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Small Animal Surgery > 6 - Small Intestines > Flashcards

6 - Small Intestines Flashcards

1
Q

How long is the intestinal length in dogs compared to their body length?

A

5x body length

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2
Q

What vessels supply the intestines? What drains them?

A

Celiac artery, cranial and caudal mesenteric arteries;

Drained by portal vein

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3
Q

What is the holding layer of the intestines?

A

submucosa

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4
Q

What 3 things does optimal healing of the intestines require?

A
  1. Good blood supply
  2. Accurate mucosal apposition
  3. Minimal surgical trauma
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5
Q

Risk of intestinal dehiscence increases with what 5 factors?

A
  1. Hypovolemia
  2. Hypoproteinemia
  3. Debilitation
  4. Concurrent infection
  5. Corticosteroids and NSAIDs
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6
Q

What are the 3 phases of intestinal healing and at what days do they occur?

A

Lag = day 0-4

Proliferative = day 3-14

Maturation = day 10-180

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7
Q

In what healing phase is dehiscence most likely?

A

lag

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8
Q

_____ deposition begins in the lag phase.

A

Collagen

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9
Q

In what healing stage does fibrous repair occur?

A

proliferative

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10
Q

Normal strength is regained in the _____ phase of healing, by day _____.

A

proliferative, 10-17

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11
Q

What occurs in the maturation stage of healing?

A

Collagen reorganizes and remodels

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12
Q

What are the 4 indications for intestinal surgery and what is the most common?

A
  1. Obstruction = most common (foreign body)
  2. Disruption (blunt/penetrating trauma)
  3. Diagnostic procedure (biopsy, culture)
  4. Supportive procedure (feeding tube)
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13
Q

What should be done first in intestinal surgery?

A

Isolate intestine and pack off

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14
Q

How many layers of the intestine should be involved in closure?

A

1

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15
Q

What layer of the intestine should be engaged in closure?

A

submucosa

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16
Q

What suture patterns should be used in intestinal surgery?

A

Appositional: simple interrupted and simple continuous

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17
Q

What suture material should be used in intestinal surgery?

A

Monofilament absorbable (Monocryl, PDS, Maxon)

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18
Q

How many lavages should be done in intestinal surgery?

A

Local lavage –> change gloves and instruments –> lavage again (entire abdomen this time)

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19
Q

What is an enterotomy?

A

Incision into the intestinal lumen

20
Q

What is an enterectomy?

A

Removal of a segment of the intestine

21
Q

What is an intestinal resection and anastomosis?

A

Enterectomy & reestablished continuity between ends

22
Q

What are 4 ways with which luminal disparity can be dealt?

A
  1. Sutures on larger lumen side spaced farther apart than smaller side
  2. Smaller lumen transected at an angle
  3. Smaller lumen spatulated
  4. Stapler
23
Q

What should always be done to supplement the surgical site/facilitate healing? What else can be done?

A

Always = omental patching

Can also do = sersal patching for severe serosal/muscularis damage when R&A is not an option

24
Q

How does omental patching help healing?

A

Helps seal and contributes blood supply

25
Q

When should barium not be used for a GI series?

A

If perforation is expected

26
Q

How should peritonitis be documented?

A

Abdominocentesis, peritoneal lavage, exploration

27
Q

What is the benefit of holding off food for intestinal surgery?

A

It decreases bacterial #s in the stomach and small intestine

28
Q

When would antibiotics be indicated with intestinal surgery?

A

With bloody diarrhea, fever, leukocytosis, lekopenia, gross spillage, shock

29
Q

What conditions call for emergency intestinal surgery?

A

Perforation, strangulation, complete obstruction

30
Q

What 6 things increase risk for leakage?

A
  1. Preop peritonitis
  2. Hypotension
  3. Hypoalbuminemia
  4. Blood product transfusion
  5. Delayed postop enteral feeding
  6. Systemic disease that impairs healing.collagen production
31
Q

Dilatation occurs _____ to an obstruction.

A

proximal

32
Q

What are the 6 steps to an enterotomy or enterectomy?

A
  1. Pack off/exteriorize bowel segment
  2. Incise thru healthy tissue distal to the object for removal
  3. Assess bowel viability after removal of object
  4. Resect devitalized intestine and anastomosis if necessary
  5. Lavage thoroughly
  6. Place omentum or create a serosal patch at the site
33
Q

At what age are animals most likely to have intussusception?

A

young

34
Q

Intussusception is associated with _____ or _____ issues.

A

enteritis, dysmotility

35
Q

What can intussusception lead to?

A

Partial to complete obstruction

36
Q

The clinical course of intususcception may span several _____.

A

weeks

37
Q

What is the intussuceptum?

A

The invaginated portion

38
Q

What is the intussucipiens?

A

The recipient of the intussusception

39
Q

Most neoplasms of the intestines are _____.

A

malignant

40
Q

Where are dog adenocarcinomas usually found in the intestines?

A

duodenum and colon

41
Q

Where are cat adenocarcinomas usually found in the intestines?

A

jejunum and ileum

42
Q

What are the 3 types of neoplasia commonly found in the intestines?

A

Adenocarcinoma, Lymphosarcoma, Leiomyosarcoma

43
Q

_____ or _____ mechanical obstruction can result from intestinal neoplasia.

A

Intramural, intraluminal

44
Q

How big should margins be for resection of intestinal neoplasia?

A

3-8 cm

45
Q

Prognosis with neoplasia of the intestines varies with _____ and _____.

A

tumor type, margins

46
Q

What are 4 important considerations for postop care with intestinal surgery?

A
  1. IV crystalloid fluids
  2. Pain meds (NOT NSAIDs)
  3. Early enteral nutrition
  4. +/- antibiotics (if contaminated or dirty procedure)

Small Animal Surgery (17 decks)

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