Unit CLINICAL VETERINARY SURGERY I

Course
Veterinary medicine
Study-unit Code
GP005364
Curriculum
In all curricula
Teacher
Rodolfo Gialletti
CFU
7
Course Regulation
Coorte 2019
Offered
2022/23
Type of study-unit
Obbligatorio (Required)
Type of learning activities
Attività formativa integrata

VETERINARY ANESTEHESIOLOGY

Code 85008702
CFU 2
Teacher Sara Nannarone
Teachers
  • Rodolfo Gialletti (Codocenza)
  • Sara Nannarone
Hours
  • 3 ore (Codocenza) - Rodolfo Gialletti
  • 23 ore - Sara Nannarone
Learning activities Caratterizzante
Area Discipline cliniche veterinarie
Academic discipline VET/09
Type of study-unit Obbligatorio (Required)
Language of instruction Italian
Contents The aim of the course is to provide students with the basic knowledge required to choose the more appropriate anesthetic protocol according to the type of surgery, the ASA status of the patient (i.e. its clinical condition) and the species. Basic knowledge of pharmacology and drugs useful in anesthesia will be discussed, beside the practical management of anesthetic protocols in several clinical settings (surgery, diagnostic, emergency) .
Reference texts Main text: Bufalari Antonello & Lachin Adriano: Anestesia cane, gatto e animali non convenzionali
Other text useful for consultation of all other animal species:
Lumb & Jones' Veterinary anesthesia and analgesia.
for a deeper consultation on equine anesthesia:
Muir & Hubbel: Equine Anesthesia - monitoring and emergency therapy. 2009, 2nd ed. Saunders
Francesco Staffieri: Anestesia e analgesia locoregionale del cane e del gatto. Poletto editore 2013
Educational objectives D1 - KNOWLEDGE AND UNDERSTANDING ABILITY
The student must
- have knowledge of the molecules that can be used in anesthesiology, in terms of times and routes of administration, as well as their desired and undesired effects;
- have knowledge of the clinical and physiological parameters to be evaluated during the preanesthetic examination and their subsequent continuous monitoring, both clinical and instrumental, during anesthesia;
- know how the anesthesia machine works and the characteristics of the main respiratory systems that can be used for maintenance of general anesthesia;
- know the possible anesthetic maintenance techniques and the main loco-regional anesthesia techniques as an important analgesic aid.

D2 - ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING
At the end of the training the student must:
- Know how to perform a preanesthetic examination and assign the ASA status class;
- know how to do the functional test of an anesthesia machine by recognizing its main components;
- know how to choose the appropriate respiratory system to perform general anesthesia according to the patient
- know how to apply intra-operative instrumental monitoring

D3 - AUTONOMY OF JUDGMENT
At the end of the training the student will be able to:
- know how to choose the most appropriate perioperative anesthetic and analgesic protocol, based on the visit and any collateral exams performed;
- evaluate and interpret intra-operative clinical and instrumental monitoring
- know how to respond to tackle an intra-operative complication using drugs or particular clinical attention

D4 - COMMUNICATION SKILLS
At the end of the training the student will be able to:
- know how to organize, prepare and exhibit, to an audience composed of peers, a presentation on a hypothetical clinical case (animal to be chosen among small or large animals) with a specific history requiring anesthesia for diagnostic investigations or surgery (elective or in emergency), or able to explain a clinical case has personally handled during the rotation, starting from the clinical examination to the choice of the protocol to the intraoperative maintenance until the awakening of the animal.
- Support an adversarial process with people of equal preparation and experts on different issues, of a regulatory, scientific, procedural and / or technological nature;

D5 - LEARNING SKILLS
At the end of the training the student will be able to:
- consult and understand scientific texts, even innovative ones, bibliographic updates,
- possess a sufficient mastery of the subject to guarantee an acceptable basis for continuing professional development throughout life, through ongoing lifelong learning
Teaching methods THEORETICAL ACTIVITY:
- lectures in classroom on all the subjects of the course.

PRACTICAL ACTIVITY:
- practical activities with clinical cases referred to the OVUD where the group of students involved will have to:
* visit the patient and define its ASA status
* identify and discuss possible problems which could arise during anesthesia due to the concurrent disease and /or the surgical procedure
* define an anesthetic protocol which fit to the case, choose the moleculs and calculate the amount to administer
* surgically prepare the area and insert the intravenous catheter, administer preoperative medical tretment required (i.e. antibiotics and antinflammatory drugs)
*assist during premedication and induction phases, as well as during maintenance while recording vital parameters by means of clinical and instrumental support, recognizing the adequate phyiologic range in order to provide a safe anesthesia devoid of risks for the animal and the operators

- According to the availability of cadavers, wet-lab would be perform to improve skillness on :
* tracheal intubation,
* venous catheterization
If cadavers would not be available, dummies will be used.

SELF-DIRECTED LEARNING ACTIVITY:
- preparation of an "anesthetic plan" based on an hypothetic patient according to its history, lab exams and occurring disease and surgeli to be performed, so that they will provide description of:
possible complications, anesthetic protocol (drugs selected for each anesthetic phase: premedication, induction, maintenance, moreover drugs and fluids of support), perioperative analgesia, breathing circuit and elective monitoring.
Extended program - introducution to the course : preanesthetic examination, preoperative instrumental exams, ASA status (1,5h)
- Phases of anesthesia and balanced anesthesia. Anesthetic depth (1,5h)
- The anesthetic machine - notes on instrumental monitoring (2h)
- Breathing systems linear and circular (1,5h)
- Preanesthetic drugs: phenothiazines and benzodiazepine (1,5h)
- Preanesthetic drugs: alpha2 agonists and opioids (1,5h)
- Induction drugs: barbiturates, cycloexamines (1,5h)
- Induction drugs: propofol and alfaxolone. Inhalant anesthetics: halogenates (1,5 h)
- Introduction on pain evaluation on domestic animals (1,5h)
- Notes on farm animals anesthesia: equids, ruminants, swines (2,5h)
- Local anesthetics and main loco-regional techniques (1,5h)

DIAGNOSTIC IMAGING

Code 85008903
CFU 3
Teacher Francesca Beccati
Teachers
  • Antonio Di Meo (Codocenza)
  • Francesca Beccati
Hours
  • 3 ore (Codocenza) - Antonio Di Meo
  • 36 ore - Francesca Beccati
Learning activities Caratterizzante
Area Discipline cliniche veterinarie
Academic discipline VET/09
Type of study-unit Obbligatorio (Required)
Language of instruction Italian
Contents Allow students to improve the knowledge on the diagnostic imaging, the diagnostic possibilities of different diagnostic techniques such as radiology, ultrasound, CT, MRI and scintigraphy in domestic animals.
Reference texts Reef: Equine diagnostic ultrasound.
Kidd: Atlas of Equine ultrasonography.
Butler: Clinical Radiology of the Horse
Bertoni Brunetti Pozzi: Radiologia Veterinaria.
Educational objectives D1 - KNOWLEDGE AND UNDERSTANDING
The student must:
- have knowledge of the physical principles of the main diagnostic imaging techniques that can be used in domestic animals (ultrasound, CT, MRI, scintigraphy and fluoroscopy)
- have knowledge of the technical aspects of ultrasound, tomographic (CT and MRI) techniques, scintigraphic and fluoroscopic instrumentation used in veterinary medicine
- have knowledge of anatomy applied to individual imaging techniques in domestic animals
- have knowledge of the expression of diseases of surgical interest in the various diagnostic imaging techniques in domestic animals, including radiographic findings

D2 - ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING
At the end of the training activity the student must:
- know how to choose the most appropriate diagnostic technique for the type of pathology and according to the history and clinical examination of the animal
- know how to choose the best settings in the single diagnostic techniques to obtain the maximum amount of information
- be able to recognize the limits of diagnostic techniques and choose the most appropriate technique or techniques for further investigations

D3 - AUTONOMY OF JUDGMENT
At the end of the training activity the student must be able to:
- choose the most appropriate diagnostic technique according to the history and clinical findings in pathologies of surgical interest in domestic animals
- be able to interpret the identified diagnostic findings in terms of significance or incidental relief
- know how to recognize the limits of the techniques used and judge the choice of further investigations

D4 - COMMUNICATION SKILLS
At the end of the training activity the student must:
- be able to describe correctly and with adequate terminology the images of the different techniques (radiograms, ultrasounds, CT and MRI tomograms, scintigraphies)
- know how to organize, prepare and present a presentation of a hypothetical clinical case motivating the choice of diagnostic imaging techniques and describing the differential diagnoses based on images and the definitive diagnosis using the knowledge of anamnesis and clinical exam
- support a debate on the relevance or otherwise of the diagnostic findings identified

D5 - LEARNING SKILLS
At the end of the training activity the student must be able to:
- consult and understand scientific texts, bibliographic updates
- possess enough knowledge of the subject that allows him/her to continue professional updating throughout the profession through continuous training
Prerequisites
Teaching methods The course is organized as follows.
Lectures on some of the topics of the module programme Tutorial in operating theaters and examination rooms of OVUD.
The students according to the number are divided into groups for the practical work and for the Clinical Rotation and, possibly with the OVUD caseload, as regards the clinical routine cases while a group take place directly on the patient diagnostic procedures, another with the teacher, address conventional diagnostic procedures.
Particular attention will be paid to the logical approach of the diagnostic procedure in emergency or elective cases from the referred animals until the therapy and possible discharge of the
case.
Other information
Learning verification modality
Extended program Introduction to the course of diagnostic imaging;
Procedures and rules for the examination; Teaching materials; Interpretation of findings of musculoskeletal radiographic changes in the horse (60')
Principles of musculoskeletal ultrasonographic findindings and sonographic artifacts (60')
Computed tomography (CT) in small animals and horse (300')
Radiographic findings of musculoskeletal disease in the horse: developmental orthopedic disease and arthropathy (150)
Radiographic findings of musculoskeletal disease in the horse: Fracture (150)
Musculoskeletal ultrasound (muscles, tendons, ligaments, joint) (150'): application in the horse
Ultrasound examination of the hock and knee in dogs (60')
Ultrasound examination of the shoulder in dogs (60')
The use of fluoroscopy (30')
Abdominal ultrasound in the horse (90')
Ultrasound of abdominal parenchymal organs in the horse (90')
Ultrasound of umbilicus in foal (60')
Ultrasound soft tissues of the neck in the horse (60')
Thoracic ultrasound in the horse (90')
Ultrasoundd examination of the eye in the horse (30')
Magnetic Resonance Image: general principles (90')
Scintigraphy: general principles and application in the horse and small animal (60')

OPERATIVE MEDICINE

Code GP005396
CFU 2
Teacher Rodolfo Gialletti
Teachers
  • Rodolfo Gialletti
  • Sara Nannarone (Codocenza)
Hours
  • 23 ore - Rodolfo Gialletti
  • 3 ore (Codocenza) - Sara Nannarone
Learning activities Caratterizzante
Area Discipline cliniche veterinarie
Academic discipline VET/09
Type of study-unit Obbligatorio (Required)
Language of instruction Italian
Contents Knowdlege of the main surgical procedures in all apparatus of the domestic animals. The emphasis of this course is development of advanced understanding of relevant surgical procedures in small and large animals that lead to appropriate decision making. There will be particular attention on the principles of reconstructive surgery, intestinal surgery and determination of intestinal viability and postoperative care and complications associated with abdominal surgery. There are also an overview of upper respiratory airway, all procedures af the muscoloscheletral apparatus, uro-genital system, nervous system and eye and adenexa.
The lessons will be held by the professor and, for some particular topics, by other teachers who are experts in the subject to be discussed.
Reference texts Auer: Equine Surgery, V edition Saunders Ed. ISBN 0 7216 2860 5
Fossum: Chirurgia dei piccoli animali, Masson Ed. ISBN 88 214 2684 X
Slatter: Chirurgia dei piccoli animali, III Ed., Antonio Delfino Ed. Roma ISBN 88 72873347
The topics discussed on classes will be available on unistudium platform: https://www.unistudium.unipg.it/unistudium/
Educational objectives The course is the first dedicated to teaching all operative medicine of small and large animals.

D1 - KNOWLEDGE AND UNDERSTANDING ABILITY
The student must
- have knowledge of surgical procedure of small and large animal .

D2 - ABILITY TO APPLY KNOWLEDGE AND UNDERSTANDING D3 - AUTONOMY OF JUDGMENT
The main objective of the course is to provide theoretical and practical sessions to address the knowledge and techniques of surgical instrumentation an materials, and most common procedures in domestic animals.
The main focus of the knowledge gained will be mainly for the knowledge of operating rooms and surgical environments, the concepts of sterilization, antisepsis, surgical patient preparation and surgical instruments as well the knowledge of the techniques and conventional and minimally invasive surgical procedures
The main skills (ie the ability to apply their knowledge) will be the acquisition by the student to know practically instrumentations and surgical procedures in small and large animals.
D4 - COMMUNICATION SKILLS
At the end of the training the student will be able to:
- to organize, prepare and exhibit, to an audience composed of peers of equal, a presentation on a surgical pathology of pets with their own evaluations supported by appropriate arguments,
- support a cross-examination with people of both equal preparation (licensed professional) and experts in different subjects, of a regulatory and scientific nature, procedural and / or technological,
- demonstrate language properties in both written and oral form as well ability to employ sufficiently appropriate terminology for
a correct approach to the profession, also important for the purposes of interviews of work.

D5 - LEARNING SKILLS
At the end of the training the student will be able to:
- consult and understand scientific texts, including the innovative ones, bibliographic updates, so as to employ them in contexts not only usual for the practical profession, including research, but also originals, - possess a sufficient mastery of the topic in order to guarantee an acceptable basis to continue updating throughout his career through continuous education
Prerequisites In order to understand and to apply the main procedures of the course, students must have passed the examinations of Patologia Chirurgica. For some topics covered in the course will require the ability to interpret the x-ray and ultrasound images in order to follow the course with profit.
Teaching methods The course is organized as follows ..
Classroom lectures on the topics of the course 18 hours
Exercises in ambulatory and surgical suites of the OVUD. The students based on the number will be divided into groups and, possibly with the OVUD caseload, one group take place directly on the patient diagnostic procedures, another will be involved under the teacher supervision in the surgical procedures or therapies and critical care as appropriate. Particular attention will be focused to the logical approach of the clinical case from the referred animals until the therapy and possible discharge of the case necessary. 8 hrs student divided in small groups
Learning verification modality The exam includes an oral test and a possible reading test of medical images (practice).
The assessment tests are carried out through: A single examination
The test lasts about 30-60 minutes. The goal of the test is to identify the capacity of the student in identifying the diagnostic path to find causes and the therapeutic approaches of the main surgical diseases

Oral examination
The oral exam consists in the discussion of clinical cases or topics related to the teaching modules or topics of surgery of small and large animals, anesthesiology and diagnostic imaging with a discussion on the programs carried out in class and indicated in the reference texts.
The oral exam will also allow students to verify the student's communication skills with language properties and autonomous organization of the exposition of the same topics with theoretical content as well as to verify the medical terminology and the ability to connect with other clinical subjects.
The practical test consists in evaluating the basic interpretative abilities of some diagnostic cases (X-ray ultrasound and diagnostic level examinations) observed and carried out by the student during the practical exercises of the course.
At this point it is run an average of 3 votes which constitute the final score of the candidate
The final examination is oral
Student do not have limit at the attempts for examination of this course
Students have to successfully complete preceding examinations/subjects before starting this subject

Anyone wishing to improve their marks may sit the oral exam with the examination commettee.
For information on support services for students with disabilities and / or DSA visit the page http://www.unipg.it/disabilita-e-dsa
Evaluation criteria:

Below 18/30 Lack of possession of minimum knowledge of the subject, of detectable skills and abilities, difficulty in focusing the requested topic and bumpy exposure.

18-20/30 Inaccurate focus of the requested topic. Fragmentary knowledge. Uncertain exposure.

20-22/30 Identification of the topic. Essential knowledge. Correct exposure.
22-24/30 Identification of the topic, good interdisciplinary links. Neat and correct topic exposure

24-26/30 Good knowledge of the subject, contextualization and good interdisciplinary connections. Ability to make logical deductions and to argue effectively.

26 28/30 Good knowledge of the subject, ability of interdisciplinary and / or multidisciplinary connections. Ability to study in depth and personal contributions.

28 30/30 Excellent knowledge of the subject of the exam, high ability of interdisciplinary connections, precision and linguistic richness, exhibition originality
Extended program Modalities and rules for the exam session; teaching material
Introduction to the surgery
Surgery facilities sterilization, Antisepsis
Preparation on the surgical patient
sepsis; Sterilization; Post Operative management (1 hr)
Shock
Patient with trauma
Endotoxiemia (1 Hr)
Biomaterials Surgical theatre (1 Hr)
Surgical instrumentations
Surgical techniques
Suture Materials and patterns surgical techniques, (1 Hr)
Surgical implants and instruments
Laser in veterinary surgery
Wound management and repair
Surgical site infection and treatment
Drains, Bandages, External Coaptation (1 Hr)
Musculoskeletal surgical techniques: method of internal and external fracture fixation (1 Hr)
Gastrointestinal surgical techniques: surgery of oral cavity, oesophagus, salivary glands, stomach, intestine, rectum and anus, liver and biliary system (2 Hr)
Respiratory surgical techniques: upper and lower respiratory tract in large and small animals (3 Hr)
Urinary and reproductive system surgical techniques: surgery of kidneys, bladder, urethra, in small and large animals testicles, ovarian and perineum
Laparoscopy (1 Hr)
Opthalmic surgery (1 Hr)
Arthroscopy, tenoscopy, concept of joint treatments (1 Hr)
Rectal and rectovaginal tears (1 Hr)
Knee elbow and ankle disease small animals
Equine hoof diseases (1 Hr)
Tendons and Ligament diseases (1 Hr)
Angular limb Deformity (1 Hr)
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