answer 10

limited excess to entire abdomen

Question 11

how is the paracostal incision made

Answer 11

caudal and parallel to the last rib

Question 12

what are the disadvantages of paracostal incision

Answer 12

• very limited exposure
• rarely used alone

Question 13

what are the advantages of combining ventral midline and paracostal incision

Answer 13

increased exposure, espercially of gall bladder and liver lobes(right)

Question 14

what are the disadvantages of combining ventral midline and paracostal incision

Answer 14

• increased bleeding
• prolonged closure

Question 15

what are the advantages of combining ventral midline and median sternotomy

Answer 15

• increeased exposure of cranial abdomen (liver and abdomen)
  *

Question 16

what are the disadvantages of combining ventral midline and median sternotomy

Answer 16

• opens pleural cavity–assisted ventilation is required
• sternum must be closed
• thoracic drainage is required

Question 17

explain the margins of opening the abdomen in exploratory celiotomy using the ventral midline approach

Answer 17

• from the xyphoid to the pubis
• the umblicus should be included in the surgical field as a landmark.
• the skin incision should be extended 1 cm cranial and caudal to the anticipated body wall incision
• the subQ layer is incised in the same line as the skin
• the linea alba is identified,tented and incised.

Question 18

discuss the ventral midline approach in male dogs

Answer 18

• the preputial orifice is draped out of the field
• the skin incision detours lateral (right or left) to the prepuse
• the preputialis mm. must be severed in half,ends are tagged for later reattachement
• the incision returns to midline after branches of caudal superficial epigastric vessels are ligated

Question 19

which layer is required for closing the abdomen with ventral midline approach

Answer 19

• the external rectus fascia
• the internal sheath is not usually closed
• suturing the rectus mm. layer should be avoided because it doesnot add streng of closure and
• also increases inflamation

Question 20

explain suturing of midline incision vs when the muscles are exposed

Answer 20

• if the incision is in the midline,full thickness bites may be placed
• if muscle is exposed, sutures are places in the rectus sheath(fascia) only
• sutures are placed 5-10 mm apart and incooperate 5-10 mm of tissue

Question 21

explain the type of suture and needle used in simple interupted closure of ventral midline

Answer 21

• monofilament absobable or non absobable suture
• dogs= size 3/0 to 0
• cats=3/0 or 4/0

Question 22

explain the type of suture and needle used in simple continuous closure of ventral midline

Answer 22

• monofilament synthetic absobable or non absobable suture
• dogs=3/0 to 0
• cats=3/0 or 4/0
• do not use chronic gut or stainless steel suture in continuous pattern in linear alba
• stsart at one end and close at the other end of the incision or
• start at each end and close towards the centre of the incision. tie 2 sutures together at centre of incision

Question 23

discuss how the subQ and skin are closed (suture pattern,size of needle)

Answer 23

• subQ tissue= simple continuous or simple interupted pattern, using 2/0 to 4/0 synthetic absobable suture
• in the male dog the preputialis mm. mustrbe accurately apposed
• skin=closed with 3/0 or 4/0 nylon

Question 24

indications for exploratory celiotomy biopsy

Answer 24

• fluid accumulation–ascites
• organ dysruption
• biopsy
• non responsive pain
• non responsive dystocia
• abnormal discharge
• content evaluation by inspection or palpation
• microbiological sampling

Question 25

what should you tell your anesthetian when using the trendelemburg positioning

Answer 25

the patient breathing is going to be impaired due to abdominal organs pressing on the diaphragm.

Question 26

list the equipment required for celiotomy

Answer 26

* balfour or gosst retractors * gelpi retractors * lap sponges * sunction * doyen interstinal forceps wlwctroscapel * delicate thumb forceps

Question 27

discuss the surgical technique for celiotomy

Answer 27

* essentially the same * after entering the peritoneal cavity,obtain sample of free fluid * ignore the obvious lesions unless they are life threatening eg haemorrhagesor leakage * thorough exploration, evaluate color,size,shape location,consistency * begin cranially with diaphragm * four quadrants * always use the same technique,be consistent, effecient * use anatomical retractors

Question 28

which type of biopsy takes the whole of the mass

Answer 28

excisional

Question 29

type of biopsy which makes a wedge of the mass and include the part of the healthy tissue

Answer 29

incisional biopsy

Question 30

organs commonly biopsied

Answer 30

* liver * prostate * interstine * lnn * kidney

Question 31

organs less commonly biopsied

Answer 31

* stomach * spleen * pancreas * urinary blader * greater omentum

Question 32

list all the techniques you can perform for biopsying the liver

Answer 32

* finger crushing--be careful with bleeding and bile peritonitis * ligature fracture technique (guillotine) * instrument fragmentation * wedge resection * biopsy punch * tru-cut * hemostasis is achieved with surgicel,vetspon or omentum *

Question 33

how much of the intestine can be biopsied and which closure suture technique should be deployed

Answer 33

* do not exceed 20% of interstinal circumference *

Question 34

which lnn are commonly biopsied

Answer 34

* mesenteric * external iliac * colic *

Question 35

why is excisional biopsy of lnn prefered over FNA

Answer 35

* provides morphological info * preserve regional blood supply * minimal handling * ligate blood supply

Question 36

which method is used to biopse the kidney

Answer 36

needle aspiration

Question 37

which suturing techniques are used to suture kidneys after biopsy

Answer 37

mattress or continuous pattern using omentum or oxidized cellulose

Question 38

methods of biopsy of stomach

Answer 38

* endoscopy * exploratory cellotomy allows full thickness biopsy *

Question 39

methods of biopsy in spleen

Answer 39

* partial spleenoctomyor wedge resection *

Question 40

methods of biopsy in pancrease

Answer 40

partial pancreactomy,distal aspect

Question 41

method of biopsy of UB

Answer 41

* full thickness * one or two layer closure