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Alimentary > Principles of Small Animal Gastrointestinal Surgery > Flashcards

Principles of Small Animal Gastrointestinal Surgery Flashcards

1
Q

gastric vomiting - effects

A

Loss of gastric hydrochloric acid - Metabolic alkalosis, Hypochloraemia
Insufficient food intake - Hypokalaemia
Dehydration - Poor tissue perfusion, Metabolic acidosis

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2
Q

acute vomiting - effects

A

Low intestinal obstruction - Loss of pancreatic Na +
, HCO3-, Metabolic acidosis, ↓Na+
Dehydration - Poor tissue perfusion, Metabolic acidosis
High intestinal obstruction - Mimics gastric vomiting
Insufficient food intake & ↓absorption - Hypokalaemia

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3
Q

Chronic vomiting, diarrhoea + weight loss - effects

A

Dehydration & electrolyte loss
Bacterial proliferation & nutrient metabolism - Maldigestion & malabsorption, Intestinal mucosal damage
Diarrhoea - Weight loss, Hypoalbumninaemia

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4
Q

How to correct effects of vomiting (all types), diarrhoea + weight loss prior to surgery

A

intravenous isotonic crystalloids

intravenous K+ supplements

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5
Q

Gastrointestinal bleeding - haematemesis, melaena - effects

A

Anaemia - non/Regenerative

Hypoalbuminaemia

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6
Q

how to correct effects of GIT bleeding before surgery

A

blood transfusion

iron supplements

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7
Q

what to check to see if animal is fit for 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 clinically indicated
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8
Q

prophylactic antibiotics - stomach

A

may not be needed for healthy animal
single broad spec antibiotic with anaerobic coverage
cephalosporin or amoxycillin-clavulante

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9
Q

prophylactic antibiotics - small intestine

A

antibiotics always indicated
single broad spec antibiotic with anaerobic coverage
cephalosporin or amoxycillin-clavulante

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10
Q

prophylactic antibiotics - colon

A

antibiotics always indicated

combo of 2 antibiotics including 1 specifically for anaerobes

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11
Q

methods to decr bacterial contamination

A 
Isolate the site of GI entry
Lavage GI wound after closure
Change gloves
Lavage abdomen with sterile saline
use separate set of instruments for contaminated part of surgery
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12
Q

methods to decr bacterial contamination - large intestine

A

mechanical preperation
No evidence to support use in veterinary medicine
Liquid faeces maybe more likely to bypass atraumatic clamps and purse string sutures
A low residue diet & at least 12-24 hr starvation recommended

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13
Q

strongest layer in intestinal wall + why

A

submucosa

high collagen content

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14
Q

1-4 days post surgery wound activity

A 
Haemorrhage 
Platelet clot - Fibrin clot
Inflammation 
Microbial killing
potential wound debridement
Epithelial migration
No change in wound strength
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15
Q

3-14 days post surgery wound activity

A

Fibroblast proliferation
Collagen formation
incr wound strength

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16
Q

rate of wound healing - stomach

A

rapid due to large blood supply

healing rarely complicated

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17
Q

rate of wound healing - small intestine

A

by day 14, 75-80% normal strength

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18
Q

rate of wound healing - large intestine

A

By day 14, regained 50% of normal tensile
? Increased collagenase production
Risk of wound breakdown greatest

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19
Q

Factors which impact negatively on intestinal wound healing

A 
Compromise to blood supply
Traumatic surgical technique (electrocautery)
hypoproteinaemia
chemo + radiotherapy
steroids
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20
Q

Repair of gastrointestinal wounds with sutures: Suture pattern + material choice

A

restore normal anatomy
promote rapid healing
multifilament material has crevices that trap bacteria
absorbable material - stays long enough to allow healing

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21
Q

Repair of gastrointestinal wounds with metal staples

A

Titanium staples: permanent, inert
Special gastrointestinal staple guns with staple cartridges
eversion or inversion of edges

22
Q

exploratory laparotomy - indications

A

To diagnose the cause of intra-abdominal disease

To correct the cause of intra-abdominal disease

23
Q

exam of GIT

A

entire GIT should be palpated and run through your hands in a logical manner
important to have good knowledge of anatomy + blood supply (know which blood vessels can be
safely ligated + to avoid damaging the blood supply to
vital organs)

24
Q

gastrotomy - define

A

incision into the stomach

25
Q

gastrotomy - repair

A

Repair in 2 layers
Mucosa & submucosa - Simple continuous
Serosa & muscularis - Simple continuous, inverting lembert (prevent leakage)

26
Q

small intestine biopsy

A

isolate intestine
milk intestinal contents away + close intestine with clamps
incise along anti-mesenteric border
ellipse for biopsy cut with metzenbaum scissorsd

27
Q

large intestinal biopsy

A

Do not biopsy the large intestine unless a lesion is
specifically identified/suspected due to increased risk
of breakdown of a large intestine wound

28
Q

liver biopsy

A

Clinical signs + blood tests results suggestive of liver disease
Generalised abnormal appearance on ultrasound or at
surgery
Presence of liver nodules or liver masses
First consider fine needle aspirates and trucut biopsy of the liver under ultrasound guidance

29
Q

Gastric Foreign Bodies - Diagnosis

A

ultrasound

30
Q

Gastric Foreign Bodies - treatment

A

Endoscopic retrieval of foreign body

Gastrotomy

31
Q

Gastric Neoplasia - Decision Making Prior to Surgery

A

Is tumour resection and reconstruction achievable?
A large proportion of the stomach can be resected but cardia must be preserved
Can the common bile + pancreatic duct be preserved?

32
Q

gastric neoplasia - prognosis

A 
Complete resection of benign tumour (leiomyoma) - good
Malignant tumour (adenocarcinoma) - poor, clinical symptoms often recurring within weeks
33
Q

partial gastrectomy

A

Same principles as gastrotomy

Consider the use of staples

34
Q

assessing GIT viability

A

Pulsations in the arterial blood vessels
presence of peristaltic muscle contractions
normal colour
normal wall thickness on palpation

35
Q

intestinal resection

A

similar to SI biopsy

ligate mesenteric vessels then incise mesentery

36
Q

luminal disparity (size mismatch)`

A

`Space sutures further apart on large side
Transect the small side at an angle to match diameter of large side
reduce small side with sutures
spatulate small side

37
Q

end-to-end anastomosis

A

Suturing as for enterotomy
Place 1st suture in mesenteric border
Place 2nd suture in anti-mesenteric border
Repair defect in mesentery

38
Q

end-to-end anastomosis - support wound

A

omentalisation (wrap omentum around wound)

serosal patch - adjacent healthy intestine tacked to intestinal wound

39
Q

intestinal foreign bodies - history

A

Persistent vomiting (frequently projectile)
Anorexia
Depression
No defaecation

40
Q

intestinal foreign bodies - clinical exam

A 
Dehydration
Depression
Abdominal Pain
Intrabdominal mass
String around tongue
41
Q

intestinal neoplasia types

A 
Adenoma/adenocarcinoma
Lymphoma
Leiomyoma/leiomyosarcoma
mast cell
Duodenal polyps
42
Q

intestinal neoplasia - clinical signs

A

Partial obstruction
Chronic intermittent vomiting
Diarrhoea
Weight loss

43
Q

intussusception - define

A

Invagination of one portion of the gastrointestinal tract

into the lumen of an adjoining segment

44
Q

intussusception - clinical signs

A 
palpable tubular mass
dehydration
depression
abdominal pain
protrusion of intussusception from anus
45
Q

intussusception - diagnosis

A

ultrasound (parallel lines/concentric rings)

radiography (gas distenstion in SI)

46
Q

intussusception - reduction or resection

A

Reduction: push rather than pull
Assess intestines
Resect if - Irreducible, Ischaemic / injured intestines, Mass present

47
Q

further treatment for intussusception

A

Enteroplication (suture loops of intestine together)
Treat underlying disease
Always check for faecal bacteria and parasites: deworm if in doubt
Prognosis - Good in young, 6-27% recurrence

48
Q

Enterotomy & Enterectomy - Complications

A

Persistent ileus - Vomiting, diarrhoea, pain, abdo distension
Stricture at anastomosis site - Partial obstruction
Short-bowel syndrome: >70% resection - Malabsorption & malnutrition
Intestinal incision dehiscence - 7-16% for intestinal biopsies

49
Q

The consequence of intestinal wound breakdown

A

septic peritonitis

50% mortality

50
Q

septic peritonitis - clinical signs

A 
vomiting
Anorexia & depression
Abdominal pain
Abdominal enlargement
Hypovolaemic shock
Pyrexia
Discharge from abdominal wound
Diarrhoea
Haematochezia, melaena, haematemesis
51
Q

septic peritonitis - diagnosis

A

Abdominocentesis

most important test

52
Q

septic peritonitis - treatment

A

Ex lap to find & correct leak
Peritoneal lavage + drainage
Intensive post-op care - Maintenance of normovolaemia &
blood pressure, nutrition is essential

Alimentary (13 decks)

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