Ch. 92: Small Intestine Flashcards

Question

Andrews JAVMA 2018 Investigation of potential risk factors for mesenteric volvulus in military working dogs risk factors and odds ratio?

Answer 1

Risk factors associated with MV: - German Shepherd breed (OR 11.5) - increasing age (OR 2) - hx of prophylactic gastropexy (37%) (OR, 65.9) - hx of other abdominal surgery (after gastropexy & requiring new anesthetic episode) (OR 17) - GI disease (OR 5.4)

Answer 2

Ultrasonographic findings included - gastric distension (8/8) and generalized (3/8) or segmental (5/8) intestinal dilation consistent with mechanical obstruction - Wall thickening was mild to moderate (3-6 mm). Normal wall layering was disrupted in all cats. - Strictures were predominantly hypoechoic (7/8) and associated with hyperechoic peri-intestinal mesentery (6/8) Histopathology showed - transmural disease with fibrosis and inflammation (8/8), often (6/8) extending into the bordering mesentery. - mucosa was the most severely affected layer and epithelial injury accompanied the mucosal fibrosis/inflammation

Answer 3

Vascularized jejunal graft incised on antimesenteric border creating rectangular segment, trimmed and sutured to duodenal recipient site as patch graft to repair defect Recovered well without complications, w/I 2 weeks appetite & bowel movements normal, no episodes of vomiting, infrequent regurgitation resolve with medical management

Answer 4

Single intussusception noted in 152 dogs; ICJ 43.1% Intraoperative complications occurred in 10 of 153 (7%) dogs Postoperative complications occurred in 53 of 153 (35%) dogs intussusception recurred in 4/153 (3%) dogs, all within 72 hours postoperatively Fourteen-day postoperative mortality rate was 6%

Answer 5

60% of post-op complications occurred in dogs that presented with clinical signs of > 3 days duration Intestinal necrosis and perforations were more common when surgery was delayed Enterectomies as well as the duration of surgery and anesthesia were increased when surgery was delayed Immediate surgery was associated with earlier return to feeding and discharge from the hospital Outcomes did not differ between dogs treated immediately or over 6 hours after presentation

Answer 6

The proportions of abnormal SNAP cPL test results in the GIFBO and non-GIFBO groups were 12% (3/25) and 16% (4/25), respectively, with no significant difference

Answer 7

67% were clinically useful of slides and thickness of lesion were associated w/ clinically useful samples in univariate analysis

Answer 8

Initially evaluated/treated for Carprofen toxicity Discharged after 72 hours of hospitalization then re-presented 2 days later US diagnosed obstruction due to foreign material, medical management failed Sx found black granular foreign material consistent with charcoal granules

Answer 9

- NSAID 6.3x - Steroids 3.0x - GI neoplasia 13.5x - GI mechanical disease (FBs, GD, GDV) 4.8x - Working dog breeds compared to mixed breeds 2.8x

Answer 10

Radiographic resolution was dependent on location of dilation: - 37.5% were gastric - 17% SI - 11% had gastric and SI obstruction Forty-nine animals without resolution went to surgery

Answer 11

Antiemetic administration in patients with GIFBO was associated with increased time to definitive care and length of hospitalization but not GIFBO associated complications Antiemetics not inherently contraindicated for suspected GIFBO

Answer 12

To investigate sidestream dark field (SDF) videomicroscopy as an objective measure of intestinal viability and determine the effects of enterectomy techniques on intestinal microvasculature in dogs with foreign body obstructions. Microvascular density (mean) at the site of obstruction (140.84) was lower than healthy controls (251.72). There was no difference in microvascular parameters (density or perfused boundary region, PBR) between obstructed dogs with subjectively viable and nonviable intestine Conclusion: SDF videomicroscopy can identify obstructed intestine and quantitate the severity of microvascular compromise (note, unable to establish quantitative guidelines to differentiate viable from nonviable intestine) Handsewn and stapled enterectomies equally preserve perfusion

Answer 13

Complications: 1/126 = 0.8% (GI dehiscence) 23 cats (18%) died within 10 days of surgery Cats with preoperative septic peritonitis (PSP) or that developed hypothermia 25–72h postoperatively had sig. higher odds of mortality

Answer 14

mean width of 3.13 mm and height of 2.47 mm in the transverse section, and length of 3.98 mm and height of 2.44 mm in the longitudinal section DP was homogeneous, subjectively isoechoic to fat and had a round and oval shape in the transverse and longitudinal sections, respectively The animals that were fed a mixed diet had a longer DP than those fed dry food.

Answer 15

No cats developed postoperative septic peritonitis (0%), and all cats survived (100% survival) Cats with an LFB had significantly higher: - body condition score - albumin - ASA status - surgery length - total cost of visit - More likely to develop a surgical site infection - More likely to be administered post-op antibiotics

Answer 16

No postop complications in either SILAIS or OL group All dogs successfully discharged from hospital Conversion from SILAIS to OL occurred in 3/13 (23%) cases No significant difference in duration of hospitalization, duration of time to recovery or sx time between SILAIS and OL

Answer 17

All biopsy samples obtained had sufficient diagnostic quality 25/27 (93%) dogs survived to hospital discharge, 3 (12%) dogs had postsurgical abnormalities unrelated to sx technique

Answer 18

approach consisted in maneuvering the intestinal foreign body into the stomach during laparotomy and then removing it via a gastroscopy. If the foreign body was unmovable, an enterotomy was performed foreign bodies were successfully removed in 25 (43%) cases via endoscopy Mean surgical time was significantly shorter for laparotomy-assisted endoscopic approach compared to enterotomy

Answer 19

Included gastrotomy, jejunotomy, jejunal or colonic anastomosis Foreign body 14/29, neoplasia 6/29, idiopathic megacolon 9, 90% (26/29) survived to discharge – 1 cat had postop CPA and 2/29 cats euthanized (both had neoplasia) 0 had incisional dehiscence

Answer 20

Complications diagnosed in 8/245 (3.3%) dogs including 3/245 (1.22%) that died or were euthanized, 3/245 (1.22%) with incisional dehiscence, and 2/245 (0.81%) with attachment of linear FB to staples at lumen Dehiscence was noted at enterotomy sites in 3 dogs at mean time of 44 hr after surgery Overall survival rate 96.1% (320/333) 2 dogs presented with another linear FB that was attached to the staples in the lumen at postop days 24 and 42 The risk factors SA with incisional dehiscence included multiple GI incisions in 1 surgery, and presence of linear FB No associations between dogs age, sex, weight, surgery tx, indication for sx, location in GIT, or experience and dehiscence rate (0 dogs had pre-op septic peritonitis; 5 dogs had postop septic peritonitis and had a 2nd surgery (2/5 had intact incisions with no evidence of dehiscence) Patient outcomes were NOT associated with anesthesia time, WBC or RBC count, or albumin Patients were hospitalized longer if leukocytopenia and thrombocytopenia present)

Answer 21

29/205 dogs (0.14, 95% CI 0.10-00.19) had dehiscence, including 21/134 dogs (0.16, 0.11-0.23) undergoing hand-sutured anastomosis and 8/71 dogs (0.11, 0.06-0.21) undergoing stapled anastomosis. There was no significant difference in the frequency of dehiscence across anastomosis methods (χ(2), P = .389). The mean (95% CI) surgery duration of 140 minutes (132-147) for hand- sutured anastomoses and 108 minutes (99-119) for stapled anastomoses was significantly different (t-test, P < .001). Conclusion: No significant difference in frequency of dehiscence was noted between hand- sutured and stapled anastomoses in dogs but surgery duration is significantly reduced by the use of staples for intestinal closure.

Answer 22

overall mortality rate of patients undergoing intestinal resection and anastomosis was 12·7% (8/63). The most common indication for resection and anastomosis was neoplasia (20/63 [31·7%]), followed by foreign body removal (19/63 [30·2%]). The overall dehiscence rate was 4·8% (3/63). No difference in mortality associated with indication for surgery, whether multiple procedures were performed, surgeon qualifications, or evidence of peritonitis at the time of surgery was identified.