VSR 421 Regional Vet Surgery

VSR 421: REGIONAL
VETERINARY SURGERY
(2+1)
- Dr.C.Ramani
VSR 421: REGIONAL VETERINARY SURGERY (2+1)
MODULE-1: SURGICAL AFFECTIONS OF LIPS CHEEK AND TONGUE
LEARNING OBJECTIVE
• At the end of this module the learner should be able to diagnose and treat the surgical
conditions affecting the lips , toungue and oral cavity.
ANATOMY
• 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.
• The upper and lower lips form the oral fissure and meet at posterior angles,with the
commissures.
• Except for the rostral two thirds of the upper lip, there is no hair along the lip margins.
• 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
spaces.
• The philtrum is the deep, narrow cleft between the two halves of the upper lip.
• In large animals lips play as a prehensile organ also.In bovines 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: Orbicular muscle for the voluntary movement, dorsal and ventral incisive muscles,
maxillonasolabial, buccinator, zygomatic, and levator nasolabial - voluntary lip movement.
• Nerve dorsal bucal, ventral buccal and auriculopalpebral brabches of the facial nerve.
MUSCLES - INNERVATION - PHYSIOLOGY
Muscles
The muscles involved are
• Orbicular muscle
• Dorsal and ventral incisive muscles
• Maxillonasolabial
• Buccinator and zygomatic muscles
• levator nasolabial muscles
Innervation
• The musculature of the lips is innervated by the dorsal buccal, the ventral buccal, and the
auriculopalpebral branches of the facial nerves.
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Physiology
• Contribute little to active prehension

• In horses lips are the prehensile organ.
• Displays behaviour, including threatening attitudes. Scent marking through the application of
secretions from glands.
DISEASES OF THE LIPS
• Foreign Bodies
• Lacerations
• Avulsion
• Infections
• Eosinophilic Ulcer Disease
• Facial nerve paralysis
• Cleft lip
• Burns
• Neoplasms
FOREIGN BODIES
• Grass pieces, splinters of bone quills, wood pieces, bullets and carbon particles are usaually
seen. Sometimes pieces from dog chain and belts are also reported.
• The animal's attempts to expel or encapsulate the foreign material results in open wound
followed by infection with bacteria .Further injury will be caused when the animal attempts to
dislodge the foreign body.
DIAGNOSIS
Clinical signs
• Inappetance
• Ptyalism ( drooping of saliva)
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• Dullness and pain
• Presence of an infected wound
• Direct visualization of foreign body under illumination
TREATMENT
• Foreign body can be removed with forceps.

• 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
remove the object.
• The wound is then gently flushed with warm sterile saline, the skin or mucous membrane
incision is closed. Small opening should be left open for drainage.
• Post operatively antibiotics and anti-inflammatory drugs are indicated for 5 days. Oral
antiseptic gel and soft light food till 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.
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• The mucosa is not included in the suture, and the knots lie deep in the lip tissue. Repair of large
lip defects needs a skin flap or graft .The overlying skin is closed with simple interrupted sutures
or vertical mattress sutures through the mucosa, submucosa, and muscle with the knots on the
oral mucosa side. Fig A
• Knots are also placed without 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
• Etiology: Automobile accidents and falls from heights.
Avulsion of lower lip in a dog
TREATMENT
• Suture the lip in place in minor avulsions with fine monofilament nylon or polypropylene
• 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
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• Pendulous lower lip in a great dane causing salivary drooling.
• Etiology: Bacterial, Viral, Canine viral oral papillomatosis, yeast and fungal candidiasis,
dermatophytosis, coccidioidomycosis blastomycosis, cryptococcosis nocardiosis.
TREATMENT
• 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 undermined 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 apposition to the
mucocutaneous border without tension.
• Papilloma Warts may be removed by sharp dissection at the level of their base with an electric
scalpel. Spontaneous regression of the remaining warts usually occurs due to auto vaccination.
• Injections of immune and hyper immune serum Vincrystin @ 0.02 mg/kg S/C
• Fungal -Antifungal therapy
EOSINOPHILIC ULCER DISEASE
• Manifested as a well-circumscribed, red-brown, ulcerated, alopecic, glistening area on the skin

of the lips or mucosa of the oral cavity
• Diagnosis is based on history, physical examination, skin biopsy impression smear of the lesion.
• Treatments surgical excision or debridement of granulomas is difficult because of the paucity of
surrounding tissue to use to repair defects. Deformity and recurrence are common com-
plications.
• Glucocorticoids and, in refractory cases, radiation therapy are the current recommended
treatments.
FACIAL NERVE PARALYSIS
• The facial nerve, supplies motor fibers to muscles of the face.

• Facial paralysis mostly affects motor function and except for taste, there is no loss of sensation
from the skin and mucous membranes.
• Chronic paralysis leads to facial muscle atrophy.
CAUSES AND SIGNS
• Causes secondary to direct nerve injury, space-occupying lesions, otitis media, and
neuromuscular or central nervous system disease
• Signs of facial paralysis are asymmetry of the ears, eyelids, and nose One ear may droop lip
droops and saliva escapes from one corner of the mouth.
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• Nose and philtrum are drawn toward the unaffected side ocular fissure on the affected side is
larger than normal and corneal and palpebral reflexes do not cause its closure
• Accumulation of food in the buccal vesicle.
TREATMENT
• Muscle nerve stimulation

• Palliative surgery: To prevent drooling a chelioplastic surgery may be carried out.
HARELIP - CHEILOPLASTY
• Normal side of nose and muzzle is measured for width of normal lip. One surgery involves
resection of the skin of the chin.
• In this procedure the lower lip is pulled ventrally to expose the lower incisors.
• When this is done a fold of skin is created on the chin and an elliptical incision is made through
the skin and subcutaneous tissue and the fold is removed.
• When the subcutaneous tissue and the cut edges of the skin are opposed the lower incisor
teeth should remain exposed.
Drooped lower lip
• 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.
• When the triangle is closed the lower lip is everted.
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.
• The subcutaneous tissue is stripped from the mandible using a periosteal elevator.
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• The tightness of the lip determines the extent of dissection required. The lip should hang just
ventral to the mucogingival junction.
• If it doesn't, additional length of lip should be dissected from the mandible. No sutures are
placed.
• The owner is advised to run their finger around the created pocket between the lip and
mandible daily.
• This has to be done to prevent the healing tissues from pulling the lip back into normal position.
• The wound heals by secondary intention healing.
AFFECTIONS OF TONGUE - INTRODUCTION
• An examination procedure of the tongue is similar to that of the oral cavity.

• Direct examination and palpation can be carried out if the patient is cooperative.
• In agressive animals sedation or general anesthesia should be resorted to.
The various disease conditions that affects the tongue are:
• Congenital defects
• Smooth tongue
• Lateral deviation of the tongue
• Ankyloglossia
• Strangulation
• Tumors of tongue
• Ranula (Honey Cyst)
• Sublingual abscess
• Gangrene of tongue
• Trauma
• Glossoplegia
CONGENITAL DEFECTS
• Smooth tongue
o The horny papillae on the dorsum of the tongue will be either small or absent. Affected
calves with smooth tongue will have difficulty in prehension. This leads to retarted
growth.
o Treatment is not indicated. Condition is more common in Brown Swiss and Holstien
Fresien
• Lateral deviation of the tongue
o If the lower canine teeth in dogs are missing the tongue may protrude laterally.
o It may be congenital or traumatic. Treatment is by excising the superficial muscle near
the frenum linguae on the contralateral side.
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• Ankyloglossia
o There will be incomplete or abnormal development of the tongue.
o Treatment is by incising the overlong frenum lingue to provide a free range of motion of
the tongue.
STRANGULATION
• 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.
• 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
• 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 this 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.
NEOPLASMS OF TONGUE
• 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.
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Clinical signs
• Difficulty in mastication.
• Salivation.
• Quidding. -Chewed food drops from mouth with saliva
• Dysphagia.
• If tumor is ulcerated – blood stained discharge from mouth.
Treatment
• Surgical excision and chemotherapy are of little value.

• 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.
• Differential diagnosis
o Neoplasia, heavy metal poisoning,vitamin deficiency.
• Treatment
o Removal of the cause
o Systemic antibiotic administration and with predinisolone in Siberian husky breed.
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MODULE-2: SURGICAL AFFECTIONS OF PALATE
LEARNING OBJECTIVE
• At the end of this module the learner should be able to analyze the surgical conditions affecting
the hard and soft palate and also will be able to differentially diagnose the affections of the
nose
AFFECTIONS OF THE HARD PALATE AND SOFT PALATE

(Congenital Oronasal Fistula or Cleft palate)
• It is an abnormal communication between the oral and nasal cavities involving the following
structures - soft palate - hard palate - premaxilla, and / or - lip.
• The Lip and Premaxilla contributes to the primary palate, and incomplete closure of this is a
primary cleft or cleft lip (harelip).
• The hard and soft palates contribute to the secondary palate, and incomplete closure of either
of these structures is called a secondary cleft or cleft palate.
CLINICAL PRESENTATION
• The cleft is present at birth.

• Not always recognized immediately. Brachycephalic 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.
WHAT SHOULD BE TAKEN CARE OF IMMEDIATELY?
• Tube feed the animal (via oesophagostomy or gastrostomy tube) to maintain an adequate
nutritional status and to reduce the incidence of aspiration pneumonia until they are old
enough for surgery.
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.
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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.
• 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.
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• 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
• Direct apposition
o Direct apposition of the fistula is performed only if the fistula is very small.
o The mucosa around the fistula is incised.
o The gingival flaps are elevated and the edges of the fistula are 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.
Palate cleft repair by mucosal flap
o To repair lesions at the junction of the hard and soft palates, debride and close the
defect with a soft palate advancement flap.
• Double-layer flap repair
o This may be performed using tissue surrounding the fistula and a flap from the
mucoperiosteum of the hard palate.
o Create the first flap by rotating the gingival margins of the fistula medially and apposing
with sutures. This flap is covered with a rotational mucoperiosteal hard palate flap.
o Uranoplasty staphyloplasty
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MODULE-3: SURGICAL AFFECTIONS OF THE NOSE
LEARNING OBJECTIVE
• At the end of this module the learner should be able to make a clinical jugdgement on the
surgical conditions affecting the nasal cavity.
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
• 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
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.
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• 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.
NASAL POLYPS/NASAL POLYPI
• 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
• 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.
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• 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.
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• 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 nose, 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.
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RESECTION OF NASAL SEPTUM
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 incision, leaving at least two inches of
the septum to support the nostril.
• Secure the cut end with a pair of forceps, then place a nasal septum chisel astride the septum
and push it along the superior border of the nasal septum until the chisel 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 narrow chisel placed anterior to and in
contact with the forceps, divide the septum transversely and remove the septum through the
nostril.
• Tamponade the nasal cavity tightly with antiseptic impregnated gauze. It is advisable to suture
the nostrils shut to retain the tampon in position.
• The tampon and trachea tube may be removed in 48 hours. After operation, nasal cavity may
be irrigated with a mild antiseptic solution through the trephine opening.
FOREIGN BODY IN THE NASAL ACTIVITY
• Rostral turbinate system helps inthe filtering of direct entry of small foreign bodies and very
rarely they get lodged in the nasal mucosa to cause inflammation.
Clinical Signs
• Epistaxis
• Excessive sneezing
• Purulent discharge unilateral
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Dignosis
• Direct visualization with magnification

• Otoscopy of the rostarl nasal passage.
• Radiography - plain and with contrast radiography
Treatment
• Removal of the foreign body depends on the space and location

• Rostral- use of a small alligator forceps along with endoscope.
• Caudal - may be embedded in the mucosa or free in the passage., use of a flexible endoscope
• Nasopharynx 2 - 4 mm diameter arthroscope or in large dogs with a bronchoscope
Surgical approach
• Dorsal and ventral approach.

• Rhinotomy is the incision in to the nasal cavity
Dorsal approach
• Make a dorsal midline skin incision from the caudal aspect 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.
• Gently lavage the nasal passage and remove the foreign body. Bone flaps are sutured by 3-0 or
4-0 wire sutures. close the skin with apposition sutures.
Ventral approach
• Make a midline incision in the hard palate. Elevate the mucoperiostium, without damaging the
palatine vessels and nerves. Extend the incision caudally to the soft palate.
• 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 interruptted
sutures.
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MODULE-4: SURGICAL AFFECTIONS OF GUTTURAL POUCH
LEARNING OBJECTIVE
• At the end of this module the learner should be able to diagnose the various surgical conditions
affecting the guttural pouch and its treatment.
INTRODUCTION
The common affections of the guttural

pouch are
• Empyema
• Mycosis
• Tympany
• Neoplasia
• Cyst
ANATOMICAL CONSIDERATION
• 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.
• The following are the important affections of the guttural pouches
o Guttural pouch tympany/ Tympanites
o Guttural pouch empyema/ Collection of pus in the guttural pouch
o Mycosis
o Neoplasia
o Cyst
GUTTURAL POUCH TYMPANY
• Definition
o It is a nonpainful distention of the guttural pouch with air characterized by an external
swelling in the parotid region.
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• Incidence
o It is usually observed in young foals, although horses up to 20 months of age may be
considered for this disorder.
o It appears to be more prevalent in fillies than in colts.
o Usually only one guttural pouch is affected but it may occur bilaterally.
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.
• In some cases infection is present in the affected pouch and the distension may be due to the
formation of gas.
• It has also been proposed that an abnormal mucosal flap at the pharyngeal orifice functions as
a unidirectional valve trapping air or fluid within the pouch.
CLINICAL SIGNS
• Clinical signs depend on the degree of distension but the usual signs are a diffuse, painless,
elastic tympanic swelling in the parotid region.
• It may extend downwards and backwards towards the throat and upper part of the jugular
furrow. If markedly affected, the foal may exhibit stertorous breathing, nasal discharge,
Dysphagia, respiratory distress or evidence of pneumonia secondary to aspiration.
• Pressure on the pouch may cause some of the air or gas to escape with a whistling sound.
DIAGNOSIS
• Diagnosis is based on significant clinical signs and 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.
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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 evident radiographically.
• On endoscopic examination, a purulent material may be seen at the pharyngeal orifice of the
Eustachian tubes.
PROGNOSIS
• Prognosis is unfavorable i.e. there is no chance of spontaneous cure but when the pus becomes
inspissated and the quantity of fluid is diminished the functional disturbance is relieved.
• Death rarely supervenes from haemorrhage due to ulceration of the mucous membrane. Some
cases prognosis is favourable when complete drainage and removal of contents is performed
TREATMENT
• Treatment may entail both medical and surgical modalities but opening and draining the
guttural pouch is the only successful method of treatment for the accumulated pus.
• Medical treatment includes lavage of the guttural pouch with saline solution and administration
of systemic antibiotic is an initial step in therapeutic management.
22
• Antiseptic inhalation, which may be of some use in a recent case by reducing inflammation of
mucous membrane. The passage of Gunther’s catheter to evacuate the fluid contents and to
enable the cavity to be irrigated with an antiseptic lotion introduced through the catheter by
means of a syringe.
• Surgery may be carried out if medical therapy is unsuccessful or if the material within the
guttural pouch is inspissated.
SURGICAL APPROACH OF THE GUTTURAL POUCH
• Indications
o An accumulation of pus or inflammatory exudates or rarely, food material in the pouch.
• Preparation of patient
o Administartion of tetanus toxoid a week before surgery
o The operative area is prepared by shaving and application of an antiseptic before
operation.
• General Anaesthesia
o Premedication with Acepromazine @ 0.02 - 0.05 mg / Kg
o Xylazine @ 0.5 to 1 mg / Kg
o Induction with ketamine @ 2.2mg /Kg
o Maintenance - Isoflurane
• Surgical procedure - Hyvertebrotomy Viborg's trainangle
o Site of operation: The antero-inferior border of the wing of the atlas.
OPERATION PROCEDURE
• Make an incision about three inches long antero-inferior border of the wing of the atlas, going
through the skin without making dissection the parotid gland. Reflect the gland forward by
blunt dissection of the loose connective tissue beneath it.
• Separate the areolar tissue, digastricas, stylo-maxillary and occipito-styloid muscle until the
pale lining of the pouch is visible. Grasp a fold of the guttural pouch membrane with an artery
forceps and incise it.
• Enlarge the opening thus made with the fingers or the jaws of a forceps and the interior of the
pouch will then be quite visible. Evacuate the contents which may be entirely liquid or partly
solid in the form of chestnut-like bodies called chondroids.
• 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.
23
GUTTURAL POUCH MYCOSIS
Casuative organism: Aspergillus
• Multiple or diffuse fungal plaques on the caudodorsal aspect of the medial guttural pouch is the
common site of lesion
Clinical signs
• Unilateral or bilateral epistaxis

• Epistaxis
• Abnormal head extension
• Ocular changes
• Facial nerve paralysis
• Lingual hemiplegia
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MODULE-5: SURGICAL AFFECTIONS OF SINUS AND HORN
LEARNING OBJECTIVE
• At the end of this module the learner should be able to understand the surgical conditions
affecting the sinuses, and will be able to treat the various affections of the horn confidently.
AFFECTIONS OF SINUS
• Pus in the sinuses

• Inflammation of sinus ( Sinusitis)
• Foreign bodies
• Parasite
PUS IN THE SINUSES
Etiology
• Causes may be primary or secondary

• Primary cause
o Injuries of the wall. Viz. contusion, open wound- causing bleeding into the cavity.
o Pyogenic organisms may multiply and cause suppuration.
• Secondary cause
o Dental affections with suppuration of the alveoli and root of teeth and perforation of
their walls into the sinus.
Symptoms
• Nasal discharge – mucopurulent, non-offensive

• Pus – grayish, yellowish – white and with streaks of blood occassionally
• Sinus – swelling, dullness on percussion
• Lacrimation , mucus plugs
Diagnosis
• Respiratory noise ( Rule out glanders by Mallein test)

• By exploration of the sinus through an opening made by a trephine.
Prognosis: generally be guarded.
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Treatment
• Drainage can be facilitated by extraction of the affected tooth

• Flush the cavity with diluted povidone Iodine
• Administration of antibiotics following an antibiogram test.
FOREIGN BODIES
• Not common.
• 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“.
PARASITES
• In dog, frontal sinus – linguatula

• In sheep, frontal and maxillary sinus- estrus ovis
Symptoms
• Mucoid discharge, sneezing and snoring and animal rubs the nose with the claws.
Treatment
• Not very satisfactory.

• After trephining, antiseptics can be injected into the sinus to control infection.
• Parasites may be removed mechanically with forceps
SINUSITIS
Etiology
• Frontal sinusitis in cattle associated with dehorning

• Maxillary sinusitis associated with infected teeth
• Infection
Clinical findings
• Frontal sinusitis occurs immediately after dehorning because the wound is still open.
• It may be unilateral.
• Anorexia
• Pyrexia
• Nasal discharge
• Dysponea
26
• Foul smelling breath
Diagnosis
• Percussion: may reveal a dull sound over the affected sinus .

• Radiographs:fluid in the sinus, dental disease, bone lysis
• Cytology of the discharge.
Treatment
• By draining the affected sinus

• Maxillary sinusitis-infected tooth can be repelled
• Once draninage has been established, the sinus can be lavaged daily with antiseptic solution ,
preferrably with pottassium per magnate.
• Parenteral antibiotic
• NSAID
Prognosis: Guarded
Control
• Dehorn calves at young age- by closed dehorning technique

• Dust control
• Fly control
CHRONIC SINUSITIS IN CATS
• Etiology - secondary viral or bacterial infections.
Treatment
• 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 intravenous tubing is usually
preferred to flush with trypsin solution
Sinus drainage
• This is more radical approach. Periostium is elevated to remove the bony layer over the sinus
with rongeurs to effect drainage
HORN - ANATOMY
• The cornual process of the frontal bone encloses the horn and corium of horn completely
envelops the horn core and fuses with its periosteum.
• The frontal sinus is continous with horn.
• It is also known as flint bone.
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• Horn corium covers the horn core, It secrete horn shell.
• Blood supply: The cornual branch of the superficial temporal artery and its satellite vein
supplies horn.
• 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 trigeminal (fifth cranial nerve) nerve.
• Interior of horn: Consists of irregular spaces, which are continuation of the frontal sinus.
• Buffaloes: Horns are massive, angular and well developed with wider base compared to cattle.
The thickness of horn increases towards apex until it becomes solid. The corium is traversed by
numerous blood vessels.
AFFECTIONS OF THE HORN
Abnormal horn growth
• Abnormal Growth
• Avulsion of horn (separation of horn cover).
• Fracture of horn.
• Fissures in horn and horn core.
• Horn cancer
Avulsion/evulsion of horn
• Etiology: Direct violence

• Repeated injury by yoke. Direct violence
• Chronic inflammation of keratogenous membrane.
Symptoms
• Horn shell will be loosely attached and falls off.

• The horn core and corium will be exposed.
• Hemorrhage from the site and from the nostril of the affected side.
• Since the bony core is sensitive the condition is often painful.
Prognosis
• The hemorrhage can be easily arrested and regeneration occurs.
Treatment
• Regional nerve block: Cornual nerve block
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• Affecting a cornual nerve block will alleviate the pain and ease the management procedures.
• Clean and disinfect the exposed horn core.
• Protect it with an antiseptic pad and bandage
• Application of Tr. Benzoin bandage will control bleeding.
• Fly repellents also will help to avoid maggot infestation.
• Clean with mild antiseptic lotion and apply or sulphanilamide – shark liver oil or any emollient
antiseptic dressing.
FRACTURE OF HORN
Etiology
• 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.
• Fracture at the base of horn.
Clinical Signs
• Presence of an open wound and bleeding from the part and from affected side nostril are the
signs
Treatment
• Treatment option depends on the type of fracture

• For incomplete fractures or fracture at the tip of horn immobilization using plaster of paris is
recommended
Horn amputation
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• For fractures at middle third or lower third of horn stabilisation is not possible. So amputation is
done below the level of fracture. Control hemorrhage with Tr Benzoin and bandage.
• For fracture at lower third of horn amputation by flap method is advocated.
Surgical procedure
• The amputatin is carried out through the frontal bone below the base of the horn after flapping
the skin forwards and backwards in two halves by a long elliptical incisio extending from the
nuchal crest to the frontal ridge.
• The horn is amputated with an axe blade; bleeding is controlled.
• The skin flaps are sutured in apposition with interrupte sutures.
Complications
• Empyema (pus) in frontal sinus.
DEBUDDING
This operation is done to prevent the growth of horns in cattle .The most suitable age is 5- 10 days old.
Techniques
• There are three methods:

1. Application of caustic pottash sticks to destroy the horn bud. This is simple but painful.
2. Use of red hot Iron-or electrically heated iron to destroy the horn bud. In this method
there will not be any pain or haemorrhage. The heated circular brim destroys the corium
and there by prevents growth of horn.
3. Use of Debudding forceps: It works like a scissors and is used to clip the horn bud.
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MODULE-6: SURGICAL AFFECTIONS OF TEETH
LEARNING OBJECTIVE
affecting the teeth gum, teeth, and alveoli.
DEVELOPMENT OF TOOTH
• The enamel develops from epithelium lining of the buccal cavity of the embryo.
• 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.
STRUCTURE OF TEETH
• The crown is the part of the tooth projecting above the gums and the root is the part contained
within the bony tooth cavity or alveolus. The crown and root meet at the neck, which is covered
by the gum.
• The hard portions of the tooth consist of the enamel, cementum and dentine. The dense, pearly
white, outer layer of the crown is the enamel which is the hardest substance in the body. At the
neck, enamel is continuous with the cementum which is a thin layer that covers the root except
for the apical foramen. The cementum is bone like tissue and is difficult to distinguish from the
dentine which it covers. The bulk of the tooth is formed by dentine which surrounds the pulp
cavity. It is thickest in the crown 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.
• 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. The small apical
foramen at the end of the root enables the passage of vessels and nerves in and out of the
tooth.
• 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.
• 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 arch is known as the occlusal or masticating surface.
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• The teeth are held in sockets called alveoli. The periodontal membranes serve as periosteum to
the alveolar bone and provide a firm attachment between the root of the tooth and the bone. It
consists of thick collagen bundles and differs from the usual periosteum in that there are no
elastic fibres.
• The gums (gingivae) cover the hard palate and the alveolar processes of the upper and lower
jaws and surround the necks of the teeth. The gums are dense fibrous tissue and are covered
with mucous membrane and are continuous with other soft tissues of the mouth.
DENTAL FORMULA
Species Dental formula

Cattle
Deciduous 0/4 , 0/0 , 3/3 = 20
Permanent 0/4 , 0/0 , 3/3 , 3/3 = 32
Dog
Deciduous 3/3 , 1/1 , 3/3 = 28
Permanent 3/3 , 1/1 , 4/4 , 2/3 = 42
Permanent teeth
• Upper jaw: 2(I3 C1 P3-4 M3)

• Lower jaw: 2(I3 C1 P3 M3)
• Goat: The adult goat's dental formula is 0/3.0/1.3/3.3/3. The juvenile formula is 0/3.0/1.3/3.
• At five years all permanent incisors are in wear.
CONGENITAL OR DEVELOPMENTAL ANOMALIES
Abnormal number of teeth
• Supernumerary incisors and molars are frequently seen and it must be differentiated from
retained deciduous teeth.
• There may be one or two extra teeth or a complete extra row of teeth
• Due to lack of wear by not coming in contact with any apposing teeth, these extra teeth show
abnormal prominences which cause injury to soft tissues are to be shortened or removed.
Irregularities in the shedding of temporary teeth
• The temporary teeth may persist for a longer period. This may in turn delay the eruption of the
permanent teeth or may alter their direction.
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Abnormalities of the position and direction of teeth
• When the teeth grow in an abnormal position or direction, they fail to come in contact with
their counterparts in the opposite jaws. This causes lack of wear and the teeth become
excessively long, causing injury to the soft tissues they come in contact with.
• Periodical shortening of the overgrown teeth is indicated in such cases.
Abnormalities due to alterations in the substance of the teeth
• Dentigerous cysts
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.
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.
ACQUIRED AFFECTIONS OF TEETH
• Dental tartar - is a greyish brown or yellow deposit accumulating in the teeth.

• This condition is common in dogs and cats. Tartar consists of organic matter, bacteria, calcium
carbonates and phosphates, predisposes to gingivitis and alveolar 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
Dental tartar int the canine tooth and

calculus in the premolars
33
• The above picture shows presence of dental tartar in the canine tooth and calculus in the
premolars in a dog.
ALVEOLAR PERIOSTITIS
• Inflammation of the alveolar periosteum is alveolar 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.
34
• 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.
35
• 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.
36
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.
37
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 root of a tooth with the outside.
• Etiology
o A dental fistula may be resulted through external injury and infection.
o Alveolar periostitis and caries of the tooth are the main causes.
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
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.
o In horses, dental fistula affecting the upper molars may either open into the nasal
chambers or into the maxillary sinus or on the outside skin and discharge may be seen
through the nostrils.
• Diagnosis
o Clinical symptoms
o Radiography: Alveolar abscess can be demonstrated radiographically in a medial oblique
projection with the affected maxilla in contact with the film.
• Treatment
o Removal of the affected tooth and the necrosed pieces of bone are the treatment.
o In the case of carnassial tooth, in most cases, the single posterior root will be involved.
o The affected carnassial tooth is extracted and the alveolus and the draining tract are
curetted thoroughly.
o In cases of involvement of maxillary sinus, open it up and clear the sinus cavity.
o Sufficient antibiotic cover should be given systemically as well as locally.
38
Dental X-ray unit for small animals
Odontoma
• It is the tumor composed of tooth tissue originating

from odontoblasts. It is only very rarely met with in
domestic animals.
• The tumor may occur in any position on the
mandible or maxilla.
• When the tumor is present, extraction of the tooth
will be difficult or in some cases, impossible.
• In such cases, curetting or chiseling out the
tumorous growth under general anaesthesia is the
treatment.
Ameloblastoma/Adamantinoma
• This tumor is not arising from the ameloblasts, but from the odontogenic epithelial remnants.
• The tumor occurs sporadically in cattle, sheep and buffaloes.
• Animal feels difficulty in mastication and deglutition due to abnormality and pain.
• In advanced cases, the incisors are displaced and embedded in the growth.
• Treatment is similar to that of Odontoma.
EXODONTIA / DENTAL EXTRACTION
Indications
• The indications for tooth extraction are,

o Retained deciduous teeth
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o Infected teeth
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.
• 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.
• Infection of a dental root with damage to the periodontal membrane is the most common
indication for extraction.
• The infection may be either primary bacterial invasion or a 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.
Technique
• 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
• 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.
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• 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 sometimes 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.
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.
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• 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
• 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 tumors Oral tumors

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• 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 acanthomatous.
• Oral pappilomas are benign tumours and regress spontaneously.
• Surgical resection is indicated only whn there is dysphagia.
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MODULE-7: SURGICAL AFFECTIONS OF THE SALIVARY GLANDS
LEARNING OBJECTIVE
affecting the salivary glands and its treatment.
INTRODUCTION
• Major salivary glands for surgical significance are

o Parotid
o Mandibular
o Sublingual
o Zygomatic salivary glands
AFFECTIONS OF THE SALIVARY GLANDS
It includes,
• Open wounds
• Stenson”s duct
• Salivary fistula
• Foreign bodies in the salivary ducts
• Destruction of the function of the gland
• Salivary calculi
• Tumors
• Subparotid abscess
OPEN WOUNDS
• If parotid gland is wounded, there is an escape of saliva through the wound.
Treatment
• 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.
• If the vessels cannot be secured by artery forceps, the vessel should be isolated at some
distance from it and then the ligature is applied.
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• Ligation of the carotid may not stop, persistant haemorrhege from the internal carotid noticed,
it can be anastomosed with the corresponding artery on the other side. Suture the wound and
apply bandage.
STENSON’S DUCT - WOUND
• 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.
• Suture the cutaneous wound and bandaged with povidone-iodine. The patient should not be
given any solid food for 24 hrs.
SALIVARY FISTULA
It may be due to a wound of the parotid, or submaxillary, salivary gland or of stenson’s duct or
Wharton’s duct.
• Etiology
o It may be caused by an open wound or an abscess involving the canal
• Symptoms - Refer dollar
• Treatment
o It occurs due to a recent incised wound of the gland 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
Indication
Occlusion of the duct and retension of secretions
Treatment
• injection of irritants
• ligation of stenson’s duct ( refer practical for surgical procedure)
• clearing the lumen of the distal portion of the duct
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• making an artificial opening into the mouth
FOREIGN BODIES IN THE SALIVARY DUCTS
• Small particles may enter into salivary glands and set up inflammation
• Foreign bodies rarely causes irritation and form a calculus
Treatment
• To remove the foreign body, give pressure on the course of the duct
• Otherwise, oral orifice of the canal may be incised or wharton’s duct may be incised.
• Apply antiseptic mouth lotion for a few days.
SALIVARY CALCULI
• Usually occur in stenson’s duct; rarely in wharton’s duct

• The sizes of calculi weighing individually 7-12 ounces have been recorded (mention in grams).
• An isolated calculus is oval; smooth and yellowish grey in colour.
• Composition of deposit 80-90% calcium carbonate and 9-10% organic matter.
Etiology
• Small particles with bacteria carrying into the duct, which cause fermentation in the saliva.
• Consequent deposition of lime on the foreign body.
Treatment
• First force the calculus into the mouth and then remove it.
• If it bulges into the oral cavity, incise the mucus membrane covering the calculus and take it
away.
• Suture the wounds in the duct and skin separately,using a very fine needle.
Tumors
• The common tumors in pariotid glands are melanomata, which are found chiefly in grey horses.
Treatment
• If the tumor is benign and circumscribed surgical excission is carried.

• If it is malignant or diffuse, it is better not to interfere.
PAROTID ABSCESS
• Strangles in the horse and tuberculosis in the ox may lead to abscess in subparotid region.
• It is a painful inflammatory swelling.
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• It may burst in the course of 8-14 days.
Treatment
• Open the abscess and drain the content.

• It may be possible to open the abscess bluntly after incising the skin.
• Use suitable antiseptic dressing and systemic antibiotic.
SALIVARY MUCOCELES
• Collection and accumulation of saliva due to blockage of the duct and is surrounded by
granulation tissue.
Symptoms
• Presence of a sweelling in the site subcutaneously.
Diagnosis
• From symptoms and exploratory pucture.
Treatment
Establishment of the patency of the duct
• Mandibular and sublingual salivary gland excision-mucocele.

• Zygomatic gland excision-zygomatic mucocele.
• Parotid gland excision.
• Destruction of gland.
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MODULE-8: AFFECTIONS OF THE UPPER AND LOWER JAW
LEARNING OBJECTIVE
affecting the maxillary and mandible region.
AFFECTIONS OF THE JAWS
Introduction
Congenital / developemntal abnormalities
Prognathism........
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
o Fracture
Brachynathysim
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CONGENITAL AFFECTIONS
Prognathism
• 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.
Brachygnathism
• It is manifested when mandible is shorter than the maxilla 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
Craniofacial Dysplasia
• 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 Direct violence, collision, striking the head violently against a hard fixed object.
• Seat of fracture
o Palatine plate or alveolar border.
• Treatment
o Loose teeth may become fixed in a few days and hence need not be removed
o If suppuration occurs in their alveoli, loose teeth should not be removed
o Semi liquid diet
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o Trephining may be required to allow leverage of a depressed fragment
Fracture of the premaxilla
• Etiology
o Direct violence, falling forward on the nose, or by a kick or blow.
• Fracture may be transverse, longitudinal, or both , uni or bilateral
• Treatment
o Follow the general principles for wounds and fractures.
o Retention is best effected by means of inter dental wiring of the adjacent teeth, mini
plating, and by external skeletal fixation with methyl methacyrlate
FRACTURE OF THE MANDIBLE, SYMPHYSIS AND RAMUS
Fracture of the Mandible
Etiology
• Kicks falls or direct violence.

• symptoms
• repulsion of tooth
• site of fracture can be on body, one / two rami, the condyle / coronoid process.
Treatment
• Fracture through symphysis

o Replace the fragments in their normal position and maintain them by joining the teeth
on either side by wire.
o In dogs the two jaws can be fixed by bandage.
• Fracture through one side of body
o Reduce the fracture; wire the teeth, so as to make the affected side intact.
o Bones may be united by wire sutures.
Mandibular fracture
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• Transverse fracture through the body or through both rami near the symphysis
o Wiring incisors to the first molars may be useful in conjunction with an apparatus to
form a ‘V’ fixed to the lower jaw.
o The apex ‘v’ being spoon – shaped to support the chin and its branches being grooved to
adapt themselves to the horizontal rami.
o Wire sutures through the bone are the best means of immobilizing the seat of fracture.
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
1. wounds
2. lacerations
3. fractures
4. abscess
• The causes for the first three conditions in new born calves are injuries associated with
obstetrical procedures.
• Abscess in lower jaw could be due to migration of ingested pnetrating foregin bodies
CONTUSIONS , SINUS AND FISTULA
Etiology
• Contusions: similar to fracture.

• Sinuses on the root of the tooth results in the formation of dental fistula.
Symptoms
• Similar to acute / chronic traumatic inflammation / of a sinus/ fistula in the bone.

• A sinus in the bone is characterized by a suppurating orifice surrounded by a hard inflammatory
enlargement.
Treatment
• When the sinus is in the mouth, dilate the opening - the sinus tract and remove loose bone and
curette the bone.
• When there is an external sinus into the bone, remove ellipitical piece of skin around its orifice
and enlarge it by trephining and irrigate with iodine and dressed with iodoform/BIPP (Bismuth
subnitrous iodoform paraffin paste).
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Open wounds
• Attention needs to be paid in open wounds of the jaw only when they are complicated by
infection/necrosis of bone.
Tumors
• Upper jaw is most commonly affected than the lower jaw. Horse and dogs are frequent victims.
VARIETIES OF NEW GROWTH FOUND AFFECTING THE MAXILLARY BONES
• Dentigerous cysts: they persist without much inconvenience but occasionally suppurate leading
to necrosis.
• Fibromata: seen mostly in the alveolar borders. Undergo calcification/ossification.
• Chondromata: hard sub periosteal tumors.
• Sarcomata: developing in the substance of bone/ beneath periosteum
• Carcinoma: More common than sarcomata in horse
Treatment
• Benign tumors, small and circumscribed - extirpation can be performed.
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MODULE-9: SURGICAL AFFECTIONS OF THE EXTERNAL EAR
LEARNING OBJECTIVE
• At the end of this module the learner should be able to diagnose the various surgical conditions
affecting the ear flap, and will be able to perform haematoma and zepp's operations in dogs.
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
o Internal ear
• Surgical landmarks of the auricular cartilage are helix, tragus, antitragus and anthelix
Congenital affections
• Microtia – small ear

• Macrotia – large ear
• Anotia – absence of ear flap
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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
• Swelling of the flap is more evident on the concave surface
Treatment
• Conservative therapy
• Simple aspiration 2 – 3 times weekly
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 disadvantage.
• Surgical incision for drainage and obliteration of the dead space
• Aseptic incision in the form of straight, S shaped or cruciate are placed to open and remove the
blood clots.
• 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.
• Application of enough pressure by application of bandage to maintain the tissue in position so
that scarring is minimal. Best results are obtained if surgery is performed in 3-4 days after the
formation of the haematoma.
OTTITIS OF THE EXTERNAL EAR
Definition
• It is defined as inflammation of the external auditory canal.
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Incidence
• 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
• Metabolic diseases- hypothyrodism
• Immnune mediated
• Keratinisation disorder
• Accumulation of ear wax
Clinical signs
• Pruritus manifested by scraching , rubbing the ear and shaking,

• mild erythema of the ear canal,
• pain on palpation exudation from the ear
• 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)
o Allergy testing
Treatment
• Medical
• Irrigation with 1 in 100 povidone Iodine ( Avoid if typanum is ruptured)
• Specific antimicrobials both systemic and topical based on ABST
• Anti inflammatory drugs
• Application of agents to dissolve the ear wax.
55
ZEPP'S OPERATION
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 bends to form a board. The drinage will be direct, Sutures are
placed in a continous manner.
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MODULE-10: OPHTHALMOLOGY - ANATOMY AND AFFECTIONS OF EYELIDS AND THEIR

CONJUNCTIVA
LEARNING OBJECTIVE
• The learner should know about its brief anatomy before considering affecting the eye ball and
adnexa.
• At the end of this module, the learner should be able to do a systematic visual function test and
will be able to diagnose the various surgical conditions affecting the eyelids and conjunctiva.
ANATOMICAL CONSIDERATION
• 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 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.
57
Conjunctiva
• The conjunctiva has two parts, the palpebral conjunctiva lining the inner surface of the eyelid
and the bulbar conjunctiva attached to the eyeball.
• The epithelial lining of the conjunctiva is continuous with the epithelial lining of the cornea.
Lacrimal gland
• 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.
Refractive media of the eye
• 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.
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 epitheliums of the cornea and of conjunctiva are continuous with each other.
• The precorneal tear film is considered as the physiological anterior most layer of the cornea.
58
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 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.
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 surfaces 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
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• 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.
• 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
ophthalmoscopic examination.
• The ophthalmoscope contains lenses of varying powers through which the examination can be
conducted. The anterior segment of the eye can be examined by using a lens ranging from +12
to +20. For observing the lens +8 to +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.
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Indirect ophtalmoscope with condensing lens
Direct ophthalmoscope
• By using tonometer (tonometry): The intraocular pressure (IOP) can be measured by using an
instrument called tonometer.
• There are two methods of tonometry, indentation tonometry using schiotz tonometer and
applanation tonometry using Tonopen - Vet.
Tonometry
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• 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
• The test can be performed with commercially

available Schirmer tear strips.
• These strips have a notch at one end which is
placed into the ventral conjunctival cul de sac.
• The strip is allowed to remain in the cul de sac
for exactly one minute.
• The strip is removed after a minute and the
distance the wetness have traveled down the
strip is immediately measured in millimeters
from a scale printed directly on the strip.
• Normal values in the dog are 15 to 25
mm/minute.
Naso lacrimal flush
• Irrigation of the nasolacrimal duct system

• Fluorescein dye is instilled on the eye
• Partial or complete
• 26G cat 24G dog and 20G cattle 2 – 10 ml saline
• Cannulated through the upper punctum
• Note the passage time
SURGICAL CONDITIONS AFFECTING THE EYELIDS
Chalazion (Tarsal cyst)
• This is a cyst caused by the distension of a tarsal gland with secretion when it is inflammed. The
size of the cyst may be about the size of a pea or more.
• Treatment
• Incise and remove the contents of the cyst using a Chalazion forceps.
Hordeolum or stye
• It is a localized inflammation of the hair follicles of the eye lashes due to staphylococcal
infection.
• Treatment
• One or two neighboring eyelashes are plucked with foreceps so as to open the abscess
and drain the pus. After draining the pus topical ophthalmic antibiotic eye ointment /
drops are indicated.
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Dacryo – adenitis
• Inflammation of lacrimal gland.

• Treatment
• Fomentations, antibiotics, etc. Do not open before it is mature. Spontaneous rupture
and healing usually happens.
Blepharitis
• Blepharitis or inflammation of eyelids, causes ulceration of the palpebral borders. The ulcers
contain a yellowish or greyish sticky discharge. The eyelids may stick together.
• Treatment
• Symptomatic
• Antibiotics may be used to control infection
Entropion-Congenital/acquired
• Inward deviation of the palpebral border, trichiasis, Distichiasis, etc.

• Treatment
• Surgical correction
• Anesthesia and control
• In small animals - General anesthesia
• In large animals auriculo palpebral nerve block
• Block supra – orbital nerve as it comes out of supra – orbital foramen (sensory to upper
lid) or by field block. The animal is controlled in standing or recumbent state.
• Technique
• A fold of skin parallel to the affected palpebral border is held by a forceps, enough to
cause the correction of the abnormality, and is severed and removed.
• The wound is sutured by ordinary apposition sutures.
Ectropion
• Outward deviation of the palpebral border resulting in an abnormal exposure of the

conjunctiva.
• Treatment
• surgical correction
• Anesthesia
• In small animals - General anesthesia
• Local infiltration
• Site
• It is ½ to 1 cm away from the free border of the eyelid.
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• 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.
• 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)
• Dropping of the upper eyelid may be congenital. It may be due to paralysis of the seventh
cranial nerve.
• Treatment
• The condition may be temporary and may become normal without treatment. Surgical
correction when necessary can be done as for entropion.
Lagophthalmos
• A condition in which the eye cannot be completely closed. (Lagos = hare).

• 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 and conjunctiva
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• Treatment
Remove the cause. Ophthalmic lubricants in the form of gel may be instilled at
frequent intervals to moisten the cornea and conjunctiva.
The lids may be kept closed by means of one or two skin sutures over the closed
lids.
Blepharospasm
• It is a state of partial or complete closure of eyelids. It may be due to foreign particles

irritating the cornea, early keratitis and conjunctivitis, photophobia, etc.
• Treatment
Blepharospasm is only a symptom and treatment depends on the cause.
Parasites in the conjunctival cul – de – sac
Thelazia rhodesii in cattle.
Prolapse of harderian gland
Prolapse of the nictitans gland is common in the dog due to inflammatory
swelling or hypertrophy. The gland protrudes outwards.
• Treatment
Surgical removal. 1 in 50,000 adrenalin may be applied locally to control
haemorrhage.
Removal of membrane nictitans (Third eyelid).
• Indications
Hypertrophy.
Neoplasm and Carcinoma.
• Anesthesia
General anethesia
• Technique
Haemostatic mattress sutures are put along the base of the third eyelid to
control haemorrhage and afterwards it is cut distal to the sutures.
• Tumors of the eye lid
SURGICAL CONDITIONS AFFECTING THE CONJUNCTIVA
• Conjunctiva has two parts called palpebral conjunctiva and the bulbar conjuctiva.
• The normal appearance of the conjunctiva is pink, smooth and moist.
• In systemic diseases the appearance of conjunctiva is altered in gastrointenstinal disorders it is
congested, in jaundice it is yellow, shows petichae (pinpoint 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).
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Conjunctivitis
• Inflammation of the conjunctiva is one of the most common eye diseases.
Conjuctivitis - Goat Conjuctivities and blepheritis in a dog
Etiology
• Bacterial or virus infection, Irritation due to chemical substances, Presence of foreign bodies,
Trauma, Allergy and Nutritional deficiencies.
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.
• According to the nature of inflammation the following varieties of conjunctivitis are recoreded.
o Catarrhal conjunctivitis, e.g., conjunctivitis due to 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.
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Symptoms
• Lacrimation: In the beginning stages of conjunctivitis lacrimation is thin and watery. Later it
becomes thicker and has a tendency to stick on to the edges of lids and cheek.
• Photophobia and blepharospasm are not marked in simple conjunctivitis. If these symptoms are
present extension of inflammation to the cornea should be suspected.
• Discomfort.
• Chemosis (swollen conjunctiva through the palpebral fissure).
Chemosis
Swollen conjunctiva through the palpebral fissure
Diagnosis
From the symptoms
• Treatment
o The conjunctival sac is irrigated at frequent intervals with warm saline solution or a mild
antiseptic lotion.
o The eye lotions commonly used were: ZAB lotion (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.
• Epiphora
o Epiphora is a symptom characterized by excessive flow of tears. It may be due to
conjunctivitis, or due to stricture, atresia or obstruction of the lacrimal passages. If due
to conjunctivitis it passes off when the inflammation subsides. Irrigation of the lacrimal
passage or exploration with a flexible probe is necessary if the condition is due to
obstruction or atresia. Flouorecin passage time can be studied.
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Epiphora
Excessive flow of tears
• Symblepharon
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
o It is adhesion of the upper and lower eyelids.
• Pterygium
o Pterygium is a condition where there is growth of conjunctiva extending towards the
cornea.
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.
o If there is corneal involvement, superficial keratectomy is performed.
Neoplasms of the third eyelid very rare- adenomas, adenocarcinomas and squamous cell carcinomas
are reported
Conjuctival tumour Thrid eyelid neoplasms
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NICTITANS MEMBRANE GLAND
• The gland of the third eyelid surrounds the base of the T-shaped cartilage.
o T – Cartilage forms the skeleton of the third eyelid.
o This gland contributes to the aqueous and mucus phases of the precorneal tear film.
o This is important in maintaining a healthy ocular surface.
Affections of nictitans gland and its treatment
Prolapsed nictitans gland
• The resulting characteristic appearance of a pink, smooth – surfaced swelling protruding around
the leading edge of the third eyelid from its inner surface.
Prolapse of the nictitans gland
• Dogs treated with surgical replacement of the gland have a lower incidence of dry eye later in
life than dogs that are either left untreated or have the prolapsed gland excised.
Surgical procedure
• Orbital rim anchorage technique

o The eyeball was fixed and it is flushed with a dilute Povidone Iodine
o An incision is made in the medio ventral conjunctival fornix using scissors.
o Blunt dissection allows access to the periosteum of the medioventral orbital rim.
o A firm bite of periosteum along the orbital rim is taken using 3 – 0 PDS.
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.
o The suture ends are then tied.
o Post operatively topical antibiotic is given.
• Conjunctival pocketing technique
o The eyeball was fixed and it is flushed with a dilute Povidone Iodine
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o An elliptical incision is made in the apex of the prolapsed gland with a No 11 BP blade
and using scissors blunt dissection is performed and the conjunctival piece is dissected
out. Further a pocket is made around the gland and the prolapsed gland is repositioned
in to this pocket. Continous sutures are applied using 4-0 vicryl taking care to burry the
suture ends.
LIMBAL MELANOMA
• Melanomas may invade the cornea secondarily.

• These tumors are usually pigmented, occasionally nonpigmented.
• 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.
• Primary limbal melanomas must be differentiated from external extension of intraocular
melanomas.
Treatment
• Full thickness corneoscleral grafts are recommended to maintain a functional eye in younger
dogs with progressive limbal melanomas.
• Grafts of nictitating membrane cartilage with overlying conjunctiva have been used to replace
corneal and scleral defects after removal of limbal melanoma.
• In aged dogs with non progressive limbal masses, periodic surveillance appears to be adequate.
NASO LACRIMAL DUCT OCCLUSION
• Topical ophthalmic application of fluorescein dye and 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).
• 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.
Symptoms
• Epiphora unilateral or bilateralIf there is obstruction of the duct, a naso lacrimal flushing after
catheterisation is practised.
• Nasolacrimal Flush (Catheterization) is indicated for epiphora and dacryocystitis.
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Procedure for indwelling nasolacrimal duct catheterization for flushing
• 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.
• 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.
• The tube is sutured in place for 2 to 3 weeks. An Elizabethan collar should be considered to
prevent the tubing from being dislodged.
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MODULE-11: AFFECTIONS OF THE EYEBALL
LEARNING OBJECTIVE
• The learner with a brief knowledge on anatomy and aqueous humor dynamics will be able to
diagnose the various surgical conditions affecting the eyeball and to differentially diagnose it
from adnexal involvement and also about the emergency procedures if any needed in vision
threatening glaucoma cases.
SURGICAL CONDITIONS AFFECTING THE EYEBALL
Anophthalmia Complete absence of the eye ball
Complete absence of the eye ball
Exophthalmos
• It is an abnormal protrusion of the eyeball.

• It may be a congenital condition or may be due to retrobulbar abscess, haematoma, or
inflammation.
• It may be seen as a symptom of diseases like hydrophthalmos and glaucoma.
• Exophthalmos due to goiter resulting from iodine deficiency is rare in animals.
Enophthalmos (pig eye)
• Enophthalmos is an abnormal retraction of the eyeball into the orbit.

• May be congential or sometimes due to debility or dehydration where there will be reduction in
vitreous volume.
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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.
• 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.
• The tunics of the eyeball, espically the sclera and cornea become thin and weak. This condition
is common in cats.
Symptoms
• Due to the general increase in the fluid contents the eyeball bulges forward causing
exophthalmos and lagophthalmos. This causes drying or dessication and interference with the
nourishment of the cornea.
• The cornea becomes opaque, due to pannus. The lens is detached and usually floats in the
aqueous humour and may become adherent to the cornea or vitreous humour.
• Keratoglobus (protrusion of cornea into a globular 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.
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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.
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• 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
Tonometry with tonopenvet Glaucoma- OS
• 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.

• Peripheral Vision is greatly reduced.
• The pupil is dilated.
• There is increased tension in the eyeball.
• megalocornea and corneal edema
• The cornea is sensitive to touch.
• There is lacrimation.
75
• 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.
• Pressure atrophy of the choroid and retina is evident by greyish patches.
Megalocornea - OS
Treatment
• 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
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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.
DERMOID CYST
• Dermoid is a misplaced embryonic cutaneous tissue contains hair which causes irrtation to the
cornea and conjunctiva. Corneal dermoids are usually seen in the lateral canthus extending on
to the cornea.
Dermoid cyst in a dog Dermoid cyst in a calf
Surgical treatment
• Superficial keratectomy
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MODULE-12: SURGICAL AFFECTIONS OF CORNEA
LEARNING OBJECTIVE
• The learner should know at the end of this module, the importance of cornea in refraction its
anatomical structures and will be able to diagnose the various surgical conditions affecting the
cornea.
KERATITIS
• Inflammation of cornea.
Etioilogy
• Bacterial, virual, rickettsial infections

• Trauma (including irritation caused by eyelashes, in 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
• Diabetes
Classification
• Keratitis may be classified as follows

o Superficial keratitis
o Interstitial keratitis (parenchymatous keratitis)
o Vascular keratitis
o Ulcerative keratitis
o Suppurative keratitis
o Non – suppurative keratitis
• The normal, clear, transparent, moist and glistening appearance of cornea is altered.
Symptoms
• Keratitis is a painful condition.
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• 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.
• 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. In chronic cases
these vessels are arranged in a brich – broom fashion.
Treatment
• Remove the cause.

• NSAIDS topically to relieve pain.
• Irrigating with antiseptic solutions like 5% povidone iodine.
• Adequate intake of vitamin A, D and B-complex.
• Instilling topical antibiotics following a ABST.
• Adminstration of antibiotics
CORNERAL ULCER
• Fluorescein dye test positive corneal ulcer viewed through the cobalt filter of ophthalmoscope.
The green colour in the center of the cornea indicates stain uptake by the corneal stroma.
Cornea ulcer
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• Ulcerative keratitis is frequently met within animals.
Etiology
• The causes may be trauma, infections (like distemper in dogs), or nutritional deficiencies (like
vitamin A deficiency and Riboflavin deficiency).
Symptoms
• The ulcer on the cornea is easily recognized. If necessary, a 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
• 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
Diagnostic kit
Fluorescein dye test
• Impregnated paper strips moistened with saline

• Placed in dorsal bulbar conjunctiva
• Excess stain is washed with normal saline
Fluorescein dye test Positive for Fluoresein dye test
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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.
Treatment of corneal ulcers
• Surgical treatment
o temporory tarsorrhaphy
o third eyelid flap
o conjunctival flap
o direct corneal suturing
o therapuetic contact lenses
o collagen grafting
• In addition to the surgical treatment, medical therapy is 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
o Moderate
o Mild
o Normal
Treatment
• Rule out Intra ocular pressure (IOP) rise
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Medical management
• Use of topical antibiotics and NSAIDS (Flurbiprofen) four times daily

• Use of saline irrigation
• Administration of placental extract, subconjunctivally
• Surgical management
• Superficial keratectomy
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MODULE-13: SURGICAL AFFECTIONS OF LENS
LEARNING OBJECTIVE
• The learner should know to do a systematic visual function test in visual deficit due to cataract
and the various surgical options of lens extraction procedures.
CATARACT
• Opacity of the lens is known as cataract.

• It is a degenerative lesion of the lens.
Cataract in a cow Cataract in a lion
Bilateral 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.)
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• 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 (nucleus) of the lens.
• Diffuse cataract – Spreading evenly through the entire lens substance.
• Calcareous cataract – Cataract in which the lens substance is partly converted into chalky
materials.
• Depending on the stage for surgical removal of the lens cataract is describes as:
Mature cataract in a dog
• In hyper – mature cataract there may be partial calcification of the lens and some portion of the
lens may also undergo liquefaction. The cortex appears milky white in colour. The nucleus of
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the lens may sink into the bottom of liquefied lens substance. Complete removal of the lens is
difficult when the cataract is hyper – mature.
ETIOLOGY
• There might be a hereditary predisposition.

• Toxins
• Senile changes attended with old age.
• As a sequelae of diseases of the eye like irirdocyclitis or systematic diseases like diabetes.
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
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.
Removal of the lens
• 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 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.
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• 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.
Intra ocular set
• Extracapsular extraction is successful only if the cataract 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 once again create opacity and this will interfere with vision.
• 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.
Phacoemulsification unit with hand piece
TECHNIQUE OF REMOVAL OF LENS
• The operation is done under general anesthesia

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• The eyeball is fixed during the operation by one or more stay sutures passed through the sclera.
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.
• In intracapsular extraction, the lens is held close to its equator with a special forceps (Duthies’
forceps or 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
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MODULE-14: SURGICAL AFFECTIONS OF THE UVEA
LEARNING OBJECTIVE
• At the end of this module, the learner should be able to do a detailed examination of the
anterior chamber, and will be able to attend its affections in large animals also.
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 coloboma is situated away from the
pupillary margin.
• Aniridia
o Aniridia is a condition in which iris is completely absent.
• Iritis
o Inflammation of the iris
• Cyclitis
o Inflammation of the ciliary body.
• Iridocyclitis
o Iridocyclitis is inflammation of the iris and the ciliary body.
o A very characteristic symptom of this condition is engorgement of vessels at the limbus .
• Choroiditis
o Inflammation of the choroids
• Uveitis
o Inflammation of the iris, ciliary body and choroids.
• Hyalitis
o Inflammation of the vitreous body (vitreous humour).
• Retinitis
o Inflammation of retina
• Anterior synechia
o Attachment of the iris to the cornea is called anterior synechia. This is sometimes seen
as a sequela of staphyloma.
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• Posterior synechia
o Attachment of the iris to the lens is called posterior synechia. Sometimes seen as a
sequela of periodic ophthalmia in the horse.
PERIODIC OPHTHALMIA
• 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.
• The eyelids become greatly wrinkled and shrunken.
Etiology
• The cause of the disease is not definitely known.

• The disease appears to be contagious but attempts to transmit the disease artificially have not
been successful.
• The disease occurs in places where a number of horses are housed together, as in the army.
Symptoms
• The disease usually starts unilaterally with photophobia, blepharospasm and lacrimation - acute
uveitis
• The tears are sticky and become adherent to the eyelids and cheek. Conjunctivitis and
engorgement of blood vessels around the sclero – corneal junction are seen.
• The consistency of the aqueous humour is altered, there is accumulation of whitish or yellowish
precipitates in the anterior chamber (hypopyon) and due to this the cornea may appear
completely opaque. Pupil is constrited. Recovery takes place in about 3 weeks, the precipitates
get absorbed and the pupil dilates to the normal size.
• After seven to ten days the symptoms recur either in the same eye or in the other eye. During
this second attack symptoms are more severe. Thus the same eye may become affected
repeatedly. Due to these recurrent attacks the eye is permanently damaged.
• The cornea and the lens show opacity; posterior synechia is a constant sequela of the disease:
the retina atrophies; and the vitreous humour undergoes liquefaction.
• The vitreous humour when examined through an ophthalmoscope presents a characteristic
appearance with star – like floating bodies described as synchysis scintillans. - posterior uveitis
• The aqueous humour gets partially absorbed and the eyeball shrinks. The fat in the orbit gets
absorbed, the eyeball sinks into the orbit and the eyelids get wrinkled resulting in permanent
blindness.
• In kerato uveitis a fleshy corneal infiltrate and pannus are identified on ocular exam.
Diagnosis
• The disease is characterized by its sudden onset without any apparent cause. The pupil is
constricted and fails to dilate. Pressure on the supraorbital fossa evinces pain. Posterior
synechia may be noticed.
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Treatment
• Symptomatic treatment for uveitis and presence of systemic infection should be ruled out.
• Agressive therapy should be intiated first. It consists of topical , subconjunctival or systemic use
of corticosteroids
• NSAIDS - flunixine meglumine, asprin are also effective.
• A cycloplegic atropine can also be used.
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MODULE-15: SURGICAL AFFECTIONS OF THE RETINA AND REFRACTION OF THE EYE
LEARNING OBJECTIVE
• At the end of this module, the learner will get an insight in to the various posterior chamber
affections leading to blindness.
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.
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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 the posterior segment is called
fundus and it comprises of optic disc, retinal vasculature, and a semitransparent neurosensory
retina.
• Through this, structures like retinal pigment epithelium chorioid or tapetum and posterior
sclera could be visualised.
VITREOUS
• About 3/4th of the volume of the eye is occupied by a gelatinous structure called vitreous, which
also gives, its shape to the eye.
• 98% of the vitreous is water and the rest 2% consists of collagen fibrils, Hyalocyte, and
mucopolysacharides and Persistent Hyaloid Artery
• On the posterior lens capsule a small attachment persists – sometimes seen along with
posterior capsular cataract.
• In ruminants, a remnant persists from the center of the optic disc.
• Persistent Hyper plastic primary vitreous
• When the vascular supply to the embryonic lens remains in the adult vitreous, the condition is
called persistent hyper plastic primary vitreous.
• Some times seen as associated with cataract and retinal detachment.
• Vitreous haemorrhage
• This condition could arise as a sequela to thromtocytopenia, trauma, neoplasia and to
infectious diseases.
• Treatment consists of systemic use of corticosteroid.
Liquified vitreous (Synchysis scintillans)
• It is usually seen in aged patients or as a sequela to inflammation.

• When the head is moved the freely floating bodies tends to move and settle.
• This condition may predispose to retinal detachment.
• When the suspended particles consists of calcium lipid complex, the condition is called Asteroid
Hyalosis.
FUNDUS
• Ophthalmoscopic picture/ image of the eye is called fundus.

• It is the part of the retina which appears through the ophthalmoscope
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• A specialised reflective layer called tapetum helps to intensify the vision in dim light. It is absent
in man and pig.
• Retinal pigment epithelium layer is the next inner layer which also maintains nutrition to the
neuro sensory retina.
• The visual image is converted to electrical signals by the neuro sensory retina to photoceptor
cells- rods and cones and finally to the visual cortex in the brain through the optic nerve.
Retinal haemorrhage
• Causes include, anaemia, thrombocytopenia, hypertension, neoplasia etc., Haemorrhage may

occur at any layers of the retina.
Retinal detachment
• 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.
OPTIC DISC
Optic disc edema / papilledema
• Swollen optic disc with hazy margins usually caused due to vitamin A deficiency in steers or due
to space occupying lesions.
Optic disc atrophy due to IOP rise- Cupping of the optic disc
• Optic papilla will be small with attenuated blood vessels.

• The pupil will be dilated with the eye blind.
• Cause – sequela to inflammatory conditions.
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MODULE-16: EYE-WORM AFFECTION IN LARGE ANIMALS
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.
• 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 uveitis.
Clinical signs
• 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.
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• 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
• The animal is restrained and a auriculo-palpeberal nerve block and retro bulbar nerve block is
administered with 2% lignocaine solution.
• The worms are manually removed from the pouch of the nictitating membrane and a lachrymal
duct flushing may attempted with normal saline as many of these worm cause dacryocystitis.
• Topical antibiotics and anti-inflammatory drugs are indicated along with administration of
broad spectrum anthelmintic like ivermectin at 200 μg/ kg bwt.
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MODULE-17: POLL EVIL, YOKE GALL AND AFFECTIONS OF WITHERS
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the yoke withers
and poll.
POLL EVIL
• 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
o Head is kept abnormally high due to pain.
• Prognosis
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.
• Treatment
o Surgical excision : Under general anesthesia
o Site: 5-8cm long incision in the middle line of poll from in front of occipital crest to a
point behind the posterior limit of the lesion.
Procedure
• Incise through skin down to the ligament nuchae.

• Disect it out as far as it is diseased.
• Sever it posteriorly, reflect it outwards, from its insertion into occipital crest.
• 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 hours
Thereafter treat it as an open wound (for 6 weeks)
Result
• First the animal feels difficulty in grazing but in course of time this inconvenience disappears
due to the stretching of the new cicatrix.
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AFFECTIONS OF YOKE PLACE
Yoke place
• Normally there is no bursa in this region, but due to constant pressure of the yoke an acquired
subcutaneous bursa develops.
• The surgical affections of this region are yoke gall, tumour and yoke ulcer. These are seen in the
cattle and buffaloes.
Yoke gall
• Localized acute inflammation of the skin and subcutis on the neck due to injury caused by
friction (rubbing) of the yoke.
• It may be a swelling due to separation of layers of skin and subcutis and accumulation of
inflammatory exudates there in.
Yoke abscess
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)
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• 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.
Acute to chronic
• Inflammatory exudates (due to the injury by the yoke) accumulate 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.
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• 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: Blistering the region and opening them
after maturation and treating on general lines.
o For solitary cold abscess with healthy skin: Enucleation with its walls intact, aseptically
as in operative surgery guide. The incision should never be across or along, but oblique
to the neck. It should 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 to avoid the rupture of the embryonic tissue in the operation site.
Complications
• Failure of healing by first intention: Causes: Infection, excessive trauma during operation, use of
irritant antiseptics, haemorrhage, improper a position of the lips, and interference by the
animal after the operational. So, avoid the causes to get good result.
• Formation of a very large scar. This interferes with the usefulness of the animal for work. Cause:
II nd intention healing.
AFFECTIONS OF WITHER
• Wither is the region over the backline where the neck joins the thorax and where the dorsal
margins of the scapula lie just below the skin.
Affections
• Fistulous withers (supraspinous bursitis) and poll evil

• Fistulous withers and poll evil are rare, inflammatory conditions of horses that differ essentially
only in their location in the respective supraspinous and supra-atlantal bursae
Etiology
• Infection - mainly through the organism Brucella abortus found near cattle
• Streptococcus zooepidemicus, Actinomyces bovis, occasionally B suis
• Parasites (Onchocera cervicalis)
• Trauma to the area
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• Fitting saddles
• Overwork
• Overloading
• Badly balanced loads
• 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 eyes, or
through broken skin.
Symptoms
• Swelling of the withers

• Heat in the withers
• 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
• 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.
Diagnosis
• Clinical signs
o ‘X’ ray – indicating presence of osteomyelitis of the underlying spinous process
o Ultrasound
Treatment
• 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
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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
prevented healing in the first instance.
• Finally surgical correction should be carried out under general anaesthesia. An incision should
be made at the lowest part of the cavity, so as to give free exit to the matter (pus) and allow of
the removal of any dead tissues that may exist, and drainage of the abscess may be effected 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 accumulate there.
Care should be taken to avoid penetration of the dorsoscapulat ligament.
• Sometimes the pus will have burrowed behind the shoulder-blade, in which case a depending
opening must 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
removed by the veterinary surgeon.
• First day the cavity should be flushed with irritant antiseptic (eg. tincture iodine) and second
day use non-irritant solution (eg. Povidone iodine).
• If the dead space is more means the cavity should be packed with antiseptic gauze and it should
be removed every alternative day. • Once it starts healing use antiseptic spray with fly
repellent.
Prevention
• Always have well-padded and properly-fitting harness and clothing, and as soon as any sign of
chafing occurs, at once remove the offending agent.
• In this way many tedious and painful wounds may be avoided.
• It is reasonable to keep horses separate from Brucella -infected cattle, and cattle separate from
horses with discharging fistulous withers.
Prognosis
• It will cure if treated early.

• Suppuration causes arthritis of the intervertebral joints, extend to the spinal cord causing
death.
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MODULE-18: AFFECTIONS OF OESOPHAGUS
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the oesophagus
and will be able to perform cervical oesophagotomy in small and large animals.
CHOKING: OBSTRUCTION OF OESOPHAGUS
• Most common in bovines as they have the habit of indiscriminate feeding and thus picking up
the foreign bodies especially during pregnancy.
Seat of obstruction
• All animals: Just behind the pharynx.

• Horse: Inferior third of oesophagus, being normally constricted.
• Ox & dog: Lower part of cervical region due to its compression between the thoracic inlet and
the first rib.
Chocking objects
• Horse: Carrot, turnip, potato, piece of wood, extracted tooth and broken balling gun swallowed
accidentally,
• Ox: Turnip, potato, apple, palm or mango kernel.
• Dog and Cat: Bone or cartilage, (fixation is due to sharp points) swallowing of foregin bodies
while playing.
Symptoms
• 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
Treatment
• Medical management emetic
Surgical treatment
• Cervical oesophagotomy
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• Thoracic oesophagotomy
AFFECTIONS OF OESOPHAGUS IN SMALL ANIMALS
Esophageal obstruction – Foreign Bodies
• The most common cause for esophageal obstruction is ingestion of foreign bodies. Various
objects may lodge and produce partial or complete obstruction in esophagus. The most
common foreign body is bones.
Esophageal obstruction – Foreign Bodies
• Others include needle, wooden sticks, rubber toys, plastics and coins. Cats are more
predisposed to ingesting fishhooks and needles. The ingested foreign bodies become lodged in
the cervical constriction, bronchoaortic constriction, diaphragmatic constriction and thoracic
inlet.
• 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 complications in thoracotomy.
• Difficulty in swallowing ,regurgitation, gulping, excessive salivation and inappetance ( cats) are
the acute clinical signs. Chronic signs are Cervical swelling ,primary malnutrition and aspiration
pneumonia.
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Thoracic foreign body
• Pre operative management of patients with esophageal disorders correct fluid electrolyte and
acid base imbalance
• Prophylactic antibiotics for esophagitis an aspiration pnuemonia suprt nutrition
• 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.
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• 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 portion of the ring to relieve
esophageal stenosis.
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.
• Abscess and granulomas may also cause this. In the thoracic inlet, cranial mediastinum and
thoracic cavity 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.
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MEGAESOPHAGUS
• Megaesophagus can develop cranial to the mechanical obstruction.

• Generalized megaesophagus can result from affections of 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.
ESOPHAGEAL DIVERTICULUM
Esophageal diverticulum
• 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.
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• 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.
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• 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.
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MODULE-19: AFFECTIONS OF TRACHEA AND LARYNX
LEARNING OBJECTIVE
• The learner will be able to understand the surgical pathology in the affections of trachea and
will be able to attend to the emergencies involving dysponea.
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.
Tracheal rupture
TRACHEAL STENOSIS
• Narrowing of the tracheal lumen can be due to formation of scar tissue because of
endotracheal tube pressure, blunt or penetrating trauma, tracheostomy and tracheal
anastomosis.
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• 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.
• 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.
• High frequency rales may be heard in partial obstruction.
• Plain radiograph, bronchoscopy are the diagnostic aid to confirm foreign bodies.
• The retrievable foreign body can be removed from with the help of rigid hollow bronchoscope
or flexible fiber-optic endoscope.
TRACHEAL RUPTURE
X-ray tracheal rupture Subcutaneous emphasema following tracheal

rupture
Causes
• In small animals dog bitten wounds and penetrating trauma on the neck region might result in
punctured wounds on the trachea.
Symptoms
• Emphysema, hissing sounds of air in the trachea
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Treatment
• Suturing of the punctured trachea / larynx with a monofilament absorbable suture material.
(1/0 PDS)
AFFECTIONS OF LARYNX IN SMALL ANIMALS
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 palate. A temporary tracheostomy is
necessary to ensure adequate passage of air during surgery and also for post operative
recovery. Dogs with stenotic nares and elongated soft palate and everted laryngeal saccules are
treated first.
• Permanent tracheostomy is an alternative for dogs with severe laryngeal collapse even after
resection of above mentioned conditions.
Laryngeal paralysis
• In dogs and cats usually occurs from an interruption of the innervation to the intrinsic muscles
of the larynx.
• 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.
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• 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.
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MODULE-20: THORAX AND ABDOMEN - THORACOTOMY AND AFFECTIONS OF RIBS
LEARNING OBJECTIVE
• At the end of this module, the learner will able to understand the affections of fracture of ribs,
perforated wounds, sternal fistula, pneumocele and pneumothorax, thoracotomy, approaches
for thoracotomy in small and large animals.
FRACTURE OF RIB, WOUND AND PNEUMOTHORAX
Fracture of Ribs
• Rib fractures are found inconjunction with other fractures (legs, pelvis,spine) and are a result of
trauma (motor vehicleaccident).
• Trauma to the chest wall can be associated withsevere respiratory (breathing) difficulty.
• Dogs can have"pulmonary contusion" , "pneumothorax" , and "flail chest"
• Rare in ruminants
• Compound fractures can cause costal fistula
Diagnosis
• Clinical examination
• X-ray of the thorax, helps to evaluate the lung injuries too
Treatment
• Costal fistula can be treated by resection of the affected rib
Pneumothorax
• Pneumothorax is the abnormal presence of air within the thoracic cavity, which restricts the
lungs from inflating normally during inhalation.
• Pneumothorax can be of following types.
• Signs include
o Exercise intolerance
o Labored breathing
o Increase in the respiratory rate
o Cyanotic tongue
o Thoracic radiographs (X-rays) to look for the presence of air in the thoracic cavity
o Arterial blood gas,
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o Pulse oximetry
Treatment
• Thoracocentesis, which is removal of air from the chest cavity with a needle and syringe.
• Treatment of concurrent fractures and soft-tissue injuries.
• Most rib fractures are managed without any treatment.
• Occasionally, the individual fractures may be surgically repaired with pins and/or wires.
• When multiple rib fractures are present, leading to a "flail chest," the freely moving section of
the chest wall usually must be stabilized by attaching the ribs within the free segment to a large
splint placed on the surface of the skin. The ribs are attached to the splint with suture material
placed through the splint and around each rib.
THORACOTOMY
• Thoracotomy is the surgical incision of the chest wall to enter the thoracic cavity.
• The normal negative pressure of the pleural space will be lost on account of air entering the
pleural cavity.
Plain radiograph showing pnemothorax
• 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
PREREQUISITES FOR THORACOTOMY
• Since the normal negativity of the thorax is altered by the presence of air in the thoracic cavity,
• Facility for mechanical ventilation of the lungs is a must before opening the thorax.
• This is done using a ventilator which provides intermittent positive pressure ventilation.
THORACOTOMY IN DOGS
Approaches to thoracic cavity
1. Intercostal incision
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2. Rib resection
3. Intercostal incision with resection of adjacent rib
4. Rib splitting
5. Median sternotomy
6. Abdominal approach.
Rib retractor in place
Intercostal incision
• Incise cranial to the rib since the intercostal vessels courses the rib caudally.
• A self retaining rib retractor should be used for exposure of the thoracic cavity.
• For closure, place series of interrupted sutures around adjacent ribs.
• Hold the ribs closer and tie the sutures individually.
• A simple continuous suture in the intercostal muscles 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.
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Intercostal thoracotomy
Lateral recumbency.
• Select the site for incision.

• Locate appropriate intercostals space.
• Sharply incise the skin, subcutis and cutaneous trunci.
• 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.
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.
Ligamentum arteriosum
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• Closure of the thoracotomy is by preplacing heavy 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 DOGS
Organ Intercostal space Side

Heart 4th or 5th Left or Right
Lungs 4th- 6th Left or Right
Cranial Oesophagus 3rd or 4th Left
Caudal Oesophagus 7th – 9th Left or Right
MEDIAN STERNOTOMY IN DOGS
• Dorsal recumbency.
• Incise skin on midline of the sternum.
• Expose sternum by incision and dissection of the overlying muscles
• Transect the sternebrae longitudinally on the midline to enter the thoracic cavity.
• Retract the edges with a Finochitto rib retractor.
• Closure is to be done with wires or heavy sutures place around the sternebrae.
• Establish negative pressure while tying the last knot.
AFFECTIONS OF RIB IN SMALL ANIMALS
• 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 restricted ventilation
or paradoxical movement of the chest wall.
• Severe kyphoscoliosis usually results in malformation of the thoracic cavity. Surgical correction
is not recommended generally.
• Metabolic bone diseases such as hyperparathyroidism, hypervitaminosis D, and multiple
cartilaginous exostosis are occasionally manifested in bony thorax.
• Rib neoplasms are usually primary and malignant. Osteosarcoma is the most common one.
Chondrosarcoma is the second most common.
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Thoracic tumor
• Thoracic radiographs usually provide information about osteolysis, intra and extra thoracic soft
tissue masses and mineralization of ribs affected with sarcomas. Malignant neoplasms can be
removed by en bloc resection.
SITES FOR THORACOTOMY IN BOVINES FOR COMMON CONDITIONS
Procedure Site
Thoracocentesis 5th to 7th
Pericardiocentesis, Pericardiotomy, Pericardiectomy 5th intercostal space or 5th rib resection
Diaphragmatic herniorrhaphy 6th or 7th rib
Transthoracic oesophagotomy 8th rib
Diaphragmatic abscess 7th rib
Lobectomy 4th or 5th rib
TECHNIQUES IN THORACOTOMY OF BOVINES
Intercostal incision
• Incise cranial to the rib since the intercostal vessels courses the rib caudally.
• A self retaining rib retractor should be used for exposure of the thoracic cavity.
• For closure, place series of interrupted sutures around adjacent ribs.
• Hold the ribs closer and tie the sutures individually.
• A simple continuous suture in the intercostal muscles 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.
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• 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.
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MODULE-21: HERNIA
LEARNING OBJECTIVE
• The learner will be able to differentially diagnose swelling and to arrive at different types of
hernia in small and large animals.
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.
Clinical signs
• 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.
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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 describe a hernia through any part of
the abdominal wall other than a natural orifice. This condition is common in horse,goat and
cattle and is generally acquired in nature.
Etiology
• Any trauma – horn thrust in cattle, violent contact with blunt objects, weakening of the
abdominal muscle
• Violent straining during parturition – common in sheep
• 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.
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• 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 depends on the site of herniation.
Treatment
• When the hernia is harmless – herniorrhaphy is elective; not an emergency.

• It is advisable to delay the surgical repair until the inflammation subsides.
• Prolonged delay may cause complications due to adhesions between the displaced viscera and
subcutaneous tissue.
• If hernia is complicated (due to incarceration/ strangulation) immediate surgical intervention is
required.
Technique
• An elliptical or linear incision is made over the hernial swelling. The contents are reduced.
Dorsal recumbency Hernial ring
• The peritoneal sac is ligated or sutured close to the ring and amputated.
Herniorrhaphy Prolene mesh
• The hernial ring is debrided and sutured using overlapping sutures with a non absorbable
suture material.
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Onlay grafting
• Hernioplasty using prolene mesh as onlay graft.

• The skin incision may be sutured with a vertical mattress sutures.
Post operative care
• 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
• 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 can occur due to the following factors.
• Hormonal disorders, Prostatic diseases, Rectal diseases and Anatomical factors – rectal
deviations, diverticula etc.,
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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.
• Hard swelling should be differentiated from perianal neoplasm.
Diagnosis
• 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
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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.
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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
oSwelling 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.
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
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• 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
• 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.
• Tendency to vomit after feeding.
• Animal is reluctant to move. Remains most of the time in 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

• plain/contrast radiography
Plain radiography - Diaphragmatic hernia
• Contrast x- ray Diaphragmatic hernia
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Contrast radiography showing intestines in the thorax
• 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.
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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 6th
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.
Treatment
• Treatment is only surgical.
Diaphagmatic vent Herniorraphy
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• The first step is to evacuate the contents of the rumen and reticulum by rumenotomy and cud
transplantation. Then for animal is kept on I/v fluids for 48 hours and thereafter in the soft diets
with fluids, surgery to correct hernia may be delayed 3-4 days.
• The common approaches for diaphragmatic hernia are abdominal and thoracic. Irrespective of
the approach, proper ruminal evacuation and assisted ventilation during herniorrhaphy are
required for successful procedure.
CONGENITAL DIAPHRAGMATIC HERNIA
Congenital Diaphragmatic Hernia/Peritoneo-pericardial Hernia
• This is a common condition due to the failure of development of septum tranversium.

• Clinical signs includes vomiting, anorexia, lethargy and diarrohea and dyspnoea is infrequent.
• On physical examination, heart sounds are muffled and intestinal sounds are heard in the
ventral portion of the 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
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• Abduction of hind limbs
• Systemic signs are evident only when the hernia gets strangulated.
Hernial contents include 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 skin is made.
Inguinal hernia
TRAUMATIC DIAPHRAGMATIC HERNIA
• This is caused usually by blunt trauma, especially automobile accidents.

• The tear can occur anywhere in the diaphragm or the diaphragm may get separated from its
attachment to the ribs.
Clinical signs
• The clinical signs may vary from absence of symptoms to severe dyspnoea Also, signs vary with
the location and the organ terminated.
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• 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.
• 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, dyspnea, reduced exercise
tolerance etc.
• Surgical correction is the only treatment.
HIATAL HERNIA
• This is a form of diaphragmatic hernia in which the caudal end of the oesophagus and cardiac
area of the stomach pass through the oesophageal hiatus of the diaphragm.
• The associated sign is the oesophagitis. Treatment consists of reducing the hernia and
reconstructing the diaphragam.
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.
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.
• Most affected animals develop recurrent tympany not responding to medical treatment. The
tympany is mild if only a small portion of reticulum is herniated.
• 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.
• 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 muffled and reticular sounds may be heard anterior to the
6th rib. In untreated cases, inanition, progressive emaciation, weakness and dehydration leading
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to death are observed. The diagnosis is confirmed by plain and contrast radiography. Left flank
exploratory laparotomy may be done.
Treatment
• Treatment is only surgical.

• The first step is to evacuate the contents of the rumen and reticulum by rumenotomy and cud
transplantation. Then the animal is kept on I/v fluids for 48 hours and thereafter in the soft
diets with fluids. Surgery to correct hernia may be delayed 3-4 days.
• The common approaches for diaphragmatic hernia are abdominal and thoracic. Irrespective of
the approach, proper ruminal evacuation and assisted ventilation during herniorrhaphy are
required for successful procedure.
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MODULE-22: SURGICAL AFFECTIONS OF STOMACH AND CARDIA IN DOGS
LEARNING OBJECTIVE
• The learner will gain knowledge on various methods of approach to perform, surgery at cardia,
stomach and pylorus-gastrotomy in small animals.
GASTRIC EMPTYING DISORDERS, GASTRITIS
The three types are
1. acclerated gastric emptying --seen in hyper thyroidism

2. retrograde or gastroesophageal reflux , Affected animals vomit usually after an overnight
fasting.
3. delayed gastric emptying due to functional obstruction or mechanical obstruction
Gastritis
• the causes are bacterial viral or toxins

• gastric ulcers also occur due to neoplasms, corticosteroids, systemic diseases
• Many acute gastric lesions are self limiting
Chronic gastritis
• Basd onthe type of cell infiltrate different types are there eoisinophilic,lymphocytic, plasmacytic
and based upon the inflammation, mild moderate, severe.
GASTROTOMY IN CANINE
• Incision through stomach wall into lumen.
Indication
• Foreign body in stomach.

• Gastric Dilatation and volvulus.
• Benign gastric outflow obstruction.
• Gastric ulceration and erosion.
• Gastric neoplasia and infiltrative disease .
• Stricture of cardia
• Foreign body in the caudal thoracic esophagus.
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Surgical anatomy
• Stomach cardia, fundus. Body, pyloric antrum, pyloric canal, pyloric ostium.
• Oesophagus entry at cardiac ostium of stomach.
• Fundus is relatively smaller in canine and dorsal to cardiac ostium. On radiography gas present.
• Body of stomach: lies against left lobe of liver
• Pyloric antrum: funnel shaped, open into pyloric canal.
• Pyloric ostium: end of pyloric canal and empties into duodenum.
• Blood supply: Aorta, Celiac artery, Gastric artery on lesser curvature & gastroepiploic artery on
greater curvature of stomach.
ANAESTHESIA
Premedication
• Atropine sulphate @ 0.02--0.04 mg/kg sc (or)

• Glycopyrollate @ 0.005--0.01 mg/kg b.wt. s.c., i.m. (reduce gastric secretion & damage to
oesophagus mucosa or respiratory tract).
Induction
• 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.
Maintenance
• Inhalant anaesthesia - isoflurane/sevoflurane.
Precaution
• Avoid nitrous oxide in Gastric dialatation /torsion /intestinal obstruction, it rapidly diffuse in
distended organ and cause additional distension.
Preoperative management
• Withhold food for 12—24 hrs.

• In younger animal of 6 months rapidly depletion of liver glycogen during fasting (don’t fast
more than 6 hrs).
• Correct dehydration if present
SURGICAL TECHNIQUE
Procedure
• Incision is taken on ventral midline from xiphoid backwards.

• Abdominal content is packed;
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• Stay sutures are placed on the stomach.
• Incision on stomach is made on ventral aspect between greater and lesser curvature at hypo
vascular area.
• Precaution is taken not to incise near pylorus (closure of incision may cause in infolding of
tissue and the outflow may be obstructed.
• Stab incision on stomach wall to lumen by scalpel and enlarged with metzenbaum scissors.
• Suction is used to aspirate gastric content and to reduce spillage.
• After correction of condition based on indication, closure of incision by 2-0 or 3-0 absorbable
suture material. Suturing pattern; two layers;
• I layer - Connell suture including all the layers followed by a Lembert/Cushing suture
• Before closing abdomen incision- instrument is substituted with sterile set and gloves are
changed
POST OPERATIVE CARE
• Monitor fluid status, maintain hydration until animal is drinking. Correct electrolyte
abnormalities.
• Start feeding 12-24 hrs after surgery if patient is not vomiting.
• Broad spectrum antibiotic
GASTRIC DIALATATION AND VOLVULUS
• Enlargement of stomach associated with rotation on its mesenteric axis.

• It is an emergency condition which warrants immediate surgical intervention
• Even in treated aniamls about 45% mortality is recorded since it is an acute condition. Hence
this is considered as an emergency condition.
Anamnesis
• Enlarged abdomen
• Animal recumbent and depressed
• Non productive retching
• Hyper salivation
Physical examination
• General appearance - Dull

• Behavior - Depressed
• Feeding habit - Not satisfactory
• Excretory habit - Normally voided
• Lymph nodes - NAD
• Pulse - Weak
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• Respiration - Thoracic
• Skin and coat - Smooth and shiny
• Conjunctival mucous memebrane - Pale
Radiography
• Right lateral view

• Gas filled structure–gastric dilatation
Right lateral view

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 and Diazepam - 0.5 mg/kg —
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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.
Synonyms
• Pyloric stenosis also known as – – Benign antral muscular hypertrophy. – Congenital

hypertrophic stenosis – Congenital pyloric muscle hypertrophy
• The cause of pyloric stenosis is unknown, but it may be due to
o Hypergastrinemia – major regulator of gastric acid secretion and is trophic for gastric
smooth muscle and mucosa.
o Gastrin administration to pregnant bitches
o Neurogenic dysfunction – spinal cord disorders.
o Acute stress
o Inflamatory disease
o Trauma
o Prolonged gastric distention
o Foreign body
o Neoplasm
Diagnosis
Clinical presentation
• Signalment
o Most commonly seen in brachycephalic breeds ( Boxers, Bulldogs, & Boston terriers )
o Siamese cats are also affected– Males may be more commonly affected.
o More common in young animals although all age groups of animals are susceptible.
• 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 Regurgitation
o Aspiration pneumonia
o Severe dehydration is uncommon but may occur
o Later chronic vomiting
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o Electrolyte imbalance
o Metabolic alkalosis
Physical examination findings
• Generally nonspecific findings – Weight loss, Anorexia, Depression – Dehydration and / or –

Abdominal pain.
• Aspiration pneumonia or reflux esophagitis ( or both ) may occur secondary to chronic vomiting
Radiography
• Survey Radiographic findings – Survey radiograph of abdomen may reveal gastric distention (
usually filled with fluid )
• Contrast Radiographic findings – It reveals delayed emptying – Pyloric wall thickening – And / or
filling defect in the pylorus.
Note: Normal elimination of liquid barium does not rule out gastric outflow obstruction
Diffrential diagnosis
• Any condition that causes vomiting is a differential diagnosis

o Gastrointestinal foreign body
o Gastritis
o Neoplasia
o Ulceration
o Uremia
o Hypoadrenocorticism
o Diabetic ketoacidosis
o Hepatic insufficiency
o Peritonitis, pancreatitis
o Inflammatory bowl disease
PYLORIC STENOSIS - TREATMENT
Medical management
• Dehydration, electrolyte & acid – base abnormalities should be corrected

• H 2 blockers.
• Antibiotics is indicated for esophagitis due to ulceration aspiration.
NOTE – Gastric prokinetics ( metoclopramide and cisapride ) should not be used if outflow obstruction
is suspected.
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Surgical management
presurgical preparation
• Withheld of the food for 24 hours before surgery.

• Presurgical endoscopy – – To define the extent of the lesion. – To confirm benign or malignant
nature.
• Intravenous prophylactic antibiotics e.g., cefazolin ; 22 mg / kg i /v once or twice at 2-4 hrs
interval.
Premedictaion
• Atropine (0.02-0.04 mg/kg s/c, I /m)

• Butorphanol (0.2-0.4 mg/kg s/c, i /m)
Induction
• Propofol (4-6 mg/kg i /v) or ketamine -diazepam

• Maintenance
Isoflurane
Site
• Dorsal recumbency
• Abdomen is prepared for a ventral midline incision – Extended from mid thorax to near the
pubis.
Ventral midline celiotomy
• Surgical procedure include Pyloromyotomy, Pyloroplasty, Billroth I ( 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 )
o Billroth II – attachment of the jejunum to the stomach ( gastrojejunostomy ) after a
partial gastrectomy ( including pylorectomy )
Fredet – Ramstedt pyloromyotomy
Procedure – It is simplest & easiest one. It probably provides only temporary benefit because healing
may lessen the lumen size.
• Hold the pylorus between the index finger & thumb in the hand.
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• Select a hypo vascular area of the ventral pylorus, & make a longitudinal incision through the
serosa & muscularis, but not through the mucosa.
• Make sure that the mascularis layer is completely incised, to allow the mucosa to bulge into the
incision site.
• If the mucosa is inadvertently penetrated, suture it with 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.
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MODULE-23: SURGICAL AFFECTIONS DIAGNOSIS AND TREATMENT OF STOMACH IN

RUMINANTS
LEARNING OBJECTIVE
• The learner with a brief knowledge on anatomy on rumen will be able to and to differentially
diagnose the affections of rumen, reticulam, omasum, abomasum and diaphragmatic hernia.
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 8th
intercostals 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 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
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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.
Acute 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.
• 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.
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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 occur 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.
TRAUMATIC RETICULOPERITONITIS
• 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.
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• Extensive adhesions develop between reticulum and diaphragm or other structures which
interfere with the reticular contractions and eructation process.
• In ruminants, the peritonitis caused by the foreign bodies are often localised . But, on rare
occasions, large abscess were formed in the abdominal cavity.
CLINICAL SIGNS
• 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.
• Clinical signs in small ruminants are almost similar. However, distension of the rumen and
suspension of rumination are the only clinical signs exhibited by camels. In camels, suspension
of rumination is usually the first sign of any systemic disease.
DIAGNOSIS
• Diagnosis is mostly based on history and clinical signs. The pole test recommended to detect
pain due to foreign body syndrome in cattle is not usually suitable and satisfactory for buffaloes
and camels. Neutrophilia with shift to left is observed in cattle and buffaloes, though it cannot
be relied upon for diagnosis.
• A lateral plain radiograph of the reticular area is a useful diagnostic tool , not only for locating
the foreign bodies,
• but also for predicting information regarding the mixture and extent of damage caused by
potential foreign bodies. However, in the case of nonmetallic, radiolucent foreign bodies,
radiograph will fail to locate them and such materials are recovered during rumenotomy.
• Dorsal reticulography may also be useful for detecting penetrating type of foreign bodies
TRAUMATIC RETICULO PERICARDITIS
Synonym - Hardware Disease
Etiology
• Perforation of the pericardium by the foreign body present in the reticulum

• Two main reasons attributed to this condition are
• Cattle do not discriminate metallic and non metallic objects while ingestion
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• Cattle do not masticate before swallowing
Pathophysiology
• In a normal functioning heart the right side pressure is less than the left side during diastole
• When fluid accumulated in between heart and pericardium due to penetrating foreign body
this pressure equilazes and results in Cardiac Tamponade
• Later penetration into myocardium results in death
Clinical Signs
• Brisket edema
• High Temperature 104 F
• Pleuritis may manifest as shallow respiration muffled heart sounds (washing machine murmur)
and pleuritic friction rubs
• Jugular vein distension and Jugular pulse
Diagnosis
• Clinical signs
• Neutrophilia and left shift in blood picture
• Radiography
• 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.
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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.
Paravertebral nerve block
• Following painting the site with antiseptics the area should be covered with sterile draper,
exposing the surgical site alone.
Application of antiseptic Draping the surgical site
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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.
Rumenotomy - Incision Fixing the weingarth rumenotomy Rumenotomy frame in position

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.
• After partial evacuation of the contents of the rumen, the ruminal floor and reticulum were
explored with the hand to locate foreign bodies.
Churned ruminal content Diphragmetic vent Completed 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.
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• 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
• 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.
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• 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
• Shifting type of lameness
• Scanty faeces
• Dehydration
Auscultation
• LDA Ping sounds in 11th, 12th, 13th intercostal space.

• RDA Ping sound in the cranial part of para lumbar fossa.
• Liptak test-If pH is 1-4, abomasal displacement is suspected.
CLINICAL PATHOLOGY, DIAGONISIS AND 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
haemoconcentration. Ketonaemia and ketonuria are also frequently present.
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Diagnosis
• The diagnosis of abomasal displacement is based on history, clinical signs detection of tympanic
resonance on auscultation and percussion and laboratory findings.
• Acuteness of the onset of clinical signs, especially rapid heart rate and drop in milk yield, help to
differentiate abomasal volvulus from RDA.
• “Liptek Test” is used in diagnosis of abomasal displacement. A 18G needle is inserted aseptically
just 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 around 4,
abomasal displacement is suspected and a pH of 5 to 7 indicate ruminal contents.
Treatment
• 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.
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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.
• 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.
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• 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. All the cases of abomasal ulcers are
associated with hyperacidity and increased mucosal permeability to hydrogen ions.
• Abdominal pain, melena and pale mucous membranes are the common clinical signs. Bleeding
ulcers cause sudden onset of anorexia, ruminal stasis and tachycardia in addition to abdominal
pain and melena.
• Calves become recumbent suddenly, with cold extremities.
• Subnormal temperature, tachycardia and dehydration which subsequently lead to a state of
hypovolemic shock.
• Death occurs with acute local peritonitis closely resemble that of traumactic reticuloperitonitis.
However, the localized pain will be on the right side instead left of Xiphoid in the case of TRP.
• The diagnosis of bleeding ulcers is based on the typical signs where as the diagnosis of non
bleeding ulcers in an intact animal is difficult.
Treatment
• Treatment of affected animals include change of diet from high to low concentration. Antacids
such as magnesium hydroxide (500 to 800g) or magnesium trisilicate administrated orally for 2-
4 days are found beneficial.
• In cases of bleeding or perforated ulcers, the treatment should be directed to control the
bleeding and to check the dehydration with adequate volumes of fluid administration
• Surgical treatment involves radical excision of ulcerative patches following abomasotomy. But
the success is limited in the case of multiple ulcers.
• Animals with perforated abomasal ulcers and diffused peritonitis usually have poor prognosis.
ABOMASOTOMY
• Site: 4 to 10 cm long paracostal incision invade about 2 inches behind the costal arch beginning
at about 6 inches away from the mid ventral line and extending cranio dorsally.
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• The lower commisure of the incision may be extended ventro medially when found necessary
to operate on the fundus.
• Another approach is through the linea alba at the mid ventral line and the incision start about 4
cm behind xiphoid cartilage of the sternum and extend up to the umbilicus. This is a rarely used
site.
Technique
• The abdominal cavity is entered by incising the skin, abdominal muscles and parietal
peritoneum. Grasp the greater curvature of the abomasum and it is pulled out through the
incision.
• 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.
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MODULE-24: SURGICAL AFFECTIONS OF SMALL INTESTINE
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the intestine and
will be able to perform operative procedure on enterotomy following principles of intestinal
surgery.
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
• Application of Omental and serosal patch aids in faster healing clean instruments should be set
aside for closure.
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• 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.
• The stay suture allows manipulation of the sample without damage. The sample and attached
stay suture can be placed directly in formalin; the suture will not interfere with processing.
• The intestinal wall should be incised near the stay suture to limit the size of the resulting
surgical wound.
INTESTINAL OBSTRUCTION
Etiology
• Foreign body obstruction

• Stenosis due to inflammation
• Paralitic Ileus
• Congenital stenosis/ agenesis
• Faecal stasis
• Intussusception.
• Torsion / volvulus
Clinical Signs
• Small animals suffering from intestinal obstruction may vomit.

• Extreme weakness and animals may die in the course of 8-10 days.
• Smooth foreign bodies pass through and may cause stoppage at the ileo-caecal valve.
• Distension of bowel loops and distended abdomen
• Passing no stool/ blood tinged mucous discharge
• per rectal examination reveals empty rectum and distended bowel loops.
Diagnosis
• clinical signs
• By palpation
• By X-rays -Plain ,Contrast (Brium Meal)
• ultrasound
• laparoscopy/ endoscopy
Treatment
Enterotomy - It is an incision into the intestine.
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• 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
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Foreign body obstruction
• Extra luminal
o Stenosis, Adhesions, Fibrous bands, Hernia, Abscess, Neoplasms
o Intussusception
o Volvulus and torsion
Functional obstruction (Paralytic lecus)
• Trauma
• Peritonitis
• 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
• Distension of abdomen
• Looking towards the site of pain (colic symptoms)
• Kicking at the abdomen
• Frequent standing and lying down
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• Increased pulse rate (depend upon duration of obstruction and involvement of blood vessels)
• Faeces is scanty with blood and thick mucus
• 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)
Treatment
• Enterotomy
• Midline laparotomy
• Locate Intestinal segment with obstruction
• Removal of obstruction
• Intraluminal mass – enterotomy
• Intestinal segment is damaged – enterectomy and anastomosis
Midline laparotomy Isolated obstructed lumen Removal of foreign body
Midline laparotomy
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Techniques - Enterectomy and anastomosis
• Many techniques are in usage.

o End to end – common
o Oblique end to end
o Side to side (lateral)
o End to side
• Telescoping type
o Approximation
o Eversion
o Inversion suture technique
o Invagination
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MODULE-25: SURGICAL AFFECTIONS OF THE LARGE INTESTINE
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the large intestine.
• Incidence: Infrequent in ruminants but common in dogs and cats

• Causes:
o Mechanical obstruction may be
Intra luminal
Extra luminal
Intra luminal
• Faecolith
• Impacted ingesta
• Foreign bodies
• Parasitic infestation
Extra luminal
• Stenosis
• Adhesions
• Fibrous bands
• Hernia
• Abscess
• Neoplasms
Functional obstruction (Paralytic ileus)
• Trauma
• Peritonitis
• Heavy concentrate feeding
• Congenital defects - agenesis of colon, visceral eventration
Malformations of the intestine eg: Hypoplasia or atresia
• Meckel’s diverticulum –
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• Miscellaneous – Mesenteric thrombosis
Clinical signs
• Incomplete obstruction: Pain in initial stages of obstruction, Cessation of defecation ,Anorexia,

Distension of abdomen, Looking towards site of pain (colic symptoms), Kicking at the abdomen,
Frequent standing and lying down, Increased pulse rate (depend upon duration of obstruction
and involvement of blood vessels), Faeces is scanty with blood and thick mucus Hypovolemia,
Endotoxaemia (in strangulated obstruction) cause cardio vascular embed assemt 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 )
Treatment
• General lines - includes Right flank laporotomy Removal of obstruction

• Intraluminal mass – enterotomy
• If intestinal segment is damaged – enterectomy and anastomosis
CAECAL DILATATION AND TORSION
• Dilatation and/or torsion of the caecum involves distension, displacement and torsion of the
caecum including the spiral colon.
o Free end of caecum in cattle is devoid of mesentery and thus prone to rotation.
Dilatation may preceed or follow the torsion.
o Condition is more common in dairy cows following parturition
o In buffaloes caecum is not predisposed to torsion because blind end is not devoid of
mesentery
Etiology
Excessive feeding of grains
• Results in production of increased concentration volatile fatty acids (VFA )

• Gas due to fermentation of undigested grains
• Volatile Fatty acids cause hypomotility or atony of the caecum resulting in accumulation of gas
and ingesta with subsequent dilatation and possible torsion of the organ.
Clinical signs
• Simple dilatation takes gradual course

• Onset may be acute if torsion occurs
• Clinical signs – similar to bowel obstruction
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• Abdominal pain – early course of disease
• Rapid loss of appetite
• Cessation of defecation
• Dehydration
• Temperature, pulse and respiration rate – normal
• Subnormal temperature, tachycardia – in advanced cases of caecal torsion
• Hypo motility or atony of rumen
• Distended right paralumbar fossa
• Tympanic resonance of right paralumbar fossa on auscultation and percussion
• On rectal palpation – a long cylindrical movable gas filled structure in pelvic inlet or just close to
pelvic bone
• Rupture of distended caecum during transportation of animal is a possibility and if it occurs
death is sudden
Diagnosis
• Based on
o History
o Clinical signs
o Auscultation and percussion
o Rectal palpation
o Right flank laparotomy
o biochemistry
o Hypochloremic, hypokalemic, metabolic alkolosis –
o Haemo concentration and azotaemia – similar in bowel obstruction
o Auscultation and percussion of right flank
o Smaller resonant area and more caudal in case of caecal dilatation (in case of right side
displacement of the abomasum - more cranial)
TREATMENT
• Conservative treatment – when animal is in good condition

• Administration of parasynpathomimetic drugs – (Neostigmine)
• Total dose of 12.5 – 2.5 mg s/c for every 3-4 hours for a period of 2-3 days
• A continuous drip of neostigmine (200 mg/10l normal saline)
• Saline purgatives alone or with liquid paraffin
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Surgical treatment
• Caecotomy
o Right flank laporotomy in standing position
o Exteriorise the free end of caecum
o Milk out the caecal contents following caecotomy
o Clean the caecal edges with normal saline
o Suture with absorbable suture with Cushing pattern followed by Lembert’s
o If torsion is there, correction should be made
o Reposition of the caecum into abdominal cavity
o Laparotomy wound is closed in a routine manner
• Typhelectomy
o In cases where the caecum is devitalized and necrotic, resection is indicated
o After exteriorization of caecum through right flank
o Intestinal clamps on the distal end of the ileum and proximal end of the colon should be
placed.
o Blood vessels supplying the caecum should be dorsally ligated and severed
o The necrosed caecum in resected out and cut edges of ileum and colon are
anastomosed by using synthetic absorbable suture material
o Close the laporotomy incision in a routine manner
o Partial resection is sufficient if only a part of caecum is necrosed
Post operative care
• Administration of broad spectrum antibiotics

• Adequate fluid therapy
• Prognosis is good following surgery
TWIST OR ROTATION OF THE COLON IN HORSES
Symptoms
• Intermittent diarrhoea and hypoalbuminemia, depression, anorexia and emaciation
Diagnosis
• Usual symptoms indicative of twist or stoppage of the bowel are evinced.

• Rectal examination. Reveals twist of the colon.
• In front of the anus one feels the distended colon.
• In torsion towards the right they run backwards and inwards
• In torsion towards the left, backwards and outwards
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Prognosis
• Favourable to guarded
Treatment
• Surgical technique
o Explore the abdomen
o Collect the specimen and isolate the involved intestine with laparotomy pads.
o Manually detort the twisted colon.
o Evaluate for viability and perforation.
o Perform a resection and anastomosis if devitalised.
AFFECTIONS OF RECTUM AND ANUS
• Rectal prolapse
• Congenital malformations
• Tumors of rectum
• Paralysis of rectum
• Stenosis of rectum and anus
• Supra rectal abscess
• Rectal tears
RECTAL PROLAPSE
• Most common surgical condition involving the rectum in cattle, buffaloes, and small ruminants.
Causes
• Prolonged tenesmus,
• Increased intra abdominal pressure due to bloat,
• Rectal inflammation and irritation,
• Diarrhoea,
• act of parturition
• Straining ,
• Foreign bodies,
• Perineal hernia,
• Constipation and
• Congenital defects.
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Classification
• Incomplete: Prolapse involving only the mucosa

• Complete: Prolapse of whole thickness rectal wall. Constriction due to tight anal sphincter leads
to extensive necrosis of prolapsed tissue.
Diagnosis
• Visual observation of mass of varied length protruding from the anus.
Treatment
• 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
• Animals should be kept on laxative diet for few days to prevent constipation
• Recurrence is common in this method
• Initiating cause must be treated to effect cure
Post surgical management
• Regular cleaning, dressing with topicak anaesthetic and use of systemic antibiotics
• Complications: Dehiscence of suture line, peritonitis, stenosis or stricture
• rectal prolapse in dogs
CONGENITAL MALFORMATIONS
• It is common in all animals.

• The anorectal passage is developed from two distinct centres in the embryo. Normally the two
tubes coalesce to form a single conduit. Sometimes one of the parts or both is insufficiently
developed.
• 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
o Rectum and bladder as one cavity.
Recto vesicular fistula
Recto urethral fistula
Recto vaginal fistula
• As development proceeds it divides into two compartments, the lower one forming the bladder
and urethra. If the separation is incomplete, recto vaginal or a recto urethral fistula results,
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Symptoms
• In case of complete obstruction:

o With in few hours after birth
o Abdominal pain,
o Distended abdomen
o Straining without expulsion of muconium
TUMORS OF RECTUM
• Warts, cysts, lipomata, myxomata, sarcomata, adenomata and carcinomata

• Cysts, polypoid myxomata and fibromata are the most common tumors of the rectal mucous
membrane.
Symptoms
• Severity of the symptoms vary according to the size of the tumour

• Difficulty in defecation
• In case of ulcerated tumor – blood and pus may be seen in faeces
• Signs of colic
• Tumor inside the rectum may protrude through the anus during defecation
Diagnosis
• Deformity of rectum due to new growth

• Rectal examination
Prognosis
• Benign tumors are easy to remove

• Malignant tumors are incurable
Treatment
• Polypoid growth may removed by ecrasseur or by ligation

• Cysts – by needle aspiration and use of irritants
• Radical surgery for excision of tumour
PARALYSIS OF RECTUM
• Most common in the horse and dog; Rare in ruminants.

• Frequently associated with paralysis of the tail, or the bladder and hind limbs
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Etiology
• Lesions of the spinal cord or nerves supplying the rectum

• Fractures and severe injuries of the sacrum, tumours of the sacral region
• Toxins of infectious diseases such as strangles
• Old age
•
• Paralysis may be complete or incomplete
Symptoms
• Distended rectal walls

• Accumulation of faeces
• Inability of the animal to expel faeces
• Colic symptoms
• The tail is limp and powerless
• Anus is open
Prognosis
• Usually unfavourable.
Treatment
• Use of nervine tonics
RECTAL TEARS
• Primarily due to trauma

• Rarely reported in ruminants
Classification
• Grade 1: tears – involves mucosa or mucosa and submucosa

• Grade 2: When only muscular layer gets ruptured
• Grade 3: Involves mucosa, sub mucosa and muscular layer
• Grade 4: Penetrates all layers and enters peritoneal cavity
Diagnosis
• Presence of excessive amounts of blood on glove on rectal palpation

• Easily palpable viscera
• Signs of shock and peritonitis
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Treatment
• under epidural anaesthesia the distal rectal tear is corrected using an absorbable suture
material using inversion pattern.
• In case of proximal rectal tears – right flank laparotomy has t be performed to repair the rectal
tears
COLIC IN HORSES
Definition
• Colic is defined as visceral abdominal pain due to spasmodic colic contraction and is presented
as acute, chronic or recurrent.
Etiology / risk factors
• Diet
o Coarse roughage - impaction colic due to low digestability
o Grain overload - Colic and laminitis due to increased gas production leading to altered
mobility and displacement of the bowel
• Enviornmental factor - Extreme summer or winter and confinement without exercise.
• Parasites - ascarides , tapeworm,strongyles
• Cribbing results in aerophagia and negative pressure created will result in movement of the
bowel in to potential space within the lesser omental sac and entrapment of intestine in to the
epiploic foramen.
• Pregnancy
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
• sand impaction
• enterolith
• large round or tape worms
• left dorsal displacement
• epiploic foramen entrapment
• mesenteric rent entrapment
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Pathology of coloic
• This can be divided in to

o simple obstruction,
o strangulating obstruction and
o nonstrangulating obstruction
Treatment
Medical colic
• Pain management
o nasogastric intubation
o decompression( enetrocentesis)
o flunixin meglumin
o alpha 2 agonists, Xylazine and detomidine
o opioids
o spasmolytic agents
o lidocaine as a prokinetic drug
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.
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MODULE-26: AFFECTIONS OF THE LIVER
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the liver and to
differentially diagnose it from other surgical conditions affecting the abdomen.
INTRODUCTION
• Portosystemic shunts (Portosystemic vascular anomalies)

• Neoplasia
• Hepatic abscess
• Trauma
• Cholelithiasis
PORTOSYSTEMIC SHUNTS (PORTOSYSTEMIC VASCULAR ANOMALIES)
• Blood draining from the stomach, intestines, pancreas and spleen (portal blood) has to pass
through the liver before going into the systemic circulation.
• 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 parenchyma
• Portocaval shunt: Shunt from portal vein to caudal vena cava
• Diagnosis is from the signalment (usually purebred dogs are at increased risk), from history
(failure to grow, small body stature or loss of body weight and varied signs), from physical
examination findings (like microhepatica, prominent kidneys, neurological abnormalities)
• Confirmation of diagnosis
o Contrast Radiography
o Ultrasonography and
o Nuclear Imaging
• Treatment: Surgical correction which aims at attenuation of the shunts.
NEOPLASIA
• Primary and Metastatic tumours
171
Primary tumours
• Less common compared to Metastatic tumours

• Hepatocellular carcinomas. May develop as solitary mass or in diffuse multiple nodules
• Bile duct carcinomas
• Hepatomas
Metastatic tumours
• More common than primary tumours

• Originating from the spleen (haemangiosarcoma)
• Originating from the colon (adenocarcinoma)
• Originating from the pancreas (adenocarcinoma, islet cell carcinoma)
• Originating from the lymph nodes (lymphosarcoma)
Liver tumour
Clinical signs
• Weight loss,
• Cachexia,
• Jaundice,
• Ascites,
• Anaemia,
• Vomiting and
• Diarrhoea.
Treatment
• Radical surgery involves excision of the mass by

o Wedge resection
o Finger fracture technique
172
• Large masses can also be treated by total or subtotal lobectomy
HEPATIC ABSCESS
• Rare in dogs and cats

• But may be the result of infection
• May develop due to haematogenous spread of infectious agents, penetrating foreign objects,
extension of biliary infections, or localized peritonitis (necrotizing pancreatitis)
Symptoms
• Prolonged and undulant fever (Suspect hepatic abscessation in case of pyrexia of unknown
origin)
• Anorexia, Abdominal pain and Vomiting
Diagnosis
• Serum biochemistry, Ultrasonography and Radiography
Treatment
• Surgical drainage (Preferable for solitary abscess)

• Antimicrobial therapy
TRAUMA
• May be due to automobile accidents, gunshot wounds, falling from heights and rupture of
necrotic tumours. Can be classified as
o Transcapsular
o Sub capsular
o Central
Symptoms
• Hypovolaemia due to Acute blood loss

• Endotoxaemia (coliform or anaerobic)
• Bile peritonitis
Diagnosis
• From Haematology and Serum biochemistry

• Radiography and Ultrasonography
• From peritoneal lavage and centesis
Treatment – Should include the following
173
• Management of shock
• 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
CHOLELITHIASIS
• Also known as gall stones and is rare in dogs.

• Causes obstruction to the flow of bile. The stones are formed by the precipitation of
supersaturated cholesterol or bilirubin in the bile.
• Obstruction to the flow of bile leads to subsequent clinical signs.
Symptoms
• Abdominal pain, Vomiting, steatorrhoea and jaundice.
Diagnosis
• Contrast Radiography (Intravenous or oral cholecystography) – because majority of the gall

stones may be radiolucent.
• Ultrasonography
Treatment
• Incision of common bile duct and removal of the gall stones, Cholecystotomy
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MODULE-27: SURGICAL AFFECTIONS OF THE SPLEEN
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the spleen and to
differentially diagnose it from other surgical conditions affecting the abdomen. and will gain
confidence to approach spleen through a laparotomy incision.
DEFINITION AND TYPES
Definition - Splenectomy
• It is the surgical removal of spleen.
Types
• Partial Splenectomy: Removal of a part of spleen.

• Total Splenectomy: Removal of whole spleen.
INDICATIONS AND CONTRAINDICATIONS
Indications
Partial splenectomy
• Traumatic lesions
• Splenic infarcts
• Focal lesions
• Total Splenectomy
• Splenic neoplasia
Spleen tumour
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• Splenic torsion
• Severe trauma
• Unsuccessful therapy for immune mediated haematological disorder
• Elective Splenectomy is often performed in dogs used as donors to reduce the risk to transfer
blood protozoa to uninfected animal during transfusion
Contraindication
• Patients with bone marrow hypoplasia where spleen is main site of haemopoises
CONSIDERATION FOR SPLENECTOMY
• Middle-aged or older patients.

• 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
• In some dogs clinical signs are acute. Splenic infarcts may be associated to liver or renal
diseases, neoplasia or thrombosis associated in cardiovascular disease.
• There is sign of altered blood flow & coagulation. It may lead to haemoabdomen or sepsis.
• Anaemia may occur due to severe haemorrhage & may associate with diseminated
intravascular coagulations.
• Malignant cancers may metastasize to other normal tissue while benign or nodular tissues are
vulnerable to rupture & severe blood loss & shock.
SURGICAL ANATOMY OF SPLEEN
• Spleen is located in the left cranial abdominal quadrant.

• It usually lies parallel to the greater curvature of stomach but exact location depends on its size
and position of other abdominal organs.
• In contracted stomach it lies in rib cage while in gastric enlargement it lies in caudal abdomen.
• It is covered by a capsule.
• It is attached to the stomach by gastrosplenic ligament.
Blood supply
• Blood supply is from splenic artery, a branch of celiac artery.

• Splenic artery gives off 3-5 primary branches in greater omentum towards ventral spleen.
• Venous drainage is via splenic vein into gastro splenic vein that empties into portal vein.
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Signalment
• Splenic torsions and tumors occur in large breed dogs; age and sex no bar.
Clinical signs
• Vomiting , anorexia, weakness & depression.

• Icterus, hematuria or haemoglobinuria.
• Abdominal pain.
• Acute torsion may result to shock.
Physical examination
• Splenic enlargement on palpation.

• Abdominal distension in splenic rupture.
• Abdominal pain, dehydration, pale mucus membrane or Icterus.
• Tachycardia, longer capillary refilling time, weak peripheral pulse.
Diagnosis
• Clinical signs.
• Radiography – splenic outline blurred, enlargement, radiopaque mass, etc.
• Ultrasonography.
• Laboratory analysis reveals anaemia, leukocytosis, haemoglobinuria, increased serum alkaline
phosphatase etc.
PRE-OPERATIVE MEDICAL MANAGEMENT
• Fluid and electrolyte deficits should be corrected. Whole blood transfusion in severe blood loss
is needed.
• Perioperative antibiotic therapy can be given.
• Cardiac status to be monitored.
Anaesthesia
• 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.
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Preoperative preparation
• Approach is paramedian in xiphoid area. Area to be prepared for aseptic surgery.
TECHNIQUES USED IN SPLENECTOMY
Partial splenectomy technique
• In dorsal recumbency laparotomy is performed and spleen is exposed.

• Desired area to be defined and double ligate and incise the hilar vessels supplying the area.
• Squeeze splenic tissue between thumb and forefinger at the line of lesion and milk splenic pulp
towards lesion.
• Place forceps on either side of the line dividing healthy spleen and lesion and resect off the
spleen between the forceps.
• Close cut surface in continuous pattern by absorbable suture. Double row can be applied.
• One or 2 rows of continuous overlapping mattress sutures 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.
• Squeeze splenic tissue between thumb and forefinger Double ligate and transect all the vessels
at splenic hilus with absorbable or non-absorbable suture.
• Transect the attachment to stomach and remove spleen. Abdomen and skin can be closed as
usual.
POST OPERATIVE CARE AND COMPLICATIONS
Post operative care
• Antibiotic and anti-inflammatory drug to be given parenterally.

• 24 hr monitoring for haemorrhage.
• Fluid therapy to stabilize hypotension.
• Daily dressing of surgical site.
• Long term antibiotic to counteract the immunosuppression.
• Skin suture can be removed after 10-14 days.
Complications
• Haemorrhage.
• Immunosuppression.
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MODULE-28: SURGICAL AFFECTIONS OF THE KIDNEY, URETER AND URINARY BLADDER
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the kidney, ureters
and bladder and will be able to differentially diagnose it from other surgical conditions affecting
the abdomen.
ECTOPIC URETER
• Ectopic ureter is a congenital anomaly where one or both ureters empty outside the urinary
bladder.
Symptoms
• Urinary incontinence
• Pyelonephritis and cystitis
• Hydroureter
• Suspect Ectopia of ureter in any young animal that has a history of incontinence since birth
• Suspect this in older animals with lifelong urinary incontinence
• More commonly diagnosed in female dogs than in males
Diagnosis
• Contrast Radiography
• Ultrasonography
Treatment
• Medical management – aimed at treating the urethral sphincter incompetence. Drugs used are
o Phenylpropanolamine
o Ephedrine
o Imipramine
o Diethylstlbestrol
Surgical techniques
• It includes the following

o Neoureterostomy – is performed for intramural ectopic ureters where the ureter course
submucosally in the bladder and opens into the urethra or vagina. After performing a
cystotomy, an incision is made into the ureter to make a stoma into the bladder. This is
followed by ligation of the ureter coursing distally to the stoma.
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o Ureteroneocystostomy – is performed for extraluminal ectopic ureters where the ureter
completely bypasses the bladder. The ureter is first ligated and transected. An new
entry for the ureter is then created in the bladder and the transected end of the ureter
is then sutured to the bladder mucosa through the newly created bladder incision.
UROABDOMEN (Uroperitoneum)
• Is a condition where there is accumulation of urine in the peritoneal cavity due to leakage of
urine from the kidney, ureter, bladder or proximal urethra.
• Rupture of the bladder is the most common cause
• Also due to blunt or penetrating trauma (eg. Automobile accidents, Penetrating injury from the
fracture fragments of pelvic bone)
• Remember that if the rupture of the bladder is small or on its dorsum, leakage will happen only
when the bladder is fully distended. In such cases, the dog may void urine normally
Diagnosis
• Suspicion from history of trauma

• Peritoneocentesis – smell of urine in the fluid and the creatinine level will be greater than that
of serum
• From physical examination findings
• Confirmatory diagnosis – Plain/Contrast radiography and Ultrasonography
Treatment
Medical management
• 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
180
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 of the perineal region with urine and
urine smell will be there., palpation reveals crepitation of the calculi in th bladder
Diagnosis
• From symptoms, and palpation of the posterior abdomen will reveal stone like bladder.
Radiography
• Plain radiography will reveal distended bladder and vesical claculi if radiopaque will reveal
stones. If they are radiolucent, pneumocystography will confirm the diagnosis.
181
Treatment
Cystotomy
• Anesthesia
o Premedication
Hydromorphone – 0.1-0.2 mg/kg SC or IM
Butorphenol – 0.2-0.4 mg/kg SC or IM
Buprenorphine –5-15 microgm/kg IM
o Induction
Thiopental -10-12 mg/kg IV
Propofol –4-6 mg/kg IV
o Maintenance
Isoflurane or sevoflurane
Procedure
• Place the animal in dorsal recumbency.

• Prepare ventral abdominal region and vulvar area in female for aseptic surgery.
• Incise skin and subcutis on the ventral midline.
• In male incise skin and subcutis parallel and adjacent to prepuce.
• Identify and ligate preputial branches of caudal superficial epigastric artery in the subcutis.
• Incise linea alba from umbilicus to pubis and para preputial approach in male dogs.
• Identify bladder and isolate it by moistened laparotomy sponges.
• Place stay sutures on the bladder apex to facilitate manipulation.
• 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
• Flush the bladder with normal saline to remove small calculi
• Examine bladder and mucosa for defects.
• Pass a catheter down the urethra to check for patency.
• Close the urinary bladder (Cystorraphy)in a single layer using continuous suture pattern.
• If two layer closure, suture the seromuscular layer by two continuous inverting suture lines
(cushings followed by lembert).
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CYSTOTOMY IN CANINES
Indications
• Cystic calculi
• Neoplasia of urinary bladder
• Correction of ectopic ureters
• Urinary tract infection which is resistant to treatment
Symptoms
• Typical symptoms include straining to urinate (stranguria).

• Blood in the urine (hematuria).
• Urinating small amounts frequently (pollakiuria).
• Excess urination (polyuria).
• Pain in the rear quarters.
• Reluctance to jump or play, or even lethargy.
Diagnosis
• A urinalysis is helpful in making a diagnosis. The pH of the urine, mineral content, and the
presence of bacteria or crystals all provide valuable information.
• Radiography-radiopaque calculi can be detected.
X ray shows the presence of urethral

and cystic calculi with distended bladder
• Ultrasonography is a good method to diagnose stones in the urinary bladder, particularly for
radio lucent calculi and anatomical defects of the abdominal wall.
ANESTHESIA AND PROCEDURE
• Correct the fluid and electrolyte imbalances because of chances of hyperkalemia associated
with urinary obstruction
183
• Withdrawal of food and water 12-24 hours before surgery.
Anesthesia
• Premedication
• Hydromorphone – 0.1-0.2 mg/kg SC or IM
• Butorphenol – 0.2-0.4 mg/kg SC or IM
• Buprenorphine –5-15 microgm/kg IM
• Induction
• Thiopental -10-12 mg/kg IV
• Propofol –4-6 mg/kg IV
• Maintenance
• Isoflurane or sevoflurane
Procedure
• Place the animal in dorsal recumbency.

• Prepare ventral abdominal region and vulvar area in female for aseptic surgery.
• Incise skin and subcutis on the ventral midline.
• In male incise skin and subcutis parallel and adjacent to prepuce.
• Identify and ligate preputial branches of caudal superficial epigastric artery in the subcutis.
• Incise linea alba from umbilicus to pubis and para preputial approach in male dogs.
• Identify bladder and isolate it by moistened laparotomy sponges.
• Place stay sutures on the bladder apex to facilitate manipulation.
• Make incision on the dorsal or ventral aspect of bladder away from ureters , urethra and
between major blood vessels. and remove the calculus with a forceps
Bladder exteriorization Placement of incision Calculi from the bladder

from the abdomen on the bladder
• Remove urine by suction or intraoperative cystocentesis before cystotomy.

• Examine bladder and mucosa for defects.
184
• Pass a catheter down the urethra to check for patency.
• Close the UB in a single layer using continuous suture pattern.
• If two layer closure, suture the seromuscular layer by two continuous inverting suture lines
(cushings followed by lembert).
Cystotomy in a female dog showing

single calculus removal
POST OPERATIVE CARE
• Antibiotic and NSAIDS

• Observe the site twice daily for redness, swelling or discharge from the site and cleaning of the
surgical site.
• Suture removal after 10-12 days.
• Special diet recommendations based on the type of calculi.
• 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.
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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 inches
forward 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
TUMOURS FROM BLADDER WALL
186
PATENT URACHUS
Cystoscopy in a heifer with rupture of a patent urachus]. [Article in German]Braun U, Previtali M, Fürst
A, Wehrli M, Muggli E.
Source
• Departement für Nutztiere der Universität Zürich, Winterthurestr. 260, CH-8057 Zürich.
ubraun@vetclinics.uzh.ch
Abstract
• 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.
• The lead signs in the seven-month-pregnant heifer were 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 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 frequently associated with omphalitis.
A membranous urethral diaphragm prevented closure of the urachus in a female calf. The
patent urachus was complicated by an ascending infection of the intraabdominal umbilical
remnants.
• Following surgical removal of the urachus and umbilical vessels along with transection of the
membranous diaphragm the calf experienced an uncomplicated recovery. This case stresses the
importance of assuring urethral patency when managing a case of patent urachus.
187
MODULE-29: URETHRAL CALCULI AND STENOSIS
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the urethra and
urinary calculi.
INDICATIONS OF URETHROTOMY
• Urethral calculi, prostate diseases.

• 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.
Radiograph showing presence of Prostatic abscess

urethral caliculi
Indications
• Urethral obstruction.
• Occasionally, biopsy of obstructive lesions (i.e. strictures, scar tissue and neoplasms).
• Allow breeding ability to be maintained.
ANAESTHESIA AND CONTROL
• 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.
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INCISION SITE
Bull
• Post scrotal site: For removal of obstruction at the sigmoid flexure, about 3 inches behind the
scrotum along the median line.
• 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.
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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 subcutaneous tissue between the caudal
aspect of the os 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.
Urethral lumen flushed with warm saline
• Leave the incision to heal by secondary intention or close the urethra with simple interrupted
absorbable sutures (4-0 or 5-0).
• Place the first layer in the urethral mucosa and corpus spongiosum then appose subcutaneous
tissue and skin with simple interrupted sutures or a continuous subcuticular suture pattern.
Perineal urethrotomy
• Place a purse string suture in the anus.
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• 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.
• Identify the retractor penis muscle, elevate it and retract it.
• Separate the paired bulbospongiosum muscles at their raphe to expose the corpus spongiosum
then incise the corpus spongiosum to enter the urethral lumen.
• Close the incision as just described for prescrotal 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.
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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
• Primary atony of the bladder occurs rarely in cattle and buffaloes. It may develop secondary to
obstructive urolithiasis due to over distension or as a complication of bladder surgery.
• Peritonitis is a rare post-operative complications.
URETHERAL PROPLAPSE
Urethral prolapse
• Prolapse of the mucosal lining of the distal portion of the urethra through the external urethral
orifice, commomn in english bull dogs.
o Reddened protrusion at the tip of the penis
o Sometimes it may be seen intermittently when the dog is sexually excited
o Some dogs lick and traumatize the prolapse, and it may bleed
Symptoms
• persistent licking of the penile area.

• red to purple pea sized lesion
• haematuria independent of micturition
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
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Treatment
• If the prolapse is reducible, reduction followed by retention with sutures from the urethral
lumen to the penile surface can be done
• Surgical resection of the prolapse is the choice when the prolapse cannot be reduced.
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MODULE-30: SURGICAL AFFECTIONS OF PENIS AND SHEATH
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the penis and
prepuce in small and large animals.
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.
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• 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
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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.
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• 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 enough to cause gangrene of the penis
amputation of the affected part may be performed.
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Penile tumors
• Penile tumours are rare in cats but transmissible venereal tumour (TVT), papilloma and
squamous cell carcinoma are common in dogs. Clinial signs and treatment vary depending on
the location, extent and type of tumour.
• TVT is never treated surgically. Even extensive cases of TVT respond favourably to appropriate
chemotherapy. Other types of tumours may have to be excised when small or require penile
amputation when the penis is extensively involved.
• Destruction of papillomas by electrocautery may provide complete cure. It has been found that
cauterization of a few papilloma nodules can cause the destruction of the remaining in a few
days or weeks due to a possible immune mediated response.
PARAPHIMOSIS
• 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 returning the penis into the prepucial sheath. Once returned, 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.
CONDITIONS AFFECTING THE PREPUCE AND SCROTUM
• 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.
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• 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.
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MODULE-31: SURGICAL AFFECTIONS OF TESTICLE AND SCROTUM
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the testis and
scrotum in large and small animals and will be able to perform castartion in farm animals.
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.
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• 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
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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.
Testicular tumor Testicular tumor Testicular tumor exposed through

skin incision
Testicular tumor operative Testicular tumor operative Testicular tumor operative

procedure 1 procedure 2 procedure 3
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Skin closure
• 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 biopsy. Orchiectomy is the treatment of choice.
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 but in cases of permanent obstruction
orchiectomy may be 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.
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• 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.
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• 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.
• 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.
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.
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• 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.
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• 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.
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• 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.
• Therefore it is not much recommended in canines
• Androgens are continually produced within one week the animal becomes azoospermic
following vas occlusion.
• But spermatozoa may persist in ejaculation for 3 weeks(canines), 7 weeks in felines after
vasectomy.
Complications
• Granuloma, scrotal swelling, incisional problems.
BOVINE CASTRATION
• To avoid indiscriminate breeding. They are usually more docile and easier to handle than bulls.
• Steers are also not as rough on equipment and are easier to manage as new individuals added
to feedlots.
• Steers are finished earlier (fatten quicker) than bulls because fat deposition occurs at a faster
rate than in bulls.
• In cases of testicular neoplasia.
• Eliminates possibility of using inferior bulls.
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METHODS OF CASTRATION IN CATTLE
• Burdizzo
• Rubber rings (elastrator)
BURDIZZO METHOD
Position and restrain
• Lateral recumbency with all the limbs tied and hind limbs pulled ahead.
Procedure
• Spermatic cord and blood vessels leading to the testicles are cut.
• Testicles tend to stop functioning for a while and then stop functioning and degenerate.
• One spermatic cord should be clipped at a time.
• It is important to clip the two cords at different levels so that the scrotal sac will receive enough
blood.
• Otherwise it will become gangrenous.
• Make sure that the spermatic cord is between the burdizzo blades.
Advantages
• Bloodless.
• Infection or maggot infestation seldom occurs.
EQUINE CASTRATION
• To make the animal docile.

• Testicular tumor.
• Scrotal hernia
Aneathesia
• For standing castration local infiltration analgesia can be used.

• For castration of recumbent animal xylazine 1.1 mg/kg + ketamine (2.2 mg/kg) or xylazine 0.5
mg/kg+ thiopentol 6.6 mg/kg.
Techniques
• Closed method
oParietal layer of tunica vaginalis is never opened before transfixation ligature.
• Open method
o Parietal layer of tunica vaginalis is incised before emasculation of spermatic cord.
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• Half closed
o Parietal layer of tunica vaginalis is incised and testis removed.
o Before removal spermatic cord is ligated and tunica vaginalis also ligated before closing.
Procedure
• Two parallel incision equidistant from median raphae in cranio-caudal direction.

• This incision made through skin dartos, blunt dissection to free the testes and spermatic cord,
fascia.
• An incision made through tunic proximal to cranial pole of the testes and testes prolapsed from
tunic.
• Emasculator placed proximal to testes advanced upwards.
• Mesorchium is perforated to separate vascular and avascular part.
• Emasculator is applied first to neurovascular portion before removing avascular part.
• Emasculator applied directly and should remain for some time.
• After both testes removed remove loose tags of fascia, fat.
• The wound should not be sutured.
CASTRATION OF CRYPTORCHID
• In dorsal recumbency skin incision is made midway between scrotum and superficial inguinal
ring.
• Pareital layer of tunica vaginalis incised, scrotal ligament also incised and contents are
removed.
• Spermatic cord vessels are ligated and vaginal tunic incisions closed.
• Loose spermatic fascia was apposed and subcuticular sutures were used to appose the skin.
POST OPERATIVE CARE AND COMPLICATIONS
Post operative care
• Before surgery tetanus toxoid should be administered.

• After castration proper exercise should be given for 7 days.
Post operative complications
• Haemorrhage
• Scrotal edema
• Evisceration
• Scirrhous cord
• Hydrocele
• Inguinal hernia, peritonitis
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• Persistent masculine behavior
COMPLICATION AND SEQUELE
• Hemorrhage
• Uterine stump pyometra
• Recurrent estrus
• Ligation of ureter
• Urinary incontinence
• Fistulous tracts and granuloma
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MODULE-32: SURGICAL AFFECTIONS OF THE OVARY AND UTERUS
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the ovary and
uterus and to differentially diagnose it from other surgical conditions affecting the abdomen.
DEFINITIONS AND INDICATIONS
Definition
• Ovariohysterectomy is the removal of both the ovaries and the uterus.
Indications
• 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
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• 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.
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.
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.
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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
Pyometra
• Pus formation in the uterus. It is opened and closed pyometra.
Pyometra - Dog
Technique
• The ant ovarian ligament is cut.
• Ligature the anterior utero – ovarian vessels.
• The ovary is disconnected from its anterior attachment.
• Posterior uterine anteries are ligatured and cut in level with the cervix.
• Broad ligament of the uterus is torn to liberate the uterine cornea.
• 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.
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Pyometra - Cat
• Complication - stump pyometra
Stump pyometra
Uterine torsion
• Condition uncommon in dogs and cats. The ravid or non-gravid uterus can rotate clockwise or
counter-clockwise from 90° to more than 200°.
• Cause: jumping during or running late in pregnancy, active fetal movements, premature uterine
contraction
• Treatment: ovariohysterectomy and c-section if viable fetuses are present.
Uterine prolapse
• Possible mechanisms: excessive relaxation and stretching of pelvic musculature, uterine atony
due to metritis, incomplete separation of placental membranes, severe tenesmus, post partum
contractions intensified by oxytocin release during lactation.
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• 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 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.
• Acute uterine rupture treated by ovariohysterectomy.Uterine neoplasia
• Clinical signs may be abdominal enlargement or a palpable abdominal mass. If the tumor
obstructs the lumen mucometra or hydrometra may develop.
Treatment
• 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.
SURGICAL TECHNIQUE
• 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.
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• 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 subcuticular sutures and interrupted
sutures respectively.
OVARIOHYSTERECTOMY IN DOGS AND CATS
• Ovariohysterectomy, is the surgical removal of the uterus and ovaries under general anesthesia.
This procedure is typically performed around or prior to six months, but can be performed on
dogs of any age.
• The procedure may be elective, or a treatment for a disease process.
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
• Eradicates unwanted estrous behavior and associated bleeding
• 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 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.
Preparation of the animal
• Position the animal in dorsal recumbency or left lateral recumbency.

• Prepare the area aseptically.
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Procedure
• 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.
• The uterus and its blood vessels are ligated just above the cervix.
Uterine stump lig Holding the uterus
• The uterus and ovaries are removed from the abdomen. The abdomen is sutured closed in
three layers: the abdominal wall, the subcutaneous tissue (tissue underneath the skin) and the
skin itself.
Complications
• Ovariohysterectomy can lead to mild complications such as incisional bruising, swelling and
infection. More serious complications such as hemorrhage and urinary obstruction are rare but
can be life-threatening.
• Ovariohysterectomy can be more difficult in larger or obese animals and may be associated
with more complications.
Postoperative care
• 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 pyometra and dystocia.
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SPAYING
• Removal of the ovary is known as spaying.
Indications
• Prevent breeding nuisance

• Prevent development of pyometra , mammary tumor.
Age
• Above 6 months of age in case of dogs.
Anaesthesia
• Premedicate with atropine , followed 10 minutes by xylazine @1 mg/kg body weight.

• 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.
Preparation of the animal
• Position the animal in dorsal recumbency or left lateral recumbency. Prepare the area
aseptically.
Sites
• From a point a little behind the umbilicus backwards along the midline over a length of 3 -5
inches.
• 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.
• The incision may be ½ inch behind the last rib on the right flank and about 1 inch behind on the
left flank.
Technique
• 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.
• The ovarian bursa is opened and the ovary is removed learning the bursa.
• 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.
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Postoperative care
• Aftercare 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.
VAGINAL FIBROMA
Vaginal fibroma Vaginal hyperplasia
AFFECTIONS OF THE OVARY
Acquired ovarioan disorders
Ovarian cysts
• Follicular cyst: develop from graffian follicles Clinical signs include prolonged estrous with
bloody vaginal discharge, cystic mammary hyperplasia,
• Lutein cysts: from corpus luteum after ovulation, maybe associated with cystic endometrial
hyperplasia or 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.
Ovarian tumors
• Large tumors palpable in the cranial right or left abdomen.
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• Surgical treatment includes ovariohysterectomy
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
Vaginal prolapse/hyperplasia
• Vaginal prolapse/hyperplasia Ocuurs as a result of edematous enlargement of vaginasl tissue

during estrus or proestrous.
Vaginal prolapse / hyperplasia
• 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
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• Mannual reduction afetr episiotomy and suturing the vulval lips till edematous stage resorbs.
• Resection of the protruding mass with OHE is 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.
222
MODULE-33: SURGICAL AFFECTIONS OF UDDER AND TEAT
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the udder in large
animals.
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.
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.
• 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.
223
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.
Udder and teat abscess
• 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.
224
• 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.
NING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the udder in large
animals.
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.
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.
• 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.
225
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.
Udder and teat abscess
• 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.
226
• 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.
227
• 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.
SURGICAL TREATMENT FOR TEAT FISTULA
Anesthesia and control
• Local infiltration or ring block
228
Surgical technique
• Moussu's method
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.
229
MODULE-34: SURGICAL AFFECTIONS OF MAMMARY GLANDS IN SMALL ANIMALS
LEARNING OBJECTIVE
• The learner will be able to diagnose the various surgical conditions affecting the mammary
glands in canines.
MAMMARY NEOPLASIA
• 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 %.
Surgical anatomy
• 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.No Gland Blood Supply Lymphatic drainage

1 Cranial thoracic Inter-costal, Internal thoracic Axillary Lymph node
and lateral thoracic artery and
2 Caudal thoracic
veins
3 Cranial Cranial and Superficial Local lymph tract
Abdominal epigastric Vessels
4 Caudal Cranial and Superficial Local lymph tract and
Abdominal epigastric Vessels and Inguinal Inguinal Lymphnode
5 Inguinal Inguinal Inguinal
Mammary tumor
230
CLASSIFICATION
Tumorigenesis
• About 50 % of all the mammary tumors in dogs are 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
Mammary tumor
Signalment and History
Physical Examination
• Cytology
• Radiography
o Thorax Dorsoventral and abdomen for metastatic lesions. If the appendicular skeleton is
involved it may also be included for radiography
• Ultrasound
231
• Biopsy
o This includes Fine needle aspiration cytology (FNAC) and incsional biopsy. FNAC gives a
tentative pattern of the nature of tumor and confirmative diagnosis is made on a
histopathological examination.
TREATMENT
Surgery
• 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.
232
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 10th 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.
233

VSR 421 Regional Vet Surgery

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VSR 421: REGIONAL

MODULE-1: SURGICAL AFFECTIONS OF LIPS CHEEK AND TONGUE

MUSCLES - INNERVATION - PHYSIOLOGY

The muscles involved are

• Contribute little to active prehension

DISEASES OF THE LIPS

• Foreign body can be removed with forceps.

• Etiology: Fights , broken edged objects and other injuries

• Etiology: Automobile accidents and falls from heights.

Avulsion of lower lip in a dog

• Cheilitis – inflammation of lips -Lip fold pyoderma or intertriginous dermatitis; common in

Pendulous lower lip

EOSINOPHILIC ULCER DISEASE

• Manifested as a well-circumscribed, red-brown, ulcerated, alopecic, glistening area on the skin

FACIAL NERVE PARALYSIS

• The facial nerve, supplies motor fibers to muscles of the face.

CAUSES AND SIGNS

• Muscle nerve stimulation

Drooped lower lip

• The second procedure is a cheiloplasty procedure.

AFFECTIONS OF TONGUE - INTRODUCTION

• An examination procedure of the tongue is similar to that of the oral cavity.

The various disease conditions that affects the tongue are:

• Surgical excision and chemotherapy are of little value.

Glossitis, inflammation of the tongue is rarely reported in dogs and cats.

MODULE-2: SURGICAL AFFECTIONS OF PALATE

AFFECTIONS OF THE HARD PALATE AND SOFT PALATE

• The cleft is present at birth.

PHYSICAL EXAMINATION FINDINGS

WHAT SHOULD BE TAKEN CARE OF IMMEDIATELY?

DEFINATIVE TREATMENT - SURGERY

• Sliding bipedicle flap technique

CLOSURE OF PRIMARY CLEFTS INVOLVING THE LIP, PREMAXILLA AND NOSTRIL

COMPLICATIONS AND PROGNOSIS

• Dehiscence and incomplete healing are the most common complications.

ACQUIRED ORONASAL FISTULA

DEFINATIVE TREATMENT - SURGERY

Palate cleft repair by mucosal flap

MODULE-3: SURGICAL AFFECTIONS OF THE NOSE

• The following are the important affection of nose

Aseptic preparation and anaesthesia

NASAL POLYPS/NASAL POLYPI

• Polyps are generally multiple and of smaller in size

• Diagnosis is based on the following procedure

NECROSIS OF TURBINATE BONES

• It occurs occasionally in the horse but rarely in other species.

• Foetid purulent discharge, usually unilateral interference with respiration, manifested by a

• Favourable when the necrotic portion can be entirely removed

• Medical management not much effective

PARASITES IN THE NASAL CHAMBERS

• Diagnosis is based on the following examination

• There is no successful treatment but supportive measurements are as follows

• Traumatic wound in the nostrils

• Operation: A tracheotomy operation is performed to permit breathing as it is necessary to

FOREIGN BODY IN THE NASAL ACTIVITY

• Direct visualization with magnification

• Removal of the foreign body depends on the space and location

• Dorsal and ventral approach.

MODULE-4: SURGICAL AFFECTIONS OF GUTTURAL POUCH