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Laparotomy/Celiotomy Flashcards

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1
Q

Exploratory laparotomy/celiotomy indications

A
  • Exploration (diagnostic), surgical correction, or procedural (e.g. C-section)
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2
Q

Standard approaches for exploratory laparotomy/celiotomy

A
  • Paralumbar fossa
  • Midline
  • Paracostal
  • Alternative approaches
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3
Q

How tightly should you suture up a cow for surgery?

A
  • VERY TIGHT

- You do not want it to be loose

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4
Q

Casting cows

A
  • can do with a double half hitch
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5
Q

Typical recumbency for sheep abdominal surgery

A
  • Dorsal recumbency
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6
Q

Left paralumbar fossa approach indications

A
  • Left side general exploration
  • Traumatic reticuloperitonitis
  • Vagal indigestion, rumenotomy
  • LDA via abomasopexy
  • Cesarean section
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7
Q

Right paralumbar fossa approach indications

A
  • SI and LI access
  • Correct LDA by omentopexy
  • Correct RDA/abomasal volvulus
  • Cesarean section
  • Nephrectomy
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8
Q

Right paramedian approach

A
  • correct LDA, RDA, RAV
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9
Q

Right paracostal approach

A
  • Pyloric or abomasal visualization
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10
Q

Ventral midline approach

A
  • Cesarean section

- Alternate approach for hardware lesion or reticular abscess

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11
Q

Ventrolateral approach indications

A
  • Cesarian section for emphysematous fetus

- Repair of postpartum uterine tear

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12
Q

Why does Dr. Barrington prefer the left sided approach for C-section?

A
  • No need to go in on any side other than the left side on a bovine
  • if you go in on the right side, things can follow them
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13
Q

Landmarks for incision for Paralumbar approach

A
  • Midway between 13th rib and tuber coxae
  • Can go vertically or obliquely depending on anatomy
  • Start about 2” below the transverse processes
  • Extend incision about 5-6” vertically through skin and cutaneous trunci
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14
Q

General paralumbar fossa approach restraint

A
  • Chute or stocks
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15
Q

General paralumbar approach preparation of surgical area

A
  • Clip with 40 blade

- Surgical scrub and final surgical prep

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16
Q

Paravertebral block - what nerves are you blocking?

A
  • Dorsal and ventral branches of spinal nerves from T13, L1, L2
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17
Q

What are advantages of the paravertebral block vs an inverted L or line block?***

A
  • (Distal) paravertebral block you can block the peritoneum
  • Line blocks it is almost impossible to block the peritoneum
  • Also you have less lidocaine in your incision
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18
Q

Where do you block T13, L1, and L2 for the distal paravertebral block?

A
  • T13: Transverse process of L1
  • L1: Transverse process of L2
  • L2: Transverse process of L4
  • Palpate the transverse process and put a needle above and below
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19
Q

C-section overview

A
  • If you’re reaching in and finding the greater curvature of the horn of the uterus but cannot pick up the calf
  • Would have to make an incision in the uterus
  • You can use a letter opener with a guarded blade to put through
  • You will spill amniotic fluid into the abdomen, which isn’t that much of a problem
  • Want to make you incision at the end of the uterine horn and on the greater curvature of the horn, somewhere down towards the end of the horn
  • Difference between right horn and left horn presentation
  • Want to get the chain around the back legs
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20
Q

Post-op risks after C-section

A
  • LDA in the first week
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21
Q

Uterine closure and placenta exposure

A
  • You do not want any placenta protruding - has t obe a perfect closure
  • Uterus wall will contract quickly, and the placenta will come out and lead to peritonitis
  • Either do one perfect incision or do two oversewn.
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22
Q

General approach to paralumbar fossa approach

A
  • Skin incision
  • Muscles incision (grid or not)
  • Abdominal visualization on left or right side
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23
Q

Which muscles do you encounter when doing a paralumbar fossa approach?

A
  • Cutaneous trunci
  • External abdominal oblique
  • Internal abdominal oblique
  • Transverse abdominus
  • Peritoneum
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24
Q

Gridding vs sharp dissection for paralumbar fossa approach

A
  • Surgeon’s choice
  • He likes to do a sharp dissection through the skin and the external abdominal oblique (both have a sheath that can be sewn back together)
  • Internal abdominal oblique and transverse abdominus don’t have a sheath, so he pokes a hole all the way through the muscle belly and widens it
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25
Viscera on the left side
- Rumen - Spleen - Bladder (very caudal)
26
Viscera on the right side
- Descending duodenum - Omentum - Right kidney - Cecum - Spiral colon (difficult to access) - Jejunum and ileum - Abomasum - Omasum - Liver
27
Exploration of the abdominal cavity in a standing paralumbar fossa approach
- Know that there are certain things that can't be exteriorized and things that cannot be palpated - Most of the jejunum can be exteriorized - Ascending duodenum you can't really pull out
28
What are the three T's of successful surgery?
- Time - Trash - Trauma
29
Closure suture type for paralumbar fossa approach?
- Catgut or Braunamid 0 to #3
30
Layers for Paralumbar fossa approach closure
- Simple continuous pattern for non-skin layers generally - Usually three deep layers closed (transverse abdominus and peritoneum, internal oblique, external oblique) - Skin (ford interlocking pattern; terminal simple interrupted suture)
31
LDA overview
- Usually to the right of midline - Propagated by shifts in abdominal content - Comes up on the left - Less likely to twist on itself due to the way it is attached - Much more common
32
RDA overview
- Much less common - May result in an RDA and/or torsion of the abomasum (torsion would result in a twisting of the mesenteric root and vasculature) - Can lead to vascular impairment and poor prognosis
33
What ways do RAVs tend to twist?
- Right and to the rear - Counterclockwise from the right and the rear - Important so that you can untwist them the right way
34
What can you not pull out?
- Transverse colon | - Ascending duodenum
35
What else is important with a displaced abomasum surgery?
- Always perform a thorough exploration of the abdominal cavity as a high percentage of displacement have other or underlying pathology
36
Culling a DA
- Don't do anything - Don't make a lot of money and don't correct a lot of things - He does not suggest
37
Rolling
- LDA only - 50% success - risk of RDA or RAV - Doesn't work very long
38
Rolling with a toggle
- LDA only - 80% success rate with an experienced - Putting the trochar on the right side
39
Steps for roll and toggle
- +/- Tranquilize and sedate - Cast them onto the right side and roll onto back - Clip and scrub - Area of the loudest ping - 4-7 inches behind the xiphoid - Assistant places pressure on lower abdominal quadriant - Trocharize the abdomen 4-7 inches behind xiphoid and 3 inches right of midline - Remove handle and push rod from trochar - Place toggle suture and push through cannula, remove trochar - Trocharize 2nd site 2-3 inches proximally - Tie two toggle sutures ends together, leaving space between skin and the knots
40
Advantage of Roll & Toggle
- Simple, quick, inexpensive - Minimally invasive - High success rate (>60-80%) similar to surgery
41
Disadvantage of roll & toggle
- Blind technique - cannot see abomasum | - Dorsal recumbent position
42
2 step laparoscopy what procedures for?
- LDA | - You can do it standing or not
43
Right paramedian approach recumbency
- Dorsal recumbency
44
Advantage of right paramedian
- DA usually corrects itself while cow being placed
45
Disadvantage of right paramedian approach
- Getting cow into dorsal recumbency and a ventral surgical site - Okay if you have a crew
46
Preparation for right paramedian
- Sedate, table, or cast into dorsal recumbency | - Prepare right paramedian site
47
Anesthesia for right paramedian approach
- Anesthesia: line block, full thickness, lateral to incision
48
Entering the abdominal cavity from right paramedian approach
- Incise skin - Rectus sheaths and muscle belly - Want to make a big cut
49
Procedure for correcting LDA from right paramedian approach
- Explore abdomen, correct abomasal displacement if needed
50
Closure for right paramedian approach
- Abomasopexy (gastropexy) - abomasum to internal layers of body wall - Close rectus rectus abdominus sheaths - Skin closure
51
Where can you attach the abomasopexy/gastropexy?
- Attach to the transverse abdominus and peritoneum | - OR the internal rectus sheath
52
Left flank paralumbar fossa abomasopexy what for?
- For an LDA | - or C-section
53
Left flank paralumbar fossa approach recumbency
- standing
54
Do you always get direct visualization with the Left flank paralumbar fossa approach?
+/- - Can see the abomasum about 30%
55
Disadvantage of Left flank paralumbar fossa approach
- Pexy requires reaching under the ventral sac of the rumen to the right paramedian area (arm length) - Limited exploration
56
Description of Left flank paralumbar fossa approach
1. Standard left flank anesthesia and surgical approach 2. Limited exploration of abdomen 3. 4-6" continuous bites are placed in greater curvature of abomasum, 2-3" off greater omentum attachment (often blind). Make sure you leave long tails 4. Suture is placed to leave 1+ meter tails 5. Decompress the abomasum 6. Cranial end: ~10 cm caudal to xiphoid, right of midline (pass needle through body wall 7. Caudal end: ~10 cm caudal to cranial end 8. Surgeon pushes deflated abomasum ventrally as assistant pull sutures bringing abomasum to ventral abdominal wall 9. Sutures tied together externally, fixing abomasum in position
57
Post-op care for left flank abomasopexy
- Tie a knot and leave it there for two weeks
58
Advantages of left flank abomasopexy
- Abomasal adhesions are best broken down by this approach - can also address problems involving the rumen - Fewer people needed - Standing procedure
59
Left flank abomasopexy disadvantages
- Short people + big cow makes flank incision lower - Viscera puncture a risk - Exposure of abomasum sometimes difficult
60
Right flank/paralumbar fossa omentopexy what for?*
- LDA, RDA, RAV
61
Approach for right flank/paralumbar fossa omentopexy
- Standard abdominal approach | - Standing
62
Success rate of right flank/paralumbar fossa omentopexy
- Redisplacements are slightly more common with this approach - Omental stretching or tearing
63
LDA procedure for right flank/paralumbar fossa omentopexy
- Decompress with a needle attached to tubing (simplex) - Have to reach over the top of the rumen - Retract to the right side
64
RDA or RAV procedure for right flank/paralumbar fossa omentopexy
- Easy to find | - Decompress and replace to proper position
65
What appearance does the pylorus have?
- "Sow's ear"
66
Omentopexy in right flank/paralumbar fossa omentopexy
- Incorporate omentum adjacent to pylorus into closure of peritoneum and transverse abdominus - Pyloropexy done by some, but be careful
67
Closing right flank/paralumbar fossa omentopexy
- Tension suture to bring it together into the closure - Omentum into peritoneum - Close the internal abdominal oblique separately - Still a risk of RDA
68
Pre-op medications for LDA/RDA
- Flunixin meglumine | - +/- antibiotics
69
Post-op medications for LDA/RDA
- Drench with electrolytes (post) - Support rumen - get cow back on feed - Monitor site - Observe drug withdrawal

Large Animal Surgery (7 decks)

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