L13: Basic GI surgery - Small animal Pt.1 (Ellison) Flashcards
CS of pyloric obstruction
projectile vomiting undigested without mucus but with bile rapid fluid loss electrolyte loss (Na, K, HCl) alkalosis
gastrotomy guidelines
- ventral midline approach
- stay sutures
- b/w lesser and greater curvatures
- use Cushing in submucosa and Lembert in seromuscular-submucosa
- absorbable suture, but no cat gut
risk factors for GDV
Great Dane > St. Bernard > Weimeraner > Irish Setter
etiologies of GDV
- diet
- overeating, postprandial exercise
- hypogastric ligament stretch
- delayed gastric emptying
- bacterial fermentation
- aerophagia
- hypergastrinemia
- gastric myoelectric dysrhythmias
CS of GDV
restless uncomfortable hypersalivation wretching abd distention hyperpnea shock
mech. of GDV rotation
fundus L to R
spleen ventral to dorsal
270 degree clockwise rotation (preceeded by dilation)
pathophys. of GDV
- venous stasis
- dec. arterial flow
- tearing of short gastric and gastroepiploic a. and v.
dec. pH and pepsin –> ischemia, necrosis, elevated serum lactate - gastric distention –> compression of portal v. –> intestinal stasis –> septic shock
- dec. production of coag factors 8 and 9 in spleen –> hemorrhage, necrosis, etc.
- 2ary DIC
tx of GDV
- decompress
- shock therapy
- tx tachycardias with lidocaine bolus
- tx seizure with valium
- 80% recur without sx
how to assess gastric wall viability
color temp peristalsis (pinch test***) thickness** fluorescein - not accurate surface oximetry
advantages of tube gastrostomy
rapid easy procedure
creates permanent adhesion
allows for gastric decompression
allows for tube feeding
incisional gastropexy
- rapid, easy
- stomach lumen not entered
- disadv: no post-op alimentation, no good follow-up
types of gastropexy
tube
incisional
ventral midline
types of intestinal obstruction
complete/incomplete high/low simple mechanical/strangulated acute/chronic perforated/non-perforated
simple complete obstruction
- ischemia, devitalization
- dec. fluid absorption
- bowel wall edema
- fluid accumulation
3 types of mechanical obstruction
luminal (FB, polypoid mass)
intramural (neoplasia, fungal granuloma)
extramural (adhesions, strangulated (or non?) hernia)
> 50% secretions from:
Stomach, duodenum, proximal jejunum (most resorbed by jejunum, ileum)
duodenal obstruction –>
loss of salivary, gastric, pancreatic duodenal secretions –> rapid dehydration
in LOW jejunal obstruction, resorptive capacity is maintained
causes of simple complete obstruction
FB trichobezoars tumors granulomas stricture enterolith parasite adhesion gas (swallowed or formed in situ)
> 1.6x midpoint height of L5 is considered dilated for dogs***
indicative of mechanical obstruction
methods of experiemental intestinal viability
temp probes pH monitors Doppler flow devices IV vital dyes surface oximetry
methods of clinical intestinal viability***
color
arterial pulsations
peristalsis - pinch test***
causes of strangulation obstruction
local pressure necrosis - FB
mesenteric vascular disruption (volvulus, intuss., hernia, thromboembolism)
lymphoma on U/S
circumferential symmetric hypoechoic
adenocarcinoma U/S
symmetric or asymmetric mixed echogenicity
intussusception on U/S
inc. circumference symmetric target
