My Friday night plans of studying with a film in the background after visiting the balloon festival vanished a few hours ago with a single phone call asking me to assist in an emergency surgery for a dog bleeding into the abdomen. 14 minutes later I arrived at the surgery to help prep the operating theatre and patient.
Now a bleeding abdomen is an emergency, as if untreated the animal can lose all its blood into the abdomen and die from blood loss (even though the blood is still insider the body). Generally this occurs from trauma, however there are circumstances where it occurs for other reasons such as the rupture of a tumour or complications after a surgery.
Generally our goal is to control the bleeding, and so anything we have that can tell us where the bleeding is coming from is good. Before I arrived the doctor had already done a ultrasound exam to confirm that there was indeed fluid in the abdomen, and was just finishing in x-ray, which is our case showed changes on the spleen so we were pretty certain this was where the bleeding was located.
Usually in a bleeding abdomen once you open it is a race against the clock to find and stop the bleeding. This is not easy when the entire abdomen is filled with blood and you cannot see much at all so have to rely on feel and knowledge of anatomy. In our case because we had localised it to the spleen this made surgery easier, as when you open the abdomen the spleen is one of the first things that you can see.
The blood vessels supplying the spleen were ligated (tied) and the spleen was removed from the body. The blood that had leaked into the abdomen was removed by suction and then we proceeded to flush the abdomen with sterile saline.
Sadly however there are only a couple of reasons for rupture of a tumour of the spleen, and here we still do not know which we are looking at. Proceeding to stabilise the patient post-surgery, we knew they were still alive because of us, and were given the best chance. However looking forward we do not know for how long as if the tumour is malignant then 2 month survival time is very low.
Today started with most of last night spent revising, so am relying heavily on coffee today. I’ve got two exams today both in physiology and anatomy, however as anatomy is such a big area this week (muscles of the head, neck and spine) I am going reschedule my physiology (or resit) it next week.
Anyways onto physiology when I got in today the test was at the start (previously it has been at the end) so did not get the opportunity to reschedule so will be resitting it later next week. The good news however is that I passed my last physiology credit test with 90% (which is a A) which was on the cardiovascular system. Todays session was on the examination of urine (called urinalysis) and looking at some of the methods used in looking at white blood cells.
Urinalysis is a great tool for diagnosis as it is simple, (generally) minimally invasive, and is relatively inexpensive. The test gives good indication of the kidney and liver health whilst also covering other diseases such as diabetes (did you know diabetes is a greek word?) too. Basically it requires a urine sample, the easiest of which is collected “free-flow” in a cup when the animal needs to go. If this is not possible a catheter can be used to collect urine directly from the bladder. In some cases a sterile sample may be needed which is usually taken by a process called cystocentesis where a needle is inserted through the abdomen into the bladder under ultrasound guidance with the animal sedated.
Todays anatomy test was on a big area with the muscles of the face & head, back and neck being covered. Despite knowing every muscle I fell at the first question as I had not learnt it by the groups the muscles are in. Duh! Well they say you learn from experience and this is one I will never forget… What was the question? Name the muscles of mastication (chewing).
Well I know these are the masster (deep and superficial parts), temporalis, pterygoidei (medialis and lateralis) and the digastricus.
Better luck next week with the diaphragm, abdominal muscles and respiratory muscles! I already know the diaphragm off by heart (no pun intended) so hopefully it should go ok!