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CVSOH 4 > Gastrointestinal Surgery > Flashcards

Gastrointestinal Surgery Flashcards

1
Q

Define AIVR.

A

Accelerated idioventricular rhythm

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2
Q

Define dilatation.

A

Something stretched beyond normal dimensions

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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
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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
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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

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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
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7
Q

What incision is made for an exploratory laparotomy?

A

Large, midline, 20cm incision

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8
Q

What is done with falciform fat upon exploratory laparotomy incision?

A

Scalpel or scissors or electrosurgery – remove, haemostasis

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9
Q

How is visualisation improved in an exploratory laparotomy?

A

Abdominal packing = moistened swabs
Exteriorisation
Manoeuvres
Retractors

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2
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10
Q

How is the abdomen explored in an exploratory laparotomy?

A

Systematic exploration = do the quadrants

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11
Q

How is a duodenal manoeuvre done in an exploratory laparotomy?

A
  1. Patient in dorsal recumbency
  2. With/without stand on patient’s left side
  3. Take duodenum and use the mesoduodenum like a fan to pull the abdominal contents towards you and expose the right gutter
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12
Q

How is a colonic manoeuvre done in an exploratory laparotomy?

A
  1. Patient in dorsal recumbency
  2. With/without stand on patient’s right side
  3. Take descending colon and use the mesocolon like a fan to pull the abdominal contents towards you and expose the left gutter
How well did you know this?
1
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2
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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

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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
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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

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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

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17
Q

How are gastric foreign bodies treated?

A

Stabilisation, emesis, endoscopic removal, gastrotomy with full abdominal exploration

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18
Q

What are the most common gastric neoplasias in cats and dogs?

A

Dogs = adenocarcinoma most common

Cats = lymphoma most common

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19
Q

What are the clinical signs of gastric neoplasia in cats and dogs?

A

Chronic vomiting
Weight loss

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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%)
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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

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22
Q

What is the prognosis of gastric neoplasia in dogs and cats?

A

Generally poor. MST 2months for gastric adenocarcinoma

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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
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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
How well did you know this?
1
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25
Q

What is the specific presentation of GDV in dogs and cats?

A
  • Non-productive retching
  • Abdominal distension/abdominal tympany
  • Mild-moderate shock
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26
Q

What is the advanced presentation of GDV in dogs and cats?

A

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
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27
Q

What 2 imaging modalities are the best when investigating a dog with a suspected gastric tumour?

A

CT and endoscopy

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28
Q

How does GDV cause shock?

A

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

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29
Q

What is the pathophysiology of outflow obstruction caused by GDV?

A

Distal oesophageal > prevents eructation

Pyloric > prevents normal outflow into duodenum

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30
Q

What is the pathophysiology of rotation caused by GDV?

A
  • 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
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31
Q

What is the pathophysiology of shock caused by GDV?

A
  • 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
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32
Q

How are GDV patients stabilised?

A
  • Client communication
  • Gastric decompression
  • IV access – minimum database, analgesia
  • IVFT – big dog do IV catheter on each leg
  • Oxygen
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33
Q

What other drugs might be considered to stabilise a GDV patient?

A

Antibiotics
Antiemetics
Antidysrhythmics

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34
Q

Why is gastric decompression done with GDV cases?

A
  • 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
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35
Q

When and which views of abdominal radiographs are taken in GDV?

A

When – after decompression

Views – right lateral, dorsolateral

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36
Q

What is the specific appearance of GDV on abdominal radiographs?

A
  • 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
How well did you know this?
1
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2
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37
Q

What is the most common direction and degree of rotation seen in GDV?

A

180 degrees clockwise

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38
Q

Outline the surgical treatment of GDV in cats and dogs.

A
  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
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39
Q

What is the presentation of gastric ischaemic damage caused by GDV once in surgery?

A
  • Colour – grey, green, purple, black
  • Thin wall
  • Walls are dry, fragile or seromuscular tears
  • Vasculature – no pulses, thrombi and no active bleeding
  • Peristalsis – absent
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40
Q

What are the GDV gastropexy options?

A
  • Incisional
  • Laparoscopic – only for prophylaxis
  • Percutaneous gastrotomy/PEG – useful if planning to use a feeding tube post-op
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41
Q

What improves GDV prognosis?

A
  • Quick presentation
  • Stable before surgery
  • No gastrectomy
  • No Gastropexy
  • Lactate less than 7mmol/l
  • No DIC
  • Lactate dropping by 40%
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42
Q

What worsens a GDV prognosis?

A
  • Delayed presentation
  • Unstable before surgery
  • Lidocaine/tachydysrhythmia
  • Gastrectomy
  • Splenectomy
  • No gastropexy
  • Lactate greater than 9mmol/l
  • Lactate not dropping
  • DIC present
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43
Q

What is the site of incision for a gastrotomy?

A

Avascular, halfway between lesser and greater curvature, middle of the Stomach body

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44
Q

What are the indications of gastrectomy?

A

Neoplasia
Necrosis
Perforation

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45
Q

When are gastrotomy tubes used and not used?

A

Why – functional stomach and GI tract

Why not – primary gastric pathology (vomiting/regurgitation

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46
Q

What are the advantages of gastrotomy tubes?

A

Easy to place
Large bore/unlikely to block
Easy to care for once in place

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47
Q

What are the disadvantages of gastrotomy tubes?

A

Need for GA
Hospitalisation
Not to be used for any primary gastric disease
Complications rare but potentially serious

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48
Q

What are the methods of placing a gastrotomy tube?

A
  • 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
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49
Q

What suturing is used for an incisional gastropexy?

A
  • Simple continuous suture from cranial to caudal – deepest/most dorsal tissue
  • Simple continuous suture from caudal to cranial – superficial/most ventral tissue
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50
Q

How are patients stabilised and prepared for exploratory lapartomies in small animals?

A
  • Starve adults 12-18 hours
  • Starve puppies/kittens 4-6 hours
  • No enemas
  • Surgery as soon as stable/before become unstable again
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
51
Q

Why are NSAIDs avoided where possible for exploratory laparatomies?

A
  • Can cause gastrointestinal bleeding
  • May delay gastrointestinal healing
  • Can affect platelet function/clotting
  • Will affect renal function if hypotensive under anaesthetic
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
52
Q

What diagnostics are used for exploratory laparotomies?

A
  • Minimum database
  • Radiography
  • Ultrasonography
  • Endoscopy
How well did you know this?
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2
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53
Q

What might radiography reveal that requires an exploratory laparotomy?

A
  • Abdominal effusion
  • Mass
  • Radio-opaque foreign body
  • Excessive gas
  • Signs of GI obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
54
Q

What might ultrasonography reveal that requires an exploratory laparotomy?

A
  • Abdominal effusion
  • Mass
  • Radio-lucent and radio-opaque foreign body
  • Signs of GI obstruction
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
55
Q

Describe the incision for an exploratory laparotomy in small animals.

A

Large, midline, 20cm incision

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
56
Q

How is visualisation improved in an exploratory laparotomy?

A
  • Abdominal packing = moistened swabs
  • Exteriorisation
  • Manoeuvres
  • Retractors
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
57
Q

How is the abdomen explored in an exploratory laparotomy?

A

Systematic exploration = do the quadrants

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
58
Q

Describe duodenal exploratory laparatomy manoeuvre.

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
59
Q

Describe colonic exploratory laparatomy manoeuvre.

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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
60
Q

How is contamination minimised in an exploratory laparotomy?

A
  • 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
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
61
Q

List the surgical diseases of the stomach in small animals.

A

Gastric foreign body
Gastric neoplasia
Gastric dilation and volvulus
Gastro-oesophageal hernia
Gastric ulceration/perforation
Hiatal hernia
Pyloric outflow obstruction/pyloric stenosis

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
62
Q

Why do linear gastric foreign bodies need prompt diagnosis and early removal?

A

Due to plication/secondary damage to small intestines

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
63
Q

How do gastric foreign bodies present in small animals?

A

Could be vomiting, regurgitation, acute/chronic/intermittent, outflow obstruction, gastric distention and/or mucosal irritation

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
64
Q

How are gastric foreign bodies in small animals treated?

A

Stabilisation, emesis, endoscopic removal, gastrotomy with full abdominal exploration as described earlier

How well did you know this?
1
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5
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65
Q

What are the most common gastric neoplasias in cats and dogs?

A

Dogs = Adenocarcinoma most common
Cats = Lymphoma most common

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66
Q

What are the clinical sigs of gastric neoplasia in small animals?

A

Chronic vomiting
Weight loss

How well did you know this?
1
Not at all
2
3
4
5
Perfectly
67
Q

How is gastric neoplasia in cats and dogs investigated?

A
  • 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%)
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
68
Q

How is gastric neoplasia in small animals treated?

A
  • Surgery – wide surgical excision for all except lymphoma
  • Adjunctive – chemo/radiation of no benefit
  • Palliation – antemetics, antacids, sucralfate, often non-responsive
How well did you know this?
1
Not at all
2
3
4
5
Perfectly
69
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
70
Q

What is the non-specific presentation of GDV in small animals?

A
  • Restless, discomfort, pain
  • Hypersalivation, ptyalism
  • Stretching, arched back
  • Early signs of shock
71
Q

What is the specific presentation of GDV in small animals?

A
  • Non-productive retching
  • Abdominal distension/abdominal tympany
  • Mild-moderate shock
72
Q

What is the advanced presentation of GDV in small animals?

A

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
Q

What 2 imaging modalities are the best when investigating a dog with a suspected gastric tumour?

A

CT and endoscopy

74
Q

How does GDV in small animals cause shock?

A

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
Q

What is the pathophysiology of GDV in small animals?

A
  • Outflow obstruction
  • Distal oesophageal > prevents eructation
  • Pyloric > prevents normal outflow into duodenum
  • Rotation or not - typically happens as dilation progresses, 180-270 degrees
76
Q

What is the pathophysiology of GDV in small animals causing shock?

A
  • 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
Q

How are GDV patients stabilised?

A
  • Client communication
  • Gastric decompression
  • IV access – minimum database, analgesia
  • IVFT – big dog do IV catheter on each leg
  • Oxygen
  • Antibiotics
  • Antiemetics
  • Antidysrhythmics
78
Q

Why is gastric decompression done in GDV small animal patients?

A
  • 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
Q

When and how are GDV abdominal radiographs taken in small animal patients?

A

When – after decompression

Views – right lateral, dorsolateral

80
Q

What is the specific appearance of GDV on small animal abdominal radiographs?

A
  • 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
Q

What is the most common direction and degree of rotation seen in GDV?

A

180 degrees clockwise

82
Q

Outline the surgical management of GDV in small animals.

A
  • 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
Q

How does gastric ischaemic damage from GDV in small animal patients present?

A
  • 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
Q

What is GDV prognosis in small animals improved by?

A
  • 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
Q

What is GDV prognosis in small animals worsened by?

A
  • Delayed presentation
  • Unstable before surgery
  • Lidocaine/tachydysrhythmia
  • Gastrectomy
  • Splenectomy
  • No gastropexy
  • Lactate greater than 9mmol/l
  • Lactate not dropping
  • DIC present
86
Q

Where is the incision site located for a gastrotomy?

A

Avascular, halfway between lesser and greater curvature, middle of the stomach body

87
Q

What are the indications for a gastrectomy?

A

Neoplasia
Necrosis
Perforation

88
Q

Why should gastrotomy tubes be used and not be used?

A

Why – functional stomach and GI tract

Why not – primary gastric pathology (vomiting/regurgitation)

89
Q

What are the advantages and disadvantages of gastrotomy tubes in small animals?

A

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
Q

What are the options for gastrotomy?

A
  • 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
Q

What are the sutures used for an incisional gastropexy?

A

Simple continuous suture from cranial to caudal – deepest/most dorsal tissue

Simple continuous suture from caudal to cranial – superficial/most ventral tissue

92
Q

What are the small animal small intestinal emergencies?

A

Partial obstruction
Complete distal obstruction
Complete proximal obstruction
Intestinal perforation

93
Q

How does partial obstruction present?

A
  • 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
Q

How does complete distal obstruction present?

A
  • 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
Q

How does complete proximal obstruction present?

A
  • 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
Q

How does intestinal perforation present?

A
  • Signs of peritonitis
  • Pneumoperitoneum
97
Q

What is intestinal torsion and mesenteric volvulus?

A
  • Marked SI distension
  • Rare as it progresses very rapidly and is often fatal due to overwhelming ischaemic damage and sepsis as per GDV.
98
Q

Distinguish intestinal torsion and mesenteric volvulus.

A

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
Q

What can happen with intestinal incarceration/strangulation?

A
  • 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
Q

What is the signalment of intussusceptions in small animals?

A

Young animals associated with inflammatory conditions - parasites, viral disease, foreign bodies

101
Q

What do clinical signs of intussusceptions in small animals depend on?

A
  • 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
Q

How are small animal intussusceptions diagnosed?

A
  • Palpable sausage mass
  • Minimum database
  • Radiography – soft tissue mass with/without SI obstruction
  • Ultrasound – concentric rings
103
Q

How are small animal intussusceptions treated?

A

Stabilisation and prompt surgery

104
Q

What are the possible complications of small animal intussusceptions?

A

Recurrence > consider enteroplication = but not recommended for first time offenders

105
Q

What are the clinical signs of small intestinal neoplasia in small animals?

A
  • 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
Q

How is small intestinal neoplasia in small animals diagnosed?

A
  • 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
Q

How is small intestinal neoplasia in small animals treated?

A
  • Staging
  • Stabilisation
  • SI resection and anastomosis with 4-8cm margins
  • Chemo for lymphoma only
108
Q

What do the clinical signs of intestinal foreign bodies in small animals depend on?

A
  • Type of FB
  • Location of FB
  • Duration of clinical signs/delay in diagnosis
  • Degree of obstruction
109
Q

How are intestinal foreign bodies in small animals diagnosed?

A

Minimum database, imaging

110
Q

How are intestinal foreign bodies in small animals treated?

A

Laparotomy, enterotomy, with/without enterectomy

111
Q

When is an enterotomy done in small animals?

A
  • Pink
  • Normal/even wall thickness
  • Smooth, moist wall texture
  • Pulsing vessels, active bleeding
  • Peristalsis treated
112
Q

When is an intestinal resection and anastamosis done in small animals?

A
  • Grey/green/purple/black
  • Thin walls
  • Dry, fragile or seromuscular tears in walls
  • No pulses, thrombi, no active bleeding
  • Absent peristalsis
113
Q

What suture material would you select to close a small intestinal enterectomy/resection ad anastomosis in an otherwise healthy 2 year old 30kg dog?

A

Monocryl 3/0 simple continuous

114
Q

What are 3 options at closure of intestinal surgery?

A

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
Q

How is intestinal biopsy done?

A
  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
Q

How is intestine isolated for intestinal resection and anastamosis?

A
  • 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
Q

Why must intestinal R&As be planned for?

A
  • 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
Q

What are the holding layers of the stomach and small intestine?

A

Submucosa of stomach and submucosa of small intestine

119
Q

Why does obstruction being prolonged complicate things for intestinal R&As and how is this resolved?

A

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
Q

What are the possible complications of gastrointestinal surgery?

A

Adhesions
Stricture/stenosis
Reperfusion injury
Short bowel syndrome
Intussusception recurrence
Ileus
Peritonitis
Sepsis

121
Q

What are the patient factors that increase risk of gastrointestinal surgery?

A

Debilitated patient
Chronic obstruction
Severity of underlying abnormality
Underlying poor healing
Non-viable tissue

122
Q

What are the surgeon factors that increase risk of gastrointestinal surgery?

A
  • Longer GA time
  • Overly enthusiastic tissue handling
  • Poor suturing technique
  • Non-viable tissue
123
Q

What are the clinical signs of peritonitis?

A

Non-specific
Lack of progress
Depression
Anorexia
Abdominal pain
Vomiting

124
Q

How is peritonitis diagnosed?

A
  • 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
Q

How does peritonitis present on haematology and biochemistry?

A

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
Q

What is very important to do when diagnosing peritonitis?

A

Cytology and abdominal tap (abdominocentesis) or diagnostic peritoneal lavage. Degenerate neutrophils with intracellular bacteria

127
Q

How is peritonitis in small animals treated?

A

Aggressive stabilisation, early surgery, intensive post-op care

128
Q

How are oesophagostomy tubes placed?

A
  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
Q

Define herniorrhaphy.

A

Opening hernia sac, replacing contents to normal place, closing hernia opening

130
Q

What is a retroflex bladder?

A

Bladder flipped through 180 degrees to lie facing caudally

131
Q

Define steatorrhea.

A

Excessive fat in faeces

132
Q

What are the clinical signs of colorectal disease?

A
  • 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
Q

How is a patient prepared for colonic surgery?

A
  • Antibiotics
  • Analgesics
  • No enemas/laxatives in the days before = increased risk of contamination and peritonitis
  • Encourage empty colon naturally
134
Q

What are the healing characteristics for colorectal surgery?

A
  • 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
Q

What are the possible complications of colorectal surery?

A
  • Higher risk of dehiscence
  • High intra-luminal pressure during defaecation further exacerbates risk of dehiscence
136
Q

What are the aetiologies of feline megacolon?

A

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
Q

What is the possible history for feline megacolon?

A

History of intermittent constipation
History of RTA/pelvic fracture

138
Q

What are you looking for on radiography to diagnose feline megacolon?

A

Soft tissue abnormalities (enlarged colon, neoplasia), orthopaedic abnormalities (pelvic narrowing, spinal abnormalities), obstructions (by neoplasia and fractures, faeces dehydrated so more radiodense).

139
Q

How do colon diameters from radiographs diagnose feline megacolon?

A

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
Q

How is feline megacolon medically managed?

A
  • 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
Q

When is surgery chosen in management of feline megacolon?

A
  • Non-response to medical therapy
  • Pelvic narrowing due to chronic fracture
  • Constipation associated with perineal herniation
  • Idiopathic megacolon
142
Q

What are the surgical options for surgical management of feline megacolon?

A

Laparotomy
Subtotal colectomy
Total colectomy

143
Q

What are the complications of surgical management of feline megacolon?

A
  • Dehiscence
  • Failure to cure
  • SIBO/small intestinal bacterial overgrowth
144
Q

What is the aetiology of rectal prolapse?

A

Prolapse typically occurs secondary to straining due to urogenital or ano-rectal problems

145
Q

What are the predisposing conditions of rectal prolapse?

A
  • Gastrointestinal parasites, colitis, colorectal or anal tumours, foreign bodies
  • Urinary tract: cystitis, urethral obstruction
  • Reproductive organs: prostatic disease, dystocia
146
Q

How is rectal prolapse differentiated from intussusceptions in small animals?

A
  • 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
Q

What is done to manage rectal prolapse if tissue is viable?

A
  • 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
Q

How are rectal prolapses surgically managed?

A
  • 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
Q

When is colopexy used in rectal prolapse management in small animals?

A
  • 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
Q

What are the clinical signs of colorectal neoplasia in cats and dogs?

A

Dogs: mass effect – faeces is passing lump, flaccid or ribbon like

Cats: weight loss, anorexia, vomiting and diarrhoea

151
Q

What is the surgical approach to colorectal neoplasia management?

A
  • 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
Q

Describe rectal roll out and rectal pull out as a surgical approach to colorectal neoplasia.

A

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
Q

Describe rectal pull through as a surgical approach to colorectal neoplasia.

A

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
Q

Why is subtotal colectomy the surgical procedure of choice for idiopathic feline megacolon?

A

Preserving the ileocaecocolic junction reduces the risk of small intestinal bacterial overgrowth

155
Q

What are the anal sac diseases seen in dogs and occasionally cats?

A
  • Impaction – treated by expression
  • Sacculitis – flushing with/without antibiotics
  • Abscessation – drainage and antibiotics
  • Neoplasia
156
Q

How are recurrent anal sac diseases treated surgically in cats and dogs?

A

Anal sacculectomy

157
Q

How do anal sac adenocarcinomas present in dogs?

A
  • Changes in defaecation
  • Dyschezia, faecal tenesmus, flattened stools and perineal swelling are common clinical signs
  • Polydipsia/polyuria
158
Q

What are the surgical options to treat anal sac adenocarcinomas?

A
  • Closed anal sacculectomy
  • Abdominal/pelvic lymph nodectomy
  • Chemotherapy for metastatic disease (carboplatin)
159
Q

What is abdominal lymph node removal?

A

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
Q

When is surgical removal of anal sacs indicated?

A

Persistent or recurrent anal sac disease and neoplasia

161
Q

What are the 2 techniques for anal sacculectomy?

A

Closed or open. Closed is preferred, as open is a contaminated surgery

162
Q

Outline how a closed anal sacculectomy is done.

A
  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
Q

What are the uncommon complications of an anal sacculectomy?

A
  • 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
Q

What are the clinical signs of perineal hernias?

A
  • Unilateral or bilateral perineal swelling (dogs)
  • Abnormal defaecation due to loss of rectal support laterally (dogs and cats)
  • Dyschezia, constipation, haematochezia
165
Q

What is the underlying cause of perineal hernias?

A

Due to weakness of the pelvic diaphragm

166
Q

How does perineal hernias cause bladder retroflexion?

A

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
Q

How does rectal palpation diagnose perineal hernias?

A
  • Loss of firm lateral rectal support
  • Sacculation of the rectum (unilateral) or dilatation (bilateral)
168
Q

How are perineal hernias medically managed?

A

Removal of impacted faeces
High fibre diet
Stool softeners

169
Q

How are perineal hernias surgically managed?

A

Perineal herniorraphy = reconstruction of the perineal diaphragm

170
Q

What are the principles of surgical repair of perineal hernias?

A
  • 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
Q

What are the augmentation options for perineal hernia repair surgeries?

A
  • Internal obturator muscle flap
  • Semitendinosus muscle flap from hindleg
  • Mesh = last resort

CVSOH 4 (13 decks)

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