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VET433: Gastroenterology > GI Surgery > Flashcards

GI Surgery Flashcards

1
Q

what perioperative antibiotic is used in all GI surgeries

A

cefazolin (high dose 1st generation cephalosporin)

used in simple GI sx:
- no septic abdomen
- no open bowel
- no spillage/perforation

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2
Q

when should broad spectrum antibiotics be used in GI surgery

A

perioperative and postoperative for:
- septic abdomen
- GI perforation

empiric: ampicillin + fluoroquinolone
- switch to specific Ab once culture and sensitivity comes back

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3
Q

what are the 4 criteria for assessing intestinal viability

A
  1. color
    - pink, red, slightly purple
  2. consistency
    - thick or normal (NOT thin)
  3. motility
    - may or may not be motile
    - motile guarantees viability
  4. bleeding/perfusion
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4
Q

what layer of the GI wall must be perfused for the intestine to be viable

A

seromuscular layer
- must bleed when incised

mucosa can be poorly perfused and still have viable intestine - will slough off and regenerate eventually

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5
Q

what is the holding layer in all GIT regions

A

submucosa

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6
Q

what suture material should be used to close the GIT

A

absorbable monofilament
(PDS)

NEVER use cutting needles

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7
Q

gastric closure

A

2 layers

  1. mucosa + submucosa
    - simple interrupted or continuous
  2. muscularis + serosa
    - inverted (lembert or Cushing)
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8
Q

small and large intestine closure

A

1 layer appositional
- simple interrupted or continuous

MUST include the submucosa in the closure but does not need to be full thickness (does not need to include mucosa)
- can be full thickness if unsure

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9
Q

characterstics of esophageal healing

A

SLOW due to:
- no serosa
- constant motion of the neck
- high tension area
- no omentum

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10
Q

what approach is used for esophageal surgery

A

cervical - ventral midline
cranial thoracic - L or R thoracotomy
caudal thoracic - L 7-9th intercostal

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11
Q

considerations for gastric surgery

A
  • balfour retractors
  • use packing to pad entire area
  • stay sutures to elevate and manipulate stomach

can resect up to 75% of the stomach without affecting lumen size

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12
Q

most common gastric neoplasia

A

gastric carcinoma

causes diffuse thickening of gastric wall (US) + severe, intractable vomiting

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13
Q

what causes gastric ulceration

A

NSAID/corticosteroid use
hepatic disease
renal disease
neoplasia

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14
Q

blood supply of the jejunum

A

vascular arcades - makes for natural breakpoints for resection

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15
Q

duodenocolic ligament

A

located at the duodenal flexure where the descending duodenum turns into ascending duodenum

does NOT have substantial blood supply - can be incised

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16
Q

indication for small intestinal biopsies

A

chronic enteropathies

goal: sample multiple sites of the SI using a punch biopsy or full thickness (if indicated)

17
Q

where should you incise into the intestine to remove a foreign body

A

aborad to the foreign body (healthy tissue)

orad segment will be inflammed/swollen

18
Q

intestinal resection & anastomosis considerations

A

always plot out where on the arcades to make ligatures to ensure remaining vessels are well supplied

crushing clamps - most important; placed over the point of resection to separate healthy tissue from nonvital

noncrushing clamps - functions to block the flow of GI contents; placed 1-2 mm from resection site on the part of the body remaining in the body

always ligate on BOTH sides of the crushing clamp

19
Q

how to handle luminal disparity during closure

A

place sutures on the large diameter segment at WIDER intervals and place sutures on the smaller diameter segment at NARROWER intervals

20
Q

intestinal anastomosis technique

A

place 3 stay sutures at the mesenteric border to prevent loss of visualization

use simple interrupted sutures around the diameter, placing the first at the bottom of the circumference and the second at the top to ensure adequate apposition

always close the mesenteric rent (hole created in mesentery)

21
Q

how to test the closure

A

pinch off segments orad and aborad to the anastamosis and inject saline to test for leakage

22
Q

technique for removing linear foreign bodies

A
  1. remove the anchor at the tongue base or pylorus
  2. gastrotomy +/- enterotomy - remove the foreign body
  3. examine mesenteric border for perforations
  4. resect areas of perforations
  5. run the entire bowel to check for tension
23
Q

intussusception

A

telescoping of one part of the bowel into another

occurs in YOUNG dogs/cats with underlying enteropathy

occurs in OLD dogs/cats with neoplasia

24
Q

how to resolve intussuception

A

reduce the telescoping by milking the intussusceptum and pulling the intussuscipiens to remove

monitor for revascularization

25
Q

risks of recto-colonic surgery

A

dehiscence
slower healing
less reliable blood supply
higher anaerobic bacterial load
more tension

26
Q

vasa recta

A

many small vessels that branch off of the ileocolic and colic arteries to feed segments of the colon

27
Q

cranial rectal artery

A

branch of the caudal mesenteric artery that supplies the distal colon

28
Q

indications for colo-rectal resection

A
  1. colonic neoplasia
  2. feline megacolon
  3. rectal neoplasia
  4. colonic foreign bodies that do not pass
29
Q

are full thickness biopsies indicated in colon

A

NO - can get full diagnostics with a scope

30
Q

feline megacolon

A

idiopathic disturbance in the activation of smooth muscle myofilaments

signs:
- fecal tenesmus
- pain defecating
- vomiting
- anorexia
- dehydration

31
Q

feline megacolon dx and tx

A

dx: radiographs - colon distension and fecal impaction

tx: subtotal colectomy - remove 95% of entire colon

32
Q

is rectal neoplasia more common in dogs or cats

A

dogs

33
Q

what is the most common rectal neoplasia in dogs

A

epithelial
- polyps
- carcinoma in situ
- adenocarcinoma

undergoes malignant transformation to gradually invade the wall

34
Q

diagnosis of rectal neoplasia

A

if superficial and coming out of the rectum:
- FNA
- core biopsy
- incisional biopsy

if proximal:
- proctoscopy
- colonoscopy

35
Q

mucosal eversion

A

retraction of the mucosal margins of the rectum using stay sutures

used for noninvasive (polyps) and superficial (caudal 1/3 of rectum) masses

36
Q

indications for anal sacculectomy

A
  1. anal sac neoplasia - non-elective
  2. anal sacculitis, infection, impaction - elective
37
Q

what kind of neoplasia affects the anal sac

A

apocrine gland adenocarcinoma

may need to do a lymphadenectomy as well

38
Q

technique for anal sacculectomy

A

closed approach - incise over the sac and dissect from the outside

VET433: Gastroenterology (16 decks)

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