1887

The adrenal glands

image of The adrenal glands
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Abstract

The increasing availability of advanced imaging techniques coupled with more veterinary surgeons (veterinarians) developing and refining the skills of ultrasonography has meant that adrenal masses are more frequently diagnosed and their removal contemplated. This chapter considers adrenalectomy, imaging, pre- and postoperative considerations, intraoperative management and the technique in cats. Practical tips and editors’ notes are highlighted throughout. Adrenalectomy including venotomy of the caudal vena cava.

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Figures

Image of 13.1
13.1 Anatomy of the adrenal glands and surrounding structures. Drawn by S.J. Elmhurst BA Hons (www.livingart.org.uk) and reproduced with her permission.
Image of 13.4
13.4 A 6-year-old Poodle bitch with pituitary-dependent hyperadrenocorticism. Note the abdominal distension, muscle wasting, alopecia and thin skin. (Reproduced from the )
Image of 13.7
13.7 An ultrasound image of an adrenal gland with normal dimensions. (Courtesy of J Shimali)
Image of 13.8
13.8 (a) CT image showing an adrenal mass invading the renal vein (arrowed). (b) CT image showing extensive abdominal metastases (arrowed) from a phaeochromocytoma.

(a, courtesy of F McConnell)

Image of 13.10
13.10 Haemostatic surgical clips.
Image of 13.11
13.11 Harmonic scalpel. ( Ethicon Inc.)
Image of The adrenal gland is exposed by carefully dissecting the peritoneum and fatty tissue away from the gland.
The adrenal gland is exposed by carefully dissecting the peritoneum and fatty tissue away from the gland. The adrenal gland is exposed by carefully dissecting the peritoneum and fatty tissue away from the gland.
Image of The phrenicoabdominal vein is dissected from surrounding structures and attachments. Vessels are ligated with haemoclips prior to being divided.
The phrenicoabdominal vein is dissected from surrounding structures and attachments. Vessels are ligated with haemoclips prior to being divided. The phrenicoabdominal vein is dissected from surrounding structures and attachments. Vessels are ligated with haemoclips prior to being divided.
Image of The adrenal gland is then removed and the surgical site examined for haemorrhage.
The adrenal gland is then removed and the surgical site examined for haemorrhage. The adrenal gland is then removed and the surgical site examined for haemorrhage.
Image of Removal of a left-sided adrenal mass with a thrombus extending into the vena cava. Rummel tourniquets are placed and a venotomy is made into the vena cava.
Removal of a left-sided adrenal mass with a thrombus extending into the vena cava. Rummel tourniquets are placed and a venotomy is made into the vena cava. Removal of a left-sided adrenal mass with a thrombus extending into the vena cava. Rummel tourniquets are placed and a venotomy is made into the vena cava.
Image of The thrombus and adrenal mass are removed en bloc. The Satinsky clamp is placed over the venotomy site, allowing restoration of blood flow once the Rummel tourniquets have been removed.
The thrombus and adrenal mass are removed en bloc. The Satinsky clamp is placed over the venotomy site, allowing restoration of blood flow once the Rummel tourniquets have been removed. The thrombus and adrenal mass are removed . The Satinsky clamp is placed over the venotomy site, allowing restoration of blood flow once the Rummel tourniquets have been removed.

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