Exam 1: Lecture 3 - Surgery of the Stomach Flashcards
what is definition of gastrotomy
an incision through stomach wall into gastric lumen
what is definition of partial gastrectomy
resection of a portion of the stomach
what is definition of gastropexy
procedure that permanently adheres the stomach to the body wall
what is definition of pyloroplasty
full-thickness incision and tissue reorientation to increase the diameter of the gastric outflow tract
what is definition of pylorectomy
removal of the pylorus
what is definition of gastroduodenostomy
attachment of the stomach to the duodenum
what is definition of billroth 1 procedure
pylorectomy + gastroduodenostomy
what is definition of billroth 2 procedure
gastrojejunostomy + after partial gastrectomy (including pylorectomy)
what is definition of pyloromyotomy
an incision through the serosa and muscularis layers of the pylorus only
what are the common reasons for gastric sx
- foreign body removal
- correction of GDV and prophylactic gastropexy (before or after GDV)
what are the 3 less common reasons for gastric sx
- treat gastric ulceration or erosion
- treat neoplasia
- treat benign gastric outflow obstruction
what are the 4 perioperative concerns for gastric sx
- vomiting animals (dehydration, hypokalemia, aspiration pneumonia, esophagitis)
- alkalosis - secondary to gastric fluid loss
- hematemesis - may indicate gastric erosion or ulceration
- peritonitis from gastric perforation/rupture
what are the food restrictions for pre-op gastric sx
- normally >8-12 hours prior to sx
- > 18 hours prior to gastroscopy
- 4-6 hours in pediatrics
T/F: surgery for gastric obstructions, distention, mal-positioning, or ulceration should be performed ASAP when patient is stabilized
true!!
Explain when/why we should use perioperative antibiotics for gastric sx
they can be used if gastric lumen is entered but not necessary if there is normal immune function or it is a simple gastrotomy
what are the 6 parts of the stomach
- cardia
- fundus
- body
- pyloric antrum
- pyloric canal
- pyloric ostium
what is the cardia of the stomach
esophagus enter stomach at cardiac ostium
what is the fundus of the stomach
dorsal to cardiac ostium, small in carnivores, usually gas-filled on rads
what is the body of the stomach
middle 1/3, lies against the left liver lobes
what is the pyloric antrum of the stomach
funnel shaped, opens into pyloric canal
what is the pyloric ostium of the stomach
end of pyloric canal that empties into duodenoum
what is the hepatogastric ligament
portion of the lesser omentum that passes from the stomach to the liver
T/F: rupture of the short gastric arteries is common
true!
what is the result of the rupture of the short gastric arteries
blood loss (intra-abdominal hemorrhage) and gastric infarction/necrosis
gastric mucosa accounts for _______ of the stomachs weight
1/2 of the stomachs weight
T/F: The submucosa and serosa are not easily separated
false! they are easily separated when using flaps or making partial incisions
why is gastric surgery common in small animals (aka why is it preferred over other techniques)
- safer than performing an esophagotomy
- safer than performing an enterotomy
- peritonitis is uncommon
- stricture is rare
- obstruction is rare
T/F: Billroth procedures are not much more difficult than the other gastric surgical techniques
false! It is more difficult and may be associated with severe complications
for FB removal, what procedure is preferred
gastroscopy over surgical removal
T/F: Gastroscopy is more sensitive when looking for erosions, physaloptera, and small lesions
true!!
what lesions can you NOT diagnose with gastroscopic biopies
submucosal lesions, pythios, scirrhous carcinoma
what approach do we do for a gastrotomy
ventral midline approach
what should we always do prior to incising the stomach
perform exploratory before!
T/F: We should isolate the stomach with moistened laparotomy pads during a gastrotomy
true!!
why do we place stay sutures for a gastrotomy
assist with manipulation and prevent spillage of gastric contents
T/F: you should make the gastric incision in a hypovascular area of the ventral aspect of the stomach
true!!
When doing a gastrotomy we should make sure the incision is not near the _____1___, of closure of the incision may cause excessive tissue to be enfolded into the gastric lumen causing __2____ obstruction
- pylorus
- outflow obstruction
how do we perform a gastrotomy
- make a stab incision into gastric lumen
- enlarge incision with metzenbaums
- use suction to aspirate gastric content
- close stomach with 2-0 or 3-0 absorbable monofilament suture with a 2-layer inverting seromuscular pattern
what are the first layer of the stomach we close and what type of suture pattern
serosa, muscularis, and submucosa with a cushing or simple continuous
what do we close in the second layer and with what suture pattern
lembert or cushing that incorporates serosal and muscularis layers
what is this procedure
gastrotomy
what are the suture patterns of D, E, F
D - lembert
E - connel
F - cushing
what are 2 important things to do during a gastrotomy
- change gloves prior to closing abdominal wall and use instruments that are uncontaminated by gastric contents
- after removing FB, dont forget to check rest of GI tract for something that can cause obstruction
what does the seromuscular layer going from red to purple mean
it is considered viable
what does the seromuscular layer going from green to black mean
probably nonviable
T/F: observation of the mucosal color is a reliable indication of gastric wall viability
no! It is NOT reliable
when is a partial gastrectomy indicated
when necrosis, ulceration, or neoplasia involves the greater curvature or middle portion of he stomach OR if there is necrosis associated with GDV
what is going on here
invagination of necrotic stomach
T/F: for invagination of a necrotic stomach you do not have to open the gastric lumen
true!!
T/F: obstruction is possible from excessive intraluminal tissue during invagination of necrotic stomach
true!
T/F: excessive hemorrhage is not possible during invagination of necrotic stomach
false, it is possible!!
what is this procedure
Billroth 1 procedure
when is a Billroth 1 indicated
- neoplasia
- outflow obstruction caused by pyloric muscular hypertrophy
- ulceration of the gastric outflow tract
what are the complications of a Billroth 1
- if common bile duct has been damaged, may need to do a cholecystoduodenostomy or cholecystojejunostomy
- if pancreatic ducts are inadvertently ligated
what procedure is this
Billroth 2 procedure
what is the difference between billroth 1 and billroth 2
similar except distal stomach and proximal duodenum are closed after pylorectomy and jejunum is attached with a side-to-side anastomosis to the diaphragmatic surface of stomach
what are the indications of a billroth 2
- neoplasia
- outflow obstruction caused by pyloric muscular hypertrophy
- ulceration of the gastric outflow tract
T/F: if extent of lesion precludes end-to-end anastomosis of the pyloric antrum to duodenum, we should do a billroth 2
true!! should consider it
what are the complications of a billroth 2
- may need to do a cholecystojejunostomy or cholecystoduodenostomy
- exocrine insufficiency may occur if the pancreatic ducts are damaged
what do pyloromyotomy and pyloroplasty do
increase diameter of pylorus
when do we do a pyloromyotomy and pyloroplasty
to correct gastric outflow obstruction (chronic antral mucosal hypertrophy and pyloric stenosis)
T/F: pyloromyotomy and pyloroplasty are difficult or impossible to reverse and may slow gastric emptying
true!!
describe characteristics of fredet-reamstedt pyloromyotomy
simplest and easiest procedure but does not allow inspection or biopsy of pyloric mucosa…..probably only temporary benefit
describe characteristics of Heineke-mikulicz pyloroplasty
allows limited exposure of pyloric mucosa for inspection and biopsy
describe characteristics of Y-U pyloroplasty
allows greater accessibility for resection and increases luminal diameter of the outflow tract
why do gastric FBs cause vomiting
- gastric outflow obstruction
- gastric distention
- gastric mucosal irritation
Cats more commonly ingest ______ foreign bodies
linera
what is this picture showing
intestinal plication
T/F: initial clin signs usually alert owners to the seriousness of the condition
false, may not alert the owner
T/F: linear FB must be removed ASAP to avoid intestinal perforation and peritonitis
true!!!
T/F: not all animals with gastric FB cause vomiting and finding a FB in the stomach guarantees that it is the cause of vomiting
false, first part is true BUT finding a FB in the stomach does not guarantee it is the cause of vomiting
T/F: linear FB are more common in cats and you should always check under the tongue
true!
T/F: most gastric FBs cannot be removed endoscopically
false, they can!
T/F: you do not always need to do a complete exploration of the entire GIT
FALSE!!! you should always and it is mandatory
T/F: you should always repeat the rads immediately before sx to make sure that the object has not moved
true!! A lot of the time the FB can move prior to sx and sx may not be indicated
Opening the _____ is seldom justified, and FB in the _____ usually are eliminated without difficulty
colon, colon
T/F: some small blunt FB may pass without causing harm but most FB warrant removal due to risk of distal obstruction/perforation
true!!!
when should we not do barium contrast studies
within 24 hours of endoscopy or if perforation is likely
should we scope first or procedure with sx when the FB is confined to the stomach
scope first and surgery second
