abdominal surgery Flashcards
why do abdominal exploratory?
confirm a diagnosis
surgical resolution
biopsy for pathology/histopatha
approches for abd explore
ventral midline, laparoscopic, can do flank or paracostal
what can you see on abd explore
diaphragm, liver, gallbladder/bile duct, pancreas, spleen, intestinal tract, kidneys, adrenals, uterus ovaries, bladder/ureters, prostate, LN
LN biopsy
whole node, careful w mesenteric (wedge)
intestinal biopsy
blade/biopsy punch, switch gloves and instruments
liver biopsy
guillotine, biopsy punch
what organs are hard to biopsy?
kidney, pancreas, bladder, spleen, adrenals, body wall (uncommon), omentum
types of peritonitis
primary- FIP
secondary- aseptic (FB, ruptured neoplasms, pancreatic enzymes, bile, urine etc)
septic- bowel perforation, wounds, surgical contamination, ruptured pyo
peritonitis C/S
depression, abd pain, nausea, v+, d+, anorexia
peritonitis dx
BW- leukocytosis, changes w uroabdomen, sepsis, etc.
AXR- free air, effusion
fluid analysis- degenerative neutrophils, bile crystals
peritonitis tx
medical- IVF, pain meds, abx (enro, ampi, metro), pressor
surgery- removal of inciting cause, lavage (300ml/kg), place JP drain
peritonitis prognosis
guarded at best, needs a lot of post op management
abd trauma
bite wounds, GSW, HBC
AXR/peritoneal lavage
abd trauma tx
ex lap for all penetrating wounds
indications for stomach sx
biopsy, FB,, GDV, hernia
stomach pathology C/S, dx
v+ w blood, bloating
BW- hypochloremia, met alk
dx w hx, rads, U/S, CT
gastrotomy indications
biopsy, FB removal
safer than enterotomy
gastrotomy
lap sponges, stay sutures, suction
cut in avascular location
close w PDS, 2 layer inverting
GDV
accumulation of air in stomach, gastric malposition (180-270)-> necrosis, perforation, bleeding from short gastric vessels
GDV risk factors, C/S
lg/giant breeds, stress, feeding
C/S- retching, distended abd, dyspnea, restless
GDV dx
MEDB (lactate), ecg, pain meds
trocarize, gastric tube (GA), 2 IVs, emerg sx
dx- RL rad
GDV sx
dorsal, long midline incision
hold duodenum, pull ventral and push dorsal/left
assess gastric viability-> palpate thickness, mucosal slip, gastrectomy if necrotic
check spleen
indications of splenectomy w GDV
torsed pedicle, no sign of contraction/surgery
gastrectomy
stay sutures on either side of viable part- cut sm portion, staple and oversew
gastropexy (which side), types?
hiatal hernia, intussusception- left
right- GDV
types- incisional (behind last rib, through transversus abd, 2 suture lines)
beltloop
GDV post op
ECG for VPCs/vtach, 24/7 monitoring
hypertrophic pylorogastropathy
congenital, brachy breeds <1y, acquired in sm breed dogs
C/S- chronic, intermittent v+, increasing frequency
dx- U/S, CT
tx- pyloroplasty
hiatal hernia grades
I- sliding
II- paraesophageal, part of fundus into thorax next to esophagus
III- combination of I and II
IV- herniation of abd contents
can get intussuception
gastric neoplasia- C/S, dx, most common, tx
v+
U/S, CT
gastric adenocarcinoma (dogs), lymphoma (cats)
SI anatomy
arterial blood from cranial mesenteric artery
venous- caudal mesenteric, portal
indications for SI sx
FB, mass, intussusception, torsion, trauma
SI disease C/S
v+/d+, inappetence, anorexia, melena, weight loss if chronic
painful abd, bloating
diagnostics for SI disease (obstruction)
BW- electrolytes (hypochloremic met alk)
dehydration, sepsis
rads- 1.6X L5 (dogs), 2X L% (cats)
bowel malposition, plication, free air
surgical considerations for SI sx
fluids- rehydrate before
abx periop
what suture should you use for SI sx?
4-0 PDS- simple interrupted, continuous
3-0 in lg dogs
single layer appositional
solitary intestinal FB
make longitudinal incision and remove, R&A if necrotic (end to end)
cut according to blood supply
what is the gambee suture?
suture pattern used in end to end R and A to prevent eversion
how to do R and A
if different sizes: cut non dilated side at a slant, wider bites on one side, cut antimesenteric side to make larger opening
leak test w saline
leak testing
used to check sutures, inject w 25g needle, use pressure (15-25mmHg)
linear FB dx
thread etc
becomes anchored under tongue, pyloris-> SI accordions along FB
dx- PE, rads (plication), contrast rads (caution)
linear FB tx
conservative- if no C/S
cut and follow through intestines
sx- start at anchor point, milked down and remove w enterotomy
SI neoplasia
adenocarcinomas, lymphoma in cats
R and A and submit for histopath
intussusception C/S, dx
young animals <1y
idiopathic, parasites, parvo, linear FB, previous sx
C/S- d+ v+ abd pain
dx- palpation, rads (obstruction), U/S (targets)
intussusception tx
exlap- check GIT, reduce if possible, R and A
tx for parasites, pain, nutritional support
mesenteric volvulus
twisting of bowel on mesenteric axis-> obstruction of veins-> edema, mucosa compromised-> arterial occlusion-> ischemia
young lg breed dogs (GSD)
mesenteric volvulus C/S, dx
collapse, rapid distension, hematochezia
dx- BW, gaseous distension on rads
mesenteric volvulus tx
rapid fluids for shock
sx (R and A)-> do not allow reperfusion injury
hernias incarceration, strangulation
incarceration- sm bowel herniation, cannot be reduced
strangulation- incarcerated w devitalization
hernia locations, tx
inguinal, scrotal, diaphragmatic, umbilical, etc
reposition bowel, R/A if needed, close hernia
intestinal sx complications
ileus- regurg, V+
tx w prokinetics, anti nausea, NGT
short bowel syndrome- resecting more than 75%-> malnutrition, weight loss, d+
tx- maintain fluid balance, nutrition
adhesions- good tissue handling, tx w surgery
dehiscence- 3-5d post op.-> septic peritonitis
lg intestinal sx
short unspecialized tube-> referral only!
poor collateral circulation, cant assess viability, dehiscence
congenital megacolon
absence of ganglionic cells-> permanent spasm-> obstruction
tx- R/A
obstipation
no stools for days-weeks
dehydration, weakness
dx- rectal, rads
tx- try medical, manually deobstipate
refer for subtotal colectomy
subtotal colectomy
remove colon from proximal site-> 3-5cm cranial to pubis
**preserve blood supply to both ends
cecal disease
impaction- typhectomy
inversion-> invagination into colon, bloody d+, typhlectomy
neoplasia- anorexia, weight loss, v+,d+, tx w excision
lg intestinal neoplasia
dogs- rectum and colon
adenocarcinoma, lieomyosarcoma
C/S- blood/mucous in stool, tenesmus
dx- rectal exam, rads, colonoscopy
tx- very aggressive, R/A guarded prognosis
colonic torsion, C/S, dx, tx
GSD
C/S- d+,v+, bloating, abd pain
dx- rads
tx- emergency-> try to R/A and L pexy
**perforation-> grave prognosis
indactions for spleen sx
biopsy (guillotine, partial splenectomy)
splenectomy- torsion, mass, trauma
splenic masses
2/3 are hemangiosarc
2-3 w sx, 6m w sx/chemo
splenectomy
ligate splenic artery/vein-> short gastrics (after pancreas) or can ligate all along the spleen (use suture, staples, bipolar vessel sealing)
splenic torsion
secondary to GDV, neoplasia
presents as acute abdomen
c shaped on rads
remove before untwisting
liver lobes
left division- L lateral and medial
central division- quadrate, R medial
right division- R lateral, caudate
indications for liver sx
biopsy after imaging
referral-> PSS< liver trauma, lobar enlargement
PSS
vasculature connection bypassing liver
congenital, usually extrahepatic
PSS tx
peri op management (treat HE)
sx for single shunting vessel-> slowly redirec bloodflow into portal vessel
suture, ameroid constrictor, cellophane banding
post op management for PSSS
complications (portal hypertension, hypoglycemia, seizures)
90% success
liver lobe torsion
one lobe (L lat), non specific C/S
dx w U/S, CT
tx liver lobectomy
liver lobectomy
R sided more complex
staples, suture ligation
may need paracostal incisions, diaphragmatic release
intensive post op-> may need transfusion, pneumo, ecg
liver abscess causes, dx, tx
rare
necrosis of neoplasm
ascending biliary infection
hematogenous spread
FB migration
dx- CT
tx- lobectomy, abx
liver neoplasia C/S, dx, tx
metastatic (from other organs)
C/S- palpable mass, weight loss, collpase if bleeding, anorexia, high liver enzymes
dx- CT
most commonly hepatocellular carcinoma, can have nodular hyperplasia
imaging-> biopsy
extrahepatic biliary duct obstruction dx, ddx
C/S are vague
dx- U/S, CT
ddx:
extraluminal (pancreatitis, neoplasia)
intraluminal- cholelith, flukes, GB mucocele
GB mucocele C/S
semo solid bile material blocking duct-> EHBO, necrosis of GB
older-middle aged dogs (shelties)
C/S- acute abdomen, variable (icterus, pain, septic shock)
GB mucocele tx
medical- low fat diet, ursodiol, SAMe
sx- cholcystectomy
cholelithiasis
rare, 50% visible on rads, obstruct CBD at duodenal papilla
referral sx
pancreatitis
compression of CBD
medical management
sx-> stent, cholecystoduodenostomy
neoplasia causing EHBO
tumors-> pancreas, gastric, duodenal tumours
sx- cholecystoduodenostomy, jejunostomy
cholecystoenterostomy complications
bile leakage-> peracute sepsis
long tern- chronic cholangiohep, stenosis b/w Gb and intestine-> can create new opening
septic cholecystitis
rare, most common in cats
acute abd-> devitalization, perforation, septic peritonitis
bile peritonitis tx
stop leak, ensure bile flow
postop management critical
indications for pancreas sx
biopsy, mass removal, pancreatitis, pseudocyst
pancreatic biopsy technique
be careful
guillotine, stapler, bipolar vessel sealing
reasons for pancreatitis sx
concurrent EHBO (stent)
need a longer term feeding tube
pancreatic abscess dx, tx
rare, complication of pancreatitis
dx- C/S similar to pancreatitis, U/S, CT
tx= sx- debride, culture, partial pancreatectomy
pancreatic pseudocyst
collection of fluid enclosed w fibrous tissue (Sterile)
dx- U/S
tx- aspiration, sx if growing
