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RUSVM Small Animal Surgery I > SASx Exam II Material - GI Tract > Flashcards

SASx Exam II Material - GI Tract Flashcards

1
Q

T/F: Linear foreign bodies often perforate the intestine at the mesenteric border

A

True

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2
Q

The layer of strength for suturing throughout the gastrointestinal tract is the:

A

submucosa

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3
Q

What is the most common malignant intestinal tumor in the dog?

A

adenocarcinoma

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4
Q

What is the most reliable physical sign of intestinal viability?

A

peristaltic contractions

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5
Q

T/F: Double layer closure is typically recommended in intestinal surgery to reduce the risk of leakage

A

False

  • Double layer closure is not recommended
    • ​Poorer submucosal apposition
    • Avascular tissue necrosis
    • Increased intraluminal protrusion
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6
Q

What is omentalization and why should you perform it?

A

placement of omentum around organs or within cavities​

  • Omentalization improves vascularization and drainage
  • The omentum has an extensive supply of blood and lymphatic vessels, providing a rich source of inflammatory and immunogenic cells - including neutrophils, T and B lymphocytes, mast cells, and macrophages - that stimulate healing and help prevent and resolve infection. The omentum’s large surface area also aids in lymphatic drainage and bacteria and particulate matter absorption. Additionally, angiogenic factors released from the omentum encourage neovascularization and activation of macrophages, mast cells, and lymphocytes from local tissues
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7
Q

What is the most common malignant rectal tumor in dogs?

A

rectal adenocarcinoma

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8
Q

What is the most common rectal tumor in dogs?

A

adenomatous polyp (benign)

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9
Q

Where does the large bowel get its blood supply?

A
  • Ileocolic artery (a branch of the cranial mesenteric artery)
  • Caudal mesenteric artery
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10
Q

Where does the small intestine get its blood supply?

A

Branches of the celiac and cranial mesenteric arteries

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11
Q

​Which of the following has NOT been identified as a risk factor for complications after intestinal surgery?

  • Surgery with pre-existing peritonitis
  • Performing multiple procedures
  • A foreign body is the underlying cause for the surgery
  • A braided absorbable suture material is used rather than a monofilament absorbable material
A

A braided absorbable suture material is used rather than a monofilament absorbable material​

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12
Q

What is the most common clinical sign of a cecal inversion?

A

chronic diarrhea with hematochezia

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13
Q

Which of the surgical approaches would be most indicated for removing a 2cm diameter pedunculated rectal polyp (adenoma) located 3cm inside the anus of a German Shepherd?

  • Transanal approach
  • Dorsal approach to the rectum
  • Rectal pull through
  • Ventral approach with pubic osteotomy
A

Transanal approach

  • Excision of small, non invasive, pedunculated polyps
  • Lesions in the caudal 4-6 cm of rectum
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14
Q

The most logical treatment for a 9-year old dog with multiple small non-ulcerated perineal masses suspected to be adenomas based on fine needle aspirate is:

A

castration

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15
Q

Cat presents with one day history of difficulty defecating. With future diagnostic tests you determine the cat has megacolon. Which of the following would NOT be recommended in the treatment of this case?

  • Cisapride
  • Low residue diets
  • Stool softeners
  • Subtotal Colectomy
A

Subtotal Colectomy​

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16
Q

This is an adenocarinoma of non-β islet cell (endocrine tumor) associated with Zollinger-Ellison Syndrome:

A

Gastrinoma

  • May originate from pancreas or duodenum, peripancreatic LNs, or mesentery
  • Metastasis present at time of diagnosis in 70% of patients
  • Typically diagnosed via fasting gastrin serum concentrations
  • Surgical resection of primary tumor may be warranted
  • Prognosis unknown due to low occurrence (1 week – 18 months)
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17
Q

This is an adenocarinoma of β islet cell (endocrine tumor) that secretes insulin in spite of hypoglycemia

A

Insulinoma

  • Clinical signs include weakness, seizures, collapse
  • Diagnosis
    • Ultrasound most commonly used for identifying tumors
      • May be very small and difficult to find
    • Serum insulin concentrations
      • Obtain sample during hypoglycemic episode
      • Normal or increased insulin level suggestive of diagnosis of insulinoma
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18
Q

Which surgical procedure can only be used for the treatment of congenital pyloric stenosis?

  • Fredet-Ramstedt procedure
  • Billroth 1
  • Billroth 2
  • Heineke Mikulicz
  • Y-U advancement
A

Fredet-Ramstedt procedure

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19
Q

An 8 year old Staffordshire Terrier presents with a mass over his pyloric sphincter. What is the most likely diagnosis?

A

gastric adenocarcinoma

60-70% of all gastric neoplasias

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20
Q

What is the name of the procedure shown below?

A

closed anal sacculectomy

22
Q

You are working up a 9 month old cat for vomiting. The abdomen is tender on palpation and you identify a classic linear foreign body pattern on radiographs. Linear foreign bodies typically become “fixed” at which of the following sites?

  • Under the tongue and gastroesophageal junction
  • Under the tongue and at the pylorus
  • At the gastroesophageal junction and at the pylorus
  • At the pylorus and the caudal duodenal flexure
A

Under the tongue and at the pylorus​

23
Q

What is shown in this picture? Which of the following types of closure would be appropriate?

  • Double layer inverting pattern: Cushing followed by Lembert pattern
  • Double layer pattern of appositional followed by inverting pattern: Simple continuous followed by Cushing pattern
  • Double layer pattern of inverting followed by appositional pattern: Cushing followed by simple continuous pattern
  • All of the above choices are appropriate closure techniques
A

Gastrotomy

All of the choices are appropriate closure techniques

24
Q

How do you close a pyloric outflow tract?

A

single layer closure

  • Pyloric outflow tract, reduced gastric volume, thickened gastric wall
    • Simple interrupted
    • Simple continuous
25
Q

What is the diagnostic modality of choice to confirm congenital pyloric stenosis?

A

Ultrasound

  • Much more diagnostic than rads/endoscopy
  • Can determine gastric/pyloric wall thickness
  • Helps to differentiate thickening vs. neoplasia
26
Q

What is the procedure shown in the image? When would this procedure be used?

A

Y-U Pyloroplasty for Chronic Hypertrophic Pyloric Gastropathy (acquired pyloric stenosis)

27
Q

This is considered the best surgical treatment for congenital pyloric stenosis and is associated with low recurrence:

A

Heineke-Mikulicz Pyloroplasty (Transverse Pyloroplasty)

  • 3-5cm full thickness
  • Suture transversely
    • Simple interrupted or continuous
  • Advantages
    • Mucosa exposed – biopsy
    • Reoccurrence unlikely
  • Disadvantage
    • Lumen opened
    • Not usually effective with acquired stenosis
28
Q

T/F: With regard to acquired pyloric stenosis, Grade 2 is seen most commonly and is characterized by muscular and mucosal hypertrophy

A

True

29
Q

T/F: Pylorectomy with gastroduedenostomy is known as a Billroth I procedure

A

True

  • Advantages
    • Abnormal tissue completely removed
    • Larger increase in gastric outflow
  • Disadvantages
    • Technically difficult
    • Longer procedure
    • Increased risk of leakage
30
Q

What is the most common gastric neoplasia?

A

adenocarcinoma

60-70% of all gastric neoplasias; most commonly affects the pyloric antrum

31
Q

What is the preferred test for diagnosing gastric adenocarcinoma?

A

endoscopy

32
Q

T/F: Gastrectomy with gastrojejunostomy is known as a Billroth I procedure

A

False

Gastrectomy with gastrojejunostomy is known as a _Billroth II procedure_

  • Billroth II Procedure
    • Indications
      • When resection of stomach is so proximal to limit end to end anastomosis
    • Allows extensive gastrectomy without tension on suture
    • LOTS OF COMPLICATIONS
      • Alkaline gastritis
        • Bile and pancreatic secretions flow into stomach
      • “Blind loop” syndrome
        • Gastric contents move orally and putrefy
      • Marginal ulceration
        • Ulceration of jejunal mucosa – not used to seeing acid contents
33
Q

A four month old Boxer presents to your hospital with intermittent vomiting that has been present since weaning. He has a poor body condition, but the owner notes that he is able to hold down water without any problem. What is the most likely diagnosis?

  • Gastric foreign body
  • Congenital pyloric stenosis
  • Chronic hypertrophic pyloric gastropathy
  • Leiomyoma within the cardia of the stomach
A

Congenital pyloric stenosis

34
Q

With regard to the pathophysiology of GDV, the pylorus will rest along (right/left) body wall on top of the esophagus and the gastric body to the (right/left).

A

With regard to the pathophysiology of GDV, the pylorus will rest along LEFT** body wall on top of the esophagus and the gastric body to the **RIGHT.

35
Q

T/F: To correct the most common type of GDV, you would have to rotate the stomach counterclockwise

A

True

Clockwise rotation of the stomach occurs most commonly with GDV, so to correct it you would rotate the stomach in the opposite direction (counterclockwise)

36
Q

Regarding surgery for GDV, how can you tell immediately whether you’re dealing with a clockwise or a counterclockwise rotation?

A

With clockwise rotation, the greater omentum covers the stomach.

With counterclockwise rotation, the greater omentum will not be visible

37
Q

T/F: Having a first degree relative with a history of GDV is a risk factor associated with development of GDV

A

True

38
Q

What radiographic view is most diagnostic for GDV?

A

right lateral

  • Gastric dilatation with compartmentalization
  • Malposition of pylorus
  • Double bubble
39
Q

A dog presents to your clinic with GDV and you stabilize him with fluids. What is your next step?

A

gastric decompression with orogastric tube

Initial stabilization → Gastric decompression (orogastic 1st choice; trocarization if you can’t pass the tube) → Pain management → Surgery

40
Q

If you’re unable to decompress your GDV patient by orogastric tube or trocarization, and other surgical treatment must be delayed, what procedure should you perform?

A

emergency gastrostomy

requires sedation and local block over right paracostal region

41
Q

When treating a patient with GDV, what is the shock dose for glucocorticosteroids?

A

TRICK QUESTION, YOU GULLIBLE SON OF A B****

There is no shock dose for glucocorticosteroids. DO NOT USE steroids in your GDV patients!

42
Q

What surgical technique is the most successful at preventing recurrent GDV?

A

tube gastropexy

43
Q

95% of deaths following GDV occur within the first four days post-op. The cause of death is most commonly:

A

hypovolemic or septic shock

44
Q

What is the most common arrhythmia seen in GDV patients?

A

ventricular premature contractions (VPC)

  • When to treat VPCs
    • Associated with weakness or syncope
    • Persistent tachycardia > 150 BPM
    • Pulse deficits or poor pulse quality
  • DOC for initial management: LIDOCAINE
45
Q

What suture pattern should be used to close an enterotomy?

A

Single layer simple interrupted

46
Q

What can be done to manage luminal disparity between two segments of intestine during anastomosis?

A
  • Place sutures farther apart on larger lumen
  • Angle smaller lumen
  • Spatulate smaller lumen
  • Suture larger lumen smaller
47
Q

Partial or complete removal of the cecum is termed:

A

typhlectomy

48
Q

Stenosis or persistent membrane of anus or rectum is termed:

A

atresia ani

  • Atresia ani
    • Stenosis or persistent membrane of anus or rectum
    • Most common reported congenital anomaly
    • Increased incidence in Toy poodles and Boston terriers
    • Signs occur at a few weeks of age
      • Straining, anal dimple, perineal swelling
    • Tx: Bougienage, analplasty, rectal pull through
49
Q

The treatment of choice for intractable idiopathic megacolon in cats is:

A

subtotal colectomy

Goal is to remove as much colon as possible​

50
Q

What is the primary differential for rectal prolapse?

A

prolapsed intussusception​

RUSVM Small Animal Surgery I (15 decks)

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