Lecture 7: Small Animal GI and Spleen Flashcards
What is indicative of a stress leukogram
Neutrophilia and lymphopenia
Identify 1-7
- Stomach
- Liver
- Kidneys
- Intestines
- Head of spleen
- Bladder
- Colon
Identify 1-7
- Liver
- Stomach
- Spleen
- Left kidney
- Right kidney
- Bladder
- Colon
Localize the problem and what is your concern
Distended small intestines and something present in stomach
To determine if the small intestine is expanded/distended what other anatomical structure can you measure it against and what is the ratio
The canine small intestine is normally equal or less than 1.6x the height of the body of L5
At what width of the small intestine is there a greater concern/likelihood for a FB
> 2.1x the size of L5
When you place a patient is right lateral where does the stomach gas travel to
Fundus
When you place a patient is left lateral where does gas travel to
Pylorus
What side is the pylorus on
Right
What side is the fundus on
Left
Where has the gas from the stomach traveled to and therefore what is the position of the patient on X-ray table
Gas is in the pylorus therefore patient is place is left lateral
Pylorus is on the right
Where is the gas in the stomach and therefore what is the position of the patient on the table
Gas is in the fundus therefore patient is in right lateral
Fundus is on the left
What is indicated by the blue circle
Pylorus- NORMAL
Describe the differences in the right and left pictures
left: gas from stomach is in the fundus therefore patient is placed in right laterals
Right: gas from the stomach is in the pylorus therefore the patient is in R. Lateral
what is indicated by the white arrow and circle
- Gas in pylorus
- FB in pylorus
** gas is black, white object is FB
What does the gastric axis measure
Liver size
What does hepatomegaly do to gastric axis
Displaces it causally, liver extends past last rib
What does microhepatica do to gastric axis
Displaces it cranially
In shallow/barrel chested dogs how is the gastric axis oriented
Deviated caudally
In deep/kneel chested codes how is the gastric axis oriented
Deviated cranially
What is the problem and what has it done to gastric axis
Enlarged SI and stomach, forced gastric axis cranially
What are the treatment options for suspected FB
- Abdominal exploratory
- Endoscopy- may still lead to exploratory
- Conservative management- fluids, pain meds, repeat rads (last choice)
What kind of cut do you make in an exploratory laparotomy
Midline celiotomy, siphons to pubis
What is the most cranial structure you see when performing exploratory laparotomy
Liver
Identify 1-8
- Right lateral lobe
- Right medial lobe
- Quadrate lobe
- Left medial lobe
- Left lateral lobe
- Papillary process of caudate lobe
- Gallbladder
- Caudate process of caudate lobe
What lobes does the gallbladder lie between
Right medial and quadrate lobe
Identify 1-8
- Right lateral lobe
- Right medial lobe
- Gallbladder
- Left lateral lobe
- Left medial lobe
- Papillary process of caudate lobe
- Stomach
- Quadrate lobe
What is the main blood supply and venous drainage of from the body that enter the liver
Hepatic artery and vein
Portal vein
What does the hepatic artery branch off of
Celiac artery
The hepatic artery provides ___% blood flow and ___% of oxygenated blood flow to liver
20%, 80%
What portal vein provides __% blood flow and __% of oxygenated blood supply to liver
80%, 20%
What is the purpose of the portal vein
Drain blood from GI and spleen to filter out toxins in the liver and then send back to caudal vena cava and heart
What is an intrahepatic shunt
Connected vessels between the hepatic veins and portal vein in the liver that bypass filtering in liver
What is an extra hepatic shunt
Connection of the portal vein and caudal vena cava outside the liver that bypasses the filtering of the liver
What structures are located in the hepatodudneal ligament
Common bile duct, portal vein, proper hepatic artery
Describe the flow of bile between the gallbladder, liver and pancreas
Liver makes bile and is stored in gall bladder, when secreted travels down in common bile duct and joints with pancreatic ducts via the major duodenal papilla
What structure does bile drain into the duodenum from
Major duodenal papilla
Identify 1-3
- Cystic duct
- Hepatic ducts
- Common bile duct
What ligaments connect the lesser omentum to the stomach and liver
- Hepatoduodenal ligament and hepatogastric ligament
What ligaments connect the greater ommentum to diaphragm, spleen and colon
Gastrophrenic ligament, gastrosplenic ligament, gastrocolic ligament
what are these
Siderotic plaques on spleen, normal in older dogs
Where does the left pancreatic lobe lie
Along greater curvature of stomach
Where does right lobe of pancreas lie
Along duodenum
Which species has an accessory duct, dogs or cats
Dogs, only 20% of cats have accessory ducts
What are 3 problems that are believed to be associated with the lack of the accessory duct in cats
- IBD
- Hepatitis
- Pancreatitis
In dogs, the common bile duct and the pancreatic duct enter the duodenum at the ___
Major duodenal papilla
What does the duodenal ligament separate
Duodenum and jejunum
What type of blood supply does the duodenum have
Segmental
What type of blood supply does the jejunum have
Arcurate
What pathology is present here
enlarged jejununal lymph nodes
What is the purpose of the mesentery
Supports the small and large intestine
What part of the small intestines has the anti-mesenteric vessel
Ileum
What are these bulges present on the jejunum and ileum
peyers patches- lymphoid follicles
What type of blood supply does the colon have
Segmental
What part of intestine is highlighted here and label 1-3
Whole thing is the colon
1. Ascending colon
2. Transverse colon
3. Descending colon
What does orad mean
Towards mouth
What does aborad mean
Away from mouth
Where should you incision be for gastrotomy
Hypovasculature area 1/2 between the lesser and greater curvature
What is the holding layer of the stomach you want to engage when you close
Submucosa
When making enterotomy incision where in relation to the FB do you want to make the cut and why
Aborad to FB because dont want to cut into compromised tissue
What is the holding layer for closing the intestines
Submucosa
When closing the abdomen what is the holding layer
External rectus sheath
Great Dane Patient presents with ptyalism, non-reproductive retching, distended and tympanic abdomen and weak femoral pulses. What is likely differential
GDV
Prior to performing x-rays of GDV individual what needs to be done
Release pressure of gastric dilation that is compressing on the caudal vena cava and portal vein
What are two methods to relieve pressure in GDV
- Gastric trochar- insert needle dorsolateral after last rib
- Orogastric tube, measure to xiphoid
What is indicated by the x-ray, what is red circle surrounding and identify 1-2
X-ray shows GDV
Red circle is around entire stomach
1. Pylorus
2. Fundus/body
Where should IVC’s be placed in GDV patient for surgery and why
Forelimbs as hind limbs are receiving less blood flow
What type of initial incision would you make in a GDV
Midline celiotomy
What are you trying to physically accomplish in GDV surgey
De-rotate stomach, pylorus has rotated itself 180-270 degrees from right to left side. Pull pylorus back to the right side while pushing down on fundus
What artery comes off the aorta and supplies the forestomach
Celiac
What are the branches of the Celiac artery
Splenic, hepatic and left gastric
What does the splenic artery give off
Left gastroepiploic and short gastric arteries
What arteries are at high risk of tearing during GDV and can cause hemoabdomen
Short gastric arteries
Where does the left gastroepiploic artery run
Greater curvature of the stomach
When performing a splenectomy, what artery is it important to spare otherwise it will kill that part of the stomach
Left gastroepiploic
What arteries should be lighted during splenectomy
- Omental branch of splenic
- Major splenic branch
- Dorsal branch of splenic
- Short gastric arteries
Describe the technique/procedure for a Gastropexy
- Incise the body walls away from the midline
- Incise the pyloric antrum
- Suture muscle layer of stomach to body wall
