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Congress on Demand 2021: Surgery
Selected lectures from BSAVA virtual congress 2021
We are pleased to present a selection of lectures from BSAVA virtual Congress 2021 that cover surgery. This collection can be purchased as a standalone item, with a discount for BSAVA members. Visit our Congress on Demand information page for information about how to access the rest of our 2021 congress lectures.
Collection Contents
4 results
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Help! Acute abdomen: what do I do?
BSAVA Congress Proceedings 2021Authors: Alison Moores and Jackie DemetriouPresentation and triage of acute abdomen: An “acute abdomen” is defined as a condition of severe abdominal pain due to disease or injury of one or more abdominal organs, usually requiring surgery. The most common causes of acute abdomen in dog and cats are septic peritonitis and haemoabdomen. The purpose of this session is to consider different clinical presentations of acute abdomen, specifically the changes seen in different body systems, such as the cardiovascular system, and consider why this assessment is important.
What is the immediate management, in terms of bloods, drugs and tests? A patient with ‘acute abdomen’ may have a condition, or conditions affecting different organs or groups of organs and many will require eventual surgery. The purpose of the pre-surgical evaluation is to stabilise the patient appropriately but also to help diagnose the pathology, so the surgeon is better prepared. This presentation discusses the assessment of these patients in terms of appropriate pre-surgical evaluation including blood, drugs and imaging including point of care diagnostics that might influence further therapy or provide prognostic information. The aim is to enable the surgeon to optimise surgical outcomes for their patients and improve their confidence in managing these difficult cases.
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How to be sure of GIT foreign bodies
BSAVA Congress Proceedings 2021Author Jane LadlowThere are a number of conditions that can cause acute or intermittent vomiting, including gastrointestinal foreign bodies, pancreatitis and gastroenteritis. With foreign bodies, palpation may be diagnostic though in most cases, imaging confirmation of gastrointestinal foreign bodies is paramount, using radiographs, ultrasound or CT. On radiographs, signs consistent with obstruction include masses (soft tissue or radio-opaque, distended loops of small intestine (diameter > twice the height of L5) and plication. Ultrasound can be very useful in the hands of a skilled operator, often giving location of obstruction and any evidence of peritoneal effusion with high sensitivity and specificity. Surgical considerations include enterotomy versus enterectomy, suture techniques, needle type, stapling versus sutures and use of drains to aid post-operative surveillance. Post-operative management is crucial, with early enteral feeding important and careful monitoring and management of pain and ileus. Post-operative analgesia will be examined, including the evidence base for the use (or with-holding) of non-steroidal anti-inflammatories. Known risk factors for increased complications are covered and methods of decreasing complications such as the surgical check list discussed.
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How to deal with abdominal surgical complications
BSAVA Congress Proceedings 2021Authors: Jackie Demetriou and Jane LadlowPost surgical complications – overview: An ‘acute abdomen’ patient that is recovering from surgery may often have multiple and serious post-surgical complications. These complications are often due to a combination of surgery and the underlying disease process so management of these can be very challenging. The surgeon has to be well equipped to detect early deleterious changes in patient progress, whether this is bleeding, infection, leakage of bile or urine. This presentation therefore provides an overview of the most common post-surgical complications of these patients, how they can be diagnosed and practical ways to best treat them.
Dealing with post-operative peritonitis: Unfortunately, post-operative peritonitis is not unusual, intestinal surgery has about a 7% dehiscence rate and peritonitis may also be seen after other common abdominal procedures, including pyometra, prostatic surgery and cystotomy. Clinical signs of post-operative peritonitis can be difficult to differentiate from post-surgical ileus, pain and medication-related nausea or anorexia. About 50% of peritonitis cases may have concurrent pancreatitis. Imaging can be confusing as it is normal to have free fluid and gas in the abdomen after an open surgical approach (although the gas with peritonitis tends to be more diffuse). If free fluid is present on ultrasound, then sampling and performing cytology and peritoneal glucose and lactate concentration comparisons with serum levels can be most helpful. Other indications of peritonitis can include hypovolaemia, hypoproteinaemia (particularly a drop in albumin), development of respiratory acidosis and metabolic acidosis. Treatment involves intravenous antibiotics, haemodynamic support and repeat surgery to resolve the source of infection. Mortality rates are in the range of 20-50% depending on the study. Post-operative peritonitis does occur, and early detection may improve outcome. Careful monitoring after surgery and the use of a closed active suction drain in any cases that may be at higher risk may aid early detection. This presentation discusses risk factors in animals and prognostic indicators to guide decision making.
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How to improve tissue handling skills
BSAVA Congress Proceedings 2021Author Mickey TiversAppropriate tissue handling is an essential part of good surgical technique. Indeed, ‘gentle tissue handling’ is one of Halstead’s principles of surgery. Tissue handling involves respecting the tissues during surgery to ensure that they are not damaged. This can be achieved by the prevention of crushing, drying out, haemorrhage and damage to the vascular supply. An understanding and appropriate use of instruments and other techniques to aid tissue handling is essential. Good tissue handling is important as it will reduce or prevent complications such as surgical site infection (SSI), wound dehiscence, haemorrhage and seroma formation. The first step of improving tissue handling is to understand the basic principles. This can then be refined through practise and experience. It is vital that the surgeon reflects on their performance and strives for ongoing improvement. This can be enhanced by observation of peers, advice from an appropriate mentor and good planning prior to surgery. Refinement of tissue handling should improve surgical outcomes. Good surgical technique is characterised by accuracy and security rather than speed and apparent ease of performance.
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