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Large Animal Surgery

Large Animal Surgery. Female Urogenital Surgery Tendonitis OCD Arthroscopy. Amy Fayette October 2005. What is pneumovagina. Aspiration of air into the vagina. What causes pneumovagina. Poor conformation Injury. What sx is done to prevent pneumovagina. Caslicks.

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Large Animal Surgery

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  1. Large Animal Surgery Female Urogenital Surgery Tendonitis OCD Arthroscopy Amy Fayette October 2005

  2. What is pneumovagina • Aspiration of air into the vagina

  3. What causes pneumovagina • Poor conformation • Injury

  4. What sx is done to prevent pneumovagina • Caslicks

  5. Why do you want to performa caslicks • Prevent vaginitis, cervicitis, metritis, infertility and noise production

  6. How is a caslicks performed • 3 mm of tissue is removed from each side of the vulva • The two sides are sutured together with mattress sutures

  7. What instrument is used • Scissors

  8. What is the most important aftercare instructions with a caslicks • Reopen before foaling

  9. What are the indications for a perineal body reconstruction • Ineffective vulvar and vestibular seal • Failed caslicks • Rectovestibular injuries

  10. What are the important aftercare instructions for a perineal body reconstruction • 4-6 weeks sexual rest • Episiotomy at foaling

  11. What is a perineal body transection used for • Decrease a forward sloping vulva

  12. What are the clinical signs of urovagina • Vaginitis • Cervicitis • Endometritis • Decreased conception rates

  13. What are the causes of urovagina • Pneumovagina • Ectopic ureter (very rare) • Excessive closure of caslicks

  14. What surgery is done to prevent urovagina • Caudal relocation of transverse fold • Or caudal urethral extension

  15. What types of injuries can occur from foaling • Perineal lacerations • Rectovestibular fistulae • Vaginal contusions • Vaginal rupture • Cervical lacerations • Uterine rupture • Uterine hemorrhage • Uterine prolapse • Eversion/prolapse/rupture of the bladder • GI injuries

  16. What is a first degree perineal laceration • Only mucosa of the vestibule/vulva

  17. What is a second degree perineal laceration • Mucosa and submucosa

  18. What is a third degree perineal laceration • Perineal body, anal sphincter, floor of the rectum

  19. What can increase the chances of perineal laceration • Primiparous mares • Fetal malposition • Nose or foot catching the vulvovaginal fold

  20. What is involved in repair of third degree lacerations • Local debridement • Tetanus prophylaxis • Repair in 4-6 weeks post partum • Diet change (soft feces)

  21. Why is a tracheostomy sometimes used to decrease the chances of a laceration • Cant close the epiglottis which decreases the pressure mares develop during parturition • Can still foal normally

  22. What are the two methods of rectovestibular repair • Aanes method (2 stage) • Goetze or Vaughan method (1 stage)

  23. In the staged procedure how long is the period between each stage • 2-3 weeks

  24. When can breeding occur post op • 6 weeks

  25. What is important to remember as aftercare instructions • Episiotomy at foaling

  26. What is a rectovestibular fistula • Laceration of dorsal vestibula into the rectum without disruption of the perineal body or anal sphincter

  27. How should rectovestibular fistulae be repaired • Small may close spontaneously • Direct closure via rectum or vestibule

  28. Tendons are made out of what type of collagen • Type 1

  29. Other than collagen what else is in tendons • Glycoproteins (COMP) • Growth factors

  30. What type of growth factors are found in tendons • BMP • TGFb • IGF

  31. What are the two ways tendon injuries occur • Athletic horses: overload stress on tendinous structures • Injury from external forces

  32. What is the definition of tendonitis • Disruption or stain of tendon fibers or musculocutaneous junction with subsequent inflammation

  33. What is this called • Overloading

  34. What is the most common site for tendonitis • SDF tendon at the mid metacarpus

  35. What are some other common site for tendonitis • Distal check ligament • DDF tendon at the level of the fetlock

  36. What are the clinical signs of tendonitis • Swelling at injury site (acute) • Pain on palpation • Reluctance to move • 3/5 lameness

  37. What is the most efficient method to diagnose tendonitis • Ultrasound

  38. What other techniques are used to diagnose tendonitis • Contrast Radiology • Thermography • Nuclear scintigraphy • MRI

  39. What are the zones for ultrasound evaluation

  40. What is a type 1 lesion • Diffuse loss of fiber density (hypoechoic)

  41. What is a type 2 lesion • Core lesion that is less than 50% of the cross section

  42. What is a type 3 lesion • Core lesion greater than 50% of the cross section

  43. What is a type 4 lesion • Core lesion of the entire cross section

  44. What is a “bowed tendon” • Tendinitis of the SDF

  45. Is a bowed tendon an emergency • YES

  46. What are the most basic treatments for tendonitis • Cold hydrotherapy • NSAIDS • Bandages, casts • Corrective shoeing • IV DMSO • Rest

  47. What are some more controversial treatments for tendonitis • Sodium hyaluronate • b-aminopropionitrile • Growth factors • Firing • Bone marrow transplantation

  48. What is the most important treatment for tendonitis • REST

  49. How does BAPN work • Blocks enzyme lysyl oxidase

  50. What is the purpose of tendon splitting • Improves the extrinsic vascular influx which facilitates healing

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