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522 (dog & cat class) > Abdominal sx > Flashcards

Abdominal sx Flashcards

1
Q

what 2 approaches to abdominal exploratory sx do we need to know?

A

ventral midline

laparoscopic (requires advanced training)

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2
Q

why do we do abdominal exploratories?

A
  • confirm a dx
  • surgical resolution
  • information (gross + histopath)
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3
Q

GI biopsies are considered ______ wounds.

A

clean-contaminated

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4
Q

which organs do you need to think twice about getting biopsies from?

A
  • kidney
  • pancreas
  • bladder
  • spleen
  • adrenals (never do it)
  • body wall
  • omentum
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5
Q

what are the C/S of peritonitis?

A

very nonspecific

depression, abd pain, nausea, vomiting, anorexia, diarrhea, ± fever, ± leukocytosis

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6
Q

how do you dx peritonitis?

A

bloodwork:
- maybe leukocytosis w/ left shift or neutropenia
- uroperitoneum: elevated BUN, creat, K+, fluid creatinine, fluid K+
- bile peritonitis: elevated bilirubin, ALP, ALT
- septic

abd rads:
- may show free air
- lack of serosal detail = effusion

peritoneal fluid analysis

cytology/Clin Path:
- septic: degenerative neutrophils with intracellular bac t

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7
Q

how do you manage peritonitis?

A

medical (first step):
- IV fluids, pain meds, Abx, diagnostics, imaging

surgery:
- removal of inciting cause
- lavage abd wall
- drainage of peritoneal cavity

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8
Q

what antibiotics should you admin for peritonitis?

A

broad spectrum!

enrofloxacin, ampicillin, metronidazole

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9
Q

what is the px of peritonitis?

A

at best, guarded

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10
Q

what are the indications for stomach surgery?

A
  • biopsy
  • FB
  • GDV/prophylactic gastropexy

there are others but these are the ones bolded in the ppt

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11
Q

what are the C/S assoc with stomach pathology?

A

V+, hematemesis, bloating

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12
Q

what are the bloodwork abnormalities with stomach outflow obstructions?

A

hypochloremia
metabolic alkalosis (initially)

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13
Q

what are the indications for a gastrotomy?

A

biopsy, FB removal

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14
Q

true or false: gastrotomy is safer than enterotomy

A

true

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15
Q

where should you make your incision during a gastrotomy? how do you suture it closed?

A

incise b/t greater and lesser curvature in a relatively avascular location

2 layers, PDS, SCP or inverting suture pattern
(mucosa/submucosa then muscularis/serosa)

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16
Q

why is GDV such a bad thing?

A

stomach rotates clockwise 180-270 degrees causing gastric ischemia, necrosis, and perforation. as well as local splenic effects and systemic effects (cardiac, pulmonary –> obstructive and hypovolemic shock)

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17
Q

what are the C/S of GDV?

A

non-productive retching, distended abdomen, ptyalism, restlessness, abd discomfort, dysrhythmia, tachypnea, dyspnea, evidence of shock/collapse

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18
Q

what initial diagnostics and mgmt do you do for a GDV?

A
  • bloodwork: basic –> CBC or PVC/TS, electrolytes, lactate (?)
  • BP, ECG (lidocaine for arrhythmias)
  • pain mgmt

then move on to stabilization

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19
Q

how do you stabilize a patient with a GDV?

A

decompression:
- trocarize
- gastric tubing

large bore IV catheters, at least 2, bolus!

emergency sx

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20
Q

what is the most definitive way to diagnose a GDV? when do you do this test?

A

abd rads… in RIGHT LATERAL!!!!
- will see gas distended stomach with compartmentalization

once pt is stable

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21
Q

describe very briefly what GDV surgery entails

A

dorsal recumbency –> long ventral midline incision (xiphoid to pubis)

detorsion (push stomach dorsal and to the L, duodenum ventral)

assess gastric, splenic and rest of abd viability

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22
Q

what side do you perform a gastropexy on for GDV? what about hiatal hernias? what about prophylactic pexy? what about gastroesophageal intussusception?

A

GDV + prophylactic pexy: RIGHT

hiatal hernia + gastroesophageal intussusception: left

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23
Q

how do you surgically treat hypertrophic pylorogastropathy (aka pyloric stenosis)?

A

pyloroplasty (referral sx)

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24
Q

what are the indications for surgery on the small intestines?

A
  • biopsy
  • FB
  • mass
  • intussusception
  • mesenteric torsion
  • trauma/perforation
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25
Q

what are the C/S and PE findings with SI disease?

A

v+, d+, inappetence, anorexia, melena/hematochezia, weight loss, depression, abd tenderness, bloated abd

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26
Q

what blood work findings are commonly seen with SI disease?

A

prox GI obstruction: hypochloremic metabolic alkalosis

hypokalemia, dehydration, sepsis?

27
Q

what abd rad should be your first projection?

A

left lateral

idk why, the ppt just said it was this one

28
Q

what are some surgical considerations when doing SI sx?

A
  • fluid therapy is important (rehydrate prior to anesthesia!)
  • Abx prophylaxis
  • monofilament sutures
  • 4-0 PDS in simple interrupted/simple continuous, 3-0 PDS for large dogs
  • holding layer is submucosa
  • single layer appositional currently recommended in SA
29
Q

what is the holding layer of the intestines?

A

submucosa (same as for every other hollow viscous organ)

30
Q

what direction do you make your incision for intestinal FBs?

A

longitudinal, along anti mesenteric border

if there is necrosis, anastomose and resect

31
Q

when you do resection and anastomosis, you should cut the non-dilated side how?

A

at a slant

32
Q

describe briefly how to do surgery to take out a linear FB

A
  • start with anchor point, often gastrotomy
  • FB can be milked down as far as possible and removed through several enterotomies
33
Q

what is the most common neoplasia in dogs of the stomach and SI?

A

adenocarcinomas

34
Q

what is the most common neoplasia in cats of the stomach and SI?

A

lymphoma

35
Q

what is the difference b/t intussusceptum and intussuscepiens?

A

intussusceptum: invaginated segment (the one inside)

intussuscepiens: receiving segment (the one outside)

36
Q

intussusceptions are most common in animals _____ (age). the cause is mostly ______.

A

<1yo
idiopathic

37
Q

what are these U/S of?

A

intussusception

38
Q

how do you surgically treat intussusception?

A

exploratory lap
resection + anastamose

enteroplication –> controversial

39
Q

how do you treat mesenteric volvulus?

A
  • rapid fluid resuscitation (shock)
  • surgery ASAP! (remove twist, resect and anastomose)
40
Q

what are some complications with intestinal surgery?

A
  • ileus
  • short bowel syndrome
  • adhesions
  • dehiscence of intestinal incision –> septic peritonitis
41
Q

how do you treat ileus?

A
  • tx underlying conditions
  • prokinetics
  • anti-nausea
  • avoid opioids
42
Q

what is ileus? when should you suspect it?

A

inadequate peristaltic activity

in a patient who just had intestinal sx that is regurg and v+, ± inappetence

43
Q

how do you treat short bowel syndrome? when does this syndrome occur?

A

maintain fluid balance, nutrition, and exogenous vitamins

can develop when resect ~75% of intestines

44
Q

how do you manage adhesions after surgery?

A

have to go in and R&A

45
Q

what is the 4 x 4 x 4 rule?

A

4-0 suture, 4mm bites, 4 days –> dehiscence (bc at this point the suture is the only thing holding the gut together –> more likely to come apart)

46
Q

true or false: you can perform full thickness biopsies on LI. why or why not?

A

false. do not do it!

there is poor collateral circulation

47
Q

what is Hirschprung’s disease? how do you tx it?

A

absence of mesenteric ganglionic cells in a distal colonic segment –> permanent muscular spasm of affected area –> functional obstruction of bowel

congenital megacolon essentially

tx with R&A

48
Q

how do you treat obstipation?

A

medically first if you can

manually deobstipate

don’t refer to surgeon –> refer to internal med

if surgery is needed: you can do a sub-total colectomy in a cat (remember, cranial rectal branch of blood supply must be preserved)

49
Q

how do you treat cecal impactions and cecal inversions?

A

typhlectomy

50
Q

how do you dx colonic torsions? how do you treat them?

A

rads

critical emergency (reposition colon, L-sided colopexy always performed, R&A maybe)

51
Q

what are the indications for splenic surgery?

A

biopsy, splenectomy

52
Q

what is the most common splenic mass?

A

hemangiosarcoma

53
Q

what should you do if you have splenic torsion?

A

splenectomy

do not try to detorse the spleen! just remove it

54
Q

true or false: pre-op mgmt of porto-systemic shunts is crucial for successful outcome.

A

true

55
Q

what is the most common liver lobe that’s involved in torsion

A

left lateral

56
Q

how do you treat liver lobe torsion?

A

liver lobectomy

57
Q

how do you treat liver abscesses?

A

lobectomy and appropriate Abx

58
Q

what is the most common liver tumour/=?

A

hepatocellular carcinoma

59
Q

what is the most common gallbladder disease?

A

gallbladder mucocele

60
Q

what is this an U/S of?

A

gallbladder mucocele

61
Q

how do you treat gallbladder mucoceles?

A

take out the gallbladder lmao

take that bitch right out

cholecystectomy (because I dont think they’ll accept “that that bitch right out” on the exam)

62
Q

what is a cholecystoenterostomy

A

surgery where the gallbladder is joined with the SI

63
Q

true or false: for any pancreatic surgeries, you should refer them

A

yes true

64
Q

what is a pseudocyst?

A

collection of fluid containing pancreatic juice and debris enclosed by a wall of fibrous or granulation tissue

uncommon complication of pancreatitis in SA

522 (dog & cat class) (31 decks)

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