Gastrointestinal Surgery Flashcards
1
Q
Define AIVR.
A
Accelerated idioventricular rhythm
2
Q
Define dilatation.
A
Something stretched beyond normal dimensions
3
Q
How are patients stabilised and prepared for exploratory laparotomy?
A
- Starve adults 12-18 hours
- Starve puppies/kittens 4-6 hours
- No enemas
- Surgery as soon as stable/before become unstable again
4
Q
Why is NSAID use avoided in exploratory laparotomy?
A
- Can cause gastrointestinal bleeding
- May delay gastrointestinal healing
- Can affect platelet function/clotting
- Will affect renal function if hypotensive under anaesthetic
5
Q
What could be identified on radiography to indicate an exploratory laparotomy?
A
Abdominal effusion
Mass
Radio-opaque foreign body
Excessive gas
Signs of GI obstruction
6
Q
What could be identified on ultrasonography to indicate an exploratory laparotomy?
A
- Abdominal effusion
- Mass
- Radio-lucent and radio-opaque foreign body
- Signs of GI obstruction
7
Q
What incision is made for an exploratory laparotomy?
A
Large, midline, 20cm incision
8
Q
What is done with falciform fat upon exploratory laparotomy incision?
A
Scalpel or scissors or electrosurgery – remove, haemostasis
9
Q
How is visualisation improved in an exploratory laparotomy?
A
Abdominal packing = moistened swabs
Exteriorisation
Manoeuvres
Retractors
10
Q
How is the abdomen explored in an exploratory laparotomy?
A
Systematic exploration = do the quadrants
11
Q
How is a duodenal manoeuvre done in an exploratory laparotomy?
A
- Patient in dorsal recumbency
- With/without stand on patient’s left side
- Take duodenum and use the mesoduodenum like a fan to pull the abdominal contents towards you and expose the right gutter
12
Q
How is a colonic manoeuvre done in an exploratory laparotomy?
A
- Patient in dorsal recumbency
- With/without stand on patient’s right side
- Take descending colon and use the mesocolon like a fan to pull the abdominal contents towards you and expose the left gutter
13
Q
How is contamination reduced in an exploratory laparotomy prior to closure?
A
New gloves - glove punctures, contamination, after flushing wise to change gloves as have converted the abdomen from dirty to contaminated
New kit - may be contaminated
14
Q
List the surgical diseases of the stomach.
A
- Gastric foreign body
- Gastric neoplasia
- Gastric dilation and volvulus
- Gastro-oesophageal hernia
- Gastric ulceration/perforation
- Hiatal hernia
- Pyloric outflow obstruction/pyloric stenosis
15
Q
What are linear gastric foreign bodies?
A
More common in cats, need prompt diagnosis and early removal due to plication/secondary damage to small intestines
16
Q
What is the presentation of gastric foreign bodies?
A
Could be vomiting, regurgitation, acute/chronic/intermittent, outflow obstruction, gastric distention and/or mucosal irritation
17
Q
How are gastric foreign bodies treated?
A
Stabilisation, emesis, endoscopic removal, gastrotomy with full abdominal exploration
18
Q
What are the most common gastric neoplasias in cats and dogs?
A
Dogs = adenocarcinoma most common
Cats = lymphoma most common
19
Q
What are the clinical signs of gastric neoplasia in cats and dogs?
A
Chronic vomiting
Weight loss
20
Q
How is gastric neoplasia investigated?
A
- Bloods to rule out other causes of vomiting
- Radiographs - with contrast otherwise futile
- Ultrasound - operator dependent
- Endoscopy - good, and allows for biopsies
- Staging for metastasis (70-80%)
21
Q
What are the treatment options for gastric neoplasia in dogs and cats?
A
Surgery – wide surgical excision for all except lymphoma
Adjunctive – chemo/radiation of no benefit
Palliation – antemetics, antacids, sucralfate, often non-responsive
22
Q
What is the prognosis of gastric neoplasia in dogs and cats?
A
Generally poor. MST 2months for gastric adenocarcinoma
23
Q
What are the extrinsic risk factors of GDV?
A
- Diet – once daily > more than once. Large meal > smaller meals
- Eating/feeding habits – raised feeding, rapid eating
- Exercise – significant activity soon after eating
24
Q
What is the non-specific presentation of GDV in dogs and cats?
A
- Restless, discomfort, pain
- Hypersalivation, ptyalism
- Stretching, arched back
- Early signs of shock
25
What is the specific presentation of GDV in dogs and cats?
- Non-productive retching
- Abdominal distension/abdominal tympany
- Mild-moderate shock
26
What is the advanced presentation of GDV in dogs and cats?
Moderate to severe shock with circulatory and respiratory compromise:
- Marked tachycardia (often >200bpm)
- Marked tachypnoea (often >40bpm)
- Weak/absent peripheral pulses
- Pale, dry mucous membranes
- Markedly prolonged CRT
- Mucous membranes dark raspberry red
- With/without dyspnoea
27
What 2 imaging modalities are the best when investigating a dog with a suspected gastric tumour?
CT and endoscopy
28
How does GDV cause shock?
Cardiogenic, distributive, obstructive – due to reduced blood returning to the heart from caudal vena cava compression
Hypovolaemic – relative. Much less likely as not usually dehydrated when GDV starts
29
What is the pathophysiology of outflow obstruction caused by GDV?
Distal oesophageal > prevents eructation
Pyloric > prevents normal outflow into duodenum
30
What is the pathophysiology of rotation caused by GDV?
- Can have just dilation with no volvulus
- Typically happens as dilation progresses
- Most common 180-270 degrees
- Usually clockwise looking from abdomen towards the head
31
What is the pathophysiology of shock caused by GDV?
- Stomach compresses caudal vena cava
- Compromised gastric mucosa > translocation of bacteria from stomach into blood stream
- Compromised blood supply to stomach
- Stomach compresses diaphragm > hypoventilation and respiratory acidosis
32
How are GDV patients stabilised?
- Client communication
- Gastric decompression
- IV access – minimum database, analgesia
- IVFT – big dog do IV catheter on each leg
- Oxygen
33
What other drugs might be considered to stabilise a GDV patient?
Antibiotics
Antiemetics
Antidysrhythmics
34
Why is gastric decompression done with GDV cases?
- Aggressive medical therapy may be enough to stabilise a dilation without volvulus and then can take steps to avoid recurrence when non-emergent
- Buys time to treat shock and stabilise for surgery if volvulus confirmed
- Still needs prompt surgery
35
When and which views of abdominal radiographs are taken in GDV?
When – after decompression
Views – right lateral, dorsolateral
36
What is the specific appearance of GDV on abdominal radiographs?
- Dorso-cranial displacement of the pylorus
- Gas dilation of gastric fundus
- ‘Reverse C’ from compartmentalised stomach
- Soft tissue shelf > still visible even if have decompressed the stomach
- Full 360’ twist makes interpretation more tricky
- Double bubble
37
What is the most common direction and degree of rotation seen in GDV?
180 degrees clockwise
38
Outline the surgical treatment of GDV in cats and dogs.
1. Stabile patient
2. Anaesthesia
3. Laparotomy
4. Decompression (1st)/de-rotation (2nd)
5. Flushing of stomach to remove fermented gastric contents
6. Gastrotomy to remove any foreign bodies and remove fermented material if can’t be flushed out per os
7. Exploration
8. Manage ischaemic injury
39
What is the presentation of gastric ischaemic damage caused by GDV once in surgery?
- Colour – grey, green, purple, black
- Thin wall
- Walls are dry, fragile or seromuscular tears
- Vasculature – no pulses, thrombi and no active bleeding
- Peristalsis – absent
40
What are the GDV gastropexy options?
- Incisional
- Laparoscopic – only for prophylaxis
- Percutaneous gastrotomy/PEG – useful if planning to use a feeding tube post-op
41
What improves GDV prognosis?
- Quick presentation
- Stable before surgery
- No gastrectomy
- No Gastropexy
- Lactate less than 7mmol/l
- No DIC
- Lactate dropping by 40%
42
What worsens a GDV prognosis?
- Delayed presentation
- Unstable before surgery
- Lidocaine/tachydysrhythmia
- Gastrectomy
- Splenectomy
- No gastropexy
- Lactate greater than 9mmol/l
- Lactate not dropping
- DIC present
43
What is the site of incision for a gastrotomy?
Avascular, halfway between lesser and greater curvature, middle of the Stomach body
44
What are the indications of gastrectomy?
Neoplasia
Necrosis
Perforation
45
When are gastrotomy tubes used and not used?
Why – functional stomach and GI tract
Why not – primary gastric pathology (vomiting/regurgitation
46
What are the advantages of gastrotomy tubes?
Easy to place
Large bore/unlikely to block
Easy to care for once in place
47
What are the disadvantages of gastrotomy tubes?
Need for GA
Hospitalisation
Not to be used for any primary gastric disease
Complications rare but potentially serious
48
What are the methods of placing a gastrotomy tube?
- PEG (like mini flank laparatomy)
- Surgical – can be removed few days post-op as seal more secure
- Both – put feeding tube into left flank behind last rib. Purse-string sutures to avoid leakage/contamination of abdominal cavity. Care/risks as for all feeding tubes
49
What suturing is used for an incisional gastropexy?
- Simple continuous suture from cranial to caudal – deepest/most dorsal tissue
- Simple continuous suture from caudal to cranial – superficial/most ventral tissue
50
How are patients stabilised and prepared for exploratory lapartomies in small animals?
- Starve adults 12-18 hours
- Starve puppies/kittens 4-6 hours
- No enemas
- Surgery as soon as stable/before become unstable again
51
Why are NSAIDs avoided where possible for exploratory laparatomies?
- Can cause gastrointestinal bleeding
- May delay gastrointestinal healing
- Can affect platelet function/clotting
- Will affect renal function if hypotensive under anaesthetic
52
What diagnostics are used for exploratory laparotomies?
- Minimum database
- Radiography
- Ultrasonography
- Endoscopy
53
What might radiography reveal that requires an exploratory laparotomy?
- Abdominal effusion
- Mass
- Radio-opaque foreign body
- Excessive gas
- Signs of GI obstruction
54
What might ultrasonography reveal that requires an exploratory laparotomy?
- Abdominal effusion
- Mass
- Radio-lucent and radio-opaque foreign body
- Signs of GI obstruction
55
Describe the incision for an exploratory laparotomy in small animals.
Large, midline, 20cm incision
56
How is visualisation improved in an exploratory laparotomy?
- Abdominal packing = moistened swabs
- Exteriorisation
- Manoeuvres
- Retractors
57
How is the abdomen explored in an exploratory laparotomy?
Systematic exploration = do the quadrants
58
Describe duodenal exploratory laparatomy manoeuvre.
- Patient in dorsal recumbency
- With/without stand on patient’s left side
- Take duodenum and use the mesoduodenum like a fan to pull the abdominal contents towards you and expose the right gutter
59
Describe colonic exploratory laparatomy manoeuvre.
- Patient in dorsal recumbency
- With/without stand on patient’s right side
- Take descending colon and use the mesocolon like a fan to pull the abdominal contents towards you and expose the left gutter
60
How is contamination minimised in an exploratory laparotomy?
- Glove punctures, contamination, after flushing wise to change gloves as have converted the abdomen from dirty to contaminated
- Instruments and kit – as for gloves, your kit may be contaminated
61
List the surgical diseases of the stomach in small animals.
Gastric foreign body
Gastric neoplasia
Gastric dilation and volvulus
Gastro-oesophageal hernia
Gastric ulceration/perforation
Hiatal hernia
Pyloric outflow obstruction/pyloric stenosis
62
Why do linear gastric foreign bodies need prompt diagnosis and early removal?
Due to plication/secondary damage to small intestines
63
How do gastric foreign bodies present in small animals?
Could be vomiting, regurgitation, acute/chronic/intermittent, outflow obstruction, gastric distention and/or mucosal irritation
64
How are gastric foreign bodies in small animals treated?
Stabilisation, emesis, endoscopic removal, gastrotomy with full abdominal exploration as described earlier
65
What are the most common gastric neoplasias in cats and dogs?
Dogs = Adenocarcinoma most common
Cats = Lymphoma most common
66
What are the clinical sigs of gastric neoplasia in small animals?
Chronic vomiting
Weight loss
67
How is gastric neoplasia in cats and dogs investigated?
- Bloods to rule out other causes of vomiting
- Imaging – radiographs (with contrast otherwise futile), ultrasound (operator dependent), endoscopy (good, and allows for biopsies)
- Staging for metastasis (70-80%)
68
How is gastric neoplasia in small animals treated?
- Surgery – wide surgical excision for all except lymphoma
- Adjunctive – chemo/radiation of no benefit
- Palliation – antemetics, antacids, sucralfate, often non-responsive
69
What are the extrinsic risk factors of GDV?
- Diet – once daily > more than once. Large meal > smaller meals
- Eating/feeding habits – raised feeding, rapid eating
- Exercise – significant activity soon after eating
70
What is the non-specific presentation of GDV in small animals?
- Restless, discomfort, pain
- Hypersalivation, ptyalism
- Stretching, arched back
- Early signs of shock
71
What is the specific presentation of GDV in small animals?
- Non-productive retching
- Abdominal distension/abdominal tympany
- Mild-moderate shock
72
What is the advanced presentation of GDV in small animals?
Moderate to severe shock with circulatory and respiratory compromise:
- Marked tachycardia (often >200bpm)
- Marked tachypnoea (often >40bpm)
- Weak/absent peripheral pulses
- Pale, dry mucous membranes
- Markedly prolonged CRT
- Mucous membranes dark raspberry red
- With/without dyspnoea
73
What 2 imaging modalities are the best when investigating a dog with a suspected gastric tumour?
CT and endoscopy
74
How does GDV in small animals cause shock?
Cardiogenic, distributive, obstructive – due to reduced blood returning to the heart from caudal vena cava compression
Hypovolaemic – relative. Much less likely as not usually dehydrated when GDV starts
75
What is the pathophysiology of GDV in small animals?
- Outflow obstruction
- Distal oesophageal > prevents eructation
- Pyloric > prevents normal outflow into duodenum
- Rotation or not - typically happens as dilation progresses, 180-270 degrees
76
What is the pathophysiology of GDV in small animals causing shock?
- Stomach compresses caudal vena cava
- Compromised gastric mucosa > translocation of bacteria from stomach into blood stream
- Compromised blood supply to stomach
- Stomach compresses diaphragm > hypoventilation and respiratory acidosis
77
How are GDV patients stabilised?
- Client communication
- Gastric decompression
- IV access – minimum database, analgesia
- IVFT – big dog do IV catheter on each leg
- Oxygen
- Antibiotics
- Antiemetics
- Antidysrhythmics
78
Why is gastric decompression done in GDV small animal patients?
- Aggressive medical therapy may be enough to stabilise a dilation without volvulus and then can take steps to avoid recurrence when non-emergent
- Buys time to treat shock and stabilise for surgery if volvulus confirmed
- Still needs prompt surgery
79
When and how are GDV abdominal radiographs taken in small animal patients?
When – after decompression
Views – right lateral, dorsolateral
80
What is the specific appearance of GDV on small animal abdominal radiographs?
- Dorso-cranial displacement of the pylorus
- Gas dilation of gastric fundus
- ‘Reverse C’ from compartmentalised stomach
- Soft tissue shelf > still visible even if have decompressed the stomach
- Full 360’ twist makes interpretation more tricky
- Double bubble
81
What is the most common direction and degree of rotation seen in GDV?
180 degrees clockwise
82
Outline the surgical management of GDV in small animals.
- Stable patient
- Anaesthesia
- Laparotomy
- Decompression (1st)/de-rotation (2nd)
- Flushing of stomach to remove fermented gastric contents
- Gastrotomy to remove any foreign bodies and remove fermented material if can’t be flushed out per os
- Exploration
- Manage ischaemic injury
83
How does gastric ischaemic damage from GDV in small animal patients present?
- Colour – grey, green, purple, black
- Thin wall
- Walls are dry, fragile or seromuscular tears
- Vasculature – no pulses, thrombi and no active bleeding
- Peristalsis – absent
84
What is GDV prognosis in small animals improved by?
- Quick presentation
- Stable before surgery
- No requirement for lidocaine
- No gastrectomy
- No splenectomy
- Gastropexy
- Lactate less than 7mmol/l
- No DIC
- Lactate dropping by 40%
85
What is GDV prognosis in small animals worsened by?
- Delayed presentation
- Unstable before surgery
- Lidocaine/tachydysrhythmia
- Gastrectomy
- Splenectomy
- No gastropexy
- Lactate greater than 9mmol/l
- Lactate not dropping
- DIC present
86
Where is the incision site located for a gastrotomy?
Avascular, halfway between lesser and greater curvature, middle of the stomach body
87
What are the indications for a gastrectomy?
Neoplasia
Necrosis
Perforation
88
Why should gastrotomy tubes be used and not be used?
Why – functional stomach and GI tract
Why not – primary gastric pathology (vomiting/regurgitation)
89
What are the advantages and disadvantages of gastrotomy tubes in small animals?
Pros – easy to place, large bore/unlikely to block, easy to care for once in place
Cons – need for GA, hospitalisation, not to be used for any primary gastric disease, complications rare but potentially serious
90
What are the options for gastrotomy?
- Percutaneous gastrotomy
- Surgical – can be removed few days post-op as seal more secure
- Both – put feeding tube into left flank behind last rib. Purse-string sutures to avoid leakage/contamination of abdominal cavity. Care/risks as for all feeding tubes
91
What are the sutures used for an incisional gastropexy?
Simple continuous suture from cranial to caudal – deepest/most dorsal tissue
Simple continuous suture from caudal to cranial – superficial/most ventral tissue
92
What are the small animal small intestinal emergencies?
Partial obstruction
Complete distal obstruction
Complete proximal obstruction
Intestinal perforation
93
How does partial obstruction present?
- Onset = over days
- V/D, anorexia, dehydration = variable
- Weight loss = often
- Depression/lethargy = mild if present
- Shock = uncommon
- Abdominal pain = mild if present
- Bloods = may be normal
94
How does complete distal obstruction present?
- Onset = over days
- V/D, anorexia, dehydration = variable, not often frequent
- Weight loss = often
- Depression/lethargy = yes
- Shock = variable
- Abdominal pain = variable
- Bloods = variable, may be normal
95
How does complete proximal obstruction present?
- Onset = < 24h
- V/D, anorexia, dehydration = yes, severe
- Weight loss = no
- Depression/lethargy = yes
- Shock = yes
- Abdominal pain = often
- Bloods = electrolyte and acid-base abnormalities
96
How does intestinal perforation present?
- Signs of peritonitis
- Pneumoperitoneum
97
What is intestinal torsion and mesenteric volvulus?
- Marked SI distension
- Rare as it progresses very rapidly and is often fatal due to overwhelming ischaemic damage and sepsis as per GDV.
98
Distinguish intestinal torsion and mesenteric volvulus.
Intestinal torsion – only a part of the intestines affected. Like for splenic torsion, identify the segment, and perform a resection and anastomosis.
Mesenteric volvulus – closes off cranial mesenteric artery. Like GDV this is far worse as the whole intestine affected and if the whole SI is ischaemic then resection would leave no intestines
99
What can happen with intestinal incarceration/strangulation?
- Displaced out of abdominal cavity – herniation, rupture
- Displaced within abdominal cavity – intra-abdominal tears
- Sliding – intestine moving freely in and out
- Incarcerated – intestine abnormally displaced
- Strangulated – intestine trapped
100
What is the signalment of intussusceptions in small animals?
Young animals associated with inflammatory conditions - parasites, viral disease, foreign bodies
101
What do clinical signs of intussusceptions in small animals depend on?
- Not obstructed and sliding (as for hernias)
- Partial obstruction only
- Obstructed
- High SI > acute history, rapid deterioration when obstructed
- Large intestinal > often more chronic presentation
102
How are small animal intussusceptions diagnosed?
- Palpable sausage mass
- Minimum database
- Radiography – soft tissue mass with/without SI obstruction
- Ultrasound – concentric rings
103
How are small animal intussusceptions treated?
Stabilisation and prompt surgery
104
What are the possible complications of small animal intussusceptions?
Recurrence > consider enteroplication = but not recommended for first time offenders
105
What are the clinical signs of small intestinal neoplasia in small animals?
- Presence of partial obstruction depends if intramural tumour or tumour causing intraluminal obstruction
- Vague signs of depression, anorexia, lethargy, with/without vomiting and diarrhoea, progressive weight loss
- Melena, haematemesis, anaemia, fever, jaundice, PU/PD, effusion
106
How is small intestinal neoplasia in small animals diagnosed?
- Palpable mass = easier in cats
- Ultrasound best – loss of layers, particularly in the muscular layers, good for targeted FNA
- Radiography – may need contrast
- Endoscopy if mucosal
- FNA or biopsy
107
How is small intestinal neoplasia in small animals treated?
- Staging
- Stabilisation
- SI resection and anastomosis with 4-8cm margins
- Chemo for lymphoma only
108
What do the clinical signs of intestinal foreign bodies in small animals depend on?
- Type of FB
- Location of FB
- Duration of clinical signs/delay in diagnosis
- Degree of obstruction
109
How are intestinal foreign bodies in small animals diagnosed?
Minimum database, imaging
110
How are intestinal foreign bodies in small animals treated?
Laparotomy, enterotomy, with/without enterectomy
111
When is an enterotomy done in small animals?
- Pink
- Normal/even wall thickness
- Smooth, moist wall texture
- Pulsing vessels, active bleeding
- Peristalsis treated
112
When is an intestinal resection and anastamosis done in small animals?
- Grey/green/purple/black
- Thin walls
- Dry, fragile or seromuscular tears in walls
- No pulses, thrombi, no active bleeding
- Absent peristalsis
113
What suture material would you select to close a small intestinal enterectomy/resection ad anastomosis in an otherwise healthy 2 year old 30kg dog?
Monocryl 3/0 simple continuous
114
What are 3 options at closure of intestinal surgery?
Serosal patching to attach small piece of small intestine over a pit of potentially unhealthy tissue to prevent intestine wide peritonitis. Leak testing. Both of these are optional, bit omentalisation is ideal.
115
How is intestinal biopsy done?
1. Isolate – find the segment(s) with the FB. Use atraumatic bowel clamps, or preferably an assistant to manipulate and occlude the segment
2. Spillage should be kept to minimum
3. Incision is anti-mesenteric, longitudinal. Can incise over the FB if intestine looks healthy. But worth considering incising a little further distal/aboral to the FB so your sutures are in healthy tissue
4. Make incision long enough to reduce risk of tearing
116
How is intestine isolated for intestinal resection and anastamosis?
- Find the segment(s) to be resected and ‘milk’ bowel contents orally and aborally to empty the segment
- Use atraumatic bowel clamps to manipulate and occlude the segment
117
Why must intestinal R&As be planned for?
- Look at the blood vessels in the mesentery to ensure there is a branch directly supplying the segments you will stitch together
- Ligate mesenteric vessels as appropriate
- Much more complicated in proximal duodenum due to biliary pancreatic ducts
118
What are the holding layers of the stomach and small intestine?
Submucosa of stomach and submucosa of small intestine
119
Why does obstruction being prolonged complicate things for intestinal R&As and how is this resolved?
The segment closest to the mouth will be dilated and have much larger diameter than the aboral segment. This can make suturing tricky
- Cut along the antimesenteric border to match the diameters
- Cut the aboral side on a diagonal when planning your R&A
120
What are the possible complications of gastrointestinal surgery?
Adhesions
Stricture/stenosis
Reperfusion injury
Short bowel syndrome
Intussusception recurrence
Ileus
Peritonitis
Sepsis
121
What are the patient factors that increase risk of gastrointestinal surgery?
Debilitated patient
Chronic obstruction
Severity of underlying abnormality
Underlying poor healing
Non-viable tissue
122
What are the surgeon factors that increase risk of gastrointestinal surgery?
- Longer GA time
- Overly enthusiastic tissue handling
- Poor suturing technique
- Non-viable tissue
123
What are the clinical signs of peritonitis?
Non-specific
Lack of progress
Depression
Anorexia
Abdominal pain
Vomiting
124
How is peritonitis diagnosed?
- Radiography
- Ultrasound
- In novice hands, repeat AFAST can be very helpful to see progression e.g. fluid build-up
- Can use to find a pocket of fluid to tap
- Can use to see diagnose ileus
125
How does peritonitis present on haematology and biochemistry?
Biochemistry – hypoproteinaemia, hypoglycaemia, lactate, compare glucose and lactate with abdominal fluid in dogs
Haematology – neutrophilia – if the count is increasing d4-6 strong suspicion of peritonitis. Neutropaenia
Electrolytes and acid-base - metabolic and/or respiratory acidosis
126
What is very important to do when diagnosing peritonitis?
Cytology and abdominal tap (abdominocentesis) or diagnostic peritoneal lavage. Degenerate neutrophils with intracellular bacteria
127
How is peritonitis in small animals treated?
Aggressive stabilisation, early surgery, intensive post-op care
128
How are oesophagostomy tubes placed?
1. Right lateral recumbency
2. Select tube
3. Tent skin
4. Skin incision
5. Use forceps to place the tube
6. Check position
7. Secure
8. Bandage
129
Define herniorrhaphy.
Opening hernia sac, replacing contents to normal place, closing hernia opening
130
What is a retroflex bladder?
Bladder flipped through 180 degrees to lie facing caudally
131
Define steatorrhea.
Excessive fat in faeces
132
What are the clinical signs of colorectal disease?
- Large intestinal diarrhoea
- Tenesmus/dyschezia
- Constipation/obstipation
- Haematochezia
- Abnormal shape faeces – mass compressing the faeces as it passes through colon/rectum/anus
- Weight loss/vomiting
- Acute abdominal crisis if there is a perforation
133
How is a patient prepared for colonic surgery?
- Antibiotics
- Analgesics
- No enemas/laxatives in the days before = increased risk of contamination and peritonitis
- Encourage empty colon naturally
134
What are the healing characteristics for colorectal surgery?
- Slower healing
- Segmental blood supply
- Longer lag phase where collagen lysis exceeding collagen synthesis for the first 3-4 days after surgery
- It is vitally important to preserve the blood supply to the colon to prevent necrosis and wound breakdown
135
What are the possible complications of colorectal surery?
- Higher risk of dehiscence
- High intra-luminal pressure during defaecation further exacerbates risk of dehiscence
136
What are the aetiologies of feline megacolon?
Congenital
Acquired:
- Mechanical – obstructive lesions. Intraluminal or extraluminal. Potentially reversible
- Functional – neuromuscular dysfunction. Potentially reversible
- Idiopathic – surgical?
- End stage – permanent loss of colonic dysfunction
137
What is the possible history for feline megacolon?
History of intermittent constipation
History of RTA/pelvic fracture
138
What are you looking for on radiography to diagnose feline megacolon?
Soft tissue abnormalities (enlarged colon, neoplasia), orthopaedic abnormalities (pelvic narrowing, spinal abnormalities), obstructions (by neoplasia and fractures, faeces dehydrated so more radiodense).
139
How do colon diameters from radiographs diagnose feline megacolon?
A ratio of maximal-colon diameter to L5 length <1.28 was proposed to be suggestive of a normal colon diameter. A ratio of 1.28:1.48 suggests constipation. A ratio of >1.48 is suggestive of megacolon.
140
How is feline megacolon medically managed?
- Correct fluid and electrolyte imbalances
- Oral with/without rectal laxatives
- Colonic prokinetic agents – cisapride or metoclopramide
- Enema – micralax or GA enemas
- Dietary management – increase fibre intake, with/without appetite stimulants
- Fluid intake – increase
141
When is surgery chosen in management of feline megacolon?
- Non-response to medical therapy
- Pelvic narrowing due to chronic fracture
- Constipation associated with perineal herniation
- Idiopathic megacolon
142
What are the surgical options for surgical management of feline megacolon?
Laparotomy
Subtotal colectomy
Total colectomy
143
What are the complications of surgical management of feline megacolon?
- Dehiscence
- Failure to cure
- SIBO/small intestinal bacterial overgrowth
144
What is the aetiology of rectal prolapse?
Prolapse typically occurs secondary to straining due to urogenital or ano-rectal problems
145
What are the predisposing conditions of rectal prolapse?
- Gastrointestinal parasites, colitis, colorectal or anal tumours, foreign bodies
- Urinary tract: cystitis, urethral obstruction
- Reproductive organs: prostatic disease, dystocia
146
How is rectal prolapse differentiated from intussusceptions in small animals?
- A lubricated finger or probe (thermometer) is passed between the prolapse and the anus. In intussusception the probe or finger can be passed easily.
- In rectal prolapse the probe or finger cannot be passed, as the rectal tissue will be confluent with the mucocutaneous junction.
147
What is done to manage rectal prolapse if tissue is viable?
- GA to allow for manual reduction of prolapse
- Purse string to reduce risk of recurrence
- The purse string is kept in place for 3-5 days and the animal is treated with stool softeners
148
How are rectal prolapses surgically managed?
- Rectal tissue non-viable
- Rectal tissue can’t be reduced
- Recurrent prolapse where resect part of rectum that has become chronically damaged/separated from its normal connective tissue attachments
149
When is colopexy used in rectal prolapse management in small animals?
- Used in recurrent cases, or cases where risk of recurrence deemed to be very high
- Keeps the colon (and therefore rectum) attached within abdomen > less able to move into pelvis and therefore be prolapsed
150
What are the clinical signs of colorectal neoplasia in cats and dogs?
Dogs: mass effect – faeces is passing lump, flaccid or ribbon like
Cats: weight loss, anorexia, vomiting and diarrhoea
151
What is the surgical approach to colorectal neoplasia management?
- For distal rectal masses, pull-out and pull-through
- Laparotomy – masses in proximal rectum
- Pelvic split = advanced. Ventral masses that can’t be resected from abdomen or perineum alone
152
Describe rectal roll out and rectal pull out as a surgical approach to colorectal neoplasia.
Relatively simple for benign masses not invading the submucosa. Stay sutures very beneficial. Can also use for small masses invading the submucosa, but higher risk of complications.
153
Describe rectal pull through as a surgical approach to colorectal neoplasia.
Advanced surgical technique. Anus is anastomosed to the colon but the damage caused at surgery leads to a high risk of post-operative faecal incontinence.
154
Why is subtotal colectomy the surgical procedure of choice for idiopathic feline megacolon?
Preserving the ileocaecocolic junction reduces the risk of small intestinal bacterial overgrowth
155
What are the anal sac diseases seen in dogs and occasionally cats?
- Impaction – treated by expression
- Sacculitis – flushing with/without antibiotics
- Abscessation – drainage and antibiotics
- Neoplasia
156
How are recurrent anal sac diseases treated surgically in cats and dogs?
Anal sacculectomy
157
How do anal sac adenocarcinomas present in dogs?
- Changes in defaecation
- Dyschezia, faecal tenesmus, flattened stools and perineal swelling are common clinical signs
- Polydipsia/polyuria
158
What are the surgical options to treat anal sac adenocarcinomas?
- Closed anal sacculectomy
- Abdominal/pelvic lymph nodectomy
- Chemotherapy for metastatic disease (carboplatin)
159
What is abdominal lymph node removal?
An advanced surgical technique to remove the intra-abdominal lymph nodes due to the proximity to the descending aorta/caudal vena cava with associated risk of haemorrhage.
160
When is surgical removal of anal sacs indicated?
Persistent or recurrent anal sac disease and neoplasia
161
What are the 2 techniques for anal sacculectomy?
Closed or open. Closed is preferred, as open is a contaminated surgery
162
Outline how a closed anal sacculectomy is done.
1. A probe is placed into the sac through the duct to help identify it
2. An peri-anal incision is made over the sac
3. The sac is dissected out, taking care not to damage the anal sphincter or rupture the sac
4. The duct is ligated with synthetic absorbable suture material and the sac is removed
5. The wound is flushed with sterile saline and the sub-cutaneous tissue and skin are closed routinely
6. Purse string removed
163
What are the uncommon complications of an anal sacculectomy?
- Persistent infection due to incomplete excision
- Wound dehiscence due to secondary infection
- Faecal incontinence due to excessive trauma to the external anal sphincter or damage to caudal rectal nerve
164
What are the clinical signs of perineal hernias?
- Unilateral or bilateral perineal swelling (dogs)
- Abnormal defaecation due to loss of rectal support laterally (dogs and cats)
- Dyschezia, constipation, haematochezia
165
What is the underlying cause of perineal hernias?
Due to weakness of the pelvic diaphragm
166
How does perineal hernias cause bladder retroflexion?
The hernia, combined with straining can result in abdominal contents being pushed into the perineum. This is typically the dilated rectum, pelvic and peritoneal fat. However, small intestine, urinary bladder and the prostate can also be present in the perineum. Animals that have retroflexion of their bladder may have signs of dysuria or stranguria.
167
How does rectal palpation diagnose perineal hernias?
- Loss of firm lateral rectal support
- Sacculation of the rectum (unilateral) or dilatation (bilateral)
168
How are perineal hernias medically managed?
Removal of impacted faeces
High fibre diet
Stool softeners
169
How are perineal hernias surgically managed?
Perineal herniorraphy = reconstruction of the perineal diaphragm
170
What are the principles of surgical repair of perineal hernias?
- Castration should be performed first as it is a clean surgery
- Purse-string in anus
- Resect or repair damaged tissue
- Close hernia using local autogenous tissue
171
What are the augmentation options for perineal hernia repair surgeries?
- Internal obturator muscle flap
- Semitendinosus muscle flap from hindleg
- Mesh = last resort
172
What are the considerations for treating abomasal surgical disorders in cattle?
- Return and stabilise abomasum in a normal anatomical position
- Manage of concurrent abdominal pathology
- Minimising additional risk
- Practicality, available handling facilities, labour
- Economic cost-benefit – clients budget, value of the cow
- Surgeon experience and familiarity with technique
173
How are LDAs in cattle conservatively managed?
- Casting and rolling
- Analgesic with/without spasmolytic
- Oral fluid therapy
- Calcium, to improve motility
- Treatment of concurrent medical conditions – metritis, ketosis
- Dietary management – high fibre and low starch
174
How should you position a cow in order to give her conservative management for LDA?
1. Roll onto her back and hold for 1-2 mins rocking back and forth
2. Continue roll into left lateral recumbency and remain there for further few minutes
3. Return to sternal
4. Whilst in sternal – give supportive therapies
175
What is the prognosis of conservative management of LDA in cattle?
40% success rate, monitor closely for return to function as signs of returning conditions are a lot subtler after this correction
176
What are the open surgical techniques to correct an LDA in cattle?
- Right sided paralumbar fossa (common) with pyloroplexy or omentopexy
- Double sided paralumbar fossa (still commonly used)
- Left sided paralumbar fossa (“Utrecht”) (less common in UK but occasionally useful)
- Right paramedian (fairly common
177
What are the closed surgical techniques to correct an LDA in cattle?
- Toggle-pin (common)
- Blind fixation (not recommended)
- Laparoscopy
178
What are the advantages of right paralumbar laparotomy with pyloroplexy or omentopexy as a method of correcting an LDA?
- Good visualisation of right abdomen
- Low recurrence risk
- Animal standing
- Assistant not require
179
What are the disadvantages of right paralumbar laparotomy with pyloroplexy or omentopexy as a method of correcting an LDA?
- Time
- Cost
- Requires arm long reach
- Difficult if abomasal adhesions to the left body wall
180
How is a right paralumbar laparotomy with pyloroplexy or omentopexy done in cattle to correct an LDA?
1. Incise skin just caudal to the last rib and middle of abdomen/bottom of paralumbar fossa (6 inch)
2. Reach caudally to the omental sling and dorsally, then cranially over the rumen to palpate the distended abomasum
3. Insert a 14G needle attached to sterile tubing into the abomasum at the most dorsal point to remove gas. Guide through the abdomen
4. Reach across the ventral body wall and grasp the pylorus or lesser omentum on the midline then gently raise the pylorus to the ventral margin of the incision
5. Perform a pyloropexy or omentopexy – anchoring abomasum to right body wall. Risk of omentoplexy is if the omentum is friable
6. Suture pexy to the peritoneum and transverse abdominal muscle at the cranial incision
7. Routine abdominal and skin closure
181
How is a double sided paralumbar fossa approach to an LDA in cattle with pyloropexy or omentopexy done?
1. As unilateral right hand side approach
2. 2nd surgeon performs a simultaneous paralumbar incision on LHS
3. Pushes down the distended abomasum to release the gas
4. Hands the lesser omentum to RHS surgeon
5. Anchored on right body wall with pyloropexy or omentopexy
182
What are the advantages of a double sided paralumbar fossa with a pyloropexy or omentopexy for an LDA in cattle?
- As right sided approach
- Very good visualisation
- Can break down adhesions
183
What are the disadvantages of a double sided paralumbar fossa with a pyloropexy or omentopexy for an LDA in cattle?
- Requires 2 surgeons
- Cost
- Time
184
What is the left paralumbar laparotomy/Utrecht method with abomasopexy to correct an LDA in cattle?
- Left flank paralumbar approach
- Decompress abomasum
- Place stay sutures in dorso cranial aspect of the abomasal fundus
185
How is the left paralumbar laparotomy/Utrecht method with abomasopexy to done correct an LDA in cattle?
1. Deflating the gas by pressing down on the top of the abomasum
2. Exteriorise an area of the abomasal fundus
3. Thread large straight or semi curved needle to ends and pass ventrally between the rumen and body wall
4. Pass needles ventrally in abdomen to exit body wall to the right of the midline caudal to sternum, avoiding any milk veins. Tie the 2 ends together with a surgeons knot
186
What are the advantages of the left paralumbar laparotomy/Utrecht method with abomasopexy to correct an LDA in cattle?
- Good visual of abomasum
- Can break down adhesions
- Low recurrence
- Animal standing
- Useful in cows in late gestation
187
What are the disadvantages of the left paralumbar laparotomy/Utrecht method with abomasopexy to correct an LDA in cattle?
- Cost
- Time
- Poor abdomen visualisation
188
How is a right paramedian laparotomy and abomasopexy done to correct an LDA in cattle?
1. Cast cow in right lateral recumbency
2. Roll into dorsal recumbency
3. Paramedian incision – hand’s breadth to the right of the midline, hand’s breadth caudal to the xyphisternum
4. Identify the abomasum
5. Abomasopexy – suturing the abomasal fundus to the internal layer of the rectus sheath and peritoneum
189
What are the advantages of a right paramedian laparotomy and abomasopexy to correct an LDA in cattle?
- Allows visualisation of abomasal fundus and some other abdominal viscera
- Adhesions with the left body wall can be managed
- More rapid than other closed procedures
- Surgeon arm length is not restrictive
- Low risk of recurrence
- Appropriate for any size of displacement
190
What are the disadvantages of a right paramedian laparotomy and abomasopexy to correct an LDA in cattle?
- Requires the cow to be rolled
- Cost
- Time
- Poor abdomen visualisation
191
How is a toggle pin suture used to correct LDA in cattle?
1. Cast into right lateral recumbency and rolled into dorsal recumbency. Once on her back, the abomasum floats up to the ventral body wall
2. Place trochar into the abomasum, push through toggle and pin am dsuture line so that we can pexy her abomasum to the body wall
3. Hand’s breath to right midline, hand’s breadth caudal to xiphisternum – location confirmed by acidic smell of abomasum through trochar
4. Trochar is removed before abomasum fully decompresses
5. Must be performed quickly to be successful so that too much gas does not escape from the abomasum
6. Needle can be removed after full decompression
7. Two sutures secured together using surgeons knot, leaving a hands breadth between body wall and tightened suture
8. Rolled onto her left side and allowed to stand
9. Remove in 7-10 days – cut string and then toggles pass down digestive tract
192
What are the advantages of toggle pin sutures for cattle LDA correction?
- Quick
- Cheaper compared to open surgery
193
What are the disadvantages of toggle pin sutures for cattle LDA correction?
- Blind trochar placement
- Can’t visualise abdomen viscera – problem if there are adhesions
- Potential risk of trauma to personal and cow
- Requires rolling (space and man power)
194
Which cases are toggle pin sutures used for LDA correction?
When showing classical signs of LDA, when 2-3 weeks away from calving, when off her colour but is well in herself
195
Describe the 2 step method of laparoscopic correction of LDA in cattle.
Involve placing toggle sutures in the displaced abomasum through keyhole incisions followed by rolling and retrieving sutures through ventral incision
196
What is the aftercare used for all cattle abomasal surgeries?
- NSAIDs
- Antibiotics
- Oral fluid therapy – 40-60L of isotonic fluid to ballast the rumen
- Treatment of concurrent medical conditions – e.g. Metritis and Ketosis
- Calcium – subclinical hypocalcaemia common in cases of LDA
- Dietary management – high fibre, low starch
197
What are the possible complications of abomasal surgery in cattle?
- Abomasitis and abomasal ulceration
- Abomasal and rumenal hypomotility/atony
- Peritonitis and wound infections
- Pexy failure with/without re-displacement
- Adhesions and intestinal incarceration
198
What is the conservative treatment for right displaced abomasum?
- Appropriate for RDA only
- Medical management as for LDA – no rolling
- Regular monitoring (every 2-4 hours) in case torsion and volvulus occurs
199
What are the indications for right displaced abomasum surgery?
- Signs of hypovolaemic/endotoxic shock
- Severe or increasing abdominal pain unresponsive to analgesics
- No response to conservative management in 2-4 hours
200
How is right displaced abomasal surgery done in cattle?
1. Correct metabolic alkalosis with hypertonic saline followed by large volumes of isotonic saline
2. Gaseous and fluid decompression performed
3. An anticlockwise volvulus can be corrected by clockwise rotation of abomasum
4. A pyloropexy or omento-pexy (as LDA) is carried out after correction
201
What are the indications for a rumenotomy in cattle?
- Traumatic reticulo pericarditis
- Ruminal foreign body (especially if linear)
- Ruminal tympany – alternatively place ruminal trochar and cannula
- Grain overload and acidosis
- Poisoning
202
How is traumatic reticulo-pericarditis conservatively managed?
- Broad-spectrum systemic antibiotics
- NSAIDs
- Oral fluid therapy
- Magnets
Generally poor response
203
What are the clinical signs of traumatic reticulo-pericarditis in cattle?
- Pain so fast shallow respiration
- Elbows out in abduction
- Arching back
- Pain on palpation of cranial lower abdomen
- May have pyrexia
- May grunt of recticular contraction
204
How is traumatic reticulo-pericarditis surgically treated in cattle?
- Explore of the cranioventral abdomen alongside the rumen and reticulum– adhesions palpable between the reticulum and the diaphragm
- Perform rumenotomy
205
How is a rumenotomy performed in cattle?
1. Secure rumen to body wall to prevent any leakage into the abdomen - stay sutures, rumenotomy frame and sleeve, 2 x IM pins
2. Siphon off excessive fluid from rumen with wide bore plastic tubing
3. Rumenotomy incision
4. Manual exploration and remove FB
5. Rumen closure
206
What is the prognosis of traumatic reticulo-pericarditis in cattle?
- Timing of surgery - at moment of exit of FB from reticulum
- Guarded if the peritonitis is generalised
- Very poor if muffled heart sounds
207
What are the indications for exploratory laparotomy in cattle?
- Severe or increasing abdominal pain unresponsive to analgesics
- Unresponsive or deteriorating shock
- Distended small intestinal loops, tight mesenteric bands or palpable impaction on rectal examination
- Chronic ruminal indigestion/tympany
- Complete absence of faecal production
- Caecal dilation and dislocation
- To obtain a diagnosis in cases where other methods have been unsuccessful or impractical or biochemistry suggests ion sequestration
208
What are the possible umbilical masses of cattle?
- Umbilical Hernia
- Omphalitis (“Navel ill”)
- Umbilical Abscess (SC or intra-abdominal)
- Umbilical Remnant Infection
- A combination of the above
209
What is the aetiology of umbilical hernias in cattle?
- Congenital predisposition
- Acquired – concurrent infection, trauma (overzealous chewing on the umbilicus of the dam)
- A combination
210
What are the clinical signs of umbilical hernias in cattle?
- Ventral midline
- Extending caudally from the umbilicus (1cm to >30cm)
- Soft
- Non-painful
- Normally reducible
- Typically BAR with no impact on appetite or growth rates
211
What is the aetiology of umbilical abscesses in cattle?
- Secondary to naval ill
- Walled-off infection persists within the umbilical stump
- Subcutaneous or intra-abdomen
212
What are the clinical signs of umbilical masses in cattle?
- Typically firm, hot and painful
- With/without draining sinus tracts and purulent umbilical discharge
- With/without pyrexia or systemic signs
213
What is the aetiology of umbilical remnant disorders in cattle?
- Failure of elastic recoil/post-partum closure of elements of umbilical cord
- Concurrent umbilical hernia
- Concurrent infection
214
What are the clinical signs of urachal abscesses in urachal remnant syndrome in cattle?
- With/without purulent umbilical discharge
- With/without pyrexia
- Poor growth/ill thrift
- Poikilluria
- Stranguria
- Pyuria
- Haematuria if cystitis
215
What are urachal abscesses in urachal remnant syndrome in cattle treated?
En-bloc resection, with/without amputation of the bladder apex
216
What are the clinical signs of persistent urachus in cattle?
Leaking urine from the umbilicus
217
How is persistent urachus in cattle treated?
Ligation and resection
218
What are the clinical signs of umbilical vein remnants in cattle?
- With/without purulent umbilical discharge
- With/without pyrexia
- Poor growth/ill-thrift
- Septicaemia and death
219
How are umbilical vein remnants in cattle treated?
En-bloc resection with/without marsupialisation and post-op lavage
220
What are the clinical signs of umbilical arteries remnants in cattle?
- With/without purulent umbilical discharge
- With/without pyrexia
- Poor growth/ill-thrift
221
How are umbilical arteries remnants in cattle treated?
En-bloc resection
222
How are umbilical masses conservatively managed in cattle?
- Resolution of small hernias – something less than 3 fingers, will resolve by itself
- Systemic antibiotics if infected naval ill or small subcutaneous abscess – E. coli, T. pyogenes
- Minimum 5 days of synulox plus NSAIDs
223
How are umbilical masses treated with drainage in cattle?
- Simple umbilical abscesses only
- Pre-operative ultrasound/FNA – to confirm diagnosis
224
Describe how umbilical masses in cattle are drained?
- Restrain the calf standing or in lateral recumbency
- Surgically prepare the incision site
- Make a bold incision (approximately 5cm long) at the most dependant point of the mass
- Express all the purulent material and flush with dilute iodine solution
225
What are the indications for umbilical herniorrhaphy in cattle?
- Umbilical hernias greater 3-5 cm
- Complicated umbilical hernias
226
Outline how umbilical herniorrhaphies are done in cattle.
1. Dorsal recumbency
2. Elliptical incision
3. With/without preputial reflection
4. Blunt dissect through the subcutaneous tissues to expose and free the hernial sac. Care not to penetrate the peritoneum
5. The free hernial sac is inverted into the abdomen. Margins of the hernial ring debrided to improve adhesion
6. Preplace tension-relieving sutures
7. Tie off individually
8. Oversew abdominal wall margin in a simple continuous pattern
9. Routine closure of SC tissues and skin
10. Possibly secure a stent over the incision to provide protection for the first 24-72 hours
227
How are meshes used in umbilical herniorrhaphy in cattle?
- Designed to close large defects
- Polypropylene or steel meshes
- Must be placed under strict sterile surgical conditions
- Contraindicated if on farm due to compromised asepsis or complicated hernias with concurrent infection
228
What are the indications for umbilical en-block resections in cattle?
- Chronic, intractable omphalitis
- Umbilical abscess complicated by herniation
- Umbilical remnant infection
229
What are the pre-operative considerations for umbilical en-block resections in cattle?
- Culture and sensitivity
- Systemic antibiotics – minimum 3 days pre-surgery
- Ultrasound abdomen – tract infection within the abdomen. If this is tracking towards the liver, give the framer a very guarded prognosis
230
How is an umbilical en-block resection done in cattle?
1. Extreme care should be taken to avoid rupturing abscesses – done by tenting the abdominal wall
2. Tent the abdominal wall and incise peritoneum either cranially (urachal abscessation, omphaloarteritis) or caudally (umbilical vein abscessation)
3. Careful resect mass from abdominal wall, as far into the abdomen as it tracts
4. Closure
231
What post-operative care is used post umbilical en block resection in cattle?
- NSAIDs – antibiotics, minimum 5 to 7 days
- Abdominal bandaging or stent
- Keep animal confined to prevent excessive movement
232
What are the possible post operative complications of umbilical en-block resections in cattle?
- Serosa formation – generally 5 to 7 days post op, keep confined for 3 to 4 weeks post op, ensure doesn’t get infected
- Unable to resects fully and infection left in abdomen – care where umbilical vein tracking into liver
- Peritonitis
233
How is a rectal prolapse simply replaced in cattle?
1. Standing restraint
2. Caudal epidural
3. For use in simple, fresh mucosal prolapse
4. Retain the rectum in its normal position with a purse string suture
234
How is rectal amputation done in cows with rectal prolapse?
- Insert a firm walled, open tube into the lumen of the prolapse – plastic tubing or syringe cases may be considered
- Anchor with a circumferential ligament outside the anus at the most proximal position of the prolapse
- The tube and the ligature will stimulate sloughing of the distal portion of the prolapse
235
How is atresia ani in cattle surgically corrected?
1. A vertical incision is made over anal sphincter, the blind end of the rectum is dissected
2. The perirectal tissue sutured to the dermis, the blind end of rectum incised and the rectal mucosa sutured to the skin
236
What is the difference between atresia ani and atresi coli and recti?
Ani - more commonly in lambs, prognosis is good with surgical correction
Coli/recti - more commonly in calves, poor prognosis with surgical correction, euthanasia should be considered
