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Small Animal Surgery > 5 - Stomach > Flashcards

5 - Stomach Flashcards

1
Q

What are indications for sx of the stomach?

A
  1. Foreign bodies
  2. GDV
  3. Tumors
  4. Ulcers/erosions
  5. Pyloric obstruction
  6. Feeding tubes
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2
Q

What are the 3 approaches to sx of the stomach?

A
  1. Ventral midline celiotomy
  2. Flank
  3. MIS
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3
Q

What are the 3 basic surgical principles that are used in stomach surgery?

A
  1. Stay sutures
  2. Laparotomy sponges
  3. Clean/dirty instruments (change gloves)
  4. Intraperitoneal lavage
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4
Q

What is a gastrotomy?

A

Incision through the stomach wall into the lumen

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5
Q

What is a gastropexy?

A

Creation of an adhesion between stomach and body wall

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6
Q

What is a partial gastrectomy?

A

Partial removal of the stomach

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7
Q

What is a gastrostomy?

A

Creation of an artificial opening into the lumen

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8
Q

What is a pyloroplasty?

A

Reconstruction of the pylorus & pyloric antrum

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9
Q

Where should the incision be made in a gastrotomy and how?

A

Hypovascular area between greater and lesser curvatures;

  1. Stab incision with scalpel
  2. Extended with scissors
  3. Sunction to aspirate gastric contents and reduce spillage
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10
Q

How many layers should be included in closure for a gastrotomy?

A

2-3 layers

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11
Q

What pattern should be used on the mucosa/submucosa during a gastrotomy?

A

Simple continuous

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12
Q

What pattern should be used to close the seromuscular layer during a gastrotomy?

A

Simple continuous

+/- inverting

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13
Q

What type of surgery is a gastrotomy considered (cleanliness)?

A

contaminated - change gloves and instruments

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14
Q

When is a partial gastrectomy indicated?

A

Necrosis (GDV), tumor, ulcer/perforation, biopsy

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15
Q

How many layers should be closed in a partial gastrectomy and what instruments can be used?

A

2 layer closure with invagination;

Doyen forceps, stay sutures, GIA stapler

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16
Q

T/F: A gastrostomy is commonly recommended and performed.

A

False

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17
Q

What are the 3 techniques by which a gastrostomy tube can be placed?

A
  1. Open placement
  2. Percutaneous endoscopic assisted
  3. Laparoscopic assisted
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18
Q

What side of the stomach/body wall is used to pexy it during gastrostomy tube placement?

A

left

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19
Q

What type of pattern is used during gastrostomy tube placement for pexy isolation?

A

box lock suture pattern

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20
Q

What is the minimum amount of time a gastrostomy tube should be in?

A

7-10 days

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21
Q

What are the 2 types of pyloric resections and what does each attach to?

A
  1. Billroth I = removal of pylorus and attachment to duodenum
  2. Billroth II = removal of pylorus and attachment to jejunum
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22
Q

What is a pyloromyotomy?

A

Incision thru pyloric serosa and muscularis

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23
Q

What is a pyloroplasty?

A

Incision and reorientation of pylorus to increase gastric outflow diameter

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24
Q

What are the 3 types of benign gastric outflow obstruction?

A
  1. Pyloric stenosis (muscular hypertrophy)
  2. Chronic antral muscosal hypertrophy
  3. Hyperplastic pyloric polyps
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25
Q

What breeds are prone to pyloric stenosis?

A

Brachycephalic breeds, Siamese cats

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26
Q

How would you correct a pyloric stenosis?

A

pyloroplasty

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27
Q

How would you correct a chronic antral musosal hypertrophy?

A

pyloroplasty

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28
Q

How would you correct hyperplastic pyloric polyps?

A

endoscopic or surgical excision

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29
Q

What procedure is this?

A

Billroth I

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30
Q

What procedure is this?

A

Billroth II

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31
Q

What conditions would indicate the need for a gastropexy?

A

GDV, hiatal hernia, intussusception

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32
Q

What are the only 2 types of gastropexy that you should be doing?

A

incisional and tube

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33
Q

How long should the incision be for a gastropexy and where?

A

3-5 cm;

Caudal to the last rib and far enough laterally so that it doesn’t run into the celiotomy

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34
Q

What is a tube gastropexy used for, what pattern is used, and what side is it on?

A

Placement of a gastrostomy tube, box lock pattern, right side

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35
Q

What gastropexy techniques are not recommended?

A

Circumcostal, belt loop, closure-pexy, gastrocolopexy

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36
Q

Why would you choose to do a laparascopic or lap assisted gastropexy?

A

More for prophylactic reasons than for therapeutic reasons

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37
Q

Stomach surgery can have concurrent _____ or _____.

A

esophagitis, pneumonia

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38
Q

Why are antibiotics generally unnecessary with stomach surgery when there is normal immunity?

A

The procedure is considered to be clean-contaminated

39
Q

What layers of the stomach are easily separated from each other?

A

Mucosa from muscularis and serosa

40
Q

What area of the stomach should be incised?

A

Hypovascular area between curvatures

41
Q

How is hemorrhage controlled during stomach surgery?

A

Direct pressure

42
Q

Stomach surgery can be closed with a ___-layer closure with an _____ or _____ pattern.

A

2, appositional, inverting

43
Q

What staplers can be used for stomach surgery?

A

TA or GIA for resection

44
Q

Healing of the stomach is _____.

A

rapid

45
Q

What is GDV?

A

Clockwise 180 degree rotation of the stomach

46
Q

What is the biggest risk factor for GDV?

A

History of a GDV in a 1st degree relative

47
Q

GDV is _____of the stomach and _____ on its _____ axis.

A

distension, rotation, mesenteric

48
Q

How does the stomach become dilated in a GDV?

A

Rotation causes outflow obstruction at both ends of the stomach preventing mechanisms of removing air (eructation, vomiting, and gastric emptying).

49
Q

What local effects does venous outflow obstruction in a GDV lead to?

A

Venous outflow obstruction –> vascular congestion (back up of blood flow in stomach wall) –> gastric necrosis +/- gastric perforation

50
Q

What local effects does increased transmural pressure in a GDV lead to?

A

Increased transmural pressure –> vascular congestoin (back up of blood flow in stomach wall) –> gastric necrosis +/- gastric perforation

51
Q

What local effects does gastric rotation in a GDV lead to?

A

Gastric rotation –> tearing of short gastric arteries –> hemoabdomen

52
Q

A

A

Gastric distension

53
Q

B

A

Caudal vena cava compression

54
Q

C

A

Decreased vascular return and cardiac output

55
Q

D

A

Hypotension, tissue hypoxemia, vascular stasis, myocardial depressant factor

56
Q

E

A

GI necrosis

57
Q

F

A

DIC

58
Q

G

A

Myocardial ischemia & VPCs (40-70% of dogs)

59
Q

H

A

Metabolic (lactic) acidosis

60
Q

What are clinical signs of GDV?

A

Retching/non-productive vomiting, distended abdomen, drooling, obtunded/hypovolemic shock

61
Q

What are PE findings consistent with a GDV?

A
  1. Distended abdomen (tympanic cranial abdomen)
  2. Splenomegaly
  3. Hypovolemic shock (tachycardia, prolonged CRT, pale MM, weak pulses, cold distal extremities, obtundation)
  4. ECG-arrhythmias (VPCs)
62
Q

What should you always treat first in a GDV patient?

A

shock

63
Q

In a GDV patient, you should always place the _____ possible catheter (___G or ___G).

A

largest, 18, 16

64
Q

What length of catheter is preferred?

A

shorter

65
Q

Where should an IVC be placed ina GDV patient?

A

Thoracic limbs or jugular vein

66
Q

What type of fluids are used in GDV patients for fluid resuscitation?

A

isotonic crystalloids

67
Q

What 6 things should be done in a GDV patient while the fluids are going in?

A
  1. FAST scan to look for free fluid
  2. ECG to check for arrhythmias (treat with lidocaine if severe)
  3. Check blood-gas
  4. Lactate
  5. Monitor BP
  6. Monitor for resolution of shock
68
Q

What should only be done AFTER the suspected GDV patient is stable?

A

radiographs

69
Q

What is the #1 rule of suspected GDV radiographs?

A

THOU SHALT ALWAYS TAKE A RIGHT LATERAL ABDOMEN

+/- VD view and thoracic rads if dog is stable

70
Q

What is the #2 rule of suspected GDV radiographs?

A

Nothing dies in radiology - stabilize the animal BEFORE taking it to radiology

71
Q

What is a subtle xray sign of a GDV?

A

Gas or loops of bowel cranial to stomach

+/- splenomegaly

72
Q

What does gas in the wall of the stomach suggest in a GDV case?

A

Gastric necrosis with gas producing;

we may need to resect something in surgery

73
Q

How is gastric dilatation treated?

A

IV shock fluids, orogastric or NG tube, monitoring, recommend gastropexy

74
Q

T/F: Gastric dilatation is not a surgical emergency

A

True

75
Q

How is food bloat treated?

A

NPO, IVF if severe dehydration/shock, +/- emesis

76
Q

What are 3 medical treatments that can be done for a GDV?

A
  1. IV shock fluids (due to CVC compression)
  2. Pain meds - facilitates gastric decompression
  3. Decompress stomach (orogastric tube or trocar with 18G-14G catheter)
77
Q

What pain meds can be used in a GDV?

A

Opioid +/- midazolam, methadone (less likely to indice vomiting)

78
Q

What are the pros and cons to passing an orogastric tube in a GDV?

A

Pros = effective, continuous decompression, gets food and gas

Cons = difficulty passing tube, anesthesia and intubation to protect airway

79
Q

What are the pros and cons to trocarization in a GDV?

A

Pros = Low risk, no anesthesia

Cons = Gas only, SQ abscess, peritonitis, splenic laceration

80
Q

What are the 4 steps taken to surgically repair a GDV?

A

Celiotomy:

  1. Decompress and derotate the stomach
  2. Assess gastric wall integrity
  3. Assess spleen
  4. Gastropexy!!!
81
Q

What 3 things should be assessed about the stomach after it is derotated?

A

Serosal color, thickness of wall (thin is bad), vascular patency

82
Q

Once the stomach is repositioned thus relieving _____, the appearance of serosa can greatly improve in _____ minutes.

A

venous outflow obstruction, 5-10

83
Q

How can vascular patency of the stomach be assessed after derotation?

A

Small incisions can be made in questionable areas, and appearance of arterial blood indicates probably survival

84
Q

How can GDV affect the heart?

A

Endotoxins and vasoactive agents can be released causing a cardiovascular crisis

85
Q

T/F: GDV patients do not need IVF postop.

A

False

86
Q

T/F: Analgesics should be continued postop.

A

True

87
Q

What medications should be considered for postop in GDV patients?

A

H2 antagonists, proton pump inhibitor, sucralfate, metoclopramide

88
Q

How often should the EKG be measured postop in GDV patients?

A

continuously for 24-48 hours

89
Q

How often should BP be monitored in a GDV patient postop?

A

Every 4-6 hours

90
Q

When can GDV patients be fed postop?

A

Can feed day of surgery, 2-3 small meals

91
Q

What are the 2 types of gastrogastric intusussception?

A

Pylorogastric or duodenogastric

92
Q

How common are gastrogastric intussusception? What breed? What is the prognosis?

A

Rare;

Large breed (GSD);

Prognosis = guarded

93
Q

What is the most common stomach tumor in dogs?

A

adenocarcinoma

94
Q

What is the most common stomach tumor in cats?

A

Lymphoma

Small Animal Surgery (17 decks)

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