Principles of Abdominal Surgery Flashcards
(49 cards)
Steps for working up a case
A. Make a list of the problems you identified from the patient history and PE
B. Write a list of DDX (differential diagnoses) for each problem
C. Not DDX that are common among the problems and consider which DDX are most likely for your patient
D. Make a diagnostic plan to determine which diagnosis/es is/are correct
E. Add any abnormalities you find as a result of your diagnostic tests to your problem list and list the DDX for these new problems
F. Repeat diagnostics until you’ve made a diagnosis
Know the normal so you recognize the abnormal of the following
A. Anatomy B. Physiology C. PE D. TPR E. Blood pressure F. PCV, TP, glucose, BUN, lactate
Normal TPR for a cat
T: 100-102.5
HR: 140-220 BPM
RR: 20-30 BPM
Normal TPR for a dog
- HR: 60-160 BPM
- RR: 10-30 BPM
- 100-102.5
Normal Blood pressure
100-150 mm Hg
Normal PCV/TP/Glucose/BUN/Lactate
- Glucose: 80-120 mg/dL about
- PCV/TP (35-55/5.5-8)
- BUN (10-30)
- Lactate (<2.5)
What should you consider when asking yourself when surgery should be performed for a patient?
- If it would be best if done…
- By a certain time
- Before or after a certain age
- Before or after other diagnostics or treatments
- Is it an emergency
What do you need to have skills and resources for in order to perform a surgery?
- Do the surgery AND
- Handle potential intra-op complications AND
- Manage the patient post-op
What systems should you consider before surgery?
- Hydration
- Electrolytes
- Cardiovascular system
- Respiratory system
- Renal function
- Nutritional status
- Infection
What potential risks or complications are common to all procedures?
- Anesthesia
- Hemorrhage
- Infection of the incision
- Infection internally at the site of procedure
- Dehiscence of the abdominal incision
- Dehiscence of the procedure’s incision (e.g. enterotomy)
- Seroma
What else do you need to prepare for and counsel to the client about besides risks common to all procedures?
- Risks specific to that procedure
- Recurrence or failure to resolve the problem
When are therapeutic antibiotics started, and for how long are they continued?
- Started at the time of diagnosis and continued for a duration appropriate for that condition (days/weeks/months)
When are prophylactic antibiotics given and discontinued?
- 30 min pre-op and q90 min intra-op
- Stopped at the end of the procedure
What is a common choice for prophylactic antibiotics at WSU?
- Cefazolin or cefoxitin
What could be an exception to starting Abx pre-op?
- If one of the surgical goals is to get a sample for culture, abx may not be started until the sample is taken
- This decision is made on a case-by-case basis
What is an exploratory laparotomy or celiotomy?
- Incise into abdomen and examine contents
Why do an exploratory laparotomy or celiotomy?
- Diagnosis and/or treat
Who can do an exploratory laparotomy or celiotomy?
- General practitioners and surgeons
How do you do an exploratory laparotomy or celiotomy?
- Be systemic and thorough
- Visualize and palpate all structures
- Know what normal looks like
- Explore the sameway every time
What do you do if you don’t find significant findings on an exploratory celiotomy?
- Biopsy organs/tissues of interest before closing the abdomen
What are three principles to keep in mind during celiotomy?
- Keep tissues moist with sterile saline! Cover with moist laparotomy pads, lavage.
- Isolate contaminated areas (contamination can mean bacteria or neoplasia)
- When done with contaminated areas, you should lavage, change gloves, and change instruments
What is considered a contaminated area with an exploratory celiotomy?
- Bacteria or neoplasia
What should you always do when you are finished with a contaminated area?
- Lavage, change gloves, and change instruments
Indications for abdominal cavity lavage
- Eliminate contaminants (bacteria or tumor cells), warm up the patient, improve visualization, find the source of hemorrhage (look for swirl of blood in saline)
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