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
Miles
Repeat Abd Rads for Mechanical obstruction
VetRadUS 2021
Resolution of dilation
38% gastric
17% SI
11% concurrent
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
Latimer et al JAVMA 2019
What is the overall intestinal dehiscence rate for dogs following full-thickness large intestinal incision? Mortality rate?
Dehiscence 10%
Mortality 17%
Latimer et al JAVMA 2019
What factors were associated with increased odds of mortality after full thickness large intestinal incisions in dogs?
Factors suggestive of sepsis
- preoperative anorexia
- hypoglycemia
- neutrophils with toxic changes
- Preoperative antimicrobial treatment
Duffy et al VetSurg 2020
Which canine typhlectomy closure technique had the maximum leakage pressure?
Staples + cushing oversew
Stronger than simple continuous parker-kerr and staples alone
Webb et al VetSurg 2019
What influences the load to failure of an incisional gastropexy, the length of the pexy or the number of suture lines?
Length (2 vs 4cm)
1 vs 2 rows of suture did not have an effect on load to failure
Baron et al VetSurg 2020
What was the paramedian incision complication rate for lap-assisted gastropexy?
19%
**Complication rate twice as high with SILS vs multiple port
O’Neill et al JSAP 2017
What percentage of surgically treated GDV cases survived to discharge?
80%
Miles, VRU 2021
Radiographic résolution of dilation
Gastric
SI
Gastric & SI
Gastric 37.5%
SI 17.1%
GAstric & SI 11.4%
Correa JFMS
How many cats that had lymph node neoplasia were correctly identified by cytology?
1 of 5
Fox-Alvarez, JAVMA, 2019:
Ultrasound-guided temporary percutaneous T-fastener gastropexy vs percutaneous trocarization for sustained gastric decompression
Complication(s) of percutaneous T-fastener gastropexy?
Complication(s) of percutaneous trocarization?
Fox-Alvarez, JAVMA, 2019:
Inadvertent splenic or jejunal placement of the T-fastener (25% of cases)
Malpositioned and ineffective trocar placement (13% of cases)
Webb and Monnet, Vet Surg, 2019:
Incisional gastropexy
Load to failure for 4cm vs 2cm incisional gastropexies?
Effect of 1 vs 2 suture lines on biomechanical strength of incisional gastropexies?
Webb and Monnet, Vet Surg, 2019:
Incisional gastropexies performed with a 4cm incision had a higher load to failure than those performed with a 2cm incision
Incisional gastropexies performed with 1 or 2 suture lines did not have an effect on the biomechanical strength of the gastropexy
Borrelli JVECC 2021
Which fluids bolused pre-op in GDV caused hypocoagulablilty?
Which fluids bolused pre-op in GDV caused hypocoagulablilty?
HES and Hypertonic Saline
Lux JAVMA 2021
What was the dehiscence rate for full-thickness large intestinal incisions?
The overall survival to discharge?
Factors associated with dehiscence and non survival?
Factors associated with dehiscence only?
What was the dehiscence rate for full-thickness large intestinal incisions?
8.3%
The overall survival to discharge?
94%
Factors associated with dehiscence and non-survival?
-Band neutrophils
-Partial colectomy
-Administration of blood products
-PO Cardiac arrest
-Incisional inflammation/infection
Factors associated with dehiscence only?
-hypoalb
-renal dysfunction
->2 classes of abs
-intra-abdominal fecal contamination
Sapora Vet Surg 2021
The order of leakage of devices used for colonic R&A
Biosyn: 49.5 mmHg
Barbed Biosyn: 45.5 mmHg
4.8 mm staples: 29.5 mmHg
3.5 mm staples: 5.3 mmHg
*Don’t use 3.5 mm staples
Mullen Vet Surg 2021
T/F: Intestine leak tested with air leaked at lower pressure than saline leak testing
True
*Air leak testing may be more sensitive to leakage
Lhuillery Vet Surg 2022
Immediate vs delayed surgery in GDV
Was there a difference in survival?
What was associated with in-hospital mortality?
Survival rates did not differ between dogs undergoing immediate or delayed surgery
What was associated with in-hospital mortality?
-Hyperlactatemia 24 h after initiation of fluid therapy
*also 1 month PO mortality
Duffy Vet Surg 2022
Which conformation of crotch suture was associated with least leakage?
Initial Leakage Pressure:
SCCS (47.6 ± 11.0, P < .002)
TCS (37.8 ± 6.4, P < .039)
SICS (33.0 ± 6.0)
NCS (27.1 ± 2.5)
Maximal leakage pressure
-greater in: SICS, TCS, and SCCS than those without crotch suture augmentation
Smith at al JAVMA 2019
What factor was associated with longer survival for small intestinal adenocarcinoma?
Age
Dogs < 8 years had a longer survival time
Smith at al JAVMA 2019
What is the MST for small intestinal adenocarcinoma?
544 days
60% alive at one year, 36% at two years
Otomo et al VetSurg 2019
How did lap-assisted GIFB removal compare to laparotomy for GIFB removal?
No difference was found
23% conversion to open due to presence of adhesions and/or free peritoneal fluid
What did McClaran et al VetSurg 2017 conclude about lap-assisted technique for GI biopsies in cats?
No difference between this technique and open laparotomy
What did Barry et al VetSurg 2017 conclude about diagnostic laparoscopy for suspected GIFB?
-laparoscopic explore takes significantly longer
- laparoscopic explore incomplete in 3/16 cases
Barry et al VetSurg 2017
What are potential reasons for conversion to an open laparotomy?
1) Adhesions
2) ileocecocolic involvement
3) Involvement of the stomach
4) Involvement of the duodenum
5) Linear foreign bodies
What did Brand et al VetSurg 2019 conclude about the effects of needle gauge and syringe size on SI leakage at injection sites?
Use a 22 gauge needle and a small syringe (less than 20mL)
Mullen et al VetSurg 2020
Which TA stapler cartridge is most appropriate for GI anastomosis?
Green cartridge - 4.8mm staple cartridge, 2mm when closed
Duffy et al VetSurg 2020
Where do FEESA leak when not oversewn?
at the level of the transverse staple line - where oversew would take place
Duffy et al VetSurg 2020
What is the effect of oversew on FEESA in dogs?
Oversew with Cushing pattern stronger than simple continuous oversew
Oversew with either pattern stronger than no oversew
According to Strelchik et JAVMA 2019 what is the dehiscence rate for enterotomies?
2%
Schwartz et al JSAP 2018
What was the dehiscence rate for GI incisions that were closed with skin staples +- suture?
0/29 cats
Schwartz et al VetSurg 2018
What risk factors were identified for dehiscence of linear GI incisions closed with skin staplers?
- Presence of linear foreign body
- Multiple GI incisions performed in one surgery
Kitshoff et al VetSurg 2018
How does the strength of a dermal incision closed with suture vs cyanoacrylate mesh compare?
on day 14, the cyanoacrylate group had higher load to failure than sutures
No difference in group was detected by day 28
DePompeo et al JAVMA 2018
What was the dehiscence rate for HSA vs FEESA?
13% for hand sewn
5% for stapled
This difference was significant
Andrews et al JAVMA 2018 identified what risk factors for mesenteric volvulus in military working dogs?
- GSD
- Increasing age
- Prophylactic gastropexy
- Abdominal surgery
- GI disease
- NSAID at the time of MV
Williams et al VetSurg 2020
What is the most common isolate from incisional infections after GI surgery? What is the most likely source of this bacteria?
E. coli
Contamination at the time of surgery
