Principles of Small Animal Gastrointestinal Surgery Flashcards by Adam Northwood

What GIT issues could complicate surgery?

GASTRIC VOMITING

Insufficient food intake

Dehydration (hypoperfusion and metabolic acidosis)

Loss of gastric HCl (metabolic acidosis & hypochloraemia)

Decreased food absorption (hypokalaemia)

Hypoalbuninaemia

Bacterial proliferation

Anaemia

How well did you know this?

Not at all

Perfectly

How can GIT problems be corrected prior to surgery?

IV Isotonic crystalloids
IV K+ supplementation

Blood transfusion

How well did you know this?

Not at all

Perfectly

How does bacteria vary within the GIT?

Increase in the number of bacteria and % of anaerobes

Stomach – SI – Colon

How well did you know this?

Not at all

Perfectly

When are prophylactic ABs indicated in GI surgery?

Surgery on SI or colon

How well did you know this?

Not at all

Perfectly

How can we decrease bacterial contamination during GI surgery other than ABs?

Isolate site of DI entry
Separate instruments for contaminated part of surgery
Lavage GI wound after closure
Change gloves
Lavage abdomen with sterile saline

How well did you know this?

Not at all

Perfectly

Which is the strongest layer in the GIT wall and why?

Submucosa because of the high collagen content

How well did you know this?

Not at all

Perfectly

What are the layers of the GIT wall?

Mucosa
Submucosa
Muscularis
Serosa

How well did you know this?

Not at all

Perfectly

When is wound breakdown most likely to happen and why?

3-5d

Overlap between inflammation and proliferation phases

How well did you know this?

Not at all

Perfectly

Which phase of wound healing is responsible for increased wound strength and how?

Proliferation

Collagen synthesis occurs

How well did you know this?

Not at all

Perfectly

Which part of GIT has the highest risk of breakdown?

Colon

How well did you know this?

Not at all

Perfectly

What can increase the risk of wound breakdown?

Compromised blood supply
Traumatic technique
Hypoproteinaemia
Chemo/radiotherapy
Steroids

How well did you know this?

Not at all

Perfectly

What suture material are suitable for GIT surgery?

Monocryl

PDS II

How well did you know this?

Not at all

Perfectly

When is an exlap indicated?

Obstruction confirmed on xray
Diagnostics tests unrewarding
Need to obtain biopsy

How well did you know this?

Not at all

Perfectly

Which retractors are suitable for an exlap?

Balfour

Gossett

How well did you know this?

Not at all

Perfectly

How is an SI biopsy carried out?

Isolate intestine
Incise along anti-mesenteric border
Milk intestinal contents away and close intestine with atraumatic forceps
Ellipse for biopsy cut with Metzenbaum scissors
Trim excess mucosa and make sure go through submuscoa
Suture 3-5 mm apart and from cut edge
Release clamps and assess for leaks

How well did you know this?

Not at all

Perfectly

When is a liver biopsy carried out?

Clinical signs and haem suggest liver disease
Abnormal appearance on US or at surgery
Presence of nodules/masses
FNA/trucut have been unrewarding

How well did you know this?

Not at all

Perfectly

How are gastric FBs diagnosed?

Radiography
US
Endoscopy

How well did you know this?

Not at all

Perfectly

How are gastric FBs removed?

Endoscopy

Gastrotomy

How well did you know this?

Not at all

Perfectly

What should ideally be preserved in surgery for gastric neoplasia?

Cardia
Bile duct
Pancreatic duct

How well did you know this?

Not at all

Perfectly

How can ischaemic necrosis of the GI tract occur?

Excessive pressure within intetinal lumen

Distruption in blood supply

How well did you know this?

Not at all

Perfectly

When is intestinal resection and anastomosis required?

Ischaemic necrosis

Neoplasia

How well did you know this?

Not at all

Perfectly

What is used to assess GIT viability?

Pulsing BVs
Presence of peristalsis
Normal colour
Normal thickness

What types of neoplasia can occur in the GIT?

Adenoma/adenocarcinoma
Lymphoma
Leiomyoma/leimyosarcoma
MCT
Dudodenal polyps

What are the signs of intestinal neoplasia?

Partial obstruction
Chronic intermittent vomiting
D+
Weight loss

What are the signs of intussusception?

``` Dehydration Depression Abdo pain Palpable tubular mass Protrusion of intusseception from anus ```

How is intussusception diagnosed?

US - parallel lines, concentric rings | Radiography - gas distension of loops of SI

What are the possible complications of intestinal surgery?

Persistent ileus Stricture > partial obstruction Short-bowel syndrome Incision dehiscence

Outline the pathophysiology of septic peritonitis

Bacteria present cause inflammatory cells to enter the peritoneal cavity along with endotoxin release. These inflammatory cells produce cytokines with in turn causes vasodilation, increased capillary permeability and diaphragmatic lymphatics blocked with fibrin. This results in increased fluid and protein in the peritoneal cavity leading to hypovolaemia and decreased vascular oncotic pressure and thus hypovolaemic shock. This can all lead to SIRS, DIC and death.

What are the clinical signs of septic peritonitis?

``` V/D Anorexia, depression Abdo pain and enlargment Hypovolaemic shock Pyrexia Discharge from abdo wound Blood in faeces ```

How is septic peritonitis diagnosed?

Abdominocentesis

How is septic peritonitis treated?

1) ABs 2) Exlap to find leak 3) Peritoneal lavage 4) Intensive postop care

When should a patient be fed after intestinal surgery?

ASAP

Why would you not take a full thickness biopsy of the colon?

Risk of infection and wound breakdown

How much of the colon can be removed?

More than 6cm is associated with faecal incontinence

How would you suture the colon?

Single layer of simple interrupted

What may be the complications of colorectal surgery?

``` Dehiscence and septic peri Wound infection Abscess Faecal incontinence Stricture and tenesmus Haematochezia ```

What is megacolon?

Flaccid enlargement of the colon, often distended with faeces due to loss of colonic muscle function

What are the causes of megacolon?

``` Primary (idiopathic) in cats Secondary to: Fractures Neoplasia Abscess Inappropriate diet ```

What are the clinical signs of megacolon?

``` Chronic constipation Tenesmus Vomiting Anorexia Weight loss Faeces in colon Dehydration Low BCS ```

What are the incidences of benign vs malignant neoplasia in the colon?

50:50

What are some benign neoplasms of the colorectum?

Adenomatous polyps | Leiomyomas

What might be the some malignant colorectal neoplasias?

``` Adenocarcinoma Leiomyosarcoma Lymphoma Haemangiosarcoma Plasmacytoma ```

What are the clinical signs of colorectal cancer?

``` Tenesmus Haematochezia Increase in defecation Ribbon-like faeces Rectal prolapse Weight loss Dogs 6-9yos ```

How might you diagnose colorectal neoplasia?

``` Rectal exam Radiography US FNA Colonoscopy ```

What might cause rectal prolapse in SAs?

GI parasites Rectal neoplasia Perineal hernia

How do you treat rectal prolapse?

Anthelmintics Faecal softeners Low residue diet Sedatives

What might be presented with anal sac impaction, inflammation and infection?

``` Perineal irritation Scooting Licking Biting Discomfort Reddened inflamed skin or drainage tract overlying region of anal sac suggests infection or ruptured abscess ```

What do anal sac secretions look like?

Normally liquid brown | Abnormal - thick white, yellow or green

How would you treat an impacted anal gland?

Manual expression

How do you treat anal sacculitis/abscess?

``` Sedation Catheterise duct opening Culture, cytology, smear lavage Dexamethasone and antibiotics Topical treatment of yeast overgrowth ```

What are the features of anal sac apocrine gland adenocarinomas?

High malignant | 50% metastasis

What would present with a dog with paraneoplastic syndrome?

Hypercalcaemia Polyuria Polydipsia

What AB would you give for SI surgery?

2G cephalosporin/amoxyclav

What AB would you give for colon surgery?

As SI (2G cephalosporin/amoxyclav) AND metronidazole for anaerobes