·         in and out the same day

·         routine surgery

·         no complications

·         rapid return to function

·         small wound

·         no sutures to remove

·         cheap price

·         sterilization

·         behavioral

·         neoplasia-testicle, scrotum

·         torsion

·         infection

·         prostatic disease

·         perineal hernia

·         urethral prolapse (often juvenile bulldog-hypersexual)

·         scrotal urethrostomy

which of the following dz is not testosterone dependent?

1.      prostatic neoplasia 

2.      benign prostatic hyperplasia 

3.      prostatic inclusion cyst

4.      para-prostatic cyst

5. prostatitis

• typically region of skin color or texture change
• hemorrhage-  tunic common site

o   vaginal tunic may prolapse through open site

§  local ulceration and bleeding

o   scrotal bleeding

§  local pressure↓

§  iv fluids, re-explore

o   right> left (right has further to travel)

o   abdominal>inguinal

o   dog>cat

·         gentle tissue handling

·         accurate knot tying

·         absorbable, monofilament

·         sterile technique

·         prevent self-trauma

which of the following is used to identify residual ovarian tissue in the bitch?

1.      PTHrp assay

2.      hCG stim test

3.      testosterone assay

4.      GnRH stim

5. ACTH Stim

_______ stim is used to check for testicular remnant; if neutered properly, should be ________. 

hCG

flatlined

• 13x more likely to develop testicular neoplasia, even if exteriorized
• sertoli cell tumor or seminoma most common
• increased tendency to torse (70% neoplastic)

o   gubernaculum, pampiniform, vas deferens (follow to testicle, NOT prostate)

• consider coagulopathy (abdonimal US, serial PCV/TS, ACT, BMBT)
• ice
• acepromazine
• scrotal ablation

which test is done to test for testicular remnant? How is it performed?

1.      PTHrp assay

2.      hCG stim test

3.      testosterone assay

4.      GnRH stim

5. ACTH Stim

hCG stim 500-700IU IV

look at testosterone baseline and 2 hours later

• redundant pendulous scrotum
• urethral sphincter incompetence

• behavioral
• prevention of 

1. ovary: abnormal cycling, neoplasia
2. uterus: cystic endometrial hyperplasia, neoplasia
3. vagina: edema, prolapse, neoplasia
4. mammary: neoplasia, no benefit after 2nd estrus

• standardization of medication (insulin, barbiturates)

benefits:

• minimal vascular development
• minimal fat
• mammary nx prophylaxis

disadvantages: 

• anesthesia and surgery concerns

3 months on

benefits:

• familiar procedure
• mammary nx prophylaxis

disadvantages: 

• fat present
• developing vascularity

before/around 1st estrus

benefits:

• increased survival time if animal goes on to develop mammary neoplasia

disadvantages: 

• vascularity
• possible pregnancy
• possibly obese
• possibly sick patient, heavy uterus
• no mammary nx prophylaxis

adult

1. anesthesia
2. inadvertent prostatectomy (anuria, uremia)

• get accurate anesthetic technique hx
• pass urethral catheter
• contrast urethrocystogram
• abdominal US

• ovarian pedicle hemorrhage
• broad ligament hemorrhage
• uterine pedicle hemorrhage

• stay calm and ask for help
•   make a larger hole, access is everything
• get blood out
• colonic (move colon to midline, everything underneath is urogenital
•          duodenal maneuver-everything to the right is urogenital
•          retract bladder caudally
•          check length of broad ligament
•       ovarian or uterine bleed more likely

• unicornuate animals
• intersex

·         infantile/recessed vulva is most common, predispose to perivuvlar dermatitis, possible urinary incontinence

·         stump pyometras (ovarian tissue left)

·         iatrogenic urogenital injury

·         ovarian/uterine stump granulomas

·         chronic fistulae

·         urinary incontinence

·         obesity

·         check serial PCV’s

·         eval coag status

·         abdominal ultrasound

·         volume resuscitation

·         abdominal exploratory, ligate pedicle

·         uterine pedicle is most commonly involved

• within 1 week is usually surgical error   

1. fat between fascial layers
2. failure to incorporate external rectus fascia
3. inappropriate suture size/type
4. infection
5. increased activity, self trauma, hemoabdomen

• delayed over 3 weeks, usually patient factors-

1. poor wound healing 
2. increased abdominal pressure
3. steroids
4. obesity

1. transfixation ligatures
2. open castrations on dogs >15kg

• 9-20% of females after OHE
• related to urethral sphincter mechanims incompetence
• loss of estrogens lead to urethral sphincter tone loss
•  caudal movement of urogenital tract due to rupture of suspensory ligaments and broad ligament
• tx: phenylpropanolamine (α-adrenergic agonist)
• or diethylstilbesterone (DES) (estrogenic)
• Sx: colposuspension (sutures in vagina to pull tract cranially

• more common in steers (multiple in feedlot, single in range steers)
• distal sigmoid flexure

1. abdominal pain
2. rectal-distended bladder

1. ventral swelling-sheath, abdomen
2. cellulitis, uremic smell
3. rectal-distended bladder

no abdominal pain

abdominal distention-symmetric (look from behind)

rectal-bladder may be full, but not tight

elevated BUN

acidotic

sheep and goats- 17% survive for >1 yr after urethrostomy

pet goats/pigs often reobstruct

• epidural, standing anesthesia
• dissect down to penis and transect penis at lower end of incision
• penile stump sutured to skin
• catheterization often difficult due to urethral diverticulum

• small ruminants
• if bladder is ruptured or persistent urethral obstruction
• paramedian celiotomy
• evacuate urine/calculi
• secure Foley in bladder and exit body wall through separate stab incision
• goal is to divert urine flow until urethra becomes patent again
• takes 6-38 days
• may recur

more permanent cystotomy

cystotomy incision sutured to an opening in abdominal wall to creat a permanent cystotomy

eventually closes

intent to reestablish urethral urine flow, may recur

• Walpole's solution
• pH 4.5
• US guided cystocentesis
• infuse into bladder, titrate pH below 7
• 80% resolution, 30% recurrence
• causes peritonitis if it gets in the abdomen

mostly male

cystic calculi

calcium carbonate

• hematuria
• stranguria 
• weight loss
• colic
• rectal-may feel urolith in bladder

• epidural anesthesia
• cut down to catheterized urethra
• crush/remove stones with lithotrix
• second intention healing

• perirectal approach
• cystotomy under general anesthesia
• urinary acidifiers (ammonium chloride)

• urachus-carries urine from fetal bladder to allantoic cavity. 
• becomes scar at apex of bladder
• umbilical arteries become round ligaments of bladder
• umbilical vein becomes falciform ligament

1. congenital-birth trauma
2. acquired-due to umbilical infection

• Abx as needed
• cauterize urachal opening with AgNO3 sticks
• Sx: elliptical incision around umbilicus thru linea alba and isolate umbilical cord from body wall
• ligate umbilical arteries and urachus separately and resect

• up to 4 weeks of age
• may or may not look normal 
• sepsis (fever, depression, inc/dec WBC, swollen joints)
• US umbilicus
• sx like for patent urachus

• adults with urolithiasis
• mares at parturition
• most common in foals at parturition

• normal at birth
• depression, anorexia, abdominal distention, colic
• dyspnea
• may continue to pass some urine
• peritoneal fluid may be clear, yellow, odorless, low specific gravity
• peritoneal creatitine is 2x that in blood
• acidotic
• hyperK, hypoNa, hypoCl

• correct dehydration, electrolytes, acid-base
• drain abdomen before sx if severely distended
• resect umbilical and urachal remnants
• ellipse around umbilicus
• dissect out umbilicus and urachus to get traction on bladder
• bladder tears usually dorsal, close with absorbably suture in a 2 layer inverting pattern, not penetrating lumen
• urachal and umbilical arteries ligated and resected before closure of abdomen

vomiting

undigested mucus+bile

rapid fluid loss

electrolyte loss, H, Cl, Na, K

spontaneous passage

induction of vomiting (careful)

endoscopy-limited

gastrotomy

·         ventral midline approach

·         stay sutures- needle suction- contain spillage

·         ventral gastrotomy incision

·         equidistant between greater and lesser curvatures

·         2 layer continuous closure

o   Cushing in submucosal

o   Lembert-seromuscular-submucosa

·         absorbable suture-no catgut

·         large and giant breeds

·         great danes>st Bernard>weimaraner, irish setters, Gordon setters, german sheps, basset hounds

o   meat vs cereal vs soy diet ,

o   overeating and postprandial exercise,

o   anatomic factors (stretching or hepatogastric ligaments, pyloric obstruction splenic torsion)

o   delayed gastric emptying

o   bacterial fermentation-clostridia?

o   aerophagia?

o   hypergastrinemia

o   gastric myoelectric dysrhythmias

o   restless, uncomfortable, painful

o   hypersalivation

o   nonprod vomiting/wretching

o   abdominal distention

o   hyperpnea >30 rpm

o   shock

o   angulation of gastroesophageal junction

§  prevents belching/vomiting

§  gastric dilatation

§  fundus from left to right

§  spleen ventral to dorsal

o   volvulus-270º clockwise, decreased arterial flow

o   dilatation alone-90º

o   portal circulation

§  gastric distention-->compression of portal vein-->intestinal stasis and septic shock

o   factors VIII and IX sequestered

o   congestion-->hypoxia-->edema

o   40% develop DIC

o   tearing of short gastric and gastroepiploic artery and vein

o   decrease pH and pepsin

o   gastric ischemia and necrosis-elevated serum  lactate levels

•    decompress, may help to hold vertically
•    don’t bother lavage stomach
•    tachycardias-lidocaine (careful of toxicity seizures), valium and slow drip.
• procainamide for hypotension, vomiting, diarrhea
• oral quinidine  

o   can hold off surgery a bit as long as decompressed and comfortable

o   reposition, assess gastric wall for necrosis/peristalsis/thickness (disrupted mucosa/muscularis)

o   tube gastrostomy-meh. once it’s detorsed, the stomach should be able to empty. allows for tube feeding

o   wrap with omentum

o   incisional gastropexy

§  behind 13^th rib, tranverse abdominus, pyloric area of stomach, quick procedure

o   can do ventral midline gastropexy with closure, does work, don’t incise over there ever again. fast and good for pt’s not doing well in surgery

advantages

• rapid and easy procedure
• stomach lumen not entered

disadvantages

• no post op alimentation
• no good clinical follow-up

• rapid and easy
• creates permanent adhesion
• allows for gastric decompression
• allows tube feeding

advantages

• muscle flap rather than fibrous adhesion stronger
• proper anatomic alignment of stomach

disadvantages

• difficult
• potential for pneumothorax
• no postoperative alimentation

• complete vs incomplete
• high vs low
• simple mechanical vs strangulated
• acute vs chronic
• perforated vs nonperforated

·         luminal

o   foreign bodies,

o    polypoid mass

·         intramural (napkin ring analogy)

o   neoplasia

o   fungal granuloma-SE America (pythiosis)

·         extramural

o   adhesions

o   strangulated hernia

• duodenal obstruction-loss of salivary, gastric, pancreatic duodenal secretions>rapid dehydration. bilious vomitus
• low jejunal obstruction-resorptive capacity maintained-chronic signs. feculent vomitus early on, then anorexia and bowel distention

describe simple mechanical obstruction

• intraluminal pressure increased
• venous+lymphatic compression
• vascular congestion
• capillary flow+tissue perfusion reduced
• mural edema

1. increased secretion
2. decreased absorption

describe strangulation obstruction

• local pressure necrosis-FB
• mesenteric vascular disruption

• volvulus
• intussusception
• hernia
• thromboembolism

color

arterial pulsations

peristalsis-pinch test

temperature probes

pH monitors

doppler flow devices

intravenous vital dyes

surface oximetry

obstructive pattern

      distended 4x rib

      distended 1.4x width of 2nd lumbar vertebra

foregin bodies-sharp objects will often pass

linear-accordion pattern, plication

advantages

• less risk of surgical dehiscence
• retain absorptive capacity

disadvantages

• wrong guess-perforation, peritonitis

handle with doyen or moistened sponges

longitudinal incision antimesenteric border 

simple interrupted appositional or crushing pattern

Gambee incorporates serosa, muscularis, and submucosa but excludes mucosa

if hypoproteinemic or cachexic, Cushing, Connell, Lembert

Dexon, PDS, Maxon, Vicryl 3-0, 4-0

release anchor point (look in mouth)

gastrotomy to release gastropyloric anchor

multiple enterotomies

• longer surgical times
• greater risk of leakage
• greater potential for stricture
• potential weight loss and diarrhea

young dogs and cats

ileocecal colic

• hypermotility
• distemper
• parvo enteritis
• intestinal parasitism
• bowel manipulation

1. inappetence
2. vomiting
3. tenesmus
4. melena

• palpation-sausage
• radiography-gaseous distention, upper GI, Barium enema
• US-bullseye sign

intussusceptum-proximal bowel segment invaginating

intussuscipiens-distal section around intussusceptum

• manual reduction
• resection and anastamosis
• enteropexy (high complication rate)
• enteroplication

• stenotic nares
•             extended soft palate
•             everted saccules
•             hypoplastic trachea

between 3rd and 4th rings 

suction gently every 2-4 hours, oxygen, observation, trach tube kit ready

• lateral/intercostal thoracotomy
• median sternotomy

large thymoma

subtotal pericardiectomy

thoracic exploration (including pneumothorax)

bleeding vessels

PDA

lung lobectomy in cats

thoracic duct ligation

• ligation of vessels and sew bronchus
• thoracoabdominal stapling device
•  individual ligation:
• pulmonary artery first, then vein (ex. silk)
• horizontal mattress, continuous oversew (prolene, PDS)

• idiopathic benign effusion
• neoplasia (right atrial HSA, heart base tummors)
• lateral intercostal or median sternotomy

thoracic duct ligation-en bloc

dog-right 9th or 10th

cat-left 9th or 10th

large-median sternal

small-lateral

R cranial-R 4th ICS

R caudal-R 5-6th ICS
L cranial-L 4th-5th ICS

L caudal 5th-6th ICS 

Finochietto rib retractor

DeBakey thoracic tissue forceps

Right angled forceps/mixters

Satinsky vascular clamps

·         distention of a hollow abd viscus with fluid, gas, or solid

·         tension on mesentery

·         intestinal ischemia

·         acute leakage of GI contents

·         gastric ulceration

·         combinations

·         pawing the ground

·         thrashing, rolling

·         stretching (abdomen)

·         sweating

·         flank-watching

·         palpebral abrasions from thrashing/rolling

·         cast against wall

·         mild-inappetance, depression, flank watching, lying down, occasional pawing, east ot control with or without meds

·         moderate-as above, but intense pawing, kicking, rolling, getting up and down, somewhat controllable with mediation

·         severe- as above but sweating, blowing/breathing hard, violent behavior, uncontrollable with drugs

females. 

males due to possibility of obstruction

• simple non-strangulating-enteroliths. bacteria-->gas and fluid due to decreased absorption
• strangulating-twisted. horses can't vomit buildup in stomach. 
• occlusion of veins, reducted arterial inflow, prolif of bacteria. endotoxin-->macrophage-->high fever, shock, etc. etc. check mucous membranes
• reperfusion injury- free radicals

• ventral midline incision 10 inches (20-50cm) (want to start small, avoid hernia) 2cm cranial to umbilicus
• exploratory celiotomy-need to know anatomy
• can exteriorize cecum, systematic approach
• follow spleen
• pelvic inlet: palpate inguinal rings, internal genitalia, bladder, rectum
• all parts of colon
• stomach, pylorus, duodenum, liver, diaphragm, epiploic foramen, etc

cecum (possible rupture) and small colon are the most dangerous (possible pressure necrosis from impaction) 

stomach

duodenum

first 10-12 inches of jejunum 

ileocecal junction

distal 10-12 inches of ileum

transverse colon

base of cecum

cecocolic junction

terminal part of right dorsal colon

how many bands are on the following?

small colon

right/left ventral colons

right dorsal colon

left dorsal colon

cecum

• cecum-4
• right/left ventral colons-4
• right dorsal colon-3
• small colon-2 (fecal balls, sacculations)
• left dorsal colon-1

ileocecal intussesceptions often indicate the presence of:

1. pelvic flexure
2. small colon
3. right dorsal colon
4. cecum

ileocecal junction

pylorus

1. dehydrated mass fills cecum and causes mod distention, gas can pass to colon-->soft feces. medication tx
2. cecal dysfunction/stasis marked distention with fluid. sx required (complete ileocolostromy best, typlotomy and deworm)

alfalfa (hi Ca)

California, midwest

• wait and see
• phenylephrine injection
• rolling
• sx if severe

• traverse vaginal ring, then pass down vaginal tunic within inguinal canal, passes internal and external vaginal rings
• standardbreds, tennessee walkers, american saddlebreds at greatest risk

young (<3) and old horses

jejunojejunal, ileoileal, ileocecal

Lembert or Cushing (don't enter lumen)

Cushing-can't see suture and can purse string the bowel. use Lembert

if you can't get to the ileum close to the cecum, need to bypass using the jejunum

Parker-Kerr on ileum stub

cushing over a clamp

side to side or end to end connection of jejunum to cecum 

use 1 tube to rinse bowel out,

different tube to rinse bowel off.

• Standing, laparoscopic procedure
• Suture nephrosplenic ligament to dorsal surface of spleen
• Use big bites

• Have to decompress the stomach
• Sometimes is due to obstruction
• Some ventral edema is ok
• Shouldn’t see dehiscence, hernia, infection
• Adhesions

nasal passages, nasopharynx, larynx, guttural pouches, cervical trachea, swallow, slap test (laryngeal hemiplegia), nasal occlusion

epidermal inclusion cysts (atheromas)

redundant alar folds

diseaseas of nasal septum (cystic, neoplastic, traumatic)

primary-URT infection

secondary-dental disease, mass, trauma

·         progressive tumor-like mass, can be from trauma

·         ethmoid labyrinth or floor of sinus

·         mild, intermittent epistaxis, usually unilateral

·         horses>6 yrs old

·         endoscopy, radiographs

·         intralesional 10% formalin, sx removal via sinus flap

recurrence can occur

·         single of loculated fluid-filled cavities

·         develop in maxillary and conchal sinuses and grow in path of least resistance (uniàbilateral)

·         any age affected

·         cause nasal discharge (sinusitis), facial swelling, airway obstruction

·         endoscopy, radiographs, CT, sx removal

·         frontal-60% from midline and 0.5cm caudal to a line drawn across from medial canthus

·         caudal maxillary sinus-2cm ventral to medial canthus

·         rostral-halfway between medial canthus and facial crest and 1 cm ventral to line from medial canthus to infraorbital canal

·         intermittent more common than persistent-mostly when horse is tired and asked for maximum effort-mostly racehorses

·         pythium infections

·         noise during expiration

·         rarely seen at rest

·         persistent nerve damage

·         Tx:

   sx:

§  staphylectomy-trimming edge of soft palate

§  sternothyrohyoideus myectomy-no collar retraction(?)

§  sternothyroideus tenectomy

§  tie-forward

·         “roarers”

·         damage to recurrent laryngeal nerve

·         long necked horses

·         paresis/paralysis of cricoarytenoideus dorsalis

·         failure to abduct arytenoid cartilage

·         inspiratory noise

·         95% on LEFT side

·         right sided usually iatrogenic

·         grading 

o   I-normal

o   II-symmetric, asynchronous

o   III-asynchronous, asymmetric- 2^nd best prognosis

§  A-can abduct and hold

§  B-can abduct and hold, worse

§  C-negative pressure, no control, functionally grade IV

o   IV-complete paralysis- best prognosis

·         prognosis links to grading. muscle movement that is left stresses tie-back and it may fail. so the most paralyzed ones have the best prognosis

o   I-normal

o   II-symmetric, asynchronous

o   III-asynchronous, asymmetric- 2^nd best prognosis

§  A-can abduct and hold

§  B-can abduct and hold, worse

§  C-negative pressure, no control, functionally grade IV

o   IV-complete paralysis- best prognosis

·         prognosis links to grading. muscle movement that is left stresses tie-back and it may fail. so the most paralyzed ones have the best prognosis

1. epiglottis
2. corniculate process (arytenoid cartilage)
3. muscular process (arytenoid cartilage)
4. thyroid cartilage
5. cricoid cartilage
6. cricoarytenoideous dorsalis muscle

• rare but life-threatening
• focal on roof of one guttural pouch
• predilection site on arteries (ICA, ECA, MA) and nerves (9-12, symp)
• epistaxis, dysphagia, horner's abnormal resp noise, nasal discharge, corneal ulcer, abnormal head posture, colic
• tx: vascular occlusion for epistaxis, surgical debridement, NSAIDS

• longitudinal incision thru skin, SC mm to trachea
• transverse incision between tracheal rings 50-75% of circumference
• place tube
• complications: cellulitis, emphysema, cartilage damage, stricture

o   trauma, neoplasia, abscess

o   structures:

§  vessels:

·         double ligate and transfix renal artery (hi volume/pressure)

·         double ligate renal vein encircling

§  ureter: removed completely

o   don’t leave a stalk off bladder- acts as nidus for infections.

o   calculi

§  20% cats die

§  refer if possible

§  magnification for tiny ureters

§  suture 5-0 to 7-0

§  sterile inflammatory cystitis

§  multifactorial

§  97% bacterial cultures are NEGATIVE

§  45% recur in first 6 months after obstruction

·         dry food? indoor? ↓water consumption?

§  females-sterile cystitis, non-obstructive, hematuria, pollakiuria

§  males-urethral plugs (mucus, blood, crystals) mostly struvites

performed in dogs

§  goal: flush urethral calculi back into bladder

§  allow stabilization before surgery

§  avoids emergency urethral surgery (elective cystotomy ALWAYS preferred

§  push down on pelvic urethra from rectum, fill syringe with saline, red rubber catheter. inject, pressure build-up. remove finger, obstruction shoots out)

lidocaine jelly, butorphanol, diazepam, ketamine if cranky

pull prepuce out and catheterize

3-0 Monocryl or PDS, BIOSYN (glycomer)is the best due to absorption time and tensility

§  ventral caudal abdomen

§  access to urethral catheter

§  isolate w/ laparotomy

§  stay sutures, have assistant hold

§  stab incision, ventral

§  enlarge incision

·         stay just off midline to avoid vessels

§  close bladder

§  Poole suction tip and flush

§  use a suction tip to remove urine flush

§  flush normograde, retrograde. FLUSHFLUSHFLUSH

§  feel if there’s anything left, take rads beforehand, etc. 

§  close: simple continuous, single layer

·         double layer decreases lumen, àserosal tearing.

·         scrotal-ALWAYS DO THIS (vs prescrotal or perineal)
o   neuter
o   move retractor penis
o   thin white ridge without cavernous tissue
o   4-5 cm at base where it curves. urine will fall with gravity.
o   incise, suture, e-collar

§  perineal

·         keep catheter in to follow urethra

·         cauterize/ligate scrotal arteries

·         ventral ligament and ischium cavernosum muscle-cut

·         dissect retractor penis muscle

·         incise up to bulbourethral gland level-urethra widens

·         1130 and 1230 spot for sutures

o   nephrolith or renolith assoc with resistant or persistent infection

o   vasc occlusion required limit to less than 15 min

o   not benign, avoid if possible

§  minimal dysfunction in normal cats

§  medical management of CKD is equally effective

o   advantages: 

§  decreased surgical time

§  decreased morbidity

§  increased visualization

§  fast return, less muscle tone loss (makes prone to injury)

o   disadvantages

§  cost

§  difficult to perform, long setup time

§  poor results from poor case selection, inexperience, and lack of skill

• 12 and 6 oclock: illumination lenses
• 9 and 9 oclock (out-in): air/water nozzle, objective lens
• 3 oclock: operating/suction channel

• full thickness intestinal biopsies
• organ biopsy/excision
• ability to obtain hemostasis
• option for therapeutic intervention if needed

o   increased morbidity

§  pain

§  anesthetic risk

§  cost

§  dehiscence

§  infection

o   PLE

§  IBD

§  lymphoma

o   hepatopathy

§  MVD

§  copper storage

o   suspected neoplasia

§  mass effect

o   radiographic

§  free gas

§  dilated SI

§  foreign body

§  herniation

§  GDV

·         untwist and look at dorsal surface for necrosis

·         transverse abdominus right side gastropexy (beltloop)

o   abdominocentesis

§  blood

·         active-clots

§  urine

·         Creatinine fluid>serum

·         potassium fluid>serum

·         contrast urethrogram

§  cytologic criteria

·         intracellular bacteria

·         bile pigment bilirubin

o   HBC, gunshots, dog bites—contamination of bile has incredibly poor prognosis

majority of small intestine

ascending colon

transverse colon

o   diaphragm

o   liver, gall bladder

o   stomach (slip),

o   pancreas

o   kidneys, adrenals, retraction of mesocolon, 

ovary, head of spleen

o   colon, bladder (look at ureters), prostate, uterus, sublumbar lymph nodes

kidney, retract mesoduodenum

ovary

adrenal gland

vena cava

portal vein

right limb of pancreas

o   running the bowel (beginning to end)

§  look at ligament at duodenal turn

o   BE THOROUGH, look for cyanosis

50ml/kg LAVAGE WITH COMPLETE EVACUATION, change gloves and instruments.

PDS or polyglyconate for body wall GET THE EXTERNAL RECTUS SHEATH

0-5kg=3-0

5-25kg=2-0

>25kg=0

SC: 3-0, 4-0 poliglecaprone/glycomer (monocryl)

Skin: 4-0 mono nylon

1. decreased survival 
2. decreased healing capacity
3. more prone to infection

advantages

• inexpensive
• fast
• avoids anesthesia

disadvantages

• dangerous
• uncomfortable

·         xylazine, metomidine, butorphanol presedation

·         anesthetic injected into skin and into core of testicle

advantages

•  IV anesthesia
•  better access
•  short acting anesthesia
• safer for surgeon, can restrain limbs

disadvantages

• must wait for horse to get back on their feet
• time consuming

·         refers to initial incision

·         skin and vaginal tunic incised

·         ¼-½ ” from median raphe. any higher will rub against the thigh

·         skin only incised, not vaginal tunic

·         dissect out tunic to exteriorize, remove tunic with testicle

·         reduces postop swelling and  peritonitis

walking exercise at least 2x daily to reduce swelling, not too much more vigorous

hydrotherapy-optional

Abx-maybe, but NSAIDS may be good idea

·         swelling

·         infection

·         hemorrhage

·         evisceration

o   bowel

o   omentum

·         hydrocele

·         unaltered behavior

·         urethral transection

·         peritonitis

·         pain

unilateral or bilateral

abdomiinal or inguinal

right versus left

stallion-like behavior

episioplasty

(Caslick's)

older, racehorses

Ford interlocking

1st degree-vestibule and vulva

2nd degree-perineal body, vestibule, anus

3rd degree-rectovaginal septum (when foaling first foal too fast, leads to rectovaginal fistula)

don't treat the 3rd degree immediately. wait for the inflammation to go down, then sew back up 

·         to remove a granulosa cell tumor or to castrate a “normal” mare (poor behavior, jump mare)

·         abnormal behavior-stallion-like, erratic, or no estrus, infertility

·         large ovary, small contralateral ovary, absence of ovulation fossa

• incision midway between last rib and tuber coxae
• insufflation with CO2
• placement of scope
• instrument portals

a. Peritoneum

b. Transversis abdominus muscles

c. Internal abdominal oblique muscles

d. External abdominal oblique muscles

e. Rectus abdominus muscles