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Large Animal Surgery > Exam 3 > Flashcards

Exam 3 Flashcards

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1
Q

Guttural Pouch Tympany; Signalment, Causes, Clinical Signs, Diagnosis

A

Signalment
 Foals
 Fillies>Colts

Causes
 Idiopathic
 Upper airway infection
 Persistent coughing
 Muscle dysfunction

Clinical Signs
 Air swelling of parotid region
 Unilateral > Bilateral
 Respiratory noise
 Nasal discharge
 Dyspnea, pneumonia, dysphagia

Diagnosis
 Endoscopy
 Rads
 Needle decompression

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2
Q

Guttural Pouch Tympany; Treatment

A

Surgical septum fenestration
* Makes 2 pouches into 1

AND

Surgical resection of inner mucosal flap of guttural pouch opening
* Gets rid of 1-way valve so that things can come in and out

Transendoscopic laser
* may cut more than you want
* less favored

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3
Q

What’s Included in Viborg’s Triangle

A

 angle of mandible
 linguofacial vein
 tendon of the sternocephalicus

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4
Q

What do urachus, umbilical arteries, & umbilical vein develop into?

A

Urachus
 Middle ligament of bladder

Umbillical Arteries
 Round ligaments of bladder

Umbilical Vein
 Falciform/round ligament of liver

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5
Q

Patent Urachus Vs infected Umbilical Remnants

A

Patent Urachus
 Leaking urine at <2wks

Infected
 Leaking urine at 2-4wks
 Warm, painful swelling
 Sepsis, pneumonia, septic joints, Ds
 Heat & pitting edema = surgical emergency

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6
Q

Infected Umbilical Remnants; diagnosis, Surgical Options

A

Diagnosis
 Ultrasound
 Vein >1cm
 Artery >1.3cm
 All > 2.5cm

Surgical Options
 Resection of umbilical portion
 Marsupialization of hepatic portion
 Inform owners of possible hernia

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7
Q

Uroperitoneum; Timing & Most Likely Cause

A

Ruptured bladder
* 3-4d

Urachal perforation
* 1-2wks

Ureteral defects
* 3-4d

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8
Q

Uroperitoneum; Signalment, Clinical Signs, Diagnosis, Presurgical Management

A

Signalment
 Foals
 Males>Females

Clinical Signs
 Straining
 Depression
 Fluid in abdomen, scrotum, thorax

Diagnosis
 Abdominocentesis
 >2:1 peritoneal creatinine:serum ratio
 Ultrasound
 Contrast rads
 Hyponatremia, hypochloremia, HYPERKALEMIA

Pre-surgical Management
 Slow peritoneal drainage
 IV NaCl
 Dextrose or insulin to reduce K below 6meq/l

Surgery
 Appositional
 Followed by inverting

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9
Q

Umbilical Hernia; Treatment

A

Treatment
 Herniorrhaphy
 Hernia clamp
 Elastrator bands
 Irritant injection
 Benign neglect

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10
Q

Strangulated Umbilical Hernias; Basics, Clinical Signs

A

 Omentum, jejunum, ileum, cecum, or ventral colon in hernial sack

Clinical Signs
* Firm warm hernial sac
* Edema
* Colic
* Richter’s hernia (intestine opens)
* Enterocutaneous fistula

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11
Q

Inguinal/Scrotal Hernias; Signalment, Types, Treatment, Herniorrhaphy

A

Signalment
 Males&raquo_space; females
 Standardbreds, draft horses, Tennesee Walkers, Saddlebreds

Types
 Indirect – thru vaginal ring most common
 Direct – thru rent near vaginal ring
 Ruptured – most challenging

Treatment
 Repeated manual reduction
 Inguinal herniorrhaphy
 Support bandage
 If you don’t do sx you must be cautious at castration

Inguinal herniorrhaphy
 Reduction and transfixation ligature
 Closure of external inguinal ring
 Tilt of operating table may ease repair

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12
Q

Foal Colic; Causes, Diagnosis

A

Causes
 Meconium impaction
 Small Intestine volvulus
 Gastroduodenal obstruction
 Ascarid impaction
 Sand impaction
 Congenital defects

Diagnosis
 Rads – plain & contrast
 abdominocentesis

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13
Q

Castration; When & What Position is Best

A

When
 Before weaning, ~4mo

How
 Dorsal recumbancy

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14
Q

Anatomy of the testicles & scrotum

A

o Go look at testical picture and review anatomy

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15
Q

Tools for Castration; What do these look like: Kocher Oschner, Serra Curved Handles, Reimer, Modified White Hausmann, Henderson Castrating Tool, Ferguson Angiotribe Forceps

A

Kocher Oschner
* Look like hemostats w/ rat teeth & alligator teeth

Serra Curved Handles
* Emasculator
* Curved handles
* 2 rounded grabbers

Reimer
* Emasculator
* 3 handles
* Several curved grabbers

Modified White Hausmann
* One strait grabber and one curved

Henderson castrating tool
* Attaches to power drill
* Twists testicle off

Ferguson Angiotribe Forceps
* Curved tip
* Looks like thinning shears

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16
Q

Ragle’s 13 Steps to Castration

A

 Wipe scrotal injection site w/ alcohol prior to surgical prep
 Inject each testicle until full w/ lidocaine
 Aseptic prep of sx site & surgeon
 2 parallel scrotal incisions 2cm from median raphe
 Incise into cranial portion of vaginal tunic of one testicle, place index finger into tunic & place kocher forceps firmly over tunic & tail of epididymis
 Apply firm tension to tunic/testicle & w/ the other hand strip away connective tissue & fat covering tunic & cremaster
 Divide cremaster from vaginal tunic & clamp w/ angiotribe & section w/ electrocautery
 Expose pedicle from inside tunic blunt puncture mesochorium to separate into vascular & non-vascular segments of pedicle
 Clamp & ligate vascular portion & section w/ electrocautery
 Replace ligated vascular portion inside tunic
 Clamp & ligate tunic & section w/ electrocautery
 Repeat steps 5-11 on remaining testicle
 SQ closure of scrotal incision and/or invert scrotum & glue

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17
Q

Castration AfterCare

A

 2hrs quiet
 Exercise 20 mins 2x per day for 2wks
 If doing Ragle method, no aftercare

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18
Q

Risks of Castrating NOT the Ragle Way

A

 Hemorrhage
 Scirrhous cord
 Eventration or evisceration
 No such thing as premature closure only excessive drainage

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19
Q

Preventing Hemorrhage After Castration, what to do if hemorrhage starts

A

 Make sure not stressed or high BP
 Ligate cord on mules, donkeys, mature stallions
 Crush cord for 6 mins prior to removal of emasculator on draft horses

If Hemorrhage begins
 Cross clamp cord for 24hr w/ R angle clamp
 Limit dissection w/in inguinal canal

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20
Q

Visceral Prolapse; Signalment, Prevention, Treatment

A

Signalment
* Draft horses
* Some Standardbred lines
* Gaited Horse-TW

Prevention
* Ligate cord excluding the cremaster muscle
* Ligate cord in all horses with predisposition to inguinal hernias and/or large vaginal rings and horses with history of inguinal swelling
* Close inguinal rings

Treatment
* Anesthetize horse, replace bowel and suture superficial ring and skin

OR
* Anesthetize horse, suture skin incision

OR
* Pack canal and close skin

OR
* Pack canal and wrap groin -> REFER

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21
Q

Cryptorchid; Types, Stats, Surgical Options

A

 Inguinal
OR
 Abdominal
* Testicle in abdomen & epidydimus outside
* Both testicle & epidydimus in abdomen

Stats
* Unilateral > bilateral
* L – usually abdominal
* R – usually inguinal
* Bilateral abdominal > bilateral inguinal

Options for Cryptorchidectomy
* Inguinal
* Parainguinal
* Flank
* Ventral midline
* Laparascopic standing flank or ventral umbilical

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22
Q

Why do Laparascopic Cryptorchidectomy

A
  • Allows thorough examination
  • Eliminates chance of evisceration
  • Earlier return to normal function
  • “Close all the holes”
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23
Q

Partial Phallectomy; Indications, William’s Technique

A

Indications
 Intractable paraphimosis
 Traumatic penile injury
 Squamous cell carcinoma

William’s Technique
 Need supreme hemostasis
 ID urethra w/ catheter ->
 Cut patch out of skin ->
 Dissect down into urethra ->
 Suture urethra to skin ->
 Remove end of penis

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24
Q

What is Preputial Resection for

A

o avoid penis amputation
o Remove lesion on penis

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25
Ovariectomy; Indications, Surgical Approaches
Indications  Neoplasia/Hematoma  Genetic control  Prevention of estrus Surgical Approaches  Colpotomy (ratchet/crushing ovary)  Paramedian Oblique/Flank/ Ventral Midline  Laparoscopy (recumbent)
26
Perineal Lacerations; Types, Repair
1st Degree  Skin + mucus membranes 2nd Degree  Skin + mucus membranes + constrictor vulvae muscle 3rd Degree  Complete disruption of perineal body Rectovaginal Fistula  Full thickness  Does not involve vulvar cleft Repair  Caudal epidural w/ xylazine & mepivacaine btwn 1st 2 coccygeal vertebrae  Rectal mucosa -> perineal body -> vaginal mucosa
27
Urine Pooling; Signalment, Options for Sx
Signalment  Skinny body condition (try top increase BW)  Cranioventral tipping of pelvis  Multiparous older females Options for Surgical Repair  Vaginoplasty for mild issue  Perineoplasty  Urethral extension (best)
28
Pneumovagina; what, Signalment, Sx
Involuntary aspiration of air into the vagina -> chronically distended vagina Signalment  COMMON in race horses  Usually seen in older, multiparous mares Surgical Repair  Vulvoplasty  reduction of the mucocutaneous junction of the vulva to prevent aspiration of air
29
Options for Surgical Removal of Uroliths
o Laparocystotomy o Perineal urethrostomy o Cystotomy (difficult) o Lithotripsy (best)
30
Causes for Pain in GI Tract
o Stretch o Ischemia o Inflammation
31
Indications for Surgical Treatment of Colic
o Acute, unrelenting pain, poor response to analgesics o Progressive abdominal distension o Silent abdomen o Continuous high volume gastric reflux, alkaline pH o HR > 60-80 bpm, or rising o Poor or deteriorating cardiovascular status o Peritoneal fluid with increased protein (>3.0 g/dL), blood-tinged
32
Abdominal Sx Approaches
o Ventral midline (most accessible) o Paramedian o Paramedian oblique o Flank o Inguinal
33
Land Marks for the Equine GI
Cecum  4 bands Ileum, Jejunum, Duodenum, Stomach  Dorsal band Colon  Lateral Band Dorsal band  ileocolic fold Duodenocolic Fold  Junction of jejunum & duodenum
34
Colonic Impactions; Causes, Signs, Treatment
o Cause  Coarse feed  Poor dentition  Abnormal motility  Decreased H2O intake Signs  intermittent colic that gradually worsens  Mild to moderate dehydration,  normal or elevated heart rate  Peritoneal fluid usually normal  Rectal palpation reveals mass or gas distension Treatment  Intravenous +/- oral fluids  Oral laxatives; mineral oil, DSS, magnesium sulfate, psyllium  Analgesics  Surgical intervention if necessary
35
Sand Colic; Causes, Signs, Treatment
Cause  Short pasture  Insufficient roughage  Sandy soil Signs  First Ds  Intermittent colic  “beach” sound on auscultation  Sand present in feces Treatment  mineral oil,  magnesium sulfate,  psyllium
36
Enteroliths; Causes, Signs, Treatment
Causes  precipitation of magnesium ammonium phosphate salts (struvite) around a nidus  more prevalent in Ca, In, Fl Signs  Intermittent colic  Gas distension of large colon on rectal exam Treatment  Removal through enterotomy  If you find a round one, probably only one  Triangles have many
37
Colon Tympany; Causes, Signs, Treatment
Causes  Fermentable feeds (carbs, alfalfa)  Hypocalcemia & hypokalemia  Atropine administration Signs  Increasing severity of pain  Gas distension on rectal exam  Circulatory shock may occur Treatment  Analgesics  Fluid therapy  Mineral oil to aid removal of fermented products  Decompression
38
Intramural Lesions; Causes, Signs, Treatment
Causes  Eosinophilic granulomas,  hematomas,  fibrotic plaques Signs  Functional obstruction  Impaction of feed  High cell & protein peritoneal fluid Treatment  MUST surgically remove impaction  Resection of affected intestine
39
Right Dorsal Displacement; What, Causes, Signs, Treatment
o Colon between cecum & R body wall Causes  Abnormal motility w/ gas distension  Large breed horses Signs  variable amounts of pain  Gastric reflux  Bands of large colon palpated in transverse orientation on rectal Treatment  Surgical correction through ventral midline celiotomy
40
Left Dorsal Displacement; Causes, Signs, Diagnosis, Treatment
Cause  Unknown Signs  variable amounts of pain  Gastric reflux Diagnosis  Rectal palpation of the entrapment  Ultrasound Treatment  Surgical correction via midline celiotomy  Surgical correction via flank laparotomy  Systematic rolling under general anesthesia  Phenylephrine
41
Displacement of the Pelvic Flexure &/or Left Colon; What, Signs, Treatment
o Cranial flexion of left colons, “gut tie”, o gastrosplenic entrapment, o diaphragmatic hernia Signs  variable amounts of pain  Metabolic compromise dependent on duration and degree of distension  Gas distension on rectal examination Treatment  Midline celiotomy
42
Colonic Torsion/Volvulus; Signalment, Signs, Treatment
o Often older brood mare post foaling Signs  acute onset of severe pain  Rapid deterioration of systemic signs  Gas distension on rectal exam  Normal or inflammatory peritoneal fluid changes Treatment  Surgery immediately  Volvulus at cecal base most common  Enterotomy aids with repositioning  Colon resection  Fluids, antimicrobials, antiendotoxemic therapy  Colopexy to avoid recurrence
43
Non-strangulating Infarction; Cause, Signalment, Signs, Treatment
Cause  Verminous arteritis Signalment  Young horses  Horse not on parasite control Signs  depression and variable amounts of pain  fever +/-  Inflammatory Peritoneal fluid  Endotoxemia if large or severe infarction  Cecum commonly affected Treatment  analgesics and fluid therapy  Surgery if clinical deterioration  Bowel resection may be required  Antimicrobials due to peritonitis
44
Intussusception; Cause, Signalment, Signs, Treatment
Cause  Altered peristalsis (often tapeworm) Signalment  Young horse Signs  acute onset of pain  Decreased borborygmi,  elevated HR,  dehydration  Gastric reflux  Distended loops of small intestine on rectal exam  Peritoneal fluid w/ elevated WBC and protein  Characteristic “doughnut” shape on ultrasound Treatment  Manual reduction if possible  Resection and anastamosis if necessary  jejunostomy or jejunocecostomy
45
Acquired Inguinal Hernia; Cause, Signalment, Signs, Treatment
Causes  strenuous exercise,  breeding,  trauma  Enlarged internal inguinal ring  Complication of castration Signalment  Standardbred,  American Saddlebred,  Tennessee Walking Horse stallions Signs  acute intestinal obstruction  Usually unilateral & indirect herniation  Firm, swollen testicle  Gastric reflux  distended SI, loop of SI into inguinal canal on rectal exam  Peritoneal fluid may be normal or elevated WBC and protein Treatment  emergency surgical correction  Inguinal & ventral midline incision  Incarcerated bowel reduced and resected if necessary  Remove affected testicle
46
Ileal Impaction; Cause, Signs, Treatment
Cause  vascular thrombotic disease  associated w/ coastal Bermuda hay  often in SE US Signs  mild to severe abdominal pain  Elevated HR  decreased borborygmi  dehydration  Gastric reflux  distended SI, palpable impaction on rectal exam  Peritoneal fluid normal or elevated protein Treatment  analgesics  IV fluids,  mineral oil  Surgical correction is usually required
47
Muscular Hypertophy of the Ileum; Cause, Signs, Treatment
Cause  Idiopathic  Secondary to strongyle larval migration Signs  Usually intermittent  distended SI on rectal exam  SI may be hypermotile Treatment  Ileal myotomy  Ileocecostomy
48
Proximal Enteritis; Signs, Treatment
o In the SE US Signs  mild to severe colic initially  Depression  blood-tinged gastric reflux  Febrile  inflammatory leukogram  mild to moderate distended SI on rectal  Peritoneal fluid elevated protein, normal WBC Treatment  Not surgical  Gastric decompression  IV fluids, analgesics  flunixin, penicillin, intestinal stimulants
49
Adhesions; Cause, Signs, Treatment
Cause  response to tissue anoxia/hypoxia, infection, foreign material Signs  variable amounts of pain  Gastric reflux  Distended SI on rectal exam  may have peritonitis  Can occur 1-2 weeks postoperatively Treatment  prevention is most important  Surgical adhesiolysis  Resection and anastamosis or bypass
50
Epiploic Foramen Herniation; Signs, Treatment
o L to R > R to L Signs  variable amounts of pain  Gastric reflux  Peritoneal fluid serosanguinous, elevated WBC & protein Treatment  surgical correction  Decompression & reduction if possible  Resection & anastamosis  Fatal rupture of CVC or portal vein can occur  Closure of epiploic foramen not possible
51
Mesenteric Defects; Cause, Signs, Treatment
Cause  Usually result of trauma Signs  acute and severe pain  Distended SI on rectal exam  Peritoneal fluid serosanguinous, elevated WBC and protein Treatment  Surgical reduction of hernia  Resection of involved bowel  Closure of mesenteric defects
52
Ascarid Impaction; Signs, Treatment
Signs  variable amounts of pain  Obstruction may be partial or complete  Gastric reflux w/ ascarids may be present Treatment  medical therapy if possible  Low efficacy anthelmintics - thiabendazole, fenbendazole  Intestinal lubricants and analgesics  Surgical correction via enterotomies
53
Small Intestinal Volvulus; Signs, Treatment
Signs  acute and severe pain  shock - elevated HR & CRT, weak pulse, injected mm, hemoconcentration  Gastric reflux  Distended loops of SI on rectal exam  Peritoneal fluid—serosanguinous, elevated WBC & protein Treatment  Surgical reduction of the volvulus  Resection & anastamosis if necessary  Euthanasia if 60% or greater devitalized
54
Pedunculated Lipomas; Signalment, Signs, Treatment
Signalment  Older horses Signs  acute and severe pain  Shock - elevated HR & CRT, weak pulse, injected mm, hemoconcentration  Gastric reflux  Distended SI, rarely feel lipoma on rectal exam  Peritoneal fluid—serosanguinous***, elevated WBC & protein Treatment  surgical correction  Sever avascular pedicle & remove lipoma  Resection & anastamosis of affected intestine
55
Pharyngeal Cysts; Locations, Signalment, Clinical Signs, Diagnosis
Locations  subepiglottic region,  dorsal pharyngeal wall  soft palate Signalment  Young thoroughbred & standardbred racehorses  Males > females Clinical Signs  result from distortion of the larynx and pharynx articulation  upper airway noise, cough, nasal discharge  exercise intolerance  dysphagia  aspiration pneumonia  dorsal displacement of soft palate Diagnosis  Endoscopic exam of the nasopharynx  +/- oral exam under general anesthesia  Contrast rads
56
Pharyngeal Cysts; Treatment
 Complete removal of the secretory lining of the cyst is necessary Surgical resection * ventral laryngotomy or pharyngotomy incision * preservation of the mucosa surrounding the cyst * may decrease scar formation and secondary epiglottic dysfunction Endoscopic-guided snare excision * difficult if a wide base attachment Laser ablation Intralesional formalin injection (new) * Minimally invasive, low-cost treatment * desiccation and coagulation of the tissue
57
Intermittent Dosally Displaced Soft Palate Treatment
 Tie forward
58
Left Laryngeal Hemiplegia; Signs, Reason, Treatment
Signs  Roaring (abnormal respiratory sounds)  Exercise intolerance Reason  Paralysis of left recurrent laryngeal nerve Treatment  Laryngoplasty – “tie back”  +/- ventriculocordectomy
59
Arytenoid Chondritis; What, Diagnosis, Treatment
o Progressive infection of the arytenoid cartilages o Often confused for left recurrent hemiplegia Diagnosis  Endoscopy  kissing lesions on opposite normal arytenoid  increased granulation tissue  lack of abduction Treatment  Arytenodectomy
60
Sinus Disease; Signs, Treatment
Signs  Odorous nasal discharge  Nose deformity  Air flow obstruction  Stertor / stridor  Draining tract Treatment  nasofrontal flap
61
Landmarks for Nasofrontal Flap
Caudal  btwn supraorbital foramen & medial canthus Rostral  cranial to infraorbital foramen & nasoincisive notch Lateral  medial to nasolacrimal duct  parallel & medial from medial canthus to nasoincisive notch

Large Animal Surgery (3 decks)

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