M6 Veterinary Surgical Assisting

What is a cystotomy?

Surgical incision into the bladder to expose the lumen/interior of the bladder

What is the primary reason for a cystotomy? (2)

Remove uroliths

Remove cystic calculi

What are secondary reasons for a cystotomy? (2)

Congenital issues

Neoplasia

What age of dogs typically receive a cystotomy?

Typically, middle-aged dogs

What are clinical signs of uroliths? (4)

Hematuria

Stranguria

Dysuria

Pollakiuria

How are uroliths diagnosed? (2)

Abdominal radiograph

Start with full urinalysis

What are special instruments to use in a cystotomy? (6)

Soft tissue pack

Bladder spoon

± Retractors

Towel packs

Laparotomy sponges

Urinary catheters

How do you prep a patient for a cystotomy?

Dorsal recumbency

Clipped and prepped for general abdominal surgery

What is an aural hematoma?

Formation of hematoma (blood) within the space between the skin and ear cartilage

How is an aural hematoma caused?

Caused by trauma to ear pinna

Head shaking, scratching, foreign body

What species tends to get aural hematomas?

Typically, in dogs

Seen in cats as well

What instruments should be used for an aural hematoma?

Soft tissue pack

Additional supplies may depend on surgeon

How would a patient be prepped for an aural hematoma?

Lateral recumbency with affected ear up

Single fenestrated drape or 4 quarter technique

Which patients is a lateral ear canal resection indicated? (2)

Patients with chronic ear infections

Patients with neoplasia

How should patients be prepped for a lateral ear canal resection?

Lateral recumbency with head slightly elevated

4 quarter draping

Clip and scrub the entire pinna along with adjacent skin

Clean ear - Flush and lavage

What are special instruments for ophthalmic procedures? (4)

Half-curved tissue forceps

Chalazion forceps

Tenotomy scissors

Castroviejo needle holders

How should a patient be prepped for an ophthalmic surgery?

Sternal or lateral recumbency

Specialized eye drape, fenestrated drape, or 4 quarter draping

Apply sterile lubricant to eyes

May clip around eye and flush post-shaving

Use very gentle scrub - no alcohol or soap-based scrubs

What are clinical signs of entropion? (5)

Lacrimation

Blepharospasms

Photophobia

Conjunctivitis

Keratitis

What are the two types of entropions?

Developmental/inherited

Spastic - secondary to an ocular condition

What are surgeries for entropion? (2)

Eyelid tacking

Holtz-Celsus Procedure

What is the Holtz-Celsus Procedure?

Removal of excess skin

What surgical duty is generally the responsibility of a veterinary technician acting as a surgical assistant?

Passing instruments from the open pack to the surgeon

What are trichobezoars?

Hairballs

What can a foreign object cause if it perforates the stomach?

Peritonitis

What surgical instrument is most appropriate to have ready for an upcoming exploratory abdominal surgery?

Balfour retractor

What strategy should be employed when preparing for a gastric surgery?

After the gastrotomy, have scrub team members change their gloves and replace all instruments with new sterile ones

What is the most appropriate position for a patient being prepared for an exploratory abdominal surgery?

Dorsal recumbency

What is it called when the intestines are folding in on themselves along the length of a linear foreign body?

Plication

What should exposed organs be kept moist and covered with?

Laparotomy sponges

What is the function of tenotomy scissors during ophthalmologic surgery?

Dissecting muscles and tendons of the eye

Why do members watch the opposite side when placing a Balfour retractor?

To avoid entrapping any organs within the Balfour retractor

What does it mean when the technician helps the surgeon explore the “gutters”?

Retracting the intestine

Which anatomical structure on a patient is sutured in a way that most ensures strength of the closure in an abdominal surgery?

Linea alba

What is dehiscence most likely to lead to?

Sepsis

What is the most likely obstruction type if a cat ate string and you are worried about plication?

Linear

What is the most appropriate action if a patient is continuing to vomit intermittently after a gastrotomy?

Withhold food and water and continue IV fluids

What kind of clamps should be prepared for an enterotomy?

Doyen clamps

What suture material is most appropriate to close an incision in the intestines?

Absorbable monofilament

What surgical procedure would most likely be used for necrosis in a section of the bowel?

Intestinal resection and anastomosis

What is an abdominocentesis?

Puncture of abdominal cavity to obtain fluid

What area should be clipped for a routine canine castration?

Just below the tip of the prepuce to just cranial to the scrotum

What is always a feature of treatment for short-bowel syndrome?

Correction of fluid loss and electrolyte imbalances

How is devitalization of intestinal tissue recognized during surgery?

Dark discoloration of tissue with lack of bleeding on cut section

What is the most common complication for a routine OHE?

Intra-abdominal hemorrhage

What is the location of the incision for a routine feline castration?

Scrotal

What scissors would you use on a uterus for a C-Section?

Metzenbaum

What is an en bloc OHE?

An OHE performed during a C section with the fetuses remaining in the uterus during removal

What would be the next appropriate step if a neonate is not breathing after being towel dried and briskly rubbed for 30 seconds?

Administer positive-pressure ventilation by mask

What is the next appropriate step if a neonate had a heartbeat for a few seconds after birth, but then it is lost and chest compressions were unsuccessful?

Administer epinephrine under the tongue

What condition is a dog most likely to develop along with septicemia if an open pyometra goes without immediate treatment?

Endotoxemia

What is the treatment for a closed pyometra?

OHE

What is the most appropriate to administer after surgery for an open pyometra?

IV antibiotics

What anatomic structure should be examined and palpated before an anesthetic agent is administered for an orchiectomy?

Scrotum

What complication is most common, in addition to scrotal hematoma, from an orchiectomy?

Hemorrhage

Which type of stone responds best to treatment with allopurinol?

Urate

What should be tried first if scrotal bleeding is noted after an orchiectomy?

Cold compress

When is it best to administer analgesia to a patient for an onychectomy?

Analgesia should be begun before surgery

In which type of onychectomy is the use of alcohol in the preparation of the toes contraindicated?

CO2 laser

How long should pain medication be administered to a patient post-onychectomy

3-5 days

What is the most appropriate surgical treatment for a patient with a history of chronic otitis externa?

Lateral ear canal resection

What would be most appropriate to dissuade a patient from self-mutilation following a lateral ear canal resection?

Bandage the ear and place an Elizabethan collar

The Holtz-Celsus techniques is indicated in a patient diagnosed with which disease process?

Conformational entropion

What are the cranial and caudal borders for clipping a patient for a laparoscopic procedure?

Xiphoid process and pubis

What is hypertrophic osteodystrophy?

Developmental disruption of the patient’s metaphyseal trabeculae when the dog was young and still growing

What is most appropriate to place on a limb during the first 48 hours after repairing the CCL?

Soft bandage

A 10-year-old female Pit Bull Terrier dog is presented for wellness evaluation. Physical examination shows a skin lesion of approximately 2 cm in diameter on her back. The veterinarian does not suspect it is malignant. Which type of biopsies is most appropriate to perform on this tissue?

Excisional

During endoscopy, what structure should appear first as a star-shaped area of folded mucosa dorsal to the larynx?

Cranial esophageal sphincter

When performing an endoscopy, what is the “J maneuver”?

The retroflexion of an endoscope to examine the GES

In preparing a patient for gastroscopy, how should the technician position the patient to enable the scope to traverse the antrum and pylorus as smoothly as possible?

Left lateral recumbency

Which step in a laparoscopy is performed by a nonsterile technician?

One end of the insufflation tubing is attached to the insufflator

A technician is holding the control section of a flexible endoscope during endoscopy using a left-handed two-finger grip. Which digit(s) operate(s) the angulation knobs?

Thumb

The surgeon plans to perform laser surgery to remove a perianal growth. How can methane production through flatulence be contained?

Place damp sponges in the patient’s rectum

If a practice does not have patient eye shields, what can be used in their place to protect the patient’s eyes during a surgery in which a CO₂ laser is used?

Moistened sponges

Which procedure will allow the veterinarian to examine the peritoneal cavity and viscera of a patient?

Laparoscopy

Which piece of equipment is used to puncture through the abdominal wall to insert an instrument during a laparoscopy?

Trocar-cannula unit

Which feature or capability of an endoscope contributes the most to retroflexion?

Four-way distal tip deflection

Which accessory instrument is most likely to be helpful in grasping a foreign object?

Rat tooth forceps (1×2 Adson forceps)

The canula of the trochar-canula unit for laparscopy is used to:

Puncture through the abdominal wall

Radiographs of a 5-year-old cat show a small smooth toy in its stomach. Which of the following surgical procedures is the veterinarian most likely to perform to remove the toy?

Endoscopy

The veterinarian wants to check the urinary bladder of a dog using a minimally invasive method. Which instrument is the veterinarian most likely to ask the technician to prepare?

Rigid endoscope

A technician is preparing a patient for endoscopy. She enters the patient data into the computer and turns on the endoscope. She ensures there is an adequate amount of distilled water for flushing. She next covers the air/water valve in water to test for insufflation. Which of the following is the most appropriate next step in this endoscopy preparation?

Test the endoscope tip for proper suction

The veterinarian suspects an ulcer somewhere between the mouth and the stomach. Which of the following minimally invasive procedures is the veterinarian most likely to perform?

Esophagoscopy

The veterinarian suspects intestinal lymphangiectasia, a disease of the small intestine. Which of the following studies is most likely to confirm the diagnosis?

Duodenoscopy

The veterinarian suspects lymphocytic plasmacytic colitis, a large bowel disease. It is most appropriate for the veterinary technician to prepare for which of the following diagnostic studies?

Colonoscopy

The purpose of cystoscopy is to:

Evaluate the bladder and lower urinary tract through the urethra

What is the best way to store a clean endoscope between procedures?

Hang the endoscope in a cabinet or on a wall or pole mount