GI Diseases and Surgery Flashcards

Question

Dental formula of SACs? And Camels?

Answer 1

SACs - deciduous - I 1/3, C 1/1, PM 2-3/1-2 Permanent - I 1/3, C 1/1, PM 1-2/1-2, M 3/3 Camels - deciduous - I 1/3, C 1/1 PM 3/2 Permanent I 1/3, C 1/1, PM 3/2, M 3/3 All have 3 upper and lower molars on each side like ruminants & horses Have a single upper incisor (vs ruminants w 0) which sits behind the lower corner incisor and looks like a canine. In addition to the normal upper canine looks like they have 4 upper canines - also makes camels bites v dangerous as can open mouths v wide (SACs can't) Camels have more premolars (3 upper 2 lower) than SACs (1-2 upper and lower), but the first premolar of camels has migrated forward and become caniniform - so the camel appears to have 3 upper and 2 lower canines on each side. Vs sheep/goats/cattle that appear to have no upper and 4 lower incisors, as the lower canine has migrated forward and appears incisor like

Answer 2

nonglandular mucosa of C1 is keratinised stratified squamous epithelium - non papillated (vs papillae found in rumen) Ventral surfaces of both the cranial and caudal sacs of C-1 contain glandular saccules (rumen has not glandular tissue)

Answer 3

Mucosal surface of C2 is glandular except for a small area on the lesser curvature that constitutes the oesophageal or ventricular groove The glandular area is subdivided by a series of intersecting crests that produce a retiform pattern and is covered by a papillated glandular mucosa; this retiform pattern is not analogous to the pattern seen in the reticulum of ruminants

Answer 4

C3- mucosa is entirely glandular; 3 pattern areas and 2 types of mucosa First 1/5 - lesser curvature - retiform pattern with short crests and shallow depressions First 1/5 - greater curvature - nonpermanent folds Middle 3/5 = permanent longitudinal pleats (approximately 50) Proximal 4/5 = mucinous glandular tissue Final 1/5 = true gastric glands. The mucosa is reddish-brown, in contrast to the lighter pink of the proximal four-fifths. The wall of this area is thickened and the mucosal surface smooth. Digestive enzymes and acid are secreted by these glands pH in the cranial segment of C3 is 6.5, decreasing to 2 in the terminal 1/5

Answer 5

Relatively small vs sheep and cows In ruminants, the omental sling covers much of the intestine - no omental sling in camelids The greater omentum is attached along both the lesser and greater curvatures of C-2 and C-3 and along the right surface of C-1 The epiploic foramen enters the sac formed by the greater omentum ventral to the liver, near the entrance of the post cava into the liver (EFE is reported in a llama)

Answer 6

Similar to ruminants - ## Footnote Caecum is approx on midline and directed caudally toward the pelvic inlet - 10cm long and 5cm diameter Colon similar to the bovine - ascending colon begins as a proximal loop that courses cranially and ventrally to enter the spiral loop The most proximal loop of the ascending colon is loosely attached by a mesentery to the more compact spiral colon. There are 5.5 centripetal coils (including the proximal loop) and 4.5 centrifugal coils. There are only 2 coils in bovines and 3 in ovines Diameter narrows from 5cm at its beginning to 2cm within the first centripetal coil of the spiral loop, making the spiral colon the primary site of faecolith impaction in camelids

Answer 7

1. Osmotic - eg epsom salts or malabsorption 2. Secretory - eg enterotoxigenic E coli - toxins rx in prolonged opening of chloride chanels rx in uncontrolled water secretion. Secretion outstrips absorption 3. Altered mucosal permeability - epithelial damage dt infection/inflammation; poor efficiency of absorption 4. Motility dysfuncion - accellarated transit time decreasing capacity for absorption

Answer 8

Less common vs equines / bovines - more voluntary control of the oesophagus Assoc. w ingestion of apples. Perii-oesophageal haematoma formation also can cause external compression CSs incl retching, coughing, dysphagia, head shaking, salivation, nasal discharge, anxiety, and, if a blockage is prolonged, dehydration & Aspiration pneumonia a common sequalae May not be able to palpate cervical obstruction as you can in the horse as the oesophagus is deeper in camelids and obscured by the ventral tubercle of the cervical vertebral TPs Dx - attempted NGT passage, contrast rads Tx - spasmolyitcs (atropine, regelen) to relax the oesophageal musculature, analgesics, followed by passage of NGT t try and push the obstruction aborally May need GA dt likihood of stimulating regurgitation Complete obstruction will prevent eructation - subsequent bloat may req needle decompression via left PLF

Answer 9

Uncommon as unlikely to consume large quantities of grain ## Footnote Overingestion of highly fermentable carbs leads to lactic acidosis, dehydration, and depression Fermentation leads to production of acetate, propionate, butyrate -\> with overload - high lactic acid & other long chain faty acids are produced Lactic, formic, valeric, and succinic acids change the osmolarity of C-1, resulting in fluid being drawn in from the circulatory system and other tissues. Thirst also results in accumulation of excessive water in C-1. The pH of C-1 may drop to 4; gastric stasis and destruction of the normal C-1 microflora Rx in profuse d+ and gastritis Liver abscessation ay occur 2ary to hepatic portal bacteraemia CSs are consistent w endoxaemia may appear upto 36hrs post ingestion CSs incl weakness, incoordination, depression, anorexia, C-1 atony, colic (grunting, grind- ing teeth), abdominal distention, dehydration, a foetid diarrhoea, and recumbency Death in 12-48hrs without tx Hx is vital in dx. Other indicators are C1 ingesta pH - shouldn’t be less than 5.5 as in cow rumen Tx - antacids alone may be sufficient in mild case 1g/kg magnesium OH or CO3 may be given in 3L (adult llama). 0.5g/kg should be used if the stomach has been emptied prior to administration Also provide thiamine HCl, IV fluids, antibiotics, and flunixin meglumine Gastrotomy to remove the grain is indicated in more valuable animals

Answer 10

See table Potassium is most useful in suspected bladder rupture. Createnine \> double in horses not mentioned in small ruminants or camelids

Answer 11

1) mineral stones (concretions, gastroliths, enteroliths), (2) compacted plant fibre balls (phytobezoars, fecaliths, impaction) (3) hair balls (trichobezoars, zoo-trichobezoars). A fourth type may be a combination of one or more of the other three In other species, mineral component typically magnesium ammonium phosphate (struvite) Saccules of C1 are a common location for concretions to form - these cause no known impairment in C1 function. Common incidental PM or rad finding Other concretions at other locations may cause obstruction, perforation, or ulceration C3 tricophytobezoars pathologic - obstruction, ultimate death. Also can affect small intestine, large (spiral) and small colon

Answer 12

* rupture liver/spleen dt trauma * Cranial uterine aa is in the freely moveable broad ligament & may be subject to trauma late in pregnancy. * Umbilical arteries may rupture too close to body wall in neonates & retract into abdomen * Spermatic cord under excessive tension during transection, can retract into the abdomen

Answer 13

1) Ventral midline; can be cranial to umbilicus or caudal to it a) Cranial to umbilicus, layers incised are: skin, SQ areolar tissue, a single layer of fascia comprised of the aponeuroses of the abdominal muscles, deep abdominal fat, and the peritoneum. Closure: peritoneum, fascia, and skin b) Caudal to the umbilicus, will incise skin, subcutaneous tissue, cutaneous trunci muscle, superficial fascia (aponeuroses of the external and internal abdominal oblique muscles), deep fascia (thin aponeurosis of the transversus abdominis muscle), deep abdominal fat, and peritoneum. Lateral to midline the 2 facsias are separated by the rectus abdominis. All other texts describe this as linea rather than separate layers of int and ext sheaths. NB in camelids, there is deep abdominal fat either side of midline - another reason for strict adherence to the midline. Closure: ensure inclusion of all the fascial layers into one or more suture layers. Recommend cruciate (figure-8) pattern w 5metric vicryll for linea/fascial layers. Dehiscence is more common with approaches caudal to the umbilicus 2) Mid-High Flank (PLF) Approach; recommended for approaches to C1 on the left hind side (like rumenotomy in a cow). Vertical incision midway between TC & last rib 6-8cm ventral to lumbar TPs. Recommend grid technique. Closure: peritoneum w simple or continuous pattern. If a grid incision was made, the muscle layers may be closed w simple interrupted sutures. If the muscle masses were incised, they should be accurately apposed and the outer muscle fascial layer included to provide more strength for the suture to optimise healing 3) Left oblique (not described as this name but most analogous to this in a cow) - Used for OVH and abdominal crypts. Begins 6-10cm to the tuber coxa running diagonally ventrally and cranially. Layers incised are skin, SQ, abdominal tunic, fibers of the internal abdominal oblique muscle (blunt dissection), aponeurosis of the transversus abdominis muscle, and peritoneum. Close as for PLF approach 4) Parainguinal - For OVH. Done in lateral. 10-15cm incision made 8cm cranial and dorsal to the inguinal canal (ext ing ring). Incise skin, sq, internal abdominal oblique muscle, which is blunt dissected in the direction of the long axis of the muscle fibres. The transversus abdominis muscle and peritoneum are penetrated in the plane of the muscle fibres 5) Right paracostal (not mentioned here but required for access to C3 and duodenum for FB/phytotrichobezoars which are not uncommon - add in when encountered)

Answer 14

a) C1 lesions - left PLF b) C2 or C3 lesions - right PLF or ventral midline c) Duodenal obstruction (trichophytobezoar) - right paracostal d) Small intestine (other than duodenum) - ventral midline or right PLF e) Large intestine - ventral midline & right PLF Ie C1 best accessed via left PLF. Duodenum right paracostal then remainder of forestomache, SI and LI either right PLF or ventral midline

Answer 15

* C1 FB * Trichophytobezoars * C3 gastric ulcers * Neoplasia * GI rupture (2ary to ab wall trauma) *

Answer 16

* Intraluminal obstruction (eg trichophytobezoar - more common in duodenum & can either be removed via duodenotomy or replusion & C3 gastrotomy. Less common in jejunum & have worse px) * Intussusception (iliocaecocolic intussusceptions may be assoc w Eimera spp) * Torsion * FB * EFE (rare but reported) * Neoplasia * Umbilical abscessses

Answer 17

Simialr vs other spp but generally 2 layer Full thickness simple cont with Cushing or Lembert oversew. No diff in bursting stregnth but tend to get less reduction in lumen diameter w Cushing vs Lembert PDS generally higher bursting strength vs PG910 - but all above clinically relevant levels so unlikely significant 3-0 or 4-0 suture recommended.

Answer 18

* Impactions (common in caecum/ascending colon) * Torsion of spiral colon * Adhesions * Diaphragmatic hernia (few reports, couldn't close, did well but recurred) * Rectal tears (caudal ventral midline or trans-anal approach)

Answer 19

20% - the distal 1/5 is HCl secreting Distinct line of separation between glandular & non-glandular mucosa, with no anatomical separation, like the margo in horses

Answer 20

Mandibular \>maxillary Premolars/molars \> incisors/canines Usually affect camelids 2-5yrs - coincides with age of erruption of cheek teeth; softer gums more likely to be penetrated w feed material

Answer 21

Prevent severe injury with intermale aggression Tooth root infection (poss iatrogenic after trimming)

Answer 22

As in other spp - more commonly affects mandibulars - so see mandibular pain/swelling, +/- draining tracts. Peri-apical lysis/sclerosis as in other spp

Answer 23

* Fusiform gingival incision around affected tooth extending to mandibule * 2nd incision made directly over the tooth root, curving caudad, in the direction of roots long axis. * Periosteal elevator to reflect gingiva & periosteum from lateral surface of mandible, then similar elevation medially, extending 1/8" from gum–tooth margin. * Segment of bone on the lateral side of the tooth is then removed +/- prior periosteal elevation. Use of a chisel on the lingual side of the tooth facilitates its removal. As bone is removed, the tooth is grasped periodically & moved side-to-side to ascertain when it is ready for extraction. * This facilitates extraction without risking fracture of the mandible. * Alveolus curetted, to remove all diseased bone associated with the root abscess, debris flushed & gingiva is apposed over the empty socket w. 2-0 absorbable, monofilament

Answer 24

* Straight incision directly over longitudinal axis of the tooth. Optionally can reflect periosteum * Bone lateral to the tooth is removed, but bone immediately ventral to the tooth is preserved. Tooth should be freed of bone at its rostral and caudal surfaces using a chisel. * Dental punch is placed on tooth root; gentle tapping seats it into the root of the tooth. Have fingertips over the crown & guide the punch with the other hand. * Assistant then delivers blows to the punch. Feel vibrations of the blows transmitted through the tooth to his fingertips. Occasionally, punch has to be redirected. * Tooth gradually loosens * Alt: hole can be made over the affected roots with a trephine or Hall air drill. * When a single root of a cheek tooth is abscessed, tooth may be split & only the crown associated w infected root removed; so can save much of the occlusal surface * Following repulsion of the tooth, any small fragments of bone or teeth are removed. The alveolus is curetted and is flushed. * Ventral half of the incision is left open for drainage of the alveolus. Upper half is closed with SI nonabsorbable sutures