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Large Animal Surgery
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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