 dorsal and ventral incisive muscles,

MODULE-1: SURGICAL AFFECTIONS OF LIPS maxillonasolabial,buccinator, zygomatic, and levator nasolabial

- voluntary lip movement
CHEEK AND TONGUE
 Nerve

 dorsal bucal ventral buccal and auriculopalpebral brabches of

the facial nerve
Anatomy
MUSCLES - INNERVATION - PHYSIOLOGY
 The lips form the rostral and most of the lateral boundaries of
the mouth and are separated from the upper and lower dental
arcades by the vestibule.
Muscles
 The upper and lower lips form the oral fissure and meet at
posterior angles,with the commissures.
The muscles involved are
 Except for the rostral two thirds of the upper lip, there is no
 Orbicular muscle
hair along the lip margins.
 Dorsal and ventral incisive muscles
 Conical papillae are present on the caudal margin of the lower
lip. The mucosa of the lower lip is firmly attached to the gum
between the canine and first premolar teeth at the interdental  Maxillonasolabial
spaces.
 Buccinator and zygomatic muscles
 The philtrum is the deep, narrow cleft be tween the two halves
of the upper lip.  levator nasolabial muscles

 In large animals lips play as a prehensile organ also.In bovines Innervation

they are less mobile. In sheep the philtrum is more deep. In
camel the upper lip is divided in to two indepedent halves by a
deep fissure.
 Muscles-
 The musculature of the lips is innervated by the dor sal buccal,
the ventral buccal, and the auriculo palpebral branches of the
facial nerves.

 Orbicular muscle for the voluntary movement, Physiology

 Contribute little to active prehension

  In horses lips are the prehensile organ. bacteria .Further injury will be caused when the animal
attempts to dislodge the foreign body.
 Displays behaviour, including threatening attitudes . Scent
marking through the application of secretions from glands.
DIAGNOSIS

DISEASES OF THE LIPS

Clinical signs

 Foreign Bodies  Inappetance

 Lacerations  Ptyalism ( drooping of saliva)

 Avulsion  Dullness and pain

 Infections  Presence of an infected wound

 Eosinophilic Ulcer Disease  Direct visualization of foreign body under illumination

 Facial nerve paralysis

TREATMENT
 Cleft lip

 Burns
 Foreign body can be removed with forceps .
 Neoplasms
 If the foreign body is buried deep within the tissue, general
anaesthesia, routine surgical preparation of the site, and an
incision in adjacent healthy skin or mucous membrane to
FOREIGN BODIES remove the object.

 The wound is then gently flushed with warm sterile saline, the
 Grass pieces ,splinters of bone quills, wood pieces, bullets and skin or mucous membrane incision is closed . Small opening
carbon particles are usaually seen. Some times pieces from dog should be left open for drainage.
chain and belts are also reported.
 Post operatively antibiotics and anti-inflammatory drugs are
 The animal's attempts to expel or encapsulate the foreign indicated for 5 days . Oral antiseptic gel and soft light food till
material results in open wound followed by infection with wound heals.
LACERATIONS

 Etiology: Fights , broken edged objects and other injuries

 Diagnosis: From clinical signs . Ptyalism dullness and pain,

Wound with irregular edges.

TREATMENT

 Patient should be restrained before surgical repair. Hemostasis

and debridement in addition to antibiotic therapy is usually
initiated until the severity of the damage is assessed.

 To close lip wounds, simple interrupted absorbable sutures are

placed in the muscle and submucosa .

 The mucosa is not included in the suture, and the knots lie deep
AVULSION
in the lip tissue. Repair of large lip defects needs a skin flap or
graft .The overlying skin is closed with simple in terrupted
sutures or vertical mattress sutures through the mu cosa,
submucosa, and muscle with the knots on the oral mucosa side.  Etiology: Automobile accidents and falls from heights.
Fig A

 Knots are also placed with out exposing to oral mucosa as in fig
B

 Post operative antibiotics and anti-inflammatory drugs for 5

days Soft light food till wound heals . Suture removal is
reccomended after 10-14 days .
Avulsion of lower lip in a dog
TREATMENT
 Suture the lip in place in minor avulsions with fine mono
filament nylon or polypropylene
TREATMENT
 suture the interdental spaces or the teeth must be used to
anchor the sutures if a large lip flap is displaced .
 Mandibular symphysis should be examined and stabilized if
separated with a full cerclage wire of 20 - gauge .
CHELITIS
 Cheilitis – inflammation of lips -Lip fold pyoderma or
intertriginous dermatitis; common in spaniels, setters, and
other breeds of dogs with large pendulous upper lips.
 Pendulous lower lip in a great dane causing salivary drooling.
Pendulous lower lip
 Etiology: Bacterial, Viral, Canine viral oral papillomatosis,
yeast and fungal candidiasis, dermatophytosis
,coccidioidomycosis blastomycosis, crypto coccosis nocardiosis.
 Bacterial Dental prophylaxis - Daily cleansing of the lip
folds with 2.5% benzoyl peroxide shampoo until the
condition improves followed by maintenance cleansing
every 2 to 5 days. Surgical extirpation of the folds to
remove a lateral lip fold an elliptical skin incision
encompassing all infected tissue and a margin of healthy
tissue is made around the fold.
 The dermis and subcutaneous tissues are under mined to
remove all involved tissue.
 The lateral lip fold is incised covering the infected tissue
and a margin of healthy tissue. After removing the fold the
 edges of the wound are undermined to allow skin  The facial nerve, supplies motor fibers to muscles of the
apposition to the mucocutaneous border without tension. face.

 Papilloma Warts may be removed by sharp dissection at  Facial paralysis mostly affects motor function and except
the level of their base with an electric scalpel. Spontaneous for taste, there is no loss of sensation from the skin and
regression of the remaining warts usually occurs due to mucous membranes.
auto vaccination.
 Chronic paralysis leads to facial muscle atrophy.
 Injections of immune and hyper immune serum Vincrystin
@ 0.02 mg/kg S/C
CAUSES AND SIGNS
 Fungal -Antifungal therapy

 Causes secondary to direct nerve injury, space-occupying

EOSINOPHILIC ULCER DISEASE lesions, otitis media, and neuromuscular or central
nervous system disease

 Manifested as a well-circumscribed, red-brown, ulcer ated,  Signs of facial paralysis are asymmetry of the ears, eyelids,
alopecic, glistening area on the skin of the lips or mucosa and nose One ear may droop lip droops and saliva escapes
of the oral cavity from one corner of the mouth.

 Diagnosis is based on history, physical examination, skin  Nose and philtrum are drawn toward the unaffected side
biopsy impression smear of the lesion. ocular fissure on the affected side is larger than normal
and corneal and palpebral reflexes do not cause its closure
 Treatments surgical excision or debridement of
granulomas is difficult because of the paucity of  Accumulation of food in the buccal vesicle.
surrounding tissue to use to repair defects. Deformity and
recurrence are common complications.
TREATMENT
 Glucocorticoids and, in refractory cases, radiation therapy
are the current recommended treatments .
 Muscle nerve stimulation

FACIAL NERVE PARALYSIS  Palliative surgery.- To prevent drooling a chelioplastic

surgery may be carried out.
  When the triangle is closed the lower lip is everted.
HARELIP - CHEILOPLASTY

TREATMENT

 The second procedure is a cheiloplasty procedure.

 Here the lower lip is separated from the chin so that the lip
can heal in a more normal position.

 With the animal on its back the lower lip is pulled down to
expose the lower incisor teeth . An incision is made along
the mucogingival junction from the first premolar tooth on
one side to the first premolar tooth on the other side.
Drooped lower lip
 The subcutaneous tissue is stripped from the mandible
using a periosteal elevator.
 Normal side of nose and muzzle is measured for width of
 The tightness of the lip determines the extent of dissection
normal lip. One surgery involves resection of the skin of
required. The lip should hang just ventral to the
the chin.
mucogingival junction.
 In this procedure the lower lip is pulled ventrally to expose
 If it doesn't, additional length of lip should be dissected
the lower incisors.
from the mandible. No sutures are placed.
 When this is done a fold of skin is created on the chin and
 The owner is advised to run their finger around the
an elliptical incision is made through the skin and
created pocket between the lip and mandible daily.
subcutaneous tissue and the fold is removed.
 This has to be done to prevent the healing tissues from
 When the subcutaneous tissue and the cut edges of the
pulling the lip back into normal position.
skin are opposed the lower incisor teeth should remain
exposed.
 The wound heals by secondary intention healing.
 A variation of this procedure involves removing a
triangular piece of skin from the ventral chin with the base
of the triangle parallel to the lower incisors. AFFECTIONS OF TONGUE - INTRODUCTION
 CONGENITAL DEFECTS

 Examination procedures of the tongue is similar to that of  Smooth tongue

the oral cavity.
o The horny papillae on the dorsum of the tongue will
 Direct examination and palpation can be carried out if the be either small or absent. Affected calves with
patient is cooperative. smooth tongue will have difficulty in prehension.
This leads to retarted growth.
 In agressive animals sedation or general anesthesia
should be resorted to. o Treatment is not indicated. Condition is more
common in Brown Swiss and Holstien Fresien
The various disease conditions that affects the tongue are :
 Lateral deviation of the tongue
 Congenital defects
o If the lower canine teeth in dogs are missing the
 Smooth tongue tongue may protrude laterally.

 Lateral deviation of the tongue o It may be congenital or traumatic. Treatment is by

excising the superficial muscle near the frenum
 Ankyloglossia linguae on the contralateral side.

 Strangulation  Ankyloglossia

o There will be incomplete or abnormal development

 Tumors of tongue
of the tongue.
 Ranula (Honey Cyst)
o Treatment is by incising the overlong frenum lingue
to provide a free range of motion of the tongue.
 Sublingual abscess

 Gangrene of tongue
STRANGULATION
 Trauma

 Glossoplegia
  In dogs and cats accidental slipping of elastic rings or
tracheal rimgs being slipped over the free portion of the
tongue is a common cause.
 Foreign bodies which lodge in the oral cavity and
penetrate the surrounding tissue, tracheal ring.
 Pieces of rubber etc may encircle and strangulate the
tongue.
NEOPLASMS OF TONGUE
 In the horses by tying a string around the free portion of
the tongue as a means of control when the animal is
vicious causes strangulation
Symptoms
 The portion of the tongue distal to the tourniquet becomes
swollen and cyanotic due to impediment in venous flow.
 Later necrosis will set in from arrest of blood supply in the
distal portion.
Diagnosis
Clinical signs
 Careful examination after sedation especially in small
animals will aid in the identification of a ligature deep in
the swollen tongue.
 The animal's efforts to remove these object by pawing and
rubbing on the ground push them further posterially.
 This leads to severe passive congestion and oedema of the
tongue .
 Treatment
 In early cases removal of the cause, antibiotics, fluid and
other supportive therapy should be followed.
 Amputation is indicated in necrosis of the tongue .
Amputation of tongue ( partial glossectomy) up to its half
can be practiced .
 Fibromata, lipomata, and angiomata are the
neoplasms of the tongue. Carcinoma confined to tongue is
unknown in animals except for canine oral viral
papillomatosis .Epithelioma affecting the face usually
involves tongue. Malignant melanoma, fibrosarcoma and
squamous cell carcinoma may be primary to the tongue.
 In Cats high incidence of tongue tumors is recorded,
Squamous cell carcinoma, fibrosarcoma papillomata,
Haemangioma.
 Difficulty in mastication.
 Salivation.
 Quidding. -Chewed food drops from mouth with saliva
 Dysphagia.
 If tumor is ulcerated – blood stained discharge from
mouth.
 o Removal of the cause
Treatment
o Systemic antibiotic administration and with
 Surgical excision and chemotherapy are of little value.
predinisolone in Siberian Husky breed.
 Radiotherapy is indicated for Squamous cell carcinoma in
small animals.

 Surgical excision is indicated for Papilloma.

 Irradiation and hyperthermia is indicated for

fibrosarcoma.

 Steroid therapy is indicated for hemangioma.

 In Large animals:. Amputation of tongue is indicated.

GLOSSITIS

Glossitis, inflammation of the tongue is rarely reported in dogs

and cats.

 Clinical signs

o Halitosis, dysphagia,oral hemorrhage, rolling of the

tongue and saliva drooling. MODULE-2: SURGICAL AFFECTIONS OF
PALATE
 Differential diagnosis

o Neoplasia, heavy metal poisoning,vitamin

deficiency.

 Treatment
  The hard and soft palates contributes to the secondary
palate, and incomplete closure of either of these structures
LEARNING OBJECTIVE is called a secondary cleft or cleft palate.

 At the end of this module

the learner should be able to CLINICAL PRESENTATION
analyze the surgical
conditions affecting the hard
and soft palate and also will  The cleft is present at birth.
be able to differentially
diagnose the affections of the  Not always recognized immediately. Brachycephalic
nose. breeds are more commonly affected. In cats siameese
breed is usually affected.

 Nasal regurgitation of milk during or after nursing,

respiratory infection and failure to thrive are the major
problems associated with this condition

PHYSICAL EXAMINATION FINDINGS

 There will be incomplete closure of the lips, incomplete

closure of the premaxilla, hard palate, or soft palate.
AFFECTIONS OF THE HARD PALATE AND SOFT
PALATE
WHAT SHOULD BE TAKEN CARE OF
(Congenital Oronasal Fistula or Cleft palate)
IMMEDIATELY?

 It is an abnormal communication between the oral and

 Tube feed the animal (via oesophagostomy or gastrostomy
nasal cavities involving the following structures - soft
tube) to maintain an adequate nutritional status and to
palate - hard palate - premaxilla, and / or - lip.
reduce the incidence of aspiration pneumonia until they
are old enough for surgery.
 The Lip and Premaxilla contributes to the primary palate,
and incomplete closure of this is a primary cleft or cleft lip
(harelip).
DEFINATIVE TREATMENT - SURGERY
 Surgery is performed when the animal is above 2 months
of age, because the puppies will be better able to
metabolise the anaesthetic drugs and hence lesser
anaesthetic risks.
CLOSURE OF HARD PALATE DEFECTS
 Sliding bipedicle flap technique
o In this, mucoperiosteal incisions are made on either
side of the cleft and the mucoperiosteum is elevated
from the hard palate with the major palatine artery.
o The nasal mucosa and mucoperiosteum are then
apposed in two layers over the defect in the hard
palate.
 Overlapping flap technique
o Mucoperiosteal flap is made on one side of the cleft,
and rotated medially to cover the hard palate defect.
o The edge of this flap is inserted between the hard
palate and the mucoperiosteum on the opposite side
of the defect.
o The flap is secured in position with horizontal
mattress sutures. Lateral relief incisions are made
to reduce tension on the repair.
CLOSURE OF PRIMARY CLEFTS INVOLVING
THE LIP, PREMAXILLA AND NOSTRIL
 A mucosal flap is created from the nasal wall and sutured
to a labial mucosal flap to separate the nasal cavity from
the oral cavity.
 The cleft lip is then repaired with one or a series of Z
plasties.
COMPLICATIONS AND PROGNOSIS
 Dehiscence and incomplete healing are the most common
complications.
 Dehiscence of hard palate repair occurs due to excessive
tension and motion of the tongue against the repair.
 In case of repair of the lip, dehiscence occurs if the
orbicularis oris muscle has not been apposed; which
causes excess tension on the suture line during movement
of the lip.
 Late dehiscence occurs due to growth-induced stress on
the repair and can be treated when the patient matures.
Prognosis is good; however several operations may be
required.
ACQUIRED ORONASAL FISTULA
  Abnormal communication between the nasal and oral
cavities caused by trauma or disease.
 Most common caused by dental disease – when a deep
maxillary periodontal pocket progresses to the apex of the
tooth, lysing the bone between the apex of the alveolus and
the nasal cavity or maxillary sinus.
 Foreign bodies lodged between the dental arcades may
cause pressure necrosis of the hard palate and subsequent
development of an oronasal fistula.
CLINICAL PRESENTATION
o The gingival flaps are elevated and the edges of the
fistula is debrided. The mucosa is then apposed over
the defect.
 Single-layer flap repair
o If the fistula is between the gingival and buccal
mucosa, the fistula is debrided and a buccal flap is
advanced over the defect.
o A rotational flap is done by debriding the fistula and
rotating a mucoperiosteal hard palate flap over the
defect.

 Any breed or gender may be affected. Oronasal fistula

occurring secondary to dental disease or tumous are seen
more often in middle-aged and older animals.

 That developing secondary to trauma may occur at any

age. Ingested food that passes through the fistula into the
nasal cavity may be expelled from the nostril by sneezing.

 Chronic rhinitis is common.

DEFINATIVE TREATMENT - SURGERY Palate cleft repair by mucosal flap

 Direct apposition o To repair lesions at the junction of the hard and soft
palates, debride and close the defect with a soft
o Direct apposition of the fistula is performed only if palate advancement flap.
the fistula is very small.
 Double-layer flap repair
o The mucosa around the fistula is incised.
 o This may be performed using tissue surrounding
the fistula and a flap from the mucoperiosteum LEARNING
of OBJECTIVE
the hard palate.
 At the end of this module the learner
o Create the first flap by rotating the gingival margins should be able to make a clinical
of the fistula medially and apposing with sutures. jugdgement on the surgical conditions
This flap is covered with a rotational affecting the nasal cavity.
mucoperiosteal hard palate flap.

o Uranoplasty staphyloplasty

INTRODUCTION

 The following are the important affection of nose

o Atheroma/ Cyst

o Nasal polyps/ Nasal polypi

o Necrosis of the turbinate bone

o Parasites in the nasal chambers

ATHEROMA/CYST
MODULE-3: SURGICAL AFFECTIONS OF
THE NOSE  It is a sebaceous cyst that mostly occurs in the false nostril
in the horse, causing a local swelling and perhaps a nasal
respiratory noise due to encroachment on the nasal
passage.
  The size of the cyst varies from a pigeon egg to a large
chicken egg. The content may be like water in the small
cyst and the large cyst may be filled with a thick, greasy
dark grey material.
 The presence of the cyst is easily diagnosed by clinical
examination.
Treatment - 1
NASAL POLYPS/NASAL POLYPI
Aseptic preparation and anaesthesia
 The skin over the cyst is prepared aseptically by clipping,
shaving and painting with povidone iodine for the
operation and the tissues may be anaesthetized by
infiltration with a local anaesthetic eg. 2% lignocaine
hydrochloride.
Surgical procedure
 A stab incision is made over the swelling area and
evacuating the contents and swabbing its lining with
tincture of iodine or any irritant or stimulating agent such
as ammonia or turpentine liniment, constitute an effective
method of treatment.
 The irritant does not come in contact with the mucous
membrane of the nose.
Treatment-2
 An alternative method of treatment is the dissecting out
the cyst. It is the best method of treatment.
Diagnosis
 The incision through the skin exposes the wall of the cyst.
The wall should be separated from the surrounding tissues
and excised.
 It may be desirable to establish drainage into the nasal
cavity. The edges of the skin incision may be united with
simple interrupted suture with nylon or silk.
 Polyps are generally multiple and of smaller in size
 The general appearance of polyps are soft, non-ulcerated
that arise from nasal mucosa. Usually they are
pedunculated and consist of loosely arranged fibrous
tissue covered by epithelium.
 The growths are commonly attached to the lateral wall and
rarely to the nasal septum.
 Polyps cause partial or complete obstruction of the nasal
passages show clinical signs like discharge, inspiratory
dyspnoea and stertor.
 There may be frequent sneezing, the animal may show
restlessness and may rub its nostrils against the ground.
 In bilateral obstruction , animals exhibit mouth breathing .
 Extensive growths produce sufficient pressure to cause
atrophy of the turbinates and also facial deformity.
  Diagnosis is based on the following procedure
o Direct visualization
o Endoscopic visualization of the nasal cavity reveals
the presence of growth
o Radiography
o Histopathology
o Microbial culture examination
Treatment
Surgical Procedure
 Pedunculated growths are removed by excision at the base
of the attachment by local infiltration anaesthesia.
 When growths are enlarged and inaccessible through
external nares, rhinotomy and excision is indicated.
Rhinotomy
 An incision through the skin and cartilage on the
dorsolateral aspect of the nostril gives enough space to
remove the growth from the nasal cavity. Base of the
growth is debrided and cauterized.
 Haemorrhage is controlled by temporory plugging of the
nasal cavity with gauze impregnated with an antiseptic
and intravenous administartion of haemo coagulase,
vitamin K, ethamsylate.
 Trephining of the nasal bones is indicated when polyps
extends upto the caudal aspect of the nasal septum.
NECROSIS OF TURBINATE BONES
Incidence
 It occurs occasionally in the horse but rarely in other
species.
Etiology
 The lesion is generally due to strangles, with an
accumulation of pus in the folds of the bones.
 Wound inflicted directly through the nostril or through the
nasal bones followed by infection of the seat of injury.
 It may be a complication of the root of a molar tooth in its
vicinity.
Symptoms
 Foetid purulent discharge, usually unilateral interference
with respiration, manifested by a snuffling or roaring
noise
 Swelling in the nasal chamber, which may or may not be
visible or palpable from nostril
 Ulceration and discoloration of the bone which may be felt
by fingers
  Dullness on percussion of the affected region and swelling
of the submaxillary lymphatic glands.
Prognosis
 Favourable when the necrotic portion can be entirely
removed
Treatment
 Medical management not much effective
Surgical treatment
Anaesthesia
 Block the maxillary nerve and sedate the patient if
necessary. It is also best to perform a tracheotomy.
Operation procedure
 Make a trephine opening where the nasal bones start to
diverge and far enough from the median line to avoid
injury to the nasal septum.
 Cut the cartilaginous anterior end of the turbinate loose
from its attachments anteriorly and with a nasal septum
chisel cut the attachment.
 Bleeding can be controlled by tamponing the cavity tightly
with gauze. It is impossible to completely remove the
ventral turbinate due to its anatomical location.
 After operation, the affected region may be insufflated
with iodoform powder or a mixture of it and boric acid
once daily as a further antiseptic precaution.
PARASITES IN THE NASAL CHAMBERS
Incidence
 The only parasite Linguatula taenioides which is almost
confined to the dog , being very rarely found in the horse,
mule sheep and goat.
Location of parasite
 It may locate in any part of the nasal chamber but most
commonly seen in the convolution of the ethmoid and in
the cul-de-sac of the middle meatus.
Transmission
 The dog becomes infested by eating the viscera of
herbivore, usually the sheep and rabbit, containing the
larvae of the parasite
Symptoms
 The usual number of parasites is two that will cause no
clinical signs but when they are more in number, they
cause agitation of the host, the dog scratching his nose
with his paws, sneezing frequently and sometimes
showing aberrations simulating rabies.
  There may be mucoid discharge from the
occasionally streaked with blood.
 The parasites remain for months in the nose, eventually
die or are expelled.
Diagnosis
 Diagnosis is based on the following examination
o Direct finding the parasites and their eggs
o Microscopic examination of nasal discharge
o Differential diagnosis- nasal catarrh, distemper,
rabies
Treatment
 There is no successful treatment but supportive
measurements are as follows
 Snuff may be used to make the dog sneeze, with a view to
causing expulsion of the pest.
 In alarming condition, trephining the nose and remove the
worms
 Slightly irritating injections have been used with some
success eg. dilute solutions of ammonia or benzene. This
may be introduced through the nostril or through an
artificial opening, their object being to dislodge or destroy
the parasites.
RESECTION OF NASAL SEPTUM
nose,
Indications
 Traumatic wound in the nostrils
 Fracture of the nasal bones
 Operation: A tracheotomy operation is performed to
permit breathing as it is necessary to tamponade the nasal
cavity to control haemorrhage.
 Anaesthesia: Anaesthesia is achieved by blocking both
maxillary nerves, if necessary sedate the patient with
appropriate drugs.
Operation technique
 A trephine opening is made on the median line of the face
at the point where the nasal bones start to diverge from
each other.
 This is determined by placing the thumb and finger on
either side of the nasal bones and passing them backward
over the dorso-lateral surface.
 A pair of compression forceps with jaws four inches long is
inserted through the trephine opening and astride the
nasal septum.
 The points of forceps should reach the full width of the
nasal septum and are then closed tightly.
  The nasal septum is then divided anteriorly by a curved  Purulent discharge unilateral
incision, leaving at least two inches of the septum to
support the nostril.
Dignosis
 Secure the cut end with a pair of forceps, then place a
 Direct visualization with magnification
nasal septum chisel astride the septum and push it along
the superior border of the nasal septum until the chisel
 Otoscopy of the rostarl nasal passage.
comes in contact with the forceps, withdraw the chisel and
insert in the same manner along the floor of the nostril,
cutting the septum free from the vomer bone with a  Radiography - plain and with contrast radiography
narrow chisel placed anterior to and in contact with the
forceps, divide the septum transversely and remove the Treatment
septum through the nostril.
 Removal of the foreign body depends on the space and
 Tamponade the nasal cavity tightly with antiseptic location
impregnated gauze. It is advisable to suture the nostrils
shut to retain the tampon in position.  Rostral- use of a small alligator forceps along with
endoscope.
 The tampon and trachea tube may be removed in 48
hours. After operation, nasal cavity may be irrigated with a  Caudal - may be embedded in the mucosa or free in the
mild antiseptic solution through the trephine opening. passage., use of a flexible endoscope

 Nasopharynx 2 - 4 mm diameter arthroscope or in large

FOREIGN BODY IN THE NASAL ACTIVITY dogs with a bronchoscope

Surgical approach
 Rostral turbinate system helps inthe filtering of direct
entry of small foreign bodies and very rarely they get  Dorsal and ventral approach.
lodged in the nasal mucosa to cause inflammation.
 Rhinotomy is the incision in to the nasal cavity
Clinical Signs
Dorsal approach
 Epistaxis
 Make a dorsal midline skin incision from the caudal aspect
 Excessive sneezing of the nasal septum to the medial canthus of the orbit.
Explore both the sides of the nasal cavity.
  A bone saw can be used to elevate the periosteal flap on
the proposed entry. The common affection
the guttural pouch are
 Gently lavage the nasal passage and remove the foreign
body. Bone flaps are sutured by 3-0 or 4-0 wire sutures.  Empyema
close the skin with apposition sutures.
 Mycosis
Ventral approach
 Tympany
 Make a midline incision in the hard palate. Elevate the
mucoperiostium, with out damaging the palatine vessels  Neoplasia
and nerves. Extend the incision caudally to the soft
palate.  Cyst

 Incise the palatine bone with rongeurs or power driven

burr. Explore the nasal cavity. After removing the foreign
body Clsoe the nasal mucosa and oral mucosa with simple ANATOMICAL CONSIDERATION
interruptted sutures.

 The guttural pouches are caudoventral diverticula of the

auditory tube. The capacity of each pouch approximates
300ml, is divided into a medial and lateral compartment
by the invagination of the stylohyoid bone. The mucosal
lining of each pouch is secretory and is being covered by
ciliated pseudo stratified epithelium with goblet cells and
gland. The mucosal lining is generally thinner than that of
nasopharynx.

MODULE-4: SURGICAL AFFECTIONS OF  The following are the important affections of the guttural
pouches
GUTTURAL POUCH
o Guttural pouch tympany/ Tympanites

INTRODUCTION o Guttural pouch empyema/ Collection of pus in the

guttural pouch
 o Mycosis  In some cases infection is present in the affected pouch
and the distension may be due to the formation of gas.
o Neoplasia
 It has also been proposed that an abnormal mucosal flap
o Cyst at the pharyngeal orifice functions as a unidirectional
valve trapping air or fluid within the pouch.

GUTTURAL POUCH TYMPANY

CLINICAL SIGNS

 Definition
 Clinical signs depend on the degree of distension but the
o It is a nonpainful distention of the guttural pouch usual signs are a diffuse, painless, elastic tympanic
with air characterized by an external swelling in the swelling in the parotid region.
parotid region.
 It may extend downwards and backwards towards the
 Incidence throat and upper part of the jugular furrow. If markedly
affected, the foal may exhibit stertorous breathing, nasal
o It is usually observed in young foals, although discharge, Dysphagia, respiratory distress or evidence of
horses up to 20 months of age may be considered pneumonia secondary to aspiration.
for this disorder.
 Pressure on the pouch may cause some of the air or gas to
o It appears to be more prevalent in fillies than in escape with a whistling sound.
colts.

o Usually only one guttural pouch is affected but it DIAGNOSIS

may occur bilaterally.

 Diagnosis is based on significant clinical signs and

PATHOGENESIS AND ETIOLOGY
 The cause of air accumulation within the pouch is not
known but it seems that the air apparently enters the
pouches during expiration or when the animal is
swallowing.
radiographic examination of the skull and pharynx. X-ray
reveals a large air filled guttural pouch with or without
fluid accumulation.
 Needle aspiration of air from one guttural pouch nearly
correct the problem if a unilateral tympany exists.
  Dorsoventral radiograph views may also be helpful in
detecting bilateral involvement.
TREATMENT
 Medical treatment like application of counterirritant or
other topics to the skin over the pouch has no beneficial
result. Puncturing the sac gives only temporary relief, as it
rapidly refills.
 Surgical correction is the good management of the guttural
pouch tympany.
 For unilateral tympany, surgical ablation of the median
septum separating the two guttural pouches is performed.
Bilateral involvement may necessitate resection of the
excessive plica salpingopharyngeal flap.
GUTTURAL POUCH EMPYEMA
 Definition
o It is the accumulation of exudates or pus within the
guttural pouch and is usually a sequela of upper
respiratory tract infection (Streptococcal species).
 Etiology
o It may result from the rupture of abscessed
retropharyngeal lymphnodes into the pouches or
may accompany cases of guttural pouch tympany.
o It may occur during the course of an infectious
disease like influenza or strangles. Infection of the
pouches usually becomes chronic because of lack of
complete drainage.
o It may occur usually secondary to an acute
pharyngitis or may also accompany infectious
parotiditis.
o It may be associated with a neoplasm on its wall.
Food material may enter the pouch through the
Eustachian tube and give rise to suppurative
inflammation.
CLINICAL FINDINGS
 Signs include an intermittent white nonodorous nasal
discharge (either unilateral or bilateral) ,
lymphadenopathy, painful distention in the parotid
region, stertorous breathing , Dysphagia, swelling of the
submaxillary lymphatic glands, a rattling noise in the
pouch during exercise, interference with swallowing and
respiration, rupture of the pouch rare occurrence and
occasionally epistaxis.
 Inspissation of the material may occur with chronic
infections, forming masses called chondroids
DIAGNOSIS
 It is based on clinical findings and confirmed by
radiographic examination. Radiograph reveals a fluid line
 or opacity in the pouch. Inspissated material may also be  Surgery may be carried out if medical therapy is
evident radiographically. unsuccessful or if the material within the guttural pouch is
inspissated.
 On endoscopic examination, a purulent material may be
seen at the pharyngeal orifice of the Eustachian tubes.
SURGICAL APPROACH OF THE GUTTURAL
POUCH
DIAGNOSIS

 Indications
 It is based on clinical findings and confirmed by
radiographic examination. Radiograph reveals a fluid line o An accumulation of pus or inflammatory exudates
or opacity in the pouch. Inspissated material may also be or rarely, food material in the pouch.
evident radiographically.
 Preparation of patient
 On endoscopic examination, a purulent material may be
seen at the pharyngeal orifice of the Eustachian tubes. o Administartion of tetanus toxoid a week before
surgery

TREATMENT o The operative area is prepared by shaving and

application of an antiseptic before operation.

 Treatment may entail both medical and surgical  General Anaesthesia

modalities but opening and draining the guttural pouch is
the only successful method of treatment for the o Premedication with Acepromazine @ 0.02 - 0.05
accumulated pus. mg / Kg

 Medical treatment includes lavage of the guttural pouch o Xylazine @ 0.5 to 1 mg / Kg

with saline solution and administration of systemic
antibiotic is an initial step in therapeutic management. o Induction with ketamine @ 2.2mg /Kg

 Antiseptic inhalation, which may be of some use in a o Maintenance - Isoflurane

recent case by reducing inflammation of mucous
membrane. The passage of Gunther’s catheter to evacuate  Surgical procedure - Hyvertebrotomy Viborg's trainangle
the fluid contents and to enable the cavity to be irrigated
with an antiseptic lotion introduced through the catheter
by means of a syringe.
 o Site of operation: The antero-inferior border of the
wing of the atlas. GUTTURAL POUCH MYCOSIS

OPERATION PROCEDURE
Casuative organism : Aspergillus

 Multiple or diffuse fungal plaques on the caudodorsal

 Make an incision about three inches long antero-inferior aspect of the medial guttural pouch is the common site of
border of the wing of the atlas, going through the skin lesion
without making dissection the parotid gland. Reflect the
gland forward by blunt dissection of the loose connective
tissue beneath it. Clinical signs

 Separate the areolar tissue, digastricas, stylo-maxillary  Unilateral or bilateral epistaxis

and occipito-styloid muscle until the pale lining of the
pouch is visible. Grasp a fold of the guttural pouch  Epistaxis
membrane with an artery forceps and incise it .
 Abnormal head extension
 Enlarge the opening thus made with the fingers or the jaws
of a forceps and the interior of the pouch will then be quite  Ocular changes
visible. Evacuate the contents which may be entirely liquid
or partly solid in the form of chestnut-like bodies called  Facial nerve paralysis
chondroids.
 Lingual hemiplegia
 To provide better drainage, a counter opening is made in
the center of Viborg’s triangle. This is defined as the
tendon of sternomaxillaris muscle, the sub maxillary vein
and the caudal border of the vertical ramus of the
mandible.

 Pass a stout metal sound into the pouch and make it bulge
the skin in the center of the triangle. Keep this opening
patent for a few days by inserting a strip of gauze through
it and the upper opening.

 The surgical wound heals by granulation.

  Secondary cause

o Dental affections with suppuration of the alveoli

and root of teeth and perforation of their walls into
the sinus.

MODULE-5: SURGICAL AFFECTIONS OF SINUS

Symptoms
AND HORN
 Nasal discharge – mucopurulent, non-offensive

AFFECTIONS OF SINUS  Pus – grayish, yellowish – white and with streaks of blood
occassionally

 Pus in the sinuses  Sinus – swelling, dullness on percussion

 Inflammation of sinus ( Sinusitis)  Lacrimation , mucus plugs

 Foreign bodies
Diagnosis
 Parasite
 Respiratory noise ( Rule out glanders by Mallein test)

 By exploration of the sinus through an opening made by a

PUS IN THE SINUSES
trephine.

Prognosis: generally be guarded.

Etiology

 Causes may be primary or secondary Treatment

 Primary cause  Drainage can be facilitated by extraction of the affected

tooth
o Injuries of the wall. Viz,., contusion, open wound-
causing bleeding into the cavity.  Flush the cavity with diluted povidone Iodine

o Pyogenic organisms may multiply and cause  Administration of antibiotics following a antibiogram test.
suppuration.
 FOREIGN BODIES SINUSITIS

 Not common. Etiology

 Smooth, clean foreign bodies without causing much
damage to the tissues may remain ‘in situ’.
 Some foreign bodies set up the condition of “pus in the
sinus“.
 Frontal sinusitis in cattle associated with dehorning
 Maxillary sinusitis associated with infected teeth
 Infection

PARASITES Clinical findings

 Frontal sinusitis occurs immediately after dehorning

 In dog, frontal sinus – linguatula because the wound is still open.

 In sheep, frontal and maxillary sinus- estrus ovis  It may be unilateral.

 Anorexia
Symptoms
 Pyrexia
 Mucoid discharge, sneezing and snoring and animal rubs
the nose with the claws.  Nasal discharge

Treatment  Dysponea

 Not very satisfactory.  Foul smelling breath

 After trephining , antiseptics can be injected into the sinus Diagnosis

to control infection.
 Percussion : may reveal a dull sound over the affected
 Parasites may be removed mechanically with forceps sinus .

 Radiographs:fluid in the sinus, dental disease, bone lysis

  Cytology of the discharge.  Sinus flushing - This is performed through a trephine hole
made just lateral to the midline on a line joning the
rostaral margins of the supra orbital process. An
Treatment
intravenous tubing is usually preferred to flush with
trypsin solution
 By draining the affected sinus

 Maxillary sinusitis-infected tooth can be repelled Sinus drainage

 Once draninage has been established, the sinus can be  This is more radical approach. Periostium is elevated to
lavaged daily with antiseptic solution , preferrably with remove the bony layer over the sinus with rongeurs to
pottassium per magnate. effect drainage

 Parenteral antibiotic
HORN - ANATOMY
 NSAID

 The cornual process of the frontal bone encloses the horn

Prognosis: Guarded
and corium of horn completely envelops the horn core and
fuses with its periosteum.
Control
 The frontal sinus is continous with horn.
 Dehorn calves at young age- by closed dehorning
technique  It is also known as flint bone.

 Dust control  Horn corium covers the horn core, It secrete horn shell.

 Fly control  Blood supply: The cornual branch of the superficial

temporal artery and its satellite vein supplies horn.

CHRONIC SINUSITIS IN CATS  Nerve supply: The cornual branch of the lachrymal nerve
supplies horn. Lachrymal nerve is the branch of
ophthalmic nerve, which in turn is the branch of
 Etiology - secondary viral or bacterial infections. trigeminal (fifth cranial nerve) nerve.

 Interior of horn: Consists of irregular space, which are

Treatment
continuation of the frontal sinus.
  Buffaloes: Horns are massive, angular and well developed  Chronic inflammation of keratogenous membrane .
with wider base compared to cattle. The thickness of horn
increases towards apex until it become solid. The corium is
Symptoms
traversed by numerous blood vessels.
 Horn shell will be loosely attached and falls off.
AFFECTIONS OF THE HORN
 The horn core and corium will be exposed.

 Hemorrhage from the site and from the nostril of the

Abnormal horn growth affected side .

 Since the bony core is sensitive the condition is often

 Abnormal painful.
Growth
Prognosis
 Avulsion of
horn  The hemorrhage can be easily arrested and regeneration
(separation of occurs.
horn cover).

 Fracture of Treatment
horn.
 Regional nerve block: Cornual nerve block
 Fissures in
horn and horn  Effecting a cornual nerve block will alleviate the pain and
core. ease the management procedures.

 Horn cancer  Clean and disinfect the exposed horn core.

 Protect it with an antiseptic pad and bandage

Avulsion/evulsion of horn  Application of Tr. Benzoin bandage will control bleeding.
 Etiology: Direct violence  Fly repellents also will help to avoid maggot infestation.
 Repeated injury by yoke. Direct violence
  Clean with mild antiseptic lotion and apply or  For incomplete fractures or fracture at the tip of horn
sulphanilamide – shark liver oil or any emollient immobilization using plaster of paris is recommended
antiseptic dressing.
 For fractures at middle third or lower third of horn
stabilisation is not possible. So amputation is done below
FRACTURE OF HORN the level of fracture. Control hemorrhage with Tr Benzoin
and bandage.

 For fracture at lower third of horn amputation by flap

Etiology method is advocated.
 External violence. Usually oblique fracture and broken
surface will be irregular.

Classification

 Complete fracture: fracture of the horn through its full

thickness.

 Incomplete fractures: Only a part of horn is fractured.

 Fracture near the tip of horn.

 Fracture at the middle of horn.

Horn amputation
 Fracture at the base of horn.

Surgical procedure
Clinical Signs
 The amputatin is carried out through the frontal bone
 Presence of an open wound and bleeding from the part
below the base of the horn after flapping the skin forwards
and from affected side nostril are the signs
and backwards in two halves by a long elliptical incisio
extending from the nuchal crest to the frontal ridge.
Treatment
 The horn is amputated with an axe blade; bleeding is
 Treatment option depends on the type of fracture controlled.
  The skin flaps are sutured in apposition with interrupte 1. Application of caustic pottash sticks to destroy the
sutures. horn bud.This is simple but painful.

Complications 2. Use of red hot Iron-or electrically heated iron to

destroy the horn bud.In this method there will not
 Empyema (pus) in frontal sinus. be any pain or haemorrhage. The heated circular
brim destroys the corium and there by prevents
growth of horn.
DEBUDDING
3. Use of Debudding forceps- it works like a scissors
and is used to clip the horn bud.

MODULE-6: SURGICAL AFFECTIONS OF TEETH

This operation is done to prevent the growth of horns in cattle DEVELOPMENT OF TOOTH
.The most suitable age is 5- 10 days old.

 The enamel develops from epithelium lining of the buccal

Techniques cavity of the embryo.
 There are three methods:  Ameloblasts of the enamel organ form enamel for the
developing tooth.
  Lining the pulp cavity are specially modified connective
tissue cells called odontoblasts and their function is the
production of dentine.
 A thin layer of bony tissue or cementum later forms on the
outer surface of dentine around the root of the tooth.
 The dentine, cementum and pulp are derived from the
mesenchyme.
 The roots of the teeth are fairly constant. The incisor and
canine teeth of both jaws have single root each. In the
upper jaw, the first cheek tooth has one root, next two
cheek teeth have two each and the last three cheek teeth
have three roots each. In the lower jaw, the cheek teeth
have two roots each, except the first and last which have
one. The most important tooth clinically is the upper
4th premolar (carnassial tooth) which has two anterior
roots in a transverse plane and a single large posterior
root.

STRUCTURE OF TEETH  The outer surface of the incisor teeth is the labial surface
and that of the cheek teeth, the buccal surface. The inner
surface of the teeth is called as the lingual surface. The
inner surface of the teeth which face the opposite dental
 The crown is the part of the tooth projecting above the
arch is known as the occlusal or masticating surface.
gums and the root is the part contained within the bony
tooth cavity or alveolus. The crown and root meet at the
 The teeth are held in sockets called alveoli. The
neck, which is covered by the gum.
periodontal membranes serve as periosteum to the
alveolar bone and provide a firm attachment between the
 The hard portions of the tooth consist of the enamel,
root of the tooth and the bone. It consists of thick collagen
cementum and dentine. The dense, pearly white, outer
bundles and differs from the usual periosteum in that
layer of the crown is the enamel which is the hardest
there are no elastic fibres.
substance in the body. At the neck, enamel is continuous
with the cementum which is a thin layer that covers the
 The gums (gingivae) cover the hard palate and the alveolar
root except for the apical foramen. The cementum is bone
processes of the upper and lower jaws and surround the
like tissue and is difficult to distinguish from the dentine
necks of the teeth. The gums are dense fibrous tissue and
which it covers. The bulk of the tooth is formed by dentine
are covered with mucous membrane and are continuous
which surrounds the pulp cavity. It is thickest in the crown
with other soft tissues of the mouth.
and tapers to a point at the root. Its outer surface is
covered by enamel in the region of crown and by the
cementum in the region of the root.
DENTAL FORMULA
 The soft portion of the tooth is the pulp which is composed
of sensory nerves, arteries, veins and lymphatics and
primitive connective tissues which hold them together. Species Dental formula
The small apical foramen at the end of the root enables the
passage of vessels and nerves in and out of the tooth.
 Cattle ANOMALIES

Deciduous 0/4 , 0/0 , 3/3 = 20 Abnormal number of teeth

 Supernumerary incisors and molars are frequently seen

and it must be differentiated from retained deciduous
Permanent 0/4 , 0/0 , 3/3 , 3/3 = 32
teeth.

 There may be one or two extra teeth or a complete extra

Dog row of teeth

 Due to lack of wear by not coming in contact with any

Deciduous 3/3 , 1/1 , 3/3 = 28 apposing teeth, these extra teeth show abnormal
prominences which cause injury to soft tissues are to be
shortened or removed.

Permanent 3/3 , 1/1 , 4/4 , 2/3 = 42

Irregularities in the shedding of temporary teeth

 The temporary teeth may persist for a longer period. This

Permanent teeth may in turn delay the eruption of the permanent teeth or
may alter their direction.
 Upper jaw: 2(I3 C1 P3-4 M3)
Abnormalities of the position and direction of teeth
 Lower jaw: 2(I3 C1 P3 M3)
 When the teeth grow in an abnormal position or direction,
 Goat: The adult goat's dental formula is they fail to come in contact with their counterparts in the
0/3.0/1.3/3.3/3. The juvenile formula is 0/3.0/1.3/3. opposite jaws. This causes lack of wear and the teeth
become excessively long, causing injury to the soft tissues
 At five years all permanent incisors are in wear. they come in contact with.

 Periodical shortening of the overgrown teeth is indicated

CONGENITAL OR DEVELOPMENTAL in such cases.
Abnormalities due to alterations in the substance of the  This condition is common in dogs and cats. Tartar consists
of organic matter, bacteria, calcium carbonates and
teeth phosphates,

 Dentigerous cysts  This condition predisposes to gingivitis and alveolar

o A dentigerous cyst is one containing a tooth from
the bone over which it is situated. It is seen
occasionally in the horse and rarely in cattle, sheep
and dogs.
o It develops soon after birth, along with tooth
eruption and is usually noticed by about two years
old. It appears initially as a soft painless swelling
towards the front of the base of the ear.
periostitis.
 The tartar is removed with dental scalers and they are
used from alveolar border to prevent injury to the gum.
 In chronic cases, this may leads to a condition called
dental calculus
 The picture shows presence of dental tartar in the canine
tooth and calculus in the premolars in a dog.

o Later the wall of the cyst ulcerates and then

ruptures, leading to the escape of the fluid.

o Passing a probe through the opening may confirm

the diagnosis. As a rule, the teeth are not firmly
fixed, but embedded deeply in the temporal bone.
Several teeth may develop successively, following
removal of a tooth.

Treatment

 Surgical excision of the lesion and try to extract the teeth

without fracturing the skull. Dental tartar int the canine tooth and calculus in the premolars

ACQUIRED AFFECTIONS OF TEETH ALVEOLAR PERIOSTITIS

 Dental tartar - is a greyish brown or yellow deposit  Inflammation of the alveolar periosteum is alveolar
accumulating in the teeth. periostitis and it may be classified into two types.
 o Chronic ossifying alveolar periostitis
o Purulent alveolar periostitis
 The chronic ossifying alveolar periostitis is more common
in horses and cattle.
 Suppurative or purulent type of alveolar periostitis is seen
commonly in carnivores.
Chronic ossifying alveolar periostitis
 Chronic ossifying alveolar periostitis is characterized by
the formation of exostosis on the root of the tooth.
 The lower molars are more commonly affected.
 The 3rd and 4th molars are more often diseased than the
other teeth.
 The incisors are only rarely affected.
Etiology
 Inflammation of the alveolar periosteum is caused by the
presence foreign body or infection.
 Accumulation of food materials or tartar, fracture of the
jaw involving the alveolus, caries of the tooth, excessive
wear of tooth up to the level of the gum etc. exposes the
alveolus to infection.
Symptoms
 Slow mastication, quidding and accumulation of food
between the teeth and cheek are seen.
 Food is not chewed in the affected side of the mouth. A
peculiar ‘carious’ smell from the mouth is present.
 Receding of the gum and change in the direction of the
affected tooth as it becomes loose are also observed.
Treatment
 Extraction of the affected tooth is the treatment.
Purulent alveolar periostitis
 Purulent type of inflammation of alveolar periosteum is
commonly seen in dogs.
 Any condition that interferes with attachment of teeth to
the gums and alveolus may be considered as a
predisposing factor.
 It is a sequel to gingivitis from any cause.
 Accumulation of tartar may be considered as main cause
for the condition.
 This condition is commonly seen in dogs maintained on
soft food.
 Lack of proper chewing is supposed to predispose
softening of gum.
 Gingivitis and alveolar periostitis in the devitalized gum
tissue due to the action of micro organisms.
Symptoms
 The condition is characterized by local inflammation and
pus formation.
 The gum will be red, swollen and bleeds easily.
 There will be ulcerations on the gum and deposition of
tartar on the teeth.
 Slimy discharge may be seen on the gum or drooling out.
 Halitosis (foul smell from the mouth) will be invariably
present.
 Falling of the teeth will be there in due course.
Treatment
 Treatment involves scaling all the teeth and extracting the
ones which are diseased, along with enough antibiotic
cover.
 A large number of teeth will reattach to the alveolus if the
treatment is started before the condition is too advanced.
SHARP TEETH
 Sharp teeth are commonly met with in cattle and horses.
 The sharpness is seen on the outer border of the upper
molars and the inner border of the lower molars.
 As the upper jaw is wider than the lower jaw, the outer
border of the upper molars and the inner border of the
lower molars extend beyond the tables of the opposing
teeth. But under normal conditions, there is more or less
uniform wear of the tables because of the side to side
movements of the jaws during mastication.
 When the side to side movement of the jaws is restricted
due to some reason, as in the case of weakness of the
masseter muscles, painful lesions in the mouth, etc, the
wear at the above mentioned borders is restricted. This
result in extra sharp borders.
 The sharp borders cause injury to the cheek and tongue
and also make lateral movements of the jaws difficult.
 The restricted jaw movements so caused further
diminishes the wear at the already prominent borders and
aggravates the condition.
Symptoms
 As the sharp borders of the upper molars rub on the cheek
and those of the lower molars cause injury to the tongue
during mastication, resulting in pain. There will be
imperfect grinding of food.
 The animal may hold the head to one side during chewing.
Partially chewed food materials mixed with saliva may
drop out of the mouth while chewing, i.e. quidding, will be
invariably present.
 Foaming saliva may be seen at the borders of the mouth
while chewing. If the mouth is opened and examined, food
materials accumulating between the cheek and molars
may be seen.
  The sharp edges of the teeth can be either palpated from
outside or they can be detected during open mouth
examination. There may be wounds or ulcers on the
tongue and inner aspect of the cheeks. There will be a
gradual loss of general condition of the animal due to
improper feeding.
Treatment
 The mouth is kept open by means of an oral speculum or
by holding the tongue pulled out through the opposite
side and the sharp borders of the teeth are rasped.
OVERLAPPING MOLARS AND OTHER
ABNORMALITIES
Overlapping Molars (Shears mouth)
 In this condition, the outer border of the tables of the
upper cheek teeth and the inner borders of the lower cheek
teeth become so prominent that they overlap like the
blades of the shears.
 Sometimes the borders may be so sharp as to injure the
opposite gum.
 Treatment consists of periodic rasping of the sharp edges.
Irregularities of individual teeth due to lack of wear
 In this condition, part of the table surface of a particular
tooth may project due to lack of wear. This is commonly
called as a dental hook.
 Dental hooks may cause injury to cheek, tongue or the
opposite gum. Dental hooks are commonly seen on the
first upper cheek tooth and the last lower molar in
herbivores.
 Dental hooks can be removed by using tooth shears or may
be rasped.
Wave-formed mouth
 In this condition, the plane of the tables of the teeth is
irregular, certain teeth being very short and their opposing
counterpart in the opposite jaw too long. Usually the
4th cheek teeth are affected in this manner.
 The teeth become short either due to some lack of
durability of the crown or due to diseases of the alveoli.
 The difficulty in mastication is caused by the opposing
long tooth causing injury to soft tissues.
 Treatment: To avoid difficulty in chewing, a soft diet may
be prescribed. Remove the sharp points and edges of the
long tooth by rasping or extract the tooth. If alveolar
periostitis is present, it should be treated.
Step-formed Mouth
 This is also caused by over growth of individual molars.
 It may also result from loss of the opposing tooth.
 The irregularity in the table surface is much more than in
wave-formed mouth. But the line of treatment is as in the
case of wave formed mouth.

Premature wear of teeth
 In some individuals, the crown of the teeth becomes worn
to the level of gum at a very young age. This causes pain
while chewing and also causes alveolar periostitis.
 There is no treatment for this condition.
 The wearing of teeth may be retarded by feeding on soft
diet.
Smooth mouth
 This is caused by an excessive wear of teeth. The table
surfaces of teeth appear very smooth instead of having the
normal rough grinding surfaces. This interferes with
proper mastication and the animal loses condition.
 There is no treatment for this condition.
 Soft diets may be prescribed.
OTHER DISEASE CONDITIONS OF TEETH
 Apart from alveolar periostitis and sharp teeth, the
following conditions are also affecting the teeth
o Mal Occlusion
o Shaky tooth in dogs
o Dental fistula
o Odontoma
o Ameloblastoma/Adamantinoma
Mal occlusion
 When the upper jaw is much longer than the lower jaw,
the upper incisors overhang the lower ones. This condition
is called Parrot Mouth/Brachygnathism.
 In this condition, the lower incisors are likely to cause
injury to the hard palate. When the lower jaw is longer
than the upper jaw, the condition is called as
hypognathism / prognathism / pig mouth / sow mouth.
The prognathism is accepted in certain breeds like
brachycephalic breeds whereas in breeds like Dachshund
and Collies, brachygnathism is common and such
malocclusions may be ignored.
 An aberrant tooth may project into opposing soft tissue
and cause pain and irritation and in such conditions, such
tooth may be extracted or their rough edges may be filed.
Shaky tooth in dogs
 This condition is generally due to the accumulation of
tartar. This condition has to be differentiated from the
natural shedding process of the teeth at the appropriate
age.
 Treatment: If tartar is removed and subsequently the
mouth and the teeth are kept clean, some cases may
respond positively. Remaining cases in which response is
not there, dental extraction may be advised.
Dental fistula
 A dental fistula is produced by the communication of the maxillary sinus or on the outside skin and discharge
root of a tooth with the outside. may be seen through the nostrils.

 Etiology  Diagnosis

o A dental fistula may be resulted through external o Clinical symptoms

injury and infection.
o Radiography: Alveolar abscess can be demonstrated
o Alveolar periostitis and caries of the tooth are the radiographically in a medial oblique projection with
main causes. the affected maxilla in contact with the film.

o Dental fistula affecting the fourth upper cheek tooth

in dog usually results from alveolar periostitis.

o The roots of this tooth are located in the antrum

(maxillary sinus) and hence this condition is
popularly known as “pus in the antrum”.

o The 4th upper premolar is clinically important

because an abscess at the root of this tooth
invariably breaks through the alveolus and
discharges to the outside, ventral to the eye.

o The lesion can vary from a small, hard swelling or

subcutaneous cellulitis to a persistent or recurring
fistula.

 Symptoms
Dental X-ray unit for small animals
o In dog, the pus is seen to escape through a small
opening on the skin below the lower eye lid. There
may be pain and difficulty in mastication. But in
many cases, there is no noticeable involvement of
the tooth.
 Treatment
o In horses, dental fistula affecting the upper molars
may either open into the nasal chambers or into the
 o Removal of the affected tooth and the necrosed
pieces of bone are the treatment.  When the tum
is presen
o In the case of carnassial tooth, in most cases, the extraction of t
single posterior root will be involved. tooth will
difficult or
o The affected carnassial tooth is extracted and the some case
alveolus and the draining tract are curetted impossible.
thoroughly.
 In such case
o In cases of involvement of maxillary sinus, open it curetting
up and clear the sinus cavity. chiseling out t
tumorous grow
o Sufficient antibiotic cover should be given under gener
systemically as well as locally. anaesthesia is t
treatment.

Odontoma

Ameloblastoma/Adamantinoma
 It is the tumor
composed of tooth  This tumor is not arising from the ameloblasts, but from
tissue originating the odontogenic epithelial remnants.
from
odontoblasts. It is  The tumor occurs sporadically in cattle, sheep and
only very rarely buffaloes.
met with in
domestic animals.  Animal feels difficulty in mastication and deglutition due
to abnormality and pain.
 The tumor may
occur in any  In advanced cases, the incisors are displaced and
position on the embedded in the growth.
mandible or
maxilla.  Treatment is similar to that of Odontoma.
  Infection of a dental root with damage to the periodontal
EXODONTIA / DENTAL EXTRACTION membrane is the most common indication for extraction.

 The infection may be either primary bacterial invasion or a

Indications
 The indications for tooth extraction are,
o Retained deciduous teeth
o Infected teeth
Technique
o Traumatised teeth
o Mal occluded and supernumerary teeth
 Normally the eruption of permanent tooth causes the
shedding of the temporary one, whose roots are small and
rudimentary.
 The cause for failure of shedding of temporary teeth is
considered to be due to the failure of the periodontal
membrane to detach from the tooth and alveolus.
 Canine distemper may facilitate retention of temporary
teeth.
 Retention of the cheek tooth is very rare as the growing
permanent tooth virtually push the temporary tooth out.
But the permanent incisors and canines being not directly
beneath the deciduous teeth, if they are not shed in time,
there will be extra number of such teeth.
sequel to gingivitis.
 In brachycephalic breeds and in certain individuals, short
jaws lead to crowding of the teeth and malocclusion. In
such cases, it is advisable to extract those maloccluding
teeth.
 The instruments required for dental extraction are root
elevators, canine extractors, molar extractors. Small sized
hack saw blades, bone chisels, rongeur forceps and
periosteal elevators.
 In small animals, general anaesthesia is required to get
effective control of the patient. Regardless of type of tooth,
the principle of tooth extraction is to displace the root
from the socket using a root elevator.
 The first step is to loosen the gums by inserting the
elevator completely around the neck between the tooth
and gum. The elevator is then inserted around the root,
separating it from the remaining attachments

 In the case of puppies, if the temporary incisors or canines

are not shed even by 6-7 months of age, they should be
extracted.

 Loosening the root in the alveolus can be hastened by
using the dental extractor to twist the tool gently back and
forth. Once the tooth is loosened, the back of the extractor
can be used as a fulcrum against the remaining teeth to
withdraw the loosened one.
 The upper molar and 4th premolar teeth present special
problems because they have 3 roots. The single posterior
root should be separated from the anterior pair before
extraction. After loosening the gum from the neck, the
tooth is split with a tooth splitter or a small hack saw
blade. Once split, the roots can be extracted separately as
described earlier.
 The upper carnassial tooth may some times pose difficulty
while extraction. In such cases the alveolar resection
method is adopted. In this case, the gum over the affected
tooth is incised vertically between the anterior and
posterior roots. The gum is reflected from the tooth and
then the lateral aspect of the alveolus is removed with a
mallet and chisel. The root elevator is driven between the
roots and by it’s up and down movement, roots are
loosened.
 Loosened molars are removed using molar extractors. The
cut edges of the gum may be apposed with
interrupted absorbable sutures. In the case of canine teeth,
their long root and firm attachment present difficulty
while extraction. In cases of failure of conventional
methods of tooth extraction, the alveolus may be opened
using a bone chisel from the neck to the apex of the root,
after retracting the gum. The lateral wall of the alveolus is
removed and the root is loosened and the tooth is
removed. The gingival incision is sutured with interrupted
sutures.
Post operative care
 Control of haemorrhage is most important. This is done by
packing the alveolus with cotton or absorbable gelatin
foam.
 The alveolus should be checked for bone spicules or rough
edges and in case of their presence, they should be
removed with a burr or a rongeur forceps. Most alveoli fill
with granulation tissue and ossify. But if the cavity is very
large or when many teeth are removed, the alveoli should
be packed with dental wax. This will seal the cavity and as
the granulation tissue fill the cavity, this plug will be
pushed out.
Post operative complication
 Osteomyelitis, endocarditis and suppurative arthritis are
the common sequelae to oral surgery. Hence these can be
prevented by providing sufficient antibiotic cover, which
should be started a day or two ahead of surgery.
REMOVAL OF MOLARS IN BOVINES
  Extraction of molars is indicated in ossifying alveolar
periostitis, odontoma and in extensive caries.
Anaesthesia and control
 General anaesthesia or local infiltration anaesthesia or
maxillary nerve block or mental nerve block may be given
and the animal is controlled on lateral recumbency.
BISHOPING
Anatomy
 The roots of the first three cheek teeth are directed slightly
forward and are not in maxillary sinus. But the roots of the
4th and 5th cheek teeth are in the floor of the maxillary
sinus and are directed backwards.
 The infra-orbital and alveolar branches of the internal
maxillary artery supply nutrition. The branches of the
maxillary nerve exit through the infraorbital foramen and
supply the upper cheek tooth. Mandibular nerve supplies
the lower cheek teeth.
Technique
 Simple extraction by using dental forceps is possible in
cases when tooth is diseased.
 Repulsion through the maxillary sinus after trephining the
maxillary sinus and removal of the external alveolar plate
in cases where the roots are embedded in the sinus. Here
the maxillary sinus is trephined in level with the root of
the affected tooth. The mouth is kept open using a mouth
gag. The roots of the tooth are identified by breaking the
alveolar plates using a chisel and mallet through the
trephine opening. A punch is applied against the root in
the direction of the tooth and it is struck with a mallet till
the tooth could be safely extracted by the hand in the
mouth. Occasionally it may become necessary to break the
root from the crown and remove them separately.
 In the case of lower cheek tooth, trephine openings are
made on the inferior borders of the ramus of the mandible
and the tooth is repelled out.
 Bishoping is a technique used to make an aged horse to
appear as young by creating infundibular marks
artificially.
 The normal infundibulum marks disappear from centrals
by six years. From lateral and corners by seven and eight
years respectively.
 By staining with silver nitrate, the artificial infundibulum
marks are made to resemble normal infundibulum marks.
 Artificial marks less deep on centrals, moderate in laterals,
deeper in corners.
 Bishoping can be easily detected by noting the shape of the
table surface of the tooth.
 In the young horse (<8 years), the table is roughly oval
sideways, whereas in aged animals (>8 years) the table is
triangular.
 In very old animals the tables become circular in shape
and also the artificial markings are not lined by enamel
unlike the normal infundibulum.
DISEASES OF THE GUM

Oral tumors

 Oral cavity is the fourth most common site for neoplasia.

 The epulides are the most common class of oral neoplasms

and accounts for 30%, less occurence is reported in cats.

 They are firm gingival masses arise from the priodontal

ligament.

 There are three types - fibromatous,ossyfing and Oral tumors Oral tumors
acanthomatous.

 Oral pappilomas are benign tumours and regress

spontaneously.

 surgical resection is indicated only whn there is dysphagia.

 o Mandibular

o Sublingual

o Zygomatic salivary glands

AFFECTIONS OF THE SALIVARY GLANDS

MODULE-7: SURGICAL AFFECTIONS OF THE It includes,

SALIVARY GLANDS
 Open wounds

 Stenson”s duct

 Salivary fistula

 Foreign bodies in
LEARNING OBJECTIVE the salivary ducts

 At the end of this module the learner  Destruction of the

should be able to understand the function of the
surgical conditions affecting the gland
salivary glands and its treatment.
 Salivary calculi

 Tumors

 Subparotid
INTRODUCTION abscess

 Major salivary glands for surgical significance are

OPEN WOUNDS
o Parotid
  If parotid gland is wounded, there is an escape of saliva  Suture the cutaneous wound and bandaged with povidone-
through the wound. iodine. The patient should not be given any solid food for
24 hrs.
Treatment
SALIVARY FISTULA
 Arrest the haemorrhage by appropriate measure. If some
of the large vessels are severed, they must be promptly
secured by artery forceps and then ligate.
It may be due to a wound of the parotid, or submaxillary, salivary
 If the vessels cannot be secured by artery forceps, the
gland or of stenson’s duct or Wharton’s duct.
vessel should be isolated at some distance from it and then
the ligature is applied.
 Etiology
 Ligation of the carotid may not stop, persistant
o It may be caused by an open wound or an abscess
haemorrhege from the internal carotid noticed, it can be
anastomosed with the corresponding artery on the other involving the canal
side. Suture the wound and apply bandage.
 Symptoms - Refer dollar

STENSON’S DUCT - WOUND  Treatment

o It occurs due to a recent incised wound of the gland

 Wounds of the duct may be transverse, longitudinal or
oblique and partial or complete.
 During feeding , there is copious discharge of saliva from
the wound. It is more difficult to obtain healing of the
lesion here than in the gland.
Treatment
 For promoting healing by first intension,perforate the
cheek at the level of the wound, when the latter is near the
mouth, to provide another passage for the saliva.
or duct, endeavour to get healing by first intension.
If the fistula has been in existence for some time,
cauterization of its edges or freshening is done.
After that, suture should be done.
o Application of silver nitrate or pure nitric acid with
a glass rod or of the hot iron, or freshening the lips
of the wound and inserting a purse- string suture is
often successful. After that there is no obstruction to
the flow of saliva.
o If the above methods fail, one of the following
procedures may be adopted:
Destruction of the function gland  Apply antiseptic mouth lotion for a few days.

Indication SALIVARY CALCULI

Occlusion of the duct and retension of secretions

 Usually occur in stenson’s duct; rarely in wharton’s duct
Treatment
 The size of calculi weighing individually 7-12 ounces have
been recorded (mention in grams).
 injection of irritants
 An isolated calculus is oval; smooth and yellowish grey in
 ligation of stenson’s duct ( refer practical for surgical
colour.
procedure)
 Composition of deposit 80-90% calcium carbonate and 9-
 clearing the lumen of the distal portion of the duct
10% organic matter.
 making an artificial opening into the mouth
Etiology

FOREIGN BODIES IN THE SALIVARY DUCTS  Small particles with bacteria carrying into the duct, which
cause fermentation in the saliva.

 Small particles may enter into salivary glands and set up  Consequent deposition of lime on the foreign body.
inflammation
Treatment
 Foreign bodies rarely causes irritation and form a calculus
 First force the calculus into the mouth and then remove it.
Treatment
 If it bulge into the oral cavity, incise the mucus membrane
 To remove the foreign body, give pressure on the course covering the calculus and take it away.
of the duct
 Suture the wounds in the duct and skin separately,using a
 Otherwise , oral orifice of the canal may be incised or very fine needle.
wharton’s duct may be incised.
Tumors
  The common tumors in pariotid glands are melanomata,  Collection and accumulation of saliva due to blockage of
which are found chiefly in grey horses. the duct and is surrounded by granulation tissue.

Treatment Symptoms

 If the tumor is benign and circumscribed surgical  Presence of a sweelling in the site subcutaneously.
excission is carried.
Diagnosis
 If it is malignant or diffuse , it is better not to interfere.
 From symptoms and exploratory pucture.
PAROTID ABSCESS
Treatment

 Strangles in the horse and tuberculosis in the ox may lead Establishment of the patency of the duct
to abscess in subparotid region.
 Mandibular and sublingual salivary gland excision-
 It is a painful inflammatory swelling. mucocele.

 It may burst in the course of 8-14 days.  Zygomatic gland excision- zygomatic mucocele.

Treatment  Parotid gland excision .

 Open the abscess and drain the content.  Destruction of gland.

 It may be possible to open the abscess bluntly after

incising the skin.

 Use suitable antiseptic dressing and systemic antibiotic.

SALIVARY MUCOCELES
 Acquired conditions

 Fracture of the superior maxilla

 Fracture of the premaxilla

 Fracture of the inferior maxilla

 Contusion, sinus ,fistula

 Open wounds

 Tumors

 Affections of the temporo-maxillay articulation

o Contusion

o Open wounds

o Dislocation
MODULE-8: AFFECTIONS OF THE UPPER AND
o Fracture
LOWER JAW

AFFECTIONS OF THE JAWS

Introduction

Congenital / developemntal abnormalities

Prognathism........
Brachynathysim Brachygnathism

 It is manifested when mandible is shorter than the maxilla

CONGENITAL AFFECTIONS
Prognathism
Craniofacial Dysplasia
 When the mandible is longer than the maxilla It is
identified by oral examination wherein the lower jaw
incisors are longer and rostral to the maxillary incisors.
 The condition is called pig mouth.
and upon oral examination the upper jaw is much longer
than the lower jaw the upper incisors overhang the lower
ones. This condition is also called parrot mouth
 It is characterized by convex profile of the nose, shorter
lower jaw, deficient ossification of frontal sutures,
exophthalmos and large tongue in Limousin breed of
cattle.

 It is due to homozygosity through a recessive gene.

FRACTURE OF THE SUPERIOR MAXILLA

Fracture of the superior maxilla

  Etiology o Retention is best effected by means of inter
dental wiring of the adjacent teeth, mini
o Direct violence, collision, striking the head violently plating, and by external skeletal fixation
against a hard fixed object.
with methyl methacyrlate
 Seat of fracture

o Palatine plate or alveolar border. FRACTURE OF THE MANDIBLE, SYMPHYSIS

AND RAMUS
 Treatment

o Loose teeth may become fixed in a few days and Fracture of the Mandible
hence need not be removed

o If suppuration occurs in their alveoli, loose teeth Etiology

should not be removed
 Kicks falls or direct violence.
o Semi liquid diet
 symptoms
o Trephining may be required to allow leverage of a
depressed fragment  repulsion of tooth

 site of fracture can be on body, one / two rami, the condyle

Fracture of the premaxilla / coronoid process.

 Etiology
Treatment
o Direct violence, falling forward on the nose, or by a
kick or blow.  Fracture through symphysis

o Replace the fragments in their normal position and

 Fracture may be transverse, longitudinal, or both , uni or
bilateral maintain them by joining the teeth on either side by
wire.
 Treatment
o In dogs the two jaws can be fixed by bandage.
o Follow the general principles for wounds and
fractures.  Fracture through one side of body
 o Reduce the fracture, wire the teeth, so as to make o Wire sutures through the bone are the best means
the affected side intact. of immobilizing the seat of fracture.

o Bones may be united by wire sutures. o In condition of necrosis of bone , amputation may
be done.

 Fracture of ramus on one side

o Requires no treatment , because of rare chance of

displacement.

o A blister may be applied on the skin at the level of

fracture. Blister cause additional inflammation and
hyperemia, which hastens the healing process.

o In all cases of fracture of jaws, soft easily masticated

food is indicated.

AFFECTIONS OF LOWER JAW IN CATTLE

Mandibular fracture
1. wounds

2. lacerations

 Transverse fracture through the body or through both 3. fractures

rami near the symphysis
4. abscess
o Wiring incisors to the first molars may be useful in
conjunction with an apparatus to form a ‘V’ fixed to
 The causes for the first three conditions in new born calves
the lower jaw.
are injuries associated with obstetrical procedures.
o The apex ‘v’ being spoon – shaped to support the
 Abscess in lower jaw could be due to migration of ingested
chin and its branches being grooved to adapt
pnetrating foregin bodies
themselves to the horizontal rami.
 Tumors
CONTUSIONS , SINUS AND FISTULA
 Upper jaw is most commonly affected than the lower jaw.
Horse and dogs are frequent victims.
Etiology

 Contusions : similar to fracture. VARIETIES OF NEW GROWTH FOUND

AFFECTING THE MAXILLARY BONES
 Sinuses on the root of the tooth results in the formation of
dental fistula.
 Dentigerous cysts: they persists without much
Symptoms inconvenience but occasionally suppurate leading to
necrosis.
 Similar to acute / chronic traumatic inflammation / of a
sinus/ fistula in the bone.  Fibromata: seen mostly in the alveolar borders. Undergo
calcification/ossification.
 A sinus in the bone is characterized by a suppurating
orifice surrounded by a hard inflammatory enlargement.  Chondromata: hard sub periosteal tumors.

 Sarcomata: developing in the substance of bone/ beneath

Treatment periosteum

 When the sinus is in the mouth, dilate the opening - the  Carcinoma: More common than sarcomata in horse
sinus tract and remove loose bone and curette the bone.

 When there is an external sinus into the bone, remove Treatment

ellipitical piece of skin around its orifice and enlarge it by
trephining and irrigate with iodine and dressed with  Benign tumors , small and circumscribed - extirpation can
iodoform/BIPP ( Bismuth subnitrous iodoform paraffin be performed .
paste).

Open wounds
 MODULE-9: SURGICAL
 Attention needs to be paid in open wounds of the jaw only AFFECTIONS OF THE EXTERNAL
when they are complicated by infection/necrosis of bone.
EAR
AFFECTIONS OF THE EAR AND THEIR
TREATMENT

Anatomy

 The ear is divided in to four parts when the disorders are

considered.

o The Pinna

o The external ear cannal

o The middle ear

Congenital affections
o Internal ear
 Microtia – small ear
 Surgical landmarks of the auricular cartilage are helix,
tragus, antitragus and anthelix
 Macrotia – large ear

 Anotia – absence of ear flap

AURAL HAEMOTOMA

Etiology

 Causes are inflammations, parasites, allergy, and foreign

bodies common physical injury of the ear flap, self
inflicted by scratching and head shaking
Symptoms  Suturing is done to oblitrate the dead space eiether by
through and through matteress suture or partial thickness
suture on the inner side of the pinna .
 Swelling of the flap is more evident on the concave surface
 Application of enough pressure by application of bandage
Treatment to maintain the tissue in position so that scarring is
minimal. Best results are obtained if surgery is performed
 Conservative therapy in 3-4 days after the formation of the haematoma.

 Simple aspiration 2 – 3 times weekly

OTTITIS OF THE EXTERNAL EAR
o Aspiration may be combined with the daily systemic
administration of proteolytic enzymes is an attempt
to liquefy the blood clot. Protective bandage in the
form of pressure bandages. Recurrence is the major Definition
disadvantage.
 It is defined as inflammation of the external auditory
 Surgical incision for drainage and obliteration of the dead canal.
space
Incidence
 Aseptic incision in the form of straight, S shaped or
cruciate are placed to open and remove the blood clots.  Common in the long eared breeds. Rare in horses and
uncommon in other animals

Etiology

 Numerous and multifactorial

 Peculiar anatomy and presence of hair in the canal

 Infection - Staphylococcus, streptococcus, pseudomonus,

proteus, E.coli and Corynebacterium

 Yeast and fungus

 Parasitic
  Atopy Food allergy o Allergy testing

 Metabolic diseases- hypothyrodism Treatment

 Immnune mediated  Medical
 Keratinisation disorder  Irrigation with 1 in 100 povidone Iodine ( Avoid if
typanum is ruptured)
 Accumulation of ear wax
 Specific antimicrobials both systemic and topical based on
Clinical signs ABST

 Pruritus manifested by scraching , rubbing the ear and  Anti inflammatory drugs
shaking,
 application of agents to dissolve the ear wax.
 mild erythema of the ear canal,

 pain on palpation exudation from the ear ZEPP'S OPERATION

 proliferative granulation tissue in chronic cases

 calcification of the ear cartilage

DIAGNOSIS

 From clinical signs and physical examination

o Radiography

o Video otoscopy

o Cytological study

o Antibiogram (ABST)

ANATOMICAL CONSIDERATION
Assessing the length of the Conchal cartilage
vertical ear canal
Site
 The tubular antero external aspect of the concha
Procedure
 Two long curved forceps are applied on either side of the
conchal cartilage with the apex of the V not connected.
 Incisions are made on the conchal cartilage and the skin
incision is reflected and the conchal cartilage is reflected
down and bend to form a board. The drinage will be direct,
Sutures are placed in a continous manner.
 MODULE-10: OPHTHALMOLOGY -
ANATOMY AND AFFECTIONS OF
EYELIDS AND THEIR CONJUNCTIVA
 The Science dealing with the structure, functions and
diseases of the eye is known as Ophthalmology.
 The powers of vision and the adaptation of lenses or
prisms for the aid of vision is Optometry.
 Orthoptics is the treatment of defective visual habits,
defects of binocular vision, defects of ocular motivity, etc.,
by training
 The eyeball and its surroundings:
o The eyeball (Oculus bulbi) is situated within the
bony cavity known as the orbit and is protected by
the eyelids anteriorly. It is surrounded by muscles
and a thick padding of retroubular fat posteriorly.
o The bony orbital rim is complete in some species.
The term closed orbits is used when the bony orbital
rim surrounding the eyeball is complete. Closed
orbit is seen in man, horse, cattle and camel. An
open orbit is an orbit with the bony rim incomplete
so that part of it is made up of a fibrous ligament.
 Open orbit is seen in cat, elephant, pig, dog and
Lacrimal gland
birds.
o The anterior segment of the eye is the portion of the
eye between the cornea and the lens consisting of
the eyelids,, conjunctiva, cornea, iris and pupil, and
the anterior capsule of the lens. Posterior segment
of the eye is from the lens backwards , namely
vitreous and retina .
Eyelids
 The borders of the two eyelids contain the eye lashes. The
third eyelid (membrane nictitans) is a piece of elastic
cartilaginous structure situated at the medial canthus of
the eye.
 The deep part of it is embedded in the retroubulbar fat.
When the eyeball is forcefully retracted, the resulting
pressure in the retrobulbar fat pushes the third eyelid
forwards to cover the eye more or less completely, e.g.,
protrusion of membrane nictitans seen in tetanus due to
the contraction of the retractor oculi muscle.
Conjunctiva
 The conjunctiva has two parts, the palpebral conjunctiva
lining the inner surface of the eyelid and the bulbar
conjunctiva attached to the eyeball.
Refractive media of the eye
 The epithelial lining of the conjunctiva is continuous with
the epithelial lining of the cornea.
Top
 It lies in a depression beneath the supra orbital process
and secretes tears into the conjunctival fornix by means of
small openings. There are numerous accessory lacrimal
glands in the conjunctiva.
 The pre corneal tear film lubricate the epithelial surfaces
of the cornea and conjunctiva. It has antibacterial
properties and is also concerned with the nutrition of the
cornea.
 The excess tears is drained through the two puncta
lacrimalia situated at the inner canthus of the eye into the
lacrimal duct.
 The conjunctival epithelium is continuous with the
epithelium of the lacrimal canal and epithelial lining of the
cornea. The patency of the lacrimal canal can be tested by
instilling a 2% solution of Fluorescein.
 Nictitans gland (Harderian gland): Resembles lacrimal
gland. Situated on the inner surface of the third eyelid
close to its outer border.
 Tarsal glands: These are modified sebaceous glands
situated within the tarsal plate. The ducts of these glands
open along the free border of the eyelid.
 Cornea, aqueous humour, lens and vitreous humour.
 Refractive surfaces of the eye: Anterior surface of the
cornea, anterior surface of the lens and posterior surface
of lens.

Tunics of the eye
 The three coats (tunics) of the eye are
o The tunica fibrosa (external fibrous tunic)
comprising the sclera and cornea.
o The vascular tunic or uvea, consisting of the
choroid, ciliary body and iris which provides
nourishment to the eyeball, and
o The tunica interna (inner layer) formed by
expansion of the optic nerve. Also called the
nervous tunic or retina.
Top
Structure of the cornea
 A section of the cornea reveals the following histological
structure from before backwards: Anterior epithelium,
Bowman’s membrane, corneal substance or substantia
propria or stroma, Decemet’s membrane and endothelium
(ABCDE).
 The anterior epithelium of the cornea and of conjunctiva
are continuous with each other.
 The precorneal tear film is considered as
physiological anterior most layer of the cornea.
Muscles of the eyeball
 There are five straight and two oblique muscles for the
eyeball. They are:
o superior rectus, (retractor oculi),
o inferior rectus,
o external rectus,
o internal rectus,
o posterior rectus (retractor oculi),
o superior oblique and inferior oblique muscles.
 All the straight muscles originate around the optic
foramen and are inserted to the sclera immediately behind
the attachment of the bulbar conjunctiva.
 Posterior rectus or retractor oculi muscle is absent in
man.
Nerve supply
 Motor nerve supply to the muscles of the
eyeball: (3rd,4th,6th cranial nerves)
o All the muscles except three (the superior oblique,
posterior rectus and external rectus), are supplied
by the oculomotor nerve.
o The superior oblique muscle is supplied by the
the fourth cranial or the trochlear nerve, the posterior
and external recti muscles are supplied by the
abducent or sixth cranial nerve (SOFT PEAS)
 Sensory nerve supply to the eye
 o It derives from the ophthalmic and nasociliary
branches.
Top
Blood supply
 Blood supply to the eye is from the ophthalmic arteries
and veins.
Iris
 Iris is a muscular diaphragm between the cornea and the
lens, with an opening in its centre. The opening is called
the pupil. The pupil of horse, cattle and sheep are
horizontally elliptical in shape. In the foal below five years
it is more round; in man, dog, monkey and most birds it is
circular; and in cat and fox it is vertically elliptical.
 The anterior surface of the iris as well as the posterior
surface of the cornea are covered by endothelium. The
posterior surface of the iris is continuous with the pigment
layer of retina.
 Corpora nigra are small black bodies seen on the papillary
border from 11'o clock to 1'o clock angle in equines and is
supposed to protect the retina from sun rays while grazing.
 Anterior chamber of the eye is the space between the iris
and cornea.
 Posterior chamber of the eye is the space between the iris
and the lens.
 Aqueous humour is the clear fluid filling the entire space
between the cornea and lens, i.e., the anterior chamber
and posterior chamber
 The lens is kept in position by the suspensory ligament of
the lens. The lens has anterior and posterior poles.
VISUAL FUNCTION TESTS
 A blind animal is nervous and is easily excitable.
 It shows anxious movements of the ears in an attempt to
grasp the environment.
 It walks with the head held upwards and takes very
cautions steps and has a “feeling gait”.
 During progression it stumbles on account of the inability
to see obstacles on an uneven ground; and in order to
avoid such obstacles it may lift the limbs unusually high
(“high stepping”).
 When driven towards an object like a wall or a post, the
animal may go and strike against the object because of the
inability to see.
 When light is suddenly flashed into a normal eye,
immediate closure of the eyelids is noticed. This is a
protective reflex known as palpebral reflex. Palpebral
reflex is absent in a blind eye.
Photomotor pupillary reflex (Photomotor pupillary
reaction)
  This is the ability of the pupil to react to changes in light. If
the eyes are normal, the pupil contracts when exposed to
bright light and dilates when there is shade or darkness.

 Absence of this reflex may indicate some abnormality.

 Consensual reflex: If both eyes are visual, the flashing of

light into one eye constricts both the pupils. This is called
crossed reflex or consensual reflex. If one eye is blind,
flashing of light into the blind eye will not induce pupillary
reflex of the normal eye.

Detailed ophthalmic examination

 Naked eye examination

o Gross abnormalities of the anterior segment of the

eye can be detected by naked eye examination with
the aid of artificial illumination if necessary. Indirect ophtalmoscope with condensing lens

 Using magnifying binocular loupe

o The binocular loupe consists of two magnifying

lenses and its use is therefore preferable to naked
eye examination.

 By using ophthalmoscope

o Ophthalmoscope is mainly used to view the fundus

o Indirect ophthalmoscope
  It is necessary to dilate the pupil. This can be brought
about by instilling a solution of homatropine (2%) or
tropicamide into eye about fifteen to thirty minutes before
 By using tonometer (tonometry): The intraocular pressure
ophthalmoscopic examination.
(IOP) can be measured by using an instrument called
tonometer.
 The ophthalmoscope contains lenses of varying powers
through which the examination can be conducted. The
 There are two methods of tonometry, indentation
anterior segment of the eye can be examined by using a
tonometry using schiotz tonometer and applanation
lens ranging from +12 to +20. For observing the lens +8 to
tonometry using Tonopen - Vet.
+12, and for vitreous humour 0 to +8, are required. For
the fundus of the eye (retina, optic disc) – 3 or less, may be
suitable. Tonometry

Direct ophthalmoscope  The normal intraocular pressure in the dog ranges from 16
to 30 mm of mercury. The normal IOP in man is 15 to 20
mm of mercury.
Schirmer tear test Naso lacrimal flush

 Irrigation of the nasolacrimal duct system

 The test can be
performed  Fluorescein dye is instilled on the eye
with
commercially
available Schirmer Partial or complete
tear strips.
 26G cat 24G dog and 20G cattle 2 – 10 ml saline
 These strips have a
notch at one end  Cannulated through the upper punctum
which is placed into
the ventral
 Note the passage time
conjunctival cul de
sac.
SURGICAL CONDITIONS AFFECTING THE
 The strip is allowed
EYELIDS
to remain in the cul
de sac for exactly one
minute.
 Chalazion (Tarsal cyst)
 The strip is removed
after a minute and o This is a cyst caused by the distension of a tarsal
the distance the gland with secretion when it is inflammed. The size
wetness have traveled of the cyst may be about the size of a pea or more.
down the strip is
immediately o Treatment
measured in
millimeters from a  Incise and remove the contents of the cyst
scale printed directly using a Chalazion forceps.
on the strip.
 Hordeolum or stye
 Normal values in the
dog are 15 to 25 o It is a localized inflammation of the hair follicles of
mm/minute. the eye lashes due to staphylococcal infection.

o Treatment
  One or two neighboring eyelashes are o Anesthesia and control
plucked with foreceps so as to open the
abscess and drain the pus. After draining the  In small animals - General anesthesia
pus topical ophthalmic antibiotic eye
ointment / drops are indicated.  In large animals auriculo palpebral nerve
block
 Dacryo – adenitis
 Block supra – orbital nerve as it comes out of
o Inflammation of lacrimal gland. supra – orbital foramen (sensory to upper
lid) or by field block. The animal is controlled
o Treatment in standing or recumbent state.

 Fomentations, antibiotics, etc. Do not open o Technique

before it is mature. Spontaneous rupture and
healing usually happens.  A fold of skin parallel to the affected
palpebral border is held by a forceps, enough
 Blepharitis to cause the correction of the abnormality,
and is severed and removed.
o Blepharitis or inflammation of eyelids, causes
ulceration of the palpebral borders. The ulcers  The wound is sutured by ordinary apposition
contain a yellowish or greyish sticky discharge. The sutures.
eyelids may stick together.
 Ectropion
o Treatment
o Outward deviation of the palpebral border resulting
 Symptomatic in an abnormal exposure of the conjunctiva.

 Antibiotics may be used to control infection o Treatment

 Entropion -Congenital/acquired (View image...) o surgical correction

o Inward deviation of the palpebral border, o Anesthesia

trichiasis, Distichiasis, etc.
 In small animals - General anesthesia
o Treatment
 Local infiltration
o Surgical correction
 o Site
 It is ½ to 1 cm away from the free border of
the eyelid.
o Technique
 A 'V ' – shaped cutaneous incision is put
with the base of the “V” close to the affected
border of the lid.
 The triangular flap of skin outlined is worked
loose from its apex by undercutting to effect
correction of palpebral border.
 The gap thus caused at the apex is closed by
suturing the sides of the “V” incision to form
a “Y”.
 Trichiasis and Distichiasis
 In trichiasis the eyelashes are directed slightly inwards so
that they irritate the cornea and conjunctiva. Distichiasis
is a congenital condition in which two rows of eyelashes
are noticed on each lid and the inner row causes irritation
of the conjunctiva. Distichiasis supposed to be hereditary.
o Treatment
 Epilation or plucking of the eyelashes.
 Destroying the hair roots by eletrocautery.
 Complete removal of the hair roots by
snipping the inner border of the lid.
 Operation for entropion may prevent the
eyelashes irriating the cornea.
 Ptosis (Blepharo ptosis)
o Dropping of the upper eyelid may be congenital. It
may be due to paralysis of the seventh cranial nerve.
o Treatment
 The condition may be temporary and may
become normal without treatment. Surgical
correction when necessary can be done as for
entropion.
 Lagophthalmos
o A condition in which the eye cannot be completely
closed. (Lagos = hare).
o Causes
 Paralysis of the orbicularis oculi muscle
resulting from injury to the seventh cranial
nerve.
 Prolapse of harderian gland
 Inflammed lacrimal gland
 Growth on the cornea.
 Staphyloma.
 Granulations on the edges of the eyelids.
  Lagophthalmos causes drying of the cornea  Surgical removal. 1 in 50,000 adrenalin may
and conjunctiva be applied locally to control haemorrhage.

o Treatment  Removal of membrane nictitans (Third

eyelid).
 Remove the cause. Ophthalmic lubricants in
the form of gel may be instilled at frequent o Indications
intervals to moisten the cornea and
conjunctiva.  Hypertrophy.

 The lids may be kept closed by means of one  Neoplasm. , Carcinoma.

or two skin sutures over the closed lids.
o Anesthesia
 Blepharospasm
 General anethesia
o It is a state of partial or complete closure of eyelids.
It may be due to foreign particles irritating the o Technique
cornea, early keratitis and conjunctivitis,
photophobia, etc.  Haemostatic mattress sutures are put along
the base of the third eyelid to control
o Treatment haemorrhage and afterwards it is cut distal to
the sutures.
 Blepharospasm is only a symptom and
treatment depends on the cause.  Tumors of the eye lid

 Parasites in the conjunctival cul – de – sac

SURGICAL CONDITIONS AFFECTING THE
 Thelazia rhodesii in cattle. CONJUNCTIVA
 Prolapse of harderian gland
 Conjunctiva has two parts called palpebral conjunctiva
 Prolapse of the nictitans gland is common in and the bulbar conjuctiva.
the dog due to inflammatory swelling or
hypertrophy. The gland protrudes outwards.
 The normal appearance of the conjunctiva is pink ,
smooth and moist.
o Treatment
  In systemic diseases the appearance of conjunctiva is  Bacterial or virus infection, Irritation due to chemical
altered in gastrointenstinal disorders it is congested, in substances, Presence of foreign bodies, Trauma, Allergy
jaundice it is yellow, shows petichae (pinpoint and Nutritional deficiencies.
heamorrhages) in toxaemia and septicaemic conditions.

 Echymosis of conjunctiva is noticed in protozon diseases

like surra. It is dry and pale in shock, pale and watery in
anaemia, ulcerated in riboflavin deficiency, and thickened
in vitamin A deficiency (Xerophthalmia).

Conjunctivitis

 Inflammation of the conjunctiva is one of the most

common eye diseases.

Sampling for ABST

Classification

 Based on etiology, conjunctivitis may be classified as

specific conjunctivitis (e.g., seen in pink eye in horses,
distemper in dogs), and non – specific conjunctivitis.

 Clinically conjunctivitis is classified into three types, ciz.,

acute, subacute and chronic conjunctivitis.
Conjuctivitis - Goat Conjuctivities and blepheritis in a
 According to the nature of inflammation the following
dog
varieties of conjunctivitis are recoreded.

o Catarrhal conjunctivitis, e.g., conjunctivitis due to

Etiology mild bacterial infection or trauma.
 o Purulent (suppurative) conjunctivitis, e.g.,
conjunctivitis seen in pink eye of horses, distemper
of dogs, etc.

o Diphtheritic conjunctivitis, e.g., croupous

conjunctivitis seen in birds. Diphtheritic
conjunctivitis seen in calves due to infection by
fusiformis necroforus.

o Granular or follicular conjunctivitis, causing small

follicular enlargements on the conjunctiva known as
trachoma.
Chemosis
Swollen conjunctiva through the palpebral fissure
Symptoms

 Lacrimation: In the beginning stages of conjunctivitis

lacrimation is thin and watery. Later it becomes thicker Diagnosis
and has a tendency to stick on to the edges of lids and
cheek. From the symptoms

 Photophobia and blepharospasm are not marked in simple  Treatment

conjunctivitis. If these symptoms are present extension of
inflammation to the cornea should be suspected. o The conjunctival sac is irrigated at frequent
intervals with warm saline solution or a mild
 Discomfort. antiseptic lotion.

 Chemosis (swollen conjunctiva through the palpebral o The eye lotions commonly used were: ZAB lotion
fissure). (zinc sulphate ½ %, alum 1%, boric acid 2%),
percholride of mercury lotion (1 in 30,000 to 1 in
10,000), argyrol (5%) and boric lotion (2 to 3 %).

o 5 % povidone Iodine can be used to cleanse the eye,

followed by topical antibiotics and NSAIDS if
necessary. Always check the integrity of the cornea
prior to use of a corticosteroid.
 o “Chloromycetin applicaps” are found effective in
many cases of conjunctivitis due to bacterial
infection. Other antibiotic eye ointments like
“teramycin eye ointment” are also effective.
Hydrocortisone eye ointments are indicated in
allergic conjunctivitis.
o Symblepharon is a condition wherein the bulbar
conjunctiva is adherent to the palpebral
conjunctiva. This may be congenital or may result
from blepharitis.
 Ankyloblepharon

 Epiphora o It is adhesion of the upper and lower eyelids.

o Epiphora is a symptom characterized by excessive  Pterygium

flow of tears. It may be due to conjunctivitis, or due
to stricture, atresia or obstruction of the lacrimal o Pterygium is a condition where there is growth of
passages. If due to conjunctivitis it passes off when conjunctiva extending towards the cornea.
the inflammation subsides. Irrigation of the
lacrimal passage or exploration with a flexible probe o
is necessary if the condition is due to obstruction or
atresia. Flouorecin passage time can be studied. o Dermoid (Dermoid cyst; Treatoma)

o Dermoid is a misplaced embryonic cutaneous

tissue. It is sometimes seen in the eye. Dermoid cyst
usually contains hairs growing on it and causes
irritation of the conjunctiva and cornea. There is
lacrimation.

 Treatment

o Large sized dermoids may be removed surgically.

o Simple excision of the tissue is usally performed.

Epiphora o If there is corneal involvement, superficial

Excessive flow of tears keratectomy is performed.

Neoplasms of the third eyelid very rare- adenomas,

 Symblepharon
adenocarcinomas and squamous cell carcinomas are reported
  The resulting characteristic appearance of a pink, smooth
– surfaced swelling protruding around the leading edge of
the third eyelid from its inner surface.

Conjuctival tumour Thrid eyelid neoplasms

NICTITANS MEMBRANE GLAND

Prolapse of the nictitans gland

 The gland of the third eyelid surrounds the base of the T-

shaped cartilage.  Dogs treated with surgical replacement of the gland have a
lower incidence of dry eye later in life than dogs that are
o T – Cartilage forms the skeleton of the third eyelid. either left untreated or have the prolapsed gland excised.

o This gland contributes to the aqueous and mucus Surgical procedure

phases of the precorneal tear film.
 Orbital rim anchorage technique
o This is important in maintaining a healthy ocular
surface. o The eyeball was fixed and it is flushed with a dilute
Povidone Iodine
Affections of nictitans gland and its treatment
o An incision is made in the medio ventral
conjunctival fornix using scissors.
Prolapsed nictitans gland
o Blunt dissection allows access to the periosteum of
the medioventral orbital rim.
 o A firm bite of periosteum along the orbital rim is  These tumors are usually pigmented, occasionally
taken using 3 – 0 PDS. nonpigmented.

o The needle is passed dorsally through the most
prominent of prolapsed gland.
o Horizontal bite is taken through the dorsal
prominence of the gland.
o Finally the needle is passed back through the last
exit hole to emerge through the original incision
thus encircling a large portion of the gland.
 The dorsolateral quadrant is usually the site of origination.
 Limbal melanomas occur in 2 age groups of dogs.
 In the younger group of 2 – 4 years of age, the tumors
were invasive.
 In the adult dogs 8 – 11 years of age, the tumors were
stationary.

o The suture ends are then tied.  Primary limbal melanomas must be differentiated from
external extension of intraocular melanomas.
o Post operatively topical antibiotic is given.
Treatment
 Conjunctival pocketing technique
 Full thickness corneoscleral grafts are recommended to
o The eyeball was fixed and it is flushed with a dilute
maintain a functional eye in younger dogs with progressive
Povidone Iodine
limbal melanomas.
o An elliptical incision is made in the apex of the
 Grafts of nictitating membrane cartilage with overlying
prolapsed gland with a No 11 BP blade and using
conjunctiva have been used to replace corneal and scleral
scissors blunt dissection is performed and the
conjunctival piece is dissected out. Further a pocket defects after removal of limbal melanoma.
is made around the gland and the prolapsed gland
is repositioned in to this pocket. Continous sutures  In aged dogs with non progressive limbal masses, periodic
are applied using 4-0 vicryl taking care to burry the surveillance appears to be adequate.
suture ends.

NASO LACRIMAL DUCT OCCLUSION

LIMBAL MELANOMA

 Topical ophthalmic application of fluorescein dye and

 Melanomas may invade the cornea secondarily. observation for its appearance at the nares confirms
 patency of the nasolacrimal duct on that side and is
referred to as the Jones or fluorescein passage test.
 The interval required for fluorescein to appear is variable
(up to 5 to 10 minutes in some normal dogs).
 The tube is sutured in place for 2 to 3 weeks. An
 In some dogs and cats, especially brachycephalic breeds,
drainage from the nasolacrimal duct may occur into the
posterior nasal cavity, resulting in false- negative result of
the Jones test unless the mouth is also examined.
 Care is taken as the tubing enters the punctum. Note: The
inferior punctum may also be used if threading via this
punctum was used. The tubing is pulled down the
nasolacrimal duct, past any obstructions.
Elizabethan collar should be considered to prevent the
tubing from being dislodged.

Symptoms MODULE-11: AFFECTIONS OF THE

 Epiphora unilateral or bilateralIf there is obstruction of EYEBALL
the duct , a naso lacrimal flushing after catheterisation is
practised.

 Nasolacrimal Flush (Catheterization) is indicated for

epiphora and dacryocystitis. SURGICAL CONDITIONS AFFECTING THE
EYEBALL
Procedure for indwelling nasolacrimal duct catheterization for
flushing
Anophthalmia Complete absence of the eye ball
 A monofilament nylon thread (2/0 with a smooth melted
end) is passed via the superior punctum to emerge from
the nose. If an obstruction is present in the sac, the duct is
threaded from the nasal end, and the thread is
manipulated to emerge from the superior punctum.

 Fine polyethylene (PE90), polyvinyl, or silicone tubing

with a beveled end is passed over the thread. Halsted
forceps are clamped behind the tubing, which is pulled
from the nasal end by forceps on the thread. In horses,
larger tubing is used.
  May be congential or sometimes due to debility or
dehydration where there will be reduction in vitreous
volume.

HYDROPHTHALMOS

Hydrophthalmos

 It is an enlargement of the eyeball associated with increase

in the quantity of aqueous humour. When
hydrophthalmos is congenital it is called megaophthalmos
or megaophthalmos congenitus.
Complete absence of the eye ball
 Hydrophthalmos is usually the result of interference with
the drainage of aqueous humour and may be due to the
adhesion of iris to the cornea at the filtration angle.
Exophthalmos
 The tunics of the eyeball, espically the sclera and cornea
 It is an abnormal protrusion of the eyeball. become thin and weak. This condition is common in cats.

 It may be a congenital condition or may be due to

Symptoms
retrobulbar abscess, haematoma, or inflammation.
 Due to the general increase in the fluid contents the
 It may be seen as a symptom of diseases like
eyeball bulges forward causing exophthalmos and
hydrophthalmos and glaucoma.
lagophthalmos. This causes drying or dessication and
interference with the nourishment of the cornea.
 Exophthalmos due to goiter resulting from iodine
deficiency is rare in animals.
 The cornea becomes opaque, due to pannus. The lens is
detached and usually floats in the aqueous humour and
Enophthalmos (pig eye) may become adherent to the cornea or vitreous humour.

 Enophthalmos is an abnormal retraction of the eyeball  Keratoglobus (protrusion of cornea into a globular
into the orbit. enlargement) or keratoconus (conical enlargement of the
cornea) may be observed.

Prognosis
 Guarded
Treatment
 Anterior chamber centesis is performed to decompress the
anterior chamber
 If hydrophthalmos is due to adhesion of the iris to the
cornea or other structural deformities, treatment is
confined to removal of diseased eyeball.
Technique
 Method Enucleation of eye
o The conjunctiva is held by forceps and is divided
around the eyeball exposing the scleral insertions of
the muscles of eyeball. These are divided one by one
so that it will be possible to turn the eyeball and
severe the rest of the attachments.
o The eyeball is removed and the orbit is packed with
sterile gauze to arrest haemorrhage. If tarsorrhaphy
is to be performed, the edges of the lid are trimmed
and sutured.
 Method Extirpation of eye (Eviseration of orbit)
o The palpebral borders of the eyelids are temporarily
sutured together. An eplliptical cutaneous incision
enclosing this suture line is made without opening
into the conjunctival sac.
o Retracting the skin edges, the eyeball along with its
muscles is detached from the bony orbit by blunt
dissection between the tenon’s capsule and bony
orbit.
o After division of the attachments close to the base of
the orbit and removal of the eyeball the orbital
cavity is packed with sterile gauze to control
bleeding.
o The skin edges are united by apposition sutures
leaving a small gap at the inner canthus for removal
of the gauze packing for subsequent dressings .
STRABISMUS
(Squint)
 It is a condition where there is abnormal deviation in the
position of the eyeball.
 Different types of squint are:
o Horizontal squint when the deviation is along a
horizontal plane. Horizontal squint may again be
classified as lateral (divergent) squint and medial
(convergent) squint.
o Vertical squint when the deviation is in the vertical
plane. Vertical squint may be in the form of an
upward deviation of the eyeball or a downward
deviation of eyeball.

Ventral deviaion - Vertical strabismus
o Oblique squint when the deviation is in a direction
other than the horizontal or vertical plane.
Causes
 Squint may be a congenital condition without any
apparent cause.
 Middle ear infections, brain tumours, etc. are sometimes
responsible for squint.
Treatment
 If squint is not due to any apparent disease condition like
meningitis, surgical treatment may be adopted.
 The object of the operation is to correct the position of the
eyeball by cutting the particular eye muscle which is
causing undue tension on the eyeball.
Technique
 With proper aseptic precaution, the eyelids are kept well
retracted with wire speculum.
 The conjunctiva in level with the muscle to be divided is
held with a conjunctival forceps and is incised.
 Through this incision a strabismus hook is introduced to
locate the muscle to be divided.
 The muscle is then cut close to its scleral attachment with
a narrow, thin bladed knife introduced through the
conjunctival wound.
 The eyeball may rotate to the normal position as soon as
the muscle is cut.
 The eye speculum is released. Post operatively a suitable
antibiotic topical drops is applied to the eye daily.
GLAUCOMA
  There is increased tension in the eyeball.

 megalocornea and corneal edema

 The cornea is sensitive to touch.

 There is lacrimation.

 Examination with an ophthalmoscope reveals the optic

disc appears to be concave (“cupping of the optic disc”).

 The retinal arteries appear constricted because of the

pressure, and retinal veins are engorged with blood due to
the compression at the optic disc.
Tonometry with tonopenvet Glaucoma- OS
 Pressure atrophy of the choroid and retina is evident by
greyish patches.
 Glaucoma is a disease condition of the eye characterized
by marked rise in the intraocular pressure.

 Glaucoma is sometimes seen in dogs, it is very rare in

other animals.

 There is increased intraocular pressure due to excessive

quantity of aqueous humour.

 It may result from increased production or decreased

drainage of aqueous humour.

Symptoms

 There is severe pain. Megalocornea - OS

 Peripheral Vision is greatly reduced.

Treatment
 The pupil is dilated.
  Palliative treatment consists of instilling pilocarpine
(1/2%), diurectics, laxatives, salt-free diet, restricted water
intake, etc.

 Surgical treatment is not of much effective value but may

provide temporary relief. The following operations may be
tried.

Scleral puncture

 Site – on the sclera, immediately behind the limbus and in

front of iris, near the temporal canthus of the eye.

 Before operation, sterilize the conjunctival cul- de-sac by

instilling antibiotic eye drops and flush with sterile
balanced salt solution. Proparacaine is used as a topical
anesthetic.

 The puncture is made through the bulbar conjunctiva and

sclera to let out the aqueous humour.
Buphthalmia - OS in glaucoma

Iridectomy

 Eye is prepared by frequent instillation of antibiotic eye

drops about twenty four hours prior to the operation and
is flushed with balanced salt solution immediately before
the operation.

 Proparacaine solution is used as a surface anesthetic. Eye

is kept open with speculum. Using a keratome the cornea
is incised close to the limbus and in front of the iris, taking
care not to injure the iris. When the knife is withdrawn,
portion of aqueous humour escapes through this incision.

 A portion of iris also protrudes and this is held with iris

forceps or iris hook and is drawn out of the wound as
much as required. Then it is swabbed with 1 in 2,000
adrenaline.

 After a few seconds the protruding portion of iris is incised

with a fine iris scissors. An iris probe is then introduced to
push the remaining portion of iris back into position. Eye
is again washed with balanced salt solution.

 Another method of doing iridectomy is by performing

keratectomy, using a corneal trephine. A portion of cornea
½ cm in diameter is cut and iridectomy is conducted as in
the previous case. This opening is covered with a
conjunctival keratoplasty.
  Inflammation of cornea.
DERMOID CYST
Etioilogy

 Dermoid is a misplaced embryonic cutaneous tissue  Bacterial, virual, rickettsial infections

contains hair which causes irrtation to the cornea and
conjunctiva. corneal dermoids are usually seen in the  Trauma (including irritation caused by eyelashes, in
lateral canthus extending on to the cornea. entropion, trichiasis, distichiasis, etc).

 Chemical irritants

 Parasites in eye.

 Allergy

 Deficiency diseases (Vitamin A, Riboflavin, etc.).

 Senility (due to old age)

 Neoplastic conditions as dermoids.

 Toxaemia
Dermoid cyst in a dog Dermoid cyst in a calf
 Diabetes

Surgical treatment Classification

 Superficial keratectomy  Keratitis may be classified as follows

 MODULE-12: SURGICAL AFFECTIONS OF o Superficial keratitis

CORNEA o Interstitial keratitis (parenchymatous keratitis)

o Vascular keratitis
KERATITIS
o Ulcerative keratitis
 o Suppurative keratitis  Irrigating with antiseptic solutions like 5% povidone
iodine.
o Non – suppurative keratitis
 Adequate intake of vitamin A, D and B-complex.
 The normal, clear, transparent, moist and glistening
appearance of cornea is altered.  Instilling topical antibiotics following a ABST.

Symptoms  Adminstration of antibiotics

 Keratitis is a painful condition.

 Photophobia and blepharospasm

 There is loss of lusture of the cornea.

 The transparency of the cornea is altered and cloudiness

or opacity is evident.

 Vascularisation of the cornea (pannus) may be noticed in

severe cases.

 The vessels invading the cornea may originate either from

the superficial vessels of the conjunctiva or from the
deeper ciliary vessels, situated at the limbus.
CORNERAL ULCER
 Vessels originating from the conjunctiva are bright red,
wavy and superficial whereas the ciliary vessels appear
pale or bluish grey and have a more or less straight course.  Fluorescein dye test positive corneal ulcer viewed through
In chronic cases these vessels are arranged in a brich – the cobalt filter of ophthalmoscope. The green colour in
broom fashion. the center of the cornea indicates stain uptake by the
corneal stroma.
Treatment

 Remove the cause.

 NSAIDS topically to relieve pain.

  Guarded and depends on how deep the ulcer
is. depe When the ulcer heals a localized opacity of cornea
results, because of the scar tissue.

Diagnosis

Cornea ulcer

 Ulcerative keratitis is frequently met within animals.

Diagnostic kit
Etiology

 The causes may be trauma, infections (like distemper in

dogs), or nutritional deficiencies (like vitamin A deficiency Fluorescein dye test
and Riboflavin deficiency).
 Impregnated paper strips moistened with saline

Symptoms  Placed in dorsal bulbar conjunctiva

 The ulcer on the cornea is easily recognized. If necessary, a  Excess stain is washed with normal saline
2% flurorescein solution may be used to aid diagnosis. The
solution is instilled into the eye so as to stain the ulcer and
make it visible.

Prognosis
 Treatment of corneal ulcers

 Surgical treatment

o temporory tarsorrhaphy

o third eyelid flap

o conjunctival flap

o direct corneal suturing

Fluorescein dye test Positive for Fluoresein dye test o therapuetic contact lenses

o collagen grafting

 In addition to the surgical treatment, medical therapy is

Complications
 Keratocele: Protrusion of an intact decemet’s membrane
through the ulcer is called keratocele. Keretocele may
rupture. The rupture might help correction of the
keratocele and the ulcer might heal up, if small. Rupture
may predispose to prolapse of iris if the wound on the
cornea is sufficiently large. So it is better to make a small
puncture of the keratocele artificially to let out the
aqueous humour and facilitate collapse of the protruded
portion. The keratocentesis may be repeated, if necessary.
 Staphyloma: It is a protrusion of iris through a wound or
ulcer on the cornea. There is leakage of aqueous humour
and there is also chance of infection being carried through
the perforation of the cornea. If the opening is large the
lens may also prolapse. A small staphyloma resulting from
a narrow opening in the cornea may slough off during the
healing of the corneal wound.
also indicated, which include topical antibiotics,
collagenase inhibitors, atropine to prevent ciliary spasm,
ocular lubricants, and systemic corticosteroids.
OPACITY OF CORNEA
 Opacity of cornea is one of the symptoms of chronic
keratitis. In mild forms there will be only cloudiness
which clears up once the inflammation subsides.
 In chronic cases this opacity becomes permanent.
Classification
 According to the degree of opacity, opacities of the cornea
may be classified as:
 o Severe  It is a degenerative lesion of the lens.

o Moderate

o Mild

o Normal

Treatment

 Rule out Intra ocular pressure (IOP) rise

Medical management

 Use of topical antibiotics and NSAIDS (Flurbiprofen)

four times daily Cataract in a cow Cataract in a lion

 Use of saline irrigation

 Administration of placental extract, subconjunctivally

 Surgical management

 Superficial keratectomy

 MODULE-13: SURGICAL
AFFECTIONS OF LENS

CATARACT

Bilateral Cataract
 Opacity of the lens is known as cataract.

Elephant Cataract
CLASSIFICATION
 Congenital cataract – Cataract present at birth. (Note: In
foetal life the lens receives its nutrition through vascular
channels. After birth the lens is entirely dependent on the
aqueous humour for its nutrition. In puppies and kitten it
is normal for the vascular covering of the foetal lens to
persist for a few days after the eyes have opened. This
should not be mistaken for congenital cataract.)
 Acquired cataract – cataract developing later in life
 Complete cataract, involving the lens completely.
 Partial cataract.
 Progressive cataract.
 Stationary cataract.
 Juvenile cataract. - Cataract seen in young animals.
 Senile cataract – Cataract developing due to old age. This
is common in veterinary practice.
 Diabetic cataract – This also is not seen in veterinary
practice. Diabetic cataract is characterized by minute
opacities developing on the superficial cortex of the lens
due to turgidity of cells in the superficial cortex of the lens.
The turgidity of cells is apparently associated with the
sugar content of aqueous humour.
 Toxic cataract – Cataract caused by the circulation of
toxins or poisons in the body, e.g., cataract due to equine
influenza, periodic ophthalmia, distemper, chronic
nephritis, ergot poisoning in cattle and pigs, experimental
feeding of naphthalene, etc.
 Capsular cataract – (Anterior capsular cataract and
posterior capsular cataract). This is not common.
 Cortical cataract – (Anterior cortical and posterior cortical
cataracts). Majority of cortical cataracts are stellate
cataracts, i.e., spreading from the centre of the lens to its
periphery. Cortical cataract sometimes develops as a
complication of a perforating corneal ulcer.
 Pyramidal cataract – A localized opacity of the lens.
 Lamellar cataract – The opacity is seen in the area
between the lens nucleus and cortex.
 Perinuclear cataract – This is lamellar cataract seen in
horses.
 Nuclear cataract – Confined to the central portion  In hyper – mature cataract there may be partial
(nucleus) of the lens. calcification of the lens and some portion of the lens may
also undergo liquefaction. The cortex appears milky white
 Diffuse cataract – Spreading evenly through the entire in colour. The nucleus of the lens may sink into the bottom
lens substance. of liquefied lens substance. Complete removal of the lens
is difficult when the cataract is hyper – mature.
 Calcareous cataract – Cataract in which the lens substance
is partly converted into chalky materials.
ETIOLOGY
 Depending on the stage for surgical removal of the lens
cataract is describes as:
 There might be a hereditary predisposition.
 Immature, mature or hyper mature cataract.
 Toxins
 Immature (unripe) cataract is a cataract in which the lens
has not become completely opaque.  Senile changes attended with old age.

 Mature (ripe) cataract is one in which the entire lens  As a sequelae of diseases of the eye like irirdocyclitis or
substance has become opaque and is indicated by a grey systematic diseases like diabetes.
white or amber colour. This is the best stage for surgical
removal of lens. Prognosis

 For juvenile cataract seen in young animals, the prognosis

is good.

Diagnosis

 The pupil is dilated by instilling tropicamide (2%) into the

eye, in order to facilitate examination of the lens.

 The diagnosis can be made by using an ophthalmoscope

TREATMENT
Mature cataract in a dog
Discission or Needling

 The anterior capsule of the lens is incised in a cruciate

fashion, using a cataract needle so that the aqueous
humour will come in contact with the lens substance and
will facilitate re – absorption of the opacity.

 Discission will have to be repeated periodically to obtain

the desired effect. It may not be effective in all cases.

Couching of the lens

 The lens is pushed downwards and backwards by

introducing a proper instrument through an incision in
the cornea. Couching of the lens is not a practicable
treatment in veterinary practice because the suspensory
ligament of the lens in animals is very strong.
 In man, dissolution of the opaque lens by using 0.02%
trypsine has been reported.
Intra ocular set
 It is occasionally done in the dog. The removal of the lens
in the dog is more difficult than in man because the lens of
the dog is proportionately much larger, and the
suspensory ligament of the lens is tough.

 Removal of the lens will not serve any purpose if there are
Removal of the lens
degenerative changes in the retina associated with
cataract. In estimating the prospects of the operation the
existence of pupiliary reflex is of some help.

 There are two methods for removal of the lens, viz., the
intracapsular extraction, and the extracapsular extraction.

 Intracapsular extraction is the extraction of the lens with

its capsule. This is difficult in animals because of the tough
suspensory ligament.

 Extracapsular extraction is the extraction of the lens

without its capsule. The anterior capsule of the lens is
incised and through that the lens substance is removed.
 Extracapsular extraction is successful only if the cataracts
is ripe (mature). At this stage the endothelial cells of the
capsule that are left behind are incapable of proliferating.
Whereas, if the operation is done before fully ripe, the
proliferation of the endothelial cells after surgery may  The operation is done under general anesthesia
once again create opacity and this will interfere with
vision.  The eyeball is fixed during the operation by one or more
stay sutures passed through the sclera.
 Extracapsular extraction of the lens is difficult if the
cataract is hyper – mature because of the partial
liquefaction or softening of the lens substance.

 ECCE +IOL ( Extra capsular catarct extraction + Intra

ocular lens)

 Extracapsular cataract extraction is an operation in which

the lens nucleus and cortex, excluding the capsule, are
delivered through a corneal incision involving about one-
half of the circumferences of the cornea, with rigid lens
implantation .

Eye ball positioned for cataract surgery

 The cornea is punctured above the 3 – O – clock point,

about 0.1 cm away from the limbus. By using a small
scissors or the Graefes’ knife the incision is extended
upwards along the cornea parallel to the limbus, to the 9 –
O – clock point.
Phacoemulsification unit with hand piece
 In intracapsular extraction, the lens is held close to its
equator with a special forceps (Duthies’ forceps or
TECHNIQUE OF REMOVAL OF LENS
 Arrugas’ forceps) and then it is gently moved and detached
fromm its suspensory ligament.

 If extracapsular ectraction is desired,the anterior capsule

of the lens is incised in the form of a T and a cataract
scoop is used to remove the lens substance.

 After removal of the lens the corneal wound is sutured.

Conjunctival keratoplasty is advisable. Postoperative
interference by patient should be guarded against. For this
it is desirable to administer sedatives for at least two or
three days.

 Phacoemulsification and IOL implantation.

 Phacoemulsification is a procedure in which the lens is

ultrasonically fragmented and aspirated through an
incision about 3.2 mm and extended upto 8mm and
4.2mm with rigid and foldable lens implantation
respectively Phcoemulsification in progress

MODULE-14: SURGICAL
AFFECTIONS OF THE UVEA

SURGICAL CONDITIONS AFFECTING THE UVEA

 Coloboma

o It is a congenital condition in which the pupil will be

irregular in shape due to absence of a portion of the
iris.
 o More than one pupil may become apparent, when o Inflammation of the vitreous body (vitreous
coloboma is situated away from the pupillary humour).
margin.
 Retinitis
 Aniridia
o Inflammation of retina
o Aniridia is a condition in which iris is completely
absent.  Anterior synechia

 Iritis o Attachment of the iris to the cornea is called

anterior synechia. This is sometimes seen as a
o Inflammation of the iris sequela of staphyloma.

 Cyclitis  Posterior synechia

o Inflammation of the ciliary body. o Attachment of the iris to the lens is called posterior
synechia. Sometimes seen as a sequela of periodic
 Iridocyclitis ophthalmia in the horse.

o Iridocyclitis is inflammation of the iris and the

ciliary body. PERIODIC OPHTHALMIA

o A very characteristic symptom of this condition is

engorgement of vessels at the limbus .
 Choroiditis
o Inflammation of the choroids
 Periodic ophthalamia of horses is characterized initially by
repeated attacks of iridocyclitis.
 After repeated attacks of the disease there is atrophy of the
eyeball and it sinks into the orbit.

 Uveitis  The eyelids become greatly wrinkled and shrunken.

o Inflammation of the iris, ciliary body and choroids.

Etiology
 Hyalitis
 The cause of the disease is not definitely known.
  The disease appears to be contagious but attempts to  The aqueous humour gets partially absorbed and the
transmit the disease artificially have not been successful. eyeball shrinks. The fat in the orbit gets absorbed, the
eyeball sinks into the orbit and the eyelids get wrinkled
 The disease occurs in places where a number of horses are resulting in permanent blindness .
housed together, as in the army.
 In kerato uveitis a fleshy corneal infiltrate and pannus are
identified on ocular exam.
Symptoms

 The disease usually starts unilaterally with photophobia, Diagnosis

blepharospasm and lacrimation. - acute uveitis
 The disease is characterized by its sudden onset without
 The tears are sticky and become adherent to the eyelids any apparent cause. The pupil is constricted and fails to
and cheek. Conjunctivitis and engorgement of blood dilate. Pressure on the supraorbital fossa evinces pain.
vessels around the sclero – corneal junction are seen. Posterior synechia may be noticed.

 The consistency of the aqueous humour is altered, there is Treatment

accumulation of whitish or yellowish precipitates in the
anterior chamber (hypopyon) and due to this the cornea  Symptomatic treatment for uveitis and presence of
may appear completely opaque. Pupil is constrited. systemic infection should be ruled out.
Recovery takes place in about 3 weeks, the precipitates get
absorbed and the pupil dilates to the normal size.
 Agressive therapy should be intiated first. It consists of
topical , subconjunctival or systemic use of corticosteroids
 After seven to ten days the symptoms recur either in the
same eye or in the other eye. During this second attack
 NSAIDS - flunixine meglumine, asprin are also effective.
symptoms are more severe. Thus the same eye may
become affected repeatedly. Due to these recurrent attacks
 A cycloplegic atropine can also be used.
the eye is permanently damaged.

 The cornea and the lens show opacity; posterior synechia  MODULE-15: SURGICAL
is a constant sequela of the disease: the retina atrophies;
and the vitreous humour undergoes liquefaction. AFFECTIONS OF THE RETINA
AND REFRACTION OF THE
 The vitreous humour when examined through an
ophthalmoscope presents a characteristic appearance with EYE
star – like floating bodies described as synchysis
scintillans. - posterior uveitis

AMAUROSIS
 Amaurosis is blindness without any apparent lesion in the
eye. It may be temporary or permanent.
 Possible causes are toxaemia, lesions in the brain, etc.
(Note: A temporary form of amaurosis is sometimes seen
in cattle due to deficiency of vitamin A which can be
corrected by administration of vitamin A.)
Refraction of the eye
 Parallel rays
o The amount of divergence of light rays falling on a
given area is inversely proportionate to the distance
from the source of light. When the distance is 20
feet or more, the divergence is so slight that the rays
can be considered as parallel.
 Emmetropia (Normal sight)
o When the refraction of the eye is normal, parallel
rays coming into the eye in a condition of rest, are
focused exactly on the retina. This condition is
known as emmetropia.
 Ametropia
o Ametropia is a term used to denote a condition of
abnormal refraction of the eye due to
hypermetropia, myopia, or astigmatism, in which
parallel rays are focused either in front or behind
the retina.
 Hypermetropia (Hyperopia; Long sight; Far sight)
o Hypermetropia is a condition of abnormal
refraction of the eye in which parallel rays come to a
focus behind the retina. This type of ametropia is
caused if the axis of the eyeball is too short or if the
refractive power of the eye is too weak.
 Myopia (Short sight; Near sight)
o Myopia is a condition of abnormal refraction of the
eye in which parallel rays get focused in front of the
retina. This may happen either due to the axis of the
eyeball being too long or due to the refractive power
of the eye being too strong. (In this condition the
eye is able to see clearly only objects very close to
it.)
 Astigmatism
o When the refraction through several meridians of
the eye is different, the condition is called
astigmatism.
o Agtigmatism may be caused by irregularities in the
cornea or the lens. Astigmatism causes blurred
vision. (Note: A certain degree of astigmatism is
normally present in the horse.)
DISEASE OF THE VITREOUS, RETINA, CHOROID
AND OPTIC NERVE/POSTERIOR SEGMENT
Introduction
  The image obtained in the ophthalmoscope while viewing  This condition could arise as a sequela to
the posterior segment is called fundus and it comprises of thromtocytopenia, trauma, neoplasia and to infectious
optic disc, retinal vasculature, and a semitransparent diseases.
neurosensory retina.
 Treatment consists of systemic use of corticosteroid.
 Through this, structures like retinal pigment epithelium
chorioid or tapetum and posterior sclera could be
Liquified vitreous (Synchysis scintillans)
visualised.
 It is usually seen in aged patients or as a sequela to
inflammation.
VITREOUS
 When the head is moved the freely floating bodies tends to
move and settle.
 About 3/4th of the volume of the eye is occupied by a
gelatinous structure called vitreous, which also gives, its  This condition may predispose to retinal detachment.
shape to the eye.
 When the suspended particles consists of calcium lipid
 98% of the vitreous is water and the rest 2% consists of complex, the condition is called Asteroid Hyalosis.
collagen fibrils, Hyalocyte, and mucopolysacharides
and Persistent Hyaloid Artery
FUNDUS
 On the posterior lens capsule a small attachment persists
– sometimes seen along with posterior capsular cataract.
 Ophthalmoscopic picture/ image of the eye is called
 In ruminants, a remnant persists from the center of the
fundus.
optic disc.
 It is the part of the retina which appears through the
 Persistent Hyper plastic primary vitreous
ophthalmoscope
 When the vascular supply to the embryonic lens remains
 A specialised reflective layer called tapetum helps to
in the adult vitreous, the condition is called persistent
intensify the vision in dim light. It is absent in man and
hyper plastic primary vitreous.
pig.
 Some times seen as associated with cataract and retinal
 Retinal pigment epithelium layer is the next inner layer
detachment.
which also maintains nutrition to the neuro sensory retina.
 Vitreous haemorrhage
  The visual image is converted to electrical signals by the Optic disc atrophy due to IOP rise- Cupping of the optic
neuro sensory retina to photoceptor cells- rods and cones
and finally to the visual cortex in the brain through the disc
optic nerve.
 Optic papilla will be small with attenuated blood vessels.
Retinal haemorrhage
 The pupil will be dilated with the eye blind.
 Causes include, anaemia, thrombocytopenia,
 Cause – sequela to inflammatory conditions.
hypertension, neoplasia etc., Haemorrhage may occur at
any layers of the retina.

Retinal detachment MODULE-16: EYE-WORM

AFFECTION IN LARGE ANIMALS
 Causes – Subretinal fluid accumulation, vitreous traction,
liquefied vitreous, etc.,

 Because of the anatomical proximity of the choroid and
retina, pathologies are usually interlinked.
Collie eye anomaly
 It is a congenital anomaly seen in collie breeds of dogs,
characterised by choroidal hypoplasia, coloboma, retinal
detachment and intraocular haemorrhage.
Intra-ocular eye worm
 Setaria digitata and Setaria cervi are isolated as intra-
ocular eye worms in horses. Setaria digitata and setaria
cervi are parasites of cattle found in the peritoneum.
Setaria equi present in horses are seen in the eye of cattle.
 Accidentally the larvae infesting the animal migrates to
the anterior chamber and causes severe ocular
inflammation in horses/ cattle.

OPTIC DISC  The antigen present on the surface of the parasite causes
an immune mediated response and the condition can
initially as uveitis and can proceed to a kerato
conjunctivitis and uveitis and end as equine recurrent
Optic disc edema / papilledema
uveitis.
 Swollen optic disc with hazy margins usually caused due to
vitamin A deficiency in steers or due to space occupying Clinical signs
lesions.
 Photophobia
  Epiphora
 Corneal Edema
 Hypopyon
 Aqueous Flare
 Miosis
Diagnosis
 The animal need to be examined in a calm environment in
day light, as well as indoor, with a focus light for the eye.
 The moving worm could be easily visualized in dark light.
In case of pain and blepharospasm restrain of the animal
with sedative like xylazine, butorphanol or detomidine and
a local nerve block may be essential.
Treatment
Surgical removal
 The animal is anesthetized in GA and casted on the
affected side up or given sedation, and given an auriculo
palpberal nerve block and retro bulbar nerve block and a
topical application of surface anesthetics
Technique
 The incision is made at the 4’O clock position at the limbus
with a No :11or 15 BP blade after retracting the eyelids.
 usally the worm tries to escape along with the aqueous
humor and if it does not occur, saline can be injected and
lavaged for removal of the worm.and the incision is
sutured back with 6-0 or 7-0 absorbable suture material in
simple interrupted pattern.
 Post operatively topical antibacterials anti-inflammatory
agents with administration of flunixin is indicated
 Medical management of the condition with Diethyl
Carbamazine with antiinflammatory agents have been
reported.
Extra ocular eyeworms
Thelaziasis
 The main species affected are cattle and horses world
wide. The most common site of lodgment is the pouch of
the nictitating membrane.
 The transmission is through house fly which feeds on the
excretions/ lacrimal discharge and the larva develops in
the fly and lodges in mouth parts and when the same fly
feeds another animal the infestation is established.
Clinical signs
 Conjunctivitis, excessive lacrimation, localized edema,
corneal clouding, and occasionally, sub-conjunctival cysts.
Diagnosis
 Clinical signs, ocular examination in a dark room with
focused light
Treatment

 LEARNING
The animal is restrained and a auriculo-palpeberal nerve
OBJECTIVE
block and retro bulbar nerve block is administered with
2% lignocaine solution.
The learner will
 The worms are manually removed from the pouch of the be able to
nictitating membrane and a lachrymal duct flushing may diagnose the
attempted with normal saline as many of these worm various surgical
conditions
cause dacryocystitis.
affecting the yoke
withers and poll.
 Topical antibiotics and anti-inflammatory drugs are
indicated along with administration of broad spectrum
anthelmintic like ivermectin at 200 μg/ kg bwt.

MODULE-17: POLL EVIL, YOKE

GALL AND AFFECTIONS OF
POLL EVIL
WITHERS
 In horse

o It is due to necrosis of ligamentum nuchae and

dorsal arch of the atlas.

 Etiology

o Injury and infection of the poll.

 Symptoms

o Inflammatory swelling, which is very painful and

lobulated.
 o Purulent discharge  First the animal feels difficulty in grazing but in course of
time this inconvenience disappears due to the stretching of
o Head is kept abnormally high due to pain. the new cicatrix.

 Prognosis
AFFECTIONS OF YOKE PLACE
o Not serious but, very troublesome as it is very
difficult to get rid of all the necrotic tissue and
provide effective drainage for the pus.
Yoke place
 Treatment
 Normally there is no bursa in this region, but due to
constant pressure of the yoke an acquired subcutaneous
o Surgical excision : Under general anesthesia
bursa develops.
o Site: 5-8cm long incision in the middle line of poll
 The surgical affections of this region are yoke gall, tumour
from in front of occipital crest to a point behind the
and yoke ulcer. These are seen in the cattle and buffaloes.
posterior limit of the lesion.

Yoke gall
Procedure
 Localized acute inflammation of the skin and subcutis on
 Incise through skin down to the ligament nuchae.
the neck due to injury caused by friction (rubbing) of the
yoke.
 Disect it out as far as it is diseased.
 It may be a swelling due to separation of layers of skin and
 Sever it posteriorly, reflect it outwards, from its insertion subcutis and accumulation of inflammatory exudates there
into occipital crest. in.
 Curette the tracks of the ligament and ulcers on the bone.

 Remove all necrotic tissues from its depth.

 Arrest the profuse haemorrhage by plugging with sterile

medicated gauze. for 24 hoursThereafter treat it as an
open wound (for 6 weeks)

Result

Yoke abscess
TOP
Yoke tumour
 It may be a cystic swelling due to bursitis or a tumour
mass due to chronic inflammation in the yoke region.
 When the tumour is very large and involves most of the
neck due to deposition of much fibrous tissue it is called
tumour neck.
 If infection gains entry in to the swelling through
superficial wound or injury this yoke gall converts in to
abscess.
Yoke ulcer
 Ulcer resulting from superficial abscess on the swelling.
Etiology
 Uneven and undue pressure of the yoke on the neck and
its sudden movements are the causes.
 Anything that weakens the neck on the yoke place.
 Thin neck (lean muscles)
 Young age (tender skin)
 Early castration (neck muscles fail to develop)
 General debility (decreases the resistance of neck muscles)
Favouring causes
 Anything that injure or contuses the yoke place.
 Yoke with a rough surface.
 Moist condition of the skin due to rain etc.
 Nervous temperament of the animal. Responsible for
sudden, undue and unusual movements of the animal and
the yoke.
 Heavy loads, improper adjustment of weights cause
unusual pressure.
 Unsuitable pair
Pathogenesis
  It may start as
o An acute lesion and become chronic due to
treatment with insufficient rest and repeated work
in the busy agricultural season or
o Chronic lesion from the outset due to slight and
repeated injuries by the yoke.
TOP
Acute to chronic
 Inflammatory exudates (due to the injury by the yoke)
accumulates in the yoke place. Poor vascularity of the part
slows its absorption. So the lesion requires treatment with
longer rest to the part. But agricultural seasons forces
work on the part before it becomes completely normal.
This agains makes the lesion acute. Insufficient rest
(during treatment) and work, alternately, for some time
ultimately makes it chronic.
 The exudates becomes organized, resulting in either local
or diffuse fibrosis
 This fibrosis effects the sensation of, and blood supply to
the part. So it becomes unhealthy and easily excoriated.
 Bacteria gain entire through the reaches into the area. Hot
or cold, single or multiple abscess for
 Due to constant irritation by the yoke, unhealthiness of the
part, mobility and defective drainage results in ulcers.
Yoke ulcer
 Due to repeated injuries by the yoke. Much fibrous tissue
is usually laid down. In long standing cases, the swelling
reaches a large size and resembles a tumor - tumour neck.
 Sometimes as a result of further contusion, the swelling
becomes acute. Such acute phases may alternate
periodically with phases of comparative quiescence during
most of the animal’s working life.
 Symptoms
o When acute those of acute inflammatory, gall,
contusion cyst in yoke place.
o Occurrence of to swelling is sudden. It may be small
or as large as a foot ball.
o Extension and flexion of neck is prevented in very
severe cases.
 When chronic: Those of chronic inflammation, localized
or diffuse fibrosis, unhealthy skin, small cold indurated
abscesses in the subcutis, multiple sinnses and indolent
ulcers in the yoke place.
 Prognosis: Early stages favourable. The exudates gets
absorbed in one or two weeks.
 Treatment
o Acute lesion: Paint liquor iodine. Apply acetic acid
chalk paste or kaolin paste or Mag.Sulph glycerin
paste for a few days, until the part becomes normal.
o For cystic swellings, acute and chronic abscesses on
general principles.
 o For multiple cold abscesses with unhealthy skin:
Affections
Blistering the region and opening them after
maturation and treating on general lines.
 Fistulous withers (supraspinous bursitis) and poll evil
o For solitary cold abscess with healthy skin:
 Fistulous withers and poll evil are rare, inflammatory
Enucleation with its walls intact, aseptically as in
conditions of horses that differ essentially only in their
operative surgery guide. The incision should never
location in the respective supraspinous and supra-atlantal
be across or along, but oblique to the neck. It should
bursae
not be on the mid dorsal line of the neck. Aim first
intention healing. The animal must be put to work,
3 or 4 weeks after the removal of sutures, gradually Etiology
to avoid the rupture of the embryonic tissue in the
operation site.  Infection - mainly through the organism Brucella abortus
found near cattle
TOP
 Streptococcus zooepidemicus, Actinomyces bovis,
occasionally B suis
Complications
 Parasites (Onchocera cervicalis)
 Failure of healing by first intention: Causes: Infection,
excessive trauma during operation, use of irritant  Trauma to the area
antiseptics, haemorrhage, improper a position of the lips,
and interference by the animal after the operational. So,  Fitting saddles
avoid the causes to get good result.
 Overwork
 Formation of a very large scar. This interferes with the
usefulness of the animal for work. Cause: II nd intention  Overloading
healing.
 Badly balanced loads
AFFECTIONS OF WITHER  The organism Brucella abortus, normally found in cattle, is
the main cause of fistulous withers. The organism enters
the horse's body through an orifice i.e. the mouth, nose or
 Wither is the region over the backline where the neck joins eyes, or through broken skin.
the thorax and where the dorsal margins of the scapula lie
just below the skin.
Symptoms
 Swelling of the withers
 Heat in the withers
Diagnosis
 Holes and tracts in the withers
 Build up of fluid at the withers
 Drainage in the form of a yellow/clear ooze
 Signs of fever and pain
 Sinus infection type symptoms
Treatment
 Harness sores
 Hair loss
 In the early stage of the disease, a fistula is not present.
When the bursal sac ruptures or when it is opened for
surgical drainage and secondary infection with pyogenic
bacteria occurs, it usually assumes a true fistulous
character.
 The inflammation leads to considerable thickening of the
bursa wall. The bursal sacs are distended and may rupture
when the sac has little covering support. In more chronic,
advanced cases, the ligament and the dorsal vertebral
spines are affected, and occasionally these structures
necrose.
 In the early stage, the supraspinous bursa distends with a
clear, straw-colored, viscid exudate. The swelling may be
dorsal, unilateral, or bilateral, depending on the
arrangement of the bursal sacs between the tissue layers.
It is an exudative process from the beginning, but no true
suppuration or secondary infection occurs until the bursa
ruptures or is opened.
 Clinical signs
o ‘X’ ray – indicating presence of osteomyelitis of the
underlying spinous process
o Ultrasound
 First remove the irritant and keeps the animal as quiet as
possible, to prevent the muscles moving on each other.
 If the skin is not broken and the swelling appears tense,
hot and painful, cold applications may be applied to try
and reduce the inflammation and the swelling. These may
be in the form of cold-water irrigation and cooling lotions
applied by soaking linen cloths and placing them across
the wither.
 If in the course of a few days the swelling does not
disappear and the pain subsides, but on the contrary
continue to increase, indicating suppuration. For this hot
water fomentations must be diligently applied, together
with some stimulating liniment, such as that of ammonia
and turpentine.
 It is an old but sometimes successful practice to "plug" the
sinus to the very bottom with some caustic, such as
corrosive sublimate, or arsenic, or a mixture of the two.
This destroys the tissues for some distance around, and
 frequently brings away the damaged structure that  In this way many tedious and painful wounds may be
prevented healing in the first instance. avoided.

 Finally surgical correction should be carried out under  It is reasonable to keep horses separate from Brucella
general anaesthesia. An incision should be made at the -infected cattle, and cattle separate from horses with
lowest part of the cavity, so as to give free exit to the discharging fistulous withers.
matter (pus) and allow of the removal of any dead tissues
that may exist, and drainage of the abscess may be effected
Prognosis
by passing a piece of tape (seton) through the wound,
being careful to bring it out at a lower level than the floor
of the cavity, so that no matter may be allowed to  It will cure if treated early.
accumulate there.
Care should be taken to avoid penetration of the  Suppuration causes arthritis of the intervertebral joints,
dorsoscapulat ligament. extend to the spinal cord causing death.

 Sometimes the pus will have burrowed behind the  MODULE-18: AFFECTIONS OF
shoulder-blade, in which case a depending opening must OESOPHAGUS
be made or a seton passed through it. At other times the
projections of the backbones (vertebral spines) will be
diseased, in which case they must be freely scraped or CHOKING: OBSTRUCTION OF OESOPHAGUS
removed by the veterinary surgeon.

 First day the cavity should be flushed with irritant

 Most common in bovines as they have the habit of
antiseptic (eg. tincture iodine) and second day use non-
indiscriminate feeding and thus picking up the foreign
irritant solution (eg. Povidone iodine).
bodies especially during pregnancy.
 If the dead space is more means the cavity should be
packed with antiseptic gauze and it should be removed Seat of obstruction
every alternative day. • Once it starts healing use antiseptic
spray with fly repellent.  All animals: Just behind the pharynx.

Prevention  Horse: Inferior third of oesophagus, being normally

constricted.
 Always have well-padded and properly-fitting harness and
clothing, and as soon as any sign of chafing occurs, at once  Ox & dog: Lower part of cervical region due to its
remove the offending agent. compression between the thoracic inlet and the first rib.
Chocking objects
AFFECTIONS OF OESOPHAGUS IN SMALL
 Horse: Carrot, turnip, potato, piece of wood, extracted ANIMALS
tooth and broken balling gun swallowed accidentally,

 Ox: Turnip, potato, apple, palm or mango kernel. Esophageal obstruction – Foreign Bodies

 Dog and Cat: Bone or cartilage, (fixation is due to sharp  The most common cause for esophageal obstruction is
points) swallowing of foregin bodies while playing. ingestion of foreign bodies. Various objects may lodge and
produce partial or complete obstruction in esophagus. The
Symptoms most common foreign body is bones.

 Cessation of feeding.

 Makes frequent gulping movements

 Frequent attempts at vomiting (arches the neck, bring the

muzzle towards the chest).

 Salivation when the obstruction in near the pharynx.

 Tympany/bloat in large animals

 swelling / bulging of the esophagus at the cervical region

in cervical obstruction
Esophageal obstruction – Foreign Bodies
Treatment

 Medical management emetic  Others include needle, wooden sticks, rubber toys, plastics
and coins. Cats are more predisposed to ingesting
fishhooks and needles. The ingested foreign bodies
Surgical treatment become lodged in the cervical constriction, bronchoaortic
constriction, diaphragmatic constriction and thoracic
 Cervical oesophagotomy inlet.

 Thoracic oesophagotomy
 Most of the foreign bodies produce acute clinical signs
because of either complete obstruction or severe, painful,
partial obstruction.

 Longer the duration of large, sharp foreign body,

obstruction is more prone to serious complications.

 Surgical management is indicated when the conservative

treatment fails. Thoracic esophagotomy is more
complicated than cervical esophagotomy. If the object is
located caudal to the base of the heart, the foreign body
can be removed via an abdominal gastrotomy. If possible
the foreign body may be crushed into small pieces to help
easy removal. Alternative method is to perform the
gastrotomy via a thoracic, transdiaphragmatic approach.
Left sided 8 th intercostal thoracotomy is performed, the
lungs are packed off , the diaphragm is incised to expose
the greater curvature of stomach. Spillage of the gastric
content in the thoracic cavity is the important
Thoracic foreign body
complications in thoracotomy.

 Difficulty in swallowing ,regurgitation, gulping, excessive

 Pre operative management of patients with esophageal
salivation and inappetance ( cats) are the acute clinical
disorders correct fluid electrolyte and acid base imbalance
signs. Chronic signs are Cervical swelling ,primary
malnutrition and aspiration pneumonia.
 Prophylactic antibiotics for esophagitis an aspiration
pnuemonia suprt nutrition

 Surgical management

 Anesthetic consideratons

 Not completed

 Non surgical method may be attempted first.

  If the object has perforated and cannot be removed,
surgery can be used to cut off the extraluminal foreign
objects while the intraluminal foreign body can be
recovered with the endoscope. If the foreign body is a
bone it may be pushed into the stomach rather than
removed by orally. Most of the bones are quickly digested
in the gastric acids and excreted within 10 days in the
feces. If the signs develop that may indicate the surgical
removal of the remaining bones.
ESOPHAGEAL STRICTURES
 Acquired esophageal stricture caused by any damage to
the mucous membrane that produces injury by foreign
body, sequle to previous esophagotomy, external
compression of the lumen by the presence of parasitic
tumour ( spirocerca nodule) , Compression of the
esophagus by tumours, abscess ( extra esophageal
mass ) Congenital esophageal stricture is rare in dogs.
 Surgical management is more complicated in this case. If
treatment is aimed at resection and anastomosis , surgeon
may inadvertently leave behind damaged tissue, which
leads to reformation of the stricture.
 The resected esophagus length is more, the anastomosis
may fail due to tension between anastomosis part. In that
situation, patch grafting, muscle interposition graft,
circular myotomies, suture line reinforcement or
segmental replacement can be use as an alternative
techniques.
 The best treatment is mechanical dilation and
pharmacological intervention with agents that reduce
fibroplasia and collagen cross-linking.
VASCULAR RING ANOMALIES
 This is the most common cause of extraluminal esophageal
obstruction in dogs and cats. Due to this kind of chronic
partial obstruction, which causes serious complications
include proximal dilation, loss of motility in the dilated
segment, ulcerative esophagitis, cachexia and aspiration
pneumonia.
 Vascular ring anomalies are the result of abnormal
development of definitive vascular structures derived from
embryonic aortic arches.
 Clinical signs result from partial or complete entrapment
of the esophagus between the base of the heart and the
affending vessels. Mechanical obstruction is produced by
vascular ring itself but concurrent fibrosis of the
underlying esophageal wall develops.
 Most common vascular ring anomaly in dog and cats
results from persistence of the right fourth aortic arch as
the definitive aorta. Stenosis of the esophagus occurs due
to ductus arteriosus.
 Affected animals are considered normal until weaning.
Liquids bypass the esophageal obstruction without
difficulty. As an animal ingests solid foods, postparandial
regurgitation occurs. Megaesophagus develops early in the
disease.
 Diagnosis of vascular ring anomalies is based on history,
physical examination, radiography and endoscopy.
Megaesophagus may be diagnosed on physical
examination by observing and palpating a bulge in the
ventral cervical and thoracic inlet after swallowing.
  Treatment is surgical, requiring division of the appropriate  Megaesophagus can develop cranial to the mechanical
portion of the ring to relieve esophageal stenosis. obstruction.

 Generalized megaesophagus can result from affections of

PERIESOPHAGEAL MASSES
 Mechanical obstruction of esophagus may occur secondary
to lesions in surrounding tissues. Esophageal dysfunction
in cervical region caused by thyroid carcinoma, laryngeal
carcinoma, salivary gland neoplasms, squamous cell
carcinoma and metastatic tonsillar carcinoma in cervical
lymphnodes.
vagus,metabolic diseases like hypoadrenocorticism,
hypothyroidism and immunological diseases like
myasthenia gravis, polymyositis, and certain drugs such as
anticholinergics, general anesthetics , and idiopathic
disorders. These are managed well by medically and
feeding in upright position than surgically.
 Other disorders like cricopharyngeal achalasia and
gastroesophageal achalasia also occurs.

 Abscess and granulomas may also cause this. In the

thoracic inlet, cranial mediastinum and thoracic cavity ESOPHAGEAL DIVERTICULUM
other lesions including thymomas, lymphomas, large lung
tumors, abscesses, and granulomas may occur.

 Clinical signs of partial obstruction includes regurgitation,

salivation, discomfort, dysphagia, cough and dyspnea if
aspiration occurs. Infiltration through the esophageal wall
can be determined by endoscopy preoperatively.

Neuromuscular diseases

 Mechanical obstruction of the esophagus and propulsion

of ingesta into the stomach results from inherent disorders
of esophageal function.

 Most of this conditions managed by medically but surgery

is necessary in some cases. Esophageal diverticulum

MEGAESOPHAGUS
  Focal out pouching of the esophageal wall is called
diverticulum. This may be congenital or acquired but not
common in small animals.
 Congenital diverticulum results from inherent weakness of
the esophageal wall, failure of the primordial foregut and
pulmonary buds to separate or eccentric vacuole
formation in the esophagus.
 Acquired diverticula are two types. Depending on their
cause and histological appearance they are called as
pulsion diverticulum or traction diverticulum.
Pulsion diverticulum
 This is an outpouching of mucosa through a defect or tear
in the overlying muscularis. This is otherwise called as
false diverticulum because not all layers of the esophagus
are represented in the protruding sac. This will develop
after focal pathological pressure applied to esophageal wall
from within the lumen. It may also result from regional
abnormalities in peristalsis in association with
obstruction.
 The most common site of diverticula is just proximal to
diaphragm. Dysphagia, regurgitation, gagging, gulping
weight loss and respiratory signs are usual clinical signs.
Contrast radiography and endoscopy are effective
diagnostic methods.
 The diverticula may be large and sometimes multiple and
often impacted with ingesta. Small diverticulum may be
managed conservatively by diet modification and upright
feedings. If the diverticulum is too large, resection of the
diverticulum is indicated.
 The diverticulum is single and focal, simple excision of the
sac with two layer repair of the esophageal wall is
sufficient. For large and multiple diverticula, resection and
anastomosis or hemicircumferential wall resection and
reconstruction is required.
Traction diverticulum
 This is otherwise called as true diverticulum, which is
composed of all layers of the esophageal wall.
 They termed “traction” because of their presumed
pathogenesis, involving the adhesion and contraction of
fibrous band to esophageal wall results in outpouching.
 The causes are local inflammation outside the esophagus
which includes disease processes involving the trachea,
lungs, hilar lymph nodes and pericardium.
ESOPHAGEAL DISEASES WITH LEAKAGE
Esophageal perforation and laceration
 This may occur from inside or outside the esophagus. Bite
wounds, gunshot wounds lacerations due to vehicle
injuries may result in perforation or laceration of
esophagus. Also results from ingestion of sharp foreign
bodies with or without signs of obstruction.
 Clinical signs depend on the location, extent and duration
of the perforation and associated leakage.
 The inflammation, hypoxia and necrosis in local tissues
may predispose to massive infection. Saliva, ingesta and
 microorganisms may leak from the esophagus which
causes local cellulitis and abscess.
 The perforation confirmed with esophagoscopy or contrast
esophagography. Conservative management includes
antibiotics, with holding of food and water for several days
and maintenance of hydration and electrolyte balance.
 In leakage, the perforation is exposed and the esophagus
repaired primarily. If the wound is unhealthy, and they are
debrided and a two-layer closure technique can be used. If
the wound is chronically infected, a reinforcing technique
is used. Postoperative care includes 3 to 5 days of
esophageal rest, using parenteral or gastric alimentation.
Esophageal fistula
 Esophageal fistula is an abnormal communication
between the esophagus and the trachea, bronchus, lung
parenchyma or the skin.
 Congenital fistulas occur due to failure in complete
separation of the developing foregut and respiratory
tracts. Acquired fistulas are more common which arises
secondary to trauma.
 Esophagobronchial fistulas are more common than
esophagotracheal and esophagopulmonary fistulas. In
dogs the fistulas most commonly occurs between
esophagus and the right caudal lung lobe. In cats, they are
in the accessory lobe and left caudal lung lobe.
 Cough induced by ingestion of food or liquids but in some
cases chronic signs of pneumonia or lung abscessation
may occur. Positive contrast radiography can be used to
demonstrate direct communication between esophageal
lumen and respiratory tract.
 Treatment involves thoracotomy to expose the esophagus ,
fistula and affected portion of the respiratory system.
 MODULE-19: AFFECTIONS OF
TRACHEA AND LARYNX
AFFECTIONS OF TRACHEA IN SMALL ANIMALS
Tracheal collapse
 This condition is reported in all age group of dogs with an
average of 7 years.
 There is no sex predeliction.
 Early signs are mild productive cough progressing to
severe exercise intolerance.
 Dyspnoea and harsh rales may be noticed. Abdominal lift
is more prominent when thoracic tracheal collapse is
severe.
 Palpation, radiographs and fluoroscopy of cervical and
thoracic region of trachea can be of diagnostic aid.
 Surgical correction should not be attempted unless the
upper respiratory obstruction, stenotic nares, laryngeal
collapse are relieved.
 Dorsal tracheal membrane plication, internal stents,
tracheal ring transection and external support are the four
common techniques used for correction of tracheal
collapse.
  Resection of long tracheal segments may require special
techniques to allow anastomosis.

 Resection of mucosal and submucosal granulation tissue

and mature scar leaves a mucosal defect that leads to
recurrence.

FOREIGN BODIES IN TRACHEA

 Small light objects may be inhaled deep within the

trachea, which leads to chronic pneumonia, abscess and
fistulous tracts.

 Acute onset of cough and dyspnea is common.

Tracheal rupture  High frequency rales may be heard in partial obstruction.

 Plain radiograph, bronchoscopy are the diagnostic aid to

TRACHEAL STENOSIS confirm foreign bodies.

 The retrievable foreign body can be removed from with the

 Narrowing of the tracheal lumen can be due to formation help of rigid hollow bronchoscope or flexible fiber-optic
of scar tissue because of endotracheal tube pressure, blunt endoscope.
or penetrating trauma, tracheostomy and tracheal
anastomosis.
TRACHEAL RUPTURE
 Dyspnea is observed during inspiration and expiration.
Tracheoscopy can be used to visualize the changes in the
lumen shape and mucosal surface.

 Dilatation of stenosis is achieved by passing large rigid

bronchoscope, stretching and flattening the stenosis.
 Laryngeal collapse

 It occurs due to result of cartilage fracture or loss of

supporting function of the cartilage. This is a
brachycephalic airway syndrome and is a progressive
disease.

 Predisposing factors are stenotic nares and elongated soft

X-ray tracheal rupture
palate. A temporary tracheostomy is necessary to ensure
adequate passage of air during surgery and also for post
Subcutaneous emphasema operative recovery. Dogs with stenotic nares and elongated
following tracheal rupture
soft palate and everted laryngeal saccules are treated first.

 Permanent tracheostomy is an alternative for dogs with

Causes severe laryngeal collapse even after resection of above
mentioned conditions.
 In small animals dog bitten wounds and penetrating
trauma on the neck region might result in punctured Laryngeal paralysis
wounds on the trachea.
 In dogs and cats usually occurs from an interruption of the
Symptoms innervation to the intrinsic muscles of the larynx.

 Emphysema, hissing sounds of air in the trachea
Treatment
 Suturing of the punctured trachea / larynx with a
monofilament absorbable suture material. (1/0 PDS)
AFFECTIONS OF LARYNX IN SMALL ANIMALS
 Any disruption of normal nerve transmission of vagus or
recurrent laryngeal nerves; may be either congenital or
acquired.
 Damage or severance of the laryngeal nerves subsequent
to cervical surgery or trauma also cause paralysis.
 Clinical Signs
  Clinical Signs include change in voice followed by gagging
and coughing in early stages. In severe cases, severe
dyspnea, cyanosis or syncope can be noticed.
 Treatment
 Unilateral or bilateral arytenoid cartilage lateralization,
ventricular cordectomy, and permanent tracheostomy are
the surgical procedures used to correct laryngeal paralysis.
Everted laryngeal saccules
 Mostly seen in brachycephalic breeds. The saccules evert
in response to decrease in pressure that is created within
the larynx during inspiration.
 Everted tissue rapidly becomes edematous and partially
occludes the ventral rima glottis.
 The saccule is grasped with long Allis tissue forceps, the
saccule is amputated at its base while applying rostral
traction.
Laryngeal trauma
 The intrinsic trauma is caused by rough intubation for
anesthesia and examination. Long term intubation can
result in temporary laryngeal paralysis and aspiration.
 Extrinsic trauma due to accident is uncommon.
Submucosal hemorrhage, mucosal laceration, luminal
obstruction due to cartilage mal-alignment or hematoma
are signs of laryngeal damage.
 Laryngoscopy and esophagoscopy are important methods
of examining the injuries.
 Advancement flaps of mucosa from the piriform area are
used to cover rostral laryngeal cartilage surfaces covered
with mucosa. Fractured cartilages are debrided, trimmed
and closed with preplaced interrupted sutures.
Laryngeal stenosis
 Obstruction of the larynx by granulation tissue and
cartilage degeneration and collapse results in progressive
reduction in airway diameter.
 These lesions vary from web stenoses to broad based scar
tissue covered by mucosa. Laryngeal stenosis is a
complication of laryngeal surgery and trauma.
Proliferative diseases
 Granulomatous laryngitis is a chronic inflammatory
disease and the lesions are found around the arytenoid
processes and cause stenosis. Regression of the lesion
usually occurs with debulking of the mass and steroid
theraphy.
 Primary neoplasia of the larynx is rare in dogs and cats.
Only Squamous cell carcinoma is the most common
laryngeal neoplasia in small animals. Inflammatory polyps
and laryngeal cysts are occasionally encountered in the
laryngeal region.
 MODULE-20: THORAX AND ABDOMEN -
THORACOTOMY AND AFFECTIONS OF
RIBS
FRACTURE OF RIB, WOUND AND
  Pneumothorax can be of following types.
PNEUMOTHORAX
 Signs include

o Exercise intolerance
Fracture of Ribs
o Labored breathing
 Rib fractures are found inconjunction with other fractures
(legs, pelvis,spine) and are a result of trauma (motor
o Increase in the respiratory rate
vehicleaccident).
o Cyanotic tongue
 Trauma to the chest wall can be associated withsevere
respiratory (breathing) difficulty.
o Thoracic radiographs (X-rays) to look for the
presence of air in the thoracic cavity
 Dogs can have"pulmonary contusion" , "pneumothorax" ,
and "flail chest"
o Arterial blood gas,
 Rare in ruminants
o Pulse oximetry
 Compound fractures can cause costal fistula
Treatment
Diagnosis
 Thoracocentesis, which is removal of air from the chest
cavity with a needle and syringe.
 Clinical examination
 Treatment of concurrent fractures and soft-tissue injuries.
 X-ray of the thorax, helps to evaluate the lung injuries too
 Most rib fractures are managed without any treatment.
Treatment
 Occasionally, the individual fractures may be surgically
 Costal fistula can be treated by resection of the affected rib repaired with pins and/or wires.

Pneumothorax  When multiple rib fractures are present, leading to a "flail

chest," the freely moving section of the chest wall usually
 Pneumothorax is the abnormal presence of air within the must be stabilized by attaching the ribs within the free
thoracic cavity, which restricts the lungs from inflating segment to a large splint placed on the surface of the skin.
normally during inhalation.
 The ribs are attached to the splint with suture material
placed through the splint and around each rib. PREREQUISITES FOR THORACOTOMY

THORACOTOMY  Since the normal negativity of the thorax is altered by the

presence of air in the thoracic cavity,

 Thoracotomy is the surgical incision of the chest wall to  Facility for mechanical ventilation of the lungs is a must
enter the thoracic cavity. before opening the thorax.

 The normal negative pressure of the pleural space will be  This is done using a ventilator which provides intermittent
lost on account of air entering the pleural cavity. positive pressure ventilation.

THORACOTOMY IN DOGS

Approaches to thoracic cavity

1. Intercostal incision

2. Rib resection

3. Intercostal incision with resection of adjacent rib

4. Rib splitting
Plain radiograph showing pnemothorax
5. Median sternotomy

6. Abdominal approach.
 Thus there will be increase in the pressure in the pleural
cavity, which overcomes the pressure of the air inside the
lungs leading to lung collapse.
  Incise the periosteum longitudinally and strip off the
periosteum completely from the rib.

 Resect the rib at the proximal end and then disarticulate it

at the constochondral junction.

 Incise the exposed periosteum of the resected rib and the

pleura to enter the thoracic cavity.

 Closure is done by suturing the pleura and periosteum

together, followed sequentially the subsequent layers.
Rib retractor in place
Split-rib technique

Intercostal incision  Expose the rib and longitudinally incise over the rib at its
centre.
 Incise cranial to the rib since the intercostal vessels
courses the rib caudally.  Section the rib transversely at either ends of the primary
incision to approach the thoracic cavity.
 A self retaining rib retractor should be used for exposure
of the thoracic cavity.  Closure of the rib incision is done by interrupted sutures.

 For closure, place series of interrupted sutures around Intercostal thoracotomy

adjacent ribs.
Lateral recumbency.
 Hold the ribs closer and tie the sutures individually.
 Select the site for incision.
 A simple continuous suture in the intercostal muscles
seals the incision against air leaks.
 Locate appropriate intercostals space.

Rib resection  Sharply incise the skin, subcutis and cutaneous trunci.

 Incise directly over the rib.  Deepen the incision through lattisimus dorsi, transect the
scalenus and pectoral muscles.
  Separate muscle fibers of serratus ventralis.

 Incise the external and internal intercostal muscles.

Ligamentum arteriosum

 Closure of the thoracotomy is by preplacing heavy

Penetrating the pleura
 Penetrate the pleura.
 Extend the incision dorsally and ventrally for desired
exposure (Avoid incising internal thoracic vessel as they
course subpleurally near the sternum).
 Use Finochitto rib retractor to spread the rib.
monofilament sutures around the adjacent rib and
approximating the ribs before tying the sutures.
 Negative pressure of the pleural cavity should be re-
established while tying the last suture of the thoracotomy
incision.
 This is done by inflating the lungs fully so that all air is
emptied from the pleural cavity.
 The last suture should be tied when the lung is in full
inflation to establish negative pressure in the pleural
cavity.

RECOMMENDED SITE FOR THORACOTOMY IN

  Transect the sternebrae longitudinally on the midline to
DOGS enter the thoracic cavity.

 Retract the edges with a Finochitto rib retractor.

Organ Intercostal Side
space  Closure is to be done with wires or heavy sutures place
around the sternebrae.

 Establish negative pressure while tying the last knot.

Heart 4th or 5th Left or
Right
AFFECTIONS OF RIB IN SMALL ANIMALS

Lungs 4th- 6th Left or

Right  Fracture of ribs,missing ribs, fused ribs, extra ribs and
malformed ribs may occur in small animals. Surgical
correction is not indicated unless the deformity results in
Cranial 3rd or 4th Left restricted ventilation or paradoxical movement of the
Oesophagus chest wall.

 Severe kyphoscoliosis usually results in malformation of

the thoracic cavity. Surgical correction is not
Caudal Oesophagus 7th – 9th Left or recommended generally.
Right
 Metabolic bone diseases such as hyperparathyroidism,
hypervitaminosis D, and multiple cartilaginous exostosis
MEDIAN STERNOTOMY IN are occasionally manifested in bony thorax.
DOGS
 Rib neoplasms are usually primary and malignant.
Osteosarcoma is the most common one. Chondrosarcoma
is the second most common.
 Dorsal recumbency.

 Incise skin on midline of the sternum.

 Expose sternum by incision and dissection of the overlying

muscles
 Diaphragmatic herniorrhaphy 6th or 7th rib

Transthoracic oesophagotomy 8th rib

Diaphragmatic abscess 7th rib

Lobectomy 4th or 5th rib

Thoracic tumor

TECHNIQUES IN THORACOTOMY OF
 Thoracic radiographs usually provide information about BOVINES
osteolysis, intra and extra thoracic soft tissue masses and
mineralization of ribs affected with sarcomas. Malignant
neoplasms can be removed by en bloc resection.
Intercostal incision

SITES FOR THORACOTOMY IN BOVINES FOR  Incise cranial to the rib since the intercostal vessels
COMMON CONDITIONS courses the rib caudally.

 A self retaining rib retractor should be used for exposure

of the thoracic cavity.
Procedure Site
 For closure, place series of interrupted sutures around
adjacent ribs.
Thoracocentesis 5th to 7th
 Hold the ribs closer and tie the sutures individually.

Pericardiocentesis, Pericardiotomy, 5th intercostal space or  A simple continuous suture in the intercostal muscles
Pericardiectomy 5th rib resection seals the incision against air leaks.
Rib resection
 Incise directly over the rib.
 Incise the periosteum longitudinally and strip off the
periosteum completely from the rib.
 Resect the rib at the proximal end and then disarticulate it
at the constochondral junction.
 Incise the exposed periosteum of the resected rib and the
pleura to enter the thoracic cavity.
 Closure is done by suturing the pleura and periosteum
together, followed sequentially the subsequent layers.
Split-rib technique
 Expose the rib and longitudinally incise over the rib at its
centre.
 Section the rib transversely at either ends of the primary
incision to approach the thoracic cavity.
 Closure of the rib incision is done by interrupted sutures.
Clinical signs

 MODULE-21: HERNIA
UMBILICAL HERNIA
Synonyms: Omphalocoele
 This is the hernia that develops in the umbilical region.
The contents usually consist of omentum and intestines.
The condition is common in foals, pigs, calves and pups
but rare in lambs and kids.
 Umbilical hernia is comparatively more common in
females than in males. The disease can be congenital or
acquired. Acquired hernia is noticed few weeks after birth.
Umbilical hernia may primarily be hereditary in origin due
to dominant genes with low penetrance and autosomal
recessive genes or due to environmental factors.
 The umbilical opening in the foetus allows the passage of
the urachus and umbilical blood vessels. At birth, these
structures are disrupted and the opening closes around the
cord.
 The wound heals by cicatrisation which represents
umbilicus in the later life. Acquired hernial ring may be
primarily due to trauma, resection of cord too close to
abdominal wall and excessive straining due to diarrhoea/
constipation. Infection of the cord may also prevent
natural closure of umbilicus.
 A discrete spherical swelling at umbilicus
o Hernial contents are usually fat and omentum
o Larger hernial sac contains loops of small intestine
Sac is formed by skin, fibrous tissue and
peritoneum
 o A circular or oval hernial ring can be palpated.
o Presence of adhesions/ umbilical abscess prevent
reduction.
o Rarely, the contents get strangulated with
symptoms of pain and intestinal obstruction
 Diagnosis: Clinical signs and physical examination
Treatment
 Umbilical hernia may be treated by various conservative or
surgical methods. Conservative treatments are suitable
only for a small reducible hernia.
o Reducible umbilical hernia containing only a small
part of the omentum or a small loop of intestine
may respond favourably to abdominal pressure
bandages or clamps.
o Reduce the hernia and the hernial ring to close by
cicatrisation.
o Use of metal or wooden clamps: The main objective
of the clamp application is to obliterate the hernial
sac and to stimulate healing of the ring.
o Control the animal in dorsal recumbency
o Reduce hernial contents manually.
o Open the jaws of clamps
o Place it longitudinally and directly over the hernial
ring
o Push down the hernial sac through the jaws of the
clamp . Tighten the nuts of clamp to keep the clamp
snugly against the abdominal wall
o The sac undergoes necrosis and sloughs down
within 10-12 days.
o The skin wound heals by second intention
Radical surgery
 Operation is done at the age of three months. If the
swelling is too big , treatment is attempted immediately.
 Anaesthesia : General anaethesia or sedation combined
with local anaethesia.
 With the animal in dorsal recumbency an elliptical
incision is made on the skin over the hernial swelling.
 The incision is extended over the sac. The contents are
reduced and the hernial ring is debrided and sutured.
 Preferably a synthetic non absorbable suture material is
used. The ring is closed in a double breasting or
overlapping pattern. Excess skin if available is trimmed
before suturing.
 Hernioplasty is indicated if the hernial ring is large and
weak which, could not be apposed.
VENTRAL HERNIA
  Ventral or lateral adnominal hernia is the term used to  Prolonged delay may cause complications due to
describe a hernia through any part of the abdominal wall adhesions between the displaced viscera and subcutaneous
other than a natural orifice. This condition is common in tissue.
horse,goat and cattle and is generally acquired in nature.
 If hernia is complicated (due to incarceration/
Etiology strangulation) immediate surgical intervention is required.

 Any trauma – horn thrust in cattle, violent contact with Technique

blunt objects, weakening of the abdominal muscle
 An elliptical or linear incision is made over the hernial
 Violent straining during parturition – common in sheep swelling. The contents are reduced.

 Ventral or lateral hernia is usually seen along costal arch,

high or low in flank and between the last few ribs in the
ventral abdominal wall near the midline

Signs

 Size of the hernial ring varies in diameter. The hernial

swelling is usually very prominent.

 It is difficult to palpate the hernial ring in initial stages due

to oedema or haematoma surrounding tissue.

 Strangulation is very rare. Nature of hernial contents Dorsal recumbency Hernial ring
depends on the site of herniation.

 The peritoneal sac is ligated or sutured close to the ring

Treatment
and amputated.
 When the hernia is harmless – herniorrhaphy is elective;
not an emergency.

 It is advisable to delay the surgical repair until the

inflammation subsides.
  Hernioplasty using prolene mesh as onlay graft.

 The skin incision may be sutured with a vertical mattress

sutures.

Post operative care

Herniorrhaphy Prolene mesh

 The hernial ring is debrided and sutured using

overlapping sutures with a non absorbable suture
material.

 Amount of feed should be restricted.

 Supportive bandage may be placed around the abdomen.

Tear of scar tissue during parturition and recurrence of
hernia may occur in some cases.

PERINEAL HERNIA

Onlay grafting  This disease is most predominantly seen in old

uncastrated male dogs. Though the condition is reported
in bitches and cats, the incidence is rare.
  Etiology Weakening of the pelvic diaphragm and hernia  Hard swelling should be differentiated from perianal
can occur due to the following factors. neoplasm.

 Hormonal disorders, Prostatic diseases, Rectal diseases Diagnosis

and Anatomical factors – rectal deviations, diverticula etc.,
 Diagnosis should be made from clinical signs.

 Contrast radiography with barium enema will help to

differentiate rectal deviation from rectal diverticulum.

 Ultra sound scan will be useful to identify a retroflexed

bladder.

Surgical management

Perineal hernia Perineal hernia - Radiographic

view

Symptoms

 Fluctuating /hard swelling ventral and lateral to the anus

(in the ischiorectal fossa)

 Swelling may be unilateral or bilateral

 The hernial contents are usually rectum, enlarged prostate

and perineal fat. Retroflexion of the bladder is not
uncommon. Incarceration of bladder in the perineal
hernia should be considered as an emergency.
Perineal herniarraphy

 Precise anatomical correction of perineal hernia is

mandatory for successful outcome.

 Many techniques are available for correction of the defect.

o Conventional method

 The animal is restrained in ventral

recumbency in an inclined position with the
hind quarters elevated. The tail is lifted up
and tied in front.

 An incision is made over the swelling. The

contents are reduced. The structures are
identified and the correction is made in the
following manner.

 The medial cocygeus muscle is sutured to the

external anal sphincter on the dorsal aspect.
 The sacro sciatic ligament is anchored to the
external anal sphincter on the lateral aspect
and the internal obturator muscle on the
pelvic floor is sutured to the external anal
sphincter on the ventral aspect.
o Internal obturator flap
 In this technique the internal obturator flap
is elevated from the pelvic floor using a
periosteal elevator and sutured to the medial
coccygeus, levator ani and external anal
sphincter.
 The advantage of this technique is that it acts
as a sling to suspend the rectum and does not
cause undue tension on the external anal
sphincter as in the conventional technique.
 Recurrent perineal hernia can be corrected
using techniques such as semitendinosus
muscle and reinforcement with tensor fascia
lata.
GUT TIE IN BULLOCKS
 This is a type of intra abdominal hernia and it is also
known as pelvic hernia and peritoneal hernia. This is
formed by the passage of a portion of intestine either
through a tear in the fold of serous membrane suspending
the spermatic cord in the sub lumbar region or through a
herinal ring like passage formed between adhesion of the
cut end of the spermatic cord to the abdominal wall and
the lateral abdominal wall.
 Incidence: Found in bullocks only; however the condition
is very rare.
Etiology
 Retraction of the cut end of the spermatic card into the
abdominal cavity during castration and formation of
adhesion between the cut end of the spermatic cord and
the abdominal wall.
 Gut tie occurs only on right side because rumen prevents
the herniation on the left side.
Symptoms
 Clinical symptoms are usually absent unless there is
strangulation. When strangulation occurs animal exhibits
signs of intestinal obstruction (Frequent lying down and
getting up; looking towards the flank; attempting
defecation)
 In some cases the symptoms are noticed for a few days
followed by spontaneous relief.
Diagnosis
 Pain is evinced when pressure is exerted on the right flank
 By rectal examination. The distended and herniated
portion of the bowels and the stretched spermatic cord can
be palpated.
Treatment
  By making the animal jump from a height or making it
walk down an inclination may sometime reduce the
hernia.
 Attempts may be made to reduce the hernia through rectal
palpation.
 Radical surgery is by making a right flank laparotomy and
severing the adhered spermatic cord with a concealed
knife.
Caudal/ femoral hernia
 This is a very rare condition and is recognized as a swelling
on the muscular aspect of the thigh between sartorius and
gracilis muscle.
 Symptoms
o Swelling in the femoral canal. The limb on the
affected side is carried forward in an
abducted manner during progression .
 Treatment
o An incision is made over the swelling and after
reducing the contents the poupart or the inguinal
ligament is sutured to the sartorius muscle.
Symptoms
DIAPHRAGMATIC HERNIA
 Congenital peritoneo pericardial hernia
 The signs occur at any age. sometimes will be shown while
shifting to solid food.
 It is also noticed incidentally in thoracic radiographs or at
necropsy.
 Clinical signs include respiratory distress and related to
the type of organ involved in herniation.
 Acquired Diaphragmatic hernia
 Diaphragmatic hernia in dogs is usually traumatic; like
accidents or a fall from a height. The hernial content is
usually a portion of omentum, stomach or liver and very
rarely intestine.
 The extent of herniation depends upon size and location of
tear. The hernia gradually develops through a small tear
due to negative pressure in the thoracic cavity and
bellowing action of the abdomen during respiration.
Weakest points in the diaphragm are
o Close to posterior vena cava
o Costal margin
o Close to the oesophagus
 Symptoms in congenital diapragmatic hernia, may not be
noticed until the pup attains six months of age and when
its starts feeding on solid foods.
 Abdominal breathing.
  Peculiar cough, tendency to tire easily, unthriftiness and
tucked up abdomen. Plain radiography - Diaphragmatic hernia

 Tendency to vomit after feeding.

 Animal is reluctant to move. Remains most of the time in

 Contrast x- ray Diaphragmatic hernia
standing position or sitting on the haunches.

 Difficulty and pain while walking down from a height.

 Chronic stomach disorders.

 Respiratory distress .

 Gurgling sounds on auscultation of chest. Absence of

respiratory sounds on affected side. More pronounced
respiratory distress immediately after feeding

Diagnosis

 History and clinical signs on auscultation – cardiac sounds

are muffled Contrast radiography showing intestines in the thorax

 plain/contrast radiography
 Exploratory laparotomy

 Ultra sound scan

Treatment

 The condition is corrected only by surgery. IPPV The

diaphragm can be approached by different approaches

o Abdominal approach
 o Lateral Thoracic approach
o Median sternotomy
o Rib splitting
o The median sternotomy and rib splitting techniques
are rarely used. Median sternototmy gives a very
good exposure whereas the exposure to the thoracic
cavity is very limited with rib splitting.
o Intra operative considerations: In all the
approaches the animal should be maintained under
positive pressure ventilation.
o Negative pressure in the thoracic cavity should be re
established by aspirating the air from the thoracic
cavity before the final closure.
Thoracic approach
 The thoracic cavity is entered through a 6th or 7th
intercostal space. The hernia is reduced and the tear in the
diaphragm is sutured with a 1/0 synthetic absorbable
suture material.
 Care should be taken to avoid injury to lungs and other
great vessels. The intercostal incision is closed including
the adjacent ribs.
Abdominal approach
 Mid line incision starting from Xyphoid backwards is
made.
 The hernia is reduced and the tear in the diaphragm is
closed in the same manner.
DIAPHRAGMATIC HERNIA
Diaphragmatic hernia in bovines
 In cattle and buffaloes, reticulum is the common
herniating organ, however the omasum, abomasums,
loops of intestine, spleen or liver may also get involved.
Etiology
 Weakening of the diaphragm by lesions of traumatic
reticulo peritonitis, congenital weak points of the
diaphragm and physical force like increased intra
abdominal pressure during pregnancy and parturition,
violent fall etc.
Clinical signs and diagnosis
 Most affected animals develop recurrent tympany not
responding to medical treatment. The tympany is mild if
only a small portion of reticulam is herniated.
 As more and more of the organ is herniated, signs became
severe due to development of adhesions between the
reticulum and other structures like lungs, pericardium,
thoracic wall and hernial ring.
 There will be complete or partial cessation of milk yield
with passing of scanty, foul smelling pasty dung. Some
 cases show slight degree of melena, Regurgitation may
lead to aspiration pneumonia.

 Brisket edema and jugular pulse along with abduction of

fore limbs may be observed. In rare cases chronic cough
may be present.

 On auscultation, cardiac sounds are snuffled and reticular

sounds may be heard anterior the 6thrib. In untreated
cases, inanition, progressive emaciation, weakness and
dehydration leading to death are observed. The diagnosisDiaphagmatic vent Herniorraphy
is confirmed by plain and contrast radiography.

 Left flank exploratory laparotomy may be done. CONGENITAL DIAPHRAGMATIC HERNIA

Treatment
Congenital Diaphragmatic Hernia/Peritoneo-
 Treatment is only surgical.
pericardial Hernia
 The first step is to evacuate the contents of the rumen and
reticulum by rumenotomy and cud transplantation. Then  This is a common condition due to the failure of
for animal is kept on I/v fluids for 48 hours and there after development of septum tranversium.
in the soft diets with fluids, surgery to correct hernia may
be delayed 3-4 days.  Clinical signs includes vomiting, anorexia, lethargy and
diarrohea and dyspnoea is infrequent.
 The common approaches for diaphragmatic hernia are
abdominal and thoracic. Irrespective of the approach,  On physical examination, heart sounds are muffled and
proper ruminal evacuation and assisted ventilation during intestinal sounds are heard in the ventral portion of the
herniorrhaphy are required for successful procedure. chest.

 Radiography confirms the diagnosis. The hernia is

repaired through ventral midline laparotomy.

INGUINAL HERNIA
Definition
 Protrusion of an abdominal organ through the inguinal
canal is called inguinal hernia (Bubonocele). If the hernial
contents extend into the scrotum in male animals the
condition is called as scrotal hernia .
 Incidence: Bitches, horses, bulls and pigs
 Anatomy
 Inguinal canal is an oblique (slit like) canal between the
abdominal muscles connecting the external and internal
inguinal rings.
 The canal acts as a passage for structure like spermatic
cord in males and external pudic artery in females.
 Internal inguinal ring is longer than external.
Causes
 May be congenital or acquired – accidental slipping causes
streching of the hind limbs outwards which may dilate
inguinal canal.
Symptoms
 In bitches appreciable swelling is noticed in the inguinal
region. Difficulty in defecation.
 In large animals swelling in the inguinal canal at the neck
of scrotum .
 Unilaterally enlarged scrotum; affected bulls or stallions
may be reluctant to serve
 Refuse to move due to pain
 Abduction of hind limbs
 Systemic signs are evident only when the hernia gets
strangulated.
Hernial contents includes intestine ,urinary bladder , uterus in
female and omentum.
Diagnosis
 Clinical signs
 Radiography/ fluoroscopy. Hernial swelling close to or
including the scrotum .
 Rectal palpation in large animals.
Treatment
 In small animals: A paramedian incision is made close to
the inguinal swelling. The contents are reduced by gentle
pressure. A kelotomy (extension of the hernial ring) may
be performed if the hernial ring is small. The edges are
debrided and closed using an absorbable suture material
by overlapping pattern.
 In large animals: After making the incision the hernia is
reduced and purse string suture is applied around the
tunica vaginalis as far high as possible. A portion of the
omentum that is difficult to reduce can be amputated.
 Overlapping suture of the muscles and routine closure of  The clinical signs may vary from absence of symptoms to
the skin is made. severe dyspnoea Also, signs vary with the location and the
organ terminated.

 Other conditions such as rib fracture, penumothroax, lung

contusion or shock also may be present.

 Due to dyspnoea, the animal (dogs) rest in sitting position

with the elbow abducted. On physical examination,
intestinal sounds may be heard in the thorax, the heart
may be displaced and the heart sounds snuffled.

 Careful palpation may reveal reduction in volume of

abdominal viscera or abnormal position of the organs.

 Lateral and ventro-dorsal radiographs will confirm

diagnosis, contrast radiography with barium meal will
help in diagnosis of herniation of stomach or intestional
loops.

Inguinal hernia  Clinical signs are not exhibited at the time of original
injury. But it may develop gradually and show clinical
signs such as intermittent vomiting, anorexia, jaundice,
TRAUMATIC DIAPHRAGMATIC dyspnea, reduced exercise tolerance etc.
HERNIA
 Surgical correction is the only treatment.

 This is caused usually by blunt trauma, especially

automobile accidents. HIATAL HERNIA

 The tear can occur any where in the diaphragm or the

diaphragm may get separated from its attachment to the  This is a form of diaphragmatic hernia in which the caudal
ribs. end of the oesophagus and cardiac area of the stomach
pass through the oesophageal hiatus of the diaphragm.
Clinical signs
  The associated sign is the oesophagitis. Treatment  Brisket edema and jugular pulse along with abduction of
consists of reducing the hernia and reconstructing the fore limbs may be observed. In rare cases chronic cough
diaphragam. may be present.

Diaphragmatic hernia in bovines
 In cattle and buffaloes, reticulum is the common
herniating organ, however the omasum, abomasum, loops
of intestine, spleen or liver may also get involved.
 On auscultation, cardiac sounds are muffled and reticular
sounds may be heard anterior to the 6 th rib. In untreated
cases, inanition, progressive emaciation, weakness and
dehydration leading to death are observed. The diagnosis
is confirmed by plain and contrast radiography. Left flank
exploratory laparotomy may be done.

Etiology
Treatment
 Weakening of the diaphragm by lesions of traumatic
 Treatment is only surgical.
reticulo peritonitis, congenital weak points of the
diaphragm and physical force like increased intra
abdominal pressure during pregnancy and parturition,  The first step is to evacuate the contents of the rumen and
violent fall etc. reticulum by rumenotomy and cud transplantation.
Then the animal is kept on I/v fluids for 48 hours and
there after in the soft diets with fluids. Surgery to correct
Clinical signs and diagnosis hernia may be delayed 3-4 days.

 Most affected animals develop recurrent tympany not  The common approaches for diaphragmatic hernia are
responding to medical treatment. The tympany is mild if abdominal and thoracic. Irrespective of the approach,
only a small portion of reticulum is herniated. proper ruminal evacuation and assisted ventilation during
herniorrhaphy are required for successful procedure.
 As more and more of the organ is herniated, signs become
severe due to development of adhesions between the
reticulum and other structures like lungs, pericardium,
thoracic wall and hernial ring.
 MODULE-22: SURGICAL
 There will be complete or partial cessation of milk yield AFFECTIONS OF STOMACH AND
with passing of scanty, foul smelling pasty dung. Some
cases show slight degree of melena, Regurgitation may
CARDIA IN DOGS
lead to aspiration pneumonia.
GASTRIC EMPTYING DISORDERS, GASTRITIS
The three types are  Gastric Dilatation and volvulus.

 Benign gastric outflow obstruction.

1. acclerated gastric emptying --seen in hyper thyroidism
 Gastric ulceration and erosion.
2. retrograde or gastroesophageal reflux , Affected animals
vomit usually after an overnight fasting.
 Gastric neoplasia and infiltrative disease .
3. delayed gastric emptying due to functional obstruction or
 Stricture of cardia
mechanical obstruction
 Foreign body in the caudal thoracic esophagus.
Gastritis
Surgical anatomy
 the causes are bacterial viral or toxins
 Stomach cardia, fundus. Body, pyloric antrum, pyloric
 gastric ulcers also occur due to neoplasms, corticosteroids, canal, pyloric ostium.
systemic diseases
 Oesophagus entry at cardiac ostium of stomach.
 Many acute gastric lesions are self limiting
 Fundus is relatively smaller in canine and dorsal to cardiac
Chronic gastritis ostium. On radiography gas present.

 Basd onthe type of cell infiltrate different types are there  Body of stomach: lies against left lobe of liver
eoisinophilic,lymphocytic, plasmacytic and based upon the
inflammation, mild moderate, severe.  Pyloric antrum: funnel shaped, open into pyloric canal.

 Pyloric ostium: end of pyloric canal and empties into

GASTROTOMY IN CANINE duodenum.

 Blood supply: Aorta, Celiac artery, Gastric artery on lesser

 Incision through stomach wall into lumen. curvature & gastroepiploic artery on greater curvature of
stomach.
Indication
ANAESTHESIA
 Foreign body in stomach.
Premedication

 Atropine sulphate @ 0.02--0.04 mg/kg sc (or)

 Glycopyrollate @ 0.005--0.01 mg/kg b.wt. s.c., i.m. Procedure

(reduce gastric secretion & damage to oesophagus mucosa
or respiratory tract).  Incision is taken on ventral midline from xiphoid
backwards.
Induction
 Abdominal content is packed;
 Thiopentone @ 10-12 mg/kg i.v. or Propofol @ 4-6 mg/kg
i.v. or Ketamine (5.5 mg/kg) + Diazepam (0.27 mg/kg) i.v.  Stay sutures are placed on the stomach.

 Incision on stomach is made on ventral aspect between

Maintenance greater and lesser curvature at hypo vascular area.

 Inhalant anaesthesia - isoflurane/sevoflurane.  Precaution is taken not to incise near pylorus (closure of
incision may cause in infolding of tissue and the
Precaution outflow may be obstructed.

 Avoid nitrous oxide in Gastric dialatation  Stab incision on stomach wall to lumen by scalpel and
/torsion /intestinal obstruction, it rapidly diffuse in enlarged with metzenbaum scissors.
distended organ and cause additional distension.
 Suction is used to aspirate gastric content and to reduce
spillage.
Preoperative management
 After correction of condition based on indication, closure
 Withhold food for 12—24 hrs. of incision by 2-0 or 3-0 absorbable suture material.
Suturing pattern; two layers;
 In younger animal of 6 months rapidly depletion of liver
glycogen during fasting (don’t fast more than 6 hrs).  I layer - Connell suture including all the layers followed by
a Lembert/Cushing suture
 Correct dehydration if present
 Before closing abdomen incision- instrument is
substituted with sterile set and gloves are changed
SURGICAL TECHNIQUE
 Physical examination
POST OPERATIVE CARE
 General appearance - Dull
 Monitor fluid status, maintain hydration until animal is  Behavior - Depressed
drinking. Correct electrolyte abnormalities.
 Feeding habit - Not satisfactory
 Start feeding 12-24 hrs after surgery if patient is not
vomiting.  Excretory habit - Normally voided
 Broad spectrum antibiotic  Lymph nodes - NAD

 Pulse - Weak
GASTRIC DIALATATION AND VOLVULUS
 Respiration - Thoracic

 Enlargement of stomach associated with rotation on its  Skin and coat - Smooth and shiny
mesenteric axis.
 Conjunctival mucous memebrane - Pale
 It is an emergency condition which warrants immediate
surgical intervention
Radiography
 Even in treated aniamls about 45% mortality is recorded
since it is an acute condition. Hence this is considered as  Right lateral view
an emergency condition.
 Gas filled structure –gastric dilatation
Anamnesis

 Enlarged abdomen

 Animal recumbent and depressed

 Non productive retching

 Hyper salivation
 Right lateral
Gas filled structure - Gastric dilatation
 Pylorus – cranial to the body
GDV - TREATMENT - BELT LOOP GASTROPEXY
Anesthetic protocol and fluid management
 Atropine - 0.02 – 0.04 mg/kg i /m —
 Ketamine - 10.0 mg/kg —
 Diazepam - 0.5 mg/kg —
view
PYLORIC STENOSIS IN DOGS
Definitions
 Pyloric stenosis – It refers to benign muscular
hypertrophy of the pylorus.
 Chronic antral mucosal hypertrophy – Refers to benign
hypertrophy of the pyloric mucosa causing outflow
obstruction.
 Chronic hypertrophic pyloric gastropathy ( CHPG )
Denotes pyloric hypertrophy without specifying whether
the mucosa or the muscularis is involved.
 o Most commonly seen in brachycephalic
Synonyms
breeds ( Boxers, Bulldogs, & Boston terriers )
 Pyloric stenosis also known as – – Benign antral muscular
o Siamese cats are also affected– Males may be more
hypertrophy. – Congenital hypertrophic stenosis –
Congenital pyloric muscle hypertrophy commonly affected.

o More common in young animals although all age

 The cause of pyloric stenosis is unknown, but it may be
due to groups of animals are susceptible.

o Hypergastrinemia – major regulator of gastric acid
secretion and is trophic for gastric smooth muscle
and mucosa.
o Gastrin administration to pregnant bitches
 History – the clinical signs are caused by obstruction of
gastric outflow.
o Vomiting – most common sign either intermittent
or delayed hours after feeding or both.

o Neurogenic dysfunction – spinal cord disorders. o Regurgitation

o Acute stress o Aspiration pneumonia

o Inflamatory disease o Severe dehydration is uncommon but may occur

o Trauma o Later chronic vomiting

o Prolonged gastric distention o Electrolyte imbalance

o Foreign body o Metabolic alkalosis

o Neoplasm Physical examination findings

Diagnosis  Generally nonspecific findings – Weight loss , Anorexia ,

Depression – Dehydration and / or – Abdominal pain .

Clinical presentation  Aspiration pneumonia or reflux esophagitis ( or both )

may occur secondary to chronic vomiting
 Signalment
Radiography
  Survey Radiographic findings – – Survey radiograph of
abdomen may reveal gastric distention ( usually filled with PYLORIC STENOSIS - TREATMENT
fluid ) –

 Contrast Radiographic findings – – It reveals delayed

emptying – Pyloric wall thickening – And / or filling defect Medical management
in the pylorus.
 Dehydration, electrolyte & acid – base abnormalities
should be corrected
Note: Normal elimination of liquid barium does not rule out
gastric outflow obstruction  H 2 blockers.

 Antibiotics is indicated for esophagitis due to ulceration

Diffrential diagnosis aspiration.
 Any condition that causes vomiting is a differential
diagnosis NOTE – Gastric prokinetics ( metoclopramide and cisapride )
should not be used if outflow obstruction is suspected.
o Gastrointestinal foreign body

o Gastritis Surgical management

o Neoplasia presurgical preparation

o Ulceration  Withheld of the food for 24 hours before surgery.

o Uremia  Presurgical endoscopy – – To define the extent of the

lesion. – To confirm benign or malignant nature.
o Hypoadrenocorticism
 Intravenous prophylactic antibiotics e.g., cefazolin ; 22 mg
o Diabetic ketoacidosis / kg i /v once or twice at 2-4 hrs interval.

o Hepatic insufficiency
Premedictaion
o Peritonitis, pancreatitis
 Atropine (0.02-0.04 mg/kg s/c, I /m)
o Inflammatory bowl disease
 Butorphanol (0.2-0.4 mg/kg s/c, i /m)
 o Billroth II – attachment of the jejunum to the
Induction
stomach ( gastrojejunostomy ) after a partial
gastrectomy ( including pylorectomy )
 Propofol (4-6 mg/kg i /v) or ketamine -diazepam

 Fredet – Ramstedt pyloromyotomy

 Maintenance Procedure – It is simplest & easiest one. It probably provides

only temporary benefit because healing may lessen the lumen
Isoflurane
size.
Site  Hold the pylorus between the index finger & thumb in the
hand.
 Dorsal recumbency
 Select a hypo vascular area of the ventral pylorus, & make
 Abdomen is prepared for a ventral midline incision – a longitudinal incision through the serosa & muscularis,
Extended from mid thorax to near the pubis. but not through the mucosa.

Ventral midline celiotomy
 Surgical procedure
include Pyloromyotomy, Pyloroplasty, Billroth I  If the mucosa is inadvertently penetrated, suture it with
( Gastroduodenostomy ) &Billroth II ( Gastrojejunostomy)
o Pyloromyotomy – an incision is made through the
serosa & muscularis layers of the pylorus only.
o Pyloroplasty – a full thickness incision and tissue
reorientation are performed to increase the
diameter of the gastric outflow tract.
o Billroth I – removal of the pylorus ( pylorectomy ) &
attachment of the stomach to the
duodenum ( gastroduodenostomy )
 Make sure that the mascularis layer is completely incised,
to allow the mucosa to bulge into the incision site.
interrupted sutures of 2 – 0 or 3 – 0 absorbable suture
material.
Heineke – Mikulicz pyloroplasty (transverse
pyloroplasty)
 3 - 5 cm longitudinal full thickness incision is made on the
antimesenteric border, centered over the pylorus..
 Stay sutures are placed at mid – distance on either side of
the longitudinal incision; traction is applied to convert the
incision to a transverse orientation.
  The incision is closed in one layer with a simple
interrupted or continuous appositional pattern.
Y – U Advancement Pyloroplasty
 Y shaped full thickness incision is centered over the
pylorus ; the body of the Y extends along the
antimesenteric border of the duodenum & the arms of the
Y extended onto the pyloric antrum.
o The point of the U shaped flap is apposed to the
end of the Y with a simple interrupted suture.
o The two sides of the resulting U shaped incision are
sutured in a simple interrupted or continuous
appositional pattern.
 MODULE-23: SURGICAL AFFECTIONS
DIAGNOSIS AND TREATMENT OF
STOMACH IN RUMINANTS
A REVIEW OF ANATOMY
 In bovines and small ruminants, the compound stomach
occupies approximately three fourth of the abdominal
cavity and almost fills the left half of it.
 The rumen, reticulum and omasum are regarded as
oeosphageal sacculations and are lined with stratified
squamous epithelium.
 The abomasum has a glandular mucous membrane. Hence
it is also called true stomach.
 The reticulum is the smallest compartment of the stomach
in bovines while the omasum is the smallest in sheep.
 The long axis of the rumen extends from a point opposite
to the ventral part of the 7th or 8thintercostals space almost
to the pelvic inlet.
 The parietal surface is related to the diaphragm, spleen
and the left and ventral abdominal wall.
 The visceral surface is related to the liver, omasum,
abomasum, pancreas, intestine, left kidney and left
adrenal. The surface of the rumen are marked by the right
and left grooves which extremely separate the dorsal and
ventral sacs.
 The rumeno reticular groove demarcates the reticulum
from the dorsal sac on the left side. The mucous
membrane of the rumen is brown in colour and free from
glands. The rumen papillae cover the mucosa to provide a
grip over the ingesta during rumen contractions.
 The reticulum lies between the sixth to 8th or 9th inter
costal space and almost equal parts lie on either side of the
median line.
 The mucous membrane of the reticulum is raised into
folds in a typical honey comb pattern and acts like a sieve
for foreign bodies.
 The reticular groove starts at the cardia to connect it with
the abomasums and its length is about 15 to 20 cm in
bovines and 7 to 10 cm in small ruminants.
  The muscular lips of the groove encircle the cardia from
dorsal aspect and pass steeply down the reticular wall in
the direction of reticulo-omasal opening in young
ruminants, the reticular groove closes when the animal
drinks milk so that the liquid passes directly to the
Acute bloat
abomasums.
 Receptors to initiate thin reflex are located in the larynx.
As the animal grows, the reflex weakens and finally both
solids and fluids are deposited in the cranial sac of the
rumen.
 The reticulo omasal orifice lies 12-15cm above the bottom
of the reticulum in the lesser curvature. In bovines, the
omasum is mainly located on the right side of the median
plane opposite to the 7th to 11th intercostal spaces reaching
up to a hand breadth below the costal arch. In small
ruminants, the omasum occupies the position between
8th and 10th intercostals spaces and does not come in
contact with the right body wall.
 The cavity of the omasum is occupied by longitudinal folds
into which food is passed in thin layers and reduced to a
fine state by round horny papillae which occupy the
surfaces of the folds.
 The omasal groove extends from the reticuloomasal
opening to the omaso-abomasal opening and is about
10cm long.
BLOAT
 It is one of the major problems of the GI tract of cattle and
buffaloes. Bloat can either be acute or chronic.
 In both cases, it is either accumulation of free gases in the
dorsal part of the rumen or gases are dispersed throughout
the rumen contents to cause frothy bloat.
 Rapid feeding and sudden change of diet appear to
predispose cattle and buffaloes to development of acute
bloat.
 Esophageal obstruction
 Presence of amphistomes at the cardia of the
stomach.
 In small ruminants, ingestion of large quantities of cereals
causes development of acute bloat which can be of serious
nature. The increased intra-ruminal pressure due to
accumulation of gases exerts pressure over the diaphragm
and the ribs, which results in reduced respiratory
movements. This will resulting hypoventilation and
reduced venous return to heart.
 The increased intra-ruminal pressure also causes
absorption of gases, particularly poisonous methane which
has a deteriorating effect on the the animal.
 The clinical signs include bulging of the paralumbar fossa
in the early stages and entire abdominal distention in the
later stage. Abduction off the forelimbs, especially at the
elbows and reluctance to move are the other clinical
features. There will be also absence of rumen motility.
 The mucous membranes are found cyanotic. In advanced
stages, the animal keeps the mouth open and tongue
 protruded. Tachycardia in the initial stages many change
later into a weak, slow pulse.
 Most common practices in relieving acute bloat is to insert
a trocar and cannula into the upper flank region of rumen.
In the case of simple tympany, trocarisation alone may be
enough to relieve the gas. But, if the bloat is frothy,
administration of anti foaming drugs into the rumen is
mandatory inorder to free the gas eiether through a
probang or trocar.
 Oral administration of 80 ml of turpentine mixed with
500 to 1000 ml of mustard oil is found to be very effective.
Antifroth agents like dimethicone also can be used for this
purpose.
TRAUMATIC RETICULOPERITONITIS
 After severe bloat, concentrates should be avoided for
atleast two days and the animal should be fed with non
leguminous hay. In goat and sheep, the mortality rate is
high, if the treatment is delayed and emergency
rumenotomy also fail to save small ruminants.
Chronic bloat
 The most common cause of recurrent tympany in cattle
and buffaloes is foreign body syndrome.
 Traumatic reticulitis and diaphragmatic hernia are the two
common conditions in buffaloes where recurrent and
chronic bloat in observed. Large omental, spleenic and
hepatic cysts in bullocks have also been observed to cause
recurrent lympany.
 Other conditions in which chronic bloat occurs in bovine
include functional reticulo-omasal and pyloric stenosis
(vagal indigestion), liver abcesses, enlarged mediastinal
lymph nodes pressing oesophagus, mega oesophagus
stricture at the cardia and neoplasms.
 The treatment in such causes is directed at the primary
cause. Rumen fistulation (Rumenostomy) may be done
 Per rectal findings of a collapsed dorsal sac of the rumen
along with ventral displacement of left kidney in the mid
abdomen, the
 Treatment is purely medical and aimed at correction of
primary disease and also the correction of fluid, acid-base
and electrolyte imbalances.
 Add pericarditis separately
 Traumatic reticulitis is a common surgical condition
affecting the bovine. The condition is rare in camels
despite the habit of ingesting foreign bodies and seldom
seen in sheep and goats.
 Cattle and buffaloes ingest foreign bodies due to their
indiscriminate feeding habits. Animals with nutritional
deficiencies may ingest various types of foreign bodies
deliberately. Small ruminants with nutritional deficiency
may consume ropes, plastic sheets etc.
 On rare occasions, metallic foreign bodies also have been
recovered from the reticulum and abomasm of goats.
 In bovines, foreign bodies are swallowed straight into the
reticulum where they inflict trauma to the reticulum and
peritoneum causing traumatic reticuloperitonitis.
  The incidence among buffaloes is found higher than in
cattle.

Pathophysiology
 When a foreign body is ingested, it gets lodged into the
honey comb structure of the reticulum. Foreign bodies
with smooth, rounded edges like nuts, coins and stones, lie
harmless and may pass out ultimately through the faeces.
However, foreign bodies with sharp pointed edges, like
nails, needles, metallic wires etc may cause other
complications apart from causing reticulitis.
 In both cattle and buffaloes, foreign body reticulitis may
extend into traumatic pericarditis, vagal indigestion,
pyothorax, abscessation of the liver and spleen,
diaphragmatic hernia, traumatic pneumonia, pleurisy etc.
Rarely, a foreign body may get lodged into the omasal
orifice or intestine.
 Reticular and diaphragmatic abscesses many develop
often. The foreign bodies may penetrate the lateral or
ventral, abdominal wall and form abscesses. Foreign
bodies are found within the abscess while opening the
abscess or they may fall down themselves.
 The most common clinical manifestation in cattle and
buffaloes are recurrent tympany, complete or partial
anorexia, retarded or suspended rumination and reduced
milk yield. However, chronic tympany may be absent in
many cases of foreign body syndrome. The reduction in
milk yield is sudden in acute cases.
 Stiffness of forelimbs and abducted elbows may be seen in
cattle and buffaloes inorder to reduce diaphragmatic
movements. Grunting is seen in bovines.
 Heart rate is usually normal in buffaloes and slightly
accelerated in cattle. Some animals may show distressed
respiration and regurgitation in buffaloes.
 Regurgitation occurs in cases of advanced cases. There are
other associated symptoms also like diarrhoea,
constipation, scanty pasty faeces, diarrhoea alternation
with constipation, regurgitation, cough, pyrexia, brisket
edema etc and many of these symptoms are seen in most
of the cases along with other more consistent signs.

 Extensive adhesions develop between reticulum and  Clinical signs in small ruminants are almost similar.
diaphragm or other structures which interfere with the However, distension of the rumen and suspension of
reticular contractions and eructation process. rumination are the only clinical signs exhibited by camels.
In camels, suspension of rumination is usually the first
sign of any systemic disease.
 In ruminants, the peritonitis caused by the foreign bodies
are often localised . But, on rare occasions, large abscess
were formed in the abdominal cavity.
DIAGNOSIS

CLINICAL SIGNS
  Diagnosis is mostly based on history and clinical signs.  Cattle do not masticate before swallowing
The pole test recommended to detect pain due to foreign
body syndrome in cattle is not usually suitable and
Pathophysiology
satisfactory for buffaloes and camels. Neutrophilia with
shift to left is observed in cattle and buffaloes, though it
cannot be relied upon for diagnosis.  In a normal functioning heart the right side pressure is
less than the left side during diastole
 A lateral plain radiograph of the reticular area is a useful
diagnostic tool , not only for locating the foreign bodies,  When fluid accumulated in between heart and
pericardium due to penetrating foreign body this pressure
equilazes and results in Cardiac Tamponade
 but also for predicting information regarding
the mixture and extent of damage caused by potential
foreign bodies. However, in the case of nonmetallic,  Later penetration into myocardium results in death
radiolucent foreign bodies, radiograph will fail to locate
them and such materials are recovered during Clinical Signs
rumenotomy.
 Brisket edema
 Dorsal reticulography may also be useful for detecting
penetrating type of foreign bodies  High Temperature 104 F

 Pleuritis may manifest as shallow respiration muffled

TRAUMATIC RETICULO PERICARDITIS heart sounds (washing machine murmur) and pleuritic
friction rubs

 Jugular vein distension and Jugular pulse

Synonym - Hardware Disease

Diagnosis
Etiology
 Clinical signs
 Perforation of the pericardium by the foreign body present
in the reticulum
 Neutrophilia and left shift in blood picture
 Two main reasons attributed to this condition are
 Radiography
 Cattle do not discriminate metallic and non metallic
objects while ingestion  Ultrasonography
Treatment
 Reducing the intrapericardial pressure is the primary goal.
 Fifth rib resection and pericardiocentesis using a IV tube
in slow manner is attempted as sudden releiving of
pressure leads to cardiac arrest.
 Removal of the foreign body if encountered is done.
 Pericariectomy is done as salvage procedure in severely
affected cases.
 Marsupialization (attaching the pericardial sac to skin
wound) can also be attempted.
 Surgical drain is a mandatory procedure.
 High end antibiotics like tetracyclines are indicated
following surgery
 Lavage of pericardium is done before closure.
 Supportive therapy in form of diuretics, inotrpic agents
like digoxin and fluid therapy is necessary following
surgery.
RUMENOTOMY
Treatment
 Rumentomy is indicated to remove foreign bodies from
the reticulum.
Site
 Rumenotomy is done through an incision in the left flank
and the site of incision is equidistant from this tuber coxae
and last rib beginning 5cm ventral to the lumbar
transverse process, due to the voluminous abdomen and
incision parallel to the last rib is preferred to provide an
easy access to the reticulum.
Preparation of site
 The whole dorsum and the left abdominal wall of the
animal should be thoroughly cleaned with soap and water
to remove all loose hairs, dirt and dust.
 The left flank is shaved cleaned and the area should be
scrubbed with antiseptic lotions like povidone iodine scrub
or chlorhexidine. After drying the area with sterile mops,
Povidone iodine should be painted.
Anaesthesia
 Paravertebral nerve block is sufficient for rumenotomy
and difficult cattle or buffaloes may be given mild sedation
for restraint.
  Surgical procedure

 The laparotomy incision should be long enough to allow

the surgeon’s arm inside the abdomen and the abdomen is
opened through a standing laparotomy procedure. If the
rumen is not full, the ruminal walls and abdominal cavity
are explored thoroughly to examine, the diaphragm, outer
wall of reticulum, spleen and liver for pathological lesions.

Paravertebral nerve block

 Following painting the site with antiseptics the area

should be covered with sterile draper, exposing the
surgical site alone.

Rumenotomy - Fixing Rumenotomy frame

Incision the weingarth rumeno in position
tomy frame

 The ruminal wall is brought to the laparotomy incision

and fixed to it using a Weingarth’s rumenotomy frame or
using a row of stay structures. The tense and exposed
ruminal wall is incised and the cut edges of the rumen wall
is everted and fixed to the skin edges.
Application of antiseptic Draping the surgical site
  After partial evacuation of the contents of the rumen, the
ruminal floor and reticulum were explored with the hand
to locate foreign bodies.
OMASAL IMPACTION
Churned ruminal Diphragmetic vent Completed
content herniorrhaphy
in case of DH
 The sharp penetrating foreign bodies should be removed
gently and small metallic materials may be retrieved by
using a magnet inserted into the reticulum.
 Before closure of the rumen, rumen PH should be corrected
and transplantation also may be done in case of disturbed
rumen microflora.
 The rumen wound edges should be thoroughly cleaned
and the surgeon must rescrub before suturing the wound.
The rumen is sutured with Cushing’s followed by
Lemberts’ suture pattern using No 1 or 2 chromic catgut.
All soiled instruments should be discarded and fresh set of
instruments should be used for closure of the lapartomy
wound.
 Postoperative care includes dressing of the cutaneous
wound, A course of antibiotics should be given for 5 to 7
days and the sutures are removed by 10th postoperative
day. Any failure in asepsis during surgery might produce a
discharging sinus at the operative site.
 Omasal impaction occurs secondary to rumen impaction
and may be a result of poor qualtity feed.
 The omasum gets distended with stagnation of ingesta and
its engorgement due absorption of fluids. Such animals are
anorectic, listless and show signs of dehydration.
 The auscultation at the level of right elbow at the
9th intercostal space will show complete absence of omasal
sounds. Using a stomach tube, few litres of water and 4-5L
of liquid paraffin or mineral oil are administered to soften
the contents.
 Two to three kg of sugar or jaggary is given along with
about 50 tab of yeast and 2-3L of rumen liquor collected
from a healthy animal, inorder to stimulate rumen flora.
The rumen is then massaged with fist and knee.
 In case of failure of this treatment, rumentomy is
performed and solutions are injected directly into the
omasum using a tube inorder to dislodge the contents.
  Neglected cases may succumb with in few days due to the
necrosis of omasal folds an account of pressure from its
contents.
RECTICULO-OMASAL AND PYLORIC STENOSIS
Functional Reticulo-omasal and Pyloric Stenosis (Vagal
indigestion)
 The condition is also known as Hoflund’s syndrome or
chronic indigestion or vagal indigestion or functional
stenosis of the stomach.
 Clincially there are two types of functional stenosis of the
stomach. These include reticulo-omasal stenosis or cranial
functional stenosis and pyloric stenosis or caudal
functional stenosis. Usually animals suffer from either of
them and rare cases suffer from both.
Aetiology
 Both these conditions are characterized by impairment of
the passage of food either through reticulo-omasal orifice
or across pylorus.
Clinical signs
 The loss of body condition is rapid and the animal
becomes dull and listless. Mild abdominal pain or
discomfort exhibited by shifting weight from one leg to
another.
 The faeces is scanty and consistency varies from normal to
diarrhoetic or constipated.
 Rumen movements are sluggish and weak. The
temperature, pulse and respiration rate are usually normal
and dehydration occurs only in the last stages of the
disease.
ABOMASAL DISPLACEMENT IN BOVINES
 Due to its loose attachment with greater and lesser
omentum abomasum tends to be a wandering organ. It is
common in animals fed on concentrates more than
roughages and in dairy cows in the age group of 3 to 7
years. It is very rare in buffaloes. Left side displacement
(LDA) is common in antepartum and right side
displacement (RDA) in postpartum.
Causes
 atony of the abomasum with accumulation of gas.
 high concentrate ration, Volatile fatty acids and gas
 effect of pressure by the gravid uetrus on the rumen
Clinical signs
 Anorexia
 Decrease in milk production
 Ketosis
  Weight loss haemoconcentration. Ketonaemia and ketonuria are also
frequently present.
 Shifting type of lameness
Diagnosis
 Scanty faeces
 The diagnosis of abomasal displacement is based on
 Dehydration history, clinical signs detection of tympanic resonance on
auscultation and percussion and laboratory findings.
Auscultation
 Acuteness of the onset of clinical signs, especially rapid
 LDA Ping sounds in 11th, 12th , 13th intercostal space. heart rate and drop in milk yield, help to differentiate
abomasal volvulus from RDA.
 RDA Ping sound in the cranial part of para lumbar fossa.
 “Liptek Test” is used in diagnosis of abomasal
 Liptak test-If pH is 1-4, abomasal displacement is displacement . A 18G needle is inserted aseptically just
suspected. below the area of resonant ping in the left abdominal wall
in cases of LDA and in the right abdominal region in cases
of RDA and the fluid is aspirated. If the pH of the fluid is
CLINICAL PATHOLOGY, DIAGONISIS around 4,abomasal displacement is suspected and a pH of
AND TREATMENT 5 to 7 indicate ruminal contents.

Treatment
Clinical pathology
 Most animals with abomasal displacement have
hypochloraemic, hypokalaemic metabolic alkalosis. But
some animals have a normal acid-base status.
 The metabolic alkalosis is more pronounced in abomasal
volvulus than following left or right displacement of the
abomasum alone.
 The alkalosis occurs due to continuous loss of hydrochloric
acid from the abomasum. Blood glucose values are highly
variable. Dehydrarion is reflected by varying degree of
 The aim of treatment of abomasal displacement is
correction of the displaced abomasum, and fixing the
displaced abomasum to prevent reccurence, restoration of
gastro intestinal motility, rehydration and correction of
metabolic disorders.
 Conservative treatments aim at the release of gases from
the abomasum, relief of abomasal impaction and
restoration of GI tract motility so that the abomasum
return to its normal position.
 Calcium borogluconate, neostigmine, saline cathartics etc
improve the GI tract motility in general. Repeated oral
 administration of mineral oils and warm salines may help
in evacuation of the contents. Repteated intravenous
isotonic fluid therapy is used to correct dehydration.
SURGICAL CORRECTION OF ABOMASAL
DISPLACEMENT
 Abomasum is a wandering organ due to its loose
attachments with the greater and lesser omentum. So it
will be easily displaced to left or right.
Left flank omentopexy (Utrecht method)
 Laparotomy is performed in a standing animal through a
long vertical incision (20 cm) in the left paralumbar fossa.
Usually the abomasum lies under the incision.
 The attachment of the greater omentum along the
abomasum is located and the needle threaded with about
two meters of heavy nonabsorbable suture material is
passed in and out of the omentum in the form of a
mattress suture over a length of about 7-10 cms. About a
metre of the suture material should extend and from each
end of the suture line.
 The abomasum is decompressed using a needle of 14 G
and syringe attached to a rubber tube. The abomasum is
then carefully pushed to its normal position.
 The cranial end of the suture is attached to a large cutting
needle which is carried along the internal body wall and
forced through the ventral mid line, 10 to 15 cm caudal to
the xiphoid and held by the assistant.
 A second needle in then threaded on the caudal end of the
suture material and similarily placed through the ventral
body wall 8 to 12 cm candal to the cranial suture.
 Both the suture ends are pulled up and tied outside the
body. The suture is retained in position for about four
weeks and after that the ends are cut as close to the skin as
possible.
Right abomasopexy
 The procedure is basically similar to omentopexy and the
suture is placed in the musculature of the greater
curvature of the abomasum.
 The suture ends are then brought through the ventral wall
as for omentopexy.
 The left flank approach is used for LDA and right flank
approach is used for RDA.
ABOMASAL IMPACTION
 Abomasal impaction is seen more frequently in dairy
cattle, due to ingestion of rubber latex but also occurs in
calves, goats, sheep and buffaloes.
 Impaction may occur in camels following ingestion of hair
balls, polythene bags and other material.
 The primary cause is excessive consumption of poor
quantity indigestible roughages and inadequate mineral
supplementation with restricted access to water.
  Foreign bodies such as phytobezoars and accumulation of
sand may also cause impaction.Ocassionally, placenta
eaten by recently calved animals may obstruct the pylorus
and cause abomasal impaction.
 The secondary impaction may occur due to any condition
that may reduce abomasal motility. Conditions like
traumatic reticulo peritonitis, abomasal lymphosarcoma
etc are found leading to abomasal impaction.
Clinical signs and diagnosis
 Complete anorexia, scanty faeces and moderate distension
of the abdomen on the right side.
 Marked dehydration and loss of body condition follows as
the condition advances. The lower right abdominal
quadrant of the affected cows appear distended giving a
“pear” shaped appearance when viewed from behind.
 Deep palpation cranial to mid-lower right quadrant
abdomen reveals abomasum. Temperature, heart rate and
respiration remain normal usually, but in the later stages
heart rate may elevate considerably.
 Laboratory findings include metabolic alkalosis,
hypochoraemia, hypokalaemia and haemoconcentration.
 Diagnosis is based on the history of feeding, clinical signs
and laboratory findings.
 The condition should be differentiated from diffuse
peritonitis, acute intestinal obstruction and functional
pyloris stenosis.
TREATMENT
 The success of treatment depends on early diagnosis.
Animals with tachycardia -heart rate of 100 or more per
minute have poor prognosis.
 Treatment should be directed at softening of the impacted
contents with lubricants or physical emptying of the
abomasum along with correction of dehydration.
 Oral cathartics like magnesium hydroxide or magnesium
sulphate are used along with lubricants such as mineral
oils and 10-15L of warm water administered directly into
the rumen by probang for 3-5 days may produce
beneficial response.
 Intravenous fluid therapy containing sodium, potassium,
calcium and chloride along with glucose is important.
 Abomasotomy may be indicated if the animal does not
respond to conservative treatment.
ABOMASAL ULCERS
 It occurs in suckling calves and adult cattle and may
cause abomasal haemorrhage, indigestion, melena and in
some cases of perforation with acute local or diffused
peritonitis.
 The course of abomasal ulcers is not clearly known. In
calves, sudden change from milk to high dry matter
content
  Abomasal ulcers are seen concomitant with trichobezoars. the dehydration with adequate volumes of fluid
All the cases of abomasal ulcers are associated with administration
hyperacidity and increased mucosal permeability to
hydrogen ions.  Surgical treatment involves radical excision of ulcerative
patches following abomasotomy. But the success is limited
in the case of multiple ulcers.
Clinical signs and diagnosis
 Animals with perforated abomasal ulcers and diffused
 Abdominal pain, melena and pale mucous membranes are
peritonitis usually have poor prognosis.
the common clinical signs. Bleeding ulcers cause sudden
onset of anorexia, ruminal stasis and tachycardia in
addition to abdominal pain and melena.
ABOMASOTOMY
 Calves become recumbent suddenly, with cold
extremities.
 Site: 4 to 10 cm long paracostal incision invade about 2
 Subnormal temperature, tachycardia and dehydration inches behind the costal arch beginning at about 6 inches
which subsequently lead to a state of hypovolemic shock. away from the mid ventral line and extending cranio
dorsally.
 Death occurs with acute local peritonitis closely resemble
that of traumactic reticuloperitonitis. However, the  The lower commisure of the incision may be extended
localized pain will be on the right side instead left of ventro medially when found necessary to operate on the
Xiphoid in the case of TRP. fundus.

 The diagnosis of bleeding ulcers is based on the typical  Another approach is through the linea alba at the mid
signs where as the diagnosis of non bleeding ulcers in an ventral line and the incision start about 4 cm behind
intact animal is difficult. xiphoid cartilage of the sternum and extend up to the
umbilicus. This is a rarely used site.

Treatment
Technique
 Treatment of affected animals include change of diet from
high to low concentration. Antacids such as magnesium  The abdominal cavity is entered by incising the skin,
hydroxide (500 to 800g) or magnesium trisilicate abdominal muscles and parietal peritoneum. Grasp the
administrated orally for 2-4 days are found beneficial . greater curvature of the abomasum and it is pulled out
through the incision.
 In cases of bleeding or perforated ulcers, the treatment
should be directed to control the bleeding and to check
  The abomasum is held in position at the laparotomy
wound by means of 4-6 stay sutures passed through the
abomasal wall and the abdominal wall.
 Any space left between the abomasam and the lips of the
abdominal wound is packed off with moist sterile towels to
prevent escape of abomasal contents into the peritoneal
cavity. Incise the abomasam to a length of 6 - 10 cm and
the cavity is explored with the hand introduced through
the incision.
 In the case of bleeding abomasal ulcers, the ulcers are
either dissected out or the bleeding vessels are ligated. The
abomasal incision in closed by a row of connel’s sutures
followed by Lemberts. The temporary stay sutures are
released and the organ is deposited back into the
abdominal cavity.
 The laparotomy wound is closed in the standard pattern
after cleaning and irrigation of the abdominal cavity with
normal saline and antibiotic or antimicrobial solutions.
 MODULE-24: SURGICAL AFFECTIONS
OF SMALL INTESTINE
PRINCIPLES OF INTESTINAL SURGERY
Fluid Therapy
 Correcting the fluid and electrolyte imbalance is of great
priority before venturing for intestinal surgery Fluids like
RL and MES are highly helpful and the dehydration score
chart is used to correct the deficit. In case of severe blood
loss blood transfusion and colloids administration is
indicated
Antibiotic Prophylaxis
 The small intestine has both gram positive and gram
negative organisms. The surgical procedure can be
classified as clean, clean contaminated and contaminated
depending upon the condition for which it is operated. In
general a broad spectrum antibiotic is indicated as
prophylaxis.
 Usually second or third generation cephalosporin is
employed. In case of gangrene to counter anaerobic
organisms metronidazole is indicated.
Assessment of Intestinal Viability
 This is important for prognosis of the patient. It can be
done by visual comparison, Fluoroscein dye test and
surface oximetry. Surface oximetry is more useful method
Choice of suture material for closure
 Monofilament synthetic absorbable (PDS) or synthetic
non-absorbable (prolene) are excellent choices.
 Multi-filaments are also employed for closure but
produces more tissue drag when compared to
monofilaments
Choice of Suture Pattern
 Simple interrupted pattern is ideal.
Suture Reinforcement  Torsion / volvulus

 Application of Omental and serosal patch aids in faster Clinical Signs

healing clean instruments should be set aside for closure.
 Clean procedures such as liver biopsy should be performed
before intestinal biopsy. Intestine samples can be obtained
with a scalpel blade or skin biopsy punch suture can be
placed in the intestine to be sampled.
 Small animals suffering from intestinal obstruction may
vomit.
 Extreme weakness and animals may die in the course of 8-
10 days.

 The stay suture allows manipulation of the sample without  Smooth foreign bodies pass through and may cause
damage. The sample and attached stay suture can be stoppage at the ileo-caecal valve.
placed directly in formalin; the suture will not interfere
with processing.  Distension of bowel loops and distended abdomen

 The intestinal wall should be incised near the stay suture  Passing no stool/ blood tinged mucous discharge
to limit the size of the resulting surgical wound.
 per rectal examination reveals empty rectum and
distended bowel loops.
INTESTINAL OBSTRUCTION
Diagnosis

Etiology  clinical signs

 Foreign body obstruction  By palpation

 Stenosis due to inflammation  By X-rays -Plain ,Contrast (Brium Meal)

 Paralitic Ileus  ultrasound

 Congenital stenosis/ agenesis  laparoscopy/ endoscopy

 Faecal stasis Treatment

 Intussusception.
Enterotomy - It is an incision into the intestine.
 Procedure
o Exteriorize and isolate the diseased or obstructed
intestine from the abdomen by packing with towels.
o Gently remove the intestinal contents from the
isolated segment.
o With non crushing intestinal forceps, occlude the
intestinal lumen.
o Make a full thickness stab incision into the
intestinal lumen with a No 11 scalpel blade.
o Remove the foreign bodies by incising the healthy-
appearing tissue distal to the foreign body.
o Remove the foreign body
o Close the incision with apposition/inversion simple
interrupted sutures. and omentalisation.
 Intussusception Or Invagination of the bowel
o It is the telescoping or invagination of a
proximal intestinal segment (intussusceptum) into
the lumen of the distal segment (intussucipiens).
o Abdominal plapation reveals a sausage shaped mass
o Treatment is by enteropexy.
o Enteroanastomosis is done if the intestinal segment
is devitalised
INTESTINAL OBSTRUCTION contd:
 Any mechanical or functional interference with
progression of the intestinal contents will cause
obstruction.
 It may be
o Simple – if vascular supply of the intestine is not
compromised
o Strangulated – if blood vessels are involved
o Complete or incomplete – depends upon degree of
occlusion
 High (proximal): Obstruction of small intestines
 Low (distal): Obstruction of large intestines
 Incidence: Infrequent in ruminants but common in dogs
and cats
Causes of mechanical obstruction
 Intra luminal
o Faecolith
o Impacted ingesta
o Foreign bodies
o Parasitic infestation eg: nodular worms
  Heavy concentrate feeding

 Congenital defects

 Malformations of the intestine eg: Hypoplasia or atresia

 Meckel’s diverticulum

 Miscellaneous – Mesenteric thrombosis

Clinical signs of incomplete obstruction

 Pain in initial stages of obstruction

 Cessation of defecation

 Anorexia

Foreign body obstruction  Distension of abdomen

 Looking towards the site of pain (colic symptoms)

 Extra luminal
 Kicking at the abdomen
o Stenosis, Adhesions, Fibrous bands, Hernia,
Abscess, Neoplasms  Frequent standing and lying down

o Intussusception  Increased pulse rate (depend upon duration of obstruction

and involvement of blood vessels)
o Volvulus and torsion
 Faeces is scanty with blood and thick mucus
Functional obstruction (Paralytic lecus)
INTESTINAL OBSTRUCTION
 Trauma

 Peritonitis
  Endotoxemia (in strangulated obstruction) cause cardio
vascular embolism and depression.

 Deterioration of general condition

Diagnosis

 History, clinical signs, rectal examination, laboratory

findings, complete absence of defecation (also seen in
diaphragmatic hernia) (radiography will help in diagnosis
etc)

Midline laparotomy Isolated obstructed Removal of foreign

Treatment lumen body

 Enterotomy

 Midline laparotomy

 Locate Intestinal segment with obstruction

 Removal of obstruction

 Intraluminal mass – enterotomy

 Intestinal segment is damaged – enterectomy and

anastomosis
Midline laparotomy

Techniques - Enterectomy and anastomosis

 Many techniques are in usage.

o End to end – common

 o Oblique end to end  Extra luminal

o Side to side (lateral) Intra luminal

o End to side  Faecolith
 Telescoping type  Impacted ingesta
o Approximation  Foreign bodies
o Eversion  Parasitic infestation
o Inversion suture technique
Extra luminal
o Invagination
 Stenosis

 Adhesions

 MODULE-25: SURGICAL  Fibrous bands

AFFECTIONS OF THE LARGE
 Hernia
INTESTINE
 Abscess
INTESTINAL OBSTRUCTION  Neoplasms

 Incidence: Infrequent in ruminants but common in dogs Functional obstruction (Paralytic ileus)
and cats
 Trauma
 Causes:
 Peritonitis
o Mechanical obstruction may be
 Heavy concentrate feeding
 Intra luminal
 Congenital defects - agenesis of colon, visceral eventration
Malformations of the intestine eg: Hypoplasia or atresia
CAECAL DILATATION AND TORSION
 Meckel’s diverticulum –

 Miscellaneous – Mesenteric thrombosis  Dilatation and/or torsion of the caecum involves

distension, displacement and torsion of the caecum
including the spiral colon.
Clinical signs
o Free end of caecum in cattle is devoid of mesentery
 Incomplete obstruction: Pain in initial stages of and thus prone to rotation. Dilatation may preceed
obstruction, Cessation of defecation ,Anorexia, Distension or follow the torsion.
of abdomen, Looking towards site of pain (colic
symptoms), Kicking at the abdomen, Frequent standing o Condition is more common in dairy cows following
and lying down, Increased pulse rate (depend upon parturition
duration of obstruction and involvement of blood vessels),
Faeces is scanty with blood and thick mucus Hypovolemia, o In buffaloes caecum is not predisposed to torsion
Endotoxaemia (in strangulated obstruction) cause cardio because blind end is not devoid of mesentery
vascular embed assemt and depression. Deterioration of
general condition
Etiology
Diagnosis
Excessive feeding of grains
 History, clinical signs, rectal examination, laboratory
findings, complete absence of defecation also seen in  Results in production of increased concentration volatile
diaphragmatic hernia (radiography will help in diagnosis ) fatty acids (VFA )

 Gas due to fermentation of undigested grains

Treatment
 Volatile Fatty acids cause hypomotility or atony of the
 General lines - includes Right flank laporotomy Removal caecum resulting in accumulation of gas and ingesta with
of obstruction subsequent dilatation and possible torsion of the organ.
 Intraluminal mass – enterotomy
Clinical signs
 If intestinal segment is damaged – enterectomy and
anastomosis  Simple dilatation takes gradual course
  Onset may be acute if torsion occurs o Clinical signs

 Clinical signs – similar to bowel obstruction o Auscultation and percussion

 Abdominal pain – early course of disease o Rectal palpation

 Rapid loss of appetite o Right flank laparotomy

 Cessation of defecation o biochemistry

 Dehydration o Hypochloremic, hypokalemic, metabolic alkolosis –

 Temperature, pulse and respiration rate – normal o Haemo concentration and azotaemia – similar in
bowel obstruction
 Subnormal temperature, tachycardia – in advanced cases
of caecal torsion o Auscultation and percussion of right flank

 Hypo motility or atony of rumen o Smaller resonant area and more caudal in case of
caecal dilatation (in case of right side displacement
 Distended right paralumbar fossa of the abomasum - more cranial)

 Tympanic resonance of right paralumbar fossa on

auscultation and percussion TREATMENT

 On rectal palpation – a long cylindrical movable gas filled

structure in pelvic inlet or just close to pelvic bone  Conservative treatment – when animal is in good
condition
 Rupture of distended caecum during transportation of
animal is a possibility and if it occurs death is sudden  Administration of parasynpathomimetic drugs –
(Neostigmine)
Diagnosis
 Total dose of 12.5 – 2.5 mg s/c for every 3-4 hours for a
 Based on period of 2-3 days

o History  A continuous drip of neostigmine (200 mg/10l normal

saline)
  Saline purgatives alone or with liquid paraffin o The necrosed caecum in resected out and cut edges
of ileum and colon are anastomosed by using
synthetic absorbable suture material
Surgical treatment
o Close the laporotomy incision in a routine manner
 Caecotomy
o Partial resection is sufficient if only a part of caecum
o Right flank laporotomy in standing position
is necrosed
o Exteriorise the free end of caecum
Post operative care
o Milk out the caecal contents following caecotomy
 Administration of broad spectrum antibiotics
o Clean the caecal edges with normal saline
 Adequate fluid therapy
o Suture with absorbable suture with Cushing
pattern followed by Lembert’s  Prognosis is good following surgery

o If torsion is there, correction should be made

TWIST OR ROTATION OF THE COLON IN
o Reposition of the caecum into abdominal cavity HORSES

o Laparotomy wound is closed in a routine manner

Symptoms
 Typhelectomy

o In cases where the caecum is devitalized and  Intermittent diarrhoea and hypoalbuminemia, depression,
anorexia and emaciation
necrotic, resection is indicated

o After exteriorization of caecum through right flank Diagnosis

o Intestinal clamps on the distal end of the ileum and  Usual symptoms indicative of twist or stoppage of the
proximal end of the colon should be placed. bowel are evinced.

o Blood vessels supplying the caecum should be  Rectal examination. Reveals twist of the colon.
dorsally ligated and severed
 In front of the anus one feels the distended colon.
  In torsion towards the right they run backwards and  Stenosis of rectum and anus
inwards
 Supra rectal abscess
 In torsion towards the left, backwards and outwards
 Rectal tears
Prognosis

 Favourable to guarded RECTAL PROLAPSE

Treatment  Most common surgical condition involving the rectum in

cattle, buffaloes, and small ruminants.
 Surgical technique

o Explore the abdomen causes

o Collect the specimen and isolate the involved  Prolonged tenesmus,

intestine with laparotomy pads.
 Increased intra abdominal pressure due to bloat,
o Manually detort the twisted colon.
 Rectal inflammation and irritation,
o Evaluate for viability and perforation.
 Diarrhoea,
o Perform a resection and anastomosis if devitalised.
 act of parturition

AFFECTIONS OF RECTUM AND ANUS  Straining ,

 Foreign bodies,
 Rectal prolapse
 Perineal hernia,
 Congenital malformations
 Constipation and
 Tumors of rectum
 Congenital defects.
 Paralysis of rectum
Classification  Complications: Dehiscence of suture line, peritonitis,
stenosis or stricture
 Incomplete: Prolapse involving only the mucosa
 rectal prolapse in dogs
 Complete: Prolapse of whole thickness rectal
wall. Constriction due to tight anal sphincter leads to
extensive necrosis of prolapsed tissue. CONGENITAL MALFORMATIONS

Diagnosis  It is common in all animals.

 Visual observation of mass of varied length protruding  The anorectal passage is developed from two distinct
from the anus. centres in the embryo. Normally the two tubes coalesce to
form a single conduit. Some times one of the parts or both
Treatment is insufficiently developed.

 Reduction after lavage with a astringent solution and
application of an emolient
 Purse string suture in the skin around anus by leaving an
opening which permits defecation
 To abolish straining – epidural anaesthesia
 The following anomalies may be met with
o Neither rectum nor the anus is fully formed –
atresia ani et recti , atresia ani et coli
o Rectum is fully developed but anus is absent –
imperforate anus

 Animals should be kept on laxative diet for few days to o Rectum and bladder as one cavity.
prevent constipation
 Recto vesicular fistula
 Recurrence is common in this method
 Recto urethral fistula
 Initiating cause must be treated to effect cure
 Recto vaginal fistula
Post surgical management  As development proceeds it divides into two
compartments, the lower one forming the bladder and
 Regular cleaning, dressing with topicak anaesthetic and urethra. If the separation is incomplete, recto vaginal or a
use of systemic antibiotics recto urethral fistula results,
Symptoms Diagnosis

 In case of complete obstruction:  Deformity of rectum due to new growth

o With in few hours after birth  Rectal examination

o Abdominal pain,
Prognosis
o Distended abdomen
 Benign tumors are easy to remove
o Straining without expulsion of muconium
 Malignant tumors are incurable

TUMORS OF RECTUM Treatment

 Polypoid growth may removed by ecrasseur or by ligation

 Warts, cysts, lipomata, myxomata, sarcomata, adenomata
and carcinomata  Cysts – by needle aspiration and use of irritants

 Cysts, polypoid myxomata and fibromata are the most  Radical surgery for excision of tumour
common tumors of the rectal mucous membrane.

PARALYSIS OF RECTUM
Symptoms

 Severity of the symptoms vary according to the size of the

 Most common in the horse and dog; Rare in ruminants.
tumour
 Frequently associated with paralysis of the tail, or the
 Difficulty in defecation
bladder and hind limbs
 In case of ulcerated tumor – blood and pus may be seen in
faeces Etiology

 Signs of colic  Lesions of the spinal cord or nerves supplying the rectum

 Tumor inside the rectum may protrude through the anus  Fractures and severe injuries of the sacrum, tumours of
during defecation the sacral region
  Toxins of infectious diseases such as strangles  Rarely reported in ruminants

 Old age Classification

  Grade 1: tears – involves mucosa or mucosa and
submucosa
 Paralysis may be complete or incomplete
 Grade 2: When only muscular layer gets ruptured
Symptoms
 Grade 3: Involves mucosa, sub mucosa and muscular layer
 Distended rectal walls
 Grade 4: Penetrates all layers and enters peritoneal cavity
 Accumulation of faeces
Diagnosis
 Inability of the animal to expel faeces
 Presence of excessive amounts of blood on glove on rectal
 Colic symptoms palpation

 The tail is limp and powerless  Easily palpable viscera

 Anus is open  Signs of shock and peritonitis

Prognosis Treatment

 Usually unfavourable.  under epidural anaesthesia the distal rectal tear is

corrected using an absorbable suture material using
Treatment inversion pattern.

 Use of nervine tonics  In case of proximal rectal tears – right flank laparotomy
has t be performed to repair the rectal tears

RECTAL TEARS
COLIC IN HORSES

 Primarily due to trauma

 potential space with in the lesser omental sac and
Definition
entrapment of intestine in to the epiploic foramen.
 Colic is defined as visceral abdominal pain due to
 Pregnancy
spasmodic colic contraction and is presented as acute,
chronic or recurrent.
o Compression of the bowel by gravid
uterus

o After delivery, space occupied by the uterus will be

filled with intestine.

Types of coilc

 pelvic flexure impaction

 spasmodic colic

 ileal impaction
Etiology / risk factors
 sand impaction
 Diet
 enterolith
o Coarse roughage - impaction colic due to low
digestability  large round or tape worms

o Grain overload - Colic and laminitis due to  left dorsal displacement

increased gas production leading to altered mobility
and displacement of the bowel  epiploic foramen entrapment

 Enviornmental factor - Extreme summer or winter and  mesenteric rent entrapment

confinement with out exercise.
Pathology of coloic
 Parasites - ascarides , tapeworm,strongyles
 This can be divided in to
 Cribbing results in aerophagia and negative pressure
created will result in movement of the bowel in to
o simple obstruction,
 o strangulating obstruction and  MODULE-26: AFFECTIONS OF THE
o nonstrangulating obstruction LIVER

Treatment INTRODUCTION

Medical colic
 Portosystemic shunts (Portosystemic vascular anomalies)
 Pain management
 Neoplasia
o nasogastric intubation
 Hepatic abscess
o decompression( enetrocentesis)
 Trauma
o flunixin meglumin
 Cholelithiasis
o alpha 2 agonists, Xylazine and detomidine

o opioids PORTOSYSTEMIC SHUNTS (PORTOSYSTEMIC

VASCULAR ANOMALIES)
o spasmolytic agents

o lidocaine as a prokinetic drug  Blood draining from the stomach, intestines, pancreas and
spleen (portal blood) has to pass through the liver before
 Surgical management going into the systemic circulation.

o Under general anesthesia and dorsal recumbency
through a midline laparotomy the correction is
performed on the intesines and the abdominal
incision is closed. Rough recovery from anesthesia
is to be avoided.
 Portosystemic shunts are abnormal vessels through which
the portal blood bypass the liver and enter the systemic
circulation.
 Two main types of shunts

o Extrahepatic – shunts located outside the liver

parenchyma
 o Intrahepatic – shunts located insided the liver  Bile duct carcinomas
parenchyma
 Hepatomas
 Portocaval shunt: Shunt from portal vein to caudal vena
cava
Metastatic tumours
 Diagnosis is from the signalment (usually purebred dogs
 More common than primary tumours
are at increased risk), from history (failure to grow, small
body stature or loss of body weight and varied signs), from
 Originating from the spleen (haemangiosarcoma)
physical examination findings (like microhepatica,
prominent kidneys, neurological abnormalities)
 Originating from the colon (adenocarcinoma)
 Confirmation of diagnosis
 Originating from the pancreas (adenocarcinoma, islet cell
o Contrast Radiography carcinoma)

o Ultrasonography and  Originating from the lymph nodes (lymphosarcoma)

o Nuclear Imaging

 Treatment: Surgical correction which aims at attenuation

of the shunts.

NEOPLASIA

 Primary and Metastatic tumours

Primary tumours
Liver tumour
 Less common compared to Metastatic tumours

 Hepatocellular carcinomas. May develop as solitary mass Clinical signs

or in diffuse multiple nodules
 Weight loss,
  Cachexia, Symptoms
 Jaundice,  Prolonged and undulant fever (Suspect hepatic
abscessation in case of pyrexia of unknown origin)
 Ascites,
 Anorexia, Abdominal pain and Vomiting
 Anaemia,

 Vomiting and Diagnosis

 Diarrhoea.  Serum biochemistry, Ultrasonography and Radiography

Treatment Treatment

 Radical surgery involves excision of the mass by  Surgical drainage (Preferable for solitary abscess)

o Wedge resection  Antimicrobial therapy

o Finger fracture technique

TRAUMA
 Large masses can also be treated by total or subtotal
lobectomy
 May be due to automobile accidents, gunshot wounds,
falling from heights and rupture of necrotic tumours. Can
be classified as
HEPATIC ABSCESS
o Transcapsular
 Rare in dogs and cats o Sub capsular
 But may be the result of infection o Central
 May develop due to haematogenous spread of infectious
agents, penetrating foreign objects, extension of biliary Symptoms
infections, or localized peritonitis (necrotizing
pancreatitis)  Hypovolaemia due to Acute blood loss
  Endotoxaemia (coliform or anaerobic) Symptoms
 Bile peritonitis  Abdominal pain, Vomiting, steatorrhoea and jaundice.

Diagnosis Diagnosis
 From Haematology and Serum biochemistry  Contrast Radiography (Intravenous or oral
cholecystography) – because majority of the gall stones
 Radiography and Ultrasonography may be radiolucent.
 From peritoneal lavage and centesis  Ultrasonography

Treatment – Should include the following Treatment

 Management of shock  Incision of common bile duct and removal of the gall
stones, Cholecystotomy
 Control of haemorrhage

 Surgery should aim at excision of dead liver tissue, 

suturing the lacerated liver tissue, control of haemorrhage,
and drainage of bile contents from the peritoneal cavity  MODULE-27: SURGICAL
AFFECTIONS OF THE SPLEEN
CHOLELITHIASIS
DEFINITION AND TYPES
 Also known as gall stones and is rare in dogs.

 Causes obstruction to the flow of bile. The stones are Definition - Splenectomy
formed by the precipitation of supersaturated cholesterol
or bilirubin in the bile.  It is the surgical removal of spleen.

 Obstruction to the flow of bile leads to subsequent clinical

Types
signs.
 Partial Splenectomy: Removal of a part of spleen.
  Total Splenectomy: Removal of whole spleen.  Severe trauma

 Unsuccessful therapy for immune mediated

INDICATIONS AND CONTRAINDICATIONS haematological disorder

 Elective Splenectomy is often performed in dogs used as

donors to reduce the risk to transfer blood protozoa to
Indications uninfected animal during transfusion

Partial splenectomy Contraindication

 Traumatic lesions  Patients with bone marrow hypoplasia where spleen is
main site of haemopoises
 Splenic infarcts

 Focal lesions CONSIDERATION FOR SPLENECTOMY

 Total Splenectomy
 Middle-aged or older patients.
 Splenic neoplasia
 Proper nutritional & metabolic status of patients.

 Concurrent haematological disorders.

PATHOPHYSIOLOGY OF SPLENECTOMY
INDICATED DISORDERS

 In torsions splenic veins get occluded resulting congestive

splenomegaly and vascular thrombosis. incude gdv

Spleen tumour  In some dogs clinical signs are acute. Splenic infarcts may
be associated to liver or renal diseases, neoplasia or
thrombosis associated in cardiovascular disease.
 Splenic torsion
  There is sign of altered blood flow & coagulation. It may  Venous drainage is via splenic vein into gastro splenic vein
lead to haemoabdomen or sepsis. that empties into portal vein.

 Anaemia may occur due to severe haemorrhage & may

associate with diseminated intravascular coagulations. CLINICAL PRESENTATION

 Malignant cancers may metastasize to other normal tissue

while benign or nodular tissues are vulnerable to rupture
& severe blood loss & shock. Signalment

 Splenic torsions and tumors occur in large breed dogs; age

and sex no bar.
SURGICAL ANATOMY OF SPLEEN

Clinical signs
 Spleen is located in the left cranial abdominal quadrant.
 Vomiting , anorexia, weakness & depression.
 It usually lies parallel to the greater curvature of stomach
but exact location depends on its size and position of other  Icterus, hematuria or haemoglobinuria.
abdominal organs.
 Abdominal pain.
 In contracted stomach it lies in rib cage while in gastric
enlargement it lies in caudal abdomen.  Acute torsion may result to shock.

 It is covered by a capsule. Physical examination

 It is attached to the stomach by gastrosplenic ligament.  Splenic enlargement on palpation.

Blood supply  Abdominal distension in splenic rupture.

 Blood supply is from splenic artery, a branch of celiac  Abdominal pain, dehydration, pale mucus membrane or
artery. Icterus.

 Splenic artery gives off 3-5 primary branches in greater  Tachycardia, longer capillary refilling time, weak
omentum towards ventral spleen. peripheral pulse.

Diagnosis
  Clinical signs.
TECHNIQUES USED IN SPLENECTOMY
 Radiography – splenic outline blurred, enlargement,
radiopaque mass, etc.
Partial splenectomy technique
 Ultrasonography.
 In dorsal recumbency laparotomy is performed and spleen
 Laboratory analysis reveals anaemia, leukocytosis,
is exposed.
haemoglobinuria, increased serum alkaline
phosphatase etc.
 Desired area to be defined and double ligate and incise the
hilar vessels supplying the area.
PRE-OPERATIVE MEDICAL MANAGEMENT
 Squeeze splenic tissue between thumb and forefinger at
the line of lesion and milk splenic pulp towards lesion.
 Fluid and electrolyte deficits should be corrected. Whole  Place forceps on either side of the line dividing healthy
blood transfusion in severe blood loss is needed. spleen and lesion and resect off the spleen between the
forceps.
 Perioperative antibiotic therapy can be given.
 Close cut surface in continuous pattern by absorbable
 Cardiac status to be monitored. suture. Double row can be applied.

Anaesthesia  One or 2 rows of continuous overlapping mattress sutures

 Patients to be given oxygen before, intra and after
anaesthesia. Anticholinergics can be given in bradycardia.
 Barbiturates to be avoided as it cause splenic congestion.
Acepromazine to be avoided as it causes hypotension.
 Propofol can be given safely.
Preoperative preparation
can be applied. Haemorrhage can be controlled by surgical
diathermy.
 Abdomen & skin can be closed in routine manner.
Total splenectomy technique
 In dorsal recumbency laparotomy is performed and spleen
is exposed. Place moistened abdominal sponges under
spleen.

 Approach is paramedian in xiphoid area. Area to be

prepared for aseptic surgery.
  Squeeze splenic tissue between thumb and  MODULE-28: SURGICAL AFFECTIONS OF
forefinger Double ligate and transect all the vessels at
splenic hilus with absorbable or non-absorbable suture. THE KIDNEY, URETER AND URINARY
BLADDER
 Transect the attachment to stomach and remove spleen.
Abdomen and skin can be closed as usual.
ECTOPIC URETER

POST OPERATIVE CARE AND COMPLICATIONS

 Ectopic ureter is a congenital anomaly where one or both
ureters empty outside the urinary bladder.
Post operative care
Symptoms
 Antibiotic and anti-inflammatory drug to be given
parenterally.  Urinary incontinence

 24 hr monitoring for haemorrhage.  Pyelonephritis and cystitis

 Fluid therapy to stabilize hypotension.  Hydroureter

 Daily dressing of surgical site.  Suspect Ectopia of ureter in any young animal that has a
history of incontinence since birth
 Long term antibiotic to counteract the
immunosuppression.  Suspect this in older animals with lifelong urinary
incontinence
 Skin suture can be removed after 10-14 days.
 More commonly diagnosed in female dogs than in males
Complications
Diagnosis
 Haemorrhage.
 Contrast Radiography
 Immunosuppression.
 Ultrasonography

Treatment
  Medical management – aimed at treating the urethral  Is a condition where there is accumulation of urine in the
sphincter incompetence. Drugs used are peritoneal cavity due to leakage of urine from the kidney,
ureter, bladder or proximal urethra.
o Phenylpropanolamine
 Rupture of the bladder is the most common cause
o Ephedrine
 Also due to blunt or penetrating trauma (eg. Automobile
o Imipramine accidents, Penetrating injury from the fracture fragments
of pelvic bone)
o Diethylstlbestrol
 Remember that if the rupture of the bladder is small or
on its dorsum, leakage will happen only when the
Surgical techniques
bladder is fully distended. In such cases, the dog may
void urine normally
 It includes the following

o Neoureterostomy – is performed for intramural Diagnosis

ectopic ureters where the ureter course
submucosally in the bladder and opens into the  Suspicion from history of trauma
urethra or vagina. After performing a cystotomy, an
incision is made into the ureter to make a stoma  Peritoneocentesis – smell of urine in the fluid and the
into the bladder. This is followed by ligation of the creatinine level will be greater than that of serum
ureter coursing distally to the stoma.
 From physical examination findings
o Ureteroneocystostomy – is performed for
extraluminal ectopic ureters where the ureter  Confirmatory diagnosis – Plain/Contrast radiography and
completely bypasses the bladder. The ureter is first Ultrasonography
ligated and transected. An new entry for the ureter
is then created in the bladder and the transected
Treatment
end of the ureter is then sutured to the bladder
mucosa through the newly created bladder incision.
Medical management

UROABDOMEN (Uroperitoneum)  If the animal is hyperkalemic or uremic, medical

treatment should be initiated

 Peritoneal dialysis is preferred in such situations

Surgical treatment
 Repair trauma of the urethra by anastamosis
 If the urethra is not completely transected, it can be
allowed to heal over a urinary catheter
 Rupture of the ureter can be corrected either by
anastamosis or by reimplantation into the bladder
 Rupture of the bladder (mostly at the apex) can be
corrected by apposition of the edges.
UROLITHIASIS
Urolithiasis (Renal, Ureteral, Cystic and Urethral calculi)
 Urolithiasis means a condition of having urinary calculi or
uroliths. Can be any of the following
o Nephrolith – calculi in the kidney
o Ureterolith – calculi in the ureter
o Cystolith – calculi in the urinary bladder
o Urethrolith – calculi in the urethra
Clinical presentation
 Some breeds have higher incidence due to metabolic
abnormalities (eg. Dalmatians)
 Signs depends on whether the stone has caused
obstruction or associated infection is present
 Renal calculi – haematuria, flank pain or renomegaly
 Polyuria and polydipsia if the animal has pyelonephritis
Diagnosis
 From symptoms
 Radiography and Ultrasonography
Treatment
 Treat the underlying infection
 If the calculi is associated with obstruction, surgical
removal is essential Surgical removal include the following
 Nephrotomy for removal of renal calculi
 Cystotomy for cystoliths
 Urethrotomy for calculi in the urethra
VESICAL CALCULI
 Symptoms related to stones in the urinary bladder are not
always shown.
 Chronic cases will exhibit hamaturia and dysuria.
Sometime complete obstruction of the urethra with stones
in male dogs will cause bladder distension.
  In female there may not be bladder distension, but soiling  Propofol –4-6 mg/kg IV
of the perineal region with urine and urine smell will be
there., palpation reveals crepitation of the calculi in th o Maintenance
bladder
 Isoflurane or sevoflurane
Diagnosis
Procedure
 From symptoms, and palpation of the posterior abdomen
will reveal stone like bladder.  Place the animal in dorsal recumbency.

Radiography  Prepare ventral abdominal region and vulvar area in

 Plain radiography will reveal distended bladder and
vesical claculi if radiopaque will reveal stones. If they are
radiolucent, pneumocystography will confirm the
diagnosis.
female for aseptic surgery.
 Incise skin and subcutis on the ventral midline.
 In male incise skin and subcutis parallel and adjacent to
prepuce.

Treatment  Identify and ligate preputial branches of caudal superficial

epigastric artery in the subcutis.
Cystotomy
 Incise linea alba from umbilicus to pubis and para
 Anesthesia preputial approach in male dogs.

o Premedication  Identify bladder and isolate it by moistened laparotomy

sponges.
 Hydromorphone – 0.1-0.2 mg/kg SC or IM
 Place stay sutures on the bladder apex to facilitate
 Butorphenol – 0.2-0.4 mg/kg SC or IM manipulation.

 Buprenorphine –5-15 microgm/kg IM
o Induction
 Thiopental -10-12 mg/kg IV
 Make incision on the dorsal aspect of bladder away from
ureters , urethra and between major blood vessels.
 Remove urine by aspiration or intraoperative cystocentesis
before cystotomy.
  remove the cystoliths  Blood in the urine (hematuria).

 Flush the bladder with normal saline to remove small  Urinating small amounts frequently (pollakiuria).
calculi
 Excess urination (polyuria).
 Examine bladder and mucosa for defects.
 Pain in the rear quarters.
 Pass a catheter down the urethra to check for patency.
 Reluctance to jump or play, or even lethargy.
 Close the urinary bladder (Cystorraphy )in a single layer
using continuous suture pattern.
Diagnosis
 If two layer closure, suture the seromuscular layer by two
 A urinalysis is helpful in making a diagnosis. The p H of the
continuous inverting suture lines (cushings followed by
urine, mineral content, and the presence of bacteria or
lembert).
crystals all provide valuable information.

 Radiography-radiopaque calculi can be detected.

CYSTOTOMY IN CANINES

Indications

 Cystic calculi

 Neoplasia of urinary bladder

 Correction of ectopic ureters

 Urinary tract infection which is resistant to treatment

Symptoms
X ray shows the presence of urethral
and cystic calculi with distended bladder
 Typical symptoms include straining to urinate
(stranguria).
  Ultrasonography is a good method to diagnose stones in Procedure
the urinary bladder, particularly for radio lucent calculi
and anatomical defects of the abdominal wall.
 Place the animal in dorsal recumbency.

 Prepare ventral abdominal region and vulvar area in

ANESTHESIA AND PROCEDURE female for aseptic surgery.

 Incise skin and subcutis on the ventral midline.

 Correct the fluid and electrolyte imbalances because of
chances of hyperkalemia associated with urinary
obstruction
 Withdrawal of food and water 12-24 hours before
surgery.
 In male incise skin and subcutis parallel and adjacent to
prepuce.
 Identify and ligate preputial branches of caudal superficial
epigastric artery in the subcutis.

Anesthesia  Incise linea alba from umbilicus to pubis and para

preputial approach in male dogs.
 Premedication
 Identify bladder and isolate it by moistened laparotomy
 Hydromorphone – 0.1-0.2 mg/kg SC or IM sponges.

 Butorphenol – 0.2-0.4 mg/kg SC or IM  Place stay sutures on the bladder apex to facilitate
manipulation.
 Buprenorphine –5-15 microgm/kg IM
 Make incision on the dorsal or ventral aspect of bladder
 Induction away from ureters , urethra and between major blood
vessels. and remove the calculus with a forceps
 Thiopental -10-12 mg/kg IV

 Propofol –4-6 mg/kg IV

 Maintenance

 Isoflurane or sevoflurane
Bladder Placement of Calculi from the
exteriorization incision bladder
Cystotomy in a female dog showing
from the abdomen on the bladder
single calculus removal

 Remove urine by suction or intraoperative cystocentesis

POST OPERATIVE CARE
before cystotomy.

 Examine bladder and mucosa for defects.

 Antibiotic and NSAIDS
 Pass a catheter down the urethra to check for patency.
 Observe the site twice daily for redness, swelling or
discharge from the site and cleaning of the surgical site.
 Close the UB in a single layer using continuous suture
pattern.
 Suture removal after 10-12 days.
 If two layer closure, suture the seromuscular layer by two
continuous inverting suture lines (cushings followed by  Special diet recommendations based on the type of calculi.
lembert).
 If struvite-decreased protein, give acidifiers such as
ascorbic acid and dl-methionine.

 If calcium oxalate, decrease protein, calcium, sodium

(spinach, milk products, table salt).
  If urate, increase the water consumption, feed a diet low in
purines, increase in pH 7.0-7.5 (Potassium citrate), adding
allopurinol to prevent conversion of purine to uric acid.
CYSTORRHAPHY
 Suturing of a wound due to injury or rupture of urinary
bladder. Suture seromucosal layer with two continuous
inverting suture lines (Cushings followed by Lembert).
 If bladder wall is thickened, suture bladder using a
continuous suture pattern using absorbable suture
material.
 If the dog has severe bleeding tendencies, suture mucosa
as a separate layer with a simple continuous suture
pattern.
CYSTOTOMY IN CATTLE
Indications
 Vesical calculi
 Neoplasm
Anesthesia and control
 General anesthesia: Xylazine- 0.03 mg/kg IM.
 Local or epidural anesthesia with lidocaine.
Site
 Pre-pubic site along linea alba starting in front of pubic
symphysis to a length of 3-4 inchesforward in female. In
male incision put lateral to sheath and subsequently along
linea alba. ( young animals)
 Oblique flank incision.
Procedure
 Perform laparotomy.
 Bladder is brought over to the incision on the abdominal
wall, turned over its neck, isolate by packing suitably to
prevent contamination of abdominal cavity.
 An incision of about 2-3 inches is made on the dorsal
surface of the bladder towards its neck.
 Remove calculi or neoplastic growth.
 Incision closed by inversion sutures.
 Close the laparotomy wound.
Prevention
 Provide calcium: phosphorus ratio as 2:1.
 Incorporate sodium chloride up to 4% of total ration to
facilitate more water intake and urinary dilution.
 Provide ammonium chloride 50-80 gm/day. Ruminitis is a
complication
  The lead signs in the seven-month-pregnant heifer were
TUMOURS FROM BLADDER WALL markedly abnormal general condition and demeanour and
a pear-shaped abdomen.

 The heifer had severe azotaemia, and abdominal

ultrasonography revealed ascites, which was diagnosed as
uroperitoneum based on an elevated creatinine level in the
fluid.

 A patent urachus was identified during cystoscopy; the

endoscope could be advanced beyond the apex of the
urinary bladder into the urachus. Based on all the
findings, a diagnosis of uroperitoneum attributable to
rupture of a patent urachus was made.

 The urachus was ligated twice via a left-flank laparotomy.
The general condition normalised within a few days of
PATENT URACHUS surgery, and the patient calved normally and was in good
health at follow-up evaluation.

 Patent urachus is a common condition in calves which is

Cystoscopy in a heifer with rupture of a patent urachus]. [Article frequently associated with omphalitis. A membranous
in German]Braun U, Previtali M, Fürst A, Wehrli M, Muggli E. urethral diaphragm prevented closure of the urachus in a
female calf. The patent urachus was complicated by an
ascending infection of the intraabdominal umbilical
Source remnants.
 Departement für Nutztiere der Universität Zürich,  Following surgical removal of the urachus and umbilical
Winterthurestr. 260, CH-8057 Zürich. vessels along with transection of the membranous
ubraun@vetclinics.uzh.ch diaphragm the calf experienced an uncomplicated
recovery. This case stresses the importance of assuring
Abstract urethral patency when managing a case of patent urachus.

 This case report describes the clinical, ultrasonographic 

and cystoscopic findings and treatment in a two-year-old
Swiss Braunvieh heifer with rupture of a patent urachus.
  MODULE-29: URETHRAL CALCULI AND  Urethral obstruction.
STENOSIS  Occasionally, biopsy of obstructive lesions (i.e. strictures,
scar tissue and neoplasms).
INDICATIONS OF URETHROTOMY  Allow breeding ability to be maintained.

 Urethral calculi, prostate diseases. ANAESTHESIA AND CONTROL

 Urethrotomy is a surgical procedure used to remove
urethral calculi most frequently in male and occasionally
in female when hydropropulsion fails to flush the calculi
into the bladder.
 The anaesthesia and surgical approaches are depending on
species and site of obstruction.
 Bull: Low (sacrocaudal) epidural anaesthesia, if necessary
local infiltration, controlled in standing or dorsal
recumbent position.
 Small ruminants and swine: High (lumbosacral) epidural
anaesthesia, controlled in dorsal or lateral recumbent
position with the upside hind limb abducted.

 Horse: Epidural with general anaesthesia; dorsal

recumbent state.

 Dog: Epidural or local infiltration, general anaesthesia;

dorsal recumbent position.

INCISION SITE

Bull
Radiograph showing presence of urethral Prostatic abscess
caliculi  Post scrotal site: For removal of obstruction at the
sigmoid flexure, about 3 inches behind the scrotum along
the median line.
Indications
  Ischial site: For obstruction close to the ischial arch. Two
inches below the ischial arch downwards along midline.
 Ventral approach: Between scrotum and preputial orifice
5-6 inch incision over the midline centering the
lodged calculi.
Horse
 The median line of perineal region, at or below the level of
ischial arch.
Dog
 At the seat of obstruction (the commonest site of
obstruction is behind the os-penis and occasionally calculi
lodged at the ischial arch).
Sheep and goat
 The urethral calculi in rams and wethers are mostly lodged
in the urethral process or in the sigmoid flexure.
OPERATION TECHNIQUE IN BULL
Post scrotal method
 A midline incision of 3 inches long is made about 3 inches
behind the scrotum.
 The areolar tissue is dissected to reveal retractor penis
muscles on either side.
 These are separated and held retracted to expose the body
of the penis.
 Palpate the urethra on the ventral aspect and incise it
longitudinally along the exact midline.
 The blockage is relieved and the patency of the canal is
established by a gum elastic catheter or a pliable metal
probe.
 A thin elastic tube may be used as a catheter and left in
situ for one or two days.
 The wound is left open to heal by second intension which
ensures if the normal passage is clear.
Ischial urethrotomy
 A skin incision 2 inches long is made along the midline
starting from about 2 inches below the ischial arch
downwards. This exposes the two retractor penis muscles.
 The incision can be started in level with the ischial arch
but will cause unnecessary bleeding due to the cutting of
the ischeo-cavernous muscle.
OPERATION TECHNIQUE IN DOG
Prescrotal urethrotomy
 With the dog in dorsal recumbency, place a sterile catheter
into the penile urethra to the scrotum or to the
obstruction.
  Make a ventral midline incision through the skin and with simple interrupted sutures or a continuous
subcutaneous tissue between the caudal aspect of the os subcuticular suture pattern.
penis and scrotum.

 Identify, mobilize and retract the retractor penis muscle

laterally to expose the urethra.

 Using a scalpel blade, make an incision into the urethral

lumen over the catheter.

 Use iris scissors to extend the incision, if necessary.

 Remove calculi with forceps and gently flush the urethra

with warm saline.

Perineal urethrotomy

 Place a purse string suture in the anus.

 Place a sterile catheter into the urethra to the level of the

bladder or the site of the obstruction.

 With the dog in sternal recumbency and rear limbs

hanging over the edge of the table, make a midline incision
over the urethra, midway between the scrotum and anus.
Urethral lumen flushed with warm saline
 Identify the retractor penis muscle, elevate it and retract
it.
 Leave the incision to heal by secondary intention or close
 Separate the paired bulbospongiosum muscles at their
the urethra with simple interrupted absorbable sutures (4-
raphe to expose the corpus spongiosum then incise the
0 or 5-0).
corpus spongiosum to enter the urethral lumen.
 Place the first layer in the urethral mucosa and corpus
 Close the incision as just described for prescrotal
spongiosum then appose subcutaneous tissue and skin
urethrotomy.
OPERATION TECHNIQUE IN STALLION
 A median cutaneous incision is made in the perineal
region at the ischial arch, 3 to 4 inches long.
 Go between the retractor penis muscles and cut through
the accelerator urinae muscle, corpus spongiosum and the
urethral wall.
 Confine to the exact median line to avoid branches of the
internal pudic artery.
 The wound may be left open or alternatively the urethra
may be sutured to correspond to the skin edges to keep the
opening patent.
OPERATION TECHNIQUE IN SHEEP AND GOAT
 The animal is restrained; the penis is pulled out gently
from the prepuce and digital pressure applied on the
urethral process to remove the calculus.
 In wethers, alternatively, urethral process can be nicked
off with a scissors and minor bleeding checked with digital
pressure.
 The technique of post scrotal urethrotomy to remove a
calculus from the sigmoid flexure is same as described in
bovines.
POST OPERATIVE CARE
 The animal should receive adequate fluid therapy
immediately after surgery and for a few days afterwards to
correct hypovolaemia.
 Analgesics should be administered fore 3 to 4 days and
broad spectrum antibiotics are given for 5 to 7 days to
check secondary infection.
 Routine wound dressing should be done daily.
 The indwelling catheter is left in situ for 3 to 4 weeks.
 Corticosteroids are often used for 2 to 3 days.
 The animal should be carefully watched for any
complications, particularly for subcutaneous infiltration of
urine due to its seepage from the urethral wound.
 Administer orally Cystone ® tablets which are thought to
act as urinary antiseptic and also to avoid recurrence of
calculus formation.
URETHROTOMY - COMPLICATIONS
 Blockade of the urethral catheter occurs mostly due to
blood clot and casts or renal or cystic cells, kinking of the
catheter and apposition of the proximal rim of the catheter
against the urethral wall.
 Urethral wound dehiscence may occur due to infection or
seepage of urine.
  Urethral stricture/ urethral stenosis o Some dogs lick and traumatize the prolapse, and it
may bleed
 Primary atony of the bladder occurs rarely in cattle and
buffaloes. It may develop secondary to obstructive Symptoms
urolithiasis due to over distension or as a complication of
bladder surgery.
 persistent licking of the penile area.
 Peritonitis is a rare post-operative complications.
 red to purple pea sized lesion

 haematuria independent of micturition

URETHERAL PROPLAPSE
Management

 May resolve spontaneously if the size is small

 Manual reduction under general anesthesia using a

urinary catheter, purse string suture is applied and later
removed after 4 days.

 Resection of the prolapsed mass is carried out in

extensively damaged cases

Treatment
Urethral prolapse
 If the prolapse is reducible, reduction followed by
 Prolapse of the mucosal lining of the distal portion of the retention with sutures from the urethral lumen to the
urethra through the external urethral orifice, commomn in penile surface can be done
english bull dogs.
 Surgical resection of the prolapse is the choice when the
o Reddened protrusion at the tip of the penis prolapse cannot be reduced.

o Sometimes it may be seen intermittently when the 

dog is sexually excited
 MODULE-30: SURGICAL AFFECTIONS OF
PENIS AND SHEATH

AFFECTIONS OF THE MALE GENITAL SYSTEM
IN DOMESTIC ANIMALS
Conditions affecting the prepuce and scrotum
 The genital system of male animals consists chiefly of the
testicles/testes, accessory sex glands and the organ for
copulation, the penis.
 The tubular structures - the epididymus, vas deferens and
urethra function as channels for the transport of the male
gametes from the testicles into the female genital passage
during coitus.
 The testicles, normally present , are located within the
scrotum as a pair in the inguinal region
 . In cats and pigs the scrotum is located in the perineal
region below the anal opening.
 The testicles produce male gametes and sex hormones
-Leydig cells produce testosterone and Sertoli cells
produce oestrogen. The accessory sex glands namely the
prostate, the seminal vesicles and the
bulbourethral/Cowper’s glands produce secretions that
have a supportive role in the transport and well being of
the male gametes as they are transferred from the male to
the female animal.
 The prostate is the only accessory sex gland in the male
dog.
 The urethra, extending from the neck of the urinary
bladder to the tip of the penis, has the dual function of
acting as a channel for the excretion of urine from the
urinary bladder as well as the transfer of male gametes
mixed with secretions of the accessory sex glands into the
female genital tract.
Conditions affecting the penis
 Congenital or acquired conditions may affect the penis of
companion animals.
 Congenital conditions.
 Hypospadias is a condition in which the failure of the
urogenital folds to fuse ventrally resulting in
an incomplete penile urethra . This is due to the fusion of
the prepuce and underdevelopment of the penis. The
urethra may open anywhere between the normal opening
at the tip of the glans penis and the perineal region.
Depending on the location of the urethral opening
hypospadias may be glandular, penile, scrotal or perineal.
 Surgical correction may not be required if there is free flow
of urine But, if the urethral opening is not sufficiently
large enough to allow free flow of urine the opening may
be enlarged by suturing the urethral mucosa to the skin.
Parts of the prepuce that interfere with the flow of urine
may also be excised surgically.
 Deformed or curved os penis may result in the inability of
the dog to retract the penis into the prepuce because of the
abnormal curvature. This can result in the exposed part of
the penis becoming dry, injured and infected later.
Treatment may be attempted by correcting the curvature
of the bone by fracturing it and immobilizing it by passing
a urethral catheter or fixed using a finger plate. Urethral
obstruction by callus is a possible complication when
treatment is attempted by fracture and fixation of the os
 penis. Such cases may have to be treated by performing a
prescrotal urethrostomy. In severe cases of curvature,
partial penile amputation may be recommended.
 Penile frenulum, the connective tissue band that joins
the penis and the prepuce ventrally, may fail to rupture
during puberty in some animals and may be a cause of
pain during erection.
 Treatment is by transecting the frenulum under general
anaesthesia.
Acquired conditions
 Fracture of os penis may rarely result from severe penile
trauma. The condition may be characterized by dysuria,
haematuria and abnormal mobility with crepitation when
the os penis is palpated. Radiography may help to
ascertain the type of fracture and decide the type of
treatment. Minimally displaced fractures may be treated
conservatively and need not be immobilized. Surgical or
non surgical immobilization as mentioned above may be
attempted in displaced fractures. Fractures associated
with severe penile trauma may have to undergo partial
penile amputation.
 Wounds of the penis may result from fighting, jumping
of fences, automobile accidents and mating. Penile
wounds have a tendency to bleed profusely. Superficial
wounds may be treated conservatively by cleaning with
mild antiseptics and application of emollient antibacterial
preparations followed by the use of systemic antibiotics. If
bleeding is severe, arterial bleeding may be controlled by
ligation and bleeding from the cavernous spaces may be
controlled by suturing the tunica albugenia. The penis
should be inspected carefully for urethral damage. Mild
cases of urethral damage may be treated by catheterization
for 7 days. In cases in which there is severe damage or
transection of the urethra, urethral suturing followed by
catheterization for 7 to 10 days may be done. Penile
erection may have to be prevented by sedating the animal.
A severely damaged penis should be partially amputated.
 Strangulation of the penis may result from malicious or
accidental application of rubber band on the penis of dogs
or the accumulation of hair around the penis. The affected
animal may show dysuria, pain, constant licking at the site
and signs of necrosis of the cranial end of the penis. The
penis may be saved in cases when the condition is
diagnosed early and timely removal of the strangulating
material is possible. In cases where strangulation was
severe or prolonged enough to cause gangrene of the penis
amputation of the affected part may be performed.
 Paraphimosis is a condition in which the penis fails to
return into the prepuce following protrusion. The
condition may occur congenitally or be acquired.
Congenital -narrowness of the prepucial orifice or
shortened prepucial sheath may cause the condition.
Acquired - conditions like trauma and infection may cause
paraphimosis. The condition may follow coitus or
masturbation. Clinical signs vary depending on the extent
of constriction of the penis by the prepucial orifice and the
duration of the condition. Penile desiccation,
inflammation, trauma, infection, necrosis and urethral
obstruction may result in protracted cases. Treatment
involves cleaning of the penis with a mild antiseptic,
application of hyperosmolal preparations and cold pack to
shrink the swollen penis, application of an emollient
lubricant and repositioning the penis into the prepucial
sheath. following this , a purse string suture may be
applied at the prepucial orifice to prevent recurrence and
kept in place for 7 to 10 days. Sometimes the prepucial
orifice may have to be surgically enlarged to allow return
 of the protruded penis. In cases where the prepuce is
congenitally short or when the exposed part of the penis is
irreparably damaged partial penile amputation may have
to be performed.
 Phimosis, inability to protrude the penis out through the
prepucial orifice, may occur congenitally or may be
acquired. A congenitally narrow prepucial orifice may
prevent the protrusion of the penis. Acquired conditions
like stricture of the prepucial orifice following trauma or
due to the presence of prepucial tumours also cause
phimosis. In cases in which the prepucial orifice is severely
narrowed urine may be voided in a thin stream or in
drops. Urine may get retained in the prepucial sheath and
cause necrosis of the inner lining of the prepuce and the
surface of the penis. Treatment involves surgical
enlargement of the prepucial opening and suturing the
prepucial mucosa to the skin all around the prepucial
opening using fine monofilament suture material like
nylon. The penis, if necrotic, may be cleaned with mild
antiseptic solution and emollient antibacterial
preparations administered.
 Prepucial abnormalities like hypoplasia, agenesis or failure
to fuse ventrally may also be seen congenitally or defects
may arise following trauma. Cases of incomplete fusion of
the prepucial folds may be treated by scarification of the
edges and suturing when the defect is small. In cases
where the prepuce is not sufficiently developed/remaining
to allow reconstruction, amputation of the exposed part of
the penis may help. Orchiectomy, scrotal ablation and
urethrostomy may have to be performed in cases in which
the prepuce is extensively affected.
 Inflammation of prepuce is called posthitis
 Prepucial tumours include all type of tumours that
affect the skin. TVT, melanomas, mast cell tumours and
perianal gland tumours have been reported from the
prepuce. Surgical treatment includes excision followed by
suturing the skin and mucosa separately or partial penile
amputation also in cases where extensive prepucial
involvement is seen.
 Scrotal injuries, scrotal infection and scrotal
tumours may be managed conservatively in mild cases by
medical management or surgical excision followed by
routine suturing. However, severe cases may warrant
orchiectomy and scrotal ablation.
HYPOSPADIAS
 Hypospadias is a condition resulting from the failure of
the urogenital folds to fuse ventrally resulting in the penile
urethra being incomplete.
 The condition is usually associated with the fusion of the
prepuce and underdevelopment of the penis. The urethra
may open anywhere between the normal opening at the tip
of the glans penis and the perineal region. Depending on
the location of the urethral opening hypospadias may be
glandular, penile, scrotal or perineal.
 Surgical correction may not be required if there free flow
of urine through the urethral orifice irrespective of its
location as the urethra cranial to the defect will not be
usually developed. However, if the urethral opening is not
sufficiently large enough to allow free flow of urine the
opening may be enlarged and the urethral mucosa sutured
to the skin. Parts of the prepuce that interfere with the
flow of urine may also be excised surgically.
  Deformed or curved os penis may result in the inability of
the dog to retract the penis into the prepuce because of the
abnormal curvature. This can result in the exposed part of
the penis becoming dry, injured and infected later.
 Treatment may be attempted by correcting the curvature
of the bone by fracturing it and immobilizing it by passing
a urethral catheter or fixed using a finger plate. Urethral
obstruction by callus is a possible complication when
treatment is attempted by fracture and fixation of the os
penis. Such cases may have to be treated by performing a
prescrotal urethrostomy. In severe cases of curvature,
partial penile amputation may be recommended.
 Penile frenulum, the connective tissue band that joins
the penis and the prepuce ventrally, may fail to rupture
during puberty in some animals and may be a cause of
pain during erection. The animal may cry out in pain and
be seen constantly licking the penis. Treatment is by
transecting the frenulum under general anaesthesia.
ACQUIRED CONDITIONS
 Fracture of os penis may rarely result from severe penile
trauma. The condition may be characterized by dysuria,
haematuria and abnormal mobility with crepitation when
the os penis is palpated.
 Radiography may help to ascertain the type of fracture and
decide the type of treatment. Minimally displaced
fractures may be treated conservatively and need not be
immobilized.
 Surgical or non surgical immobilization as mentioned
above may be attempted in displaced fractures. Fractures
associated with severe penile trauma may have to undergo
partial penile amputation.
Wounds
 Wounds of the penis may result from fighting, jumping of
fences, automobile accidents and mating. Penile wounds
have a tendency to bleed profusely.
 Superficial wounds may be treated conservatively by
cleaning with mild antiseptics and application of emollient
antibacterial preparations followed by the use of systemic
antibiotics. If bleeding is severe, arterial bleeding may be
controlled by ligation and bleeding from the cavernous
spaces may be controlled by suturing the tunica albugenia.
 The penis should be inspected carefully for urethral
damage. Mild cases of urethral damage may be treated by
catheterization for 7 days. In cases in which there is severe
damage or transaction of the urethra, urethral suturing
followed by catheterization for 7 to 10 days may be done.
Penile erection may have to be prevented by sedating the
animal. A severely damaged penis should be partially
amputated.
Strangulation
 Strangulation of the penis may result from malicious or
accidental application of rubber band on the penis of dogs
or the accumulation of hair around the penis.
 The affected animal may show dysuria, pain, constant
licking at the site and signs of necrosis of the cranial end of
the penis. The penis may be saved in cases when the
condition is diagnosed early and timely removal of the
strangulating material is possible.
  In cases where strangulation was severe or prolonged  Clinical signs vary depending on the extent of constriction
enough to cause gangrene of the penis amputation of the of the penis by the prepucial orifice and the duration of the
affected part may be performed. condition. Penile desiccation, inflammation, trauma,
infection, necrosis and urethral obstruction may result in
protracted cases.
Penile tumors
 Treatment involves cleaning of the penis with a mild
 Penile tumours are rare in cats but transmissible venereal
antiseptic, application of hyperosmolal preparations and
tumour (TVT), papilloma and squamous cell carcinoma
cold pack to shrink the swollen penis, application of an
are common in dogs. Clinial signs and treatment vary
emollient lubricant and returning the penis into the
depending on the location, extent and type of tumour.
prepucial sheath. Once returned, a purse string suture may
be applied at the prepucial orifice to prevent recurrence
 TVT is never treated surgically. Even extensive cases of
and kept in place for 7 to 10 days.
TVT respond favourably to appropriate chemotherapy.
Other types of tumours may have to be excised when small
 Sometimes the prepucial orifice may have to be surgically
or require penile amputation when the penis is extensively
enlarged to allow return of the protruded penis.
involved.
 In cases where the prepuce is congenitally short or when
 Destruction of papillomas by electrocautery may provide
the exposed part of the penis is irreparably damaged
complete cure. It has been found that cauterization of a
partial penile amputation may have to be performed.
few papilloma nodules can cause the destruction of the
remaining in a few days or weeks due to a possible
immune mediated response.
CONDITIONS AFFECTING THE PREPUCE AND
SCROTUM
PARAPHIMOSIS
 Phimosis, inability to protrude the penis out through the
 Paraphimosis is a condition in which the penis fails to prepucial orifice, may occur congenitally or may be
return into the prepuce following protrusion. The acquired. A congenitally narrow prepucial orifice may
condition may occur congenitally or be acquired. prevent the protrusion of the penis.
Congenital narrowness of the prepucial orifice or
shortened prepucial sheath may cause the condition.  Acquired conditions like stricture of the prepucial orifice
following trauma or due to the presence of prepucial
 Acquired conditions like trauma and infection may cause tumours also cause phimosis. In cases in which the
paraphimosis. The condition may follow coitus or prepucial orifice is severely narrowed urine may be voided
masturbation. in a thin stream or in drops.
 Urine may get retained in the prepucial sheath and cause
necrosis of the inner lining of the prepuce and the surface
of the penis.
 Treatment involves surgical enlargement of the prepucial
opening and suturing the prepucial mucosa to the skin all
around the prepucial opening using fine monofilament
suture material like nylon. The penis, if necrotic, may be
cleaned with mild antiseptic solution and emollient
antibacterial preparations administered.
 Prepucial abnormalities like hypoplasia, agenesis or failure
to fuse ventrally may also be seen congenitally or defects
may arise following trauma. Cases of incomplete fusion of
the prepucial folds may be treated by scarification of the
edges and suturing when the defect is small.
 In cases where the prepuce is not sufficiently
developed/remaining to allow reconstruction, amputation
of the exposed part of the penis may help. Orchiectomy,
scrotal ablation and urethrostomy may have to be
performed in cases in which the prepuce is extensively
affected.
 Prepucial wounds may be acquired following fights,
during mating, accidents or while jumping over barbed
wire. Superficial wounds may be allowed to heal by second
intention. Full thickness injuries may be sutured. The
prepucial mucosa and the skin have to be sutured
separately.
 Prepucial tumours include all type of tumours that affect
the skin. TVT, melanomas, mast cell tumours and perianal
gland tumours have been reported from the prepuce.
Surgical treatment includes excision followed by suturing
the skin and mucosa separately or partial penile
amputation also in cases where extensive prepucial
involvement is seen.
 Scrotal injuries, scrotal infection and scrotal
tumours may be managed conservatively in mild cases by
medical management or surgical excision followed by
routine suturing. However, severe cases may warrant
orchiectomy and scrotal ablation.

 MODULE-31: SURGICAL AFFECTIONS OF
TESTICLE AND SCROTUM
CONDITIONS AFFECTING THE TESTIS
Congenital conditions
 In the fetus, the testes are located intra-abdominally near
the kidneys. They descend into the scrotum in cats and
dogs by about five days after birth. However, normal
testicular descend may take six months to complete in
some animals.
 Failure of the embryonic development of the testicles or
their descent into the scrotum can result in congenital
abnormalities like anorchism, monorchism, testicular
hypoplasia or cryptorchidism.
 Anorchism is the congenital absence of both testicles. It is
rare in companion animals. Monorchism is the congenital
absence of one testicle, the left testicle being usually
absent.
  Anorchism and monorchism can be diagnosed by careful
palpation of the scrotum, inguinal region and the
abdomen (intra-abdominal testes are usually palpable only
when they are larger than normal). Ultrasonography,
laparoscopy or exploratory laparotomy may be required
for confirmation.
Testicular tumour
 The conditions are usually asymptomatic except for the
failure of development of secondary sexual characters in
cases of anorchism and need not be treated.
 Testicular hypoplasia may affect one or both testicles. The
affected testicles may be located within the scrotum, will
be very small, normal or soft in consistency and difficult to
palpate.
 Usually animals which are bilaterally affected will be
sterile. However, the testicular hormones may be
produced. Some of the affected animals may show
feminization and orchiectomy may have to be performed.
 Cryptorchidism is the failure of one or both testicles to
descent into the scrotum from the abdominal cavity.
 This is the most common congenital condition affecting
the testes. Unilateral cryptorchidism is more common and
the right testicle is mostly affected.
 The ectopic testis/testes may be located in the prescrotal
region, inguinal canal or within the abdominal cavity, the
latter being more common. The condition may be
diagnosed by careful palpation of the prescrotal region,
inguinal canal and the abdominal cavity (normal sized
intra-abdominal testicles are difficult to palpate).
Ultrasonography, laparoscopy and exploratory laparotomy
may be required for the diagnosis of intra-abdominal cases
of cryptorchidism.
 In bilateral cases of cryptorchidism the animal will be
sterile as the germinal cells of the testes undergo
degeneration in the raised ambient temperature in the
ectopic location. However, the endocrine function remains
normal and even in cases of bilateral involvement the
secondary sexual characters are normal. But, feminization
may be seen in cases where the ectopic testicle/testicles
have developed Sertoli cell tumour as intra-abdominal
ectopic testicles have a high tendency to develop
neoplasms especially Sertoli cell tumour and seminoma.
The intra-abdominal ectopic testicles also are prone to
suffer from torsion as they are more freely movable.
 Treatment involves orchiectomy. Bilateral orchiectomy is
preferred even in unilateral involvement to prevent the
onward transmission of genes responsible for the
condition. The pre-scrotal or inguinal testes are removed
through an incision placed on the skin directly over the
ectopic testicle. Intra-abdominal testicles are removed
through a ventral median laparotomy incision.

ACQUIRED CONDITIONS
 The testis/testes may be affected by acquired diseases like
orchitis, testicular trauma and testicular tumours.
 Orchitis, the inflammation of the testis, may result from
infection of the testicular tissue. The usual route of
infection is through the vas deferens from an infected
urethra, prostate or urinary bladder. The infection may
also reach the testis by a haematogenous route or via a
penetrating injury through the scrotal skin.
 The condition may be unilateral or bilateral and may be
acute in onset or chronic. In acute cases the animal may
show pain, tenseness and scrotal oedema. Systemic signs
of infection like leukocytosis, fever, anorexia and
listlessness may also be seen. The testis appears enlarged
and later may get adhered to its tunics. In chronic cases,
abscesses may develop which may drain through tracts
onto the skin.
 Acute cases may be treated using appropriate antibiotics,
anti-inflammatory/analgesic agents and cold application.
In cases of accumulated pus, incisional drainage will be
useful in hastening the healing process. Cases that do not
respond to conservative measures and are severe or
chronic may be treated by orchiectomy.
 Trauma of the testicles may result following fights,
accidents or attack by man. However, the condition has a
low incidence considering the relatively exposed nature of
the organs. The affected animal may have swelling of the
testis, signs of local pain and even lameness of the hind
limbs. Scrotal swelling, bruising and haematoma may be
seen in more severe cases.
 The tunica albugenia may be ruptured and the testicular
tissue may protrude through to variable degrees. Damage
to testicular tissue, epididymus and spermatic cord may
result in life threatening haemorrhage. Damage to the
testicular tissue may lead to temporary or permanent
infertility, spermatic granuloma formation due to the
antigenic nature of the sperms or immune mediated
orchitis.
 Mild cases may be treated using local cold application,
systemic anti-inflammatory/analgesic agents and
antibiotics when possibility for infection is suspected. In
cases of severe trauma it is recommended to surgically
open the scrotal sac and explore to assess the degree of
damage to the testicle.
 Any bleeding present should be arrested appropriately. In
case of rupture of tunica albugenia with resultant
protrusion of testicular tissue, the protruding tissue
should be excised and the tunica albugenia sutured with
synthetic absorbable suture material. After closure of the
skin incision a course of antibiotic should be administered.
In cases of extreme irreparable cases of testicular trauma
or unresponsive immune-mediated orchitis, orchiectomy
may be the treatment of choice.
 Tumours of the testicle are common in old dogs. The most
common are interstitial cell tumours, seminomas and
Sertoli cell tumours. Signs include increase in size and
firmness of the testicle/testicles, nodular induration on
palpation, pain and signs of feminization in cases of Sertoli
cell tumours.
 The condition should be differentiated from other
conditions that can cause an enlargement of the testis or
the scrotum like orchitis, torsion of the spermatic cord,
testicular/associated tissue trauma, epididymitis,
 spermatocele, scrotal neoplasms and scrotal hernia.
Diagnosis may be confirmed by FNAB or excisional 2 3
biopsy. Orchiectomy is the treatment of choice.

Skin closure
Testicular tumor Testicular tumor Testicular tumor
exposed through
skin incision
CONDITIONS AFFECTING THE TUBULAR CONDUITS

 Conditions affecting the epididymus and the vas deferens

can affect the functioning of the genital system. The tubes
may suffer from congenital aplasia or occlusion secondary
to inflammation/trauma.

 Obstruction to the flow of sperm through these channels

will lead to the formation of spermatoceles or spermatic
granulomas, pain and can cause infertility when bilaterally
involved.

 Cases of epididymitis may be treated along routine lines

Testicular tumor Testicular tumor Testicular tumor but in cases of permanent obstruction orchiectomy may be
operative procedure 1 operative procedure operative procedure performed.
  Tumours of the epididymus or vas deferens may have to be
treated by surgical removal of the affected part and also
orchiectomy on the affected side. Bilateral orchiectomy
may be performed if further breeding of the animal is not
desired.
 Conditions affecting the urethra like urethritis and
urethral tumours cause signs primarily associated with
urine outflow obstruction rather than genital involvement
and should be treated appropriately.
ORCHIECTOMY IN COMPANION ANIMALS
 Orchiectomy is a common surgical procedure in
companion animals performed for managemental,
prophylactic and therapeutic purposes.
 Bilateral orchiectomy renders the male animal benign and
easier to manage, prevents roaming especially in search of
females in heat, reduces injuries due to fighting and
prevents development of prostatic hyperplasia.
 Orchiectomy is also performed to treat prostatic diseases,
perineal hernia and irreparable injuries/neoplasms
affecting the testis.
 In dogs, the surgery is usually performed by the open
method by a prescrotal approach under general
anaesthesia. After controlling the animal on dorsal
recumbency and preparation of the prescrotal and scrotal
skin, a midline incision is placed on the prescrotal skin
after tensing one of the testicles under the skin.
 The incision extends through the skin, subcutaneous
tissue and the tunica vaginalis. The testis is squeezed out
and the attachment of the epididymus to the tunica
vaginalis is separated bluntly by traction or transected.
The vascular and the avascular bundles of the spermatic
cord are separated.
 The vascular bundle is ligated using No. 1-0 catgut and
transfixed. The ends of the suture material may be used
for ligating the avascular bundle also. The spermatic cord
is transected distal to the ligation and the stump returned
into the tunica vaginalis. The other testicle may be
removed through the same skin incision by incising the
scrotal septum after tensing the testicle against it.
 The procedure is repeated to remove the second testicle.
Subcutaneous sutures may or may not be placed using No.
4-0 absorbable suture material and the skin incision can
be closed using No. 3-0 or 4-0 nylon.
 In cats, orchiectomy is performed by placing separate
longitudinal incisions on the scrotal skin over each testicle.
 The spermatic vessels may be ligated as in the dog or the
vascular and avascular components of the spermatic cord
may be used for arresting bleeding by applying two square
knots with them. The scrotal skin incision may be left
without suturing.
CONDITIONS AFFECTING THE PROSTATE
GLAND
 Dogs commonly suffer from prostatic diseases. Male dogs
showing tenesmus, dysuria, anuria, pyuria, haematuria,
caudal abdominal pain and difficulty in walking with the
hindlimbs should be examined for prostatic involvement.
 Prostatic diseases are rare in cats. Diagnosis of prostatic
diseases may be made from history and clinical signs, per
rectal digital palpation of the prostate, plain and contrast
radiography, ultrasonography, laparoscopy, biopsy and
laboratory evaluation of blood, urine and ejaculate.
 Benign prostatic hyperplasia is the most common prostatic
disease affecting dogs. It is a normal old age related
condition in which the prostate gets enlarged and the
enlargement of the gland is testosterone dependant.
Constipation, tenesmus, bloody urethral discharge or
retention of urine may be seen. Dyschezia is more
characteristic than dysuria due to the physical obstruction
caused by the enlarged prostate to the expansion of the
rectum in the pelvis. Prolonged straining to pass feces may
lead to weakening of the pelvic diaphragm and subsequent
perineal hernia. Digital palpation per rectum reveals a
uniformly enlarged non-painful prostate with a normal
spongy consistency. Haemogram and biochemical
parameters are usually normal. Bacterial cultures of urine,
prostatic fluid and ejaculate are negative. Biopsy may be
required for confirmation. However, the latter is reserved
for cases that do not respond to treatment.
 Prostatitis and prostatic abscess are not rare findings in
dogs. The close proximity of the prostate to the urethra
which normally has resident bacteria predisposes it to
infection. The condition may be acute or chronic. Clinical
signs in acute cases include pyrexia, lethargy, anorexia,
urine retention, constipation, purulent urethral discharge,
signs of caudal abdominal pain and hind limb gait
abnormality. Systemic signs of sepsis may be seen.
Palpation of the gland reveals it to be asymmetrically
swollen, painful and fluctuant when abscesses are present.
Application of pressure on the fluctuating swelling may
cause drainage of pus from the urethra. In cases where the
abscesses have ruptured signs of peritonitis and septic
shock may develop. Urine may be collected and evaluated
revealing haematuria and pyuria. Culture of urine and
prostatic fluid obtained by catheterization or fine needle
aspiration reveals bacteria. Plain and contrast
radiography, ultrasonography and laparoscopy may
further help in diagnosis.

 The recommended treatment for benign prostatic

hyperplasia is bilateral orchiectomy. Once the stimulation
to the prostatic cells by testosterone is removed,
permanent involution of the prostate and clinical relief is
obtained in 2 to 3 weeks. In cases where castration is not
desired oestrogenic preparations may be used. However,
they have the potential to cause feminization and loss of
fertility. In valuable animals where it is desirable to retain
the fertility, drugs like finasteride may be administered
orally. However, the condition may return when the drug
is stopped.

Prostatic abcess

TREATMENT
 Treatment involves the use of appropriate antibiotics,
castration to reduce the size and activity of the prostate,
drainage of abscesses, omentalization, marsupialization
and partial or complete prostatectomy.
 Prostatic and paraprostatic cysts may result from the
increased production of prostatic fluid or a structural or
functional obstruction to the outflow mechanism. The
accumulated secretions may get secondarily infected and
form abscesses. Clinical signs may be produced due to the
physical obstruction caused by the enlarged cysts as in
prostatic abscesses except for the signs related with
infection and sepsis. Diagnosis is also made by the
techniques described earlier. Culture of the prostatic
secretions reveals no bacteria except in cases with
secondary bacterial infection.
 Surgical treatment is aimed at drainage, removal or
debulking of the affected prostatic tissue and
omentalization of the remnants. Castration is also
recommended.
 Prostatic tumours typically affect old dogs and can be
prevented by castration. Though adenocarcinoma and
transitional cell carcinoma are most common in dogs
other types have also been reported. Clinical signs are
produced by the physical obstruction to the urinary and
fecal outflow. Also, other signs of neoplasia like cachexia,
anorexia and pain will also be pronounced.
 Metastasis to adjacent and distant organs also produces
related symptoms. Rectal or abdominal palpation reveals a
painful, firm, irregular and nodular prostate which may or
may not be adherent to the surrounding structures.
Lymphadenopathy may be palpable or may be
ultrasonographically visualized. Biopsy may be performed
for differentiation of the condition from other conditions
that cause an enlargement in the size of the prostate.
 Treatment by prostatectomy may be performed before the
tumour has started metastasizing. Advanced cases have
poor prognosis.
 Trauma of prostate may occur because of trauma to the
pelvic region resulting in pelvic fractures or penetrating
caudal abdominal injuries. Mild cases may be treated by
establishing the patency of the urethra by catheterization
and allowing the damaged gland to heal by second
intention.
 In cases where catheterization cannot establish patency of
the urethra an exploratory laparotomy may be performed
and the damaged prostate may be repaired by suturing the
capsule. Partial or excisional prostatectomy may be
performed in severe cases of prostatic trauma.
CONDITIONS AFFECTING LARGE ANIMALS
 Most of the conditions affecting the genital system in
companion animals affect large animals. Treatment of
most of the conditions is also similar. However, treatment
may not be attempted for conditions which have poor
prognosis or diseases like tumours that have a high chance
of recurrence or metastasis because of financial reasons.
Valuable horses may be an exception for this.
 Conditions that are different from those in companion
animals in clinical presentation and treatment are
discussed.
 Hydrocele, the accumulation of fluid in the tunica
vaginalis, may result from trauma to the testicle or faulty
castration technique using Burdizzo castrator in bulls.
Surgical treatment involves orchiectomy on the affected
side by the open-covered method. In cases of bilateral
involvement, bilateral orchiectomy and scrotal ablation
may be performed.
 Cryptorchidism may be treated by surgical removal of
the affected testicle in a standing or recumbent animal by
a flank incision on the affected side. The surgery may be
performed under paravertebral nerve block or standing
chemical restraint with local analgesic infiltration. The use
of an emasculator to severe the spermatic cord helps
efficient control of haemorrhage in bulls as well as horses.
 Prepucial prolapse and prepucial fibrosis may be
seen in bulls. Acute cases of prolapse of prepucial mucosa
may be treated conservatively by cold application, cleaning
with mild antiseptic solutions, return of the prolapsed
mucosa into the prepucial sheath and application of a
purse string suture around the prepucial orifice. The
animal may be controlled on lateral recumbency with the
fore and hind limbs tied separately under sedation and/or
local analgesic administration.
 In chronic cases of prepucial prolapse, the mucosa may be
sufficiently traumatized to result in infection and fibrosis
during healing so as to result in sufficient stricture of the
prepucial orifice to cause phimosis. The condition may be
treated by surgical excision of the contracted part of the
prepucial orifice (circumcision).
 Penile haematoma and contusions may occur in
bulls as well as stallions and are usually associated with
copulation. The extent of the haematoma and contusion
also vary depending on the level of trauma. Mild cases may
be left to heal on their own. Sexual stimulation should be
avoided during the healing period. In extensive cases the
tunica albugenia in the affected part of the penis may be
incised, blood clots removed and major bleeding points
arrested. This surgery may be performed in bulls under
pudental nerve block and sedation and in horses under
general anaesthesia in the recumbent position. The
incision in the tunica albugenia may then be sutured using
synthetic absorbable suture material.
 Penile deviation may be seen in bulls. This can interfere
with copulation and may be of traumatic or non-traumatic
origin. Traumatic lacerations and subsequent scar tissue
formation can lead to penile deviation. In mild cases the
deviation can be surgically corrected by treatment of the
laceration and surgical release of the excessive scar tissue.
In penile deviation of spontaneous non-traumatic origin
spiral, ventral or “S” shaped deviation of the penis may be
seen. The condition may result from a damaged or
weakened apical ligament, a thick band of collagen arising
from the outer layer of tunica albugenia on the dorsal
aspect of the penis. The condition may be surgically
treated by surgical implantation of strips of fascia lata or
apical ligament into the tunica albugenia.
CASTRATION IN FARM ANIMALS AND HORSE
Castration in farm animals
 Cattle, sheep and goats are usually castrated by the closed
method using Burdizzo castrator. After controlling the
 animal in lateral recumbency with appropriate restraint by
tying up the fore and hind legs together, the spermatic
cord on one side is identified.
 The spermatic cord is kept tensed against the scrotal skin
and trapped within the jaws of the castrator. The arms of
the castrator are approximated thereby crushing the
spermatic cord.
 The castrator is removed and the procedure is repeated on
the other side taking care that the crush lines on the
scrotal skin on either side do not meet to avoid sloughing
of the scrotal skin distal to the crush lines.
 The crushing of the spermatic cord may be repeated at two
levels on each side if desired.
Castration in horses
 Castration of horses is performed under general
anaesthesia by the open-covered method. After restraning
the animal on lateral recumbency and aseptic preparation
of the scrotal and surrounding skin, a longitudinal incision
is made on the scrotal skin over one testicle. The tunica
vaginalis is incised and the testicle exteriorized.
 The vascular and avascular bundles are doubly ligated
using heavy catgut. The spermatic cord is crushed and
transected distal to the ligation using an emasculator and
the stump returned as high as possible in the external
inguinal ring.
 The tunica vaginalis is ligated as high as possible and
transfixed and the part distal to the ligation transected and
removed. Alternatively, the tunica vaginalis may be
transected close to the level of the external inguinal ring
and the edges apposed and sutured.
 The scrotal sac and the ventral aspect of the inguinal canal
may be packed with sterile gauze which can be kept in
place for two days to stimulate inflammation and early
closure of the inguinal canal to prevent chances of inguinal
herniation.
 The procedure is repeated on the other side to remove the
remaining testicle. In addition to a post-operative course
of antibiotic an appropriate dose of tetanus toxoid should
also be administered.
VASECTOMY
 Vasectomy inhibits male fertility but maintains
behavioural pattern.
Procedure
 Make a 1 to 2 cm incision over the spermatic cord between
the scrotum and inguinal ring.
 Locate spermatic cord, incise vaginal tunic
 Isolate the ductus deferens by blunt dissection
 Double ligate ductus deferens and resect a 0.5cm section
of ductus between ligatures.
 Repeat the same on the contralateral spermatic cord.
 Appose subcutis and skin.
 Vasectomy – reduces hormone associated diseases.
  But not roaming, aggression and urine marking.  Rubber rings (elastrator)

 Therefore it is not much recommended in canines

BURDIZZO METHOD
 Androgens are continually produced within one week the
animal becomes azoospermic following vas occlusion.

 But spermatozoa may persist in ejaculation for 3 Position and restrain

weeks(canines), 7 weeks in felines after vasectomy.
 Lateral recumbency with all the limbs tied and hind limbs
pulled ahead.
Complications

 Granuloma, scrotal swelling, incisional problems. Procedure

 Spermatic cord and blood vessels leading to the testicles

BOVINE CASTRATION are cut.

 Testicles tend to stop functioning for a while and then stop

functioning and degenerate.
 To avoid indiscriminate breeding. They are usually more
docile and easier to handle than bulls.
 One spermatic cord should be clipped at a time.
 Steers are also not as rough on equipment and are easier
 It is important to clip the two cords at different levels so
to manage as new individuals added to feedlots.
that the scrotal sac will receive enough blood.
 Steers are finished earlier (fatten quicker) than bulls
 Otherwise it will become gangrenous.
because fat deposition occurs at a faster rate than in bulls.
 Make sure that the spermatic cord is between the burdizzo
 In cases of testicular neoplasia.
blades.
 Eliminates possibility of using inferior bulls.
Advantages

METHODS OF CASTRATION IN CATTLE  Bloodless.

 Infection or maggot infestation seldom occurs.

 Burdizzo
 o Before removal spermatic cord is ligated and tunica
EQUINE CASTRATION vaginalis also ligated before closing.

Procedure
 To make the animal docile.
 Two parallel incision equidistant from median raphae in
 Testicular tumor. cranio-caudal direction.

 Scrotal hernia  This incision made through skin dartos, blunt dissection to
free the testes and spermatic cord, fascia.
Aneathesia
 An incision made through tunic proximal to cranial pole of
 For standing castration local infiltration analgesia can be the testes and testes prolapsed from tunic.
used.
 Emasculator placed proximal to testes advanced upwards.
 For castration of recumbent animal xylazine 1.1 mg/kg +
ketamine (2.2 mg/kg) or xylazine 0.5 mg/kg+  Mesorchium is perforated to separate vascular and
thiopentol 6.6 mg/kg. avascular part.

 Emasculator is applied first to neurovascular portion

Techniques
before removing avascular part.
 Closed method
 Emasculator applied directly and should remain for
sometime.
o Parietal layer of tunica vaginalis is never opened
before transfixation ligature.
 After both testes removed remove loose tags of fascia, fat.
 Open method
 The wound should not be sutured.
o Parietal layer of tunica vaginalis is incised before
emasculation of spermatic cord.
CASTRATION OF CRYPTORCHID
 Half closed

o Parietal layer of tunica vaginalis is incised and testis  In dorsal recumbency skin incision is made midway
removed. between scrotum and superficial inguinal ring.
  Pareital layer of tunica vaginalis incised, scrotal ligament
also incised and contents are removed. COMPLICATION AND SEQUELE

 Spermatic cord vessels are ligated and vaginal tunic

incisions closed.  Hemorrhage

 Loose spermatic fascia was apposed and subcuticular  Uterine stump pyometra
sutures were used to appose the skin.
 Recurrent estrus

POST OPERATIVE CARE AND COMPLICATIONS  Ligation of ureter

 Urinary incontinence
Post operative care
 Fistulous tracts and granuloma
 Before surgery tetanus toxoid should be administered.

 After castration proper exercise should be given for 7 days.
 MODULE-32: SURGICAL AFFECTIONS OF
Post operative complications THE OVARY AND UTERUS

 Haemorrhage
DEFINITIONS AND INDICATIONS
 Scrotal edema

 Evisceration
Definition
 Scirrhous cord
 Ovariohysterectomy is the removal of both the ovaries
and the uterus.
 Hydrocele

 Inguinal hernia, peritonitis Indications

 Persistent masculine behavior  Elective sterilization of the female dog or cat.

  Infections of uterus (e.g. pyometra, localized or diffuse
cystic endometrial hyperplasia), ovaries, or oviducts.
 Ovarian-hormone imbalances.
 Also in mammary tumors to reduce the endogenous
production of estrogen.
 Extensive traumatic injuries (uterine rupture).
SURGICAL ANATOMY
 Right and left broad ligament: Attaches ovaries, oviducts
and uterus attached to dorso-lateral wall of abdominal
cavity and lateral wall of pelvic cavity.
 Broad ligament is divided into mesovarium, mesosalphinx
and mesometrium.
 Suspensory ligament: Attaches ovary to broad ligament
cranially.
 Proper ligament: It’s the caudal continuation of
suspensory ligament, attaches ovary to the uterine horn.
 Round ligament: Continuation of proper ligament,
attaches to the cranial tip of the uterine horn
 Ovarian arteriovenous complex lies on the medial side of
the broad ligament.
SURGICAL AFFECTIONS OF UTERUS AND ITS
TREATMENT
Affections of uterus
 Atresia or occlusion of the OS Uteri
 Wounds of the uterus
 Metrorrhagia
 Metritis
 Chronic endometritis or pyometra
 Neoplastic or incurable lesions affecting the uterus
Atresia or occlusion of the OS uteri
 This condition may be due to a neoplasm or cicatricial
contraction.
 In renders impregnation difficult or impossible.(implantation)
Treatment
 When the opening is not completely obliterated, it may be
dilated with the fingers or special dilators.
TOP
Wounds of the Uterus
 It may be confined to its mucous membrane or extend more
deeply and perforate abdominal cavity.
  Gravid uterus may be rupfused by violent impact of the
abdominal wall against a fixed object.
Treatment
 Rupture during gestation, all that can be done is to treat for
internal haemorrhage.
 Non perforating wounds inflicted at the time of parturition are
treated by antiseptic irrigation and antiseptic cpessaries.
 When the organ is perforalted, these is no effective treatment
for the condition.
 The administration of sedative medicine to allay straining may
help to bring about spontaneous recovery.
 When haemorrhage is profuse, measures to assest it are
indicated.
TOP
Metrorohagia
 Haemorrhage from the uterus is usually the result of a round
inflicted during parturition.
Prognosis
 Grave
Treatment
 Cold douches over the loins.
 Injections of cold or very hot water into the uterus
 Packing the uterus and vagina with sterilized cloths
 Hypodermic injection of adrenalin or pituitrin - more effective
 Packing material should be removed after 24 hrs.
 Uterus should be irrigated with suitable antiseptic solution.
TOP
Metritis
 Inflammation of uterus due to presence of pathogenic bacteria,
local inflammation, febrile disturbance, offensive muco –
parculent dischange from the vagina.
Treatment
 Repeated irrigation by antiseptic solutions, antiseptic pessaries
 Administering suitable medicine internally, including pericillin
 In chronic cases autogenous vaccine is indicated
TOP
Pyometra
  Pus formation in the uterus. It is opened and closed pyometra.  Apply two clamps anterior to the cervix and cut in between
them to finally disconnect and remove the uterus with the
ovaries.

 The stump can be either closed by inversion sutures when the

calmp is removed.

 The laparotory wound is sutured.

Pyometra - Dog

Technique

 Perform laparotomy.

 The ant ovarian ligament is cut.

Pyometra - Cat
 Ligature the anterior utero – ovarian vessels.

 The ovary is disconnected from its anterior attachment.  Complication -- stump pyometra

 Posterior uterine anteries are ligatured and cut in level with the
cervix.

 Broad ligament of the uterus is torn to liberate the uterine

cornea.
 partum contractions intensified by oxytocin release during
lactation.

 Treatment: if animal is in good condition manual reduction

maybe attempted. Sterile gauze soaked in warm sterile saline
placed around the uterus. General or epidural anesthesia is
usually necessary.

 Extensive uterine devitalization needs ovariohysterecomy after

reduction of prolapse. If reduction is not possible the uterus is
amputated and stump reduced.

Uterine rupture

 Rupture of gravid uterus rare occurrence and can occur during

Stump pyometra parturition or after severe trauma.

 Fetuses expelled into the abdominal cavity may die immediately

or be reabsorbed or remain intact, causing peritonitis. If fetal
circulation remains intact fetuses may live to term.

Uterine torsion  Acute uterine rupture treated by ovariohysterectomy.Uterine

neoplasia
 Condition uncommon in dogs and cats. The ravid or non-gravid
uterus can rotate clockwise or counter-clockwise from 90° to  Clinical signs may be abdominal enlargement or a palpable
more than 200°. abdominal mass. If the tumor obstructs the lumen mucometra
or hydrometra may develop.
 Cause: jumping during or running late in pregnancy, active fetal
movements, premature uterine contraction
Treatment
 Treatment: ovariohysterectomy and c-section if viable fetuses
are present. Ovariohysterectomy uncommon in dogsand cats. One or both
the horns may proloapse during prolonged labour or upto 48
hours after parturition when the cervix is extremely dilated.
Uterine prolapse

 Possible mechanisms: excessive relaxation and stretching of

pelvic musculature, uterine atony due to metritis, incomplete SURGICAL TECHNIQUE
separation of placental membranes, severe tenesmus, post
 Incision site
o Dog: Midline abdominal incision, extending from
umbilicus to a point midway between umbilicus and
brim of pubis.
o Cat: 1 cm caudal to umbilicus and extends
approximately 3-5 cm caudally
 Ventral midline incision is made on the skin, continued
through the linea alba and peritoneum.
 Left uterine horn is easy to reach, as it is located more
caudally than the right.
 Left uterus horn is located with ovariohysterectomy hook
or index finger.
 Traction of the uterine horn exposes the ovary and ovarian
pedicle.
 Suspensory ligament is stretched or broken with index
finger.
 The ovarian arteriovenous complex is clamped with two or
three haemostatic forceps as per the surgeon’s preference.
 The surgeon should maintain constant digital contact with
the ovary when applying the first clamp to ensure the
entire ovary is removed.
 A third clamp is placed on the proper ligament between
the ovary and the uterine horn.
 Absorbable suture (e.g. chromic catgut or PGA) is
preferred for all ligatures.
 A circumferential suture is tightened so that it lies in the
groove of the crushed tissue created by the clamp.
 A transfixation suture is placed between the
circumferential suture and the cut end of the pedicle.
 Pedicle is grasped with thumb forceps, the final clamp is
released and the pedicle is inspected for bleeding.
 If no bleeding occurs, the pedicle is replaced in the
abdomen.
 The right uterine horn is isolated following the left uterine
horn distally to the bifurcation.
 The ligation procedure is repeated on the right ovarian
pedicle.
 Large vessels in the broad ligament are ligated when broad
ligament is grasped and torn.
 Uterine body is exteriorized and the cervix is located.
 Three clamps are placed in the uterine body proximal to
cervix.
 Circumferential suture is placed around the distal clamp,
the clamp is removed and the suture is tightened in the
groove of the crushed tissue.
 A transfixation suture is placed between the
circumferential suture and the remaining clamp which is
removed after severing the uterine body.
 Abdominal incision is closed either in a simple interrupted
suture pattern with absorbable suture material or in
simple continuous pattern with non absorbable suture.
  Subcutaneous tissue and skin are closed routinely with with ketamine @ 10 mg/kg body weight and diazepam 0.3
subcuticular sutures and interrupted sutures respectively. mg/kg body weight.

 Maintain anaesthesia with same ketamine and diazepam

OVARIOHYSTERECTOMY IN DOGS AND CATS or propofol @ 3-5 mg/kg body weight.

Preparation of the animal

 Ovariohysterectomy, is the surgical removal of the uterus
and ovaries under general anesthesia. This procedure is  Position the animal in dorsal recumbency or left lateral
typically performed around or prior to six months, but can recumbency.
be performed on dogs of any age.
 Prepare the area aseptically.
 The procedure may be elective, or a treatment for a disease
process.
Procedure

Reasons for performing the surgery
 Vastly decreased chance for development of mammary
cancer
 200 times less likely if ovariohysterectomy performed
before the first estrus
 Eliminates chance of developing a pyometra or uterine
infection
 The surgical incision is usually made along the ventral
abdomen, but flank approaches have been reported.
 Separate the subcutaneous tissues and facia. Incised linea
alba. The ovary is identified and surgical clamps are
applied to the ovarian blood vessels.
 The vessels are then ligated (tied with sutures) to prevent
bleeding and the pedicle is replaced into the body. This
procedure is repeated for the other side.

 Eradicates unwanted estrous behavior and associated  The uterus and its blood vessels are ligated just above the
bleeding cervix.

 Eliminates unwanted pregnancies and risks of dystocia

(difficult birth)

Anaesthesia

 Premedicate with atropine , followed 10 minutes by

xylazine @1 mg/kg body weight. Induce the anaesthesia
  After care includes house rest, with no running, jumping
or rough play for two weeks following surgery. Pain
medications are often prescribed for several days following
surgery.

 An Elizabethan collar may be necessary to prevent licking

of the surgical wound. Further treatments may be
necessary following ovariohysterectomy for treatment of
pyometra or other disease.

Prognosis

 The prognosis is excellent for routine ovariohysterectomy.

Prognosis is good following ovariohysterectomy for
Uterine stump lig Holding the uterus pyometra and dystocia.

 The uterus and ovaries are removed from the abdomen. SPAYING
The abdomen is sutured closed in three layers: the
abdominal wall, the subcutaneous tissue (tissue
underneath the skin) and the skin itself.
 Removal of the ovary is known as spaying.

Complications
Indications
 Ovariohysterectomy can lead to mild complications such
 Prevent breeding nuisance
as incisional bruising, swelling and infection. More serious
complications such as hemorrhage and urinary
 Prevent development of pyometra , mammary tumor.
obstruction are rare but can be life-threatening.

 Ovariohysterectomy can be more difficult in larger or Age

obese animals and may be associated with more
complications.  Above 6 months of age in case of dogs.

Postoperative care Anaesthesia

  Premedicate with atropine , followed 10 minutes by  The ovarian bursa is opened and the ovary is removed
xylazine @1 mg/kg body weight. learning the bursa.

 Induce the anaesthesia with ketamine @ 10 mg/kg body
weight and diazepam 0.3 mg/kg body weight.
 Maintain anaesthesia with same ketamine and diazepam
or propofol @ 3-5 mg/kg body weight.
 The other ovary also is removed in a similar manner.
 The abdomen is sutured closed in three layers: the
abdominal wall, the subcutaneous tissue (tissue
underneath the skin) and the skin itself.

Preparation of the animal Postoperative care

 Position the animal in dorsal recumbency or left lateral  Aftercare includes house rest, with no running, jumping or
recumbency. Prepare the area aseptically. rough play for two weeks following surgery.

Sites  Pain medications are often prescribed for several days

following surgery.
 From a point a little behind the umbilicus backwards
along the midline over a length of 3 -5 inches.  An Elizabethan collar may be necessary to prevent licking
of the surgical wound.
 2. 1 – 1 ½ inches incision on either flank, parallel to the
last rib, below the lumbar transverse processes, at the level
of the posterior lobe of the kidneys. VAGINAL FIBROMA

 The incision may be ½ inch behind the last rib on the

right flank and about 1 inch behind on the left flank.

Technique

 Perform laparotomy.

 The ovary with its bursa is held with fingers.

 A ligature is applied anterior to the ovary and another one

behind it, around the respective vascular connections.

Vaginal fibroma
AFFECTIONS OF THE OVARY
Acquired ovarioan disorders
 Surgical treatment includes ovariohysterectomy
Vaginal hyperplasia
Congenital anomalies of the uterus
 Congenital abnormalities are rare in dogs and cats. Uterus
unicornis, agenesis of uterine horn, hypoplasia, atresia,
segmental aplasia, septate uterine body and double cervix.

AFFECTIONS OF THE VAGINA

Ovarian cysts

 Follicular cyst: develop from graffian follicles Clinical

signs include prolonged estrous with bloody vaginal Vaginal prolapse/hyperplasia
discharge, cystic mammary hyperplasia,
 Vaginal prolapse/hyperplasia Ocuurs as a result of
 Lutein cysts: from corpus luteum after ovulation, maybe edematous enlargement of vaginasl tissue during estrus or
associated with cystic endometrial hyperplasia or proestrous.
pyometra. Mostly asymptomatic and found during routine
ovariohysterectomy or laprotomy.

 Parovarian cyst: originate either from remanats of

mesonephric or paramesonephric ducts and tubules. More
common in dogs than in cats. Located between ovaries and
ovaries and uterine horns. No clinical signs and found
incidentally.

Inflammatory diseases

 Inflammatory disease of ovary and oviduct not a distinct

disease. Ovaritis or pyosalphinx occurs secondary to
pyometra.

Vaginal prolapse / hyperplasia

Ovarian tumors

 Large tumors palpable in the cranial right or left abdomen.

  Vaginal prolapse occurs as a 360 o involvement of the
protrusion of the mucosa where as hyperplasia arise from
a stalk of mucosa from the vaginal floor.weakeness of the
vaginal connective tissue results in edema and prolapse
through the vulva.
 occurs in young bitches 2years or younger and is extremly
rare in cats.
Differential diagnosis - uterine prolapse.
 The most common types of vulval vaginal tumors are
fibroleiomyoma, sqaumous cell carcinoma,and
transmissible veneral tumour.( Malignant)
Treatment
 If the protrusion is small the prolapse will resolve once the
effects of estrogen diminshes.
 For this GnRH can be given at the dose rate of 50
microgram / 40lb bodyweight.In TVT Vincrysticine can be
administered at the dose rate of 0.025 mg/kg up to 1 mg
IV weekly for 3-6 weeks
Surgical treatment
 OHE is recommended to prevent injury to the evereted
mucosa
 Mannual reduction afetr episiotomy and suturing the
vulval lips till edematous stage resorbs.
 Resection of the protruding mass with OHE
recommended if the tissue is severly damaged.
 Resection of the protruding mass without OHE may
require hysteropexy, cystopexy or colopexy' : but this is
not practiced in TVT cases.

 MODULE-33: SURGICAL AFFECTIONS OF
UDDER AND TEAT
AFFECTIONS OF UDDER AND TEAT
 Affection of udder and teats are getting much attention
now a days as these affects the economy of the farmer.
Milk alone contributes around 63% to the total output
from livestock.
 The udder and teats are vulnerable to external trauma or
injury because of their anatomical location, increase in
size of udder and teats during lactation, faulty methods of
milking, repeated trauma to the teat mucosa, injury by
teeth of calf, unintentionally stepped on teat, paralysis
resulting from metabolic disturbances at parturition.
 Any disease condition of udder and teats not only causes
painful milking but also makes udder and teats prone to
mastitis. The diseases of udder can be congenital
anomalies are known at the time of first calving but
acquired anomalies can affect any stage of lactation.
 Congenital and acquired surgical conditions of udder and
teats can be grouped into three main categories.
is
o Conditions of epithelial surface of udder and teats.
 o Conditions of glands and teat cistern or canal.
o Conditions of teat sphincter.
CONDITIONS OF EPITHELIAL SURFACE OF
UDDER AND TEAT
Supernumerary or extra teats
 These teats are often seen on the posterior surface of
udder and in-between the teat. They may be functional or
nonfunctional, functional activity can be determined only
after parturition of the animal.
 They frequently interfere with free milking process and are
objectionable on show animals.
Udder and teat abscess
 It has been reported that presence of supernumerary teats
has no significant effect on milk yield, lactation length, age
at calving, conception rate and service period.
 Surgical removals of these teats are best in young animals
and in case of older cow in dry condition. Surgery
performed under local infiltration analgesia with two
elliptical incisions at the junctions of teat and udder and
skin wound closed with interrupted suture using
nonabsorbable suture material.
Bovine ulcerative mammitis (sore teats)
 The teats become painful due to presence of crakes,
traumatic injuries, lesions due to disease conditions such
as pox, FMD etc. If these lesions are not treated well in
time, the animal will not allow touching the affected teat
for milking.
 These lesions become ulcers in due cource of time and the
condition are then known as bovine ulcerative mammitis.
 Oozing of blood from injured teat causes contamination of
milk while milking thereby making it unfit for human
consumption.
 In such cases, sterilized teat siphon should be used to
drain the milk out. For treatment of such painful lesions,
the wound should be washed with light potassium
permanganate solution and then soothing preparation
such as iodized glycerin, bismuth iodoform paraffin paste,
zinc oxide ointment or antiseptic dressing with soothing
emollient may be continued till the complete healing of the
lesion occurs.
 Abscess formation occurs more often on the udder than
the teat. Many cases with chronic mastitis especially due to
resistant microbes suddenly develop abscessation on side
of affected udder. Such cases can easily be diagnosed by
puncturing the swollen part.
 The abscess cavity is opened for complete drainage of pus.
After drainage of the pus, the cavity is dressed with
tincture iodine followed by application of soothing agents
until obliteration of abscess cavity.
 In case of necrosis of teat or udder, amputation of teat or
affected quarter is recommended followed by daily
dressing till complete healing of wound occurs.

Udder abscess
Teat laceration and fistulae
 The condition is mostly observed in those animals that
have long teats and pendulous udder.
 When animal tries to jump over the barbed wire or pass
through the thorny bushes, their teat get teared due to
laceration of skin and muscles. If this laceration is deeper,
then even teat canal gets opened and milk will start
flowing through the teared portion. This condition is
called as teat fistula.
 The cases of teat fistula are considered as emergency
because any delay in repair of such teat will cause
development of mastitis or necrosis of the teat. For repair
of such teat, all aseptic precautions should be taken into
considerations.
 A full coverage of systematic antibiotic is required and for
proper drainage Larson’s teat plug is used. Different
suture techniques are used to repair the teat fistula but
double layer simple continuous suturing with PGA 3/0
and in between simple vertical mattress simple
interrupted suturing of skin with nylon 1/0 is found
suitable for repair of teat fistula.
CONDITIONS OF GLAND AND TEAT CISTERN OR
CANAL
Lactolith (milk stone)
 Milk stone are formed into the teat canal when the milk is
rich in minerals and salty in taste due to super saturation
of salts.
 The stone moves freely in teat canal and hinder the milk
flow, if large in size.
 They usually get washed out along with ilk but if large in
size then it can be crushed with small forceps or cutting
the sphincter with litchy teat knife or teat bistouries and
milked out.
Teat canal polyp
 These are small pea sized growths attached to the wall of
teat canal. The polyps hinder the milking process and
sometimes even block the passage of teat canal.
 Teat polyps can easily take out by Huges teat tumour
extractor. If its location is above the teat canal thelotomy
is the best method for resection of excessive tissue.
 Postoperative gentamicine and prednisolone infusion for
five consecutive days found suitable to check infection as
well as helpful in checking further growth of the polyp.
Teat spider
 This condition is usually due to congenital absence of teat
cistern or canal.
 It can be acquired in cases of injury, tumour or
inflammation of mammary tissue resulting in formation of
thin or thick membrane, situated either at the base or
middle of the teat.
 This membranous obstruction removed by teat scissor,
Huges teat tumour extractor, teat bistouries or Hudson
spiral teat instrument.
Fibrosis of teat canal
 This condition is commonly observed in most of the
lactating animals where a hard fibrous cord like structure
is observed in the teat.
 Exact cause of this condition is not clear. However,
repeated trauma due to mechanical injuries, thumb
milking and calf suckling are the main contributory
factors.
 Sometimes mastitis can also result into fibrosis of quarter
followed by teat canal. This fibrotic cord will obstruct the
teat canal and will create hindrance during milking.
 In such cases, initially hot water fomentation followed by
counter irritant massage such as iodine ointment and
turpentine liniment massage is very useful.
 In some cases it is advisable to place polythene catheter
after removal of fibroid mass by Hugs teat tumour
extractor.
Tumour of mammary gland
 These are infrequently in lactating animals however, fibro
adenoma reported in heifer.
 The growth can be surgically removed under caudal block
or local infiltration analgesia.
CONDITIONS OF TEAT SPHINCTER
Teat stenosis (Hard milker)
 It is the condition when teat sphincter gets contracted due
to repeated trauma resulting in hard milking of teat.
During milking one has to apply more force to take the
milk out and milk will come out in fine stream.
 Stenosis of streak canal without acute inflammation can be
treated successfully by incising the sphincter in three
directions with teat knife, Bard parker blade No.11, Udall’s
teat knife, McLean teat knife.
Teat leaker ( Free milker)
 This condition is just reverse of teat stenosis. It can be due
to injury or relaxation of teat sphincter.
 In this case milk will go on leaking and sometimes
infection may gain entry leading to mastitis. This
condition is treated by injection of 0.25 ml of lugo’s iodine
around the orifice or scarification and suturing with one or
two stitches with monofilament nylon.

Blind teats
 This condition may be congenital or acquired due to any
trauma near the teat sphincter. Such cases generally
reported just after parturition on palpation milk thrill
found in teat cistern on pressing milk passed backward
toward milk udder cistern.
 Imperforated teat treated by 15 gauze needle, after
creating opening, it is further dilated using hugs teat
tumour extractor, milk canula fixed for 24 hour after that
frequent milking advised at 4 to 6 hours intervals to
prevent adhesion.
 Administration of proper antibiotics is done for a
minimum period of 3-5 days.
MAMMARY NEOPLASIA
SURGICAL TREATMENT FOR TEAT FISTULA
Anesthesia and control
 Local infiltration or ring block
Surgical technique
 Moussu's method
Surgical anatomy
o The edges of the teat fistula are freshened and are
sutured by a set of mattress sutures passing through
the skin and subcutis on one edge and only subcutis
on the other edge.
o Another layer of interrupted sutures are applied and
a teat siphon is introduced and bandaged.
 Gold's method
o Following freshening of the fistula a series of
mattress sutures are placed through the muscular
and skin of eiether side with out piercing the
mucous edge.

 MODULE-34: SURGICAL AFFECTIONS OF
MAMMARY GLANDS IN SMALL ANIMALS
 Mammary neoplasia is the major surgical affection
reported in small animal practice. The condition has high
correlation with the effect of spaying or neutering age.
 Old un-spayed female dogs are highly susceptible to this
condition and can proceed to either a benign or malignant
tumor of the mammary gland. If the animal is neutered
before 8 months of age the incidence is less than 0.2 %.
 In Small animals especially, cats and dogs have five pairs
of mammary gland and their blood supply and lymph
drainage is listed in the following table
S.N Gland Blood Supply Lymphatic drainage
o

1 Cranial Inter-costal, Internal thoracic and Axillary Lymph node

thoracic lateral thoracic artery and veins

2 Caudal
thoracic

Mammary tumor
3 Cranial Cranial and Superficial epigastric Local lymph tract
Abdominal Vessels
CLASSIFICATION

4 Caudal Cranial and Superficial epigastric Local lymph tract and

Abdominal Vessels and Inguinal Inguinal Lymphnode Tumorigenesis

 About 50 % of all the mammary tumors in dogs are

5 Inguinal Inguinal Inguinal classified as benign and the most common being fibro-
adenoma.

 The malignant tumors reported at this institute have been

classified as adenocarcinoma, papillary cystic
adenocarcinoma and mixed malignant tumors. Sarcoma is
reported very rarely.

 In cats the most common tumor reported is

adenocarcinoma. These tumors commonly metastasize
primarily to the regional lymph node and the thorax.
Secondary metastasis is found in liver kidney, spleen,
ovary, heart and diaphragm.
Mammary Acinar Cells

Diagnosis

 Biopsy

o This includes Fine needle aspiration cytology

Mammary tumor (FNAC) and incsional biopsy. FNAC gives a
tentative pattern of the nature of tumor and
confirmative diagnosis is made on a
Signalment and History histopathological examination.

Physical Examination
TREATMENT
 Cytology

 Radiography Surgery

o Thorax Dorsoventral and abdomen for metastatic
lesions. If the appendicular skeleton is involved it
may also be included for radiography
 Ultrasound
 Surgery is the most feasible therapeutic option in India
and cost effective also. The procedures done include
o Lumpectomy which involves removing the tumor
mass alone
 o Simple Mastectomy wherein the affected mammary
glands are removed
 Regional Mastectomy: wherein the affected mammary
gland and ipsilateral glands are also removed.
 Enbloc resection wherein the affected mammary gland,
regional lymphnode and all interfering glands and
lymphatics are removed
 Unilateral Mastectomy: The affected glands with all other
mammary glands on that side is removed
 Bilateral mastectomy: Removing all the mammary glands
on both sides. This could be done as staged process to
prevent complications like dehiscence and also to reduce
the pain to the animal
Procedure
 The procedure is performed with the patient in general
anesthesia.
 The Surgical technique involves proper aseptic
preparation of the site from ulcerative discharges, dirt and
casting the animal in dorsoventral recumbency.
 A elliptical skin incision is made around the affected gland
including 1-2 cm of normal tissue on all planes and careful
hemostasis is adhered. The principles of surgical oncology
states that we need to isolate the major blood vessels
supplying the tumor mass and ligate them so that we
prevent the tumor cells draining into these vessels and
causing tumor seeding or metastasis post operatively.
 If the tumor mass is malignant it can produce excessive
VEGF (Vascular endothelial growth factor) causing more
blood vessels originating from the normal anatomical
course and need to be double ligated as well. Incise
through the subcutaneous tissue and using a metzenbaum
scissors with gentle traction to one end of the tumor start
resecting the tumor.
 If the subcutaneous tissue or muscle is involved then
include them also and make necessary reconstructive
procedures. Ligate all major blood vessels and remove the
regional lymphnodes if they are enlarged. The
subcutaneous tissue is apposed with 3-0 or 4-0 absorbable
suture materials and skin apposed with silk 2-0 or 3-0 in
cruciate pattern.
Postoperative care
 The animal is bandaged with a absorbent gauze material
and the surgical site is dressed with antiseptic every 2 days
and a course of antibiotic is given for a period of 5 to 7
days.
 The sutures of skin are removed on the 10 th post operative
day.
Chemoptherapy
 Anti estrogenic compounds like tamoxifen is effective in
controlling the tumorogenesis associated with the action
of estrogen on mammary acinar cells.
 Antineoplastic agents administered include Doxorubicin
IV at 30mg/m2 on day 1 and Cyclophosphamide at 100
mg/m2 on days 3 to 6 of a 21 day cycle and repeated based
on response to therapy
  Radiation therapy is effective for carcinomas unresponsive
to chemoterapy as well as sarcomas

Immunotherapy

 Intravenous BCG therpay on 1st, 2nd, 4th week for every 8

weeks.

 Gamma interferon therapy

Complications

 Hemorrhage, Pain, Inflammation, Seroma, Infection,

Wound dehiscence and tumor recurrence

Prognosis

 It is influenced by tumor size, histology, mode of growth

and clinical stage of the disease.

Note:- Feline mammary tumors are more infiltrative and are best
treated by extensive surgery by removing all the glands.

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