GI - SA surgery Flashcards by Mary Tilling

What are the different surgical diseases of the oropharyngeal cavity?

Oral neoplasia - benign, malignant
Congenital oronasal fistulae (cleft palate)
Tonsil enlargement/obstruction/SCC
Aural/nasopharyngeal polyps
Nasopharyngeal atresia/stenosis
Tongue laceration/neoplasia

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What benign oral masses can animals get?

Gingival hyperplasia
Epulides
Odontogenic cysts

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What malignant oral neoplasia do dogs and cats get?

Cats - SCC
Dogs - fibrosarcoma, melanoma

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What is the surgical treatment for oral neoplasia?

Mandibulectomy
Maxillectomy

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How can you treat oro-nasal fistulae surgically?

Primary cleft - repair of harelip
Secondary cleft - palatal flaps
Dehiscence common

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What are the surgical treatment for aural/nasopharyngeal polyps?

Resection - oral, just pull out
Bulla osteotomy

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What is nasopharymgeal atresia/stenosis? How is it treated?

Narrowing of nasopharynx - congenital or trauma/infection
Resect stenotic area - open surgery
Endoscope guided resection/stent

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What is the name for tongue (partial) amputation? How much can you take?

Glossectomy - up to 40-60%

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What is the treatment for oropharyngeal stick injury?

Surgical exploration of neck - if chronic or sings of cervical emphysema
Intraoral approach - if acute, no swelling

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What structure do you need to be careful of in neck surgery?

Recurrent laryngeal nerve - close to incision

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What salivary gland are most affected by mucocoeles?

Mandibular - cervical salivary mucocoele
Sublingual - sublingual (or ranula)

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How do you treat mucocoeles?

Salivary gland excision
Marsupialise ranula - make hole and suture open

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What are common foreign bodies?

Bones
Rawhide chews
Needles (cats)
Fish hooks (most common in cervical region as get stuck)
String
Toys
Hairballs

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How do you treat an oesophageal foreign body?

Oesophagoscopy - extract orally if can be done without trauma
Otherwise advance the object into the stomach
Try to avoid oesophageal surgery - high risk of leakage, stricture complications

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What type of surgery is an ex lap GI surgery?

Clean contaminated - if no spillage
Contaminated - spillage
Give therapeutic anitbiotics - amoxyclav

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What can you use to improve access in an ex lap?

Retractors - balfour or gosset
Larger incision
Duodenal and colic manoeuvres
Pack swabs

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What is the duodenal manoeuvre? What is the colonic manoeuvre? which is which side

Ascending duodenum on right side - is retracted ventromedially
Descending colon on left side - retracted ventromedially too

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What suture material do you use to close the linea alba?

PDS - strong

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What are the surgical diseases of the stomach?

Foreign bodies
GDV
Neoplasia
Perforated gastric ulcer
Pyloric outflow obstruction
Hiatal hernia

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Where should you make a gastrotomy incision to remove a gastric foreign body?

Body

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How do you close the stomach?

Two layers - mucosa, submucosa(serosa)
Appositional followed by inverting
Continuous suture

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What are the different gastric surgeries?

Gastrostomy tube
Gastropexy - GDV
Partial gastrectomy
Pyloromyotomy - for pyloric outflow obstruction

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Where is the gastrostomy tube located?

Body of stomach on left side of the body wall behind last rib

How do you put in a gastrostomy tube?

Midline approach
Pull tube through left wall
Place purse string suture in stomach and stab incision through middle
Push mushroom tip of gastrostomy tube into stomach
Place simple sutures around tube

What are the surgical diseases of the small intestine?

Foreign bodies - simple, linear Intussusception Neoplasia Mesenteric volvulus/torsion

What surgery do you do to remove a SI foreign body?

Enterotomy - longitudinal antimesenteric incision distal to the FB

When do you do a resection and anastomosis of the SI?

If there is ischaemia or necrosis

What suture material do you use to close the intestine?

Monocryl

What suture pattern do you use for the SI?

Appositional Continuous or interrupted MUST engage submucosa - strength holding layer

What should you do if there is a size disparity when doing resection and anastomosis?

Spatulate the smaller portion on anti-mesenteric border

What can you use to reinforce SI suture line?

Omental patch - with simple interrupted sutures Serosal patch - suture jejunum to it

What is the treatment for intussusception?

Manual reduction - if early Resection and anastomosis - if necrotic

How can you reduce contamination in SI surgery?

Pack off organs with swabs Second dirty/GI kit Lavage prior to closure

What is the risk of dehiscence following GI surgery?

5-15% Highest for colonic surgery Less for gastric surgery

What are the signs of dehiscence?

Vomiting Depression Anorexia Abdominal pain

How do you treat septic peritonitis?

Rapid stabilisaiton Ex lap - explore abdomen, control source of contamination Lavage On-going drainage Nutritional support - feeding tube

What is the prognosis for septic peritonitis?

Poor - 20-70% mortality

How should you remove faeces before colonic surgery?

Natural - walk dog before Avoid preop enema - liquified faces in colon likely to leak Sterile surgical swab pushed up rectum forward

What are the main colorectal diseases?

Neoplasia Rectal prolapse Megacolon

What are the most common colorectal neoplasias?

Adenoma (mass effect), adenocarcinoma, lymphoma, leiomyoma Rectal polyps

What are the different colorectal surgical options?

Rectal pull out - benign neoplasia Rectal pull through - malignant Endoscopic/laparoscopic removal - difficult, expensive

How do you do a rectal pull out?

Use progressive stay sutures to pull out Then remove neoplasia

How do you do a rectal pull through?

Take wide margins Anastamose anus to colon Will lead to some faecal incontinence

What can cause a rectal prolapse?

Excessive straining - parasites, colitis, FBs, cystitis, prostatic diseases

What basic management do you use for a rectal prolapse before surgery?

Apply some lubrication, cover the prolapse Sugar and salt for the oedema if very swollen Analgesia straight away - stop straining Buster collar on Antibiotics - if infected but not otherwise

What is the surgical treatment for rectal prolapse?

Reduction and purse string suture Treat underlying cause

What could you do if rectal prolapse reoccurs?

Colopexy - suture to abdominal wall

What are the different anal diseases?

Anal furunculosis Anal neoplasia Anal sac disease Atresia ani Stricture Trauma

What is anal furunculosis?

Immune mediated perianal ulceration and inflammation Common in GSDs Rectocutaneous fistulae in the perineal tissues Very painful

Is anal furunculosis a surgical disease?

No Requires lifelong therapy - immunosuppressive medication Topical ciclosporin Hygeine therapy Analgesia

What perianal neoplasia do you get? What is most common?

Adenoma/adenocarcinoma In apocrine anal sac glands or perianal glands Circumanal gland adenoma most common

How do you treat circumanal gland neoplasia?

Majority seen in entire male dogs - castrate them (associated with androgen levels)

What are the different anal sac (apocrine glands) diseases?

Impaction Sacculitis Abscess Neoplasia

What is the surgery for recurrent/persistent anal sac disease?

Closed anal sacculectomy - closed due to risk of infection

What breed are predisposed to anal sac adenocarcinoma?

Cocker spaniels

What causes perineal hernia?

Failure of the pelvic diaphragm - levator ani and coccygeus muscles Associated with straining, megacolon

What is the surgical treatment for perineal hernia?

Castration Replace/fix herniated organs/tissues to normal position Resect/repair damaged tissues Close hernia ring