Intestinal & urinary surgery

Question 1

Label the layers of the bowel

Answer 1

Question 2

What is going on here

Answer 2

Gastrotomy

often done to remove FB from stomach

Use stay sutures to manipulate stomach

Packed off with swabs to prevent contamination

Question 3

Describe the closure of a gastrotomy

Answer 3

Absorbable monofilament (e.g. polydioxanone) & atraumatic needle

size:
- 3/0 cats
- 3/0 or 2/0 dogs

pattern:
- 1 layer: full thickness (simple interrupted, simple continuous or continuous inverting)
- 2 layer: submucosa & seromuscular

omentalise

Question 4

Why is omentalisation done?

Answer 4

Improve vascular supply

lymphatic drainage

rich source of inflammatory & immunogenic cells

neo-vascularisation

Question 5

What is intussusception

Answer 5

Portion of bowel invaginates into adjacent segment

intussusceptum: inner segment

intussescipiens: portion of bowel containing intussesceptum

Causes bowel obstruction

Treatment involves reducing intussusception & maintaining it

Question 6

What is an enterotomy

Answer 6

Making hole into intestine

To take full thickness bowel biopsy or removal of intestinal FB

Use atraumatic clamps or fingers of assistant to prevent leaking of bowel

Question 7

Describe closure of an enterotomy

Answer 7

Suture options:
- Polydioxanone (PDS)
- Polyglyconate (Maxon)
- Glycomer 631 (Biosyn)
- Poliglecaprone (monocryl)

size:
- 3/0 or 4/0

good early tensile strength (days 5-7)

resistant absorption for >21 days

simple interrupted ot simple continuous appositional sutures

2-3mm apart & 2-3 mm from edge

atraumatic needle

omentalise

Question 8

Describe leak testing

Answer 8

Clamp off bowel on either side of incision

Stick needle attached to syringe with sterile saline into lumen

Don’t inject under too much pressure – causes anastomosis to leak

Question 9

What is an enterectomy

Answer 9

Remove portion of bowel

End to end anastomosis: bring 2 ends together

Question 10

What is a (subtotal) colectomy

Answer 10

Removal/semi-removal of colon

e.g. in megacolon

Lots of anaerobic bacteria – use antibiotic that is good against anaerobic bacteria (e.g. metronidazole)

Question 11

Why is feeding post GI surgery important?

Answer 11

starvation after GI surgery considered detrimental:
- villous atrophy
- ulceration
- breakdown in gut barrier
- ileus

Early enteral nutrition indicated in most circumstances

Oral route best but other routes in different circumstances

Question 12

What are some reasons for performing a urinary bladder cystotomy

Answer 12

calculi (urolithiasis)

biopsy

tumour

ureteral ectopia

Question 13

How is a urinary bladder cystotomy performed

Answer 13

1. Stay sutures placed (2 either side and 1 at pole)
2. Pack off with sterile swabs
3. Drain bladder
4. Longitudinal incision on ventral surface of bladder (preserves blood supply)

Question 14

Describe a cystotomy closure

Answer 14

Absorbable monofilament (e.g. polydioxanone)

size:
- 4/0 or 3/0 cats
- 4/0 or 3/0 or 2/0 dogs

pattern:
- 1 layer: full thickness (simple interrupted, simple continuous or continuous inverting)
- 2 layer: submucosa & seromuscular

atraumatic needle

Drape omentalise site of repair