Veterinary Surgical

A.Y. 2019/2020
8
Max ECTS
88
Overall hours
SSD
VET/09
Language
Italian
Learning objectives
The module aims to provide clinical-practical knowledge and skills in the management of surgical diseases, making use of the theoretical knowledge provided in previous courses. In particular, the objective of the module is that they acquire practical skills in diagnosis, staging, surgical therapy, communication of prognosis and possible alternative therapies of surgical lesions of dogs and cats. These skills will be acquired by attending the clinical care activity of the University Veterinary Hospital following the clinical diagnostic therapeutic path of the individual patient and discussing the diagnostic therapeutic choices made on a case-by-case basis. The student will acquire communication skills by interacting directly with the owner in all phases of the clinical management of the patient
Expected learning outcomes
The student will learn the main practical skills required in basic hospital activities, carried out in the various operating units of the Veterinary Teaching Hospital, and should be able to evaluate clinical and diagnostic information related to the clinical cases addressed, in order to make a diagnosis and to set an adequate therapeutic plan. The student must also be able to interact and communicate correctly with the patient's owner.
Course syllabus and organization

Unique edition

Lesson period
First semester
Prerequisites for admission
The module, divided into 8 CFU, includes:
- Frontal teaching (5 CFU) dedicated to the clinic of the main surgical diseases of small and large animals. The main objective of frontal teaching is to provide the epidemiological, physiopathological, clinical diagnostic, therapeutic and prognostic framework for each surgical disease.
- Practice 3 CFU (1 CFU = 16 hours/student)
The practice will be carried out in groups of 5/6 people directly at the Lodi University Veterinary Hospital both in small and large animal clinics, and in operating theaters. The practice will take place under the supervision of the teacher and with the possible collaboration of the structured and unstructured medical staff of the surgical clinic. Students will be directly involved in the clinical examination and in communication with the owner. During the practice the students will be admitted to the operating room and some will be directly involved in the execution of the operating procedures.
Assessment methods and Criteria
The lectures are organized as indicated in the lists below, dealing with the most common surgical diseases of small and large animals. Epidemiological data, etiopathogenesis, the most frequent clinical presentation (signs and symptoms), possible differential diagnoses, diagnostic and laboratory tests necessary for its classification, possible therapeutic options and prognosis will be reported for each disease. In order to interact effectively with the teacher, the student must have acquired the knowledge and skills of the previous courses (anatomy, topographical anatomy, pathological anatomy and clinical pathology, surgical and medical semeiotics, surgical and medical pathology radiology, operative medicine and anesthesiology). The student will learn how to approach the patient suffering from surgical pathologies and manage the possible differential diagnoses, the possible therapeutic choices, the possible complications in the short, medium and long term and the prognosis.
Finally, the student will have to demonstrate ability to communicate the skills acquired with appropriate terminology and to independently develop the concepts and insights on the subject of surgery.
The exam will consist of a written test with multiple choice questions (20 questions for each individual module. Each question has 5 possible answers of which only one is correct). The exam will take place in a computer room of the Polo di Lodi.
Clinica chirurgica dei piccoli animali
Course syllabus
The course consists of 16 hours of frontal lessons and 16 hours of pratical rotation clinical course. The frontal lessons are structured as indicated in the list below, treating the most common soft tissue surgical diseases of dogs and cats. The main epidemiological data, the etiopathogenetic, the most frequent clinical presentation (signs and symptoms), the possible differential diagnoses, the diagnostic and laboratory examinations necessary for its classification, the possible therapeutic options and the prognosis will be repeated for each disease. In order to effectively interact with the lessons, the student needs to have acquired knowledge and skills from previous courses such as anatomy, topographic anatomy, pathology and clinical pathology, surgical and medical semeiotics, surgical pathology and medical pathology, diagnostic imaging , surgical techniques and veterinary anesthesiology The student learns how to approach the patient suffering from soft tissue surgical pathology and manage the possible differential diagnoses, the possible therapeutic choices, the possible short, medium and long term complications and the prognosis.
The student will have to demonstrate to own knowledge and concepts that lead him to a correct differential diagnosis in order to establish the correlations and the connections between the different topics covered.
The student must demonstrate the ability to critically analyze differential diagnoses.
Finally, the student will have to demonstrate the ability to communicate the skills acquired with appropriate terminology and to develop in an autonomous way the concepts and in-depth studies on dog and cat soft tissue surgery
FRONTAL LESSONS

Introduction Preoperative evaluation of the surgical patient 0.5h

Introduction to the course
Study material and its correct use
Introduction Clinical core practice in surgery
Problem-oriented medical history
Clinical examination and laboratory data
Diagnostic approach of surgical diseases and categorization of surgical prognosis
Communication with the owner

Introduction to oncologic surgery 1.5h

Definition of local, loco-regional, and distant disease
Examples of oncological staging in clinical practice
Classification of oncologic surgery techniques
Surgical biopsy for each anatomical site: techniques and equipment

Skin surgery 3h

Clinical management of skin wounds
Complications of healing of cutaneous wounds
Reconstruction of skin defects: stress release techniques; local flaps, myocutaneous axial flaps, free flaps.
Cutaneous oncological surgery: mast cell tumor and soft tissue sarcomas

Ear surgery 1h

Surgical therapy of external-medium and internal otitis
Surgical therapy of neoplasms of the external-internal ear
Surgical therapy of the pinna

Oral cavity and oropharynx surgery 1h

Congenital and acquired fistulas
Sialoceles
Oral and pharyngeal tumors





Esophagus surgery 0,5h

Cricopharyngeal Dyshagia
Vascular Ring Anomalies
Foreign bodies and laceration
Stricture diverticula, fistulae
Neoplasia

Gastric surgery 1h

Hiatal hernia
Gastroesophageal intussusception
Foreign bodies
Neoplasia
Gastric Ulceration and perforation
Gastric Dilatation and Volvulus

Small intestinal surgery 0,5h
Foreign bodies: linear and no linear
Intussusception and mesenteric volvulus
Neoplasia

Ciecum, Colon and rectum surgery 0,5 h
Surgical disease of ciecum
Megacolon
Neoplasia of the colon
Atresia ani
Rectal prolapse

Perineum surgery 1.5h

Perineal hernia
Perianal and perineal neoplasms
Perinal fistulas
Surgical diseases of the anal sacs

Upper respiratory tract surgery 1,5h

Brachycephalic dog syndrome
Laryngeal collapse
Laryngeal paralysis
Tracheal collapse
Nasal planum, nasal cavity and sinuses (tumors)
Rhinitis and nasal foreign body

Low respiratory tract surgery 1h

Lung
Chest wall
Thoracic cavity: pneumothorax, chylothorax , pyothorax tumor
Diaphragmatic hernia and Peritoneopericardial diaphragmatic hernia


Urinary and ureter bladder surgery 2 h

Ectopia ureters
Surgical management of bladder and urethral lithiasis
Urethral prolapse
Bladder rupture
Bladder and urethral neoplasms
Diseases of the cat's lower urinary tract


Abdominal surgery 1h

Ventral abdominal hernias
Inguinal, scrotal and femoral hernias
hemoperitoneum
peritonitis


Pratical rotation clinical course (16 h)

a) Consultation rooms ((under supervision of clinical/academic staff)
First opinion vs specialized consultation vs postoperative recheck

- Recording of the patient
- Clinical History collection ( discussion)
- Physical examination vs specialized examination ( discussion)
- Proposal of differential diagnosis ( discussion)
- Discussion with clinical staff on the decisional algorithm for diagnostic procedures
- Follow the patient in the diagnostic procedures( X-rays, ultrasonography endoscopy etc..)
- provide a diagnosis, adequate treatment and prognosis
- Write the clinical report and drug prescription ( if needed)
-

b) Surgical theatre (under supervision of clinical/academic staff)

- Recording the patient
- Clinical History collection ( Discussion)
- Clinical examination for surgical treatment and anesthesiology protocol ( Discussion)
- Explanation of surgical treatment and anesthesiology protocol and possible complications ( Discussion)
- Cooperation in the owner consent taking for surgical treatment and anesthesiology protocol
- Discussion of the surgical treatment/technique, postoperative care and potential complications
- Discussion anesthesiologic and analgesic protocol based on surgical treatment plus postoperative analgesic protocol
- Preoperative- procedures for patient:
Preparation of the surgical site involves a series of steps such as clipping of hair, removal of dirt and oils, and removal of microbes.
Draping
- Preoperative procedures- surgical staff
Scrubs, scrubs hands and applications of specific surgical dress

- Preparation of the surgical site
- Assistant at surgical procedures/ performing some surgical procedures
- Planning postoperative care and communication with hospitalization service
- Follow/ recheck the patient in hospitalization service
- Write the surgical report
- Write the form for histopathologic exam ( surgical biopsy)
- Discussion with clinical staff of the surgical case/ cases.
- Write the clinical report and drug prescription ( if needed)

Students' reception: by appointment via e-mail
Teaching methods
The Module, divided into 3 CFU, includes:
- Frontal teaching (2 CFU - 16 hours) dedicated to the clinic of the main surgical diseases of small animals excluding orthopedic and neurological ones. The main objective of frontal teaching is to provide the epidemiological, physio-pathological, clinical diagnostic, therapeutic and prognostic framework for each surgical disease.
- Exercises (1 CFU - 16 hours)
The Veterinary Teaching Hospital of Lodi will be held in groups of 5-6 people both in the clinics and in the operating rooms. The exercise activity will take place under the supervision of the teacher and with the possible collaboration of the structured and unstructured medical staff of the surgical clinic. Students will be directly involved in the clinical examination and in communication with the owner. During the practical exercises the students will be admitted to the operating room and some will be directly involved in the execution of the operating procedures.
Teaching Resources
1. Veterinary Surgery: Small Animal Karen Tobias & Spencer Johnston Ed.2012 Saunders ISBN 978-1-4377-0746-5 Part Vol 1: 9996073696; Part Vol 2: 9996073637 (Lingua Inglese)
2. Small Animal Surgery 5th Edition; Theresa Fossum Hardcover ISBN: 9780323443449
Imprint: MosbyPublished Date: 29th May 2018 Page Count: 1584

The student, at his discretion, can consult the following texts for further information regarding pathophysiology and surgical therapies of small animal diseases:

- Mechanisms of Disease in Small Animal Surgery di M. Joseph Bojrab (Autore), Eric Monnet
(Autore) Editore: Teton NewMedia; 3 edizione (1 gennaio 2010) Lingua: Inglese ISBN-13: 978-
1591610380

- Current Techniques In Small Animal Surgery BOJRAB-WALDRON-TOOMBS 5° Ed., 1162
Pagg., 1000 Ill., TETON NEWMEDIA, Dicembre 2014 Lingua inglese ISBN 9781591610359

OTHER EDUCATIONAL MATERIAL
-Ariel: SI http://dstefanelloccpa.ariel.ctu.unimi.it/ (pdf of the slide utilized during frontal teaching)
Ortopedia e clinica traumatologica veterinaria
Course syllabus
1. Orthopedics
a. Approach to an animal with orthopedic disease. Pain, lameness, gait disorders.
Examination, how to perform it, how to interpret it
b. Diagnostic tests in orthopedics. Blood tests, ultrasound, radiography, CT, MR,
c. Traumatic Orthopedic diseases
d. Non traumatic orthopedic diseases
2. Surgical Neurology
a. Clinical approach to the neurologic patient. Neurologic examination. Partient with
spinal pain, paresis /plegia in the limbs
b. Diagnostic procedures in Neurology. Blood tests, ultrasound, radiography, CT, MR
c. Surgical diseases of the brain and skull
d. Surgical diseases of the spine
3. Acutely traumatized patient, clinical procedures according to the ABC approach
a. A as Airways: respiratory emergencies
b. B as "bleeding", hemorrhage, shock
c. C as CNS traumatic pathology. Brain and spinal trauma
d. D as digestive, abdomen
e. E as secretory, abdomen
f. F as fractures, fractures and orthopedic traumatic conditions. See 1.c
g. In particular a more in deep study is requested for a.b.c. and f.
Class lectures:
- Neurology and Neurosurgery
- Function and anatomy in brief of the nervous system: motor system, sensory system,
ventricular system and CSF
- Diagnostic procedures and diagnosis of nervous system diseases
- Surgical Brain pathologies, list of diseases with associated clinical sigs
- Hydrocephalus
- COMS (Caudal Occipital Malformation Syndrome) / "Chiari like syndrome" - Syringomielia
- Arachnoid diverticula
- Traumatic Brain Injury (TBI)
- Brain Neoplasia
- Spinal Diseases, anatomy of the spine, clinical signs associated with spinal pathology
- C1C2 (atlanto-axial) instability / subluxation
- Acute Spinal Trauma
- Disc herniation
- Caudal Cervical Spondylomyelopathy ("wobbler syndrome")
- Degenerative lumbosacral disease
- Spondylosis, DISH, degenerative joint disease of spinal synovial joints
- Vascular pathologies. FCEM (fibrocartilagineous embolic myelopathy - spinal infarct)
- Spinal tumors
- Dyscospondylitis
- Orthopedics and traumatology of the skeleton and joints
- Joint pathologies, classification, generality
- Arthritis - polyarthritis
- Shoulder conditions: anatomy and joint physiology. Shoulder dysplasia, humeral head OCD, scapular and shoulder luxartions, shoulder instability, shoulder muscles pathology (infraspinatus, supraspinatus, brachial biceps), shoulder salvage procedures
- Elbow conditions: anatomy and joint physiology. Congenital Elbow luxation, elbow
dysplasia (UAP, FCP, OCD, humeral-radio-ulnar incongruence), degenerative joint disease, elbow salvage procedures
- Hip conditions: anatomy and joint physiology. Hip dysplasia, Legg Calvée Perthes disease, degenerative joint diseases, hip salvage procedures
- Stifle conditions: anatomy and joint physiology. Patellar luxation, OCD of the femur, cranial and caudal cruciate ligaments rupture, degenerative joint disease, stifle salvage procedures
- Hock conditions: anatomy and joint physiology. OCD of the talus. Hock salvage procedures
- Fractures and traumatic conditions of the forelimb: from scapula to hand
- Fractures and traumatic conditions of the hindlimb: from pelvis to foot
- General Traumatology
- Acutely traumatized patient, how to approach. ABC approach to trauma
Teaching methods
The course is composed of 16 hours of lectures.
The main goal of the course is to learn the most common orthopedic, neurologic and
neurosurgical conditions, as well as to learn a modern approach to general traumatology in domestic animals, with a focus on small animals (dog and cat).
1. Orthopedic conditions are the first focus. The student has to learn a clinical approach, diagnostic methods and how to make a diagnosis and treat the most common orthopedic conditions of dogs and cats; some large animal diseases has to be known as well (mainly of the horse)
2. Neurologic and neurosurgical conditions of the spine and the brain are a second focus of the course. How to approach an animal with a surgical neurologic condition, how to make a neurologic examination, how to make a lesion localization. It is important to know the principal neurosurgical conditions of the spine and the brain
3. Some knowledge on general traumatology, how to approach an animal with a traumatic condition is required; triage concept, the ABC trauma approach has to be known.
Teaching Resources
- Lectures notes and keynotes
- SMALL ANIMAL SURGERY - Theresa Fossum, 5th edition, MOSBY, 2018
- Handbook of SMALL ANIMAL ORTHOPEDICS AND FRACTURE REPAIR, 5TH edition, 2016
- Piermattei's Atlas of Surgical Approaches to the bones and joints of the dog and cat. Kenneth Johnson. 5th edition, 2014. Elsevier
- Il trauma acuto nei piccoli animali. Brasmer. Edi Ermes
Clinica chirurgica veterinaria
Course syllabus
A - LECTURES
The lectures are organized as indicated in the list below, dealing with the most common surgical diseases of large animals. Epidemiological data, etiopathogenesis, the most frequent clinical presentation (signs and symptoms), possible differential diagnoses, diagnostic and laboratory tests necessary for its classification, possible therapeutic options and prognosis will be reported for each disease. In order to interact effectively with the teacher, the student must have acquired the knowledge and skills of the previous courses (anatomy, topographical anatomy, pathological anatomy and clinical pathology, surgical and medical semeiotics, surgical and medical pathology radiology, operative medicine and anesthesiology).

Surgical treatment of the equine limb wounds in the equine (1 hour)
Equine Hoof surgical diseases (1 hour)
Surgical aproach to horse abdominal diseases (2 hours)
Surgical aproach for equine tendon pathologies (1 hour)
Surgical aproach to the diseases of the horse's upper respiratory tract (2 hours)
Surgical aproach to dental pathologies in the equine (2 hours)
Surgical aproach to equine joint diseases (1 hour)
Surgical aproach for cattle foot lesions (2 hours)
Surgical aproach to bovine abdominal diseases (2 hours)
Surgical aproach to umbilical diseases in calf (2 hours)
Surgical aproach to ocular pathologies in domestic animals (2 hours)

B - VET LABS (1CFU - 16 hours / student)

Vet labs takes place at the University Veterinary Teaching Hospital with specific reference to:

- Patient registration
- Collection of anamnesis (discussion)
- Basic clinical examination vs specialist examination (discussion)
- Proposal for differential diagnosis (discussion)
- Discussion with clinical staff on the decisional algorithm for diagnostic procedures
- Follow the patient in diagnostic procedures - Issuing a diagnosis, adequate treatment and prognosis
- Preparation of the clinical report and prescription of drug therapies (if necessary)
- Clinical examination for the surgical and anesthesiological protocol (Discussion)
- Explanation of the surgical and anesthesiological protocol and possible complications (Discussion)
- Participation in the illustration of the informed consent to surgical and anesthesiological procedures to the owner
- Discussion on surgical / technical treatment, postoperative care and potential short, medium and long term complications
- Discussion of anesthesiological and analgesic protocol based on surgical treatment plus discussion / choice of postoperative analgesic protocol

- Preoperative procedures for the patient:
- Patient preparation (trichotomy, cleaning and disinfection)
- Preoperative procedures - surgical staff (hand scrub and specific surgical clothing applications)
- Preparation of the surgical site
- Assistance to surgical procedures / execution of some surgical procedures
- Planning of postoperative assistance and communication with the hospitalization service
- Follow / recheck the patient in the ward
- Preparation of the surgical report
- Preparation of the form for the histopathological examination (surgical biopsy)
- Clinical discussion of the case / surgical cases.
- Preparation of the clinical report and prescription of drug therapies (if necessary)
Teaching methods
The module is organized in 16 hours of lectures and 16 of wet labs for student. The student will learn how to approach the patient suffering from surgical pathologies and manage the possible differential diagnoses, the possible therapeutic choices, the possible complications in the short, medium and long term and the final prognosis.
Finally, the student must demonstrate the ability to communicate the skills acquired with appropriate terminology and to independently develop the concepts and insights on the subject of surgery.

Goals to be achieved
1) Knowledge and understanding:
The student will have to demonstrate knowledge of the pathogenetic basis of surgical diseases of domestic animals

2) Ability to apply knowledge and understanding:
The student must demonstrate that he is able to possess knowledge and concepts that allow him to independently propose the differential diagnoses referring to the individual clinical patient.

3) Autonomy of judgment:
The student must demonstrate his ability to correctly describe the injuries found and the results of the collateral tests performed.

4) Communication skills:
The student must demonstrate the ability to communicate the skills acquired with appropriate terminology and to independently develop the concepts on the subject of Veterinary Surgery
The lectures are held in the classroom with the help of slides. Students are invited to actively participate in the lesson on the basis of the knowledge acquired in the propedeutic subjects. The wet labs are carried out in the structures of the University Veterinary Teaching Hospital in small groups of students with direct interaction with patients admitted under the supervision of the teacher.
Teaching Resources
Ross, Lameness in the horse Saunders 2nd ed. 2011
Auer Stick Equine Surgery Lea Febiger 2018
Dirksen, Medicina interna e chirurgia del bovino Le point Veterinaire 2010
Clinica chirurgica dei piccoli animali
VET/09 - VETERINARY CLINICAL SURGERY - University credits: 3
Practicals: 16 hours
Lessons: 16 hours
Professor: Stefanello Damiano
Shifts:
Professor: Stefanello Damiano
Turno 1 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 10 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 11 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 12 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 2 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 3 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 4 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 5 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 6 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 7 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 8 per un gruppo di studenti
Professor: Stefanello Damiano
Turno 9 per un gruppo di studenti
Professor: Stefanello Damiano
Clinica chirurgica veterinaria
VET/09 - VETERINARY CLINICAL SURGERY - University credits: 3
Practicals: 16 hours
Lessons: 16 hours
Professor: Gualtieri Massimo
Shifts:
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 1
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 10
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 11
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 12
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 13
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 2
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 3
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 4
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 5
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 6
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 7
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 8
Professor: Gualtieri Massimo
Turno per un gruppo di studenti 9
Professor: Gualtieri Massimo
Ortopedia e clinica traumatologica veterinaria
VET/09 - VETERINARY CLINICAL SURGERY - University credits: 2
Practicals: 16 hours
Lessons: 8 hours
Professor: Lombardo Rocco
Shifts:
Professor: Lombardo Rocco
Turno per tutti gli studenti
Professor: Lombardo Rocco