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SAS I > GI > Flashcards

GI Flashcards

1
Q

A cat has a rectal prolase and the tissue is nonviable. What procedure would you use to fix?

A

amputate dead tissue and resect (not with any procedure to prevent relapse)

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2
Q

What suture would you use to resect intestine in a 30 kg dog?

A

3-0, monofilament absorbable suture. Close in an appositional pattern- simple continuous, interrupted, or modified Gambee technique- SINGLE LAYER CLOSURE. 2 mm from edge and 2-3 mm apart. Must be water tight.
Leak Check and then omentalize.

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3
Q

Conditions that predispose to Pica in dogs.

A
  • Hepatic encephalopathy
  • pancreatic exocrine encephalopathy
  • iron deficiency
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4
Q

What is the layer of strength for the GI?

A

Submucosa

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5
Q

T/F: The way to enhance formation of fibrin seal is to ensure apposition of submucosa.

A

False, to enhance formation of fibrin seal, ensure serosa-to-serosa contact.

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6
Q

The “traditional” closure of the stomach is ________ oversewn with _________ pattern.

A

The “Traditional” closure is Cushing oversewn with Lambert.

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7
Q

A recently weaned puppy comes in to the clinic for intermittent vomiting, upon doing a radiographic contrast study you see an “apple core” or “beak” appearance showing delayed gastric emptying at the pylorus. What diagnostic would you use to differentiate congential pyloric stenosis from neoplasia?

A

Ultrasound- see the muscular layer hypertrophied

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8
Q

There are two treatments for pyloric stenosis, Fredet - Ramstedt Pyloromyotomy and Heineke- Mikulicz Pyloroplasty. What is the main difference between the two?

A

The Fredet-Ranstedt Pyloromyotomy involves the serosa and muscular layers. Think F for Fast!. It is quick and easy and doesnt involve any lumen exposure. It is only indicated for congenital cases.
The Heinke-Mikulicz is full thickness and exposes the lumen. Think H for Hole in lumen.

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9
Q

In Acquired Pyloric Stenosis, also called Chronic Hypertrophic Pyloric Gastropathy (CHPG) it commonly affects middle aged, excitable/ agressive, small breed dogs and it most often involves hypertrophy of two layers, the ______ and _______, which is a grade ____.

A

Acquired stenosis involves Mucosal and Muscular. Think Middle Aged, Mean and Manly Mini dogs get their Mucosal and Musclular layers Messed up.
Called a grade 2.

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10
Q

Describe the grades of CHPG.

A

Grade 1: Muscular hypertrophy
Grade 2: Muscular and Mucosal Hypertrophy
Grade 3: all layers- Muscular & Mucosal Hypertrophy plus submucosal inflammation.

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11
Q

What are the treatment options for CHPG?

A

Transverse Pyloroplasty, Y-U Pyloroplasty, Billroth 1 or Biopsy.

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12
Q

The Y-U Pyloroplasty for treatment of CHPG transposes pyloric region to antral wall. Transection of what ligament provides better exposure for this procedure? Which ligament should be avoided bc it can damage the common bile duct?

A

Transection of Gastrosplenic ligament provides better exposure.
Avoid cutting the Hepatoduodenal ligament. If you cut the Hepatoduodenal Lig, you need Help!

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13
Q

What is indicated if the animal has a grade 3 CHPG?

A

Billroth 1=

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14
Q

The esophagus does not have what layer?

A

Serosa

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15
Q

Which surture pattern is full thickness?

a. cushing
b. lambert
c. connell

A

Connell! Cushing and Connell are similar, except that Cushing is not full thickness.

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16
Q

If you needed to perform a gastrectomy to remove part of the stomach wall that was necrotic or neoplastic, would you use a double layer closure or a single layer closure?

A

Single Layer bc you don’t want to make the inverting pattern bc it would decrease stomach volume.

17
Q

What are the two signs that differentiate congenital pyloric stenosis from the acquired form?

A
  1. Age- will be young puppies- typically after weaning.

2. Muscular hypertrophy of pylorus

18
Q

Normal wall thickness of the pyloric region of the stomach is the muscular layer < ______ mm and the pyloric wall is < ____ mm.

A

muscle < 4 mm

pyloric wall < 9 mm

19
Q

For a grade 3 acquired pyloric stenosis with severe outflow obstruction, you would use what surgical procedure?

A

Billroth 1= Pylorectomy with Gastroduodenostomy

20
Q

Most common stomach cancer in the cat?

A

Lymphoma- malignant

21
Q

What is the most common stomach neoplasia in dogs? Breeds/ genders predisposed? Where does it normally metastasize?

A

Gastric adenocarcinoma
Common in Rough Collie, Staford Terr, Belgian Shepherd
2.5x more common in males.
Spreads to regional LNs and Liver.

22
Q

You identify gastric adenocarcinoma in a dog. The appearance is rough, thickened- “leather bottle stomach”. What type of adenocarcinoma is this?

a. discrete polypoid
b. Mucosal ulcerated plaques
c. infiltrative

A

Infiltrative!

23
Q

To surgically treat a case of gastric adenocarcinoma, aggressive technique is required. This involves wide margins of > ___ cms in the pylorus.

A

> 5 cm margins.

24
Q

What is a Billroth II procedure? What are the 3 main complications associated with this surgery?

A

Billroth II= Gastrectomy with Gastrojejunostomy.
Complications:
1. Alkaline Gastritis- bc of bile and pancreatic secretions that flow into stomach
2. Blind Loop Syndrome: Gastric contents can get stuck in blind sac of jejunum.
3. Marginal Ulceration- ulcerations in jejunum bc not used to acid secretions

25
Q

This procedure is preferred over the Billroth II because it avoids the blind loop syndrome

A

Roux-en-Y anastamosis

Avoids blind loop syndrome but ulceration is still a complication.

26
Q

Leiomyosarcoma is another type of gastric neoplasia that has a longer MST and, unlike the adenocarcinoma, originates in the _____ part of the stomach.

A

Leiomyosarcoma normally originates in the cardia of the stomach, whereas adenocarcinoma originates in the pyloric region.

27
Q

This disease mimics the CSs of adenocarcinoma in dogs, but is caused by an aquatic organism and normally affects young, large-breed hunting dogs in the SE United States.

A

Pythiosis (Oomyosis)

28
Q

T/F: Diagnosis for Pythiosis can be done via biopsy and histopathology.

A

False- histopath rarely isolates the organism. Need to do an Elisa SnapTest for P. Insidiosum

29
Q

Most commonly, GDV is associated with (Clockwise or Counterclockwise) rotation of the stomach, in which the greater omentum will be completely covering the stomach.

A

Clockwise- normally 180 degrees

30
Q

T/F: Feeding dogs with raised feed bowls help prevent GDV.

A

False! It is the opposite- raised feed bowls increase the incidence of GDV.

31
Q

What type of acidosis/ alkalosis will you see in GDV dogs?

A

Metabolic and respiratory acidosis.

32
Q

What diagnostic indicator is often used for GDV, and is a byproduct of the condition?

A

Lactate levels.

>6mmol/L= higher incidence of gastric necrosis. 50% mortality if level is this high.

33
Q

In a GDV case that presents to your emergency clinic, what do you do in order to stabilize them?

A

1st. Fluids- crystalloids and colloids
2nd. Decompression: try orogastric tube 1st- is that doesn’t work, use trocharization (10-14 g catheter or needle), or if that doesn’t work- emergency trocharization.
3rd. Pain Management
Then antimicrobials and free-radical scavengers

34
Q

When should you give glucocorticosteroids to GDV patients?

A

NEVER. Glucocorticoisteroids is contraindicated.

35
Q

When performing an Incisional Gastropexy as a result of GDV, you would suture what two structures together?

A

The pyloric antrum to the right lateral body wall. * gastropexy doesn’t prevent dilation, just volvulus.

36
Q

Arrhythmias are common after surgery for GDV. What is the most common type? And when do you treat with lidocaine?

A

Ventricular premature contractions. Only treat if the patient has persistent tachycardia >150 bpm, has weakness or syncope, poor pulse, or multifocal VPCs. Lidocaine can make it worse, so only treat if you have one or more of the listed conditions on top of the arrhythmia.

37
Q

Diagnosing a Foreign body in the intestine on rads, measure L5 and compare it to the diameter of the gas-filled intestinal loops. Intestinal diameter: L5 height ratio. Is the ratio is >___. FB obstruction is likely.

A

If Intestinal diameter: L5 height= >2, then FB is likely.

<1.6 = no obstruction.

38
Q

Which suture pattern has less chance of inverting the tissue in intestinal surgery?

a. modified gambee
b. simple, continuous
c. simple, interrupted.

A

a. Modified Gambee

39
Q

Where do you start suturing the intestine for an anastamosis?

A

The mesenteric border

SAS I (8 decks)

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