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Equine Surgery: QOD > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

The major and minor duodenal papilla are the openings for what?

A

Major: Bile and pancreatic ducts Minor: Accessory pancreatic duct

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2
Q

What provides the blood supply to the ileum? a) Cecocolic artery b) Ileocecal artery c) Caudal mesenteric artery d) Cranial mesenteric artery

A

b) Ileocecal artery NB. It is a branch of the cranial mesenteric artery

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3
Q

Which cell type makes up the majority of small intestinal epithelium? a) Paneth cells b) Goblet cells c) Columnar absorptive cells/enterocytes d) Enteroendocrine cells

A

c) Columnar absorptive cells/enterocytes

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4
Q

What cells are the pacemakers of the intestine?

A

Interstitial cells of Cajal (ICCs)

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5
Q

Which option correctly matches the phase of activity with the type of activity of small intestinal motility? a) I: NSA, II: ISA, III: RSA b) I: ISA, II: NSA, III: RSA c) I: RSA, II: ISA, III: NSA d) I: RSA, II: NSA, III, ISA

A

a) I: NSA, II: ISA, III: RSA

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6
Q

What are the borders of the epiploic foramen

A

Visceral surface of caudate process of liver (dorsal and craniodorsal) Portal vein (cranioventral) Gastropancreatic fold (ventral)

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7
Q

Describe the procedure for a functional end-to-end jejunojejunostomy

A

Bowel ends lined up in antiperistaltic fashion Stoma created with GIA along opposing surfaces Bowel ends closed

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8
Q

Mesenteric rents can be congenital in origin but what structure is the cause

A

Mesodiierticular band

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9
Q

The prognosis for mesenteric rents is lower than for other strangulating lesions. What are the reasons for this

A
  1. Inability to reduce hernia 2. Long segments of bowel involved 3. Haemorrhage from mesentery 4. Failure to close entire mesenteric defect
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10
Q

What is the difference between direct and indirect hernias

A

Indirect: Small intestine passes through naturally occurring ring (eg. vaginal ring) Direct: Small intestine passes through acquired defect in musculature

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11
Q

What are the risk factors for enteroliths

A

1.California, Florida, 2.Arabians, Morgans, American Saddlebreds, donkey and Minis 3. feeding alfalfa hay 4.

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12
Q

For how long should feed be withheld following a jejunocolostomy

A

36-48 hours

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13
Q

What is the mortality rate for large colon volvulus (according to Auer)

A

56-65% (although one study reported 84%

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14
Q

List the complications associated with large colon resection

A
  1. Perstent endotoxemia 2. Peritonitis (contamination or bowel) 3. Continued bowel devitalisation 4. Post-op pain 5. Post- op diarrhoea 6. Weight loss 7. Colon ileus 8. Haemorrhage
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15
Q

How should small colon enterotomy incisions be closed

A

2 layers Full thickness simple continuous Seromuscular inverting pattern 2-0 polyglactin 910 Careful not to invert too much

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16
Q

Describe the post-op care following esophagotomy

A

Withheld feed 48 hours (can be immediate if incision closed and separate esophagostomy tube placed) Small quantities pelleted feed over next 8 days Parenteral electrolytes - can as deficiencies can happen Attention to hydration status Will heal by first intention and intraluminal suture will slough within 60 days

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17
Q

List the options for fixing rectal tears

A

Indwelling rectal liner Loop Colostomy: Single incision - high flank/low flank/ventral midline. Double incision - high flank/ventral midline End Colostomy Direct suturing Medical treatment

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18
Q

Describe the mechanism of action of the following prokinetics: a. metoclopramide b. lidocaine c. erythromycin d. neostigmine

A

a. metoclopramide dopamine 1 (DA1) and 2 (DA2) receptor antagonism and through 5-HT 4-receptor (5-HT4) agonism and 5-HT3 receptor antagonism b. lidocaine - Basically a sodium channel blocker but Auer has a bunch of info: reducing the level of circulating catecholamines through inhibition of the sympathoadrenal response, (2) suppressing activity in the primary afferent neurons involved in re ex inhi- bition of gut motility, (3) stimulating smooth muscles directly, and (4) decreasing in ammation in the bowel wall through inhibition of prostaglandin synthesis, inhibition of granulocyte migration and their release of lysosomal enzymes and cyokines, and inhibition of free radical production. c. erythromycin motilin agonist that in u- ences motility partly by acting on motilin receptors on GI smooth muscles and motilin and/or 5-HT3 receptors to stimulate the release of acetylcholine. d. neostigmine cholinesterase inhibitor

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19
Q

List the grades of rectal tear and describe them. Also give the prognosis for each (based on the two papers mentioned in Auer)

A

I - mucosa and submucosa only 93% (medical) 100% (medical) II - muscular only (mucosa intact) 100% (medical) IIIa - mucosa, submucosa, muscular (serosa remaining) 70% (medical) 38% (medical) 81% (suturing) IIIb - tear into mesorectum or retroperitoneal tissues 69% (medical) IV - everything (communicates with abdomen) 6% (medical) 2% (medical) 50% (suturing)

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20
Q

Name the methods for repairing chronic incising hernias

A

Subperitoneal Mesh Placement with Fascial Overlay Subperitoneal Meach Placement with Hernial Ring Apposition Subcutaneous Mesh Placement with Hernial Ring Apposition Laparoscopic Intraperitoneal Mesh Onlay

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21
Q

What mesh materials are available for repairing incisional hernias

A

Knit polypropylene mesh (Marlex): Strong, elastic, inert, resists infection Coated polyester (Mersilene) Polyglactin 910 Absorbable mesh; may not need to be removed, even if infection

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22
Q

What suture size, type and patterns would be used to close umbilical hernias in foals

A

Simple continuous appositional pattern recommended using appropriate size (USP 1,2,3) absorbable, monofilament suture

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23
Q

What are the predisposing factors for prepubic tendon rupture

A

Hydrops allantois Hydrops amnions Trauma Twins Fetal gaints Normal pregnancy Draft breeds Older mares

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24
Q

What material, patter, bite size, etc is used to repair acute total dehiscence of an abdominal incision

A

Monofilament stainless steel wire Through and through interrupted vertical mattress pattern Sutures 2-3cm apart Suture through skin, fascia, rectum abdominal muscle 5cm from wound edge Hard rubber tubing used as stents Second bite 2.5cm from wound edge Preplace sutures and close by applying tension on all sutures Wires twisted Cut ends bent back into lumen of tubing Leave skin unsutured if infected

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25
Q

Name 2 drugs, their function and their doses that can be used to treat gastric ulcers

A

Histamine (H2) antagonists:

Ranitidine (6.6mg/kg PO q8hrs or 1.5-2mg/kg IV q6-8hrs)

Proton pump inhibitors:

Omeprazole (2-4mg/kg PO q24hrs)

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26
Q

What is the fancy term for migration of epithelium across gastric ulcers

A

Epithelial restitution

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27
Q

What methods can be used to treat gastric impactions

A

Medical:Nasogastric intubation:

Water

Reflux contents

Carbonated cola

Surgery:Infusion/Massage

Massage

Infuse impaction via insertion of needle adjacent to greater curvature

Infusion of balanced polytonic fluid

Gastronomy:

Pack of abdomen with towels

Incision parallel and caudal to attachment of omentum on greater curvature

Evacuate contents

Double layer inverting closure

Rarely necessary to open stomach

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28
Q

Describe the arterial supply and venous drainage of the spleen

A

Arterial supply:

Splenic artery (branch of celiac artery)

Within hilus

Branches to supply spleen and greater curvature of stomach

Venous drainage:

Affluent of portal vein

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29
Q

List the possible approaches for splenectomy

A

Left side. Standing or right lateral recumbency

Incision caudal to 18th rib in left paralumbar fossa:

Difficult to assess primary vessels

Between ribs 17-18

Resection of 18th/17th/16th rib

Removal of distal aspect of last 3 ribs

Removal of 17th and transecting of 16th and 18th ribs

Laparoscopic-assisted

30
Q

Describe the ventrolateral approach to the oesophagus

A

GA, right lateral or dorsal recumbency or standing

Place feeding tube

5cm skin incision just ventral to jugular vein

Sternocephalicus and brachiocephalicus muscles separated

Deep cervical fascia incised to expose oesophagus

May be necessary to incise cutaneous colli muscles in distal cervical area

31
Q

List the methods of treating oesophageal stricture

A

First 60 days:

Bougienage - not useful

Pneumostatic/hydrostatic dilators - no useful

Balloon dilation

Initially low-bulk diet, NSAIDs and antibiotics for first 60 days

Then surgical options:

Esophagomyotomy

Partial or complete resection and anastomosis

Patch grafting

32
Q

What suture material/patterns should be used in an oesophageal resection and anastomosis

A

Submucosal layers apposed with 3-0 simple interrupted monofilament non absorbable polypropylene placed 3cm from cut edge, 2-3mm apart, with knots tied in lumen

Oesophageal muscle apposed with interrupted horizontal mattress sutures, 2-0 polydioxanone or monofilament non absorbable suture material (relief incision - circular myotome 4-5cm proximal or distal to anastomosis may help)

33
Q

List the complications of oesophageal surgery

A

Dehiscence and stricture

Acid-base electrolyte alterations

Laryngeal hemiplegia

Carotid artery rupture

34
Q

What are the 4 layers of the oesophagus

A

Tunica adventitia (fibrous layer)

Tunic muscular (muscular layers)

Tela submucosa (submucosal layer)

Tunica mucosa (mucous membrane)

35
Q

How can you treat diastemata

A

Cleaning out periodontal pockets with diastema forceps, dental picks, long forceps or high pressure-pneumatic or water instruments and filling periodontal defects with antibiotics in plastic impression material

Use diastema burr to wide to 4-6mm (clear periodontal pockets and diastema for feed first). Stop burr at 5 second intervals. Spray water continuously. Remove more from rostral aspect of caudal tooth as pulp horns located towards caudal aspect of tooth

May require extraction of a displaced cheer tooth

Do not widen diastema in young horses

36
Q

Name lots of methods of removing cheek teeth and which teeth they are appropriate for

A

Oral (anything)

Minimally invasive transbuccal (anything but more difficult caudally as may not be able to get sufficient angle)

Repulsion (any)

Lateral buccotomy (Upper 6,7,8; can also be used for lower 6,7,8)

37
Q

How do you close a partial (decent size that needs repair but not needing partial glossecomy) thickness tongue laceration

A

GA/Standing and local

Debride

Lavage

Multi layer closure

Vertical mattress sutures replaced deep in muscular body of tongue with absorbable or non-absorbable size 0 or 1 monofilament suture

Buried rows of simple interrupted 2-0 to 0 monofilamter absorbable suture subsequently used to appose muscles, obliterating dead space

Vertical mattress sutures tied and lingual mucosa apposed with simple continuous or interrupted vertical matters sutures

38
Q

What are sialoliths made of

A

Calcium carbonate and organic matter that develops within salivary duct (or a gland)

39
Q

How do you treat a laceration of the parotid duct

A

Most close spontaneously in 1-3 weeks

Anastomosis techniques:

Suture over intraluminal tube

Three sutures opposing two cut ends as a triangle and suturing between apices

(Size 2 nylon threaded normograde through distal laceration; guide tubing over nylon to cannulate duct before suturing)

Use 4-0 to 7-0 absorbable or non-absorbable suture in simple interrupted pattern

Leave tube in place while duct heals

If only one side lacerated, do not need to leave tube in place after closing defect

If anastomosis not possible, interposition polytetrafluoroethylene tube graft may restore duct continuity

Can create fistula from duct to oral cavity proximal to injury

Duct translocation

Surgical removal of gland, duct ligation or chemical ablation of gland

40
Q

What are the normal peritoneal fluid values day 6 post-op?

A

40,000 WBC/ml; 6g/dL TP

41
Q

What are the normal peritoneal fluid values day 4 post-op?

A

200,000WBC/ml

42
Q

What are the most common organisms found in septic peritonitis?

A

Streptococcus

Rhodococcus equi

Esherichia coli

Staphylococcus

Bacteriodes (anerobic)

Clostridium (anerobic)

Fusobacterium (anerobic)

43
Q

In what percentage of cases does recurrences of a right dorsal displacement of the large colon occur?

A

15%

44
Q

What are the predisposing and protective factors for incisional complication?

A

Predisposing factors:

Repeat laparotomy

Increased duration of surgery

Use of near-far-far-near

Chromic catgut

Leukopenia

Incisional edema

Post-operative pain

>300kg weight

>1 year age

Staple

Closure by less experienced surgeons

Protective factors:

Abdominal bandage

Short surgery time

Adequate draping

Isolating enterotomy incision

Minimize trauma to incision during exploration

Minimally reactive suture material

Do not take overly large bites

Avoid excessive force when tightening sutures

45
Q

List the uses of buscopan

A

Anti-spasmodic for colic

Choke

Rectal exam

Uterine movement during pregnancy

46
Q

What side effect of buscopan may affect monitoring for colic/pain

A

Increases heart rate

47
Q

Which laxative is anionic?

A

DSS

48
Q

Which laxative can form an oil embolus when administered with mineral oil?

A

DSS

49
Q

On incision, the oesophagus separates into 2 layers, what is in each layer?

A

Mucosa and submucosa:

Inner

Elastic

Muscular layer and adventitia:

Outer

Inelastic

50
Q

Describe the arterial blood supply to the oesophagus

A

Cervial part:

Carotid arteries

Thoracic/abdominal part:

Bronchoesophageal and gastric arteries

Vascular pattern arcuate but segmental

Minimal collateral circulation (preservation of vessels important)

51
Q

Describe the ventral approach to the oesophagus

A

GA, dorsal recumbency

10cm skin incision exposes 6cm esophagus

Skin and subQ fascia divided used scalpel blade

Paired steronothyroid, sternohyoid and omohyoid muscles are separated along midline to expose trachea

Blunt separation of fascia on left side of trachea permits identification of esophagus containing NG tube

Retract trachea to right

Gentle sharp dissection of overlying loose adnentitia to expose ventral wall of esophagus

52
Q

List the possible diagnostic tests for choke (even the funky tests)

A

Clinical exam

Palpation

Ultrasound

Radiography

Contrast radiography

Negative/double positive contrast radiography

Bloodwork: WBC, electrolytes, hydration

Cineradiogrpahy

Electromyography

Manometric evaluation

Functionally distinct regions:

Cranial esophageal sphincter

Caudal esophageal sphincter

Fast (cranial 2/3)

Slow (caudal 1/3)

53
Q

What drugs does Auer like to use for choke?

A

Atropinization (0.02mg/kg)

Acepromazine

Oxytocin (0.11 and 0.2IU/kg)

Xylazine

54
Q

The left carotid sheath is super close to the oesophagus - what structures does it contain?

A

Carotid artery, vagus and recurrent largngeal nerves

55
Q

Describe the procedure for a cervical esophagostomy

A

Lateral recumbency and GA or standing and local anesthesia

Pass NG tube

Skin over left jugular furrow prepped (can occasioanlly be right)

5cm skin incision ventral to jugular vein

Esophagus sharply incised lonitudinally for 3cm down to indwelling NG tube

NG tube removed and polyethylene NG tube (outer diameter 14-24mm) placed into stomach (make sure placed through both layers of esophagus)

Place sutures in mucosa to form a seal around tube (likely unncessary as saliva will still leak)

Secure tube firmly with butterfly tape bandages sutured to skin, then elastic tape bandages

Large diameter tubes preferred

Cap tube between feedings; flush with water at end of each feeding

Tube should remain in place for minimum of 7-10 days to allow stoma to form (longer if in area of rupture or perforation)

Can feed normally when tube removed

Large portion of swallowed feed lost through stoma when fed from ground (feed a withers height)

Stoma heals spontaneously

Fistula formation rare

Complications:Fatal infection:

Drain and infection early

ABs for 7-10 days, until mature stoma develops

56
Q

What do I cells release and what does it do?

A

Cholecystokinin (CCK): Released in response to protein and fat in duodenum. Stimulates pancreas to secrete amylase, lipase, trypsin, chymotrypsin, carboxypeptidase, elastase and colipase.

57
Q

What is the effect of high Mg on Ca absorption?

A

Decreases Ca absorption

58
Q

Describe the neural stimulation of motility of the small intestine

A

Vagus nerve, components of sympathetic NS, enteric NS

Enteric NS: ganglia in myenteric (Auerbach) plexus and submucosal (Meissner) plexus - independent of CNS

Myenteric neurone: innervate longitudinal muscle and outer lamella of circular muscle

Submucosal neurons innervate inner lamella of circular muscle

59
Q

Apart from WBC and TP, which 6 factors in peritoneal fluid have a strong correlation with a strangulating lesion?

A

Gross appearance

Peritoneal chloride

pH

Lactate (peritoneal better than blood; also good for prognosis)

Myeloperoxidase (MPO) - potentially useful to indicate neutrophil activation

D-dimer concentration - potentially for fibrinolytic activity

60
Q

What 4 issues in the GI tract can Parascaris equorum lead to?

A

Obstruction

Intussusception

Abscesation

Rupture

61
Q

What is a Littre hernia?

A

Protrusion of a Meckel diverticulum through a potential abdominal opening

62
Q

What is a Richter hernia?

A

Antimesenteric wall of intestine protrudes through defect in abdominal wall

63
Q

Between which bands (for the cecum and colon) do you perform a cecocolic anastomosis

A

CCA between dorsal and lateral bands of cecum and lateral and medial free bands of RVC

64
Q

List the causes of cecocecal or cecocolic intussusception

A

Dietary changes

Cecal wall abscess

Salmonella

Eimeria leuckarti

Strongulus vulgaris arteritis

Organophosphate exposure

Parasympathomimetic drugs,

Tapeworm

65
Q

What type of laxative is Polyethylene glycol 3350?

A

Osmotic laxative

66
Q

What is DCAB? What is the equation to calculate it and what is the target in horses?

A

Dietary cation anion balance (DCAB)

Target DCAB +200-300 mEq/kg

Grass hay/cereal grains ok

Not alfalfa - important in enterolith formation

67
Q

List the Ddx for meconium impaction

A

Bladder rupture

Atresia colic

Ileocolonic aganglionosis

Enteritis

68
Q

List the factors that predispose to post-op ileus

A

Intestinal ischemia

Distention

Peritonitis

Electrolyte imbalances

Endotoxemia

Traumatic handling of intestine

R&A

Anesthesia

>10yrs

Arabian

PCV>45%

High serum protein and albumin

Elevated serum glucose

>8L reflux at admission

Anesthesia >2.5hrs

Surgery >2yrs

High pulse rate

Strangulating lesions of SI and ascending colon

Length of SI resection

Obstruciton of SI

Ischemic SI

69
Q

List 2 factors that protect against post-op ileus (presuming the horse had SI surgery)

A

Pelvic flexure enterotomy

Intra-operative lidocaine

70
Q

What is the mechanism of action of bethanecol

A

Muscarinic cholinergic agonist

Stimulate Ach (M3 and M2) recetors at level of myenteric plexus

Affects duodenum, jejunum, cecum emptying, pelvic flexure, gastric emptying

71
Q

List the complications that can occur with abdominal drain placement

A

Partial obstruction of drain (26%)

Leakage of fluid around drain (16%)

Subcutaneous fluid accumulation (12%)

I guess peritonitis too but not listed in Auer

Equine Surgery: QOD (13 decks)

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