Intestinal Sx-Exam 2

Question 1

What fluids are used to tx hypovolemia pre-intestinal surgery?

Answer 1

Crystalloids and colloids

Question 2

What is an antibiotic that is used for prophylaxis in intestinal sx?

Answer 2

Cefazolin 22 mg/kg

20-30 minutes prior incision

Question 3

What are some standard criteria for viable intestine?

Answer 3

Pink
Moist
Pulsation of mesenteric vessels
Bleeding from cut surface
Peristalsis (pinch test)

Question 4

What type of suture should be used for intestinal sx?

Answer 4

Monofilament absorbable

Don’t use non-absorbable because this allows for foreign bodies to attach to suture

Question 5

What layer must be penetrated when suturing intestines?

Answer 5

SUBMUCOSA- this is the holding layer

Question 6

What is the suture pattern recommended for primary healing?

Answer 6

Appositional pattern-simple interrupted/continuous

Question 7

Which suture pattern minimizes eversion?

Answer 7

Modified-gambee pattern

Doesn’t take full bite of mucosa

Question 8

What size sample is taken for an intestinal biopsy?

Answer 8

3-4 mm wide sample

Question 9

What side of the intestine will you perform a biopsy on?

Answer 9

Anti-mesenteric border

Question 10

What is the pathophysiology of a small intestinal obstruction?

Answer 10

Distention of bowel proximal (oral) and unaffected aboral

Question 11

What locations would be involved in a proximal intestinal obstruction?

Answer 11

Duodenum or proximal jejunum

Question 12

What locations would be involved in a distal intestinal obstruction?

Answer 12

Distal jejunum/ileum/ileocecal junction

Question 13

What will be seen on rads in a patient with small intestinal obstruction?

Answer 13

Dilated intestinal loops
Plicated intestinal loops
Radiopaque foreign body

Question 14

What is the typical signalment for linear foreign bodies?

Answer 14

Young animals (cats>dogs)
Sewing thread, yarn or string

Question 15

When do CS appear in a patient with a linear foreign body?

Answer 15

When FB becomes fixed at some point cranially (around tongue or @ pylorus)

Question 16

WHere does the FB need to be freed from initially and what is performed if at pylorus?

Answer 16

Free from base of tongue

Perform gastrotomy

Question 17

What border of intestine should be examined for perforations?

Answer 17

Mesenteric border

Question 18

What is a complication of linear foreign body sx?

Answer 18

Short bowel syndrome w/ extensive resections

Question 19

Where should a FB be removed?

Answer 19

Enterotomy aboral to FB on anti-mesenteric border

Question 20

Why is the enterotomy performed aboral to FB?

Answer 20

The tissue is healthier making closing quicker

Question 21

What should be performed if there is nonviable tissue?

Answer 21

Resection and anastamosis

Question 22

What are two underlying causes of intussusception?

Answer 22

Parasitism or Parvovirus

Question 23

What are the three common areas for intussusception?

Answer 23

Ileocolic
Jejuno-jejunal
Cecum

Question 24

What is the signalment for intussusception?

Answer 24

young puppies

Question 25

What is noticed on US in a patient with intussusception?

Answer 25

``` Target lesion (transverse plane) Onion like appearance ```

Question 26

What is the sx managment for intussusception?

Answer 26

Manual reduction Resection/Anastomosis Enteroplication

Question 27

What are three complications of enteroplication?

Answer 27

Obstruction Strangulation Perforation

Question 28

What are CS in a patient w/ cecal inversion?

Answer 28

Chronic diarrhea w/ hematochezia

Question 29

What is typhlectomy?

Answer 29

Removal of cecum

Question 30

What breed is seen to get mesenteric volvulus?

Answer 30

GSD

Question 31

What are some CS of mesenteric volvulus?

Answer 31

Acute abdominal distention and pain, v+ and shock | Non-responsive OG intubation

Question 32

What is a cause for concern when tx the mesenteric volvulus?

Answer 32

Reperfusion injury

Question 33

Where do you begin anastamosis for mesenteric volvulus?

Answer 33

Mesenteric border | cut at an angle to account for 10-20% narrowing occurring during healing

Question 34

What can be wrapped around intestines to help with healing?

Answer 34

Omentum

Question 35

What are three differences in SI vs. LI?

Answer 35

LI: higher bacterial population Healing: 3-4 day lag period, collagenolysis, wound strength 75% normal at 4 months- slower Blood supply: vasa recta; maintain tissue perfusion

Question 36

When is a colotomy indiated?

Answer 36

FB removal Impacted feces Bx

Question 37

What are the closure options for colotomy?

Answer 37

Longitudinal | Single layer, simple interrupted, appositional

Question 38

What is the term for permanent adhesion between colon and abdominal wall?

Answer 38

Colopexy

Question 39

Which side should colopexy's be performed?

Answer 39

L side

Question 40

What are the indications for a colopexy?

Answer 40

Recurrent/retal prolapse

Question 41

What species most commonly has megacolon?

Answer 41

Cats

Question 42

What is congenital megacolon?

Answer 42

Aganglionic distal colonic segment-absence of inhibitory neurons=functional obstruction

Question 43

What breed cats commonly get the neurological megacolon?

Answer 43

Manx cats

Question 44

What is the primary/idiopathic form of megacolon?

Answer 44

Dysfunciton of colonic smooth muscle

Question 45

What is the go to tx for megacolon?

Answer 45

Medical therapy first- diet, hydration, enemas, prokinetic drugs (cisapride) or stool softeners (lactulose)

Question 46

When should sx management be performed in a cat with megacolon and what is the sx?

Answer 46

When medical management fails | Colectomy

Question 47

What are the three areas of colectomy?

Answer 47

Colocolonic anastamosis Ileocolic anastomosis Jejunocolic anastomosis

Question 48

Which two colectomy methods remove the ileocecal valve and which one preserves the ileocecal valve?

Answer 48

Removes: ileocolic anastomosis & jejunocolic anastomosis Preserve: colocolonic anastomosis

Question 49

What is seen if you preserve the ileocecal valve?

Answer 49

Prevention of bacterial overgrowth and increased tension at anastomosis

Question 50

What are some complications that can occur following intestinal sx?

Answer 50

``` Ileus Adhesions Obstruction Dehiscence Peritonitis Short bowel syndrome ```

Question 51

What are four risk factors for dehiscence after sx?

Answer 51

FB/Trauma Pre-operative albumin <2.5 g/dL Post-op peritonitits Post-op rise in band neutrophils