Abdominal Sx 2 Flashcards
main arterial blood supply for small intestines
mainly cranial-mesenteric artery
main venous drainage for small intestine? where does it empty?
portal vasculature: mainly cranial mesenteric vein, empties into liver
the segments of the small intestine are
duodenum, jejunum, ileum
name a few indications for small intestine surgery
biopsy
FB: linear or solitary
mass: neoplasia, infectious, inflammatory
intussusception
mesenteric torsion
trauma or perforation
name some generalized C/S for small intestine disease
V/D, inappetence, anorexia
melena, hematochezia (for volvulus) weight loss, cachexia (for chronic issue)
PE findings for small intestinal disease in general
lethargy, abdominal discomfort
+/- abdominal distension, palpable abnormality (mass or FB 14% of time)
name some bloodwork findings for small intestinal disease, generally
electrolytes: hypochloremic metabolic alkalosis, hypokalemia, Na+ imbalance
dehydration: hemoconcentration, hyperlactatemia (perfusion abnormalities)
if sepsis present: hypoglycaemia, hyperbilirubinemia, hypelactatemia
imaging for SI disease: which projection to perform first and why
LEFT LATERAL projection
movement of gas during repositioning of patient can result in pathology being seen clearly on only 1 view
when order used is LLat, DV, then RLat, gas is more likely to be present in pylorus and duodenum
imaging for SI disease: what is suggest of obstruction for DOG
dilated SI loops at least 1.6X height of mid C5 vertebrae (lateral)
if radiolucent FB, may see: stomach and pylorus shifted to right, gravel signs with chronicity, lack of serial detail (peritoneal effusion), intestinal crowding or plication, free abdominal gas if perforation)
imaging for SI disease: what is suggestive of obstruction for CATS
dilated SI loops at least 2X height of cranial endplate of L5 (lateral)
if radiolucent FB, may see: stomach and pylorus shifted to right, gravel signs with chronicity, lack of serial detail (peritoneal effusion), intestinal crowding or plication, free abdominal gas if perforation)
SI disease imaging: besides rads, what other imaging methods can be used
barium radiography (contraindicated if perforation or vomiting!)
abdominal U/S (very sensitive and specific with radiologist)
CT (fast and definitive, but expensive)
SI surgery perioperative treatment: what fluids to use? when do you want to rehydrate patient?
- crystalloid, colloide, electrolyte supplementation, since patients are at risk for fluid and electrolyte imbalances when undergoing SI sx
- usually dehydrated, so rehydrate PRIOR to anesthesia; some FBs will pass with fluids alone
SI surgery perioperative treatment: what antibiotics to use, and when to give?
- antibiotic prophylaxis indicated since GIT surgery is clean-contaminated to contaminated
- 1st gen cephalosporins (usually CEFAZOLIN) (Gr+ and Gr-)
- give 30 MIN BEFORE surgical incision and continue 24 hours post-op if clean-contaminated or >24h if contaminated
SI surgery: what suture to use
3-0 PDS
4-0 very large dogs
want MONOFILAMENT with LONG ABSORPTION TIME and good maintenance of strength if low albumin
SI surgery suture technique: what is holding layer
SUBMUCOSA is holding layer, same for all hollow viscera
SI surgery suture technique: what pattern to use?
GAMBEE or MODIFIED GAMBEE
if experienced SI or SC is ok
SINGLE LAYER appositional; you are apposing submucosa
what surgical technique to remove a solitary (focal) FB
if mobile and in duodenum: manipulate to stomach then gastronomy
if not mobile or too abroad: enterotomy, abroad incision ideally
after removing FB, what surgical technique to use if some intestine is necrotic/compromised
R&A, intestinal resection and anastomosis
either end to end R&A or (more advanced) functional end to end anastomosis
which pink line is better position for an intestinal resection and anastomosis
want avoid leaving areas with poor blood supply
intestinal resection and anastomosis: what 4 techniques could you use if there is luminal size disparity
- cut smaller side on angle
- slightly wider suture bites on larger side
- extend incision along anti mesenteric border on smaller side
- side to side anastomosis
what are 2 methods of testing if intestine will leak following surgery? which is better?
saline leak testing, 10-15 mL per 10 cm segment of intestine, gentle pressure
probe testing with mosquito hemostats, gentle pressure
both are equally effective
intestinal surgery: what are 2 types of suture line reinforcement? which is controversial?
omental wrapping
conflicting evidence on efficacy, does provide blood supply but not physical support, low/no risk, does not increase sx time
serosal patching: again conflicting studies on efficacy, provides physical support, does increase sx time and risk of loops
controversial
what are 2 common locations for anchor point of a linear FB
base of tongue or pylorus
what are some imaging methods to diagnose linear FB
- rads: see SI plication and teardrops, stomach and pylorus to right of midline
- contrast rads: caution, because SI perforations common an barium can cause peritonitis
- Abd U/S: Se, Sp, but not usually needed
- ex lap: if suspicious of FB and stable patient, may be safer than contrast rads
what is wrong with the cat
linear foreign body
can see SI plication
in what case is it acceptable to do conservative treatment for linear FB
patients presenting soon after ingestion with NO CLINICAL SIGNS and visible FB anchored at base of tongue
(not great idea, increased risk of intestinal perforation if it doesn’t work, do if no $)
what is conservative treatment for linear FB
release FB from under tongue, put radiopaque clip on it, should pass in 1-3 days, can do serial rads
do not pull on FB
describe surgical treatment for linear FB
perioperative stabilization, as with all SI sx
isolate bowel if possile
start with anchor point, often gastrotomymost effective and safest technique
8-13% of all tumors in dogs and cats arise in which body section
small intestine
what are the 3 most common malignant SI neoplasias in DOGS
adenocarcinoma, gastrointestinal stroma tumors (GIST), lymphoma (diffuse)
what are the 3 most common malignant SI neoplasias in CATS
lymphoma (55%) (large cell or small cell), adenocarcinoma (32%), mast cell tumours (4%)
describe treatment for SI intestinal neoplasia if FOCAL disease is present
resection and anastomosis: 5-10 cm margins, submit for histopath
describe treatment for SI intestinal neoplasia if DIFFUSE disease is present
NOT surgery
refer to oncology or internal medicine
what is intussusception? what are the names for the segments?
invagination of one part of the GIT, the intussusceptum, into the lumen of an adjoining segment, the intussuscipiens
name some causes of intussusception
idiopathic, enteric parasites or viruses (eg. parvo), linear FB, previous abdominal surgeries
neoplasia, maybe, in adult/older patients
post-partum queens up to 8 weeks after delivery: dunno why
who is intussusception most common in
animals <1 year old
diagnosis of intussusception: what findings on abdominal palpation, rads, US
tubular mass in cranial to mid abdomen (if patient is skinny)
may see obstructive pattern on rads
concentric rings “target” pattern, alternating hyper and hypo echoic lines, on AUS
what condition does this young animal have
intussusception
two treatment options for intussusception are? which is controversial?
ex lap with reduction if possible and R&A of affected portion
enteroplication: controversial because associated with increased risk of morbidity and complications weeks to months post-op
what is the difference between torsion and volvulus
torsion = when tube twists on itself
volvulus - twist is on vascular pedicle
young adult male English pointer presents with acute abdomen, rapidly progressive abdominal distension, hematochezia, pain, and collapse. lat view rad shown. diagnosis?
mesenteric volvulus
why:
- see gas distension of entire SI on rads
- C/S are typical of condition. vomiting can also be present
- signalment of young adult male large breed dog is typical; German shepherds and English pointers especially affected
what are C/S of mesenteric volvulus?
acute abdomen, ABDOMINAL DISTENSION, HEMATOCHEZIA, pain, collapse, +/- pain and vomiting
mesenteric volvulus: describe treatment
rapid fluid resuscitation to treat shock
surgery ASAP! VERY URGENT.
- derogate volvulus and R&A viable parts of SI
what is prognosis of mesenteric volvulus
survival possible with early recognition and immediate surgery, but most dogs present late and so px is grave to nil
high risk reperfusion injury with derogation of dead bowel -> SIRS -> DIC -> death :(
herniation of small intestine: what is difference between incarceration vs strangulation?
incarceration: small bowel is herniated (through various body wall or mesenteric defects) and cannot be reduced
strangulation - incarcerated bowel with devitalization
name a few common locations of herniation of small intestine
inguinal, scrotal, diaphragmatic, umbilical, failed body wall closure, traumatic body wall hernias, mesenteric rents not closed at time of surgery
following intestinal surgery, dog is regurgitating, vomiting, and inappetent. you diagnose ileus, a complication of intestinal surgery. what is treatment?
- treatment of underlying conditions, eg. sepsis, electrolyte abnormalities
- prokinetics: metoclopramide CRI, cisapride, erythromycin
- antinausea medication: maropitant, ondansetron
- NG tube to mitigate discomfort and give meals
- feed the dog
what complication of intestinal surgery can develop when 75% of intestinal length is resected and presents with weight loss, malnutrition, and diarrhea?
short bowel syndrome
what complication of intestinal surgery presents with ischemia, hemorrhage, FB, and/or infection, is uncommon in SA, and can be prevented with Halstead’s principles
adhesions
what complication of intestinal surgery usually occurs 3-5 days post-op, in the lag phase of wound healing, when the integrity of the enterotomy of R&A is almost entirely dependent on the SUTURE
dehiscence of intestinal incision(s)
dehiscence of intestinal incision(s) can lead to what condition? (hint: has a guarded prognosis, 50% survival with surgery)
septic peritonitis
