ex lap and biopsy Flashcards
(29 cards)
when doing an abdominal exploration, what should we always have?!
Make a plan and stick to it!
- If done methodically – you will remember to look everywhere
– Examine organs in the same order each time
– Don’t interrupt unless you have to do so!
– Cover organs with moist towels and try not to exteriorize them unless you need to - Prevent contact of organs with the skin
what to look for in organs in an exlap?
- Position
- Thickening
- Enlargement
- Irregularity
- Mass
- Discolouration * Etc.
what should we do if we find free fluid upon entry into the abdomen?
-take a sample for culture +/- cytology
how should we examine the liver during an exlap?
visually inspect and palpate all lobes
what do we do with the gall bladder during an exlap
express to confirm patency of the bile duct
what is normal to find on the spleen during an exlap?
siderotic plaques
what do we see in an acute vs chronic splenic torsion?
acute - red
chronic - white, pale
how do we “explore the gutters” in an exlap? what are we looking for?
Use the mesoduodenum to retract the intestines to the left and examine the right gutter
– Kidney, adrenal gland, ureter +/- ovary / horn / testis/ etc.
Use the descending colon (mesocolon) to achieve the same on the left
how do we limit tissue trauma during and exlap?
- Keep organs moist
- Prevent contact with skin
- Use less traumatic instruments (Debakey)
- Use stay sutures
how do we lavage?
- Warm sterile saline
- Until clear
- Ideally suction…
what should we change before closing if its a contaminated surgery?
gloves, instruments
should we administer antibiotic therapy for an exlap?
- Depends on:
– Underlying disease / surgical procedure – Duration of procedure
– Type of procedure
what type of surgical procedures do not warrant antibiotics?
- Surgeries <1.5–2hrs with no entry into a hollow viscus or contamination do not warrant prophylactic antibiotics
what do perioperative antibiotics entail?
- Perioperative means to start1⁄2 hour before cutting the skin and to stop once the procedure is finished
what type of antibiotics are usually used in antibiotic therapy for surgery? when do we administer it? when do we stop?
- Cefazolin (cefoxitin if lower jejunum or colon)
- First dose at induction (22mg/kg) &q90min during surgery
- Without contamination, stop antibiotics immediately post-op
how do we do a liver biopsy? where should we take it from and what techniques are available to use? should we use antbiotics?
- Edge of the most accessible lobe(s)
- Representative sample for focal lesion
- Guillotine/loop biopsy
- Skin punch biopsy
- Assistant or stay suture in stomach and laparotomy sponges cranial to liver (don’t forget to remove it)
- Cefazolin*
how do we perform a guillotine biopsy? what type of suture should we use and what is the technique?
- 3-0 or 2-0 PDS or Monocryl
- Single throw better than surgeon’s throw
- ~1 cm of tissue
- Crush through capsule and parenchyma – Crush all the way!
- 3 or 4 throws
- Leave a small stump (ischemic)
- Oozing vs hemorrhage (Gelfoam or suture)
when would we use a liver punch biopsy? how? what are the advantages and disadvantages? what type of tool should we use?
- Focal mass lesions of diaphragmatic surface
– More risky for visceral surface > bleeding - 4-6 mm Keyes punch biopsy
- Invade less than 50% thickness
- Pressure to control bleeding
- +/- Gelfoam
how to we isolate a region for gastric biopsy? what is a good region?
use laparotomy sponges
* Use stay sutures (include submucosa)
* Less vascular region b/w lesser & greater curvature
what is the technique we use to take a gastric biopsy?
- Stab & extend scissors ~2cm
- Ellipse/edge of cut surface – *full thickness
- 2-layer closure (simple continuous & Cushing or Lembert)
- No chromic gut
- No need to ligate / cauterize bleeders - they will stop when you suture
what is the technique for taking an intestinal biopsy?
- Isolate with moist laparotomy sponges
- Stop intestinal flow!
- Stab anti-mesenteric border with a blade
- Extend with Metzembaum scissors ~1cm
- Remove 2-3mm full thickness edge
- Do not cauterize or ligate bleeders
what is the purpose of a transverse closure for the intestine?
- Prevent luminal stricture if small lumen (pediatric patient, rabbit, ferret)
how do we close an intestinal biopsy? what suture material and size? what pattern?
Absorbable monofilament (3-0 or 4-0)
* No Chromic gut
* Single layer closure – simple interrupted (2-4 mm bites)
* Continuous pattern (Weisman 1999)
* Some mucosal eversion is normal
* Longitudinal vs transverse closure
what techniques can we use to take an intestinal biopsy?
punch or wedge
