ESOPHAGUS, STOMACH, INTESTINE, RECTUM: 90, 91, 92, 93, 94 Flashcards
vagus nerve course in relation to esophagus
left and right vagus nerves, form each a ventral and dorsal branch that unite dorsally and ventrally and pass thprugh esophageal hiatus.
CAT vs DOG esophageal muscolature
DOG: striated muscle entire length for dog
CAT: striated most length, smooth in the terminal part.
name the 3 phases of swallowing
oropharyngeal
esophageal
gastroesophageal
causes of esophagus dysfunction
functional or neuromuscolar
mechanical
inflammatory
factor associated with higher complication rates in esophageal surgery
lack of serosa segmental nature of blood supply lack of omentum constant motion by swallowing tension at surgical site
name cranial to caudal vasculature of esophagus
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
what is the functional suture-holding layer of the esophagus?
the submucosa
length of resection and anastomoses in the esophagus
experimentally 20% cervical, 50% thoracic
higher risk of dehiscence if >3-5 cm are removed
materials that can be used for esophageal patching
omentum, pericardium, local muscle flaps, stomach, intestine, synthetic mesh
how to create an omental pedicle flap for esophageal patching
paracostal or midline laparotomy
ligate right gastroepiploic and it’s branches.
flap through diaphragm incision
how many types of vascular ring abnormalities are described in small animals?
what is the most common one?
7 types.
the most common is persistent right aortic arch with a left ligamentum arteriosum. (aortic arch develops from the right fourth aortic arch)
muldoon et al survival rates for PRAA
94% at 2 weeks.
typical localization of foreign bodies on the esophagus
55-79% beetwen hearth and diaphragm
11-34% over hearth base
most common cause of ACQUIRED esophageal strictures in dogs and cats
DOG: esophageal reflux during anesthesia (46%)
CAT: oral antibiotics (doxicicline, clindamicine)
name the two possible treatement for esophageal strictures. differences?
bougieneage or balloon dilatation
no difference in terms of prognosis or incidence of perforation
how can esophageal diverticula can be classified?
most common in SA?
pulsion or traction
in dogs described only epiphrenic diverticula, beetween the hearth base and the diaphragm.
can you differentiate acquired or congenital esophageal fistulas based on age?
no
describe the surgical treatement for cricopharingeal dysphagia
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
most sensitive method to distinguish beetwen benign and malign nodules from spircocerca lupi
video-endoscopy
describe the vascular supply to the stomach
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
what other cells produce collagen in the gastrointestinal tract?
other than fibroblast, also smooth muscle cells prodice collagen in GI tract
temperature raccomandation for lavage of the peritoneal cavity
37-39 ° C
what type of suture do you use for routine closure of gastrotomy?
double layer inverting suture
POLYGLYCONATE (HL 75) OR POLIGLECAPRONE 25 (15) , polidioxanone half life is only 12 days
how accurate is subjective evaluation of vitality of the stomach?
about 85% MATTHIESEN 1983
what’s the risk in performing gastric invagination?
14 days after procedure ulcer of varyng depth were reported in the majority of dogs PARTON 2006
gastric wall abscesses?
what is a risk in performing circumcostal gastropexis?
pneumotorax
describe the 3 types of piloroplasty
fredet-ramstedt pyloromyotomy: half thickness, incision through muscolar and serosa, not mucosa
heineke-mikulicz pyloroplasty longitudinal incision full thickness, close transversally
Y-U pyloroplasty
postoperative complication related to gastro-duodenal anastomosis
hypoalbuminemia (62.5)
anemia (58.3%)
how many types of hiatal hernia exists? what is the most common in SA?
4 types (1-sliding of gastroesophageal junction, 2-paraesophageal, only stomach erniates, 3= 1+2, 4= other organs other than stomach)
type 1
describe the medical management of hiatal hernia
block H2 receptor, sucralfate, omeprazolo, metoclopramide.
LORINSONS 1998 8-15 dogs successfully treated for hiatal hernia
gastroesophageal insussusception SIGNALMENT
75% dogs <3MO
<50% german shepard
GIST (gastrointestinal stomal tumors) derive from what cells?
from the interstital cells of cajal
wath is the mechanism causing gastric ulcer from renal and hepatic failure?
in both seem to be the decreased renal clearance of gastrin- decreased gastrin and histamine degradation by liver
mechanism of gastric ulceration by NSAIDS
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
what is the only portions of teh intestines that can’t be completely exteriorized?
caudal duodenal flexure and ascending duodenum
how many branches give rise the cranial mesenteric artery?
12-15
what are the most common electrolyte imbalances in animal with bowel obstruction?
hypokaliemia, hyponatremia, hypochloremia
what antibiotics remain one of the best choiches for antimicrobial intestinal surgery prophylaxis?
first generation cephalosporins
is there any difference between closure with continue vs single interrupted suture in the gut?
no: low and comparable rate of intestinal leakage WEISMAN 1999
what type of suture is GAMBEE suture? is it recommended for closure of intestinal incisions?
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
what tests can be performed to see if an anastomosis leak? are them useful?
milking intestinal contents saline injection (10 cm bowel closed by hands, 16-19 ml) probe testing
where are the two starting point for continuous suturing positioned with an intestinal anastomosis?
one on the antimesenteric side, other at the mesenteric site
possible clinical post-op complications of enteroplication
obstruction, strangulation, perforation
generalized ileus
septic peritonitis
how often does peritoneal lavage have to be performed to prevent formation of adhesions?
200 ml saline through dialisis catether 3 times day for 4 days after closure
what ratio is used to see on RX if there is a bowel obstruction?
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
what is the minimum extension of tissue that has to be removed when performing a enterectomy for neoplasia
3cm + lesion
what are ther first 3 branches of the cranial mesenteric artery?
COMMON TRUNK: divides in right colic, middle colic and ileocolic arteries
CAUDAL PANCREATICODUODENAL
3RD BRANCH GIVE RISE TO ALL JEJUNAL ARTERIES
what section of the colon is supplied by the left colic branch of the caudal mesenteric artery?
distal half of the descending colon
elencate systemic and local factors that influences colonic wound healing
LOCAL: hypoperfusion, poor apposition, tension, infection and distal obstruction
SYSTEMIC: hypovolemia, recent blood transfusion, icterus, chemoterapeutic agents (cisplatin), immunodeficiency, diabetes poorly controlled
i hypotiroidism and hyperadrenocorticism responsible for poor wound healing?
no association found
has acute-high dose somministration of corticosteroids effect on wound healing?
WANG 2013: no association found. probably chronic somministration does have an effect
reccomended suture pattern for colon closure
simple layer, simple interrupted appositional pattern.
is it useful to prepare colon before surgery?
no: actually it could be counterproductive because it turns feces in liquid slurry so higher risk of leakage
what diet is recommended after colonic surgery?
hugh residue, low-fat
because epitelial lining of the colon relies upon nutrients in the lumen rather than nutrition from the systemic blood
percentage of success in colopexy with or without serosa incision
similar success rates with both techniques
signalment of animals with cecal inversion
usually animal younger than 4 month
MEGACOLON: pathophysiology
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
feline megacolon: most common causes
WASHABAU 1997
62% idiopatic
23% pelvic stenosis
6% neurologic disorders
5% manx
during colectomy what part of the colon should always be preserved?
ileocecocolic junction
recommended margins for colonic neoplasia
5-8 cm
what are the two branches of the caudal mesenteric artery?
cranial rectal and left colic
all the portions of the rectum have a serosal lining T or F
false: retroperitoneal portion lacks serosa
main artery to provide blood to caudal colon and rectum
cranial rectal artery (from caudal mesenteric)
origin of caudal and middle rectal artery
internal pudendal artery (from internal iliac)
muscle type of internal and external anal sphincter
internal: smooth muscle, involuntary function
external: circular band of striated muscle
nervous system of the rectum
intrinsic system: enteric nervous system
extrinsic: parasympathetic nerves
use of antibiotics as a prophylactic therapy before colonic and rectal surgery
different opinion and outcomes. seems like it is recommended to reduce post.op surgical site infection
timing of antibiotic administration before surgery
6-60 min before surgical incision, greatest reduction in surgical site infection
possible approach to the rectum
ventral
dorsal
lateral
caudal
when is recommended a ventral approach to the rectum?
cranial rectum and colo-rectal junction
possibility of sacroiliac luxation after pelvic symphysiotomy and abaxial retraction of the hemipelvis?
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
when is recommended dorsal approach to the rectum
caudal to mid rectum
dorsal rectum surgical approach
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
different techniques for caudal approach to the rectum
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
how many anatomic types exists for atresia ani?
1: concenital stenosis
2, 3, 4: varying degrees of rectal agenesis along with anal abnormalities
clinical signs of patients with rectovaginal or urethrorectal fistulas
vulvar or perianal inflammation dysuria hematuria pollakiuria chronic or recurrent urinary tract infection tenesmus diarrhea megacolon
what is an anogenital cleft?
feces and urines entrar the same common cavity and body opening (cloaca)
how to differentiate rectal prolapse from rectal prolapsed intussusception
pass an instrument beetwen prolapse and anus: if it do not pass is a prolapse
therapy for rectal prolapse
topical 50% dextrose
systemic furosemide
gentle pressure to reintroduce
nonadsorbable monofilament purse string suture
fed low residue diet and laxatives such as lactulose
3 most common perianal tumors
circumanal gland adenoma, adenocarcinoma. anal sac adenocarcinoma
perianal adenomas are hormone dependent?
yes: stimulated by androgens and inhibited by estrogens. in femal occurs more frequently in spayed bitches.
perianal epithelial tumors in cats?
described but not clear if are really hepatoid gland tumors
% of success for treatement
90% in male dogs if excision and castration is performed
10% of dogs also develop testicular tumors, especially if concurrent perineal hernia
are perianal adenocarcinoma hormone dependent?
it seems not, but it is recommended castration
classification for perianal adenocarcinoma
T1: <2cm
T2: 2-5 cm
T3: > 5 cm or invasive
T4: invasive
difference beetween adenocarcinoma of rectum and small intestine
small int andenocarcinoma has a more malignant behavoiur
3 most common deseases of anal sac
impaction
abscessation
sacculitis
use of cox2 inhibitors for treatement of anal sac adenocarcinoma
100% AS adenocarcinoma reported expression of cox2
incidence of pseudohyperparatiroidism in anal sac adenocarcinoma
20-90%
most common syte of metastasi for AS adenocarcinoma
sub lumbar lymphnodes
is hypercalcemia common in cats with AS adenocarcinoma?
not very common neoplasia. hypercalcemia is rarely a feature
pros and cons of open vs closed anal sacculactomy technique
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
possible complication after surgery for perineal fistulas
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%)
perineal hernia: name the muscles that composes the pelvic diaphragm
sphincter ani externus muscle
elevator ani muscle
coccygeus muscle
med to lat
most common localization for perineal hernia
beetween elev. ani, int. obturator, ext anal sphincter (CAUDAL HERNIA)
name other localization of perineal hernia
DORSOLATERAL: coccygeus-levator ani
VENTRAL: ischiouretralis, bulbocavernosus, ischiocavernosus
LATERAL: coccygeus, sacrotuberous ligament
incidence of testicular neoplasia in dogs with perineal hernia
up to 69.7%
incidence of bladder retroflexion in perineal hernia
20-29%
