Small Intestine Flashcards
Describe the pathophysiology associated with intestinal foreign bodies
gas and fluid accumulation
- fermentation
- increased secretions
- decreased absorption
- intestinal wall edema
wall ischemia
- mucosal sloughing
- bacterial translocation
- risk of perforation
What are the clinical signs associated with intestinal foreign bodies?
- vomiting
- anorexia
- depression
- abdominal pain
- diarrhea
How are intestinal foreign bodies diagnosed?
- radiograph
- contrast radiographs
- ultrasound
What radiographic results indicated an intestinal foreign body?
- multiple loops of gas filled intestines
- SI:LF height > 2
How is an intestinal foreign body treated?
- enterotomy if healthy
- resection and anastomosis if necrotic tissue
What is used to evaluate viability of intestine?
- peristalsis pinch test
- color
- pulsation of vessels
- wall texture/thickness
- flurescein infusion
- surface oximetry
Describe the basic enterotomy incision for removal of a foreign body
- longitudinal
- distal to obstruction
- on anti-mesenteric border
What does it mean to “omentalize”?
Why is it done?
- pushing omentum onto surgical site
- angiogenic (aids in healing)
- helps minimize leakage
- controls infection
- allows lymph drainage
Which is the layer of strength when closing the intestine?
submucosa
What are the methods of anastomosis with staplers?
- triangular end-end
- skin stapler
- inverting end-end
- side-side anastomosis
What is serosal patching?
securing an antimesenteric border of small intestine over a suture line or defect
What is the major concern with linear foreign bodies?
mesenteric perforation of the intestines
What is the clinical presentation of a linear foreign body?
- vomiting, anorexia, depression
- abdominal pain
- clumping and pleating of intestine
What is seen of radiograph of a linear foreign body?
- plicated intestines
- bunched in central abdomen
How is a linear foreign body treated?
- if asymptomatic, free FB from tongue
- enterotomy
- catheter technique
What is the catheter technique for removal of linear FBs?
- free the FB cranially
- 1 cm incision into proximal duodenum
- tie FB to catheter
- milk catheter down intestines
- unplicating intestines over the catheter
What are the post-op complications with removal of foreign bodies?
- septic peritonitis
- adhesions caused by disruption of fibrinolysis
- dehiscence
- intestinal ileus
- short bowel syndrome
What are the causes of intestinal ileus?
- stimulation of sympathetic nervous system
- rough tissue handling
- long surgical time
- extensive resection
What are the clinical signs of intestinal ileus?
- regurgitation
- vomiting
- pain
How is intestinal ileus treated?
fluids
electroyltes
prokinetics
What is Short Bowel Syndrome?
- removal of too much bowel, so the body cannot compensate
- decreased muscosal surface area
- gastric and intestinal hypersecretions
- decreased intestinal transit time
What are the clinical signs of short bowel syndrome?
- persistent, watery diarrhea
- malnutrition
- weight loss
How are intussusceptions treated?
enteroplication
- suture intestinal loops at 3-5 cm intervals along lateral wall
- prevents recurrence
- avoid tight turns
What is mesenteric torsion?
- intestine twists on the mesenteric axis
- compression of cranial mesenteric arteries
- ischemic necrosis of all intestines
What are the clinical signs associated with mesenteric torsion?
- abdominal distension
- hematochezia
- collapse and death
How is mesenteric torsion diagnosed?
- distended abdomen not relieved with tube
- radiographs: gas filled intestines with normal stomach
How is mesenteric torsion treated?
- fluid resuscitation
- immediate surgery
What is the most common intestinal neoplasm in the dog?
adenocarcinoma
What is the most common intestinal neoplasm in the cat?
lymphosarcoma
What is seen on physical exam of an animal with an intestinal neoplasm?
poor condition
palpable mass
thickened intestines
How can an intestinal neoplasm be diagnosed?
- radiograph (abnormal gas pattern or visceral displacement)
- ultrasound
- endoscopy
How are intestinal neoplasias treated?
surgical resection and chemotherapy
What are the techniques for intestinal biopsies?
- longitudinal biopsy with longitudinal or transverse closure
- transverse biopsy
- dermal punch
- transverse wedge biopsy
- ultra-sound guided
- flexible endoscope
- laparoscopic assisted
What are the disadvantages of ultrasound-guided intestinal biopsy?
- insensitive in detecting mucosal lesions
- can miss focal lesions
- can result in tumor seeding
Which antibiotics are used for intestinal surgery?
1st and 2nd generation cephalosporins
