Introduction to veterinary surgery

Introduction to Veterinary Surgery

Definition: Treatment of injuries or diseases by manual procedures or operations by hand                            is called surgery.

            An act of performing surgery may be called a surgical procedure, operation or simply surgery. The verb operate means to perform surgery. The adjective surgical means pertaining to surgery like surgical instruments.

            The term surgery can also refer to the place where surgery is performed or simply the office of a physician or veterinarian.

            A procedure is considered surgical when it involves cutting of a patients tissues or closure of a previously sustained wound.

            All surgeries are invasive procedures, noninvasive procedures refers to an excision that does not penetrate the structures being excised ( Eg:  Laser ablation of the cornea or radio surgical procedure like irradiation of a tumour.

Synonyms: Greek word - Cheirourgike ( hand work) – Cheir- hand Ergon – work.

                    Latin word – Chirurgiae (hand work)

                    Sanskrit word – kar = hand.

History of Veterinary Surgery

            Dhanvantari is God of medicine, sushruta and Charaka are his disciples and ancient healers of India. Sushruta Samhita is ancient unique book on Indian Surgery(600-500 BC). In 300-400 BC Nagarjuna has done recension of Sushruta Samhita with 120 chapters on Anatomy, Physiology,Pharmacology, Nutrition, Obstetrics and Poisoning.

            In surgery he has in detail described preparation for surgery, instruments and care, surgical methods, wound dressing and symptoms to predict prognosis.

            In surgical methods he has described are cautery, foreign body removal obstructions, surgical grafting (ear and nose), fracture treatment, dislocation, piles and fistula, suturing methods and plastering.

            Qualities of a surgeon -  Honesty, Courage, Compassion, Empathy and  Continuous improvement of knowledge.

            Nakula was expert in cattle and Sahadeva was expert in Horse treatment in Mahabharata.

            In Kautilya ArthaSharstra there is an account of Department of Livestock under king Chandragupta Mourya (322-298)

            Ashoka (273-232 BC) developed Veterinary Hospitals all over his kingdom.

            In Egypt, Papyri to treatment of fractures and wounds.

            In Greece, Hippocrates(468-370 BC) taught surgery.

            In 13^th century Jordanus Ruffus was Chief Veterinarian of Friedrick II ruler of Sicily , regenerator of Veterinary Art.

            Carlo Ruini (1598) worte book on Anatomy of Horse.

            Ambroise pare treated gunshot wounds in napoleon war.

            The three main developments which permitted transition to modern surgical approach are Control of bleeding by cautery or sutures, Control of pain through anaesthesia and control of infection by antibiotics.

            In 1762, Claude Bourgelat, Veterinary Practioner established first Veterinary school in Lyon, France.

            In 1846, Ether Anaesthesia developed developed by W.T.G.Morten.

            In 1853, C.P.Jadeson, Boston physician used ether anaesthesia in animals.

            Joseph Lister introduced the theory and practice of Asepsis , phenol for instruments.

            Louis Pasteur and Joseph Lister practiced antisepsis which revolutionized surgery.

            Robert Koch developed steam sterilizer.

            In 1847, Ignaz Semmelweis for compulsory washing of hands.

            In 1875 Ore reported intravenous anaesthesia by Chloral Hydrate.

            In 1867 Pean, used forceps for contron of haemorrahage.

            In 1894, Halstead used rubber gloves and given Tenets of Halstead for Surgery.

            In 1886, Von Bergmann shown sterilization of instruments by boiling.

            In 1895 Roentgen discovered X-Rays.

            In 1897-1916, Father of Veterinary Radiology, R.Eberlein used X-Rays in Veterinary practice.

            In 1920, Rotzgen,Benesch, and Brook applied the technique of epidural anaesthesia in larger animals.

            In 1929, Alexander Flemming deveopled Pencillin, which helped in great success of surgery.

            In 1950, Charpantier produced general anaesthesia in larger animals by Phenothiazine.

            In 1903, discovery of Barbiturates, used for general anaesthesia in small animals.

            In 1965 , Publication of Archibald edition of canine surgery shown application of anatomy and physiology in surgery.

            In 1977, Indian society for veterinary surgery was established at Hissar.

Reasons for conducting Surgery:

1. To save the life of an animal Eg: Acute Intestinal Obstruction.

2.To prolong the life of an animal Eg: Onchosurgery.

3.To hasten the recovery from an injury Eg: Suturing the wound.

4. To eliminate the disease process Eg: Onchosurgery of benign tumor.

5. Cosmetic reasons Eg: Ear cropping, Docking.

6.To correct deformitied or malfunctioning Eg: Staphylorraphy, Cryptorchidism.

7.Replacement of a part by an artificial one Eg: Prosthetic Surgery

8. Economic reasons Eg: Castration in dogs and sheep, Debleating of sheep, Debarking in dogs.

9. In diagnosis of a pathological process Eg: Exploratory Surgery.

10.For investigation in research work Eg: Experimental Surgery in salivary or gastric  fistula.

Types of Surgery –

1.Minor                                                           2.	Major
↓                                          ↓
Simple to perform	Difficult
No threat to life	Threat to life
Less time to conduct	Takes more time
No assistance required	Assistance required
Eg: Abcess opening, wound dressing	Eg: Caesarian section, Thoracic Surgery.

Major Surgeries categorized by

1.Urgency /Timing	2.Purpose	3.Type of Procedure	4.Body System involoved	5.Degree of Invasiveness	6.Special Instrumentation
↓	↓	↓	↓	↓	↓
Elective	Exploratory	Coservative	Tissue (Bone,Muscle)	Minimal (Laproscopic)	Laser (Laser instead of Scalpel)
Semi Elective	Therapeutic	Radical	Organ (Heart)	Open Surgical Procedure ( Laprotomy)	Microscopic ( Using operating Microscope)
Emergency	Experimental	Recontructive	Organ System (G.I system)		Robotic Surgery. (Davinci or Zeus surgical system) which controls instrumentation under surgeons direction
	Clinical	Cosmetic
		Replantation
		Plastic

Elective Surgery – In nonlife threatening condition, at patients request, subject to availability of surgeon and on availability of theatre. Eg: Cataract.

Emergency Surgery – Done promptly to save the life, limb or functional capacity. Eg: Obstruction in intestines.

Semi-Elective Surgery: Postponed for short period but must be done to avoid permanent diability or death. Eg; Caesarian in dystocia, onchosurgery.

Exploratory Surgery: performed to aid or confirm diagnosis.

Therapeutic surgery: To treat previously diagnosed condition.

Experimental Surgery: Systematic investigation of surgical problem.

Clinical Surgery: Teaching of surgery to the student.

Conservative Surgery: To preserve or restore a disabled part rather than its removal. Eg: Fracture immobilization rather than removal.

Radical Surgery: To remove the source or root cause of the disease. Eg. Onchosurgery.

Cosmetic Surgery: To improve the appearance of the animal or for owner fancy. Eg: Ear trimming or docking.

Reconstructive Surgery: For correction of deformities or malformation Eg: Surgery for Cleft Palate( Staphylorraphy )

Replantation Surgery: To reattach a severed part.

Plastic Surgery: To repair the defects or deformities by direct union of parts or transfer of tissues from one part to another. Eg: Rhinoplasty.

Based on Terminology

-ectomy	-otomy	-oscopy	-ostomy	-oplasty	-rraphy
Procedure to remove a part of body. Eg: Trachectomy	Procedure to cutting into an organ or tissue. Eg: Laprotomy	Minimal invasive,small incision through which endoscope is passed.Eg: Laproscopy	Procedure for forming permanent or temporary opening called stoma in the body.Eg: Oesophagostomy	Reconstructive, plastic or cosmetic starts with name of the body part to be reconstructed. Eg: Rhinoplasty	Reparation of damaged or congenital abormalities. Eg: Herniorraphy

Transplantation surgery:

Replacement of an organ or body part by insertion of another from same , different or animal parts into patient. Donor  and Recipient  are two important components in this surgery, if these are from same individual it is autograft, from different individuals of same  species it is allograft, between different individuals of different species it is xenograft, like organs kidneys and liver from pigs to humans, isograft between twins, split transplant from one donar to two recipients, Domino transplants in case of cystic fibrosis lungs  and heart are replaced and heart of recipient to another recipient. ABO incompatible transplants in young patients below 12 to 24 months, who donot have well developed immune system to receive organs from incompatible donors.

Branches of Surgery

1	Opthalmic
2	Orthopedic
3	Soft tissue	Gastro intestinal & Liver	Pulmo-thoracic	Urology (Kidney & Bladder)	Reproductive (OH,Ceasarian,Castration,Spaying)
4	Dental
5	Cardiothoracic
6	Udder
7	Otolarygology
8	Vascular
9	Surgical Onchology

Interdisciplinary Branches of Surgery

1	2	3	4	5
Surgical Anatomy (Anatomy of limited area of operation)	Surgical Physiology (Study of  effects on body physiology by a surgical condition)	Surgical Pharmacology (Study of pharmacology related to surgery)	Surgical Bacteriology (Study of microbes concerned with surgery)	Surgical Pathology (Study of effects produced on body by surgical condition0
↓
Surface Anatomy ( Study of configuration of the body surface in relation to deeper parts)
Regional/Topographic(Anatomy of different divisions of the body)
Systemic Anatomy(Study of individual organs in a system)

General terms in Veterinary practice:

1. Aseptic Surgery: Surgery carried out practically free of microbial contamination, so that                             post operative infection and suppuration is avoided.

2. Antiseptic Surgery: Surgery conducted with the use of antiseptic agents to control                                            microbial contamination.

3.Clinic/Hospital: An institution in which medical attention is given to patients.

4.Trauma: Injury (external violence) inflicted to a part of the body or to an organ by some                           outside agent. Physical agent or Chemical agent like strong acid or alkali.

5. Fever: Elevation of the body temperature due to a disease.

6.Pyrexia: Simple elevation of the body temperature.

7.History(Anamnesis)-Greek term means recalling. Gathering information about the                                           patient condition like symptoms exhibited before or after the medical                                attention given.

8.Incidence(Occurance)-Occurance of a particular disease with reference to                                                                         susceptibility,frequency in particular species,age group or locality.                                               Eg: Broken knee in horses, Splints in young horses.

9.Etiology: Study of the cause of disease. Causes can be Predisposing causes or Exciting causes.

10.Symptom(sign): Change in the condition of the patient indicating some abnormality. 

a)Physical – sign of disease Eg: Limping

b)Functional – Deviation from the normal functioning of a part or organ.Eg: # of radius.

C)Pathognomonic – Symptom to establish the diagnosis of a particular disease Eg: Pulpy                                             kidney in ET.

11. Diagnosis: Determination of the nature of the disease

a) Tentative: Yellow mucous membranes indicating jaundice.

b)Definitive: Increased bilirubin content in blood.

12.Differential Diagnosis: Comparative study of the diagnostic features of closely related diseases.

a) Clinical: Diagnosis based on symptoms or lab tests.

b)Post-mortem diagnosis:Diagnosis of disease after death of the patient by examination on body and internal organs.

13.Lesion: Any pathological alteration in tissues due to disease or trauma.

a) Gross lesion: Visible to the naked eye.

b)Microscopic: Visible under microscope or by histopathology.

Sequela: Lesion from prolonged existence of the disease or by disease. Eg: Chorea in CD, Deformity by paralysis.

Prognosis: Forecast as to the prospect of recovery of disease.

Types of Treatment:

Remedial Rx	Palliative Rx	Symptomatic Rx	Expectant Rx
Knowing the cause of disease and treating accordingly. Eg: Thomas splint in tibial fracture.	Sponging in fever	Paracetamol in pyrexia	Rantac in NSAID

Physical therapy:

Therapeutic use of physical agents other than the drugs like heat ,light, water , electricity in massage,physiotherapy,Acupressure,Accupunture.

Aphormism : Concise statement of a principle in any science.

Blood Pressure:

Systolic	Diastolic	Mean BP
Maximum pressure developed by contraction of heart	Lowest point in the pressure curve	Measure of the degree of filling of the circulatory system at a given period of time.It is less than the average of systolic and diastolic pressure.

Anorexia: Complete loss of appetite.

Inappetence: Partial loss of appetite.

Nystagmus: Rhythmic movement of the eye in a particular direction followed by movement in the opposite direction. It could be lateral of vertical movement.

Priniciples of Halstead:

Principles of modern surgery-Halstead(1852-1922)

1. Gentle handling of tissues: To decrease the trauma by gentle handling,using sharp cutting instruments, preventing unnecessary clamping of tissues with forceps.

 2. Aseptic Surgery: Surgery under aseptic conditions.

 3.Anatomical Surgery: No muscle, major nerve or blood vessel should be dissected unnecessarily, but shifted a side. To approach a deeper part it is better to separate the muscle but if unavoidable cut a tendinous part than belly to minimize the bleeding.

4.Control of hemorrhage: Bleeding should be controlled at every stage during surgery.

5. Obliteration of dead space: Dead space or vacant cavities  are  created when a part of organ is removed, where blood and exudates might get collected, for which proper packing is desirable. Eg: Dead space in mammectomy should be sutured properly.

6. Use of minimum quantity of suture material: As suture material is a foreign body, it should be used minimum.

7.Avoidance of suture tension: Tight suture on the edges of wounds will cause obstruction of blood supply leading to tissue necrosis and may cut through the tissue leading to disruption of wound.

8.Immobilisation: Preventing the excessive movement of the wounded area is important for healing. Sutures, adhesive tapes, bandages, plaster casts help in immobilization.