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ASSISTANCE TO STATES FOR CONTROL OF ANIMAL DISEASES (ASCAD)

TRAINING COURSE on

ADVANCES IN SURGICAL AND IMAGING TECHNIQUES FOR ANIMALS October 14-19, 2013

Department of Veterinary & Radiology College of Veterinary Science & Animal Husbandry Junagadh Agricultural University, Junagadh-362001, Gujarat, India

ASSISTANCE TO STATES FOR CONTROL OF ANIMAL DISEASES (ASCAD) TRAINING COURSE on ADVANCES IN SURGICAL AND IMAGING TECHNIQUES FOR ANIMALS

October 14-19, 2013

Course Director Dr. P H Vataliya

Course Co-ordinator Editors Dr. P B Patel Dr. Vineet Kumar Dr. S H Talekar Dr. J V Vadalia Dr. A M Patel

Department of Veterinary Surgery & Radiology College of Veterinary Science & Animal Husbandry Junagadh Agricultural University, Junagadh-362001, Gujarat, India

Dr. P. H. Vataliya Principal & Dean

From ASCAD Training Course Director’s Desk Gujarat state has achieved more than 10% growth in agriculture GDP in the past decade where growth in animal husbandry sector has contributed satisfactory especially by ensuring livelihood security to rural population.

The growth in the sector can be sustained only through better livestock health services where medical, gynecological and surgical interventions become imperative in various ailments of livestock.

Advancement in the imaging tools for the diagnosis of aliments of livestock requiring surgical intervention, the adaption of new methods of surgical approach and adoption of modern surgical tools makes the veterinary surgery and radiology an exciting field of livestock health services.

The present training on the “Advances in Surgical and Imaging Techniques for Animals” aims at updating the field on recent advances.

The compendium covers an array of topics viz. current diagnostic techniques and advanced surgical modalities. I am delighted to note that, Dr. P.B. Patel, Professor & Head of Veterinary Surgery and Radiology and the team of surgeons have made sincere efforts to make this volume an important resources book. I hope the training will be highly interactive, fruitful and will be of immense help to the field veterinarians to meet the challenges of threatening animal diseases and will contribute to improve the livestock health and wealth.

(P. H. Vataliya) Course Director & Dean College of Veterinary Science & A. H. JAU, Junagadh

Dr. P. B. Patel Course Co-ordinator

MESSAGE

The Department of Veterinary Surgery and Radiology, College of Veterinary Science & Animal Husbandry is fully furnished with advance diagnostic facilities like CR system, Positive Pressure Ventilation, Dental Scalars, Ultrasonography, Veterinary patient monitor, ECG, Small Animal Inhalant Anesthetic Machine etc. The construction of small animal clinical complex building is also completed. This will be giving an important leverage to small animal surgery and radiology at Veterinary College, Junagadh.

The training course on “Advances in Surgical and Imaging Techniques for Animals” include advance diagnostic techniques such as Computerized Radiography, Ultrasonography, General and Regional anesthetic techniques beside basic operation like tumor, abdominal surgery, and diaphragmatic hernia in large and small animals. The compendium has been meticulously compiled by the teachers of the department which I hope, will be a useful document and guide for the further reference to veterinarians.

I am thankful to Dr. A. J. Kachhiapatel, Director, Animal Husbandry. Government of Gujarat, Gadhinagar and Dr. P. H. Vataliya, Principal & Dean, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh for giving full support for conducting the training course.

(P. B. Patel) Course Co-ordinator, Professor & Head Department of Veterinary Surgery & Radiology College of Veterinary Science & A. H. JAU, Junagadh

Department of Veterinary Surgery & Radiology College of Veterinary Science & Animal Husbandry JAU, Junagadh-362001, Gujarat Participants: Training on "Advances in Surgical and Imaging Techniques for Animals" October 14-19, 2013

Sr. Name and Correspondence Address Email Phone No. No. 1 Dr. Valjibhai Veljibhai Bhut 9723617921 V. O., District Panchayat, Junagadh 2 Dr. Sunilkumar Maheshbhai Patel [email protected] 9714331333 V. O., District Panchayat,Surendranagar 3 Dr. Kalpeshkumar Prabhatbhai Deshai [email protected] 9428023028 V. O., District Panchayat, Rajkot 4 Dr. Milindkumar Harshadray Fotariya [email protected] 9974416601 V. O., District Panchayat, Rajkot 5 Dr. Yusufhbhai Valibhai Mansuri [email protected] 9427059188 V. O., District Panchayat, Rajkot 6 Dr. Parikshitkumar Natvarlal Prajapati [email protected] 9574513634 V. O., District Panchayat, Jamnagar 7 Dr.Vasantbhai Rameshbhai Parmar [email protected] 9974453754 V. O., District Panchayat, Jamnagar 8 Dr. Jayesh Dineshbhai Makvana 9426852738 V. O., District Panchayat, Amreli 9 Dr. Pravinkumar Nagjibhai Chaudhari [email protected] 9429288990 V. O., District Panchayat, Amreli 10 Dr. Kiritkumar Jayantilal Chavda [email protected] 9725767741 V. O., District Panchayat, Junagadh

LIST OF FACULTY MEMBERS Department of Veterinary Surgery & Radiology College of Veterinary Science & Animal Husbandry Junagadh Agricultural University, Junagadh-362001

Name of Faculty Member Photograph Dr. P. B. Patel Professor & Head Phone: 094274 84944 [email protected]

Dr. S. H. Talekar Associate Professor Phone: 095580 04859 [email protected]

Dr. Jignesh V. Vadalia Assistant Professor Phone: 089809 57065 [email protected]

Dr. A. M. Patel Assistant Professor Phone: 094083 87407 [email protected]

Dr. Vineet Kumar Assistant Professor Phone: 096013 54407 [email protected]

INDEX

S. Topic Author Page No. 1 Modern diagnostic techniques in veterinary surgery P. B. Patel 1-3

2 Laminitis in equine J. V. Vadalia 4-5 3 Topographic of surgical sites in animals Anil Sharma 6-10 4 General anaesthetic techniques for abdominal surgery S. H. Talekar 11-13 in canines 5 Anatomical location for regional nerve blocks in Vishnudeo 14-17 domestic animals Kumar 6 Cryosurgery in Veterinary Patients J. V. Vadalia 18-19 7 Ultrasonography and techniques in S. H. Talekar 20-24 veterinary practice 8 Management of urolithiasis in small animals Vineet Kumar 25-28 9 Regional anaesthetic techniques in large animals P. B. Patel 29-31 10 Surgical affections of eye in small animals J. V. Vadalia 32-35 11 Mammary gland (breast) tumors in A. M. Patel 36-38 12 MRI, CT Scan and Digital Radiography S. H. Talekar 39-41 13 Recent advances for the management of abdominal Vineet Kumar 42-43 wall defects 14 Surgical affections of ear in small animals J. V. Vadalia 44-46 15 Management of diaphragmatic hernia in buffalo P. B. Patel 47-49 16 External and internal immobilization of fracture A. M. Patel 50-54 17 Critical care and management J. S. Patel 55-60 18 Use of X-ray for the diagnosis in small animal A. M. Patel 61-64 19 Contrast radiography P. B. Patel 65-67 20 Management of intestinal obstruction in small animals Vineet Kumar 68-70 21 Ultrasonography for gynaecological disorders in Rupesh Raval 71-74 veterinary patient 22 Reticular syndrome in large animals P. B. Patel 74-79

Modern Diagnostic Techniques in Veterinary Surgery P B Patel, H M Padheriya, A M Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Diagnostic techniques are Ultrasonography seems to have a considered as an integral part of all the promising future in , methods available for the diagnosis of particularly for the assessment of intra- pathological conditions. A wide variety of periabdominal disease. pathological lesions can be diagnosed by Ultrasonography is viewed as the radiography and other specialized single most versatile addition to the techniques such as diagnostic ultrasound, noninvasive and nonsurgical computed tomography and magnetic armamentarium of the veterinary clinician resonance imaging are becoming more since the advent of fibreoptic endoscope. popular now. Diagnostic Ultrasonography Although other sophisticated imaging has empowered the veterinary clinician modalities like CT and nuclear imaging with a non invasive means of evaluating can provide additional information, the the thorax, abdominal cavity, accessibility and cost effectiveness of musculoskeletal system and other these procedures do not make these as tissues/organs with accuracy. promising as Ultrasonography. All these imaging modalities have 3) Computed tomography brought changes in the diagnosis of a CT has been an extremely clinical case. Precise and an instant significant development which has a diagnosis of an intricate case can be made unique cross sectional imaging ability with their usage. The modalities which can useful for the diagnosis of tumors, be used under Indian conditions are: malformations, inflammation, degenerative and vascular diseases and 1) Image Intensifier T.V. system Generally used in orthopedics trauma. CT is a diagnostic modality that is surgery. This facilitates fracture repair fundamentally different from X-ray using a small incision thus achieving method in which an organ is scanned in minimal invasive surgical maneuver. IITV successive layers by a narrow beam of X- helps in X-ray imaging of the rays in such a way that the transmission of intraoperative site for the intraoperative X-ray photons across a particular layer can orthopedics manipulations, and the same be measured and by means of a computer, can be stored for future reference purpose. used to construct a picture of the internal structure. This facilitates introduction of Steinman pin giving a small incision 4) MRI MRI is a highly sensitive and 2) Ultrasound In small animal and equine noninvasive technique providing accurate practice, ultrasound is routinely used as a and detailed anatomic images with good diagnostic aid. Applications of ultrasound contrast and spatial resolution. However, in ruminants have not been fully exploited, in veterinary medicine MRI is still in its except in pregnancy. There could be infancy and its use is infrequent. To date, numerous organs which can be scanned MRI has been used in developed countries using an ultrasound scanner. in clinical cases as well as a research tool

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 1

especially for CNS diseases in small 6) DSA animals. MRI has a wide spectrum of DSA is a radiographic modality application. It can be used for imaging all which allows dynamic imaging of the body regions in small animals, but only the vascular system following intravascular extremities and the head can be imagined injection of iodinated X-ray contrast media in large animals. It is useful in answering through the use of image intensification, many questions related to the enhancement of the iodine signal and musculoskeletal diseases in animals such digital processing of the image data. as understanding the pathogenesis of Temporal subtraction of the images navicular disease, traumatic arthritis and obtained during the first arterial phase of osteochondrosis in equines and wobbler injection of the contrast medium from the syndrome in dogs. The newer applications images obtained before and after contrast of MRI are Magnetic resonance medium administration yield images angiography and MR spectroscopy. It is which are devoid of bone and soft tissue. especially used to differentiate an This imaging modality plays an important inflammatory process from a neoplastic role in highlighting the vascular mass, tumors from peritumoral oedema. It pathologies like stenosis etc. is more specific and sensitive in detecting 7) localizing and differentiating Laparoscopy has been a valuable osteomyelitis, cellulites and abscess. diagnostic and therapeutic tool in human However, its use is contraindicated in clinical medicine. Only in the last 15 pregnancy. years, its use has been extensive in various 5) Nuclear scintigraphy animal species for research and clinical Nuclear scintigraphy is a highly diagnostic and therapeutic purposes. sensitive advanced procedure in which Laparoscopic surgery offers significant radioisotopes are used to detect the advantages over open in fields of functional abnormalities of the body cholecystotomy, appendicectomy, system. The interpretation is based on the vagotomy, hernia repair and adhesion appearance of the increased (hot spots) or release etc. For gynecological problems decreased (cold spots) radioactivity like ovarian cyst or in the case of regions. For eg. an active process is and hysterectomies, indicated by a hot spot while a dull process laparoscopic surgery (scarless surgery) is like lack of perfusion is indicated by cold now considered a better alternative in spot. Nuclear scintigraphy has been used addition to laparoscopic sterilization. The to detect functional disorders of the most advantageous characteristic of kidney, liver, lungs, GI tract, thyroid gland laparoscopy is that it allows direct and many other organs. It is very useful in examination of abdominal cavity with only the diagnosis of occult lameness, lung minimal and superficial surgical perfusion and ventilation and patency of intervention. has been the ureter in both large and small animals. employed in man for the diagnosis and Also used for vertebral column imaging treatment of diseases of the pleura, lung, and monitoring the progress of fracture mediastinum, great vessels, pericardium healing and in tumor detection. and oesophagus. Visceral inspection of the

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thoracic cavity by thoracoscopy has been absorbs varying amounts of light used to provide a more accurate diagnosis dependent on its saturation with oxygen. and prognosis in affected with Hence, pulse oximetry remains the pleurapneumonia and other thoracic and standard of care during anaesthesia as well oesophageal disorders. Thoracoscopy as in the recovery room and intensive care allows visualization and biopsy of a large unit. A vital part of treating equine surface of the lung and provides adequate problems is an initial accurate diagnosis. specimen for histopathological diagnosis. High quality images are an important aspect of this. 8) Endoscopy It is a minimal invasive diagnostic As well fixed and mobile X- ray modality which aids in a best way to machines, the Hospital has an image document mucosal inflammation- intensifier for intra-operative monitoring hyperemia, active bleeding, irregular with x-rays. mucosal surface, and facilitates biopsy in The Arsenics Impact ultrasound tubular organs like the GI tract, and machine provides high quality images of respiratory and the urogenital organ muscles, tendons and ‘ligaments; whereas systems the Ving-med System can image the 9) Pulse Oximetry equine thorax and , as well as Pulse oximetry represents the giving detailed analysis of blood flow in greatest advance in the patient monitoring. various organs and tissues. It has the unique advantage of To conclude, the advances in continuously monitoring the saturation of diagnostic technology in veterinary haemoglobin with oxygen, easily and surgery is in infancy stage in India. An all noninvasively, providing a measure of out effort is required to introduce the basic cardiorespiratory function. imaging modality - ultrasound in The fundamental physical property veterinary practice at district polyclinics that allows the pulse oximeter to measure and city hospitals. The use of radiology the oxygen saturation of hemoglobin is needs to be strengthened by its optimum that blood changes colour as haemoglobin use in clinical cases.

3 Laminitis in Equine J V Vadalia Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Laminitis is an avascular due to excessive weight bearing for a involving the sensitive laminae, which prolonged period. intermesh with the hoof wall. The exact History and presenting signs cause is unknown, but blood bypasses the Over feeding of grain. dermal laminae via arteriovenous shunts at Gastrointestinal problems, particularly the base of the laminae, either due to after colic surgery, retained placenta. Fat increased postcapillary resistance and pony grazing lush pasture. Recent pleuritis within the laminae or as a direct or pneumonia due to gram-negative effect of opening of the shunts due to . Non-weight-bearing lameness in vasoactive compounds. The unique opposite limb. housing of the blood supply to the foot in a Clinical findings and diagnosis nonexpandable structure (the hoof) may Although all four feet can be accentuate the impact of blood flow involved in laminitis, the forelimbs are changes. Laminitis occurs in association more frequently affected than the with conditions that cause endotoxemia hindlimbs. Affected horses show such as acute gastrointestinal diseases and reluctance to move, and a typical metritis. However, endotoxemia is not "sawhorse" stance is seen with the consistently found in cases of forelimbs placed well out in front of the experimentally induced laminitis, and body. It will be difficult to pick up one of laminitis has not been induced by the forelegs. Examination usually will administration of endotoxin. Therefore, reveal increased heat in the feet and there must be other mechanisms involved. around the coronary band, with intense The outcome is a loss of blood pain on application of the hoof testers. supply to the laminae, despite an increase Palpation of the palmar arteries over the in blood flow to the foot. This leads to abaxial surface of the sesamoid bones will separation of the dermal and epidermal reveal an increase in both rate and laminae and an unstable pedal bone within amplitude of the pulse. An abaxial nerve the foot. The pedal bone may rotate due to block (see Fig. 4-26) will improve the the pull of the deep digital flexor tendon signs of lameness, but in acute cases, it is or, with more extensive laminae contraindicated due to instability of the involvement, displace distally. The most pedal bone. Signs of pedal bone rotation or common causes are grain engorgement, sinking include a palpable indentation at grazing in lush pastures, postfoaling the dorsal aspect of the coronary band and metritis, and systemic gramnegative protrusion of the sole, dorsal to the apex of bacterial . In fat ponies, it is the frog. In chronic cases, abnormal hoof common to find laminitis during the spring wall growth with a greater distance months, when the soluble carbohydrate between growth rings at the heels than at content increases in grasses and clovers. the toe, and a concave dorsal hoof wall, Laminitis can also occur in a single limb are noted.

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 4

Treatment between 7 and 21 days may be necessary In acute cases of laminitis, it is steroidal anti-inflammatory drugs, important to establish the cause so that phenylbutazone appears to be the drug of treatment can be directed at eliminating choice for effective pain relief. It is the sources of vasoactive substances. important to realize that non steroidal anti- In cases of grain engorgement, 3 to inflammatory drugs have the potential to 4 L of paraffin should be administered by cause toxic effects, particularly on the stomach tube to help eliminate the grain gastrointestinal system, and potential from the .Where toxicity should be monitored by metritis is the initiating cause, aggressive intermittent measurement of plasma total irrigation of the to remove protein concentration. accumulated exudates should be combined Many different methods have been with systemic broad-spectrum antibiotics. suggested to provide support for an Early in the course of disease, application unstable pedal bone. Deep sand bedding of cold to the feet will be helpful in conforms well to the sole and also has the decreasing the severity of the problem. advantage of allowing the to stand This can be done most simply by standing with its feet at the most comfortable angle. the horse in cold water. If there are signs Padded bandages can be applied to the feet of shock (prolonged capillary refill time, if there is any risk of sole penetration. In injected mucous membranes, etc.), acute cases shoeing should be avoided, intravenous fluid therapy may be required because the concussion will cause pain, (20-40 mL/kg of a polyionic, isotonic and prolonged weight bearing on the fluid). opposite limb is detrimental. Hoof wall In acute cases the horse should be resection is indicated where there is confined to a stall, preferably with a deep marked separation and the dorsal lamina is sand bed as even walking has the potential providing no support to the pedal bone to exacerbate displacement and rotation of and/or is applying excessive pressure to an unstable pedal bone. the coronary band, preventing normal If cases are identified within the growth. Sectioning of the deep digital first 48 hours, peripheral vasodilators such flexor tendon, as a salvage procedure, can as acepromazine will improve digital be used in cases that are not responding to blood flow and have been shown to therapy. Although often providing relief prevent the development of chronic from signs, there is evidence that it does laminitis in a high proportion of cases. not improve the long-term prognosis. In Acepromazine also has the advantage of chronic laminitis where some pedal bone sedating the horse, thus reducing stability has returned, corrective trimming movement. Therapy should be continued of the feet is essential. Because the blood for 48 hours. Chronic cases of laminitis supply to the coronary band at the heels is rarely respond to this type of treatment. greater than at the dorsal midline, it is Non steroidal anti-inflammatory drugs important to trim back the excessively such as phenylbutazone, flunixin long heels to maintain normal heel height meglumine, or ketoprofen are essential. and to square the toe to facilitate break Maximal dose rates are used for the first 2 over. Progress can be assessed from lateral to 4 days, and continuation of therapy for radiographs. depending on the response. Of the non

5 Topographic Anatomy of the Surgical Sites in Animals Vishnudeo Kumar and Anil Sharma Department of Anatomy, College of Veterinary Science & Animal Husbandry Junagadh Agricultural University, Junagadh-362001

The study of topographic Indications- to facilitate good anatomy based on regions or divisions drainage through the external ear canal of the body and emphasizing the in dogs. relations between various structures Site- The tubular portion of the antero- (muscles and nerves and arteries etc.) external aspect of concha and skin in that region. Different structures are below it. studied as they present during the 3. of horn This is used as course of dissection. Indications- Irreparable injury, applied part of the subject where the malignant disease of horn. structures of some specific sites are Sites - I. Below the base of horn. studied for application in surgical II. Any level above the base of the practice. horn but below the seat of damage. Operations of head region This is preceded by cornual nerve block. 1. Ligation of stenson’s duct in Surgical anatomy- The cornual bovine Indications- In persistent salivary process is a part of the frontal bone. It fistula and to prevent excess salivation. is covered by corium (sensitive Site - Immediately in front of anterior portion) and shell (insensitive portion) border of the masseter muscle and which all together form horn. At the About 1/2 to 1 inch above the inferior base of horn appreciate cornual artery, border of the horizontal ramus of vein & nerve. Tourniquet is applied to the mandible where the duct can be prevent bleeding from cornual vessels. palpated. 4. Enucleation of eyeball: Refers to Surgical anatomy- The duct of the removable of eye ball. parotid salivary gland (Stenson’s duct) Indication- Irreparable injury, orbital arises from the ventro-medial aspect of abscess and malignant disease. the gland and proceeds along the Surgical Anatomy: The eye ball is ventral and anterior borders of the situated in the bony orbit formed by masseter muscle to open into the the frontal, lacrimal and malar bones. vestibule of the mouth at the level of There are seven muscles of the eyeball 5th upper cheek tooth through papilla in the orbit, viz., Superior rectus, salivalis. Anterior to masseter it is inferior rectus, medial rectus, lateral related to facial artery and vein in rectus; superior oblique, inferior front. oblique and retractor oculi muscles are present. Retract the skin edges and the 2. Zepp’s operation (dogs) The external ear canal is not a eyeball along with its muscles will be straight tube. It has a horizontal portion detached from the bony orbit by blunt and vertical portion formed by the dissection. tubular portion of concha. 5. Hyovertebrotomy of the guttural pouch

ASCAD training on “Advances in Surgical and Imaging Techniques for Animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 6

Indication- empyema of the guttural 2. Tracheotomy pouch. Indications - Persistent epistaxis and Sites- Ventral site: An incision is made obstruction of the upper respiratory in the Viborg’s triangle which is tract. formed by the tendon of Site - it is 1 to 2 inches longitudinally sternomandibularis muscle, the along the ventral aspect of the neck, linguofacial vein and the angle of the preferably at the junction of its upper mandible. The pouch wall is palpable and middle third since here the two when enlarged and a stab incision is opposite muscles diverge so that made through the ventral wall of pouch trachea is bare and directly under skin. to provide drainage. Surgical anatomy- trachea is in Lateral site- An incision is made along midline below the bodies of cervical the line parallel with the anterior and first four thoracic vertebrae and it border of the wing of the atlas. is covered by the two bands of Surgical anatomy- In equines, the sternothyro-hyoideus muscle in neck guttural pouch is a thin walled peculiar region. caudoventral diverticulum of the 3. Paracentesis thoracis auditory tube. It is located caudo- Indications - to relieve severe dorsal to the pharynx and on the respiratory distress in moist pleurisy beginning of the esophagus. Its and collection of fluid samples for capacity in adult horse is about 300 ml. diagnostic purpose. The inflammation of the guttural pouch th th Site - 6 or 7 intercostal space below is usually catarrhal due to mucous type level of costo-chondral junction. of secretory mucosal lining. Avoid the damage to the external carotid artery Operations of abdominal region and IX and XII cranial nerves. 1. Paracentesis abdomen Operations of neck and thorax Indications - To relieve excess gases region from the rumen, collection of rumen liquor for diagnostic purpose. 1. Oesophagotomy Site - Paralumbar fossa on left side in Indication s - Oesophageal obstruction . (choke) Site - on the left side of the neck along 2. Laparotomy the superior border of jugular furrow, Indications – gastrotomy, enterotomy close to the level of the obstruction. and enterectomy, hysterectomy etc. Surgical anatomy- from 3rd cervical Sites- a. Flank site: Left side-For vertebra onwards oesophagus deviates rumenotomy, spleenctomy. Right side to left side of trachea. Dorso-lateral to - enterotomy the oesophagus carotid sheath is Vertical or oblique incision on the present containing the internal jugular hollow of the flank is made. vein, common carotid artery and b. Ventral Midline site- Incision vagosympathetic trunk. While through the linea alba between the ventrally it is related left recurrent xiphoid cartilage of sternum and pubic laryngeal nerve. symphysis for caesarean operation.

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This site is preferred since it is least and subcutaneous fat; external obliques vascular. muscle, the fibers are directed c. Paramedian site- parallel to the downward and backward. Internal linea Alba along the belly of rectus obliques muscle, the fibers are run abdominis muscle for caesarean downward and forward. The transverse operation. abdominis muscle which is thin and d. Para rectal site- parallel to rectus fibers extend in a perpendicular abdominis muscle along its lateral direction. In addition, deep iliac fascia, border for caesarean operation. sub peritoneal fat, parietal layer of e. Paracostal site- for abomasotomy in peritoneum and the rumen wall is seen. ruminants on right side. The 1st and 2nd lumbar nerves which Surgical anatomy- lateral wall of the run nearly perpendicular in direction abdominal cavity is formed by obliqus are encountered while incising the abdominis externus, internus and structures in this region. transversus abdominis muscles and 4. Gastrotomy in floor is formed by rectus abdominis Indications- Foreign bodies in the muscle and linea alba which is formed stomach, chronic gastric ulcer, by aponeurosis of externi, interni and etc. transverse muscles of two sides. Site - 1. Midline incision between the 3. Rumenotomy xiphoid cartilage and umbilicus. Indications - persistent rumen 2. Para costal incision on the left side impaction, hair balls and other foreign in large and deep chested animal. bodies in the rumen or reticulum, Surgical anatomy- stomach of dog is frothy bloat etc. lies largely in the transverse position Site - left flank (paralumbar fossa) a more to the left of the median plane. It vertical incision or near last rib in case forms an extensive concavity in the of large size animal in traumatic caudal surface of the liver. The greater reticulitis cases. curvature is convex and extended from Incision can be made in the direction the cardiac to the pylorus and is of muscle fibers there by avoiding attached by the greater omentum. sutures (suture less laparotomy) then Stomach wall consist of serosa, rumenotomy is done. The layers muscularis (inner circular and outer incised in wall of rumen from exterior longitudinal layers), submucosa and to interior are serosa, muscularis and mucosa. mucosa. 5. Surgical anatomy- rumen occupies Indications - Uterine inertia, dystocia, almost left half of the abdominal cavity torsion of uterus etc. th or 8th intercostals space to the from 7 Sites - Many sites are there for this pelvic inlet and extends over the operation. median plane to the right side I. Between the anterior mammary veins ventrally. and the midline either on left or right The structures to be cut in side from the front of the udder rumenotomy included skin, subcutis forwards.

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II. Parallel to milk vein. below the ischial arch downwards III. Oblique flank incision downwards along the median line. and forward from a little below the Surgical anatomy: the penis of external angle of ilium on right side. ruminants is comparatively thin and IV. Vertical incision on the right long. Near the scrotum penis forms a paralumbar fossa. sigmoid flexure. it is the common seat of urethral obstructions. The corpora 6. Ovariohysterectomy cavernosa penis has a strong thick Removal of both and uterus. tunica albuginea. After the transaction Uterus consists of two horns and each of the skin, at the operation site, in the horn is continued anteriorly by oviduct ischial arch of the male animal, the which ends near . structures are encountered between the 7. Cystotomy skin and subcutaneous connective Indications - calculi in tissue are retractor penis muscle, and neoplastic growth. bulbocavernous muscle, corpus Site - the prepubic site is chosen along cavernosum urethrae, and Urethra. linea alba starting in front of the pubic Operations of the limbs symphysis to a length of about 3 to 4 1. Patellar desmotomy inches forward. Indications : in chronic subluxation Surgical anatomy- it is a musculo- of patella. membranous sac lies on the floor of the Site - close to the insertion of the pelvic cavity. It varies according to medial ligament to the anterior contents and sex. Ventral surface is tuberosity of tibia. related to pelvic floor and reaches to Surgical anatomy- comprised of abdomen when it distends. The dorsal femoro-patellar and femoro – tibial surface in male is related to rectum, articulation. Femoro-Patellar genital fold, terminal part of vas articulation having three straight deferens, seminal vesicles and the ligaments- medial, middle and lateral prostate gland. In female it is related patellar ligaments. The patella gets ventrally to the body of uterus and fixed above the trochlea of femur and vagina. When the bladder is full the the medial straight ligament is tightly vertex reaches the rumen and intestine. over stretched behind the medial 8. Urethrotomy trochlear ridge which prevents the Indications- urethral calculi, downward return of the patella. This is amputation of the penis to make a because medial ridge of trochlea of urethral fistula. femur is larger and higher than lateral Site - Post scrotal site: for removal of one. So the stifle joint is in an extended obstruction at the sigmoid flexure. It is state and animal drags the limb. This is about three inches the scrotum along more common in the emaciated the median line. animals. Ischial site: for removal of obstructions The site mentioned above is close to ischial arch, it is two inches most suitable site as it is easier to locate. Causes less bleeding and there

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is no danger of injuring to the joint tibial nerve on plantar aspect. observe capsule. Bleeding if any is from complex muscle, tibialis anterior, geniculate artery supplying this joint peroneus longus, lateral digital which is a branch of femoral artery. extensor, peroneal nerve and anterior The object of the operation is to tibial artery and veins on dorsal aspect. mechanically bring down the patella by Operation of tail cutting the tensed medial straight Amputation ligament of the patella. Indications - to improve appearance of 2. Amputation of forelimb the animal, injury or neoplasm of the Indications - multiple fracture, tail, tail gangrene. irreparable injury, tumour and Site - above the seat of injury, between gangrene. two adjacent vertebrae. Site - common site is at junction of Bleeding is mainly from the middle lower and middle third of the forearm. Coccygeal artery. So tourniquet is Surgical anatomy - observe extensor applied proximal to incision. carpi radialis, medial digital extensor, Surgical anatomy - the skeletal common digital extensor, lateral digital framework of tail is made up of extensor. Ulnaris lateralis, radial nerve coccygeal vertebrae. The paired and cephalic vein on dorsal aspect. muscles of the tail are enclosed in the Observe flexor carpi radialis, flexor strong coccygeal fascia which is carpi ulnaris, superficial digital flexor, loosely attached at the root of the tail. deep digital flexor, radial artery, ulnar Sacro-coccygeus dorsalis muscles lie artery, median nerve and ulnar nerve on either side of the dorso-median on volar aspect. aspect of the tail. Sacro-coccygeus 3. Amputation of hind limb lateralis muscles lie immediately Indications - multiple fracture, lateral to dorsalis. Sacro-coccygeus irreparable injury, tumour and ventralis lies on the ventral aspect of gangrene. the sacrum and Coccygeal vertebrae. Site - at the middle third of the leg Intertransversalis caudae consists of region. muscular bundle and lie on the lateral Surgical anatomy- observe aspect of the tail between gastrocnemius, popliteus, superficial sacrococcygeus lateralis and ventralis. digital flexor, deep digital flexor and

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General Anesthetic Techniques for Abdominal Surgery in Canine Shivaji H.Talekar and Vineet Kumar Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

A general anesthetic to a healthy healthy according to result or change the dog should bear little risk as compare to anesthetic protocol if required. unhealthy dogs in case of abdominal A detail physical and clinical surgery. Many choices are available to examination to determine any administered anesthetic protocols to meet abnormalities must be carried out. the demand of increased Sophistication of Auscultation for cardiac dysrhythmias and abdominal surgical procedures, and with murmurs, or abnormal lung sounds will smooth induction, careful Monitoring in provide useful information regarding oxygenation, circulation and ventilation, preexisting cardiopulmonary disease. and attention to fluid balance and smooth Stabilize dog if debilitated by giving fluid recovery, a safe in dogs. therapy. Surgery of the stomach or Pre-anesthesia intestines is very common. Reasons for Pre-anesthesia facilitates smooth operating on the gastrointestinal tract induction and reduces anesthetic dose include ovariohysterectomy or spaying, maintenance. There are many choices Gastric dilatation volvulus (GDV), available for Pre-anesthesia. It contains caesarian section (C.S.) in Sedative (, ) bitches,spleenctomy,nephrectomy neuroleptanalgesia (e.g. acepromazine and ingested foreign bodies, cancer, twisted morphine), Anti cholinergic (atropine intestines, intussusception, bloat, and to sulphate), tranquilizers (siquil, largactil, collect full-thickness biopsies of the acepromazine), etc. all preanesthetic intestines,etc. A variety of diagnostic tests provides better restraint and analgesia. are done prior to the abdominal Common Anesthetic used for abdominal exploratory in order to pin point where the surgery in dogs problem is and what the nature of it is. and its combinations Pre-anesthetic considerations Ketamine is generally used at the Fasting for about twelve hours dose rate of 10 mg/kg which produces usually ensures a dog will have an empty good anesthesia in dogs for any type of stomach. With held water till abdominal surgery. Ketamine is premedication is not given or at least two dissociative anesthesia which increased hours prior to give anesthesia. Laboratory muscle rigidity and excessive salivation test is always useful informing about Ketamine may cause increased heart rate, outcome of surgery and to be a safer side cardiac output, and blood pressure so pre- for judging animal is ready to take stress anesthetic sedatives are combined with of surgery. Before proceeding surgery or ketamine to induce deep or light prior to anesthesia, minimum information anesthesia with good muscle relaxation. about blood test including Diazepam at 0.5-1 mg/kg added to CBC,PCV,SGPT,TP, BUN and glucose is ketamine either IM or IV produces deep compulsory to finalize either give general sedation often recumbency. Butorphanol anesthesia or wait if animal status is not 0.1-0.4 mg/kg, at 5 – 40

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 11

mcg/kg, is administered at 0.1 Methohexitone sodium is 10 mg /kg I/V to – 0.3 mg/kg IV, IM can be used as a effect. combination for better sedation, analgesia Other non barbiturates: and muscle relaxation. Diazepam can be Profofol: it is used in dog, causes substituted by xyalzine 0.1-0.5 mg/kg, smooth induction of anesthesia. This is resulting in longer duration of effect. dose dependent respiratory depression. It Barbiturates can be used combination with Pentobarbitone sodium: it depresses the acepromazine. Dog dose rate of profofol is CNS and takes appreciable time to cross 6 mg /kg I/V if not premedicated or 4 blood brain barrier. The drug depress mg/kg if premedicated. respiratory centre. It causes slight fall in Inhalation anesthetic agents: blood press due to peripheral : it can be administered vasodilatation and is destroyed primarily with oxygen and nitrous oxide or any in liver and some of it is excreted through mixture with etc. it causes urine. Dog dose rate of pentobarbitone respiratory and cardiac depression but it is sodium is 20-25 mg /kg I/V. dose dependent. Highly volatile and has Thiopentone sodium: it produces brief low blood solubility. It has low partion period of unconcioueness.it crosses coefficient so rapid recovery from any placental barrier with great speed. Its depth of anesthesia, great muscle injection followed by a period of apnoea.it relaxation it is used 1.3 minimum alveolar is a myocardial depressant. It depress concentration (MAC). Vapor setting is at respiratory centre parallel to depth of 3-4 % in dogs at induction with oxygen narcosis. Recovery is slower. Ataxia is flow at 60 ml/kg/min and is reduced nearly always present. Dose rate is given between 1.5-3 % during the maintenance in canine is 7-13 lb/kg or 15-20 mg/kg. with oxygen flow at 20 ml/kg/min. The solution of thiopental has Strictly I/V. a very high pH and the drug can only be Methods of inhalation induction given intravenously. General anesthesia can be induced Thiamylal Sodium: Closely resemble to by administering isoflurane, halothane, thiopentone but it is more potent and less , or via a facemask cumulative effect, less excitement during .There are two methods; ‘incremental’ or induction and recovery. Premedication ‘crash’ induction. ‘Incremental’ induction with atropine sulphate to check salivation technique uses 3 min of preoxygenation is necessary. Dog dose rate of Thiamylal and then introduction of 0.5 % vapor Sodium is 20-25 mg /kg I/V. setting for 30-60 seconds and then 0.5 % Methohexitone sodium: two to three time increment for the same period. ‘Crash’ more potent than thiopemtone sodium. It induction is achieved with 3-5 % vapor set has short duration effect rapid injection of isoflurane following pre-oxygenation. may produce transient hypotension but The dog will more likely struggle with the blood pressure soon return to normal. crash induction method. It is preferable to Rapid recovery to full alterness, even after use non-rebreathing circuits for quicker prolong anesthesia. Dog dose rate of induction and then switched to the circle

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rebreathing systems even for animals The ECG is useful to monitor weighing more than 6 kg. cardiac dysrhythmias. The respiratory Tracheal in dogs is system is evaluated by monitoring important before giving inhalation respiratory rate and volume. It can be anesthesia. Inhalation anesthesia is the estimated by observing the emptying of method of choice for maintaining the rebreathing bag of the anesthetic anesthesia for most prolonged procedures. machine during respiratory cycles. Pulse Halothane, isoflurane, sevoflurane, oximetry and/or arterial blood gas analysis desflurane and nitrous oxide are available provide information of the ventilatory The advantages are patent airway, rapid efficiency. control of anesthetic depth, quick and Ocular reflexes are used to monitor smooth recovery, and disadvantages are the central nervous system. Ophthalmic more pronounced cardiovascular ointment should be applied to the eyes depression including myocardial during anesthesia to prevent corneal depression, hypotension, bardycardia and injury. Body temperature is also an irritation to upper respiratory tract. important parameter to monitor during Monitoring of patient during anesthesia anesthesia. Because of the tendency for Anesthetic monitoring is important anesthetized animals to lose body heat, to maintain a proper plane of anesthesia supplemental heat sources are often and to prevent excessive insult to the required to maintain adequate body cardiovascular, respiratory, and central temperature (100-103.5˚F). nervous systems. Anesthetic depth can be Post operative pain management and measured by observation of the following recovery: post operative management is signs: physical movement or jaw chewing necessary to give proper pain in response to stimulation, eye position killers.Recovery is smooth then problem is and degree of muscle tone, and presence or not arise but if there is seizures and absence of palpebral reflexes etc.Variables hypovolumia or hypothermia etc we have used to monitor the cardiovascular system to give treatment accordingly include heart rate, pulse pressure, mucous Conclusion membrane color, and capillary refill time. Any General anesthesia in Direct blood pressure measurement can abdominal surgery is not safe until we provide continuous hemodynamic status of should not take a proper care. Inhalation the animal and can be easily accomplished anesthesia is good for maintenance in any through catheterizing the auricular artery. type of abdominal surgery.

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Anatomical Location for Regional Nerve Blocks in Domestic Animals Vishnudeo Kumar and Anil Sharma Department of Veterinary Anatomy, College of Veterinary Science & A.H. Junagadh Agricultural University, Junagadh

Regional nerve blocks are block the lacrimal branch and close to temporary blocking of pathway for dorsal margin of the orbit to block the passage of impulses by injecting local infratrochlear branch. anaesthetic solution resulting in 2. Mandibular nerve block: The desensitization and paresis in the mandibular nerve is a branch of region. The successful regional nerve trigeminal and enters the mandibular blocks require the thorough knowledge foramen on the medial aspect of of anatomy of the particular region, vertical ramus of the mandible and course of nerve and the proper site of emerges through mental foramen on injection. The regional anaesthesia is the lateral aspect of the mandible. not only used for surgical operations During its course sensory branches are but also for diagnosis, prognosis, given off to teeth and gums of lower remove the pain, lameness due to jaw. chronic conditions and splints, Indications- To desensitize the cheek ringbone, navicular disease, laminitis teeth, alveoli and gums of lower jaw. (Horse) etc. Site: Cattle and Horse - At the mandibular foramen on the medial Nerve blocks of head region 1. Cornual nerve block: Cornual aspect of the vertical ramus. The nerve is a sensory nerve supplying to Mandibular foramen is located at the the horn core and skin around its base. intersection of two imaginary line It is a branch of lacrimal nerve which passing along the masticatory surface is a division of the ophthalmic branch of mandibular cheek teeth and of trigeminal nerve (CLOT). The perpendicular line running through the cornual nerve emerges behind the orbit lateral canthus of the eye. and ascends along frontal crest and Dog - The Mandibular foramen is placed relatively superficial in the located at the depression just in front upper third covered by skin and the of the angular process of mandible. 3. Mental nerve block: The thin layer of frontalis. The caudal part mandibular nerve gains exit at the of the nerve is having close association mental foramen on the lateral aspect of with the superficial temporal artery. the horizontal ramus of the mandible. Indications- For of horn in certain conditions affecting the horn Indications- To desensitized the lower eg. Horn cancer and fracture of horn. lip. Site- At the mental foramen on the Site- Close to frontal crest of the lateral aspect of the horizontal ramus frontal bone about one inch below the of the mandible near the body. base of horn. In case of goat two site to Dog - Mental foramen is located block the cornual nerve - Behind the immediately below the root of second root of the supraorbital process to lower premolar tooth about ½ the

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 14 distance between the dorsal and ventral Indication - To desensitize the upper border of the mandible. eyelid. 4. Maxillary nerve block: The Site - At the root of the supraorbital maxillary nerve which is a branch of process. the trigeminal nerve, is sensory in 7. Orbital nerve block: Ophthalmic nature and emerges through the and maxillary branches of trigeminal foramen orbitorotundum, passes nerve are sensory in nature and emerge forwards in the pterygopalatine fossa out from the cranium through foremen and enters into infraorbital canal orbitorotundum. The ophthalmic nerve through maxillary foramen. The supplies branches to the eye ball maxillary nerve gives branches to the proper, eyelids, conjunctiva, lacrimal teeth of upper jaw. sac and third eyelid. While zygomatic Indications - To desensitize the teeth, branch of maxillary nerve supplies to alveoli and gums of upper jaw. skin of lower eyelid. Site - The maxillary foramen to be Indication - Evisceration of the reached by inoculation needle through eyeball, orbital abscesses, malignant the site 2 to 3 cm below the external diseases of eye Site - Foramen canthus of the eye and between the orbitorotundrum reached through posterior border of the malar bone and behind the middle of the coronoid process of mandible. supraorbital process in the temporal 5. Infraorbital nerve block: fossa. Infraorbital nerve is the continuation of 8. Retrobulbar block: This block maxillary nerve and emerges out provides akinesia of the extraocular through infraorbital foramen just muscles by blocking cranial rostral to the facial tuberosity and nerves II, III, and VI, thereby dorsal to the first molar teeth. preventing movement of the globe. Indications - Surgical interference Indication - Enucleation of the eye or with the upper lip and nostrils. for surgery of the cornea. Site- Cattle-The infraorbital foramen is Site -The needle placement for reached through above the level of the retrobulbar injection are the midway upper third cheek tooth. between medial and lateral canthus of Horse- The infraorbital foramen is eye or the upper and lower eyelids. The reached through a line drawn between surgeon’s finger is used to deflect the the nasomaxillary notch and the globe to protect it from the point of the anterior end of facial crest. The middle needle. of this line is located and a finger 9. Auriculopalpebral nerve block: breadth towards the eye. Auriculopalpebral nerve supplies to the 6. Supraorbital (Frontal) Nerve orbicularis occuli muscles it is the one block: Supraorbital is one of the of the branches of facial nerve and terminal branches of the ophthalmic motor to eyelid and auricular muscle. division of the fifth cranial nerve. It is Indication - Surgical affection related accompanied by the supraorbital artery to eyelid. and sensory to the upper eyelid. Site - At the level of the zygomatic arch.

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Nerve block of trunk region Paravertebral nerve block: The nerve Pudic nerve block supply to the flank region is by Pudic nerve is the continuation of the thirteenth thoracic and first and second ventral branch of the 3rd sacral nerve lumbar spinal nerves. Each nerve has with a variable contribution from 2nd dorsal and ventral and 4th sacral spinal nerves. It can be branches. The dorsal branch supplies to best judged by palpating per rectum the the muscles of the loin. The ventral internal pudic artery on the ventro- branch supplies to the skin, abdominal lateral aspect of the pelvic cavity just muscles and peritoneum. In addition to cranial to the lesser sciatic foramen. this the 3rd lumbar nerve supplies a The artery is usually one inch below cutaneous branch to the flank region. the nerve. The ventral branch travels the Indications - Surgical interference intertransverse ligament so anaesthetic with the penis and prepuce. solution should be injected below this Site - The ischiorectal fossa of either ligament. side (the depression between the anal Indication - Laprotomy, rumenotomy, orifice and the ischial tuberosity). ruminal fistula, caesarean section etc. Nerve blocks of the limbs: Site - The last thoracic nerve is The nerve blocks in limbs are indicated blocked about 5 to 6 cm lateral to the for operations on a site distal to the mid dorsal line at a point behind the point of nerve block. It is also used in level of the last rib. The sites of diagnosis in order to localized blocking the first three lumbar nerves lameness. are 5 to 6 cm lateral to mid dorsal line A. Fore limb- and behind the transverse process of 1. Median Nerve block: The median first three lumbar vertebrae nerve passes below and beneath the respectively. pronator teres muscle. It is then runs Epidural nerve block- down along the forearm between the Epidural space is the space between the radius and flexor carpi radialis spinal canal and the spinal duramater. muscles. Median nerve supplies This space is filled with fat and areolar pronator teres, flexor carpi radialis, tissue. superficial digital flexor, humeral and Indication - Surgery of hind limbs and radial heads of deep digital flexor posterior regions of the body, for muscles. surgical manipulations of penis in bull Site - Below the medial tuberosity of and correction of prolapses of uterus the radius at the groove between caudal and vagina in cow. border of the radius and flexor carpi Site - 1. Sacrococcygeal site (between radialis muscle. sacrum and first coccygeal vertebrae). 2. Ulnar nerve block: At the lower 2. Inter coccygeal site (between first one third of the forearm this nerve lies and second coccygeal vertebrae). (In relatively superficial between the dog and lumbo-sacral space). flexor carpi ulnaris and ulnaris lateralis muscle. Ulnar nerve supplies the flexor

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carpi ulnaris, superficial digital flexor and ulnar head of deep digital flexor. Site - It can be located in the femoral Site - A few inches above accessory triangle as it runs distally just cranial to carpal the femoral artery. Using the arterial 3. Volar nerve block: The volar or pulse as a landmark, 2-5 ml of 2% metacarpal nerves are terminal procaine hydrochloride or equivalent is branches of the median nerve. The injected anterior to the artery. lateral volar nerve merges with the 2. Tibial nerve block: The tibial nerve deep branch of the ulnar nerve. The is continuation of the sciatic nerve. In medial volar nerve is accompanied by the proximal third of the leg the nerve the medial volar metacarpal artery the is under the cover of the medial head lateral volar nerve is accompanied by of the gastrocnemius muscle and lies lateral volar metacarpal artery. Each along the medial aspect of the volar metacarpal nerve continues as superficial digital flexor muscle. Tibial respective volar abaxial digital nerve nerve supplies branches to the muscles where as volar common digital nerve is of the plantar aspect of the leg region. formed by union of middle branches of Site - On the medial aspect of the leg median nerve. about a hands breadth above the point Site - High volar block - 5 to 7 cm of hock and ½ inch in front of the above the fetlock in the depression tendoachillis. between suspensory ligament and 3. Peroneal nerve block: The peroneal deep flexor tendon both on medial and nerve is a branch of sciatic nerve and lateral aspects. passes over the lateral head of Low volar block - Midway between Gastrocnemius muscle downwards and the fetlock and coronet in between forwards and divides into superficial deep digital flexor and superficial and deep peroneal branches. The nerve digital flexor both on medial and gives branches to the all the lateral aspects. dorsolateral group of muscles of the B. Hind limb- leg. 1. Saphanous nerve block: This is a Site - Two inches below and behind branch of the femoral nerve and is the lateral condyle of the tibia in the motor to the Sartorius muscle and groove between peroneus longus and sensory to the medial surface of the lateral digital extensor muscles. thigh, stifle and leg.

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Cryosurgery in Veterinary Patients J V Vadalia Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Cryosurgery is the destruction of 2. The method of application tissue by the controlled application of cold 3. The type and thickness of lesion temperature. The term comes from the treated Greek words, Cryo (κρύο) meaning “icy 4. The lesion location (body area) cold” and Surgery (cheirourgiki - Cryogens χειρουργική) meaning “hand work” or A Cryogen is a Medium for Extracting “handiwork”. Minor Surgery and minimal heat from a target tissue. Uses of invasive surgery. Easy to perform, heals Cryogens are limited because of Dangers quickly, minimal complications. of combustion & Tissue require rapid

Cryobiology freezing. LN2 and N2O are cryogens used Tissue destruction by freezing can most commonly in Veterinary Oncological

be done by two ways: Surgery. CO2 can also be used but it 1. Direct or Early cause fatal embolus formation when

By intracellular and extracellular delivered in body cavity. LN2 is the most crystal or ice formation. Change in versatile cryogen having boiling point of - cell’s ability to regulate ion 195.8 0C & can be used as a spray or with permeability and cause swelling and a probe. death of cell Cryosurgical instruments

2. Indirect or Delayed 1. Cryo sprays: Due to vascular stasis, the Self pressurizing spray guns permeability of vessels is increased deliver a combination of vapour and which causes loss of plasma. Damage droplets of LN2 on target tissue or surface. to endothelium of arterioles and Most effective and versatile method. The venoules size of spray droplet is controlled by:

3. Tissue react to cold depending on  The diameter of orifice water content. cellularity. vascularity  The volume of cryogen released,

4. Dry tissues are resistant to damage by regulated by “Trigger” freezing 2. Cryoprobes: 5. The cellular components of peripheral Can be cooled by circulating LN2 or nerves are destroyed by freezing, not By releasing a high pressure gas through a fibrous epithelium and so regeneration small orifice within the tip of probe. Easier is possible to control and less lethal to tissues. 6. Damage to tendons or ligaments is irreversible and should be avoided Surgical procedure 7. After tissue necrosis by freezing,  Preparation of Patients: cutaneous tissues heal by normal Preparation of site is less important. inflammation, granulation, Clipping of hairs will permit. Easier visual epitheliazation inspection of the expanding ice ball. Factors affecting cryosurgery Recognization of potential problems with 1. The length of time of application cryogen run-off  Anaesthesia

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 18

General anaesthesia mostly not needed 2. The scab slough off in 10-14 Sedation is only required for cryosurgery. days The Animal is sedated, restrained and 3. Depigmentation: melanocytes and hair Surgical site is desensitized by Local or follicles are destroyed Topical Anaesthetics. Adjacent areas are 4. Odour protected by Petroleum jelly and Shield Indications  Monitoring of the Frozen Area:  Neoplastic and benign cutaneous  It can be done by subjectively or lesions objectively  Choice of treatment for benign,  Subjective Assessment by Visual perianal, oral and ocular tumours Inspection and Palpation of Ice ball as it do not require sterile surgical Objective Monitoring by use of Pyometers field to measure temp. achieved beyond limit of  Successful experimental the target tissue. cryosurgery on prostate, adrenal Post operative sequelae gland, kidney and liver 1. Swelling:  Cryodestruction of lesions within  Due to local vasodilation and body cavity and increased vascular permeability endoscopic delivery of cryogens.  It is self limiting and resolved Contraindications within 48 hours  Cutaneous Mast Cell Tumours 2. Bleeding:  Tumor that have major Bony  May result in hemorrhage but involvement not life threatening  Low Water containing Cortical 3. Necrosis: Bone 1. It forms a dry scab that protects  Highly vascular Calcious Bone underlying healing

19 Ultrasonography and Endoscopy Techniques in Veterinary Practice Shivaji H.Talekar and Vineet Kumar Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Ultrasound Sonography is of organs such as heart and bowel. defined as sound waves of frequencies Ultrasound can be used to guide needles greater than which is audible to the or biopsy instruments into organ mass. human ear i.e. greater than 20000 Hz. Ultrasound collect more diagnostic Frequencies between 1-10 MHz are information with less effort on the part mainly used for purpose of diagnosis. of clinicians, less stress to the patient, Ultrasound waves travels in a pulse and less expense to clinicians. when it is reflected back it becomes an Abdominal Sonography echo. It is pulse echo principle which is Abdominal Sonography and used for ultrasound imaging. ultrasound guided biopsies often Sonography has become an eliminates exploratory laparotomy. In important and popular diagnostic tools large animals ultrasound can diagnose in veterinary practice in both small diaphragmatic hernia, omasal animals as well as large animals. impaction, abomasal impaction, Popularity of Ultrasonography in reticular or liver abscess, lung cysts or veterinary practice because of it is abscess etc. Ultrasound can be used for simple, non-invasive diagnostic therapy of tendinitis, arthritis etc. procedure that seldom requires the use Ultrasound has many industrial uses of tranquizers or anesthetics, and like ultrasound cleaners etc. Ultrasound equipment that is affordable and easy to scalers are used in veterinary and operate has become available. human dentistry. Diagnostic ultrasound is a non Abdominal Ultrasonography is ionizing form of energy that has increasingly used in veterinary medicine minimal known health risks. Ultrasound and has an important role in decision is able to image radiolucent objects, making process or emergency situation such as urate and cystine uroliths, and in colic in horses as well as GDV cases foreign bodies such as wood and string. in dogs. Rectal palpation may detect The pancreas, adrenal glands, ovaries, distended loops of intestinal lymph nodes and internal structures of obstruction, but sonographically we can the eye. Free fluid is easily penetrated confirm to degree of distension of by ultrasound. Gases are reflect intestinal wall, and presence or absence ultrasound, which creates artifacts on of intestinal motility. the sonogram. Sonography can be used to use Ultrasound machine to detect pregnancy earlier than Most of the ultrasound radiography. Fetuses are easily detected machines are equipped with a 3, 5, and by ultrasound. Fetal heart can be 7.5 MHz probe. Large animal practices monitored by real time ultrasound; even and newer ultrasound machine may also fetal death is readily detected have a 10 MHz transducer Larger the sonographically. Real time ultrasound number, higher the frequency of sound allows clinicians to evaluate movement waves emitted from the probe (7.5

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 20

millions of cycles per second verses 3 distance from the transducer and the million cycle per second). amplitude. The horizontal line shows Higher the frequency, greater the distance and the amplitude is the resolution of the picture, but less depicted on the vertical line. depth of penetration. B-mode (B stand for brightness): 10 MHz transducers used for horse The brightness of the dot is tendon,7.5 MHz for average size dog as made proportional to the amplitude of well as 3.5 MHz for very large size dog the echo. The picture represents a slice echocardiography and deep structure of area covered by transducer. The study. information of the amplitude is maintained in the brightness of the dot Types of transducers Three are three types of on the screen. transducers, Linear: These are M-mode (M stand for motion): composed of thin rectangular clips lined This is an adaptation of real, up side by side, each producing sound time scanning. It records the position waves. The beam thus produces is and motion of the echo and resembles rectangular shape and permit a good B- mode. Each spikes on the display is visualization of superficial structures replace with dot. These images are with an easy analysis of the anatomical moved along a horizontal axis showing relationship. This can be used for the movement of structures along that abdominal scan in small animals or by line. A wiggly line represents the doing slight modification in shape of motion of echo with time. Organ transducer z (rectal or vaginal movement will be viewed in real time transducer) it can be used for diagnosis when the images displayed in a B mode of, urinary bladder or uterus scan are formed rapidly and presented examination etc .in large animals. in sequences. Convex: The composition of this Conclusion transducer is similar to that of linear Veterinary practice Ultrasound except that the crystals are placed in a sonography is now an important curvilinear fashion. Thus with the same, diagnostic aid in future it is compulsory contact area imaging of a greater area to learn about sonography. can be effected. Endoscopy Micro- convex and Sector: Such Endoscopy is the use of transducers contain a single or more specialized video cameras to evaluate crystal which oscillate or rotate to areas within the body in a minimally produce a fan shaped beam. The small invasive manner. In most instances, size gives them more maneuverability endoscopy is performed for diagnostic and access to more organs through a purposes allowing visualization and small contact area. sampling of abnormalities. However, Display endoscopy can also be used for Display mode: there are three therapeutic purposes as well, termed modes of display in diagnostic interventional endoscopy. ultrasound i.e., A, B and M modes. Endoscopy allows a visual A-mode (A stand for amplitude) examination of internal organs and body It displays two parameters of parts without invasive exploratory the echoes in the form of spikes i,e., surgery. Optical lenses were developed 21 which could be used in viewing devices recovery times are two advantages of and endoscopy could start to be used. over arthrotomy (surgical Endoscopy is performed with either a exam of the joint). Disadvantages rigid or flexible fiber optic instrument. include its limitation during diagnostic Flexible endoscopes such as those used and corrective surgical procedures in in the examination of the stomach small patients. consist of a long, flexible insertion tube Cystoscopy: an examination of the with a bending tip at the end that enters vagina, urethral opening, urethra, the body, an eyepiece, and a control bladder, and urethral openings. section. Laparoscopy: an exam of the The tip of the endoscope is abdominal cavity performed through a manipulated using a control knob in the small incision in the wall of the hand piece. In addition to the fiber abdomen or through the navel. It is bundles which provide the light source, done in veterinary medicine to obtain two channels are present within the hepatic (liver) and renal endoscope. One channel permits various (kidney) biopsy samples. endoscopic tools to be passed and fluids Proctoscopy: an exam of the large to be suctioned or samples taken. The bowel and rectum. other allows air or water to be passed Rhinoscopy: an exam of the nasal into the stomach/intestine to insufflate cavity and nasopharynx (junction (inject air into the area), or wash away between the nasal area and the back of mucus from the viewing port. the throat). Special video cameras can be attached Thoracoscopy: an examination of the to the endoscopes which allow viewing chest cavity. This is currently not of the exam on a television screen, as performed frequently in veterinary well as recording the exam on video. medicine. The rigid endoscope cannot be used in Respiratory tract endoscopy some areas, such as the stomach Rhinoscopy: an exam of the nasal because it does not have the bending cavity and nasopharynx (junction tip, so it cannot be between the nasal area and the back of flexed to allow examination of the throat). This procedure is used to all parts of the stomach. evaluate patients with clinical signs Types of endoscopy such as sneezing, nasal discharge, nasal Flexible endoscopy congestion, or nasal bleeding. It is Bronchoscopy: an exam of the lower allows visualization of the nasal cavity airways. and the back of the throat. Colonoscopy: an exam of the Tracheoscopy/Bronchoscopy transverse colon, ascending colon, These procedures are commonly cecum, large bowel, and rectum. performed together to evaluate the Endoscopy: an exam of the esophagus, trachea and the lower airways. Patients stomach, and upper intestines. with chronic cough, respiratory Rigid endoscopy difficulties, pneumonia, or airway Arthroscopy: an exam of soft tissue disease can benefit from these structures and joint cartilage, which is evaluations. In addition to visualizing not visible on radiographs. Decreased the airways, samples can be obtained damage to the joint and shortened using bronchoalveolar lavage (BAL) or

22 an endoscopic brush for cytology and of endoscopy. It can be used to look for cultures. abnormalities such as anatomic Upper gastrointestinal endoscopy irregularities (e.g., any abnormality), Esophagoscopy: This procedure allows urinary stones, masses, or polyps. In evaluation of the esophagus and can be some instances, stones or polyps can be useful in patients with clinical signs removed during endoscopy. such as regurgitation, excessive Abdominal endoscopy drooling, or difficulty swallowing. Laparoscopy: Laparoscopy allows Esophagoscopy can be utilized to evaluation of abdominal organs using a diagnosis diseases such as esophagitis, minimally invasive procedure. An esophageal masses, esophageal endoscopic camera and instruments are strictures, and esophageal foreign introduced into the abdomen using two bodies. to three incisions that are 5-10 mm in Gastroscopy: this procedure allows length. The organs of the abdomen thorough evaluation of the inside of the including the liver, gall bladder, stomach. The procedure is of benefit in kidneys, pancreas, and GI tract can then evaluating patients with conditions such be visualized. Biopsies of abnormal as chronic vomiting, anorexia, organs can be obtained and this form of suspected GI bleeding, or gastric the procedure is called diagnostic masses. laparoscopy. Liver biopsy is the most Lower gastrointestinal endoscopy common reason for performing Colonoscopy: This procedure is used to diagnostic laparoscopy and has several evaluate the colon or large intestine. In advantages over ultrasound-guided and order to maximize the benefits of this open surgical biopsy techniques. procedure, the colon must be properly Laparoscopy can also be used prepared, or cleared out. This is therapeutically. accomplished by giving an oral solution Advantage of endoscopy and multiple enemas during the 12-24  Evaluating the digestive system is hours prior to the procedure. that it is nonsurgical. Colonoscopy is used to evaluate  The technique allows for patients with large bowel diarrhea, fresh visualization of the lining of the blood in the stool, difficulty defecating, digestive system or with abnormal findings on a digital  Direct Biopsy samples can take rectal exam. Similar to upper GI from organs. endoscopy, biopsy samples can be  Many foreign bodies in the obtained to help make a definitive esophagus and stomach may be diagnosi removed via endoscopy. Urinary and Genital Tract Endoscopy  Specialized video camera with high Cystoscopy/Urethroscopy/Vaginascop resolution to evaluate is now y: Cystoscopy, urethroscopy, and available in market for better and vaginoscopy are used to evaluate the accurate diagnosis. urinary bladder, urethra, and vagina, Disadvantage of endoscopy respectively. These procedures are  Necessity to give general anesthesia usually performed concurrently. Patients to the patient with chronic or recurrent lower urinary tract disease may benefit from this form 23  Adequate laboratory testing and  Enemas are compulsory to clean the radiology is required before an intestines endoscopy  Care should be required at the time  Evaluation of blood test before of endoscopy like tearing of giving anesthesia is important for intestine; perforation wound confirmation of patient is ready to otherwise immediate surgery is take anesthetic risk or not required to correct the problem.  Fasting of animals are at least 12 hours before an elective endoscopy Conclusion  General anesthesia with tracheal Endoscopy is very good fast diagnostic intubation is recommended as well as therapeutic tool in emergency  A mouth gag is used to prevent cases like chock,oesophagial damage to the endoscope. obstructions etc.In veterinary practice  If lower part is to be examine it endoscopy is now becomes very requires fasting more than 24 hrs to popular and compulsory tools. 48 hrs.

24 Management of Urolithiasis in Small Animals Vineet Kumar and S H Talekar Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Urolithiasis is a common clinical younger than 1 year, infection-induced problem in dogs and . Several risk struvite and urate uroliths are most factors for urolith formation, such as common. Historical information may breed, sex, age, diet composition, water include previous urinary tract disease, intake, infection of the urinary tract, underlying metabolic disease predisposing environment and drug administration, have to urolith formation, or no preexisting been recognised. Many minerals may disease. When uroliths occur in the lower precipitate in the urinary tract but urinary tract, clinical signs may include magnesium ammonium phosphate stranguria, hematuria, pollakiuria, hexahydrate (struvite) and calcium oxalate inappropriate urination, and urethral are the predominant mineral types in obstruction. Clinical signs associated with urolithiasis in dogs and cats. Prevalence of uroliths that form in kidneys or ureters struvite, calcium oxalate, and urate may include polysystemic illness urolithiasis in dogs are 49.6%, 31.4% and (vomiting, depression, and anorexia) or 8%, whereas in cats it is 42.4%, 46.3% and abdominal pain, although many upper 5.6%. In both species, the incidence of urinary tract uroliths are not associated struvite urolithiasis is decreasing while the with clinical signs. Uroliths may form with incidence of calcium oxalate urolithiasis is other metabolic diseases, such as bacterial increasing. More than 99% of uroliths in urinary tract infections, hypercalcemia, dogs and cats occur in the lower urinary hyperadrenocorticism, lract (urinary bladder and urethra). hyperparathyroidism, and liver disease; clinical signs of the underlying disease Etiology Formation, dissolution, and may be most obvious. prevention of uroliths involve complex Physical examination physical processes. Major factors include Physical examination findings are supersaturation of urine with calculogenic often normal unless urethral obstruction is minerals resulting in crystal formation, present. Urocystoliths may be palpated in effects of urinary inhibitors of approximately 20% dogs and cats. crystallization and aggregation, urinary Animals that form ammonium urate crystalloid complexors, effects of urinary urocystoliths with portosystemic shunting promoters of crystal aggregation and of blood may be small in stature, look growth, and effects of noncrystalline unkempt, or exhibit signs of matrix. hepatoencephalopathy. Dogs with hyperadrenocorticism may show signs Diagnosis typical of that endocrinopathy. History and clinical signs Struvite, xanthine, and cystine Laboratory examination uroliths occur in young adult animals, and Serum biochemical analysis calcium oxalate uroliths form in middle Serum biochemical analysis is aged to older animals. In dogs and cats usually normal. Hypercalcemia may be

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 25

observed in approximately 4% of dogs and ACTH stimulation testing, low-dose 35% of cats with calcium oxalate uroliths. dexamethasone suppression test, high-dose A low blood urea nitrogen (BUN) dexamethasone suppression test or concentration, hyperammonemia, and abdominal ultrasonography). hyperuric acidemia may be observed in Imaging studies animals with ammonium urate uroliths that Survey radiography is often form because of portosystemic shunting of sufficient for detection of uroliths if they blood. Hyperuric acidemia is observed in are radiopaque. Urate and cystine uroliths dogs with urate uroliths. Azotemia, are inconsistently observed because of low hyperkalemia, and metabolic acidosis may mineral density. Use of double-contrast be observed if urethral obstruction is cystography improves the detection of present. urocystoliths. Excretory urography may be Urinalysis necessary to identify nephroliths and Abnormalities may include ureteroliths and to determine whether haematuria, pyuria, bacteriuria, and ureteral obstruction is present. crystalluria. Although a bacterial urinary Ultrasonography may demonstrate tract infection induces most struvite uroliths, but it is difficult to determine the uroliths formed in dogs and in some cats, number of uroliths ultrasonographically. presence of a urinary tract infection does Analysis of uroliths not necessarily prove that uroliths are Quantitative analysis of uroliths composed of struvite. Infection with a voided during micturition or retrieved urease-producing organism is required for through voiding urohydropropulsion, infection-induced struvite uroliths to form. urinary catheterization, or cystotomy Urine culture provides the most information about the Urine cultures should be positive mineral composition of uroliths. for a urease-producing organism (usually Treatments Staphylococcus species, occasionally Urocystoliths that are smaller than Proteus, Streptococcus, Klebsiella or the smallest diameter of the urethra may be Ureaplasma species) in the presence of retrieved by voiding urohydropropulsion infection-induced struvite uroliths. Urine or a catheter-assisted retrieval technique. cultures may be positive with any urolith Surgical removal or medical dissolution of in which a secondary bacterial urinary uroliths should not be the end point of tract infection has occurred. therapy because many types of uroliths are Additional laboratory testing recurrent. Appropriate preventive Additional laboratory testing may measures and follow-up evaluations are be indicated in animals with predisposing required. metabolic diseases such as portosystemic Retrograde urohydropropulsion shunts (urate uroliths; provocative Uroliths that cause urethral serum bile acid testing, contrast obstruction are retropulsed into the urinary portography or transcolonic nuclear bladder if possible. The dog or cat is imaging) and hyperadrenocorticism sedated or anesthetized, and a red rubber (calcium oxalate or struvite uroliths; catheter (dogs, 5.0 to 8.0 French) or

26 polypropylene catheter (cats, 3.5 French) every 12 hours in dogs & 7.5 mg/kg orally is inserted to the site of obstruction. Sterile at every 12 hours in cats) and a low- lubricant-fluid solution is infused under protein, alkalinizing diet. Average time for pressure. Most urethroliths can be moved dissolution is 4 weeks. into the bladder successfully with this Xanthine is a purine that is procedure. Urate, cystine and most struvite metabolized to uric acid primarily by the uruliths move easily because of their hepatic enzyme xanthine oxidase. In dogs smooth texture; calcium oxalate uroliths and cats receiving allopurinol for treatment are less mobile because of their irregular of urate uroliths, xanthine concentrations surface texture. This procedure is not in serum and urine incrcase. Xanthine successful if uroliths are embedded in the uroliths also occur spontaneously in cats. urethral mucosa or if there is a stricture Xanthine uroliths cannot be dissolved proximal to the uroliths in the urethra. medically. Cystine uroliths may be dissolved Voiding urohydropropulsion It is done under deep sedation or with use of 2-mercaptopropionylglycine . It may be used to (15 mg/kg orally at every 12 hours) and retrieve uroliths that have a diameter feeding a low-protein, alkalinizing diet. smaller than the smallest luminal diameter Average time for dissolution is 4 to 6 of the urethra. Uroliths smaller than weeks. 2-Mercaptopropionylglycine is approximately 5 mm in female cats, 1 mm used with caution in cats because there is a in male cats, 10 to 15 mm in female dogs, higher rate of complications, such as blood and 1 to 5 mm in male dogs can typically dyscrasias and gastrointestinal signs, than be retrieved. For larger uroliths, a in dogs. cystotomy must be performed or medical Other mineral types, such as dissolution attempted. calcium phosphate and silica, cannot be dissolved. Medical dissolution of uroliths Dissolution of infection-induced Prevention of uroliths struvite uroliths is possible with Prevention of sterile struvite appropriate antimicrobial therapy and a uroliths diet which is restricted in protein and can be achieved by feeding a diet that magnesium and induces aciduria. Average produces a urine pH between 6.1 and 6.5 dissolution time is 8 to 10 weeks. because struvite is more soluble in acidic No protocol available for urine (pH < 6.8). Dietary magnesium dissolution of calcium oxalate uroliths. restriction may also be useful. Most Surgical removal remains the treatment of "struvite prevention" diets are restricted in choice for calcium oxalate uroliths. magnesium and phosphorus and induce Dissolution of ammonium urate aciduria compared with routine uroliths in animals with portosystemic maintenance diets. shunting of blood has not been successful; Feeding a protein and sodium therefore, surgical removal remains the restricted, alkalinizing diet to dogs delays treatment of choice. recurrence of calcium oxalate uroliths. If a Urate uroliths may be dissolved neutral to slightly alkaline urine pH is not with use of allopurinol (15 mg/kg orally at produced by diet, potassium citrate may be

27 given (initial dose, 75 mg/kg orally every diet is highly successful in preventing 12 hours; adjust to induce a urine pH of formation of cystine uroliths. Cystine 7.0 to7.5). In cats with hypercalcemia and solubility increases in alkaline urine; calcium oxalate uroliths, prevention is therefore, maintaining a urine pH above more successful with feeding of a higher- 7.5 is important. If the urine pH is not fiber diet and administration of potassium above 7.5, potassium citrate may be citrate (initi al dose, 75 mg/kg orally every administered (initial dose, 75 mg/kg orally 12 hours; adjust to induce a urine pH of every 12 hours; adjust dose to induce a 7.0 to 7.5). Other proposed treatments urine pH above 7.5). Alternatively, 2- include vitamin B6 (2 mg/kg orally at mercaptopropionylglycine (15 mg/kg every 24 hours) and hydrochlorothiazide orally every 24 hours) with alkalinization (2 to 4 mg/kg orally at every 12 hours). therapy with or without modification of Because calcium oxalate uroliths recur, diet can be tried. serial monitoring of urinalyses and Surgical removal and lithotripsy repeated survey abdominal radiographs are Nephroliths and ureteroliths are important. commonly composed of calcium oxalate. Feeding a low-protein, alkalinizing Surgical removal and lithotripsy are the diet to dogs with urate calculi in the only options if uroliths must be removed absence of portosystemic shunts prevents from the kidneys or ureters because recurrence in approximately 80% of cases. calcium oxalate uroliths cannot be If urate crystalluria persists despite feeding dissolved medically. The decision to of an appropriate preventive diet, remove a nephrolith or ureterolith should allopurinol may be administered (7 to 10 be considered carefully because of the mg/kg orally at every 12 to 24 hours). difficulty associated with ureteral surgery Feeding a low-protein, alkalinizing diet to and long-term damage to a kidney induced cats has been more than 95% successful in by nephrotomy. Hence, nephroliths or preventing recurrence of urate calculi. Use ureteroliths should be monitored by of allopurinol in cats is not recommended abdominal radiography at every 3 to 6 until safety and efficacy studies are done. months. If it is increasing in size or Feeding a low-protein, alkalinizing number or causing pain, hematuria, diet has been successful in preventing infection, or obstruction, they should be recurrence in animals that form xanthine removed surgically to attempt to prevent uroliths unassociated with allopurinol loss of the associated kidney. By formation. performing cystotomy and urethrotomy, Feeding a low-protein, alkalinizing upper urinary tract uroliths are removed.

28 Regional Anaesthetic Techniques in Large Animals P B Patel, H M Padheriya, A M Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Regional analgesia is brought strikes coronoid process of the mandible. It about by blocking conduction in the is redirected towards the petrygopalatine sensory nerve or nerves innervating the fossa rotral to the foramen orbitorotundum region where an operation is to be at a depth of 8-10 cm, and 15-20 ml of 2 performed. The operative field itself is not per cent lignocaine is injected. To block touched while its sensitivity is being auriculopalpebral nerve, to paralysis abolished. Success in regional analgesia eyelids, 18 G needle is withdrawn to the comes from through knowledge of S/C tissue and redirected caudally and topographical anatomy of the nerves and laterally. Five to seven ml of solution is the site of injection. injected at this place. The technique blocks the orbit and eyelids. Local anaesthesia Adverse effects are orbital The local anaesthetic decreases the haemorrhage, pressure on eye ball and permeability of the excitable membrane to damage to optic nerve. + Na and in higher concentration also block Auriculopalpebral nerve block + the K channels. causes motor paralysis of the eyelids and The anaesthetics are mainly facilitation examination of the eye or inactivated in livers by estrases, amidases. removal of foreign bodies. Toxicity Mental nerve block Multiple injections near a highly It can be used for surgery of the vascular area may result into toxicity. The lower lip and lower jaw. In bovine the symptoms arise from CNS and include mental foramen is located on the lateral restlessness, muscular tremors or even aspect of the ramus just behind the fourth tonic convulsions. The stimulation is incisor. A 3-4 cm long 20 G needle is followed by depression, hypotension and inserted slowly into the foramen and 10-15 some degree of respiratory depression. ml of 2 percent lignocaine is injected. Fatalities in neonates are common. If Mandibular-alveolar nerve block toxicity occurs, diazepam or barbiturates Mandibular alveolar nerve is can be used to overcome convulsions. blocked at the mandibular foramen on Nerve Blocks medial aspect of the ramus of the Peterson’s eye block mandible. In bovines, the needle is inserted from the angle of the jaw along the The ideal site to anaesthesia the eye mandible surface of the ramus of the and its associated structures is just at the mandible, at a point where an imaginary foramen orbitorotundum from where line along the masticatory surface of the oculomotor, trochear and abducens nerves lower molar teeth is crossed by another and ophthalmic, maxillary and mandibular imaginary vertical line from the lateral nerves emerge. In this technique a 2.5 cm canthus of the eye. A 15 cm long, 18 G 16 G needle is first introduce under aseptic needle is used. About 20 ml of 2 percent condition though the skin in the depression lignocaine is injected to induce analgesia just caudal to point where the supraorbital of the molar teeth, incisors and lower lip. process meets the zygomatic arch. A 12cm long 18 G needle is then inserted through previously placed needle and pushed till it Infraorbital nerve block

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 29

The block is used for surgery of the another 5 ml of the solution is injected at upper lip, nostrils, incisors and gums. the level of dorsal surface of the transverse Infraorbital nerve emerges from the process to block the dorsal branch of the infraorbital foramen which is located respective nerve. For rumenotomy rostral to facial tuberosity, dorsal to first blocking the flank, the L2 nerve should molar tooth. A 4 cm long 20 G needle is also be blocked. inserted about 2.5 cm deep into the caunal Distal paravertebral anaesthesia and 5-10 ml of 2 percent lignocaine is injected to block the nerve. A lateral approach is followed in this technique to desensitize the dorsal and Cornual nerve block ventral branches of the T13, L1 and L2 The block is indicated for surgery nerve of cattle at the distal ends of the of the horn. The corneal nerve passes lumber transverse process of the L1, L2 through the periorbital tissue dorsally to and L4 vertebrae. The local anaesthetic run along the lateral border of the frontal solution is deposited dorsal and ventral to crest where to the base of horn. In cattle, the end of transverse process and about 20 an 18 G needle is inserted midway ml of the solution is injected at each site in between nerves is superficial. About 5 ml a fun-shaped fashion. The needle is of 2 percent lignocaine is injected around completely withdrawn and reinserted the nerve. In older animal or if the horns dorsal to the transverse process in a are well developed, the skin sensation may slightly caudal direction where the come from first or second cervical nerve. cutaneous branch of the dorsal rami is Therefore, in such cases, some amount of blocked with about 5 ml of the solution at local anaesthetic should be infiltrated just each site. caudal to the base horn. Epidural anaesthesia Proximal paravertebral anaesthesia In this technique, a local In bovines, the dorsal and ventral anaesthetic agent is injected into the nerve routes of the last thoracic (T13) and epidural space. Caudal epidural block is first and second lumber (L1, L2) spinal routinely used in bovines to block the nerves are blocked on emerging from the coccygeal and sacral nerves so as to resepective intervertebral foramen. desensitize the tail, anus, perineum, valve and vagina. The technique is used in The site is about 5 cm from the obstetrical procedure and for surgery. It is midline, for T just cranial to the 13 also used to cheek tenesmus. Crranial transverse process of the L , for L just 1 1 (anterior or high) epidural block can be cranial to the transverse process of the L 2 used in calves, sheep and goats to and for L just cranial to the transverse 2 desensitize the abdominal region. Usually process of the L . The skin over the sites is 3 caudal block is differentiated from the desensitized by injecting 2 to 3 ml of 2 cranial block by the absence of percent lignocaine using a 2 cm long 15 G incoordination of the limbs with the needle. Using this needle as a cannula, a foramer. Both cranial and caudal blocks 15 cm, 18 G needle is inserted down to can be produced from the same site by contact the cranial edge of the transverse increasing the volume of local anaesthetic process of the lumber vertebra. The needle agent used as larger volumes facilitate the is then advanced about one centimetre to spread of solution cranially. The most pass through the interansverse ligament. commonly used sites are the About 10 ml of 2 percent lignocaine is sacrococcygeal space and the first injected 6to block the ventral branch of the intercoccygeal space. In the buffalo, the respective nerve. The needle is withdrawn sacral ridge is inelined more downward above the intertransverse ligament and

30

and so the anaesthetic solution may not at a median plane at a right angle or at 10 sometimes reach the uppermost parts when to 150 to the vertical. Small quantity of the first intercoccygeal space is used. local anaesthetic solution is injected to Therefore, the sacrococcygeal space make a dermal weal. should be preferres. In routine practice, 2 The needle is then pushed down till percent lignocaine is used. Repeated it contacts the floor of the vertebral canal. injection can be given to prolong the A syringe filled with local anaesthetic the duration of effect. Alternatively, longer presence of blood. If blood is present the acting agents like bupivacaine can be used. needle is withdrawn, checked of the blood The site is located by elevating and clot and reinserted. Eight to ten ml of 2 lowering the tail and palpating the percent lignocaine is then injected. If the depression between the sacral and first needle id in correct position, there is coccygeal or between the first and second practically no resistance felt during the coccygeal vertebrae. In cattle and injection. If the resistance is felt, the buffaloes, a 10 cm 18 G needle is inserted needle should be slightly withdrawn and redirected.

31 Common Surgical Affection of Eye in Small Animals J V Vadalia Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

1. trauma, surgery, thermal or chemical Inversion of lid margins of the eyelid injury or chronic inflammation. Etiology Symptoms: A. Congenital Typical turning out of the lid Involving the lower eyelid. margin, Epiphora, Blepharospasms, May Commonly seen in Chow-chow, Blood be conjunctivitis or keratitis. hound, Labrador, Doberman, St. Bernard, Treatment Irish setter Surgical B. Acquired V-Y blepharoplasty is done under Cicatricial contraction following suitable anesthetic technique. injuries. Chronic inflammation due to Postoperatively, topical eye antibiotics blepharospasms associated with the with corticosteroid for 6-8 days. Local painful eye disease known as spastic antiseptic dressing of the suture line for 8- entropion. 10 days or till the sutures are removed. Symptoms 3. Hordeolum Typical in rolling of the lid margin, Localized suppurative Epiphora, Blepharospasms, conjunctivitis inflammation of lid margin usually due to or keratitis, vascularization (Pannus) or Staph ulceration of the cornea. External Hordeolum: Also known as Treatment ‘Sty’, involves glands of Zies and Moll. Surgical- Seen in young dogs characterized by Elliptical piece of the offending solitary or multiple small abscesses on the eyelid removed with a pair of scissors or lid margin. Internal Hordeolum: Also scalpel. Wound sutured with fine silk or known as ‘Chalazion’ and involves catgut. Postoperatively, topical eye meibomian glands. Mostly seen on the antibiotics with corticosteroids for 6-8 palpebral conjunctiva. Common in middle days. Local antiseptic dressing of the aged dogs. suture line for 8-10 days or till the sutures are removed. Treatment Hot compression of the swelling 2. Ectropion followed by manual compression with Typical eversion of the lid margin cotton plug and then flushing the affected exposing the palpebral and bulbar eye using 2% Boric acid or NSS. Topical conjunctiva antibiotics with corticosteroids qid daily for 6-8 days. Etiology A. Congenital due to the inadequacy of 4. Prolapse of the gland (cherry eye) lateral retractor muscle of the eye. Protrusion of the gland over the B. Acquired due to decreased tone of the free edges of 3rd eyelid is called orbicularis oculi muscle. Secondary to hypertrophy, hyperplasia or adenoma. Commonly known as “Cherry Eye”.

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from th th 14 to 19 October 2013 32 Develops due to the congenital weakness removal of the clotted blood from the of connective tissue in between cartilage chamber. Thereafter flush the anterior and the glandular tissue. If unilateral, other chamber with 1000 to 1250 units/ml eye should be examined for potential fibrinolysin and NSS. Use of topical prolapse. mydriatics (1% atropine) with antibiotic and corticosteroids combinations is quite Treatment If possible return the gland to its helpful in the management of the normal position under general anesthesia condition. and keep it in position by suturing. 7. Extirpation of Eye Ball Alternately, if the above procedure fails, Indications surgical removal of the gland is done. Neoplastic growth of the eye ball Check hemorrhage with topical adrenaline and adjacent tissue. Penetrating (1:5000). Postoperatively install topical associated with evacuation of ocular antibiotics with corticosteroids for 5-7 contents and causing irreparable injury to days. the eye. Supportive destruction of the eye. 5. Prolapse of 3rd eyelid Site of operation and anaesthesia An acquired condition mostly seen Between eye ball and orbital rim due to median canthus injury leading to through the skin of both eye lids about half weakness of the connective tissue cm from the border. The animal is anchorage to the orbital tissue. Surgical controlled in lateral recumbency with the excision is done under regional block affected side up. Sedative/tranquilizer or followed by topical antibiotics with general anaesthesia can be administered corticosteroids for 8-10 days. A technique depending upon the temperament of used to protect the cornea for better animal. Analgesia at the site of operation healing during many disease conditions. is achieved by auriculo palpebral and retrobulbar nerve blocks or by infiltration Indications: Corneal ulcers, iris prolapsed, of local anaesthetic into upper and lower management of corneal wounds eye lids and deeper tissues at the site of incision, in case sedative or tranquilizers 6. Hyphema are used Blood in the anterior chamber. Whole of the eye looks red. Mostly seen in Surgical technique some trauma. Not so common causes are The upper and lower eye lids are Warfarin poisoning, severe anterior sutured together with a continuous suture uveitis, glaucoma. leaving the suture ends at least 15-20 cm long for grasping and applying traction Treatment: There is no satisfactory treatment during the operative procedure. An to stop slow bleeding from retinal incision completely encircling the eye lids detachment. is made approximately 1/2 cm from the Treatment of the primary cause is a must margin of the lids. The incision is (glaucoma, iridocyclitis etc.). Paracentasis extended around the entire circumference of the anterior chamber at 6 ‘O’ clock of the lid margin between the orbital rim position using No. 11 BP blade for easy and eyeball by blunt dissection taking care

33 not to puncture conjunctiva. Haemorrhage its capsule which results in the loss of the is carefully controlled either by ligation or transparency of the lens. forcipressure. Classification Conjunctiva from the lids back to its attachment to the orbit 'is separated  Capsular or False Cataract: When leaving its attachment to the border of the the lesions are present in the capsule. lids. The dissection is carried out back to  Lenticular or true cataract: When the point of insertion of the conjunctiva to the lesions are present in the lens itself. the orbit. All the muscles of the eye are  Capsulo-lenticular or mixed incised with scissors and finally the optic nerve is cut. Before cutting, the optic Depending upon the etiology: vessels are ligated firmly in order to  Developmental cataract: Congenital control the haemorrhage. All the or juvenile cataract. periorbital fat is left in place. The  Traumatic cataract: Due to certain haemorrhage is controlled with gauze external violence and resultant pressure temporarily packed up inside the perforating wound. orbital cavity. All the blood clots are  Classification removed from the cavity. Temporary pack  Senile cataract: Seen in the old age. is removed and a 70-80 cm long piece of  Diabetic cataract: Seen in Diabetes bandage impregnated in antiseptic lotion is mellitus. inserted into the orbital cavity. Outer skin  Radiation cataract; Rare in animals. edges of the lids are sutured with  Hereditary cataract: In Miniature interrupted sutures in order to close the Schnauzer, Golden Retriever and wound leaving a little portion of Labrador. impregnated gauze outside towards the  Toxic cataract: In naphthalene inner canthus. poisoning, uremia, drug toxicity Post operative care (pilocarpine) and certain metallic A pressure bandage should be tied toxicity (Thallium, Cobalt and for about 24 hours after the Operation. A Selenium). 15-20 cm piece of impregnated bandage  Complicated cataract: Secondary to should be removed on 3rd and 7th day, and other ocular disease like uveitis, lens the rest on l0th day after the operation. A luxation, retinal detachment, course of antibiotics should be intraocular tumors and glaucoma. administered for 4-5 days or till the Stages of cataract healing is complete. The sutures of the lids  Incipient stage: Beginning of cataract should be removed 8 to 10 days after the when streaks or vacuoles are seen in operation or till the healing is complete the nucleus or just inside the posterior 8. Cataract capsule. The vision is normal. Opacity of lens or its capsule.  Immature stage: There is cloudiness Develops due to the opacification of lens of the lens but fundic reflex fibers and change in the water content of (Reflection of light from the tapetum) the lens. Disruption of lamellar is still present. Slight difficulty in architectural arrangement of lens fibers or walking.

34  Mature stage: There is shrinkage of sulfonamides, acetazolamide preparations the lens with complete opacity. The for topical use. The success rate with fundic reflex is absent. The cataract is medicinal treatment is very less and it is often referred as ‘ripe’ cataract. believed that any apparent improvement in  Hypermature stage: There is further the vision was not due to the medication decrease in the size of the lens with but probably due to spontaneous cataract liquefaction of the cortex. The lens resorption. 1-2% topical atropine can be appears milky or speckled in the used twice weekly to dilate the pupil and appearance. Finally the nucleus may enhance the vision. sink to the bottom (Morgagian B) Surgical treatment cataract) and may be there is return of Surgical removal of the cataract the vision. lens is done under general anaesthesia. The Symptoms and diagnosis aim is to restore aphakic vision. Mostly  History of progressive loss of vision. two methods of lens extraction are  Focal or diffuse opacity of the lens. recommended i.e.  The lens appears ‘pearly white’. Extracapsular (the anterior capsule of lens is removed and lens content is Treatment expelled) Medical treatment The aim of medical treatment is to Intracapsular removal (no opening is promote the absorption of inflammatory made in the capsule and the zonular exudates. Many drugs have been tried like attachments are severed and the lens is Catamed or Cataline 1-2 drops twice daily. delivered within the capsule). Various Homeopathic medicine ‘Senararia” can methods which can be employed for the also be tried. removal of the cataract lens are: Ultrasonic Other drugs which have been tried fragmentation, Aspiration technique with are iodine, calcium, cysteine, needle or after fragmentation.

35 Mammary Gland (Breast) Tumors in Dogs A M Patel, H M Padheriya and P B Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Mammary gland tumors are the most common tumors in dogs. In fact, among unspayed females the risk of a mammary tumor is 26 percent. Most mammary gland tumors occur in bitches over 6 years of age (the average age is 10). Forty-five percent are cancerous and 55 percent are benign. An increased incidence occurs in sporting breeds, Poodles, Boston Terriers, and Dachshunds. Multiple tumors are common. If a bitch has one tumor, she is three times more likely to have or develop a second tumor. Anatomy The mammary glands in female dogs vary in number and can be determined by counting the nipples. The Fig 2: Lymphatic supply of mammary typical bitch has 10 mammary glands, five gland on each side of the midline, beginning on The mammary gland is a modified the chest and extending to the groin. The apocrine sweat gland found only in largest glands are located near the groin. mammals. It consists of a network of ducts surrounded by a fibrovascular and adipocyte-rich stroma. The development of

this gland is unique, as the last stages of development occur in the adult female only during pregnancy. With each pregnancy there is proliferation of the ductal tissue, differentiation to milk- producing acini, secretion of milk by the acinar cells, and, at the end of lactation, involution of the secretory component of the gland with preservation of the ductal structures.

Table: Lymphatic drainage of the mammary gland in the bitch Fig:1 Location of mammary gland in bitch M ammary Normal Neoplastic Gland Lymphatic Lymphatic

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 36

Drainage Drainage metastases, present in 30 percent of these cancers. Ultrasonography is useful in M1, cranial Axillary Axillary LN, determining whether the pelvic lymph thoracic LN sternal LN nodes are involved. Biopsy of the tumor M2, caudal Axillary Axillary LN, may not be necessary if surgical removal is thoracic LN sternal LN contemplated. Inflammatory cancer, M3, cranial Axillary Axillary LN, however, must be biopsied, because there Abdominal LN, superficial is little to be gained in attempting Superficial inguinal LN, aggressive treatment in these tumors. inguinal medial iliac Benign growths are often smooth, LN LN small, and slow growing. Signs of malignant tumors include rapid growth, M4, caudal Superficial Superficial irregular shape, and firm attachment to the Abdominal inguinal inguinal LN, skin or underlying tissue, bleeding, and LN axillary LN ulceration. Occasionally, tumors that have M5, Superficial Superficial been small for a long period of time may inguinal inguinal inguinal LN, suddenly grow quickly and aggressively, LN popliteal LN, but this is the exception not the rule. lymphatics— Treatment medial thigh Removing the lump with adequate margins of normal tissue is the treatment of choice for all mammary tumors, Mammary Tumor whether benign or malignant. How much The principal sign is a painless tissue will be removed depends on the size lump or mass. Most lumps occur in the and location of the tumor. Removing a larger glands closest to the groin. A mass small tumor with a rim of normal tissue is may be large or small, with boundaries called a lumpectomy. A simple that are distinct or indefinite. Some lumps mastectomy is the removal of the entire are freely moveable, while others adhere to mammary gland. A complete unilateral the overlying skin or underlying muscle. mastectomy is the removal of all five Occasionally, the mass ulcerates the skin mammary glands on one side of the body. and bleeds. The inguinal lymph nodes are often Inflammatory cancer is a rapidly included in a unilateral mastectomy. A progressive neoplasm that spreads specimen is then submitted to a pathologist throughout the chain of mammary glands for a tissue diagnosis to determine the and into surrounding skin and fat. Death prognosis. usually comes in a matter of weeks. The success rate of surgery Inflammatory cancer may be difficult to depends on the biological potential and the distinguish from acute septic mastitis. size of the tumor. Benign tumors are Malignant tumors spread widely, primarily cured. Bitches with small malignant to the pelvic lymph nodes and lungs. tumors less than 1 inch (25cm) across have Before embarking on treatment, a chest X- favorable cure rates. Those with large, ray should be taken to rule out lung

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aggressive tumors are more likely to have to less than 1 percent. If she is spayed after metastatic disease and a poor prognosis. one heat period, her risk is still only 8 The addition of chemotherapy, percent. After two heat cycles, however, immunotherapy, and complete there is no reduction in risk. It is important ovariohysterectomy does not improve cure to examine the mammary glands of rates, although chemotherapy may offer unspayed bitches every month, starting at some relief in bitches with advanced 6 years of age or younger. If feel a cancers that cannot be surgically excised. suspicious lump or swelling, than do Prevention medical checkup. Thus, the opportunity to Spaying a female before the first cure many mammary cancers is lost. heat cycle reduces her risk of breast cancer

38 MRI, CT Scan and Digital Radiography Shivaji H.Talekar and Vineet Kumar Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Magnetic resonance imaging radiation. The magnetic resonance (MRI) is a sophisticated computerized phenomenon has been steadily gaining in imaging technique, which has been a vitro application in the fields of chemistry, clinical diagnostic tool since 1980. MRI is biochemistry, and the medical life sciences used to create images with extraordinary since its inception in 1946. detail of the body or brain by applying The technique was first extended nuclear magnetic resonance phenomena. to a live animal by Jasper Jackson in 1967, The distribution of hydrogen nuclei and the first two-dimensional MR image (protons), found in cellular water, depends was generated in 1972 by Paul Lauterbur. on the tissue type and whether or not the Since initial reports of the identification of tissue is healthy or diseased. MRI central nervous system (CNS) measures and records changes in the abnormalities by magnetic resonance magnetic properties of these protons. The imaging during the 1980's, the progression MRI technique uses a strong magnetic of MR as a diagnostic modality for CNS field, pulsed electromagnetic fields known disease has been rapid. Magnetic as gradients, and radio waves to excite the Resonance Imaging became routine in protons and produce the image in the human medicine during the 1980s. The region of interest. The image is produced superior clarity of the images, particularly then displayed on a gray scale from black of the brain, combined with its non to bright white. The image brightness is a invasive nature led to its quick acceptance. complex function of the hydrogen MRI in Veterinary Practice concentration or intensity. Contrast, Until recently MRI has had limited described as the difference between signal application in veterinary medicine, intensities, provides the optimum primarily due to the expense of the difference between light and dark regions imaging unit and associated computer of the tissue or organ to help the needs, as well as the requirement for detect lesions, such as a specially constructed rooms to house the tumor. Although MRI is normally a units. However, a few specialty veterinary noninvasive technique, contrast agents can facilities including Advanced Veterinary be administered to a patient to enhance a Medical Imaging have obtained their own region of interest. imaging units for veterinary use. Most Soft tissue, such as internal organs, veterinary facilities rely on older, used is relatively transparent to X-rays, limiting equipment. Our new, state of the art, high the practical application of other imaging field GE MRI scanner will ensure a more modalities such as computed tomography efficient and rapid exam. Furthermore the (CT). MRI, however, has excellent most sophisticated monitoring equipment sensitivity for these tissues with 100% available will minimize anesthetic related increase in soft tissue resolution compared concerns. Advanced Veterinary Medical to its closest competitor CT. MRI has the Imaging has acquired the most dedicated additional benefit of not using ionizing and skilled staff available in the MRI

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 39

industry today in an effort to provide the For a CT scan, a dog is placed best care possible for your . under anesthesia, positioned on a table that An MRI (magnetic resonance slides the pet through a ring containing the imaging) scan is similar to an X-ray in that x-ray source and the X-ray detectors. The it will provide the veterinarian images of CT images are cross- sectional slices of the the inside of your dog, but it provides area imaged, as if the patient was cut like a more detail and it is safer because it does loaf of bread. These slices can be not use radiation. While an X-ray or an examined one by one to reveal the details ultrasound scan will show the size and inside. shape of an internal organ or tissue, an Contrast agents containing iodine MRI scan will show what the inside of the are typically administered intravenously as organ or tissue looks like. part of the scanning process to enhance The dog will need to be placed visualization of abnormal soft tissues and under general anesthesia because it needs blood vessels. The General anesthesia is to remain perfectly still for up to two typically used because most studies require hours. The dog will be allowed only water the patient to remain motionless for a few on the day of the scan, and it will need minutes. about two hours after the scan to recover A CT scan can take a few minutes from the anesthesia. The imaging to an hour depending on the complexity of specialist will usually be able to make a the exam, the size of the patient, and the diagnosis while the dog is recovering. number of body regions examined. After MRI scans for dogs are normally the CT scan is acquired and the patient is reserved for diagnosing problems with the awake, CT images can be further brain and spinal chord and they are only processed and reconstructed into two- used when more traditional diagnostic dimensional and three-dimensional images techniques can't determine the problem using computer manipulation for further with the dog. MRIs are also starting to be analysis as radiologists evaluate the used for diagnosing problems with bones images. and joints in dogs. CT scan is a non-invasive, non- An MRI uses magnetic fields to painful for better diagnosis of cancers, create images of the dog's body. The dog fractures etc. is placed inside a giant magnet which Digital Radiography (X-Rays) sends radio waves into the body. When the Radiographs or “x-rays” are used magnet is turned off, the body releases the to evaluate muscular-skeletal structures, radio waves which the computer uses to cardiovascular, gastrointestinal, make an image of the body. pulmonary, urinary, and reproductive CT (CAT) Scanning systems. Digital radiography offers Computed Tomography (CT) numerous benefits: Immediate observation imaging uses X-rays in conjunction with of radiographic images, less x-ray digital X-ray detectors and computer exposure, improved image quality, Ability processors to image the patient. A CT scan to enhance images, more accurately is sometimes called a CAT scan (for diagnose problems. Data Storage for easy computed axial tomography) history and retrieval, Quick communication with specialists.

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Digital radiography is an updated No change in X ray machine use version of X-ray imaging. Instead of using 60,100,160,500mA X ray Machine. electromagnetic radiation and chemical Gelatin coated X ray plate is required. processing to record an X-ray on to digital image receptor IP,image processing film, digital radiography uses digital X-ray unit, image management system, image sensors to record the X-ray onto an image data storage device, a communication capture device, which then creates a network, a display device and laser printer, digital image file. This file can then be Scanner is required material for digital used by veterinarians to interpret the X- radiography. ray, and the file can be attached to a Advantages of digital radiography patient’s record for future reference.  Save times, better quality Two types of digital  better post processing unit radiography are used. The first, known as  Integrated with radiographic indirect digital radiography, involves equipment amorphous silicon (a-Si) flat panel  easy to learn and adopt, detectors, and it works by converting X-  Decrease chances of repeated ray images to light and channeling the exposures. image through an amorphous  Portable versions are available in silicon photodiode layer that converts it to the market. a digital signal. Thin Dis-advantages film transistors (TFTs) then read  Very costly replacements are costly this digital output, and it is turned into a  Annual maintenance contract part data file that can be viewed by the X-ray too costly technician.  Number of artifacts viz, phantom The second type is image, dead pixels etc. direct digital radiography and involves Conclusion amorphous selenium (a-Se) flat panel MRI, CT and Digital radiography detectors. This uses a high-voltage is recent advance diagnostic tools now electrode to accelerate X-ray photons a day used in veterinary practice. MRI, through a selenium layer, and the pattern is CT and Digital radiography have its then recorded. This creates an image file own advantage and good enough to that is sent directly to the technician and have better diagnosis for veterinary on to the radiologist. clinician for routine cases.

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Recent Advances for the Management of Abdominal Wall Defects Vineet Kumar and S H Talekar Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Abdominal wall defects, may be Diagnostic imaging congenital (umbilical hernia) or acquired Ultrasonographic examination is (ventral, inguinal and scrotal hernias). one of the valuable tool to confirm the Often, such defects result from prior abdominal wall defects. It may also help to abdominal surgery, trauma or weakness of define contents of hernias. abdominal musculature, massive infection, Treatment or tumor resection. Prevention of evisceration, creation of a tension free Surgical procedures are performed abdominal wall repair and stable soft under either local analgesia or general tissue coverage are the goals of abdominal anaesthesia depending upon the species of wall reconstruction. Decisions regarding the animals. Animals were then positioned technique are based on the location and in dorsal or lateral recumbency, according size of the defect. Currently open primary to the type and position of the hernia, and tissue closure of these defects is routinely the proposed surgical site is prepared for practiced. This surgical approach can lead aseptic surgery. In cases of ventral and to wound dehiscence, recurrence and non- umbilical hernias, ring is identified healing of the wound. Another surgical following cutaneous and hernial sac approach for tension-free repair of these dissection. After hernial contents defects is open or laparoscopic prosthetic reduction, ring is repaired with adequate mesh placement. Non-absorbable synthetic size biological mesh using techniques such mesh is one of the most widely used as onlay (mesh is placed anterior to prosthetic materials for reconstruction of external sheath of rectus abdominis these defects. The use of nonabsorbable, muscle), inlay (mesh is placed in the synthetic mesh material has been reported abdominal wall defect and sutured to to cause complications such as mesh wound edges), pre-peritoneal or sublay extrusion, bowel adherence, fistula (mesh is placed dorsal to rectus abdominis formation, wound infection, skin erosion muscle and anterior to internal sheath of and seroma development. Biological rectus abdominis muscle) or intra- meshes may be an attractive option to deal peritoneal technique (mesh is placed on with these synthetic mesh-related peritoeum from within abdominal cavity). complications. These techniques are depicted in figure given below. Diagnosis In case of caudal abdominal History and clinical signs hernias (inguinal and scrotal hernias), a A history of trauma is common straight incision is made directly over the with abdominal hernias. Palpation at the external inguinal ring. The subcutaneous site of defects may reveal presence of a tissues and skin are dissected from the large, soft, round mass with a discernible hernial sac, and the fibrous outer layer of ring. Multiple loops of bowel could be the hernial sac is incised. The tunica palpated traversing the hernial ring. vaginalis is opened, and hernial contents

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 42 are reduced. The spermatic cord is transfixed with absorbable suture materials just distal to the inguinal ring and emasculated between the ligatures, and testes are removed. The tunica vaginalis is closed. Biological mesh is placed between the closed vaginal tunic and the deep inguinal ring and sutured craniolaterally to the internal abdominal oblique muscle and ventromedially to the rectus abdominis muscle (deep inguinal canal) using preplaced surgical silk in a horizontal mattress pattern. The subcutaneous tissues are closed in 2 layers, using absorbable suture material. The skin incision is then closed using nonabsorbable suture material in a horizontal mattress suture pattern.

43 Surgical Affections of Ear in Small Animals J V Vadalia Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Surgical disorders of the pinna It is a dentigerous cyst with fistulous A-Wounds opening on the ear’s anterior edge. Most of recent ear injuries are Symptoms traumatic as a result of biting, barbed wire An opening of the fistula is present or tree and are characterized by perfuse at the anterior edge of the ear 1-3 cm from hemorrhage, while old wounds are either its base, through which a gray mucoid or extension of neglected recent wounds or purulent fluid comes out and runs down the occur as a result of seton, mild irritation temporal and buccal regions and dries. The after using rope or chain tie at the base of skin around the opening shows excoriation. the horn. The fistulous tract is connected to a tooth- Symptoms like structure that can be determined by The same general symptoms of passing a probe or by radiography. wound (hemorrhage in recent wounds, and Treatment cellulites and infection in old one). Treatment is primarily surgical and Prognosis includes surgical excision of the fistula with When a part of the tip of the pinna separation of the bony tooth-like structure has been avulsed, it is difficult to restore the form its attachment to the temporal bone, ear appearance. The splitted or punctured then the wound is closed in layers. ear should be repaired surgically as quickly C-Auricular cellulitis as possible to achieve the maximal cosmetic It is an inflammatory condition of the appearance of the ear. earflap as a result of pyogenic infection of Treatment the ear wound. In recent wounds, arresting of Symptoms bleeding should have the priority. The The earflap is swollen (of 1-2 cm wound edges are excised and refreshed thickness), warm, and painful. The swollen (including the cartilage if necessary). earflap droops to one side and can’t be Divided cartilage is not sutured but the skin raised. Serous fluid exudates form the ear, over the cartilage on both sides is sutured. dries on both surfaces of the ears and forms The head of the animal should be restrained crusts. to prevent the animal from rubbing the ear Treatment against fixed objects. The aftercare is the The external auditory meatus is same as general principles used for ordinary backed with cotton, an ear bandage is wound. Treatment of the old wounds applied and moisted with warm water every follows the rules of general surgery (daily 2 hours. Massive dose of antibiotic should dressing with antiseptic and injection of be administered. The fate of such condition antibiotic). is either resorption or abscess formation B-Ear fistula over the earflap. When an abscess is formed,

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 44 it is treated by the general principles of Symptoms surgical treatment without splitting of the Accumulation of blood between the cartilage but if necrosis occurred in the skin and the cartilage, either on one side or cartilage, it is indicated to perform partial on both sides, and the size and consistency amputation of the earflap. of the hematoma depend up on the duration D- of the external ear and severity of trauma. The most predominant type of Treatment neoplasms observed on the ear is the wart or It is treated either by application of papilloma, which is a benign tumor, but counter irritants or antiflugestic to facilitate other types of tumors can involve the deeper resorption if the condition is recent and auricular tissues. small-sized or by drainage technique. Treatment Sometimes it is better to leave it for 7-10 Neoplasms of the ear can be treated days to permit closure of the ruptured either by surgical resection, cryotherapy or vessels and clotting of the blood, and then thermally. Neoplasms on the edge of the surgical incision is indicated. earflap or on its inner or outer surface are 1-Drainage technique removed surgically and in some cases it is It is a method used for recent necessary to remove a part of the cartilage hematoma on the concave surface of the during resection. While neoplasms of deep pinna to facilitate drainage of the hematoma auricular tissue, that cause obstruction of the by applying two plastic canulas at the external ear canal, should be removed with proximal and distal aspects of the hematoma the canal itself. via stab incision of the skin. The canulas are E-Broken conchal cartilage fixed by silk, and the hematoma is flushed Treatment with sterile saline daily with monitoring the The condition is treated surgically by maintenance of the drainage, and they are incising and reflecting the skin over the removed after 7-21 days when the drainage injured cartilage, then two or three is minimal. Kirschner wire pins are inserted into the 2-Incision-Suture Technique cartilage and fixed externally to the skin by A medial S-shape incision is made stitch. along the hematoma, the clot is removed, the The cartilage is suture with wire cavity is flushed with saline, the pinna is suture by simple interrupted pattern and the sutured with non-absorbable suture material skin is closed routinely. The wire pins are using through and through mattress suture removed 16-20 days after surgery. pattern parallel to the incision and the ear F-Hematoma of the ear vessels in order to close the dead space, the The condition is a common affection ear is bandaged and prevented from self- in pet animals. The exact cause of such traumatization, the bandage is changed affection is not well known, but it is frequently and removed after 7 days when accepted that it is a self-inflecting trauma the drainage is diminished, and the sutures leading to rupture of blood vessels. are removed after 14 days. Disadvantage of

45 this technique is the possibility of thickening solution (three parts 70% isopropyl alcohol and wrinkling of the ear. and one part vinegar) that has cleaning and drying action and changes the pH. 3- Incision-sutureless technique An elliptical incision is made from Surgical end to end of the hematoma to expose it, the 1-Lateral vertical ear canal resection cavity is flushed, the ear is firmly taped to It is performed in order to provide expose the incision, the pinna is reflected ventilation, and remove moister, humidity, over a large roll of cast padding and taped in and temperature. place, and a nonstick dressing bad is applied 2-Vertical canal ablation to the incision and changed according to the It is indicated when the horizontal need for three weeks. Suturing is not used in ear canal is obliterated with proliferative this technique. tissue and the animal didn’t response to resection of the vertical ear canal. G-Otitis externa 3-Total ear canal ablation It is an inflammation of the It is used for removal of the entire epithelium of the external ear canal vertical and horizontal ear canal, and is characterized by an increased production of indicated for treatment of severe ear trauma, ceruminous and sebaceous material, neoplasia of the horizontal canal, or desquamation of epithelium, and pain. persistent otitis externa following the two Etiology previously mentioned techniques. The usual causes of otitis externa are parasitic infestation, bacterial or fungal H-Otitis media infection, allergy, trauma, or presence of It is an inflammation of the mucous foreign body. membrane of the tympanic cavity as a result of extension of infection from the pharynx Signs through the eustacian tube or from otitis Chronic cases can change the size externa after perforation of the tympanic and characters of the external ear canal membrane. In the horse it is also caused by permanently. The epithelium can be infection of the upper respiratory tract and thickened, fibrosed, and ulcerated, and if the the guttural pouch. epithelium become scarred, the canal Signs undergo stenosis. The head is held to one side, Treatment disturbance of the movement, equilibrium, Medical and general condition of the animal. Foul- The initial treatment is directed smell pus comes out from the external ear toward irrigation and cleaning of the canal and soils the hair below it. with antiseptic and topical antibiotic, Treatment antifungal or antiparasitic according to the The condition is usually incurable in cause with parenteral injection of antibiotic the horse, and treatment attempts include and using of ceruminolytic agents. Chronic irrigation with antiseptic and application of case is better treated by topical Swimmer antibiotic.

46 Management of Diaphragmatic Hernia in Buffalo P B Patel, H M Padheriya, A M Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Diaphragmatic hernia (DH) is cases. Some of affected animals show defined as the passage of abdominal intermittent constipation or diarrhoea. viscera in to the thoracic cavity through a Undigested feed is occasionally seen in congenital or acquired opening in the faeces. All the animals show graduated diaphragm. Commonly, it is the reticulum decreased in milk yield. which herniates into the thorax, however, Diagnosis the omasum, abomasums, loops of I. History and symptoms intestine, spleen or liver may also get i. Chronic recurrent tympany occurring involved without exhibiting additional ii. History of advance gestation or recent specific clinical signs. parturition Etiology iii. The animal usually shows movement 1) Chronic and repeated trauma by with bent and abduction of fore limbs. foreign bodies. iv. Incomplete or complete cessation 2) Weakness of diaphragm. yield. 3) Physical forces: Last stage of v. Intermittent constipation or diarrhoea. gestation and parturition. vi. Ruminal ingesta is frothy. Symptoms II. Physical examination i. The rectal temperature is normal with (1) General condition and appearance The animal with D.H. will show slightly low pulse rate progressive emaciation, weakness, ii. Auscultation: The cardiac sound is dehydration leading to death. In chronic muffled in most of the cases. The th cases skin is dug with patches where hair reticular sound is heard cranial to 6 rib in the thoracic region. has been rubbed off. III. Thoracic puncture (2) Chronic tympany Aspiration of the reticular contents It is one of the commonest sign through the 5th and 6th intercostals space seen in animals suffering from DH. The reveals ingesta. This procedure is tympany is mild in cases where there is however, involves risk of ingesta into the small protrusion of reticulum. However, pleural or mediastinal space leading to with more herniation of reticulum the further complication. signs becomes severe due to adhesion between reticulum other structure i.e., IV. Radiography Both plain and contrast lungs, pericardium, diaphragm, thoracic radiography is best tool for diagnosis. wall and hernia ring. Involvement of oesophageal groove lead to the V.Exploratory derangement in the normal alignment of laparotomy/rumenotomy the cardia and oesophageal groove and Treatment In the first step, rumenotomy is reticulo-omasal opening. The distortion of performed routinely under local this groove prevents the eruption of gas anaesthesia, approximately 2/3rd of total and thus result in the distention of rumen. rumen contents are evacuated. Size and The motility is reduced in majority of ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 47 location of ring in the diaphragm are given post operastively. Ventral wound is noted. Foreign bodies, penetrating and carefully protected. non-penitrating, are removed and pH is Advantage: There is direct access to the corrected. Suturing of rumen, muscles and ring and greater degree of freedom is skin is done in routine. A period of 2-3 there while separating and suturing hernia days is given before herniorrhaphy. ring. Anaesthetic management Disadvantage: Excessive stress related to Animal is administered about 10 recumbency is said to be a major liters of normal saline before surgery; 1-2 disadvantage. Other problems related to liters of dextrose with saline administered intra-operative manipulations and wound intravenously a day before herniorrhaphy and its management. is helpful. If herniorrhaphy is performed Thoracic approach under general anaesthesia mechanical This is perform under general ventilation of lung is mandatory. anaesthesia and mechanical ventilation Different combination such as chloral and in left lateral recumbency the hydrate-thiopental, chloral hydrate- diaphragm is approached from right diazepam-thiopental are used with oxygen thoracic side by 6th or 7th rib resection. along or with halothane. Continuous drip After skin incision muscles are incised of saline with lignocain is given end and later by incising and periosteum throughout the operation. on the rib is separated, the rib is first cut Surgical approaches for diaphragmatic at the proximal end and later disarticulate herniorrhaphy at the costo-chondral junction. Thorax is Abdominal approach then entered by incising periosteum and pleura. Reticulum is separated by blunt The operation is performed under dissection and pushed back into the general anaesthesia and mechanical abdomen. Ring is sutured and thoracic ventilation. Animal is secured in dorsal incision is closed. Negative pressure in recumbency and abdomen is entered the thorax is achived by suction. Routine through post-xyphoid crescent shaped antibiotic, and B-complex incision. Ring is located and reticulum is injection are given post-operatively. separated by blunt dissection and is pulles Advantages: Recumbancy related back into the abdomen. Special care is to cardio-pulmonary stress is less. be exercised in case of a reticular abscess Disadvantages: Limited exposure and or fibrous nodules as reticulum is likely to surgeons’work in close vicinity of vital get opened. The edges of the ring are structures e.g., venacava lungs, heart etc. cleared and ring is sutured by continuous Other complications are related to intra- lock sutures with silk #3. Negative operative manipulation and wound and its pressure in the thorax is created either by management. suction or hyperinflation of lung before closing last sutures. Abdominal incision is Other approaches Successful diaphragmatic closed with silk #3 by horizontal sutures herniorrhaphy through abdominal mattress and skin is closed similarly. approaches in cast animals under sedation Animal is gently tited in the lateral and local infiltration analgesia have been recumbency. Routine antibiotics, reported. In this technique the animal is analgesics and B-complex injection are restrained in dorsal or semi-dorsal

48 recumbency and sedation. Local General post-operative management anaesthesia is infiltrated in the post Routine antibiotics, analgesics and xiphoid area. Other procedures are same B-complex injection are given daily. as done for abdominal approach. Rumen tonic e.g. Liv-52, yeast tablets etc. Advantage: This method may be suitable To promote rumen microflora are for field condition where facilities of required. mechanical ventilation are not available. In some cases rumen cud transplantation may be required. Ad. lib. Disadvantage: Accidental rupture of Water should be given and common salt mediastinum leading to collapse of both may be added to it. Green fodder is the lungs, difficulty in restraint in dorsal provided and to start with 2-3 kg. Twice recumbency, collapse due to respiratory is given and increased gradually so that failure as result of left lung functional full quota is attained in about a month’s disorder particularly in recumbent time. Wound dressing and wound animals and pain during surgery are the protection is meticulously followed to major disadvantages. avoid post-operative infection.

49 External and Internal Immobilization of Fracture A M Patel, H M Padheriya, P B Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

The external fixator is one of the to prevent joint stiffness, fracture mainstays of operative fracture treatment. disease, and muscle atrophy. It allows “local damage control” for 4. Rehabilitation of the patient within fractures with severe soft-tissue injuries a reasonable home, allowing the animal to and can be used for definitive treatment of continue at the level of service at which it many fractures as it provides relative functioned previous to the injury. stability, which results in healing by callus Depending on the fracture, one formation. External fixation is an essential animal might be treated in a cast or splint, part of damage control surgery in whereas another animal would require polytrauma as it permits rapid stabilization open reduction and internal fixation. No of fractures with minimal additional hard and fast rules can be given in all cases (surgical) injury. Deformity correction and for a method of optimal treatment. bone transport are also possible with Treatment regimes suggested in this external fixation. textbook should be evaluated in light of the needs and abilities of the readers to Principles of fractures treatment optimally treat their patients. The ideal objective of fracture Methods of management treatment is to provide a completely Fracture management can be rehabilitated patient as quickly as possible. classified according to the type of method Successful fracture treatment comprises a used to achieve bony union. This perfectly aligned bone of full length that classification is given below: has solidly united joints that are freely  Closed reduction with external movable to their fullest range, and fixation such as a cast or splint musculature, innervation, and integument  Open reduction without internal surrounding the site of the previous fixation, with reduction maintained fracture that are completely normal. It is in a cast or splint important that the surgeon strive to meet External skeletal fixation in which these criteria using all avenues of reduction may be either open or treatment by means of operative and closed and immobilization of the nonoperative management of the fracture. bone is maintained through the use The objectives to be strived for include the of pins, clamps, and sidebars following:  Open reduction with internal 1. Sufficient reconstruction or restoration fixation, such as intramedullary of normal form to meet the pins or plate and screws requirements expected of the limb  Closed reduction with internal 2. Immobilization of bone fragments until fixation: rather than making the fracture healing has occurred exposure in the fracture site, an 3. Mobilization of all joints involved incision is made through the skin during the process of fracture healing allowing introduction of the internal fixation device, for

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 50

example, closed intra-medullary bones can also be immobilized in a cast or pinning or Kuntscher nailing. splint after reduction. These modalities of treatment Contraindications for closed constitute the majority of cases treated in reduction and external fixation are small animal orthopedics. unstable fractures that cannot be reduced or are overriding and have uncorrectable Closed reduction Closed reduction, usually with rotational or angular deformities. Closed external fixation in the form of a cast or reduction is also contraindicated for splint, can be accomplished in many fractures that when immobilized through fractures seen in small animal orthopedics. external fixation in cast or splints may The technique is used whenever a fracture cause joint stiffness or fracture disease. can be reduced to the point at which the If closed reduction is planned, it is displacement is not more than one half the important that it be done as soon as width of the diaphysis of the broken bone. possible following the injury. Although it Axial and rotational alignment should be is important to ascertain that the dog is in correct, and the fracture should be stable condition before anesthesia, it is inherently stable after reduction so also important to obtain the closed overriding does not occur when the animal reduction before there is sufficient is placed in a cast or splint. If these criteria swelling and hematoma formation to are met, the animal's fracture can be safely immobilize the fragments. Muscle spasm treated with external fixation. One resulting in overriding and shortening as additional problem associated with casting well as hematoma formation, which causes and splinting is immobilization of joints swelling, occur quickly following injury. above and below the fracture site. Faster and more adequate reduction Although it has been shown by Sarmiento with less soft tissue trauma can often be that it is unnecessary to immobilize the accomplished if gentle traction is applied joint above and below the fracture site, it is first. Fractures of the radius and ulna, for often advantageous to do so to maintain instance, are often treated by suspension of stability at the fracture site, thus initiating the limb with gentle traction for 10 to 15 fracture healing. If immobilization of the minutes prior to closed reduction. This joint above or below the fracture site will helps stretch the muscles involved without cause limitation of joint movement causing the secondary trauma associated following fracture healing, other forms of with manipulation. Whenever closed fracture treatment should be considered. reduction is accomplished, the leg should The most common fracture treated with be prepped in a standard fashion as would closed reduction and cast or splint be done for an open reduction and the immobilization in our clinic is that of the closed reduction is carried out in a sterile radius and ulna, followed with less manner using cap, mask, and gloves. If by frequency by the tibia. The humerus and chance a closed fracture becomes an open femur are treated with closed reduction one through manipulation, the risk of and external fixation less commonly. contamination and infection is decreased Metacarpal, metatarsal, and other shorter considerably and the wound can then be managed appropriately. The reduction itself is usually accomplished after flexing

51 the elbow by toggling bone ends together reduction must be adequately maintained and then reestablishing the axis of the bone while applying the cast or splint. The with proper rotation. Flexion of the elbow position used for this procedure maintains releases some tension of the extensors of firm gentle traction on the extremity the forearm, making reduction easier. All during the entire procedure to allow closed reductions should be checked adequate immobility to apply a cast radiographically to ascertain that the following reduction. The surgical exposure criteria described above are met. necessary for such fracture reduction is usually minimal and the time interval to Open reduction without internal accomplish this is often shorter than that of fixation Occasionally transverse or short the manipulation required to perform oblique fractures occur with sufficient closed reduction of closed fractures; overriding that closed reduction is therefore, the risks of infection are impossible. These fractures are completely extremely low. stable once reduced; therefore, an open External skeletal fixation reduction is accomplished using a bone Transfixation pinning, whether elevator to reduce the fracture fragment, using half pins or full pins, can be and no internal fixation is necessary. These accomplished by means of either open or fractures are then incorporated in plaster or closed reduction techniques. Occasionally some cast material and treated as closed in severely comminuted fractures, the fractures after closed reduction. Fractures proximal and distal fragments are grasped treated in this manner include midshaft to with the transfixation pins to maintain distal one third radial and ulnar fractures axial alignment, allowing the central and proximal transverse tibial fractures. comminuted aspect of the fracture to By obtaining a perfect reduction, these coalesce and heal. In these cases open fractures usually heal rapidly without reduction is usually not carried out, but the further interference of the blood supply by end result is satisfactory. Transfixation an internal fixation device. When pinning is also often used with open performing open reduction without reduction of open fractures following internal fixation, it is important that thorough surgical debridement. internal fixation equipment be available Contraindications for external pin should it become necessary at the time of fixation include fractures in which an surgery. adequate purchase of the fracture fragment Reduction of the fracture itself is cannot be obtained with the use of the accomplished by using an elevator inserted transfixation pin. It is best not to use into the medullary cavity of the proximal transfixation pins through areas where a fragment and then levering the distal large muscle mass must be penetrated to fragment into place while removing the attach the pin to the bone, since this causes elevator. It is important to interdigitate the soft tissue necrosis and may lead to more fracture surfaces perfectly so that they are serious pin tract infection. stable. The surrounding musculature then Complications include pin tract exerts further axial force against the infection, loosening of the fixation, fracture surfaces to provide stability. The breakage of the clamps where transfixation

52 pins are connected to sidebars, and problems for the owner. Fractures bending of pins or sidebars causing associated with arterial laceration and/or deviation of the axis of the bone in nerve trunk enervation are often opened as question. a result of these complications. Since it is Open reduction and internal fixation important to immobilize the fracture to Open reduction and internal prevent re-injury of the trapped nerve or fixation allows the anatomical reduction of injured blood vessel, internal fixation is fracture fragments with complete control accomplished at this time. over their immobilization. This excellent In open fractures it is often reduction and stability encourages rapid necessary to debride the bone surgically. union with earlier useful function of the Since these fractures are already open, it limb. The need for an external splint or may be advantageous to provide internal cast, which would compromise the fixation to immobilize the bone, which in function of the joint and lead to muscle turn assists in immobilizing the soft atrophy, is eliminated. tissues, thus speeding consolidation of the Indications for open reduction and wound as well as the fracture. Certain internal fixation include fractures that open fractures should not be treated with require open reduction because of inability internal fixation. to reduce and/or stabilize the fracture by Problems associated with open closed means. Many comminuted or reduction over and above those associated overriding fractures cannot be brought into with closed reduction relate to the risks of adequate approximation and alignment by infection. Therefore open reduction should closed methods; therefore these fractures not be considered if the soft tissues are must be treated by open reduction and incapable of healing. This is not internal fixation. Most of these fractures uncommon in badly comminuted fractures are inherently unstable when reduced; in which the vascularity of the soft tissues hence the internal fixation must be applied may be compromised as a result of the after the open reduction. Certain fractures explosive nature of the fracture injury can be treated with closed reduction and itself. Additional contraindications to open internal fixation, but the best functional reduction with internal fixation are result is usually achieved with open associated with lack of adequate reduction and internal fixation. The criteria equipment to accomplish the proposed for using one method over another depend procedure and inadequate training or skill on the expected result, the final desired of the surgeon. The equipment available function of the animal, and the skill of the for performing certain internal fixation surgeon. Occasionally open reduction and procedures is not a luxury but a necessity. internal fixation is performed with the goal When contemplating open reduction and of limiting the convalescent period of internal fixation, the surgeon should have rehabilitation. The total time of the available every instrument necessary to surgeon involved with the patient accomplish the proposed task. It is decreases, since it is unnecessary to important to have several back-up perform cast or splint changes weekly over measures in readiness, supported by a continuing period. This results in faster adequate equipment, should the proposed rehabilitation of the dog and fewer procedure fail. Although there are times

53 when procedures will not proceed as that delayed open reduction planned, the excuse of inadequate and internal fixation is associated with a equipment associated with failure of decreased rate of nonunion. This delay of internal fixation only reflects the lack of approximately 10 days probably allows the preparedness of the surgeon. soft tissues to revascularize, resulting in Open reduction and internal healthier tissue at the time of surgical fixation should be carried out as soon as interference. The problem associated with the patient is able to withstand the rigors this delay is that the reduction itself can be of anesthesia. It is important that the difficult to accompiish. The slight animal be stable and can be assumed to advantage of decreased rates of nonunion survive the procedure before attempting associated with experimental animals open reduction and internal fixation. If the therefore becomes of secondary open reduction and internal fixation can be importance when treating clinical patients. accomplished before a great deal of It is important, however, not to perfomm swelling has occurred, the reduction of the open reduction and internal fixation at the fragments is much easier and the time of height of the edema phase, since closure of surgery reduced. Since the time of surgery the wound may be jeopardized by suture is often related to the susceptibility of the line tension, resulting in tissue necrosis patient to infection, this is a significant and wound breakdown with impending point to consider. The literature reports infection of both soft tissue and bone.

54 Critical Care and Management J. S. Patel , Joice P. Joseph, Amit Prasad, Bhavika R Patel Department of Medicine, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Critical care medicine is a rapidly 7. If any haemorrhage, apply firm growing field of Veterinary small animal pressure using a clean cloth, towel, medicine in the developing countries in the paper towel, femine hygiene product recent past. Critical care unit is a vital etc. Cover any external wounds using a component of Veterinary teaching hospital bandage material soaked in warm in treating emergency and critically ill water. patients. The veterinarian working in 8. If any obvious fracture, immobilize the critical care unit should have a thorough area with home made splints. knowledge on the art of triage and initial 9. If burns, place wet cool towels over the stabilization the patient, recognize the burned area. Remove and replace as disease conditions, differential diagnosis the compress warms to body and treating the case in a rapid manner in temperature order to save the life of the animal 10. In shivering or in shock, wrap to presented with poor physiological conserve heat reserves. Small animal critical care 11. In heat stroke, cool the animal with practice also need skills on the emergency room temperatue wet towel (not cold) procedures and use of critical care and transport to clinic. facilities. This paper will discuss the Preparation for transport triage, critical care facilities and important 1. Call ahead emergency conditions in small animal 2. Line upholstery practice. 2. Move the patient carefully Triage: 4. Drive safely Triage, a French word trier, means to sort. Hospital Triage: Involves five steps It is a method of quickly identifying Step 1: Recognition of life threatening animals who have immediately life Disease Step 2: Be prepared threatening injuries/conditions and who Step 3: Establish a triage classification have the best chance of surviving. Triage system Step 4: Arrival at the includes prehospital and hospital triaging Veterinary Clinic the patients. Step 5: Patient stabilization Pre hospital triage: Step 1: Recognition of life threatening 1. Call for help. Disease 2. Alert oncoming traffic. • Goal should be to select and triage the 3. Moving the animal to safe location patients that have serious traumatic 4. Is there patent airway? – Extend head injury / acute illness. and neck; wipe mucus, blood or • Without recognition of life threatening vomitus from the mouth. In processes and their potential sequela, unconconscious animal, maintain head one can’t effectively triage patients, and neck stability. which will inevitably result in 5. If no evidence of breathing or gum increasing morbidity and mortality. colour is blue, begin mouth to nose • Typically, life threatening conditions breathing 15-20/min. are associated with cardiac, pulmonary 6. If no sign of cardiac function, begin and neurological disorders, external cardiac compression 80- environmental injuries and intra 120/min. abdominal disorders. Step 2: Be prepared

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 55

1.Education: Class III: • Tutorials and conference education Require definitive management within a • Practical training sessions on basic and few hours advance life support techniques:  No shock ,Minor trauma endotracheal intubation, positive  Ventilatory and cardiovascular pressure ventilation, intravenous function present ,Superficial wounds catheter placement, IV fluid set up, Class IV: ECG set up and preparing equipment Less serious for centesis.  Non trauma related 2.Emergency ready area  Vomiting, diarrhea or lameness • Locate in a central area Step 4: Arrival at the veterinary clinic: • Equipments should be readily Receptionist to be trained to recognize life accessible including an oxygen supply, threatening conditions endotracheal tubes, anesthetic Emotional support of the client equipment, Ambu-bag, IV catheters, IV Continual update of the client fluid pumps, needles, syringes, Evaluate with in 1 minute of arrival at the equipments for centesis, emergency clinic drugs and good light source. Primary survey: • Clear labeling Initial evaluations-ABCDE and it should • Stock levels to be checked after each be completed in 30 – 60 sec use or on weekly base A – AIRWAY 3. In house laboratory,Team approach B – BREATHING 4. SOP (Standard Operating Procedures) – C – CIRCULATION aid in ensuring important diagnostic and D – DISABILITY treatment steps are not over looked. E – RAPID WHOLE BODY Step 3: Establish a triage classification EXAMINATION system A = Airway  Based on the urgency of needed  Patency of airway and adequacy of treatment ventilation should be assessed.  Can change rapidly during first four  Respiratory noises – High pitched hours of admission stridor/sonorous, wheezes suggestive  If there is concern regarding a patient, of partial airway obstruction or place in more serious class bronchial constriction respectively.  Ensure all staff is aware of your triage  Commissures of mouth – move with system inhalation / exhalation? Class I:  Exaggerated ventilatory effort (open Most seriously ill, should receive mouth breathing, flaring of nostrils) treatment with seconds. These include  Expiratory distress with an abdominal  Traumatic respiratory failure push on exhalation  Cardiopulmonary arrest or airway  Posture – Orthopnea (head extended & obstructions elbow abducted)  All unconscious animals  Paradoxical chest wall movement (flail Class II: chest) Very seriously ill, critical patients. Require  Auscultate thorax bilaterally – treatment within minutes (up to 1 hr crackles, muffled, inspiratory wheezes following the onset of severe symptoms).  Colour of mucous membrane – Pink,  Multiple injuries, GI torsions ,Burn Pale, cyanotic. victims, Penetrating wounds B=Breathing  Shock or bleeding but has adequate • Breathing? airway and ventilatory functions

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Eupnea- Normal ventilatory nature Rhythm: Common arrhythmias: PAC, and rate. Tidal volume should be 10- PVC, atrial fibrillation & Ventricular 20ml/min, rate (8-20/min) tachycardia. All pulse abnormalities Tachypnea-hypoxia, hypercapnea, should be confirmed by ECG. hyperthermia, pain and metabolic • CRT? I t is an indication of acidosis peripheral perfusion. Normal 1- 2 Bradypnea & Apnea-Intracranial minue. Prolonged CRT is due to space occupying lesions, drug vasoconstriction (caused by induced, hypo or severe hyper capnea hypovolemia, exciement, ear and and medullary respiratory centre pain). dysfunction. D=Disability • Auscultation for breathing sounds Levels of consciousness (LOC) – absent or diminished breath 1. Obtunded: State of decreased sounds suggestive of pleural filling responsiveness problem Less responsive to visual/tactile

• Assess chest wall integrity – stimuli, quiet/dull. This may arise crepitus indicate s/c emphysema from a variety of complications • Look for blood or secretions from and illnessess. mouth or nares 2. Stupor: Can be aroused only with • Observe for gag or swallow painful stimuli. Is a sign of severe reflexes neurologic or metabolic • Breathing patterns derangement.  Rapid and shallow, deep and slow 3. Coma,Can not be aroused with any with respiratory stress stimuli.  Apnea shows medullary Coma and seizures are signs of dysfunction abnormal cerebral electrical  Cheyne stokes breathing is activity from primary neurologic characterized by cyclic disease or secondary to metabolic hypoventilation and is attributed to derangements such as hepatic greater than normal delays in the enceplopathy medullary response to changing Motor activity carbon dioxide levels 1. Ambulatory Vs nonambulatory  Biot’s breathing is characterized by 2. Ataxia, hemiparesis, tetraparesis or cyclic hyporventilation and apnea hemiplegia and is a sign of serious medullary 3. Decerebrate posture disturbance. • Opisthotonous with extensor  Apneustic breathing may be rigidity of all 4 limbs associated with brain stem disease. • Mentation is stuporous to C=Circulation comatous. Indicates lesion on the • What is the circulation status? It is rostral pons and midbrain assessed by visualization, palpation and Pupillary abnormalities auscultation 1. Unilateral mydriatic, unresponsive • Heart rate, rhythm and quality? pupil loss of parasympathetic Tachy cardia (>160 beats/min): innervations to the eye. Can Hypovolemia, fever, pain, excitement, indicate increased inra cranial exercise pressure. R/O topical ophthalmic Bradycardia (<60 beats/min): high vagal atropine or tropicamide. tone, severe electrolyte disturbances, AV 2. Bilateral miosisn- May precede conduction block. bilateral mydriatic unresponsive

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pupils. Can be seen with diffuse 3 parameters are in a careful balance. metabolic encephalopathies or Normals are diffuse mid brain compression with Systolic 100-120 mmHg,Diastolic increased intracranial pressure 50-100 mmHg,Mean 70-120 mm Hg 3. Bilateral mydriatic, unresponsive (Systolic BP + 2(Diastolic BP)/3) pupils: Fixed and dilated pupils. Hypotension (<80 systolic BP ; <60 Severe bilateral compression or mean BP): Vasodialation, destruction of the midbrain or hypovolemia, arrhythmia, anesthetic cranial nerve III. Typically from drugs. bilateral cerebral herniation. N=Nerves E=Rapid whole body examination Conciousness (normal, obtunded, Perform a rapid whole body exam stuporous and coma) looking for wounds, lacerations, Ancillary diagnostic evaluations punctures, bruises, fractures, Haemodynamic techniques abdominal pain/distension and any ECG, BP, Pulse oximetry other signs of debilitation. Imaging techniques: Secondary survey X ray of thorax and abdomen to rule A CRASH PLAN pneumothorax, pulmonary contusiobn, A=Airway diaphragmatic hernia, pleural or C & R = Cardiovascular & Respiratory abdominall effusion or A= Abdomen pneumoperitoneum. Palpate for pain Laboratory evaluations: Any penetrating wound To evaluate PCV, Total solids, ity, Reddening around umbilicus suggest CBC, BUN, Urine specific gravity, intraabdominal hage CBC, Peripheral blood smear for Fluid wave? Mass? Examine inguinal, platelet count, morphology of RBC caudal thoracic and paralumbar regions and WBC, Arterial blood and Clip the fur and look for bruises or electrolytes, Coagulation parameters penetrating wounds (ACT, PT, APTT), Serum Auscultate for borborygmi biochemistry profile and Urinalysis. S=Spine :Examine for symmetry, pain, swelling, fracture. Invasive testing H=Head • Thoraco Eyes: Examine for ulcers with centesis,Abdominocentesis,Dia fluorescent dye, aniscoria? Horners gnostic peritoneal lavage syndrome? Step 5: Patient stabilization Examine ear, mouth, teeth and nose,All • Repeated evaluation of the patient cranial nerves is an essential component of P=Pelvis emergency medicine Examine perineum, rectum, genitalia- • Concentrate on the respiratory, Perform rectal examinations,Examine circulatory and neurological for fracture, hemorrhage. symptoms L=Limbs:Any open or closed fracture? • Complete physical examination Quickly splint to prevent further damage and help to control pain. The rapidly decompensating patient A=Arteries Animals that do not respond to initial Examine pulse, B.P. Blood pressure is resuscitation usually have severe ongoing a prodascular capacity and blood or preexisting physiological disturbances volume. Tuct of cardiac output, These that contribute to continued instability.

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The most frequently seen clinical problems • In cats the heart can be stabilized associated with decompensating patients and compressed using single hand are: with the thumb on one side and • Internal hemorrhage, three fingers on the other side of Pneumothorax the chest • Coagulopathies-disseminated intra • Successful CPR – femoral or vascular coagulation (DIC) lingual arterial pulses. • Bowel and gastric ruptureentral If pulse are not identified nervous system edema and • CPR efforts should be evaluated hemorrhage and adjusted • Sepsis or septic shock – fever, • Administration of epinephrine and pain, hypovolemia, abnormal or vasopressin, patterns of ventilation, abnormal • Administration of crystalloid or levels of consciousness, colloids tachycardia, tachypnea and lowered • Open chest CPR for manual blood glucose levels cardiac compression • Rupture of the urinary bladder,m Most commonly used drugs Oliguria and Acute renal failure. Atropine: Cardiopulmonary resuscitation Dose: 0.04 mg/kg IV or intratracheal. Can Set of the procedures designed to repeat q3-5 mins x 3 doses increase oxygen delivery to the heart Indication: Slow heart rate or no heart rate and the brain during cardiac arrest. (vagolytic) Ultimate goals of CPR are Epinephrine 1: 1000 • To restore spontaneous, Low dose: 0.01 mg/kg IV.Can repeat q 3-5 effective cardiac and mins: If no effect increase dose or use respiratory efforts vasopressin • Once agonal breathing or LOC High dose: 0.1 mg/kg IV. Intratracheal is identified dose: 0.03-0.1 mg/kg IV • First step is to intubate, Indication: Asystole/no heart rate: Intilation of breathing Increases copronory and cerebral perfusion • Confirmation of cardiac arrest, (alph2agonism.) efforts at cardiac compression 20 mg/ml: Dose: 2 mg/kg. Closed chest CPR Indication: Ventricular premature • Right lateral recumency to contractions. facilitate venous return to the heart Less commonly used • In small dogs compression of the • Sodium bicarbonate 1 mEq/ml: heart – 70-90 compressions /min Dose: 1mEq/k • In small breed dogs more effective Indications: Severe metabolic cardiac compressions can be acidosis achieved using one hand on either • Calcium gluconate 10%: 100 side of thorax mg/ml: Dose 50 mg /kg (0.5-1.5 • In large breed dogs both hands are ml/kg) Slow bolus placed higher on the chest wall and Indications:Hyper kalemia (ie blocked cat, the chest and the chest and heart Addison’s disease), low calcium (ie. are compressed between the table Eclampsia, calcium channel blocker and the hands. toxicity) • Interposed abdominal • Magnesium 4 mEq/ml Dose: 0.2 compressions are an adjunctive mEq/kg slowly over 10 minutes CPR procedure

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Indications: Refractory ventricular 1. Sound understanding of life arrhythMias, prolonged CPR threatening conditions • Vasopressin 20 units/ml. Dose 02 2. Astute observation of the patient U-0.8U/kg (IT: 0.4-1.2U/kg) 3. Good support staff: Indications: Ventricular fibrillation after Knowledgeable, work well under defibrillation, atrial fibrillation, condition of stress Ventricular tachycardia 4. Well organized treatment • Naloxone 0.4mg/ml: Dose 5. Well defined set of guidelines for 0.04mg/kg identification and management of Indications: Overdose of opioid, reversal emergency patients of opioid medications. 6. Constant reevaluation of patients 7. Team work Conclusions

MM Colour Significance Pink Normal Yellow Liver disease Pale/ White Blood loss, anemia or shock Brick red / Injected Sepsis, polycythemia, hyperthermia Grey Due to stagnation of blood Blue (cyanosis) Hypoxia, methemoglobinemia and peripheral stagnation of blood due to shock. In anemia, cyanosis may not be seen. For cyanosis to occur 5 g% unoxygenated hemoglobin must be present.

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Use of X-Ray for the Diagnosis in Small Animal A M Patel, H M Padheriya, P B Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

X-rays were discovered by Wilhelm therefore very useful for diagnosing bone- Roentgen in 1895. They are related problems. X-rays can be used to electromagnetic energy waves that are far help identify: more energetic than light rays. X-rays are • Fractures and breaks most commonly used for medical diagnosis, • Problems with teeth, such as tooth but also for cancer treatment. The heart of decay an X-ray machine is a vacuum-sealed glass • Thinning and weakening of the cylinder containing a pair of electrodes. bones (osteoporosis). When electricity is sent through the tube, • Bone infection (osteomyelitis). X-rays are released at the positive • An abnormal curvature of the spine electrode. The high-energy rays pass (scoliosis). through soft body tissue, but get absorbed • Bone cancers, such as by dense material such as bone. This . creates ’shadows‘that can be captured with X-rays are also sometimes used during photographic or fluoroscopic techniques. investigative or therapeutic procedures to An x-ray (radiograph) is a help the surgeon guide equipment to the noninvasive medical test that helps area being examined or treated. For physicians diagnose and treat medical example, X-rays are often used during a conditions. Imaging with x-rays involves coronary angioplasty, where a catheter (a exposing a part of the body to a small dose long, thin, flexible tube) is inserted into a of ionizing radiation to produce pictures of blood vessel either in your groin or arm. X- the inside of the body. X-rays are the oldest rays are used to guide the tip of the catheter and most frequently used form of medical to the heart or the arteries that supply to imaging. X-Ray imaging is used for heart. A special fluid that shows up clearly diagnosing various medical problems in on X-rays (contrast medium) is injected bones, chest, upper and lower through the catheter. The images that are gastrointestinal tract, contrast studies and a produced (angiograms) are able to highlight myriad of fluoroscopic studies. For whether a blood vessel is blocked. example, a radiograph can determine broken bones, joint dislocation, fracture, Diagnostic use of X- ray infection, arthritis, bone cancer and locate Diagnostic uses of radiation can be foreign objects in soft tissue. considered according to the type of detector Physicians use the examination to used as well as according to whether the help diagnose or monitor treatment for source of the radiation is outside or within conditions such as: pneumonia, heart the patient's body. The former case, frailer, emphysema, lung cancer or other "passive" investigation, is typified by medical conditions. Routine Radiography, conventional X-ray imaging: the physical Tomography, Barium Studies (upper and basis of the information is the transmission lower GI tract), Contrast studies (IVP, (or in some cases the scattering) of Hysterosalpingogram, Arthrograms, radiation as it passes through the body. Cholangiogram) are carried out for various Distinctions among tissues are often disease diagnosis. enhanced by injection or ingestion of materials that are substantially more or less When X-ray is used likely to scatter or transmit the radiation Bone is a very hard and dense tissue than the tissues themselves (e.g., Barium that shows up clearly on X-rays. X-rays are

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013

61 enemas, air bubbles). "Active" the source is along a particular line. The set investigations are typified by the "gamma of all such lines covers an area on the camera" and "PET" scanner: a radioactive patient's body, and the radiation as a biochemical is introduced into the body and function of position provides information the radiation is detected by position- or comparable to that of a conventional X-ray, direction-sensitive means, so that the site except that the signal depends on the local within the body can be established. Like the concentration of the labeled biochemical, so enhanced contrast studies alluded to above, it can be relevant to particular metabolic or such studies may be either dynamic circulatory processes. (following the initial bolus through the 4. Scanners patient's circulatory or digestive systems) or Although the physical principles equilibrium (after thorough mixing, which underlying their operation are not the same, may take minutes, hours, or days, CAT, PET, and NMR (or MRI) scanners depending on the system involved). have much in common: they provide an 1. Film X-rays image, typically of a cross-section through In medical diagnostic applications the patient's body, limb, or head, presented the radiation source is typically an X-ray either on a video display or on film made machine operating with an accelerating from a video display, based on computation potential between 50 and 150 kV. There are from a multitude of measurements, of the two basic types of X-ray film for diagnostic same property, made for successive, or research uses: "screen" and "no screen." adjacent or overlapping, segments of the patient's body. Usually the varying 2. Fluoroscopy quantitative results will be displayed as a If the radiation is displayed visibly range of colors (a "false color image"). at the same time it is detected, the clinician Computed Axial Tomography was the first can observe dynamic processes, such as the of these techniques to be widely used. The beating heart or a probe moving through a "axial" refers to the fact that the segments cardiac artery or vein. The material was measured all pass through the same axis, in chosen on the basis of visible light emission different directions. In the CAT scanner, upon bombardment with X-rays, a special the measurement made is of X-ray case of fluorescence, which generally refers transmission along these "diameters" to the emission of longer-wavelength through the patient. The information electromagnetic radiation upon presented is a picture of a cross-section bombardment by shorter-wavelength through that part of the patient, typically radiation. Direct X-ray fluoroscopy has two showing X-ray transparency levels by major problems: first, the detection is not different colors or by shades of gray. very efficient, so that a larger dose of Positron Emission Tomography, a radiation to the patient is required. Second, more recent innovation, may be viewed as there is often a great deal of scattered an exotic sort of Gamma Camera. A radiation or radiation. radioactive material that emits low-energy 3. Gamma Cameras positive beta rays is introduced into the Gamma cameras provide images patient's body. The decay positrons travel a based on the straight-line propagation of modest distance through the tissues in a gamma radiation. Labeled biochemicals are random direction before coming to rest, administered to the patient, either by mouth where they annihilate with electrons from or injection, and the radiation examined by the atoms present there. The annihilation a detector that includes a great many photons are of an energy that is highly individually reporting sensitive regions, penetrating, so much of the dose to the each exposed only through collimators that patient will come from the initial kinetic prevent radiation from reaching it unless energy of the positron and from any X-rays

62 emitted as the atomic electrons rearrange Sialography. In ruminants main indications themselves following the nuclear are: transformation. i) To diagnose space occupying lesions of Nuclear Magnetic Resonance parotid gland, scanners are the most recent of these ii) To locate the site of obstruction in the devices. Unlike the CAT and PET scanners, stenson’s duct, they are truly non-invasive, since they iii) To locate the site of leakage of saliva in subject the patient to no ionizing radiation. cases of sialocele. Because some people recoil at the mention 3. Bronchography of the word "nuclear," they are now being Bronchography is the radiographic called "Magnetic Resonance Imaging" (or visualization of the bronchial tree after "MRI") scanners, but the physics is the infusing oily contrast media into the same benign thing. Another of their major airways. Bronchography should be done advantages clinically, besides being non- cautiously in patients withcardiopulmonary invasive, is that they produce images based diseases. Only one lung should be on different chemical conditions, so the investigated at a time. combination of PET scan or gamma camera images with MRI scans may permit a much 4. Barium Swallow (Oesophagraphy) more confident diagnosis and treatment The technique is used to evaluate planning than would be possible based on both structural and functional status of any one technique alone. oesophagus after introduction of a positive contrast media. Oesophagraphy is indicated Contrast medium to diagnose case of oesophageal Contrast medium is liquid that obstruction, stenosis, diverticulum and contains dye. It is sometimes swallowed or mucosal diseases. injected before an X-ray is taken and shows up clearly in white, helping to distinguish 5. Reticulography between different structures in the body. This technique is usually indicated Contrast medium is usually harmless and todiagnose cases of reticular hernia in passes out of the body in your urine. buffaloes and cattle by feeding barium However, in rare cases it can cause an sulphate suspension to the animal. allergic reaction. 6. Barium series Contrast radiography for different parts The technique is used to examine of body radiographically the gastro intestinal tract. It is routinely used in small animals but is 1. Dacrocystorhinography of limited value in large ruminants. The Dacrocystorhinography is the procedure is indicated to evaluate structural contrast radiographic study of the and functional status of gastrointestinal nasolacrimal duct. This is indicated in tract. The technique should be avoided if cases suspected of partial or complete rupture of the stomach or intestines is obstruction, atresia, inflammation, suspected. deviation or distortion of the nasolacrimal 7. Peritoneography duct. Quick radiographic exposures are It is radiographic study of the required if water soluble agents are used peritoneal cavity and its contents after because of their rapid drainage. introduction of negative contrast agent 2. Sialography (pneumoperitoneography) or a combination of a negative and a positive contrast agent Contrast radiographic study of the (double contrast peritoneography). The salivary glands and duct is called technique is indicated to visualize outlines of various abdominal organs and to locate a

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suspected abdominal mass. It should not be 12. Intravenous Pyelography (Excretory used if diaphragmatic hernia is suspected Urography) because of risk of pneumothorax. Intravenous xylography (IVP) refers to contrast radiographic examination of the 8. Renal angiography kidneys and ureters after introduction of The technique is used to visualize positive contrast medium. Apart from being renal vascular architecture and also helps to an aid to diagnose abnormalities of urinary assess renal cortex to medulla ratio. tract, the technique also serves as a rough 9. Myelography index to kidney function. It should never be The technique refers to the contrast used in severely dehydrated patients radiographic examination of the spinal cord because of risk of fatal anuria. and emerging spinal roots after injecting the contrast material into the subarchnoid 13. Urethrography The technique is indicated to space. It is indicated to diagnose diagnose abnormalities of urethra in male intervertebral disc protrusion, intraspinal such as urethral obstruction, stenosis and lesions, vertebral canal haemorrhage and fistula. spinal cord oedema. It should not be used in cases of meningitis, myelitis and 14. Cystography myelomalacia. It refers to the contrast radiographic examination of urinary bladder and is 10. Arteriography indicated to diagnose structural It refers to the contrast radiographic abnormalities and diseases of bladder such examination of arterial system of an area. It as cystoliths, carcinomas and rupture of is indicated to study the arterial pattern in bladder. normal subjects and also to diagnose arterial occlusion. 15. Angiography Angiography is a type of X-ray used 11. Fasciagraphy to examine blood vessels. The images It is a contrast radiographic study of created during angiography are called tendons and associated structures. The angiograms. As blood vessels do not show technique can be used to diagnose up clearly on ordinary X-rays, contrast adhesion, calcification and rupture of medium is injected into the area being tendons and muscle. examined.

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Contrast Radiography P B Patel, H M Padheriya, A M Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

A contrast medium is a either highly tube may also be used administer the radiolucent or highly radiopaque substance, contrast agents directly into the stomach. which is administrated to a patient to Double contrast study increase radiographic contrast within an organ or system. Contrast radiography is a Here either air through a stomach special radiographic procedure using contrast tube or a carbonated beverage (50 – 60 media. Contrast studies are used to ml) may be given before or, after the use supplement or confirm information gained of barium. water soluble iodine from routine survey radiographs. compound @ 7 ml/kg body weight by using stomach tube(as these agents are Classification very bitter test) should be used when There are two categories of contrast media: perforation of the oesophagus ,stomach or intestine is suspected.as the stomach a) Positive contrast media usually contains some gas or swelled air, (Elements of high atomic number) virtually all contrast studied are double • Barium sulphate preparation contrast studies. Double contrast studies are particularly valuable in studying the • Water soluble iodine preparation gastric mucosa. • Viscous and oily preparation Negative contrast study • Preparations excreted through biliary Room air is given by a stomach tube system ( cholycystopaques ) @ 6 to 12 ml/ kg body weight, or a carbonated beverage (30 to 60 ml) may b) Negative contrast media be given. Negative contrast study is (Agents with low specific gravity) useful to located radiolucent foreign Indication body. It is used in certain cases to delineate Barium enema internal structure, which allows the Barium enema is used to outline the visualization of soft tissue structures and colon and rectum in suspected cases of evolution of size, shape and position. It is intra-luminal or extra-luminal also possible to assess the physiological obstructions. This technique is not condition. indicated if perfection is suspected. Ten Contrast techniques to 24 hours fasting prior to this procedure is advisable. Laxative is needed to be Barium series: gastrointestinal tract is administered 12 hrs. Before the study. studied in this technique. Contrast study Warm soap water enema is administered may be positive, negative or double about 2hrs before. Deep sedation or contrast. general anaesthesia is desirable to Positive contrast study: barium or water eliminate straining Barium suspension of soluble iodine preparation may be used. about 15 to 20%(W/V) concentration Micro pulverized barium suspension @ @20 to 30ml/kg body weight is 2-5 ml/kg body wt. is administrated administered slowly through a cuffed slowly into the buccal pouch. Stomach rectal catheter by gravity flow from a large contain or by using syringe

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013

65 Oesophagography Sialography It is contrast radiographic study of Contrast radiographic study of the oesophagus .this technique is used to salivary glands and ducts is called evaluate both structural and functional status sialography. It’s performed to locate the of the oesophagus. Oesophagography is site of obstruction in the stenson’s duct useful to diagnose oesophageal obstruction, and leakage of saliva in cases of stenosis, diverticulum and mucosal diseases. sialocele. Sialograph is also done to Barium sulphate suspension (micro diagnose space-occupying lesions of the pulverized barium sulphate suspension) is parotid gland. usually use contrast agent. Under sedation and local anaesthesia, A barium paste is useful to study the salivary ducts through its opening in the mucosa of oesophagus since it adheres better oral cavity is exteriorized, cannulated and to the oesophageal folds. If rupture of the 0.1 to 0.3 ml of oily material or upto 2 ml oesophagus is suspected, it is preferable to of aqueous contrast medium is use water soluble contrast agent instead of administered into the salivary duct. barium. Dose of barium suspension is 5 Bronchography ml/kg body wt. through the buccal pouch. Radiographs are taken as soon as the last of It’s the contrast radiography of the the barium is being swallowed. If the bronchial tree. The patient is oesophagus is grossly dilated, additional anaesthetized and intubated. The contrast amounts of barium will be required to outline material is then administered by means its lumen fully. Normally, longitudinal folds of a catheter through the endotracheal of the mucous membrane is observed in dog tube. The catheter is placed at the point while in cat, longitudinal folds in the just cranial to its bifurcation and the proximal ¾ of the oesophagus and the distal contrast agent is deposited. One lung is ¼th has oblique mucosal folds, giving a studied at a time. The lung to be herringbone pattern. radiographed is positioned in lateral recumbancy so that gravity carries the Gastrography contrast materials i.e. for Bronchography Reveals stomach rugae with barium of left lung, left lateral recumbancy is the contrast studies of stomach. Barium meal correct positioning. Selective study of descending duodenum shows bronchography can be done under lymphatic craters on the anti-mesenteric fluoroscopic control. Two ml of contrast border of the duodenum, visualized as agents are adequate for each lung. A 50 depression, which may be mistaken for to 60 % w/v 1 ml per bronchus has been ulcers, and it is called as pseudo-ulcers. recommended. Bronchography should be done cautiously in patients with Dacrocystorhinography cardiopulmonary disease. It’s study of nasolacrimal ducts where contrast agents are administered into the Angiocardiography ducts by means of cannula inserted into the A cannula is inserted into the external superior puncta lacrimata. Radiographs are jugular vein and contrast medium is taken in quick succession just after administered in a bolus form and the administration of contrast agents. The radiograph is taken. procedure is indicated in cases of suspected Myelography partial or complete obstruction, atresia, inflammation, deviation or distortion of the Flex the lead ventrally and palpate the nasolacrimal duct. wings of the atlas, spine of the axis, and occipital protuberance. Draw a line between the wings and a line from the occipital

66 protuberance to the spine of axis. Placed the Any deviations in the contrast lines, needle on midline ½ inch in front of the line therefore in the cord is to be looked. between the wings. Go roughly parallel to Discontinuity or thinning in the pushed the caudal wall of the skull and feel for the inward could be due to a mass outside the “pop” of resistance as the needle passes meninges (herniation of disc). Contrast through the dorsal atlanto-occipital ligament. medium is heavier than CSF, so gravity can Stop when through the ligament. Positive be used to move it up or down the sub contrast medium (non-ionic and of low arachnoid space. osmalarity) is injected into the spinal subarachnoid space and radiograph is taken Contraindication at different time interval. The subarachnoid Barium sulphate, if take into the space becomes visible as two white lines are thorasic or abdominal cavities, may cause separated by a space (spinal cord). Normal granulomatous response as it not absorbed or radiograph shows smooth contrast lines. Two eliminated. Therefore, it should not be used bulging site one at cervical and another at if there is any possibility of perforation of lumber area are normal due to brachial the gastrointestinal tract. plexus and lumber intumescence.

67 Management of Intestinal Obstruction in Small Animals Vineet Kumar and S H Talekar Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

Intussusception, foreign bodies, of dogs with intussusception, most torsion, incarceration, volvulus, and frequently in the cranial abdomen. The neoplasia are the possible causes of the clinical signs of intestinal intussusception intestinal obstruction in dogs and cats. may be acute or chronic in nature. The Intussusception is defined as invagination reported duration of signs from onset to of one segment of intestine presentation ranges from 1 to 90 days. The (intussusceptum) into the lumen of an nature, severity, and duration of clinical immediately adjoining segment signs are related to the location of the (intussuscipiens) and has been reported in intussusception within the intestinal tract. both humans and animals. It is most The most severe clinical signs, including commonly occuring at the ileocecocolic vomiting and electrolyte imbalance, are junction in dogs where invagination is more likely to occur with intussusceptions usually in the normal direction of that are in the proximal intestinal tract peristalsis. Although, majority of intestinal (i.e., enteroenteric). Other factors, such as intussusceptions reported in dogs are the degree of intestinal obstruction, the idiopathic in nature, many conditions amount of compromised intestine involved reportedly predispose dogs to their in the intussusceptum, and the presence formation, including intestinal parasitism, and severity of peritonitis, may contribute viral enteritis, intestinal foreign bodies, to both the severity and duration of clinical and intraluminal and extraluminal mass signs prior to presentation. lesions. Physical examination Diagnosis Physical examination in dogs with intestinal intussusceptions may reveal a History and clinical signs Seventy-five percent of dogs palpable cranial abdominal mass. In some diagnosed with intestinal intussusceptions cases, the intussusceptum may protrude are younger than 1 year of age. German from the anus, in which case the shepherds dogs and Siamese cats may be intussusceptum must be differentiated predisposed to intestinal intussusception. from a rectal prolapse. This is The most common presenting accomplished by attempting to pass a clinical signs in dogs with intestinal blunt, lubricated probe between the rectal intussusceptions are vomiting, diarrhea wall and the prolapsed tissue. In the case with hematochezia or melena, anorexia, of a small-intestinal or colonic and weight loss. Other reported clinical intussusception, the probe can be passed to signs include dehydration, abdominal pain, a level cranial to the pubis; however, the tenesmus, and rectal prolapse. A palpable probe cannot be advanced when a rectal abdominal mass was present in 50% to prolapse is present. 70%

ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 68

Imaging of an intestinal intussusception is a series Abdominal radiographs in dogs of concentric rings in the transverse plane, with intussusceptions commonly reveal frequently described as a “target sign” or fluid- or gas-distended bowels, consistent “bullseye lesion,” and multiple parallel with mechanical intestinal obstruction. A lines in the longitudinal plane. These soft-tissue opacity mass may be identified findings correlate with the different layers on survey radiographs, but a definitive of intestinal wall of the intussusceptum diagnosis of intussusception is difficult and intussuscipiens present within the without contrast radiography or intussusception. ultrasonography. In some cases, there is Treatment and Prevention sufficient gas accumulation within the Before surgical intervention, the affected bowel to outline the patient’s hemodynamic and electrolyte intussusceptum on plain radiographs. status must be stabilized. Definitive Contrast radiography using either an upper treatment of intestinal intussusception gastrointestinal study or a barium enema must include reduction of the may increase the likelihood of diagnosing intussusceptum from the intussuscipiens intussusceptions. The most appropriate and reestablishment of a patent GI tract. In contrast radiographic study to perform dogs, this requires exploratory celiotomy depends on the type of intussusception and either manual reduction of the suspected. Enterocolic, cecocolic, or intussusception or resection of the colocolic intussusceptions are best intussusception with anastomosis of the identified with a barium enema, while remaining intestine. Manual reduction of intussusceptions in a more orad location the intussusception should be attempted by (i.e., enteroenteric) are best identified by gentle “milking” of the intussusceptum an upper GI study or ultrasound. Contrast from within the intussuscipiens. This media may outline the intussusceptum technique should employ more pressure on within the lumen of the intussuscipiens of the intussuscipiens in an effort to reduce an enterocolic intussusception following a the intussusceptum by pushing it out rather barium enema, or a ribbon of contrast than using traction on the intussusceptum. media may be present within the Care must be taken to avoid tearing the intussusceptum of an enterocolic, a serosa. Serosal adhesions, vascular cecocolic, or an ileocolic intussusception compromise, or the presence of intestinal following an upper GI contrast study. perforation prohibited manual reduction Factors influencing the success of positive and necessitated resection and anastomosis contrast studies include location of the in dogs. intussusception, completeness of the The recurrence rate of intestinal obstruction, and the presence of significant intussusception after surgical intervention intestinal ileus. in dogs reportedly ranges from 3% to 25%. Abdominal ultrasonography has Recurrence of the disease process in both also been shown to be a reliable diagnostic dogs and humans usually occurs in an tool for diagnosis of intestinal anatomic location other than the original intussusceptions in dogs. The site. The recurrence is frequently in a characteristic ultrasonographic appearance location orad to the original

69 intussusception and is reported more Enteroplication, defined as the formation commonly in idiopathic intussusceptions. of permanent serosal adhesions between Butorphanol tartrate has been reported to adjacent loops of small intestine, has been decrease the occurrence of intussusception advocated as a means to prevent formation. It is hypothesized that opioid recurrence of intussusception in dogs. administration increases the tone of the Complications of enteroplication included small intestine and reduces or prevents intestinal obstruction with vegetative local bowel wall inhomogeneity and material and strangulation of segmental ileus and, therefore, decreases enteroplicated loops of jejunum between the likelihood of intussusception. enteroplication sutures.

70 Ultrasonography for Gynaecological Disorders in Veterinary Patient Rupesh Raval, Karshan Vala, Kiran Parmar, Gajendra Solanki Department of Veterinary Gynaecology and Obstetrics, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

The ultrasonography is currently in current. These waves are directed through regular application in veterinary practice in tissue of interest by moving and varying the the field of research as well as diagnostic angle of transducer. Thus, ultrasound waves purpose. The physiological status of ovaries travel from a transducer in a pulse, strike to and uterus along with pregnancy diagnosis tissue of interest and then reflect back from possible through this technique. Recently, tissue to transducer in form of an echo. studies on ovarian follicular dynamics and These echoes received by transducer are success in retrieving immature oocyte electrically converted by computer either in repeatedly from live cattle through to sound, which can be heard by ear phone ultrasound guided oocytes aspiration or in to pictures which can be monitored in technique made this technology possible to screen. Thus, transducer acts both as play vital role in the success of in vitro transmitter of sound waves as well as fertilization and embryo transfer technology. receiver of echos. The echos received by Ultrasonography has become an important transducer are converted in to electric tool in research programmes and has been impulses and displayed on ultrasound screen integrated into clinical as well as animal as varying shades of grey (Black to reproduction. White).The most common used frequencies of ultrasound in large animal reproduction Principles of ultrasonography Before ultrasound technology can be are 3.5, 5.0 and 7.5 MHz. put to use in animal reproduction it is Modes of ultrasound essential to understand basic principles by There are three modes of ultrasound which ultrasound images are generated. machines viz. A mode, B mode and M Ultrasound waves are the sound waves mode. inaudible to human ear and operate at A mode is amplitude mode and frequencies of 1 to 10 megahertz (MHz). depicted as line graph. One dimensional The normal range of sound that human display of echo, fat and lean (meat animals) being can perceive is 20 to 20,000 Hz. A thickness measurement. sound wave with a frequency higher than B mode is brightness modality and 20,000 Hz is called as Ultrasound. The most of the ultrasound scanners used in ultrasonography utilizes high frequency bovine reproductive research is linear array sound waves to produce image of tissue and B-mode. It is a two dimensional display in internal organs. the form of dots. The sound waves are produced by M mode is an adaptation of B mode vibrations of specialized crystals called and used for evaluation of moving structures “Piezo Crystals” which are fixed on such as heart. ultrasound transducer. The vibrations of crystals are generated by pulses of electric ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th th to 19 October 2013 71

Labeling of images and Handling of the machine measurements can be done, selected image Connect the transducer in its on the screen is freezed and print is taken. transducer channel of the machine, connect Interpretation of ultrasound images the cord of the printer to the scanner, Ultrasonic images are usually Connect the scanner and the printer to the displayed as white against black main electric line through CVT, set up background. Various terms used to describe operational systems like contrast, brightness, the image are: focus, TCG, programme etc. of the machine. Hyperechogenic: This represents the Keep the transducer in freeze position when bright echoes that appear as white on screen. not in use, scanning in a completely dark Such images are given by highly reflective area is preferred. interfaces of dense tissues such as fetal Preparation of the animal bones, bovine cervix etc. Preferably withheld feed for 12-24 Hypoechogenic: These appear as hours, provide plenty of drinking water, grey image on dark screen and are given by shave and clean ventral abdominal wall for interfaces of moderate reflection. transabdominal scanning, Tab. Charcol or Anechoic or echoiuscent: In absence Gasex and mild laxative may be given 12 of an echo the images appear as black on hours prior to scanning. Clean off the faecal screen and are presented by complete material before rectal scanning. transmission of sound waves like follicular fluid, chorionic or amniotic fluid. Scanning approaches Transrectal scanning: Animal is Image quality and examining conditions restrained standing inside a travis, Rectal Examination conditions must be transducer is taken per rectum under a optimized for better production and sleeve for scanning. Commonly used in interpretation of ultrasound images. It is large animals, place acoustic surface of found to be interaction of four factors: (1) transducer on structures and avoid operator, (2) scanner (3) environment and obstruction of finger, avoid entry of (4) animal excessive air in to rectum. The ultrasound instrument should be Transabdominal scanning: placed close to the operator at eye level to Approached from ventral abdominal wall. control the adjustments and to facilitate Commonly used in small animal, put the viewing. A high quality probe is another animal on dorsal recumbency, scanning on prerequisite. The intensity of ambient light lateral/ventral abdomen of standing animal should be dim to reduce reflections and is also done, apply adequate ultrasound gel avoid excessive brightness or contrast. As on the skin surface, put the transducer head mentioned earlier animals must be well on the gel of skin surface and scan the restraints for better interpretation of underlying organs. ultrasound image. Recording of images

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Limitation of ultrasonography of view and depth penetration of sound Ultrasonography is not particularly waves. However, reliable period for useful in the lungs because air causes a great pregnancy diagnosis with a positive deal of artifact. Diagnostics images predictive value of over 95 per cent varies sometimes cannot be obtained because of between days 20 and 42 post-breeding. patients’ built. Ultrasound image will not be Based on these results the most realistic of diagnostic in scans of abdomen if there early date for reliable pregnancy diagnosis are excessive bowel gases. All types of by ultrasound under field condition may be imaging in radiology, ultrasonography is the day 30 post-breeding. The gravid horn starts most operator dependent. to sink ventrally in abdominal cavity Clinical applications of ultrasound between days 30 and 130 of pregnancy. In scanning in bovine reproduction such cases the gravid horn can be drawn In bovine reproduction back by manipulating the cervix caudally ultrasonography has been used for using gentle digital pressure through rectal pregnancy diagnosis, determination of fetal wall. sex, diagnosis of early embryonic death, 2. Determination of fetal sex diagnosis of follicular and luteal cyst, A very recent exciting use of evaluation of superovulatory response and ultrasound technology is determination of recently transvaginal ultrasound guided fetal gender by determining the relative follicular aspiration of oocytes for in vitro location of genital tubercle. The genital fertilization and embryo transfer tubercle is forerunner of penis and clitoris. It programme. begins to develop between the hind limbs, 1. Pregnancy diagnosis and then gradually moves close to the It is possible to recognize the umbilicus in male, and beneath the tail in presence of an embryo within the uterus females. Bovine fetal sex can be determined between days 12 and 14 following between day 73 and 120 of gestation with 5 insemination. It is evident that a 5 MHz or MHz probe being used for early and 3 MHz 7.5 MHz transducer provides more reliable probe for later stage of gestation. Fetal sex information than a 3 MHz transducer for can be determined even earlier with 7.5 early pregnancy diagnosis in cattle. MHz probe but not earlier than day 45 of Embryonic vesicle gradually increases in pregnancy because of small size of fetus and length until day 26 when it starts sex organs. The sex determination should be encroaching in to opposite horn. By day 32, performed between days 50 to 70 of the embryonic vesicle fully occupies both gestational order to obtain highest degree of the horns. The heartbeat is visualized accuracy. The fetal landmarks, such as between day 26 and 19. Fluid filled heartbeats, umbilical cord, rear legs and tail structures (eyes, brain, heart and stomach) are used for orientation. are easily recognized because of non- 3. Diagnosis of ovarian follicular and echogenic nature of their contents. luteal cysts Visualization of entire fetus is difficult in In field condition follicular cysts, advance pregnancy because of limited field luteal cysts and cystic corpus Luteum is well

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recognized problem and differentiation by (white) are attributed to the dense per rectal examination is difficult. The connective tissue folds and the hypogenic follicular cysts, cystic corpus luteum and (dark) areas are attributed to the outer leuteal cysts are successfully diagnosed portion of edematous therefore, makes through ultrasonography which is based on possible to estimate accurately the stage of presence of different echogenic structures estrus cycle in individual animal. present on surface on ovary. Ultrasound scanning also helps to know the 4. Uterine pathology timing of ovulation, thus it aids in timely The use of ultrasound for post- breeding of animals. partum or post-estrual examinations will Clinical applications of ultrasound allow early detection of potential uterine scanning in male animal pathology. Ultrasound will allow Orchitis: It is defined as inflammation of differentiation of uterine cyst (focal fluid the testis and usually occurs in conjunction filled areas), (fluid with increased with epididymitis. Testicular enlargement, echogenisity), dead fetus (no heart beats), decrease echogenisity and hypervascularity resorbing fetus (poorly delineated are typical findings. In the acute phase of gestational sacks with or without fetal orchitis, testis or focal areas of the testis remains), and premature placental appear less echogenic than a normal . separation (fluid between uterine wall and Increased blood flow from hyperemia may placental tissue). be identified and reactive hydrocele may be 5. Studies on morphological changes in present. Hypervascularity may be the only ovaries and uterus abnormal finding, so Color Doppler analysis Diagnostic ultrasound technology is more sensitive in the diagnosis of orchitis provides rapid non – invasive form of than is grey scale sonography. visual access to the ovaries, uterus and : Testicular torsion is a cervix for evaluating normal morphological twisting of the spermatic cord, which results changes in cattle. Image of ovaries are in the loss of blood supply to the testis and primarily composed of follicles and corpus blocks the venous drainage of blood from Luteum. As follicular fluid is non- the testicle. In the acute phase, the echogenic follicles appears as black, epididymis and testis enlarge and the testis roughly spherical areas on ultrasound appears hypoechoic and inhomogeneous. images. Ovulation can be detected by the Conclusion acute disappearance of a large follicle and Ultrasound scanning is important subsequent formation of CL. The luteal tool for the study of reproductive process in tissue appears as grey to white on bovines. It is effectively applied for ultrasound image. During estrus there is understanding of follicular dynamics, early marked edematous expansion of pregnancy diagnosis and identification of endometrial folds. Estrus echo texture is fetal sex. This technique plays key role in characterized by alternating and inter- the study of abnormalities of reproductive twisting areas of hyper and hypo- organs and developmental abnormalities of echogenisity. The hyper- echogenic areas the fetus.

74 Reticular Foreign Body Syndrome in Bovaine P B Patel, H M Padheriya, A M Patel Department of Surgery & Radiology, College of Veterinary Science & Animal Husbandry, Junagadh Agricultural University, Junagadh-362001

The incidence of Foreign Body maximal production, high-rise in deficiency Syndrome were higher in India may be state especially of calcium, phosphorus and attributed to practice of livestock rearing micro-minerals, has resulted in perverted based on hand feeding compared to pasture appetite, which is one important factor for rearing. Among the buffalo breeds highest intentional ingestion of foreign objects. In (23.88%) were recorded in Murrah-cross our country, buffaloes and cattle rearing are buffaloes Higher incidence has been generally based on backyard rearing or reported in recently calved buffaloes and organized dairy farms based on stall- that too older buffaloes compared to feeding. Thus the chance of occurrence of lactating and dry buffaloes. Foreign Body Syndrome is more as maximal The condition tends to be more intake of foreign bodies is via chaffed feed. common during drought because animals are Etiology grazing closer to the ground or are being fed The typical foreign body is a harvested material that is contaminated with metallic object, such as a piece of wire or a foreign objects, such as short ends of baling nail, often greater than 2.5 cm in length But wire. The disease presents considerable sometimes non-metallic objects like stiff difficulty in diagnosis because ruminalatony broom-bristles or sharp pieces of plastics and abdominal discomfort may occur in and their lodgment into the reticulum, due to other diseases. The various conditions anatomical predisposition has also been originating from Foreign Body Syndrome reported A large number of adult dairy are traumatic reticulitis, traumatic buffaloes have metallic foreign bodies in reticuloperitonitis (Local and diffuse), their reticulum without signs of clinical traumatic pericarditis, diaphragmatic hernia. disease and occasionally non-perforating Other minor complications are reticular foreign bodies such as ball bearings, stones, abscess, vagal indigestion or Hoflands coins may be passed out in faeces. It is Syndrome, hepatic abscess, splenic abscess, likely that a predisposing factor in otherwise rupture of left gastro-epiploic artery, normal buffalo, such as tenesmus or a gravid traumatic pneumonia and pleurisy, uterus, causes migration of the foreign body mediastinal abscess. into the reticular wall. Buffaloes are clumsy Factors attributed to emergence of and indiscriminate feeder and they take a foreign body syndrome nail or some other metallic objects into their Rapid industrialization and rapid mouth and it passes beyond the dorsum of civilization has resulted in increased the tongue, they do not seem to be able to incidence of the Foreign Body Syndrome, split it out and in most cases reaches due to spread of metallic and non-metallic abomasum. Apart from this some animals garbage and waste and thus more incidence suffer from mineral deficiencies seem to of these cases are reported in highly relish objects with a mineral or metallic industrialized and urbanized areas such as taste. Swallowed foreign bodies may lodge Punjab, Haryana and other big cities. Due to in the upper esophagus and cause intensive system of Livestock rearing for obstruction in the esophageal groove and ASCAD training on “Advances in surgical and imaging techniques for animals” held at COVSc&AH, JAU, Junagadh from 14th to 19th October 2013 75

vomiting but in most instances they pass to long periods. Arching of the back occurs in the reticulum. Many lie there without some of cases along with the appearance of causing any harm but the honeycomb like tenseness of the back and the abdominal structure of the reticulum provides many muscles so that the animal appears gaunt or sites for fixation of the foreign body and ‘tucked-up’. Defecation and urination cause contractions of the reticulum are sufficient pain and accompany usually with grunting. to push a sharp-pointed object through the This results in constipation, scant feces and wall. in some cases retention of urine. In others there is recumbency and reluctance to stand. Diagnosis Regurgitation, kyphosis, abduction Complete Blood Count (CBC) The CBC in a buffaloes with TRP of elbows , pellety dung, poorly digested can vary depending on whether the fiber, recurrent bloat, Brisket edema, peritonitis is acute or chronic and localized muffling heart sounds were observed .The or diffuse. In general, animal with persistent general behavior and attitude of all the purulent inflammation have leukocyte animals were unsettled. The rectal counts ranging from 5,000-15,000 cells/μL, temperature varied from 38.95 to 39.45°C in with neutrophilia (unsegmented neutrophils) cows and 38.43 to 39.50°C in buffaloes. The Although lymphocytes are the predominant heart rate was between 44.90 and 89.00 in -1 in buffaloes leukocyte circulating in healthy cattle, cows and 78.75 and 82.00 min and the respiratory rate varied between endogenous corticosteroid release secondary 32.64 and 39.45 in cows and 30.14 and to stress may cause lymphopenia by cell 39.50 min-1 in buffaloes. Ruminal motility redistribution; circulating lymphocytes do reduces in all cases. Out of the five grunt not re-enter the lymphatics but become tests conducted, scootch test (70.15%), sequestered in lymphoid tissue and bone reticular grunt (67.16%) and xiphisternum marrow. Affected animal also will show percussion (64.18%) were found to give hyperfibrinogenemia, with fibrinogen -1 highest positive results in TRP and allied concentrations greater than 1,000 mg dL .Fibrinogen is an acute phase and in cattle syndrome. Sometimes, trembling of muscles may be the best indicator of acute over the left side on the back of elbow, inflammation because fibrinogen occasionally over rumen and rarely on both concentrations often increase prior to sides is reported. development of neutrophilia. A moderate systemic reaction is Some buffaloes with acute, localized common in acute localized peritonitis. In peritonitis will have CBCs within normal acute localized peritonitis the clinical sign reference intervals, while others will have a commences 24 h after the penetration. The -1 degenerative left shift. Buffaloes with acute temperature, the heart rate is about 80 min and the respiratory rate about 30 min-1. diffuse peritonitis, the onset is sudden with Temperatures above 40°C (104° F) complete anorexia and a marked drop in accompanied by heart rates greater than 90 milk yield. Sub acute abdominal pain is min-1 suggest severe complications. common in most cases and the animal is Rumination is absent and reticulo-rumen reluctant to move. Walking, particularly movements are markedly depressed and downhill, is often accompanied by grunting. usually absent. In 75% cases with induration Most animals prefer to remain standing for of medial reticular wall due to traumatic

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injury, the normal tension receptor activity results primarily by anorexia, but is abolished and hypomotility of rumeno- may be potentiated slightly by ion exchange retuicularoccurs.The rumen may appear to caused by the alkalosis. With alkalosis, be full because of the presence of a free-gas intracellular H+ ions can be exchanged for bloat with moderate distension of the left extracellular K+ ions, decreasing serum paralumbar fossa .Pain can be elicited by potassium concentrations. This effect is deep palpation of the abdominal wall just minor as compared with K+ ion shifts caudal to the xiphisternum. Palpation is associated with acidosis. done using short, sharp pushes with the The changes in haematological closed fist or knee and also have a values and biochemical parameters such as degenerative left shift. In chronic cases, a elevation of fibrinogen, aspartate mature neutrophilia is common. aminotransferase and alkaline phosphatase Neutrophilia in the absence of leukocytosis are suggestive of inflammatory changes in was indicative of diffuse traumatic the body not only traumatic reticulo- reticuloperitonitis.There is daily periodic peritonitis. Although the haematological shift of TLC from higher to lower or vice- examination is of considerable value as a versa and a definite neutrophillic shift to diagnostic aid in TRP, these alterations are left is observed as the continuous progress non-specific and can also be seen in from normal to acute diffuse association with other bacterial infections peritonitisNeutrophilia has also been following severe stress. observed in a buffalo with extra-reticular Abdominocentesis fibrous nodules. Normal peritoneal fluid of an adult Serum biochemical profile- cow is straw-colored, clear and odorless. The most common chemistry abnormality Protein and fibrinogen concentrations can associated with TRP is hyperproteinemia vary from 1.0-3.0 g dL-1 and 100-500 g dL-1, with a hyperglobulinemia. Total protein -1 respectively. The nucleated cell count is -1 concentration greater than 10 mg dL should be less than 10,000 cells μL . The highly suggestive of TRP.Highly significant majority of nucleated cells are non- increase in globulin and fibrinogen levels degenerate neutrophils and mononuclear and decreases in albumin and Plasma cells. At least 10% of the nucleated cell Protein: Fibrinogen ratio (PP: F) was population should consist of recorded. eosinophils.Turbid samples or samples Other chemistry abnormalities containing gross pus or fibrin is indicative of associated with TRP may include peritonitis, at least locally. It is, however, hypochloremia, hypokalemia and metabolic normal for bovine peritoneal fluid to clot alkalosis; these abnormalities are secondary upon standing. Nucleated cell count, cell to ruminalhypomotility. Decreased rumen percentages and character of cells present function cannot maintain normal can be suggestive of disease. If a sample plasma/rumen chlorine gradients and contains immature, degenerative, or toxic ruminal chloride ions increase. Chloride ions neutrophils, purulent peritonitis can be also can become sequestered in cases of suspected. Samples with greater than 40% severe ruminalhypomotility. Metabolic neutrophils or less than 10% eosinophils are alkalosis occurs secondarily. Hypokalemia also indicative of purulent peritonitis. Intra-

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nuclear bacteria and degenerate neutrophils gas-producing bacteria involved in the indicate septic peritonitis . abscess formation or from Normal cytological findings do not compartmentalization of gas from the exclude TRP since bovines tend to wall-off reticulum .Some of the associated lesions inflammation in the peritoneal cavity, like phrenic abscess, reticular abscess, making it more difficult to diagnose local cardiophrenic adhesions and pneumothorax peritonitis. can also be diagnosed. Laparoscopy and Metal Detection Ultrasonographic findings (Ferrosope) : Right flank laparoscopy using Ultrasonography is useful for a flexible fiberoptic laparoscope, 14 mm observing reticular motility and for diameter and 1120 mm working length, is a recognizing fibrinous deposits, abscess and reliable diagnostic aid for the presence of accumulation of fluids. However, metal traumatic reticuloperitonitis. foreign bodies and magnets cannot be Metal detectors were used at one visualized and radiography remains the best time to aid in the diagnosis of traumatic method for this purpose. The reticulum and reticuloperitonitis and in rapid collection of adjacent organs of cattle and buffaloes can data on incidence of foreign body in the be examined with ultrasonography using a fore-stomach of the ruminants.Ferrous 3.5 MHz linear transducer applied to the metallic foreign bodies can be detected with ventral midline of the thorax over the 6th metal detectors but the instruments are of and 7th inter-costal spaces and from the left limited use because most normal diary and right sides of the midline. The reticulum bovines are positive for metal over the can be visualized in more than 90% of cows reticular area. in spite of interference by the ribs and Radiographic findings sternum. A healthy bovine reticulum appears Radiological examination of the as half moon shaped structure with a smooth reticulum with the animal in dorsal contour that contract at regular interval in recumbency (dorsal reticulography) is an ultrasonography. Ultrasonography accurate diagnostic method for the examination includes observation of evaluation of cattle with suspected traumatic reticular motility during three-minute reticuloperitonitis.An X-ray machine with a period, of reticular contours and of adjacent capacity of 1000-1250 mA and 150 kV is structure such as the diaphragm, anterior needed. The major advantages of dorsal blind sac of rumen, the ventral sac of radiography are that metallic foreign bodies the rumen, the spleen, omasum, abomasum can be visualized and their position and liver. In cows with disturbed reticular determined. Radiography as an aid in the motility, biphasic contractions are slower diagnosis of the conditions includes a than normal or indistinct and the numbers of typically positioned foreign bodies, contractions are reduced. Fibrinous changes abnormal gas shadows in the region of the appear as echogenic deposits, sometimes reticulum and depression in the cranio- accompanied by hypoechogenic fluid. ventral margin of the reticulum .Small gas Treatment inclusion or gas bubbles over a fluid The choice of treatment is largely interface in the region of the reticulum are governed by economics and the facilities pathogenic for the condition, resulting from and time available for surgery. Since

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reticular foreign bodies often migrate back also be treated with 3-7 days of systemic into the lumen of the reticulum, conservative antibiotic therapy (ceftiofur, ampicillin, or treatment can have good results. tetracycline), stall rest and other supportive Conservative treatment consists of therapy as indicated. Affected animal should instillation of a magnet to recover or be re-evaluated in 48-72 h. If a magnet is immobilize the metal foreign body (if iron- already in place or conservative therapy is containing), by administration of not successful, an exploratory laparotomy or antibacterial drugs to control the progression rumenotomy is indicated for removal of the and possibly the oral administration of a foreign body. The recovery rate after magnet. The animal can be tied or surgery is likely to be much lower if only sanctioned or confined in a box stall for complicated cases are operated on. A several days. The immobilization facilitates rumenotomy, satisfactorily performed, is the the formation of adhesions and removal of best treatment but is unnecessary in many the foreign body, may be further aided by cases because of the tendency of the foreign standing the animal on an inclined plane. body to fall back into the reticulum. The Either made of a door or planks or by best genera1 policy is to treat the animal packing earth under the front feet of the conservatively for 3 day and if marked animal. The front feet should be elevated improvement has not occurred by that time about 25 cm above the floor. Feed, to perform a rumenotomy. particularly the roughage should be reduced Prevention to about half. The response is often so good Prevention of TRP is preferred to that the farmer is tempted to turn the cow either conservative medical treatment or loose before the allotted time and relapses surgery. frequently occur. Antimicrobials are Although one source does not administered parentally daily for 3-5 days. believe magnets are an effective Sulfamethazine at the rate of 150 mg kg-1 preventative measure. The majority of body weight daily for 3-5 days provided clinicians agree that all cattle over one year good results in uncomplicated cases. of age should have a prophylactic magnet Penicillin or broad spectrum antimicrobials placed in the reticulum. Following oral given parentally daily for 3-5 days are also administration, most magnets do not enter widely used with empirical success. For the reticulum directly, but are first deposited lactating dairy cattle, those antimicrobials in the cranial sac of the rumen before with a short milk withdrawal period are entering the reticulum following ruminal desirable. The general effect appears to be contractions. Buffaloes should be kept away good and a high rate of recovery is recorded from construction sites and crop fields with antimicrobials parentally combined should be monitored for metal debris. Also, with immobilization provided treatment is processed feed can be passed over magnets begun early. Bovines past their 6th month of to recover any iron-containing foreign pregnancy are likely to show incomplete bodies prior to being fed to these animals. recovery or relapse. Affected animal can

79 Faculty and Participants of ASCAD Training Course

Department of veterinary Surgery and Radiology College of Veterinary Science and Animal Husbandry Junagadh Agricultural University, Junagadh-362001