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Small animal (fourth year) > Soft tissue surgery (GI) > Flashcards

Soft tissue surgery (GI) Flashcards

1
Q

what is a very important party of the incision of a coeliotomy?

A

needs to be big enough - allow exploration, reduce tissue trauma…

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2
Q

what structures in the abdomen are particularly sensitive/fragile to handle?

A

liver and pancreas

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3
Q

what are some points to remember for GI surgery?

A

keep tissue moist
use stay sutures
use hands to handle gut

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4
Q

how can you manoeuvre the duodenum to make abdominal exploration easier?

A

duodenal dam - exteriorise from abdomen and the pull across to the left (trapping all the contents behind it)

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5
Q

how can you manoeuvre the colon to make abdominal exploration easier?

A

colonic dam - exteriorise from abdomen and pull to the right (trapping all the contents behind it)

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6
Q

what is the best suction tip for the abdomen?

A

poole - has fenestration on side so it doesn’t block as easily

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7
Q

what instrument can be used to occlude the lumen of the intestines?

A

doyan bowel forceps (best to get assistant to use fingers to occlude the bowel)

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8
Q

what is the least vascular part of the stomach, so the best part to incise?

A

halfway between greater and lesser curvature

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9
Q

what is the least vascular part of the small intestines, so the best part to incise?

A

antimesenteric border (except ileum)

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10
Q

what is the least vascular part of the ileum, so the best part to incise?

A

2/3 way from mesenteric to antimesenteric border of ileum

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11
Q

what can be done if the liver is bleeding extensively during surgery?

A

Pringle manœuvre (temporarily occlude blood flow to liver for around 15 minutes) - pinching portal veins and hepatic arteries

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12
Q

how can blood flow be occluded to part of the liver or pancreas?

A

guillotine technique - slowly tighten ligature around section of liver

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13
Q

what subjective criteria can be used to determine if tissue is viable or not?

A

colour
pulses in small vessels
if peristalsis is present or not

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14
Q

what word is used to describe the blood supply of the oesophagus?

A

segmental

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15
Q

how does the contamination of the gut lumen change down the digestive tract?

A

relatively sterile in stomach then increases as you travel further distally (increasing bacterial concentration)

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16
Q

what bacteria is found in canine liver that is a worry for contamination?

A

clostridia

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17
Q

what are some ways of preventing contamination into the abdomen when performing GI surgery?

A

externalise and pack off part you are incising into
milk content out of the lumen where you are going to cut and occlude

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18
Q

what GI structures are stay sutures commonly used for?

A

oesophagus and stomach

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19
Q

what should be done to the abdomen before closure?

A

lavage with sterile saline (no antibiotics/disinfectants)

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20
Q

how are prophylactic antibiotics used during GI surgery?

A

must be present in tissue when contamination occurs (give IV at start of surgery)
must be active against common contaminants
must be continued for around 24 hours

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21
Q

what is a good choice of antibiotic for prophylactic use during GI surgery?

A

amoxicillin (liver)
metronidazole (distal GI tract)

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22
Q

what areas of the GI tract can tension cause a problem for surgery?

A

oesophagus
colon during subtotal colectomy

23
Q

what are the two main methods of making intestinal incisions to allow accurate apposition?

A

longitudinal incision, longitudinal closure
longitudinal incision, transverse closure
(avoid transverse incision and closures)

24
Q

why should you avoid transverse incisions and closures of the intestines?

A

strictures form

25
Q

why does the oesophagus heal poorly after surgery?

A

incomplete serosal covering
poor vascularity
lot of tension and motion

26
Q

what sections of the GI tract heal slowly?

A

oesophagus and colon

27
Q

what type of suture should be used for closure of the GI tract?

A

monofilament 1.5 to 2 metric

28
Q

what layer of the GI tract do sutures need to catch?

A

submucosal

29
Q

why does the submucosal layer have to be incorporated into sutures of the GI tract?

A

strongest layer
accurate apposition allows good healing

30
Q

how should the stomach be sutured closed?

A

2 layer closure -can use inverting suture

31
Q

how is an end to end anastomosis of intestine closed if the size of the lumen varies?

A

space sutures further apart on larger side
cut through the smaller side at an angle (makes lumen larger)
end to side anastomosis

32
Q

what can be done to support an incision made into the intestine?

A

wrap momentum around it
serosal patch - use wall of another piece of intestine to support the incised wall

33
Q

why do considerable fluid/electrolyte losses occur throughout abdominal surgery?

A

lot of exposed viscera - evaporation occurs

34
Q

what is peritonitis?

A

inflammation of peritoneum

35
Q

is primary or secondary peritonitis more commonly seen in animals?

A

secondary

36
Q

what are the types of secondary peritonitis?

A

chemical (eg. bile…)
septic (bacteria)

37
Q

what are some pathological effects of peritonitis?

A

hypovolaemia
metabolic acidosis
electrolyte imbalance
endotoxic shock
death

38
Q

why does hypovolaemia occur in peritonitis cases?

A

loss of fluid into abdomen
reduced fluid intake (ill)
vomiting

39
Q

why do animals with peritonitis get metabolic acidosis?

A

poor deep tissue perfusion due to the hypovolaemia

40
Q

what are some clinical signs of peritonitis?

A

depression
anorexia
vomiting
pain/distention (more in dogs)
ileus
pyrexia
shock

41
Q

what would be found on haematology of an animal with peritonitis?

A

neutrophilia and left shift (sometimes degenerate)

42
Q

what would be seen when analysis abdominocentesis fluid from an animal with peritonitis?

A

degnerate neutrophils
free/intracellular bacteria
(compare lactate/glucose to serum)

43
Q

how is peritonitis treated?

A

fluid therapy
antibiotics
correct primary cause
peritoneal lavage (labour intensive…)

44
Q

how common are adhesions seen as a complication?

A

uncommon/rarely

45
Q

what are the two types of adhesion?

A

restrictive and non-restrictive (non-restrictive are normally coincidental finding)

46
Q

when does short bowel syndrome occur?

A

after removal of more then 80% of the small intestine (sequential removal of bowel causes this)

47
Q

how is short bowel syndrome managed?

A

small frequent meals
supplements (increase absorption)

48
Q

what is ileus?

A

inadequate peristalsis of the GIT leading to functional obstruction

49
Q

what is ileus caused by?

A

a vagosympathetic reflex from over handling, inflammation…

50
Q

what is given for supportive therapy of patients with ileus?

A

fluids
metoclopramide, ramitadine…

51
Q

what specific things can be done to monitor for peritonitis post-op?

A

pain on palpation
measure abdominal circumference
weigh them (fluid accumulation)

52
Q

how is the oesophagus approached for surgery?

A

ventral cervical midline (to level of second rib)
right intercostal thoracotomy

53
Q

what is the most important layer to catch when nurturing the lines alba?

A

external sheath of rectus abdominis

Small animal (fourth year) (26 decks)

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