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RUSVM Small Animal Surgery 2017 > GI Surgery > Flashcards

GI Surgery Flashcards

1
Q

Why is healing delayed with the esophagus?

A

there is no omentum around the esophagus

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2
Q

What layer is missing in the esophagus?

A

serosal layer

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3
Q

What are the causes of Gastric Foreign Bodies?

A

Ingested by patient

Penetrating wound

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4
Q

What are the common Gastric Foreign bodies for dogs?

A

Rocks
Toys
anything

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5
Q

What are the common Gastric Foreign Bodies for cats?

A

Trichobezoars
Needle
String

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6
Q

What disease predispose to Gastric Foreign body ingestion?

A

Pancreatic exocrine insufficiency
Hepatic encephalopathy
Iron deficiency

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7
Q

What is the cause of anemia in Gastric Foreign Body?

A

Bleeding

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8
Q

What is the cause of Azotemia in Gastric Foreign Body?

A

dehydration

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9
Q

What is the cause of Alkalosis in Gastric Foreign Body?

A

Vomiting

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10
Q

What is the cause of Acidosis in Gastric Foreign Body?

A

Dehydration

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11
Q

What is the cause of Hypokalemia in Gastric Foreign Body?

A

Not Eating and Vomiting

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12
Q

What is the cause of Hypochloremia in Gastric Foreign Body?

A

vomiting and not eating

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13
Q

What are the laboratory findings in gastric foreign body?

A 
Anemia
Azotemia
Alkalosis or acidosis
Hypokalemia
Hypochloremia
Leukocytosis
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14
Q

What is a noninvasive way to remove and view Gastric Foreign Body?

A

Endoscopy

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15
Q

What are the 4 ways to treat gastric foreign body?

A
  1. Treat with fluids, gastro-protectants and antiemetics and hope the foreign body passes
  2. Remove the endoscopy
  3. Induce emesis for removal
  4. Perform surgery to remove the foreign body immediately
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16
Q

What specific treatments are for Lead and Zinc foreign bodies?

A

Chelating agents

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17
Q

-otomy

A

cutting into

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18
Q

-ectomy

A

cutting a section out

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19
Q

-ostomy

A

making a hole

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20
Q

What is the function of the gastric pacemaker?

A

controls normal gastric contractions

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21
Q

What approach do you make for a Gastric Foreign Body surgery?

A

Dorsal recumbency

Ventral midline approach

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22
Q

What forceps should you NOT use on a gastrotomy?

A

Babcock forceps

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23
Q

Why do you need to change gloves and instruments when removing a gastric foreign body?

A

they are contaminated with stomach contents

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24
Q

What is the layer of strength in the stomach?

A

Submucosa

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25
Q

Why is serosa to serosa contact important?

A

Creates a fibrin water tight seal

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26
Q

What is the traditional 2 layer closure for the stomach?

A

Cushing pattern oversewn with Lembert

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27
Q

What are the two alternative techniques for stomach closure?

A

Simple continuous in submucosa and a cushing pattern in seromuscular layers
Simple continuous in serosa and cushing pattern in seromuscular layers

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28
Q

What is the problem with the Lembert pattern?

A

no serosa to serosa apposition

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29
Q

What is the difference between the Connell and the Cushing pattern?

A

Connell - Full thickness

Cushing - not full thickness

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30
Q

What is the problem with the simple continuous pattern in the serosa and the cushing pattern in the seromuscular layer?

A

inverts the tissue more and reduces gastric volume

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31
Q

What type of pattern do you not want to use with a pyloric stenosis?

A

No inverting patterns

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32
Q

What causes Congenital Pyloric Stenosis?

A

Hypertrophy of circular muscles

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33
Q

What breeds are predisposed to Congenital pyloric stenosis?

A

Brachiocephalic breeds

Siamese Cats

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34
Q

What layer of the pylorus is affected by congenital pyloric stenosis?

A

Muscular layer

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35
Q

What are the clinical signs of Congenital Pyloric stenosis?

A

Intermittent vomiting
Dietary modification alters signs
Normal to decreased body condition
Abdominal distension but no pain

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36
Q

If clinical signs improve with a liquid diet what is the diagnosis?

A

Congenital Pyloric Stenosis

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37
Q

What sign will you see on contrast radiography with Pyloric Stenosis?

A

“Beak or Apple core” sign

Delayed gastric emptying

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38
Q

What is the number one way to diagnose Pyloric Stenosis?

A

Ultrasound

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39
Q

What are the different treatments for Pyloric Stenosis?

A

Fredet-Ramstedt Pyloromyotomy

Heineke-Mikulicz Pyloroplasty

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40
Q

What is the advantage of the Fredet-Ramstedt Pyloromyotomy?

A

Limited contamination

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41
Q

What is the disadvantage of Heineke-Mikulicz Pyloroplasty?

A

goes into the lumen of the pylorus

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42
Q

When would you perform the Fredet-Ramstedt Pyloromyotomy?

A

Congenital Pyloric Stenosis

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43
Q

What is a Grade 1 Acquired Pyloric Stenosis?

A

Muscular hypertrophy

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44
Q

How would you treat a Grade 1 Acquired Pyloric Stenosis?

A

Heineke-Mikulicz

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45
Q

What is a Grade 2 Acquired Pyloric Stenosis?

A

Mucosal and Muscular Hypertrophy

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46
Q

What is a Grade 3 Acquired Pyloric Stenosis?

A

Submucosal, Mucosal, and Muscualr hypertrophy

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47
Q

What is the signalment for Acquired Pyloric Stenosis?

A

Small breeds: Lhasa Apso, Shih Tzu
Excitable or vicious
Middle aged males

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48
Q

What is the most useful diagnostic modality for Chronic Hypertrophy Pyloric Gastropathy?

A

Ultrasound

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49
Q

What are the clinical signs of Chronic Hypertrophy Pyloric Gastropathy?

A

Intermittent vomiting
Vomiting frequency increases over time
Dietary modification affects frequency

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50
Q

What do you see on Radiography with Chronic Hypertrophy Pyloric Gastropathy?

A

Gastric Distension

Delayed gastric emptying

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51
Q

What do you see on Ultrasound with Chronic Hypertrophy Pyloric Gastropathy?

A

Pyloric wall and muscle thickness

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52
Q

Describe the Y-U pyloroplasty

A

Transposes antral wall to pyloric region
creates a wider pylorus
Suture antral flap to base

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53
Q

What pattern would you use in the Y-U Pyloroplasty?

A

Simple continuous

Simple Interrupted

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54
Q

What is an advantage of the Y-U pyloroplasty?

A

Transection of gastrohepatic ligament provides better exposure

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55
Q

Why must you suture back the defect in the Y-U Pyloroplasty?

A

provides protection from gastric ulceration

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56
Q

When would you perform a Pylorectomy with Gastroduedenostomy?

A

Severe acquired pyloric stenosis in middle aged animals

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57
Q

What suture do you use with a Pylorectomy with Gastroduedenostomy?

A

3-0 monfilament PDS or monocryl suture

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58
Q

What forceps do you use with a Pylorectomy with Gastroduedenostomy?

A

Doyen Forceps

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59
Q

Doyen Forceps

A

Non traumatic forceps to decrease contamination from the GI contents

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60
Q

What are the advantages to the Billroth 1?

A

Abnormal tissue completely removed

Large increase in gastric outflow

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61
Q

What are the disadvantages to the Billroth 1?

A

Technically difficult
Longer procedure
Increased risk of leakage
Resecting a lot of tissue and higher risk of dehiscence, leakage, and contamination

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62
Q

What is the most common Gastric Neoplasia in dogs?

A

Adenocarcinoma

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63
Q

What is the most common gastric neoplasia in cats?

A

Lymphoma

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64
Q

What are the clinical signs of Gastric outflow obstruction?

A 
Vomiting
Anorexia
Regurgitation
melena
hematomesis
pain
weight loss
abdominal distension
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65
Q

What are the laboratory findings of Gastric Neoplasia?

A

Anemia
Acidosis
Hypochloremia
Hypokalemia

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66
Q

What is the signalment for Gastric Adenocarcinoma?

A

Older Males

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67
Q

Where is Gastric Adenocarcinoma usually located?

A

Pyloric antrum

lesser curvature

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68
Q

Where does Gastric Adenocarcinoma usually metastasize?

A

Regional Lymph nodes

Liver

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69
Q

What are the different types of Gastric Adenocarcinoma?

A

Infiltrative
Ulcerated mucosal plaques
Discrete polypoid

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70
Q

What are the most common forms of Gastric Adenocarcinoma?

A

Infiltrative

Ulcerative mucosal plaques

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71
Q

Linitis plastica

A

a thickened tissue that is a line of demarcation of the tumor

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72
Q

What can you see on contrast radiographs with Gastric Adenocarcinoma?

A

Filling defects
Delayed gastric emptying
loss of rugal folds
mucosal thickening

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73
Q

What should you evaluated with ultrasound with Gastric Adenocarcinoma?

A

Liver and lymph nodes

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74
Q

What is the preferred test for diagnosis of Gastric Adenocarcinoma

A

Endoscopy

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75
Q

What are the treatments for Gastric Adenocarcinoma?

A

Aggressive surgical excision: Gastrectomy, Billroth 1, Billroth 2 or Cholecystoenterostomy

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76
Q

What is wrong with Billroth 2?

A

High Morbidity and aggressive

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77
Q

When is Gastrectomy indicated?

A

Neoplasia
Ischemic injury
Ulcer
Trauma

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78
Q

Billroth 2

A

Gastrectomy with gastrojejunostomy

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79
Q

What are the complications of Billroth 2?

A

Alkaline gastritis due to Bile and pancreatic secretions flowing into stomach
“Blind loop” syndrome - gastric contents move orally and putrefy
Marginal ulceration of the jejunum mucosa due to acid

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80
Q

What is the advantage of Roux-en-Y Anastomosis?

A

Avoids alkaline reflux gastritis and decreases likelihood of blind loop syndrome

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81
Q

What is still a problem with Roux-en-Y Anastomosis?

A

Marginal ulceration still an issue

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82
Q

What is the signalment for Gastric Leiomyosarcoma?

A

Middle aged

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83
Q

Where is the most common place for Gastric Leiomyosarcoma?

A

Cardia

Pylorus

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84
Q

What is the signalment of Gastric Leiomyoma?

A

Older patients

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85
Q

How would you treat Gastric Leiomyoma?

A

Gastrotomy incision into the mucosa and scoop out the tumor from the submucosa

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86
Q

What time of year do you see Pythiosis?

A

Fall

Winter

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87
Q

Where do you find Pythiosis?

A

aquatic environment

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88
Q

What is the signalment for Pythiosis?

A

young large breed working dogs

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89
Q

What layers of the stomach are affected by Pythiosis?

A

Submucosa and muscularis

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90
Q

What are the clinical signs of Pythiosis?

A 
Weight loss
vomiting
diarrhea
hematochezia
palpable abdominal mass
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91
Q

How do you diagnose Pythiosis?

A

ELISA Snap Test

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92
Q

How do you treat Pythiosis?

A

Surgical excision
medical treatment
Itraconazole and Terbinafine

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93
Q

What is the prognosis for Pythiosis?

A

guarded to poor

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94
Q

GDV

A

Gastric Dilatation Volvulus

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95
Q

Acute Gastric Dilation

A

Stomach is in the normal position but distended

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96
Q

Chronic Gastric Volvulus

A

Slight malposition of the stomach

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97
Q

How do you treat Acute Gastric dilation?

A

Emesis and wait for digestion

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98
Q

How do you confirm GDV?

A

Contrast Studies

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99
Q

Gastric Dilation Volvulus

A

Distension of the stomach and rotation of the stomach on its mesenteric axis

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100
Q

What is the pathophysiology of GDV?

A

Stomach distension through gas, fluid or fermentation that limits eructation and emptying causing further distension, clockwise rotation of the stomach and pylorus

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101
Q

What are the different types of GDV?

A

Clockwise

Counterclockwise

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102
Q

Clockwise GDV

A

70-360 degree rotation of the stomach

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103
Q

What is the key to identifying a Clockwise GDV?

A

Greater omentum covers stomach

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104
Q

Counterclockwise GDV

A

Limited to 90 degrees rotation

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105
Q

Which GDV is more symptomatic?

A

Clockwise GDV

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106
Q

What are the predisposing factors of GDV?

A 
Large and Giant Breeds 
Deep chested dogs 
First degree relative
Faster eating
Larger volumes daily 
Raised Food Bowls
Post prandial activity
Fats and oils
Restricting water before/after feeding 
Egg or fish decreases risk
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107
Q

Why is age a predisposing factor?

A

ligaments of the stomach are stretched

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108
Q

What is the #1 cause of death in GDV patients?

A

Hypovolemic Shock

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109
Q

What are the cardiovascular effects of GDV?

A 
Compression of low pressure veins
Decreased pre load, afterload, CO, BP
Catecholamines causing vasoconstriction, tachycardia, and increased BP
Arrhythmias
Myocardial hypoxia
Metabolic acidosis 
Myocardial depressant hormone released
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110
Q

What is the most common Arrhythmia caused by GDV?

A

VPCs

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111
Q

What happens with Reperfusion injury?

A

Accumulation of toxic waste products from Anaerobic metabolism released into general circulation causing Capillary permeability, Altered vascular tone, platelet activation, vascular occlusions, Fever, Negative Inotrope

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112
Q

What are the respiratory effects of GDV?

A 
Impingement on diaphragm
Decreased excursions 
Decreased TV
Increased CO2
Respiratory acidosis
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113
Q

What are the GIT effects of GDV?

A

Gastric distension
Vascular compromise of stomach mucosa
Mucosal hemorrhage and necrosis

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114
Q

What are the metabolic effects of GDV?

A 
Poor tissue perfusion 
Cellular hypoxia
Anaerobic metabolism
Increased Lactate
Metabolic acidosis
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115
Q

What are the immune effects of GDV?

A 
Hypoxemia causes mucosal ischemia
Loss of protective barrier
Bacterial translocation
Damage to mucosal associate lymphatics 
Portal hypertension
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116
Q

What happens to Potassium with GDV?

A

Potassium shifts outside of the cells
Catecholamines shift potassium intracellular
Potassium sequestered in gut and lost from vomiting

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117
Q

What happens to Glucose with GDV?

A

Decreased perfusion causes Anaerobic metabolism and inefficient glucose utilization causes Hypoglycemia

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118
Q

What are the Renal effects of GDV?

A

Profound vasoconstriction causes increased BP and decreased GFR
Oliguria/Anuria
Acute renal failure

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119
Q

What are the physical findings of GDV?

A 
Distended painful tympanic abdomen
Active retching 
Hypersalivation 
Tachypnea
Tachycardia 
Collapse
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120
Q

What are the laboratory findings of GDV?

A 
Increased WBC (stress leukogram)
Increased ALT
Increased bilirubin
increased BUN/Creatinine
Hypokalemia
Increased lactate
Decreased clotting times become increased clotting times and DIC
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121
Q

What radiographic view is diagnostic for GDV?

A

Right Lateral

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122
Q

What do you see on radiographs for GDV?

A

Gastric dilation with compartmentalization
Malposition of pylorus
“Double bubble” sign

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123
Q

What is the first treatment for GDV?

A

Fluids

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124
Q

What are the treatments for GDV?

A

Fluids
Decompression
Pain Management
Antimicrobials and free radical scavengers

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125
Q

Why do you give antibiotics for GDV?

A

Bacterial translocation due too sloughing and hemorrhage of the GI tract

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126
Q

What does free radical scavengers treat with GDV?

A

reperfusion injury

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127
Q

What fluids do you use with the treatment of GDV?

A

Combination of

Crystalloids and Colloids

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128
Q

What is a prognostic indicator of GDV?

A

Lactate

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129
Q

Why do you use Colloids in the treatment of GDV?

A

decrease third spacing from reperfusion injury

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130
Q

What vein is the less desirable for the fluid administration in the treatment of GDV?

A

Saphenous

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131
Q

What is a possible complications from Gastric Decompression?

A

Esophageal perforation

CV instability from endotoxins

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132
Q

What are the different types of Gastric decompression?

A

Orogastric intubation
Trocharization
Emergency gastrostomy

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133
Q

What is the advantage to Gastric Decompression?

A

Improves cardiac and respiratory function

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134
Q

What do you perform when you are unable to pass a orogastric tube?

A

Trocharization

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135
Q

What is a complication of trocharization?

A

Puncturing the spleen

Lacerating the stomach causing peritonitis

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136
Q

What is the last procedure you perform after trocharization and orogastric intubation have failed for gastric decompression?

A

Emergency Gastrostomy

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137
Q

What approach do you make for an Emergency Gastrostomy?

A

Right Paracostal Approach

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138
Q

Describe the Emergency Gastrostomy

A

Incision through the abdominal Muscles to isolate the stomach. Suture the stomach to the incision and incise the stomach

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139
Q

What is the disadvantage of the Emergency Gastrostomy?

A

Will have to do more repaire when you reach surgery and some reconstruction

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140
Q

What are some other important treatments for GDV?

A

Oxygen therapy
Pain control
Correct electrolyte imbalance

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141
Q

What should you AVOID in GDV treatment?

A

Glucocorticosteroids

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142
Q

Why should you avoid Glucocorticosteroids in GDV treatment?

A

They are immunosuppressive, delay healing, and ulceragenic

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143
Q

What are the free radical scavengers used in GDV treatment?

A 
Acetylcysteine
Vitamin C and E
Selenium 
Deferoxamine - iron chelator
Lidocaine
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144
Q

Why is it good to use Lidocaine for GDV treatment?

A

Treats arrhythmias
Free radical scavenger
Pain control

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145
Q

What are the goals of surgical treatment of GDV?

A

Determine gastric and splenic viability
Correct gastric and splenic positioning
Prevent gastric malposition recoccurence

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146
Q

What increases the mortality of GDV patients?

A

Gastric wall necrosis

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147
Q

How do you approach a GDV surgery?

A

Vental midline celiotomy

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148
Q

What will occur when you derotate the stomach?

A

Reperfusion episode

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149
Q

How do you assess gastric wall viability?

A 
Peristalsis
Serosal color
Palpate for thinning or friability of the stomach wall 
Pulsation of vessels
Bleeding of cut surfaces
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150
Q

What do you perform on a stomach with gastric necrosis?

A

Partial Gastrectomy

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151
Q

Where do you normally find gastric necrosis?

A

Greater curvature of the stomach

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152
Q

What layer must you engage for stomach apposition?

A

submucosal layer

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153
Q

When would you perform a Gastric Invagination?

A

If the stomach necrosis is small or questionable

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154
Q

What is a disadvantage of performing a Gastric Invagination?

A

High risk of obstructing gastric outflow at the pylorus
Stomach becomes smaller
Risk of gastric ulceration

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155
Q

What is an advantage of gastric invagination?

A

decreases contamination

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156
Q

What should you do before closing a patient after GDV surgery?

A

Evaluate the spleen

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157
Q

What should you evaluate the spleen for?

A

Venous congestion
vessel thrombosis
Spenic torsion

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158
Q

What should you do if you see splenic torsion in a patient with GDV?

A

Remove the spleen

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159
Q

What will happen if you have vessel thrombosis of the spleen?

A

shedding of Clostridial organisms

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160
Q

What do you suture in a Gastropexy?

A

Pyloric antrum/right lateral body wall

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161
Q

Why perform a Gastropexy?

A

decreases recurrence rate

162
Q

What does Gastropexy not prevent?

A

dilation

163
Q

What are the different types of Gastropexy?

A

Incisional
Belt Loop
Circumcostal
Tube Gastropexy/Gastrotomy

164
Q

What type of suture do you use for a Gastropexy?

A

3-0 or 2-0 monofilament absorbable suture

165
Q

What is the disadvantage of the Belt Loop and Circumcostal Gastropexy?

A

Takes longer than the incisional method

166
Q

What is the advantage of a Tube Gastropexy/Gastrostomy?

A

Allows the patient to be fed through the tube after surgery

Maintains decompression of the stomach

167
Q

When do you perform a Tube gastropexy/Gastrostomy?

A

when a patient has severe necrosis and will not be eating well after surgery

168
Q

What is the pathophysiology behind Intestinal Foreign Body?

A

Proximal gas and fluid accumulation

Wall Ischemia

169
Q

What causes distension?

A

Accumulation of secretions proximal to the obstruction

170
Q

What complications come from distension?

A

venous congestion
mucosal sloughing
bacterial translocation
peritonitis

171
Q

What are the clinical signs of Intestinal Foreign Body?

A 
Anorexia 
vomiting
depression 
abdominal pain 
diarrhea
172
Q

What do you see on radiographs with and intestinal foreign body?

A

Multiple loops of gas filled dilated intestines

Ratio-small intestine diameter/ L5 height

173
Q

What is the treatment for Intestinal Foreign Body?

A

Explore the entire abdomen
Enterotomy
Evaluate viability of the Intestines

174
Q

How do you evaluate Intestinal viability?

A 
Peristalsis-pinch test 
Color
Pulsation of vessels 
Wall texture/thickness
Fluorescein infusion 
Surface oximetry
175
Q

What is the incision used in Enterotomy?

A

Longitudinal incison

176
Q

What suture do you use with an Enterotomy?

A

3-0 monofilament

177
Q

What suture pattern do you use with an Enterotomy?

A

Simple continuous

Simple interupted

178
Q

What is important to do with an Enterotomy?

A

Ometalize

179
Q

Why do you Omentalize?

A 
Angiogenic 
Immunogenic
Adhesive 
Controls infection 
Lymph drainage
180
Q

What are the indications for Resection and Anastomosis?

A

Removal of necrotic or ischemic intestines
Removal of irreducible intussusceptions
Removal of traumatized intestine
Removal of neoplasms

181
Q

What forceps do you use during an Enterotomy?

A

Doyen Forceps

182
Q

What suture would you use during an Enterotomy that is less susceptible to infection?

A

Monofilament synthetic absorbable or non absorbable

183
Q

What are the different Suture choices for closing an Enterotomy?

A

Monfilament suture

Surgical staples

184
Q

What are the complications for Multifilament absorbable suture in an Enterotomy?

A

More tissue drag

Potentiates infection

185
Q

What is the layer of strength in the intestine?

A

Submucosa

186
Q

What is the reason for apposing the submucosa in the intestinal surgery?

A

Water tight seal

Better healing

187
Q

What suture pattern is not used for Intestinal surgery?

A

Inverting pattern

Double layer closure

188
Q

What are the complications for using double layer closure and inverting pattern in an enterotomy?

A

decrease lumenal size
predispose to obstruction
compromise blood supply to that segment and less likely to get submucosal apposition

189
Q

What is the best suture pattern for an enterotomy?

A

Modified Gambee

190
Q

What are the four ways to Manage Lumen Disparity?

A
  1. Angle the smaller segment to increase the surface area to attach to the larger diameter
  2. place sutures in a more strategic manner to corrugate and suit the other diameter
  3. “fish mouth” the smaller diameter to attach to the other segment
  4. suture part of the larger diameter to make it smaller to attach to the smaller segment
191
Q

Serosal Patching

A

Securing a antimesenteric border of small intestine over a suture line or defect

192
Q

What are the indications for Serosal Patching?

A

When omentum is not available
Closure integrity is questionable
Non resectable duodenal defects
Enterotomy, Colotomy, Urinary bladder

193
Q

What is a linear Foreign Body?

A 
Thread 
Nylone 
Stocking 
Rope 
String
194
Q

What species are Linear Foreign Bodies common in?

A

Cats

195
Q

Where does Linear Foreign Bodies anchor?

A

Base of tongue

Pylorus

196
Q

What is the complications of Linear Foreign Bodies?

A

embed in mesenteric border

perforate intestines

197
Q

What are the clinical signs of Foreign Bodies?

A 
Vomiting 
Anorexia 
depression 
Abdominal pain 
Clumping and pleating of intestine
198
Q

What do you see on Radiographs with Linear Foreign Bodies?

A

Plicated intestines

Bunched in central abdomen

199
Q

What do you see on Contract study with Intestinal Foreign Body?

A

Obvious pleating

Teardrop shaped air bubbles

200
Q

What is the treatment for Linear Foreign Bodies?

A

Free FB from under the tongue

Enterotomy

201
Q

What are complications of Intestinal surgery?

A

Septic peritonitis
Adhesions
Dehiscence risk factors

202
Q

What risk factors cause Dehiscence?

A

Technical errors
Multiple Intestinal procedures
Pre-existing peritonitis
Lack of omentum

203
Q

What causes Intestinal Ileus?

A

Stimulation of sympathetic nervous system
Rough tissue handling
Long surgical time
Extensive resection

204
Q

What are the clinical signs of Intestinal Ileus?

A

Regurgitation
vomiting
pain

205
Q

How do you treat Intestinal Ileus?

A

Fluids
electrolytes
prokinetics

206
Q

How do you avoid Short bowel syndrome?

A

Provide nutritional support to allow the bowel to adapt

Allow intestinal adaptation

207
Q

What is the problem with Short Bowel Syndrome?

A

May never resolve

208
Q

Intussusception

A

Invagination of one portion of bowel loop into an adjacent segment

209
Q

What is the etiology of Intussusception?

A

Previous illness: virus, bacteria or parasites

Recent intestinal surgery

210
Q

What is the clinical signs of proximal intussusception?

A

vomiting

Abdominal pain

211
Q

What is the clinical signs of Distal Intussusception?

A

Tenesmus

Abdominal pain

212
Q

What do you see on radiographs with Intussusception?

A

Abdominal mass effect

Gas accumulation proximally

213
Q

What is the surgical management for Intussusception?

A

Attempt manual reduction
resection and anastomosis of necrotic bowel
Perform enteroplication

214
Q

Mesenteric Torsion

A

Intestine twisting on mesenteric axis

215
Q

What are the possible causes for Mesenteric Torsion?

A

Lymphocytic enteritis
Ileocolic carcinoma
GIT foreigns body

216
Q

What are the clinical sign sof Mesenteric torsion?

A

Abdominal distension
Hematochezia
Collapse and death

217
Q

How do you treat Mesenteric Torsion?

A

Fluid resuscitation

immediate surgery: untwist the torsion and resection/anastomosis

218
Q

What is the most common intestinal malignancy in dogs?

A

Adenocarcinoma

219
Q

What is the most common rectal neoplasia in dog?

A

Adenomatous polyp

220
Q

What is the most common neoplasia in cats?

A

Lymphosarcoma

Adenocarcinoma

221
Q

What is the clinical signs of Intestinal neoplasia?

A 
Depression 
Anorexia 
lethargy
vomiting 
weight loss
diarrhea
222
Q

How do you treat intestinal neoplasia?

A

Resection

223
Q

What are the techniques for surgical intestinal biopsy?

A

Longitudinal biopsy with longitudinal closure
Longitudinal biopsy with transverse closure
Transverse biopsy
Dermal Punch

224
Q

What are the advantages of Ultrasound Guided biopsy?

A

Obtain sample from any part of the intestine
Safe and quick
Can sample lymph nodes or other masses

225
Q

What are the disadvantages of Ultrasound Guided biopsy?

A

Insensitive in detecting mucosal lesions
can miss focal lesions
tumor seeding

226
Q

What is the advantage of flexible endoscopy biopsy?

A

Least Invasive

Able to visualize mucosa

227
Q

What is the advantage of Laparoscopic assisted Biopsy?

A

Can biopsy jejunum and other organs

Full thickness biopsies

228
Q

What is the disadvantage of Laparoscopic assisted Biopsy?

A

Cannot visualize mucosal lesions

229
Q

What antibiotic would you choose for the Proximal Small intestine?

A

1st generation cephalosporin

230
Q

What antibiotic would you choose for the Distal and large intestine?

A

2nd generation cephalosporin

231
Q

What is the post op care for intestinal surgery?

A

Taper fluid and electrolyte therapy as oral intake returns
Offer water 8-12 hours post op
If no vomiting offer bland food the day after surgery
Pain management

232
Q

What should you monitor in GI surgery patients?

A 
General attitude
MM
Abdominal palpation 
Temp
CBC
Abdominocentesis
233
Q

What is the function of the spleen?

A

Reservoir for platelets, phagocytes, RBC
Lymphocyte production and storage
Extramedullary hematopoeisis
Filtration of blood: removal of abnormal RBCs, infectious organisms, denatured hemoglobin

234
Q

What is the diagnostic of choice for the Spleen?

A

Ultrasound

235
Q

What are the differntials for a Hyperechoic Spleen?

A

Nodular hyperplasia
Neoplasia
Hematoma

236
Q

What is a Hypoechoic rim with a Hyperechoic center on Ultrasound of the spleen?

A

Malignancies

237
Q

What suture would you use for Splenorrhaphy?

A

4-0 monofilament absorbable suture

238
Q

What is the suture pattern for Splenorrhaphy?

A

Interrupted mattress pattern

239
Q

How would you control hemorrhage of the spleen?

A

direct pressure

240
Q

What is the advantage of Partial Splenectomy?

A

Preserves function

241
Q

What are the indications for Partial Splenectomy?

A

Focal abscesses

Focal injury

242
Q

What are the contraindications for a Partial Splenectomy?

A

Neoplasia

243
Q

What are the indications for Total Splenectomy?

A

Neoplasia
Torsion
Severe trauma
IMHA refractory to medications

244
Q

How would you approach a Total Splenectomy?

A

Ventral Midline

245
Q

Why must you handle the spleen gently during a Total Splenectomy?

A

Iatrogenic rupture

246
Q

Where on the Spleen must you perform a double ligation during a Total Splenectomy?

A

Hilus

247
Q

What is the advantage of approaching the spleen from the ometal bursa during a Total Splenectomy?

A

Fewer ligatures
Less Manipulation
Zone of Resection

248
Q

What causes a symmetrical generalized Splenomegaly?

A

Inflammation: Bacteria, Viral, Fungal, parasitic
Immune Reaction
Congestion: RHF, Portal Hypertension, VAscular outflow obstruction, or Drugs
Infiltration: Neoplasia

249
Q

What causes an asymmetrical Localized Splenomegaly?

A 
Nodular Hyperplasia
Segmental infarction 
Siderotic plaques
Splenosis
Neoplasia: Benign or Malignant
250
Q

What is a complications of Nodular Hyperplasia?

A

Rupture causes Hemoabdomen

251
Q

What causes splenic infarction?

A

Thrombosis or hypercoagulable states: Renal Disease, Hyperadrenocorticism, Neoplasia, DIC, Heart Disease,
Prior Splenic Torison

252
Q

Siderotic Plaques

A

Tan or rust colored plaques on the margin primarily of iron or calcium caused by aging

253
Q

What causes Splenosis?

A

Congenital or traumatic

254
Q

Splenosis

A

Multiple nodules of normal splenic tissue in the abdominal cavity caused by trauma or congenital

255
Q

What are the surgical treatments for Splenic Trauma?

A

Splenorrhaphy
Partial Splenectomy
Total Splenectomy

256
Q

What are the diagnostic measures for Splenic Trauma?

A

Serial PCV/TP

Measure abdominal circumference

257
Q

Splenic Torsion

A

Twisting of the spleen on its vascular axis

258
Q

What are the possible etiologies for Splenic torsion?

A

Abnormality or trauma of gastrosplenic or splenocolic ligament
Maybe GDV

259
Q

What are the clinical signs of Acute Splenic torsion?

A

Acute abdominal pain and distension
Arrhythmias
DIC
Collapse

260
Q

What are the clinical signs associated with Chronic Splenic torsion?

A

Lethargy
Anorexia
Intermittent vomiting and Diarrhea
Weight loss

261
Q

What is the treatment for Splenic Torsion?

A

Splenectomy

Gastropexy

262
Q

What are the clinical signs of Splenic Hemangiosarcoma?

A 
Decreased appetite
Anorexia 
Lethargy 
Weight loss
Abdominal distension 
Acute collapse
263
Q

What is the treatment for benign Splenic Masses?

A

Splenectomy and Histopathology

264
Q

What is the treatment for Splenic Hemangiosarcoma?

A

Stabilize the patient

Splenectomy

265
Q

What are the complications of Splenectomy?

A 
Improper ligation 
other abdominal tumors
Ligation proximal to pancreatic artery
Splenic torsion 
VPCs
Myocardial hypoxia from hypertension and anemia
MDF from pancreas
266
Q

What are the functions of the pancreas?

A

Digestive secretions
Insulin
Gastrin

267
Q

What is the complications of removing the Pancreas?

A

the dog becomes diabetic and loss of exocrine function

268
Q

What are the indications for a partial pancreatectomy?

A

Pancreatic abscess
Pseudocyst
Isolated mass
Focal trauma

269
Q

What is important in a Partial Pancreatectomy?

A

maintain ducts!

270
Q

What is the treatment for Pancreatic Abscess?

A

Drainage
Debride
Omentalize

271
Q

Pancreatic Pseudocyst

A

Pancreatic secretions and debris within fibrous sac

272
Q

What is the treatment for Pancreatic Pseudocyst, if it is asymptomatic and single cyst?

A

Monitor by Ultrasound

273
Q

What is the treatment for Pancreatic Pseudocyst if greater than 4cm and symptomatic?

A

Ultrasound guided aspiration

274
Q

What is the treatment for Pancreatic Pseudocyst if it reoccurs or signs persist after aspiration?

A

Resect if possible

Debride and drain

275
Q

What is the most common Exocrine Pancreatic Neoplasia of Dogs and Cats?

A

Adenocarcinoma

276
Q

Where does Adenocarcinoma originate from in the Pancreas?

A

Acinar cells or ductal epithelium

277
Q

What is the treatment of Exocrine Pancreatic Neoplasia?

A

Surgical resection

Palliative (Billroth 2)

278
Q

What is the problem with Insulinoma?

A

Secrete insulin despite Hypoglycemia

279
Q

What is the medical management of Insulinoma?

A 
Frequent small meals
Restrict exercise
Glucocorticosteroids
Diazoxide - oral hyperglycemic
Streptozocin - destroys beta cells
280
Q

What are the surgical treatments for Insulinoma?

A

Allows resection

Partial pancreatectomy

281
Q

How can you find the insulinoma and identify islets?

A

IV methylene blue

282
Q

Gastrinoma

A

Tumor of non Beta islet cells
Secretes excessive gastrin
Increased gastric acid secretion
Leads to gastric ulceration

283
Q

How do you treat a Gastrinoma?

A

Exploratory

Resection

284
Q

What is the treatment for Trauma of the liver?

A

Ligate severed vessels
Partial Lobectomy
Complete Lobectomy
Pringle manuever

285
Q

What is the Pringle Maneuver?

A

Temporary occlusion of portal vein and hepatic arteries to aid in identification of source of bleeding and plan repair

286
Q

What are the most common primary tumors of the Liver?

A

Hepatocellular

Cholangiocellular

287
Q

In what species are Liver tumors more common?

A

Dogs

288
Q

What are the 3 forms of Hepatocellular tumors?

A

Massive
Nodular
Diffuse

289
Q

Massive Hepatocellular tumors

A

Good prognosis with complete surgical excision

290
Q

Nodular Hepatocellular tumors

A

Metastasis more likely

Complete excision unlikely

291
Q

Diffuse Hepatocellular tumors

A

Poor prognosis

Metastasis to LNs, peritoneum, and Lungs

292
Q

In what species are Cholangiocellular tumors more common?

A

Cats

293
Q

How do you treat Cholecystitis/Cholangiohepatitis?

A

Treat medically if not ruptured

Cholecystectomy

294
Q

W\hat are the possible etiologies of Biliary Mucoceles?

A

Hyperplasia of mucus-secreting cells and excessive mucus secretion
Alterations in gallbladder motility
Accumulation of inspissated bile

295
Q

What endocrinopathies are Biliary Mucoceles associated with?

A

Hyperadrenocorticism

Hypothyroidism

296
Q

What is a complication of Biliary Mucoceles?

A

Gallbladder rupture

297
Q

What is the signalment for Biliary Mucoceles?

A

Shetland Sheepdoogs, Cocker Spaniels, and Miniature Schnauzers around the age of 9

298
Q

What is the treatment for Biliary Mucoceles?

A

Choleretics
Cholecystectomy
Antibiotics

299
Q

Choleretics

A

increased the flow and increase the turnover of bile - thinning the bile

300
Q

What causes Intraluminal Biliary obstruction?

A 
Inflammatory disease
Choleliths and Choledocholiths
Neoplasia
Inspissated bile 
Parasites
301
Q

What causes Extraluminal Biliary obstruction?

A

Pancreatic disease

Duodenal disease

302
Q

When is a Cholecystotomy indicated?

A

decompress gall bladder and/or antegrade catheterize of bile duct prior to cholecystectomy

303
Q

Choledochotomy

A

Bile duct exploration/reconstruction

304
Q

What is the importance of the Central division of the liver?

A

Caudal vena cava goes through the liver and the gallbladder is located here

305
Q

What artery supplies the gallbladder?

A

Cystic artery

306
Q

Complete lobectomy of the liver

A

Removal of lobe near to or at the level of the hilus

307
Q

What division of the liver is more accessible for complete lobectomy?

A

Left division

308
Q

What division is more difficult to perform a complete lobectomy?

A

Central and right

309
Q

What are the Liver Biopsy Techniques?

A 
Fine needle aspirate
Tru-cut needles
Laparoscopic 
Skin biopsy Punch 
Guillotine Technique
310
Q

What is the thickness you should not exceed with a Punch Biopsy?

A

1/2 the thickness of the liver

311
Q

When is a Partical and Complete Lobectomy indicated?

A 
Biopsy 
Neoplasia
Trauma
Abscess
Cysts
312
Q

When should you perform a Complete Liver Lobectomy?

A

Should only be used for Left lateral and left medial liver lobectomy

313
Q

What technique results in the most blood loss with the liver?

A

Partial Lobectomy

Parenchymal Fracture and ligation

314
Q

Choledochal Stenting

A

most commonly done to relieve obstruction due to extraluminal compression secondary to pancreatitis

315
Q

What is used for Choledochal Stenting?

A

Red Rubber Catheter

316
Q

When do you perform a Cholecystotomy?

A

suspected temporary biliary obstruction

Pancreatitis

317
Q

Describe a Cholecystotomy

A

a catheter is places laproscopically or surgically to divert bile flow externally through the body wall caudal to the last rib on ventral abdominal surface

318
Q

What are the indications for Cholecystectomy?

A 
Necrotizing cholecystitis
Chronic Cholecystitis
Biliary mucocele
Cholelithiasis
Neoplasia 
Trauma
319
Q

What must you perform before a Cholecystectomy?

A

duodenotomy with catheterization of bile duct to confirm patency of bile duct

320
Q

What is the complication of excising the gallbladder?

A

getting into the bile duct resulting in a transection of small hepatic ducts leading to bile peritonitis
Bleeding due to failure to ligate the cystic artery

321
Q

When would you perform a Biliary Diversion?

A

Irreparable obstruction or trauma of common bile duct

322
Q

Cholecystoduodenostomy

A

Attaching the gallbladder to the duodenum

323
Q

Cholecystojejunostomy

A

Attach the gallbaldder to the jejunum

324
Q

What is a complications of a Cholecystoduodenostomy?

A

risk of the gallbladder becoming impacted with ingesta causing cholecystitis and/or cholangiohepatits

325
Q

What are the complications associated with Biliary diversion?

A

Leakage
Stroma stricture
Ascending infections - Cholangiohepatitis

326
Q

What is an advantage to using the Thoracoabdominal stapling technique?

A

Fast

Results in minimal hemorrhage

327
Q

Portosystemic Shunt

A

Anatomic anomaly resulting in abnormal communication between the portal vasculature and the systemic vasculature

328
Q

Patent Ductus Venosus

A

Failure of closure results in left side intrahepatic shunt

329
Q

What are the classifications of Portosystemic Shunts?

A

Macrovascular

Microvascular

330
Q

How do you treat microvascular Portosystemic Shunts?

A

Liver transplant

331
Q

How does trauma cause the formation of Portosystemic Shunts?

A

a vessel is damaged and heals back to another vessels the wrong way

332
Q

What breeds are predisposed to Extrahepatic PSS?

A 
Yorkies
Shih Tzu 
Maltese
Poodle
Schnauzer
Dachshund
Pugs
333
Q

Extrahepatic Shunts

A

Veins that should join the portal vein enter the caudal vena cava or azygous vein instead

334
Q

What veins are most commonly involved in Extrahepatic Shunts?

A

Left Gastric Vein

Splenic Vein

335
Q

What breeds have Intrahepatic PSS?

A

Large breeds: Labrador retriever, Golden Retriever, Australian Shepherd

336
Q

Intrahepatic Portal Vein Hypoplasia

A

Microvascular shunting within the liver

337
Q

What is a laboratory test for Portal Vein Hypoplasia?

A

Protein C

338
Q

What is the treatment for Portal Vein Hypoplasia?

A

Medical management: Diet

339
Q

What diseases cause Multiple Extrahepatic PSS?

A

Cirrhosis
Non-cirrhotic portal hypertension
Hepatic A-V malformation

340
Q

Multiple Extrahepatic Shunts

A

Vestigial embryonic communications that can “open up” preventing lethal portal hypertension from developing

341
Q

What are some physical exam findings in cats with Multiple Extrahepatic Shunts?

A

Ptyalism
Copper Colored irises
Aggressive behavior

342
Q

What can you perform to diagnose a portosystemic shunt?

A

Portography

Nuclear Scintigraphy

343
Q

Where do you inject for a Portography?

A

Mesenteric Vein

344
Q

What is the gold standard for diagnosing Portosystemic Shunt?

A

CT Angiography

345
Q

What is the medical management for Portosystemic Shunts?

A 
Diet with reduced protein 
Lactulose
Antimicrobials 
Control Intestinal parasites
Seizure control/prevention
346
Q

What is a poor prognostic indicator for improvement after surgery with portosystemic shunts?

A

Lack of improvement in clinical signs from medical management

347
Q

What are the surgical options for Extrahepatic PSS?

A

Acute ligation/attentuation

Gradual attenuation: Ameroid Constrictors, Cellophane Banding

348
Q

Describe an Ameroid Constrictor

A

Hygroscopic casein ring surrounded by metal or plastic sheath

349
Q

What are the complications of Acute occlusion?

A

Rapid closure

kinking

350
Q

What are the complications of Chronic occlusion?

A

Incomplete occlusion
Acquired shunts
Implant migration

351
Q

What is the surgical management for Intrahepatic Shunts?

A

Extravascular occlusion

Inravascular occlusion

352
Q

What are the acute postoperative complications for surgery for Intrahepatic shunts?

A 
Portal hypertension : Hypovolemic Shock, Hypothermia, Weak pulses, Abdominal pain and swelling, vomiting, diarrhea
Hypoglycemia
Seizures
Hemorrhage
Electrolyte disturbances 
Portal vein thrombosis
353
Q

What are the chronic postoperative complications for surgery for Intrahepatic shunts?

A

Recurrence of signs

354
Q

Name some Immediate Postoperative Management for surgery of Intrahepatic Shunts?

A 
Fluid therapy 
Early food intake 
Monitor vitals
Monitor for portal hypertension 
Monitor for seizures 
Avoid hypothermia
355
Q

When is the minimum time for a recheck on surgery from intrahepatic shunts?

A

4-8 weeks

356
Q

What is the post op monitoring for intrahepatic shunt surgery?

A

Routine blood work
Liver function tests: Protein C
Repeat imaging: Ultrasound, nuclear scintigraphy and/or angiography

357
Q

Omentum

A

Peritoneal fold between greater and lesser curvature of stomach

358
Q

Describe the properties of the Omentum

A 
Rich blood supply 
High absorptive capacity 
Pronounced angiogenic activity 
absorbs bacteria 
Plays role in isolating and sealing of contamination source: abscess or intestinal perforation
359
Q

Peritonitis

A

Inflammation of the peritoneal lining

360
Q

What is the pathophysiology of Peritonitis?

A

Inflammation –> Vasodilation –> Hypovolemia –> SIRS/DIC/MODS

361
Q

What factors can worsen the severity of inflammation and clinical signs of peritonitis?

A

High levels of bacterial contamination
Virulence of organism
Presence of adjuvants
Adequacy of local and systemic immune responses

362
Q

What adjuvants can worsen the severity of peritonitis?

A

Gastric mucin
Bile
Foreign material
Blood/ Hemoglobin

363
Q

How do you classify Peritonitis?

A

Primary vs. Secondary

364
Q

Primary Peritonitis

A

Source of inflammation is outside of abdomen

365
Q

Secondary Peritonitis

A

Source of inflammation is within the abdomen

366
Q

Aseptic Peritonitis

A

Absence of infectious organisms within peritoneal fluid

367
Q

Septic Peritonitis

A

Presence of infectious organisms within peritoneal fluid

368
Q

What is an example of Primary Aseptic peritonitis in Cats?

A

Feline Infectious Peritonitis

369
Q

Describe Primary Septic Peritonitis

A

Hematogenous or lymphatic spread of bacteria; translocation from GI tract and possibly oviduct

370
Q

Examples of Secondary Aseptic Peritonitis

A

Chemical Peritonitis: Bile Peritonitis, Pancreatitis, Uroperitoneum
Peritoneal Foreign body
Mechanical peritonitis: Sclerosing encapsulating peritonitis

371
Q

What is the most common source of infection in Secondary septic peritonitis?

A

GI tract

372
Q

What are the early non-specific clinical signs of Septic Peritonitis?

A

Vomiting
Lethargy/Depression
Inappetance
Abdominal Pain

373
Q

What are the signs of more severe systemic illness that occur with worsening condition of Septic Peritonitis?

A 
Hyper- or Hypothermia 
Weakness/collapse secondary to hypotension 
Tachycardia 
Injected or pale MM
Abdominal effusion
374
Q

What 2 or more changes indicate SIRS?

A

Heart Rate
RR
Temperature
WBC

375
Q

What do you see on CBC with Septic Peritonitis?

A

Leukopenia or leukocytosis
Left Shift
Thrombocytopenia
Anemia or Hemoconcentration

376
Q

What do you see on Chemistry with Septic Peritonitis?

A 
Hyperbilirubinemia 
Hypoalbuminemia 
Hyponatremia 
Hyperkalemia 
Hypoglycemia 
Azotemia
377
Q

What are some diagnostic tests for Septic Peritoneum?

A

Radiographs
Ultrasound
Abdominocentesis
Diagnostic Peritoneal Lavage

378
Q

What Diagnostic Results are suggestive of septic peritonitis?

A

Pneumoperitoneum

Abdominal effusion with intracellular bacteria and toxic/degenerate neutrophils

379
Q

What are the systemic changes consistent with Sepsis/SIRS?

A 
Hypotension 
Elevated lactate
Tachycardia
Metabolic acidosis
Increeased ALT and T. Bili 
Hypoglycemia 
Hypoalbuminemia 
Leukopenia or leukocytosis 
Presence of bands with toxic changes
380
Q

What is the treatment for Septic Peritonitis?

A

Exploratory celiotomy

Stabilize the patient and correct the primary disease!!

381
Q

What are the goals of Fluid therapy for Septic Peritonitis?

A

Improve perfusion
Treat hypotension
Improve metabolic acidosis
Correct electrolyte abnormalities

382
Q

What types of fluid should be used for Septic Peritonitis?

A

Crystalloids and colloids

383
Q

How do you treat Septic Peritonitis?

A 
Fluid Therapy 
Antibiotics
Analgesia
Pressors for treatment of hypotension 
Dobutamine for CV support 
Antiemetics
Blood products 
Gastroprotectants/Antacids
384
Q

What is the optimal Administration of Analgesia for Septic Peritonitis?

A

CRIs

385
Q

What is the main treatment of Septic Peritonitis?

A

Surgery

386
Q

What are the main goals of surgery for septic peritonitis?

A

Correct and contain the primary source of bacteria
Reduce peritoneal bacteria load
Remove foreign material, inflammatory mediators

387
Q

How do you achieve the goals of surgery for Septic Peritonitis?

A

Repair/Remove source of bacterial contamination
Lavage
Debride tissues that are necrotic or cannot be decontaminated
Abdominal drainage

388
Q

What should not be used in the abdomen?

A

Antiseptics

389
Q

What is a complication of using Povidone Iodine in the abdomen?

A

Metabolic acidosis and can lead to complication rates

390
Q

What is a complication of using chlorohexidine in the abdomen?

A

Interferes with normal healing process

391
Q

What does Abdominal drainage allow in the treatment of septic peritonitis?

A

Allows for continuous removal of suppurative material from abdomen
Allows for continued evaluation of fluid character and cytologic changes

392
Q

When would you consider putting in an abdominal drainage for septic peritonitis?

A

Moderate to Severe Peritonitis

393
Q

What are the indications for Open Peritoneal Drainage?

A

Severe generalized peritonitis
Ongoing contamination
Extensive fibrinous adhesions

394
Q

What are the advantages of Open Peritoneal drainage?

A

“Drain” entire abdomen
“Second look” opportunities
Repeated lavage

395
Q

What are the disadvantages of Open Peritoneal Drainage?

A

Very high maintenance
Fluid/electrolyte/protein losses
Nosocomial infection

396
Q

Why do you need to implement Enteral feeding after septic peritonitis surgery?

A

High metabolic demands due to massive protein losses

397
Q

What are the feeding options for Septic Peritonitis?

A

Nasoenteric
Esophagostomy tube
Gastrostomy tube
Jejunostomy

398
Q

What is the preferred method of feeding for a patient with septic peritonitis surgery?

A

Enteral feeding

399
Q

What is commonly associated with vehicular trauma?

A

Uroabdomen due to bladder rupture

400
Q

Is surgery always necessary for the treatment of uroabdomen?

A

NO!

RUSVM Small Animal Surgery 2017 (17 decks)

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