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TOBIAS VETERINARY SURGERY > ESOPHAGUS, STOMACH, INTESTINE, RECTUM: 90, 91, 92, 93, 94 > Flashcards

ESOPHAGUS, STOMACH, INTESTINE, RECTUM: 90, 91, 92, 93, 94 Flashcards

1
Q

vagus nerve course in relation to esophagus

A

left and right vagus nerves, form each a ventral and dorsal branch that unite dorsally and ventrally and pass thprugh esophageal hiatus.

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2
Q

CAT vs DOG esophageal muscolature

A

DOG: striated muscle entire length for dog
CAT: striated most length, smooth in the terminal part.

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3
Q

name the 3 phases of swallowing

A

oropharyngeal
esophageal
gastroesophageal

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4
Q

causes of esophagus dysfunction

A

functional or neuromuscolar

mechanical

inflammatory

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5
Q

factor associated with higher complication rates in esophageal surgery

A 
lack of serosa
segmental nature of blood supply
lack of omentum
constant motion by swallowing 
tension at surgical site
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6
Q

name cranial to caudal vasculature of esophagus

A

cranial+caudal thyroid artery (cervical)

broncoesophageal artery (cranial 2/3 thoracic)
esophageal branches aorta or dorsal intercostal  (remaining thoracic portion)

left gastric (terminal portion)

veins: satellites of arteries

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7
Q

what is the functional suture-holding layer of the esophagus?

A

the submucosa

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8
Q

length of resection and anastomoses in the esophagus

A

experimentally 20% cervical, 50% thoracic

higher risk of dehiscence if >3-5 cm are removed

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9
Q

materials that can be used for esophageal patching

A

omentum, pericardium, local muscle flaps, stomach, intestine, synthetic mesh

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10
Q

how to create an omental pedicle flap for esophageal patching

A

paracostal or midline laparotomy

ligate right gastroepiploic and it’s branches.

flap through diaphragm incision

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11
Q

how many types of vascular ring abnormalities are described in small animals?

what is the most common one?

A

7 types.

the most common is persistent right aortic arch with a left ligamentum arteriosum. (aortic arch develops from the right fourth aortic arch)

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12
Q

muldoon et al survival rates for PRAA

A

94% at 2 weeks.

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13
Q

typical localization of foreign bodies on the esophagus

A

55-79% beetwen hearth and diaphragm

11-34% over hearth base

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14
Q

most common cause of ACQUIRED esophageal strictures in dogs and cats

A

DOG: esophageal reflux during anesthesia (46%)
CAT: oral antibiotics (doxicicline, clindamicine)

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15
Q

name the two possible treatement for esophageal strictures. differences?

A

bougieneage or balloon dilatation

no difference in terms of prognosis or incidence of perforation

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16
Q

how can esophageal diverticula can be classified?

most common in SA?

A

pulsion or traction

in dogs described only epiphrenic diverticula, beetween the hearth base and the diaphragm.

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17
Q

can you differentiate acquired or congenital esophageal fistulas based on age?

A

no

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18
Q

describe the surgical treatement for cricopharingeal dysphagia

A

1- important to differentiate from pharyngeal dysphagia (weakness pharingeal constictor muscle)

miotomy or miectomy of the cricopharyngeal muscle (O: both lat surf cricoid, over dorsal surface esophagus)

can do a ventral (with 180° rotation of larynx) or lateral approach

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19
Q

most sensitive method to distinguish beetwen benign and malign nodules from spircocerca lupi

A

video-endoscopy

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20
Q

describe the vascular supply to the stomach

A

celiac artery

3 BRANCHES:

 splenic: L limb pancreas, spleen (-> short gastric), L gastroepiploic

 hepatic: liver+GB, right gastric, gastroduodenal (2 branches: 
 pancreaticoduodenal  and right gastroepiploic)

 left gastric
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21
Q

what other cells produce collagen in the gastrointestinal tract?

A

other than fibroblast, also smooth muscle cells prodice collagen in GI tract

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22
Q

temperature raccomandation for lavage of the peritoneal cavity

A

37-39 ° C

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23
Q

what type of suture do you use for routine closure of gastrotomy?

A

double layer inverting suture

POLYGLYCONATE (HL 75) OR POLIGLECAPRONE 25 (15) , polidioxanone half life is only 12 days

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24
Q

how accurate is subjective evaluation of vitality of the stomach?

A

about 85% MATTHIESEN 1983

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25
Q

what’s the risk in performing gastric invagination?

A

14 days after procedure ulcer of varyng depth were reported in the majority of dogs PARTON 2006

gastric wall abscesses?

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26
Q

what is a risk in performing circumcostal gastropexis?

A

pneumotorax

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27
Q

describe the 3 types of piloroplasty

A

fredet-ramstedt pyloromyotomy: half thickness, incision through muscolar and serosa, not mucosa

heineke-mikulicz pyloroplasty longitudinal incision full thickness, close transversally

Y-U pyloroplasty

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28
Q

postoperative complication related to gastro-duodenal anastomosis

A

hypoalbuminemia (62.5)

anemia (58.3%)

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29
Q

how many types of hiatal hernia exists? what is the most common in SA?

A 
4 types 
(1-sliding of gastroesophageal junction, 2-paraesophageal, only stomach erniates, 3= 1+2, 4= other organs other than stomach)

type 1

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30
Q

describe the medical management of hiatal hernia

A

block H2 receptor, sucralfate, omeprazolo, metoclopramide.

LORINSONS 1998 8-15 dogs successfully treated for hiatal hernia

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31
Q

gastroesophageal insussusception SIGNALMENT

A

75% dogs <3MO

<50% german shepard

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32
Q

GIST (gastrointestinal stomal tumors) derive from what cells?

A

from the interstital cells of cajal

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33
Q

wath is the mechanism causing gastric ulcer from renal and hepatic failure?

A

in both seem to be the decreased renal clearance of gastrin- decreased gastrin and histamine degradation by liver

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34
Q

mechanism of gastric ulceration by NSAIDS

A

topical: effect of the acidic and lipid soluble drug on gastric mucosa
systemic: inhinit COX so prostaglandin (decreased decrease blood flow, decrease mucous, decrease bicarbonate production, decrease epithelial turnover

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35
Q

what is the only portions of teh intestines that can’t be completely exteriorized?

A

caudal duodenal flexure and ascending duodenum

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36
Q

how many branches give rise the cranial mesenteric artery?

A

12-15

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37
Q

what are the most common electrolyte imbalances in animal with bowel obstruction?

A

hypokaliemia, hyponatremia, hypochloremia

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38
Q

what antibiotics remain one of the best choiches for antimicrobial intestinal surgery prophylaxis?

A

first generation cephalosporins

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39
Q

is there any difference between closure with continue vs single interrupted suture in the gut?

A

no: low and comparable rate of intestinal leakage WEISMAN 1999

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40
Q

what type of suture is GAMBEE suture? is it recommended for closure of intestinal incisions?

A

is a single interrupted pattern, with half thickness bites (only submucosa+musco+serosa), no mucosa.

difficult to obtain consistent bites through submucosa so olly for experienced surgeons

41
Q

what tests can be performed to see if an anastomosis leak? are them useful?

A 
milking intestinal contents 
saline injection (10 cm bowel closed by hands, 16-19 ml) 
probe testing
42
Q

where are the two starting point for continuous suturing positioned with an intestinal anastomosis?

A

one on the antimesenteric side, other at the mesenteric site

43
Q

possible clinical post-op complications of enteroplication

A

obstruction, strangulation, perforation

generalized ileus

septic peritonitis

44
Q

how often does peritoneal lavage have to be performed to prevent formation of adhesions?

A

200 ml saline through dialisis catether 3 times day for 4 days after closure

45
Q

what ratio is used to see on RX if there is a bowel obstruction?

A

max bowel diameter/L5.

if > 2 very likely. 66 % se,sp

there are other 2 criteria

SI max diameter/SI min diameter
SI max diameter/SI average diameter

46
Q

what is the minimum extension of tissue that has to be removed when performing a enterectomy for neoplasia

A

3cm + lesion

47
Q

what are ther first 3 branches of the cranial mesenteric artery?

A

COMMON TRUNK: divides in right colic, middle colic and ileocolic arteries
CAUDAL PANCREATICODUODENAL
3RD BRANCH GIVE RISE TO ALL JEJUNAL ARTERIES

48
Q

what section of the colon is supplied by the left colic branch of the caudal mesenteric artery?

A

distal half of the descending colon

49
Q

elencate systemic and local factors that influences colonic wound healing

A

LOCAL: hypoperfusion, poor apposition, tension, infection and distal obstruction
SYSTEMIC: hypovolemia, recent blood transfusion, icterus, chemoterapeutic agents (cisplatin), immunodeficiency, diabetes poorly controlled

50
Q

i hypotiroidism and hyperadrenocorticism responsible for poor wound healing?

A

no association found

51
Q

has acute-high dose somministration of corticosteroids effect on wound healing?

A

WANG 2013: no association found. probably chronic somministration does have an effect

52
Q

reccomended suture pattern for colon closure

A

simple layer, simple interrupted appositional pattern.

53
Q

is it useful to prepare colon before surgery?

A

no: actually it could be counterproductive because it turns feces in liquid slurry so higher risk of leakage

54
Q

what diet is recommended after colonic surgery?

A

hugh residue, low-fat

because epitelial lining of the colon relies upon nutrients in the lumen rather than nutrition from the systemic blood

55
Q

percentage of success in colopexy with or without serosa incision

A

similar success rates with both techniques

56
Q

signalment of animals with cecal inversion

A

usually animal younger than 4 month

57
Q

MEGACOLON: pathophysiology

A

congenital

acquired
mechanical: pelvic stenosis, prostatomegaly, perineal hernia, colorectal and
anal tumors, foreigh body, anal atresia, poor diet, ovariohysterectomy

   functional: spinal cord desease, pelvic nerve injury, dysautonomia, metabolic 
   desease, manx
58
Q

feline megacolon: most common causes

A

WASHABAU 1997

62% idiopatic
23% pelvic stenosis
6% neurologic disorders
5% manx

59
Q

during colectomy what part of the colon should always be preserved?

A

ileocecocolic junction

60
Q

recommended margins for colonic neoplasia

A

5-8 cm

61
Q

what are the two branches of the caudal mesenteric artery?

A

cranial rectal and left colic

62
Q

all the portions of the rectum have a serosal lining T or F

A

false: retroperitoneal portion lacks serosa

63
Q

main artery to provide blood to caudal colon and rectum

A

cranial rectal artery (from caudal mesenteric)

64
Q

origin of caudal and middle rectal artery

A

internal pudendal artery (from internal iliac)

65
Q

muscle type of internal and external anal sphincter

A

internal: smooth muscle, involuntary function
external: circular band of striated muscle

66
Q

nervous system of the rectum

A

intrinsic system: enteric nervous system

extrinsic: parasympathetic nerves

67
Q

use of antibiotics as a prophylactic therapy before colonic and rectal surgery

A

different opinion and outcomes. seems like it is recommended to reduce post.op surgical site infection

68
Q

timing of antibiotic administration before surgery

A

6-60 min before surgical incision, greatest reduction in surgical site infection

69
Q

possible approach to the rectum

A

ventral
dorsal
lateral
caudal

70
Q

when is recommended a ventral approach to the rectum?

A

cranial rectum and colo-rectal junction

71
Q

possibility of sacroiliac luxation after pelvic symphysiotomy and abaxial retraction of the hemipelvis?

A

25% retraction (25-35 kg) of sacral width did not result in luxation (1-1,7 cm gap)

50-70% retraction usually determine unilateral sacroiliac luxation

72
Q

when is recommended dorsal approach to the rectum

A

caudal to mid rectum

73
Q

dorsal rectum surgical approach

A

after incision and fat dissection can see

retrococcygeus muscle
dorsal surface rectum
external anal sphincter

setrococcygeus can be transected near ventral attachments to coccygeal vertebrae

blunt dissection between elevator ani and ext anal sphincter

74
Q

different techniques for caudal approach to the rectum

A

rectal eversion: prolapse of the rectum to approach small lesions

transcutaneous rectal pull-through procedure: skin incision adjacent to anal opening. retrococcygeus muscle is transected

transanal rectal pull-through procedure: incision made 1-2 cm cranial (inside) the anocutaneous junction

combined abdominal-transanal approach

75
Q

how many anatomic types exists for atresia ani?

A

1: concenital stenosis

2, 3, 4: varying degrees of rectal agenesis along with anal abnormalities

76
Q

clinical signs of patients with rectovaginal or urethrorectal fistulas

A 
vulvar or perianal inflammation 
dysuria
hematuria
pollakiuria
chronic or recurrent urinary tract infection 
tenesmus
diarrhea
megacolon
77
Q

what is an anogenital cleft?

A

feces and urines entrar the same common cavity and body opening (cloaca)

78
Q

how to differentiate rectal prolapse from rectal prolapsed intussusception

A

pass an instrument beetwen prolapse and anus: if it do not pass is a prolapse

79
Q

therapy for rectal prolapse

A

topical 50% dextrose
systemic furosemide

gentle pressure to reintroduce

nonadsorbable monofilament purse string suture

fed low residue diet and laxatives such as lactulose

80
Q

3 most common perianal tumors

A

circumanal gland adenoma, adenocarcinoma. anal sac adenocarcinoma

81
Q

perianal adenomas are hormone dependent?

A

yes: stimulated by androgens and inhibited by estrogens. in femal occurs more frequently in spayed bitches.

82
Q

perianal epithelial tumors in cats?

A

described but not clear if are really hepatoid gland tumors

83
Q

% of success for treatement

A

90% in male dogs if excision and castration is performed

10% of dogs also develop testicular tumors, especially if concurrent perineal hernia

84
Q

are perianal adenocarcinoma hormone dependent?

A

it seems not, but it is recommended castration

85
Q

classification for perianal adenocarcinoma

A

T1: <2cm
T2: 2-5 cm
T3: > 5 cm or invasive
T4: invasive

86
Q

difference beetween adenocarcinoma of rectum and small intestine

A

small int andenocarcinoma has a more malignant behavoiur

87
Q

3 most common deseases of anal sac

A

impaction
abscessation
sacculitis

88
Q

use of cox2 inhibitors for treatement of anal sac adenocarcinoma

A

100% AS adenocarcinoma reported expression of cox2

89
Q

incidence of pseudohyperparatiroidism in anal sac adenocarcinoma

A

20-90%

90
Q

most common syte of metastasi for AS adenocarcinoma

A

sub lumbar lymphnodes

91
Q

is hypercalcemia common in cats with AS adenocarcinoma?

A

not very common neoplasia. hypercalcemia is rarely a feature

92
Q

pros and cons of open vs closed anal sacculactomy technique

A

open:
P: permits visualization of secretory lining. better visualization, sure removal
C: trauma to ext anal sphincter, post.op infection, tumor dissemination

more complication seen with the traditional open technique

93
Q

possible complication after surgery for perineal fistulas

A

success rates 51-83%
recurrence rates 13-56%
fecal incontinence 13-29%

fecal incontinence due to damage to the caudal rectal nerve and ext anal sphincter (20-33%)

94
Q

perineal hernia: name the muscles that composes the pelvic diaphragm

A

sphincter ani externus muscle
elevator ani muscle
coccygeus muscle

med to lat

95
Q

most common localization for perineal hernia

A

beetween elev. ani, int. obturator, ext anal sphincter (CAUDAL HERNIA)

96
Q

name other localization of perineal hernia

A

DORSOLATERAL: coccygeus-levator ani
VENTRAL: ischiouretralis, bulbocavernosus, ischiocavernosus
LATERAL: coccygeus, sacrotuberous ligament

97
Q

incidence of testicular neoplasia in dogs with perineal hernia

A

up to 69.7%

98
Q

incidence of bladder retroflexion in perineal hernia

A

20-29%

99
Q
A

TOBIAS VETERINARY SURGERY (25 decks)

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