small animal GI surgery

Question 1

problems with gastric and high int. vomiting and how to correct prior to surgery

Answer 1

• loss of HCl
• dehydration
• insufficient food intake
  correct: IV isotonic crystalloids, IV K+ supplement

Question 2

problems with lower int. vomiting and how to correct prior to surgery

Answer 2

Loss of pancreatic Na, HCO3
dehydration
insufficient food intake
correct: IV isotonic crystalloids, IV K+ supplement

Question 3

How to correct before surgery if have GI bleeding

Answer 3

blood tansfusion, iron supplement

Question 4

What do gastric surgical diseases cause?

Answer 4

Gastric vomiting

Question 5

What do S.int complete obstruction cause?

Answer 5

Acute vomiting

Question 6

What do S.int partial obstruction cuase?

Answer 6

chronic vom, diah, weight loss

Question 7

What does GI bleeding cause?

Answer 7

haematemesis (vom blood)

melaena

Question 8

Stomach surgery risks and precautions?

Answer 8

• Acid kills most bacteria
• antibiotics not necessary if young,healthy and under 90 min surgery
• single broad spectrum antibi. with anaerobic cover (2nd gen cephalosporin / amoxycillin-clavulante)

Question 9

Small intestine surgery risk and precautions?

Answer 9

10^2 - 10^6 CFU/ml 50%anaerobe

• use antibiotics if compromised
• broad spectrum with anaerobic cover

Question 10

Large intestine surgery risk and precautions?

Answer 10

10^9 - 10^11 CFU/ml 79%anaerobe

• always use antibiotics
• broad spectrum and anaerobic only (metronidazole)

Question 11

Methods to decrease contamination?

Answer 11

• isolate site of entry
• pack abdomen with moist swabs
• change instruments and gloves for contaminated part
• lavage wound after closure

Question 12

GI wound healing - 2 phases

Answer 12

Lag phase (1-4 d)
Proliferative phase (3-14 d)

Question 13

Different organ healing abilities

Answer 13

stomach - rapid and uncomplicated

s. int - 75-80% of tensile strength by d 14
l. int - 50% of tensile strength by d 14

Traumatic surgical techniques and electrocautery can affect healing

Question 14

Suture material and why?

Answer 14

Monofilament so no crevices for bacteria, absorbable, retains strength >5 d

E.g PDS II

Question 15

What is an exploratory laparotomy?

Answer 15

direct visual and tactile exam of the abdominal organs at surgery via and incision into the abdomen.

incision from xiphisternum to pubis

Question 16

Gastrotomy

Answer 16

between greater and lesser curvature

repair in 2 layers - mucosa + submucosa and serosa + muscularis

Question 17

Enterotomy

Answer 17

milk contents away

incise along along anti-mesenteric border

Question 18

Liver biopsy

Answer 18

first try fine needle aspirate and trucut biopsy

take from periphery as less blood

Question 19

Pancreas biopsy

Answer 19

Tighten suture ligature around area before cutting

Question 20

Check viability of intestines

Answer 20

pulsations in arterial BV
peristalsis
colour
wall thickness

Question 21

What is luminal disparity and how to get around it?

Answer 21

different opening sizes when resecting the int.

• space sutures further apart on large size
• transect small side at an angle to match diameter
• reduce big side with sutures
• spatulate small side

Question 22

How to do an end - to - end anastomosis

Answer 22

Simple interrupted suture
1st - on mesenteric border as harder to apposition
2nd on anti-mesenteric border

Question 23

Two ways of supporting a wound

Answer 23

omentalisation

serosal patch - tack adjacent healthy int. to wound

Question 24

Signs and how to deal with a string like foreign body?

Answer 24

on radiograph : concertina int., stacking of int

cut string up…multiple enterotomies

Question 25

What is intussusception? Signs? How to reduce?

Answer 25

invagination of one portion of the GI tract into the lumen of an adjoining segment

Signs: abdo pain/mass, parallel lines on ultrasounds, gas distension on radiograph

push to reduce and resect if needed

can prevent hapenning again by entroplication - suturing loops of int together

Question 26

What is the main complication of GI surgery?

Answer 26

Septic peritonitis - bacterial inf of peritoneum

wound dehiscence

Question 27

What are the results of septic peritonitis?

Answer 27

Hypovolaemic shock, systemic infl response, DIC, 50% die

Question 28

Signs and treatment of septic peritonitis?

Answer 28

Signs - vomiting, anorexia, depression, abd pain, hypovolaemia, pyrexia, wound discharge, dia, haematochezia, melaena, haematemesis

3-5 d post surgery

Treat - pre-op stabilisation, exp lap to correct leak, peritoneal lavage and drainage, extensive post op care

Question 29

4 approaches to colorectal surgery

Answer 29

• ventral midline laparotomy
• pelvic split
• dorsal perianal approach
• transanal

Question 30

complication of resecting too much colon?

Answer 30

reduce resevoir and absorptive capacities ( increased faecal frequency and wateryness)

Question 31

How much rectum can be resected out?

Answer 31

no more than 6 cm

Question 32

Surgical diseases of the colon and rectum? (3)

Answer 32

megacolon
colorectal neoplasia
rectal prolapse

Question 33

secondary megacolon causes

Answer 33

pelvic fracture
intrapelvic space occupying lesion
colorectal neoplasia / abcess
perineal hernia
inappropriate diet

Question 34

How to diagnose megacolon?

Answer 34

chronic constipation, tenesmus, vom, anorexia, weight loss, dehydration

Question 35

Signs of colorectal neoplasia

Answer 35

tenesmus, haematochezia, increased defecation frequency, ribbon - like faeces, rectal prolapse, weight loss

Question 36

2 ways to treat colorectal neoplasia

Answer 36

submucosal resection

colorectal resection and anastomosis

Question 37

how to repare a rectal prolaps

Answer 37

resect if needed, push in and put a stitch in anus to decrease diameter.
give faecal softners, anthelmintics, low residue diet

Question 38

treatment of anal sac disease

Answer 38

• mannual expression
• sedate and catheterise them (sample and cytology)
• anal sacculectomy (open or closed removal)