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Small animal surgery I > Gastrointestinal > Flashcards

Gastrointestinal Flashcards

1
Q

What is the holding layer of the GIT?

A

Submucosa

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2
Q

List some surgical diseases of the stomach.

A

Foreign body, obstruction, ulceration, neoplasia, oomycosis, GDV

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3
Q

What will you see with an animal that has ingested a foreign body that is stuck in its stomach?

A

Distended abdomen, dehydrated, melena, azotemia, acid/base disturbance, hypokalemia, hypochloremia, leukocytosis

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4
Q

How do you treat a gastric foreign body?

A

Stabilize patient with fluids, gastroprotectants, removal of object

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5
Q

What are some ways to remove a gastric foreign body?

A

Conservative, endoscopy, gastrotomy, emesis

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6
Q

How do you approach a gastric foreign body surgery?

A

Ventral midline incision from xiphoid to pubis

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7
Q

T/F: Stomach heals slowly

A

False. RAPIDOO

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8
Q

What are the two gastric closure options you can use?

A

Traditional - cushing with lembert

Alternative - simple continuous in submucosa with cushing in seromuscular OR simple cont in serosa, muscle, and submucosa with cushing in seromuscular

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9
Q

When would you perform a single payer closure on the stomach and what patterns would you use?

A

Pyloric outflow tract, reduced gastric volume, thickened gastric wall.

Use simple interrupted or simple continuous

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10
Q

What happens with congenital pyloric stenosis and gastric outflow obstruction?

A

Hypertrophy of circular muscles

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11
Q

What are the CxS with gastric outflow obstruction?

A

Intermittent vomiting, abdominal distension but PAINLESS

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12
Q

What is the best diagnostic tool for gastric outflow obstruction/ congenital pyloric stenosis?

A

Ultrasound - tells you the layer thickness and differentiates neoplasia

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13
Q

What are the treatments used for congenital pyloric stenosis and which one is better?

A

Fredet-Ramstedt pyloromyotomy (better) - seromuscular layer, no lumen exposure

Heineke-Mikulicz Pyloroplasty - full thickness, exposes lumen

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14
Q

What do you see with chronic hypertrophic pyloric gastropathy?

A

Mucosal & muscular hypertrophy, intermittent vomiting

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15
Q

What do you see with DI with CHPG?

A

Rads - gastric distension, delayed gastric emptying

U/S - pyloric wall and muscle thickness

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16
Q

What can the endoscopy see with CHPG, what can it not se?

A

Sees hypertrophy of mucosa, but not the muscular layer

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17
Q

What are the grades of CHPG?

A

Grade 1 muscular hypertrophy

Grade 2 muscular and mucosal

Grade 3 muscular and mucosal with submucosal inflammation

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18
Q

What are the treatment options for CHPG?

A

Transverse pyloroplasty, Y-U pyloroplasty, Billroth 1, biopsy

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19
Q

What does a Y-U pyloroplasty do? How do you do it?

A

Creates a wider pylorus

Create a Y incision to transpose antral wall to pyloric region. suture antral flap with simple pattern

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20
Q

What ligament do you want to avoid with Y-U pyloroplasty and why?

A

Hepatoduodenal ligament because it can damage the common bile duct

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21
Q

What happens with a Billroth 1 procedure?

A

You excise a portion of the pylorus and suture that to the duodenum

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22
Q

What is the most common form of gastric neoplasia?

A

Adenocarcinoma

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23
Q

T/F: Gastric adenocarcinoma is rare in cats

A

True

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24
Q

Where will you expect gastric adenocarcinoma to metastasize to?

A

Regional lymph nodes, liver

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25
Q

How can gastric neoplasia be presented?

A

Infiltrative and diffuse, ulcerated, or discrete polypoid

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26
Q

What is the preferred test for gastric neoplasia?

A

Endoscopy

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27
Q

How do you treat gastric neoplasia?

A

Aggressive excision >5 cm margins, removal of regional lymph nodes

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28
Q

What surgical techniques are used for gastric neoplasia?

A

Billroth 1, billroth 2, gastrectomy

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29
Q

When would you perform a billroth 2?

A

When the resection of the stomach is too proximal where it limits end to end anastomosis

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30
Q

What are some complications with billroth 2?

A

Alkaline gastritis, blind loop syndrome, marginal ulceration

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31
Q

What does a roux-en-y anastomosis helps resolve in regards to billroth 2 complications?

A

Avoids alkaline reflux and likelihood of blood loop sydrome

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32
Q

Where is gastric leiomyosarcoma more common located?

A

In the cardia

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33
Q

T/F: Gastric leiomyomas are very fast growing and fatal

A

False. Slow growing and incidental findings

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34
Q

What organism causes pythiosis?

A

Pythium insidiosum

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35
Q

What happens with pythiosis?

A

Rapid growth and extensive infiltration of organism to the submucosa and muscularis of stomach and SI

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36
Q

What are the CxS with pythiosis?

A

weight loss, vomiting, diarrhea, hematochezia

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37
Q

What will you find on histopathology of pythiosis?

A

Eosinophilic pyogranulomatous inflammation

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38
Q

What test can you run to diagnose pythiosis?

A

ELISA for antibodies

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39
Q

How do you treat pythiosis?

A

Surgical excision with 3-4 cm borders. Combine with antifungal meds and immunotherapy.

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40
Q

What is the prognosis for pythiosis?

A

Guarded to poor

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41
Q

Define Gastric-Dilatation-Volvulus

A

The distension of the stomach and rotation of it on its mesenteric axis

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42
Q

What direction, clockwise or counterclockwise, does the stomach usually turn with GDV? How can you tell?

A

Clockwise rotation is more common and can be determined by visualization of the greater omentum.

Counter-clockwise rotation will not have a visible greater omentum

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43
Q

List some predisposing factors for GDV.

A

Large/giant breeds, deep chested, fast eater, post prandial activity, raised food bowls, temperament

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44
Q

How does GDV affect the heart?

A

Decreased preload, afterload, CO, BP. Compression of veins.

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45
Q

T/F: Reperfusion injuries can occur leading to absent tissue flow despite GDV correction.

A

True

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46
Q

T/F: GDV cases will exhibit respiratory alkalosis

A

False. acidosis

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47
Q

What metabolic effects are seen with GDV?

A

Cellular hypoxia, anaerobic metabolism, increased lactate, metabolic acidosis

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48
Q

T/F: Potassium levels with GDV is low

A

True, but not always due to electrolyte shifts and sequestration. It is unpredictable

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49
Q

T/F: You will always see hypoglycemia with GDV

A

True

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50
Q

What renal effects are seen with GDV?

A

Decreased GFR, olig/anuria, acute renal failure

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51
Q

What PE findings are noted with GDV?

A

Distended, painful, tympanic abdomen. Retching, pytalism, tachypnea, tachycardia, collapse

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52
Q

What kind of leukogram will you see with GDV?

A

Stress leukogram

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53
Q

With the hepatocellular damage done with GDV, what values from the chemistry will you monitor?

A

ALT

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54
Q

What values are monitored for renal damage?

A

BUN/creatinine

55
Q

T/F: Due to the damage to the body and hypoxia, you will see decreased bilirubin on the chemistry panel.

A

False. Increased

56
Q

Why is a VD radiographic view contraindicated with GDV?

A

It may lead to reflux and aspiration

57
Q

What angle/position/view of the patient with GDV most diagnostic on radiographs?

A

Right lateral

58
Q

How do you initially treat a GDV patient?

A

Fluids, decompression, pain management, antibiotics -> surgery

59
Q

What are the best types of fluids to use for GDV?

A

Crystalloids and colloids, hypertonic saline

60
Q

What are some ways to decompress the stomach in a case with GDV?

A

Orogastric intubation, trocharization, emergency gastrostomy

61
Q

What type of steroids do you give to a patient with GDV?

A

Glucocorticosteroids

62
Q

What meds can you give to aid in the occurrence of any reperfusion injuries with GDV?

A

Free radical scavengers - vitamin C, vitamin E, deferoxamine, lidocaine, acetylcysteine

63
Q

How do you perform a GDV surgery?

A

Ventral midline celiotomy, retract incision, decompress stomach, derotation

64
Q

What are the names of the retractors used in GDV surgery?

A

Balfour

65
Q

How can you assess the viability of the gastric wall with GDV?

A

Peristalsis, serosal color, friability, vessels, bleeding

66
Q

What are some surgical techniques to treat GDV?

A

Partial gastrectomy, gastric invagination (faster, less contamination)

67
Q

What is pexied with a gastropexy?

A

Pyloric antrum to the right lateral body wall

68
Q

What are the different methods for gastropexy?

A

Incisional, belt loop, circumcostal, tube, incorporatin, laparascopic-assisted, endoscopic-assisted

69
Q

What suture do you use for gastropexies?

A

2/0 or 3/0 antibacterial sutures

70
Q

What is different with the belt loop gastropexy?

A

Ties the peritoneum to the muscle

71
Q

Which gastropexy requires uses a purse string suture in the stomach and a mushroom tip catheter?

A

Tube gastropexy

72
Q

T/F: Incorporating gastropexies are the most recommended

A

False. NOT recommended

73
Q

What are the common post-operative causes of death with GDV?

A

Shock, gastric necrosis, reperfusion injury, arrhythmias

74
Q

What are some post-operative therapies for GDV?

A

NPO and fluids for 24 hours, H2 blockers, prokinetics (vomiting), gastric protectors, analgesics

75
Q

What is the most common type of arrhythmia with GDV? When should you treat it?

A

VPCs. Only treat with there are poor pulses

76
Q

What test can you run to determine prognosis of GDV?

A

Lactate levels.

> 6 mmol/L - bad
<6 mmol/L - good

77
Q

What can you have the owner do to prevent GDV reoccurrence?

A

Feed moist food, fish, egg, water added, outdoor activity, gastropexy, non-stressful environment

78
Q

What pathophysiological phenomenons occur with intestinal foreign bodies?

A

Proximal gas and fluid accumulation leading to edema, wall ischemia leading to tissue loss and bacterial translocation

79
Q

What are the CxS seen with intestinal foreign bodies?

A

Vomiting, anorexia, depression, abdominal pain, diarrhea

80
Q

How can you determine the likeliness of obstruction in the intestines with radiographs?

A

Ratio of small intestine to the height of the L5

<1.6 is no obstruction
>2 is likely

81
Q

What are some surgical procedures used to treat intestinal foreign bodies?

A

Enterotomy, R/A, Serosal patching, Enteroplication

82
Q

How can you evaluate the viability of the intestinal tissue?

A

Peristalsis pinch test

Color

Blood vessel characterization

Wall thickness/texture

83
Q

How do you perform an enterotomy to treat FBs?

A

Identify and isolate the affected area and pack off with sponges, occlude the area proximal and distal, longitudinal incision, close with suture, leak check, omentalize

84
Q

What suture do you use and what pattern with enterotomies?

A

3/0 monofilament with simple patterns

85
Q

What does R/A stand for, and how do you perform it?

A

Resection and Anastomosis. Remove necrotic, traumatized, neoplastic tissues by occlusion of affected segments, removal of mesentery, excision, close, omentalization

86
Q

How can you enlarge the lumen size when cutting the intestine for an R/A?

A

Cut at an angle

87
Q

What materials are used to close off intestines for surgery?

A

Monofilament* sutures

Surgical staples

88
Q

T/F: Like bladder surgery, double layer closure of the intestines is recommended

A

False, poorer apposition

89
Q

What are some suture patterns used in intestinal surgery?

A

Simple continuous, simple interrupted, modified gambee (inverts the mucosa which is good because you don’t want mucosal eversion)

90
Q

What should you do before injecting saline to test for a leak check after intestinal anastomosis?

A

Occlude intestine proximally and distally

91
Q

How far should your staples be placed from one another in an intestinal surgery?

A

3 mm apart

92
Q

What methods of intestinal surgery are there that utilize staples?

A

Anastomosis with staples
Skin stapler
Inverting end-to-end
Side-to-side with GIA stapler

93
Q

What will you see with linear foreign bodies?

A

Vomiting, anorexia, abdominal pain, clumping and pleating of intestines

94
Q

What do you see on contrast radiograph study?

A

Teardrop shaped air bubbles

95
Q

How can you surgically manage linear foreign bodies?

A

Remove from base of tongue (rare)

Gastrotomy(multiple)

96
Q

How does the catheter technique work in removing a linear foreign body?

A

Tie FB to catheter and milk it down the intestines to be removed easier through incision or through the anus

97
Q

What are some post-op intestinal surgery complications?

A

Septic peritonitis, adhesion, dehiscence

ILEUS

Short bowel syndrome

98
Q

What occurs with short bowel syndrome?

A

The body cannot compensate for the loss of mucosa in the gut and it leads to hypersecretions from the GIT and less intestinal transit time -> diarrhea, malnutrition, weight loss

99
Q

How do you treat short bowel syndrome?

A

Nutritional support, wait for the body to adapt (may never)

100
Q

What is the #1 cause of intussusception in small animals?

A

Viral enteritis

101
Q

What CxS is seen with proximal intussusception? Distal?

A

Proximal - vomiting

Distal - tenesmus

102
Q

If the tissue from an intussusception is necrotic, how do you manage it?

A

R/A!

103
Q

How can you prevent reoccurrence of intussusception?

A

Enteroplication

104
Q

How long do you want the intestines to be when performing an enteroplication?

A

3-5 cm intervals

105
Q

What happens if the cranial mesenteric arteries are compressed for too long? (disease: mesenteric torsion)

A

Ischemic necrosis of all the intestines occurs

106
Q

What do you see with mesenteric torsion?

A

Abdominal distention, hematochezia, collapse, death, shock

107
Q

T/F: Mesenteric torsion has a very poor prognosis

A

True, but immediately surgery might work

108
Q

T/F: Most intestinal neoplasias are malignant

A

True

109
Q

What is the most common neoplasia in the dog intestine?

A

Adenocarcinoma.

Lymphoma for cats

110
Q

How large are the borders when removing a malignant intestinal mass? Benign?

A

4-8 cm borders for malignant

Minimal borders for benign

111
Q

What is the preferred method of obtaining an intestinal biopsy?

A

Full-thickness layer that is 3-4 mm wide. Use a transverse wedge biopsy

112
Q

What complication can occur with an U/S guided biopsy of the intestine?

A

Tumor seeding

113
Q

When do you use antibiotics for intestinal surgery?

A

Only at time of surgery, no more than 24 hours after.
Prox intestine = 1st gen ceph
Distal large = 2nd gen

114
Q

What are the some large intestinal surgical procedures done?

A

Colopexy, colon R/A, typhlectomy, colostomy

115
Q

What are the blood vessels that supply the large intestine and colon?

A

Ileocolic, cran and caudal mesenteric

116
Q

What do you see with cecal intussusception (inversion)?

A

Diarrhea, hematochezia, tenesmus

117
Q

What is the best way to diagnose cecal inversion?

A

Endoscopy

118
Q

How do you treat cecal inversion?

A

Typhlectomy. First ligate the arterial supply, open, milk out, transect and suture

119
Q

What are the most common types of cecal neoplasia?

A

Leiomyoma/sarcoma

120
Q

T/F: Megacolon is more common in dogs than cats

A

False.

121
Q

What signs are seen with megacolon?

A

Chronic constipation

122
Q

How does megacolon happen?

A

Feces are retained and dehydrates -> pain -> colonic distention -> muscle and nerve damage -> intertia -> bacterial absorption

123
Q

What is the most common type of megacolon?

A

Idiopathic megacolon

124
Q

How can you surgically treat megacolon?

A

Subtotal colectomy

125
Q

T/F: You do not need to prep the bowel before performing a subtotal colectomy

A

True!

126
Q

What suture material and pattern do you use for subtotal coletomy?

A

3/0 PDS with simple pattern

127
Q

What is the most common congenital abnormality of the anus?

A

Atresia ani

128
Q

How do you treat an anal prolapse?

A

Manually reduce and place a purse string, treat underlying cause

129
Q

How can you differentiate between a rectal prolapse and a prolapsed intussusception?

A

You cannot insert your finger into a rectal prolapse

130
Q

What are some ways to treat a recurrent prolapse?

A

Non-incisional colopexy

Incisional colopexy

131
Q

What is the most common benign tumor in the rectum? Malignant?

A

Benign - adenomatous polyps

Malignant - adenocarcinoma

132
Q

How do you surgically prep a patient with rectal neoplasia?

A

Withhold food for 1-2 days prior, prophylactic antibiotics

133
Q

What are some surgical approaches to the rectum?

A

Transanal, dorsal, rectal pull through, ventral, lateral (rare)

Small animal surgery I (8 decks)

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