Intestinal Surgery

Question 1

Principles of Intestinal Sx (10)

Answer 1

• Perform sx ASAP
• Exteriorize intestine to open & pack off abdom. cavity
• Preserve blood supply
• Appose mucosa accurately
• Engage submucosa with all sutures - simple appositional
• Use small size, monofilament synthetic absorb or non absorb suture waged on taper needles
• Cover sx site w/omentum or w/a serosal patch
• Recommend prophylactic abx

Question 2

Indications for Small Intestine Surgery (4)

Answer 2

• Obstruction
• Perforation
• Diagnosis
• Biopsy

Question 3

One of the main reasons for small intestine surgery

Answer 3

Obstruction

Question 4

What are the recommend prophylactic abx for the upper and middle SI

Answer 4

1st generation fo Cephalosporins (Cefazolin)

Question 5

What are the recommended prophylactic abx for the lower SI and LI?

Answer 5

2nd generation Cephalosporins (Cefoxitin)

Question 6

Causes of intestinal obstruction

Answer 6

• Foreign body
• Intussusception
• Ileus
• Neoplasia
• Pythiosis
• Trauma
• Mesenteric torsion
• Herniation

Question 7

The severity of signs of intestinal obstruction depends on

Answer 7

• Completeness - complete vs partial
• Location
• Blood supply
• **Complete, high, or strangulated obstructions results in more severe signs **** **
• Cause vs signalment

Question 8

Linear FB are more common in ____; while other FBs are more common in _____

Answer 8

Cats

Dogs

Question 9

Intussusception is more common in ____.

What should you do after you dx intussusception and why?

Answer 9

More common in young dogs

After dx, do fecal exam → usually due to intestinal parasites

Question 10

Mesenteric torsion is most common in ___

Answer 10

Adult dogs (German Shepard)

Question 11

What is ileus?

What is the minimum pressure befoer the kidneys shut down?

Answer 11

Bowel no longer moving - bacteria grows - fluid goes into 3rd space of lumen

**60mmHg **

Question 12

Signalment usually associated with intestinal neoplasia

Answer 12

Middle aged/old dogs and cats

Question 13

When are C/S of infection following enterectomy seen?

Answer 13

**3-5 days **

Question 14

Sensitivity of GIT to Hypoxia - What is seen at the following times?

>20 min

>60 min

1-3 hrs

>4 hrs

> 8 hrs

8-12 hrs

12-36 hrs

20 hrs

3-4 days

Answer 14

• >20 min = superficial villus injury
• >60 min = destruction of villus
• 1-3 hrs = wall edema, hemorrhage, mucosal sloughing
• >4 hrs = transmucosal necrosis - affected segment of intestine is turgid - whole blood collects w/in lumen
• >8 hrs = transmural infarction
• 8-12 hrs = affected gut appears black, distended, and elongated
• 12-36 hrs = gaseous bowel distention develops - followed by loss of fluid into intestinal lumen
• 20 hrs = gross necrosis evident
• 3-4 days = death due to hypovolemia if obstruction remains

Question 15

Pathophysiology of intestinal obstruction - metabolic alkalosis

Answer 15

**Pyloric/proximal duodenal obstruction **

Question 16

Pathophysiology of intestinal obstruction - metabolic acidosis

Answer 16

**Mid-duodenal to ileal obstruction **

Question 17

Pathophysiology of intestinal obstruction - Fluid loss due to

Answer 17

• Vomiting
• Sequestration in inestinal lumen - increased secretion and decreased absorption
• Edema of intestinal wall, especially w/venous occlusion of intestine

Question 18

What is the definition of a strangulating obstruction?

What does it result in?

Answer 18

• Simple obstruction + occlusion of blood supply to intestine results in:
  
  • bacterial overgrowth
  • increased bowl permeability
  • perforation & escape of bowel contents
  • pertonitis

Question 19

What is one of the most dangerous adhesions found?

Answer 19

**Hairpin adhesion **

Question 20

An adult mixed breed dog presents to you clinic for abdominal pain. After PE, you decide to proceed with rads –> you see an opacity that resembles food, and you suspect an obstruction. You move to surgery –> you find an adhesion –> What type of adhesion is this most likely to be, and how does it occur?

Answer 20

Hairpin adhesion

Bolus of food cannot pass around the curve & gets stuck –> food accumulation –> obstruction

Question 21

C/S of intestinal obstruction

Answer 21

• V+
• Dehydration, electrolyte imbalance, acid-base imbalance
• Abdominal palpation
• Distended loops of intestines
• Palpable abdominal mass

Question 22

Tx of intestinal obstruction

Answer 22

• Stabilize or optimize P
• **Correct underlying condition surgically **

Question 23

What is pica?

Answer 23

Appetite for non-nutritive substances

Question 24

Why should you check under a cat’s tongue during a physical exam?

Answer 24

Cats like to get linear foreign bodies

**Liner foreign bodies are ofgetn anchored under the tongue **

Question 25

During the physical exam of a 1 year old exam of a female Maine Coon cat. What do you do?

Answer 25

• Inspect oral cavity
• **Release the FB carefully **
• **See if it can pass naturally **

Question 26

Where else may a linear foreign body get stuck?

Answer 26

**Pylorus - is more common **

Question 27

What happens to the intestines when there is a linear FB?

Answer 27

**Peristalsis –> intestine keeps pulling and plactating in attempt to pass FB –> linear FB gets embedded and cuts thru - perforation or ischemic tissue **

Question 28

When you take rads of a linear FB, what do you expect to see?

Answer 28

**Intestine plicated in cranial abdomen **

**Teardrop shape of gas bubbles in intestine **

Question 29

What part of the intestine are you concerned with the linear FB perforating?

Answer 29

**Mesenteric border of intestines **

Question 30

**_____ may be required to remove linear FB? **

Answer 30

Multiple eneterotomies (Anderson technique)