ganjei

Question 1

Contaminated versus Dirty surgical wound

Answer 1

Contaminated: any traumatic wound without evidence of infection, a sx wound with gross spillage, a sx wound with major break in aseptic technique

Dirty: woundwith obvious infection, abscess, purulent discharge, necrotic tissue

Question 2

Major difference b/w clean and clean-contaminated wounds

Answer 2

Clean: no luminal structures entered (OVH, Neuter, ABD explore, liver biopsy, splenectomy, prophylactic gastropexy)

Clean-Contaminated: luminal structures entered in controlled manner (gastrotomy, gastrectomy, enterotomy, R&A, cystotomy)

Question 3

Ways to reduce risk of surgical site infection other than via ABX (4)

Answer 3

1. Aseptic technique
2. Decr. tissue resistance by supporting overall tissue health
3. Minimize sx time
4. Minimize anesthesia time

Halsted’s Principles: gentle tissue handling, preserve blood supply, control hemorrhage, eliminate dead space, appose tissue accurately, aseptic technique

Question 4

Perioperative versus Therapeutic antibiotic use

Answer 4

Perioperative: administration of ABX prior to sx or during sx to prevent infection: start 30-60mins prior and stop within 24h post op

Therapeutic: administration of **full course ** of ABX for an active infection (e.g., pt with UTI who is undergoing cystotomy sx –> receiving abx prior, during and post op, 1 week)

Question 5

Boundaries of abdominal wall (during laparotomy)

Answer 5

Dorsally: quadtratus lumborum
Ventrally: rectus abdominus
Laterally: EAO, IAO, transverse abdominus

Question 6

What artery must be ligated in male dog in ventral midline laparotomy?

Answer 6

Preputial branch of the caudal SF epigastric artery

Question 7

Technique to avoid inadvertent organ damage when incising abdominal body wall on midline

Answer 7

1. tent body wall
2. “reverse press cut”
3. blade directed upside down & horizontal

Question 8

Closure of abdominal wall inbolves what suture type?

Answer 8

Monofilament (e.g., PDS) + taper needle

Question 9

What is the most critical layer to engage for abd wall closure?

Answer 9

linea alba (suture should engage ≥5mm of fascia)

Question 10

Approach for abdominal exploratory sx in bovines

Answer 10

Left or right paralumbar celiotomy

Question 11

Approach for abomasal displacement sx in bovines

Answer 11

Right paramedian celiotomy

Question 12

Which 3 nerves must be blocked to access the paralumbar fossa in ruminant abd sx? What are 2 methodfs of doing so?

Answer 12

T13, L1 & L2 nerves - blocked w/ lidocaine

1. Distal paravertebral block (above & below TPs of L1, L2, & L4)
2. Inverted L (left side) or 7 (right side) - just caudal to last rib under TPs

Question 13

What is the most anchored region in stomach?

Answer 13

Cardiac region

Question 14

What region of stomach suffers most vascular compromise in GDV?

Answer 14

cardiac/fundic region

Question 15

Holding layer of the stomach

Answer 15

Submucosa layer

Layer with the most collagen to hold suture during healing period

Question 16

Methods for atraumatic handling in gastrotomy

Answer 16

• stay sutures (3-0 & clamp w/ hemostats)
• specialized forceps (Babcock)

Question 17

Most common pattern in gastrotomy closure

Answer 17

Double Layer (where 2nd layer is inverting)
- appositional -> inverting
- inverting -> inverting
- appositional (mucosal engaged) -> inverting (outer 3 layers engaged)

Question 18

Describe technique when incising into stomach during a gastrotomy

Answer 18

1. “Press-cut” (stab incision) w/ blade in pencil grip
2. Then, extend incision with Metzenbaum scissors

Question 19

What is the favored type of gastropexy? What type should be avoided?

Answer 19

Favored = Incisional

Avoid! = Incorporating

Question 20

Where are the 2 incisions in incisional gastropexy made?

Answer 20

1. pyloric antrum area (or perpendicular to long axis of stomach)
2. thru peritoneum & transverse abdominus on V-L right abd wall, caudal to last rib

Question 21

Rectal prolapse versus colonic intussusception

Answer 21

Rectal prolapse: when rectum protrudes thru anus, leading to edema & congestion –> probe will hit a wall when passing through

Colonic Intussusception: probe will be able to pass through all the way

Question 22

How is rectal prolapse treated? Risks of each?

1. Viable & reduceable
2. Non-viable
3. Viable but non-reduceable
4. Recurrent despsite tx

Answer 22

1. Viable & reduceable = reduction + purse string –> PRONE TO RECURRENCE
2. Non-viable = R&A –> recurrence & stricture in cats!!
3. Viable but non-reduceable = Colopexy or R&A –> do NOT penetrate the colonic mucosa!!!
4. Recurrent despsite tx = consider colopexy -> recurrence & tenesmus common

Question 23

What rectal prolapse technique should be avoided in cats?

Answer 23

R&A due to high risk of stricture formation

Question 24

Perineal Hernia
- signalment
- pathogenesis

Answer 24

signalment = Older, intact male dogs

pathogenesis = weakened pelvic diaphragm –> rectum & abd organ herniation, +/- fecal obstruction. Assumed hormonal effect (testosterone).

Question 25

What tumor commonly arises from the circumanal glands?

Answer 25

SF, benign tumors - Perianal Adenomas

Question 26

What tumor commonly arises from the glands of the anal sacs?

Answer 26

Deeper, malignant timors (Anal Sac Adenocarcinoma - AGASACA)

Question 26

Where does AGASACA commonly metastasize to?

Answer 26

the lungs & lymph nodes

Question 27

Anal Sac Impaction versus Anal Sacculitis

Answer 27

Anal Sac Impaction: no inflammation, large, non-painful anal sacs. Tx = expression

Anal Sacculitis: PAINFUL anal sacs + inflammation –> more severe form = anal sac abscess. Tx = flush or anal sacculectomy for recurrent/persistent cases