SOFT TISSUE SX 6 &7 : stomach & SI Flashcards
What is a gastrotomy?
Incising the stomach
What does a gastrectomy involve?
Excising a portion of the stomach
Define gastrostomy.
Creating a stoma usually using a tube in the stomach
What is a gastropexy?
Fixing stomach to body wall
What are 4 significant risks during gastrointestinal surgery?
-Intra-operative contamination
-post-operative dehiscence and leakage
-septic peritonitis
-iatrogenic obstruction
What are 2 items that can be used to exteriorise and isolate contamination from the rest of the abdomen?
swabs
laparotomy pad
What are 5 ways that the stomach can be isolated in cases of contmaination?
stay sutures
babcock forceps
packing around the site
occlude stomach on either sides of incision
stay suture to tent stomach
What are 3 techniques/strategies to reduce risk of dehiscence in surgery?
atraumatic tissue handling
omental wrap [good for blood supply, immune response…]
serosal patch [serosa from different region of intestine sutured on incision]
What is the percentage of degiscence?
5-10%
To reduce risk of dehisence, what type of suture material should be used?
mono or multi?
synthetic or natural?
absorbable or non-absorbable?
monofilament, synthetic, absorbable
What are the two main indications for gastrotomy
foreign body removal
biopsy
What are the steps to a gastrotomy?
expose stomach
pick avascular area away form pylorus
place stay sutures on either side
tent stomach and isolate with swabs
stab with no.11 scalpel
extend incision
Does the stomach have a large or small collateral blood supply?
large
How many layers are included in the closure of a gastrotomy? (just stomach, not wall/skin etc)
What are the layers?
1-2
1:mucosa & submucosa
2: muscularis & serosa
Should patients be starved after gastrotomy surgery?
no
List some clinical signs of gastric disease.
- Vomiting
- Haematemesis
- Melena [black feces]
- Dehydration
- Loss of appetite
- Weight loss
What can gastric foreign bodies cause?
Pyloric/intestinal obstruction and rapid deterioration
[can also be incidental]
What diagnostic tool is used to detect radio-opaque foreign bodies?
Radiography
What is the size of a normal fundus? [in relation to # of intercostal spaces]
normal fundus < 3 icsp
if >6 icsp, suspect pathology
How can gastric foreign bodies be treated? (3 ways)
- Induce emesis
- Endoscopic removal
- Gastrotomy
Define primary peritonitis.
Spontaneous, inflammation with no primary cause. less common
What is an example of a condition causing secondary peritonitis?
FIP
What substances is secondary peritonitis commonly caused by?
urine
bile
pyometra
pancreatitis
What are clinical indicators of peritonitis?
- History of GI surgery/foreign body sx
- Dullness/lethargy
- Abdominal distension
- Abdominal pain
What clinical signs may indicate septic peritonitis?
- Signs of shock
- Signs of sepsis
- Pyrexia
What can be seen on radiographs for diagnosing peritonitis?
- Loss of serosal detail in radiograph due to free fluid
- Free abdominal gas
Which is preffered for diagnosing perotinitis: ultrasound or radiographs?
US [free abdominal fluid present in front of bladder]
What is abdominocentesis?
4 quadrant tap or ultrasound guided tap to analyze fluid
What is the treatment for septic peritonitis?
Surgical emergency requiring oxygen,
fluid resuscitation,
antimicrobials,
control of the source,
nutrition,
management of organ damage
True or False: Septic peritonitis is most common in cats.
False
What is an enterotomy?
Incision into the intestine
Define enterectomy.
Removal of a segment of the intestine
What is intestinal resection and anastomosis?
Enterectomy with re-establishment of the cut ends
What does enteroplication refer to?
Surgical fixation of one intestinal segment to another, in parallel
What two structures can be used to find/ identify the duodenum in surgery?
pancreas
Duodeno-colic ligament
What can be used to find /identify the jejunumin surgery
Arcading blood supply
What can be used to find /identify the ileum in surgery
Antimesenteric vessels and connection to the cecum
What is the main strength holding layer of the intestine?
Submucosa
What are the common clinical signs of intestinal foreign body ingestion?
Vomiting,
loss of appetite,
abdominal discomfort,
diarrhoea,
melaena
What are extra considerations in linear foreign bodies?
causes intestinal plication
[due to peristalsis trying to move it down]
What are two types of surgeries to treat a foreign body?
enterotomy
enterectomy
Describe how to perform a leak test in an enterotomy
To check for leaks after closure
Does omentalisation need to be sutured into place?
no
True or False: It is acceptable to incise directly over a foreign body or injured site.
False
What should be done to isolate the intestine during surgery?
Exteriorize, use swabs to isolate, hold away from abdomen, milk contents away, occlude the lumen
What are the systemic effects of intestinal foreign bodies?
local effects?
S: Dehydration, electrolyte loss, weight loss
L: pressure necrosis, perforation, peritonitis
What is a common site for luminal disparity in animals?
Ileocaecocolic junction
What are ways to reduce contamination in intestinal sx?
isolate intestine
lavage & suction
atraumatic handling
what is the name of these long clamps?
doyen clamps
to assist with atraumatic tissue hadnling, wht are two types of foreceps that can be used?
and one type tht should not be used
2 good: plain forceps, debakey forceps
do not use: rat toothed forceps
what is the post common primary care intestinal pathology?
foreign body
what are 4 common intestinal apthologies?
What could be seen in bloodwork results of a patient with a foreign body obstruction?
hypochloremia: losing chloride through vomiting
describe the pathophysiology/local effects of foreign body
describe the systemic effects of a foreign body
Other than seeing the foreign bdoy itself, what can be seen in radiology to diagnose a foreign body?
distended loops of small intestine
peritonitis
plications arounds the foreign body
Other than seeing the foreign bdoy itself, what can be seen in ultrasounds to diagnose a foreign body?
distended loops with fluid or gas
describe the steps to a intestional foreign body enterotomy
ADD MORE
When would an enterecotmy be performed (Rather than an enterotomy?)
when intestine is not viable
What are the steps to an intestinal resection (not anastamosis)
ADD MROE
What are the steps to an anastamosis?
ADD MORE
what is the msot common site of iatrogenic leakage post anastamosis?
mesenteric border
What is the solution to a luminal disparity during anastamosis?
[luminal disparity=one diameter is larger than another]
What are common causes of intussusception in young animals?
INTESTINAL BIOPSY
ADD MORE
What are some options for fixing and preventing recurrence in an intussusception lesion?
- reduce intussusception (manually pull it apart)
- intestinal resection and anastamosis
- enteroplication [rare n usually not indicated]
