GI Pancreatic Colonic Perineal Flashcards
1
Q
What is the estimated prevalence of anal sac disease in the dog population?
A
12%
Anal sac disease is associated with impaction, inflammation, and abscessation.
2
Q
What are possible predisposing factors for anal sac disease? (4)
A
- Chronic diarrhoea
- Glandular hypersecretion
- Poor muscle tone
- Obesity
The specific cause of impaction and sacculitis is unknown.
3
Q
List the clinical signs of anal sac disease (4).
A
- Licking
- Scooting
- Swelling
- Discharge
These signs indicate discomfort or issues related to the anal sacs.
4
Q
What does acute infection of anal sacs typically present as?
A
Painful unilateral swelling at either 5 or 7 o’clock
Rupture of the sac can lead to cellulitis and abscessation.
5
Q
What is the treatment for an open abscess of the anal sac?
A
- Lavage
- Systemic antibiotics
Anal sacculectomy should not be performed until infection and inflammation have resolved.
6
Q
Indications for removal of anal sacs include (4):
A
- Recurrent anal sacculitis or abscessation
- Chronic impaction
- Treatment of perianal fistula
- Anal sac adenocarcinoma
These conditions justify surgical intervention.
7
Q
True or False: Open anal sacculectomy is quicker and easier to perform than closed but has a higher rate of complications.
A
True
It involves cutting through the external anal sphincter muscle.
8
Q
What is a modified open anal sacculectomy?
A
An incision is made into the duct, then the anal sac is dissected out as for a closed anal sacculectomy
This technique results in less damage to the external anal sphincter muscle.
9
Q
What is the difference between open and closed anal sacculectomy in terms of technique?
A
Open involves cutting through the external anal sphincter; closed minimizes damage to the sphincter
Closed technique is appropriate for removing anal sac tumours.
10
Q
What complications can arise from anal sac surgery?
A
- Incomplete resection leading to abscessation
- Faecal incontinence
- Dehiscence of the surgical site
Meticulous surgical technique is required to avoid these issues.
11
Q
What is the most common perianal tumor in dogs?
A
Perianal adenoma (hepatoid gland adenomas)
These tumors are benign and androgen-dependent.
12
Q
What is the treatment for perianal adenomas?
A
- Marginal excision of the tumor
- Castration
This is usually curative.
13
Q
Adenocarcinomas of anal glands - features: (3)
A
Often single, locally invasive, and ulcerated
They may metastasize to sublumbar lymph nodes and beyond.
14
Q
What are anal sac adenocarcinomas known for?
A
Highly malignant, locally invasive, and metastasizing to lymph nodes and lungs
Up to 80% of cases have metastases present at diagnosis.
15
Q
What can anal sac adenocarcinomas produce that leads to hypercalcaemia?
A
Parathyroid-related protein in up to 90% of cases.
16
Q
Treatment for anal sac adenocarcinomas includes:
A
- Surgical excision of the primary tumor
- Removal of metastatic lymph nodes
Removing all gross disease usually reverses hypercalcaemia.
17
Q
Other tumors seen in the perineal area include:(6)
A
- Squamous cell carcinoma
- Malignant melanomas
- Fibrosarcomas
- Neurofibromyxomas
- Myxosarcomas
- Other connective tissue tumors
These tumors can vary in behavior and treatment.
18
Q
What is the perineum?
A
The area of the body wall that covers the caudal pelvis and surrounds the openings to the anal and urogenital canals.
19
Q
What are the most common diseases associated with the perineum? (4)
A
- Perineal hernias
- Perianal fistulae
- Anal sac disease
- Perianal tumours
20
Q
What is perineal hernia?
A
Occurs between the muscles of the pelvic diaphragm due to weakness and atrophy of the muscles.
21
Q
What muscles make up the pelvic diaphragm in dogs?
A
- Coccygeus
- Levator ani
22
Q
Where does perineal hernia most commonly occur?
A
Between the levator ani muscle and external anal sphincter (caudal perineal hernia).
23
Q
What can be found in most perineal hernias? (3)
A
- Pelvic fat
- Prostatic fat
- Occasionally organs such as the bladder, intestine, or prostate.
24
Q
What is the primary problem involved in perineal hernia?
A
Atrophy of the levator ani muscle.
25
What age range is most commonly affected by perineal hernia?
7 to 13 years, with a peak incidence around 8 years.
26
Which breeds have an increased incidence of perineal hernia? (6)
* Boston terriers
* Pekingese
* Corgis
* Boxers
* Poodles
* Old English Sheepdogs
27
What is a contributing factor to the development of perineal hernia?
Hormonal imbalance leading to degenerative myopathy of the pelvic diaphragm muscles.
28
What are the clinical signs of perineal hernia? (4)
* Straining
* Perineal swelling (unilateral or bilateral)
* Dychezia (painful defecation)
* Constipation
29
What is the recommended treatment for perineal hernia?
Surgical repair + castration .
30
What is the risk associated with conservative treatment for perineal hernia?
Limited benefit and potential for bladder entrapment.
31
What emergency treatment is needed for bladder entrapment? (3)
* IV fluids to start diuresis
* Catheterisation or needle paracentesis
* Manual reduction of the hernia
32
What is the position of the patient during surgery for perineal hernia repair?
Sternal recumbency with hindlimbs hanging off the back of the surgery table.
33
What type of sutures are used in standard herniorrhaphy?
Monofilament absorbable or non-absorbable sutures of size 0 to 2-0.
34
What is the purpose of using the internal obturator muscle flap in hernia repair?
To provide additional support for the repair of perineal hernia.
35
What is a common complication of perineal hernia repair?
Recurrence of perineal hernia up to 70% of cases.
36
What percentage of dogs may experience permanent faecal incontinence after perineal hernia repair?
Up to 15%.
37
What should be avoided when placing sutures around the sacrotuberous ligament?
Entrapping the sciatic nerve.
38
What is the purpose of cystopexy in relation to perineal hernia repair?
To prevent bladder retroflexion.
39
What is the role of synthetic mesh in perineal hernia repair?
To increase the chances of surgical success and reduce recurrence rates.
40
Fill in the blank: Perineal hernia is almost always a _______ disease.
[surgical]
41
What is the primary focus of surgery of the pancreas?
Obtaining biopsy samples and managing pancreatic neoplasia or trauma, usually by partial pancreatectomy.
42
What are the two lobes of the pancreas?
* Left lobe
* Right lobe
43
What arteries supply the right lobe of the pancreas?
* Cranial pancreatoduodenal artery
* Caudal pancreatoduodenal artery
44
Where is the body of the pancreas located?
Immediately caudal to the pylorus.
45
What is the accessory pancreatic duct?
A duct formed by the communication of the two excretory ducts of the pancreas, opening into the duodenum at the minor duodenal papilla.
46
In cats, how many pancreatic ducts are typically present?
One pancreatic duct that joins with the common bile duct.
47
What surgical indication may arise from pancreatitis?
Abscess or obstruction of the common bile duct.
48
What is the most common neoplasm of the pancreas?
Adenocarcinoma of the exocrine glands.
49
What is the prognosis for pancreatic neoplasia?
Very poor.
50
What is a gastrinoma?
A tumor that results in increased secretion of gastrin, causing gastroduodenal ulceration, hemorrhage, and vomiting.
51
What are the treatment options for gastrinoma?
* Surgical resection
* H2 receptor antagonists
* Gastroprotective agents (e.g., sucralfate)
52
What are insulinomas?
Islet cell adenocarcinomas arising from the beta-cells of the islets of Langerhans.
53
What symptoms are caused by insulinomas? (5)
* Hypoglycemia
* Muscle tremors
* Weakness
* Collapse
* Seizures
54
What is the recommended treatment for insulinoma?
Resection by partial pancreatectomy.
55
What is the significance of monitoring blood glucose levels post-operatively in insulinoma cases?
To monitor for rebound hyperglycemia and recurrence or metastasis.
56
What techniques can be used for pancreatic biopsy?
* Suture fracture technique
* Blunt dissection technique
57
What is the maximum percentage of the pancreas that can be removed in a partial pancreatectomy without affecting function?
Up to 90%.
58
What is the importance of preserving the draining duct during a partial pancreatectomy?
To maintain pancreatic function.
59
What is the recommended post-operative monitoring after pancreatic surgery?
Monitoring plasma glucose and serum amylase activity.
60
What is the purpose of bowel preparation before large intestine surgery?
To reduce the incidence of post-operative sepsis and wound breakdown.
61
What are the two methods for reducing bacterial load in the large bowel?
* Removal of faeces
* Antibiotic prophylaxis
62
What is the recommended antibiotic regimen for pre-operative prophylaxis in large intestine surgery?
Intravenous cephazolin and metronidazole.
63
What is the best suture pattern for healing large intestine wounds?
Single layer of simple interrupted monofilament absorbable sutures.
64
What is a colotomy and when is it performed?
An incision made in the colon for relief of obstipation or foreign body removal.
65
What is the significance of the ileocaecal branches of the cranial mesenteric artery?
They supply the ascending and transverse colon and caecum.
66
What is the most common complication associated with colorectal surgery?
Infection due to surgical contamination or leakage.
67
what is a complication that can occur 3-5 days post op (enterectomy) and why
Increased collagenolysis leading to decreased wound strength and increased incidence of dehiscence in the first three to five post-operative days.
68
What are other complications associated with surgical procedures on the bowel?
Post-operative stricture of the bowel wall and faecal incontinence due to damage to the pelvic nerve plexus.
69
How is the large intestine divided for surgical approaches?
Into three regions:
* Prox 3rd Colon and colorectal junction
* Middle third of the colon
* Caudal third of the rectum
70
Which approach is used for the caudal third of the rectum?
Caudal rectal pull-through.
71
What is the rectal mucosal eversion technique used for?
Accessing small, non-invasive masses of the distal rectum, such as benign polyps.
72
Describe the first stage of the abdomino-anal pull-through technique.
Involves ventral laparotomy, ligating the vasa recti arteries, and bluntly dissecting the rectum from its attachments.
73
What is the risk of resecting greater than 4 cm of the rectum?
High incidence of post-operative incontinence.
74
What is the significance of stretch receptors in the rectal wall?
They are responsible for feedback to the external anal sphincter, aiding in continence.
75
What can cause faecal incontinence post-surgery?
Decreased number of stretch receptors or damage to nerve fibres in the pelvic plexus.
76
What must be identified and protected during the ischial pubic flap technique?
The obturator nerve at the cranio-lateral aspect of the obturator foramen.
77
What are the common malignant tumors of rectum in dogs? (4)
* Adenocarcinomas
* Leiomyosarcomas
* Lymphosarcomas
* Fibrosarcomas
78
What are the common malignant tumors in cats? (rectums, 3)
* Lymphosarcoma
* Adenocarcinomas
* Mast cell tumors
79
What is the most common benign tumor found in the rectum?
Adenomatous polyps.
80
What is the typical treatment for narrow, superficial strictures of the rectum?
Bougienage and intralesional triamcinolone.
81
What can cause rectal perforation? (4)
Gunshot injuries,
sharp objects,
pelvic fractures,
As a consequence of surgery.
82
What is the primary treatment for rectal prolapse?
Reduction of the viable prolapsed rectal wall and placement of a purse-string suture.
83
What is a colopexy?
A surgical procedure where sutures are placed between the bowel wall and the transverse abdominal muscles.
84
What is the consequence of rectal resection greater than 1.5 cm?
It may lead to a decreased number of stretch receptors, affecting continence.
85
What is the primary treatment for recurrent prolapses?
Colopexy
## Footnote
Involves placing several sutures between the bowel wall and the transverse abdominal muscles via a ventral midline laparotomy.
86
What is the procedure for rectal amputation?
The prolapsed rectal segment is cleaned and several stay sutures are placed full-thickness through all layers of the prolapse before resection.
## Footnote
Resection occurs 1-2 cm from the anus.
87
What is obstipation?
Colonic impaction leading to severe constipation
## Footnote
It can be primary (due to large bone meal) or secondary (due to obstruction or pain).
88
How can most cases of obstipation be treated?
With faecal softeners, laxatives, and enemas
## Footnote
Colotomy is rarely necessary.
89
What surgical treatments are available for obstipation secondary to pelvic fractures?
Pelvic osteotomy, removal of bone, or subtotal colectomy
## Footnote
Subtotal colectomy is often the preferred method for chronic constipation in cats.
90
What is idiopathic megacolon?
Gross dilation of the large intestine with inability to evacuate faecal material
## Footnote
It is an acquired disease commonly affecting middle-aged male cats.
91
What are the symptoms of idiopathic megacolon?
Recurrent constipation, anorexia, vomiting, dehydration, depression, thin appearance, poor hair coat
## Footnote
Abdominal palpation reveals a hard colon full of faeces.
92
How is idiopathic megacolon diagnosed?
Abdominal Radiographs
By ruling out other causes of constipation
## Footnote
Such as pelvic fractures, colonic strictures, and neoplasia.
93
What medical treatments are used for idiopathic megacolon? (3)
Soft food
prokinetic medications (e.g., cisapride)
osmotic laxatives (e.g., polyethylene glycol 3350)
## Footnote
These treatments help manage the condition.
94
What is the surgical treatment for refractory cases of megacolon?
Subtotal colectomy
## Footnote
This procedure is performed through a ventral midline laparotomy.
95
What are the two levels at which the colon can be transected during subtotal colectomy?
1. Distal to the ileocolic valve with colocolonic anastomosis
2. Proximal to the ileocolic valve with enterocolonic anastomosis
## Footnote
A subtotal colectomy (also called a partial colectomy) involves surgically removing the majority of the colon, leaving the rectum and a small portion of the colon intact, to treat conditions like megacolon or other bowel issues.
96
What is a potential consequence of removing the ileocaecal valve during subtotal colectomy?
Prolonged diarrhoea (more so in dogs)
## Footnote
This can occur due to bacterial overgrowth and changes in bile salt absorption.
97
What is the expected outcome after subtotal colectomy in cats?
Most cats pass soft but well-formed faeces within a short time post-surgery
## Footnote
Diarrhoea is common but usually transient, resolving within eight weeks.
98
What percentage of cases have an excellent prognosis after subtotal colectomy?
90%
## Footnote
Diarrhoea is rare and manageable in these cases.
99
What is the common surgical procedure performed in cases of abdominal issues?
Exploratory laparotomy
100
What are the two types of portosystemic shunts recognized in dogs and cats?
Congenital and acquired
101
What percentage of congenital shunts are extrahepatic?
66-75%
102
What breeds of dogs commonly have single extrahepatic shunts?
Small breeds of dogs
103
What are the two types of intrahepatic shunts?
Persistent ductus venosus and portohepatic or portocaval shunts
104
What are acquired shunts typically in response to?
Chronic portal hypertension
105
What are some neurological clinical signs associated with portosystemic shunts? (10)
* Dullness
* Lethargy
* Stargazing
* Head pressing
* Wall walking
* Pacing/circling
* Ataxia
* Intermittent blindness
* Collapse/weakness
* Aggression
* Seizures
* Coma
106
What are some gastrointestinal clinical signs associated with portosystemic shunts? (10)
* GI haemorrhage
* Vomiting
* Ptyalism (especially in cats)
* Diarrhoea
* Anorexia
* Foreign body ingestion
* Failure to thrive
* Small stature
* Failure to gain weight
* Weight loss
107
What are the clinicopathological abnormalities associated with portosystemic anomalies?
Increased values:
* White blood cell count
* Coagulation times
* Serum ALP
* Serum ALT
* Post-ammonia tolerance
* Post-prandial bile acids
Decreased values:
* Glomerular filtration rate
* Erythrocyte count (normochromic, non-regenerative)
* MCV
* Total protein
* Blood urea nitrogen
* Cholesterol
* Albumin
* Blood glucose
* Creatinine
108
What is a sensitive indicator of hepatic dysfunction?
Elevated pre and post-prandial bile acids
109
What imaging technique is most common for visualizing a portosystemic shunt?
Abdominal ultrasound
110
What is considered the gold standard for imaging portal vasculature in humans?
CT Angiography
111
What is the purpose of nuclear scintigraphy in diagnosing portosystemic shunts?
To calculate the ratio of radioactive uptake between the liver and lungs
112
What is the goal of medical therapy for portosystemic shunts?
To control the clinical signs associated with a portosystemic shunt
113
What is the recommended protein restriction in moderately protein restricted diets for dogs?
18-22%
114
What oral antibiotic is commonly used to reduce ammonia production?
Metronidazole
115
What is the purpose of oral lactulose in treating portosystemic shunts?
To decrease ammonia absorption and produce soft faeces, (decrease GIT transit time)
116
What are the preferred anaesthetic agents for surgical treatment of portosystemic shunts?
Agents minimally metabolised by the liver and not highly protein bound
117
What is the preferred method of occlusion for portosystemic shunts?
Gradual occlusion
118
What is an ameroid constrictor?
A device that gradually constricts a vessel by stimulating fibrosis
119
What is a significant challenge in the surgical management of intrahepatic shunts?
Identification and dissection due to being surrounded by liver parenchyma
120
What is the normal portal pressure in animals without portosystemic shunts?
8-13 cm H2O or 6-10 mmHg
121
Fill in the blank: The preferred method of attenuation for intrahepatic portosystemic shunts is minimally invasive _______.
intravascular coil placement
122
What are the seven major liver lobes?
* − Right medial
* - Right lateral
* − Left medial
* - Left lateral
* − Quadrate
* − Caudate lobe with papillary process
123
What are the two main blood supplies to the liver?
− Hepatic artery
− Portal vein
124
What percentage of the liver's blood volume is supplied by the portal vein?
80%
125
What is the role of the hepatic veins?
They drain blood from the liver into the caudal vena cava.
126
What is the basic surgical approach to the liver?
Cranial midline abdominal incision with right paracostal extension if required.
127
What percentage of the liver can be removed during a lobectomy?
Between 70% and 80%
128
What are some indications for liver lobectomy? (5)
− Neoplasia
− Abscess
− Cysts
− Trauma
− Arterio-venous fistulae
129
What is the finger fracture technique in liver surgery?
Blunt fracture of the parenchyma with fingers or tissue forceps after sharp incision of the hepatic capsule.
130
What is the Pringle manoeuvre?
Digital occlusion of the hepatic artery and portal vein to limit hepatic hemorrhage through the omental bursa
131
What are the open techniques for liver biopsy? (4)
− Ligation and amputation
− Wedge resection
− Dermal biopsy punch
- needle aspiate
132
What is a contraindication for liver biopsy techniques?
Blood clotting deficiencies.
133
What can severe hepatic trauma result in?
Profound hemorrhage.
134
What is the common complication following hepatic trauma?
Bacterial toxaemia (clostridial infection).
135
What are the four histologic types of liver tumors?
− Hepatocellular
− Biliary
− Neuroendocrine
− Mesenchymal (sarcomas)
136
What is the most common primary liver tumor in dogs?
Hepatocellular carcinoma.
137
What are the three morphological forms of hepatocellular carcinoma?
− Massive
− Nodular
− Diffuse
138
What is the prognosis for massive hepatocellular carcinoma?
Mean survival times in excess of 4 years after surgical removal.
139
What is the most common primary liver tumor in cats?
Bile duct carcinoma.
140
What is cholecystotomy?
Surgical procedure to access the gallbladder.
141
What must be confirmed before performing a cholecystectomy?
Patency of the common bile duct.
142
What is choledochotomy?
Surgical incision into the common bile duct.
143
What is cholecystoenterostomy indicated for?
Permanent obstruction of the common bile duct.
144
What are potential complications of cholecystoenterostomy?
− Hemorrhage
− Dehiscence
− Cholangitis
− Stoma stricture
− Gastric ulceration
145
What is biliary stenting?
Placement of a stent in the common bile duct to relieve obstruction.
146
What are clinical signs of biliary trauma?
Anorexia, depression, vomiting, abdominal guarding.
147
What is the significance of elevated total serum bilirubin abdominal effusion (>serum bilirubin)?
Indicates bile accumulation in the abdominal cavity.
148
What is the expected outcome after substantial partial hepatectomy?
Post-operative hypoglycaemia may occur.
149
What results from bile within the abdominal cavity?
Chemical peritonitis and jaundice become evident.
## Footnote
Total serum bilirubin is elevated, and bilirubinuria is often present.
150
What is the characteristic of fluid collected by abdominocentesis in cases of bile leakage?
High in bilirubin and greater than that in the serum.
## Footnote
This indicates the presence of bile in the abdominal cavity.
151
What is the procedure for tears in small peripheral biliary ducts?
They may be simply ligated safely due to the presence of interlobular communicating ducts.
## Footnote
This allows for safe closure without significant complications.
152
What must be ensured when repairing large tears in biliary ducts?
Anastomosis must be performed in healthy tissue with accurate mucosal repair using fine sutures.
## Footnote
A supporting stent may be placed to prevent post-healing stenosis.
153
What should be done if the ruptured ends of the common bile duct are anastomosed?
They may be anastomosed over a stent, but ligation and permanent biliary-intestinal anastomosis are preferable if repair viability is in doubt.
## Footnote
This avoids complications from a potentially non-viable repair.
154
What is the approach if damage to the duct is too extensive for primary repair?
Bypass techniques may be used after double ligation of the traumatized duct.
## Footnote
This is to ensure proper function of the biliary system despite the injury.
155
What is the procedure if the gall bladder is severely injured but the biliary system is intact?
The gall bladder can be removed.
## Footnote
This is done to prevent further complications from the injury.
156
What is a characteristic radiographic sign of gastric dilatation-volvulus (GDV)?
The 'double bubble/smurf hat' appearance caused by dorsal displacement of the pylorus.
## Footnote
This appearance is noted in R lateral abdominal radiographs of dogs with GDV.
157
What is primarily responsible for GDV according to analysis of gas from live dogs?
Aerophagia rather than gastric fermentation.
158
In which direction does the stomach typically rotate during GDV?
Clockwise direction as viewed cranially.
Pylorus moves ventrally and then cranially
159
Pathoanatomy of GDV
- Deep chested dogs: stomach rotates on its axis, trapping air within, leading to severe dilatation
- Duodenum and pylorus move ventrally and cranially,
- Stretching the hepatoduodenal ligament
- Pylorus moves R-> L, creating a fold in the stomach,
- Trapping air and leading to increased intragastric pressure
- Decreased venous return through abdomen
- Portal hypertension
- Systemic hypotension
- cardiogenic shock
160
6Pathophysiology GDV- 5 main areas
1. Blood flow: reduced venous return to heart, portal hypertension
1. Respiratory: increased pressure on diaphragm reduces ventilation
1. Cardiac dysfunction: reduced coronary flow, myocardial ischemia,
1. Gastric Wall necrosis
1. Bacterial translocation
1. Reperfusion injury
161
Lab Findings with GDV
1. Hemoconcentration with stress leukogram.
1. thrombocytopenia (Platelet consumption or loss)
1. increased ALT/Bilirubin (hepatocellular damage)
1. Increased BUN/Crea (hypotension)
1. Electrolyte abnormalities: variable
1. increased Plasma lactate (Hypoperfusion)
162
How is lactate helpful in GDVs? (3)
1. evaluating perfusion
2. monitoring resuscitation efforts
3. possibly predicting survival**
| >6mmol/L is 88% specific and 61% sensitive for gastric necrosis
## Footnote
99% survival if lactate < 6mmol/L
Also better survival if fluid resusc drops lactate below 6mmol/L
163
what structure allows the pylorus and duodenum to move so much?
a stretched/longer Hepatoduodenal ligament
164
What are the pathophysiological changes caused by gastric distension?
Compression of the portal vein and caudal vena cava leading to:
* Congestion of blood in abdominal organs
* Tissue hypoxia and lactic acidosis
* Decreased venous return to the heart- cardiogenic shock
* Poor tissue perfusion and arterial hypotension
* portal hypertension, decreased cleareance of bacteria and endotoxins from the blood
165
What changes occur in the lungs due to GDV? (2)
* Reduced Tidal volume due to pressure on diaphragm makes inspiration more difficult and decreases oxygen delivery.
* Poor venous return and cardiac output make it difficult to exhale carbon dioxide, leading to respiratory acidosis.
166
What is the consequence of compression of the portal vein in GDV?
Reduced blood flow to the liver (provides 80% supply to liver), causing reduced ability of the liver to neutralize endotoxins, potentially leading to endotoxic shock.
167
What is a negative prognostic factor in GDV management? (7)
1. High lactate levels
1. Need for splenectomy or partial gastrectomy
1. Gastric necrosis,
1. Pre-existing arrhythmias,
1. Prolonged time between clinical signs and admission
1. Body temp < 38.0
1. Peritonitis, sepsis, DIC
168
What is the initial treatment focus for GDV?
Shock therapy and gastric decompression.
169
What fluid therapy is recommended for hypovolemic shock in GDV?
Crystalloids such as Lactated Ringer’s solution or 0.9% NaCl.
Shock rates 60-90ml/kg total in 25% increments
170
Fill in the blank: Gastric decompression is best achieved by a smooth pliable and lubricated wide bore _______.
stomach tube.
171
What procedure can be performed for immediate decompression if an orogastric tube cannot be passed? (GDV)
Percutaneous trocharisation of the stomach.
172
What should be monitored during anaesthesia in GDV patients?
ECG for cardiac arrhythmias- VTach, VPC's
173
What is the treatment of choice for severe ventricular arrhythmias in GDV?
2% lignocaine administered intravenously.
174
What are the three objectives of successful surgical management in GDV?
* Correction of the dilatation/torsion
* Prevention of recurrence (gastropexy)
* Assessment of gastric and splenic viability (gastric resection, splenic resection)
175
What is one technique used to prevent recurrence of GDV?
Gastropexy.
176
What is the expected recurrence rate of GDV without stabilization?
42-80%.
177
What type of sutures are typically used for incisional gastropexy?
2-0 monofilament absorbable suture material such as PDS/Maxon
178
What is the risk associated with circumcostal gastropexy? (2)
Risk of rib fracture or pneumothorax.
179
What should be done if there are necrotic portions of the stomach during surgery?
Resect the necrotic portions.
180
What is a common arrhythmia observed during anaesthesia and post-operatively in GDV?
Paroxysmal ventricular depolarisations and ventricular tachycardias.
181
What should be the goal of gastric decompression procedures?
Improve cardiorespiratory function and increase venous return.
182
What should be done if the arrhythmia is not controlled after initial treatment?
Use a lignocaine CRI.
183
What is circumcostal gastropexy?
A technique that utilises a muscular flap to anchor the stomach to a caudal rib, producing a strong adhesion but is more difficult to perform.
## Footnote
Risks include rib fracture or pneumothorax.
184
What is belt-loop gastropexy?
A modification of circumcostal gastropexy where the muscular flap is passed through a tunnel in the abdominal muscle rather than around a rib.
185
How is the belt-loop in belt-loop gastropexy created?
By making two parallel incisions in the transverse abdominus muscle, 2.5 cm long and 2.5 cm apart, and undermining to create a tunnel or belt-loop.
186
What is the size of the seromuscular flap created in belt-loop gastropexy?
2.5 cm wide and 4 cm long, centred on a branch of the right gastroepiploic artery.
187
What is indicated if a spleen is severely torsed in cases of GDV?
Splenectomy may be necessary if the blood supply reveals irreversible thrombosis or damage.
188
What should be monitored post-operatively in GDV patients? (10)
1. Cardiac arrhythmias
1. PCV
1. serum total protein
1. peripheral pulse quality
1. urine output
1. electrolyte and acid-base balance
1. Lactate
1. Appetite
1. Perfusion parameters
1. TPR
189
What is the percentage of GDV cases that may develop cardiac arrhythmias post-operatively?
40-70% of cases.
190
What is the mortality rate associated with GDV despite treatment?
15 to 18 %.
191
How is an enterotomy closed?
With a single layer of 3-0 or 4-0 monofilament absorbable suture in a simple interrupted or continuous appositional suture pattern.
192
What are the indications for intestinal resection/anastomosis? (4)
Non viable segment of bowel due to:
* * Foreign body removal
* Trauma
* Neoplasia
* Intussusception
193
What is the importance of the angle of incision in intestinal resection?
The incision should be angled slightly away from the lesion to ensure good blood supply at the antimesenteric border.
194
What is a method to address luminal disparity during anastomosis?
* Spacing sutures farther apart on the larger lumen side
* Spatulating the smaller side
* Angling the resection on the smaller side to match length of longer side*(preferred)*
* Wider bite on the larger side
195
What is the role of the omentum in gastrointestinal anastomoses?
It contributes to the seal of a gastrointestinal wound by creating adhesions and provides immune functions.
196
What is the purpose of using a serosal patch?
To reinforce the wound and allow formation of a fibrin seal to prevent leakage even if the intestinal wall necroses.
197
What is the recommended action if the integrity of the intestinal wall is in doubt during foreign body removal?
Consider a serosal patch over the site or perform a resection and anastomosis
197
198
What should be done if a linear foreign body is detected?
Open the abdomen, isolate the plicated section of intestine, make an enterotomy half way along, grasp the linear FB, then release it from the proximal place of adhesion (if pyloric requires a gastrotomy), Apply gentle traction on FB. May require multiple enterotomies.
199
What is intussusception?
Intussusception occurs when a segment of intestine telescopes into another
## Footnote
The outer sleeve is called the intussuscipiens, and the invaginated segment is the intussusceptum.
200
what makes it hard to assess GI viability after linear FB removal?
mesenteric fat along the mesenteric border
201
what is a pro and con of red rubber/catheter technique of milking linear FBs through the anus via a single enterotomy?
1. PROS - small single 1cm incision
2. CONS - Iatrogenic intestinal perforation if guts are ischemic or necrotic
202
why is rubber/catheter technique probably not useful in dogs?
because they mostly ingest bulky/thicker FB's (cats like to eat string/ribbons)
203
Mortality rates FB surgeries
1-8%
204
What are the signs of intussusception?
Palpation of a sausage-shaped mass in the abdomen, signs of intestinal obstruction on US - target sign- concentric rings
## Footnote
Concentric rings may be observed during abdominal ultrasound.
205
What is the treatment for intussusception with minimal vascular compromise?
Reduction by gently squeezing from the outside while applying traction to the proximal intestine
## Footnote
If adhesions have formed, surgical intervention may be required.
206
What is enteroplication?
A technique to prevent recurrence of intussusception by folding the intestine into loops along each others lengths and suturing them in place
## Footnote
Controversial due to higher complication rates reported.
207
What types of neoplasms can be found in the gastrointestinal tract? (4)
Epithelial (carcinoma's - adenocarcinoma)
mesenchymal (sarcomas- leiomyosarcoma)
neuroendocrine
round cell origin (MCT, lymphoma)
## Footnote
Most intestinal tumors are malignant.
208
Which intestinal tumor is most common in dogs?
Intestinal adenocarcinoma, leiomyosarcoma, gastrointestinal stromal tumors (GIST)
## Footnote
Leiomyosarcoma and GIST most commonly involve the caecum.
209
What is the prognosis for dogs after surgical removal of intestinal tumors? (adenocarcinoma, GIST, Leio's)
Adenocarcinoma - One-year survival rate is about 40%
Better survival times for Gastrointestinal Stromal tumours and leiomyosarcoma (1-3 years).
210
What is mesenteric torsion?
Twisting of a gastrointestinal structure on its mesenteric axis
(Volvulus is twisting along its longitudinal axis.)
211
What complications can arise from intestinal torsion and volvulus?
Ischaemia, inflammation, and poor prognosis if large intestine is involved
## Footnote
Requires resection of involved intestine without derotation.
212
What is the recommended post-operative care for contaminated peritoneal cavities?
Thorough lavage with warmed isotonic saline solution until gross contamination is removed (200ml/kg minimum)
## Footnote
Antiseptics or antibiotics in lavage fluid are not recommended.
213
What is short bowel syndrome?
Presents as intractable diarrhea and severe weight loss after significant intestinal resection - when 70% or more of the small intestine is removed.
214
What are the dietary changes recommended for managing short bowel syndrome? (4)
Small frequent meals
low fat diets
medium chain triglycerides
vitamin and mineral supplements
## Footnote
Antidiarrheal agents and oral antibiotics may also assist.
215
What are common signs of peritonitis? (5)
1. Abdominal splinting
1. persistent vomiting
1. depression
1. Fever
1. Shock
## Footnote
May rapidly result from perforation of the gastrointestinal tract.
216
What is the typical survival rate for animals with peritonitis?
Survival rates are generally reported to be around 70-80%
## Footnote
Improved due to intensive medical support.
217
What is the 'lag' phase in intestinal wound healing?
A delay in the gain in wound strength during inflammation and debridement phases
## Footnote
Lasts from day 0-4, during which the wound is weakest.
218
What is the significance of clinical deterioration around day 3-5 after gastrointestinal surgery?
It raises suspicion of post-operative dehiscence or leakage
219
What is the primary emphasis in tissue handling during surgery?
Atraumatic tissue handling using careful use of fingers and instruments.
## Footnote
Consideration of Halsted’s principles is crucial.
220
What are the two types of instruments used for intestinal surgery?
Crushing and non-crushing instruments.
## Footnote
Examples include Carmalt crushing forceps and Doyen forceps.
221
What is the function of Carmalt crushing forceps?
They grip well due to longitudinal grooves and serrations at right angles to tension.
## Footnote
They can be loosened and easily slid laterally for oversewing.
222
True or False: Doyen forceps are considered non-crushing forceps.
True.
## Footnote
They are standard non-crushing forceps used in intestinal surgery.
223
What is a key consideration when assessing bowel viability?
Judgement based on subjective criteria, as there is no reliable objective measure available.
## Footnote
Factors like color improvement and arterial pulsation are indicators.
224
What does the presence of arterial pulsation indicate during bowel viability assessment?
It is a good indicator of bowel viability.
## Footnote
However, absence does not necessarily mean necrosis.
225
Fill in the blank: The technique that measures the partial pressure of oxygen at the surface of the intestine is called _______.
Surface Oximetry.
## Footnote
This method is still in the research stage.
226
What is the purpose of fluorescein fluorescence in bowel viability assessment?
To check circulation to the bowel segment by observing fluorescence under UV light.
## Footnote
This method is inaccurate in cases of venous strangulating obstruction.
227
What suture pattern is recommended for intestinal closure to promote rapid healing?
Simple interrupted or simple continuous patterns.
## Footnote
These techniques maintain lumen diameter.
228
What is the main disadvantage of everting techniques in suturing of intestinal segments? (2)
They cause stenosis at the anastomotic site and delay mucosal healing.
## Footnote
Techniques like Connell or Cushing are historically leak-proof but narrow the lumen.
229
what are Halsteds 7 principles?
1. Gentle Handling of Tissues
1. Meticulous Hemostasis:
1. Preservation of Blood Supply:
1. Strict Aseptic Technique:
1. Minimum Tension on Tissues:
1. Accurate Tissue Apposition:
1. Obliteration of Dead Space:
230
Describe the Gambee suture technique.
It is designed to invert the everting mucosa by passing through a portion of the mucosa and submucosa.
## Footnote
This helps pull the everted mucosa into apposition.
231
What type of suture material is recommended for intestinal suturing?
Absorbable monofilament in 3-0 or 4-0 on a taper needle.
## Footnote
Examples include Polydioxanone (PDS) and polyglyconate (Maxon).
232
What is the purpose of packing off during surgery?
To isolate the area of intestine being worked on from the abdomen.
## Footnote
This is done using laparotomy sponges moistened with warm saline.
233
What is peritoneal lavage used for?
To remove contaminants from the abdominal cavity before closure.
## Footnote
It reduces the incidence of peritonitis in traumatized patients.
234
What are the four luminal divisions of the stomach?
* Cardia
* Fundus
* Body
* Pylorus
## Footnote
Each division has distinct anatomical and functional characteristics.
235
What are the indications for performing gastric surgery? (5)
* Biopsy of stomach wall
* Removal of gastric foreign bodies
* Gastric ulceration
* Gastric neoplasia
* GDV
## Footnote
These conditions often require surgical intervention.
236
What is the recommended suture pattern for gastrotomy closure? (2)
One or two-layer closures using synthetic absorbable suture material- PDS, monosyn, maxon, 2/0, taper needle
If doing 2 layer: Can either do full thickness closure for both; OR 1st layer only including mucosa/submucosa, second layer is an inverting layer of the muscularis and serosa
## Footnote
The two-layer closure provides better sealing and haemostasis.
237
What is the maximum percentage of the stomach that may be removed during partial gastrectomy?
Up to 70%.
## Footnote
however taking this much can lead to morbidity and alterations in gastric function.
238
What surgical procedures may be necessary if the pylorus is involved? (2)
Pylorectomy with gastroduodenostomy (Billroth Type I) or gastrojejunostomy (Billroth Type II)
239
What are the potential complications of pylorectomy and gastrojejunostomy? (6)
1. * Maldigestion
1. * Enterogastric reflux
1. * Gastroenteric ulceration
1. * Dumping syndromes (??)
1. * Pancreatitis
1. * Biliary tract complications
240
What technique is used for resection of the pylorus in gastroduodenostomy?
One layer end-to-end anastomosis with 2/0 to 3/0 PDS
241
What is the purpose of stay sutures during GI surgery?
To retract excised ends, reducing luminal spillage and facilitating suture placement
242
What are common clinical signs of gastric ulceration? (3)
* Vomiting digested blood (coffee grounds appearance)
* Melena
* Anaemia
243
What is the most common type of gastric neoplasia in small animals?
Adenocarcinoma (40 – 90% of gastric neoplasia)
244
What is the typical survival time for patients with gastric adenocarcinoma?
Most no longer than 6 months
245
What causes delayed gastric emptying in young animals?
Congenital pyloric stenosis due to hypertrophy of pyloric muscles
246
What are the two surgical interventions for improving gastric outflow?
* Pyloromyotomy
* Pyloroplasty
247
What does pyloromyotomy try to correct?
Used in minor pyloric outflow obstruction to correct muscular hypertrophy
248
What is the purpose of a full-thickness incision in pyloroplasty?
To correct both muscular and mucosal hypertrophy
249
What is the typical aetiology of gastric dilatation-volvulus (GDV)?
Uncertain, but multiple factors such as gastrin's effect, gastric myoelectric dysfunction, and dietary factors have been suggested
250
What breeds of dogs are most commonly affected by GDV? (5)
* Great Dane
* Weimeraner
* St Bernard
* Gordon Setter
* Irish Setter
251
What risk factors for GDV have been identified? (8)
1- large pure breeds
2 – close genetic relative
3 – anxious/fearful/aggressive dogs
4 – exercising shortly after eating
5- eating fewer larger meals
6 – longer gastrosplenic ligament
7 – eating smaller kibble?
8 – deep chested breeds
252
What is the mortality rate associated with GDV?
Generally reported to be between 15 – 20%
253
What surgical procedure was performed on 'Tiny' the French Bulldog?
Y to U pyloroplasty
254
What histological finding was noted in 'Tiny's' biopsy?
Significant hypertrophy of the muscularis with little or no hypertrophy of the mucosa
255
What term describes obstruction of the pyloric canal caused by hypertrophy of pyloric smooth muscle?
Pyloric stenosis or chronic hypertrophic pyloric gastropathy
256
What is a common pre-existing condition associated with GDV?
Inflammatory bowel disease
257
What are some potential predisposing factors for GDV?
Gender, feeding a single food type, recent kennelling or car ride, nervous temperament, eating rapidly, if oil or fat was one of the primary ingredients in the food being fed, eating from a raised food bowl, post-prandial activity, or if a first degree relative has had a GDV.
## Footnote
These factors are useful in the decision-making for prophylactic gastropexy.
258
What is the recommendation regarding gastropexy after splenectomy?
It is recommended that a gastropexy be performed if splenectomy or removal of a large abdominal mass has been performed, if the patient is stable enough for the procedure.
## Footnote
There is controversy about whether a gastropexy should be performed after splenectomy, as it may increase the risk of later GDV.
259
List the presenting signs of GDV.
* Restlessness
* Pain
* Abdominal tympany
* Retching
* Salivation
## Footnote
These signs are critical for diagnosing GDV.
260
What do lateral abdominal radiographs show in cases of GDV?
Severe gaseous distension of the stomach with dorsal displacement of the pylorus.
## Footnote
The pathognomonic radiographic sign is the presence of the gas-filled pylorus in the craniodorsal abdomen.
261
What is the pathognomonic radiographic sign of GDV?
Presence of the gas-filled pylorus in the craniodorsal abdomen.
## Footnote
This sign is crucial for the diagnosis of GDV.
262
Fill in the blank: The appearance of gastric compartmentalisation indicates the presence of a _______.
soft tissue band
## Footnote
This finding is associated with GDV.
263
What are clinical signs of oral disease?
Dysphagia, decreased appetite, inability to swallow, weight loss, salivation, regurgitation, bleeding from the mouth, halitosis
264
What areas should be examined during a physical examination of the oral cavity?
Lips, teeth, gums, palate, tongue, tonsils, salivary glands
265
What is the significance of the oral mucosa's blood supply and metabolic rate?
Oral mucosa heals more rapidly than skin due to higher blood supply and metabolic rate
266
What type of suture materials are preferred for the oral cavity?
Rapidly absorbed suture materials such as polyglecaprone (Monocryl)
267
Fill in the blank: Nutritional support by _______ may be necessary during the healing process.
tube feeding
268
What should be done for tongue trauma during surgical treatment?
Minimal debridement, simple lacerations sutured with each layer separately, necrotic lesions left to slough
269
What clinical signs indicate oropharyngeal foreign bodies?
Drooling, bloody saliva, pain, dysphagia, subcutaneous emphysema
270
What is a common cause of penetrating injuries to the oropharynx in dogs?
Chasing or chewing sticks
271
What are common materials that cause foreign bodies in the oropharynx?
Wood, needles, bones, grass awns
272
What imaging techniques may be needed to visualize foreign material in the oropharynx?
CT and MRI
273
What is the preferred approach for exploring the ventral cervical and retropharyngeal area?
Ventral midline approach
274
What is essential before planning treatment for oral masses?
Establish a definitive diagnosis through biopsy
275
What imaging method is essential for assessing the extent of oral tumors?
High detail radiographs or CT examination
276
What makes lymph node staging challenging for oral neoplasia?
Mandibular lymph nodes are least commonly involved despite being the most accessible
277
What is the common treatment approach for malignant melanoma in dogs?
Wide surgical excision
278
What is the mean survival time post-operatively for malignant melanoma?
5 – 11 months
279
What is the prognosis for squamous cell carcinoma in dogs versus cats?
Better in dogs, poor in cats with median survival times of 3 months or less
280
What is the recurrence rate for fibrosarcomas after excision?
Up to 50%
281
True or False: Oral papillomas usually occur in older dogs.
False
282
What is the surgical approach for peripheral odontogenic fibroma?
Complete excision usually requires removal of underlying bone
283
What are the classifications of maxillectomy?
Unilateral or bilateral, rostral, lateral, or caudal
284
What complications may arise from maxillectomy and mandibulectomy?
Haemorrhage, incisional dehiscence, ptyalism, mandibular drift, dental malocclusion, difficulty prehending food or drinking
285
What is the importance of perioperative analgesia in maxillectomy?
Vigilant focus is imperative for pain management
286
What is a three-quarter mandibulectomy?
Complete unilateral mandibulectomy with contralateral rostral partial mandibulectomy
287
What are the types of mandibulectomy mentioned?
unilateral, bilateral, rostral, segmental, caudal, complete
## Footnote
A three-quarter mandibulectomy involves unilateral complete mandibulectomy with contralateral rostral partial mandibulectomy.
288
What care is needed during total or caudal mandibulectomy?
Locate and ligate the mandibular alveolar artery and vein, avoid cutting these vessels when disarticulating the temporomandibular joint.
289
What happens after rostral mandibulectomy?
Mandibles move independently, and although stabilization is described, it is not necessary as dogs and cats generally learn to eat and drink well.
290
What should be done if the mandibular and sublingual salivary ducts cannot be avoided during surgery?
They are ligated.
291
What is the approach for removing only the vertical ramus?
Remove and later replace the zygomatic arch.
292
What are the four paired salivary glands in dogs and cats?
* Parotid gland - serous saliva
* Mandibular gland - mixed serous and mucoid saliva
* Zygomatic gland - mixed serous and mucoid saliva
* Sublingual gland - mucoid saliva.
293
What are common symptoms associated with salivary gland diseases?
Drooling, inflammation, collection of saliva within the tissues of the oropharynx or submandibular area.
294
What is sialography?
Outlining the duct system with contrast agents.
295
What condition is a salivary mucocoele?
A condition where saliva leaks from a damaged gland or duct and collects in the intermandibular space, beneath the tongue (ranula), or behind the pharynx.
296
What is the typical appearance of a salivary mucocoele upon aspiration?
Thick stringy mucoid saliva.
297
What is the definitive treatment for a salivary mucocoele?
Excision of the appropriate gland, usually the sublingual gland.
298
What surgical technique is preferred for the removal of the mandibular and sublingual salivary gland complex?
Ventral approach.
299
What are Halstead's principles important for in oesophageal surgery?
Careful approximation of tissue edges, avoidance of tension, gentle tissue handling, and minimization of foreign material.
300
What factors influence oesophageal wound healing compared to other gastrointestinal areas?
* Lack of omentum
* Segmental blood supply
* Lack of redundant length
* Motion of the oesophagus.
301
What are the indications for oesophagotomy/oesophagectomy?
* Foreign body removal
* Excision of diverticulae
* Removal of tumours
* Stricture resection.
302
What is the recommended technique for oesophageal closure?
Single or double layer closure with a monofilament absorbable suture.
303
Fill in the blank: Salivary _______ are stones found within the duct of a salivary gland.
sialoliths
304
True or False: Removal of the parotid gland is easy due to its distance from the facial nerve.
False
305
What should be done if leakage from a sublingual gland occurs during sialography?
Perform surgical excision of the affected gland.
306
What is the recommended intercostal thoracotomy approach for the caudal thoracic oesophagus?
Left 7th, 8th or 9th intercostal thoracotomy
## Footnote
This approach avoids the caudal vena cava.
307
What type of suture is recommended for oesophageal closure?
Monofilament absorbable suture
## Footnote
Single or double layer closure is recommended.
308
What is the strongest tissue layer of the oesophageal wall that should be included in sutured wounds?
Submucosa
309
What suture pattern is preferred for oesophageal closure?
Interrupted patterns, particularly simple interrupted
## Footnote
These do not interfere with oesophageal dilation.
310
How far apart should sutures be placed during oesophageal closure?
2 – 3 mm apart
311
In a two-layer closure, what is the first layer made up of?
Mucosa and submucosa with knots tied in the lumen
312
What is the second layer in a two-layer closure of the oesophagus?
Muscularis and adventitia with knots placed extraluminally
313
What can be used for oesophageal resection/anastomosis?
Circular end-to-end anastomosis staplers
314
What techniques can be used for suture line reinforcement?
* Omental flaps
* Intercostal pedicle flaps
* Pericardium
* Local muscle flaps
* Stomach or small intestine
* Synthetic products or biomaterials
315
What muscle can be used for grafting in the cervical region for full thickness deficits of the oesophagus?
Sternothyroideus muscle
316
What are some techniques adapted from human surgery for oesophageal reconstruction?
* Isoperistaltic tubes
* Anti-peristaltic tubes from the stomach
317
What is the recommended post-operative care regarding food intake?
Withhold food for 24-72 hours
318
When are gastrostomy tubes particularly important?
When oesophageal mucosal injury is extensive and severe, or after oesophageal resection and anastomosis
319
What are common complications after oesophageal surgery?
* Dehiscence
* Fistulation
* Diverticularisation
* Stricture
* Aspiration pneumonia
* Infection
320
What is the predominant clinical sign of oesophageal obstruction?
Regurgitation of solid food
321
What occurs quickly in acute oesophageal obstruction?
Regurgitation
322
What should be used to confirm the diagnosis of oesophageal obstruction?
Endoscopy and radiography
323
What is the most common cause of extraluminal obstruction in dogs and cats?
Vascular ring anomaly
324
What is the most common vascular ring anomaly?
Persistent right aortic arch (PRAA)
325
What is the expected long-term result after surgical relief of oesophageal stricture due to PRAA?
Clinical signs of regurgitation improve in 90% of cases
326
What is the best treatment for oesophageal stricture?
Balloon catheter dilation
327
What is a common diagnosis tool for swallowing disorders?
Barium swallow and fluoroscopy monitoring
328
What stages comprise the act of swallowing?
* Oropharyngeal
* Oesophageal
* Gastroesophageal
329
What congenital condition results in an inability to swallow due to incoordination?
Cricopharyngeal dysphagia
330
What are the clinical signs of oesophageal stricture?
Cannot be differentiated clinically from oesophagitis
331
What can be indicated by a barium swallow in cases of vascular ring anomalies?
Location of the stricture
332
What type of neoplasia is relatively rare in the oesophagus?
Carcinomas and leiomyomas
333
What is detected by a barium swallow and fluoroscopy monitoring?
Weak pharyngeal constrictor, failure of the cricopharyngeal muscle to relax, incoordinated swallowing reflex
334
What is cricopharyngeal dysphagia?
A congenital condition resulting in incoordination between the cricopharyngeal sphincter and pharyngeal contractions, or failure of the sphincter to relax
335
What are common clinical signs of cricopharyngeal dysphagia in dogs?
* Gagging
* Drooling
* Regurgitation of solid food
* Repeated re-eating of food
336
What is a common complication of cricopharyngeal dysphagia?
Aspiration pneumonia
337
What surgical treatment is often used for cricopharyngeal dysphagia?
Cricopharyngeal myotomy
338
What percentage of cases showed resolution of clinical signs after cricopharyngeal myotomy according to a meta-analysis?
Approximately 50%
339
What are the two separate conditions recognized in cricopharyngeal dysphagia?
* Cricopharyngeal achalasia
* Cricopharyngeal asynchrony
340
What is the risk associated with performing contrast studies if megaoesophagus is visible on radiographs?
Risk of barium aspiration pneumonia
341
What type of muscle is primarily responsible for swallowing in dogs and cats?
Striated muscle
342
What neuromuscular transmission disorder can affect swallowing in dogs?
Myasthenia gravis
343
What is the most common vascular ring anomaly in dogs and cats?
Persistent right aortic arch
344
What diagnostic methods are used to assess gastrointestinal disease?
* History
* Clinical Examination
* Radiology/ultrasonography
* Haematology/biochemistry
* Diagnostic peritoneal lavage
* Exploratory surgery
* Abdominal CT/MRI
345
What is the cornerstone of accurate diagnosis in gastrointestinal disease?
A thorough, accurate history and physical examination
346
What can abdominal palpation detect in a clinical examination?
* Pain
* Swelling
* Fluid
* Position and size of organs
347
What does ballotment of the abdomen help detect?
Fluid wave due to accumulation of ascites, blood, or exudate
348
What is the benefit of measuring blood pressure in patients with gastrointestinal disease?
Provides important information about the requirement for pre-operative supportive care
349
What are the limitations of haematocrit interpretation soon after acute haemorrhage?
May not reflect the extent of blood loss for 12 – 24 hours
350
What is paracentesis used for?
Diagnosis of serious intra-abdominal injuries with free fluid
351
What is the technique for performing paracentesis?
Insert an 18 or 20 gauge needle or butterfly catheter with bevel toward abdominal cavity
352
What is the diagnostic accuracy of diagnostic peritoneal lavage for alimentary tract trauma?
Up to 95 percent
353
What is the purpose of exploratory laparotomy?
To diagnose diseases defying other avenues of diagnostic evaluation or to identify and correct a suspected problem
354
What should be assessed before performing an exploratory laparotomy?
* Risks of anaesthesia and surgery
* Potential benefits
* Clinical and pathological investigations
355
What is the equation used to estimate the amount of blood in the abdominal cavity during peritoneal lavage?
X = L x V, where X = amount of blood, L = PCV of returned fluid, V = volume of fluid infused, P = PCV of peripheral blood
356
What is the primary goal regarding the timing of a laparotomy?
Maximise diagnostic and therapeutic success while minimising patient risk.
357
What should be done before deciding on a laparotomy?
Conduct a full clinical and pathological investigation.
358
What may decrease the potential for success in laparotomy?
Excessive delays in the procedure.
359
What is diagnostic peritoneal lavage used for?
To eliminate uncertainty in surgical decision-making.
360
What are the two major clinical signs of gastrointestinal dysfunction?
* Vomiting
* Diarrhoea
361
What type of fluid therapy is preferred for pyloric or high duodenal obstruction?
Isotonic saline to replace chloride.
362
What imbalance results from obstructions below the bile duct?
Metabolic acidosis due to bicarbonate loss.
363
What is the role of pre-operative electrolyte and blood gas analysis?
To direct crystalloid therapy.
364
What is the risk of not using antibiotics for obstructed intestines during surgery?
Increased risk of contamination and infection.
365
Name one common bacteria responsible for infection in obstructed intestines of dogs.
* E. coli
* Streptococcus
* Clostridium
* Bacteroides
366
When should prophylactic antibiotics be administered?
At the time of anaesthetic induction.
367
What is the most commonly used perioperative intravenous antibiotic?
Cephazolin.
368
What is a key characteristic of Enrofloxacin?
It is effective against a range of gram-negative bacteria.
369
What should be avoided in anaesthesia for abdominal surgery?
Phenothiazine tranquillisers (e.g., acepromazine).
370
What is the importance of oxygen therapy preoperatively?
It may help relieve gaseous intestinal distension.
371
What is the ventral midline incision primarily used for?
It is the most frequent and versatile incision for abdominal surgery.
372
What should be done first when closing a ventral midline laparotomy incision?
Close the caudal end first.
373
What type of sutures are preferred for closing a laparotomy incision?
Simple continuous absorbable sutures.
374
What is the purpose of stay sutures in a flank approach?
To facilitate later closure of the incision.
375
What should be included in general considerations for surgical preparation?
* Clip a large area of skin
* Use a water-repellent draping technique
* Protect wound edges with laparotomy sponges
376
What should be done if previous surgery has been performed?
Check for adhesions before making a long incision.
377
What should be used to aid exposure during a laparotomy?
A self-retaining retractor such as the Balfour.
378
What anatomical structures are examined first during an abdominal surgery?
* Diaphragm
* Liver
* Biliary system
379
What is a unique feature of the caudal abdomen's linea alba?
It is narrow and the incision may stray from the midline.
380
Fill in the blank: The falciform ligament is usually ______ and has a good blood supply.
fatty
381
What is the risk associated with premature deflation of the endotracheal tube cuff?
Aspiration due to gastro-oesophageal reflux.
382
What should be monitored during anaesthesia for abdominal surgery?
Analgesia levels.
383
What is a common method for closing a flank incision?
Interrupted sutures for layers other than the deepest layer.
384
What is the purpose of using a retaining retractor like the Balfour during surgery?
To aid exposure
## Footnote
A retractor helps keep the surgical site open for better visibility and access.
385
How can a surgeon create a mesenteric basket during a laparotomy?
By using the long mesocolon or mesoduodenum to draw the entire intestinal mass to one side
## Footnote
This technique helps in managing the intestinal mass effectively.
386
Where is most of the intestinal mass located in the abdominal cavity?
Cradled within the mesoduodenum on the right and mesocolon on the left.
387
What technique can be used to expose the abdominal roof during surgery?
Drawing the descending duodenum or descending colon toward the midline.
388
What should be done to prevent desiccation of exposed viscera during surgery?
Regularly moisten with warm sterile saline or cover with a moistened laparotomy sponge.
389
Why do small patients lose heat rapidly during surgery?
Due to a greater surface area to volume ratio.
390
What can accelerate heat loss when abdominal viscera are exposed?
The exposure of abdominal viscera during surgery.
391
What are some methods to reduce heat loss during surgery?
* Patient warmers (e.g., heating mats)
* Forced air blankets (e.g., BAIR hugger)
* In-line intravenous fluid warmers
* Use of pre-warmed fluids for lavage.
392
Why is it important to monitor body temperature during and after surgery?
Body temperature loss can be dramatic.
393
Cardiovascular consequences GDV (4)
* Compression of caudal vena cava, reduced blood returning to heart
* inadequate coronary flow (down by 50%) leads to myocardial ischemia and cardiogenic shock
* Cardiac arrythmias can develop, decreasing systemic perfusion.
* Dilated stomach increases pressure within abdomen, collapsing low pressure vessels.
394
Respiratory consequences GDV (2)
1. * Reduced Tidal volume due to pressure on diaphragm makes inspiration more difficult and decreases oxygen delivery.
1. * Poor venous return and cardiac output make it difficult to exhale carbon dioxide, leading to respiratory acidosis
395
Effects on stomach wall- GDV (2)
* increased pressure inside the stomach puts pressure on the capillaries within the stomach wall, causing necrosis of gastric mucosa.
* With systemic hypotension, full thickness gastric wall necrosis can develop in some dogs – possibly due to avulsion of the short gastric arteries in combination with hypotension
396
what occurs first in GDV - dilatation or torsion?
It is not known if the stomach rotates first or becomes distended first; however possibly both could be true and case/individual dependent. The fact that gastropexy prevents GDVs so well suggests that volvulus might occur before dilatation. Its hard to understand a mechanism that explains why a stomach would torse after being dilated with gas initially.
397
Pathoanatomy GDV
GDV Usually occurs in large deep chested dogs in which stomach rotates clockwise on its axis blocking off the distal oesophageal sphincter.
The pylorus and proximal duodenum move ventrally and cranially, stretching the hepatoduodenal ligament and allowing the pylorus to move right to left, folding the stomach, and creating a trap for air leading to increased intragastric pressure and enlargement of the stomach.
398
Systemic effects GDV (9)
1. - Cardiogenic shock + Electrolyte abnormalities: cardiac arrythmias
1. - increased portal hypertension
1. - Systemic hypotension, circulatory shock, increased BUN/Crea
1. - Hypoperfusion; increased Plasma lactate (>6 is 88% specific and 61% sensitive for gastric necrosis)
1. - Hemoconcentration with stress leukogram
1. - Platelet consumption or loss – thrombocytopenia
1. - Hepatocellular damage, reduced blood supply to liver: increased ALT/Bilirubin, and decreased drainage, pooling of enterotoxin
1. * Reperfusion injury can result in circulation of oxygen free radicals released from ischemic tissues.
1. * SIRS, MODS, DIC
399
400
underlying cause Transudates (4)
1. non exfoliating neoplasia
1. lung lobe torsion
3. portal hypertension
4. Hypoalbuminemia
401
underlying cause Modified Transudate (3)
1. Heart failure: LS>RS
2. Liver diseaes
3. Non exfoliating neoplasia
402
causes of Chyloud effusion (3)
1. Cardiac disease
2. Idiopathic
3. Neoplasia
403
Causes Lymphocyte rich effusion
1. Cardiac disease
2. Idiopathic
3. Neoplasia
4. Thymoma
5. Small cell lymphoma
404
Causes of exudate effusions
1. Infectious: bacteria, fungal, parasitic
2. Ruptured/leaking viscous
3. Neoplasia
4. Bile peritonitis
5. Uroperitoneum
6. Pancreatitis
405
Causes of neoplastic effusions (2)
1. Round cell neoplasia
2. Epithelial cell neoplasia
406
407
Causes of hemorrhagic effusion
1. Pericarditis
2. Pericardial neoplasia
3. Trauma
4. Ruptured spleen/liver
5. Neoplasia
6. Coagulation defect; rodenticide toxicity, liver failure
408
Causes of biliary rupture
1. Trauma
2. Mucoceole rupture
3. cholelithiasis
4. neoplasia
5. cholangiohepatitis
6. Pancreatitis/biliary obstruction
