SA Intestinal obstruction (Ganjei)

Question 1

Main clinical sign of intestinal obstruction

Answer 1

acute vomiting ( < 2 weeks)

Question 2

Obstructive pattern on radiographs

Answer 2

Marked segmental dilation
- dogs: > 2x height of L5 vertebra
- cats: 4x height of L2 vertebra

Bunching (linear FB)

Non-obstructive: generalized dilation

Segmental dilation

Question 3

Pathophysiology of FB obstruction

Answer 3

• focal mucosal ischemia
• ileus & dilation (from oral to FB location)
• increased bacterial numbers
• gas production from bacterial fermentation
• fluid loss
• bowel dysfunction
• generalized bowel hypoxia

extreme dehydration leads to hypovolemia -> body compensates by shunting blood away from intestines in order to supply heart, brain, lungs -> -> bowel hypoxia

Question 4

Pre-op, operative and post-op fluid plan for FB sx

Answer 4

• crystalloid replacement fluid
• correct ≥ 25% of fluid loss over 3-4 hours prior to sx
• continue therapy during and after sx so that: ≥ 50% of deficit is corrected in 6-8 hours (total) and 100% is corrected in 24h

also, correct any electrolyte abnormalities gradually

Question 5

When to not perfrom fb sx

Answer 5

if FB reaches the colon

Question 6

Main blood supply to all intestines

Answer 6

Cranial mesenteric artery (@ the mesenteric root)

Question 7

4 options to removing a SI FB

Answer 7

1. manipulate FB back into stomach, then gastrotomy
2. manipulate FB into colon, then remove rectally
3. enterotomy
4. resection & anastomosis (esp. if sharp)

Question 8

What are the Four P’s in assessing viability of intestines?

Answer 8

1. Pink
2. Palpation
3. Peristalsis
4. Pulses

Question 9

What are the “clean” procedures?

Answer 9

step 3 in surigcal steps = prepare for contamination –> isolate segment of intestine, separate instruments, have suction ready, “milk” chyme away from segment & hold off with atruamtic forceps (Doyens)

Question 10

Describe enterotomy incision

Answer 10

• incision on the anti-mesenteric portion of bowel
• LONGITUDINAL (never transverse)
• Aboral to the FB

Question 11

Describe bite locations when closing enterotomy

Answer 11

3-5mm from the edge, 3-5mm apart

full-thickness bites (go into mucosa/lumen)

Question 12

Resection & Anastomosis:
crushing forceps (Rochester-Carmalt forceps) and atraumatic forceps (Doyen intestinal forceps) locations.

Answer 12

Crushing = portion to be resected

Atraumatic = portion to be anastomosed

Question 13

When anastomosing, it is imperative to close the hole in the ?

Answer 13

Close the hole in the MESENTERY!
- risk for hernation and intestinal strangulation

Question 14

Sequela of GI incision dehiscence and overall risk of dehiscence?

Answer 14

GI leakage -> septic peritonitis

Risk of GI incision dehiscence = 12%

Question 15

When does lag phase of intestinal healing peak?

Answer 15

3-5 days post op

When the incision is WEAKEST!!

Question 16

What is the most significant potential complication of a linear FB?

Answer 16

Intestinal perforation
- intestine bunches along the linear fb -> repeated “sawing” motion of the FB and intestinal wall against one another -> leakage of intestinal contents into abdomen (peritonitis)

not uncommon to have multiple perforations

Question 17

common areas for linear FB perforation

Answer 17

cranial mesenteric border; duodenal-colic flexure