Small Intestine

Question 1

Describe the pathophysiology associated with intestinal foreign bodies

Answer 1

gas and fluid accumulation

• fermentation
• increased secretions
• decreased absorption
• intestinal wall edema

wall ischemia

• mucosal sloughing
• bacterial translocation
• risk of perforation

Question 2

What are the clinical signs associated with intestinal foreign bodies?

Answer 2

• vomiting
• anorexia
• depression
• abdominal pain
• diarrhea

Question 3

How are intestinal foreign bodies diagnosed?

Answer 3

• radiograph
• contrast radiographs
• ultrasound

Question 4

What radiographic results indicated an intestinal foreign body?

Answer 4

• multiple loops of gas filled intestines

- SI:LF height > 2

Question 5

How is an intestinal foreign body treated?

Answer 5

• enterotomy if healthy

- resection and anastomosis if necrotic tissue

Question 6

What is used to evaluate viability of intestine?

Answer 6

• peristalsis pinch test
• color
• pulsation of vessels
• wall texture/thickness
• flurescein infusion
• surface oximetry

Question 7

Describe the basic enterotomy incision for removal of a foreign body

Answer 7

• longitudinal
• distal to obstruction
• on anti-mesenteric border

Question 8

What does it mean to “omentalize”?

Why is it done?

Answer 8

• pushing omentum onto surgical site
• angiogenic (aids in healing)
• helps minimize leakage
• controls infection
• allows lymph drainage

Question 9

Which is the layer of strength when closing the intestine?

Answer 9

submucosa

Question 10

What are the methods of anastomosis with staplers?

Answer 10

• triangular end-end
• skin stapler
• inverting end-end
• side-side anastomosis

Question 11

What is serosal patching?

Answer 11

securing an antimesenteric border of small intestine over a suture line or defect

Question 12

What is the major concern with linear foreign bodies?

Answer 12

mesenteric perforation of the intestines

Question 13

What is the clinical presentation of a linear foreign body?

Answer 13

• vomiting, anorexia, depression
• abdominal pain
• clumping and pleating of intestine

Question 14

What is seen of radiograph of a linear foreign body?

Answer 14

• plicated intestines

- bunched in central abdomen

Question 15

How is a linear foreign body treated?

Answer 15

• if asymptomatic, free FB from tongue
• enterotomy
• catheter technique

Question 16

What is the catheter technique for removal of linear FBs?

Answer 16

• free the FB cranially
• 1 cm incision into proximal duodenum
• tie FB to catheter
• milk catheter down intestines
• unplicating intestines over the catheter

Question 17

What are the post-op complications with removal of foreign bodies?

Answer 17

• septic peritonitis
• adhesions caused by disruption of fibrinolysis
• dehiscence
• intestinal ileus
• short bowel syndrome

Question 18

What are the causes of intestinal ileus?

Answer 18

• stimulation of sympathetic nervous system
• rough tissue handling
• long surgical time
• extensive resection

Question 19

What are the clinical signs of intestinal ileus?

Answer 19

• regurgitation
• vomiting
• pain

Question 20

How is intestinal ileus treated?

Answer 20

fluids
electroyltes
prokinetics

Question 21

What is Short Bowel Syndrome?

Answer 21

• removal of too much bowel, so the body cannot compensate
• decreased muscosal surface area
• gastric and intestinal hypersecretions
• decreased intestinal transit time

Question 22

What are the clinical signs of short bowel syndrome?

Answer 22

• persistent, watery diarrhea
• malnutrition
• weight loss

Question 23

How are intussusceptions treated?

Answer 23

enteroplication

• suture intestinal loops at 3-5 cm intervals along lateral wall
• prevents recurrence
• avoid tight turns

Question 24

What is mesenteric torsion?

Answer 24

• intestine twists on the mesenteric axis
• compression of cranial mesenteric arteries
• ischemic necrosis of all intestines

Question 25

What are the clinical signs associated with mesenteric torsion?

Answer 25

• abdominal distension
• hematochezia
• collapse and death

Question 26

How is mesenteric torsion diagnosed?

Answer 26

• distended abdomen not relieved with tube

- radiographs: gas filled intestines with normal stomach

Question 27

How is mesenteric torsion treated?

Answer 27

• fluid resuscitation

- immediate surgery

Question 28

What is the most common intestinal neoplasm in the dog?

Answer 28

adenocarcinoma

Question 29

What is the most common intestinal neoplasm in the cat?

Answer 29

lymphosarcoma

Question 30

What is seen on physical exam of an animal with an intestinal neoplasm?

Answer 30

poor condition
palpable mass
thickened intestines

Question 31

How can an intestinal neoplasm be diagnosed?

Answer 31

• radiograph (abnormal gas pattern or visceral displacement)
• ultrasound
• endoscopy

Question 32

How are intestinal neoplasias treated?

Answer 32

surgical resection and chemotherapy

Question 33

What are the techniques for intestinal biopsies?

Answer 33

• longitudinal biopsy with longitudinal or transverse closure
• transverse biopsy
• dermal punch
• transverse wedge biopsy
• ultra-sound guided
• flexible endoscope
• laparoscopic assisted

Question 34

What are the disadvantages of ultrasound-guided intestinal biopsy?

Answer 34

• insensitive in detecting mucosal lesions
• can miss focal lesions
• can result in tumor seeding

Question 35

Which antibiotics are used for intestinal surgery?

Answer 35

1st and 2nd generation cephalosporins