Laurea Magistrale a Ciclo Unico in Medicina Veterinaria

The purpose of this teaching is the reasoned and progressive learning of the correct clinical approach to the surgical disease of small domestic animals, inherent to the musculoskeletal, cardiovascular and respiratory systems. This acquisition needs the correct clinical and instrumental interpretation of the local and systemic alterations induced, in small animals, by pathological changes affecting the districts considered. The understanding of the pathologies of surgical interest, the signs that accompany them and the methods of intervention will be supported by the contextual study, within the module of applied anatomy, of the clinically relevant aspects of regional anatomy. In relation to what has been described above, the purpose of this teaching is to ensure that those who attend it are able to choose the most appropriate anesthesia technique, drugs and monitoring for the clinical condition present for both small and large animals. Scope of thi course is also: to illustrate the orthopedic instrumentation; to explain the Fracture Patient Assessment Score method; to explain the fracture reduction techniques; to define the indications and application technique of a bandage; to define the indications and explain basic techniques of internal fixation; to define the indications and explain basic techniques of internal fixation; to define the indications and explain basic techniques of external skeletal fixation.In the same way, the purpose of this course is the knowledge of surgical materials and instruments, of the principles of asepsis, of disinfection / sterilization techniques, of the structuring and organization of surgical rooms and of the operators' clothing and dressing methods.

MD Anesthesiology Understanding of factors that influence safety in anesthesia, knowledge of anesthetics, their effects, basic anesthetic techniques and most common equipment in use in veterinary anesthesiology. The teaching allows you to achieve the following portfolio skills:
EQ_1.30_1: The student assesses the animal prior to performing the sedation or anesthesia
EQ_1.30_2: The student calculates and applies correctly the most adequate sedation and anaesthetic protocol to the animal demonstrating that is able to use at least the following drugs: Butorphanol, Diazepam, Midazolam, alpha-2 agonists, dissociative agents, barbiturates, inhalant anaestethics
EQ_1.30_3: The student induces the anesthesia correctly and knows how to place an endotracheal tube
EQ_1.30_4: The student maintains the anesthesia correctly using the monitoring equipment to prevent poor patient outcome and contributes to oxygen delivery to tissues, acid-base balance, and anaesthetic triad of narcosis, analgesia and muscle relaxation
EQ_1.31_1: The student recognizes or assesses the pain with the proposed scale in the clinical daily record
EQ_1.31_2: The student is familiar with the most important analgesics used in the hospital on horses
EQ_1.31_3: The student is able to calculate and dose the analgesia in a patient within the hospitalization
EQ_1.32_1: The student recognizes and understands when the euthanasia is ethically and scientifically justified in a horse
EQ_1.32_2: The student performs a simulated euthanasia on a mannequin head. The student is expected to describe all measures adopted before and after inoculation of euthanasia solution
CA_1.30_2: The student plans a perioperative anaesthetic/analgesic drug protocol based on the animal condition (weight, mental status, etc.) and the surgical/diagnostic procedure, being able to justify his/her choices
CA_1.30_3: The student knows how to properly use the most common instruments of the anesthetic equipment for dogs and cats and is able to check and set up a basic anesthetic trolley
CA_1.30_4: The student knows how to induce the anesthesia correctly and to place an endotracheal tube
CA_1.31_1: The student knows the main behaviors which might suggest a painful state in dog and cat
CA_1.31_2: The student identifies the most important drugs and techniques to provide pain relief in dog and cat
CA_1.31_4: The student knows how to use a pain scale
These skills are provided in the theoretical lessons of the course and in the exercises, therefore they are considered acquired upon passing the exam. Validation on the portfolio of these skills must be requested from the prof. Paolo Franci and Elena Lardone.

Operative medicine Knowledge of surgical materials and instruments, of the principles of asepsis, of disinfection/sterilization techniques, of the structuring and organization of surgical rooms and of the operators' clothing and dressing methods. Knowledge of basic surgical techniques in relation to the various systems and tissues (hard and soft). The teaching allows you to achieve the following portfolio skills:
EQ_1.16_2: The student shows confidence and handles hospitalized horses in a safe manner
EQ_1.28_1: The student wears correctly gloves, gowns, footwear, headcovers and surgical facemask in the surgical room
EQ_1.28_3: The student assists the preparation of the surgical instruments and correctly prepares the sterile tools of equipment
EQ_1.28_4: The student clearly identifies and holds correctly at least the following surgical instruments: needle holder, blades, scalpel handle, scissors (Mayo & Metzenbaum), courettes, forceps (Babcock, Allis, Mosquito), Backhaus towl clamps &retractors (hand -held, Gelpi & Weitlaner)
EQ_1.28_5: The student names the suture material and selects the appropriate type of suture and needle for the proposed surgical need
EQ_1.29_1: The student assists the surgeon performing a sterile surgical procedure (laparotomy, castration, arthroscopy, wound repair, osteosynthesis surgery)
CA_1.28_1: The student correctly wears gloves, gowns, footwear, head covers and surgical facemask
CA_1.28_3: The student clearly identifies and holds correctly at least the following surgical instruments: needle holder, blades, scalpel handle, scissors (Mayo & Metzenbaum), courettes, forceps (Babcock, Allis, Mosquito), Backhaus towel clamps & retractors ( hand-held, Gelpi & Weitlaner)
CA_1.28_4: The student names the suture material and selects the appropriate type of suture and needle for a proposed wound closure
CA_1.28_5: The student sutures a wound at least with the following suture pattern: interrupted (simple interrupted & simple and cruciate mattress) and continuous (simple continuous, continuous lock or Ford interlocking, Cushing, Lembert)These skills are provided in the theoretical lessons of the course and in the exercises, therefore they are considered acquired upon passing the exam. The validation of these skills on the portfolio must be requested from Prof. Gessica Giusto.

MD Semeiotics and clinical surgery I Knowledge of the nosology of the main surgical diseases of the musculoskeletal and respiratory systems of small animals and their clinical and diagnostic classification. The problem-oriented approach method is used, which is based on: collection of reports and anamnesis; BOA (Breed Oriented Approach) method, clinical findings, differential diagnosis, collateral investigations, definitive diagnosis, therapeutic options. The teaching allows you to acquire the following portfolio skills:
CA_1.29_1: The student knows how to remove a skin knot and perform a cystotomy, enterotomy/enterecomy, and splenectomy
CA_1.29_3: The student knows how to perform a laparotomy
CA_1.17_34: The student successfully completes a gait examination and identifies at least the following gait abnormalities: lameness, head bobbing, and limb circling
CA_1.17_35: Student correctly completes a gait exam and identifies at least the limb affected by lameness
CA_1.17_36: The student correctly differentiates a neurological lameness from an orthopedic lameness
CA_1.17_37: The student correctly understands the diagnostic and therapeutic priorities in a trauma patient suffering from fractures
CA_1.17_39: The student correctly identifies the presence of limb deformities
CA_1.17_40: The student correctly identifies muscle atrophy by palpating the muscles
CA_1.17_41: Student identifies pathognomonic lameness
CA_1.17_43: The student correctly evaluates hip instability (using the Ortolani sign)
These skills are provided in the theoretical lessons of the course and in the exercises, therefore they are considered acquired upon passing the exam. Validation on the portfolio of these skills must be requested from the prof. Bruno Peirone and Matteo Olimpo.

ABILITY TO APPLY KNOWLEDGE AND COMPREHENSION
Ability to reach a diagnostic hypothesis and/or to prepare an anaesthetic, diagnostic or therapeutic  protocol in a clinical case setting.
Ability to choose a particular surgical technique or surgical approach, and the appropriate suture material.
Acquisition of a working strategy allowing the achievement of the determined goal (diagnosis, therapy), and to apply it again to new clinical cases, in terms of surgical and anaesthesiologic procedures, materials and drugs.

JUDGEMENT AUTONOMY
Ability to identify the diagnostic protocol or to reach a diagnosis by excluding all other differential diagnoses.
Ability to discriminate among different surgical materials, techniques and protocols.
Ability to express an overall judgement on a clinical case, based on the critical evaluation of history, clinical signs, diagnostic results, also comparing them with a literature review.

COMMUNICATION SKILLS
Ability to talk with other colleagues using an appropriate and unequivocal language.
Competence in dealing with the problem and ability to pass on the information.

LEARNING SKILLS
Acquisition of a clinical method for studying and for mental elaboration of the obtained data able to facilitate and encourage the acquisition of further data.

MD Semiotics and Surgery I: clinical and diagnostic overview of the main surgical diseases of the muscle-skeletal and respiratory apparatus in companion animals. The Problem Oriented Approach is applied based on: signalment and clinical history; Breed Oriented Approach (BOA), differential diagnosis, ancillary diagnostics, final diagnosis, therapeutic options.

1) Muscle-skeletal apparatus: main traumatic articular diseases, dysplastic articular diseases in growing animals, cruciate ligament rupture, patella luxation, traumatic muscular diseases are considered. The diagnostic protocol to identify and interpret lameness, based on gait evaluation, orthopaedic examination and ancillary diagnostic imaging procedures are explained.

Practical part: interactive clinical cases on power point presentation.

2) Respiratory apparatus: main diseases of the upper respiratory apparatus (in brachycephalic and not brachycephalic breeds) are presented. Diseases of the pleural and pericardial space, diseases of the thoracic wall (pneumothorax, pleural effusion). Clinical signs evaluation, diagnosis and treatment will be explained.

Practical part: presentation and discussion on clinical cases on the subject.

Particularly (the following competences can be acquired either during theoretical lessons, training or clinical rounds):

- identification of the following gait abnormalities: lameness, head swing and limb circling;

- how to perform a gait examination and at least the limb affected by lameness and how

differentiating a neurological lameness from an orthopedics one;

- identify diagnostic and therapeutic priorities in a traumatized patient suffering from fractures;

- how to identify the presence of limb deformities;

- how to identify muscle atrophy by palpation of the muscles;

- identification of pathognomonic lameness;

- correct evaluation of hip instability (using the Ortolani sign);

- differential diagnosis based on age, race and localization of pain;

MD Applied anatomy: theoretical-practical module looking at the regional anatomy of the main domestic species, mainly pet Carnivores and horse, aimed at performing imaging procedures, knowing the physiologic consequences of diseases and the interpretation of clinical sing of the surgical diseases. The theoretical part of the course aims at promoting an inductive attitude of the student towards the study of anatomy, so that, starting from the presentation of clinical cases, a link to the descriptive anatomy knowledge could be possible.

Practical part on cadavers: applied anatomy of head and neck, thorax, abdomen, limbs.

Except for the MDs Anaesthesiology and Applied anatomy, which deal with both large and small animals, the other MDs deal mainly with pet animals, since the same subjects on large animals are dealt with in the CI VET0030 - Veterinary Surgery 2.

MD Anaesthesiology :
theoretical- practical course during which the techniques for sedation, anaesthetic premedication, induction and maintenance of general anaesthesia induced by injectable and inhaling drugs and/or balanced techniques (mainly "pre-emptive analgesia") in pet and food animals are presented. It also deals with the evaluation of the deepness of anaesthesia performed by clinical and instrumental monitoring,  anaesthetic complications and their treatment, loco-regional anaesthesia techniques, perioperative pain control.

Particularly (the following competences can be acquired either during theoretical lessons, training or clinical rounds):

- evaluation of the animal before performing sedation or anesthesia;

- calculate and apply an adequate sedation and anesthetic protocol demonstrating to be able to use at least, but not limited to, the following drugs: Butorphanol, Diazepam, Midazolam, alpha-2 agonists, dissociative agents, barbiturates, inhalant anesthetics

- how to maintain anesthesia correctly using monitoring equipment to prevent patient instability and contributes to the supply of oxygen to the tissues, acid-base balance and the anesthetic triad of narcosis, analgesia and muscle relaxation;

- how to recognize and evaluate pain;

- how to plan an anesthetic / analgesic perioperative protocol based on the condition of the animal (weight, mental status, etc.) and on the surgical / diagnostic procedure;

- how to prepare the anesthesia equipment and how to use it correctly for the anesthesia of dogs and cats;

- analyze the main behaviors that could suggest a painful state in dogs and cats;

- the most important techniques and drugs to relieve pain in dogs and cats;

- how to use a pain scale;

Surgical Techniques: theoretical-practical course during which will be treated the following: orthopaedic instrumentation; FPAS method; bandage technique and indications; internal fixation techniques and indications; external fixation techniques and indications. Practical section on: anaesthetic instrumentation in the operating room; pre-anaesthetic protocols based on mock clinical cases both on pet and food animals; oropharyngeal intubation on canine mannequins and on cadavers of various animal species (based on availability).

General principles of veterinary surgery, main characteristics of the operating room and surgical environment, modality for the sterilization of the surgical materials, how to scrub in for surgery and how to aseptically prepare the animal are also presented. Main surgical instrumentation for soft tissue and orthopaedic surgery, how to choose surgical material, basic surgical techniques (surgical knots and sutures, principles of hemostasis), techniques for fracture fixation and repair, access to the abdominal cavity in companion animals and its complications (peritonitis) are explained.

Particularly (the following competences can be acquired either during theoretical lessons, training or clinical rounds):

- how to correctly wear gloves, gowns, footwear, headgear and surgical mask in the operating room

- how to assist in the preparation of surgical instruments and correctly prepare the sterile instruments of the equipment

- identifying characteristics of the following surgical instruments: needle holders, blades, scalpel handle, scissors (Mayo and Metzenbaum), curette, forceps (Babcock, Allis, Mosquito), Backhaus forceps and retractors (manual, Gelpi and Weitlaner)

- know the suture material and know how to select the appropriate type of suture and needle for the proposed surgical need.

- how to suture a wound at least with the following suture pattern: interrupted (simple interrupted and simple and cruciate mattress) and continuous (simple continuous, continuous block or Ford interlocking, Cushing, Lembert)

- how to remove a skin node and perform a cystotomy, enterotomy / enterecomy and splenectomy

- how to perform a laparotomy

- know the suture material and know how to select the appropriate type of suture and needle for the proposed surgical need.

Practical part: surgeon's surgical scrub; main sutures on mannequin; main sutures on canine and feline cadavers; median celiotomy and splenectomy on rabbit cadavers; discussion on clinical cases; seminar on equines operating medicine.

Further practical part is carried out during the clinical rounds in small groups that cover: Surgery visits, Surgery operating room, Exotic animals surgery (visits, anaesthesia, surgery), Anaesthesiology.

Anaesthesiology - Theoretical lessons: 21 hours - Practical lessons: 16 hours (shared, in teaching room, based on clinical cases or seminars: 13 hours) + 6 hours of clinical rounds in small groups in the operating room.

Sirgical Techniques - Theoretical lessons: 21 hours - Practical lessons: 13 hours (small groups in operating room or dissection room: 8 hours; groups in teaching room based on clinical cases: 3 hours; shared seminar: 2 hours).

MD Semiotics and Surgery I
Respiratory system: Theoretical lessons: 7 hours - Practical lessons: 5 hours (discussion on clinical cases - the students are divided into 3 groups) + clinical rounds in small groups together with VET0030 and shared with collegues:12 hours in the operating room, 6 hours in chemotherapy and medical oncology.
Muscle-skeletal system: Theoretical lessons: 14 hours - Practical lessons: 15 hours (in groups in the teaching room, discussion of clinical cases and in the dissection room) + 12 hours of clinical rounds in small groups.

MD Applied anatomy
Theoretical lessons: 30 hours - Practical lessons: 9 hours, divided in 3 practice exercises of 3 hours each, with students divided in small groups.

Verification of learning is carried out by means of a written test and an oral and practical test with a multidisciplinary approach, consisting of the discussion of simulated clinical cases, with the aim of identifying knowledge and skills in accordance with the expected results.

The written exam, which is held in the computer laboratory of the Faculty of Veterinary Medicine, consists of 50 multiple-choice questions with four possible answers, divided as follows

Anaesthesia module: number 10
Semeiotics and clinical surgery module I: number 20
Surgical module: number 10
Applied Anatomy Module: number 10

Each question has at least one correct and one incorrect answer. The test is passed with a score >18/30 and is worth 50% of the final grade. There are no penalties in the calculation of the score for the written exam, but choosing incorrect alternatives will deduct points from the correct answers. For example, if I have two correct answers and two incorrect answers, each correct answer is worth 0.5 and each incorrect answer is worth -0.5. Choosing two correct answers and one wrong answer gives a score of 0.5+0.5-0.5= 0.5. However, there are no negative scores, so the minimum score for each question is 0, even if only wrong alternatives are chosen. The final score is then converted from fiftieths to thirtieths. Only candidates who pass the written test will be admitted to the next stage.

The oral and practical tests take place 2 days after the written test and cover all the topics covered in the different modules of the course. During the examination, the candidate will discuss with the examination board a clinical case related to the small animal systems (dogs and cats) covered in the course, covering aspects such as clinical signs, aetiopathogenesis, diagnostic and therapeutic approach. The candidate will also be asked to answer about the main anaesthetic techniques that can be used in the different species (small and large animals), also in relation to the type of surgical intervention and the clinical situation. Finally, the candidate will be asked about the criteria for the selection of materials used in surgery and the recognition of surgical instruments for soft and hard tissues.

Further details regarding the division of the score of the written test are uploaded to the teaching material at the link: https://www.clmveterinaria.unito.it/do/didattica.pl/Show?_id=l1q4

Clarke K.W., Trim C.M., Hall L.W.: Veterinary Anaesthesia.  XI ed. W.B. Saunders Company, 2013.

Merighi A.: Anatomia applicata e topografia regionale veterinaria. Piccin Nuova Libraria.

Supplementary texts:

Tranquilli W.J., Thurmon J.C., Grimm K.A.: Lumb & Jones' Veterinary Anaesthesia and Analgesia 4th ed. Wiley-Blackwell, 2007.

Bojrab M.J.: Current techniques in small animal surgery. 4th ed. Williams & Wilkins.

Tobias-Johnston. Veterinary surgery. Small animal. Elsevier ed., 2012.

Slatter D.: Textbook of small animal surgery 3rd ed. Saunders.

The slides shown during the lessons are published on line under "materiale didattico".

These slides should only be considered as a basis for the study that has to be carried out on the suggested textbook (Applied anatomy), on one out the two suggetsed textbooks (Anaesthesilogy) or one of the four suggested textbooks (Semiotics, Surgery and Surgical techniques).