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Bovine GI surgery 2

Rachael Jones 4. Gastrointestinal English 45 cards

Cards in this deck (45)

  1. 1What is the conservative management of traumatic reticulo-pericarditis?- Broad-spectrum systemic antibiotics
    - NSAIDs
    - Oral fluid therapy
    - Magnets
    - Generally poor response
  2. 2What is the surgical treatment of traumatic reticulo-pericarditis?- Timing crucial
    - Left paralumbar fossa laparotomy
    - Explore of the cranioventral abdomen alongside the rumen and reticulum
    * Adhesions palpable between the reticulum and the diaphragm
    - Perform rumenotomy
  3. 3What is the method of a rumenotomy?- Secure rumen to body wall
    * Stay sutures
    * Rumenotomy frame and sleeve
    * 2 x IM pins
    - Rumenotomy incision
    - Manual exploration and remove FB
    - Rumen Closure
    * Two layers
    * continuous inverting suture pattern
    * #2 synthetic absorbable suture material
  4. 4What pattern is used to suture the seromuscular layer of the rumen to the skin?Inverting pattern
  5. 5What is the prognosis with traumatic reticulo-pericarditis?Guarded to poor
    - Usually poor response to medical treatment
    - Surgery is often unrewarding
    - Timing of surgery is key
    * At moment of exit of FB from reticulum
    * Easier and more successful if performed early
    - Guarded if the peritonitis is generalised
    - Very poor if muffled heart sounds
  6. 6Give 4 other indications for rumenotomy.1. Ruminal FB (especially if linear)
    2. Ruminal tympany: Alternatively place ruminal trochar and cannula
    3. Grain overload and acidosis
    4. Poisoning
  7. 7What are the indications for exploratory laparotomy?1. Severe or increasing abdominal pain unresponsive to analgesics
    2. Unresponsive or deteriorating shock
    3. Distended small intestinal loops, tight mesenteric bands or palpable impaction on rectal examination
    4. Chronic ruminal indigestion / tympany
    5. Complete absence of faecal production
    6. To obtain a diagnosis in cases where other methods have been unsuccessful or impractical
  8. 8What are general features of rectal prolapse?Uncommon
    Use standing restraint
    Caudal epidural anaesthesia
  9. 9How do you perform a simple replacement of rectal prolapse?- For use in simple, fresh mucosal prolapse
    - Retain the rectum in its normal position with a purse string suture
    * Place suture 1 to 2 cm outside the anal sphincter
    * Anal opening should allow adequate faecal passage
    * Suture should remain for several days only
  10. 10How do you perform a rectal amputation?- Insert a firm walled, open tube into the lumen of the prolapse
    * Plastic tubing or syringe cases may be considered
    - Anchor with a circumferential ligament outside the anus at the most proximal position of the prolapse
    - The tube and the ligature will stimulate sloughing of the distal portion of the prolapse
  11. 11What are atresi ani/coli/ recti classed as ?Congenital absence of sections of the terminal GIT
  12. 12What are features of atresia ani?- Seen most commonly in lambs
    - Treatment involves surgically recreating an opening
    - A vertical incision is made over anal sphincter, the blind end of the rectum is dissected,
    - The perirectal tissue sutured to the dermis, the blind end of rectum incised and the rectal mucosa sutured to the skin
    - Prognosis with surgical correction is good
  13. 13What are features of atresia coli and recti?- See more in calves
    - Very poor prognosis even with surgical correction
    - Euthanasia should be considered
  14. 14What are the differential diagnoses for umbilical masses?- Umbilical Hernia
    - Omphalitis (“Navel ill”)
    - Umbilical Abscess (SC or intra-abdominal)
    - Umbilical Remnant Infection
    - A combination of the above
  15. 15What is the aetiology for umbilical hernia?Failure of umbilical closure
    1. Congenital predisposition
    - Heritable (e.g. Holsteins)
    2. Acquired
    - Concurrent infection
    - Trauma (overzealous chewing on the umbilicus of the dam
    3. A combination of the above
  16. 16What are the clinical signs with umbilical hernias?- Ventral midline
    - extending caudally from the umbilicus (1cm to >30cm)
    - Soft
    - Non-painful
    - Normally reducible
    - Typically BAR with no impact on appetite or growth rates
  17. 17What can the content of an umbilical hernia be?1. Greater omentum : majority
    2. Abomasal fundus
    3. Intestinal loops : rare, due to short mesenteric attachments and omental sling
  18. 18How can omphalitis be treated?Medical therapy
  19. 19What is the aetiology of umbilical abscess?- Secondary to Naval ill
    - Walled-off infection persists within the umbilical stump
    - Subcutaneous or intra abdomen
  20. 20What are the clinical signs with umbilical abscesses?- Typically firm, hot and painful
    - +/- draining sinus tracts and purulent umbilical discharge
    - +/- Pyrexia or systemic signs
  21. 21What is the aetiology for umbilical remnant disorders?- Failure of elastic recoil / post partum closure of elements of umbilical cord
    - Concurrent umbilical hernia
    - Concurrent infection
  22. 22In what direction do the umbilical remnants go?- Umbilical vein = cranial to liver
    - Umbilical arteries = straight up
    - Urachus = caudal to bladder
  23. 23What is a common problem from an umbilicus remnant?Urachal abscess
  24. 24What is the diagnostic approach to umbilical masses?- History
    - Full clinical examination
    - Digital palpation of the umbilical mass
    - Deep abdominal palpation: Start from the umbilical mass and work dorsally, then cranially and caudally in turn
    - Ultrasound examination
  25. 25What are the diagnostic considerations with umbilical masses?1. Is the umbilical mass non-painful, soft and reducible?
    2. Is the mass firm, hot and painful?
    3. Is there a purulent umbilical discharge?
    4. Is the calf pyrexic or systemically unwell?
    5. Does deep abdominal palpation reveal a palpable intra-abdominal extension?
    6. Does ultrasound examination reveal the presence of omentum or gastro-intestinal tract?
    7. Does ultrasound examination reveal the presence of hyperechoic (“starry sky”) pus?
    8. Does ultrasound confirm an intra-abdominal extension of the umbilical mass?
  26. 26What are the treatment options for umbilical masses?- Conservative
    - Drainage
    - Umbilical herniorrhaphy
    - En-block resection
  27. 27What is the conservative treatment for umbilical masses?- Resolution of small hernias
    +/- Abdominal bandaging
    - Systemic antibiotics: E. coli, T. pyogenes, Min. 5 days
    - NSAIDs
  28. 28What is the prognosis with conservative treatment for umbilical masses?1. Good:
    - Small hernia
    - Omphalitis
    - though extensive scarring and fibrosis can lead to recurrence
    2. Poor response
    - Complicated cases with concurrent umbilical hernia, abscessation or umbilical remnant infection
  29. 29How can establish drainage work for treatment of umbilical masses?- Simple umbilical abscesses only
    - Pre-operative ultrasound / FNA : to confirm diagnosis
  30. 30What is the prognosis for drainage treatment for umbilical masses?- Good: simple umbilical abscesses
    - Poor: complicated umbilical abscesses with concurrent herniation or if infected umbilical remnants remain
  31. 31What is the approach for establish drainage for umbilical masses?- Restrain the calf standing or in lateral recumbency
    - Surgically prepare the incision site
    - Make a bold incision (approximately 5cm long) at the most dependant point of the mass
    - Express all the purulent material and flush with dilute iodine solution
  32. 32What other drugs can be given with draining?- systemic antibiotics
    - NSAIDs
  33. 33What are features of umbilical herniorrhaphy (repair)?1. Indications:
    - Umbilical hernias greater 3-5 cm
    - Complicated umbilical hernias
    2. Timing
    - Around 3-4 months of age if possible
    3. Anaesthesia
    - GA (preferred)
    - Lumbosacral epidural and sedation
  34. 34What is the approach for umbilical herniorrhaphy?- Elliptical incision
    - +/- preputial reflection
    - Blunt dissect through the subcutaneous tissues to expose and free the hernial sac
    - Care not to penetrate the peritoneum
    - The free hernial sac is inverted into the abdomen.
    - Margins of the hernial ring debrided to improve adhesion
    - Preplace tension-relieving sutures
    - Tie off individually
    - Oversew abdominal wall margin in a simple continuous pattern
    - Routine closure of SC tissues and skin
    - Possibly secure a stent over the incision to provide protection for the first 24-72 hours
  35. 35Give 2 types of tension-reliveing sutures that can be used for umbilical herniorrhaphy.- Mayo overlapping suture (vest over pants)
    - Horizontal mattress sutures
  36. 36What can be used for umbilical herniorrhaphy although rare now?Meshes
  37. 37What are features of using meshes for umbilical herniorrhaphy?- Rarely used
    - Designed to close large defects
    - Polypropylene or steel meshes
    - Must be placed under strict sterile surgical conditions
    - Contraindicated if
    * on farm due to compromised asepsis
    * complicated hernias with concurrent infection
  38. 38What are the indications for en bloc resection for umbilical masses?- Chronic, intractable omphalitis
    - Umbilical abscess complicated by herniation
    - Umbilical remnant infection
  39. 39What are the preoperative considerations for en bloc resection?- Culture and sensitivity
    - Systemic antibiotics: min 3 days pre-surgery
    - Ultrasound abdomen: tract infection within the abdomen
  40. 40How must en block resection be performed?General anaesthesia essential
  41. 41What is the approach for en bloc resection?- Initially as for umbilical repair
    - Extreme care should be taken to avoid rupturing abscesses
    - Tent the abdominal wall and incise peritoneum either:
    * cranially: in cases of urachal abscessation and omphaloarteritis
    * caudally : in cases of umbilical vein abscessation
    - Careful resect from abdominal wall
  42. 42What are features of umbilical remnants?- Urachal abscessation: the proximal urachus is ligated or the bladder tip amputated
    - Umbilical vein abscessation: the proximal umbilical vein is ligated, or if it extends into the liver tissue, marsupialised at a separate site
    - Umbilical Artery Abscess: Tract as far as possible into the abdomen
  43. 43What is the post of care of en bloc resection?- NSAIDs
    - Antibiotics, min. 5 to 7 days
    - Abdominal bandaging
    - Keep animal confined to prevent excessive movement
  44. 44What are possible post op complications for en bloc resection?1. Serosa formation (common)
    - Generally 5 to 7 days post op
    - Keep confined for 3 to 4 weeks post op
    - Ensure doesn’t get infected
    2. Unable to resects fully and infection left in abdomen
    - Care where umbilical vein tracking into liver!
    3. Peritonitis
  45. 45A 3 week old calf presents with an umbilical mass approx. 12 cm diameter. It is hard, hot, and painful to touch. The calf is off colour. What would be the most useful diagnostic test to perform?Ultrasound

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4. Gastrointestinal (Bovine Gastrointestinal Surgery - Julie MacFarlane) Flashcards on Bovine GI surgery 2, created by Rachael Jones on 01/11/2018.
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