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3. Cat & Dog > GI surgery large intestine > Flashcards

GI surgery large intestine Flashcards

1
Q

recto-colonic surgery - dehiscence and strength of tissue considerations

A
  • In humans large intestinal anastomoses dehisce at higher rate then small intestinal
  • Colonic wound strength returns more slowly than SI (30% of normal at 48 hrs, 75% of normal at 4 months)
  • Colonic wound healing is compromised by poorer blood supply in the mid-rectum (preserve cranial rectal artery)
  • Large anaerobic load present
  • Tension: reduces blood supply, oxygen tension
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2
Q

ileoceco-colic junction resection leads to what?

A

Leads to loss of antegrade and retrograde reflux regulation
-antegrade effects: diarrhea, nutrient malabsorption, dehydration
-retrograde effects: small intestinal bacterial overgrowth

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3
Q

ileum resection leads to…

A

-bile acid reabsorption and cobalamin absorption impaired

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4
Q

ICJ RESECTION principles
- where to dissect? considerations?

A
  • Similar principles to large intestinal resection
  • Dissect close to margin of the bowel to preserve as much collateral circulation as possible
  • Sometimes metastatic lymph nodes incorporated into resection
  • Luminal disparity usually has to be managed as colon larger than ileum/jejunum
  • Preserve as much ileum as possible without compromising neoplastic margins
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5
Q

INDICATIONS FOR COLO-RECTAL RESECTION

A
  • Feline megacolon
  • Colorectal neoplasia
  • Colonic foreign bodies > Can usually be milked out of the rectum
  • No need for full-thickness colonic biopsy – don’t do it!!
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6
Q

FELINE MEGACOLON
- causes?

A
  • Mostly idiopathic, also pelvic stenosis or neurologic disease
  • Caused by disturbance in the activation of smooth muscle myofilaments
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7
Q

feline megacolon clinical signs

A

C/S: fecal tenesmus, pain defecating, vomiting, anorexia, dehydration

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8
Q

feline megacolon Dx

A

C/S and radiographs showing dramatic colonic distension with fecal impaction

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9
Q

FELINE MEGACOLON - MANAGEMENT

A
  • Medical management: Stool softeners and enemas, IV fluids, Cisapride
    > Rarely successful for long-term management
  • Surgical management: Subtotal colectomy
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10
Q

SUBTOTAL COLECTOMY
- do we preserve ICJ? what if we remove it? what if we leave it?

A
  • Can be performed with or without preservation of the ileocecocolic jct
  • If IC jct removed can predispose to small intestinal bacterial overgrowth (SIBO)
  • Cats with IC jct resection may have softer stools post-op
  • Only resect IC jct if excessive tension on closure
  • If leave, even modest amount of colon can get recurrence
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11
Q

ANAL SACCULECTOMY -INDICATIONS

A
  • Neoplastic
    > Apocrine gland anal sac adenocarcinoma (AGASACA)
  • Non-neoplastic
    > Sacculitis
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12
Q

Apocrine gland anal sac adenocarcinoma (AGASACA)- signalment? how usually found? how often metastatic?

A
  • Median age 10 - 11 yrs old
  • Commonly incidental finding at rectal exam or visible mass present
  • Evidence of metastatic disease in 36-39% of dogs
    > Ileo-lumbar LNs, spleen, liver, thoracic LNs, lungs
    > Rare in cats
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13
Q

Apocrine gland anal sac adenocarcinoma (AGASACA)- how do get diagnosis? common related issue?

A
  • FNA of mass is usually diagnostic
  • Paraneoplastic hypercalcemia is common
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14
Q

Apocrine gland anal sac adenocarcinoma (AGASACA)- prognosis?

A
  • Surgery alone 12-18 months BUT a variety of factors
  • Size of tumor
  • Metastatic LNs?
  • Presence of hypercalcemia
  • Chemotherapy may help in metastatic scenario
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15
Q

ANAL SACCULECTOMY -AGASACA
- possible complications

A
  • Infection / rectal perforation
  • Fecal incontinence
  • Local recurrence
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16
Q

ANAL SACCULECTOMY -AGASACA
0 how to perform

A

Closed technique only for AGASACA
* Lumen of anal sac not entered
* Incision over anal sac
* Dissect from surrounding tissue
* Duct ligated, transected

17
Q

SPLENECTOMY -HILAR LIGATION
- what is it? when to use? timing?

A
  • Individual ligation of hilar vessels
  • Diffuse disease
  • Small masses
  • Increased sx time
18
Q

SPLENECTOMY
-RAPID / 4-CLAMP TECHNIQUE
- pros and cons

A
  • Advantages
    > Rapid, less dissection of hilar vessels required
  • Disadvantages
    > Need to ID vascular structures
19
Q

SPLENECTOMY -POSTOPERATIVE CARE

A

Continuous monitoring required!
* Analgesia (opioid +/- NSAID)
* ECG
* PCV/TS
* +/- Blood transfusion
* IV fluids

20
Q

spleniic neoplasias that are common

A

Benign and Malignant
* Hemangiosarcoma
* Lymphoma, hemangioma,
* Non-traumatic hemoab

21
Q

are benign or malignantsplenic masses usually larger?

A
  • Higher weight in benign masses
  • Higher Mass:Spleen ratio
22
Q

hemoperitoneum is strongly associated with what splenic disease?

A
  • 76% malignant neoplasia
  • of these, almost all hemangiosarcoma
    > metastasis often
23
Q

HSA Px

A

4-6 months w chemo
4-6 weeks without

24
Q

incidentally found splenic mass - what is it, probably? reccomendation?

A

Recent study —> 70% (74/105) dogs had benign disease
* Recommend splenectomy; confirm dx with histopathology
* If HSA, still may have an improved prognosis compared to if hemoabdomen ensues

25
Q

Most common reason for sialadenectomy

A

SIALOCELE
- Cervical fluid filled swelling + ranula most common clinical sign

26
Q

SIALOCELE -DIAGNOSIS

A
  • FNA fluid pocket - proteinaceous fluid
  • Cytology - small to moderate #’s of non degenerate nucleated cells and pink staining mucin
  • Consider cervical ultrasound to evaluate all salivary glands - determine side for removal
  • Computed tomography
27
Q

Sialocele; Cervical swelling of saliva
- what glands do we remove?

A
  • Leakage from mandibular and sublingual salivary glands/ducts
  • EXCISED TOGETHER
28
Q

SIALOCELE
-HOW TO CHOOSE WHAT SIDE TO REMOVE?

A
  • Turn on their back / Check sublingual region - Diagnostic imaging
  • Bilateral removal?
29
Q

approaches for sialocele removal - which is better?

A

-LATERAL VS VENTRAL APPROACH
> No difference in complication rates
> Recurrence more likely after lateral approach
> Wound complications more likely after ventral approach
()
Ventral approach removes significantly > salivary gland tissue and lower recurrence in a study

30
Q

COMPLICATIONS FOLLOWING SIALADENECTOMY

A
  • Seroma / wound infection
  • Trauma to local anatomical structures
  • RECURRENCE
    > Usually occurs within the first month post op
31
Q

SIALOCELE
Now that the glands are gone….what about the sialocele?

A

Depends on location……
- In the cervical region, drainage via an incision and then place a closed suction drain
- Marsupialize ranula

3. Cat & Dog (33 decks)

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