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6th MELEAH SAS 1 > Intestine > Flashcards

Intestine Flashcards

1
Q

procedure for insusseption, to prevent recurrence, must plicate the entire small intestine and avoid _____ _____

A

Enteroplication (avoid tight turns)

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2
Q

What are some of the complications of Enteroplication, recurrence rate? Complication rate?

A
  1. Obstruction
  2. Strangulation
  3. Perforation

recurrence rate 5%
complication rate 19%

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3
Q

What CS do you see with cecal inversion?

A

Cecal intussesception

Chronic D+ with hematochezia

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4
Q

How do you dx cecal inversion?

A

Rads (survey, contrast studied)

Endoscopy

Ultrasonography

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5
Q

How do we treat cecal inversion?

A

Attempt manual reduction

expose through colotomy if irreducible

typlectomy (remove the cecum they dont have to have it)

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6
Q

What breed do you think about when you mesenteric volvulus?

A

german shepherds

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7
Q

This condition is rare and often fatal and where the intestine twists on mesenteric axis causing a strangulating mechanical obstruction, (often ischemia of SI)

A

Mesenteric Volvulus

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8
Q

What CS do we see with mesenteric volvulus?

A

Acute abdom. pain
V+
Shock
non responsive to orogastric intubation

unremarkable rads initially, once clear, bad

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9
Q

What can you do to improve mesenteric volvulus? What yields a better prognosis

A

rapid fluid resuscitation and immediate abdominal exploratory

Derotation +/- resection and anastomosis if possible consider a reperfusion injury though

Segmental w/o derotation better prognosis

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10
Q

Describe some of the basics for principle of intestinal surgery?

A

Minimize contamination (pack off affected area, separate instruments to be used for intest. procedure from rest of pack)

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

Decompress dilated bowel loops

Gentle tissue handling

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11
Q

If intestines are empty _____ is not mandatory and decrease manipulation/trauma?

A

occlusion

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12
Q

Why do you angle your cut when cutting intestine?

A

Enlarges your lumen because when healing bc 10-20% narrowing is inherently going to happen and you want enlargement as much as you can

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13
Q

Describe the 8 steps of resection and anastomosis?

A
  1. Pack off affected segment
  2. Determine extent of excision and ligate blood supply
  3. Occlude proximal and distal segments at atraumatically as possible
  4. Minimize mucosa eversion
  5. Begin anastomosis at mesenteric border
  6. Interrupted or continuous suture pattern
  7. Close rent in mesentary
  8. Wrap anastomosis with omentum
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14
Q

Appositional patterns? (2)

A

simple interrupted or simple continuous

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15
Q

When dividing the intestine state the pros and cons of scissors versus scalpel

A

Scissors: more control more traumatic

Scalpel: less control less traumatic

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16
Q

How can you minimize mucosal eversion (what pattern), what would eversion potentially cause?

A

Use of modified gambee

Mucosal Eversion could potentially cause increase risk of infection and adhesion formation

17
Q

Leakage is most common at what site of the intestine and state why? What is the significance of this site for intestinal resection and anastomosis sx procedure?

A

Leakage of the mesenteric border because no serosa and fat in mesentery and impairs visualisation

; begin your anastomosis there!!!

18
Q

Describe your sizing of the suture bites for resection and anastomosis?

A

3-4 mm bites

3-4 mm apart

19
Q

What should you always do to double check your resection and anastomosis and how do you do it?

A

Leak test!!!!

Occlude intestine proximally and distally and inject saline until intestine is evenly distended

gently compress and look for leaks

20
Q

What do we do before we close no matter whether or not they have spillage?

A

Lavage the anastomosis site and change sx instruments used during the intestinal procedure for new ones

21
Q

We wrap the anastomosis site with this. What is this very important structure used in reducing the risk of wound healing problems after intestinal surgery because of the ______ and ______ supply?

A

Omentum; vascular; lymphatic

22
Q

With _____ _____ the omentum is not available?

A

serosal patch

23
Q

What is a serosal patch and what is it used for?

A

Used to reinforce suture lines in questionable tissue areas like from enterotomy, colotomy, and urinary bladder. take portion of serosa from jejunum and seal your enterotomy site or anastomosis. much stronger and permanent adhesion than omentum

24
Q

L. intestine and small intestine principles are the same but what are the difference for large intestine

A

High bacterial population in colon (why we avoid it)

initial strength of wound healing is weaker

more collagen breakdown

wound strength is 75% of normal at 4 months

more segmental BS so make sure maintain ing tissue perfusion well

25
Q

What are some indications for doing a colotomy (3)

A
  1. FB removal
  2. Impacted feces
  3. Biopsy
26
Q

How do you close when doing a colotomy?

A

Longitudinal, single layer, simple interrupted, appositional

27
Q

What large intestine procedure creates a permanent adhesion between colon and abdominal wall?

A

Colopexy (often done on left side of abdomen) incisional or non incisional

28
Q

Why would we do a colopexy?

A

Recurrent rectal prolapse

29
Q

What are some of the complications of colopexy?

A

Infection, Dehiscence, Recurrence

30
Q

Why would we do a colonic resection and anastomosis? (4)

A
  1. Megacolon
  2. Perforation
  3. Neoplasia
  4. Irreducible necrotic intussusception
31
Q

You can either do a partial or subtotal colectomy, what is a subtotal colectomy including?

A

With or without preservation of the ileocecal valve

32
Q

Megacolon occurs more in ____ than _____ (species)

A

cats> dogs

33
Q

What are some causes of megacolon? Which is most common in cats

A

Congenital/acquired

Mechanical or functional colonic obstruction

Neurologic

Idiopathic (most common in cats)

34
Q

What causes pain with megacolon and what are the adverse effects from this conditon?

A

Concretions of feces too large to pass and causes prolonged distension because water is constantly being taken from it so it gets more hard and causes smooth muscle damaage and nerve damage

35
Q

Not very common in cats but what causes congenital megacolon?

A

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

36
Q

Neuro reason causing megacolon is from? (3) state the breed assocation

A

Lumbosacral disease

Key Gaskell feline progressive dysautonomia

sacral spinal cord deformity seen often in manx cats!!

37
Q

Pelvic trauma can cause _____ from callus formation from healing pelvic fracture and SI luxation. What can you do to lead to a good prognosis?

A

megacolon

Good prognosis if you catch it early!!! <6 months, but often is dependant on degree and distension

6th MELEAH SAS 1 (8 decks)

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