Surgery clinics 499



Jordan University of Science and Technology

Faculty of veterinary Medicine

Department of veterinary clinical Sciences

Surgery clinics VM 499

Objectives:

By the end of each rotation, students are expected to perform and master the following skills.

1. Differentiate between surgical and non surgical problems in animals by performing an accurate and comprehensive physical examination.

2. Perform and master animal preparation for aseptic surgery.

3. Perform surgeon's and instrument preparations for surgery.

4. Know the correct names for instruments and their correct uses.

5. Know different types of suture materials and suture techniques.

6. Stick to aseptic technique during surgical operations.

Course Requirements

Students are required to posses the following items during the training in this course:

1. Stethescope

2. Thermometer

3. 2 clean overalls

4. 2 clean labcoats

5. Long rubber shoes

6. Name tag

7. Surgical scrubs and pants

Grading Criteria

1. Students attitude and participation

2. Student attire and cleanliness

3. Basic knowledge

4. Clinical skills

5. Communication skills

6. Team work with peers

7. Responsiveness to senior’s directions

8. End of rotation exam

Preparation for Surgery

Training in this section emphasis on preoperative procedures that involve the animal, surgeon, and instruments. The importance of aseptic technique and surgical common sense will be emphasized. In addition, students will be trained on client communication regarding surgical diseases outcome, complications, and follow-ups.

Preoperative Antibiotics and Analgesics

The emphasis on control of surgical infections and pain is prevention.  These common problems of surgery should be anticipated and treated before they occur, since such treatment is always more effective, humane, and cost-effective than attempting to do so after infection or pain has become established following surgery.

Not every case will benefit from one or both of these considerations, but most will.

Local and Regional Anesthesia

The use of local anesthetics in large animal practice is usually to enable minor surgical procedures in the field.  The commonly-used drugs are safe, effective, and may prevent the need for general anesthesia in many circumstances.  The techniques of regional anesthesia can also be used for prolonged control of severe pain, and are not used enough for this purpose.  

The indications for local and regional anesthesia in large animal practice (equine and bovine).

The drugs that are commonly used and best uses, advantages, and disadvantages of them: Esters (cocaine, procaine), Amides (lidocaine, mepivacaine, bupivacaine, proparacaine, tetracaine), Others (ethanol, xylazine, morphine).

Considerations where local anesthetics are formulated with other drugs (preservatives, epinephrine).

Pharmacology of conduction anesthetics and the manner in which these drugs act on the body; ester anesthetics (unstable, hydrolyzed), amide anesthetics (N-dealkylation, then hydrolysis).  Vasodilation, and differential blockade.

Selected techniques of regional bovine analgesia and when the different techniques are used: line block, "L" block, Peterson block, intravenous block, paralumbar fossa block (by line block (or L-block), paralumbar regional block, and paravertebral regional block), epidural block, cornual nerve block, auriculopalpebral nerve block, teat blocks.

Selected techniques of regional equine analgesia and when the different techniques are used: line block, L-block, and epidural anesthesia, supraorbital nerve block, auriculopalpebral nerve block, infrarbital nerve block, standing castration blocks.

Minor Procedures

Indications for dehorning; reduce injuries, reduce trimming loss, decrease hazard, prevent entrapment.

Calf dehorning: preparations for the procedure and considerations based on age of calf, and the instruments used for dehorning.

Dehorning adult cattle: anatomy of horns, preparation (clipping, regional anesthesia), procedure (tools, removal, and suturing or bandaging).

Dehorning the goat: the difference between goats and cattle, possibilities for anaesthesia and different procedures for horn removal in goats.

Abomasal surgery - Bovine

Rumen surgery –Bovine, Ovine, Caprine

Open Wound Management

Definitions; open and closed wounds

Principles of wound healing

  -wounding or injury

  -inflammatory phase

  -debridement phase

  -repair phase

  -maturation (scar) phase

Factors affecting wound healing

  -patient age, health, anemia/blood loss, medications, infections, etc.

Wound closure types & techniques

  -primary wound repair

  -second intention healing

  -delayed closure

  -patient evaluation, wound assessment, wound preparation

  -debridement, antimicrobials, wound care, control of exhuberant granulation

Reconstructive techniques

  -self directed review

Umbilical Diseases and Herniorrhaphy

Umbilical hernias result from either of two mechanisms: 1)  a slight weakness of genetic origin in the linea alba, or 2)  an immediate obstruction to the normal process of closing of the umbilical opening in the neonate.  

Intro to inguinal and diaphragmatic hernias.

Causes and results of umbilical hernias

Assessing an umbilical hernia before surgery (palpation, radiography, ultrasound imaging) and determining where to do surgery (farm or clinic).

Rule of thumb to decide when to do surgery, based on size of hernia.

Non surgical methods of hernia repair and their advantages, disadvantages, and effectiveness; taping, hernia clamps, subcutaneous injection of iodine.

Surgical technique of repairing umbilical hernia

Marsupialization, the surgical technique for abdominal abcess.

Approaches to the Abdomen

Review of the anatomy of the abdominal wall, review of anatomic locations of abdominal organs, options for approaches to abdominal organs, and advantages and disadvantages of each approach.

Ventral approaches: ventral midline (cranial, middle, caudal), ventral paramedian, inguinal, paringuinal

Flank approaches: paralumbar fossa

Vaginal approaches: colpotomy

Other approaches: laparoscopic approaches (ventral and flank), paracostal, and paramammary

Considerations when deciding which approach to use.

Ophthalmic Surgery

The following surgical procedures will be described:

-Tarsorrhaphy; the indications are deep corneal trauma or ulcer

-Nictitans Conjunctival Flap

-Sliding Conjunctival Flap

-Congenital Entropion in foals, lambs and rarely calves

-Enucleation

-Exenteration

-Tumors; squamous cell carcinoma, equine sarcoid

Diseases of the Nasal Airway and Sinuses

The surgical procudures and prognosis for the following conditions will be covered;

Epidermal Inclusion Cyst:

-benign, dermal, squamous cyst

-dorsolateral aspect of rostral face

-simple local excision

Nasal Flutter:

-inspiratory noise and performance problem

-excision of the alar flap

Facial Fractures:

-collapse of bone into sinus space

-surgical repair is not difficult

Deviation of Nasal Septum:

-thickening, fibrosis and deviation may cause noise, airway obstruction

-radiographic diagnosis, surgical excision is preferred

Ethmoid Hematoma:

-fibrous, giant-cell tumor of nasal mucosa

-displaces normal airway structures

-recurrence following excision is common

-endoscopic injection of formalin

Bovine Sinusitis:

-common in older animals following dehorning, esp. in windy conditions

-trephination is curative

Equine Sinusitis:

-primary disease of Streptococcus sp., secondary to dental disease, tumors

-surgical drainage and daily lavage

-trephination

-fenestration of medial sinus wall

Paranasal Sinus Cysts:

-unilateral airway obstruction, noise, facial swelling

-surgical excision is curative

Neoplasia:

-Squamous cell Ca, granuloma, osteosarcoma are all uncommon

-adjunct treatments necessary following surgical debulking

-prognosis unfavorable

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