Feline Soft Tissue and General Surgery

S. J. Langley-Hobbs, Jackie Demetriou, Jane Ladlow

• Publisher: Saunders Ltd.
• Year: 2013
• eBook ISBN: 9780702054204
• Topic: Medicine
• Subtopic: Veterinary Medicine

• Provides a comprehensive, detailed and up-to-date summary of all available information on all aspects of feline general and oncological surgery.
• Gives detailed practical information on how to operate on cats with medical conditions, internal disease and neoplasia.
• Gives access to website showing videoclips of key surgical procedures.
• International author team offers worldwide expertise and appeal.
• Lavish full-colour line drawings and photographs throughout.

Section 1

The perioperative period

Introduction

The success of a surgical procedure is reliant on thorough preoperative preparation and good postoperative nursing and nutrition, in addition to surgical technique. In recent years there has been an increased awareness of pain assessment and treatment in cats and also the development of cat friendly environments.

Initially, a thorough preoperative assessment of the patient is required and this is covered in detail in the first chapter in the book. Cats need a calm approach to assessment, and there are many aspects of both the physical examination and the environment in which the cat is examined that can be adapted to suit the nature of the cat.

The second chapter on anesthesia and analgesia focuses on cats with surgical diseases of the various organ systems including the thorax, abdomen, and head and neck. Analgesia of the cat should continue throughout the perioperative period. There have been big advances and progress made in the assessment of pain in the cat. Pain in cats is not always easy to detect, particularly as cats are often anxious and stressed due to their visit to the veterinarian. Pain scoring of cats should be something that is done routinely in both the preoperative and postoperative period. A cat that has had surgery performed should always be given the benefit of the doubt and given analgesia even if the signs of pain are not obvious. The subsequent two chapters are also focused on postoperative care. During the postoperative period the cat needs regular assessment to ensure it has a smooth recovery from surgery so complications are avoided, or recognized and treated promptly when they do occur. Thoughtful postoperative nursing can improve the recovery for the cat, and decrease the stress of hospitalization.

Surgical patients may require blood or blood products and the mechanisms and practicalities associated with giving a cat a blood transfusion are well described. If there is pre-existing blood loss or anemia, then the transfusion can be given preoperatively. If it is anticipated that there may be significant blood loss intraoperatively, then blood should be readily available in case it is needed. In either case the cat should be blood typed and cross-matched in preparation for a safe transfusion.

Cats that are unwell and hospitalized are not always keen to eat, and inappetent cats, particularly if overweight, are at risk of hepatic lipidosis. The importance of adequate nutrition and encouraging oral feeding cannot be overlooked and this topic is discussed in detail in the final chapter of this part of the book. Cats that eat postoperatively can usually be discharged more quickly and recover more swiftly.

Chapter 1

Preoperative assessment for surgery

V.R. Barrs and J.A. Beatty

Pre-operative assessment of the patient provides a solid foundation for a safe and successful surgical procedure. The assessment relies heavily on information obtained from a thorough history and physical examination. It establishes the baseline physiologic data for the individual, facilitates assessment of intercurrent disease and its potential relevance, identifies current medications that may need adjustment in the perioperative period and directs appropriate preoperative testing.

Arrival and history taking

Evaluation of the patient begins at reception. Sick cats often present for lethargy and inappetence regardless of their underlying disease. Cats should be observed in their carriers by staff on arrival to identify injured or dyspneic patients that require immediate stabilization.

History taking

Regardless of the surgical procedure planned, the clinician should familiarize themselves fully with the medical history. The history can be considered in two parts; the general history and the specific history. The general history involves collection of background epidemiological information for the patient (Box 1-1). Signalment should be confirmed. Owners may, unwittingly, provide inaccurate information on their cat's age, breed or sex. It should be ascertained whether the cat was acquired as a kitten or as an adult of unknown background. A reasonable estimate of age can be made in cats that are still growing (up to 18–24 months) and in geriatric cats if there is iris discoloration or age-associated disease, e.g., most cats with hyperthyroidism are over 10 years old. Information regarding the cats' living circumstances is important. Owners of cats living in apartments can usually provide detailed information on toileting, appetite and activity levels that owners of cats that roam will be unable to provide. Owners should be questioned about current medications with the drug, dose, frequency and time of last dosing being recorded. In presurgical patients, special attention should be given to medications that may affect coagulation (e.g., heparins, warfarin, aspirin, and clopidogrel) and wound healing (e.g., prednisolone).

Box 1-1 General history

An outline of questions to assist in obtaining background information

Confirm signalment (age, sex, breed)

Determine origin of cat

shelter/breeding cattery/pet-shop/stray?

geographic origin/travel history?

age when acquired?

Present environment

outdoor access? (free roaming/restricted?)

rural/urban?

other pets? (number/species/health status)

exposure to other animals?

toxin exposure?

Diet

amount and type including supplements and treats

ingestion of prey? (e.g., rodents, reptiles, birds)

Previous medical problems

type of illness, management, outcome

current medications (prescription, over-the-counter, holistic)

Vaccination and parasite control status

The specific history relates to the presenting complaint (Box 1-2). This establishes what abnormalities the owner has noticed, their duration and the pattern of disease. It is the responsibility of the clinician to find a way of communicating with each owner that best facilitates information flow. Although the problem might not be exactly what the owner perceives it to be, if a problem is reported, there almost certainly is one.

Box 1-2 Specific history

An outline of questions to assist in characterizing the presenting complaint

What is the presenting complaint?

Is this a recurrence of a previously investigated problem?

What were the first signs?

What is the duration of these signs?

Are signs intermittent or continuous?

Are signs static, progressive or resolving?

Present status

weight loss/gain?

activity level, demeanor?

appetite, water intake?

urination and defecation characteristics?

any gastrointestinal or respiratory signs?

Physical examination

A complete preoperative physical examination is essential to identify factors that may affect...

Table of contents

• Cover image
• Title page
• Table of Contents
• Dedication
• Copyright
• Preface
• Contributors
• Acknowledgments
• Section 1: The perioperative period
• Section 2: Diagnostics, equipment and implants
• Section 3: Oncological surgery and adjunctive therapy
• Section 4: Skin and adnexa
• Section 5: The abdomen
• Section 6: Thorax
• Section 7: The head and neck
• Index