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lam surgery
| Question | Answer |
|---|---|
| How many permanent incisor teeth on each side upper & lower | 3i. |
| How many permanent canine on each side upper & lower | 1c. |
| How many permanent premolars lower | 3pm. |
| How many permanent premolars upper | 3 or 4. |
| How many permanent molars on each side upper & lower | 3m. |
| 3 incisors on each side upper & lower | deciduous teeth. |
| 3 premolars on each side upper & lower | deciduous teeth. |
| 1 st deciduous incisors erupt | at birth or during the first week. |
| All deciduous premolars erupt | at birth or during the first week. |
| 2 nd deciduous incisors erupt | 4 to 6 weeks. |
| 1 st permanent premolars erupt | 5 to 6 months. |
| Sharp points are worn of the uppers | Lateral side. |
| Sharp points are worn of the lowers | Medial side. |
| Premolars & molars usually require a & for visual examination | speculum, light source. |
| Are commonly incriminated when a horse reacts abnormally to a bit | Wolf teeth. |
| Proof that the teeth are the problem is very difficult | wolf teeth. |
| Common term is parrot mouth | brachygnathism. |
| The m&ible is too short & as a result the upper incisors are rostral to the lowers | Brachygnathism. |
| Common term is sow mouth | Prognathism. |
| The m&ible is too long & as a result the upper incisors are caudal to the lowers | prognathism. |
| In addition to the fact that the incisors do not meet adequately in this condition the dental arcades do not wear properly | Prognathism. |
| Secondary to esophageal perforation or surgery | Esophageal Fistula. |
| Clinical sign is Food tinged drainage | Esophageal Fistula. |
| Waiting for several months for management is indicated | Esophageal Fistula. |
| Many will heal given time | Esophageal Fistula. |
| All will markedly decrease in size in time | Esophageal Fistula. |
| Surgical dissection & closure using the techniques described in esophageal stricture repair | Esophageal Fistula. |
| Clinical signs chronic esophageal obstruction-signs as described in esophageal obstruction | Esophageal Diverticulum. |
| Diagnosis is radiography | Esophageal Diverticulum. |
| Surgical management, excision & surgical repair, approach as in partial resection | Esophageal Diverticulum. |
| Excision of the involved mucosa & submucosa | Esophageal Diverticulum. |
| Closure as in partial resection | Esophageal Diverticulum. |
| Cervical esophagostomy caudal to the site is indicated | Esophageal Diverticulum. |
| Mucosal inversion-suggested technique | Esophageal Diverticulum. |
| Submucosa of the diverticulum is dissected from the muscularis, diverticulum is inverted into the lumen & the muscularis sutured | Mucosal inversion technique. |
| An animal w/ an esophageal injury | indication for cervical esophagostomy feeding. |
| An animal that can not swallow | indication for cervical esophagostomy. |
| General anesthesia & dorsal recumbency is recommended | Cervical esophagostomy. |
| Can be done st&ing w/ sedation local anesthesia | Cervical Esophagostomy. |
| Acute pain of abdominal origin continues to be a considerable problem in the equine species | Colic. |
| In the past-assumed that a majority of causes of colic were associated w/ | Internal parasites,primarily strongylus vulgaris. |
| W/ very effective anthelmintics, is still a common problem | Colic. |
| No single test is available to determine | that an acute abdomen needs to be surgically explored. |
| Usually recommended to close both the superficial & the deep sheath of the rectus muscle | Closure of a paramedian approach to the abdomen. |
| Drains can be used as in ventral midline | Closure of a paramedian approach to the abdomen. |
| Subcutaneous tissue & skin as in ventral midline | Closure of a paramedian approach to the abdomen. |
| Usually it is slightly distended w/ gas & directly dorsal to the midline incision | Cecum. |
| If the cecum is not easily found, identify the | right ventral colon & follow the cecocolic ligament to the cecum. |
| Identify the dorsal b& of the cecum & follow it anteriorly until it becomes the | ileocecal fold & then the antimesenteric b& of the ileum. |
| Trace the small intestine anterior to the | duodenocolic fold which attaches the duodenum to the descending colon. |
| Starting cranially-much much more difficult but identify the duodenocolic fold | trace the intestine to the rear. |
| Under normal circumstances the stomach would have been decompressed prior to inducing anesthesia & this would not be a diagnosis made as a result of abdominal exploration | Gastric Dilatation. |
| Surgery to remove the large amount of ingesta present is a possibility, but very difficult | In the case of primary gastric dilatation. |
| The stomach could easily be dilated secondary to a | functional or mechanical obstruction of the small intestine. |
| In gastric dilatation it is quite important to pass a stomach tube prior to anesthetic induction | since in the horse it is extremely difficult to pass a stomach tube after the horse is anesthetized. |
| Occurs secondary to gastric dilatation | Gastric rupture. |
| Thorough medical evaluation prior to surgery should allow one to make this decision prior to surgery | gastric rupture. |
| In gastric rupture | occasionally surgery is performed to confirm the diagnosis. |
| When the abdomen is opened, ingesta is free in the peritoneal cavity, when there is this degree of contamination | there is no hope of a horse surviving the peritonitis,Euthanasia is the only option. |
| Gastric ulceration w/ resulting pyloric stenosis | occurs in foals. |
| Predisposed by stress & or non steroidal anti-inflammatory drugs | gastric ulceration w/ resulting pyloric stenosis. |
| This diagnosis is normally made w/ the aid of a cytology exam performed on gastric washings | gastric neoplasis. |
| Not normally a cause of acute abdominal pain | gastric neoplasia. |
| Occurs in foals & weanlings | ascarid impaction. |
| Older animals have normally developed an immune response to ascarids & although they may be infected the numbers are not adequate to cause an | obstruction. |
| Many times occur as a complication of abdominal surgery | Adhesions. |
| Older horses many times develop | lipomas that are attached to the mesentery by a peduncle or stalk. |
| Occasionally these become wrapped around a segment of bowel & cause an obstruction | pedunculated lipoma. |
| Very few if any cases have been reported outside of the | southeastern US. |
| Suggested causes of impaction of the distal ileum | Muscular hypertrophy,lack of proper motility,character of the feedstuff-coastal hay has been suggested. |
| This causes an adhesion | abdominal abscess. |
| Best management by diverting the flow of ingesta around the & placing the horse on | long term antibiotic therapy. |
| Telescoping of the bowel | intussusception. |
| Most common in foals | intussusception. |
| Ileum into the cecum –ileocecal | most common intussusceptions. |
| Possible to correct & leave the bowel in place but in animals it is usually | necessary to perform a resection & anastomosis. |
| Twisting of a segment of bowel on it’s mesentery so as to obstruct blood flow as well as passage of intestinal contents | Volvulus. |
| If surgery is performed w/in 6 hours of occlusion of the blood supply | it is possible to correct the volvulus & leave the bowel in place. |
| Usually requires resection & anastomosis | volvulus. |
| More common in older horses | internal hernia epiploic foramen. |
| Entrance to the omental bursa | epiploic foramen. |
| 4 to 6 cm in length | epiploic foramen. |
| Dorsal border-posterior vena cava | epiploic foramen. |
| Ventral border-portal vein | epiploic foramen. |
| W/ the horse in dorsal recumbency-feel along the right medial surface of the liver at about 9 oclock,the fingers will enter the | epiploic foramen. |
| According to one early study only what percentage of animals w/ intestine herniated through the epiploic foramen lived | 5. |
| Although only 5 pct animals lived w/ intestine herniated through the epiploic foramen lived | changed significantly as it is now routine to perform surgery earlier. |
| Diagnosis is complicated b/c the incarcerated bowel is trapped in the omental bursa | internal hernia through the epiploic foramen. |
| Most commonly the jejunum passes from right to left & into the omental bursa but | occasionally the intestine gains access to the omental bursa & passes from left to right. |
| B/c of its boundaries it is not possible to enlarge the | foramen. |
| Many times this is necessary to drain the bowel prior to pulling the intestine back through the foramen | perform an enterotomy. |
| Commonly requires a resection & anastomosis | internal hernia of the intestines through the epiploic foramen. |
| Intestine passes through an abnormal hole in the mesentery | mesenteric defect. |
| Presents a diagnostic problem since the hole may be anyplace | mesenteric defect. |
| Management involves identification & then either simple correction or correction before or after a resection & anastomosis | mesenteric defect. |
| A persistence of the omphalomesenteric duct 2 pct of humans have this | Meckel’s Diverticulum. |
| A finger like diverticulum 2cm in diameter & 6cm long connecting the antimesenteric surface of the ileum to the body wall in the area of the umbilicus | Meckel’s diverticulum. |
| Lumen of the meckel’s diverticulum is continuous w/ that of the | ileum. |
| Structure serves as an axis for a volvulus | Meckel’s Diverticulum. |
| Remember this condition when repairing umbilical hernias | Meckel’s Diverticulum. |
| When the peritoneal cavity is not opened, in repairing an umbilical hernia, this condition will probably not be diagnosed & corrected | Meckel’s Diverticulum. |
| Repair involves identification & surgical removal | Meckel’s Diverticulum. |
| Formed by persistence of the distal segment of a vitelline artery & the associated mesentery | Mesodiverticular B&. |
| Extends from one side of the mesentery of the jejunum to the antimesenteric surface of the jejunum | Mesodiverticular b&. |
| A triangular pocket is formed btw the b&, the mesentery & the jejunum | Mesodiverticular b&. |
| A loop of intestine becomes trapped in the pocket & causes a secondary volvulus | mesodiverticular b&. |
| Repair involves identification & surgical removal | mesodiverticular b&. |
| Seldom cause an acute abdomen but it is possible | Umbilical hernia. |
| Greater potential problem for a small hernia to cause & acute abdomen | Umbilical hernia. |
| Ideal time to correct umbilical hernias | Application of pressure or use of irritants early. |
| Surgical closure of umbilical hernia | Shortly after weaning 4 to 6 months. |
| Adequate time is usually given for the hernia to close naturally | umbilical hernia. |
| Clamp applied when the animal is a yearling 1 to ½ yrs old | umbilical hernia. |
| Diagnosis is usually obvious | Umbilical hernia. |
| Differentiate from umbilical abscess | umbilical hernia. |
| Abscesses predispose | umbilical hernias. |
| When the problem is acute, evidence of aabdominal pain,area is firm,painful & becomes edematous | umbilical hernia |
| Many of these in foals & some in calves will correct if given time | Umbilical hernias. |
| If the ring is less than 3cm in diameter there is a good possibility that it will correct by the time the animal is a yearling | Umbilical hernia. |
| Application of external pressure is not well documented | Umbilical hernia. |
| Some will close if an encircling b& is applied to keep the intestine in the abdomen | Umbilical hernia. |
| Simple obstructions of the colon | do not normally produce as acute a condition as do small intestinal problems. |
| Usually best to medicate these w/ laxatives,analgesics & adequate fluid support both orally & intravenously for a period of time | Simple obstruction of the colon. |
| Oral fluids can be given at the rate of 10 liters | every hour for prolonged periods of time to adequately hydrate the bowel content. |
| If there is no gastric reflux this has been shown to be better than intravenous fluid administration | Oral fluids. |
| Most commonly occurs at the pelvic flexure or the right dorsal colon | Impaction of the Large Colon. |
| Rectal exam is usually quite helpful in diagnosing the problem | impaction of the large colon. |
| Most commonly managed medically | impaction of the large colon. |
| Surgery is indicated if there is intractable pain,excessive gastric reflux, unresponsive to medical therapy for several days | impaction of the large colon. |
| Surgery involves ventral midline laparotomy,removing pelvic flexure from abdomen to perform pelvic flexure enterotomy, & flushing out the contents | Impaction at the site of the pelvic flexure of the large colon. |
| Usually the result of a motility problem | Impaction of the cecum. |
| Occasionally results when very course & poor quality hay is fed,peanut hay especially | impaction of the cecum. |
| Horse does not commonly show intense pain | impaction of the cecum. |
| Feces passes | impaction of the cecum. |
| Rectal reveals very firm hard cecum | impaction of the cecum. |
| Most have a nidus of some foreign material such as plastics,nets, halters | enteroliths in the large & or small colon. |
| Usual locations are in the right dorsal,transverse, or small colon | Enteroliths in the large & or small colon. |
| Manipulation to move the to an accessible area | Enteroliths in the large & or small colon for surgical removal. |
| If the enterolith is in the anterior small colon & can not be moved | open the abdomen from xyphoid to pubis,move the small & great colons out of the abdomen to improve access,towel off the involved area & remove the enterolith. |
| The left colon occasionally becomes trapped dorsal to the | nephrosplenic ligament. |
| Horses w/ this problem usually do not show the extreme pain associated w/ strangulating obstructions | nephrosplenic ligament entrapment. |
| On rectal examination it is sometimes possible to feel the displacement | nephrosplenic ligament entrapment. |
| Ultrasound is of value in making the diagnosis | nephrosplenic ligament entrapment. |
| Medical management includes controlling pain, keep off feed, intravenous fluids & forced exercise | Nephrosplenic ligament entrapment. |
| Phenylephrine has been used to reduce the size of the spleen in nephrosplenic ligament entrapment but | has been reported to cause fatal hemorrhage in horses 17yrs. |
| Bleeding has been used in the past to reduce the size of the spleen | Nephrosplenic ligament entrapment. |
| Short acting general anesthesia,pick horse up by rear legs to allow colon to move dorsally,put horse down on its rt side & roll to dorsal recumbency & then to left lateral & sterna recumbency | Non surgical management of nephrosplenic ligament entrapment. |
| VM lap, Id problem, force colon dorsal & lateral to free it from the nephrosplenic lig,reposition colon medial to the spleen,close incision | surgical management of nephrosplenic ligament entrapment. |
| close the NS space through a flank incision w/ animal st&ing or w/ a laprascope,perform a colopexy or large colon resection | Prevention-techniques that might be considered if the displacement is repeated. |
| The colon is twisted around its long axis | Torsion of the large colon. |
| Most common at the diaphragmatic & sterna flexure | Torsion of the large colon, volvulus. |
| The bowel is twisted around the mesenteric axis | Volvulus of the colon & or cecum. |
| Most common just anterior to the mesenteric attachment to the right body wall | Volvulus of the colon or cecum bowel is twisted around the mesenteric axis. |
| It’s possible to dx & reposition volvulus involved bowel w/ intestinal contents in place but | best to get pelvic flexure out of abdomen, perform enterotomy & flush prior to manipulating. |
| Following removal of intestinal contents, damage to the bowel is much less likely & manipulation much easier | surgical management of volvulus of colon or cecum. |
| Marked discoloration & lack of hemorrhage is reason to consider amputation of the large colon in | surgical management of volvulus of the colon or cecum. |
| Horses do fairly well w/ as | much as 90pct of their large colon removed. |
| If the entire cecum & large colon are involved in the volvulus & nonviable | then euthanasia is the only option. |
| Cecocolic intussusceptions | very rare. |
| Cecum passes through the ceocolic orifice into the right ventral colon | Cecocolic intussusceptions. |
| Non strangulating infarction of the colon | Mesenteric thrombus. |
| Results in an ileus & secondary impaction | Mesenteric thrombus. |
| Enterotomy to remove contents of the colon,reduction of distension & tension may allow recovery | surgical management of mesenteric thrombus. |
| Amputation of the involved colon, up to 90pct can be removed | surgical management of mesenteric thrombus. |
| Occurs in pig most frequently | rectal prolapsed. |
| Estrogens in feed relax anal region,high protein diets,Ab irritates anal region,limited exercise | Etiology of rectal prolapsed. |
| 1Edema & prolapsed of only the mucosa,2Evagination of the rectum | Types of rectal prolapses. |
| Surgical repair of rectal prolapse involves caudal epidural anesthesia which | is commonly used in all species except pigs. |
| Lumbosacral epidural anesthesia for surgical repair of rectal prolapse | is commonly used in pigs. |
| Position in surgical repair of rectal prolapse in horses,cows,sheep & mature hogs | St&ing,head down position for small pigs. |
| Used in rectal prolapse of the mucosa when tissue is fresh & there are no lacerations | Replacement & a purse string suture. |
| Leave the suture in place only long enough to control the rectal prolapse for several days | Purse string suture. |
| In rectal prolapsed resection of the mucosa is used when | the mucosa is not viable. |
| 2 parallel circumferential incisions are made 1 at the proximal portion of the rectal prolapse & 1 at the distal then | longitudinal incision is made connecting the 2 incisions & the ring of mucosa is dissected free. |
| Appose the 2 cut mucosal edges of the rectal prolapsed w/ interrupted sutures then | replace the rectum & maintain w/ a purse string suture. |
| Indicated when there is an invagination of the rectum | Amputation of the rectum. |
| Most commonly a problem in the horse | Rectal rupture. |
| Possible etiology is misdirection of the penis or iatrogenic in the course of a rectal exam 18-24 in cr to anus | Rectal rupture. |
| It is important during a rectal exam is | allow the h& to be pushed caudally when the animal strains. |
| Following rectal exam there is usually blood on the glove | Rectal rupture. |
| Consider an epidural to prevent straining & then do bare h&ed rectal exam | when a rectal rupture is suspected. |
| Allows one to feel defects in the rectal wall much more accrurately | Rectal rupture. |
| Through mucosa & submucosa | Rectal tear grade 1. |
| Through the muscularis-mucosa intact | Rectal tear grade 2. |
| Through mucosa & muscularis | Rectal tear grade 3. |
| Through mucosa, muscularis & serosa | Rectal tear grade 4. |
| Alert the owner of the problem-very important | 1 step in managing a rectal tear. |
| Mineral oil, antibiotics, limit hay & careful observation | Management of grade 1 & 2 rectal ruptures. |
| Suggested methods,keep feces soft,constant manual removal feces,suture blindly by 1 h&,production of temp colostomy diverting feces out lower flank | Management of grade 3 rectal rupture. |
| Rates a poor prognosis-peritoneum is heavily contaminated | Management of grade 4 rectal tear. |
| Temporary colostomy or the use of a rectal sleeve are indicated in this situation | Management of grade 4 rectal tear. |
| Will normally be referred | Grade 3 & 4 rectal tears. |
| Usually, antibiotics & ship as soon as possible | Grade 3 & 4 rectal tears. |
| Possible to do as a st&ing procedure but usually done under GA | Diverting colostomy. |
| Low left flank approach | Diverting colostomy. |
| Suture peritoneum, abdominal fascia & skin to the anterior small colon 1 suture line for each layer | Diverting colostomy. |
| Incise colon on the antimesenteric b | Diverting colostomy. |
| Flush feces out of the small colon & rectum,the rent in the rectum is allowed to heal | Diverting colostomy. |
| The colostomy must be repaired after the rectum heals | Diverting colostomy. |
| LF = P & V | forestomachs. |
| RF = P & V | abomasum. |
| RPM = X | Abomasum. |
| RF = P & V | Duodenum. |
| RF = V & X | Jejunum. |
| LF = P, V & possibly X | Jejunum. |
| RF = P, V & X | ileum. |
| RF = P, V & X | Cecum. |
| RF = P, V & possibly X | ascending colon proximal loop 1 st part. |
| RF = P | ascending colon proximal loop 2 nd part. |
| RF = P | ascending colon proximal loop 3 rd part. |
| RF = V & X | centripetal loops. |
| RF = V & X | centrifugal loops. |
| RF = V | central flexure. |
| 1 ½-2 turns in bovine,3 in ovine & 4 in caprine | Spiral loops. |
| Last centrifugal turn spirals away from the coil & becomes associated w/ the mesenteric border of the jejunum | Ovine & Caprine. |
| Distal loop 1 st part | RF = P. |
| Distal loop 2 nd part | RF = P. |
| Transverse colon | RF = P. |
| Descending colon & rectum | RF = P. |
| Inaccessibity of rumen & rectulum | RF surgical approach. |
| Ability to evaluate reticulum | LF surgical approach. |
| Rumen acts as a space occupying lesion to keep the intestines out of the surgical field | LF surgical approach. |
| Restraint & condition of the patient,exposure vs short mesentery of the ruminant bowel,poor choice for exploratory lap | Bovine ventral midline approach. |
| Usually right,specific purposes such as abomasal surgery LDA or RDA,poor choice for exploratory lap | Bovine Paramedian surgical approach. |
| Usually right, specifc purposes such as abomasal surgery or cesarean w/ an emphysematous fetus | Bovine paracostal surgical approach. |
| Etiology dietary changes immediately prepartum or in the early postpartum period | LDA. |
| Too little fiber, subclinical hypocalcemia | LDA. |
| Recently emptied uterus creating an abdominal void | Mechanical factor for LDA. |
| Poor ruminal fill due to the presence of the gravid uterus or low dry matter in early postpartum | Mechanical factor for LDA. |
| Characteristic ungainliness of dairy cows as they rise or become recumbent | Mechanical factor for LDA. |
| Liptak test +,aspiration of fluid from the region just below the lowest border of the ping | LDA. |
| Abomasal ph<3,Ruminal ph>51/2 | LDA Liptak test +. |
| Diff Dx,ruminal gas cap w/ poor rumen motility,pneumoperitoneum,abdominal void due to poor ruminal fill | LDA. |
| Conservative Tx is rolling but high incidence of recurrences | LDA. |
| When facing patient from rt side an RDA results in | a 90 degree clockwise rotation. |
| When facing patient from rt side an abomasal torsion/volvulus results in a | 180-270 degree counter clockwise rotation. |
| Rarely the omasum will be involved in the | RTA. |
| The only hollow organs in the abdomen that cannot routinely result in a ping on the rt side | ROB=reticulum,Omasum,Bladder. |
| Rectal palpation will aid in determining which organ is associated w/ the rt sided | ping. |
| Tightly distended smooth surfaced viscus can be palpated rectally in the | Rt cr abdominal quadrant. |
| Seldom occurs | RDA. |
| Pylorus displaced dorsally & slightly cranially | RDA. |
| Greater curvature displaced dorsally | RDA. |
| Minimal rotation at omasal-abomasal junction | RDA. |
| Liver is not separated from the rt body wall by the abomasums | RDA. |
| This is relatively common | RTV,RTA. |
| Pylorus displaced cranially-counter clockwise motion | RTV,RTA. |
| Greater curvature is dorsal & cranial | RTV,RTA. |
| Noticeable twist or rifling at omasal-abomasal junction may occur at reticulo-omasal jct is a small pct of cases | RTV,RTA. |
| Important-liver will be displaced medially,away from the body wall by the greater curvature of the abomasums | RTV,RTA. |
| Electrolyte & acid-base abnormalities,Metabolic alkalosis,Hypochloremia,Hypokalemia | RTV,RTA. |
| Cecal dilation/torsion | right sided ping. |
| Finding a 6-10in diameter blind ended pouch or several loops of bowel of this size on rectal palpation | Cecal dilation/torsion. |
| One of the few conditions that may result in colic(colicy pain) in an adult bovine | Cecal dilation/torsion. |
| Lap findings,large distended cecum w/ or w/out a palpable torsion | Cecal dilation/torsion. |
| Lap findings except for the cecum other segments of intestine are relatively undistended due to the acute nature of the disorder | Cecal dilation/torsion. |
| Dx is abdominal pain (colic) during the first 6 hours,after this time animal seems relatively pain free | Bovine Intussusception. |
| Rectal palpation to find a 6-12in long sausage shaped mass in the ventral caudal abdomen | Bovine intussusceptions. |
| Dark, tarry feces | Bovine intussusceptions. |
| Adult bovine intussusceptions are typically very short in length | due to short mesentery & large amount of mesenteric fat. |
| Urachus becomes | Vestigial part of the bladder. |
| Two umbilical arteries become | The lateral or round ligaments of the bladder. |
| Umbilical vein becomes | Round ligament of the liver. |
| Five basic categories or conditions all cause enlargement of the umbilicus | UUUUE. |
| Most common congenital defect in cattle | Uncomplicated umbilical hernia. |
| Greater incidence in Holstein heifers,much less common in beef breeds | Uncomplicated umbilical hernia. |
| Heritable dominant recessive & sporadic characteristics | Uncomplicated umbilical herna. |
| Present early in life & routinely enlarge as the calf grows | Uncomplicated umbilical hernia. |
| Physical findings are completely reducible w/ a palpable ring & usually no systemic signs | Uncomplicated umbilical hernia. |
| Strangulation may occur & may involve small intestine, omentum, abomasums | Uncomplicated umbilical hernia. |
| Will cause obstruction of outflow producing a hypochloremic, hypokalemic, metabolic alkalosis | Uncomplicated umbilical hernia causing strangulation. |
| Will cause parietal hernia-richters hernia,where only one wall of the bowel is through that portion of the organ that is not through the ring | Uncomplicated umbilical hernia. |
| Abomasal fistula sometimes occurs when the abomasums is involved | Uncomplicated umbilical hernia. |
| Calves are more likely to have an abscess than are foals | Umbilical hernia w/ fibrous core or abscess. |
| Calves are more likely to wall of abscess umbilical hernia & not show systemic illness | than are foals but some will show systemic effects. |
| The normal situation is enlarged cord since birth w/ mass forming after several weeks | Umbilical hernia w/ a fibrous core or abscess. |
| Calf is usually in good general condition | umbilical hernia w/ fibrous core or abscess. |
| Palpation reveals a reducible dorsal hernia & a firm nonreducible ventral portion attached to the skin | Umbilical hernia w/ a fibrous core or abscess. |
| Any combination may be involved in umbilical hernia w/ infection of the umbilical cord remnants | OOU=Omphalophlebitis,Omphaloarteritis-least common,Urachal abscess-most common. |
| Many times there is failure of passive transfer | Umbilical hernia w/ infection of the umbilical cord remnants. |
| Organisms involved in umbilical hernia w/ infection of the umbilical cord remnants | SPCSEE=staph,proteus,corynebacterium pyogenes-most common,strep,ecoli,enterococcus. |
| Inflammation may inhibit through palpation & usually partially reducible | Umbilical hernia w/ infection of the umbilical cord remnants. |
| There is usually a cycle of enlargement followed by discharge | Umbilical hernia w/ infection of the umbilical cord remnants. |
| The calf is many times unthrifty & may have concurrent disease | Umbilical hernia w/ infection of the umbilical cord remnants. |
| Clinical findings warm,painful,nonreducible,usually firm but sometimes fluctuant,no hernia,may or may not show signs of systemic involvement | Umbilical Abscess. |
| Management is to lance, drain & flush | Umbilical Abscess. |
| Secondary to POT=Persistent patent urachus,Omphalitis,Treatment of the umbilicus w/ harsh antiseptics | Enlarged Umbilical Stump. |
| Clinical findings-mass which was noted at a young age that has not changed w/ the growth of the animal,good health,nonreducible,firm,nonpainful | Enlarged umbilical stump. |
| Dx Tech of umbilical masses | =CUPABC-contrast rad,US,Palpation,Aspiration,Bact culture,CBC. |
| REVIEW ANATOMY L side,R side | rumen, abomasum, omasum,reticulum. |
| Clinical signs suggestive of GIT diz | anorexia,decreased milk production (dairy cows)alterations in abd contour,abnormal feces,abd pain acute or chronic. |
| Clinical exam of bovine abd & GIT | Hx/habitus,abd contour,gross exam of feces,examination L&R sides,auscultation,percussion,ballottement,rectal exam. |
| detection of abd pain | w/ers pinch test, knee/grunt test. |
| Surgical approaches L flank,grid vs modified grid vs non-grid | modified grid is BEST approach. |
| St | paralumbar fossa. |
| recumbent – stay ABOVE fold of flank (or everything falls out). | |
| rumen acts as SOL | keeps intestines out of field. |
| R flank | st&ing – paralumbar fossa. |
| recumbent stay above fold of flank | rumen & reticulum INACCESSIBLE. |
| Ventral midline – most commonly used for | C-section. |
| POOR choice for exploratory | ventral midline. |
| Paramedian | usually on the R,specific purposes LDA or RDA |
| POOR choice for exploratory | paramedian. |
| Paracostal | usually R. |
| specific purposes abomasal Sx or C-section W/ emphysematous fetus | paracostal. |
| Anesthesia – GA | not typically done. |
| Local – LIDOCAINE (infiltration) | line block or inverted L block. |
| Regional | blocking specific nn (uses less anesthetic than local). |
| Paravertebral | T13, L1, L2. |
| Proximal = Farquaharson | needle perpendicular to lateral spinous processes. |
| Distal = Cakala-Delahanty (easier) | inject over/under end of lateral process (needle parallel to transverse spinous process). |
| Exploratory laparotomy (L paralumbar approach)should include location & evaluation of | reticulum & area (palpate but don’t see)rumen pull out & evaluateL attachment of greater omentum,caudal aspect of diaphragm,spleen. |
| Exploratory laparotomy (R paralumbar approach)MUCH better access & can see | liver/gallbladder,omasum,abomasums,cecum,R kidney. |
| Exploratory laparotomy In gen evaluate | GIT & mesenteric lnn,L kidney,pelvic lnn,inguinal rings (male),internal genitilia,ureters – where palpable in sublumbar fat,bladder. |
| ALWAYS do an exploratory when you do | bovine abd Sx. |
| Left Displaced Abomasum (LDA)Etiology | Dietary changes immediately pre-partum OR in early postpartum,too little fibre,subclin. Hypocalcemia. |
| LDA Mechanical factors | recently emptied uterusabd void POSTPARTUM. |
| LDA mechanical factor | poor ruminal fill due to presence of gravid uterus or low DMI (early postpartum period). |
| LDA clinical findings | off feed,decreased milk production,wt loss,NORMAL TEMP,slab-sided on L,PING on auscultation (on L side!)dripping sound use plexor & pleximetre. |
| liptak test (+) | to ID the structure. |
| LDA asp fluid from region just b/l lowest border of the ping | abomasal pH <3,ruminal pH >5,5. |
| LDA conservative Tx | rolling – cast on R & roll in clockwise direction, st& up & auscultate |
| LDA con tx | HIGH incidence of recurrence. |
| LDA Surgical correction/stabilization,Principles of repair | varies w/ approach,decompression, replacement, fixation. |
| LDA fixation techniques | abomasopexy, omentopexy, pyloropexy. |
| LDA L flank laparotomy & abomasopexy | approach of choice if abomasal ulcer suspected. |
| LDA L flank requires | ave to long arm (NOT for small people) & 2 people. |
| st&ing w/ local/regional anes | LDA L flank. |
| LDA ORDER OF REPAIR w/ LONG piece of suture preplace fixation suture IN greater curvof abomasum as far cranial as poss | simp cont or interlock,someone on otherside to pass needle back to you,decompress abomasum,pass sut thru body wall from insout halfway b/t xyphoid process &R milk wellveintie sut together,abo is FIXEDtolower,cr abd wall,leave for 4wk&cut sut from outside. |
| Left Displaced Abomasum Sx Approach | R flank laparotomy & pyloropexy OR omentopexy |
| Left Displaced Abomasum Sx Approach Pyloropexy | elevate pylorus to incision,suture to peritoneum & transversalis mm at cr/vtral aspect of incision. |
| LDA Omentopexy | elevate pyloric omentum to incision & suture w/ large horizontal mat sutures to peritoneum cr & ca to incision,alter,bunch up omentum & incorporate into peritoneum/transersalis closure = COMBO (pyloropexy/omentopexy). |
| Left Displaced Abomasum Sx Approach R paramedian laparotomy & abomasopexy | sedate/cast in dorsal,position slightly off dorsal,quicker approach,local infiltration anes. |
| ORDER OF REPAIR | decompression & replacement usually accomplished by POSITIONING,incision to R of midline,caudal to xyphoid,abomasum ID & sutured to peritoneum,LorR of incision,abomasum incorporated into closure of internal sheath of rectus mm. |
| LDA Sx Approach R paramedian laparotomy & abomasopexy | quick,no need for long arms,NO blind procedures,dorsal recumbency MAY regurg/asp,HARD to do exploratory. |
| LDA Sx Approach contd Blind suture techniques | position as for R paramedian,gen abomasum comes into proper position this way,carpet needle or GrymerSterner toggle suture(bar suture)AFIX TO SKIN,quick & cheap,disadv,miss abomasums,entrap some other organ,abomasal fistula more common complication. |
| Left Displaced Abomasum General post-op care | return to feed ASAP,b/c omentopexy LESS secure, AVOID high grain diet for several days allows adhesion formation,skin suture removal in 2wk EXCEPT L flank abomasopexy3-4wk. |
| LDA Complications | abomasal dysfunction(vagal indigestion)peritonitis,abomasal rupture,abomasal fistula. |
| LDA Prognosis | fair to excellent depending on length of time condition has existed,return to lactation variable,Abomasal volvulus/torsion (RTA/RTV) & Right Displaced Abomasum. |
| LDA NOT a big deal compared to | RDA/RTA. |
| Difference b/t RDA/RTA | when facing the patient from R |
| when facing the patient from R, an RTA/RTV | 180-270 COUNTER clockwise rotation,rarely omasum involved. |
| Abomasal volvulus/torsion (RTA/RTV) & Right Displaced Abomasum (RDA)DDx | ping on R can be due to gaseous distension of many organs. |
| only organs that CANNOT give ping | reticulum, omasum, bladder,rectal palpation will aid in Dx. |
| RTA/RTV – tightly distended smooth surfaced viscus palpated rectally in | R cr abd quadrant. |
| RDA | SELDOM OCCURS. |
| RTA/RTV relatively common | pylorus displaced cranially,counter clockwise motion,greater curvature is dorsal/cranial,noticeable twist/rifling at omasal-abomasal jxn,LIVER DISPLACED MEDIALLY AWAY FROM BODY WALL BY GREATER CURVATURE of abomasums. |
| Abomasal volvulus/torsion (RTA/RTV) & Right Displaced Abomasum | Electrolyte/acidbase abnormalities,metabolic acidosis, hypoCl, hypoK,GIVE FLUIDS B/F Sx,Repair of RTA/RTV,standing R flank laparotomy w/ pyloropexy or omentopexy. |
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