Abdominal surgery

Question 1

What part of the cow should be prepped for rumen surgery?

Answer 1

Paralumbar fossa from the last rib to the tuber coxae

Question 2

At what point does rumen surgery become “dirty”? What should the surgeon do at this point?

Answer 2

When entering the rumen; surgeon should change sleeves, gloves, and drape once rumen is closed

Question 3

What are the different regional anesthesia approaches for rumen surgery?

Answer 3

Line block, inverted L block, distal paravertebral block, proximal paravertebral block

Question 4

Describe a line block for a rumen surgery

Answer 4

Infuse lidocaine in deep and superficial layers of the flank directly where it will be cut

Question 5

Describe an inverted L block for a rumen surgery

Answer 5

Infuse lidocaine in a line ventral to the transverse processes and then caudal to the 13th rib

Question 6

Describe a distal paravertebral block for rumen surgery

Answer 6

Infuse lidocaine dorsal and ventral to the transverse processes of L1, L2, and L4 (+/- L3)

Question 7

Describe a proximal paravertebral block for rumen surgery

Answer 7

Infuse lidocaine cranial and caudal to L1 and caudal to L2

Question 8

What layers will you have to cut into to get into the abdomen?

Answer 8

Skin, external abdominal oblique, internal abdominal oblique, transversus abdominus, peritoneum

Question 9

What type of suture is usually used for closure of an abdominal surgery?

Answer 9

2-0 or 3-0 absorbable suture (Vicryl, chromic gut) in a simple continuous pattern for first two layers, 2-0 or 3-0 non-absorbable suture (Vetafil or Braunamid) in a Ford interlocking pattern for the third layer

Question 10

What layers are closed in an abdominal surgery?

Answer 10

First layer- peritoneum, transversus abdominus, internal abdominal oblique
Second layer- external abdominal oblique
Third layer- skin

Question 11

What measure can you take to simplify treatment of an abscess at an incision site?

Answer 11

Use a cruciate or simple interrupted suture for the ventral few centimeters so the sutures can easily be removed to drain the abscess

Question 12

What kind of medications are indicated post-operatively for rumen surgery?

Answer 12

High doses of procaine penicillin (extra-label), flunixin

Question 13

How would you prepare to make a rumen fistula in a calf?

Answer 13

Relieve any rumen distension via orogastric tube, prep and block the left paralumbar fossa

Question 14

Describe the steps of creating a rumen fistula in a calf

Answer 14

Create a 2-3cm hole in the skin and the abdominal musculature and peritoneum, grasp the underlying rumen wall and pull some through the hole, suture the rumen to the hole in four places using 0-0 non-absorbable suture and a horizontal mattress pattern, remove the protruding rumen, use simple interrupted pattern to suture the edges of the rumen to the hole

Question 15

How long does it take for a rumen fistula to close in a calf?

Answer 15

2-3 weeks (during which the respiratory disease usually resolves as well)

Question 16

Why shouldn’t trocars be used as a long-term solution to relieve gas accumulation?

Answer 16

Because they have increased risk of peritonitis

Question 17

Where is the location for a left flank celiotomy?

Answer 17

4cm caudal and parallel to the last rib, 6-8cm ventral to the transverse processes; can be moved cranially to better examine reticulum

Question 18

What part of the abdomen should you explore last in a left flank celiotomy and why?

Answer 18

The left cranial abdomen where the spleen and reticulum are- highest risk of contamination here

Question 19

What are the most common indications for a rumenotomy?

Answer 19

Evacuation of the rumen from grain overload, removal of wire causing TRP, removal of a foreign body causing rumen outflow obstruction

Question 20

How is a rumen board used?

Answer 20

Enter the abdomen and pull a portion of the dorsal sac of the rumen through the incision and rumen board. Hook it ventrally and dorsally, then incise the rumen incrementally while attaching it to the hooks on either side.

Question 21

What are the benefits and disadvantages of a rumen board?

Answer 21

It is quicker and easier than suture but allows for greater abdominal contamination

Question 22

How is rumen sutured to skin in a rumenotomy?

Answer 22

A portion of the dorsal sac of the rumen is exteriorized and sutured dorsally and ventrally. The rumen is then sutured circumferentially using 1-0 or 2-0 non-absorbable suture and a cutting needle in a Cushing-type pattern (not full thickness). The rumen is then incised.

Question 23

Once you have removed any foreign bodies with a rumenotomy, what else should you determine?

Answer 23

Palpate the reticulum wall and determine if there are any abscesses present

Question 24

How do you figure out if there are adhesions present during a rumenotomy?

Answer 24

Grasp the reticular wall and attempt to invert it into the rumen. If this isn’t possible, there are likely adhesions between the serosal surface and the diaphragm, liver, or peritoneum

Question 25

Where would you locate an obstruction in a rumenotomy?

Answer 25

In the omasal orifice

Question 26

What should you do prior to closing a rumenotomy site?

Answer 26

Return rumen contents, remove gross contamination from the rumen wall. If sutured, close the rumen before undoing sutures. If using a board, leave the board attached and dorsal and ventral commissures and incrementally remove the rumen from the hooks as you close it. Change into sterile gloves

Question 27

What do you use to close the rumen in a rumenotomy?

Answer 27

Either simple continuous oversewn with Cushing, or a single layer Utrecht Use 1-0 or 2-0 absorbable suture (Vicryl or PDS)

Question 28

Why might a farm keep a cannulated cow?

Answer 28

For rumen fluid collection and donation to other cows

Question 29

Where is a rumen cannulation placed?

Answer 29

Incision is centered in the paralumbar fossa and 6cm below the transverse processes

Question 30

How long are antibiotics needed after cannulating a cow?

Answer 30

5-7 days with daily monitoring and cleaning of the surgery site

Question 31

What situations make it impossible to perform a fetotomy rather than a c-section?

Answer 31

Non-reducible uterine torsion, closed cervix

Question 32

What are the advantages and disadvantages of approaching a c-section from the left flank?

Answer 32

Easier on the cow, requires less assistance; carries the highest risk of abdominal contamination

Question 33

In what circumstances is approaching a c-section from the left flank inappropriate?

Answer 33

If the calf is dead or if the uterine environment is heavily contaminated

Question 34

What challenge do you face performing a c-section from a low oblique or paramedian/median approach?

Answer 34

You need to avoid the large and tortuous mammary veins

Question 35

When should you perform a c-section vs. a fetotomy?

Answer 35

Fetotomy if the calf is dead, C-section if it is alive or fetotomy is not possible

Question 36

Where would you make a c-section incision using a flank approach?

Answer 36

Slightly caudal of the middle of the paralumbar fossa

Question 37

How long should a c-section incision be?

Answer 37

Approximately 40cm

Question 38

How do you avoid nicking the rumen when performing a c-section?

Answer 38

Tent the peritoneum to incise it

Question 39

What should you try to locate once you are in the abdomen of a c-section?

Answer 39

The hind limb (anterior presentation) or the forelimb (posterior presentation)

Question 40

Once you have located a limb in a c-section, what should you do next?

Answer 40

Pull the limb to exteriorize it and then incise the uterus between the toes of the calf. Extend the incision to the hock/carpus, and place a chain on the fetlock. Have an assistant gently pulls o you can locate the other limb and place a chain on it.

Question 41

Once there are chains on two limbs during a c-section, what do you do?

Answer 41

Have the assistant pull the calf from the incision while you ensure the uterine incision does not tear, then grasp the edges of the uterus so it doesn't fall back into the abdomen and check to see if another calf is present.

Question 42

How should you close the uterus in a c-section?

Answer 42

Using 2-0 or 3-0 Vicryl or chromic gut in a Utrecht or a simple continuous oversewn with Cushing pattern

Question 43

Do you remove the placenta during a c-section?

Answer 43

No, it may be trimmed if it interferes with closure, but it is firmly attached so it shouldn't be removed

Question 44

What do you do after you've closed the uterus in a c-section?

Answer 44

Lavage the exterior to remove any blood clots or contamination

Question 45

How do you close the abdomen in a c-section?

Answer 45

Simple continuous with 2-0 to 3-0 Vicryl or chromic gut in two layers; skin closed with large non-absorbable suture in a Ford interlocking pattern

Question 46

What medications should be administered post-c-section?

Answer 46

Oxytocin, analgesics, systemic antibiotics

Question 47

What is the prognosis of a c-section and a fetotomy?

Answer 47

Simple c-section- good prognosis Complicated c-section/fetotomy- worse prognosis