GIT Surgery!!!! Flashcards
GIT surgery is considered clean-contaminated - which means what?
- give peri-op ABs (Gram -ves, anaerobes)
- isolation of viscus
- change instruments/gloves
- local lavage
suture choice
monofilament, absorbable on reverse cutting/taper needle
Indications for a gastrotomy/gastrectomy
- gastric FBs
- full thickness biopsy
- resection of neoplasia (uncommon)
- resection of devitalised tissue - GDV
Gastrotomy closure technique
- Closure; single layer appositional vs 2.layer appositional (mucosa then seromuscular+submucosa)
- simple cont. - Run entire GIT and explore abdo
gastrotomy post-op
- IVFT and lytes
- Gastroprotectants
- Pro-motility drugs (ileus)
- Food and water as soon as willing to eat
Risk factors for GDV
- Large/giant breeds (3x)
- Thoracic depth (conformation)
- Feeding practices?? large volumes of food at high speeds
GDV clinical signs
- acute, non-productive retching
- salivation
- abdo distention and discomfort
- tachypnea, dyspnea, weakness, collapse
- pale/injected mm
- weak peripheral pulse/pulse deficit
what rad view to diagnose GDV?
Right lateral view = large gas filled stomach with displacement of pylorus (smurf)
what antibiotics to treat endotoxaemia assoc. w/ GDV?
3rd gen cephalosporins
Surgical management of GDV once stable(ish)/ASAP
- reposition stomach (decompress + derotate)
- assess gastric and splenic viability
- Permanently fix antrum to right cranial abdominal quadrant
GDV post-op monitoring/complications
- IVFT
- ABs
- Gastroprotectants/motility
- Coagulopathy
- Arrhythmia
- Peritonitis/sepsis –> pyrexia, pain, abdo incision discharge ,
distention
what are the two approaches to a prophylactic gastropexy
- Laparoscopic-assisted gastropexy
2. Open incisional gastropexy
Indications for splenectomy
- neoplasia: haemangiosarcoma, lymphoa, histiocytic sarcoma
- trauma/torsion
- abscessation/splenitis (Clostridia)
- non-responsive IMT
the major splenic pedicles
- Splenic
- Left gastroepiploic
- Short gastrics
what is the holding layer of the intestines when closing?
submucosa
size/type suture for intestinal closure
monofilament absorbable 3-0 to 5-0
risk factors for an ileocolic intussusception in young dogs
parasitism, enteritis, caecal inversion
common presentation of an intestinal adenocarcinoma
annular, stenotic lesion in the large intestine (dogs) or jejunum (cats - siamese)
common presentation of an intestinal lymphosarcoma
infiltrative, intramural disease, discrete lesion
what is the prognosis of a cat with chronic lymphocytic lymphosarcoma?
2-3yrs w/ chemo
prognosis of intestinal adenocarcinoma vs. lymphosarcoma of a dog
adenocarcinoma - recurrence or metastasis in 3-9months
lymphosarcoma - poor - months
prognosis of GIST (leiomyosarcoma)
depends on grade - up to 12months
CS of a high intestinal obstruction
vom, abdo pain
CS of a low intestinal obstruction
abdominal pain, bloody, mucoid D+
describes steps of enterotomy
- Exteriorise and pack off intestinal segment
- Milk the intestinal contents away from the proposed incision site
- Occlude the lumen with your assistant’s fingers or intestinal forceps (Doyen’s)
- Longitudinal incision on anti-mesenteric margin of intestine
- Closure: simple interrupted full thickness sutures
- Check closure by injecting sterile saline into intestinal lumen using 22G needle and syringe
describe steps for intestinal resection and anastomosis
- Exteriorise segment
- ID section for resection
- Ligate arcade vessels + Mesenteric (vasa recta)
- Crushing forceps on part being removed - angled away from resection + non-crushing (fingers/Doyen’s) on healthy tissue (~5cm from resection site to allow room)
- Transect intestine away from crushing clamps
- Anastomosis: simple interrupted full thickness 3-0/4-0 monofilament absorbable –> work from mesenteric edge up either side
what do you do if there is disparity in size of intestinal edges for closure after a resection?
make the smaller section larger with an extension of the incision longitudinally - NEVER make the larger section smaller
what is intestinal plication?
pexy the transverse colon to the greater curvature of the stomach
pexy the descending colon to the left body wall
+ strategically placed seromuscular sutures along the length of intestine to prevent intuss recurrence
common causes of obstipation
perineal hernia, perianal fistulas, anal sac disease, pelvic trauma/fxs, rectal strictures (neoplasia), idiopathic megacolon (cats)
describe the technique of a subtotal colectomy
- Removal of ileocecocolic junction
- Preserve as much of the ileum as possible
- Size disparity of anastomosis
- Simple interrupted full-thickness closure
how do you treat an acute rectal prolapse?
- Lubricant
- Epidural (morphine)
- Manual reduction
- Anocutaneous purse-string for 4-5days
- Stool softener
when is a colopexy indicated?
indicated for extensive or repeated prolapse
post-op considerations for rectal prolapse amputations/colopexies
- stool softeners
- epidural - straining
- E.Collar
- avoid rectal manipulation
- address inciting cause
types of primary rectal tumours dogs
- adenoma/adenocarcinoma
- lymphosarcoma
- leiomyoma/sarcoma
types of primary rectal tumours cats
- adenocarcinoma
- lymphosarcoma
- leiomyosarcoma
CS of rectal neoplasia
- haematachezia
- tenesmus
- rectal bleeding independent of defecation
- rectal prolapse
what rectal tumour is commonly ‘egg like’?
leiomyoma
what rectal tumour commonly forms strictures?
adenocarcinoma
what rectal tumour is commonly assoc. w/ intramural thickening?
leiomyosarcoma
prognosis of malignant rectal neoplasias
poor, recurrence likely 2-3months
prognosis of benign rectal neoplasia
fair but frequent evaluation as malignant transformation possible and recurrence if inadequate resection
