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lam surgery

QuestionAnswer
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.
Created by: alljacks