GI surgery Flashcards
-otomy definition
opening something up then closing it again
-ostomy definition
opening something and keeping it open (gastrostomy= opening of the stomach to allow decompression or feeding bypassing the oesophagus, via a tube)
-oscopy definition
looking inside something (endoscope
-ectomy definition
removing something (enterectomy= removing part of the intestine)
-ectomy definition
removing something (enterectomy= removing part of the intestine)
pre-op care of GI patient
- often emergency surgeries
- fluid and electrolyte stabilisation
- starve for 12hrs ideally
surgical prep for oral surgery
- flush mouth with saline to remove debris
surgical prep for ventral midline laparotomy
- clip and aseptic prep of wide area to allow for wide incision
- above xiphoid to below pubis
surgical prep for anal/rectal surgery
- packing or purse string suture
- check positioning with surgeon
equipment for GI surgery
- tilt patient slightly as high risk of aspiration
- lap swabs to pack off abdomen
- pre-warmed saline for abdominal lavage
- stomach tube and bucket
suture material for GI surgery
- short duration, absorbable- GI tract heals quite quickly
- synthetic monofilament- braided can wick in infection
- taperpoint/round body needle ideal as least traumatic
treatment plan for GDV
- treat shock
- IV antibiotics
- decompressions of stomach through stomach tube
- right lateral radiograph to confirm diagnosis
- surgery to decompress and de-rotate stomach
what to monitor post op
- TPR
- CRT
- nutritional status (glucose levels)
- hydration status
- wound care
- analgesia
immediate post-op complications
- physiological abnormalities worsening (hypothermia, hypotension)
- pain
- haemorrhage
- drug/anaesthetic reaction
- vom/regurgitation
- wound breakdown
long term post-op complications
- pain
- haemorrhage
- aspiration pneumonia
- ileus (gut stops contracting)
- infection of wound
major complications following GI surgery
- dehiscence
dehiscence definition
- disruption of wound edges
- most common days 3-5 post-op
- skin, abdominal wall or intestines
skin/cutaneous dehiscence clinical signs
- usually 4-5 days post-op
clinical signs: - serosanguinous/purulent discharge
- swelling
- necrosis of edges
abdominal wall dehiscence clinical signs
- usually within first 7 days post-op
clinical signs: - wound oedema/inflammation
- serosanguinous drainage
- creates hernia
intestinal dehiscence clinical signs
- leads to septic peritonitis
- usually within 2-5 days post-op
clinical signs: - depression, anorexia, vom, abdominal pain, acute collapse
risk factors for dehiscence
- surgical technique (suture choice, tension)
- self trauma
- underlying neoplasia of area
- closure of non-viable skin
- systemic factors (obesity, endocrine disease, hypoproteinaemia, viral status of cat)
peritonitis
- inflammation of the peritoneum
primary peritonitis- only happens in cats
secondary peritonitis- result of another pathology - aseptic- reaction of surgery itself
- septic- infection
peritonitis causes
- dehiscence
- ischaemic necrosis
- leakage during surgery
- insufficient lavage
- insufficient prep
peritonitis clinical signs
- anorexia, vom, lethargy, pyrexia, acute collapse
- may adopt prayer position (sign of abdominal discomfort)
oesophagus complications
- regurgitation
- oesophagitis
- strictures
stomach complications
- vom
- anorexia
- ulceration
- gastric outlet obstruction (stricture)
- pancreatitis
small intestine complications
- peritoneal/serosal adhesions
- ileus
- perforation
- stenosis
- diarrhoea
- anorexia
large intestine complications
- haemorrhage
- faecal contamination
- leakage
- stricture
- stenosis
- incontinence
perineum, rectum and anus complications
- tenesmus
- rectal prolapse
- temp/perm incontinence
- anal stricture
- urethral obstruction
- stenosis
aims for post-op care plan
- restore hydration and maintain electrolyte balance
- resume normal feeding and gut motility
- manage GI effects (nausea)
- pain management
- prevent infection
useful drugs for managing nausea
- maropitant (anti-emetic, pain relief)
- cerenia, prevomax
- metoclopramide (anti-emetic, prokinetic)
- vomend, emeprid
pain management
NSAIDs- caution as can cause ulceration and GI upset
opiods- almost always used
- may affect gut motility
codeine- can cause constipation
paracetamol- dogs only
