L13: Basic GI surgery - Small animal Pt.1 (Ellison)

Question 1

CS of pyloric obstruction

Answer 1

projectile vomiting
undigested without mucus but with bile
rapid fluid loss
electrolyte loss (Na, K, HCl)
alkalosis

Question 2

gastrotomy guidelines

Answer 2

• 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

Question 3

risk factors for GDV

Answer 3

Great Dane > St. Bernard > Weimeraner > Irish Setter

Question 4

etiologies of GDV

Answer 4

• diet
• overeating, postprandial exercise
• hypogastric ligament stretch
• delayed gastric emptying
• bacterial fermentation
• aerophagia
• hypergastrinemia
• gastric myoelectric dysrhythmias

Question 5

CS of GDV

Answer 5

restless
uncomfortable
hypersalivation
wretching
abd distention
hyperpnea
shock

Question 6

mech. of GDV rotation

Answer 6

fundus L to R
spleen ventral to dorsal
270 degree clockwise rotation (preceeded by dilation)

Question 7

pathophys. of GDV

Answer 7

• 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

Question 8

tx of GDV

Answer 8

• decompress
• shock therapy
• tx tachycardias with lidocaine bolus
• tx seizure with valium
• 80% recur without sx

Question 9

how to assess gastric wall viability

Answer 9

color
temp
peristalsis (pinch test***)
thickness**
fluorescein - not accurate
surface oximetry

Question 10

advantages of tube gastrostomy

Answer 10

rapid easy procedure
creates permanent adhesion
allows for gastric decompression
allows for tube feeding

Question 11

incisional gastropexy

Answer 11

• rapid, easy
• stomach lumen not entered
• disadv: no post-op alimentation, no good follow-up

Question 12

types of gastropexy

Answer 12

tube
incisional
ventral midline

Question 13

types of intestinal obstruction

Answer 13

complete/incomplete
high/low
simple mechanical/strangulated
acute/chronic
perforated/non-perforated

Question 14

simple complete obstruction

Answer 14

• ischemia, devitalization
• dec. fluid absorption
• bowel wall edema
• fluid accumulation

Question 15

3 types of mechanical obstruction

Answer 15

luminal (FB, polypoid mass)
intramural (neoplasia, fungal granuloma)
extramural (adhesions, strangulated (or non?) hernia)

Question 16

> 50% secretions from:

Answer 16

Stomach, duodenum, proximal jejunum (most resorbed by jejunum, ileum)

Question 17

duodenal obstruction –>

Answer 17

loss of salivary, gastric, pancreatic duodenal secretions –> rapid dehydration
in LOW jejunal obstruction, resorptive capacity is maintained

Question 18

causes of simple complete obstruction

Answer 18

FB
trichobezoars
tumors
granulomas
stricture
enterolith
parasite
adhesion
gas (swallowed or formed in situ)

Question 19

> 1.6x midpoint height of L5 is considered dilated for dogs***

Answer 19

indicative of mechanical obstruction

Question 20

methods of experiemental intestinal viability

Answer 20

temp probes
pH monitors
Doppler flow devices
IV vital dyes
surface oximetry

Question 21

methods of clinical intestinal viability***

Answer 21

color
arterial pulsations
peristalsis - pinch test***

Question 22

causes of strangulation obstruction

Answer 22

local pressure necrosis - FB

mesenteric vascular disruption (volvulus, intuss., hernia, thromboembolism)

Question 23

lymphoma on U/S

Answer 23

circumferential symmetric hypoechoic

Question 24

adenocarcinoma U/S

Answer 24

symmetric or asymmetric mixed echogenicity

Question 25

intussusception on U/S

Answer 25

inc. circumference symmetric target