Exam 3: Lecture 22 - Principles of LA soft tissue sx

Question 1

How is handling large animal tissue different from small animal

Answer 1

thicker skin, skin does not bruise, and hemorrhage is generally not a problem

Question 2

what are the 3 ways to reduce trauma in LA tissue handling

Answer 2

1. fingers
2. stay sutures
3. atraumatic forceps

Question 3

What happens if a horse loses <15% of their blood volume

Answer 3

no clinical signs, acceptable amount during surgery

Question 4

What happens if a horse loses 15-20% of their blood volume

Answer 4

there are clinical signs

Question 5

What happens if a horse loses >40% of their blood volume

Answer 5

there is significant risk of death

Question 6

what are the benefits of having a horse stand for surgery

Answer 6

1. prevents complications of being recumbent
2. prevents risk of recovering from anesthesia
3. better access for select structures
4. reduced cost

Question 7

what are the benefits of having a horse recumbent for surgery

Answer 7

1. safer for the surgeon
2. no movement - better control of surgical field
3. better access to MOST structures

Question 8

what is this structure?

Answer 8

Epiglottis

Question 9

Why do we do upper respiratory tract endoscopy

Answer 9

primarily for diagnostic purposes

Question 10

what are the 3 ways you can perform an upper respiratory endoscopy

Answer 10

1. not sedated at rest
2. treadmill
3. under saddle

Question 11

what is the most common way to access/visualize the arytenoids

Answer 11

laryngotomy

Question 12

what is a secondary way we can access the arytenoids

Answer 12

pharyngotomy

Question 13

what type of retractors are these (self retaining or hand held)

Answer 13

self retaining

Question 14

what type of retractors are these

Answer 14

handheld

Question 15

what are the considerations for healing when doing upper airway surgery in LA

Answer 15

mucosa heals rapidly but there is usually a lot of swelling and the potential need for a tracheotomy for relief

there is also potential for mucosal “webbing” which requires later revision

Question 16

what are the common complications of upper respiratory surgery

Answer 16

1. excessive swelling - blocks airway
2. damage to nearby structures
3. surgeries that are re-opening airway
4. surgical site infection

Question 17

What is the most serious complication of URT surgery

Answer 17

excessive swelling

Question 18

how do we correct excessive swelling in URT surgery

Answer 18

post-op tracheotomy if needed

Question 19

what organ is nicknamed “sparky”

Answer 19

cecum

Question 20

what are the problems with diagnostics of GI issues in the horse

Answer 20

it is limited due to the size of abdomen and length of GIT

Question 21

How can we diagnose issues in the GIT

Answer 21

1. gastroscopy
2. rectal palpation
3. abdominal ultrasound
4. abdominal radiographs
5. nasogastric tube intubation
6. abdominocentesis
7. bloodwork

Question 22

what are the things we usually do for a colic workup

Answer 22

1. rectal palpation
2. abdominal ultrasound
3. abdominal radiographs
4. nasogastric tube intubation
5. abdominocentesis
6. bloodwork

Question 23

what are the approaches for a celiotomy

Answer 23

ventral midline - most common
paramedian - right side
paralumbar fossa - uncommon
laparoscopic portals

Question 24

what is the most common surgery in LA

Answer 24

exploratory laparotomy (colic sx)

Question 25

what are the surgical considerations for colic sx

Answer 25

clean if bowel is unopened and clean-contaminated if the bowel is open (but game over if ingesta enters abdomen because theres nothing we can do to prevent sepsis)

Question 26

what are the 5 steps to colic sx

Answer 26

1. exploration 2. de-rotation 3. enterotomy 4. resection and anastomosis 5. biopsy

Question 27

what are some considerations for healing with abdominal sx in LA

Answer 27

serosa can have problems and do not EVER use dry gauze

Question 28

what are the 7 complications of abdominal sx in LA

Answer 28

1. adhesions 2. hemoabdomen 3. peritonitis 4. ileus 5. diarrhea 6. endotoxemia 7. incisional infection

Question 29

what is a MAJOR post-operative issue of colic surgery that can lead to death

Answer 29

intra-abdominal adhesions

Question 30

what are the ways to reduce adhesions

Answer 30

1. gentle handling of the tissues 2. keep tissues moist 3. use of lubricants 4. strict asepsis 5. prevent blood from entering the abdomen

Question 31

what are the diagnostics we can use for surgical urogenital tract

Answer 31

palpation, ultrasound, or endoscopy

Question 32

what are common urogenital tract procedures for males

Answer 32

1. castration 2. cryptorchid castration 3. urolithiasis 4. penile injuries and problems 5. preputial injuries and problems 6. inguinal hernia

Question 33

what are common urogenital tract procedures for females

Answer 33

1. repair foaling injuries 2. correct vaginal conformation 3. ovariectomy

Question 34

what are common urogenital tract procedures for foals

Answer 34

bladder rupture

Question 35

what are the 3 approaches for cryptorchid surgery

Answer 35

inguinal, parainguinal, and laparoscopic

Question 36

what are the approaches for male urogenital surgery (for non cryptorchid)

Answer 36

perineum and penis

Question 37

what are the approaches for female urogenital tract surgery

Answer 37

via the back end with standing sedation and epidural

Question 38

what are the 4 approaches for ovariectomy in mares

Answer 38

1. laparoscopy 2. flank 3. vagina 4. ventral midline celiotomy

Question 39

what are some surgical considerations for urogenital tract surgery

Answer 39

1. may need to catheterize bladder 2. function is an important outcome 3. approaches can be challenging (small spaces and bladder is difficult to access in adult horse)

Question 40

what are some considerations for healing with urogenital tract surgery

Answer 40

1. healing can be a challenge (stricture formation and breakdown of repair) 2. back end of the mare has a lot of contamination (repair breakdown is common) 3. give distal urethra a rest (create a perineal urethrostomy)

Question 41

what are the most common complications of urogenital tract surgery

Answer 41

1. bleeding 2. loss of function 3. breakdown of repair 4. stricture 5. infection

Question 42

what are the principles of laparoscopy in equine medicine

Answer 42

1. abdomen is insufflated with CO2 2. blind stab incision is made to place scope portal 3. scope is introduced through portal that maintains pressure in abdomen 4. remaining portals are created with visualization from the scope

Question 43

what 3 instruments do you usually need for laparoscopy

Answer 43

1 scope and 2 instrument portals

Question 44

what are the common uses for equine laparoscopy

Answer 44

1. cryptorchidectomy 2. ovariectomy 3. explore abdomen in chronic cases

Question 45

what type of cryptorchidectomy is this picture showing

Answer 45

intra-abdominal testis

Question 46

what type of cryptorchidectomy is this picture showing

Answer 46

gubernaculum but no cord

Question 47

what type of cryptorchidectomy is this picture showing

Answer 47

It is the cord exiting normally through the internal ring...... not cryptorchidectomy

Question 48

what are the 3 main preoperative considerations

Answer 48

1. withhold feed 2. NSAIDs 3. Antibiotics

Question 49

why do we withhold feed

Answer 49

1. space in abdomen 2. less weight on diaphragm if in trendelenburg position 3. increase time withheld for dorsal recumbency

Question 50

what are some general complications for equine sx

Answer 50

1. subcutaneous emphysema 2. retroperitoneal insufflation 3. bowel perforation 4. hemorrhage