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VETM 522 > abdominal surgery > Flashcards

abdominal surgery Flashcards

1
Q

why do abdominal exploratory?

A

confirm a diagnosis
surgical resolution
biopsy for pathology/histopatha

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2
Q

approches for abd explore

A

ventral midline, laparoscopic, can do flank or paracostal

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3
Q

what can you see on abd explore

A

diaphragm, liver, gallbladder/bile duct, pancreas, spleen, intestinal tract, kidneys, adrenals, uterus ovaries, bladder/ureters, prostate, LN

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4
Q

LN biopsy

A

whole node, careful w mesenteric (wedge)

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5
Q

intestinal biopsy

A

blade/biopsy punch, switch gloves and instruments

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6
Q

liver biopsy

A

guillotine, biopsy punch

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7
Q

what organs are hard to biopsy?

A

kidney, pancreas, bladder, spleen, adrenals, body wall (uncommon), omentum

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8
Q

types of peritonitis

A

primary- FIP
secondary- aseptic (FB, ruptured neoplasms, pancreatic enzymes, bile, urine etc)
septic- bowel perforation, wounds, surgical contamination, ruptured pyo

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9
Q

peritonitis C/S

A

depression, abd pain, nausea, v+, d+, anorexia

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10
Q

peritonitis dx

A

BW- leukocytosis, changes w uroabdomen, sepsis, etc.

AXR- free air, effusion

fluid analysis- degenerative neutrophils, bile crystals

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11
Q

peritonitis tx

A

medical- IVF, pain meds, abx (enro, ampi, metro), pressor
surgery- removal of inciting cause, lavage (300ml/kg), place JP drain

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12
Q

peritonitis prognosis

A

guarded at best, needs a lot of post op management

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13
Q

abd trauma

A

bite wounds, GSW, HBC
AXR/peritoneal lavage

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14
Q

abd trauma tx

A

ex lap for all penetrating wounds

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15
Q

indications for stomach sx

A

biopsy, FB,, GDV, hernia

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16
Q

stomach pathology C/S, dx

A

v+ w blood, bloating
BW- hypochloremia, met alk
dx w hx, rads, U/S, CT

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17
Q

gastrotomy indications

A

biopsy, FB removal
safer than enterotomy

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18
Q

gastrotomy

A

lap sponges, stay sutures, suction
cut in avascular location
close w PDS, 2 layer inverting

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19
Q

GDV

A

accumulation of air in stomach, gastric malposition (180-270)-> necrosis, perforation, bleeding from short gastric vessels

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20
Q

GDV risk factors, C/S

A

lg/giant breeds, stress, feeding
C/S- retching, distended abd, dyspnea, restless

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21
Q

GDV dx

A

MEDB (lactate), ecg, pain meds
trocarize, gastric tube (GA), 2 IVs, emerg sx
dx- RL rad

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22
Q

GDV sx

A

dorsal, long midline incision
hold duodenum, pull ventral and push dorsal/left
assess gastric viability-> palpate thickness, mucosal slip, gastrectomy if necrotic
check spleen

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23
Q

indications of splenectomy w GDV

A

torsed pedicle, no sign of contraction/surgery

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24
Q

gastrectomy

A

stay sutures on either side of viable part- cut sm portion, staple and oversew

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25
Q

gastropexy (which side), types?

A

hiatal hernia, intussusception- left
right- GDV

types- incisional (behind last rib, through transversus abd, 2 suture lines)
beltloop

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26
Q

GDV post op

A

ECG for VPCs/vtach, 24/7 monitoring

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27
Q

hypertrophic pylorogastropathy

A

congenital, brachy breeds <1y, acquired in sm breed dogs
C/S- chronic, intermittent v+, increasing frequency
dx- U/S, CT
tx- pyloroplasty

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28
Q

hiatal hernia grades

A

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

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29
Q

gastric neoplasia- C/S, dx, most common, tx

A

v+
U/S, CT
gastric adenocarcinoma (dogs), lymphoma (cats)

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30
Q

SI anatomy

A

arterial blood from cranial mesenteric artery
venous- caudal mesenteric, portal

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31
Q

indications for SI sx

A

FB, mass, intussusception, torsion, trauma

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32
Q

SI disease C/S

A

v+/d+, inappetence, anorexia, melena, weight loss if chronic
painful abd, bloating

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33
Q

diagnostics for SI disease (obstruction)

A

BW- electrolytes (hypochloremic met alk)
dehydration, sepsis
rads- 1.6X L5 (dogs), 2X L% (cats)
bowel malposition, plication, free air

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34
Q

surgical considerations for SI sx

A

fluids- rehydrate before
abx periop

35
Q

what suture should you use for SI sx?

A

4-0 PDS- simple interrupted, continuous
3-0 in lg dogs
single layer appositional

36
Q

solitary intestinal FB

A

make longitudinal incision and remove, R&A if necrotic (end to end)

cut according to blood supply

37
Q

what is the gambee suture?

A

suture pattern used in end to end R and A to prevent eversion

38
Q

how to do R and A

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

39
Q

leak testing

A

used to check sutures, inject w 25g needle, use pressure (15-25mmHg)

40
Q

linear FB dx

A

thread etc
becomes anchored under tongue, pyloris-> SI accordions along FB
dx- PE, rads (plication), contrast rads (caution)

41
Q

linear FB tx

A

conservative- if no C/S
cut and follow through intestines
sx- start at anchor point, milked down and remove w enterotomy

42
Q

SI neoplasia

A

adenocarcinomas, lymphoma in cats

R and A and submit for histopath

43
Q

intussusception C/S, dx

A

young animals <1y
idiopathic, parasites, parvo, linear FB, previous sx
C/S- d+ v+ abd pain
dx- palpation, rads (obstruction), U/S (targets)

44
Q

intussusception tx

A

exlap- check GIT, reduce if possible, R and A

tx for parasites, pain, nutritional support

45
Q

mesenteric volvulus

A

twisting of bowel on mesenteric axis-> obstruction of veins-> edema, mucosa compromised-> arterial occlusion-> ischemia
young lg breed dogs (GSD)

46
Q

mesenteric volvulus C/S, dx

A

collapse, rapid distension, hematochezia
dx- BW, gaseous distension on rads

47
Q

mesenteric volvulus tx

A

rapid fluids for shock
sx (R and A)-> do not allow reperfusion injury

48
Q

hernias incarceration, strangulation

A

incarceration- sm bowel herniation, cannot be reduced
strangulation- incarcerated w devitalization

49
Q

hernia locations, tx

A

inguinal, scrotal, diaphragmatic, umbilical, etc
reposition bowel, R/A if needed, close hernia

50
Q

intestinal sx complications

A

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

51
Q

lg intestinal sx

A

short unspecialized tube-> referral only!
poor collateral circulation, cant assess viability, dehiscence

52
Q

congenital megacolon

A

absence of ganglionic cells-> permanent spasm-> obstruction
tx- R/A

53
Q

obstipation

A

no stools for days-weeks
dehydration, weakness
dx- rectal, rads
tx- try medical, manually deobstipate
refer for subtotal colectomy

54
Q

subtotal colectomy

A

remove colon from proximal site-> 3-5cm cranial to pubis
**preserve blood supply to both ends

55
Q

cecal disease

A

impaction- typhectomy
inversion-> invagination into colon, bloody d+, typhlectomy
neoplasia- anorexia, weight loss, v+,d+, tx w excision

56
Q

lg intestinal neoplasia

A

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

57
Q

colonic torsion, C/S, dx, tx

A

GSD
C/S- d+,v+, bloating, abd pain
dx- rads
tx- emergency-> try to R/A and L pexy

**perforation-> grave prognosis

58
Q

indactions for spleen sx

A

biopsy (guillotine, partial splenectomy)
splenectomy- torsion, mass, trauma

59
Q

splenic masses

A

2/3 are hemangiosarc
2-3 w sx, 6m w sx/chemo

60
Q

splenectomy

A

ligate splenic artery/vein-> short gastrics (after pancreas) or can ligate all along the spleen (use suture, staples, bipolar vessel sealing)

61
Q

splenic torsion

A

secondary to GDV, neoplasia
presents as acute abdomen
c shaped on rads
remove before untwisting

62
Q

liver lobes

A

left division- L lateral and medial
central division- quadrate, R medial
right division- R lateral, caudate

63
Q

indications for liver sx

A

biopsy after imaging
referral-> PSS< liver trauma, lobar enlargement

64
Q

PSS

A

vasculature connection bypassing liver
congenital, usually extrahepatic

65
Q

PSS tx

A

peri op management (treat HE)
sx for single shunting vessel-> slowly redirec bloodflow into portal vessel
suture, ameroid constrictor, cellophane banding

66
Q

post op management for PSSS

A

complications (portal hypertension, hypoglycemia, seizures)
90% success

67
Q

liver lobe torsion

A

one lobe (L lat), non specific C/S
dx w U/S, CT
tx liver lobectomy

68
Q

liver lobectomy

A

R sided more complex
staples, suture ligation
may need paracostal incisions, diaphragmatic release

intensive post op-> may need transfusion, pneumo, ecg

69
Q

liver abscess causes, dx, tx

A

rare
necrosis of neoplasm
ascending biliary infection
hematogenous spread
FB migration
dx- CT
tx- lobectomy, abx

70
Q

liver neoplasia C/S, dx, tx

A

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

71
Q

extrahepatic biliary duct obstruction dx, ddx

A

C/S are vague
dx- U/S, CT
ddx:
extraluminal (pancreatitis, neoplasia)
intraluminal- cholelith, flukes, GB mucocele

72
Q

GB mucocele C/S

A

semo solid bile material blocking duct-> EHBO, necrosis of GB

older-middle aged dogs (shelties)
C/S- acute abdomen, variable (icterus, pain, septic shock)

73
Q

GB mucocele tx

A

medical- low fat diet, ursodiol, SAMe
sx- cholcystectomy

74
Q

cholelithiasis

A

rare, 50% visible on rads, obstruct CBD at duodenal papilla
referral sx

75
Q

pancreatitis

A

compression of CBD
medical management
sx-> stent, cholecystoduodenostomy

76
Q

neoplasia causing EHBO

A

tumors-> pancreas, gastric, duodenal tumours
sx- cholecystoduodenostomy, jejunostomy

77
Q

cholecystoenterostomy complications

A

bile leakage-> peracute sepsis
long tern- chronic cholangiohep, stenosis b/w Gb and intestine-> can create new opening

78
Q

septic cholecystitis

A

rare, most common in cats
acute abd-> devitalization, perforation, septic peritonitis

79
Q

bile peritonitis tx

A

stop leak, ensure bile flow

postop management critical

80
Q

indications for pancreas sx

A

biopsy, mass removal, pancreatitis, pseudocyst

81
Q

pancreatic biopsy technique

A

be careful
guillotine, stapler, bipolar vessel sealing

82
Q

reasons for pancreatitis sx

A

concurrent EHBO (stent)
need a longer term feeding tube

83
Q

pancreatic abscess dx, tx

A

rare, complication of pancreatitis
dx- C/S similar to pancreatitis, U/S, CT
tx= sx- debride, culture, partial pancreatectomy

84
Q

pancreatic pseudocyst

A

collection of fluid enclosed w fibrous tissue (Sterile)
dx- U/S
tx- aspiration, sx if growing

VETM 522 (22 decks)

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