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BVMS 3 > Module 16 Wk 2 > Flashcards

Module 16 Wk 2 Flashcards

1
Q

(Oropharyngeal problems and cervical swellings)

What is Sialocoele?

A

It is leakage of saliva from gland or duct which can collect submucosally or subcutaneously causing a swelling.

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2
Q

What are the aetiologies of sialocoele?

A
  • Idopathic
  • Trauma
  • Sialoliths
  • Neoplasia
  • Foreign Body
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3
Q

What is sialoliths?

A

Salivary stones which block ducts

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4
Q

How would a patient present when suffering with sialocoele

A

A non-painful fluctuant swelling

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5
Q

Location deterimines the clinical signs of the patient, What will you see clinically if its in the zygomatic glands?

A

Exophthalamus

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6
Q

What is Exophthalamus?

A

a bulging or protruding eyeball or eyeballs

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7
Q

Location deterimines the clinical signs of the patient, What will you see clinically if its in the Pharyngeal glands?

A

Laboured breathing/airway obstruction

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8
Q

Location deterimines the clinical signs of the patient, What will you see clinically if its in the Sublingual glands?

A

Dysphagia + cervical swelling

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9
Q

How can you diagnose sialocoele?

A
  • Clinical signs
  • Aspiration of fluid via cytology and appearence
  • Imaging
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10
Q

What should the cytology and appearence of the aspirated fluid show?

A
  • Cytology - stain for mucin, small amounts of nuertrophils, macrophages, lymphocytes and plasma cells and RBC.
  • For diagnosis fluid should appear viscous and honey coloured
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11
Q

What imaging can you use to diagnose sialocoele?

A
  • sialogram but hard to perform
  • Contract CT
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12
Q

How can you treat a sialocoele?

A
  • Surgery - Sialoadenectomy
  • Conservative management but not reconemended as will most defo recur
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13
Q

What is the main cause of Cenrvical swelling in dogs?

A

Oropharyngeal stick injury

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14
Q

Describe how dog might present with acute oranpharyngeal stick injury?

A
  • Pain
  • dysphagia
  • Bloody saliva
  • Gagging/retching
  • Oronpharyngeal haemorrhage
  • s/c emphysema
  • Pyrexia
  • Pyothorax/mediastinitis
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15
Q

When a dog presents like this what should you proceed to do with the aid of sedation or GA?

A
  • Check sublingual, whole oropharyns, hard and soft palate
  • Can use endoscope to identify and expore tracts
  • Radiograph cervical area and throax
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16
Q

What might the radiographs presenting with acute oropharyngeal stick injury symptoms look like?

A
  • Precence of free gas within cervical tissue planes
  • Pneumothorax
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17
Q

What should occur on surgical exploration of an acute stick injury presentation?

A
  • Explore tract and remove any debris
  • Oral or ventral cervical approach
  • Flush lots to remove debris
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18
Q

Why do dogs present with chronic oranpharyngeal stick injury?

A
  • accute injury was missed
  • occurs after initail treatment being unsuccessful
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19
Q

What are the differentials for cervical swellings?

A
  • abscess
  • cyst
  • granuloma
  • neoplasia
  • lymphadeopathy
  • heamatoma
  • sialocoele
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20
Q

How do you diagnose a chronic oranpharyngeal stick injury?

A
  • Clinical signs and hostory
  • Response to treatment
  • FNA of swelling
  • Orpharyngeal exam
  • Imaging
  • Surgical exploration
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21
Q

What should happen in a surgucal exploration of a chronically presenting oranpharyngeal stick injury?

A
  • Remove foreign material ans infected tissue
  • Debride wound and lavage
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22
Q

What is a cleft palate?

A
  • Congenital lip and palate defect in cats and dogs
  • Acquired due to trauma
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23
Q

What age should a congenitial cleft palate be repaired at?

A

3-4months

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24
Q

What trauma can cause cleft palate?

A
  • Fall from height
  • Electric cord chewing
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25
Q

What usually causes a oronasal fistuala?

A

Usually occurs due to severe peiodontal disease or tooth extraction.

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26
Q

What do you see with chronic nasal fistuala?

A

Unilateral nasal discharge and sneezing

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27
Q

What do you see with acute oronasal fistuala?

A

nasal bleeding or visualisation of the nasal cavity

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28
Q

How can you surgically repail an oronasal fistula?

A
  • Labial flap
  • Must not be under tension or will fail
  • May be chronically infected
  • Consider referral for large chronic defects
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29
Q

What are common oral neoplasia found in dogs?

A
  • Malignant melanoma
  • Squamous cell carcinoma
  • Fibrosarcoma
  • Peiodontal ligament tumour
  • Equlids
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30
Q

What are common oral neoplasia in cats?

A
  • Squamous cell carcanoma
  • Fibrosarcoma
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31
Q

What are clinical signs of oral neoplasia?

A
  • Abnormal prehension of food
  • Blood tinged saliva
  • Difficulty swallowing
  • ulceration
  • halitosis
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32
Q

What is halitosis?

A

HOnking breath

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33
Q

How can you treat oral neopasia?

A
  • Surgery
  • Chemotherapy
  • Radiotherapy
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34
Q

Describe the surgery, Maxillectomy, to treat oral neoplasia

A
  • Removal of part of the upper Jaw
  • Usually indicated for oral neoplasia
  • Can have good functional outcome but needs careful case selection
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35
Q

Describe the surgery, Maxillectomy, to treat oral neoplasia

A
  • Removal of part of the lower jaw
  • Usually indicated for oral neoplasia
  • Good outcome and usually well tolerated
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36
Q

(The Oesophagus -regurgitation & dysphagia)

What is dyspahgia?

A

Difficulty swallowing

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37
Q

Describe the process of normal swelling?

A
  1. Oral - preparatory (voluntary) - prehension, mastication, prep of food bolus
  2. Pharyngeal - pharynx contracts to allow bolus to move into the proximal oesophagus
  3. oesophageal
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38
Q

Describe the anatomy of the oseophagus?

A

It runs from the pharynx to the stomach starting dorsal to larynx, running on the left side dorsally to the trachea entering stomach at the cardia

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39
Q

What are the two sphinchters called and where are they located at either end of the oesophagus?

A
  • upper and lower oesophagal sphincter
  • cricopharynx and cardia of stomach
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40
Q

What are the layers of the oesophagus?

A
  • Mucosa
  • Submucosa
  • Muscularis - Striated muscle (dog) and Striated 1/3 & smooth muscle 2/3 (cat)
  • Adventitia (no serosa)
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41
Q

What is the oesophagus innervated by?

A

The vagus nerve

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42
Q

List the Mechanical oesophageal diseases

A
  • Vascular ringe abnormaly
  • Foreign body
  • Stricture (rare)
  • Hiatal hernia
  • Perioesophageal obstruction (rare)
  • Neoplasia (rare)
  • Gastro-oesophageal intussception (very rare)
  • Parasitic granuloma (very rare in UK)
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43
Q

List the functional oesophageal diseases

A
  • Megaoesophagus (MO) (congenital or acquired)
  • Idiopathic oesophageal dysmotilit
  • Oesophagitis
  • Gastroesophageal reflux
  • Lower oesophageal sphincter achalasia-like syndrome (rare)
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44
Q

What is cricopharyngeal achalasia/asynchrony?

A

It is the failure of the upper oesophagus sphincter to relax (achalasia)
OR
Incoordination between pharyngeal contraction and upper oesophageal sphincter relaxation (asynchrony)

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45
Q

What are the clinical signs of cricopharyngeal achalasia/asynchrony?

A

When patient try and swallow repeatedly but gag, retch, struggle to drink and may eject food from mouth immediately after eating

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46
Q

How do you treat cricopharyngeal achalasia/asynchrony?

A
  • Myotomy or muyectomy of the cricopharyngeus muscle
  • Botox
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47
Q

What are oral symptoms of dysphagia?

A
  • Abnormal prehension
  • Dropping food
  • Halitosis
  • Ptyalism
  • Cough
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48
Q

What are the pharyngeal symptoms of dysphagia?

A
  • Halithosis, Ptyalisms
  • Hard/REPETITIVE swallowing whilst eating and/or drinking
  • Gagging
  • Coughing
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49
Q

What are oesophageal symptoms of dysphagia?

A
  • Usually only 1 swallowing attempt (or repetitive dry swallowing), may or may not be able to drink, may bring up food at any time after eating
  • Ptyalism
  • Halitosis
  • REGURGITATION
  • Restless
  • Epigastric pain
  • Cough
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50
Q

Define regurgitation

A

Passive evacuation of food and/or fluid from the oesophagus resulting from local mechanical events within the oesophagus

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51
Q

Aspiration Pneumonia is a complication that can occur due to regurgitation. What is it?

A

It is food or water aspirated into lungs causing chemical injury followed by secondary infection.

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52
Q

What are clinical signs of aspiration pneumonia?

A
  • Soft cough
  • dyspnoea
  • tachypnoea
  • pyrexia
  • lung crackles
  • +/- nasal discharge
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53
Q

How do you treat aspiration pneumonia?

A
  • O2 therapy
  • Fluid therapy
  • Broad spectrum antibiotic
  • Nebulation
  • Coupage
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54
Q

What is coupage?

A

Coupage is a technique that can be performed by veterinary staff and pet owners to help clear secretions from the lungs. Coupage is performed by striking the chest gently but firmly with cupped hands.

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55
Q

How should you investigate an oesophageal disease?

A
  • Signalment/History
  • Clinical examination
  • Clinical pathology
  • Plain thoracic radiographs
  • Contrast radiographs
  • Fluoroscopy
  • oesophagoscopy
  • oesophageal surgery
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56
Q

On your clinical exam, what abnormalities may you find in a patient suffering from an oesophagal disease?

A
  • hypersalivation
  • poor BCS
  • Bulging in neck - could be food ro air
  • Muscle atrophy/weakness
  • Resp signs
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57
Q

T/F haematology is usually expected with oesophagal disease.

A

True

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58
Q

What might you see on the haematology of a patient with aspiration pneumonia?

A
  • Leucocytosis
  • Left shift neutrophilia
  • monocytosis
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59
Q

What abnormalities would you see on radiographs of a patient that is suffering with an oesophageal disease?

A
  • Radioopaque FB
  • Dilation of oesophagus
  • Hiatal defects
  • Pulmonary changes
  • Pneumomediastinum/
    mediastinitis/pleural effusion
  • Peri-oesophageal masses
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60
Q

What is contract radiography useful for when it comes to oesophagal diseases?

A
  • Luminal obstruction
  • Mucosal irregularity
  • Significant alterations in motility
  • Hiatal hernia
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61
Q

What oesophageal disease might be better evaluated with fluoroscopy?

A
  • Pharyngeal disorders
  • Subtle oesophageal motility disorders
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62
Q

What does an oesophagoscopy allow?

A
  • Assessment of lumen & mucosa for Obstructions, Inflammation, Perforation or Hiatal hernia
  • Biopsy or cytology sampling (rare)
  • Foreign body removal
  • Balloon dilation of strictures
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63
Q

T/F oesophageal surgery is often indicated?

A

False - rarely

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64
Q

What are the challenges with oesophageal surgery?

A
  • Risk of AP on induction of GA
  • Thoracotomy for intrathoracic oesophagus
  • Risk of contamination of thoracic cavity
  • Healing challenging
  • Fixed length
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65
Q

What is an oesophagotomy?

A

Incision into lumen

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66
Q

What is an oesophagectomy?

A

Removal of portion of oesophagus

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67
Q

What is oesophagostomy?

A

Creation of opening for feeding tube

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68
Q

What is vascular ring anomaly?

A

Persistent right aortic arch is the most common, where the right arch becomes a functional aorta instead of the left fourth arch.

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69
Q

What does vascular ring anomaly cause and how does it present?

A
  • Causes significant narrowing and obstruction of the oesophagus
  • Start regurgitating when weaned, often have weight loss and stunting.
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70
Q

What breeds are predisposed to vascular ring anomaly?

A
  • GSDs and Irish setters
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71
Q

How can you treat vascular ring anomalys?

A
  • Surgery to transect ligamentum arteriosum
  • Treat aspiration pneumonia and improve BC
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72
Q

What are common foreign bodies in small animals that can cause oesophageal disease?

A

Bones, fish hooks, needles, sticks and toys

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73
Q

What are common sites where foreign bodies obstruct?

A
  • Thoracic inlet
  • Heart base
  • Just cranial to diaphragm
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74
Q

A patient with a foreign body obstructing the oesophagus has what presentation on clinical examination?

A
  • honky breath
  • Cervical FB maybe be palpable
  • systemic signs suggest aspiration pneumonia or perforation
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75
Q

How should you treat a patient with a foreign body obstruction?

A
  • Stabilise patient
  • GA
  • endoscopic removal
  • If unable to do this, remove endoscopically or large perforation you should do an oesophagotomy or oesophagectomy
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76
Q

What are the 3 potential sequelae from a foreign body obstruction of oesophagus?

A
  • stricture
  • Fistula
  • Diverticulum
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77
Q

What is strictures?

A

Circular band of scar tissue secondary to severe oesophagitis

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78
Q

What are progressive signs of strictures?

A
  • Hungry but loose weight
  • Better with liquids
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79
Q

How do you diagnose Strictures?

A
  • Difficult to see on plain films, so contrast radiography used
  • Endoscopy to find cause and take biopsy
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80
Q

How should you treat strictures?

A
  • Endoscopic balloon dilation
  • Followed by medical therapy for oesophagitis
  • +/- steroids to reduce recurrence
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81
Q

What are the two main types of hiatal hernia?

A
  • Sliding – distal oesophagus and stomach move into mediastinum through oesophageal hiatus
  • Perioesophageal – portion of stomach moves into mediastinum through defect adjacent to oesophageal hiatus
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82
Q

What are the effects of a hiatus hernia?

A
  • gastroesophageal reflux due to reduction in LES pressure
  • Oesophagitis
  • Hypomotility
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83
Q

What are the clinical signs of hiatus hernia?

A
  • If it is congenital, it will be soon after weaning
  • regurgitation, vomiting, hypersalivation, haematemesis, poor BC, dyspnoea, AP
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84
Q

How should you treat a hiatus hernia?

A

Small hernia
- Medical management for
oesophagitis

Large hernia
- Surgical management
- Narrow oesophageal hiatus
- Pexy oesophagus
- Pexy fundus of stomach

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85
Q

What is a megaoesophagus (MO)

A

Diffuse oesophageal dilation & aperistalsis
Congenital

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86
Q

What breeds are predisposed to MO

A

Irish setter, GSD, Great Danes, Newfoundlands, Labrador retrievers

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87
Q

When do clinical signs of congenital MO start?

A

Clinical signs usually start at weaning

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88
Q

What can MO be secondary too?

A
  • Myasthenia gravis
  • Severe oesophagitis
  • Generalised myopathy
  • Generalised neuropathies
  • Toxins
  • Hypoadrenocorticism
  • Hypothyroidism
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89
Q

What are the clinical signs of MO?

A

Regurgitation, dysphagia, +/- hypersalivation, +/- weight loss

  • +/- respiratory signs
  • +/- signs of underlyingdisease
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90
Q

How do you diagnose MO?

A

Xray (usually plain)
Oesophagoscopy - If suspect secondary to structural problems or oesphagitis

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91
Q

How might you look for secondary causes of MO?

A
  • Neuro exam
  • Haematology/biochemistry
  • CK/AST
  • Acetyl choline receptor antibodies
  • ACTH stimulation test
  • T4/TSK
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92
Q

How should you treat MO?

A
  • Treat underlying cause if secondary
  • Postural feeding
  • Ideal food consistency varies
  • Sildenafil
  • Treat aspiration pneumonia
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93
Q

What is oesophagitis?

A

Inflamed oesophagus

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94
Q

What can oesophagitis be caused by?

A
  • Chronic vomiting
  • Gastroesophageal reflux
  • Ingestion of caustic agents
  • Foreign bodies
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95
Q

What are the Clinical signs or oesophagitis?

A
  • Variable (asymptomatic to severe)
  • Dysphagia, regurgitation, odynophagia, hypersalivation, food avoidance, weight loss
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96
Q

How do you Diagnosis Oesophagitis?

A
  • Inflammation seen endoscopically
  • Biopsy usually unnecessary
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97
Q

How do you treat oesophagitis?

A
  • Small, low fat, high protein meals +/- withhold food PO
  • Sucralfate liquid
  • Metoclopramide
  • Gastric acid secretory inhibitors
  • H2 antagonists or proton pump inhibitors
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98
Q

What is Gastroesophageal reflux

A

Disorder of LES allowing reflux of fluids/ingesta into oesophagus which leads to oesophagitis

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99
Q

What is gastroesophageal reflux caused by?

A
  • Chronic vomiting
  • Gastric emptying disorder
  • Hiatal hernia
  • Upper airway obstruction
  • Anaesthesia
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100
Q

How do you go about treating gastroesophageal reflux?

A
  • Avoid high fat diets
  • Sucralfate suspension
  • Gastric acid secretory inhibitors
  • Metoclopramide
  • Surgery for upper airways in brachycephalic dogs helps
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101
Q

How can you diagnose Myasthenia gravis?

A
  • Tensilon test – generalised only, non-specific
  • Acetyl choline
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102
Q

How do you treat myasthenia gravis?

A
  • Pyridostigmine
  • Consider injectable
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103
Q

(Investigation & Management of Vomiting in Dogs & Cats)

What may activate the chemoreceptor trigger zone?

A
  • Uraemia
  • DKA
  • Cardiac glycoside toxicity
  • Apomorphine
  • Chemotherapy
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104
Q

What are the receptors found in the chemoreceptor trigger zone?

A
  • D2 (dopamine)
  • 5HT3 (serotonin)
  • M1 (cholinergic)
  • Opioid receptors
  • Histamine
  • NK1 (Neurokinin-1 receptor)
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105
Q

What may activate the gastro-intestinal tract/peripheral stimuli?

A
  • Chemicals/irritants
  • Inflammation
  • Excessive stretch of the GI tract
  • Peritonitis
  • Colitis may vomit too due to stretch
  • Bladder obstruction
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106
Q

What are the receptors found in the gastro-intestinal tract?

A
  • 5HT1 (serotonin)
  • a1-Adrenergic
  • Nk1 (Neurokinin-1 receptor)
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107
Q

What can triggering of the vestibular apparatus cause clinically?

A
  • Motion sickness
  • Vestibular syndroms
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108
Q

What are the receptors that resinate in the vestibular apparatus?

A
  • H1 (histamine)
  • M1 (cholinergic)
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109
Q

Define vomiting

A

Active and forceful expulsion of gastric and/or duodenal contents

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110
Q

Define regurgitation

A

Passive retrograde expulsion of oesophageal or gastric contents with NO forceful abdominal contractions

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111
Q

What are the aetiologies of acute vomiting?

A
  • GI disorders
  • Non-GI disorders
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112
Q

What are GI disorders that will cause vomiting?

A
  • acute gastritis/enteritis
  • dietary indiscretion
  • Foreign body
  • mesenteric torsion
  • Intussusception
  • (GDV)
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113
Q

What are non-GI disorders that can cause acute vomiting?

A
  • Acute pancreatitis
  • Acute hepatobiliary disease
  • Acute renal failure
  • Peritonitis
  • Acute neurological insult
  • Endocrine dysfunction
  • Toxin ingestion/explore
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114
Q

What questions should you ask when taking a history of a patient of acute vomiting?

A
  • Recent dietary changes?
  • Scavenging?
  • How frequently is the patient vomiting?
  • Is the vomiting productive?
  • Undigested food / partially digested / faecal odour?
  • Is there blood or coffee grounds in the vomit?
  • Has there been any recent weight loss?
  • Concurrent GI Signs?
  • Is the patient on any medication?
  • Is the patient systemically unwell?
  • Appetite?
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115
Q

What should you assess on physical examination of a patient with acute vomiting?

A
  • Systemic disease
  • Demeanour
  • Pyrexia
  • Liver disease
  • Painful abdomen
  • Assess hydration
116
Q

What investigation should you do on a patient with acute vomiting?

A
  • CBC and serum biochem
  • Urinalysis
  • Diagnostic imaging to see if surgery is needed
  • Abdom US
117
Q

When performing imaging on a patient with acute vomiting, what should you be looking out for?

A
  • GDV
  • GI FB
  • Obstructive pattern
  • GI perforation
  • Peritonitis
118
Q

When performing an abdominal US what should you be evaluating and looking for?

A
  • Evaluate the whole GI tract
  • Assessment of the biliary system
  • Evaluate the pancreas
  • Evaluate repro system
119
Q

What should you use to address fluid and electrolyte disturbances caused by vomiting?

A

IVFT with appropriate electrolyte supplementation

120
Q

What should you use to reduce the frequency/stop vomiting?

A

Anti emetic drugs?

121
Q

What should you use to reduce acid production, particularly if there are concerns for gastro-duodenal ulceration?

A

Anti-ulcer drugs

122
Q

What should you use to improve gastric emptying?

A

Prokinetic drugs

123
Q

List the different types of anti emetics seen in practice?

A
  • NK1 pathway inhibitors (Maropitant)
  • Anti-dopaminergics (Metoclopramide)
  • Serotonin antagonists (Ondansetron)
  • Phenothiazines (Chlorpromazine)
124
Q

List the types of anti-ulcer drugs seen in practice?

A
  • Histamine (H2)- blockers
    (Cimetidine, Ranitidine, Famotidine)
  • Proton pump inhibitors
    (Omeprazole)
  • Sucralfate
  • Synthetic prostaglandins
    (Misoprostol)
125
Q

What are the different types of pro-kenetic drugs used in practice?

A
  • Metoclopramide (CRI)
  • Ranitidine
  • Cisapride
126
Q

What is the pump inhibitor drug of choice for ant-ulceration therapy?

A

Drug of choice where gastric or duodenal ulceration is present

127
Q

How are sucralfate anti-ulceration therapy used and how does it work?

A
  • Orally
  • Binds to gastric ulcers
128
Q

Cimetidine < Ranitidine < Famotidine
H2 Blockers
Cimetidine is the only veterinary licensed product
* Oral preparation only
* Causes inhibition of cytochrome P450 enzymes and therefore may interfere with metabolism of other drugs
Ranitidine is available as an intravenous product
* Prokinetic activity
* Care with IV injection as it can cause hypotension

bro idek man

A

still dont know man

129
Q

How should you investigate chronic vomiting?

A
  • CBC
  • serum biochem
  • urinalysis
130
Q

What can you use the initail investiagtion tests for?

A

Use the results to locate where the primary diseases process is - liver, chronic kidney or endocrine.

131
Q

What can you identify in the abdominal US of chronically vomiting patients?

A
  • Chronic FB
  • GI neoplasia
  • PYloric outflow obstruction
  • Chronic pancreatopathy
132
Q

When would you use endoscopic evaluation of a patient with chronic vomiting?

A
  • When primary GI disease is suspected
  • Investigate haematemesis
  • Gastric FB removal
  • Mucosal biopsy for definitive diagnosis
133
Q

What are potential causes of gastritis in chronically vomiting patients?

A
  • parasitic infection (e.g. Ollunlanus in cats)
  • fungal infection (e.g. pythiosis, rare)
  • bacterial infection (Helicobacter-associated gastritis*)
  • Dietary hypersensitivities/intolerance
134
Q

How should you manage chronic gastritis?

A
  • Treat the underlying cause
  • Diet modification e.g. a hypoallergenic diet
  • Immunosuppressant medication (prednisolone)
  • Symptomatic management (anti-emetics)
135
Q

What is helicobacter-assoc gastritis?

A

Spiral shaped gram –ve bacteria often identified in dogs and cats with chronic gastritis

136
Q

How should you treat Helicobacter-associated gastritis?

A

Triple therapy

  • Amoxicillin plus metronidazole plus bismuth +/- famotidine
  • Amoxicillin plus metronidazole plus omeprazole
  • Clarithromycin plus metronidazole plus ranitidine
137
Q

(Approach to the Abdomen and GI Surgery)

What are the aims of an exploratory laparotomy?

A
  • Be systematic
  • Assess everything
  • Recognise normal abdominal anatomy
  • Recognise abnormal abdominal structures and pathology
  • Know appropriate action dependant on findings (cystotomy, enterotomy etc)
138
Q

What is in the cranial quadrant of the abdomen?

A
  • Diaphragm
  • Liver
  • Gall bladder
  • Stomach
  • Spleen
  • Pancreas (left limb)
139
Q

What is contained in the right quadrant of the abdomen?

A
  • Kidney
  • Adrenal
  • Ureter
  • (ovary)
  • Right limb of the pancreas
  • Caudal vena cava
140
Q

What is contained in the left quadrant of the abdomen?

A
  • Kidney
  • Ureter
  • Adrenal
  • (ovary)
141
Q

What is contained in the caudal quadrant of the abdomen?

A
  • Colon
  • Bladder
  • Urethra
  • Prostate
  • Inguinal canals
142
Q

What is contained in the central compartement of the abdomen?

A

Intestinal tract
* Start at pylorus
* Examine entire small and large intestine
* Check colour, peristalsis
* Check mesenteric LN
Check omentum

143
Q

What steps should you take before closing the abdomen?

A
  • Replace organs
  • Ensure all swabs have been removed
144
Q

What should be included when closing the linea alba?

A

External rectus sheath provides the strength in linea alba closure so must be included in each bite.

145
Q

What pattern should you use when Closing the abdomen?

A

Simple cont or interupterd

146
Q

What are two instruments used in Gastrointestinal surgery?

A
  • Bowel clamps
  • Atraumatic forceps
147
Q

What suture material and needles are used in gastrointestinal surgery?

A
  • Monofilament syntheitic abdorbable material
  • Taper pointed needle SWAGEDDD ON
148
Q

What suture pattern should you use on the ntestine in gastrointestinal surgery?

A

Simple interrupted or cont

149
Q

What suture pattern should you used on the stomach different layers in a gastrointestinal surgery?

A

Mucosal/submucosal layer = simple cont
seromuscular layer = inverting (cushing or lambert)

150
Q

What is the priniciples of GI surgery?

A
  • Try to exteriorise portion of GI tract being operated on
  • Isolate area with moistened swabs
  • Have a dirty area on your trolley
  • Handle foreign bodies with instruments and then discard these.
  • Change gloves at instruments once GI tract is closed
  • Lavage at the end of surgery (100-200ml/kg)
151
Q

W.hat is omenatal wrap?

A

Its where you place omental wrap around insicion lines to promote early serosal seals

152
Q

What are the benefits of using omental wrap?

A
  • Speeds up healing
  • Increases blood supply
  • Increases drainage
  • Reduces leakage
  • Stimulates and augments angiogenesis
153
Q

What is the most common indication for a gastrotomy?

A

FB that cannot be endoscopically retrieved and emesis is not indicated/appropriate

154
Q

How do you do a gastrotomy?

A
  • Cranial abdominal incision (xiphoid to umbilicus)
  • Incision between greater and lesser curvatures
  • Stay sutures used to lift up area and surround with swabs to minimise contamination
155
Q

How many layers for closure in a gastrotomy?

A

2

156
Q

What are the indiactions for a SI surgery

A
  • obstruction
  • Enterotomy
  • Enterectomy
157
Q

What kind of things could be causing an obstruction in the SI?

A
  • Foreign body
  • Neoplasia
  • Intussusception
  • Intestinal Voluvulus/strangulation
  • Linear FB
158
Q

What is an enterotomy?

A

Incise into intestine to remove FB

159
Q

What is an enterectomy?

A

Remove a portion of intestine

160
Q

DEscribe the steps of an enterotomy?

A
  1. Exteriorise area of small intestine
  2. Milk intestinal contents away from the segment
  3. Place bowel clamps (or assistant fingers) proximal and distal to FB
  4. Incise distal to FB (not directly over FB) using a no.15 scalpel blade
  5. Make a linear incision on the antimesenteric border of the intestine
  6. Extend incision to easily remove Fb without tearing intestine
  7. Remove Fb using instruments
161
Q

What suture patterns should you use to close and enterotomy?

A

Simple interrupted or simple continuous

162
Q

What suture material should you uses when closing up an enterotomy?

A

Use monofilament absorbable suture material on taperpoint needle

163
Q

How should you perform a leak test after an enterotomy?

A
  • Occlude intestine
  • Using a 25g needle inject 5mls saline
  • Apply gentle pressure and look for leakage
164
Q

Describe the steps to perform and enterectomy?

A
  1. Exteriorise section of bowel and pack with moistened swabs
  2. Identify area to resect allowing for a healthy margin
  3. Double ligate vessels suppling area to be resected incise the mesentery
  4. Milk intestinal contents out of the segment
  5. Place crushing clamps: portion to excise
  6. Place non-crushing clamps (doyen) on the portion to suture
  7. Excise the portion of intestine
  8. Close with simple interrupted appositional sutures
  9. Monofilament absorbable synthetic suture, taperpoint needle
  10. Place first suture at mesenteric border
  11. Second at antimesenteric border
  12. Then 3 o’clock and 9 o’clock
  13. Place sutures with 3mm bites and fill in 3mm apart
  14. Close the mesentery (simple continuous suture)
  15. Leak test and omentalise
165
Q

When might you see intussusception in young animals?

A
  • Heavy worm burden or enteritis
  • Can occur spontaneously
166
Q

When can you see intussusception in older animals?

A

seconday to neoplasia

167
Q

What can you use to diagnose intussusception?

A
  • Clinical signs of GI obstruction
  • Palpation – ‘sausage’
  • Radiography
  • Ultrasound – classic target like mass
168
Q

How can you treat intussusception?

A
  • Reduction
  • Enterectomy
169
Q

How do you perform an enteroplication?

A

Suture adjacent loops of SI together on antimesenteric surfaces

170
Q

What are the benefits and cons of enteroplication?

A

May prevent recurrence but complications can be life threatening so should only be used in recurrent cases where benefit outweighs the risk.

171
Q

What sort of items cause linear foreign bodies in cats?

A

String or thread

172
Q

How does the string or thread become an issue?

A
  • It becomes anchored around the base of the tongue and is swallowed
  • Intestines bunch up around the string and become ‘concertina’
  • String ‘cheese wires’ mesenteric border of gut.
  • Can cause perforation and secondary peritonitis.
173
Q

(GDV)

What may be the cause of cause in the stomach with GDV?

A
  • Aerophagia
  • Bacterial proliferation
  • Failure to eructate or pass gas into the intestine
174
Q

What may cause fluid causing dilation of stomach in GDV?

A
  • Food
  • Gastric secretions
  • Transudate from mural venous congestion of the stomach wall
175
Q

What are the 11 risk factors that can contribute to GDV?

A
  1. Breed
  2. Deep-chested conformation
  3. First degree relative with history of GDV
  4. Previous GDV
  5. Diet
  6. Excercise
  7. Stress
  8. Age
  9. Previous splenectomy
  10. Splenic torsion
  11. Gastric FB
176
Q

Even though any breed can get GDV what breeds are predisposed?

A

Great Dane, St Bernard, Standard Poodle, Weimaraner, Gordon Setter, Irish Setter Basset hound

177
Q

What is the pathophysiology of GDV?

A

Distention and movement of the stomach impact severely on many different body systems

178
Q

What effects does GDV have on the cardivascular system?

A
  • Reduces venous return to the heart
  • Occludes the portal vein, causing venous congestion of the intestinal tract
  • Reduces venous return back to the heart and reduces circulating blood volume.
  • Endotoxic and septic shock due to compromised mucosal barrier
  • myocardial ischemia
179
Q

What percentage of GDV cases develop ventricular arrythmias within 48hrs?

A

25%

180
Q

Why might a GDV patient develop cardiac arrythmias?

A

Due to reduced tissue perfusion…

181
Q

What Respiratory effects can GDV cause?

A

Dyspnoeic with rapid, shallow breathing

182
Q

What does the dialted stomach putting pressure on diaphragm cause?

A

Reduces functional reserve capacity of the lungs

183
Q

What is spleen attached to stomach by?

A

Gastrosplenic ligament

184
Q

How is the spleen effected in GDV?

A

The spleen gets displaced dorsally anf to the right where it becomes congested due to stretching and twisting of its vessels.

185
Q

With GDV, what does the increased intramuscular intraluminal pressure in the stomach cause?

A

It prevents blood flow to the gastric wall, causing hypoxia and necrosis of the gastric wall.

186
Q

In GDV what does the stomach do

A
  • Stomach rotates in a clockwise direction (on the longitudinal axis) (usually, can rotate both ways)
  • 90 to 360 degree rotation
  • Pylorus moves ventrally and to the left
  • Fundus moves to the right
187
Q

What are the clinical signs of GDV?

A
  • Retching
  • Unproductive vomiting
  • Cranial abdominal distension
  • Circulatory collapse (weak pulses and tachycardic)
  • Hypersalivation
  • Dyspnoea
188
Q

When physical exam on a patient with GDV what can you expect to find?

A
  • Distended painful abdomen (hyper resonant on percussion)
  • Tachycardic
  • Tachypnoeic
  • Pale
  • Slow CRT
  • Collapse
189
Q

How do you diagnose GDV?

A
  • Clinical signs
  • physical exam
  • history
  • Abdominal radiography will confirm
190
Q

What will you see on abdominal radiograph of a patient suffering with GDV?

A
  • Gas filled distended stomach
  • Compartmentalisation lines (‘inverted c’)
  • Can’t see fluid filled pylorus
191
Q

T/F Emergency stabilisation should be started BEFORE imaging suspected GDV patients

A

True obvs

192
Q

How should you go about stabilising a GDV patient?

A
  • Fluid therapy
  • Gastric decompression
193
Q

How should you go about fluid therapy in the GDV patient?

A
  • Place 2 cephalic catheters (as large bore as possible)
  • Shock fluid bolus = 90ml/kg/hr over 15mins then reassess and Repeat up to 4 times
194
Q

Orogastric intubation (stomach tubing)
* Wide bore stomach tube is measured from nose to 11th rib
* Lubricated the tube
* Patient should be sitting
* Place 7.5cm coflex bandage roll in mouth (hollow centre) and tape mouth closed in improvised gag
* Pass stomach tube down the core of the roll
* DO NOT FORCE
* Once passed decompress then gastric lavage
* Cannot always pass tube

A
195
Q

Percutaneous decompression
* 14, 16 or 18g over the needle catheter
* Clipped prepped area of tympanic right flank
* Try orogastric intubation first
* May be able to pass orogastric tube after needle decompression (reduced pressure at gastro-oesophageal junction)

A
196
Q

What is further stabilisation you could do in the GDV patient?

A
  • IV antibiosis
  • O2 therapy
  • Anti arrythmics
  • Analgesics
197
Q

What are surgical goals for GDV patients?

A
  • Reposition stomach
  • Assess stomach for necrosis
  • Perform gastropexy
198
Q

Do all patients with GDV require surgery?

A

Oui

199
Q

Step by step how do you reposition the stomach in a GDV case?

A
  1. Midline ventral laparotomy
  2. Establish direction of rotation before derotating
  3. re-position with care
  4. Find duodenum and follow it to pylorus
  5. Pylorus is gently lifted across to the right and fundus pushed down and to the left
  6. Check cardia to ensure untwisted
200
Q

What is the most common type of rotation with GDV and how can you tell if the stomach has rotated like that?

A
  • 180o clockwise rotation most common
  • Greater omentum covering the stomach suggests clockwise
201
Q

What should a normal gastric wall look like when assessing for viability?

A
  • Pink, blanches and rapidly recolours.
  • Peristalsis.
  • Active haemorrhage from the cut surface.
202
Q

If the gastric wall is compromised how might you describe it and what does this mean?

A

Erythematous - redness of the skin or mucous membranes caused by increased blood flow to the capillaries

203
Q

If the gastric wall is necrotic what colours might you see?

A

green blu purp and bla

204
Q

What should you do with necrotic areas of the gastric wall?

A

Perform a partial gastrectomy or gastric invagination

205
Q

What is an incisional gastropexy?

A

Incisional gastropexy is a surgery where the stomach is attached to the abdominal wall using small cuts and stitches. This helps stop the stomach from twisting, which can cause a serious condition called bloat.

206
Q

How do you perform an incisional gastropexy?

A
  • Vertical incision 4-6cm is made in the right body wall (transverse abdominus) behind the last rib, 5cm from the linea alba
  • A similar incision is made on the pyloric antrim between the greater and lesser curvatures through the seromuscular layer.
  • The edges of the stomach wall are sutured to the edges of the body wall doing the cranial incisions first.
207
Q

(Investigation & Management of Diarrhoea in Dogs & Cats)

What would your differential diagnosis list be when presented with a dog or cat with diarrhoea?

A
  • Dietary issue
  • Infectious cause
  • Neoplasia
  • Inflammation
  • Extra-intestinal disorder
  • Miscellaneous
  • Drugs or toxins
208
Q

What dietary things could cause diarrhoea?

A
  • Abrupt dietary change
  • Dietary indiscretion
  • Dietary intolerance/allergy
209
Q

How could be diarrhoea be cause by an infectious agent?

A

Parasitic, Viral, bacterial or fungal

210
Q

What kind of neplasms could cause diahhorea to occur?

A
  • Alimentary lymphoma
  • Intestinal carcinoma
  • Leiomyosarcoma
  • Mast cell tumour
211
Q

What inflammatory conditions can result in diarrhoea?

A
  • Inflammatory Bowel Disease
  • Colitis
  • Lymphangiectasia
212
Q

What extra-intestinal disorders result in diarrhoea?

A
  • Exocrine pancreatic insufficiency
  • Hydroadrenocortism (addi)
  • Liver disease
  • Pancreatitis
  • Peritonitis
213
Q

What questions should you ask about the onset of the diarrhoea?

A
  • Is the diarrhoea acute or chronic? Chronic is more than 2 weeks
  • Is the diarrhoea constant or intermittent?
214
Q

What question can you ask owner to try determine if its a small or large intestinal disease causing the diarrhoea?

A

Ask them about the characteristics of the diarrhoea

215
Q

What other two things should you ask owner about in a consultation about a dog with diarrhoea?

A
  • in contact animals
  • anthelmintic history and vaccination
216
Q

What are the characteristics that it is a small intestine causing diarrhoea?

A
  • Normal to large volume
  • Frequency of defaecation is normal to mildly increased
  • Melaena
  • Concurrent weight loss**
  • Concurrent vomiting
  • Ascites if associated with protein-losing enteropathy (PLE)
217
Q

What are the characteristics that it is a large intestine causing the diarrhoea?

A
  • Variable but often small volume
  • Increased frequency of defaecation often associated with urgency
  • Mucus
  • Haematochezia (fresh blood)
  • Faecal tenesmus
  • Dyschezia (pain associated with defaecation)
218
Q

On clinical examination of a patient with diarrhoea, what might pyrexia indicate?

A

An infectious cause or maybe a systemic complication of the underlying disorder.

219
Q

On clinical examination of a patient with diarrhoea, what might Malnutrition indicate?

A

Chronic maldigestion or malabsorptive disorder

220
Q

On clinical examination of a patient with diarrhoea, what might presence of ascites indicate?

A

May suggest protein losing patient

221
Q

What is you DDx for acute haemorrhagic diarrhoea?

A
  • parvo
  • coronavirus
  • samonella
  • campylobactor
  • E.coli
  • clostridial diarrhoea
  • Clostridium perfringens-assoc diarrhoea
  • acute heam diarrhoea syndrom
  • abdominial castrophe
222
Q

What is abdominal castrophe?

A

peritonitis from a visceral source

223
Q

How would you diagnose parvo as the cause of acute diarrhoea?

A
  • Feacal antigen test
  • serology from anti-CPV antibodies
  • haemagglutination inhibition test
  • PCR on feaces
  • IFA on tissue specimans at PM
224
Q

How would you diagnose Entero-pathogenic bacteria as the cause of acute

A
  • standard feacal culture
  • Feacal culture for characteristics of specific bacteris using PCR
  • ELISA
  • Screening for giardia
225
Q

How can you diagnose extra-intestinal causes for the acute diarrhoea?

A
  • Heam + biochem
  • Cortisol to exclude addisons
  • Diagnostic imaging
226
Q

How should you go about managing acute diarrhoea that is thought to be caused by dietary indiscretion?

A
  • Dietry modification
  • Supportive IVFT if required (severy dehydrated)
  • Probiotics
227
Q

How should you go about managing parvoviral enteritis?

A
  • You should perform heam and biochem
  • Venous blood gas management
  • coagulation profile
228
Q

Why would you perform the a heam and biochem on a patient who has parvoviral enteritis?

A
  • Heam and biochem - would do this because neutropenia may influence whether to give antibiotics or not, and electrolyte deficiency will influence IVFT.
229
Q

Why would you perform a venous blood gas analysis on a patient suffering from parvoviral enteritis?

A

Acid-base derangements may impact the choice of fluid therapy and aggressiveness of fluid therapy.

230
Q

Why would you perform a coagulation profile on a patient suffering from parvoviral enteritis?

A

Parvoviral enteritis is sometimes associated with DIC and may influence desicion to administer plasma

231
Q

How should you treat a patient with parvoviral enteritis

A
  • IVFT
  • IV antibiotics if neutropenic
  • Anti-emetics
  • Early nutritional support
  • Interferon
232
Q

What kind of Fluids would you use in a patient with parvociral enteritis?

A

Crystalloids +/- colloids and plasma

233
Q

T/F the management of acute haemorrhagic diarrhoea syndeom is the same as parvoviral enteritis apart from interferon?

A

True

234
Q

What is your DDx for chronic diarrhoea?

A
  • Dietary
  • Neoplastic
  • Inflammatory
235
Q

What investigation tests should you use when diagnosing chronic diarrhoea

A
  • Faecal analysis
  • Heam and serum biochem
  • Diagnostic imaging
  • Endoscopic assessment of GI mucosa
  • Histopathology
236
Q

Why would you perform a faecalrformal analysis on a patient with chronic diarrhoea?

A
  • feacl parasitology
  • Faecal dysbiosis index
237
Q

What non-GI disorders are you looking for on heam and bio chem of a patient with chronic diarrhoea?

A
  • Liver, endocrine diseases
  • pancreatic disorders
  • renal disease
238
Q

Why would you use diagnostic imagaing on a patient with chronic diarrhoea?

A
  • To identify or rule out neoplastic processes or disorders such as partial bowel obstruction
  • To inform decision-making about whether endoscopy or exploratory coeliotomy should be performed to obtain a diagnosis
239
Q

Why would you do histopathology on a patient with chronic diarrhoea?

A
  • neoplastic vs non-nesoplastic
240
Q

How would you treat chronic diarrhoea that has been caused by protazoa?

A

anti-protozoal agent

241
Q

How would you treat a patient with chronic diarrhoea that has been caused by EPI?

A

Enzyme replacement therapy

242
Q

How would you treat a patient with chronic diarrhoea caused by hypoadrenocortism?

A

Hormone replacement therapy

243
Q

How would you treat a patient with chronic diarrhoea caused by intesntinal lymphoma

A

chemo

244
Q

What is faecal tenesmus?

A

Straining to defecate

245
Q

What is dyschezia?

A

Difficult or painful defaecation

246
Q

Is Diarrhoea a alarge or small intestinal characteristic?

A

Large

247
Q

What is haemoatochezia?

A

Passage of fresh blood on faeces

248
Q

What are the causes of tenesmus and Dyschezia?

A
  • Colorectal disease
  • perianal and perineal disease
  • Prostatic disease
  • Urogenital disease
  • Miscellaneous
249
Q

What investigations should you perform on a patient with feacal tenemus/dyschexia plus diarrhoea and what for?

A
  • Feacal parasitology and culture for giardia. Trichuris, Ancylostoma, Tritrichomonas
  • Rectal cytology for infectious agents like fungal elements
  • Diagnostic imaging to rule out extraluminal disease and intussusception and to identify lymphadenopathy and mural thickening
  • colonoscopy and mucosal biopsy
250
Q

What might idiopathic inflammation of the colon occur concurrent with?

A

May occur concurrently with IBD affecting the small intestine

251
Q

How do you diagnose idiopathic colitis?

A

Exculsion plus compatible histopathological chnages

252
Q

How should you manage idiopathic colitis diet wise?

A

Hydrolysed protein diets or supplememtal fibre

253
Q

What antibiotic would you use when treating idiopathic colitis?

A

Metronidazole

254
Q

What anti-inflammatory drug should you use when treating idiopathic colitis?

A

Sulfasalazine

255
Q

What immunosuppressive drugs can you use when treating idiopathic colitis

A
  • Prednisolone (1st line immunosuppressive agent)
  • Azathioprine (2nd line immunosuppressive agent in dogs)
  • Cyclosporine (2nd line immunosuppressive agent in dogs)
  • Chlorambucil (2nd line immunosuppressive agent in cats)
256
Q

What antibiotic should you use to treat granulomatous colitis

A

Fluoroquinolones

257
Q

How do Fluoroquinolones work?

A

They work by inhibiting bacterial DNA replication, specifically targeting enzymes called DNA gyrase and topoisomerase IV, which are essential for bacterial cell survival and reproduction.

258
Q

How would you describe idiopathic large intestinal diarrhoea in dogs?

A

Intermittent diarrhoea is characterised by increasing frequency, faecal mucus, hematochezia and tenesum

259
Q

What does trichomonas foetus infection cause in cats?

A

Mild to mod lymphpplasmacytic and neutrophilic colitis

260
Q

What are diagnostic tests for tritrichomonas foetus? and what are their sensitivities?

A
  • Feacal wet prep - less than 20%
  • In-pouch culture - 65%
  • PCR for trich DNA - 97%
261
Q

How should you go about treating a patient with Tritichomonas foetus infection?

A
  • International Cat Care website for up-to-date information
  • High High-fibrefibre diet
  • Ronidazole
  • Probiotics
  • Treatment of concurrent infections?
262
Q

What mechanical obstruction cause constipation?

A
  • Intraluminal - Impaction with bones/hair, rectal stricture, perineal hernia (diverticulum)
  • Intramural - Neoplasia
  • Extramural - Pelvic fractures/stenosis, neoplasia, prostatic disease
263
Q

What neuromuscular dysfunctions can cause constipation?

A
  • lumbosacral disease
  • Hypogastric or Pelvis nerve disorders
  • colonic smooth muscle dysfunction
264
Q

What metabolic/endocrine doseases can lead to constripation?

A
  • Dehydration
  • Hypokalaemia
  • Hypercalcaemia
  • Hypothyroidism
  • Obesity
265
Q

What inflammatory processes may cause constripation?

A
  • Anal sac disease
  • Anal furunculosis/Perianal fistula
266
Q

What enviromantal impacts could cause constripation?

A
  • soiled litter tray
  • inactivity/HospitalisationW
267
Q

What kind of drugs could induce constipation?

A
  • opiods
  • anticholingerics
268
Q

If a cat presents with constipation, obstipation and megacolon what might be the patients history?

A

Typically there is a chronic history of reduced production of faeces +/- faecal tenemus and dyschezia

269
Q

If a cat presents with constipation, obstipation and megacolon what might be their clinical presentation?

A
  • Intermittent haematochezia and mucoid diarrhoea
  • Systemic signs of inappetance, malaise, vomiting, weight loss
  • May be a history of RTA/pelvic trauma
270
Q

What is the main cause of obstipation in cats?

A
  • Idiopathic megacolon
  • pelvic canal stenosis
  • Nerve injury or sacral deformity
271
Q

What should you do to exculed other causes of obstipation?

A
  • serum biochem
  • T4
  • Abdominal radiography +/- US
  • colonoscopy
272
Q

What are the aims of therapy of feline constipation?

A
  • Chieve normal hydration
  • remove impacted faeces
  • increase dietry fibre
  • pharmalogic manipulation of clonic function
273
Q

How can you remove impacted faeces?

A

Enemas and manual evacuation

274
Q

What diet should you put a patient on that is suffering with constipation?

A

High fibre for mild constipation and low residue diets for obstripation?megacolon

275
Q

What are cosequences of chronic obstipation and megacolon

A
  • mucosal ulceration and inflammation
  • clonic perforatio
  • sub to total colectomy +/- pelvic osteotomy
276
Q

When would you perform a pelvic osteostomy on a patient with chronic obistiapation and megacolon?

A

If the megacolon is secondary to pelvic canal stenosis

277
Q

What is anal furunculsosis/Perinanal fistula?

A

Chronic inflammatory disease resulting in ulceration and fistulous tracts in the nal and perianal areas.

278
Q

What breed is predisposed to anal furunculosis and perinanal fistula?

A

GSDs

279
Q

What might anal furunculosis/Periananla Fistula be concurrent with?

A

Idiopathic colitis

280
Q

How would you non-specifically treat anal furunculosis/Perinanal fistula?

A
  • Clean to reduce bacterial contamination
  • Antibiotics to treat secondary infection
  • Analgesia
  • stool softners
281
Q

what immunosupressive therapy can be used to treat anal furunculosis/perianal fistula?

A

ciclospornin orally +/- ketoconazole
Tacrolimus topicallu

282
Q

What is perianal hernial a common cause of?

A

Straining to defeacate

283
Q

What is a perineal hernia?

A

It is a perineal swelling where there is a loss of lateral support to rectum and deviation of rectum into subcut hernia

284
Q

What kind of dogs are more likekly to suffer with perineal hernias?

A

older male entire dogs

285
Q
A

BVMS 3 (11 decks)

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