intestinal and urinary surgery

Question 1

what are the 4 layers of the intestine?

Answer 1

• serosa
• longitudinal muscle and circular muscle
• submucosa
• mucosa

Question 2

when closing the intestine what is the most important layer in terms of suture holding and strength?

Answer 2

submucal layer - make sure to include when closing

Question 3

what is gastrotomy?

Answer 3

making a hole into the stomach (most commonly done to remove foreign bodies)

Question 4

what technique is used to exteriorise and manipulate the stomach?

Answer 4

stay sutures and surrounding with sterile saline swabs
also if there is any contamination it can be restricted to this site and won’t contaminate the peritoneal cavity

Question 5

how do we close a gastrotomy?

Answer 5

• Absorbable monofilament (e.g., polydioxanone, polyglyconate, poliglecaprone, glycomer 631)
• atraumatic needle

Size
- 3/0 cats
- 3/0 or 2/0 dogs

Pattern
- One-layer – full thickness (simple interrupted, simple continuous, continuous inverting (e.g., Connell, Cushing, Lembert)
Two-layer (more common)
- Submucosal / mucosa
- Seromuscular

Omentalise - drape greater omentum over site of insicion

Question 6

why do we omentalise?

Answer 6

• Improved vascular supply
• Lymphatic drainage
• Rich source of inflammatory and immunogenic cells (neutrophils, T and B lymphocytes, macrophages, etc.)
• Neo-vascularisation (angiogenic factors)

Question 7

what is intussusceptum?

Answer 7

inner segment of intussesception

Question 8

what is intussuscipiens?

Answer 8

portion of bowel containing the intussusceptum

Question 9

what is an enterotomy?

Answer 9

making a hole in the small intestine

Question 10

give the name for the suture pattern that is a simple continuous inverting pattern

Answer 10

connell pattern

Question 11

what is used to close an enterotomy/enterectomy?

Answer 11

• Polydioxanone (PDS), polyglyconate (Maxon), Glycomer 631 (Biosyn), poliglecaprone (Monocryl)
• 3/0 dog or 4/0 cat

Good early tensile strength (days 5-7)
Resist absorption for > 21 days

• Simple interrupted or simple continuous appositional (or rarely inverting) sutures
• 2-3mm apart, 2-3mm from edge
• Use atraumatic needle
• Omentalise

Question 12

what is an enterectomy?

Answer 12

removign a portion of the small intestine

Question 13

what is the issue with leak testing?

Answer 13

an unphysiological force is often applied on the lumen of the intestine, this can result in a leak occuring that wouldnt actually occur but also the pressure can be so large that the intestine can rupture

Question 14

what is a subtotal colectomy?

Answer 14

removal of part of the large intestine (colon)

Question 15

what is the concern with surgery onthe large intestine?

Answer 15

higher infection risk as high conc of anaerobic bacteria (need to pick antibiotic that is good against anaerobic bacteria)

Question 16

what antibiotic is good against anaerobic bacteria?

Answer 16

metronidazole

Question 17

starvation after GI surgery is considered detrimental what can it cause?

Answer 17

• Villous atrophy
• Ulceration
• Breakdown in gut barrier
• Ileus - no peristaltic activity
  oral feeding is best

Question 18

what is the name of the operation that makes a hole in the bladder? name 4 reasons why this is done?

Answer 18

cystotomy
* Calculi (urolithiasis)
* Biopsy
* Tumour
* Ureteral ectopia
*

Question 19

how many and at what location are stay sutures placed onthe bladder?

Answer 19

3 stay sutures, one at the pole and one either side of the insicion to be made

Question 20

where is the inscision on the bladder typically made and why?

Answer 20

longitudinal incision on the ventral surface - to preserve blood supply

Question 21

what is used to close a ctstotomy?

Answer 21

Absorbable monofilament (e.g., polydioxanone, polyglyconate, poliglecaprone, glycomer 631)

Size
* 4/0 or 3/0 cats
* 4/0, 3/0 or 2/0 dogs

Pattern
One-layer – full thickness (simple interrupted, simple continuous, continuous inverting (e.g., Connell, Cushing, Lembert)

Two-layer (historiacally)
* Submucosal / mucosa
* Seromuscular

Single layer continuous appositional closure +/- second layer of inverting suture if concerned about leakage in thin walled bladder

Use an atraumatic needle

Drape omentalise the site of repair

Question 22

can you leave knots on the lumial surface of the bladder?

Answer 22

no - can act as a place where crystals can form leading to urolithiasis