Ex-Lap and Biopsy

Question 1

what is the best kind of gauze to use for a laparotomy

Answer 1

laparotomy sponge; may also be good to use sponges with radiomarking

Question 2

what is a key thing to do with every abdominal exploration

Answer 2

make a plan and stick to it -> examine organs in the same order every time and dont interrupt if you dont have to

Question 3

T/F if you are performing an ex-lap and see an abnormal finding, it is important to stop what you are doing and investigate that abnormality to ensure that you do not forget to go back to it

Answer 3

F; keep with your plan and do not interrupt unless you have to

Question 4

how do you protect the organs during abdominal exploration

Answer 4

cover with moist towels; try not to exteriorize unless you have to; prevent contact with the skin

Question 5

what are 6 things to look for on ex-lap

Answer 5

• position/torsion
• thickening/thinning
• masses/FB
• enlargement
• irregularity
• discoloration

Question 6

T/F free fluid in the abdomen is a normal finding on ex-lap except for in young animals

Answer 6

F; may see in very young animals but it should be clear

Question 6

what should you do if you see free fluid in the abdomen

Answer 6

take a sample, culture, cytology

Question 7

how does peritonitis look

Answer 7

inflammed, hyperemic, fibrinous intestines

Question 9

what should you do if you suspect peritonitis

Answer 9

take a sample and send it to lab

Question 10

where is a good place to start your explore

Answer 10

diaphragm and serosal surfaces

Question 11

how should you approach investigating the gall bladder

Answer 11

1) make sure biliary tree is normal
2) express gallbladder to confirm patency of bile duct

Question 12

T/F you should never make a hole in the omentum, even if you cant visualize the pancreas

Answer 12

F; it is ok to make a hole to ensure you can see both left and right limbs of the pancreas

Question 13

what is the name for an insulin-secreting tumor

Answer 13

insulinoma

Question 14

what might happen to the spleen after you handle it (or if the patient is shocky)

Answer 14

may get smaller

Question 15

while you evaluate the spleen you see small white spots that form a bit of a sheet in some areas…

what is this?

are you concerned?

Answer 15

siderotic plaques; normal (they are iron deposits from RBC recycling)

Question 16

what happens with a splenic torsion

Answer 16

veins collapse but arteries do not (thicker walled) -> blood keeps coming in -> get a ton of congestion

Question 17

T/F splenic torsion can be acute or chronic

Answer 17

T

Question 18

how can you tell the intestines from the ovarian horns

Answer 18

intestines are smoother and more vascular; will never see a bifurcation in intestines

Question 19

you do an ex-lap on a cat and the intestines are coiled up like an accordion… what do you expect is going on

Answer 19

linear foreign body

Question 20

mesenteric lymph nodes are _________ in __________ patients due to more _________ stimulation from the gut

Answer 20

bigger; younger; immune

Question 21

where does the colon usually run

Answer 21

from pubis to cecum

Question 22

what is the term for when the ileum and cecum are pushed into the colon

Answer 22

ileo-cecal intussusception

Question 23

use the ___________ to retract the intestines to the ______ and examine the right gutter

Answer 23

mesoduodenum; left

Question 24

use the _____________ to retract the intestines to the _______ and examine the left gutter

Answer 24

mesocolon; right

Question 25

what do we see in the "gutter"

Answer 25

kidney, adrenal, ureter, ovary/horn/testis

Question 26

basket using the ________ on LEFT

Answer 26

colon

Question 27

basket using the __________ on RIGHT

Answer 27

duodenum

Question 28

the adrenal glands sit ________ to the kidney

Answer 28

cranially

Question 29

what artery crosses the adrenal gland

Answer 29

phrenicoabdominal

Question 30

for a cystotomy you can cut what ligament if needed? what ligament should you not cut

Answer 30

ventral; lateral

Question 31

why shouldnt you cut the lateral ligament

Answer 31

it contains vessels, nerves and the ureters

Question 32

it is possible to see what kinds of lesions post bladder obstruction

Answer 32

ischemic

Question 33

what structure in the caudal aspect of the abdomen do you only evaluate if you suspect an issue

Answer 33

prostate

Question 34

what are some ways to limit tissue trauma during an ex-lap

Answer 34

1) keep organs moist 2) prevent contact with skin 3) use less traumatic instruments (ex. debakey) 4) use stay sutures (instead of holding with hands or forceps for long time)

Question 35

how do we lavage the abdomen

Answer 35

with warm sterile saline until clear and ideally using suction

Question 36

how many times do we lavage

Answer 36

1 time if nothing dirty happened 2+ if something dirty (also leave drain)

Question 37

you should begin with the _________ procedures and work your way to the ________

Answer 37

cleanest; dirtiest

Question 38

what is an important step before closing if you think you contaminated something

Answer 38

change gloves and instruments

Question 39

T/F you should always biopsy something during ex-lap, even if it was a negative explore

Answer 39

T

Question 40

what does the decision to give antibiotic therapy depend on

Answer 40

- underlying disease - duration of procedure - type of procedure

Question 41

in general, give _______________ as antibiotic therapy and give ___________ if lower jejunum or colon

Answer 41

cefazolin; cefoxitin

Question 42

how do you give perioperative antibiotics (what time interval and what dose)

Answer 42

- first dose at induction: 22 mg/kg - q90 min for duration of surgery - stop immediately post-op, unless contamination

Question 43

what antibiotic do we give patients that we do a liver biopsy on

Answer 43

cefazolin

Question 44

what two ways do we do a liver biopsy

Answer 44

- guillotine if on edge of liver lobe - skin punch if not on edge

Question 45

how do you keep things out of the way while doing liver biopsy

Answer 45

assistant or stay sutures in the stomach and lap sponges cranial to liver

Question 46

what size and type of suture should you use for a guillotine biopsy

Answer 46

3-0 or 2-0 PDS or Monocryl

Question 47

how many throws for a guillotine biopsy

Answer 47

3 or 4

Question 48

T/F you can expect some mild oozing when you do a guillotine biopsy

Answer 48

T

Question 49

what type of suture pattern do you use for a wedge liver biopsy

Answer 49

transfixing/mattress/simple interrupted

Question 50

when would a punch biopsy of the liver be good and when would it be bad

Answer 50

focal mass on the diaphragmatic surface; less good for visceral surface

Question 51

what size biopsy should you use for a liver punch and how deep should you go

Answer 51

4-6mm; <50% thickness

Question 52

what is useful to control bleeding for a liver punch biopsy

Answer 52

gelfoam

Question 53

how many gelfoam plugs should you apply for a liver punch biopsy

Answer 53

1-3

Question 54

how do you set up for a gastric biopsy

Answer 54

1) isolate with moist lap sponges 2) stay sutures (being sure to include submucosa) 3) aim for less vascular region between greater and lesser curvatures

Question 55

what are the inverting suture patterns

Answer 55

Cushing and Lembert

Question 56

what suture would you NOT use for a gastric biopsy

Answer 56

chromic gut or monocryl

Question 57

T/F it is important to ligate or cauterize bleeders when doing a gastric biopsy as they will bleed profusely if you do not

Answer 57

F; they will collapse when you suture

Question 58

what size suture should you use for a gastric biopsy

Answer 58

3-0 or 2-0

Question 59

how do you cut and close a gastric biopsy

Answer 59

stab and extend scissors approx 2 cm; do elipse of full-thickness bites close in 2 layers (simple continuous for inner and inverting for outer)

Question 60

what will want to fall off when doing a gastric biopsy

Answer 60

mucosa

Question 61

what are the steps for performing an intestinal biopsy

Answer 61

1) isolate with moist lap sponges 2) stop intestinal flow with boyan clamp or fingers 3) stab antimesenteric border with blade 4) extend 1cm with metzembaum 5) take 2-3mm edge full thickness

Question 62

how can we close the intestines in a way that prevents luminal structure in the cases of a small intestinal lumen? what is a consequence?

Answer 62

transverse closure; increased risk of leaks so only use when needed

Question 63

T/F you can do a punch biopsy of the intestines

Answer 63

T

Question 64

how do we close the intestines after biopsy

Answer 64

- single layer closure using absorbable monofilament size 3-0 or 4-0 - no monocryl or chromic gut - single layer closure using simple interrupted or continuous - can be longitudinal or transverse - omentalize and do leak test

Question 65

what are the 3 methods to do a lymph node biopsy and which is best

Answer 65

wedge, guillotine or whole node resection; guillotine is best

Question 66

what size suture do you use for guillotine biopsy on a lymph node

Answer 66

3-0 or 4-0

Question 67

what should you beware of if you are going to do a whole node resection

Answer 67

mesenteric root vasculature

Question 68

what 3 things should you do before closing the abdomen

Answer 68

1) return all organs to anatomic location 2) ensure mesenteric root not twisted 3) ask for used gauze count

Question 69

in what direction should you suture if you are right handed

Answer 69

R -> L

Question 70

what is a good option for suture type and pattern for closing the linea

Answer 70

3-0, 2-0 or 0 PDS -> simple continuous (or interrupted while learning)

Question 71

what should you include in every bite of the linea

Answer 71

external rectus fascia

Question 72

what is an ideal suture type and pattern for sub-cutaneous

Answer 72

monocryl; simple continuous

Question 73

what is an ideal suture type and pattern for skin

Answer 73

4-0 or 3-0 nylon or prolene; simple interrupted or cruciate; can also use staples