GI tract Sx Flashcards
Halsteds principles of Sx
Gentle tissue handling
Meticulous haemostasis
Preservation of blood supply
Strict asepsis
Minimal tension
Accurate tissue apposition
Obliteration of dead space
Gentle tissue handling
Hands for gut- avoid excess handling (ileus)
Keep tissue moist
Stay sutures
Scalpel for initial incision
Liver and pancreas fragile
Order of coeliotomy evaluation
Parachymatous first
-liver, spleen, pancreas, kidney and adrenals
Intestines
-stomach, SI, LI, mesenteric LN
Bladder Ureters
Repro tract
Meticulous haemostasis
Incise at least vascular part
-1/2 way between greater and lesser curvature
Antimesenteric SI
Liver
-highly vascular, hepatopathy-> coagulopathy
Pringle manouvare
Pancreas
-sim to liver, guillotine technique, blunt dissect between lobules
Strict asepsis
Stomach relatively sterile
More bac -> colon
Liver has clostridia
Lavage pre closure
Prophylactic AB
Longitudinal closure and incision (apposition)
Suture material
2 metric
Monofilament absorbable
(PDS)
Incorporate submucosa in sutures
Simple continuous
-less mucosal eversion, less adhesion, better submucosal apposition
Lower post op Dz risk
Exteriorise incision site
Incise distal to FB
Secure monofilament closure
Check leakage after gut closure
Lavage pre closure
Prophylactic AB
Change instruments to close
Anastamoses
Oversew end of distal segment
Suture end of proximal segment to antimesenteric border of distal segment
Fluid therapy
GIT Sx cases often have fluid deficits and e- imbalance
Address pre Sx
Give necessary fluids peri-op
Peritonitis
Hypovolaemia, metabolic acidosis, e- imbalance, endotoxic shock
CS
-anorexia, lethargy, Abd pain (pray)
-ileus, pyrexia, shock
Dx
-radiography, haematology
-serum biochem (azotaemia, hyposugar)
-Abd paracentesis
Tx
-Fluids
-Broad spec Ab
-Correct 1° problem
Adhesions, SBS
Adhesions-
Rare
(non) restrictive)
Good technique to avoid
Short bowel syndrome-
>80% SI removal
Medically managed
Poor prognosis
Ileus
Poor peristalsis
Due to vagosympathetic reflex
Gut distended/ fluid filled
Correct cause, support
Oesophagus
Approach
-ventral cervical midline to 2nd rib level
Ventral midline coeliotomy
Close linea alba
Single layer of simple continuous appositional sutures in external sheath of RA
-5mm from edge, 3-12mm apart
Laparotomy
Flank incision (parallel to msc fibres)
Not norm used
Terminal colon approach
Ventral ap.
-pelvic osteotomy
Anal ap.
-evert rectum with stay sutures
Rectal pull through ap.
Dorsal and lateral approaches
Cleft palate
1°- harelip
-failure of lips and premaxila to fuse
2°-
-hard and soft palate fail to fuse
Brachys and siamese common
2° cleft palate
CS-
-milk drain from nares
-gag/ cough when eating
-difficulty suckling
Sx - 8-12 wks/o
Complications
-dehiscence
-recurrence
-Chr rhinitis
Salivary mucocoele
Most common canine salivary problem
Sublingual gland normally
Cause - trauma, sialolith, neo?
CS- painless swelling
-dysphagia, ptyalism, inspiratory stridor
Dx- fluid filled aspirate
Localisation - technical sonography
Tx- Sx excision of gland
Feline nasopharyngeal polyps
Benign inflammatory polyps
Causes URT obst.
Dx- visual/ radiographs
Tx- traction removal
Pharyngeal stick injuries
Ac onset of gagging, jaw pain
Dx- CE, Xray, US
Remove FB
Debride
Med - analgesia, Ab
Tonsilectomy
Recurrent tonsilitis
Neoplasia
Sharp excision, individual vessels ligation
Oesophageal FB
Lodge - thoracic inlet, heart base, pre cardia
Remove
Sx- perforations
Complications- oesophagitis
Vascular ring abnormalities
Aortic arch encircle trachea and oesophagus
PRAA most common
-retained right aortic agent
Present- weaning, food regurgitation
-Cr megaoesophagus
Tx- ligation of least important encircling vessel
