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Alimentary - Surgery > Principles > Flashcards

Principles Flashcards

1
Q

What are four things that should be considered before gastrointestinal surgery?

A

Is the animal fit for GI surgery?

What is the risk of infection from GI bacteria?

How does the GIT heal?

Septic peritonitis - can be a major complication

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2
Q

What are the problems associated with gastric surgical diseases and gastric vomiting?

A

Loss of gastric hydochloric acid

  • Metabolic alkalosis
  • Hypochloraemia

Dehydration

  • Poor tissue perfusion causing metabolic acidosis

Insufficient food intake

  • Hypokalaemia
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3
Q

What can be caused by small intestinal complete obstructions that is a problem when wanting to undertake GI surgery?

A

Acute vomiting

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4
Q

What can be some problems associated with acute vomiting that need correcting before surgery?

A

High obstruction

  • Mimics vomiting

Low obstruction

  • Loss of pancreatic Na+ and HCO3-
  • Causing metabolic acidosis

Dehydration

  • Poor perfusion causing metabolic acidosis

Insufficient food intake and decreased absorption

  • Hypokalaemia
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5
Q

What can a small intestinal partial obstruction cause that can complicate surgery?

A

Chronic vomiting

Diarrhoea

Weight loss

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6
Q

What should be done to correct problems caused by small intestinal partial obstructions, small intestinal complete obstructions and gastric vomiting?

A

Intravenous isotonic crystalloids

K+ supplementation provided

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7
Q

How should gastrointestinal bleeding problems be corrected prior to surgery?

A

Blood transfusions

Iron supplementation

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8
Q

What six things should be done to determine whether an animal is fit for anaesthesia and surgery?

A

Complete history

Complete physical examination

Check haematocrit and total protein

Check electrolytes: K+ and Na+

Check acid-base status

Complete haematology and biochemistry: if indicated

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9
Q

Should we use prophylactic antibiotics for stomach surgery and why?

A

Antibiotics may not be necessary in healthy young dogs

If it is then a single broad spectrum antibiotic

Anaerobic coverage is recommended

Cephalosporin or amoxycillin-clavulante

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10
Q

Should we use prophylactic antibiotics for small intestine surgery and why?

A

Always use antibiotics

Single broad spectrum antibiotic

Anaerobic coverage

Cephalosporin or amoxycillin-clavulante

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11
Q

Should we use prophylactic antibiotics for colon surgery and why?

A

Always use antibiotics

Combination of 2 antibiotics

Antibiotic specifically targeted to anaerobes

Metronidazole plus cephalosporin/amoxycillin-clavulante

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12
Q

What are ways of decreasing bacterial contamination that isn’t antibiotics?

A

Isolate site of entry

Lavage wound after closure

Change gloves

Lavage abdomen

Use separate set of instruments for contaminated part

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13
Q

What are three things that need to be known about intestinal wound healing?

A

How quickly will it heal?

Is there a risk of breakdown?

  • Higher in some animals?

How long is the wound strength dependent on sutures or staples used?

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14
Q

What is the strongest layer in the intestinal wall and why?

A

Submucosa

  • High collagen content
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15
Q

Describe the process of intestinal wound healing

A

Haemostasis

  • Days 1-4
  • Platelet-fibrin clot formation

Inflammation

  • Days 1-5
  • Microbial killing
  • Wound debridement

Proliferation/granulation

  • Days 3-weeks
  • Fibroblast proliferation
  • Collagen synthesis
  • Angiogenesis

Remodelling/maturation

  • Weeks-years
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16
Q

Why is there a chance of intestinal wound breakdown during days 3-5?

A

Overlap between inflammation and proliferation

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17
Q

What happens to the rate of wound healing as you move along the GIT?

A

It decreases

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18
Q

Describe the rate of wound healing at each stage of the GIT

A

Stomach

  • Rapid healing (abundant blood supply)
  • Rarely complicated

Small intestine

  • Day 14 regained 75-80% of normal strength

Large intestine

  • Day 14 regained 50% of normal strength
  • Greatest risk of wound breakdown
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19
Q

What five factors would impact negatively on intestinal wound healing?

A

Compromise to blood supply

Traumatic surgical technique (no electrocautery)

Hypoproteinaemia

  • Can rarely be corrected before surgery

Chemotherapy/radiotherapy

  • Delay for 3 weeks

Steroids

  • Discontinue where possible
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20
Q

What are the three suture patterns used for repair of GI wounds and why are they chosen?

A

Full thickness appositional

Simple interrupted

Simple continuous

They restore normal anatomy and promote rapid healing

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21
Q

What type of suture material should be chosen and why?

A

Any material that is:

  • Resistant to infection (monofilament)
  • Retains its strength enough to permit healing
  • Disappears after wound healing
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22
Q

Name two types of suture material are recommended for GI wounds. Which is preferred?

A

Monocryl and PDS II

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23
Q

What else can be used to repair GI wounds instead of suture material?

A

Metal staples

24
Q

What is exploratory laparotomy?

A

Direct visual and tactile examination of the abdominal organs at surgery via an incision into the abdomen

25
Q

When should exploratory laparotomy be carried out?

A

Diagnose the cause of intra-abdominal disease

Correct the cause of intra-abdominal disease

26
Q

When should biopsies be taken and of which organs?

A

If no discrete lesion is found

Take biopsy of:

  • Stomach
  • Small intestine
  • Liver
  • Pancreas
  • Enlarged lymph nodes
27
Q

Describe the surgical approach for exploratory laparotomy

A

Ventral midline incision from the xiphisternum down to the pubis

In male would have to cut through preputial muscle

Retractors used to hold wound open

  • Balfour retractors
  • Gossett retractors
28
Q

Describe an examination of the gastrointestinal tract through laparotomy and what you should have good knowledge of

A

Entire GI tract should be palpated

Run through hands in logical manner

Need knowledge of anatomy and blood supply

29
Q

Describe gastrotomy repair

A

Repair in 2 layers

Mucosa and submucosa

  • Simple continuous

Serosa and muscularis

  • Simple continuous
  • Inverting lembert (prevents leakage)
30
Q

Describe a small intestine biopsy

A

Isolate intestine

Milk intestinal contents away

Close with atraumatic clamps/fingers

Incise along anti-mesenteric border

Biopsy ellipse cut with metzenbaum scissors

31
Q

Why should you trim excess mucosa when repairing a small intestine biopsy?

A

To ensure sutures are placed through the submucosa

  • 3-5mm apart
  • 3-5mm from the cut edge
32
Q

What should be done after releasing clamps in a small intestine biopsy?

A

Assess enterotomy for leaks

33
Q

When should you do a large intestinal biopsy and why?

A

Never

  • Unless a lesion is specifically identified or suspected

Increased risk of breakdown of a large intestine wound

34
Q

When should a liver biopsy be carried out?

A

Clinical signs/blood tests suggestive of liver disease

Abnormal appearance on ultrasound

Abnormal appearance during surgery

Presence of liver nodules/masses

35
Q

What should be considered before undertaking a liver biopsy?

A

Fine needle aspirates

Trucut biopsy under ultrasound guidance

36
Q

What is the main complication with doing a liver biopsy?

A

Bleeding

  • Use haemostats to crush blood supply
  • Use electrocauterization to stop bleeding
37
Q

Which part of the liver should you biopsy?

A

Tiny triangular segment along the edge of the liver

Pack with haematostatic agents

If a nodule is present then biopsy nodule instead

38
Q

What are the two ways that gastic foreign bodies can be treated?

A

Endoscopic retrieval of foreign body

Gastrotomy

39
Q

What should be provided with post-op care of a gastrotomy and what is the prognosis?

A

Feed

Antacids

Gastric protectants

Excellent prognosis

40
Q

What should be decided before making surgery to correct a gastric neoplasia?

A

Are there any obvious metastases?

Is tumour resection and reconstruction achievable?

Can the cardia be preserved?

Can the common bile duct be preserved?

Can the pancreatic duct be preserved?

41
Q

What is the prognosis of a gastric neoplasia?

A

Complete resection of benign tumour

  • Good

Malignant tumour

  • Poor
  • Clinical symptoms often recurring within weeks
42
Q

What type of closure should always be used partial gastrectomy?

A

Eversion - edges turned out

43
Q

In what two instances is intestinal resection and anastomosis needed?

A

Ischaemic necrosis

Neoplasia

44
Q

What should the GI tract be assessed for before surgery?

A

Pulsations in arterial blood vessels

Presence of peristaltic muscle contractions

Normal colour

Normal wall thickness on palpation

45
Q

Describe intestinal resection

A

Milk out intestinal contents

Isolate intestine with atraumatic clamps

Ligate mesenteric vessels

Incise mesentery

Incise intestine close to clamps on intestine to be resected

46
Q

What should be done with luminal disparity?

A

Sutures should be spaced further apart on the larger side

Transect the small side at an angle to match diameter of large side

Reduce small side with sutures

Spatulate small side

47
Q

Describe how an end-to-end anastomosis should be carried out

A

Suture as for enterotomy

Place first suture in mesenteric border

Place second suture in anti-mesenteric border

Repair defect in mesentery

48
Q

Describe how an intestinal wound is supported during end-to-end anastomosis

A

Omentalisation

Serosal patch

  • Adjacent pieces of healthy are tacked to intestinal wound
49
Q

What should be encouraged as soon as possible after enterotomy and enterectomy?

A

Encourage oral nutrition

50
Q

What are some complications inolved with enterotomy and enterectomy?

A

Persistent ileus

Stricture at anastomosis site

Short-bowel syndrome

Intestinal incision dehiscence

51
Q

What is the consequence of intestinal wound breakdown?

A

Septic peritonitis

52
Q

What is the prognosis of spetic peritonitis?

A

Extremely guarded

50% mortality

53
Q

Why can poor wound healing occur with oesophageal wounds?

A

Lack of a serosa

Segmental blood supply

Constant motion of swallowing and breathing

Lack of an omentum

Tension at the surgical site

54
Q

What should be done medically as treatment prior to surgery for a vascular ring anomaly?

A

Slurry diet

Feed from a height

Maintain upright for 20 mins post feeding

Treat for aspiration pneumonia if required

55
Q

Why is surgical exploration of oropharyngeal stick injury essential?

A

Assess and repair damaged structures

Remove any further stick material

Lavage the tissues

Collect samples

Alimentary - Surgery (3 decks)

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