Exploratory and rumen surgery, abomasal diseases, abomasal surgery

Question 1

What are the blocks for paralumbar fossa analgesia?

Answer 1

Line block (local)
Inverted L
Proximal/Distal lumbar paravertebral
Caudal epidural

Question 2

Local analgesia blocks _____ whereas regional analgesia blocks _______.

Answer 2

Local–infiltration of local analgesic

Regional–desensitization by blocking major nerves

Question 3

Why is regional analgesia preferred over local?

Answer 3

Better incisional healing.

Question 4

What nerves do you block with proximal intervertebral?

Answer 4

T13, L1, L2

Question 5

What is the landmark for proximal intervertebral block?

Answer 5

Foramen located immediately caudal to corresponding vertebra. ID cranial edge of transverse process, then ID point 1.5-2 inches off midline (this is where you block).

Question 6

What is the landmark for distal paravertebral block?

Answer 6

Distal extremity of transverse processes of L1, L2, L4

Question 7

Where do you inject block for distal paravertebral?

Answer 7

Ventral and dorsal to transverse process, have to block ventral and dorsal rami.

Question 8

When do you use a standing approach for an exploratory laparotomy?

Answer 8

Minimal intra-abdominal pressure

Question 9

When do you use a left flank approach?

Answer 9

problem suspected on the left side (rumen)

Question 10

When do you use a right flank approach?

Answer 10

problem suspected on right side (intestinal, liver)

Question 11

Sleeve goes on the ____ arm for a right flank approach and the ____ arm for a left flank approach.

Answer 11

Left arm–right flank

Right arm–left flank

Question 12

When in the abdomen, what is an indicator that there is no torsion/volvulus?

Answer 12

Find omasum and should palpate vessel on top, this is indicator.

Question 13

What structure is “home base” when in the abdomen?

Answer 13

left kidney

Question 14

Where do you make your incision for exploratory?

Answer 14

Hands width below transverse process and hands width behind last rib

Question 15

What are the layers that you cut through when making an incision for exploratory?

Answer 15

1. external abdominal oblique (thickest)–fibers run caudal ventral
2. internal abdominal oblique–fibers run cranial ventral
3. transverse abdominus (thinnest)–fibers run straight up and down
4. peritoneum

Question 16

Air should move ____ abdominal cavity upon incision.

Answer 16

INTO, if air comes out suspect rupture

Question 17

What structures should you be conscious of when cutting through peritoneum?

Answer 17

Rumen or LDA in left flank approach.

Duodenum, RDA, abomasal volvulus (AV) in right flank approach.

Question 18

What is the most common indication for a rumenotomy?

Answer 18

Hardware disease

Question 19

What should be done during a rumenotomy to prevent contamination of abdomen?

Answer 19

Anchor rumen to incision, creates a seal.

Question 20

What order should you place suture when anchoring the rumen during a rumenotomy?

Answer 20

External skin
Seromuscular layer of rumen
External skin
Seromuscular layer of rumen

Question 21

What are your options for suture patterns for rumen closure?

Answer 21

Double layer inverting continuous pattern
Cushings
Guard rumen stitch works best

Question 22

What steps are taken when closing a rumenotomy incision?

Answer 22

1. rumen closure
2. lavage serosa of rumen prior to removing stay sutures
3. routine closure of fossa incision

Question 23

What are indications for a rumenostomy?

Answer 23

chronic rumen tympany, enteral nutrition

Question 24

What are the reasons for a permanent rumen fistula?

Answer 24

research, large commercial farms (transfaunation)

Question 25

What is important in pathophysiology of abomasal displacement?

Answer 25

Atony, displacement occurs as a result

Question 26

What species is abomasal dispalcement most common in?

Answer 26

dairy, usually older female Holsteins

Question 27

Is LDA or RDA more common?

Answer 27

LDA

Question 28

What will you find on an exam of a cow with DA?

Answer 28

Ping in location of displacement

Question 29

What is the clinical pathology of a DA?

Answer 29

``` hypokalemia hypochloremia metabolic alkalosis ketosis hypoglycemia hypocalcemia ```

Question 30

What is different about clin path of an AV?

Answer 30

hemoconcentration, hyponatremia

Question 31

What causes atony of the abomasum?

Answer 31

high VFA concentration, concurrent diseases

Question 32

Is it okay to wait till tomorrow to treat an RDA?

Answer 32

NO! Never sleep on an RDA, can easily turn into an AV.

Question 33

What is a nonsurgical procedure to treat a DA?

Answer 33

cast and roll

Question 34

What are differentials for a left sided ping?

Answer 34

LDA Rumen void Pneumoperitoneum or rumen tympany

Question 35

What are the two right sided, off-feed pings?

Answer 35

proximal colon distention (spiral colon gas) | Duodendal gas

Question 36

What factors predispose cattle to abomasal ulcers?

Answer 36

Stress and high concentrate feeds

Question 37

What are the two categories of abomasal ulcers?

Answer 37

Perforating | Non-perforating

Question 38

What signs do you see with a Type 1 ulcer? What signalment?

Answer 38

mild anemia, dark soft feces | early post-partum period in dairy cows, calves under stress

Question 39

What signs do you see with a Type 2 ulcer?

Answer 39

melena, anemia, depression, acute death

Question 40

What other disease are Type 3 ulcers associated with?

Answer 40

Lymphosarcoma

Question 41

What signs do you see with a Type 3nulcer? What signalment?

Answer 41

Anemia, melena, enlarged LN or evidence of LSA, grave prognosis BLV-positive cows

Question 42

What signs do you see with a Type 4 ulcer?

Answer 42

Perforation with localized peritonitis, signs similar to hardware disease

Question 43

Where in the abomasum are Type 4 ulcers typically found?

Answer 43

LESSER curvature

Question 44

What signs do you see with a Type 5 ulcer? What signalment?

Answer 44

Perforation with diffuse peritonitis, severe systemic disease, signs look like shock

Question 45

Where in the abomasum are Type 5 ulcers usually found?

Answer 45

GREATER curvature

Question 46

What type of abomasal ulcer may require surgical repair?

Answer 46

Type 4

Question 47

Abomasitis is caused by what organism?

Answer 47

Clostridium perfringens type A

Question 48

What happens as a result of abomasitis? What is the signalment?

Answer 48

profound endotoxemia leads to death | young neonatal calves, usually dairy <21 days old

Question 49

How does abomasitis present?

Answer 49

rumen/abomasal tympany abomastitis abomasal ulceration

Question 50

What is the better approach for surgical repair of an LDA?

Answer 50

standing restraint--left paralumbar fossa abomasopexy on left side

Question 51

What structures should you be conscious of when doing a RIGHT paralumbar omentopexy?

Answer 51

Duodenum, RDA, AV

Question 52

What are the goals of a right paralumbar fossa omentopexy?

Answer 52

LDA--move back on right side of ventral abdomen RDA/AV--lift dorsally and push cranially Incorporate omentum into first layer of closure of peritoneum and transversus abdominus.

Question 53

What are the advantages of doing a standing DA surgery?

Answer 53

Can do alone. Less possibility of cuasing abomasal dysfunction. Not necessary to have displacement upon presentation.

Question 54

What structures should you be conscious of when doing a LEFT paralumbar fossa abomasopexy?

Answer 54

rumen, LDA

Question 55

Which abomasopexy approach gives the most stable and exact fixation?

Answer 55

Right paramedian abomasopexy

Question 56

After doing a right paramedian abomasopexy, roll patient into ____ lateral recumbency, then what?

Answer 56

LEFT, then sternal

Question 57

What is the sequence of a "Roll and Toggle" procedure?

Answer 57

Animal in RIGHT lateral recumb, roll from to dorsal and ping cow, insert trocar into ping area. Place toggle, then repeat 8cm caudal to first trocar with second toggle. Tie toggles, then roll into LEFT lateral recumb.

Question 58

Roll and toggle is a ______ procedure.

Answer 58

BLIND

Question 59

It is necessary to have a _________ abomasum for roll and toggle.

Answer 59

Gas-filled

Question 60

Which techniques are good for a "floating" LDA?

Answer 60

Omentopexy, pyloro-omentopexy

Question 61

Which LDA surgery is best for a pregnant cow?

Answer 61

Left flank abomasopexy

Question 62

Which LDA surgery is best for young calves?

Answer 62

Right paramedian abomasopexy

Question 63

What kind of situation is abomasal volvulus?

Answer 63

SURGICAL EMERGENCY

Question 64

What procedure should you NOT do with an abomasal volvulus?

Answer 64

Roll and toggle

Question 65

What condition can lead to an abomasal volvulus?

Answer 65

RDA