6 - Small Intestines Flashcards
How long is the intestinal length in dogs compared to their body length?
5x body length
What vessels supply the intestines? What drains them?
Celiac artery, cranial and caudal mesenteric arteries;
Drained by portal vein
What is the holding layer of the intestines?
submucosa
What 3 things does optimal healing of the intestines require?
- Good blood supply
- Accurate mucosal apposition
- Minimal surgical trauma
Risk of intestinal dehiscence increases with what 5 factors?
- Hypovolemia
- Hypoproteinemia
- Debilitation
- Concurrent infection
- Corticosteroids and NSAIDs
What are the 3 phases of intestinal healing and at what days do they occur?
Lag = day 0-4
Proliferative = day 3-14
Maturation = day 10-180
In what healing phase is dehiscence most likely?
lag
_____ deposition begins in the lag phase.
Collagen
In what healing stage does fibrous repair occur?
proliferative
Normal strength is regained in the _____ phase of healing, by day _____.
proliferative, 10-17
What occurs in the maturation stage of healing?
Collagen reorganizes and remodels
What are the 4 indications for intestinal surgery and what is the most common?
- Obstruction = most common (foreign body)
- Disruption (blunt/penetrating trauma)
- Diagnostic procedure (biopsy, culture)
- Supportive procedure (feeding tube)
What should be done first in intestinal surgery?
Isolate intestine and pack off
How many layers of the intestine should be involved in closure?
1
What layer of the intestine should be engaged in closure?
submucosa
What suture patterns should be used in intestinal surgery?
Appositional: simple interrupted and simple continuous
What suture material should be used in intestinal surgery?
Monofilament absorbable (Monocryl, PDS, Maxon)
How many lavages should be done in intestinal surgery?
Local lavage –> change gloves and instruments –> lavage again (entire abdomen this time)
What is an enterotomy?
Incision into the intestinal lumen
What is an enterectomy?
Removal of a segment of the intestine
What is an intestinal resection and anastomosis?
Enterectomy & reestablished continuity between ends
What are 4 ways with which luminal disparity can be dealt?
- Sutures on larger lumen side spaced farther apart than smaller side
- Smaller lumen transected at an angle
- Smaller lumen spatulated
- Stapler
What should always be done to supplement the surgical site/facilitate healing? What else can be done?
Always = omental patching
Can also do = sersal patching for severe serosal/muscularis damage when R&A is not an option
How does omental patching help healing?
Helps seal and contributes blood supply
When should barium not be used for a GI series?
If perforation is expected
How should peritonitis be documented?
Abdominocentesis, peritoneal lavage, exploration
What is the benefit of holding off food for intestinal surgery?
It decreases bacterial #s in the stomach and small intestine
When would antibiotics be indicated with intestinal surgery?
With bloody diarrhea, fever, leukocytosis, lekopenia, gross spillage, shock
What conditions call for emergency intestinal surgery?
Perforation, strangulation, complete obstruction
What 6 things increase risk for leakage?
- Preop peritonitis
- Hypotension
- Hypoalbuminemia
- Blood product transfusion
- Delayed postop enteral feeding
- Systemic disease that impairs healing.collagen production
Dilatation occurs _____ to an obstruction.
proximal
What are the 6 steps to an enterotomy or enterectomy?
- Pack off/exteriorize bowel segment
- Incise thru healthy tissue distal to the object for removal
- Assess bowel viability after removal of object
- Resect devitalized intestine and anastomosis if necessary
- Lavage thoroughly
- Place omentum or create a serosal patch at the site
At what age are animals most likely to have intussusception?
young
Intussusception is associated with _____ or _____ issues.
enteritis, dysmotility
What can intussusception lead to?
Partial to complete obstruction
The clinical course of intususcception may span several _____.
weeks
What is the intussuceptum?
The invaginated portion
What is the intussucipiens?
The recipient of the intussusception
Most neoplasms of the intestines are _____.
malignant
Where are dog adenocarcinomas usually found in the intestines?
duodenum and colon
Where are cat adenocarcinomas usually found in the intestines?
jejunum and ileum
What are the 3 types of neoplasia commonly found in the intestines?
Adenocarcinoma, Lymphosarcoma, Leiomyosarcoma
_____ or _____ mechanical obstruction can result from intestinal neoplasia.
Intramural, intraluminal
How big should margins be for resection of intestinal neoplasia?
3-8 cm
Prognosis with neoplasia of the intestines varies with _____ and _____.
tumor type, margins
What are 4 important considerations for postop care with intestinal surgery?
- IV crystalloid fluids
- Pain meds (NOT NSAIDs)
- Early enteral nutrition
- +/- antibiotics (if contaminated or dirty procedure)
