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Surgery > E2- Intestinal sx > Flashcards

E2- Intestinal sx Flashcards

1
Q

What is important to rememeber about fluid therapy before intestinal surgery?

A

correct pre-existing

treat hypovolemia- combo of crystalloids and colloids

monitor electrolytes

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2
Q

Should we use prophylactic antibiotics before intestinal sx?

A

its still debated

clean contaminated/contaminated

small intestinal flora: gram -/+

(give 20-30min prior to incision, no more than 24hrs after)

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3
Q

Give an example of prophylactic antibiotics before sx

A

cefazolin 22mg/kg

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4
Q

List the 4 standard criteria of assessing viability

A

pink, moist glistening color

pulsation of mesenteric vessels

bleeding from cut surface

peristalsis- pinch test

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5
Q

What can we inject to assess viability of intestines?

A

fluorescein dye injected IV

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6
Q

T/F: you can use a pulse ox on the intestines to determine viability

A

True

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7
Q

In the intestines, sutures must penetrate ______

A

submucosa

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8
Q

Appositional pattern is recommended for ____ healing.

Give 2 examples

A

primary healing

simple continuous or simple interrupted

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9
Q

The modified Gambee suture pattern can be used for what?

A

to help with everted mucosa

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10
Q

What is important to remember when handling tissue with forceps?

A

grasp as little tissue as possible to minimize tissue trauma

note: forceps are grasping tissue just at cut edge and not the full thickness of the intestinal wall

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11
Q

When taking an intestinal biopsy, what is important about the size?

A

full thickness biopsy- wide enough that all layers remain intact (sample 3-4mm wide)

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12
Q

After we finish an intestinal biopsy, what is important to do before we close the animal up?

A

leak test!

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13
Q

Describe a longitudinal intestinal biopsy

A
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14
Q

Describe a transverse wedge biopsy

-wedge should not be >____ % of circumference

A

full thickness wedge 3-4mm wide taken perpendicular to long axis of intestine

-wedge should not be >20-25 % of circumference

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15
Q

Minimally invasive biopsy method?

A

Laparoscopic- standard technique, use of cutting/coagulation unit (harmonic scalpel)

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16
Q

Small intestinal obstruction clinical signs are determined by?

A

location of obstruction

degree of obstruction

moving vs. stationary

integrity of intestinal wall

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17
Q

Small intestinal obstruction pathophysiology

A

distension of bowel proximal (oral)

absorption

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18
Q

Describe the clinical presentation of a proximal intestinal obstruction

A

duodenum or proximal jejunum

acute/severe signs

persistent vomiting

gastric secretions

electrolyte imbalances

dehydration

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19
Q

Describe the clinical presentation of a distal intestinal obstruction

A

distal jejunum, illeum, illeocecal junction

vague

intermittent anorexia

lethargy

occasional vomiting

several days or weeks

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20
Q

Diagnosis of intestinal obstruction

A

CS/Hx

rads: dilated intestinal loops, plicated intestinal loops, radiopaque foreign body

repeat rads

ultrasound

contrast studies (dont use barium if suspected perforation bc will cause peritonitis)

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21
Q

Who usually presents with linear foreign bodies?

A

young animals, ususally cats

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22
Q

Give examples of linear foriegn bodies

A

sewing thread, yarn, string, tinsel

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23
Q

When do we see signs of a linear foreign body?

A

when the foreign body becomes fixed at some point cranially typically around tongue (base of tongue) or at pylorus

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24
Q

Clinical signs seen with a linear foreign body

A

vomiting

depression

abdominal pain: posture, gait, guarding on palpation

palpable bunching of intestines in central abdomen

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25
Q

Where do we need to check when doing an exam for a suspected linear foreign body?

A

UNDER THE TONGUE

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26
Q

What are radiographic signs of a linear foriegn body?

A

plication- bunching up

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27
Q

With a linear FB- how do we “free” the FB?

A

by cranially removing from base of tongue or performing gastrotomy

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28
Q

With a linear FB- examine _____ border of the intestine for perforations

A

mesenteric

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29
Q

How can a red rubber catheter help when removing a linear FB from the intestines?

A

attach the catheter to FB and push it through

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30
Q

Linear FB removal complication from inflammatory changes?

A

impaired intestinal function secondary to inflam

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31
Q

Linear FB complication from extensive resections?

A

short bowel syndrome

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32
Q

T/F: With a nonlinear FB, we have to do a complete abdominal exploratory

A

TRUE

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33
Q

Describe the direction/placement of the removal of a foreign body

A

remove through enterotomy ABORAL (distal) to foreign body

(resection and anastomosis if non-viable

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34
Q

_____ is telescoping or invagination of the intestines

A

intussusception

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35
Q

List 2 underlying causes of intussusception

A

parasitism

parvovirus- (viral)

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36
Q

Intussesception clinical signs are influenced by what?

A

location and degree of obstruction

  • ileocolic
  • jejuno-jejunal
  • cecum
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37
Q

An intussusception makes a _____ lesion on an ultrasound

A

target lesion- transverse plane

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38
Q

What is the signalment and history for intussusception?

A

young puppies

acute or chronic

physical exam palpation- feels like abdominal mass

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39
Q

What surgical options are there for intussusception?

A

exploratory celiotomy

manual reduction- gentle traction

resection and anastomosis -unsuccessful reduction, non viable

biopsy

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40
Q

Complications of manual reducations

A

brusing, tearing of mucosa

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41
Q

What is enteroplication used for?

What must we keep in mind while doing the procedure?

A

to prevent reocurrence of intussusception

must plicate entire small intestine, avoid tight turns

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42
Q

Complications of enteroplication

A

obstruction, strangulation, perforation

43
Q

Is enteroplication necessary…. recurrence rate? …complication rate?

A

low recurrence rates 5%

complication rate 19%

44
Q

What is cecal inversion? Signs?

A

cecal intussesception

chronic diarrhea with hematochezia (lower GI signs)

45
Q

Diagnosis of cecal inversion

A

radiographs: surgery, contrast studies

endoscopy

ultrasound

46
Q

Treatments for cecal inversion

A

attempt manual reduction

expose through colotomy if irreducible

typhlectomy- removal of the cecum

47
Q

What is mesenteric volvulus?

A

rare, often fatal

intestines twist on mesenteric axis

  • strangulating mechanical obstruction
  • ischemia of SI
  • can be focal
48
Q

Mesenteric volvulus mostly occurs in what breed?

A

German shepards

49
Q

T/F: mesenteric volvulus is responsive to orogastric intubation

A

FALSE- nonresponsive

50
Q

Clinical signs of mesenteric volvulus?

A

acute abdominal distension and pain

vomiting

shock

51
Q

How are radiographs a prognastic factor for mesenteric volvulus?

A

rads are initially unremarkable

once clear on rads its bad news

52
Q

When we suspect mesenteric volvulus, what do we need to do immediately?

A

rapid fluid resuscitation

abdominal exploratory

53
Q

Describe what we do in surgery for mesenteric volvulus

A

derotation +/- resection and anastomosis- if possible

we worry about reperfusion injury

segmental w/o derotation has a better prognosis

(you cant remove everything, short bowel syndrome if we take too much)

54
Q

How can we minimize contamination in intestinal surgery?

A
  • pack off affected area
  • separate intruments to be used for intestinal procedures from rest of the pack
  • occlude intestine proximal and distal with intestinal forceps or fingers
  • decompress dilated bowel loops
55
Q

T/F if intestines are empty, occlusion is not mandatory and decreases manipulation/trauma

A

True

56
Q

Begin anastomosis at the _____ border

A

mesenteric

57
Q

After anastomosis, what do we do before closure?

A

wrap with omentum

58
Q

T/F mucosal eversion in intestinal resection and anastomosis is not a worry

A

False- minimize mucosal eversion

59
Q

Cut mesentery close to _____ of segment being removed

A

vessels

60
Q

What is going on in this image?

A

occlude proximal and distal segments as atraumatically as possible

61
Q

Scissors vs scalpel

A

the intestine can be divided with scissors or scalpel

scissors- more control; more traumatic

scalpel- less control; less traumatic

62
Q

During a resection and anastomosis, how can we account for the narrowing that occurs during healing?

A

angling cut enlarges lumen size intitially to account for the 10-20% narrowing which typically occurs during healing

63
Q

What suture pattern helps to minimize mucosal eversion in the intestines?

A

use of modified gambee suture pattern

64
Q

Why is mucosal eversion a bad thing?

A

increases risk of infection and adhesion formation

65
Q

Leakage is most common at what site of the intestinal anastomosis?

A

leakage most common at mesenteric border- no serosa and fat in mesentery impairs visualization

66
Q

Explain leak testing anastomosis

A

occlude intestine proximally and distally

inject saline until intestine is evenly distended- not overly full

gently compress and look for leaks

67
Q

Can staples be used to close and anastomosis?

A

yes, use staples that close tightly at tips

68
Q

Explain the “fishmouth” or Cheattle incision

A

cut smaller segment at an angle

space sutures closer on smaller segment

placing mesenteric and antimesenteric sutures stretches the smaller segment

69
Q

____ the anastomosis site bc of intestinal content spillage

A

Lavage

70
Q

T/F we cannot use instuments used during surgery on intestinal procedures for the closing part of the procedure

A

TRUE - contamination

71
Q

The ____ is very important in reducing the risk of wound healing promblems after intestinal surgery

A

omentum

**wrap anastomosis with omentum**

72
Q

When do we use a serosal patch?

A

when omentum isnt available

73
Q

Why do we use a serosal patch?

A

to reinforce suture lines in questionable tissue: enterotomy, colotomy, urinary bladder

induces permanent adhesion much stronger than omentum

74
Q

T/F surgical principles of the large intestine are the same as the small intestine

A

true

75
Q

List the differences of large intestinal surgery compared to small intestinal sx

A

Large intestinal sx

  • high bacterial population
  • healing
    • intitially, strength of wound weak: 3-4 day lag period
    • collagenolysis
    • wound stregth 75% of normal at 4 months- slower than SI
  • blood supply
    • segmental- vasa recta
    • maintain tissue perfusion
76
Q

Indications for a colotomy

A

foreign body removal

impacted feces

biopsy

77
Q

Closure of the colotomy

A

longitudinal

single layer, simple interrupted, appositional

(not worried about having a small lumen size)

78
Q

A colopexy creates a permanent adhesion between?

A

colon and abdominal wall

79
Q

What is the reason we do a colopexy?

A

recurrent rectal prolapse

80
Q

T/F: a colopexy can be done both incisional and nonincisional

A

true

81
Q

Complications from a colopexy

A

infection

dehiscence

recurrence

82
Q

Indications for a colonic resection and anastomosis

A

megacolon

perforation

neoplasia

irreducible/necrotic intussusception

83
Q

T/F you can do a subtotal colectomy with or without preservation of the ileocecal valve

A

true

84
Q

Megacolon usually occurs in _____

A

cats > dogs

85
Q

Causes of megacolon

A

congenital vs aquired

mechanical or functional colonic obstruction

neurologic

idiopathic

86
Q

How can feces cause a megacolon?

A

the longer feces sits, water is absorbed and gets more difficult to pass

concretions form

painful

too large to pass

87
Q

Prolonged distension from megacolon causes what 2 things?

A

smooth muscle damage

nerve damage

88
Q

Congenital megacolon

A

Aganglionic distal conolic segment- absence of inhibitory neurons = functional obstruction

rare in cats

(hirschsprungs dz in humans)

89
Q

Neurological conditions

A

lumbosacral dz

Key-Gaskell- feline progressive dysautonomia

sacral spinal cord deformity- manx cats

90
Q

Pelvic trauma causes a ____ formation from healing pelvic fracture and SI luxation

how can we tx pelvic trauma

A

callus

pelvic osteotomy- good prognosis if early (<6m), dependent on degree of distension

91
Q

What is a complication of the colon sometimes seen from an OVH?

A

adhesion formation- scar tissue that obstructs the colon

delayed complication

clinical signs may occur weeks to years post op

incidental finding on exploratory

92
Q

Treatment of a OVH adhesion

A

surgical dissection and removal

potential for resection and anastomosis

93
Q

Primary/Idiopathic colon obstruction/megacolon

A

cats

rule out secondary causes- pelvic trauma, neurologic dz, perineal hernia

dysfunction of colonic smooth muscle- decrease in contractility vs colonic dilation, effects of cisapride

medical vs surgical management

94
Q

Medical management for megacolon

A

Diet: low residue diets

Hydration

Enemas- deobstipation under general anesthesia

Prokinetic drugs- cisapride

Stool softeners- lactulose

95
Q

If medical management is unsuccessful we turn to _____ management

A

surgical

96
Q

Ileocecal valve preservation

A

bacterial overgrowth prevented

increases tension at anastomosis- tension can cause leakage

no real clinical benefit

97
Q

Preoperative management?

A

no enemas or stool softeners

bc we dont want the potential for spillage… better to have hard feces

contaminate surgery

98
Q

Postop bowel movements after intestinal sx

A

+/- tenesmus: 7 days

diarrhea- loose stool: weeks

increase frequency of defecation

99
Q

Complications of intestinal surgery

A

dehiscence and recurrence

ileus

adhesions

obstructions- intussusception, entrapement, stenosis

peritonitis

short bowel syndrome

100
Q

Post op care of intestinal sx patients

A

taper fluid and electrolyte therapy as oral intake returns to normal

offer food and water the day after sx unless contraindicated- feed enterocytes orally helps health of intestine :)

pain management

101
Q

Most complication from surgery occur when?

A

first 3-5 days

102
Q

Risk factors for dehiscence after intestinal surgery

A

foreign bodies and trauma

preop albumin <2.5g.dl (recheck after fluids)

postop rise in band neutrophils

preop peritonitis

103
Q

Mortality/prognosis with intestinal surgery

A

leakage/dehiscence increases mortality rates

overall dehiscence rate 7-15% -mortality 74-85%

no dehiscence and discharge from hospital = overall good prognosis

Surgery (15 decks)

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