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Alimentary > Principles of Small Animal Gastrointestinal Surgery > Flashcards

Principles of Small Animal Gastrointestinal Surgery Flashcards

1
Q

What GIT issues could complicate surgery?

A

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

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2
Q

How can GIT problems be corrected prior to surgery?

A

IV Isotonic crystalloids
IV K+ supplementation

Blood transfusion

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3
Q

How does bacteria vary within the GIT?

A

Increase in the number of bacteria and % of anaerobes

Stomach – SI – Colon

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4
Q

When are prophylactic ABs indicated in GI surgery?

A

Surgery on SI or colon

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5
Q

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

A 
Isolate site of DI entry
Separate instruments for contaminated part of surgery
Lavage GI wound after closure
Change gloves
Lavage abdomen with sterile saline
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6
Q

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

A

Submucosa because of the high collagen content

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7
Q

What are the layers of the GIT wall?

A

Mucosa
Submucosa
Muscularis
Serosa

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8
Q

When is wound breakdown most likely to happen and why?

A

3-5d

Overlap between inflammation and proliferation phases

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9
Q

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

A

Proliferation

Collagen synthesis occurs

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10
Q

Which part of GIT has the highest risk of breakdown?

A

Colon

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11
Q

What can increase the risk of wound breakdown?

A 
Compromised blood supply
Traumatic technique
Hypoproteinaemia
Chemo/radiotherapy
Steroids
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12
Q

What suture material are suitable for GIT surgery?

A

Monocryl

PDS II

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13
Q

When is an exlap indicated?

A

Obstruction confirmed on xray
Diagnostics tests unrewarding
Need to obtain biopsy

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14
Q

Which retractors are suitable for an exlap?

A

Balfour

Gossett

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15
Q

How is an SI biopsy carried out?

A
  1. Isolate intestine
  2. Incise along anti-mesenteric border
  3. Milk intestinal contents away and close intestine with atraumatic forceps
  4. Ellipse for biopsy cut with Metzenbaum scissors
  5. Trim excess mucosa and make sure go through submuscoa
  6. Suture 3-5 mm apart and from cut edge
  7. Release clamps and assess for leaks
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16
Q

When is a liver biopsy carried out?

A
  • Clinical signs and haem suggest liver disease
  • Abnormal appearance on US or at surgery
  • Presence of nodules/masses
  • FNA/trucut have been unrewarding
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17
Q

How are gastric FBs diagnosed?

A

Radiography
US
Endoscopy

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18
Q

How are gastric FBs removed?

A

Endoscopy

Gastrotomy

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19
Q

What should ideally be preserved in surgery for gastric neoplasia?

A

Cardia
Bile duct
Pancreatic duct

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20
Q

How can ischaemic necrosis of the GI tract occur?

A

Excessive pressure within intetinal lumen

Distruption in blood supply

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21
Q

When is intestinal resection and anastomosis required?

A

Ischaemic necrosis

Neoplasia

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22
Q

What is used to assess GIT viability?

A

Pulsing BVs
Presence of peristalsis
Normal colour
Normal thickness

23
Q

What types of neoplasia can occur in the GIT?

A 
Adenoma/adenocarcinoma
Lymphoma
Leiomyoma/leimyosarcoma
MCT
Dudodenal polyps
24
Q

What are the signs of intestinal neoplasia?

A

Partial obstruction
Chronic intermittent vomiting
D+
Weight loss

25
Q

What are the signs of intussusception?

A 
Dehydration
Depression
Abdo pain
Palpable tubular mass
Protrusion of intusseception from anus
26
Q

How is intussusception diagnosed?

A

US - parallel lines, concentric rings

Radiography - gas distension of loops of SI

27
Q

What are the possible complications of intestinal surgery?

A

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

28
Q

Outline the pathophysiology of septic peritonitis

A

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.

29
Q

What are the clinical signs of septic peritonitis?

A 
V/D
Anorexia, depression
Abdo pain and enlargment
Hypovolaemic shock
Pyrexia
Discharge from abdo wound
Blood in faeces
30
Q

How is septic peritonitis diagnosed?

A

Abdominocentesis

31
Q

How is septic peritonitis treated?

A

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

32
Q

When should a patient be fed after intestinal surgery?

A

ASAP

33
Q

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

A

Risk of infection and wound breakdown

34
Q

How much of the colon can be removed?

A

More than 6cm is associated with faecal incontinence

35
Q

How would you suture the colon?

A

Single layer of simple interrupted

36
Q

What may be the complications of colorectal surgery?

A 
Dehiscence and septic peri
Wound infection
Abscess
Faecal incontinence
Stricture and tenesmus
Haematochezia
37
Q

What is megacolon?

A

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

38
Q

What are the causes of megacolon?

A 
Primary (idiopathic) in cats
Secondary to:
Fractures
Neoplasia
Abscess
Inappropriate diet
39
Q

What are the clinical signs of megacolon?

A 
Chronic constipation
Tenesmus
Vomiting
Anorexia
Weight loss
Faeces in colon
Dehydration
Low BCS
40
Q

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

A

50:50

41
Q

What are some benign neoplasms of the colorectum?

A

Adenomatous polyps

Leiomyomas

42
Q

What might be the some malignant colorectal neoplasias?

A 
Adenocarcinoma
Leiomyosarcoma
Lymphoma
Haemangiosarcoma
Plasmacytoma
43
Q

What are the clinical signs of colorectal cancer?

A 
Tenesmus
Haematochezia
Increase in defecation
Ribbon-like faeces
Rectal prolapse
Weight loss
Dogs 6-9yos
44
Q

How might you diagnose colorectal neoplasia?

A 
Rectal exam
Radiography
US
FNA
Colonoscopy
45
Q

What might cause rectal prolapse in SAs?

A

GI parasites
Rectal neoplasia
Perineal hernia

46
Q

How do you treat rectal prolapse?

A

Anthelmintics
Faecal softeners
Low residue diet
Sedatives

47
Q

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

A 
Perineal irritation
Scooting
Licking
Biting
Discomfort
Reddened inflamed skin or drainage tract overlying region of anal sac suggests infection or ruptured abscess
48
Q

What do anal sac secretions look like?

A

Normally liquid brown

Abnormal - thick white, yellow or green

49
Q

How would you treat an impacted anal gland?

A

Manual expression

50
Q

How do you treat anal sacculitis/abscess?

A 
Sedation 
Catheterise duct opening
Culture, cytology, smear
lavage 
Dexamethasone and antibiotics
Topical treatment of yeast overgrowth
51
Q

What are the features of anal sac apocrine gland adenocarinomas?

A

High malignant

50% metastasis

52
Q

What would present with a dog with paraneoplastic syndrome?

A

Hypercalcaemia
Polyuria
Polydipsia

53
Q

What AB would you give for SI surgery?

A

2G cephalosporin/amoxyclav

54
Q

What AB would you give for colon surgery?

A

As SI (2G cephalosporin/amoxyclav)

AND metronidazole for anaerobes

Alimentary (14 decks)

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