intestinal and urinary surgery Flashcards
what are the 4 layers of the intestine?
- serosa
- longitudinal muscle and circular muscle
- submucosa
- mucosa
when closing the intestine what is the most important layer in terms of suture holding and strength?
submucal layer - make sure to include when closing
what is gastrotomy?
making a hole into the stomach (most commonly done to remove foreign bodies)
what technique is used to exteriorise and manipulate the stomach?
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
how do we close a gastrotomy?
- 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
why do we omentalise?
- Improved vascular supply
- Lymphatic drainage
- Rich source of inflammatory and immunogenic cells (neutrophils, T and B lymphocytes, macrophages, etc.)
- Neo-vascularisation (angiogenic factors)
what is intussusceptum?
inner segment of intussesception
what is intussuscipiens?
portion of bowel containing the intussusceptum
what is an enterotomy?
making a hole in the small intestine
give the name for the suture pattern that is a simple continuous inverting pattern
connell pattern
what is used to close an enterotomy/enterectomy?
- 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
what is an enterectomy?
removign a portion of the small intestine
what is the issue with leak testing?
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
what is a subtotal colectomy?
removal of part of the large intestine (colon)
what is the concern with surgery onthe large intestine?
higher infection risk as high conc of anaerobic bacteria (need to pick antibiotic that is good against anaerobic bacteria)
what antibiotic is good against anaerobic bacteria?
metronidazole
starvation after GI surgery is considered detrimental what can it cause?
- Villous atrophy
- Ulceration
- Breakdown in gut barrier
- Ileus - no peristaltic activity
oral feeding is best
what is the name of the operation that makes a hole in the bladder? name 4 reasons why this is done?
cystotomy
* Calculi (urolithiasis)
* Biopsy
* Tumour
* Ureteral ectopia
*
how many and at what location are stay sutures placed onthe bladder?
3 stay sutures, one at the pole and one either side of the insicion to be made
where is the inscision on the bladder typically made and why?
longitudinal incision on the ventral surface - to preserve blood supply
what is used to close a ctstotomy?
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
can you leave knots on the lumial surface of the bladder?
no - can act as a place where crystals can form leading to urolithiasis
