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Preoperative assessment

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Abstract

The success or otherwise of a surgical procedure can depend largely on good planning, awareness of potential risk factors and selection of the appropriate procedure. It is therefore critical that thorough preoperative patient evaluation is performed in every case, to ensure that surgical risk is minimized and that the chance of a successful outcome is maximized. The chapter covers Taking a clinical history; Clinical examination; The critical patient; Clinical pathology; Diagnostic imaging; Other investigations; Establishing surgical risk; and Communication with the client. Also included are guides to performing the following techniques: Needle thoracocentesis; Abdominocentesis; and Diagnostic peritoneal lavage.

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Figures

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8.3 Lateral thoracic radiograph of a cat showing some typical findings associated with pneumothorax: a ‘floating’ cardiac silhouette, atelectasis of caudal lung lobes and straightening of diaphragmatic outline. In this case the cause of the pneumothorax was a tracheal lesion cranial to the carina, resulting in a one-way valve effect and ultimately rupture of the pulmonary parenchyma.
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8.4 Lateral thoracic and cranial abdominal radiograph of a cat showing loss of diaphragmatic outline and cardiac silhouette, dorsal displacement of lung fields and numerous tubular radiolucent structures within thorax. These findings are consistent with diaphragmatic rupture and the presence of abdominal viscera within the thorax.
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8.5 BMBT is a useful and simple preoperative test that many dogs will tolerate either conscious or with light sedation. It is important not to wipe off a forming clot inadvertently when blotting the site, as this will artificially prolong the BMBT. (See also Chapter 20.)
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8.7 CT scan of the tympanic bullae in a West Highland White Terrier with severe right-sided chronic otitis externa and media with para-aural abscessation. This is an example of an imaging procedure that can be followed immediately by surgery under the same anaesthetic.
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8.8 The presence of free abdominal fluid severely impairs radiographic interpretation. Ultrasonography could be considered as an alternative.
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8.9 Ultrasound scan showing lymph node enlargement in the mesenteric region of a patient with an intestinal carcinoma.
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8.10 Right lateral radiograph showing the pylorus in a dorsal position and gas-filled, while the fundus is also gas-filled and located caudoventrally. With these findings, gastric dilatation–volvulus is likely. A compartmentalization line is also seen, suggesting the presence of volvulus.
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8.11 This patient suffered prolonged urinary tract obstruction due to a urethral calculus. A ruptured bladder was confirmed with a positive-contrast retrograde urethrocystogram. At surgery the apical third of the bladder was necrotic, necessitating partial cystectomy to excise the devitalized tissue.
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Image of Reproduced from the BSAVA Guide to Procedures in Small Animal Practice.
Reproduced from the BSAVA Guide to Procedures in Small Animal Practice. Reproduced from the
Image of Reproduced from the BSAVA Guide to Procedures in Small Animal Practice.
Reproduced from the BSAVA Guide to Procedures in Small Animal Practice. Reproduced from the
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8.12 Biopsy should be part of any endoscopic examination of the gastrointestinal tract, as gross visual inspection is not accurate in identifying abnormal from normal. When taking biopsy samples from the gastrointestinal tract, caution needs to be exercised when sampling areas that appear diseased or abnormal or if taking multiple samples from a single site.
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8.13 Cutaneous mast cell tumour aspirate stained with Diff-Quik (original magnification ×1000).

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