Gastrointestinal Flashcards
Winter, JAVMA, 2017:
Ultrasound vs CT for diagnosing GI obstructions
Abdominal CT diagnosis vs exploratory surgery diagnosis?
Abdominal ultrasonography diagnosis vs exploratory surgery diagnosis?
Winter, JAVMA, 2017:
All abdo CT results agreed with ex-lap diagnosis of obstruction
Abdo ultrasound misdiagnosed 1 case with obstruction when it had functional ileus instead
Abrams, Vet Surg, 2019:
Gastric carcinoma in dogs
Post-op complication rate?
% of cases that developed septic peritonitis secondary to dehiscence?
Median progression-free interval?
MST?
Dogs that experience an intra-op complication had increased risk of what?
Effect of adjuvant chemotherapy on survival?
Abrams, Vet Surg, 2019:
Post-op complication rate: 20%
10% developed septic peritonitis secondary to dehiscence
Median progression-free interval: 54 days
MST: 178 days
Dogs that experience an intra-op complication had increased risk of death
Adjuvant chemo was correlated with improved survival
Seim-Wikse, JAVMA, 2019:
Gastric carcinoma in dogs
Factors that make a diagnosis of gastric carcinoma more likely than chronic gastritis?
Seim-Wikse, JAVMA, 2019:
Dogs >8 years of age
body condition score <4
serum C-reactive protein concentration >25mg/L
abnormally low serum folate concentration
Smith, JAVMA, 2019:
Small intestinal adenocarcinoma in dogs
Overall MST post-op?
What factor was associated with a longer MST?
What was not associated with survival time?
Smith, JAVMA, 2019:
Overall MST post-op: 544 days
Age <8 years was associated with a longer MST
Lymph node metastasis, adjuvant chemo and NSAID administration were not associated with survival time
Tidd, Vet Surg, 2019:
GI lymphoma in cats treated with surgical resection
Distribution of masses with the GIT?
What % survived to discharge?
MST?
What location of masses was associated with a longer survival time?
What surgical factor was associated with survival?
Tidd, Vet Surg, 2019:
58% small intestinal, 23% large intestinal, 19% gastric
90% survived to discharge
MST: 185 days
Large intestinal masses were associated with longer survival times than small intestinal and gastric masses
Complete surgical excision was positively associated with survival
Andrews, JAVMA, 2018:
Mesenteric volvulus in military working dogs
What % of the dogs died or were euthanized shortly after diagnosis?
Factors associated with increased odds of mesenteric volvulus?
Presence of post-op complications following previous prophylactic gastropexy was associated with development of mesenteric volvulus - true or false?
Andrews, JAVMA, 2018:
93% died or were euthanized
Factors associated with increased odds of mesenteric volvulus: German Shepherd breed, increasing age, history of previous prophylactic gastropexy, history of GI disease, history of other abdominal surgery, and NSAID administration at the time of mesenteric volvulus
True
Plavec, Vet Surg, 2017:
Colonic or ileocecocolic volvulus
What % of affected dogs had previously had surgery for GDV?
Plavec, Vet Surg, 2017:
46% of affected dogs had previously had surgery for GDV, suggesting that a motility disorder could be a potential cause
Schwartz and Coolman, Vet Surg, 2018:
Disposable skin staplers for closure of linear GI incisions
Dehiscence rate?
What was found to be associated with incisional dehiscence?
Of the dogs that underwent a second GI surgery for another foreign body, what % had a linear foreign body attached to the staples in the intestinal lumen?
How soon post-op do the skin staples migrate into intestinal lumen, and by when to the staples pass into the fecal stream?
Schwartz and Coolman, Vet Surg, 2018:
1% dehiscence rate
Linear FBs were associated with incisional dehiscence
20% had a subsequent linear FB attached to the staples in the intestinal lumen
Most of the skin staples will migrate into the intestinal lumen as early as 2 weeks post-op, and pass into the fecal stream by 6 months post-op
DePompeo, JAVMA, 2018:
Complications of hand-sutured vs stapled intestinal anastomoses
Dehiscence rates for hand-sutured anastomoses vs FEESA?
Mortality rate for patients with dehiscence?
What 3 factors were not risk factors for dehiscence?
DePompeo, JAVMA, 2018:
13% dehiscence rate for hand-suture anastomoses vs 5% dehiscence rate for FEESA
Mortality rate for patients with dehiscence: 69%
Pre-op peritonitis, hypoalbuminemia and anatomic location of the anastomosis were not risk factors for dehiscence
Davis, Vet Surg, 2018:
Dehiscence of enterectomy sites
What % of dogs with pre-op septic peritonitis had hypoalbuminemia vs dogs without pre-op septic peritonitis?
Overall dehiscence rate?
Average time to dehiscence?
Anastomotic technique (stapled vs sutured) was not significantly associated with dehiscence in cases without pre-op septic peritonitis, however in the presence of pre-op septic peritonitis, stapled anastomoses were less likely to dehisce than sutured anastomoses - true or false?
Dogs with pre-op septic peritonitis were how many times more likely to dehisce than dogs without pre-op septic peritonitis?
Mortality rate for dogs with dehiscence?
What was not a risk factor for dehiscence?
Davis, Vet Surg, 2018:
73% of dogs with pre-op septic peritonitis had hypoalbuminemia vs 41% of dogs without pre-op septic peritonitis
Overall dehiscence rate: 11%
Average of 5 days to dehiscence
True
Dogs with pre-op septic peritonitis were 4 times more likely to dehisce than dogs without pre-op septic peritonitis
67% mortality rate for dogs with dehiscence
Foreign body obstruction was not a risk factor for dehiscence
Sumner, Vet Surg, 2019:
FEESA
Effect of suture reinforcement for FEESA?
Sumner, Vet Surg, 2019:
Oversewing the transverse staple line in FEESA was associated with lower dehiscence rates
Gill, JAVMA, 2019:
Dehiscence and mortality rates following GI surgery
What factor(s) were associated with the development of dehiscence?
What factor(s) were associated with death?
Gill, JAVMA, 2019:
Dogs with ASA status of 3 or higher were more likely to develop dehiscence
Dogs with ASA status of 3 or higher and dogs with high lactate concentrations were less likely to survive surgery
Latimer, JAVMA, 2019:
Large intestinal surgery
Overall dehiscence rate?
Overall mortality rate?
Factors associated with development of dehiscence?
Factors associated with death?
Latimer, JAVMA, 2019:
Overall dehiscence rate: 10%
17% mortality rate
Factors associated with dehiscence: pre-existing colon trauma or dehiscence, pre-existing peritonitis, administration of blood products, administration of >2 classes of antimicrobials, positive microbial culture from a surgical sample, open abdominal drainage
Factors associated with death: pre-op anorexia, hypoglycaemia, neutrophils with toxic changes, administration of pre-op antimicrobials
Strelchik, JAVMA, 2019:
Enterotomy for foreign body removal
Dehiscence rate?
Mortality rate for dogs with dehiscence?
Strelchik, JAVMA, 2019:
2% dehiscence rate
40% mortality rate for dogs with dehiscence
Risselada, JAVMA, 2018:
Gastrojejunostomy tubes
How much time should be allowed for curing to ensure no leakage?
Why was the combination of a 20Fr G-tube and a 10Fr J-tube not appropriate for clinical use?
What could and could not be administered through the 8Fr J-tube
Risselada, JAVMA, 2018:
12-24 hours for curing; constructs that were allowed to cure for only 6 hours leaked
The combination of a 20Fr G-tube and a 10Fr J-tube is not appropriate for clinical use because no solution could be injected through it due to the outer diameter of the 10Fr J-tube being a similar size to the inner diameter of the 20Fr G-tube
Water and enteral diet could be administered through the 8Fr J-tube but not blenderized canned diet
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