Abdominal sx Flashcards
what 2 approaches to abdominal exploratory sx do we need to know?
ventral midline
laparoscopic (requires advanced training)
why do we do abdominal exploratories?
- confirm a dx
- surgical resolution
- information (gross + histopath)
GI biopsies are considered ______ wounds.
clean-contaminated
which organs do you need to think twice about getting biopsies from?
- kidney
- pancreas
- bladder
- spleen
- adrenals (never do it)
- body wall
- omentum
what are the C/S of peritonitis?
very nonspecific
depression, abd pain, nausea, vomiting, anorexia, diarrhea, ± fever, ± leukocytosis
how do you dx peritonitis?
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
how do you manage peritonitis?
medical (first step):
- IV fluids, pain meds, Abx, diagnostics, imaging
surgery:
- removal of inciting cause
- lavage abd wall
- drainage of peritoneal cavity
what antibiotics should you admin for peritonitis?
broad spectrum!
enrofloxacin, ampicillin, metronidazole
what is the px of peritonitis?
at best, guarded
what are the indications for stomach surgery?
- biopsy
- FB
- GDV/prophylactic gastropexy
there are others but these are the ones bolded in the ppt
what are the C/S assoc with stomach pathology?
V+, hematemesis, bloating
what are the bloodwork abnormalities with stomach outflow obstructions?
hypochloremia
metabolic alkalosis (initially)
what are the indications for a gastrotomy?
biopsy, FB removal
true or false: gastrotomy is safer than enterotomy
true
where should you make your incision during a gastrotomy? how do you suture it closed?
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)
why is GDV such a bad thing?
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)
what are the C/S of GDV?
non-productive retching, distended abdomen, ptyalism, restlessness, abd discomfort, dysrhythmia, tachypnea, dyspnea, evidence of shock/collapse
what initial diagnostics and mgmt do you do for a GDV?
- bloodwork: basic –> CBC or PVC/TS, electrolytes, lactate (?)
- BP, ECG (lidocaine for arrhythmias)
- pain mgmt
then move on to stabilization
how do you stabilize a patient with a GDV?
decompression:
- trocarize
- gastric tubing
large bore IV catheters, at least 2, bolus!
emergency sx
what is the most definitive way to diagnose a GDV? when do you do this test?
abd rads… in RIGHT LATERAL!!!!
- will see gas distended stomach with compartmentalization
once pt is stable
describe very briefly what GDV surgery entails
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
what side do you perform a gastropexy on for GDV? what about hiatal hernias? what about prophylactic pexy? what about gastroesophageal intussusception?
GDV + prophylactic pexy: RIGHT
hiatal hernia + gastroesophageal intussusception: left
how do you surgically treat hypertrophic pylorogastropathy (aka pyloric stenosis)?
pyloroplasty (referral sx)
what are the indications for surgery on the small intestines?
- biopsy
- FB
- mass
- intussusception
- mesenteric torsion
- trauma/perforation
what are the C/S and PE findings with SI disease?
v+, d+, inappetence, anorexia, melena/hematochezia, weight loss, depression, abd tenderness, bloated abd
what blood work findings are commonly seen with SI disease?
prox GI obstruction: hypochloremic metabolic alkalosis
hypokalemia, dehydration, sepsis?
what abd rad should be your first projection?
left lateral
idk why, the ppt just said it was this one
what are some surgical considerations when doing SI sx?
- 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
what is the holding layer of the intestines?
submucosa (same as for every other hollow viscous organ)
what direction do you make your incision for intestinal FBs?
longitudinal, along anti mesenteric border
if there is necrosis, anastomose and resect
when you do resection and anastomosis, you should cut the non-dilated side how?
at a slant
describe briefly how to do surgery to take out a linear FB
- start with anchor point, often gastrotomy
- FB can be milked down as far as possible and removed through several enterotomies
what is the most common neoplasia in dogs of the stomach and SI?
adenocarcinomas
what is the most common neoplasia in cats of the stomach and SI?
lymphoma
what is the difference b/t intussusceptum and intussuscepiens?
intussusceptum: invaginated segment (the one inside)
intussuscepiens: receiving segment (the one outside)
intussusceptions are most common in animals _____ (age). the cause is mostly ______.
<1yo
idiopathic
what are these U/S of?
intussusception
how do you surgically treat intussusception?
exploratory lap
resection + anastamose
enteroplication –> controversial
how do you treat mesenteric volvulus?
- rapid fluid resuscitation (shock)
- surgery ASAP! (remove twist, resect and anastomose)
what are some complications with intestinal surgery?
- ileus
- short bowel syndrome
- adhesions
- dehiscence of intestinal incision –> septic peritonitis
how do you treat ileus?
- tx underlying conditions
- prokinetics
- anti-nausea
- avoid opioids
what is ileus? when should you suspect it?
inadequate peristaltic activity
in a patient who just had intestinal sx that is regurg and v+, ± inappetence
how do you treat short bowel syndrome? when does this syndrome occur?
maintain fluid balance, nutrition, and exogenous vitamins
can develop when resect ~75% of intestines
how do you manage adhesions after surgery?
have to go in and R&A
what is the 4 x 4 x 4 rule?
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)
true or false: you can perform full thickness biopsies on LI. why or why not?
false. do not do it!
there is poor collateral circulation
what is Hirschprung’s disease? how do you tx it?
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
how do you treat obstipation?
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)
how do you treat cecal impactions and cecal inversions?
typhlectomy
how do you dx colonic torsions? how do you treat them?
rads
critical emergency (reposition colon, L-sided colopexy always performed, R&A maybe)
what are the indications for splenic surgery?
biopsy, splenectomy
what is the most common splenic mass?
hemangiosarcoma
what should you do if you have splenic torsion?
splenectomy
do not try to detorse the spleen! just remove it
true or false: pre-op mgmt of porto-systemic shunts is crucial for successful outcome.
true
what is the most common liver lobe that’s involved in torsion
left lateral
how do you treat liver lobe torsion?
liver lobectomy
how do you treat liver abscesses?
lobectomy and appropriate Abx
what is the most common liver tumour/=?
hepatocellular carcinoma
what is the most common gallbladder disease?
gallbladder mucocele
what is this an U/S of?
gallbladder mucocele
how do you treat gallbladder mucoceles?
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)
what is a cholecystoenterostomy
surgery where the gallbladder is joined with the SI
true or false: for any pancreatic surgeries, you should refer them
yes true
what is a pseudocyst?
collection of fluid containing pancreatic juice and debris enclosed by a wall of fibrous or granulation tissue
uncommon complication of pancreatitis in SA
