Exam 1 - GI Foreign Bodies

Question 1

what diagnostic tests you would recommend to confirm or rule out a gi foreign body?

Answer 1

radiographs/ultrasound/bloodwork

need to look at the patient as a whole - are they stable? shocky?

3 view rads - left lateral to be able to see the pylorus/duodenum

Question 2

what factors would you consider in deciding when to perform surgery?

Answer 2

is the patient stable? must stabilize prior to surgery!

is the patient at risk for perforation? has the patient perforated?

could the object move into the colon?

is there actually a foreign body?

financial constraints of the owner

potential for using endoscopy

Question 3

what are the basic surgical equipment needed for a foreign body surgery?

Answer 3

doyens, expander thing to open the abdomen, lap sponges, cautery, saline, spay pack, saline to lavage

Question 4

how is a gastrotomy performed?

Answer 4

patient prepped from xiphoid to pubis (wide prep) midline incision is made, stomach is identified & packed off from the abdomen using moist lap sponges

incision is made through both layers of the stomach avoiding major vessels (not on the greater curvature)

item is removed using forceps

two layer closure of the stomach - mucosa & submucosa simple continuous & seromuscular layer in an inverting pattern (cushing/connell/lembert)

lap sponges removed/final gauze count, abdomen lavaged, body closed

Question 5

how is an enterotomy performed?

Answer 5

patient prepped from xiphoid to pubis (wide prep) midline incision is made, site of foreign body in the small intestines is identified & packed off from the abdomen using moist lap sponges

bowel is milked to get ingesta out of the way

incision is made aboral to the foreign body & removed

enterotomy site is closed in simple continuous/simple interrupted

Question 6

how is an R&A performed?

Answer 6

segment of intestines that is being removed is packed off from the abdomen

crushing forceps are placed to isolate the intestines being removed making sure to include both the diseased bowel & healthy bowel to ensure anastomosis site will not dehisce - make sure the mesenteric borders are slightly longer than the antimesenteric borders

ingesta is milked away from the proposed transection sites & kept in place by non-crushing clamps or assistant’s fingers

blood vessels in the segment to be removed are ligated including the connecting arcades in the mesenteric border of the intestine making sure blood supply is kept intact for the rest of the bowel

mesentery is incised near the ligated vessels to leave as much mesentery as possible for later closure

intestine is transected with a scalpel alongside the crushing forceps & the diseased bowel is discarded

end to end anastomosis is done with simple interrupted sutures starting on the mesenteric aspect!!!! - engaging the submucosa

mesenteric defect is repaired in a simple continuous pattern avoiding the blood vessels in the mesentery

Question 7

how do you assess bowel availability?

Answer 7

pink/color

pulses - should have pulses, indicates blood supply

peristalsis - bowel is working/moving

Question 8

what is the most common site for a linear foreign body to be anchored in a dog?

Answer 8

pylorus - dorsal aspect

Question 9

what is the most common site for a linear foreign body to be anchored in a cat?

Answer 9

under the base of the tongue

Question 10

what findings would you expect to see in a partial or complete gi obstruction?

Answer 10

abdominal pain, depression/lethargy/shocky, & vomiting

metabolic alkalosis - gi obstruction oral to the major duodenal papilla (pyloric obstruction)

Question 11

T/F: it is okay to give barium to an animal with a potential foreign body even if there are signs of perforation

Answer 11

false

Question 12

what are some signs seen on radiographs that indicate a foreign body?

Answer 12

signs of small intestinal mechanical ileus - 2 populations of small intestines!!! segmental dilation

loops of bowel stack on top of each other

may see a gravel sign

grid-like gas pattern - corn cob

linear foreign bodies - plication/bunching of the small intestines, duodenum is displaced medially in vd view, fragmented/small irregularly shaped gas bubbles in the gi tract

Question 13

if there is effusion you take off the patient using abdominocentesis, what tests should you run on it?

Answer 13

TP/TS, glucose, & lactate

Question 14

T/F: the small intestines don’t have to be dilated with a linear foreign body

Answer 14

true

Question 15

why is an oblique cutting angle made in an R&A surgery?

Answer 15

maintains blood supply - not for luminal diameter (although it is probably a benefit??)

Question 16

what location is the biggest risk for dehiscence after an R&A surgery? how do you combat this?

Answer 16

mesenteric border - start you suturing here

Question 17

the holding layer of the small intestines is the?

Answer 17

submucosa

Question 18

why do we see the small intestines evert during R&A surgeries?

Answer 18

the edema

Question 19

before closing an R&A, what should you do?

Answer 19

lavage the abdomen, count sponges, make sure no instruments are inside the body, & then change gloves & instruments

Question 20

if you have a linear foreign body anchored in the stomach, what should you do?

Answer 20

release the anchored foreign body & try to remove it through a gastrotomy if possible!!!!

monitor the bowel while doing this

after finding & releasing the anchor, the bowel should elongate & relax - make sure you’re holding the foreign body with hemostats

Question 21

T/F: if an animal perforates from an intestinal foreign body, the prognosis immediately becomes 50/50

Answer 21

true

Question 22

after an R&A surgery, what days are you most concerned about potential dehiscence? why?

Answer 22

days 3-5

wound is at its wekest!!!