Course code: VS3201

Course title: General surgery

An Assignment on Tumors, Cysts, Abscess, Necrosis
and Gangrene, Sinuses and Fistulae, Hematoma,
Hernia

Submitted by: Submitted To:

S. M. Akash Dr. Rukhsana Amin Runa
ID: 2001034 Professor
Reg. No: 50936 Department of Surgery and Obstetrics
Section: A Faculty of Veterinary Science
Session: 2019-20 Bangladesh Agricultural University

Tumors (Neoplasms):
A tumor (neoplasm) is caused by a purposeless multiplication of living cells. (The word neoplasm means new growth.
Neoplasia means formation of new tissue. A neoplasm is different from inflammatory hyperplasia.)

Clinical Signs:

Here are some common signs that may indicate the presence of a tumor in animals:
1. Unexplained Lumps and Bumps: If you notice any unusual growths or bumps on your pet’s body, it’s
essential to have them examined by a veterinarian. These lumps could be benign or cancerous tumors.
2. Sores That Won’t Heal: Persistent sores or wounds that do not heal properly can be a sign of underlying
health issues, including tumors.
3. Loss of Appetite: A sudden decrease in appetite or refusal to eat may be indicative of health problems,
including cancer.
4. Weight Loss: Unexplained weight loss can be concerning and should prompt a veterinary evaluation. Tumors
can affect metabolism and lead to weight changes.
5. Lethargy and Weakness: If your pet seems unusually tired, weak, or lacks energy, it’s essential to
investigate the cause. Tumors can impact overall vitality.
6. Difficulty Breathing: Respiratory difficulties, such as labored breathing or coughing, may be associated with
tumors affecting the lungs or airways.
7. Limping: Persistent limping or lameness, especially if it doesn’t improve with rest, could be related to bone
tumors or joint issues.
8. Digestive or Tummy Problems: Repeated digestive issues, such as diarrhea or vomiting, should be evaluated
by a veterinarian. Tumors in the gastrointestinal tract can cause such symptoms.

Treatment

Removal of tumours may be done by any of the following techniques.

1. Ligation: A tight ligature is applied at the base of the tumor so as to cut off its blood supply. The tumor sloughs off
within about ten days.
2. By using red hot iron: The tumour is clamped below its base and the red hot iron is applied distal to the clamp so as
to remove the tumour. By this method removal is possible without much haemorrhage.
3. By using the ecraseur: The ecraseur is useful specially for removing small pedunculated tumors situated in the
pharynx, vagina, etc.
4. The wart enucleator is very useful for removing small tumours like warts. .
5. Chemical caustics like caustic potash, arsenical paste, nitric acid, acetic acid, etc., may be used for removing small
tumours.
6. Excision (surgical removal): The tumour is carefully dissected out from the surrounding tissues. If the surrounding
lymph glands are involved, they should also be removed.
7. Treatment for malignant tumours: Treatment is useless in the case of malignant tumors because of their tendency
to recur. But temporary relief may be afforded by total excision of the tumour. Combination of surgery, radiation and
chemotherapy, as practiced in human medicine, are rarely practicable.
8. Treatment for warts: Larger warts may be enucleated surgically. The use of "wart vaccine" is found useful in
certain cases in the bovine.
Dimethyl sulphoxide (DMSO) has been successfully used in the treatment of warts. The (medical) DMSO is to be
applied undiluted over the warts. Single application usually assures gradual disappearance of warts with no
recurrence.

Cysts:
A cyst is a sac containing liquid or semisolid substance. Ordinarily a cyst has an inner lining of secreting membrane.
Occasionally a cyst may contain a solid structure like tooth, hair, etc.
Examples are dentigerous cyst, dermoid cyst.

Clinical signs:
 An abnormal skin lump or bump ranging in size from very small to very large
 A swollen area (particularly within the body)
 An oral growth
 Enlarged lymph nodes
  Lameness or swelling affecting a bone
 Pain or discomfort in the upper abdominal region or chest, nausea, vomiting, or coughing may occur as a result of
the growing cysts2.
 Swelling or redness around the area
 Pain
 Hair loss around the bump

Treatment
1. The cyst is punctured with a trocar and canula or inoculation needle and the contents are evacuated. An irritant
solution like tincture iodine is then injected into the cavity to destroy the lining membrane. During the healing process,
the cavity of the cyst may get obliterated.
2. The cyst may, instead of puncturing, be incised to evacuate the contents. This is specially useful when the contents
are semisolid or solid.

Abscess:
An abscess is an abnormal cavity containing pus. The cavity is formed in tissues, due to local suppurative
inflammation. Tissue reaction against the invading organism or foreign body as well as degenerative changes are
evident in the zone of tissue surrounding the pus. This zone is called 'pyogenic membrane'.

Signs
•Animals with abscesses may appear healthy without any outwards signs of disease and abscess can be found
throughout the body.
•The severity of an abscess is dependent on the location in the body, the pressure they may exert on nearby tissues, the
amount of tissue destroyed, their age and amount of bacterial toxins that are produced.

Treatment
 Fomentation and/or applications (if blisters are advised to bring about early maturation of the
abscess. The blister commonly used is Biniodide of mercury ointment (l in 32 to 1 in 8). When the
abscess is ripe the pus collects in a cavity. It is not ordinarily advisable to open an abscess which is
notfully ripe as secondary abscess may form afterwards.
 However, abscesses situated close to a joint or peritoneum may have to be opened before fully
mature, to avoid the chance of rupture into the joint or peritoneal cavity.
 The site where it is proposed to open and the surrounding areas should be cleaned and prepared as
for a surgical operation: after shaving and washing the area with soap and water, drying and applying
asuitable antiseptic like tincture iodide.
 A sterilized "Syme's abscess knife" or scalpel may be used to open the abscess. The opening should
be at the site where it "points". It should as far as possible be in a "dependant portion" to facilitate
drainage. Dependant portion here means a lower area through which drainage by gravity is possible
in the normal position of the patient. If the abscess is not pointing at a dependant portion it is
sometimes necessary to make another opening in the dependant portion to provide drainage. This is
called a "counter opening". In order to make a counter opening, a seton needle may be passed
through the first opening made and taken out through the dependant portion.
 Afterwards a "seton" (gauze dipped in antiseptic lotion) may be passed through the eye of the seton
needle and carried through the openings and tied, in order to keep the openings patent.
 The seton is changed each day after cleaning the abscess cavity.
 However, many abscesses drain satisfactorily without a counter opening and it is sufficient to make a
single opening at the place where it "points".
 After opening the abscess, the contents usually start draining. The abscess cavity should be irrigated
with hypertonic saline.
 Afterwards it is stuffed with gauze dipped in Tincture iodine. This is intended to destroy any
infection remaining therein and also to exert a mild irritant action to stimulate the healing process.
  The gauze packs are removed after twenty four hours (i.e., second day) and then the abscess cavity is
irrigated with a mild antiseptic lotion. The conventional method was to irrigate with a 1 in 500
solution of Acriflavin sulphate as it is a solution which retains its antiseptic properties even in the
presence of pus.
 In modem times many patent antiseptic solutions like dettol, savlon, etc., are available.
 The abscess cavity from the second day onwards is packed with sterile gauze dipped in Magnesium
sulphate-Glycerine paste, which greatly favours drainage and absorption of fluid exudates.
 Topical application of antiseptics or antibiotics in the form of ointments or dusting powder is
indicated if virulent infection is suspected, and systemic use of
 antibiotics may also be necessary in some cases.
 Bismuth-iodoform-paraffin paste (BIPP) is a conventional antiseptic dressing used. It contains
Bismuth subnitras (1 part) and Iodoform (2 parts) mixed in Liquid paraffin to form a paste of desired
consistency.
 The normal time required for the healing of an opened out abscess is usually three weeks.

Necrosis:
Necrosis is the death of a cell or group of cells in a living body, due to pathological reasons.

Examples of necrosis are:

1. A vascular necrosis (bland necrosis; simple necrosis; spontaneous necrosis; anaemic necrosis; or aseptic necrosis)
wherein the necrosis is caused without infection and inflammation.
2. Coagulation necrosis is most frequently seen in infarction, wherein the cell form and arrangement are not altered.
3. Liquifactive (colliquative) necrosis results in death of the cells involved.
4. Ischaemic necrosis is due to occlusion of an artery supplying the region.
5. Embolic necrosis is caused by embolism.
6. Diphtheritic necrosis is necrosis of a mucous membrane wherein a tough membranous layer called "diphtheritic
membrane" is formed by the coagulated cells and fibrin.

Clinical Signs:
The signs and symptoms of necrosis can differ with the exact type. Generally, the symptoms can include:
 pain
 dusky, purple discoloration occurring several hours after tissue death
 coolness from a lack of blood supply
 numbness
 loss of sensation
 abnormal sensations, such as burning, tingling, or prickling
 skin discoloration, appearing red, white, or black for gangrene
 blisters filled with blood or clear liquid

Gangrene:
Gangrene is the death of extensive area or mass of tissue due to failure of blood supply, disease, or injury.

Local Symptoms
In dry gangrene contraction of tissue and the loss ofnormal appearance of the tissue becomes evident, e.g., the skin
presents a wrinkled appearance with its hair dry and erect.
In moist gangrene the enlargement of the tissue with blood and serum causes an initial increase in the volume and
change in the colour of tissue. At this stage there is severe pain. The tissues may present a blackish or purple or
greenish appearance. When death of tissue takes place they appear cold and insensitive and pain disappears. A dark
red, foul smelling discharge is noticed.

Treatment
1. The cause of gangrene should be removed and the spreading of the lesion to surrounding tissues should be
prevented. Sloughing of the dead tissues should be facilitated.
2. Application of an irritant to the area to induce hyperaemia and separation of the slough.
3. Scarification of the tissue is sometimes advised to allow the discharges to escape from the dead tissue and to make
possible penetration of antiseptics into the tissues but it may provide chances for fresh bacterial invasion.
4. Excision of the dead tissue is comparatively safe in the case of dry gangrene but may at times give rise to septic
complications.

Sinuses and Fistulae:

Sinuses
A sinus is a tubular, inflammatory tract leading from a deeper inflammatory area, with one or more external openings
upon a mucous or cutaneous surface.
The interior of a sinus is lined by granulation tissue. In chronic cases there is thickening around the sinus tract due to
fibro-connective tissue.
Clinical sign:
Usually asymptomatic but when infection manifests-
 Recurrent /persistent discharge
 Pain
 Constitutional symptoms if any deep seated origin
 Fever
Treatment:
1. Remove the foreign body, if any, causing the condition.
2. The sinus tract is cleaned with 5% to 10% Zinc chloride lotion or is swabbed with Phenol followed by Tincture
iodine. It helps separation of necrotic tissue.
3. Drainage can be facilitated by injecting and filling the sinus with a 50% solution of Bismuth subiodide in white
petrolatum.
4. Drainage can be provided by making a counter opening and passing a seton dipped in antiseptic solution. The seton
is changed daily.
5. Opening out the sinus. Before opening a sinus it is better to inject into it a coloured antiseptic solution like
methylene blue (1%) so that it will be easier to identify the tract.
6. Use of antibiotics.
7. Bier's hyperaemia.
8. Inoculations of autogenous vaccine.

Fistula
A fistula is a tubular inflammatory tract open at both ends connecting two surfaces covered by epithelium or at times
mesothelium. It may be caused by injury, a destructive inflammatory or neoplastic process, or may be a congenital
defect.
Clinical signs:
In animals the most common fistula is Perianal fistula, common signs are:
1. Difficulty Defecating: Animals with perianal fistulas may struggle during bowel movements, experiencing
discomfort or pain.
2. Incontinence: Loss of control over bowel movements can occur due to the presence of these fistulas.
3. Biting and Licking of the Perianal Area: The affected animals may exhibit excessive biting and licking
around the anal region.
4. Purulent Discharge: Perianal fistulas often result in chronic, malodorous, and ulcerating sinus tracts that
produce pus-like discharge

Treatment
Congenital fistulae, excretory and secretory fistulae may require surgical correction, depending on its location and the
organ involved. Other varieties are treated more or less on general principles of treatment as for sinus.

Hematoma:
A hematoma is an abnormal collection of blood outside of a blood vessel. It occurs because the wall of a blood vessel
wall, artery, vein, or capillary, has been damaged and blood has leaked into tissues where it does not belong. The
hematoma may be tiny, with just a dot of blood, or it can be large and cause significant swelling.

Hematomas may occur anywhere in the body. Regardless of how a hematoma is described or where it is located, it
remains a collection of clotted blood outside a blood vessel.

Signs
The common signs are-
1. Swelling
2. Discoloration
3. Deformity (especially when located on the ear)
4. Pain and aversion to touch
5. Scratching or head shaking
However, when the hematoma is internal, away from the skin, it can lead to more severe complications. Here are some
possible symptoms:
1. Seizures
2. Comas
3. Neurological damage
4. Organ failure
5. Pain
6. Incontinence

Treatment
a. Veterinary Consultation: If you suspect your pet has a hematoma, consult a veterinarian promptly.
b. Small Hematomas: Small hematomas may resolve on their own with time. Rest and restricted activity can
help.
c. Ear Hematomas:
i. Needle Aspiration: A vet may use a needle to drain the blood from the hematoma.
ii. Bandages and Drainage Systems: More severe cases may require bandages, tube drainage systems, or
incisional drainage.
iii. Tacking Sutures: Sutures may be used to eliminate the space where fluid can accumulate.
d. Large Hematomas or Critical Areas:
i. Surgical Drainage: Hematomas in critical areas (such as the thorax or abdomen) may require surgery.
ii. Hygiene and Care: Good hygiene and regular pet care can help prevent hematomas.

Hernia:
A hernia occurs when an organ pushes through an opening in the muscle or tissue that holds it in place. For example,
the intestines may break through a weakened area in the abdominal wall.

Most hernias aren’t immediately life threatening, but they don’t go away on their own. Sometimes they can require
surgery to prevent dangerous complications.

Sign-Symptoms

1. Swelling and Bulging: A visible bulge or swelling may appear on the skin. This occurs when part of the
abdominal contents (such as intestines) protrudes through a weakened area in the abdominal wall.
2. Pain and Discomfort: Cattle with hernias may experience pain and discomfort due to the pressure exerted by
the herniated tissue.
3. Tiredness and Exercise Intolerance: Hernias can cause fatigue and exercise intolerance. The strain on the
abdominal muscles affects the animal’s overall energy levels.
4. Respiratory Complications: Depending on the type and location of the hernia, respiratory issues may arise.
For example, diaphragmatic hernias can lead to breathing difficulties.
 5. GI Obstruction and Vomiting: Hernias involving the gastrointestinal tract (such as inguinal or femoral
hernias) can cause obstruction, leading to symptoms like vomiting and abdominal discomfort.
6. Cardiac Tamponade: In some cases, hernias may compress the heart, resulting in cardiac tamponade (fluid
accumulation around the heart).
7. Other Signs: Depression, dullness, and scanty feces may also be observed in cattle with hernias.
Treatment
Umbilical Hernias:

i. Small Hernias: Small hernias (less than ¼ inch or 1 cm) may close spontaneously by the age of 3 to 4
months.
ii. Larger Hernias: If the hernia does not close naturally, surgical intervention may be necessary. Surgery
involves opening the hernia, removing any protruding tissue, and closing the muscle and skin.
iii. Risk Reduction: Surgical closure helps prevent future complications like intestinal incarceration.

Inguinal or Scrotal Hernias:

i. Manual Reduction: The hernial contents are manually reduced (pushed back into place).
ii. Surgical Closure: Surgical repair involves closing the hernial ring to prevent recurrence.
iii. Clamps: Metal or wooden clamps may be used to obliterate the hernial sac and stimulate healing of the
ring.
iv. Positioning: The animal is placed in dorsal recumbency (lying on its back) during surgery.

Hiatal Hernias:

i. Treatment options vary based on severity and clinical signs. Surgery may be needed to correct the hernia
and prevent complications

Differential Diagnosis:
Disease Diagnosis
Tumors Papillomas and warts are easily identified by their gross
appearance. A benign tumour is comparatively slow in-growth.
It resembles the tissue of origin, is not adherent to overlying
skin, and usually do not ulcerate. They do not invade or
infiltrate into surrounding tissue. Malignant tumors (cancer),
such as sarcomata and carcinomata, grow rapidly and give rise
to secondary tumors in their vicinity and in other parts of the
body as a result of neoplastic elements carried through the
blood or lymph stream. Skin is usually adherent to the tumor
and may ulcerate. The cells constituting the tumor are immature
and are in a state of active multiplication.
Cysts
Cysts are non-inflammatory and slow in development.They
have a well defined periphery.
cyst containing fluid will fluctuate uniformly. A cyst is easily
differentiated from an inflammatory swelling, abscess and
haematoma.
Abscess An abscess should be differentiated from a cyst, a haematoma, a
synovial distention or an abdominal hernia.
 A cyst develops slowly and fluctuates uniformly.
 A haematoma (which contains coagulated blood and
serum) has a doughy consistency and may crepitate on
palpation. It is not painful and does not point like an
abscess.
 A distended synovial sheath is recognized by its
location and by careful palpation.
 An abdominal hernia can be differentiated by the
presence of the hernial ring.
Necrosis Same features as sign-symptoms-
 dusky, purple discoloration occurring several
hours after tissue death
 coolness from a lack of blood supply
 numbness
 loss of sensation
 abnormal sensations, such as burning, tingling, or
prickling
 skin discoloration, appearing red, white, or black
for gangrene
 blisters filled with blood or clear liquid
Gangrene In dry gangrene contraction of tissue and the loss of normal
appearance of the tissue becomes evident, e.g., the skin presents
a wrinkled appearance with its hair dry and erect.
In moist gangrene the enlargement of the tissue with blood and
serum causes an initial increase in the volume and change in the
colour of tissue. At this stage there is severe pain. The tissues
may present a blackish or purple or greenish appearance. When
death of tissue takes place they appear cold and insensitive and
pain disappears. A dark red, foul smelling discharge is noticed.
Sinus Fluids injected into the sinus may show its capacity and a probe
passed through the sinus may indicate its depth and direction.
Fistula A probe passed through the fistula may indicate its path,
openings and direction.
Hematoma
Hematomas of the skin and soft tissues, such as muscles and
joints, are often diagnosed by physical examination alone.
For patients exhibiting signs of internal bleeding, the healthcare
professional will decide the best imaging modality to evaluate
the situation. Plain X-rays may be needed to assess for
bone fracture. Patients with significant head injuries often
require CT scans. Ultrasound is the testing modality of choice
for females who are pregnant.
Hernia Cardiac tamponade
Dyspnea
Tachypnea
Exercise intolerance
Coughing
Vomiting

protrusion or changes in the abdominal wall may be

 seen on close inspection.

the hernia sac and its contents may be found on

pulpation.

References
Tumors:

Essentials of Veterinary Surgery, 8th Edition

https://www.petmd.com/dog/care/10-signs-cancer-dogs

Cysts:

Essentials of Veterinary Surgery, 8th Edition

Tumors, Growths, and Cysts in Dogs (thesprucepets.com)

Sebaceous Cysts on Dogs | Great Pet Care

Abscess:

Essentials of Veterinary Surgery, 8th Edition

Necrosis and Gangrene:

Essentials of Veterinary Surgery, 8th Edition

Necrosis: Symptoms, Causes, and Treatments (healthgrades.com)

Sinuses and Fistulae:

Essentials of Veterinary Surgery, 8th Edition

Hematoma:
https://dogtime.com/dog-health/54225-hematomas-dogs-symptoms-causes-treatments
Hematoma Meaning, Types, Pictures, Symptoms, Treatment (medicinenet.com)
https://betterpet.com/hematomas-in-dogs/
https://www.petcarerx.com/article/treating-hematomas-in-dogs-and-cats/1687

Hernia:
Hernia: Types, Symptoms, Causes, and More (healthline.com)
https://ijclinmedcasereports.com/pdf/IJCMCR-RW-00091
https://www.merckvetmanual.com/digestive-system/congenital-and-inherited-anomalies-involving-the-digestive-
system/hernias-in-animals
https://vcahospitals.com/know-your-pet/hernia-umbilical-in-dogs
https://www.msdvetmanual.com/digestive-system/congenital-and-inherited-anomalies-involving-the-digestive-
system/hernias-in-animals