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362 Cards in this Set
- Front
- Back
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"Summer sores" refers to what condition?
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cutaneous habronemiasis (CH)
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T/F: CH is a condition that does not response to routine treatment
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true
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T/F: CH is associated with cool weather
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false: warm weather (SUMMER sores)
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CH is associated with what?
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wounds
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Where is it found?
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in thin-skinned areas (prepuce, penis, medial canthus of the eye)
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What causes CH?
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it is an allergic reaction to aberrant larvae of the Habronema species
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What are the 3 Habronema species that cause CH and where are the adults found for each species?
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Habronema musca- on stomach mucosa
Habronema microstoma- on stomach mucosa Drashia megastoma- in granulomas in the stomach wall |
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Which habronema species is the toughest to control?
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Drashia megastoma
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How do you diagnose CH?
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typical lesion in typical locations is usually adequate
biopsy and ID larva |
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How do you treat CH?
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remove the larvae (parenteral meds - ivermectin)
topical meds (antibacterial ointment w/added ivermectin, corticosteroid, DMSO) control/remove excess granulation tissue control allergic response |
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How do you control CH?
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interrupt the life cycle of the parasite
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which life cycle causes the problem in horses?
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the abnormal one (as opposed to the normal one)
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What is the normal life cycle of habronema spp?
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adults in stomach --> eggs pass in feces --> house/stable flies ingest eggs (intermediate hosts) --> H larvae emerge from fly and are deposited around mouth of horse --> oral mucosa --> stomach --> adults mature --> eggs passed in feces
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what is the ABnormal life cycle of Habronema spp?
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fly feeds on wound exudate or in thin skinned areas --> H larve deposited in these areas --> larvae cause allergic response and excessive granulation tissue
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How do you interrupt the life cycle?
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control flies
repel flies remove adults from stomach |
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How do you remove the adults fro the stomach?
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H musca & microstoma are senssitive to most routinely used equine anthelmentics
D megastoma sensitive to avermectins deworming with an avermectin gets rid of all H species |
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What are three common problems wth wounds of the periosteum and bone?
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bone sequestrum
osteomyelitis periosteal proliferation |
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What can cause a bone sequestrum?
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trauma cause periosteal damage
open wounds causing drying of the periosteum application of caustics to periosteum or bone |
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How does osteomyelitis commonly develop?
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as a result of poor drainage of wounds involving bone or hematogenous infection
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Which is most commonly the cause of osteomyelitis in foals?
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hematogenous infection
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periosteal proliferation commonly develops as a result of what?
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continued irritationfrom either physical or infectious causes
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What are some ways to manage wounds involving bone/periosteum?
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radiograph to check for fxs
bandage until granulation tissue covers bone good drainage systemic antibiotics NO caustics or healing powders on exposed bone |
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T/F: When bone is properly manages and there is good drainage, there is less chance of sequestrum, osteomyelitis, or periosteal proliferation
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true
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What are 3 ways to surgically manage wounds involving bone?
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fx repair
exploration and removal of bone fragments removal of bone sequestrum |
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T/F: occasionally a small sequestrum will be absorbed and healing will progress without surgical removal
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true
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T/F: healing involving the coronary band is easily predictable
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false
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What may result from a wound involving the coronary band?
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abnormal hoof development
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What would you do to allow more accurate determination of the devitalized tissue?
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wait several days following the injury to debride
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T/F: removal of a 1-2 inch segment of the coronary band usually results in regeneration of a normal coronary band
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false: removal of a <1inch segment
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What is required for optimum healing?
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a snug pressure bandage
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A cast should extend to what area?
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midpastern
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What is the best way to apply a bandage on this area?
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the constricting bandage should apply pressure from the injured area to the hoof on the opposite side of the limb (so that the constricting bandage does not encircle the coronary band)
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T/F: a normal leg wrap will not apply adequate pressure
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true (and if proper pressure is not applied, is will NOT heal correctly)
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T/F: caustic drugs are indicated
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false: contraindicated
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Why are small puncture wounds of the tendon sheath a considerable problem?
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bc many times owners don't realize the severity of the wound and delay treatment
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Two ways to surgically manage a wound involving the tendon sheath
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primary or delayed closure
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When do you use delayed closure?
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whent he wound is more than 10 hours old and there is adequate tissue to close without undue tension
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How would you manage a small puncture would that has recently occurred involving the tendon sheath?
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antibiotics, consider regional limb perfusion
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How would you manage a would with an open sheath, but w/o adequate tissue to close surgically?
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maintain drainage, bandaging, flushing, and antibiotics until wound closes by contraction and epithelialization
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What is the prognosis for this type of wound and management?
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fair if adequate drainage is maintained
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How would you manage a wound involving the tendon sheath with an established infection in a closed tendon sheath?
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establish liberal drainage
bandage w/parenteral antibiotics for 4-5 days, then sterile bandage until sheath closes |
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What is the prognosis for this type of wound and management?
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usually results in at least a pasture sound animal
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How was this problem originally handled (tendon wound with established infection in a closed tendon sheath)?
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prior to the use of this technique, most animals with this problem were destroyed
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Name the three things most commonly involved in wounds caused by encircling material.
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wire, rubber bands, and twine
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Wounds on what surface should always be explored for a foreign body?
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anterior (or all wounds that don't heal as expected)
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what is the most effective way to search for a foreign body?
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the bare, thoroughly scrubbed finger
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What is the best way to diagnose foreign bodies in wounds?
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ultrasound
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T/F: infusion of sterile methylene blue into the tract to stain all involved tissue and metal foreign body is very helpful
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false: WOOD foreign body (not metal)
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T/F: after using methylene blue, you must always remove all the stained tissue
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false: it is sometimes indicated to remove all the stained tissue, but not always
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What causes an abscess?
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localization of a hematogenous infectin or secondary to a poorly draining wound
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How do abscesses develop (in succession)?
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bacteria localize --> WBCs migrate --> purulent exudate is formed by living and dead WBCs, bacteria, and cellular debris
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When do you treat an abscess?
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wait until it matures (will initially be hard and firm - with time it will become fluctuant)
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T/F: use of caustics to destroy the abscess wall may be indicated in goats/sheep
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false: may be indicated in cattle, but no other livestock, nor dogs and cats)
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What are indolent wound?
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wounds that reach a stage of healing and then don't get worse but don't heal
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What are the possible causes of indolent wounds? (4)
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Animal in poor nutritional state
Epithelial fatigue (occurs in large wounds where the epithelium has to proliferate a considerable distance) Chronic infection Over exuberant attempts to control granulation tissue (steroids, caustic agents, DMSO) |
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How do you manage indolent wounds?
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correct underlying problem
stimulate epithelialization |
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What can be used to stimulate epithelialization of the wound in an indolent wound?
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mild irritants ex Scarlet red
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What is the problem with wounds in the axillary area?
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tend to pump air in and out (edges gap and close as animal moves) --> can get very bad!!
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What can cause Subcutaneous Air?
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wounds that pump air
wounds in the respiratory tract gas forming organisms |
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What is the most common wound to pump air?
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wound in the axilla
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what can cause wounds of the respiratory tract?
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wounds of the trachea
early removal of a tracheotomy tube |
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What is one bacterial species known to cause SQ air?
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clostridium
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What can iatrogenically cause clostridial infections of deeper tissues?
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IM banamine (so DON'T give it IM)
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How do you manage a wound that pumps air or involves the respiratory tract?
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no treatment required bc the air will be absorbed in 3-4 days
can be prevented or reduced by limiting the amount of movement (tying or stalling an animal) |
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how do you manage SQ air that's secondary to a clostridial infection?
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establish drainage and debride
very high doses of ABx anticipate large muscle sloughing |
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What do you need to tell the owner about SQ air that is secondary to a clostridial infection?
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warn owner of its severity and that death is likely
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SKIP TO WORD DOCUMENT
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SKIP TO WORD DOCUMENT
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List the synonyms for retained testicle (4)
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cryptorchid
high flanker rig or ridgling original |
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T/F: Ruminants seldom have testicle a retained in the abdomen
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true
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In ruminants, where is the testicle usually if it is not in the scrotum?
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usually in the SQ relatively close to the external inguinal ring
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How can the retained testicle be removed in a ruminant?
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skin incision directly over the testicle and remove it with an emasculator
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Where is a retained testicle usually located on a pig?
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abdomen
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T/F: it is not economically sound to remove a retained testicle on a sheep/goat
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false: it is not economically sound to remove on in a PIG
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T/F: meat quality is not affected if intact males are slaughtered at market weight
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true
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Where are the testicles of a horse located at birth?
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in the scrotum
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How do you differentiate between the testicle and the bulb of the gubernaculum in a foal upon palpation?
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Trick: you can't
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What does it mean when it si reported that the foal had testicles present in the scrotum at birth and these testicles were pulled back into the abdomen?
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the mass palpated in the scrotum was the gubernaculum
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T/F if a colt still has a retained testicle after two years, it is unlikely that it will find it way to the scrotum naturally
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true
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What is the most common reason a cryptorchid is presented for surgery?
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he is difficult to manage (a horse with a retained testicle is usually considerably more difficult to manage than stallions)
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T/F: it is considered unethical to register a foal sired by a cryptorhid
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false: some breeds allow registration of foals sired by cryptorchids
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T/F: one procedure commonly done is surgical reposition of a testicle into the scrotum, as commonly done in humans
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false: that is considered unethical
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T/F:cryptorchidism is considered a heritable condition
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true
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Relaxation of what muscle (due to sedation) many times allows testicls to be palpated?
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the cremaster muscle
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What can you sometimes palpate rectally concerning cryptorchids?
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the testicle in the abdomen
or the vas deferens going through the internal inguinal ring |
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What needs to happen to a testicle before birth?
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considerable reduction in size (otherwise it stays in the abdomen) -- (testicle starts out by the kidney --> pulled by the gubernaculum through the inguinal ring)
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Levels of what hormone indicate whether or not a testicle is still in place?
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horses > 3yrs -- estrogen levels > 400pg/mL = testicle still there
< 100pg/mL = no testicular tissue |
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How do you test testosterone levels?
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draw initial sample --> inj 10,000 units of HCG --> draw samples 30 and 60 minutes post-injection
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Interpret the results of this test
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geldings = testosterone level of 0
animals 2/testicular tissue: --pre-injection: 2-9 nanomols/Liter --post-injection: increase to > 7nanomols/Liter |
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T/F: you can also use gas chromatography on a blood sample to test for levels of testosterone
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false: use it on a urine sample
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What is the ratio of unilateral to bilateral retention of a testicle?
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13:1 (so most animals presented for sx have one testicle retained in the inguinal canal and the other in the scrotum)
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What is monorchidism?
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where the animal really only has 1 testicle
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T/F: testicles are retained on the right and left sides with equal regularity
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true
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Which testicle is larger int he fetus just prior to testicular decent?
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the left
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When the right testicle is retained, where is it most likely located? the left?
Why is this important? |
right: inguinal canal
left: abdomen if gives the surgeon an idea of how difficult the surgery might be, depending on which testicle is retained |
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How could you stimulate the decent of a testicle?
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HCG
GnRH or deslorein (only is colt is sexually mature) |
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When do you use the inguinal canal surgical approach?
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when there is a questions about the location of the testicle
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Where do you do the parainguinal approach? Why is this used compared to the inguinal approach?
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approach 4 to 5 centimeters anterior and medial to the external inguinal ring
is it easier to repair this area with suture than it is to suture the external inguinal ring |
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When would a ventral midline or paramedian approach be used?
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may be indicated for bilateral retention although both abdominally retained testicles can normally be removed through a single inguinal or parainguinal approach
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Why is this approach more complicated?
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by the location of the penis and prepuce
skin incision must be made lateral and then the penis and prepuce reflected to gain access to the caudal midline |
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What is the major advantage to the flank approach?
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can be done on the standing animal
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What must be known to use this approach?
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the testicle must be in the ABDOMEN
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Following the mesorchium to the testicle can only be used in what surgical approach?
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flank approach
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Where will you find the mesorchium?
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at the caudal pole of the ipsilateral kidney
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When doing a flank approach, what two ways can you find the testicle?
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by following either the mesorchium or the vas deferens
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How much the horse be positions when doing inguinal or parainguinal techniques?
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GA
dorsal recumbency |
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Why must the retained testicle be removed first?
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bc if, for any reason, the retained testicle cannot be found, you don't remove the scrotal testicle bc the next person asked to try will not know which one (if either) has been removed or if both are retained
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T/F: if the surgical procedure has been done in less than ideal circumstances, the surgeon may choose not to suture all layers
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true: the chosen approach may be to suture all layers except the SQ and the skin (or with the inguinal approach, some choose not to suture the inguinal canal and SQ and pack them and suture the skin, the remove skin sutures and gauze in 24-48 hours)
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T/F: the inguinal surgical technique includes distention of the abdomen with carbon dioxide or nortous oxide with a teat cannula inserted through the umbilicus or the flank
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false: the LAPROSCOPIC technique includes all that
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What type of inguinal hernias do domestic animals usually get?
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indirect (bowel goes through the vaginal ring)
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What is a direct inguinal hernia?
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bower goes through a BREAK in the peritoneum
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What type of hernia is most commonly a post-breeding problem in stallions?
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acute irreducible inguinal hernia (seldom occurs secondary to breeding in other species)
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What are some signs associated with acute irreducible inguinal hernias?
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-acute abdominal pain
-rectal exam reveals intestine passing thru the internal inguinal ring (can be missed shortly after the hernia occurs but after several hours the segment of bowel proximal to the herniated portion is markedly distended and rectal findings are most obvious) -scrotum usually distended |
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What type of hernias are considered a heritable trait?
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congenital scrotal hernias of the newborn (so do not use these animals for breeding)
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What are the signs for this type of hernia?
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palpable enlargement of the inguinal area
intestine can usually be forced back through the enlarged inguinal ring |
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T/F: in foals, many of these are self correcting in time as a result of decreased muscular tone
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false: as a result of increased muscular tone
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What can you use to help manage this in a foal?
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a truss can be applied to maintain pressure over the inguinal area
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T/F: congenital scrotal hernias are uncommon in pigs
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false: are uncommon in cows
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How can this easily be seen on pigs?
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when holding pigs for castration, the application of pressure to the abdomen will force intestine thru the inguinal ring and aid in the diagnosis
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T/F: there is an immediate danger of strangulation with a chronic reducible inguinal hernia
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false
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What happens to stallions or bulls bc of chronic reducible inguinal hernias?
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they have a marked reduction in fertility bc of the increased testicular temperature (must be surgically corrected to maintain fertility)
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T/F: inguinal hernias are thought to be heritable in goats and sheep
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false: heritable in horses and swine
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T/F: bulls in this condition are many times those who have been in show condition prior to entering the breeding herd
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true (thought to be bc there is enough fat in the area to dilate the inguinal canal)
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T/F: it is very rare to see a left sided hernia in a bull
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false: very rare to see a right sided (bc bulls usually lie down with their right rear leg under them and the left slightly extended and as a result the left inguinal ring is distended)
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D/dx for inguinal hernias
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periorchitis
mesothelioma hydrocele |
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How do you correct inguinal hernias in the stallion?
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some can be corrected w/o sx if diagnosed and treated soon after they occur
surgical correction |
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How do you non-surgically correct inguinal hernias?
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testicle grasped w/one hand and traction applied to cause vaginal tunic to become a rigid tube --> pressure applied to force viscera proximally --> hand in rectum can grasp intestines proximal to internal inguinal ring and try to free the viscera --> monitor to make sure intestines are viable (blood supply)
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T/F: When surgically correcting an acute inguinal hernia, it is usually unnecessary to increase the size of the external inguinal ring to place the intestines back into the abdomen
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false: it is usually necessary
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What are the c/s of chronic hernias in the bull?
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hour glass appearance of the scrotum
intestine can be palpated in the scrotum |
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What are the c/s of chronic hernias in the stallion?
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sometimes have recurring digestive problems
occasionally assoc w/a slight rear leg lameness |
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Why would you do an ischial urethrotomy?
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removal of the urethral or vesicular (bladder) calculi in the male
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What position would the animal be in and what type of anesthesia would it be under?
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standing with epidural or local anesthesia
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Where would you make the first incisions for an ischial urethrotomy?
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midline incision just below the anal sphincter
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Where would the next dissection be in an ischial urethrotomy?
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sharply dissect between the retractor penis muscles thru the bulbospongiosus muscle, the corpus spongiosum, and the urethra
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What can be used to break down the calculi for removal?
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lithiotripsy with shock wave or laser technology
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T/F: the wound is now left to heal as an open wound
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true
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What type of postoperative complications would you expect?
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none
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T/F: pararectal cystotomy is an extremely old technique
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true (it has recently been revisited)
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Why is it worth considering instead of an ischial urethrotomy?
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-for large calculi that are too large to remove through ischial urethrotomy
-better than an abdominal approach bc the bladder is quite difficult to get to the body wall incision without abdominal contamination |
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Where is the incision made for the pararectal approach?
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10cm vertical pararectal skin incision between the rectum and the semimembranous muscle
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Where should the surgeon's hand be and why?
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in the rectum to force the calculus back into the retroperitoneal segment of the bladder where a small incision is made in the bladder wall to remove the calculi
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What can cause injury to the penis?
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-kicks (commonly occur during breeding - serves men right!!)
-movement of the mare during breeding -jumping and becoming stranded on top of a fence or partitions -poorly managed stallion ring |
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What is paraphimosis?
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swelling of the penis and prepuce which causes the penis to be retained outside the preputial orifice
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T/F: paraphimosis occurs mainly in stallions
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false: occurs in both bulls and stallions
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how do you treat paraphimosis in a stallions?
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-manual support (manufactured from a nylon mesh laundry bag and latex tubing to hold the penis against the ventral abdomen)
-massage aided by ointments and lubricants (I could see men watching and laughing at this one...) -NSAIDS -diuretics -mild exercise -ABX |
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T/F: is attended to promptly and aggressively, is it usually possible to manipulate the penis back into the prepuce within 24 hours
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true
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How is the penis kept in place?
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if there are no lacerations, insert a probang into the prepucial orifice - cannot be used if there are any breaks in the preputial skin bc an abscess may decelop
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What is phimosis?
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swelling of the penis and prepuce which causes the penis to be retained inside the preputial orifice
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T/F: common in both bulls and stallions
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false: seldom occurs in stallions and fairly common in bulls
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What does "penile paralysis" mean?
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animal loses ability to retrace the penis into the prepuce
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What can cause penile paralysis?
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phenothiazine-derived tranquilizers used in stallions
failure to adequately treat paraphimosis |
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how do you treat penile paralysis?
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replacement of the penis in the prepuce and retention as described under paraphimosis (occasionally retention for a prolonged time will allow return of function)
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What does "reefing" mean?
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term commonly used for circumcision in the stallion
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Why would you perform this procedure?
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remove abnormal growths or scar tissue that do not extend deeper than the dermis
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When would you use general anesthesia on a patient for this procedure?
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when the lesions are extensive and a lot of tissue must be removed (local anesthesia is used in the standing animal when the lesions are small)
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How is this procedure performed?
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pull penis anterior (use umbilical tape snare) --> circumferential skin incisions anterior and posterior to the lesion --> dissect skin from deeper tissues --> remove ring of diseased tissue --> close in 2 layers (superficial fascia and skin)
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T/F: these stallions cannot breed for at least 6 months
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false: erection in these stallions should be limited for 3 to 4 weeks, then a breeding ring should be applied
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What is a possible postop complication and how can you avoid it?
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hematoma at surgical site - proper hemostasis will avoid it (drainage is indicated if it develops)
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When would you think about amputating the penis?
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carcinoma involving structures deeper than the skin and penile paralysis (Boltz technique is better)
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What is suggested prior to amputation of the penis?
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castration
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What is the best method of anesthesia?
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GA with dorsal recumbency
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What is true about the site of amputation selected?
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the more caudal the site, the more difficult the surgery (also carefully select site to avoid urine scald or excoriation)
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When actually amputating the penis, how should it be cut?
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starting at the base of the triangular incision made so that the cut edge at the dorsal aspect is slightly anterior to the ventral cut edge
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T/F: postop hemorrhage is sometimes a concern for several weeks
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false: several days
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Ganulomas and stenosis (as a postop complication of penil amputation) are the result of what?
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inadequate ligation and an inadequate number of skin sutures
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Why can this result in urine scald?
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when it has been necessary to amputate a considerable amount of the penis, it is sometimes not possible for the horse to extend the penis when urinating
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What are the three surgical procedures performed on the penis?
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reefing
amputation retraction |
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Why would you surgically retract the penis?
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if there is still paralysis of the penis after all efforts to stimulate spontaneous retraction have been exhausted
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What technique would you use?
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the Boltz technique
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What would need to be done presurgically?
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-castration - at lest one month prior
-removal of granulomatous growths (if necessary) |
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How should the horse be situated during the surgery?
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GA and dorsal recumbency
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After the horse is standing (after the surgery), what should be done?
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the stay sutures should be adjusted so that the glans is just insides the preputial orifice (very important!!)
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What is the aim of the surgery?
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to produce a firm adhesion between the prepuse and the skin and in this way maintain the penis in a retracted position
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|
What seems to be the common factor in all penile surgeries?
|
catheterize the urethra so you can identify it and not damage it
|
|
|
What can you examine rectally in the female urogenital system?
|
vagina, cervix, uterus, and ovaries
|
|
|
What is pneumovagina?
|
involuntary aspiration of air into the vagina ("windsucker:)
|
|
|
What can cause pneumovagina?
|
faulty seal of the vulva bc of poor closure or abnormal position (can be associated w/poor general health, tipped vulva, inversion of vulvar lips, perineal lacerations)
|
|
|
In what animals is a tipped vulva frequently a cause of pneumovagina?
|
multiparous mares
|
|
|
How do you treat pneumovagina?
|
correct underlying cause (if poor general condition)
surgical correction |
|
|
What are the four surgical techniques that can repair pneumovagina?
|
Caslick's technique
variations of the caslick's technique gadd technique perineal body transection (Pouet's technique) |
|
|
What is the restraint used for a Caslick's technique?
|
standing w/rear quarters stabilized (stocks or cross ties)
sedation or tranquilization twitch |
|
|
What are you removing with the caslick's technique?
|
a small band of skin and mucosa at the mucocutaneous junction (from the dorsal aspect of the vulva extending distally to the floor of the bony pelvis
|
|
|
What do you need to be careful not to do?
|
do not remove too much tissue bc scar tissue will be too thick
|
|
|
How would you breed after Caslick's technique?
|
breeding by natural cover usually requires opening the sutures tissue and then resuturing following breeding (can also be done by inserting a breeding stitch, where the stallion won't disrupt the suturing)
|
|
|
T/F: it is possible to examine the mare with a tube vaginal speculum and breed without cutting the sutured tissue
|
true: you can breed artificially
|
|
|
T/F: it is best to freshen the edges and close the vulva as soon as possible after the foal has passed (when foaling)
|
false: as soon as the placenta has passed
|
|
|
T/F: once the caslick's is performed, the seal of the vulva has been compromised so it is common to "suture the mare" for the rest of her reproductive life
|
true
|
|
|
What are some postop complications that can occur?
|
incomplete seal
urine pooling suture sinus |
|
|
When does urine pooling occur/
|
when the closure is extended too far ventrally and the urine can't escape adequately and accumulated in the anterior vagina
|
|
|
How can suture sinus be prevented>
|
by not going through the vaginal mucosa with the suture (insert suture thru he skin, thru the cut edge on the same side, then thru the cut edge on the opposite side, then out the skin)
|
|
|
What is the variation that can be made on the caslick's technique?
|
removal of the mucosa (only0 and insertion of the sutures slightly anterior to the MCT junction
|
|
|
Why could this be a better procedure to perform?
|
this doesn't compromise the seal of the vulva and as a result it is not necessary to continue to do the procedure for the breeding life of the mare
good to use if it is being done to make the mare/filly more acceptable (esthetically) |
|
|
Why is this variation not commonly done?
|
bc it takes a little more time (and apparently us vets are lazy)
|
|
|
What is the Gadd technique used for?
|
episioplasty or perineal body reconstruction
|
|
|
What does the Gadd technique involve?
|
the surgical removal of a right angle triangle shaped piece of mucosa from the dorsal aspect of the vestibule (one arm of the triangle is at the MCT junction, one arm at the dorsum of the vestibule, and the hypotenuse anterior and ventral
|
|
|
What does this technique do?
|
reconstructs or increases the size of the perineal body which improves the natural seal that occurs when the perineal body presses against the brim of the pelvis
|
|
|
What two conditions is the perineal body transection (Pouet's technique) used for?
|
pneumovagina and urivagina
|
|
|
What does Pouet's technique involve?
|
the division of the attachments between the rectum and caudal repro tract
|
|
|
What is the purpose of this?
|
it returns the vulva to a more natural conformation
|
|
|
How is this done?
|
a 6 cm horizontal incision is made between the rectum and vulva --> continued cranially to sever connection between the rectum and caudal repro tract --> allows the vulva to regain a more normal vertical orientation
|
|
|
How is this sutured and why?
|
usually there is considerable disparity and the skin (ventral to the anus) must be sutured to the musculature dorsal to the vagina
|
|
|
When do perineal lacerations occur?
|
secondary to problems associated with deliveray of a foal or calf
|
|
|
How are they classified?
|
first, second, and third degree
|
|
|
What is a first degree laceration?
|
involved only the skin and mucous membrane
|
|
|
What is a second degree laceration?
|
involved the perineal body but not the rectum
|
|
|
What is a third degree laceration?
|
involved the perineal body, the dorsum of the vagina, and the rectum
|
|
|
What does a third degree laceration lead to?
|
contamination of the genital tract
|
|
|
Which type of laceration is most commonly found in prima parous mares after first foaling?
|
third degree laceration
|
|
|
How would you repair a first degree laceration?
|
these heal without complication and don't require special care
|
|
|
When should a second degree laceration be repaired?
|
best to wait 5-10 days (after inflamm and infection have subsided) - though they can be repaired immediately if necessary
|
|
|
How will you repair a second degree laceration if the mucosa has been allowed to heal compeltely?
|
debride the area over the tear - this will be essentially the same as the Gadd technique (the debrided area will be in the form of a right angle triangle w/the hypotenuse facing ventrodorsal)
|
|
|
How does a third degree laceration usually occur?
|
at the time of delivery --> usually a foot of the foal is forced thru the dorsal vagina and into the rectum --> mare's delivery efforts force the foal out and produce the laceration
|
|
|
What is the normal routine for repair of a third degree laceration?
|
to wait 6 weeks or, if the foal is alive, until it is weaned (thought repair immediately after occurrence is supposedly possible)
|
|
|
What must be done with a third degree laceration?
|
tetanus prophylaxis
|
|
|
**What do you need to consider preoperatively?
|
**dietary management to maintain a soft, unformed stool
(lush pasture, bran or grain w/no long stemmed hay, completely pelleted feed, laxatives - mineral or linseed oil, saline laxatives) |
|
|
How is the horse most likely positioned to repair a third degree laceration?
|
standing with an epidural
|
|
|
When using a modified goetz technique to repair a third degree laceration, where is the first suture placed?
|
slightly cranial to the most cranial aspect of the incision
|
|
|
What is the difference between the Modified Goetz technique and the Annes technique?
|
Annes: the anal sphincter us closed 2-3 weeks later at a second surgery
they also use different suturing patterns (Annes uses horizontal mattress for a lot of it) |
|
|
When is the pullback technique used for third degree lacerations?
|
for very shallow third degree lacerations
|
|
|
What should be done postop for third degree lacerations?
|
non-formed stool for 10 days
tetanu prophylaxis parenteral ABX for 4-5 days remove nonabsorbable sutures in 10 days |
|
|
What are some complications that can occur?
|
excessive straining to defecate
partial or complete wound breakdown |
|
|
What can cause a rectovaginal fistula?
|
-birth related injury
-foal foot forced through dorsal vagina and into rectum --> foot is pulled back into vagina to continue normal birthing process --> in time there is a marked wound contraction but a fistula routinely persists |
|
|
T/F: time for repair and dietary considerations are the same for rectovaginal fistulas and third degree lacerations
|
true
|
|
|
What fistulas are best repaired by making an incision to produce a third degree laceration and then repairing the laceration?
|
large fistulas or those 6 or more inches anterior to the vulva
|
|
|
T/F: when repairing a rectovaginal fistula, the sutures are places from the ventral side of the rectum, the knots are tied ventrally, and the sutured penetrate the rectal mucosa
|
false: they do NOT penetrate the rectal mucosa
|
|
|
What is the postop care?
|
the same as for third degree lacerations
|
|
|
What can cause vaginal injuries? (3)
|
difficult birth
mare backing into a projecting object (occasional) perverted humans (rare, thank god) |
|
|
What are 4 different types of vaginal injuries?
|
contusions, hematomas, varices, and lacerations
|
|
|
T/F: contusions of the vagina usually resolve without complication
|
true
|
|
|
T/F: never drain a hematoma of the vagina
|
false: may occasionally need to be drained
|
|
|
What is a varice?
|
varicose veins (lets hope it's the same as for humans bc I had to look this up)
|
|
|
How can you manage a varice?
|
occasionally need to be ligated or injected with a sclerosing agent to prevent continual hemorrhage
|
|
|
How do you manage lacerations of the vagina?
|
-careful evaluation to determine extent (those extending into the peritoneal cavity require sutures to prevent eventration)
-tetanus prophylaxis -antibiotics |
|
|
What are the possible complications of vaginal lacerations? (4)
|
pelvis abscess
vaginal adhesions peritonitis evisceration |
|
|
Vaginal laceration complications: What are pelvic abscesses usually associated with?
|
persistent straining
|
|
|
Vaginal laceration complications: What is required to treat pelvic abscesses?
|
requires adequate drainage, which are many times difficult to establish
|
|
|
Vaginal laceration complications: What are the two different types of adhesions?
|
two dimensional and three dimensional
|
|
|
Vaginal laceration complications: What do two dimensional adhesions form?
|
a membranous partitions (like a persistent hymen)
|
|
|
Vaginal laceration complications: how do you treat a 3 dimensional adhesion?
|
dissections must be performed from caudal to cranial to establish a pathway to the cervix and then the area dilated daily until epithelium covers the surfaces
|
|
|
Vaginal laceration complications: What should be done at the first indication of adhesion formation?
|
daily dilation and medication to prevent development and to allow epithelialization of the injured surfaces
|
|
|
Vaginal laceration complications: What c/s will you see with peritonitis?
|
fever, anxiety and depression, mild colic or splinted abdomen, hesitance to move
|
|
|
Vaginal laceration complications: what will an abdominocentesis look like with peritonitis?
|
high wbc
sp gravity > 1.017 |
|
|
Vaginal laceration complications: How do you treat peritonitis?
|
high levels of ABS
drainage and flushing of the abdomen support: fluids, acid/base correction, serum |
|
|
Vaginal laceration complications: What is the usual result of evisceration?
|
if the bowel has been severely damages, euthanasia is usually indicated
|
|
|
Where is urine present with urine pooling?
|
int he anterior vagina
|
|
|
T/F: urine pooling results in a marked decrease in conception
|
UNKNOWN! there is a lot of controversy about this
|
|
|
in what animals is urine pooling generally seen?
|
in older mares in poor general condition
|
|
|
How do you manage urine pooling conservatively?
|
increase the general condition of the mare to increase vaginal fat
|
|
|
What are the main goals of each surgical technique for manage urine pooling?
|
extend urethra caudally using the transverse fold and mucosa of the vagina
|
|
|
What is surgery for urine pooling complicated by?
|
breakdown of the closure resulting in urinary fistula formation
|
|
|
What are the names of the techniques used for urine pooling? (4)
|
Monin
Brown McKinnon Shires |
|
|
What is the Monin technique?
|
a vestibuloplasty
|
|
|
How is the Monin technique performed (name the sequence of events)?
|
transverse fold grasped and retracted caudally --> free edge removed 2cm lateral to midline to the jnct of transverse fold and vaginal wall on both sides --> pull transverse fold caudally -->
|
|
|
...and then...
|
incisions made in lateral sides of vagina starting anteriorly at jnct of transverse fold and vagina --> incised edge of transverse fold sutures to incisions made in lateral sides of the vagina --> pull urethral orifice caudally
|
|
|
How is the Brown technique performed (name the sequence of events)?
|
free edge of transverse fold is split into dorsal and ventral layer w/scalpel --> incisions continued caudally from jnct of the transverse fold w/wall of vagina to vulva -->
|
|
|
...keep going...
|
continuous horizontal mattress suture used to appose the ventral flaps of mucosa that were produced by dissection (everting the cut edges into the tunnel produced) --> continuous suture used to appose the dorsal flaps of mucosa produced by the dissection (everting cut edges into vagina)
|
|
|
What is the McKinnon technique similar to? what is the difference?
|
the Brown technique
-only the most ventral layer of tissue is sutured, the dorsal tissues are allowed to heal by second intention |
|
|
What does the Shires technique require?
|
a Foley catheter placed in the bladder
|
|
|
how is the Shires technique done?
|
Foley catheter is placed in the bladder --> interrupted mattress sutures placed on each side of the catheter to pull the mucosa of the vagina up over the catheter and produce large ridges of mucosa over the catheter -->
|
|
|
...and?...
|
everted edges of mucosa are removed w/scissors to leave 4 cut edges of mucosa --> these cut edges are sutured in 2 layers using simple continuous suture pattern
|
|
|
Through where can the bladder prolapse? (2)
|
through the urethral orifice or the vaginal wall
|
|
|
how do you diagnose a bladder prolapse through the urethral orifice/
|
the surface of the prolapse is mucous membrane and the openings of the ureters can be identified
|
|
|
how do you manage a bladder prolapse through the urethral orifice?
|
epidural anesthesia
thorough cleaning massage to relieve edema for everted bladder back through urethral orifice reduce straining (continuous epidural, tracheotomy**) |
|
|
How do you diagnose a bladder prolapse through the vaginal wall?
|
a vaginal laceration is present
the serosal surface of the bladder is visible |
|
|
How do you manage a bladder prolapse through the vaginal wall?
|
epidural anesthesia
thorough cleaning replace bladder in the abdomen suture laceration ABX and abdominal flushing to control peritonitis |
|
|
How do you diagnose uterine prolapse?
|
OBVIOUS!
|
|
|
Why is hemorrhage so difficult to control with a uterine prolapse?
|
the endometrium is so vascular that ligatures are of little value
|
|
|
What is the most effective means of hemorrhage control?
|
rapid return to the normal position
|
|
|
how is it returned to the normal position?
|
by forcing through the vulva and cervix
|
|
|
What should be done after repositioning the penis?
|
inject oxytocin to stimulate contraction of the uterus and cervix
|
|
|
T/F: suture the vulva tightly to prevent recurrence
|
false: do not use sutures on the vulva to prevent recurrence bc a mare can apply enough pressure to tear out sutures in the vulva (once the uterus has been placed through the cervix and the cervix has contracted, the uterus will not prolapse)
|
|
|
What problem do you need to prevent that can happen in conjunction with uterine prolapse?
|
metritis
|
|
|
In this situation, what does metiritis commonyl cause?
|
laminitis
|
|
|
how do you prevent metiritis?
|
consider daily infusion and siphoning of the uterus
local systemic ABX Banamine |
|
|
T/F: Vaginal prolapse commonly occurs in mares
|
false: seldom, if ever, occurs
|
|
|
How can you examin the cervix?
|
manual and visual
necessary to palpate the cervix to be sure the musculature is intact uterine exam (including biopsy) is indicated prior to considering surgery |
|
|
When should a cervical exam be done?
|
needs to be done when the mare's in diestrus (otherwise the cervix will just be flaccid)
|
|
|
Cervical conditions are usually secondary to what?
|
foaling or abortion
|
|
|
Why are they usually secondary to abortion?
|
severe stretching or tearing (embryotomy, extended labor, occasionally damage happens during normal delivery)
|
|
|
What types of lesions could happen to the cervix?
|
loss of tone or ability to contract
lacerations |
|
|
loss of tone or ability to contract the cervix includes what structures?
|
the musculature WITHOUT involvement of the mucosa
|
|
|
How do you treat lacerations that involve only the mucosa?
|
tx to prevent adhesions
|
|
|
Most lacerations of the cervix involve what?
|
involve only the segment of the cervix that projects into the vagina (thought some involve the entire length)
|
|
|
What do you do for a: laceration detected postpartum tht only involves the mucosa?
|
massage w/antibiotic ointments to prevent adhesions
|
|
|
What do you do for a: laceration detected postpartum that involves the muscular layer?
|
manage to prevent adhesions
delay repair for 30-60 days |
|
|
For the above question, why should you delay repair for 30-60 days?
|
bc it may heal on its own and not need surgery
|
|
|
What needs to be checked before surgical repair?
|
**endometrium: the status of the endometrium is VERY important
|
|
|
What do you do if there's loss of tone of the cervix but no obvious muscular damage?
|
purse string suture though it's not too effective
|
|
|
How small does the purse string suture make the opening?
|
reduce lumen to insemination pipette size (suture must be cut prior to delivery)
|
|
|
What do you do if there's a laceration involving the musculature?
|
-anesthesia (standing w/epidural or pudendal or paracervical blocks or GA)
-isoxsuprine for relaxation -removal of a wedge of tissue and suture repair -close w/3 layers of absorbable suture (difficult) -prevent postop adhesions |
|
|
T/F: if the laceration involving the musculature is repaired successfully and the mare becomes pregnant, the tear will probably recur at foaling
|
true
|
|
|
How does the uterus twist in a uterine torsion?
|
on its long axis
|
|
|
In ruminants, when does this occur?
|
at term
|
|
|
Ruminant uterine torsion: Does the dam strain? why or shy not?
|
no bc the fetus is not in the pelvis
|
|
|
Ruminant uterine torsion: What is the conformation of the vulva?
|
there is a definite asymmetry of the vulvca
|
|
|
Ruminant uterine torsion: where is the twist?
|
usually caudal to the cervix
|
|
|
Ruminant uterine torsion: How can you feel the twist?
|
the twist int he vagina can be felt on a vaginal and/or rectal exam
|
|
|
Mare uterine torsion: when does this occur?
|
several months prior to term
|
|
|
Mare uterine torsion: What c/s will be seen?
|
abdominal pain (colic)
|
|
|
Mare uterine torsion: Where is the twist usually located?
|
anterior to the cervix
|
|
|
Mare uterine torsion: What is the conformation of the vulva?
|
vulva is symmetrical
|
|
|
Mare uterine torsion: what structure can you feel?
|
can feel the broad ligaments of the uterus as tense bands crossing above and below the body of the uterus
|
|
|
Mare uterine torsion: In what position do you palce the mare (under GA) for non-surgical management?
|
right side- if the twist is clockwise
left side- if the twist is counterclockwise |
|
|
Mare uterine torsion: Then what?
|
roll the mare int he same direction as the twist and assume that the uterus is going to stay in one place and the mare is going to be rotated around the uterus (best to roll the mare then check rectally to determine the response)
|
|
|
Mare uterine torsion: What is recommended surgically?
|
standing flank laparotomy (controversy about best side)
|
|
|
Mare uterine torsion: What is the safest procedure?
|
to raise the fetus and repel as compared to grasping an appendage and pulling (right side clockwise, left side counterclockwise)
|
|
|
Mare uterine torsion: what is the suggested routine?
|
correct the malposition, repair the abdominal wall, and allow the fetus to be delivered in due time in a normal manner
|
|
|
Mare uterine torsion: What happens if the torsion is >270 degrees?
|
it si difficult to correct by manipulation and it will probably be necessary to perform a C-section to save the mare's life
|
|
|
What can cause uterine rupture or laceration?
|
usually secondary to a difficult delivery
|
|
|
How do you diagnose uterine rupture/laceration?
|
manual exam (dx only possible when tear is in the uterine body)
signs of peritonitis following foaling w/o evidence of GI complications |
|
|
T/F: uterine rupture/lacerations are commonly in the uterine body
|
false: uncommonly in the uterine body
|
|
|
Where are most uterine rupture/laceration?
|
in the uterine horns
|
|
|
How do you manage uterine rupture/lacerations?
|
suture repair of the defect in the uterus and/or medical management w/o surgery
|
|
|
What is the prognosis for uterine rupture/laceration in the study from the notes??
|
approx 75% recovered
foaling hx after rupture was available for 26 of 41 - 23 foaled some time after the rupture |
|
|
What is the window of opportunity for delivery (naturally or by c-section) to keep the foal alive once second stage labor has started?
|
delivery must be within 30 minutes or the foal will most likely be dead
|
|
|
What are some predisposing factors that may lead to a necessary c-section in the mare (bc it's only needed in equines)?
|
bicornual pregnancy (rare)
large fetus malposition which can't be easily corrected uterine torsion that cannot be corrected by other means deformities of the maternal pelvis |
|
|
T/F: having a large fetus is a common problem in a mare
|
false
|
|
|
T/F: in the equine species, the size of the dam is a major determining factor in fetal size
|
true (a small mare bred to a large stallion will routinely have a fetus she can deliver)
|
|
|
T/F: malposition not easily corrected is a common problem in foalings
|
true bc of the long appendages of the foal
|
|
|
In these cases, what is anesthesia dictated by?
|
the status of the fetus
|
|
|
If the fetus is dead (which is the usual case), what happens?
|
life of the mare is the only concern to GA can be sued
|
|
|
If the fetus is alive, when what happens?
|
use minimal amounts of barbituates and maintain with gas anesthesia
|
|
|
Where is the most common laparotomy site for a C-section?
|
ventral midline (provides the best exposure and is the incision of choice in north america)
|
|
|
What are the other approaches?
|
Marcenac
paracostal paramediam incision |
|
|
What is the Marcenac approach?
|
-mare in R lateral recumbency w/legs extended slightly to the rear
-a grid incision w/the skin incision directed caudoventral from the middle of the costal arch to the fold of the flank (parallel to the fibers of the external abdominal oblique muscle) |
|
|
What is the paracostal approach?
|
low flank incision in which the skin incision is perpendicular to that of the Marcenac approach and is approx 10cm from the last rib
|
|
|
What is the paramedian incision?
|
an incision amde 4 to 6 inches lateral to the midline (exposure almost hte same as a ventral midline approach)
|
|
|
Why use a ventral midline approach rather than a paramedian incision?
|
paramedian has a greater problem w/hemorrhage and closure
|
|
|
Where is the incision made in the uterus?
|
in the greater curvature of the uterus
|
|
|
What do you do if the foal is delivered alive?
|
several minutes are allowed for blood to clear the placenta before clamping and cutting the umbilical cord
|
|
|
T/F: the peritoneum is not routinely sutured
|
true
|
|
|
What can fescue toxicosis cause?
|
laboring may not progress --> oversize foal --> C-section
|
|
|
If you don't have adequate facilities to do any of this, what needs to be considered?
|
killing the mare to save the foal
|
|
|
What do you do postop for a c-section?
|
-ABX depending on the circumstances surrounding the sx
-oxytocin to encourage uterine contraction and expulsion of the placenta -tetanus prophylaxis |
|
|
T/F: cystic ovaries are extremely common in the mare
|
false: they are extremely rare
|
|
|
What is a common problem with diagnosing cystic ovaries?
|
don't get trapped in this diagnosis on the basis of exam made during only one estrus cycle --> usually if an abnormally sized ovary is examined at the next estrus cycle it is normal
|
|
|
Why does this (the answer to the last question) occur?
|
bc there are marked variations in follicle sizes in normal mares
|
|
|
T/F: Nymphomania is not an ovarian abnormality but is commonly considered one
|
true
|
|
|
How do you diagnose nymphomania?
|
mares are very difficult to manage
routinely show signs of psychic estrus cycle yet will not stand to be bred stallion-like behavior and develop masculine conformation (thick neck, etc) |
|
|
T/F: an ovariectomy is usually the best course of action to handle nymphomaniacs?
|
false: an ovariectomy usually has no value at all in managing the problem
|
|
|
What is the one time with nymphomaniacs that an ovariectomy may help?
|
if the abnormal behavior tends to be cyclical (though this is very unlikely)
|
|
|
How should you manage nymphomaniacs?
|
-check for any reason for vaginal irritation (improper vulvar closure, sutures not removed following third degree perineal laceration repair)
-progesterone for extended period -move mare to change environment -pregnancy (though it is usually very difficult to get them pregnant, some have returned to normalcy afterwards) |
|
|
List the neoplasms that have been reported in the ovaries of mares (6)
|
melanoma
epithelioma cystadenoma cystadenocarcinoma teratoma granulosa cell tumor |
|
|
Which tumor is the most common?
|
granulosa cell tumor (by far)
|
|
|
how do you diagnose these tumors?
|
-enlarged ovary on rectal exam that stays enlarged through several estrus cycles or for prolonged periods
-changes in the estrus cycle (usually anestrus, occasionally showing nymphomania) |
|
|
How do you manage ovarian neoplasms?
|
surgical removal
|
|
|
T/F: an ovariectomy will prevent a mare from cycling
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false: there might be some modification of the heat cycle or the intensity of the signs of estrus in the ovarectomized mare but it will NOT stop the mare from cycling
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What are the different approaches to performing an ovarectomy?
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flank
inguinal ventral midline colpotomy paramedian parainguinal lapraopscopic |
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When is a flank approach used?
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reasonable if the mare will allow a standing procedure and if the ovary is relatively smal
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What is the problem with the ventral midline approach?
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it is difficult to ligate the ovarian vessels
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When could a colpotomy be used?
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acceptable approach to remove a normal sized ovary but doesn't work well for enlarged ovaries
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What is beneficial about the paramedian approach?
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the ovary can be delivered from the incision and it si not too difficult to ligate the ovarian vessels
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Which is the best approahc and why?
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parainguinal bc it is easier to get to the ovary and the ovarian vessels (the external incision is closer to the ovarian attachment) and as a result less effort is required to ligate the vessels
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When can the laparoscopic procedure be performed?
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through the flank in a standing mare or through ventrally places incision in an anesthetized mare
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What should you do during an ovariectomy when the ovary is found to be cystic?
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use a large bore needle to drain it
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When doing a colpotomy approach, what should be done before surgery?
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the mare should be kept off feed for 24 hours
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How is the colpotomy approach performed?
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with the mare sedated and standing w/epidural anesthesia
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Where is the incision made when using the colpotomy approach?
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a stab incision is made at the 2 or 10 o'clock position dorsal to the cervix with care taken to avoid the aorta
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In what approach is a chain ecraseur used?
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colpotomy approach
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What does a chain ecraseur do?
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it is used to cut the supporting ovarian structures during an ovariectomy
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T/F: after using the paramedian approach for an ovariectomy, the incision is allowed to heal as an open wound
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false: this happens after using the colpotomy approach
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What should happen after surgery?
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the mare should be placed in cross ties and prevented from straining until the incision heals (5-7 days)
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Will the mare still come into heat after the ovary is removed?
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yes bc the estrus cycle of the mare is NOT ovary driven
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