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Surgery Lecture Test
| Question | Answer |
|---|---|
| surgical prep for orthopedic surgeries | -extra large area for extreme sterile precautions -cover end of foot with VetWrap -3 stage prep on each side, moving outwards from centre -cover leg with sterile stockinette |
| True or False: we use Opsite during orthopedic surgeries | true |
| what do you do to a stockinette if you are leaving it on the leg during the surgery | suture edges to the incision to maintain sterility |
| For a femoral intramedullary pinning procedure, when you are approaching fracture site through surgical dissection, you must avoid cutting/damaging... | - muscles -tendons/ligaments -nerves -arteries/veins -other important structures |
| 4 types of orthopedic surgeries | 1. femoral intramedullary pinning 2. declaw 3. dewclaw removal 4. tail docking |
| what infection is very difficult to resolve once established | Osteomyelitis |
| for the femoral intramedullary pinning where do you incise? | just cranial to the femur |
| 3 steps to femoral intramedullary pinning | 1. incise through stockinette/opsite and skin just cranial to the femur 2. incise the fascia lata just in front of the femur 3. locate the vastus lateralis and biceps femoris 4. blunt dissection 5. pinning occurs 6. top of pin is cut flush to skin |
| 2 types of orthopedic pinning | 1. Normo-grade pinning 2. Retro-grade pinning |
| what is Normo-grade pinning | pin chuck is used to push the IM pin into the bone marrow, it is started at the Trochanteric fossa and proceed down the marrow past the fracture. fin is advanced until it lodges in the distal epiphysis of the bone |
| what is retro-grade pinning | pin is inserts at the fracture, advanced into proximal portion until it pops out the top of the femur. pin is pushed through incised skin, pin chuck is removed and then the pin is advanced distally until the end of the pin lodges in the distal epiphysis |
| how would we close the left pinning before taking a rad to ensure placement | skin will be temporarily closed with towel clamps or by quickly suturing just the skin closed |
| what are the last 2 steps of a pinning procedure | 1. top of pin is cut flesh with the muscles/skin with pin cutters 2. skin incision at hip and original surgical incision are closed |
| suturing patterns and layers for femoral intramedullary pinning surgery | -muscle layer and fascia lata is closed with simple interrupted absorbable suture -skin is any suture pattern or skin staples |
| 3 things to watch out for during post op after a femoral intramedullary pinning | -swelling and discharge -ensure the animal is not licking the area -clients should monitor surgical site |
| how long should orthopedic surgical patients not be vigorously exercised for | 7 days post op |
| when is the suture removal for an orthopedic surgery | 10-14 days (by now the animal will most likely be using their fractured leg somewhat |
| when would be remove a pin after orthopedic surgery | -maybe never -4-8 weeks |
| what does the removal of the pin after a orthopedic surgery depend on | -severity of the fracture -age of animal (young heal faster) -species (cats heal quicker) |
| how is the skin closed after a pin removal | incision closed with 1-2 sutures or allowed to heal by second intention healing |
| what are Rongeurs used for during orthopedic surgeries | break up/cut/shape/remove bone |
| what are bone holding forceps used for during orthopedic surgeries | -used to hold bone while pinning and have strong gripping teeth |
| what are liston bone cutting forceps | cuts larger pieces of bone, of have a double handle to increase power |
| what are vergrugge and reduction forceps used for | hold bone fragments in reduction while inserting fixators such as screws |
| what is a bone curete used for | have a sharp edge to remove bone and a cup shape on the end to scoop out pieces of bone. most commonly used to cut out OCD (osetochondritis dissecans) lesions |
| what is a rake retractor used for | -used to hold muscle tissue out of the way |
| what is a weitlander retractor used for | retracts muscle without a person needing to hold them |
| what is a jacobs chuck used for | used to advance intramedullary pin into marrow cavity |
| what are intramedullary pins used for | to stabilize fractures |
| what are kirschner wires used for | stabilize fracture site |
| what are bone plates and screws used for | used in more complicated fractures |
| what are external fixators used for | combination of internal and external components of pins and apparatus to stabilize fractures |
| what are wire twisters used for | used to twist circlage wired |
| what are bone rasps used for | smooth rough edges of bone |
| what are periosteal elevators used for | remove muscle from bone by releasing periosteum |
| what is a osteotome used for | used to cut through bone |
| what is a bone mallet used for | used to strike an osteotome or any other instrument that needs to be pounded during surgery |
| what is a cast saw used for | cut casts for removal |
| what does physical therapy provide after orthopedic surgeries | -pain relief -build strength - re-educate patients to walk in a balanced manner after injury of illness |
| 5 examples of physical therapy | -magnets -anxiety wrap -electrical stimulation -hydrotherapy -massage |
| what 4 things is physical therapy normally in the treatment plan for | -orthopedic conditions -neurological conditions -post op -wound care |
| what is a VT's role in physical therapy | -carrying out procedures -educating clients -expanding education with different courses |
| True or False: A declaw is performed by a VT | false |
| what feet are normally declawed | front two feet |
| surgical prep for a declaw | -feet are scrubbed with betadine or chlorhexidine and warm water and rinsed with alcohol. -squirt betadine or chlorhexidine solution onto each toe and wrap feet with clean gauze |
| explain the paw block for a declaw | palmar aspect of paw -medially (0.10-0.15ml) -laterally (o.10-0.15ml) Dorsal aspect of paw -distal to carpus from lateral to medial (0.20ml) -between metacarpal I and II (0.10ml) |
| what is applied above the elbow before a declaw after that paws blood has been milked into the body | 2 tourniquets |
| how long can a tourniquet stay on for | maximum of 20 minutes |
| where is the line of the cut for the declaw | should extend through the white membrane at the claw base |
| what are the 3 methods of declaws | 1. Guillotine method 2. Scalpel/Dissection Method 3. laser |
| explain the guillotine method for declaw | 1. trimmers are pressed against the bone, cut the white membrane at base 2. nail is removed with a firm motion 3. will be able to see P2 dorsally and a small portion of P3 remaining 4. a #15 scalpel blade can be used to remove remaining portion of P3 |
| explain the scalpel /dissection method for declaw | 1. claw is grasped with an Ochsner forcep and traction is placed to open joint 2. #15 scalpel blade P3 is dissected out 3. First cut behind P3 to loosen its attachment to the paw 4. P3 is gently twisted in each direction and dissected off |
| why is the laser method for declaw so popular | results in less hemorrhage and post-op pain |
| what happens to the hole in the toe after a declaw | -may be left unclosed (not common) -sutured -closed with tissue glue |
| where does the tissue glue go after a declaw | ONLY to the skin..NO internal tissue or bone |
| how to wrap the paw immediately follow declaw prior to other foot bing done | 1. pressure bandage put on 2. sterile telfa pad with ointment applied over incision 3. apply gauze, reflected over the end of the paw and go up 3/4 way to the elbow 4. apply layer of vetwrap |
| how to bandage the paw for a longer period of time after a declaw procedures | 1. remove tourniquet 2. last, apply several pieces of adhesive tape around the top of the bandage |
| when are declaw bandages removed | the day after the procedure and observed for hemorrhage |
| what to do post-op for a declaw | - use news litter or non clay litter as nothing can get in the openings for a minimum of 7 days - examine paws twice daily for signs of infection or bleeding |
| 7 declaw post-op complications | 1. hemorrhage 2. swelling (usually temporary thrombosis in the veins 3. infection 4. pain (gabapentin used for Phantom limb pain 5. regrowth of a claw (if portion of P3 is left) 6. missed claws 7. osteomyelitis |
| a few declaw alternatives | 1. scratching post 2. trim nails frequently 3. soft paws to cap nails 4.behavioural techniques to dissuade 5. tenotomy |
| what does declawing reduce | cats ability to climb up/down trees, catch birds and defend itself (be cautious if the cat goes outdoors) |
| when is a declaw removal ideally done and why | 3 days of age, pups immune system are still naive |
| why are declaws performed | -prevent damage to claws later in life - conform to breed specifications |
| why is tail docking normally done | conform with breed standards |
| what is the length the tail would be docked too | length is chosen according to the breed standards set out by the American/Canadian kennel club |
| what should you always do before cutting the tail during a tail docking | retract skin on tail cranially to ensure there is enough to cover the end of the tail |
| 3 devices used for tail docking | -scissors -guillotine devise -laser |
| how is a tail docking incision closed | tissue glue or single interrupted absorbable suture |
| 4 reasons for caesarian sections | -breed related dystocia - uterine inertia - maternal problem - fetal problem |
| 3 reasons to avoid caesarian sections | -potential for maternal anesthetic problems -potential for anesthetic problems for pups -potential for bitch to fail to bond to offspring |
| explain C-section procedure | -wide surg prep - cut linea alba -pack off -pull out one horn and incise -gently massage placenta to detach from uterus -extrude sac with puppy and pass to assistant -uterus closed in 2 layers the rest is closed in the same manner as spay |
| why do you need to ensure to take care when opening linea alba | dont cut the milk glands |
| True or False: a c-section is considered a contaminated surgery | true |
| examples of care of neonates | -receive in warm clean towel -pull sac off face -Aspirate mouth and nose with bulb syringe -rub chest gently to stimulate breathing -wait a few mins to clamp and cut cord |
| normal puppy vitals | heart rate= 70-120 bpm resp rate= 15-40 rpm temp= 38.0-39.0 °C |
| 3 reasons for doing a cystotomy | 1. remove bladder stones 2. exploratory to check for chronic cystitis 3. repair ruptured bladder |
| 1 thing done to prep for cystotomy | 1. urinary catheter is helpful to empty bladder before surgery and helps flush bladder after surgery |
| explain the procedure for a cystotomy | 1.cut linea alba, caudal to spay location 2.exteriorize/pack off bladder 3.stay sutures can be used, empty bladder 5.incise avascular area with scalpel 6.pull out stones 7.flush saline in catheter 8.close 2 layers 9.leak test 10.abdomen closed |
| what is involved in aftercare after a cystotomy | -special diets -antibiotics -stones should be analyzed |
| what is intervertebral disc disease | when a disc ruptures, material may go ventrally, laterally, or dorsally |
| which disc ruptures presents the most clinical signs | dorsal rupture |
| where does interverterbral disc disease normally happen | usually located midcervical region, or L1 and L2 |
| clinical signs of intervertebral disc disease | -pain -ataxia -lack of proprioception -paralysis -loss of sensation (superficial or deep) |
| what is the non-surgical treatment for intervertebral disc disease | -rest -diazepam or tranquilizers to minimize movement -corticosteroids to decrease swelling -NSAIDS for pain -Need to do surgery ASAP if not responding |
| 2 surgical treatments for intervertebral disc disease | 1. laminectomy 2. fenestration |
| what is a laminectomy | remove part of the vertebrae at affected area, expose spinal cord and take prolapsed disc out, then put bone back |
| what is a fenestration | remove diseased discs before they rupture completely |
| what is the 5 importances of the cruciate ligament | 1. no supporting muscles 2. stifle joints lacks snug ball in socket 3. relies on 7 ligaments 4. most commonly cranial cruciate is ruptured 5. often due to sudden movement or fall in an overweight animal |
| clinical signs of a cruciate ligament rupture | -wont use affected limb -anterior drawer movement present -can move tibia back and forth relative to femur |
| small animal vs large animal cruciate ligament repair | small animals can most likely repair itself with cage rest but large animals should have surgical repair |
| what is a very common complication of a cruciate ligament repair | arthritis |
| 3 cruciate ligament repair options | 1. extracapsular suture stabilization 2. intracapsular stabilization 3. TPLO (tibial plateau leveling osteotomy) |
| post op care for cruciate ligament repair | -NSAIDS -Bandaging -Physical therapy |
| what is a femoral head ostectomy | involves removal of the head and neck of the femur |
| what is a femoral head ostectomy also known as | femoral head excision or femoral head arthroplasty |
| 3 reasons why a femoral head ostectomy is done | 1. treat a fracture of the femoral head 2. treat a luxated hip that cannot be reduced 3. to relieve arthritic pain from severe hip dysplasia |
| after a femoral head ostectomy what does the body form | a "false joint" with muscles and ligaments |
| other alternative treatments for hip dysplasia | -nutraceuticals -omega fatty acids -NSAIDS -cartrophen -pectinectomy -triple osteotomy -artificial hip replacement |
| what is a pectinectomy | older treatment being used again where the pectineus muscle is severed, this appears to relieve pain but it is temporary |
| what is a triple osteotomy | changes the configuration of hip joint, must be done before arthritic changes are present |
| in a artificial hip replacement, what is it replacing | -acetabulum -femoral head and neck |
| what are the 2 approaches for a thoracotomy | -sternotomy -through ribs |
| what must we preserve during a thoracotomy | heart and lung function |
| 5 reasons why a thoracotomy is performed | 1. internal compressions 2. repair congenital heart defects 3. treat lung lobe torsions 4. treat chest abscesses 5. cardiovascular studies in research |
| what do you do for a pneumothorax during thoracic surgery | -IPPV (intermittent positive pressure ventilation) -Ventilator -Decrease anesthetic concentration -monitor depth |
| what species are abscesses normally found in | intact tom cats |
| what is a typical appearance of a abscesses | -swelling -alopecia -febrile -if it ruptures there will be blood and pus |
| treatments for abscesses (early detection) | -plush or shave hair around wound -hot packs -antibiotics -anti-inflammatories -drains |
| treatment for abscesses (late detection) | -shave area widely -lance if not already open -flush thoroughly -place drain -antibiotics and anti-inflammatories usually administered |
| what 2 other things should be done after a cat gets an abscess | -if still intact cat should be neutered -tested for FeLV and FIV |
| home care for abscesses | -flush with chlorhexidine along side drain -give antibiotics -hot pack or soak if difficult to drain |
| steps to treating a laceration | 1. put sterile jelly on wound 2. clip and clean around wound 3. trim edges smooth 4. debride wound 5. flush with water or saline 6. close or leave open 7. place drain 8. antibiotics/anti-inflammatories 9. dehiscence is common |
| when is a vaginal prolapse most common | during proestrus or estrus in the bitch |
| True or False: vaginal prolapse rarely occurs during parturition in small animal species | True |
| 3 types of vaginal prolapses | 1. Type I: found on vaginal palpation and tissue is smooth and shiny 2. Type II: protrudes from vulva, only 1cm of vaginal floor is affected 3. Type III: rare, entire circumference of vagina protrudes, tissue is dry/wrinkly and maybe cracked/ulcerated |
| treatment of vaginal prolapse | -support until edema/hyperplasia resolves with progression of estrus cycle -protect tissue from trauma/infection -apply topical antibiotic/steroid cream -OVH if not breeding (resolves in 5-7 days) -surgical excision to remove devitalized tissue |
| when does a rectal prolapse normally occur | in young animals secondary to irritation of rectum and straining to defecate |
| what 2 conditions can cause a rectal prolapse | 1. colitis 2. enteritis |
| what cats are predisposed to a rectal prolapse | Manx cats |
| clinical findings of rectal prolapse | -colonic or rectal mucosa extending from the anus |
| treatment of rectal prolapse | -resolve primary cause -lubricate finger, push mucosa back into rectum -place a purse-string suture in anus for 1-3 days if re-prolapses |
| treatment to prevent straining | -epidural may be necessary -kaopectate retention enema to provide relief -surgical correction and resection of affected rectum in severe cases |
| what are biomedical lasers | -specialized surgical equipment used to cut or destroy tissues |
| advantages of biomedical lasers | -hemostasis while cutting -less post-op swelling and pain than with scalpel |
| disadvantages of biomedical lasers | -delayed wound healing -safety |
| what are the specialized safety precautions when using biomedical lasers | -special glassess -prevent ignition of combustible smoke emission by using a smoke evacuator -wear a laser-safe surgical mask to prevent inhalation of debris |
| what is electrosurgery (cautery) | -cut or coagulate tissue to minimize bleeding -passes high frequency alternating electrical current through tissue |
| 2 types of electrosurgery (cautery) | 1. monopolar 2. bipolar |
| what is monopolar electrosurgery | -current passess from hand-piece, through patient, to metal ground place under the patient (use gel between plate and patient) |
| what is bipolar electrocautery | -current passes between two tips on the hand piece that are used to grasp tissue |
| what is a hernia | protrusion of an organ or fat out of its normal location in the abdomen, through a defect in the body wall |
| hernias can be ______________ or _______________. | congenital, acquired |
| 7 common types of hernias in domestic animals | 1. umbilical 2. inguinal 3. scrotal 4. diaphragmatic 5. perineal 6. incisional 7. traumatic |
| what is a umbilical hernia | usually fat or omentum that is swelling seen at umbilicus |
| what is a inguinal hernia | abdominal contents come through inguinal canal, site is usually where leg meets the body and it could contain intestine |
| what sex is a inguinal hernia most common in | males |
| what is a scrotal hernia | similar to inguinal hernia except that the contents fo all the way into scrotal sac |
| what is a diaphragmatic hernia | abdominal contents go through tear in diaphragm into chest |
| what is a diaphragmatic hernia recognized by | dyspnea |
| treatment for diaphragmatic hernia | pull back abdominal contents through linea alba and suture the diaphragm |
| what is a perineal hernia | abdominal contents particularly bladder, go through muscles adjacent to base of tail |
| what is a incisional hernia | -secondary to a surgery -suture line dehisces and some contents emerge |
| what is a traumatic hernia | -occurs anywhere on body wall -muscle tears and organs escape |
| what are the dangers of a un-repaired hernias | -loop of bowel or bladder may go through body wall into hernial sac -may become trapped -circulation may be impaired -may see G.I. obstruction |
| can congenital hernias self repair | yes |
| surgical steps to repairing/correcting a hernia | 1. incise skin, expose contents of hernial sac 2. replace abdominal contents or remove 3. close muscle layers 4. close skin 5. may sometimes need mesh if large |
| what type of suture pattern is used to correct a hernia and why | "vest over pants" pattern as extra strength is needed for repair |
| explain the "vest over pants" suture pattern | tissues overlap rather than lining up |
| 6 reasons to do a C-section in large livestock | -calf is too large or heifer too small -malposition that cant be corrected -twins tangled up -uterine torsion -fetal monsters -failure to progress during birth |
| how is anesthesia given for a c-section in livestock | -usually done standing -give xylazine or acepromazine for sedation -may give epidural -block paralumbar fossa |
| what approach do you used for a normal C-section in livestock | -Left Paralumbar fossa |
| how big is the incision for a C-section in cattle | 18 inches long through all 3 muscle layers and peritoneum |
| what is the calf usually put out with during a c-section | OB chains |
| what part of the calf is usually removed first during a c-section | legs first |
| uterus is closed in how many layers | 2 |
| what suture pattern is used to close the skin layer of a cow after a c-section | ford interlocking pattern |
| cafe care right after birth | -hang over gate to remove fluid -tickle nose with straw -suction -dry and rub with towel -treat navel with iodine solution -ensure colostrum is ingested |
| what is a rumenotomy | incision into the rumen |
| reasons for doing a rumenotomy | -hardware disease -grain overload -removal of other foreign objects |
| where is the incision made in a rumenotomy | paralumbar fossa |
| where is the rumen in the body | -rumen is cranial to incision, under ribs |
| why is the rumen sewn to skin | avoid spillage of rumen contents into abdomen |
| the rumen is closed in how many layers | 2 layers |
| how to close up the skin layer | -ford interlocking pattern and then simple interrupted at bottom on incision |
| what is LDA | left displaced abomasum |
| what is RDA | right displaced abomasum |
| what is LDA/RDA | -during pregnancy, abomasum moves back and forth under rumen -after parturition abomasum can no longer move -gets trapped on left or right side |
| how do you detect LDA | -cow feels sick and has a decreased appetite and reduced milk production -can auscultate a "ping" when cow is tapped over the abomasum |
| why is there a "ping" sound during LDA | due to gas build up in abomasum (gas caps) |
| steps to surgical correction of LDA | 1. go through linea alba or paralumbar fossa 2. prep skin 3. often use big lap sheet and shoulder length gloves 4. muscle layers incised 5. locate abomasum and decompress with syringe 6. rotate it back 7. suture in place to body wall |
| other methods of correction for LDA/RDA | use toggle method - this is done blind - not suitable for all candidates |
| what is equine colic | -abdominal pain of various causes |
| causes of colic | - obstructions -displaced organs - torsions - poor circulation - parasites - change in feed - etc |
| appearance of animal with colic | -restless -anxious -kicking at flank |
| vitals of an animal with colic | -heart rate and resp rate increased (HR of 40 ok, 40-80 painful but wait, >80 do surgery) -increased CRT -congested MM |
| medical treatments for colic | -banamine or NSAID first -pass nasogastric tube -rectal check for impaction, displacement, etc |
| surgical treatment for colic | -place IV catheters to give fluids -may give mineral oil PO if impacted -Analgesics -Linea alba approach with general anesthetic |
| post op problems after colic surgeries | -dehiscence (bandage for support) -stormy recovery -diarrhea -myositis -laminitis -ileus -recurrence of colic -nerve damage |
| what is ileus | failure of gut motility |
| what is the reason for equine castration | behaviour more controllable |
| open vs closed castration | Open: take testicle out of vaginal tunic Closed: leave testicle in vaginal tunic |
| steps of castration in equine | 1. skin incision and either do closed or open technique 2. crush spermatic cord with emasculators (nut-to-nut) 3. remove testicle and part of cord 4. often leave skin incision open to drain |
| in a cryptorchid castration what do we need to do before they are under | -locate the testicle if in inguinal canal, approach externally |
| post op problems in equine after a castration | -infection -flies -herniation and dehiscence -swelling (exercise helps) |
| what is it called when horses aspirate air through vulva | -windsucking |
| how to fix windsucking in a horse | caslicks surgery |
| what is caslicks surgery | -suture dorsal vulvar lips together to prevent this -must leave small hold for urination -must remove sutures before breeding or foaling |
| what can windsucking cause | -air in vagina can predispose to vaginitis and infertility |
| what is roaring | paralysis of laryngeal cartilages such that they don't pull out of the way when horses breathes |
| what side is roaring usually most common on | only left side |
| how can you observe roaring | -observe by endoscopy |
| how to correct roaring | -general anesthesia with a roaring burr or suture material to hold open |
| before surgery for equine what must you do to them | groom, bathe, wash feet, wash mouth, remove shoes |
| why must you avoid perivascular injection | thrombosis and phlebitis |
| where must a horse be recovered | padded stall |
| where should you put padding under a horse when they are in dorsal recumbency | underneath the shoulder and gluteal muscles |
| which surgeries are to be performed in dorsal recumbency | -abdominal surgeries -laryngeal ventriculectomy -arthroscopies -neurectomy |
| when in lateral recumbency for equine surgery what direction should the down foreleg be pulled | pulled forward |
| why is the head well padded on a horse during surgery | protect the facial nerve from paralysis |
| which surgeries are performed in lateral recumbency | -eye surgeries -tooth extractions -mandible fracture repairs -laryngotomy -arthroscopies -periosteal strips -splint fracture removal -neurectomy -condyle fracture repair |
| which procedures can be performed when they are sedated and standing | -extraction of wolf teeth (1st premolars) -repair rectovaginal tears (epidural) -caslkicks procedure -perianal lacerations (epidural) -uncomplicated ovarioectomies -tendon splitting -castration -neurectomy (of a single branch) |
| how many minutes is your chlorhexidine scrub for a horse surgical site | minimum 7 mins |
| what 2 procedures do you not use alcohol on for equine | -castrations -eye surgeries |
| if eye is being enucleated (removed) what must you do to the eyelids | eyelids are sutured closed |
| what position do horse recover in after surgery | the same recumbency they were in during surgery |
| what lateral recumbency is preferred for recover in horses after surgery | left lateral |
| where is padding placed on a horse during recovery | padding placed between the halter and the face |
| what must be worn by the personnel during the recovery of a horse | helmet |
| when is the ET tube pulled out during an assisted recovery | when they swallow |
| when is the ET tube pulled out during a non-assisted recovery | horse is standing |
| where should a horse be kept post op | kept in a warm and quiet location |
| what is the feeding regimen for horses post op | -clinic specific -determined by type of surgeries -monitor feces |
| what condition is ALWAYS a risk during general anesthesia for a horse | ileus (cessation of intestinal motility) and can lead to impactions/obstructions |
| when can soft food be offered to horses after surgery | after feces is passed |
| when can a small amount of hay be fed to horses after surgery | a few hours after eating soft food such as bran mash |
| what to do if a horse does not pass any feces after surgery | -vet does a rectal exam to see if impacted |
| what to do if a horse is impacted after surgery and cannot pass feces | mineral oil and warm water is introduced into the stomach |
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jscott41
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