GI tract Sx

Question 1

Halsteds principles of Sx

Answer 1

Gentle tissue handling
Meticulous haemostasis
Preservation of blood supply
Strict asepsis
Minimal tension
Accurate tissue apposition
Obliteration of dead space

Question 2

Gentle tissue handling

Answer 2

Hands for gut- avoid excess handling (ileus)
Keep tissue moist
Stay sutures
Scalpel for initial incision
Liver and pancreas fragile

Question 3

Order of coeliotomy evaluation

Answer 3

Parachymatous first
-liver, spleen, pancreas, kidney and adrenals
Intestines
-stomach, SI, LI, mesenteric LN
Bladder Ureters
Repro tract

Question 4

Meticulous haemostasis

Answer 4

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

Question 5

Strict asepsis

Answer 5

Stomach relatively sterile
More bac -> colon
Liver has clostridia
Lavage pre closure
Prophylactic AB
Longitudinal closure and incision (apposition)

Question 6

Suture material

Answer 6

2 metric
Monofilament absorbable
(PDS)
Incorporate submucosa in sutures
Simple continuous
-less mucosal eversion, less adhesion, better submucosal apposition

Question 7

Lower post op Dz risk

Answer 7

Exteriorise incision site
Incise distal to FB
Secure monofilament closure
Check leakage after gut closure
Lavage pre closure
Prophylactic AB
Change instruments to close

Question 8

Anastamoses

Answer 8

Oversew end of distal segment
Suture end of proximal segment to antimesenteric border of distal segment

Question 9

Fluid therapy

Answer 9

GIT Sx cases often have fluid deficits and e- imbalance
Address pre Sx
Give necessary fluids peri-op

Question 10

Peritonitis

Answer 10

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

Question 11

Adhesions, SBS

Answer 11

Adhesions-
Rare
(non) restrictive)
Good technique to avoid
Short bowel syndrome-
>80% SI removal
Medically managed
Poor prognosis

Question 12

Ileus

Answer 12

Poor peristalsis
Due to vagosympathetic reflex
Gut distended/ fluid filled
Correct cause, support

Question 13

Oesophagus

Answer 13

Approach
-ventral cervical midline to 2nd rib level

Question 14

Ventral midline coeliotomy

Answer 14

Close linea alba
Single layer of simple continuous appositional sutures in external sheath of RA
-5mm from edge, 3-12mm apart

Question 15

Laparotomy

Answer 15

Flank incision (parallel to msc fibres)
Not norm used

Question 16

Terminal colon approach

Answer 16

Ventral ap.
-pelvic osteotomy
Anal ap.
-evert rectum with stay sutures
Rectal pull through ap.
Dorsal and lateral approaches

Question 17

Cleft palate

Answer 17

1°- harelip
-failure of lips and premaxila to fuse
2°-
-hard and soft palate fail to fuse
Brachys and siamese common

Question 18

2° cleft palate

Answer 18

CS-
-milk drain from nares
-gag/ cough when eating
-difficulty suckling
Sx - 8-12 wks/o
Complications
-dehiscence
-recurrence
-Chr rhinitis

Question 19

Salivary mucocoele

Answer 19

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

Question 20

Feline nasopharyngeal polyps

Answer 20

Benign inflammatory polyps
Causes URT obst.
Dx- visual/ radiographs
Tx- traction removal

Question 21

Pharyngeal stick injuries

Answer 21

Ac onset of gagging, jaw pain
Dx- CE, Xray, US
Remove FB
Debride
Med - analgesia, Ab

Question 22

Tonsilectomy

Answer 22

Recurrent tonsilitis
Neoplasia
Sharp excision, individual vessels ligation

Question 23

Oesophageal FB

Answer 23

Lodge - thoracic inlet, heart base, pre cardia
Remove
Sx- perforations
Complications- oesophagitis

Question 24

Vascular ring abnormalities

Answer 24

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

Question 25

Gastrotomy

Answer 25

1 or 2 layer closure
1st- (sub)mucosa - simple continuous
2nd- serosa, msc- cushin
Partial ectomy
-necrosis (GDV), neo
Invagination of tissue

Question 26

GDV

Answer 26

Acture fatal emergency
Large dogs
Haemodynamic effects - less Abd blood flow
Resp dysfunction- high Abd pressure
Cardiac dysfunction- less perfusion
Necrosis, bacterial translocation, reperfusion injury (free rad)
Tx
-FT, decompress, gastropexy (fix pylorus to right Abd wall)