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Question 1. Endoscopic correction of a Left Displaced Abomasum (One or Two-step) is classed as a:
Points "C" and "D", which represent the abomasopexy points for Christiansen and Meyer respectively.
Question 2. The first objective in any corrective endoscopic procedure in cattle is to:
From Laparoscopy, to Thoracoscopy, to Thelioscopy and once we've established the optical portal, we inspect for abnormalities and establish a prognosis. Displacements, signs of inflammation, or various stages of tissue haemorrhage are of huge importance and help us decide, whether to proceed with the operation or dispatch the animal.
Question 3. During the preparation phase for an endoscopic operation in cattle, the following options are available to restrain the patient while the procedure is carried out. Which of the following is the best approach?
Any endoscopic procedure starts with the animal standing, even if our selected approach is the two-step method. Ideally we should have a purpose built crush, but these are often not availalbe. To avoid any unnecessary disruption that can jeopardise the animal and the surgeon safety, restraining the head firmly and safely in a fixed point in an internal corner is the best way to minimise the patient's lateral movements.
Question 4. This video extract documents a laparoscopy, in particular the setting-up of the optical portal. A number of instruments are inserted through the prepared area of the skin on the left paralumbar fossa. Which are the instruments used?
We insert the 5mm Trocar & Cannula first in order to ascertain the correct angle that the 8mm or 10mm Trocar and Cannula need to be inserted. This step is blind, ie we cannot observe the advance of the 5mm, 8mm or 10mm trocar. Inserting a smaller instrument first, such as the 5mm Trocar & Cannula allows us to minimise the risk of inadvertent visceral trauma, while setting up the optical portal.
Question 5. This video extract documents a laparoscopy, in particular the setting-up of the optical portal. Why is the surgeon constantly placing his ear opposite to the valve of the Trocar?
To determine whether we are in the peritoneum, a cavity or solid tissue. We listen for the hissing of passing gas, then we have to dermine its direction of movement. We feel the expirating gas , whereas we don't feel the aspirating air into the peritoneum. We smell the gas and distinguish between abomasal or ruminal content.
Question 6. This image is taken from a cow on dorsal recumbency during a two-step procedure. The optical portal lies a hand's width caudal to the xiphoid process on the right hand side of the Linea Alba. Name the organs depicted:
This image is particularly important when carrying out a corrective endoscopy for right displacement of abomasum. In such cases, before committing to the Abomasopexy, we need to determine whether the pylorus lies cranially or caudally of the abomasum. In other words, whether the RDA is volvulated or not.
Question 7. This video extract documents a one-step corrective laparoscopy, in particular the setting-up of the Transfixer. Why is the surgeon holding the instrument in such manner?
It is important before inserting the Transfixer through the working portal, to ensure that there is adequate clearance above the patient. For the same reason, a conventional crush is not suitable to carry out the procedure in, because of the top horizontal bars. Such precaution also ensures that the internal needle remains retracted before Transfixer advancement.
Question 8. This video extract documents a laparoscopic exploration, in this case the optical portal lies on the left paralumbar fossa and the endoscope moves from cranio-dorsal to caudo-dorsal. Which is the organ that this video extract focuses on?
At the beginning and the end of any corrective endoscopic procedure you are strongly advised to carry out an exploration. In this case, the left kidney looks healthy, although a question should be raised about the perinephreal fat or in this case, its abscence. There are a number or reasons as to why the perinephreal fat coverage may be less than anticipated, genetic predisposition or debilitating disease including paratuberculosis are some of the reasons. Although such findings are not pathognomonic of Johnes, the disease status of the patient should be checked.
Question 9. The research by Seeger and others in 2006 (PDF link below) represents a randomised clinical trial of left displacement of abomasum corrective approaches with two surgical cohorts, the laparotomic and the laparoscopic group. Which of the following statements represents more accurately the findings of the trial?
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Median daily milk yield for the abomasopexy group was 28.8 kg (Q1, 25.2 kg; Q3, 32.1 kg; range, 15.8 to 51.3 kg), which was significantly (P < 0.01; Wilcoxon Mann-Whitney U test) higher than for the control group (median, 26.3 kg; Q1, 22.2 kg; Q3, 30.2 kg; range, 13.6 to 39.2 kg).
Question 10. The research by Wittek and others in 2012 (PDF link below) represents a randomised clinical trial of left displacement of abomasum corrective approaches with three surgical cohorts, the right laparotomic, the left laparotomic and the laparoscopic group. Which of the following statements represents more accurately the findings of the trial?
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No bacteria were present in PF after surgery. The number of PF leukocytes increased in all groups on day 1 after surgery with the highest value after laparoscopy (median, 1st quartile, 3rd quartile, R: 13.1, 6.4, 16.0; L: 13.6, 9.9, 17.4; J: 33.7, 21.1, 46.9 G/l). Laparotomy resulted in an increase of blood and PF CK on day 1 after surgery, whereas, laparoscopy caused an increased PF CK only. All groups had elevated PF D-dimer concentrations before surgery, with further increase in groups R and L on day 1 after surgery.
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