Abdominal Sx 3 Flashcards
anatomy of large intestine: what is the diverticulum off colon called? does it communicate with ileum?
cecum
no
anatomy of large intestine: which has a long mesocolon, the small intestine or the large intestine?
small intestine has long mesentery and large intestine has a short mesentery
large intestinal bacteria? what Gram and aerobe status are most common
GRAM NEGATIVE ANAEROBES
does large intestine have good collateral circulation
NO, unlike the small intestine it has poor collateral circulation
so, wound tensile strength is slow and bowel viability is hard to assess
you are suspicious of a mass on the colon. should you perform a full thickness biopsy?
NO it is too high risk to do this on colon. you only ever remove areas of suspected avascularity or necrosis
how is cecal disease (cecal impactions, inversion, neoplasias) treated
typhlectomy (excision) (it is not called a cecumectomy, that would make too much sense)
typhlotomy not recommended
what is most common type of neoplasia in cecum
GIST, gastrointestinal stromal tumor
what is Hirschsprung’s disease? is it common in SA?
congenital megacolon.
absence of mesenteric ganglionic cells in distal colonic segment that cause permanent muscular spasm of affected area, so functional obstruction of bowel
this is rare in SA
what is wrong? how to treat?
full of poop (obstipated)
medical management first unless obvious neoplastic cause
manually deobstipate under SEDATION OR GA
if you need to refer, do so to an IM specialist
anatomy: what provides blood supply for the large intestine?
cranial and caudal mesenteric artery/vein
subtotal colectomy: what is the important blood supply to preserve?
CRANIAL RECTAL BRANCH of caudal mesenteric artery
do cats adapt well to subtotal colectomy
yes, they adapt well to loss of water absorptive capability; 80% will eventually not have diarrhea and good function
what are 2 examples of benign large intestinal neoplasia? what layer of LI do they invade?
adenomatous polyps and leiomyoma
they are in the mucosa and do not invade submucosa
what are 2 examples of malignant large intestinal tumors?
adenocarcinoma and leiomyosarcoma
carcinoma in situ - is malignant cells but don’t invade basal lamina, so only in mucosa
who most commonly gets chronic volvulus
large breed dogs, especially German shepherds
risk factors include previous GI disease, previous abdominal sx, EPI
what is carcinoma in situ
malignant cells present in mucosa but no invasion through basal lamina (group of abnormal cells that are only found in the place they first formed)
what is wrong with the large intestine?
colonic volvulus
note severe gaseous dilation and malpositioning of the large intestine
what is wrong with the large intestine?
nothing, this is a normal canine large intestine
describe surgical treatment of colonic volvulus
- CRITICAL surgical emergency!
- derotate colon. there is very high reperfuision risk if black/ischemic
- R&A may be needed if devitalized
- ALWAYS do a left-sided colopexy
- DO NOT cut down to muscular layer of diseased colon; SCARIFY ONLY
- 24 pot-op care
name 2 possible causes of colonic perforation
sharp or blunt abdominal trauma, eg. GSW, knife wound, dog bites, bone fragments, rarely FBs
iatrogenic
non-traumatic perforation due to steroid admin or torsion
what surgical procedure should you perform for treatment of splenic neoplasia
complete splenectomy (partial not recommended)
what type of biopsy us most often used for splenic biopsy
aspiration/Trucut
but biopsy in general is uncommon, usually just remove entire spleen
splenic mass: unless metastatic diseases present, it is difficult to differentiate between being and malignant masses without _______
HISTOPATHOLOGY
what is the most common splenic mass in a DOG
hemangiosarcoma (1/3 to 2/3 all splenic masses are malignant, and 2/3 of these are HSA)
what is are the TWO most common splenic masses in a CAT
mast cell tumor, followed by lymphosarcoma (37-73% of all splenic lesions in cats are malignant)
what order to ligate the vessels in for splenectomy
splenic artery and vein (separately)
gastroepiploic and short gastric vasculature
momentum and associated vessels
what is the treatment for splenic torsion
splenectomy (do not detorse first, just remove)
what is wrong with spleen?
splenic torsion
C-shaped spleen on radiographs
what is wrong with spleen?
splenic torsion
starry night appearance on US
Doppler would show absence of blood flow
how to diagnose splenic trauma/laceration
abdominocentesis with PCV of abdominal fluid greater than or equal to peripheral blood
AUD to define source
ex lap if you can’t control hemorrhage
how would you treat a splenic hemorrhage conservatively
pressure bandage of entire abdomen and hindlimb
monitor and support care
how many lobes does the liver have
6
the _______ supplies 25% of blood flow and 75% of oxygen to liver, while the ________ supplies 75% of blood flow to the liver
hepatic artery; portal vein
portosystemic shunts tend to be _______) in small dogs and cats but ________ in large breed dogs (although latter is rare)
extrahepatic; intrahepatic
a young cat presents with poor growth, lethargy, hepatic encelopathy, ammonia urate crystals in urine, and ptyalismn, and eyes that look like this. what are you suspicious of?
portosystemic shunt
note, inappetence and urinary signs are present in some but not all cases.
signs are similar in dogs except for ptyalism and copper-coloured eyes.
delete this card
ok
describe pre-operative treatment of portosystemic shunt
preoperative treatment for at least 2 weeks prior to surgery: treat hepatic encelopathy, and if needed give antiepileptics
which portosystemic shunt patients can be surgically treated? which can be medically treated?
if single shunting vessel: surgical treatment
if multiple acquired shunts medical
which kind of portosystemic shunt has longest mean survival time
congenital single PSS with surgical treatment and no post-op seizures
slightly better post-op success rate for EHPSS vs IHPSS, don’t know about MST
name a few post-operative complications of portosystemic shunts
portal hypetension
seizures
hypothermia
hypothermia
hypoglycaemia
liver lobe torsion: what is the most commonly affected lobe
left lateral lobe
liver abscess: what is the most common organism
E. coli
this condition is uncommon in SA
liver abscess: what is the best imaging to do
AUS or CT plus an FNA most valuable
which is more common: primary liver neoplasia or metastatic liver neoplasia
metastatic
what are the 2 most common primary hepatic neoplasias
hepatocellular carcinomas 50-70% (most common, malignant, but good prognosis if surgically resectable)
hepatocellular adenomas 30% (benign, but can be very large and cause issues)
(other liver masses: nodular hyperplasia is benign, found in older dogs. lymphosarcoma is not surgical and prognosis is grave. infectious etiologies possible)
you diagnose extrahepatic biliary obstruction (EHBO) based on US findings and increased liver enzymes (ALT, ALT, AST, and especially increased bilirubin). give at least two differentials for or conditions that can cause EHBO
intralumunial obstruction of bile flow: CHOLELITHS, GB MUCOCELE, flukes
extraluminal compression of CBD: pancreatitis in cat, neoplasia
patient has elevated ALT, GGT, total bilirubin, and very high ALP. what is diagnosis? does this condition always appear like this?
gallbladder mucocele (bile-laden semisolid to immobile material in the GB)
no, not always kiwi appearance
what are two possible sequelae of GB mucocele
extrahepatic bile duct obstruction
rupture due to disruption of GB wall blood flow resulting in pressure necrosis
what is the MOST COMMON gallbladder disease and what is typical signalment
GB MUCOCELE
older to middle aged dogs
breed dispositions: SHELTIES, Cocker Spaniels, Mini Schnauzers, Border terriers. very uncommon in cats
what is the cause of GB mucoceles
unknown
often concurrent Cushing’s, hypothyroidism, or hyperlipidemia
maybe genetic factors or hyperplasia of mucin-secreting glands
medical vs surgical treatment for GB mucocele: when is surgery clearly indicated
if immobile, stellate, or striated appearance of GB mucocele and biochemical markers for hepatobiliary disease
note this is a referral procedure; there are many perioperative and post-op risks and 24h intensive care is needed
what is treatment for cholelithiasis (EHBO) (super simple)
surgical referral
(cholecystectomy, choledochotomy +/- cholecystoenterostomy)
a rare cause of EHBO is ________. caused bu calcium bilirubin ate or bilirubin concretions and 20-50% visible radiographically
cholelithiasis
pancreatitis (EHBO): acute or chronic fibrosis pancreatitis causes compression of ______
common bile duct
neoplasia (EHBO): what are most common neoplasias
tutors of exocrine pacnrease
gastric tumors
proximal duodenal tumors
septic cholecystitis is rare, but most common in cats. what is the most common causative organism?
E. coli
in cases of bile peritonitis, what are the 2 aims of surgery
stopping the leak
ensuring bile can flow form liver to small bowel
what are 4 indications for pancreas surgery
- biopsy
- mass removal
- pancreatic pseudocyst
- pancreatitis? (50-100% mortality rate. only if concurrent EHBO and need for stent, or need a longer feeding tube than NG tubes)
REFER cases
what is most common complication of pancreatitis in dogs
pancreatic abscess
what is a pancreatic pseudocyst
sterile collection of fluid containing pancreaatic juice and debris enclosed by wall of fibrous or granulation tissue
an uncommon cause of pancreatitis in dogs and cats
sterile
