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GI: Fubini abomasal SX

Terms in this set (17)

3 goals of abomasal SX
return organ to original spot
prevent recurrence
minimal trauma/stress to patient
location of LDA
line from elbow to tuber coxae
pings from ICS 9 to rib 13
don't miss the low ones!
approaches to LDA (5)
1) R paramedian
2) R PLF
3) L PLF
4) percutaneous toggle pin
5) percutaneous suture
L PLF/L flank approach

-how

-pros and cons
PLF celiotomy

find abomasum

Ford interlocking through gr curvature (minus mucosa)

leave ends long and pass ventrally into abd, pass needles through ventral abd to outside assitant

assistant ties sutures externally
~ ~ ~ ~ ~
pros: good in heavily preg cow
cons: somewhat blind, need long arms
R paramedian approach

how

pros and cons
cow sedated, cast, dorsal recumbency

decompress abomasum +/- rumen

pexy just caudal to reticuloabomasal junction and a short distance from attachment of gr omentum to gr curvature

pexy to abdominal wall (internal rectus sheath)
~ ~ ~ ~
pros: can visualize abomasum, direct fixation of abomasum to body wall

cons: poor exposure of cd abdomen, dorsal recumbency may exacerbate resp disease, very vascular area (ventral abd) for incision, incisional complications (d/t gravitational wt of organs on incision line), cannot roll a very pregnant cow onto back, should NOT roll a cow with a volvulus
why you do not put suture through mucosa of abdominal viscera
using multifilament non absorbable suture for pexy, want to create adhesions

penetration of mucosa will wick bacteria from inside out, abomasal fistula may form
holding layer of any abdominal wall surgery
external rectus sheath
R PLF approach
standing cow with inverted L or paravertebral block

PLF celiotomy

reach over rumen and decompress/reach down under and replace abomasum (pull toward you)

omentopexy: incorporate fold of omentum (sow's ear) into closure of internal rectus sheath
~ ~ ~ ~ ~
pros: easy to visualize intestinal tract (ie. things distal to pylorus), minimal stress (standing), can perform prophylactic pexy, good success, less vascular incision area, pyloro or omento or pyloro-omentopexy possible

cons: indirect fixation relying on strength of omentum, can stretch or tear, long arms, limited visualization of LDA, slightly higher recurrence rates
closed approaches to LDA repair (4)
rolling- roll the cow clockwise with the hopes that the gas in the LDA will "float" it up (ventral) and back over to the R

percutaneous blind tack- dorsal recumbency, ping before placing stiches; quick and cheap but risk tacking wrong viscus or peritonitis/abomasal fistula

toggle pin- same as blind tack but can sample pH/smell the gas from the viscus to ddx abomasum (pH 2) from rumen (pH 7), if not better in 24 hours = remove it

laparotomy- not very common yet, $
location of RDA
line from tuber coxae to elbow
ping from rib 10-13
mild increase HR and RR
incomplete obstruction but has potential to twist
always SX emergency
+/- palpable per rectum
CS/location of RAV
RDA rotates counterclockwise on itself (when viewed from rear...so it flips to the right)
dorsal ping
ventral fluid wave

very sick d/t outflow obstruction (HHMA)
approaches to RDA or RVA (2)

goal of both
R PLF

R paramedian

goal = flip the abomasum clockwise to de-obstruct
HHMA
hypochloremic- Cl sequestered in abomasum
hypokalemic- anorexia and acidosis
metabolic acidosis- H+ sequestered in abomasum
how to repair RAV
R PLF or paramedian incision

decompression of gas +/- fluid

reduction of volvulus: flip clockwise (if having difficulty, find the omasum and pull it clockwise & abomasum will follow)
3 keys to ensure proper abomasal positioning after SX
follow pylorus to gr curve to reticulum

follow duodenum cranially to liver

palpate omasum against R body wall
complications of RAV to warn client about
peritonitis
abomasitis/omasitis
metabolic issues (acidosis)
adhesions at SX site
50% end up with vagal indigestion = cull
incisional complications (esp if long and ventral)
severe prolonged RAV = shock, acidosis, hyperkalemia, die

PX for RDA > RAV
2 cardinal rules of abomasal SX
do not let the sun set on an RDA

do not roll a cow with a volvulus or uterine torsion
THIS SET IS OFTEN IN FOLDERS WITH...