Exam 1: Lecture 3 - Surgery of the Stomach

Question 1

what is definition of gastrotomy

Answer 1

an incision through stomach wall into gastric lumen

Question 2

what is definition of partial gastrectomy

Answer 2

resection of a portion of the stomach

Question 3

what is definition of gastropexy

Answer 3

procedure that permanently adheres the stomach to the body wall

Question 4

what is definition of pyloroplasty

Answer 4

full-thickness incision and tissue reorientation to increase the diameter of the gastric outflow tract

Question 5

what is definition of pylorectomy

Answer 5

removal of the pylorus

Question 6

what is definition of gastroduodenostomy

Answer 6

attachment of the stomach to the duodenum

Question 7

what is definition of billroth 1 procedure

Answer 7

pylorectomy + gastroduodenostomy

Question 8

what is definition of billroth 2 procedure

Answer 8

gastrojejunostomy + after partial gastrectomy (including pylorectomy)

Question 9

what is definition of pyloromyotomy

Answer 9

an incision through the serosa and muscularis layers of the pylorus only

Question 10

what are the common reasons for gastric sx

Answer 10

1. foreign body removal
2. correction of GDV and prophylactic gastropexy (before or after GDV)

Question 11

what are the 3 less common reasons for gastric sx

Answer 11

1. treat gastric ulceration or erosion
2. treat neoplasia
3. treat benign gastric outflow obstruction

Question 12

what are the 4 perioperative concerns for gastric sx

Answer 12

1. vomiting animals (dehydration, hypokalemia, aspiration pneumonia, esophagitis)
2. alkalosis - secondary to gastric fluid loss
3. hematemesis - may indicate gastric erosion or ulceration
4. peritonitis from gastric perforation/rupture

Question 13

what are the food restrictions for pre-op gastric sx

Answer 13

1. normally >8-12 hours prior to sx
2. > 18 hours prior to gastroscopy
3. 4-6 hours in pediatrics

Question 14

T/F: surgery for gastric obstructions, distention, mal-positioning, or ulceration should be performed ASAP when patient is stabilized

Answer 14

true!!

Question 15

Explain when/why we should use perioperative antibiotics for gastric sx

Answer 15

they can be used if gastric lumen is entered but not necessary if there is normal immune function or it is a simple gastrotomy

Question 16

what are the 6 parts of the stomach

Answer 16

1. cardia
2. fundus
3. body
4. pyloric antrum
5. pyloric canal
6. pyloric ostium

Question 17

what is the cardia of the stomach

Answer 17

esophagus enter stomach at cardiac ostium

Question 18

what is the fundus of the stomach

Answer 18

dorsal to cardiac ostium, small in carnivores, usually gas-filled on rads

Question 19

what is the body of the stomach

Answer 19

middle 1/3, lies against the left liver lobes

Question 20

what is the pyloric antrum of the stomach

Answer 20

funnel shaped, opens into pyloric canal

Question 21

what is the pyloric ostium of the stomach

Answer 21

end of pyloric canal that empties into duodenoum

Question 22

what is the hepatogastric ligament

Answer 22

portion of the lesser omentum that passes from the stomach to the liver

Question 23

T/F: rupture of the short gastric arteries is common

Answer 23

true!

Question 24

what is the result of the rupture of the short gastric arteries

Answer 24

blood loss (intra-abdominal hemorrhage) and gastric infarction/necrosis

Question 25

gastric mucosa accounts for _______ of the stomachs weight

Answer 25

1/2 of the stomachs weight

Question 26

T/F: The submucosa and serosa are not easily separated

Answer 26

false! they are easily separated when using flaps or making partial incisions

Question 27

why is gastric surgery common in small animals (aka why is it preferred over other techniques)

Answer 27

1. safer than performing an esophagotomy 2. safer than performing an enterotomy 3. peritonitis is uncommon 4. stricture is rare 5. obstruction is rare

Question 28

T/F: Billroth procedures are not much more difficult than the other gastric surgical techniques

Answer 28

false! It is more difficult and may be associated with severe complications

Question 29

for FB removal, what procedure is preferred

Answer 29

gastroscopy over surgical removal

Question 30

T/F: Gastroscopy is more sensitive when looking for erosions, physaloptera, and small lesions

Answer 30

true!!

Question 31

what lesions can you NOT diagnose with gastroscopic biopies

Answer 31

submucosal lesions, pythios, scirrhous carcinoma

Question 32

what approach do we do for a gastrotomy

Answer 32

ventral midline approach

Question 33

what should we always do prior to incising the stomach

Answer 33

perform exploratory before!

Question 34

T/F: We should isolate the stomach with moistened laparotomy pads during a gastrotomy

Answer 34

true!!

Question 35

why do we place stay sutures for a gastrotomy

Answer 35

assist with manipulation and prevent spillage of gastric contents

Question 36

T/F: you should make the gastric incision in a hypovascular area of the ventral aspect of the stomach

Answer 36

true!!

Question 37

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

Answer 37

1. pylorus 2. outflow obstruction

Question 38

how do we perform a gastrotomy

Answer 38

1. make a stab incision into gastric lumen 2. enlarge incision with metzenbaums 3. use suction to aspirate gastric content 4. close stomach with 2-0 or 3-0 absorbable monofilament suture with a 2-layer inverting seromuscular pattern

Question 39

what are the first layer of the stomach we close and what type of suture pattern

Answer 39

serosa, muscularis, and submucosa with a cushing or simple continuous

Question 40

what do we close in the second layer and with what suture pattern

Answer 40

lembert or cushing that incorporates serosal and muscularis layers

Question 41

what is this procedure

Answer 41

gastrotomy

Question 42

what are the suture patterns of D, E, F

Answer 42

D - lembert E - connel F - cushing

Question 43

what are 2 important things to do during a gastrotomy

Answer 43

1. change gloves prior to closing abdominal wall and use instruments that are uncontaminated by gastric contents 2. after removing FB, dont forget to check rest of GI tract for something that can cause obstruction

Question 44

what does the seromuscular layer going from red to purple mean

Answer 44

it is considered viable

Question 45

what does the seromuscular layer going from green to black mean

Answer 45

probably nonviable

Question 46

T/F: observation of the mucosal color is a reliable indication of gastric wall viability

Answer 46

no! It is NOT reliable

Question 47

when is a partial gastrectomy indicated

Answer 47

when necrosis, ulceration, or neoplasia involves the greater curvature or middle portion of he stomach OR if there is necrosis associated with GDV

Question 48

what is going on here

Answer 48

invagination of necrotic stomach

Question 49

T/F: for invagination of a necrotic stomach you do not have to open the gastric lumen

Answer 49

true!!

Question 50

T/F: obstruction is possible from excessive intraluminal tissue during invagination of necrotic stomach

Answer 50

true!

Question 51

T/F: excessive hemorrhage is not possible during invagination of necrotic stomach

Answer 51

false, it is possible!!

Question 52

what is this procedure

Answer 52

Billroth 1 procedure

Question 53

when is a Billroth 1 indicated

Answer 53

1. neoplasia 2. outflow obstruction caused by pyloric muscular hypertrophy 3. ulceration of the gastric outflow tract

Question 54

what are the complications of a Billroth 1

Answer 54

1. if common bile duct has been damaged, may need to do a cholecystoduodenostomy or cholecystojejunostomy 2. if pancreatic ducts are inadvertently ligated

Question 55

what procedure is this

Answer 55

Billroth 2 procedure

Question 56

what is the difference between billroth 1 and billroth 2

Answer 56

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

Question 57

what are the indications of a billroth 2

Answer 57

1. neoplasia 2. outflow obstruction caused by pyloric muscular hypertrophy 3. ulceration of the gastric outflow tract

Question 58

T/F: if extent of lesion precludes end-to-end anastomosis of the pyloric antrum to duodenum, we should do a billroth 2

Answer 58

true!! should consider it

Question 59

what are the complications of a billroth 2

Answer 59

1. may need to do a cholecystojejunostomy or cholecystoduodenostomy 2. exocrine insufficiency may occur if the pancreatic ducts are damaged

Question 60

what do pyloromyotomy and pyloroplasty do

Answer 60

increase diameter of pylorus

Question 61

when do we do a pyloromyotomy and pyloroplasty

Answer 61

to correct gastric outflow obstruction (chronic antral mucosal hypertrophy and pyloric stenosis)

Question 62

T/F: pyloromyotomy and pyloroplasty are difficult or impossible to reverse and may slow gastric emptying

Answer 62

true!!

Question 63

describe characteristics of fredet-reamstedt pyloromyotomy

Answer 63

simplest and easiest procedure but does not allow inspection or biopsy of pyloric mucosa.....probably only temporary benefit

Question 64

describe characteristics of Heineke-mikulicz pyloroplasty

Answer 64

allows limited exposure of pyloric mucosa for inspection and biopsy

Question 65

describe characteristics of Y-U pyloroplasty

Answer 65

allows greater accessibility for resection and increases luminal diameter of the outflow tract

Question 66

why do gastric FBs cause vomiting

Answer 66

1. gastric outflow obstruction 2. gastric distention 3. gastric mucosal irritation

Question 67

Cats more commonly ingest ______ foreign bodies

Answer 67

linera

Question 68

what is this picture showing

Answer 68

intestinal plication

Question 69

T/F: initial clin signs usually alert owners to the seriousness of the condition

Answer 69

false, may not alert the owner

Question 70

T/F: linear FB must be removed ASAP to avoid intestinal perforation and peritonitis

Answer 70

true!!!

Question 71

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

Answer 71

false, first part is true BUT finding a FB in the stomach does not guarantee it is the cause of vomiting

Question 72

T/F: linear FB are more common in cats and you should always check under the tongue

Answer 72

true!

Question 73

T/F: most gastric FBs cannot be removed endoscopically

Answer 73

false, they can!

Question 74

T/F: you do not always need to do a complete exploration of the entire GIT

Answer 74

FALSE!!! you should always and it is mandatory

Question 75

T/F: you should always repeat the rads immediately before sx to make sure that the object has not moved

Answer 75

true!! A lot of the time the FB can move prior to sx and sx may not be indicated

Question 76

Opening the _____ is seldom justified, and FB in the _____ usually are eliminated without difficulty

Answer 76

colon, colon

Question 77

T/F: some small blunt FB may pass without causing harm but most FB warrant removal due to risk of distal obstruction/perforation

Answer 77

true!!!

Question 78

when should we not do barium contrast studies

Answer 78

within 24 hours of endoscopy or if perforation is likely

Question 79

should we scope first or procedure with sx when the FB is confined to the stomach

Answer 79

scope first and surgery second