Intestinal Surgery Flashcards
Principles of Intestinal Sx (10)
- 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
Indications for Small Intestine Surgery (4)
- Obstruction
- Perforation
- Diagnosis
- Biopsy
One of the main reasons for small intestine surgery
Obstruction
What are the recommend prophylactic abx for the upper and middle SI
1st generation fo Cephalosporins (Cefazolin)
What are the recommended prophylactic abx for the lower SI and LI?
2nd generation Cephalosporins (Cefoxitin)
Causes of intestinal obstruction
- Foreign body
- Intussusception
- Ileus
- Neoplasia
- Pythiosis
- Trauma
- Mesenteric torsion
- Herniation
The severity of signs of intestinal obstruction depends on
- Completeness - complete vs partial
- Location
- Blood supply
- **Complete, high, or strangulated obstructions results in more severe signs **** **
- Cause vs signalment
Linear FB are more common in ____; while other FBs are more common in _____
Cats
Dogs
Intussusception is more common in ____.
What should you do after you dx intussusception and why?
More common in young dogs
After dx, do fecal exam → usually due to intestinal parasites
Mesenteric torsion is most common in ___
Adult dogs (German Shepard)
What is ileus?
What is the minimum pressure befoer the kidneys shut down?
Bowel no longer moving - bacteria grows - fluid goes into 3rd space of lumen
**60mmHg **
Signalment usually associated with intestinal neoplasia
Middle aged/old dogs and cats
When are C/S of infection following enterectomy seen?
**3-5 days **
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
- >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
Pathophysiology of intestinal obstruction - metabolic alkalosis
**Pyloric/proximal duodenal obstruction **
Pathophysiology of intestinal obstruction - metabolic acidosis
**Mid-duodenal to ileal obstruction **
Pathophysiology of intestinal obstruction - Fluid loss due to
- Vomiting
- Sequestration in inestinal lumen - increased secretion and decreased absorption
- Edema of intestinal wall, especially w/venous occlusion of intestine
What is the definition of a strangulating obstruction?
What does it result in?
- Simple obstruction + occlusion of blood supply to intestine results in:
- bacterial overgrowth
- increased bowl permeability
- perforation & escape of bowel contents
- pertonitis
What is one of the most dangerous adhesions found?
**Hairpin adhesion **
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?
Hairpin adhesion
Bolus of food cannot pass around the curve & gets stuck –> food accumulation –> obstruction
C/S of intestinal obstruction
- V+
- Dehydration, electrolyte imbalance, acid-base imbalance
- Abdominal palpation
- Distended loops of intestines
- Palpable abdominal mass
Tx of intestinal obstruction
- Stabilize or optimize P
- **Correct underlying condition surgically **
What is pica?
Appetite for non-nutritive substances
Why should you check under a cat’s tongue during a physical exam?
Cats like to get linear foreign bodies
**Liner foreign bodies are ofgetn anchored under the tongue **
During the physical exam of a 1 year old exam of a female Maine Coon cat. What do you do?
- Inspect oral cavity
- **Release the FB carefully **
- **See if it can pass naturally **
Where else may a linear foreign body get stuck?
**Pylorus - is more common **
What happens to the intestines when there is a linear FB?
**Peristalsis –> intestine keeps pulling and plactating in attempt to pass FB –> linear FB gets embedded and cuts thru - perforation or ischemic tissue **
When you take rads of a linear FB, what do you expect to see?
**Intestine plicated in cranial abdomen **
**Teardrop shape of gas bubbles in intestine **
What part of the intestine are you concerned with the linear FB perforating?
**Mesenteric border of intestines **
**_____ may be required to remove linear FB? **
Multiple eneterotomies (Anderson technique)
