DVM Doctor of Veterinary Medicine Large Animal Surgery Questions and Answers — Questions and Answers
Question 1: A 10-year-old Thoroughbred gelding presents with acute, severe abdominal pain that is unresponsive to analgesics. On rectal palpation, you identify multiple loops of tightly distended, edematous small intestine in the caudal abdomen. What is the most appropriate next step?
- Administer a different class of analgesic and re-evaluate in one hour.
- Perform abdominocentesis to evaluate the peritoneal fluid.
- Immediately refer the horse for an exploratory celiotomy. (Correct answer)
- Pass a nasogastric tube and administer mineral oil.
Correct answer: Immediately refer the horse for an exploratory celiotomy.
The finding of multiple loops of tightly distended and edematous small intestine on rectal palpation is highly suggestive of a strangulating obstruction, which is a surgical emergency. Delaying surgery significantly worsens the prognosis. While abdominocentesis and nasogastric intubation are important colic diagnostics, the rectal findings alone are sufficient to warrant immediate surgical referral.
Question 2: What is the primary purpose of performing a right paralumbar fossa omentopexy for the correction of a left displaced abomasum (LDA) in a dairy cow?
- To suture the abomasum directly to the right body wall.
- To decompress the gas-filled abomasum before repositioning.
- To create a permanent adhesion between the greater omentum and the right body wall, preventing redisplacement. (Correct answer)
- To manually break down any adhesions that have formed between the abomasum and the left body wall.
Correct answer: To create a permanent adhesion between the greater omentum and the right body wall, preventing redisplacement.
A right paralumbar omentopexy involves suturing the greater omentum, which is attached to the greater curvature of the abomasum, to the peritoneum and muscle layers of the right flank. This creates a permanent adhesion that holds the abomasum in its correct anatomical position, preventing future displacement. While decompression is part of the procedure, the pexy is the key to prevention of recurrence.
Question 3: Which of the following is considered the most common and clinically significant long-term complication following a laryngoplasty ('tie-back') procedure in a horse for treatment of recurrent laryngeal neuropathy?
- Incisional site infection or seroma.
- Suture failure leading to loss of abduction.
- Chronic coughing and/or dysphagia. (Correct answer)
- Persistent roaring during exercise.
Correct answer: Chronic coughing and/or dysphagia.
By permanently abducting one of the arytenoid cartilages, a laryngoplasty compromises the larynx's ability to fully close and protect the airway during swallowing. This can lead to chronic, low-grade aspiration of food and saliva, resulting in persistent coughing or difficulty swallowing (dysphagia). While suture failure and infection can occur, chronic coughing is a more frequent long-term management challenge.
Question 4: A 2-year-old male Boer goat presents for stranguria and vocalization. You perform a urethral process amputation, which successfully relieves the obstruction. However, the goat re-obstructs 24 hours later. The owner wants to pursue further treatment for this valued pet. What is the most appropriate surgical option to provide long-term patency?
- Perineal urethrostomy.
- Repeated urethral process amputation.
- Bladder marsupialization.
- Tube cystostomy. (Correct answer)
Correct answer: Tube cystostomy.
A tube cystostomy is considered the gold standard for treating recurrent obstructive urolithiasis in small ruminants intended to be kept long-term. It diverts urine flow, allowing the urethra to heal and small calculi to pass without causing obstruction. A perineal urethrostomy is a salvage procedure often complicated by stricture, and bladder marsupialization has a high rate of ascending infection and urine scald.
Question 5: When performing a standing flank laparotomy in a horse, which regional anesthetic technique provides the most complete desensitization of all layers of the body wall, including the peritoneum?
- Line block.
- Inverted L block.
- Proximal paravertebral block. (Correct answer)
- Caudal epidural block.
Correct answer: Proximal paravertebral block.
A proximal paravertebral block desensitizes the dorsal and ventral nerve roots of the spinal nerves (T18, L1, L2) as they emerge from the intervertebral foramina. This provides a wide and deep area of anesthesia, including the skin, muscle layers, and peritoneum, which is ideal for a flank laparotomy. A line block and inverted L block do not reliably anesthetize the deeper muscle layers or the peritoneum. A caudal epidural affects the perineal region, not the flank.
Question 6: A farmer presents a 4-week-old calf with a soft, non-painful, easily reducible swelling at the umbilicus approximately 3 cm in diameter. There are no signs of infection or systemic illness. What is the most appropriate initial management recommendation?
- Advise surgical repair within the next week.
- Suggest monitoring; many small, uncomplicated hernias resolve spontaneously. (Correct answer)
- Recommend immediate application of a hernia clamp.
- Prescribe a course of systemic antibiotics to prevent infection.
Correct answer: Suggest monitoring; many small, uncomplicated hernias resolve spontaneously.
Small (less than 5 cm or '2-3 fingers' wide), uncomplicated, reducible umbilical hernias in young calves often resolve without intervention as the calf grows and the abdominal wall strengthens. Surgical correction is typically delayed until the calf is older (e.g., weaning) if the hernia persists or enlarges. Hernia clamps are generally not recommended due to risk of complications, and antibiotics are not indicated without evidence of infection.
DVM Doctor of Veterinary Medicine Large Animal Surgery Questions and Answers
A 10-year-old Thoroughbred gelding presents with acute, severe abdominal pain that is unresponsive to analgesics.
On rectal palpation, you identify multiple loops of tightly distended, edematous small intestine in the caudal abdomen.
What is the most appropriate next step?