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Questions and Answers
What are the primary reasons for performing an abdominal exploratory procedure in small animals?
What are the primary reasons for performing an abdominal exploratory procedure in small animals?
Abdominal exploratory procedures are ONLY recommended for critically unwell patients.
Abdominal exploratory procedures are ONLY recommended for critically unwell patients.
False (B)
What is the standard approach to the abdomen in small animal surgery?
What is the standard approach to the abdomen in small animal surgery?
Ventral midline incision
A [BLANK] is a surgical procedure to prevent the recurrence of intussusception.
A [BLANK] is a surgical procedure to prevent the recurrence of intussusception.
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Which of the following procedures is NOT considered a standard abdominal exploratory procedure?
Which of the following procedures is NOT considered a standard abdominal exploratory procedure?
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Match the following surgical procedures with their primary purpose:
Match the following surgical procedures with their primary purpose:
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What are three advantages of open celiotomy for abdominal exploratory procedures?
What are three advantages of open celiotomy for abdominal exploratory procedures?
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List two potential disadvantages of open celiotomy.
List two potential disadvantages of open celiotomy.
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Which of the following is NOT a recommended technique for gentle tissue handling during a biopsy?
Which of the following is NOT a recommended technique for gentle tissue handling during a biopsy?
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It is acceptable to enter a contaminated visceral organ like the GIT during a biopsy without changing instruments and gloves.
It is acceptable to enter a contaminated visceral organ like the GIT during a biopsy without changing instruments and gloves.
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What is the primary purpose of copious lavage during wound closure after a biopsy?
What is the primary purpose of copious lavage during wound closure after a biopsy?
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Biopsy samples should be labeled with the _______ and _______ of the sample.
Biopsy samples should be labeled with the _______ and _______ of the sample.
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Match the following biopsy procedures with their associated risks:
Match the following biopsy procedures with their associated risks:
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Which of these is NOT a recommended suture material for closing biopsy sites?
Which of these is NOT a recommended suture material for closing biopsy sites?
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Air-dried smears and impression smears are both methods used to prepare samples for cytological analysis.
Air-dried smears and impression smears are both methods used to prepare samples for cytological analysis.
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What is the importance of a three-layer closure in wound closure after a biopsy?
What is the importance of a three-layer closure in wound closure after a biopsy?
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Which of the following is NOT a factor to consider when deciding whether to perform exploratory laparotomy (Ex Lap)?
Which of the following is NOT a factor to consider when deciding whether to perform exploratory laparotomy (Ex Lap)?
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Contrast radiography is still the preferred method for diagnosing intussusception.
Contrast radiography is still the preferred method for diagnosing intussusception.
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What are the four views used in point-of-care ultrasound to look for free fluid?
What are the four views used in point-of-care ultrasound to look for free fluid?
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When deciding whether to perform Ex Lap, it's crucial to have a ______ and ______ with the owner regarding potential risks, outcomes, and the procedure itself.
When deciding whether to perform Ex Lap, it's crucial to have a ______ and ______ with the owner regarding potential risks, outcomes, and the procedure itself.
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Match the imaging technique with its associated characteristic:
Match the imaging technique with its associated characteristic:
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Which of the following is NOT a potential risk associated with exploratory laparotomy?
Which of the following is NOT a potential risk associated with exploratory laparotomy?
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The presence of free fluid in the abdominal cavity always indicates septic peritonitis.
The presence of free fluid in the abdominal cavity always indicates septic peritonitis.
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What are some alternative techniques that can be used before considering exploratory laparotomy?
What are some alternative techniques that can be used before considering exploratory laparotomy?
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What is the minimum number of throws required for multifilament suture material in an interrupted pattern?
What is the minimum number of throws required for multifilament suture material in an interrupted pattern?
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Synthetic absorbable sutures can be used for both continuous and interrupted techniques.
Synthetic absorbable sutures can be used for both continuous and interrupted techniques.
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What is the purpose of the subcutaneous layer in wound closure?
What is the purpose of the subcutaneous layer in wound closure?
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In continuous suture techniques, one throw is added to the _______ and two throws are added to the _______.
In continuous suture techniques, one throw is added to the _______ and two throws are added to the _______.
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Match the following suture materials with the correct minimum throws required for interrupted sutures:
Match the following suture materials with the correct minimum throws required for interrupted sutures:
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What is a common use of laparoscopy in companion animals?
What is a common use of laparoscopy in companion animals?
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Laparoscopy allows for full tactile inspection during procedures.
Laparoscopy allows for full tactile inspection during procedures.
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What gas is used to inflate the abdomen during laparoscopic procedures?
What gas is used to inflate the abdomen during laparoscopic procedures?
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One of the disadvantages of laparoscopy is limited ______ inspection.
One of the disadvantages of laparoscopy is limited ______ inspection.
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Match the following laparoscopic procedures with their purposes:
Match the following laparoscopic procedures with their purposes:
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What is one potential benefit of laparoscopic procedures?
What is one potential benefit of laparoscopic procedures?
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Lap-assisted techniques allow for the withdrawal of tissue through incisions.
Lap-assisted techniques allow for the withdrawal of tissue through incisions.
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What should a surgeon have in place before proceeding with a laparoscopic surgery?
What should a surgeon have in place before proceeding with a laparoscopic surgery?
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What is the recommended suture size for medium to large dogs?
What is the recommended suture size for medium to large dogs?
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Intradermal skin closure increases the risk of dehiscence more than simple continuous patterns.
Intradermal skin closure increases the risk of dehiscence more than simple continuous patterns.
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What is the primary complication associated with laparotomy that can lead to herniation?
What is the primary complication associated with laparotomy that can lead to herniation?
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The closure of the _____ sheath is the first layer in a three-layer closure technique.
The closure of the _____ sheath is the first layer in a three-layer closure technique.
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Match the following complications of laparotomy with their descriptions:
Match the following complications of laparotomy with their descriptions:
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Which of the following is NOT a recommendation for post-operative patient care?
Which of the following is NOT a recommendation for post-operative patient care?
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Avoiding dead space during closure is essential for proper healing.
Avoiding dead space during closure is essential for proper healing.
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What is a key practice to avoid seroma formation following surgery?
What is a key practice to avoid seroma formation following surgery?
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Flashcards
Linea alba
Linea alba
A fibrous structure incorporating the rectus abdominis muscle sheath.
Suture material types
Suture material types
Different materials (e.g. Vicryl, PDS) used for suturing wounds.
Interrupted suture technique
Interrupted suture technique
A suturing method using individual knots, requires specific throws based on material.
Continuous suture technique
Continuous suture technique
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3 layer closure
3 layer closure
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Haemoabdomen
Haemoabdomen
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Ex Lap (Exploratory Laparotomy)
Ex Lap (Exploratory Laparotomy)
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Indications for Ex Lap
Indications for Ex Lap
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Imaging Tools
Imaging Tools
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Point of Care Ultrasound
Point of Care Ultrasound
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Contrast Radiography
Contrast Radiography
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Informed Consent
Informed Consent
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Thorough History and Physical Exam
Thorough History and Physical Exam
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Indications for surgical exploration
Indications for surgical exploration
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Exploratory laparotomy
Exploratory laparotomy
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Adventages of exploratory laparotomy
Adventages of exploratory laparotomy
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Disadvantages of exploratory laparotomy
Disadvantages of exploratory laparotomy
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Standard surgical approach
Standard surgical approach
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Three-layer closure
Three-layer closure
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Laparoscopy
Laparoscopy
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Biopsy Procedure
Biopsy Procedure
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Sampling Techniques
Sampling Techniques
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Tissue Handling
Tissue Handling
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Suture Material
Suture Material
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Sample Preparation
Sample Preparation
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Wound Closure Techniques
Wound Closure Techniques
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Swab Counting
Swab Counting
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Instrument Change Protocol
Instrument Change Protocol
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Suture size for cats
Suture size for cats
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Avoiding skin suture overtightening
Avoiding skin suture overtightening
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Bites for fascial sheath
Bites for fascial sheath
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Complication: Seroma formation
Complication: Seroma formation
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Peritonitis causes
Peritonitis causes
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Common mistakes in laparotomy
Common mistakes in laparotomy
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Post-operative patient care
Post-operative patient care
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Advantages of Laparoscopy
Advantages of Laparoscopy
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Disadvantages of Laparoscopy
Disadvantages of Laparoscopy
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Common uses in animals
Common uses in animals
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Veress needle
Veress needle
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Trocar
Trocar
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Laparoscopic techniques
Laparoscopic techniques
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Surgical planning
Surgical planning
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Study Notes
Introduction
- Title: Approach to the Small Animal Abdomen (2025)
- Presenter: Alison Livesey MRCVS
- Institution: University of Surrey
- Date: 2025
Learning Objectives
- Understand indications for surgical abdominal exploration in companion animals.
- Describe safe, effective, and systematic abdominal exploration in small animals.
- Describe standard surgical approach to the abdomen in small animals.
- Describe the standard 3-layer closure of a ventral midline abdominal wound in small animals.
- Recognize the significance of specialized procedures like laparoscopy.
Abdominal Exploratory Procedures
- Routinely performed in first-opinion practices.
- Useful diagnostic and therapeutic tool.
- Standard approach used for neutering, foreign body retrieval, urinary calculi removal, and biopsies.
- Used for healthy stable and critically ill patients.
Indications
- Diagnostic/Prognostic: Sampling (culture, histopathology, cytology, visual inspection) to diagnose or confirm conditions.
- Therapeutic: Haemoabdomen, peritonitis, mass removal, obstruction/torsion, trauma/hernia, calculi, congenital abnormalities (e.g., ureter shunt), tube placement (enteral/cystostomy), dystocia/pyometra, sub-total colectomy.
- Preventative: Neutering, gastropexy, and colopexy as preventative measures.
Intestinal Plication
- Previously performed to prevent intussusception recurrence.
- No longer advised.
Exploratory Laparotomy (Open Celiotomy)
- Advantages: Direct visual and tactile inspection, good sample collection, potential for therapeutic procedures.
- Disadvantages: Invasive, costs uncertain, risk of general anesthesia (GA) complications (pain/morbidity), time-consuming.
When to Perform Ex Lap?
- Utilize other diagnostic tools (history, physical exam, radiographs, ultrasound, endoscopy, minimally invasive biopsy techniques or CT/MRI) to avoid unnecessary surgeries.
Successive Radiographs
- SI diameter greater than 1.9 compared to L5 vertebral body height indicates potential obstruction.
Imaging
- Images provided demonstrating the absence of foreign bodies. Barium radiographs superseded by ultrasound in a specific case. Ultrasound is advantageous for diagnosing intussusception.
Point of Care Ultrasound
- Key viewpoints/views – Diaphragmatic-hepatic (DH), Cystocolic (CC), Splenorenal (SR), Hepatorenal (HR).
- Free fluid is always abnormal but doesn't always mean septic peritonitis.
Prepare the Owner
- Emphasize good communication as the procedure is emotive, costly, and risk unknown.
- Discuss client's decision process, procedure risks, possible outcomes, and euthanasia as an option.
Preoperative Stabilization
- Chronic conditions: address comorbidities (e.g., clotting disorders, cardiovascular problems), correct electrolyte and dehydration imbalances, and provide nutritional support (e.g., parenteral nutrition).
- Acute/Emergency conditions: provide intravenous fluids, correct electrolyte imbalances, address hypovolemia, and correct dehydration.
What to Find During Surgery
- Potential findings and preparation for: Intestinal mass, biopsy, enterectomy/anastomosis, foreign body obstruction, enterotomy/enterectomy, intussusception, splenic mass, liver mass, and disseminated neoplasia. Equipment needed: abdominal retractors, suction/lavage, multiple haemostats, extra swabs, assistant, blood transfusion, feeding tube.
Adequate Exposure
- Use of surgical instruments, like Balfour and Gosset retractors, is vital for proper exposure.
Halsted's Principles
- Crucial considerations for successful surgical procedures: Gentle tissue handling, meticulous haemostasis, preservation of blood supply, strict aseptic technique, tension-free closure, accurate apposition of tissues, and effective dead space elimination.
Prepare the Patient
- Proper patient preparation: dorsal recumbency, wide clipping and prepping the surgical area, 4-corner draping, catheterization for male patients, parapreputial incision extension on males, and ligating epigastric vessels, and surgical incision from xiphoid to pubis.
Ex Lap Male Patient
- Surgical methods and instruments
Ex Lap Spay Prep
- Prepping of a spay patient for surgery
Surgical Approach; Midline Abdominal Incision
- Steps in the surgical procedure: instrument count, swab count, ventral midline incision, subcutaneous tissue dissection, and expose linea alba.
Common Errors in Skin Incisions
- Avoiding mistakes: proper cutting technique, full-thickness incisions, appropriate stabilization, correct incision depth to avoid blood loss or worse outcomes, proper perpendicularity of incisions relative to the skin's surface, and maintaining equal edges.
Surgical Approach
- Key techniques: tenting linea alba, using a scalpel/reverse blade, assessing structures like bladder, stomach, intestines, uterus, spleen, and masses, and checking for adhesions.
Surgical Approach
- Techniques to extend incision using scissors/blade, tenting tissues, reverse cutting technique, avoiding rectus abdominis muscle, employing a suitable incision size, ensuring adequate visibility, and promoting minimally painful procedures.
Surgical Approach
- Remove falciform fat, use abdominal retractors, and utilize moistened laparotomy swabs.
Full Systematic Abdominal Exploration
- Systematic exploration approach using defined approaches to cranial and caudal quadrants, examine tissue texture, and detect abdominal fluid, intestinal motility, lymph tissue presence and appearance.
Identify, Palpate and Visually Inspect All Organs
- Cranial quadrant: liver, gallbladder (including duct patency examination), diaphragm, spleen, stomach, duodenum, pancreas, kidneys, adrenals, ovaries, and uterus. Caudal quadrant: jejunum, ileum, colon, lymph nodes, urinary bladder, and prostate.
Identify, Palpate and Visually Inspect All Organs (Continued)
- Identifying organs, specific quadrants, and surgical maneuvers like duodenal manoeuvre to locate/ palpate right kidney, adrenal gland, and ovary; colon manoeuvre for locating the left paravertebral fossa and/or ureter.
Identify, Palpate and Visually Inspect Organs- GIT
- Exteriorization and examination of omentum and mesentery of the GIT (Gastrointestinal tract), and keeping organs moist.
Duodeno-Colic Ligament
- Finding, inspection, and possible surgical resection of the colic lymph nodes in this region—common site of obstruction.
I Didn't Find Anything
- Assessing the necessity for further investigation if no abnormalities are found. Considerations for owner discussions are presented about negative findings.
Sample/Biopsy
- Biopsy areas (lymph nodes, lymph tissue, GALT), fluid collection (for cytology/smears), gallbladder, urine, and abdominal fluid sample collection.
Biopsy
- Isolate the area of interest, pack with moist swabs, gently handle tissue, using sutures/atraumatic forceps/assistant's fingers. Collection of adequate samples and proper packaging for subsequent analysis, and the importance of correct labeling.
Wound Closure
- Counting surgical swabs, performing copious lavage (using warm, sterile saline), removing contaminating material, changing instruments/gloves appropriately if necessary (after entering a contaminated viscous area e.g. GIT, bladder, or if encountering FB/biopsy), and performing peritoneal/incisional block closure or other post operative care procedures.
Wound Closure- 3 Layer Closure
- Incising linea alba, incorporating rectus abdominis muscle using appropriate bite sizes, avoiding subcutaneous tissue, and employing synthetic absorbable sutures for the closure procedures.
Wound Closure- 3 Layer Closure (Continued)
- Subcutaneous layer closure of dead space by apposing edges and using appropriate synthetic absorbable sutures. Skin closure (using correct technique), risk of seromas, and avoiding overtighteing sutures.
Top Tips - 3 Layer Closure
- Selection of suture materials and appropriate sizes per patient parameters (cat, small/giant dogs, medium-large dogs and their corresponding metric sizes), ensuring correct technique to avoid dehiscence risk. Methods for the subcutaneous and preputial muscle (male animals) closures are also discussed along with the importance of obliterating dead space. Avoiding overtightening skin sutures and dead space.
Post-Operative Patient Care
- Providing analgesia, using antibiotics if indicated, turning patient if not ambulatory, caring for catheters/drains/feeding tubes, maintaining fluid balance, and performing serial monitoring.
Complications of Laparotomy Wound
- Possible complications: seroma formation (potentially leading to wound breakdown/herniation), infection, suture reaction, adhesions, and iatrogenic peritoneal foreign bodies, which may result in abscess years later.
Complications of Laparotomy
- Potential complications following exploratory laparotomy: peritonitis (inflammation of the peritoneum), caused by abdominal surgeries, and procedures where organs are ruptured, necrosed, perforated, or have penetrating foreign bodies.
Common Mistakes
- Potential errors: insufficient clipping/incision size, incomplete exploration, inadequate biopsy collection, unpreparedness for unexpected findings, and/or choosing the wrong cases for surgery.
Laparoscopy
- Advantages: Minimally invasive, good visual and biopsy sample collection from most organs, capability for some therapeutic procedures.
- Disadvantages: Limited tactile inspection, inability to perform some procedures, reliance on specialized equipment/training, higher costs, and potential longer surgical time.
Laparoscopy (Continued)
- Common uses in companion animals: Ovariohysterectomy, biopsy (liver), cholecystectomy, lap-assisted gastropexy, lap-assisted cryptorchid castration, lap-assisted cystotomy, and detecting and assessing diseases.
Laparoscopy Technique
- Surgical techniques: wide clipping and prepping, CO2 inflation using vessers needle procedures, and the use and insertion of trocar/cannula for scopes and instrumentation and the insertion of further instrument ports, tissue removal from ports, and procedures to locate and withdraw tissue.
Top Tips- Ex Lap
- Importance of proper procedural setup, thoroughness, using a plan (plan A, B, and C), avoiding getting sidetracked, correctly preparing samples, employing careful tissue handling, and excellent client communication.
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Description
Test your knowledge on abdominal exploratory procedures in small animals. This quiz covers reasons for surgery, techniques, and considerations in veterinary practice. Ideal for veterinary students and professionals aiming to enhance their surgical skills.
