Intestine Flashcards
procedure for insusseption, to prevent recurrence, must plicate the entire small intestine and avoid _____ _____
Enteroplication (avoid tight turns)
What are some of the complications of Enteroplication, recurrence rate? Complication rate?
- Obstruction
- Strangulation
- Perforation
recurrence rate 5%
complication rate 19%
What CS do you see with cecal inversion?
Cecal intussesception
Chronic D+ with hematochezia
How do you dx cecal inversion?
Rads (survey, contrast studied)
Endoscopy
Ultrasonography
How do we treat cecal inversion?
Attempt manual reduction
expose through colotomy if irreducible
typlectomy (remove the cecum they dont have to have it)
What breed do you think about when you mesenteric volvulus?
german shepherds
This condition is rare and often fatal and where the intestine twists on mesenteric axis causing a strangulating mechanical obstruction, (often ischemia of SI)
Mesenteric Volvulus
What CS do we see with mesenteric volvulus?
Acute abdom. pain
V+
Shock
non responsive to orogastric intubation
unremarkable rads initially, once clear, bad
What can you do to improve mesenteric volvulus? What yields a better prognosis
rapid fluid resuscitation and immediate abdominal exploratory
Derotation +/- resection and anastomosis if possible consider a reperfusion injury though
Segmental w/o derotation better prognosis
Describe some of the basics for principle of intestinal surgery?
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
If intestines are empty _____ is not mandatory and decrease manipulation/trauma?
occlusion
Why do you angle your cut when cutting intestine?
Enlarges your lumen because when healing bc 10-20% narrowing is inherently going to happen and you want enlargement as much as you can
Describe the 8 steps of resection and anastomosis?
- Pack off affected segment
- Determine extent of excision and ligate blood supply
- Occlude proximal and distal segments at atraumatically as possible
- Minimize mucosa eversion
- Begin anastomosis at mesenteric border
- Interrupted or continuous suture pattern
- Close rent in mesentary
- Wrap anastomosis with omentum
Appositional patterns? (2)
simple interrupted or simple continuous
When dividing the intestine state the pros and cons of scissors versus scalpel
Scissors: more control more traumatic
Scalpel: less control less traumatic
How can you minimize mucosal eversion (what pattern), what would eversion potentially cause?
Use of modified gambee
Mucosal Eversion could potentially cause increase risk of infection and adhesion formation
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?
Leakage of the mesenteric border because no serosa and fat in mesentery and impairs visualisation
; begin your anastomosis there!!!
Describe your sizing of the suture bites for resection and anastomosis?
3-4 mm bites
3-4 mm apart
What should you always do to double check your resection and anastomosis and how do you do it?
Leak test!!!!
Occlude intestine proximally and distally and inject saline until intestine is evenly distended
gently compress and look for leaks
What do we do before we close no matter whether or not they have spillage?
Lavage the anastomosis site and change sx instruments used during the intestinal procedure for new ones
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?
Omentum; vascular; lymphatic
With _____ _____ the omentum is not available?
serosal patch
What is a serosal patch and what is it used for?
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
L. intestine and small intestine principles are the same but what are the difference for large intestine
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
What are some indications for doing a colotomy (3)
- FB removal
- Impacted feces
- Biopsy
How do you close when doing a colotomy?
Longitudinal, single layer, simple interrupted, appositional
What large intestine procedure creates a permanent adhesion between colon and abdominal wall?
Colopexy (often done on left side of abdomen) incisional or non incisional
Why would we do a colopexy?
Recurrent rectal prolapse
What are some of the complications of colopexy?
Infection, Dehiscence, Recurrence
Why would we do a colonic resection and anastomosis? (4)
- Megacolon
- Perforation
- Neoplasia
- Irreducible necrotic intussusception
You can either do a partial or subtotal colectomy, what is a subtotal colectomy including?
With or without preservation of the ileocecal valve
Megacolon occurs more in ____ than _____ (species)
cats> dogs
What are some causes of megacolon? Which is most common in cats
Congenital/acquired
Mechanical or functional colonic obstruction
Neurologic
Idiopathic (most common in cats)
What causes pain with megacolon and what are the adverse effects from this conditon?
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
Not very common in cats but what causes congenital megacolon?
Aganglionic distal colonic segment and absence of inhibitory neurons = functional obstruction
Neuro reason causing megacolon is from? (3) state the breed assocation
Lumbosacral disease
Key Gaskell feline progressive dysautonomia
sacral spinal cord deformity seen often in manx cats!!
Pelvic trauma can cause _____ from callus formation from healing pelvic fracture and SI luxation. What can you do to lead to a good prognosis?
megacolon
Good prognosis if you catch it early!!! <6 months, but often is dependant on degree and distension
