GI - SA surgery Flashcards
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
What benign oral masses can animals get?
Gingival hyperplasia
Epulides
Odontogenic cysts
What malignant oral neoplasia do dogs and cats get?
Cats - SCC
Dogs - fibrosarcoma, melanoma
What is the surgical treatment for oral neoplasia?
Mandibulectomy
Maxillectomy
How can you treat oro-nasal fistulae surgically?
Primary cleft - repair of harelip
Secondary cleft - palatal flaps
Dehiscence common
What are the surgical treatment for aural/nasopharyngeal polyps?
Resection - oral, just pull out
Bulla osteotomy
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
What is the name for tongue (partial) amputation? How much can you take?
Glossectomy - up to 40-60%
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
What structure do you need to be careful of in neck surgery?
Recurrent laryngeal nerve - close to incision
What salivary gland are most affected by mucocoeles?
Mandibular - cervical salivary mucocoele
Sublingual - sublingual (or ranula)
How do you treat mucocoeles?
Salivary gland excision
Marsupialise ranula - make hole and suture open
What are common foreign bodies?
Bones
Rawhide chews
Needles (cats)
Fish hooks (most common in cervical region as get stuck)
String
Toys
Hairballs
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
What type of surgery is an ex lap GI surgery?
Clean contaminated - if no spillage
Contaminated - spillage
Give therapeutic anitbiotics - amoxyclav
What can you use to improve access in an ex lap?
Retractors - balfour or gosset
Larger incision
Duodenal and colic manoeuvres
Pack swabs
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
What suture material do you use to close the linea alba?
PDS - strong
What are the surgical diseases of the stomach?
Foreign bodies
GDV
Neoplasia
Perforated gastric ulcer
Pyloric outflow obstruction
Hiatal hernia
Where should you make a gastrotomy incision to remove a gastric foreign body?
Body
How do you close the stomach?
Two layers - mucosa, submucosa(serosa)
Appositional followed by inverting
Continuous suture
What are the different gastric surgeries?
Gastrostomy tube
Gastropexy - GDV
Partial gastrectomy
Pyloromyotomy - for pyloric outflow obstruction
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
