LA Sx, final, VII

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HLW
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187543
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LA Sx, final, VII
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2012-12-06 10:33:22
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LA Sx final VII
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LA Sx, final, VII
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  1. What are some clinical signs that suggest GIT disease in cows?
    • anorexia
    • decreased milk production
    • altered abdominal shape
    • abnormal feces
    • pain- acute or chonic
  2. If i want to evaluate the reticulum what flank do i enter- left or right?
    left flank
  3. A left displaced abomasum (LDA) can be caused by what?
    • - diet changes right before or right after birth (not enough fiber, low calcium)
    • -mechanical problems (uterus just emptied, poor ruminal fill)
  4. What are clinical signs of an LDA?
    • -not eating, not milking
    • -weight loss
    • -normal temp
    • -looks slab sided on the left
    • -ping
    • -liptak test positive
  5. What is the liptak test and what does it tell me for an LDA patient?
    • -aspirate fluid from region just below where you heard the ping
    • -pH of fluid = <3 its the abomasum
    • -pH of fluid = >5.5 its the rumen
  6. What are the 3 general principles of repair of an LDA?
    • 1. decompression
    • 2. replacement
    • 3. fixation
  7. What are the 3 appraoches for surgically fixing an LDA?
    • 1. left flank laparotomy and abomasopexy
    • 2. right flank laparotomy & pyloro or omentopexy
    • 3. right paramedian laparotomy and abomasopexy
  8. How many people are required to do a left flank surgical approach to an LDA and why?
    • 2 people
    • b/c we are adhering abomasum to ventral body wall so we need an assistant on the right side of the cow
  9. In a left flank surgical approach to LDA, where are the fixation sutures placed?
    • -greater curvature of abomasum as far cranial as possible
    • -sutures passed outside halfway b/w xyphoid process and right milk well
  10. What is the approach of choice if the poing is on the left side very low (LDA)?
    right flank laparotomy
  11. In a right flank approach to fix an LDA how do we return the abomasum to right lower quadrant (normal)?
    reach under rumen and grab greater omentum and pull!
  12. In a right paramedian laparotomy to fix an LDA how do we fixate the abomasum?
    • -sutured to peritoneum near your incision
    • -also incorporated into closure of internal sheath of rectus muscle
  13. In all of the LDA surgical approaches we are closing in 3 layers- what are they?
    • 1. peritoneum and transverse abdominus
    • 2. external abdominal oblique & IAO
    • 3. skin
  14. There are 2 blind surgical techniques for fixing an LDA- what are they? how is cow placed?
    • 1. carpet needle
    • 2. Grymer-Sterner toggle suture/Bar suture
    • cow is in dorsal recumbancy
    • (so abomasum fills with air and should be near ventral midline)
  15. What are disadvantages of the blind suture techniques to fix an LDA?
    • -you dont know if you actually are suturing abomasum to wall
    • (could be something else you got there!)
  16. What are the post-op care requirements after an LDA surgery?
    • -return to feed quickly
    • -avoid high grain diet until adhesions form in a few days
    • -antibiotics depending on contamination
    • -suture removal in 3-4 weeks (skin in 2 weeks)
  17. What are some complications after an LDA surgery?
    • -abomasal dysfuntion (vagal tone prob)
    • -peritonitis
    • -abomasal rupture (usually w/ulcers)
    • -abomasal fistula
  18. What is the prognosis for an LDA surgery cow?
    • -fair to excellent (depends on how long it went on before surgery)
    • -return to lactation variable
    • -high heat/humidity = lower prognosis
  19. Do beef cows or dairy cows get RDA/LDA's more often?
    dairy cow problem usually
  20. What happens anatomically in an RDA?
    when looking at patient from right side- a 90 degree clockwise rotation of abomasum
  21. What happens anatomically in a abomasal torsion/volvulus patient?
    • (when looking at patient from right side)
    • 180-270 degree counter clockwise rotation
    • omasum rarely involved
  22. In abomasal torsion/volvulus what do i feel on rectal exam?
    tightly distended smooth surfaced organ in right cranial quadrant
  23. What is more common LDA or RDA?
    LDA much more common
  24. What happens more RDA or right abomasal torsion/volvulus?
    • right abomasal torsion/volvulus more common
    • (RDA might just be a forerunner to this)
  25. Where is the liver located in RDA vs abomasal volvulus/torsion?
    • RDA- liver is in normal location
    • R torsion/volvulus- liver is displaced medially away from body wall, near the grater curvature of the abomasum
  26. In RDA & right abomasal torsion/volvulus what are the electrolyte imbalances we see?
    • -metabolic alkalosis
    • -hypocloremia
    • -hypokalemia
  27. What are the 2 surgical approaches to fix an abomasal torsion/volvulus?
    • 1. standing right flank laparotomy w/ pyloro or omentopexy
    • 2. right paramedian with abomasopexy
  28. What fluids should I use post op in my abomasal torsion/volvulus patient?
    NaCl with or without KCl to correct electrolytes and acid/base problems
  29. What side to I hear a ping on for cecal dilation/torsion?
    right side
  30. What are some of the few conditions that looks like colic in a cow?
    • cecal dilation/torsion
    • early intussusception
  31. What is the general surgical procedure to repair a cecal torsion/dilation?
    • 1. right paralumbar fossa- exteriorize apex of cecum
    • 2. cut into cecum and empty as much as you can (empty up to ascending colon)
    • 3. close cecum
    • 4. put cecum back into abdomen
  32. Why do some people like emptying the cecum when doing a surgical repair of decal dilation/torsion?
    positioning the cecum back into the abdomen is much easier when empty, and getting correct position not as important
  33. How do we diagnose an intussusception?
    • -first 6 hrs = colic signs (pain free after that)
    • -abdomen distended
    • -rectal- 6"-12" long sausage shaped mass in ventral caudal abdomen
    • -dark tarry feces
  34. Where are intussusceptions usually located in the bovine?
    jejuno-ileum of small intestine ("flange area of bowel")
  35. What approach is used to surgically repair intussusceptions?
    • -right flank laparotomy
    • -or right flank with recumbant animal
    • (dont do ventral midline b/c cows have short mesentary and we probobly cant get to the intuss. from there)
  36. How do we repair the intussusception?
    • exteriorize
    • resection & anastomosis
    • use appositional or everting suture (NOT inverting)
  37. What are indications to perform a rumenotomy?
    • -hardware disease/traumatic reticuloperitonitis
    • -grain overload
    • -ingested toxins
  38. What is the only surgical approach for a rumenotomy?
    left flank laparotomy- verticle incision a few inches caudal to the last rib
  39. Before opening the rumen what should you check for?
    adhesions on the serosal surface of the reticulum
  40. How do we close the rumen? Am i concerned about rumen contents in the abdomen?
    • 1 or 2 layers (usually 2)
    • less of a concern compared to other organs- just give antiviotics
  41. When would i put in a rumen fistula? what does this do?
    • young animals that are chronic bloaters
    • rumen is foxed to right paralumbar fossa
    • left open to air can get out
    • will heal over in time-hopefully patient stops bloating by then
  42. In small intestine or mesenteric volvulus are patients painful? what is their acid base status? prognosis?
    • very painful- looks like acute abdomen
    • acidotic- due to shock and perfusion problems
    • Px= poor to guarded
  43. What should always be part of a newborn calf check?
    look for atresia ani
  44. What are the signs in a calf with atresia ani? where does this come from?
    • CS= no feces, abdominal distention
    • heritable condition
  45. What is the prognosis for a calf with atresia ani?
    • poor Px
    • unless segment is really close to rectum and we can fix it
  46. Atresia coli is usually found where? can we surgically correct? is this heritable?
    • usually found in spiral colon
    • yes- sx is resection and anastomosis
    • not considered heritable
  47. Is intussusceptions more painful in adults or neonates and why?
    • neonates much more painful
    • b/c no mesenteric fat yet (blood supply cut off)
  48. I have a 2-12 month old calf presenting with chronic bloat with a variable ping on left side- what is the most likely dx?
    • Left displaced abomasum
    • (fix/tx same as adult)
  49. I have a 1-8 week old bottle fed dairy calf with a right sided ping & acute abdomen I picked up after i fed her alot of milk- whats the most likely dx?
    • abomasal volvulus/torsion
    • (repair thru right paramedian)

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