Soft Tissue Surgery: Specific Surgical GIT Conditions Flashcards
What is a primary and secondary cleft palate?
Primary- failure of fusion of primary palate- lips and premaxilla
Secondary- failure of secondary palate and sometimes soft palate
How is cleft palate treated?
- Tube feeding until 8-12 weeks old
- Medcially treat pneumonia
- Repair surgically
Primary- skin reconstruction
Secondary- high complications- mucosal flaps
Complications
* Dehisecence usually due to tension, motion or tight sutures
* Chronic rhinitis is common
* Fistulae formation from rapid growth
When are maxillectomy and mandibulectomy indicated?
Oral neoplasia
* Bone and overlying tissue removed- 2cm margin
* Oral mucosa and skin are reconstructed over the defect
* Supportive post treatment ABs, anti-inflam and gastrostomy tube usually
What is salivary mucocoele?
What is the aetiology and clinical signs?
- Salivary ‘mucus cyst’
- Saliva from disrupted salivary gland or duct
- Sublingual gland most commonly affected
Aetiology- trauma, neoplasia, sialoliths
CS
* Painless fluctuant swelling
* Sublingual mucoceles- dysphagia, ptyalism, blood tinged saliva
* Pharyngeal mucocoeles may cause inspiratory stridor
What stain can be used to identify mucus
(salivary mucocele)
Periodi acid-Schiff
Staining for polysaccharides- glycogen
How are salivary mucocoele treated?
- Drainage
- Mandibular and sublingual sialadenoectomy
- Marsupialisation
Complicactions: Haemorrhage, infection, recurrence
- What are nasopharyngeal polyps?
- What are clinical signs?
- How are they diagnosed?
- How are they treated?
- Pedunculated benign inflammatory lesions- cats
- airway obstruction, dysphagia, dysphonia, otitis externa
- Direct visualisation under GA
- Surgical excison- retract soft palate rostrally and traction on polyp, oral pred may reduce recurrence
- How do patients with pharyngeal stick injury/abscess present?
- How is it diagnosed?
- How is it treated?
- Discomfort with gagging, head shaking, pawing at mouth, hypersalivation, pain on opening mouth
- CS, examination, radiography, US
- Remove FB, arrest harmorrhage, debride, lavage wounds and heal by second intention- large may require suturing
When is tonsillectomy indicated?
Describe the surgery
Chronic recurrent unresponsive tonsillitis or neoplasia
* Place cuffed ET tube and pack pharynx with swabs
* Grasp the tonsil and retract the tonsillar crypt
* Sharply excise with scissors or clamp with curved haemostat then ligate en mass
What limits the distension of the oesophagus?
- Thoracic inlet
- Heart base
- Caudal oesophagus just infront of the cardia
What are the clinical signs of oesophagus perforation?
- Pneumothorax
- Mediastinitis
- Pyothorax
- Pleuritis
- Pyrexia
- Depression
- Resp distress
How can oesophageal FB be treated?
- Endoscopic removal
- Push into stomach- gastrotomy
- Surgical endoscopic
After inspect oesophagus lining for ulcers and tears
How are vascular ring anomalies treated?
Ligation and devision of the least important vessel forming the ring
* Ligamentum anteriosum
What is a hiatal hernia?
How is it treated?
Herniation of the cardia of the stomach through the oesophageal hiatus (opening of diahpragm)
In persistent herniation- combined suture reduction, oesophagopexy and left fundic gastropexy
- What is the indication for gastrotomy?
- What is the approach and technique?
- FB removal or exploratory
- Ventral midline coeliotomy
* Pack of stomach- stabilise with 3-4 stay sutures
* 2 layer inverting closure- simple continuous then cushings
What are the haemodynamic, respiratory and cardiac effects of GDV?
Haemodynamic- reduced abdominal blood flow and venousn return
Resp- diaphragm pressure
Cardiac- reduced coronary blood flow
Gastric wall necrosis
Reperfusion injury after correction
How is GDV treated?
- Stabilise patient
- Fluid therapy- crystalloids, colloids, hypertonic saline
- Gastric decompression- mouth gag, needle paracentesis, temporary flank gastrostomy
- Gastropexy- fix pylorus to right abdominal wall
- Longitudinal incision in serosa/muscularis of pyloric antrum
- Transverse incision of abdominis muscle- suture insicions together
- Tube- gastropexy
- Splenectomy if detect thrombosis
When may gastrectomy be indicated?
- Active bleeding
- Palpable pulses in short gastric vessels
- Reduced thickness/increased pliability of gastric wall
- Serosal colour- dark reddish
What surgery can treat gastroc outflow obstruction?
- Pyloric stenosis
- Pyloric muscular hypertrophy
- Neoplasia
Y-U antral flap pyloroplasty
Describe an enterotomy
- Isolate and pack off affected area of gut
- Manually express contents of region and occlude intestinal lumen with assistants fingers
- Make a longitudinal incision
- Simple interupted or continuous apposition sutures
What procedure allows large resection of of distal stomach and pylorus?
Billroth I and II
What technique is used for GI tract biopsies?
- Longitudinal wege and closure
- Longitudinal wedge, transverse closure- small patients
How can liear foreign body be treated?
Conservative
* no peritonisis
* Looped around tongue- cut
* 3 days in faeces
Surgery
* not arround tongue
* peritontitis
* remove entire length
* start with gentle traction at distal end of bunched area
* Work proximally
* May need multiple enterotomies
How is intussception treated?
Manual reduction
* gentle traction
* Milk intussusicipiens
What is the sequale of intestinal torsion and strangulation?
What are the clinical signs?
- Cranial mesenteric artery/vein compromised
- Venous then arterial thrombosis
- Mucosal necrosis
- Endotoxaemia
Poor prognosis
