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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
Where do we need to check when doing an exam for a suspected linear foreign body?
**UNDER THE TONGUE**
26
What are radiographic signs of a linear foriegn body?
plication- bunching up
27
With a linear FB- how do we "free" the FB?
by cranially removing from base of tongue or performing gastrotomy
28
With a linear FB- examine _____ border of the intestine for perforations
mesenteric
29
How can a red rubber catheter help when removing a linear FB from the intestines?
attach the catheter to FB and push it through
30
Linear FB removal complication from inflammatory changes?
impaired intestinal function secondary to inflam
31
Linear FB complication from extensive resections?
short bowel syndrome
32
T/F: With a nonlinear FB, we have to do a complete abdominal exploratory
TRUE
33
Describe the direction/placement of the removal of a foreign body
remove through enterotomy **ABORAL** (distal) to foreign body (resection and anastomosis if non-viable
34
\_\_\_\_\_ is telescoping or invagination of the intestines
intussusception
35
List 2 underlying causes of intussusception
parasitism parvovirus- (viral)
36
Intussesception clinical signs are influenced by what?
location and degree of obstruction - ileocolic - jejuno-jejunal - cecum
37
An intussusception makes a _____ lesion on an ultrasound
target lesion- transverse plane
38
What is the signalment and history for intussusception?
young puppies acute or chronic physical exam palpation- feels like abdominal mass
39
What surgical options are there for intussusception?
exploratory celiotomy manual reduction- gentle traction resection and anastomosis -unsuccessful reduction, non viable biopsy
40
Complications of manual reducations
brusing, tearing of mucosa
41
What is enteroplication used for? What must we keep in mind while doing the procedure?
to prevent reocurrence of intussusception must plicate entire small intestine, avoid tight turns
42
Complications of enteroplication
obstruction, strangulation, perforation
43
Is enteroplication necessary.... recurrence rate? ...complication rate?
low recurrence rates 5% complication rate 19%
44
What is cecal inversion? Signs?
cecal intussesception chronic diarrhea with hematochezia (lower GI signs)
45
Diagnosis of cecal inversion
radiographs: surgery, contrast studies endoscopy ultrasound
46
Treatments for cecal inversion
attempt manual reduction expose through colotomy if irreducible typhlectomy- removal of the cecum
47
What is mesenteric volvulus?
rare, often fatal intestines twist on mesenteric axis - strangulating mechanical obstruction - ischemia of SI - can be focal
48
Mesenteric volvulus mostly occurs in what breed?
German shepards
49
T/F: mesenteric volvulus is responsive to orogastric intubation
FALSE- nonresponsive
50
Clinical signs of mesenteric volvulus?
acute abdominal distension and pain vomiting shock
51
How are radiographs a prognastic factor for mesenteric volvulus?
rads are initially unremarkable once clear on rads its bad news
52
When we suspect mesenteric volvulus, what do we need to do immediately?
rapid fluid resuscitation abdominal exploratory
53
Describe what we do in surgery for mesenteric volvulus
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
How can we minimize contamination in intestinal surgery?
* 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
T/F if intestines are empty, occlusion is not mandatory and decreases manipulation/trauma
True
56
Begin anastomosis at the _____ border
mesenteric
57
After anastomosis, what do we do before closure?
wrap with omentum
58
T/F mucosal eversion in intestinal resection and anastomosis is not a worry
False- minimize mucosal eversion
59
Cut mesentery close to _____ of segment being removed
vessels
60
What is going on in this image?
occlude proximal and distal segments as atraumatically as possible
61
Scissors vs scalpel
the intestine can be divided with scissors or scalpel scissors- more control; more traumatic scalpel- less control; less traumatic
62
During a resection and anastomosis, how can we account for the narrowing that occurs during healing?
angling cut enlarges lumen size intitially to account for the 10-20% narrowing which typically occurs during healing
63
What suture pattern helps to minimize mucosal eversion in the intestines?
use of modified gambee suture pattern
64
Why is mucosal eversion a bad thing?
increases risk of infection and adhesion formation
65
Leakage is most common at what site of the intestinal anastomosis?
leakage most common at mesenteric border- no serosa and fat in mesentery impairs visualization
66
Explain leak testing anastomosis
occlude intestine proximally and distally inject saline until intestine is evenly distended- not overly full gently compress and look for leaks
67
Can staples be used to close and anastomosis?
yes, use staples that close tightly at tips
68
Explain the "fishmouth" or Cheattle incision
cut smaller segment at an angle space sutures closer on smaller segment placing mesenteric and antimesenteric sutures stretches the smaller segment
69
\_\_\_\_ the anastomosis site bc of intestinal content spillage
Lavage
70
T/F we cannot use instuments used during surgery on intestinal procedures for the closing part of the procedure
TRUE - contamination
71
The ____ is very important in reducing the risk of wound healing promblems after intestinal surgery
omentum ## Footnote **\*\*wrap anastomosis with omentum\*\***
72
When do we use a serosal patch?
when omentum isnt available
73
Why do we use a serosal patch?
to reinforce suture lines in questionable tissue: enterotomy, colotomy, urinary bladder induces permanent adhesion much stronger than omentum
74
T/F surgical principles of the large intestine are the same as the small intestine
true
75
List the differences of large intestinal surgery compared to small intestinal sx
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
Indications for a colotomy
foreign body removal impacted feces biopsy
77
Closure of the colotomy
longitudinal single layer, simple interrupted, appositional (not worried about having a small lumen size)
78
A colopexy creates a permanent adhesion between?
colon and abdominal wall
79
What is the reason we do a colopexy?
recurrent rectal prolapse
80
T/F: a colopexy can be done both incisional and nonincisional
true
81
Complications from a colopexy
infection dehiscence recurrence
82
Indications for a colonic resection and anastomosis
megacolon perforation neoplasia irreducible/necrotic intussusception
83
T/F you can do a subtotal colectomy with or without preservation of the ileocecal valve
true
84
Megacolon usually occurs in \_\_\_\_\_
cats \> dogs
85
Causes of megacolon
congenital vs aquired mechanical or functional colonic obstruction neurologic idiopathic
86
How can feces cause a megacolon?
the longer feces sits, water is absorbed and gets more difficult to pass concretions form painful too large to pass
87
Prolonged distension from megacolon causes what 2 things?
smooth muscle damage nerve damage
88
Congenital megacolon
Aganglionic distal conolic segment- absence of inhibitory neurons = functional obstruction rare in cats (hirschsprungs dz in humans)
89
Neurological conditions
lumbosacral dz Key-Gaskell- feline progressive dysautonomia sacral spinal cord deformity- manx cats
90
Pelvic trauma causes a ____ formation from healing pelvic fracture and SI luxation how can we tx pelvic trauma
callus pelvic osteotomy- good prognosis if early (\<6m), dependent on degree of distension
91
What is a complication of the colon sometimes seen from an OVH?
adhesion formation- scar tissue that obstructs the colon delayed complication clinical signs may occur weeks to years post op incidental finding on exploratory
92
Treatment of a OVH adhesion
surgical dissection and removal potential for resection and anastomosis
93
Primary/Idiopathic colon obstruction/megacolon
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
Medical management for megacolon
Diet: low residue diets Hydration Enemas- deobstipation under general anesthesia Prokinetic drugs- cisapride Stool softeners- lactulose
95
If medical management is unsuccessful we turn to _____ management
surgical
96
Ileocecal valve preservation
bacterial overgrowth prevented increases tension at anastomosis- tension can cause leakage no real clinical benefit
97
Preoperative management?
no enemas or stool softeners bc we dont want the potential for spillage... better to have hard feces contaminate surgery
98
Postop bowel movements after intestinal sx
+/- tenesmus: 7 days diarrhea- loose stool: weeks increase frequency of defecation
99
Complications of intestinal surgery
dehiscence and recurrence ileus adhesions obstructions- intussusception, entrapement, stenosis peritonitis short bowel syndrome
100
Post op care of intestinal sx patients
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
Most complication from surgery occur when?
first 3-5 days
102
Risk factors for dehiscence after intestinal surgery
foreign bodies and trauma **preop albumin \<2.5g.dl** (recheck after fluids) postop rise in band neutrophils preop peritonitis
103
Mortality/prognosis with intestinal surgery
_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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