intestinal and urinary surgery Flashcards
What are the layers of the bowel?
Outer serosa
Muscularis (longitudinal and circular)
Submucosa
Mucosa
What is the most important layer of the bowel when closing?
Submucosa
What is a gastrotomy?
making a hole into the stomach
Most commonly used for removing foreign bodies
Describe the closure of a gastrotomy
Absorbable monofilament suture material
Atraumatic needle
3/0 (cats and dogs) or 2/0 (dogs)
submucosal/mucosal layer & seromuscular layer closed
Omentalise
What is omentalisation?
drape the greater omentum over the site of incision during closure of a gastrotomy
What is the purpose of omentalisation?
improve vascular supply and lymphatic drainage
Rich source of inflammatory and immunogenic cells
What is intussusception?
a small portion of bowel invaginates into the adjacent segment (proximal to distal typically)
Intussusceptum = Inner segment of intussusception
Intussuscipiens = Portion of bowel containing the intussusceptum
What is an enterotomy?
Making a hole in the small intestine
What methods are used to occlude the bowel from leaking?
Atraumatic clamps or fingers
Describe the suture of an enterotomy
Polydioxanone (PDS)
polyglyconate (Maxon)
Glycomer 631 (Biosyn)
poliglecaprone (Monocryl)
3/0 or 4/0
Simple interrupted or simple continuous appositional (or rarely inverting) sutures
Atraumatic needle
Omentalise
How can enterotomy closure sites be leak tested?
Close off either side of suture
Inject sterile saline into SI to check for leakage
What is an enterectomy?
removing a portion of small intestine
What is a subtotal colectomy?
removing a portion of large intestine
What is more concerning about operating on the large intestine?
Higher bacteria load (anaerobic bacteria)
Consider when choosing antibiotics
What are the effects of starvation after GI surgery?
Villous atrophy
Ulceration
Breakdown in gut barrier
Ileus (no peristaltic activity)
important to feed after GI surgery
