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What is the medical term for surgical incision into the abdominal cavity?
what is term for flank approach to abdominal cavity?
What are options for abdominal approach?
- ventral midline
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
What muscle belly has to be displaced for paramedian incision?
rectus abdominus m.
what are landmarks for flank incision?
lateral incision btwn last rib and tuber coxae, starting ventral to paralumbar muscles
where is paracostal incision made?
- caudal and parallel to last rib
- (limited expsure so rarely used alone)
What is required when pleural cavity is opened?
- assisted ventilation
- thoracic drainage
What is location/length of incision in exploratory celiotomy?
xyphoid process to pubis (incise through umbilicus)
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
Where is the linea most easily recognized in the dog?
cranial to umbilicus
What vessels run parallel to linea cranial to umbilicus?
cranial superficial epigastric vessels
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)
in male dog, is the prepucial orifice draped in or out of the field for celiotomy?
out of the field
What muscle must be severed in the male dog for celiotomy? should ends be reattached later?
- prepucialis muscle
- yes, reattach later
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)
Should the rectus muscle be included in suture when closing celiotomy?
No, does not add strength to closure and increases inflammation
In closure, how far apart should sutures be and how much tissue is incorporated?
- 5-10mm apart
- 5-10mm of tissue
Is chromic gut appropriate suture for closing skin? stainless steel?
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
What pattern in used for external sheath?
simple continuous (or interrupted)
How is SQ tissue closed?
simple continuous or interrupted, using 2-0 to 4-0 synthetic absorbable suture (close preputialis m. in males)
What is the most efficient diagnostic tool for definitive diagnosis of problems in abdominal cavity?
exploratory celiotomy and biopsy
What is Trendelemburg positioning?
tilting table so head lower than feet-be aware of ventilation (reverse Trendelemburg has head higher than feet)
What is the difference between excisional and incisional biopsy?
- excisional: remove with margins
- incisional: take wedge or part for sampling
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
What organs are commonly biopsied?
- liver, lymph node
What method of liver biopsy collection incises and ligates at same time?
guillotine (ligature fracture technique) - can only do at lobe margins
what suture pattern is best for wedge resection of liver?
horizontal or vertical mattress
What % of intestinal circumference should not be exceded when taking biopsies?
not to exceed 20% of circumference to avoid stricture
When closing intestine, use a single or double layer closure? invert, evert, or appositional? partial or full thickness?
single - appositional - full thickness
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
What suture pattern is used after biopsy of lymph node?
horizontal mattress (low tension - friable tissue)
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
Why is it important to palpate prostrate before collecting sample (what structure needs to be avoided)?
avoid penetrating urethra, avoid dorsal aspect
What is main difference between collecting biopsy from stomach via endoscopy v. celiotomy?
- full thickness sample with celiotomy
- endoscopy not full thickenss, sampling mucosa
what must be performed immediately prior to abdominal closure?
abdominal lavage w/warm isotonic solution