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Large Animal Surgery

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moonlup's version from 2017-09-18 15:12

Section 1

Question Answer
How to Dx milk flow obstructionsPalp, graduated rod, Cul&Sen, Imaging, Theloscopy
What gives a teat laceration a poor prognosis?older than 12 hrs, Complex, Transverse, distal/streak canal, full thickness
What Abx do we use in teat lacerations?Procaine penicillin, Flunixin/systemic & intramammary
What sedation is usually used in teat repairs?xylazine, ketamine, & butorphanol
Types of local anesthesia for teat repairsring block at base, infuse teat cistern, inverted V block, regional perfusion
What suture pattern do you use in the mucosa?simple continuous, unless complex then simple interrupted okay
What suture pattern in the muscular/submucosasimple continuous
What suture pattern in the skin?interrupted or horizontal mattress, may need stents if old. Remove in 10 days.
How do you milk following teat repair?Machine or insert drain
How do you milk if the streak canal was injured?insert and leave a capped tube (max 3d), then wax/silicon/FA rod inserted between milkings (poor prog)
How do you repair fistulas?let heal completely, then elliptical incision around fistula and repair as laceration
What do you do with supernumerary teats?<4wks-<6m crush with forceps and remove with scissors/scalpel, heal by 2nd intention w/ Abx spray
What do you do with blunt trauma to teat end?drain milk via tube and infuse Abx. Stopper with silicone implant. Remove to drain on day 3 and 6. Don't resume milking till D9.
Define tight streak canalreduced flow of milk with hand and machine milking
How do you correct a tight streak canal?Oxytocin IV, lidocaine teat cistern, 4 cuts with Hug knife at 45*, hand milk to make sure deep enough and every 1-2hrs until after morning milking. Insert melting wax povidone stent after milking for 5-6D
Tx approaches for obstructed rosette of FurstenbergBlind excision, Thelotomy, Theloscopy
How do you remove milk calculi?forced hand milking, spiral teat probe. May need to crush with forceps first
Tx for obstructed teat cistern/annular ringremove via streak canal or thelotomy. Latter better to avoid scar tissue in streak canal
Dx and Tx of gland fibrosisPalp or U/S, no treatment (cull)
What can't you inject IV in the teat?epinephrine will cause sloughing
For extensive surgery, where can you anesthetize?Paravertebral (cranial udder/teats) or Lumbosacral (recumb., umbilicus caudal)
What is Thelotomy?open teat surgery
What is and When do you use a prosthetic implant?tubing from gland cistern to Furstenberg ring. Use when >30% mucosa defect (pressure inhibits scar tissue). Remove in 3-6w unless infection/mastitis (then NOW)
Tx streak canal agenesisimperforate: scalpel and manip for patent. Incomplete: cutting obterator, 10d teat canula
Tx teat spiderremove scar tissue via teat canal
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Section 2

Question Answer
What breeds are prone to eye SCC?white faced breeds, Herefords and Holsteins
Where in the eye are SCC common?dorso-lateral limbus, eyelids, w/ slow progression to cornea, eyeball, and socket
What and where is an auriculopalpebreal block?nerve caudal socket over Z arch, anesth Z arch, upper eyelid, and motor. For PE, not surgery (unless 3rd eyelid removal)
What to you do if you want to examine/Sx lower lid?Line block
What and where is a Peterson block?insert behind eye from lateral socket to Optical nerve exit. Anesth motor and sensory of eye stuff
What does a retrobulbar nerve block block?motor: optic, oculomotor, abducens. Sensory: cliary, cornea, uvea, conjunctiva. Can result in anesthesia of meninges
enucleationremoving the eye globe
exenterationremoving all soft tissues in the orbit
Why do you need to go slow in enucleation?vasovagal reflex: too fast = bradycardia and fainting
Hotz-Celsus procedurecorrects entropion, remove strip of skin below eye
What type of closure in eyelid lacerations?2layer Muscle/SQ (simp continuous) and skin (figure 8)
What rare complication can happen when removing the 3rd eyelid?orbital fat prolapse
Dermoid TxGA +/- retrobulbar, sharp excision/laser
Corneal Ulcer TxAbx/serum, syst NSAIDs, conjunctival flap
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Section 3

Question Answer
When does the horn bud attach to the bone?2 months
When does the frontal sinus attach to the horn?4-6m
What is the blood supply to the horn?cornual branch from superficial temporal artery
What is the nerve to the horn?cornual nerve
How should you anesthetize for dehorning?best with LA and NSAID, but NA commonly does nothing
How can you disbud a horn?chemical (<1w) or thermal (1w-2m) cautery
A tube dehorner is for what sized horns?up to 1.5in
Scoop/gouge dehorner for what size?>1.5in, 6m old calves
Guillotine dehorner for what size?14m old calves
How do you remove very large horns?obstetric wire
When shouldn't you use hemostatic powders?in animals over 2m, don't want to get in sinus
How do you avoid hemorrhage?grasp artery and pull and twist until it breaks below skin level
How long should the cow avoid getting rained on?24-48hr
What's the difference tween cow and goat dehorning?MUST anesthetize, Xylazine & LA. Complications more likely
Where do you nerve block in a goat?cornual branches of lacrimal AND intratrochlear nerves, Lidocaine
When can you disbud a goat?3-14d, thermal or tube
Post-op care in goatsIsolated till healed, NSAIDs, bandages
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Section 4

Question Answer
What type of hernia is most common in horses and cows?umbilical hernia
When are umbilical hernias noticed in pigs?9-14w
What else could a hernia be?abscess, omphalitis, ventral hernia
How can you repair simple equine hernias?<5cm leave alone, hernia clamps, Sx if >10cm
How can you repair simple bovine hernias?<5cm clamp, band, bandage, or inject irritants. >5cm Sx
What's the doctor word for hernia repair?herniorrhaphy
What suture technique on open herniorrhaphy?matresses, minimal tension
What suture technique on closed herniorrhaphy?simple interrupted appositional
How do you close large hernias?mesh herniorrhaphy (needs Abx)
Who gets herniorrhaphy complications and what are they?calves>horses, edema, seroma, hemotoma, dehis
Tx of Omphalitisdrain, lavage. If recurs, Sx (open herniorrhaphy)
Tx of abscessed herniaopen herniorrhaphy
Most likely organism of infection in herniaA. pyogenes
Most common umbilical infectionurachus, will have urinary signs
What's the concern with omphalophlebitis?may reach liver and cause abcesses via umbilical vein
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Section 5

Question Answer
What tools tail dock? Which ones risk tetanus more?hot chisel*, Burdizzo, sharp amputation, elastrator*
Where do you tail dock?distal level of caudal tail fold (rectal prolapse if too short)
What procedure for mature ewe?GA or caudal epidural, tourniquet, V shaped incision, cut between vertebrae, close. Abx, NSAIDs, fly control post op
Common problem on pig farmsrectal prolapse
What do you check for in rectal prolapse in pigs?necrosis/lacerations, herniation of bladder and SI
Conservative rectal prolapse Txonly if no trauma, massage back in, pursestring suture removed in 5-7d
If rectal prolapse has trauma, what do you do?Blade amputation (rubber tube, cross pin, cut, suture) or Prolapse ring (tube, tight ligature, necrose 5-7d)
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Section 6

Question Answer
When do you castrate llamas?4-6m BUT delayed physeal closures. Skeleton mature at 18-24m
Castration techniquesscrotal, pre-scrotal
Which technique needs post op care?pre scrotal
How do you remove fighting teeth?dremel or Gigli to 2-4mm above gums, may repeat. Also Sx resection, but root is long and curved
Common angular limb deformitycarpal valgus
Angular limb deformity caused bytrauma, pain, VitD insuff (fall/winter born), uterine malposition, immature MSK at birth
Best treatment for angular limb deformityTransphyseal bridging and ulnar ostectomy at >4m
memorize

Section 7

Question Answer
Where outside is descending duodenum near?right flank
Cow TPR100.5-102.5, 40-80, 12-36
What is the ballottement order?gas, doughy/fibrous, fluid
normal number of rumen contractions3/2min
Where is the rumen ping found?left paralumbar fossa
Where is LDA ping found?line from elbow to hip
What's a pinch test?pinch at withers and should ventro flex BUT if painful won't
Most common forestomach disordervagal indigestion (damage to vagal nerve results in outflow obstruction)
Cornell classification TIeructation failure, rumen gas distension
Cornell classification TIIomasal transport failure, rumen gas and feed/fluid distention
Cornell classification TIIIAbomasal obstruction, rumen fluid and feed distension, abomasal distention
Clin path of TRPtraumatic reticuloperitonitis (neutro philia, left shift, elevated fibrinogen, globulin, and TP)
Type I contourL upper and lower distension
Type II & III contourType I with R lower distension
Dx vagal indigestionrectal, U/S rad, abdominocentesis
Clin path vagal indigestionhypochloremia/kalemia and metabolic alkalosis
T1 differentialsrumen atony, esophagus obstruction
T2 differentialscarb overload, reticular lesions
T3 differentialsabomasal impaction, obstruction, pyloric lymphosarcoma
Sx approach for vagal indigestionleft or right flank depending on presentation, explore and evacuate
Dx left displaced abomasumping test, liptak test, rectal, U/S
CS of right torsed abomasummetabolic alkalosis, hypochloremia/kalemia (same as vagal indigestion)
Dx right displaced/torsed abomasumping test, rectal
Sx treatment approaches for LDA/RDAleft or right flank (pexy) or right paramedian
Dx small bowel issueCS (sick cow plus ileus and caudal abd pain), U/S, Rectal
Tx small bowelright flank celiotomy
Distension/ping on right paralumbar fossa impliescecal dilation/torsion
Displaced abomasum causesperipartum, diet, hypocalcemic, 2y disease
Cecal dilation causeshypocalcemia, increased VFA production
Tx of Cecal dilationright flank celiotomy, typhlotomy
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Section 8

Question Answer
When is recumbent flank approach used?SI or colon conditions
What is ventral paramedian approach used for?ventral abomasopexy (RDA, LDA, mild RTA), toggle/blind tack
Standing anesthesia optionsline block, inverted L-block, high/low paravertebral (better anest, least drugs)
Recumbent anesthesia optionsGA, high/cranial epidural
Where does a flank incision go?middle of paralumbar fossa 3-5cm distal to transverse process, 20-25cm long
How many layers do we close in?3, peritoneum and transverse, abdominal obliques and SQ, skin
What suture pattern do we use?simp cont, but skin is ford interlocking with 2-3 interrupted at ventral aspect
What suture material do we use?chromic catgut, but skin is heavy monofilament
Post-op careAbx, NSAIDs, remove sutures in 2-3 weeks
Special thing in rumenotomyanchor rumen to body wall before opening it
Typhlotomydeflating and draining the cecum, close in two layers
Omentopexystanding right, fix omentum near pylorus to peritoneum and transverse abd w/ 2 mattress. Also incorporate omentum into ventral 2/3 of closure
Abomasopexyattach greater curvature (cont. interlocking) to ventral body wall (prep right paramedian area 1/2 tween xyphoid and milk well, will pass sutures through)
Special for ventral paramedian pexyline block, incorporate in 1st layer, close external rectus with horizontal mattress
Where do we blind tack / toggle?right cranioventral abdomen, locate abomasum via ping and punch trochar through
Which approach fixes abomasum easiest?ventral paramedian
Which was the worst complications?blind tack
Which is best for exploring?Left flank
Which is best for severely compromised cows?Right flank
Which displacement needs Abx?RDA/RTA
Neostigminemay stimulate intestinal motility
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Section 9

Question Answer
Episiotomy procedureepidural, incision at 2 or 10 through skin, SQ, and vetibule mucosa, suture immediately after delivery
Minchev procedurevaginopexy to prevent vaginal prolapse
Winkler techniquecervicopexy to prevent vaginal prolapse, attaches cervix to preputial tendon
When do pigs uterine prolapse? Cows?during or few days after vs immediately pp.
How do you replace uterus in pigs?replace from tip (cows from cervix), left paralumbar incision if not possible
Uterine amputation techniqueligate arteries and uterus, oversew stump 2 layer
Cow hysterectomy techniquestanding, fast 1-2d
Uterine torsion treatmentrock fetus, cast and roll, celiotomy and C-section
Ovariectomy considerationsfast 1-2d, early luteal stage, standing preferred
C-Section approachstanding L/R paralumbar fossa or L oblique. Can do ventral midline, but be fast. Dairy has udder in the way. No paramedian! Lateral ventrolateral.
C-Section anesthesiaepidural, line block, regional anesthesia (paravertebral T13-L2 prox and distal)
C-section special procedure stuffleave stuck placenta in uterus, 2 layer (or 1 in Utrecht) Muscles and skin (nonabsorb)
Post-op C-Sectionoxy till placenta passes, Abx, mastits risk
C-section approach in small rumis/pigsdorsal or R lateral recumbency
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Section 10

Question Answer
Caslick's indexvertical length x angle of declination, want <150 for best fertility
Sedation for urogenital Sxalpha2 & butorphanol CRI
Analgesia for urog Sxalpha2 (detomidine), epidural (lido/mepi & xyla)
Gadd techniqueperineal body reconstruction for busted labia and vestibule seal, improves orientation but reduces vestibule
Perineal body transectionbest for sunken anus and sloping vulva, horizontal transection until vulva is vertical, 2nd intention healing
When can you diagnose urovagina?only during estrus
Monin procedureeasiest way to fix urovagina but only minor ones. Relocate caudal fold
Brown and Shire proceduresshire is simple brown. Transect transverse fold and extend vulvar labia close 3layer, risks fistulas and continued pooling, reduces vestibule size
McKinnon procedureextend with vaginal mucosa, not transverse fold, larger and stronger repair without reducing vestibul, risks fistula
1st degree perineal lacerationmucosa and skin (self-limiting/Caslick)
2nd degree perineal lacerationmucosa, submucosa, muscles (Caslick/Gadd)
3rd degree perineal lacerationdisruption of perineal body, anal sphincter, rectal floor, vestibular ceiling
how soon do you repair perineal lacerations?wait 4-6w
How do you repair perineal lacerations?minimal tension apposition in 1 or 2 stages
When do you diagnose cervical lesions?diestrus
best c-section for horseventral midline or modified low flank
c-section post opAbx, NSAIDs, placenta should pass in 6h, 30% foals survive
memorize

Section 3