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RUSVM Small Animal Surgery 1 > Intestinal Surgery > Flashcards

Intestinal Surgery Flashcards

1
Q

What antibiotic is used prophylactically in intestinal surgery?

A

Cafazolin

  • gram - and gram +
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2
Q

What is the wound classification for intestinal surgeries?

A

Clean contaminated
OR
Contaminated

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3
Q

Standard criteria for assessing intestinal viability?

A

Pink, moist, glistening
Pulsation of mesenteric vessels
Bleeding from cut surface
Peristalsis - pinch test

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4
Q

What technique is used for suturing the intestine?

A

Appositional pattern - recommended for primary healing (simple interrupted or simple continuous)

Modified Gamble - to help with everted mucosa
— sutures must penetrate the submucosa (holding layer)

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5
Q

What suture material do you use in intestine?

A

Monofilament, absorbable

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6
Q

How is a transverse wedge biopsy done?

A

Full thickness wedge 3-4mm wide taken perpendicular to long axis to intestine

Wedge should not be > 20-25% of circumference

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7
Q

What are all the possible intestinal biopsy techniques?

A

Longitudinal biopsy w/ longitudinal/transverse closure

Transverse biopsy

Dermal punch

Laparoscopic (minimal invasive)

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8
Q 
Acute/severe signs
Persistent vomiting 
Gastric secretions 
Electrolyte imbalance 
Dehydration

Is this a proximal or distal intestinal obstruction ??

A

Proximal — duodenum or proximal jejunum

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9
Q

Intermittent anorexia
Occasional vomiting
Can occur over several days/weeks

Is this a proximal or distal intestinal obstruction?

A

Distal - distal jejunum, ileum, or ileocecal junction

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10
Q

What might you see on radiographs for intestinal obstruction?

A

Dilated intestinal loops
Placated intestinal loops
Radiopaque foreign body

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11
Q

Signalment and clinical signs of linear foreign bodies?

A

Cat> dog
Young

Vomiting
Depression
Abdominal pain - posture, gain, guarding on palpation

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12
Q

What do you see on radiographs with linear foreign bodies?

A

Plication of intestines

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13
Q

How do you manage a linear foreign body?

A

Free FB cranial by removing from base of tongue or performing gastrotomy

Examine mesenteric border of intestine for perforations

Remove foreign body through gastrotomy and enterotomy(ies)
—> remove pieces at a time, no tension (tears mucosa)

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14
Q

Complications of linear body removal?

A

Impaired intestinal fxn secondary to inflammatory changes

Short bowel syndrome with extensive resections

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15
Q

How would you remove a non-linear foreign body?

A

Complete abdominal exploratory

Removal through enterotomy aboral to FB on anti-mesenteric side

Resection and anastomosis if non-viable

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16
Q

You do an ultrasound in a dog and see what looks like a target. What is this lesions?

A

Intussusception

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17
Q

T/F: colonoscopy can be used to visualize jejuno-jejunal and ileocolic intussusception

A

False

Can only visualize ileocolic

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18
Q

Signalment of intussusception?

A

Young puppies

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19
Q

How can you surgically manage intussusception ?

A

Exploratory celiotomy

Manual reduction

Resection and anastomosis (if reduction is unsuccessful or nonviable tissue)

Biopsy

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20
Q

You manual reduce an intussusception, but see a full thickness tear.. how will you address this?

A

Resection and anastomosis of tissue

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21
Q

What is enteroplication? What are the complications?

A

Plication of the entire small intestine..
avoid tight turns

An attempt to prevent recurrence of intussusception

Obstruction, strangulation, perforation

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22
Q

Clinical signs associated with cecal inversion?

A

Chronic diarrhea with hematochezia

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23
Q

How can you diagnose a cecal inversion?

A

Radiographs - survey and contrast studies

Endoscopy

US

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24
Q

Treatment for cecal inversion?

A

Attempt manual reduction
Expose through colostomy if irreducible

Typhlectomy

25
Q

What breed of dog is mesenteric volvulus most common?

A

German shepherd

26
Q

Clinical signs associated with mesenteric volvulus

A

Acute abdominal distention and pain
Vomiting
Shock
Non responsive to orgogastric intubation

27
Q

How does de-rotation differ between a segmental intestinal torsion vs mesenteric volvulus?

A

Segmental — do NOT untwist, just resection and anastomosis (better prognosis)

Mesenteric volvulus — must de-rotate (risk of reperfusion injury)

28
Q

How can you minimize contamination during intestinal surgery?

A

Pack-off affected area

Separate instruments used for intestinal procedures from the rest of the pack

Occlude intestine proximal and distal with intestinal forceps or fingers (unless intestine is empty)

Decompress dilated bowel

29
Q

What is the method followed during intestinal resection and anastomosis?

A

Pack off affected segment

Determine extent of excision and ligate blood supply

Occlude proximal and distal segments as atraumatically as possible

Minimize mucosal eversion
Begin anastomosis at mesenteric border

Interrupted or continuous suture pattern (ligate between two sutures
Close rent in mesentery

Wrap anastomosis with omentum

30
Q

How can you put two different sized lumens of intestine together with anastomosis?

A

Angle cut - enlarged lament

Antimesenteric incision “fishmouth” or cheattle incision

Placing mesenteric and anti-mesenteric sutures stretches the smaller segment - sutures are placed closer on the smaller segment

31
Q

How can you minimize mucosal eversion in anastomosis of intestine?

A

Modified gambee

Can cut mucosa

32
Q

When suturing two loops of intestine together. Where do you start?

A

Mesenteric border
- leakage most common at this site (no serosa and fat in mesentery impairs visualization)

Antimesenteric border

33
Q

What suture patterns do you use in intestinal anastomosis?

A

Simple interrupted or simple continuous

3-4mm bites

34
Q

How do you leak test anastomosis?

A

Occlude intestine proximal and distally

Inject saline until saline is evenly distended

Gently compress and look for leaks

35
Q

T/F: staples can be used in intestinal anastomosis ?

A

True — skin staples that close tightly

36
Q

After leak testing your anastomosis site, what do you do before you close the abdomen?

A

Lavage
Change gloves and instruments before closure

Wrap anatamosis with omentum —> vascular and lymphatic supply improve healing

37
Q

What is a serosal patch and when is it used?

A

Suturing of intestinal anastomosis site to colon —> reinforce suture lines in questionable tissue

Omentum not available
Induced permanent adhesion much stronger than omentum

38
Q

Is healing of the small or large intestine faster??

A

Small intestine faster than large intestine
—> lg initially takes 3-4weeks lag period before strengthening
—> collagenolysis
—> wound strength 75% of normal at 4 months

39
Q

What are indications for colostomy?

A

Foreign body
Impacted feces
Biopsy

40
Q

How do you close a colotomy?

A

Longitudinal

Single layer, simple interrupted, appositional

41
Q

What are the indications for colopexy?

A

Recurrent rectal prolapse

42
Q

Complications from colopexy?

A

Infection
Dehiscence
Recurrence

43
Q

Indication for colonic resection and anastomosis ?

A

Megacolon
Perforation
Neoplasia
Irreducible/necrotic intussusception

44
Q

T/f: Megacolon is more common in dogs than cats

A

False

Cats> dogs

45
Q

What are causes of megacolon?

A

Congenital vs acquired
Mechanical or functional colonic obstruction
Neurologic
Idiopathic (most common in cat)

46
Q

Prolonged colonic distention leads to damage of??

A

Smooth msucle and nerve

47
Q

What neurological conditions can lead to megacolon?

A

Lumbrosacral disease
Key-Gaskell (feline progressive dysautonomia)
Sacral spinal cord deformity (Manx)

48
Q

What type of trauma can lead to a megacolon?

A

Callus formation from healing pelvic fracture and SI luxation

49
Q

How would you you treat a megacolon associated with pelvic trauma?

A

Pelvic osteotomy

— good prognosis if early (<6months)

50
Q

How do you treat a megacolon caused obstructive/entrapment due to adhesion formation for OVH?

A

Surgical dissection and removal

Potential for resection and anastomosis

51
Q

Cats can get an idiopathic/primary megacolon.. what are the medical management ?

A

Diet -low residue diets
Hydration
Nama

Prokinetic drug - cisapride
Stool softeners - lactulose

52
Q

What is the surgical management for primary megacolon in cats?

A

Colectomy

  • colocolonic anastomosis
  • ileocolic anastomosis
  • jujunocolic anastomosis

Ileocecal valve preservation

  • bacterial overgrowth prevented
  • increases tension at anastomosis
53
Q

T/F: prior to surgery you should use a stool softener and enema to clear the colon

A

False

You are only going to surgery if medical management has failed.. Do NOT use these —> increased contaminated surgery

54
Q

What can you expect to see in patients post op colectomy?

A

+/- tenesmus - 7 days
Diarrhea
Increased frequency of defection

55
Q

How should colectomy patients be managed postop?

A

Taper fluid and electrolyte therapy as oral intake returns to normal

Offer food and water the day after surgery unless contraindicated

Pain management

56
Q

Most complications due to colectomy occur in the first 3-5days post op… what will you be monitoring in these patients?

A 
General attitude 
Mucous membranes 
Abdominal palpation. 
Temp bid to tid 
CBC 
Abdominocentesis or diagnostic peritoneal lavage (DPL) 
Ultrasonography 
Re-exploration
57
Q

Common complications following intestinal surgery?

A 
Ileus 
Adhesions 
Obstruction (intussusception, entrapment, stenosis) 
Dehiscence 
Peritonitis 
Short bowel syndrome
58
Q

What are risk factors for dehiscence after intestinal surgery?

A

Foreign body/ trauma
Perioperative albumin <2.5g/dL
Postoperative rise in band neutrophils
Perioperative peritonitis

59
Q

What is the prognosis for intestinal surgery?

A

No dehiscence —> good prognosis

Dehiscence (7-15% of cases) —> poor, mortality 74-85%

RUSVM Small Animal Surgery 1 (39 decks)

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