Gastrointestinal Flashcards
Gill
Dehiscence and mortality after GI Sx
JAVMA 2019
Survival less likely
>3 ASA
Increased Lactate (4.6 vs 2.4)
Dehiscence
>3 ASA
Schwartz
Disposable skin staplers for GI incision
VetSurg 2018
Complications 3%
~Died 1%
~Dehiscence 1%
~Attachement of linear FB 1% at staple site
Risk factors associated with incisional dehiscence
~multiple gastrointestinal incisions performed in 1 surgery ~presence of a linear foreign body
No associations ~age ~sex ~weight ~surgery time ~indication for surgical intervention ~surgery location in the gastrointestinal tract ~surgeon experience
Lopez
Enterotomy vs R&A
JAVMA 2021
Overall Dehiscence 7%
~Enterotomy 4%
~R&A 18%
Factors associated with dehiscence:
>3 ASA
Older age
No effect
~NG tube
Mullen
Leak Testing
JAVMA 2021
Overall Dehiscence 9%
~FEESA 10%
~Hand sewn 6%
Not significant ~technique ~leak testing ~per-op septic peritonitis ~omental/ serosal patch ~alb concentration ~Sx indication
No effect: ~Leak Testing ~preoperative septic peritonitis ~use of omental or serosal reinforcement ~preoperative serum albumin concentration ~surgical indication
Strelchik
Enterotomy incisional dehiscence for FB removal
JAVMA 2019
2% incisional dehiscence
3% had pre-op peritonitis
Tidd
Cats intestinal GI lymphoma
VetSurg 2019
MST 185 d
~Large intestine 675d
~Small intestine 64d
~Gastric 96d
Complete Sx Excision great survival
370 vs 83 d
Summer
Suture reinforcement for stapled intestinal anastomosis
VetSurg 2019
Oversewn 0 dehiscence
No oversewn 15%
Location of the dehiscence
~along the transverse staple line
Larose
Outcomes of intestinal intussusceptions
VetSurg 2020
Life‐threatening short‐term complications 14%
PO complications 35%
~Postoperative mortality rate was 6% at 14 days
~Recurrence 3%
No identifiable cause 67%
Location ileocolic 43%
Williams
Microorganisms associated with incisional infection after GI Sx
VetSurg 2020
Incisional infection rate 7%
E.coli
~ not susceptible cefazolin and cefoxitin
Duffy
Oversew transverse stable line in FEESA
VetSurg 2020
Initial leakage pressure increased with staple and Cushing’s 1.8x others
Mean Maximal leakage pressure with staple and sutures greater than no oversewn 1.4x
Leakage occurred at the level of the transverse staple line in non-oversewn constructs
Maxwell
Delay in Sx in GIFB
VetSurg 2021
Delay associated with
~Intestinal necrosis
~perfortaaions
*not significant
Risk factors for necrosis and perforations ~duration of CS ~incrseased lactate ~linear FB ~timing of surgery
Delay associated with
~R&A
~duration of Surgery
~duration of anesthesia
Immediate surgery associated with
~earlier feeding
~earlier Discharge
Miles
Repeat Abd Rads for Mechanical obstruction
VetRadUS 2021
Resolution of dilation
38% gastric
17% SI
11% concurrent
Rosenbaum
Use of disposable skin staples for R&A
JSAP 2016
Mortality 13%
Dehiscence 5%
No difference in mortality ~indication for Sx ~mutiple procedures ~Evidence of peritonitis ~Sx qualifications
Swinbourne
Dehiscence in Full-thickness GIB biopsies
JSAP 2017
Death in cats associated with
~low serum ALB
~Neoplasia
Dehiscance
~Cats 1-2%
~Dogs 1-2%
In dogs, there was no association between any outcome measure and the putative risk factors.
Andrews
Mesenteric volvulus in Military working dogs
JAVMA 2018
GSD Increased age History of Gastropexy (and complication) Previous abdominal surgery GI disease
Sogame
Intestinal lymphoma in dogs
JAVMA 2018
MST 62d
Negative prognostic indicators
~Anorexia
~spetic peritonitis
~location (Intestin only> lymph nodes> extra intestinal)
DePompeo
Complications following Intestinal R&A by suture vs FEESA
JAVMA 2018
Dehiscence
~Sutured 13%
~Stapled 5% * significant
Repeat surgery following Dehiscnece
Sutured > Stapled
Impaction noted at staple site
Latimer
Dehiscence following full-thickness Large intestinal incisions in dogs
JAVMA 2019
Dehiscence 10%
Mortality 17%
Increased odds of death ~per-op anorexia ~hypoglycemia ~neutrophils with toxic change ~pre-op antimicroial tx
Dehiscence associated with ~pre-existing colon trauma ~peritonitis ~blood products >2 classes of antibiotics \+microbial sample ~open abdominal management
Cranial mesenteric a. branches
Caudal pancreaticoduodenal
Jejunal
-mesenteric ileal
Common trunk
- middle colic
- right colic
- Ileocolic to cecal to antimesenteric ileal
How to close intestines with luminal disparity
~Place sutures further apart
~Transect smaller lumen at an angle
~Smaller lumen spatulated
~larger lumen reduced to the size of the smaller with antimesenteric sutures
Portions of intussuception
Intussusceptum into intussuscipiens
Caudal mesenteric a. branches
Left colic
Cranial Rectal
Substances secreted from Islet cells of Pancreas
alpha- Glucagon
beta- Insulin
delta- Somatostatin
Substances secreted from acinar cells of Pancreas
Bicarbonate
Proteases
Amylase
Lipase
Exocrine pancreas tumors
Carcinoma
Endocrine pancreas tumor
Insulinoma
Cell origin of Gastrinomas
Pancreatic islet cells
-delta cells
