Surgery – General Abdominal Surgery

What are common premedications and their doses?
Acepromazine: 0.02-0.05 mg/kg

What are common induction agents and their doses?
Propofol: 4-6 mg/kg
Propofol at 2 mg/kg and diazepam at 0.25 mg/kg
Ketamine at 5 mg/kg plus Valium at 0.25 mg/kg or combined Ket/Val at 1 ml/10 ikg

What are common medications for fractious cats and their doses?
Medetomidine at 0.02 mg/kg
Butorphanol at 0.2 mg/kg
Ketamine at 5 mg/kg

What is commonly used for maintenance of anesthesia?
isoflurane and sevoflurane

What is the most common antibiotic?
cefazolin (1/2 hour prior to start of surgery and every 2 hours intra-op)

How long should the incision be for exploratory laparotomy?
at least 10 to 15 cm margins (from the xiphoid process to the pubis)

What type of sponges should be used during a laparotomy surgery?
laparotomy sponges only – do not use 4×4 sponges

What are the three layers to go through when entering the abdomen?
(1) the skin, (2) subcutaneous tissue and (3) linea alba/rectus abdominis

What are the four parts of the linea alba/rectus abdominis (superficial to deep)?
(1) linea alba, (2) external rectus sheath, (3) rectus abdominis and (4) internal rectus sheath

What part of the rectus sheath holds the strength?
the external rectus sheath

What part of the rectus sheath is usually intimate with the peritoneum?
the internal rectus sheath

What type of cutting is most commonly used for incising through the skin?
slide cutting

Why do you not want to undermine, dissect or remove SQ fat to find the linea alba?
it increases the risk of post-operative seroma or infection

What can be applied by the surgeon to increase slide cutting efficiency and precision?
force vectors

Where do you make incisions for the following procedures?
-exploratory laparotomy?
-dog OHE?
-cat OHE?
-cystotomy?
-gastrotomy?
– exploratory: xyphoid to pubis
– dog OHE: cranial third of the caudal abdomen
– cat OHE: middle (cranial) third of the caudal abdomen
– cystotomy: umbilicus to pubis
– gastrotomy: xyphoid to pubis

How can you provide adequate hemostasis when making incisions into the abdominal wall?
by cauterizing, ligating or applying pressure to small bleeding vessels before proceeding to the next layer

When making abdominal incisions, what needs to be done differently in the male dog?
need to curve the skin incision to the right (or left) to avoid the prepuce

In male dogs, what vessels do you need to ligate or cauterize that is different from the other animals?
branches of the superficial caudal epigastric artery and vein

How do you enter the abdomen through the linea alba?
palpate interior surface of linea for adhesions; tent the abdominal wall at or cranially to the umbilicus with tissue forceps to protect underlying organs; make a sharp reverse stab incision into the linea alba with the scalpel blade horizontal; use dissecting scissors to extend the incision cranially and caudally

What is an exploratory laparotomy?
a methodical examination of the abdominal organs

When would you perform an exploratory laparotomy?
organ biopsy; therapeutic reasons; emergencies; severe trauma

Why does the falciform ligament need to be removed? How can it be removed?
need to get it out of the way to better see the viscera and allow for better abdominal closure; can remove by excising with cautery or scissors/blunt traction with hemostats only from its attachment at the midline in small patients

What type of retractors are used for exploratory laparatomy?
balfour

Why should you place moistened lap sponges along the subcutaneous tissue before placing retractors?
to prevent direct contact of viscera with skin; prevent dessication of exposed tissue and prevent contamination of exposed tissue

How should exploration of the abdomen be performed?
systematically

What can be found in the cranial abdomen?
liver, gall bladder and common bile duct, stomach, diaphragm, left pancreatic duct and cranial abdominal lymph nodes

Explain the duct system found in the cranial abdomen?
the cystic duct from the gall bladder receives hepatic ducts from each liver lobe; this bile duct empties into the duodenum on the major duodenal papilla

The omental bursa needs to be opened to view which structures?
the dorsal surface of the stomach, the left pancreatic limb and the cranial abdominal lymph nodes

What is found in the right gutter?
the right adrenal gland, the right kidney, the right ureter and the right ovary and uterine horn (or stump)

What acts as a natural internal retractor?
the duodenum and mesoduodenum

Why can the right adrenal gland be difficult to see?
because it is covered by the caudate process of the caudate hepatic lobe

Where is the epiploic foramen?
cranailly in the root of the mesoduodenum and it lies medial to the caudate process of the liver bounded by the portal vein ventrally, and the vena cava/celiac artery dorsally

What can often be visualized in the area of the epiploic foramen?
portosystemic shunts

What is a common location for entrapped bowel in equine colic patients?
the epiploic foramen

What is found in the left gutter?
spleen, left adrenal gland, left kidney, ureter and ovary and uterine horn or stump

What is found in the caudal abdomen?
the bladder, the sublumbar lymph nodes, the prostate gland and the uterine body or stump

What is the ventral ligament and can it be transected?
a reflection of the peritoneum and it can be reflected

Why can the right and left ligaments of the bladder not be cut into?
they contain the ureters, hypogastric nerves and primary blood supply to the bladder

Why is biopsy rather than complete excision of masses in the bladder usually performed?
because the masses are typically located at the trigon making it difficult to excise

What type of pattern do you close the bladder with?
a single or double layer appositional or inverting pattern using absorbable suture

What is found in the central abdomen?
the omentum, intestines, mesenteric lymph nodes and the pancreas

Can the mesenteric lymph nodes be removed?
no as this will damage mesenteric vessels and kill the small intestine

What should you do in case of ileus?
milk luminal contents distally to prevent absorption of enterotoxins

What are all tissue biopsies submitted in for histological examination?
10% buffered formalin

What is an incisional biopsy?
a biopsy of a selected portion of a lesion with some adjacent normal tissue

What is a wedge biopsy?
a biopsy where a wedge of tissue is taken from the organ/lesion

What is an excisional biopsy?
a biopsy of an entire lesion including a significant margin of normal appearing tissue

What is a punch biopsy?
a circular sample taken with a Baker’s punch

Define transect
cut through

Define incise
to cut into

Define excise
to cut out

Define proximal
relative term used to describe a structure closer to the heart

Define distal
relative term used to describe a structure farther from the heart

What is a percutaneous liver biopsy good for? Which patients should it be cautioned in? How can the sample be taken?
diffuse liver disease; patients with coagulation concerns; make a small incision through the skin on the left side of the xiphoid and insert the biopsy needle in a craniodorsal direction aiming to the left of the midline

What is the guillotine method of biopsy used to obtain? How is this done?
a periphery sample of the liver; absorbable suture material is placed around the protruding margin of a liver lobe and pulled tight – hold the liver and with a sharp blade, cut the hepatic tissue approximately 5 mm distal to the ligature

When can a biopsy punch be done? How do you provide hemostasis afterwards?
when the lesion is more centrally located; place a small plug of gelatin hemostatic sponge within the biopsy site to provide hemostasis

What type of biopsies can be done for a lymph node?
a Tru-Cut needle biopsy or an incisional biopsy

What type of biopsies can be done for the spleen?
– FNA – diffuse pathology
– Focal lesions (FNA, Tru-Cut, punch biopsy and excisional biopsy)
– Diffuse lesions – partial or total splenectomy

What type of biopsies can be done for the kidney?
– percutaneous biopsy (Tru-cut)
– wedge biopsy

What type of sutures should be placed in the stomach after doing a biopsy?
a stay suture

How is a stomach and/or an intestinal biopsy done?
a 3-5 mm elliptical incision into the lumen either transversely or longitudinally is made; usually closed with interrupted appositional sutures of 3-0 or 4-0 monofilament absorbable suture

What is the “leak test” for GI organs?
saline is injected into the biopsied segment while the area is occluded digitally or with Doyon forceps

When is lavaging the abdomen indicated for? What do you use?
peritonitis, diffuse intra-operative contamination and GI surgery; warmed balanced electrolyte solutions (without antiseptics or antibiotics) and then remove the lavage fluid by suction

What is the holding layer that must be included when closing the abdomen?
the external rectus sheath

What pattern can be used when closing the linea alba?
a simple interrupted or a simple continuous pattern

Why is a subcuticular pattern used when closing the skin?
eliminates dead space and provides apposition of skin to decrease tension on the skin; client does not need to return to have stitches removed; animal does not have any sutures to chew on; reduces scarring

What types of needles are there and what are they used for?
taper needle – preferable for hollow organs and soft tissues that are easily penetrated
cutting needle – used for hard tissues (skin, ligaments, etc)
reverse cutting needle – a midway for solid tissues

What rate should fluids be at post-op?
5 ml/kg/hr

What is a paracostal celiotomy (or paralumbar incision) used to expose? What position is the animal in? How is the incision made?
kidneys and adrenals; lateral recumbency; incision is made from the ventral vertebral column to near the ventral midline – the incision is centered halfway between the wing of the ilium and the last rib – the incision is extended through the internal abdominal oblique – the peritoneal and transversalis fascia is exposed – the peritoneum is tented and incised with a reverse stab incision

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