Lecture 21 - Small Animal GI Surgery Flashcards
What are common procedures involving the stomach?
Gastrotomy, GDV, gastropexy, gastrectomy
What are common procedures involving the intestines?
Enterotomy, resection and anastomosis
What are common procedures involving the colon? Which should you avoid?
Colopexy
Colotomy (AVOID)
What is a clean wound?
Nontraumatic, noninflamed operative wounds;
Respiratory, GI, urogenital, and oropharyngeal tracts are not entered
What is a clean-contaminated wound?
Respiratory, GI, or urogenital tracts are entered under controlled conditions without unusual contamination;
Clean procedure in which a drain is placed
What is a contaminated wound?
Traumatic wounds without purulent discharge;
Spillage of GI contents or spillage of infected urine occurs;
Major break in aseptic technique occurs
What is a dirty wound?
Traumatic wounds with purulent discharge, devitalized tissues, or foreign bodies;
Perforated viscus or fecal contamination occurs
What is the infection rate of a clean wound?
2.0-4-9%
What is the infection rate of a clean-contaminated wound?
3.5-4.5%
What is the infection rate of a contaminated wound?
4.6-9.1%
What is the infection rate of a dirty wound?
6.7-17.8%
What is the approach/steps to accessing the abdominal cavity?
- Ventral midline (xyphoid to pubis)
- Skin incision
- Remove SQ tissue from linea
- Grab linea with forceps, lift, inverted blade for stab incision
- Feel for adhesions
- Extend with mayo scissors
What grip of the scalpel handle provides for more stability?
overhand
What is the advantage to incising on the linea alba?
Less bleeding - better for the patient and for visualization
When should an abdominal exploratory be done?
Every time you enter an abdomen
What are the general steps to a gastrotomy and when would you do one?
Do for foreign body:
- Isolate areas of interest from remainder of abdomen
- Stay sutures can help
- make full-thickness incision
How many layers does closure of the stomach involve and what are they?
2 = mucosal-submucosa, seromuscular
What suture pattern and material should be used for stomach closure?
Inverted (Cushing), interrupted/continuous
Absorbable, monofilament, tapered needle
What is the most common correction for GDV?
Derotate and do an incisional gastropexy
What are the steps to an incisional gastropexy?
- Feel mucosal slip
- Incise only seromuscular layer
- Incise body wall (transversus abdominis) caudal to last rib
- Suture together with simple continuous pattern, absorbable material (PDS)
What is the most common gastric neoplasia in dogs and where does it occur?
Adenocarcinoma (42-72%);
Pylorus and lesser curvature
What are possible gastric neoplasias in dogs other than adenocarcinoma?
Lymphoma, leiomyoma
What are general steps to excising gastric neoplasias?
- Excise mass with margins
- Closure same as gastrectomy
Excision of gastric neoplasia is more complicated if the _____ is involved.
pylorus
Where should your incision be with respect to the foreign body in a healthy intestine?
aborad to the foreign body
Where on the intestine should the incision be for a foreign body?
On the antimesenteric border
What is the holding layer of the intestine?
Submucosa
What suture material and pattern should be used in an enterotomy?
Absorbable suture, appositional pattern (gambee)
What color is concerning in the intestines?
Black and purple
How can we measure intestinal viability?
Color, blood supply, feel (thin/friable?), peristalsis
What are anchor points for linear foreign bodies?
under tongue and pylorus
Where are perforations most common with linear foreign bodies?
On mesenteric border
What type of sutures should be used and where initially in a resection and anastomosis?
Interrupted @ mesenteric border (most likely to leak)
What type of pattern is best in a resection and anastomosis?
Appositional with wide bites
How can you perform a leak test after a resection and anastomosis?
10 cm bowel takes about 14 ml saline for near physiologic pressures
How can a R&A be reinforced?
Serosal patch, wrap in omentum
How can we account for size discrepancies in a R&A?
Spatulate;
Cut at an angle on smaller lumen size (long size is mesenteric border)
What types of neoplasia are common in the intestines?
Lymphoma, adenocarcinoma, leiomyoma/leiomyosarcoma, mast cell tumor
How can we perform an intestinal biopsy?
- Ellipse incision along antimesenteric border
- Close as enterotomy
- Should be full-thickness
How big should margins be for a R&A?
5-10 cm on each side
What can be done with a colon torsion?
Colopexy or R&A
What are the general steps to performing a colopexy?
- Abrade colon or partial thickness incision
- Suture dorsal-dorsal and ventral-ventral in continuous line
- Absorbable suture
What is the best way to deal with a foreign body in the colon?
Gently milk it to the rectum
What are common neoplasias of the colon?
Adenocarcinoma, leiomyoma/leiomyosarcoma, lymphoma
What are some concerns for GI surgery in small animals?
- Septic abdomen
- Albumin <2.0 g/dL
- Large resections (short bowel syndrome)
- Poor nourishment
- Debilitated state
- Risk of dehiscence are days 3-5
What is the holding layer of the abdominal wall?
External rectus sheath
What suture material and pattern should be used with abdominal wall closure?
Absorbable/long-lasting suture;
Simple interrupted, cruciates, simple continuous
What should the spacing be when closing the abdominal wall?
5-10 mm from incision and from previous bite
What suture material and pattern should be used to close the SQ?
Absorbable;
Buried cruciates, simple continuous (appositional)
What is the purpose of suturing the SQ of the abdomen?
Obliterating dead space (tack to body wall)
What suture material and pattern should be used to close the skin of the abdomen?
Intradermal (absorbable);
External sutures = simple interrupted, cruciate, simple continuous
Staples
