Principles of LA Soft Tissue Surgery (22)

Question 1

How does large animal skin differ from small?

Answer 1

• thicker tissue
• skin does not bruise
• hemorrhage generally not a problem

Question 2

How much blood can LA lose during surgery?

Answer 2

<15 %

starts to show clinical signs 15-20%

Question 3

What percent blood loss in LA is there a risk of death?

Answer 3

> 40%

Question 4

What are the characteristics to LA standing surgery?

Answer 4

• prevents complications of being recumbent
• prevents risk of recovering from anesthesia
• better access for select structures - dorsal
• reduced cost

Question 5

What are the characteristics to LA recumbent surgery?

Answer 5

• safer for surgeon
• no movement
• better access for most structures

Question 6

What is this structure?

Answer 6

epiglottis

Question 7

What method do you use to visualize this structure?

Answer 7

URT endoscopy

Question 8

What are the characteristics of URT endoscopy?

Answer 8

• NOT sedated at rest
• treadmill
• under a saddle

Question 8

What are the approaches to LA URT surgery?

Answer 8

TIGHT spaces; most procedures are done in <3 in wide spaces

Question 9

What instrument is critical to URT surgeries?

Answer 9

retractors: self-retaining, hand held

Question 10

What are URT considerations for healing?

Answer 10

mucosa heals rapidly

potential for mucosal “webbing”

Question 11

What are complications of URT surgery?

Answer 11

• excessive swelling - blocks airway
• damage to nearby structures
• surgeries that are re-opening airway
• surgical site infection

Question 12

What are diagnostics for GI surgery?

Answer 12

limited due to size of abdomen and length of GIT

Question 13

What is part of a colic work up?

Answer 13

• rectal palpation
• abdominal u/s
• nasogastric tube intubation
• abdominocentesis
• bloodwork

Question 13

What is a paramedian incision?

Answer 13

right side

Question 14

What are the approaches to celiotomy for LA?

Answer 14

• ventral midline - most common
• paramedian
• paralumbar fossa
• laparoscopic portals

Question 15

What is the most common surgery in equine GI?

Answer 15

exploratory laparotomy (colic surgery)

Question 16

If the bowel is closed, the surgery is considered _____. If the bowel is open, the surgery is considered ______

Answer 16

clean
clean-contaminated

Question 17

What are considerations for healing of the equine GI tract?

Answer 17

serosa can have problems
- intra-abdominal adhesions - a dysfunction of fibrinolysis

DO NOT USE DRY GAUZE EVER

Question 18

How do you reduce adhesions for GI surgery?

Answer 18

• gentle handling of tissues
• keeps tissues moist
• use of lubricants
• strict asepsis
• prevent blood from enters abdomen

Question 19

What are potential complications of equine GI surgeries?

Answer 19

Question 20

What is wrong in this picture?

Answer 20

intra-abdominal testes

Question 21

Look at common surgical procedures LA for urogenital tract

Answer 21

Question 22

Where do you enter for a cryptorchid surgery?

Answer 22

• inguinal
• parainguinal
• laparoscopic

Question 23

What are approaches to female urogenital system LA?

Answer 23

the back end —> standing sedation and epidural ovariectomy —> laparoscopy, flank, vagina, ventral midline celiotomy

Question 24

What are surgical considerations for LA urogenital tract?

Answer 24

- may need to catheterize bladder - function is an important outcome - approaches can be challenging - small spaces, accessibility

Question 25

What are considerations for LA urogenital surgeries?

Answer 25

- healing can be a challenge - back end of mare has a lot of contamination - give distal urethra a rest

Question 26

What are common complications for LA urogenital tract surgeries?

Answer 26

- bleeding - loss of function - breakdown of repair - stricture - infection

Question 27

How does laparoscopy work?

Answer 27

- abdomen is insufflated with CO2 - blind stab incision made to place scope portal - scope introduced through portal that maintains pressure in abdomen

Question 28

What are the common laparoscopic surgeries?

Answer 28

cryptorchidectomy ovariectomy exploring abdomen in chronic cases

Question 29

How do you prepare equine pre-operatively?

Answer 29

withhold feed overnight NSAIDs antibiotics for clean-contaminated

Question 30

What are general complications for equine surgery?

Answer 30

- subcutaneous emphysema - retroperitoneal insufflation - bowel perforation - hemorrhage