Quiz 1

Pudendal Nerve BlockAnesthetize retractor penis muscle, and rectal vaginal tone --> can get the penis out *does not get the sensory aspectPudendal Nerve BlockBlocks internal pudendal , caudal rectal, and pelvic splanchnic nerve. Repeat bilaterallyBAER BlockIV regional anesthesia that goes into the dorsal digital veinPeterson Blockeye block --> local four point --> blocks auriculopalpebralPeterson BlockLandmarks: Notch made by the zygomatic and temporal processes & Coronoid process of the mandibleCornual Blockdone in goats for desbudding or cattle in dehorningCaprinewhat species has a low lidocaine toxicity dose, caution when removing horns/budsBovineWhat species has one branch of the cornual nerveCaprinewhat species has 2 branches of the cornual nerveRumenotomyPart of the dorsal rumen sac is exteriorized through the laparotomy incisionPartial_____ thickness bites should be taken through the rumen and uterine wallLeft Flank Laparotomythe incision is done bovine a hand width to the last ribs and a couple hands width ventral to the transverse processRumenotomygoals of this surgery is to avoid peritoneal contamination and gain access to the rumenSkin Suturing FixationThe most secure and safe seal of the rumenSkin Suturing FixationDorsal sac of rumen is exteriorized --> sutured to skin using continuous Connell (inverted) pattern in nonabsorbable suture in a circle around the incisionRumenotomy Boardpros: fast, less suture used, minimal contamination, and fast in emergencies cons: hard to feel the rumenRumen Exploratoryindicated in Hardware DiseaseRumenotomyclosure should be in 2 layers inverted with absorbable suture and copious amount of lavageRumenostomyred devils or cannulas are used in aRumenostomythis surgery allows free gas to escape when bloated, will heal in about 2 monthsBovinewhich ruminant species does better with rumen cannulasCesarean SectionCondition of the cow/heifer at the time of _______________ is a major determining factor deciding outcome of the caseLeft flank celiotomyMost common standing surgical approach of C-sections in bovineFlankMost common surgical approach of C-sections in small ruminants (also done in swine)Ventral midline celiotomyMost common recumbent surgical approach of C-sections in bovineUterine ContaiminationIf ________________________ is present, the uterus MUST BE fully exteriorized during cesarean section to prevent spillage of uterine contents into the abdomenLeft flank celiotomyIndications 1.Live fetus (cow or heifer will remain standing) 2.Minimal-no uterine contamination (spillage of uterine contents inevitable) 3.Uterine torsion Contraindications 1.Heavy uterine contamination (dead, rotten, emphysematous fetus) 2.Cow or heifer wanting to go downXylazineWhat drug is avoided in a standing left flank celiotomy due to it's effects on the uterusAcepromazineIf we were to use a tranquillizer in a standing left flank celiotomy, what would we usetail tieWhat must ALWAYS be done in a standing left flank celiotomy preoperativelyT.pyogenes, E.coliWhat are the two most commonly isolated bacteria from parietal peritonitis and general peritonitis resulting from c-sectionCaudoventralExternal abdominal oblique fibers orientateCranioventralInternal abdominal oblique fibers orientateDorsoventralTransversus abdominus fibers orientateRectal Exam____ should always be done before ANY type of c-sectionCaudoventralWhere is the uterus in relation to the rumenAnterior, dorso-sacral presentation and positionThe fetal position that allows you to grasp the hoof and hockPosterior, dorso-sacral presentation and positionThe fetal position that allows you to grasp the hoof and carpus/elbowPlacentomesWhen making a uterine incision you should cut along the greater curvature, avoiding the ____ and fetusAbdominal Contamination_____________ is inevitable with standing c-section approachesUtrechtan inverting, not full thickness suture pattern done on uterine closuresContraindications: Emphysematous fetus and Heavy uterine contamination Peri-op considerations: Bloat, Radial nerve paresis/paralysis, Regurgitation and aspirationPeritonitisleading cause of mortality associated with cesarean sectionAdhesion formation20-60% of all cesarean sections get due to tissue trauma, bacteria, inflammation, exposed sutureFuture Fertilityadhesions and duration of dystocia have an effect onNegativeemphysematous fetuses will have an ________ post operative outcomeNegativelonger dystocias will have an ________ post operative outcomePositiveExteriorizing the uterus during surgery will have an _____ post operative outcomePositiveBurying suture, continuous, partial thickness suture patterns and use of anti-inflammatories will have an _____ post operative outcomePositiveAppling pressure to opposite abdominal wall prior to closure of peritoneum/transversus abdominus will have an _____ post operative outcomeTraumatic Inflammation Phase0-3 days of wound healing (length varies on the injury)Traumatic Inflammation PhaseIncreased blood flow ↑ Capillary permeability Exudation and wound edema Fibrin depositionTraumatic Inflammation PhaseSurgical technique (ie preserving blood supply, strict asepsis, approximation of tissue, hemostasis, decreased wound tension, and gentle tissue handling) greatly influences this stage --> earliest stage24Fibrin exudation during the inflammatory phase will result in a fibrin seal in < _____ hours --> seal but no strengthDestructive Phase1-6 days of wound healingDestructive PhaseWhen the cellular events are dominated by the leukocytic responseDestructive PhaseWhen phagocytosed material taken up by lymphatics and clearedDestructive PhaseSurgical technique (ie preserving blood supply, strict asepsis, approximation of tissue, hemostasis, decreased wound tension, elimination of dead space, and gentle tissue handling) greatly influences this stage --> why we do not scrape with a scalpel or use soaps in woundProliferative Phase5-16 days of wound halingProliferative PhaseFibrinolysis Capillary proliferation Fibroblast proliferation Collagen deposition3-5 daysWhen is a wound most weak/most likely to dehisce?Day 0A wound is strongest on ______, thanks to suturesDay 5A wound is the weakest on ____. Before that the strength decreases, after it increases. This is when fibroblast appearDay 16Synthesis and lysis of collagen and proteoglycans come into balance after _____Maturation Phase14 days to years in wound healingMaturation PhaseDecreased cellularity Decreased vascularity Collagen crosslinking Increased tensile strengthPrimary Healing___________will always be faster, cheaper, and more cosmeticSecond Intention Healing______ requires daily assessment and adjustmentBandage_______ techniques need to be adjusted as wounds progress from one stage to the next. There is also no indication to begin or stop treatmentsHydrotherapyUse of isotonic fluids for irrigationFresh Tissue____ will imbide waterGranulation Tissue___ will not absorb waterDay 10Topical are not helpful past ___Granulation Tissueis an impervious barrier to bacterial penetrationEdemaPressure bandages, NSAID's, Sweat bandages, and Restricting motion will help manage wound _____Granulation TissueExuberant ______ is not favored, it can happen with bandages, moist environments, and too much motion. Treatment is to remove immediatelySecond Intention HealingA wound healing by _______ will usually not become exuberant if left unbandaged and allowed to form a scabEpitheliumThe presence of _____ at the wound periphery indicates the wound is ready to be resurfacedContraction______ and epithelization are independent but may take place simultaneously --> superior cosmetically and functionally to epithelizationContractionProcess by which a wound diminishes in size by sliding of full thickness skin. Does not begin until the wound bed is granulated level with the skin --> depends on amount of available skinEdemaImproperly managing wound _____ in the early phase of wound healing leaves a larger leg with insufficient skin to cover the defect. Do not cut flap of skin if present.ContractionMost wound medications are toxic to the cells causing _____ and epithelizationSquamous Cell CarcinomaYou have a bull presenting with a rough, nodular mass on the penis. what is not on your differential list?Penile HematomaIn herfords and other horned breeds, they are more likely to have a _____ when swelling is noted --> @ base of prepucePrepucial problemsIn angus and other polled breeds, they are more likely to have a _____ when swelling is noted --> @ distal 1/3 of penisTestosteroneThe frenulum will break down due to ____PapillomaTreatment of ______ is to debride and disrupt so that an immune reaction can attempt to clear itPapillomaOccurrence of _____ on a penis/prepuce can indicate a deeper immunity problem in bullsRetractor prepuce muscleAngus and Polled Herefords have minimal or no ____Preputial Lacerations/ProlapseMore common in polled breeds (angus) and zebu‐type cattle (Brahman)Preputial Lacerationshould be treated as a surgical emergency, especially if blood is present at time of presentationElectro ejaculatorsWhat is not preferred in examination of preputial lacerationsPreputial Prolapsea complication of chronic preputial lacerationsPreputial Prolapsewhat surgery is not a rush? --> if the duration is too late, there is nothing we can do and the bull will be out of commission until the next breeding season anywayPreputial LacerationWhen repairing an acute _____, surgery is done with a ring block of lidocaine +/- pudendal block to extend penis. The penis is cleaned, debrided and repaired, then put in a preputial retainerPreputial Retainera tube put into penis (not on glands) and wrapped up to allow urine drainagePosthioplastyPreputial Laceration surgery (_____) is indicated if the mobility of the penis or prepuce is compromisedPosthioplastyIndications: Prophylactic (repeated minor trauma or in bos indicus bulls), Restrictive adhesions, or Circumferential scar.PosthioplastyBefore this surgery we want the sheath to be 2x the length. During surgery we will remove scar tissue on the penis via a circumferential incision and must control hemostasis. Closure is appositional interrupted with absorbable suture.Posthioplastyprognosis after ____ depends on the ability to extend the penis and compromise of elastic laminaePenile HematomaBending of penis against escutcheon of cow and restraint by retractor penis muscle can result inPenile Hematomaswelling on the Base of scrotum --> ______Abscessswelling on Preputial orifice --> ______Medical ManagementA penile hematoma that is < 20 cm should be treated with _______Surgical ManagmentA penile hematoma that is > 20 cm should be treated with _______Penile HematomaWhether treated medically or surgically, a penile _____ patient has a good prognosis (75%) to return to breedingAdhesions#1 complication of penile injury is ____ --> causes restriction of the penis' mobilitySidewinders Penile and Preputial Transpositionsurgery where the penis is put through an undermined hole under the skin that extends into hole made into the skin --> causes penis to come out of the bull's sideVentral Penopexytacking the corpus cavernous to the linea alba. This is a cheaper procedure but bulls don't like it as much