SURGICAL CLINIC

Integrated educational activity

Course Sheet

Academic Year of enrolment:

2015/2016

Optional/Mandatory:

Compulsory

Degree:

5-year Single Cycle Master's Degree Programme in VETERINARY MEDICINE

Language:

Italian

Moduls:

ANESTHESIOLOGY

3 credits
OPERATIVE MEDICINE

2 credits
ATTIVITA' ORIENTAMENTO

1 credits
SURGICAL CLINIC I

3 credits
SURGICAL CLINIC II

2 credits

Credits:

Programme Year:

Hours of classroom activity:

145

Prerequisites:

Prerequisites for the integrated course of Clinical Surgery are the knowledge and the passing of the exams of the following disciplines: anatomy, physiology, pharmacology, surgical semeiotics, general pathology, surgical pathology.

AF code:

40001680

Assessment Methods

Verification of learning:

During the frontal teaching in the lecture hall, the student must demonstrate participation and attention. During the practical teaching activity, which will take place in small groups, the student must participate actively, paying attention to the procedures, demonstrating precision, order and sense of good organization, basic requirements for safe and effective surgery and anesthesia.
The exam will be final, oral and public on topics covered in the training. There is a wide possibility of demonstration by the student and evaluation by the teacher, of the degree of knowledge, for an assessment as objective as possible.
During the assessment of the learning, the student must demonstrate possession of knowledge that allows to apply original ideas in the surgical and anesthesiological context, useful to solve problems also related to new or unfamiliar subjects; the student must demonstrate capacity to communicate clearly and unambiguously with both specialists and non-specialists; the student must demonstrate acquisition of sufficient autonomy in the field of surgery and anesthesiology.

Teaching period

First semester

Objectives

The integrated course of Veterinary Surgical Clinic, including the modules of Clinical Surgery I, Clinical Surgery II, Anesthesiology and Surgical Medicine, aims to provide the basic concepts concerning knowledge and technical ability in surgery and anaesthesia in domestic animal.
The two courses of Surgical Clinic will focus on the symptoms, the diagnosis, the differential diagnosis and the treatment of the main pathologies of surgical interest of the various apparatuses. The clinical cases will be addressed through inspection, palpation and auscultation as well as any appropriate manual tests, and then move on to specific instrumental examinations such as radiography. The diagnosis, prognosis and possibilities of surgical treatment of the case will then be explained. The activities will be aimed at giving the student the ability to critically examine each clinical case presented, making use of the knowledge of the preparatory disciplines for the surgical clinic, in order to recognize the pathology responsible for the clinical symptomatology and to understand the proposed surgical therapies.
The course of Operative Medicine will illustrate surgical techniques, both manual and instrumental, aimed at the correction of pathologies of surgical interest, from the incision of the skin to the reconstruction of the tissues involved, including the operations of soft tissues and hard tissues. The notions of asepsis and antisepsis of the instruments and of the operative field will be explained and the main surgical instruments and equipment will be illustrated, including synthesis materials. The activities will be aimed at the acquisition of surgical techniques on the topics presented. In particular, in the first person, each student will perform access to the abdominal cavity and perform different types of sutures. Particular attention will be given to the management of the asepsis and the preparation of the material, of the surgeon and of the patient before the intervention.
The course of Anesthesiology will deal with the pharmacological and technical procedures necessary and appropriate to place and maintain a patient under general anesthesia or only in loco-regional anesthesia, in order to allow surgery. The various anesthetic agents will be illustrated and framed in the respective groups both from a chemical and a clinical point of view and will be explained how to use them in dedicated protocols for precise clinical situations. Information will be given, both theoretical and practical, on the anesthetic effects of the drugs that will be used from time to time and on the attention that must be placed to avoid or reduce unwanted side effects that characterize each of them.
The lessons of the above mentioned courses will be complemented by practical activities that will take place in the outpatient rooms and operating theaters of the Didactic Hospital of the Department of Veterinary Medicine, and from activities that will take place "in the field" at farms in the neighboring area.
At the end of the integrated course the student will have received the notions to perform a clinical visit from a surgical point of view, to recognize the pathology and issue appropriate diagnosis with relative prognosis, to identify the appropriate treatment and to choose the most suitable anesthesia protocol to the case.

Contents

Surgical Clinic
Clinical cases of large animals:
Locomot app (lameness at anterior and post limbs, contract muscular flexus phalans, fract I falan, break legam sesam dist, fract large sesam, podoflemm, cron, deviaz ang carpus, dorsal osteoperiostitis metacarpus, fract pyramid eminence, fract hoof , osteoperiost III metacarp, tenor flexor phalans, laceraz tend extens anter phalans and estens metacarpus, disloc dorsal patella, ectasia interfalan joint, metacarpal fract, tibia fract).
Digestive app (sialolithiasis, parotid duct, colic for intest obstruct).
Respir app (nasal stenosis, progressive ethmoid hematoma, laryng hemiplegia, pneumothorax).
Other app (upper lip paresis, radial nerve paresis, scrotal hernia, umbilic hernia, patent urachus, rectal prolapse, rectovaginal laceration, cutaneous fibrosarcoma, sores of various origins and sites).
Small animal clinical cases:
Locomot app (lameness at anterior and post limbs, hip dysplasia, rupt Achille’s tend, anterior cruciate leg rupture, patella luxation, tarsal-metatarsal dislocation, osteosarcoma humerus, coxo-femoral luxation, abnormal radio-ulna growth, fracture of femour, of tibia, of humerus, of radius-ulna, legam-carpal laxity, femoral trochlea flattening, aseptic femoral head necrosis, mandibular fracture, cleft palate).
Digestive app (sublingual gland ectasia, intestinal intussusception, gastric torsion dilatation, megaesophagus).
Respiratory app (pneumothorax, trachea rupture, diaphragm rupture, flail chest, secondary lung neoplasia, laryngeal obstruction, brachycephalic syndrome).
Urinary app (penile urethral prolapse, urolithiasis, hydronephrosis).
Other app (surgical splenopathy, perineal hernia, rectal prolapse, inguinal hernia, ascites, bite wounds, ulcers and sores, eye diseases).
Operative Medicine
Patient containment in various species of domestic animals. Principles of asepsis and antisepsis. Preparation of surgical instruments. Patient preparation and operative field. Definitions and principles of dieresis, exeresis, hemostasis. Catheterisms and drainages. Access to the chest and abdomen. Soft tissue synthesis media. Interrupted and continuous sutures. Main interventions for the digestive, respiratory and urinary systems. Management of wounds, sores and ulcers. Amputations. Hernie. Treatment of fractures of long bones, means of synthesis and their possibility of use. Principles of cancer surgery.
Anesthesiology
Terminology. Preanesthesia visit. Premedication: phenothiazines, alpha 2 agonists, benzodiazepines, opioids, butyrophenones, atropine. Induction: thiopental, propofol, dissociative anesthetics, alfaxalone. Intubation: laryngoscope and endotracheal tubes, laryngeal mask, errors and complications, species differences.
General anesthesia maintenance: inhalational anesthetics (isofluorane, sevofluorane, desfluorane), totally intravenous anesthesia (TIVA), partially intravenous anesthesia (PIVA). Neuromusc blockin agents.
Anesthesia monitoring: clinical monitoring, electrocardiography, pulse oximetry, blood pressure, capnography, temperature. Complications and their management, vasoactive amines. Hydroelectrolyte balance, infusion therapy and outline of blood gas analysis. Anesthesia equipment: gas supply systems, operating room safety, evacuation circuits, anesthesia devices, vaporizers, breathing circuits, infusion pump.
Acute, chronic and neuropathic pain. Pain therapy.
Anesthesia and loco-reg analgesia (lidocaine, mepivacaine, bupivacaine, levobupivacaine, ropivacaine). Anesthesia in the dog, cat, horse, farm animals, wild and unconventional.

Recommended Bibliography

Small Animal Surgery. T.W. Fossum. 5th Ed. Mosby, 2018.
Mechanisms of Disease in Small Animal Surgery. M.J. Bojrab. 3rd Ed. 2012.
Manual of Equine Practice. R.J. Rose. 2nd Ed. Sounders, 2000.
Adams & Stashak’s. Lameness in Horses. 6th Ed. Wiley 2011.
Essentials of Small Animal Anesthesia and Analgesia. Kurt A. Grimm. Wiley 2nd Ed. 2011
Equine Emergencies: treatment and procedures. Orsini J.A. – 3rd ed. Saunders, 2008.
Dirksen G., Grunder H.D., Stober M. Ed. PVI, 2004.

Teaching Methods

The topics of the program will be treated from the theoretical point of view in the lecture hall, followed by practical demonstration in the clinic, in the operating room and in the field.
During practical teaching, which will take place in small groups, the students will follow the clinical cases of patients present in the clinics and operating theaters or who, for the treatment of particular cases, will be presented on screen. Under constant supervision of the teacher of the course, the activities will be addressed at conferring the ability to critically examine each clinical case presented, to acquire the surgical skill and anesthesiological knowledge of general and loco-regional anesthesia that the patient should require.

Contacts/More Information

The teachers are available to receive interested students from Monday to Friday from 10:00 to 13:00, compatibly with other teaching, clinical and departmental assignments.

SURGICAL CLINIC

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SURGICAL CLINIC