Term 5 Week 2 RPM

A canine patient is being draped for a routine OVH procedure. What landmark needs to be visible to the surgeon to ensure an accurate midline incision? 

The umbilicus

The correct scalpel grip is important based on the procedure bring performed to ensure stability and control. What scalpel grip is recommended for long incisions in OVH procedures? 

Violin grip 

To ligate an ovarian pedicle, the suspensory ligaments need to be stretched or ruptured. What direction should traction be applied using an index finger to achieve this? 

Caudomedial traction  

A patient is schedule to be spayed in the junior surgery and anesthesia lab (JSAL), and the procedure is anticipated to take 4 hours. What are the common anesthetic complications most likely associated with a longer procedure? 

Nociception, hypotension, hypothermia 

What is the benefit for using the Quadratus Lumborum Block (QLB) for a spay procedure?

It decreases nociception

What SpO₂ reading in an anesthetized dog would indicate a need for immediate investigation?

96%

A dairy herd experiences increased late-term abortions. Investigation reveals several cows were fed moldy hay containing mycotoxins for 6 weeks. Aborted fetuses show no evidence of infectious agents on laboratory testing. What pathophysiological mechanism best explains this non-infectious pregnancy failure?

Toxic interference with maternal or fetal metabolic processes

A breeder reports that a 3-year-old queen has consistently resorbed embryos at approximately 25–30 days of gestation over three consecutive breeding attempts with different toms. The queen appears healthy with normal estrous cycles. What type of cause should be prioritized in the diagnostic investigation?

Non-infectious endocrine or genetic factors (luteal insufficiency, endocrine abnormalities, chromosomal abnormalities, and uterine factors)

Where are the ovaries located

At the caudal pole of the kidneys

Where are the uterine horns located

Dorsal-lateral in the body cavity

Where is the uterine body located

Between the urinary bladder and colon adjacent to the ureters

What may obscure vessels in the spay procedure especially if your dog is well conditioned

Fat within the ovarian bursa, mesovarium, and mesometrium

What does the mesovarium and mesometrium include

Vessels

What does the suspensory ligament attach

The ovary to the last rib

What does the proper ligament attach

The ovary to the uterine horn

Where will R handed surgeons stand for the spay procedure

On R side of the pt

Which grip will be used on the scalpel blade to incise the skin for a spay

Modified violin grip using your non dominant hand to stretch the skin

How can you control bleeding during a spay

Blot!

Use mosquitos to clamp and place ligatures if necessary

What is the tunneling method in the SGU spay

Blunt dissect the subQ with metzenbaums and tunnel til you can see the linea alba

To tunnel: make a small cut on the subQ tissue caudally on one side of the linea and insert the scissors making a tunnel THEN one blade in the tunnel and one blade out and push and cut

You may have to tunnel on the other side of the linea if needed

How will you enter through the linea alba in the spay technique

Use forceps to grasp the linea (either adson brown or rat tooth if needed)

In you dominant hand use the scalpel with the blade facing up and preform a stab incision at a 45 degree angle into the abdominal cavity

How do you extend your incision on the linea alba in a spay

Insert the grooved director in the same angle that you inserted the blade and slightly release tension on the thumb forceps for this (assistant surgeon usually does this)

R hand surgeons cut with left hand with the groove director going cranially and then reverse the GD direction and make an incision with a dominant hand in the caudal direction to match the length of the skin incision

How long should you incision on the linea alba be

As long at the skin incision!

How will you use a spay hook

Insert hook along abdominal wall then rotate 180 degrees and scoop up vertical (90 degree angle from incision)

If you get omentum on your spay hook what can you do

Push it back in cranially to get it out of your way

What should you do with the ovary when you find it

Assistant should clamp the proper ligament with a halstead or mosquito hemostats

If you are a R handed surgeon loosening the suspensory ligament of the R ovary how would you preform this

Right hand pulls caudo-medially and left hand moves into a lateral to medial motion once the suspensory ligament is followed down

What will you do right after you exteriorize the ovary

Make a hole in the mesovarium and create a long vertical window parallel to the vessels (which is usually preformed by the assistant surgeon)

Who places the clamps on the ovarian pedicle and how should they hold them

Assistant surgeon will place proximal middle or distal clamp and hold them from above

Where is the most distal clamp located on the ovarian pedicle

Proximal to the entire ovary

What is the modified 3 clamp technique

If your ovarian pedicle is not long enough the proximal and distal clamp will be on the ovarian pedicle and the distal clamp will be placed ALL the way around the proper ligament thru the window

Why should you NOT clamp down to the last rachet when preforming a spay

The uterine and ovarian tissue is friable especially in females in heat, pregnant or with a pyo

Why must you feel for the ovary if it is in the bursa or not before you ligate the ovarian pedicle

To make sure you are removing ALL ovarian contents so there is no retained ovarian tissue

(sometimes it hides in the bursa so just make sure you get all of the ovary)

What ligatures will you place for ligation of the ovarian pedicle and how will you place them

Modified millers placed in the area of the proximal crush (assistant should NOT remove the proximal clamp until the primary is ready to tighten it):

-Using thumb to thumb for first 2 throws with flashing and 2 securing throws

-A Halstead forcep will be kept as a safety line on the long end of the millers lig this will be used to check the pedicle later before closing

Transfixing ligature will then be placed distal to the millers (same technique as for castrations)

Make sure these ligatures have room in between them and that they at NOT kissing

What is the principle behind flashing

Tissue that is not flashed is flat so when the ligatures are placed with no flashing its like a belt that is too big when the clamp is removed and the tissue regains more circular form

How will you incise the ovarian pedicle

Between middle and distal clamps in a cranial direction or towards you NOT the assistant

Cut with blade parallel to abdominal wall

After you incise the ovarian pedicle what should you do

Check your pedicle for bleeding and make sure you got out all of the ovary and that it is not within the bursa

Also check you ligatures (you can hold on the long end of you millers with forceps to make sure it is tight enough)

Where is the mesometrium or broad ligament located?

Lateral to the uterine vessels

How is the mesometrium cut or torn

Manual traction

Pozzi technique

Ligature

What may you have to do with the mesometrium in obese dogs

Ligation

What is a tense band that can be found in the mesometrium

The round ligament

How do you tear the broad ligament

Start near uterine vessels and work your way out carefully tearing

What is the pozzi technique in terms of tearing the broad ligament

When should you ligate the broad ligament separate from the uterine body

Engorged vessels, in heat, pregnant, constant oozing

How does the cervix appear in the dog

Whiter and feels firmer

How do you ligate the ovarian body

In the same fashion as the ovarian pedicles distal to the cervix with millers (with safety line) and transfixing

What should you check to make sure you didn’t ligate with the ovarian body

The ureters! they can sometimes follow and be included in the broad lig so be careful you don’t ligate them leading to hydronephrosis

What is the natural retractor on the right side? What will you do with this?

The descending duodenum or mesoduodenum

Grab it up and look under at the gutters for bleeding

What is the natural retractor on the left side? What will you do with this?

The mesocolon or the descending colon which feels thick

Lift it up to look at the gutters and kidney on the left side

What must you make sure to count before you close the abdomen

Gauze (you should have 40)

In which animals can hemoclips (basically staple like ligeratures) be used in

Young or small dogs and cats

What should you do with the omentum before you close

Place the omentum from cranial back below the incision covering the organs and surgical site

How will you close the linea alba

Simple interrupted pattern with surgeons knots 5mm bites on each side (this is the holding layer)

Place one knot cranial and one caudal and then work caudally to cranially

How will you close the subQ layer

Simple continuous pattern from cranial to caudal with buried knots tacking to the external rectus sheath in each bite to reduce dead space

How will you close the skin

Intradermal ending with an aberdeen from caudal to cranial

What are some OVH complications intraoperative

Ureter ligation

Intra-abdominal gauze

Ovarian remnant syndrome

What are some OVH complications post operative

Partial incisional dehiscence

Brusing

Seroma

Eventration

Evisceration (intestines out)

What can a gauze left in an animal after surgery form

Gossypibomas

What should you suggest to breeders when monitoring for parturition

Check temperature 3 times a day (every 8 hrs)

What are some gestational problems seen in dogs

Pregnancy toxemia and DM

What is pregnancy toxemia associated with in bitches

Lack of carbs or altered carb metabolism

Bitches with very large litters (not enough room in their stomach)

Inadequate nutrition

When does pregnancy toxemia occur

Late gestation

What are clinical signs of pregnancy toxemia

Anorexia, weight loss, hepatic lipidosis

What UA result would be more consistent with pregnancy toxemia

Ketonuria (NOT with glucosuria like DM)

How do you tx pregnancy toxemia in dogs

Supplement nutrition (high calorie foods)

Terminate pregnancy with a C section (usually this over PGF2a because that takes a lot longer)

What leads to DM in pregnant dogs

The bitch usually has DM and it gets worse with pregnancy (increased progesterone) and they start to show clinical signs and are dx during pregnancy

What can DM from the mom lead to in the puppies

Macrosomia (big puppies because insulin is important for fetal growth)

What is the tx for a pregnant bitch with DM

Insulin therapy to maintain euglycemia

Termination of pregnancy in cases where insulin therapy doesn’t work

Poor fetal viability

When are insuline requirements increased

During diestrus and pregnancy

When does puerperal metritis happen in bitches

During first week post partum

Severe inflammation of the uterus