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What is the medical term for surgical incision into the abdominal cavity?
celiotomy
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what is term for flank approach to abdominal cavity?
laparotomy
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What are options for abdominal approach?
- ventral midline
- paramedian
- flank
- paracostal
- combinations
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When opening on ventral midline, what is incised to enter abdomen? what is the advantage of cutting here?
- linea alba
- less bleeding, exposure of all abdominal organs
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What muscle belly has to be displaced for paramedian incision?
rectus abdominus m.
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what are landmarks for flank incision?
lateral incision btwn last rib and tuber coxae, starting ventral to paralumbar muscles
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where is paracostal incision made?
- caudal and parallel to last rib
- (limited expsure so rarely used alone)
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What is required when pleural cavity is opened?
- assisted ventilation
- thoracic drainage
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What is location/length of incision in exploratory celiotomy?
xyphoid process to pubis (incise through umbilicus)
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How long should the skin incision be in relation to the body wall incision?
skin incision extended 1cm cranial and caudal to anticipated body wall incision
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Where is the linea most easily recognized in the dog?
cranial to umbilicus
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What vessels run parallel to linea cranial to umbilicus?
cranial superficial epigastric vessels
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What is technique for entering abdominal cavity at linea alba?
- use thumb forceps to tent linea alba w/constant pressure
- make stab incision w/blade up at 45-60 degree angle
- cut SQ with slide incision (violin grip)
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in male dog, is the prepucial orifice draped in or out of the field for celiotomy?
out of the field
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What muscle must be severed in the male dog for celiotomy? should ends be reattached later?
- prepucialis muscle
- yes, reattach later
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When closing celiotomy, should peritoneum (internal sheath) be sutured?
does not need to be included in suture (not holding layer and could increase adhesion formation)
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Should the rectus muscle be included in suture when closing celiotomy?
No, does not add strength to closure and increases inflammation
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In closure, how far apart should sutures be and how much tissue is incorporated?
- 5-10mm apart
- 5-10mm of tissue
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Is chromic gut appropriate suture for closing skin? stainless steel?
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what size suture is used to close celiotomy in dogs? in cats?
- dogs: 3-0 for all layers in med-small dog; 2-0 for linea in dog >25kg
- cat: 3-0 for 4-0
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What pattern in used for external sheath?
simple continuous (or interrupted)
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How is SQ tissue closed?
simple continuous or interrupted, using 2-0 to 4-0 synthetic absorbable suture (close preputialis m. in males)
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What is the most efficient diagnostic tool for definitive diagnosis of problems in abdominal cavity?
exploratory celiotomy and biopsy
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What is Trendelemburg positioning?
tilting table so head lower than feet-be aware of ventilation (reverse Trendelemburg has head higher than feet)
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What is the difference between excisional and incisional biopsy?
- excisional: remove with margins
- incisional: take wedge or part for sampling
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How deep of a margin should be excised?
- 1cm below or include one fascia layer below
- deeper for fixed mass; moveable mass has more connective tissue as margin
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What organs are commonly biopsied?
- liver, lymph node
- intestine
- kidney
- prostate
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What method of liver biopsy collection incises and ligates at same time?
guillotine (ligature fracture technique) - can only do at lobe margins
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what suture pattern is best for wedge resection of liver?
horizontal or vertical mattress
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What % of intestinal circumference should not be exceded when taking biopsies?
not to exceed 20% of circumference to avoid stricture
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When closing intestine, use a single or double layer closure? invert, evert, or appositional? partial or full thickness?
single - appositional - full thickness
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How should biopsy samples from intestines be taken?
- multiple sites
- full thickness, 1cm long
- preserve luminal diameter
- close w/normal transverse with simple interupted OR longitudinal to avoid stricture
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What suture pattern is used after biopsy of lymph node?
horizontal mattress (low tension - friable tissue)
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What is a main concern when taking biopsy of kidneys? what suture pattern to close?
- hi arterial pressure so careful of hemostasis
- mattress or continuous pattern
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Why is it important to palpate prostrate before collecting sample (what structure needs to be avoided)?
avoid penetrating urethra, avoid dorsal aspect
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What is main difference between collecting biopsy from stomach via endoscopy v. celiotomy?
- full thickness sample with celiotomy
- endoscopy not full thickenss, sampling mucosa
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what must be performed immediately prior to abdominal closure?
abdominal lavage w/warm isotonic solution
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