Benha University
Faculty of Veterinary Medicine
Surgery department
5th Year Final Examination, January 2011
Regional Veterinary Surgery
Allowed Time: 3-Hours
THE MODDLE ANSWER
1- Choose only the incorrect statements from the following , correcting the underlined words in each of them and copy
them in your answer paper : ……………………………………………………………………………………………. (14- Marks)
1- Schiotz tonometer is usually used for the measurement of the intraocular pressure (IOP) to diagnose glaucoma.
2- The anterior chamber of the eye ball contains the aqueous humor, while the posterior chamber contains also
aqueous humor.
3- Alveolar periostits in equine may be complicated with empyema of the maxillary sinus.
4- The sharp enemal points in equines mainly occur along the lateral edges of upper cheek teeth and the medial
edges of the lower cheek teeth
567891011121314- Strangulated hernia in which the content are so compressed by the hernial ring or its neck that their circulation
might be arrested with subsequent gangrene.
1516171819202122- The pain test are used for diagnosis of traumatic reticulo-peritonitis include :Withers test , Going up and down
on a hill , and Percussion test.
23- Lingual mucosa resection is an operation mainly used for surgical correction of self - sucking in cattle .
242526- As the posterior lens capsule is firmly attached to the vitreous in domesticated animals , So, Extra-capsular lens
extraction is the most suitable technique used for mature rigid cataract surgery.
2728-
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Question Two: From the clinical signs, give your tentative diagnosis as well as your suggestion of treatment for each of the
following clinical cases: ………………………………………………………………………………………………… ( 16 – marks )
1- Diagnosis of the first case :Inversion of the urinary bladder
Treatment :
Washing the inverted bladder with a warm antiseptic solution. When the mucous membrane is swollen and edematous
apply astringent solutions as alum solution. Then reduce the inverted bladder. To prevent reoccurrence of the
condition a purse string suture is made around the urethral orifice in the vagina. This suture is tied lightly in order to
permit the urine to pass.
2- Diagnosis of the second case : Ruptured urinary bladder
Treatment :
In cases of ruptured bladder a para- median laparotomy cranial to the pubic bone was performed . The abdominal
cavity was gradually and carefully evacuated from the fluid inside . The urinary bladder was exposed outside the
wound and washed with saline. A catheter was passed through the neck of the bladder into the urethra to flush it with
normal saline to ensure the free passage. If there was any obstruction, a perineal urethrotomy or penis amputation
should be done. Then, the ruptured bladder was sutured with double rows of Lembert suture. This was followed by
intra-abdominal antibiotic application and the abdominal wound was closed as usual
3- Diagnosis of the third case : Inguinal hernia
Treatment :
The inguinal hernia of the bitch is easy to operate. The skin is incised for a 4 cm incision. The processus vaginales is
bluntly separated from the surroundings. Then it is folded with an artery forceps and twisted till its contents are
reduced in the abdominal cavity. Catgut ligature is applied at the base of the processus vaginalis and then cut it. The
ligature is fixed to the hernial ring. The skin is then sutured. When the hernia is incarcerated, herniotomy is
performed and reduce the content and complete the operation as mentioned before.
4- Diagnosis of the fourth case : Inflammation of the anal pockets
Treatment :
Evacuation of the anal pockets by introducing a finger inside the rectum and the other finger from outside, then press
the 2 fingers. The pocket is evacuated and the typical smell of the secretion is noticed. In recurrent cases removal of
the anal pockets surgically is indicated
5- Diagnosis of the fifth case : Cervical mucocele (salivary cyst, sialocele, honey cyst):
Treatment :
As the mucocele have no definite wall, their surgical excision appeared to be difficult. The cystic evacuation followed
by its injection with lugol’s iodine solution several times give encouraged results. They were appeared gradually
reduced in their size and recovery was obtained within 3-weeks from the first injection. The surgical treatment of the
mucocele necessitate the total extirpation of the mandibular and sublingual salivary gland with incision of cervical
mucocele .
6- Diagnosis of the sixth case : Sharp teeth (sharp enamel points)
Treatment :
The sharp enamel poinst are periodically rasped by a special tooth rasp.
7- Diagnosis of the seventh case : Keratitis sicca - keratoconjunctivitis sicca – dry cornea – xerophthalmia
Treatment :
1 - Artificial tear therapy, Methyl cellulose 1/2% is used.
2 - Surgical transposition of the parotid duct into the conjunctival sac.
8- Diagnosis of the eighth case : Pterygium
Treatment :
Superficial keratectomy is indicated. The conjunctival encroachment was dissected from the surface of the cornea.
This was followed by application of regaepithel eye ointment to regenerate the corneal epithelium.
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Question Three: Describe briefly on four only from the following surgical techniques ………………………............( 10 – marks )
a) An operation after Strub for tongue lolling in cattle.
A mouth gag is inserted, the tongue is grasped and raised. The fraenulum lingue is grasped with the hand, and one or
two rings (3-4 cm in diameter are clipped in place with ring forceps. When the animal tries to play with its tongue, it
will be painful and the animal gets accustomed not to play with it. The ring must be removed if it interferes with
feeding. It should be removed in any case after 6-months.
b) Omento-abomasopexy in cattle.
This techniques is used for correction of L.D.A. as well as the R.D.A.
Surgical procedures:
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Make a vertical skin incision ventral to the right para-lumbar fossa and adequate in length (15 to 20 cm)
for easy arm insertion.
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Perform a modified muscle spread of the abdominal wall.

It is strongly recommended to conduct a peritoneal cavity exploratory before abomasal manipulation.
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Using a 14- to 16-ga., 5- to 6-cm hypodermic needle with attached tubing or stomach tube(the free end of
the tubing should be outside the body cavity), deflate the abomasum of excess gas. Insert the needle into
the dorsal aspect of the abomasum. Removing excess gas is often needed to facilitate movement of the
abomasum under the rumen and into its normal position .

Place your left hand on the dorsal aspect of the displaced abomasum. With a combined sweeping motion
of the abomasum and a lifting of the rumen, bring the abomasum medially under the rumen and into its
normal position.
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Identify the greater omentum and retract it dorsally and caudally through the abdominal incision until the
thickened portion is closely allied to the pylorus. Grasp the omentum with two Backhaus towel clamps or a
Vulsellom forceps and retain it outside the abdominal cavity before placing sutures.

Optional abomasopexy suture.
a) Use heavy, synthetic non-absorbable suture material.
b) Initiate the mattress suture outside the body wall (previously prepared area of skin). Penetrate the body
wall with a large, curved, cutting-edge needle. Take a 2- to 3-cm bite of abomasal wall (omentum-free
tissue) and redirect the needle outside the body wall.
c) Then apply moderate tension to the suture ends to bring the serosa of the abomasum in contact with the
peritoneum. Triple-tie a surgeon’s knot, leaving the ends 5 to 8 cm long.
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Omentopexy:
a) Using medium chromic catgut No. 3-0, place two matterss sutures, one caudal and one cranial to the
ventral aspect of the abdominal incision. They should include the peritoneum, transverse and internal
oblique muscles, and both layers of the greater omentum.
b) The peritoneum and transverse and internal oblique muscles are sutured in a continuous pattern.
c) A small bite of the greater omentum may be incorporated into the suture line on the ventral aspect of the
incision. This bite stimulates further adhesions of the omentum to the peritoneum.

Suture the external oblique muscle and subcutaneous tissue with medium chromic catgut No. 2-0 or no. 30 in a continuous pattern. Suture the skin with a synthetic non-absorbable suture material using an
interrupted or a continuous interlocking pattern.
c) Andre’s technique for rumenotomy in large ruminants .
Follow to laparotomy incision , the rumen is reached, then grasped with the hand and a large fold is taken out
through the abdominal wall incision. Two strong ruminal forceps are applied to the upper and lower edges of the fold
of the rumen and well fixed by an assistant, so that the ruminal fold must kept outside the abdominal wound.
A sterile towel is placed around the protruding portion of the rumen to protect the abdominal cavity from
contamination. A vertical incision is then made in the wall of the rumen by means of a scalpel and widened by a
scissors. Each lip of the rumen wound is grasped by an artery forceps in the middle and the wall of the rumen is kept
over the towel so that no ruminal contents should fall into the abdominal cavity during evacuation of the rumen .
Then, the operation is completed as previously mentioned in Weingarth’s technique.
d) Trephining of the Superior maxillary sinus in equine.
With the head vertical, trephine about 4 cm cranially from the distal extremity of the facial tubercle and about 2.5 cm
medially.
Procedure:
1. The skin is prepared for aseptic operation. A circular area of skin is then excised by cutting around a coin. There
is little subcutaneous tissue over the frontal and inferior maxillary sinuses, but it is necessary to clear the
superior levator labial muscle from the anterior maxillary site. A branch of the facial vein crosses the area may
require ligation.
2. The periostium should be scraped by means of a curette for exposing the bone .
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3.
Determine the exact site of the bone to be removed and perforate the centre by the aid of bone gimlet, where the
nail of the trephining machine is to be lodged .
4. A circular segment of the bone corresponding to the contour of the crown of the machine is removed by playing
the trephining machine in a rotatory movement .
5. The detached disc of bone is usually come away inside the crown. If dropped into the sinus, it can be removed by
means of a forceps.
In case of empyema of the frontal sinus, the inferior maxillary sinus will be trephined also for drainage by
breaking down the septum between the latter and the superior maxillary sinus. Irrigate the sinuses with warm
saline solution then disinfect with a mild antiseptic solution using rubber tubing attached to a funnel .
e) Bloodless method for Castration in small ruminants .
Bloodless method either by crushing the spermatic cord from outside using burdizzo or by application of an
elastic ligature around the neck of the scrotum, suppressing the nutrition to the testicles by using elastrator
Question Four: Give a brief account on five only from the following : ……………………………………………….. (10 – marks )
a) Lachrymal sac histoplasmosis in donkeys .
The disease frequently recorded in donkeys of Upper Egypt. Histoplasma farciminosum or capsulatum are considered
the causative agent of the condition.
Symptoms: In the early stage: The medial part of the lower eyelid becomes swollen and inflamed . The lower puncta
lachrymal becomes dilated and granulomatus tissue started to protrude from it . In other cases, both upper and lower
puncta lachrymals are affected .
In the advanced cases: the granulomatus tissue appeared in the form of tumour like swelling filling the medial
canthus of the eyeball . and may be extend to cover the whole cornea . This granulomatus tissue is rosy red in color,
friable, vascularized and easily detached Muco-purlent discharges is noted to soiled the skin below the medial
canthus of the eye or it may be observed at the nostril of the same affected side, as it is exuded through nasal opening
of the naso-lachrymal duct.
Treatment:
In the early stages of the disease, the treatment was restricted to the pressure by the thumb and index fingers
over the lachrymal sac to squeeze its content . This is followed by curetting of the lachrymal sac and the upper portion
of the N.L. duct through the dilated puncta lachrymal.
Flushing of the N.L.D. through the nasal opening is necessary to remove the remnants of the granulomatus
friable tissues collected in the lachrymal sac and duct. In advanced cases surgical excision of the friable
granulomatus swelling using blunt scissors is indicated . Injection of antibiotic solution through the dilated punctum is
also indicated
b) Atheroma of the false nostril in equine.
An atheroma is a sebaceous cyst that forms in the caudal portion of the false nostril in the horse. Its development
occurs between the mucous membrane lining of the false nostril deeply and the skin superficially. Atheromas may
occur unilaterally or bilaterally. They vary in size from that of a small pigeon’s egg to as large as a tennis ball. The
contents will also vary, most frequently being a thick, oily, gray material. Which composed from dead epithelial cells,
fat substances and fine hairs.
Their presence, when small, does not interfere with any vital functions of the animal; but as an atheroma
grows larger, it may interfere with air flow on that particular side of the nostril. If They are bilateral they may become
a significant factor in respiration. Since they are cysts, aspiration of the contents is transitory in effect, and the cyst
will again fill up with fluid. Diagnosis is based on observation of the part, its location, and the fact that it is rather soft
to the touch. Since small cysts do not interfere with vital function, usually no attempt is made to correct these.
However, when they do grow larger, they should be removed.
c) Surgical exposure of the cervical esophagus in a horse .
It is a surgical technique in which the oesophagus is exposed without opening of its wall and pushing the foreign body
towards the pharynx.
In horses: The exposure of the oesophagus in the upper ¾ of the of the cervical region was performed through the
ventro-lateral exposure. The incision is performed between the sternocephalic muscle and trachea.
The lower ¼ of the cervical oesophagus can be exposed by the lateral exposure technique at the jugular
groove between the jugular vein and sternocephalic muscle or between that vein and brachiocephalic muscle.
d) Teat fistula in a cow .
Teat fistula (milk fistula), is an opening in the wall of the teat, connecting the exterior to the teat canal and
characterised by persistant outflow of milk. Such fistula may be congenital or acquired. It is mostly acquired as a
result of penetrating wound that extend to the teat canal or cistern and fails to heal completely because of the
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continuous drainage of milk. Fistula will vary in size from that one which is so tiny and difficult to locate to large ones
through which the mucous membrane may be seen.
Symptoms:
The outstanding signs consist of the fistulous tract and milk coming through it at milking time.
Treatment:
 Anaesthesia can be obtained by a ring block at the base of the teat or local infiltration anaesthesia of the
wound edges using 1% solution of procaine hydrochloride.
 The entire area is prepared for aseptic surgery by washing the field of the operation with soap and water,
swap with alcohol. Tincture iodine should never be used because of its marked irritant effect.
 Apply a suitable tourniquet as rubber tube of the blood transfusion set at the base of the teat as much high as
possible to secure haemorrhage during the operation.
 The wound edges should be, if necessary, debrided before suturing. If the fistula is old and the tissue around
it have healed, the tract should be excised before suturing.
 Apply a teat siphon to guard against injuring tissues of the other side and to avoid excessive trimming.
 The teat fistula is then sutured after dusting the site with an antibiotic powder. The suture is carried out in
two rows including all layers with the exception of the mucosa. The apposition must be complete and firmly
held in place as milk seepage will cause the fistula to recur.
 A teat bougie is applied to prevent adhesion of both sides of the teat cistern.
 An Elastoplast or elastic adhesive bandage is wrapped around the teat to reduce milk pressure on the
sutures and by virtue, to protect the wound.
 The tourniquet is then removed. The skin stitches may be removed in 10-14 days post operatively. Remove
the bandage after 5-7 days.
Frequent siphoning of the milk followed by. Intra-mammary infusion of Terramycine udder ointment to guard
against mastitis. Apply the teat bougie. Care must be taken that it is contra-indicated to carry out such surgery if
mastitis is supervening or the lips of the wound are oedematous. This should be first treated before the surgery. It is
also preferable to be performed in non-lactating season.
e) The favorable form of the perforating abdominal wounds.
It is the Perforating abdominal wounds with prolapse of the omentum:This form is favourable owing to the fact that
the omentum closes the wound and prevent any infection to go inside.
Treatment: The prolapsed part of the omentum should be slightly withdrawn and thoroughly washed with saline
solution or warm water. A ligature is made at its base and the protruding part should be cut. The abdominal wound is
then sutured in several layers after local application of antibiotics. The prolapsed part of the omentum should be
returned into the abdominal cavity before suturing.
f) Odentolithiasis .
It is the deposition of greyish brown deposit on the tooth near the gum. It is a firm and smooth layer of calcium
phosphate and carbonate mainly present on the buccal and lingual surfaces of the tooth.
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Causes:
The condition is commonly encountered in animals getting little teeth exercise where these animals received easily
prehinsed food that requires no tearing or growing which is very essential for self cleaning of the teeth.
Presence of leptothrix microorganism in the oral cavity act as a predisposing factor for the condition.
Complications:
The deposits are first present at the neck , then encroaches on the crown and root of the teeth causing their
separation from the gum .
The former sign greatly predisposes for food accumulation between the root of the tooth and the gum setting up
alveolar periostitis where the offensive odour is usually coming out from the mouth.
Treatment:
Scrapping of the dental tartar by means of tooth scalar or curette.
Washing the oral cavity with potassium permanganate 1/1000 or H 2O2 1/5.
Touch the gum and the scrapped area on the tooth with glycerine iodine.
If alveolar periostitis supervened extraction of the affected tooth is indicated.
GOOD LUCK.
PROF. DR. SAMY F. ISMAIL
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