Basic GI SX Part 2

Question 1

How far on either side of a FB in the intestines do I want to milk fecal matter away from the FB before applying the doyen forceps?

Answer 1

10 cm

Question 2

where is the longitudinal incision made for an enterotomy?

Answer 2

the antimesenteric border in the health intestine immediately distal to the FB

Question 3

What suture type is used for an enterotomy?

Answer 3

All suturing is done with 3-0 to 4-0 polyglactin 910 (Vicryl), polyglycolic acid (Dexon), polydiazoxinone (PDS) or polyglactone (Maxon) on a taper cut needle.

Question 4

What layers does the gambee pattern include in an enterotomy closure?

Answer 4

serosa, muscularis, and submucosa (not mucosa- helps to decrease eversion of the mucosa)

Question 5

If the animal has hypoproteinemia or cachexic, what suture pattern should be used?

Answer 5

a simple continuous or inverting Cushing, Connell or Lembert pattern is performed

provides watertight seal and god serosa-serosa apposition

Question 6

Why is surgical gut suture not good to use in either the stomach or colon?

Answer 6

stomach: acid breaks suture down too fast
colon: collagenases speed up tensile strength loss

Question 7

How can a linear FB be removed with a single enterotomy incision vs. multiple?

Answer 7

use a red rubber catheter to detach the FB from the wall of the intestine and push it aborally toward the stomach

Question 8

Ideal suture choice for closing an enterotomy?

Answer 8

4-0 PDS

Question 9

What is the concern with using a Cushing pattern for an enterotomy closure?

Answer 9

eversion causes narrowing of intestinal lumen

Question 10

What is a key thing to address before you start making enterotomy incisions to remove a linear FB?

Answer 10

relieve the anchor point (under tongue or at pylorus)

Question 11

What are the Ad/DisAd to performing anastomoses?

Answer 11

Question 12

How do you want to cut the aborad side the intestine for an anastomosis?

Answer 12

60 degree angle to match the dilated orad side

Question 13

How many mL water do you use for the leak test?

Answer 13

10 mL

Question 14

If a dog has an omental resection and peritonitis, how does this affect mortality?

Answer 14

>90%

Question 15

How much vital tissue should be removed with the devitalized tissue with an intestinal resection?

Answer 15

1.5 cm

Question 16

How much SI can be removed?

Answer 16

80%

Resections greater than 75-80% may result in weight loss, cachexia, macrocytic anemia, hypoproteinemia and chronic diarrhea.

Question 17

Why are approximating patterns preferred over inverting/everting for intestinal R/A?

What are of the intestine would an inverting suture possibly be better?

Answer 17

1) create an increased lumen diameter when comparing to everting or inverting patterns
2) give rapid and precise primary intestinal healing
3) minimize the potential for postoperative adhesion formation.

Inverting w/ colon d/t watertight seal to prevent leakages of bacteria and life-threatening peritonitis

Question 18

What suture pattern is preferred for an R/A?

What tissue layer is critical to include in the incision?

Answer 18

simple interrupted approximate or crushing

submucosa (layer of greatest strength)

Question 19

Which border do you start when suturing an anastomosis?

Answer 19

mesenteric (location of most fat and hardest to suture)

Question 20

After the anastomosis, what is performed?

Answer 20

simple continuous on the mesentery and an omental wrap

Question 21

Two common causes of intussusception? Common associated age?

Answer 21

endoparasites- young animals

neoplasia- older animals

Question 22

Where is the common location for an intussusception to occur?

Answer 22

ileocecal colic jxn

Question 23

What is the sign on U/S for an intussusception?

Answer 23

bullseye sign

Question 24

What will an intussusception feel like on palpation?

What radiographic signs are typically observed?

Answer 24

sausage

gas distention upper GI, Ba enema

Question 25

What can be performed to prevent reoccurrence of an intussusception? Which procedure has more associated complications?

Answer 25

enteropexy and enteroplication enteropexy

Question 26

What do we call the different parts of the invaginating bowel in an intussusception? Which usually has to be resected?

Answer 26

a proximal bowel segment invaginates (intussusceptum) into a distal section of bowel (intussuscipiens) intussusceptum often has to be resected

Question 27

What are some conditions that predispose to intussusception?

Answer 27

Question 28

What is the difference in the presentation of a dog with ileocecocolic vs. a more proximal intussusception?

Answer 28

Patients with high intussusceptions usually undergo **profuse vomiting, rapid dehydration** **and** **early death**. Ileocolic intussusceptions often present with a history of **sporadic vomiting, inappetence, or bloody stools**.

Question 29

When is reduction not possible and an R/A needs to be performed on an intussusception?

Answer 29

When mature adhesions have formed between the invaginated and ensheathing layers, reduction is usually not possible, and resection and anastomosis are performed.

Question 30

Where is intestinal volvulus most likely to occur (rotation along mesenteric axis)? Why?

Answer 30

jejunum and proximal ileum free mesentery

Question 31

Which breed is predisposed to intestinal volvulus? Cause? Most common C.S.?

Answer 31

GSH (large dogs, males 4:1) many causes: tumor, EPI, recent laparotomy hematochezia (vomiting not common unlike w/ GDV)

Question 32

What is the concern with reducing the volvulus to assess intestinal viability

Answer 32

the release of endotoxins if intestine already necrotic, should perform R/A w/o reduction of the volvulus to prevent the release of endotoxins

Question 33

Signs of megacolon

Answer 33

Question 34

Age of cats with megacolon?

Answer 34

range 1-15yrs average 5 years (aka middle-aged cats)

Question 35

Why are fleet enemas avoided in cats?

Answer 35

Hypertonic sodium phosphate (Fleet) enemas should be avoided in cats because they may cause dehydration, hypernatremia, hyperphosphatemia, and tetany due to hypocalcemia.

Question 36

Medical Tx for megacolon in casts?

Answer 36

cisapride (motility-causing the release of acetylcholine from the enteric nervous system which stimulates colonic smooth muscle to contract. ) lactulose (stool softener)

Question 37

For a subtotal coletomy procedure, what is resected and what is anastamosed? Suture pattern and type? What should be administered during sx?

Answer 37

The proposed resection sites are at the ileocecal junction and in 1-2 cm cranial to the brim of the pubis. The ileum is anastomosed to the colon in end-to-end (or end to side) fashion using a simple interrupted pattern of 4-0 prolene. Abx- Cefoxitin

Question 38

What is the main complaint from owners post subtotal coletomy for megacolon in cats?

Answer 38

The major complaint by some owners is chronic perineal soiling caused by the loose feces. (cats will have soft cow-pie feces for remainder of life)

Question 39

What are some considerations for colonic sx?

Answer 39