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What are considerations for complications with any abdominal surgery? (6)
- pain
- anesthetic complications (the risks really end at extubation)
- infection
- shock- hypovolemic, hemorrhagic, septic
- andominal hemorrhage
- unrelated issures- GDV, GI obstruction, intussusception, peritonitis, pancreatitis
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What should you do first when you find you patient with high HR, high RR, prolonged CRT, lethargic, etc?
- establish IV access
- fluid therapy- crystalloids (LRS, plasmalyte), shock doses if signs of hypovolemia; maybe colloidsjQuery1101020353799895383418_1485875171651
- then assess patient
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Describe patient assessment for complications. (4)
- abdominal palpation- don't squeeze! feel for distention, fluid wave
- ascult heart and lungs- aspiration
- character and quality of pulse
- temperature
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What is the first hint that a patient has aspirated under anesthesia?
develop a fever, usually within 10 hours after surgery (cough doesn't develop until later)
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What diagnostics do you go to first immediately when you suspect complications? (4)
- PCV/ TS- serial samples
- indirect doppler BP
- warm patient- heating pad, bair hugger
- maybe EKG
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What information does radiographing patients after abdominal surgery give you?
nothing- there will be air in the abdomen for up to 2 weeks and it will be impossible to interpret them (unless you're looking for a surgical instrument or sponge left in the abdomen)
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What are indications of active bleeding? (4)
- abdominal fluid PCV similar to peripheral PCV
- presence of platelets or clumps on a smear of the abdominal fluid
- serial evaluation of peripheral PCV continuing to decrease
- failure to respond to appropriate fluid and/or colloid therapy
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How do you manage a patients with a bleeding ovarian pedicle? (4)
- increase abdominal pressure by putting a compression bandage on
- give colloid therapy
- monitor vitals
- if very severe, give blood products (packed RBCs, plasma)
- [an ovarian pedicle will not cause a dog to bleed out!]
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What are the most common complications of OVH? (6)
- urogenital injury- ligation/ sever ureter, bladder perforation, bladder torsion
- ovarian remnant
- excessive bleeding
- braided suture- draining tract
- abdominal dehiscence
- urinary incontinence
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What is the typical presentation with inadvertent ligation of the ureter?
hydronephrosis--> weeks, months, years later with a giant kidney
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What are causes of incisional dehiscence? (5)
- failure to close correct layer (missed external rectus fascia)
- suture failure
- poor choice of suture material- premature loss of tensile strength, inappropriate suture size
- failure to restrict exercise
- iatrogenic patient trauma
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Describe treatment of incisional dehiscence. (5)
- bandage exposed tissues
- reduce anything that has herniated out (as long as viable)
- surgical repair
- clean and prep open wounds or exposed tissues
- primary closure of open tissues
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What are rule-outs for incisional swelling? (4)
- incisional dehiscence
- seroma
- incisional abscess
- cellulitis
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How do you manage a seroma?
- wait....advise owners that it's going to take take but it will reabsorb
- maybe warm compresses
- maybe belly wrap
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What are some potential hemorrhagic situations? (5)
- VWD- deficiency of factor VIIIA- prolonged BMBT- have FFP or cryoprecipitate ready to transfuse
- coagulopathy
- platelet deficiency or dysfunction
- rodenticide toxicity
- liver dysfunction
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