Staplers

Question 1

5 main kinds of staplers we use:

1.
2.
3.
4.
5.

Answer 1

1. GIA = gastro-intestinal-anastomosis
   aka Intra Luminal Anastomosis (ILA)
2. TA = Thoracoabdominal
3. LDS = Ligating-Dividing-Stapler
4. EEA = End-End-Anastamosis
5. Skin Stapler

Question 2

T/F: You can autoclave staplers

Answer 2

F, you can’t. Use gas sterilizer if you can.

Question 3

Average number of times you can re-use staplers?

Answer 3

12 times.

Question 4

Advantages of stainless steel stapler?

Answer 4

they can be autoclaved for re-use.

Question 5

T/F: There are no staplers made specifically for large animals.

Answer 5

T. We can use TA 90s if we need to.

Question 6

GIA Staplers require there are a minimum of how many staple lines?

Answer 6

2

Question 7

TA 90: what does the 90 mean in the name?

Answer 7

The staple line is 90 mm (9 cm). It’s the largest one available

Question 8

T/F: There is no cutting action when using the TA 90

Answer 8

True, just crushing. Run a scalpel blade close to the edge of the crushed tissue by hand.

Question 9

LDS comes in handy because it can perform _______ during what kind of procedure?

Answer 9

isolate blood vessels
bowel resections (where you can see the BVs very easy.

Question 10

Staples in the LDS: purpose behind mechanism?

Answer 10

LDS ligates/crushes the lumen of vessels

Question 11

Identifying characteristic of EEA stapler?

Answer 11

Large wingnut at the end.

Question 12

What shape staple line does an EEA stapler make?
Diameter of staple line?
How many rows of staple lines?

Answer 12

circular
21.2 mm
two

Question 13

What is a “good night stitch”?

What is the consequence of not putting one in?

Answer 13

A stay suture placed via GIA stapler during a bowel anastamosis

The staple line can open up like a zipper

Question 14

Functional End-To-End Anastamosis of bowel requires using what two staplers?

Answer 14

GIA and TA90

Question 15

Jejunocecostomy is what type of anastamosis?

Answer 15

End-to-Side or Side-to-side

Question 16

What stapler can you use for jejunocecostomy?

Answer 16

GIA,

Question 17

What stapler is most often used for resection of the colon in a horse?

Answer 17

TA 90. You’ll need multiple cartridges

Question 18

What stapler is most often used for creation of a pelvic flexure after colon resection in a horse?

Answer 18

GIA

Question 19

Cecocolon anastamosis - Describe the procedure?

Answer 19

make an additional opening between cecum and the large colon using GIA with stab incision, helps the cecum empty easier to avoid impaction.

Question 20

Equine-cecal resection is usually performed when?

Answer 20

When the tip of the cecum goes inside the cecum like an inverting sock, and the cecum starts to auto-digest itself.

Question 21

What stapler is used for equine-cecal resection?

Answer 21

TA90. Staple that part of the cecum off.

Question 22

Broad Causes of Left Displaced Abomasum:

1. Abomasal ____
2. decreased ______
3. _____
4. Abomasum changes in ___, ___, ____
5. time periods?

Answer 22

1. Atony
2. decreased rumen volume
3. calving
4. dimensions, position, volume
5. last 3 months of gestation, first 3 months of lactation

Question 23

4 common causes of abomasal atony that can lead to LDA:

Answer 23

1. increased abomasal VFA
2. Hypocalcemia
3. metritis
4. mastitis

Question 24

Mean incidence of LDA in herds?

Answer 24

1-5%, but may exceed 15% in some herds.

Question 25

Clinical symptoms of LDA: 1. refuse ____ 2. Temp? Defecation? 3. ____ in left flank

Answer 25

1. refuse grain 2. normal temp, still passing feces 3. tympany

Question 26

4 surgical procedures used to correct LDA: 1. 2. 3. 4.

Answer 26

1. Right flank omentopexy 2. Left flank abomasopex 3. Right paramedian abomasopexy 4. closed suture or bar techniques

Question 27

In right paramedian abomasopexy, the animal is in ____ recumbancy. Sedation (is/is not) required?

Answer 27

dorsal Is! Heavily sedated!

Question 28

Nerve block options for right flank omentopexy: 1. 2. 3. 4.

Answer 28

1. Proximal paravertebral block (T13-L2) 2. Distal paravertebral block (T12-L2) 3. Inverted L block 4. Line block

Question 29

Right flank omentopexy: Initial incision into ____, located between the ____ and ____.

Answer 29

paralumbar fossa between last rib and tubor coxae

Question 30

3 muscle layers you cut through in right flank omentopexy:

Answer 30

internal, external and transverse abdominal oblique muscles.

Question 31

Abomasum is supposed to be where, relative to the rumen?

Answer 31

ventral to the rumen.

Question 32

Why do you insert a large cannulated needle first into an incision site for a right flank omentopexy?

Answer 32

to relieve the gas bubble that has accumulated (it pulls the abomasum more and more dorsally between rumen and bodywall and we need to get rid of that gas)

Question 33

Which of these procedures is performed "blind"? Right flank omentopexy or Left flank celiotomy

Answer 33

right flank omentopexy

Question 34

Use what instruements to keep the abomasum in the incision site for a right flank omentopexy?

Answer 34

grasping forceps

Question 35

1st part of suturing for right flank omentopexy: 1. Place (small/large) sutures though the ____, than through the _____. 2. Suture pattern used? 3. Immediately after finishing the first suture, you should do what?

Answer 35

1. large body wall, then the portion of omentum (sows ear) and out. 2. Horizontal mattress 3. do it again in reverse order on the other side.

Question 36

2nd part of suturing for right flank omentopexy: 1. continue the pattern into the ____. 2. In a standing cow, you should start suturing (ventrally/dorsally). Why?

Answer 36

1. on the peritoneum | 2. ventrally. You want to avoid some of the other bowel spilling out.

Question 37

Other structures to palpate from a right flank celiotomy 1. 2. 3.

Answer 37

1. Liver 2. Left and right kidneys 3. Urinary bladder

Question 38

What equipment should you have prepared specifically for a left flank abomasopexy?

Answer 38

2 straight intestinal needles with 3 feet of suture in-between

Question 39

What suture pattern should you perform on the abomasum in a left flank abomasopexy?

Answer 39

simple continuous

Question 40

After suturing at the greater curvature, what broad area do you take the needle to in a left flank abomasopexy?

Answer 40

right paramedian area

Question 41

Peforming left flank abomasopexy when in the right paramedian area: 1. Push needle through ______ 2. Make sure you don't hit the _____ 3. Direct assistant to do what?

Answer 41

1. abdominal wall 2. milk vein 3. push with second needle at the same time as you, but 6 inches caudally.

Question 42

Describe the incision for a right paramedian abomasopexy 1. length? 2. location?

Answer 42

1. 20 cm long incision between midline and right SQ abdominal vein. Incision started 8 cm behind the xiphoid

Question 43

T/F: You will likely have to search around for abomasum after making the initial incision in a right paramedian abomasopexy.

Answer 43

F: it will probably be right under your incision b/c it is full of gas

Question 44

In a right paramedian abomasopexy, the (medial/lateral) aspect of the ______ of the abomasum is sutured to the _____

Answer 44

lateral greater curvature peritoneum

Question 45

Suture technique for right paramedian abomasopexy?

Answer 45

3 mattress sutures (along the greater curvature) already in place through entire body wall

Question 46

What method of LDA correction involved "Shaking" to properly replace the abomasum?

Answer 46

Closed Suture or Bar Technique

Question 47

With the closed suture or bar technique, the ping should be where if you have properly replaced the abomasum?

Answer 47

in the right paramedian area

Question 48

Right sided "ping" indicates....

Answer 48

right displaced abomasum

Question 49

RDA simple displacement can be treated ______ or ______

Answer 49

medically (via Ca2+/dextrose, or exercise) or surgically

Question 50

In a right sided abomasal displacement, the ping foes from _____ to ____

Answer 50

paralumbar fossa to rib 8