Stomach

Question 1

Where do we want to make our incision for gastrotomy?

Answer 1

In a hypovascular area, on the ventral aspect of stomach
between the lesser and greater curvature

Question 2

Once we make our stab incision into the gastric lumen (gastrotomy), how do we enlarge the incision?

Answer 2

With metzenbaum scissors

Question 3

How do we close the gastrotomy site?

Answer 3

• Double layer inverting pattern** (traditional*):
• 1st: Cushing** (engage serosa, muscularis, & submucosa*)
• 2nd**: oversew w/ Lembert (engage serosa & muscularis only)*

OR (alternatively…)

Appositional, then inverting (also double layer):

• 1st**: Simple continuous (engage mucosa*)
• 2nd**: Cushing or Lembert (engage serosa, muscularis, & submucosa*)

Question 4

What’s the holding layer for the stomach?

Answer 4

Submucosa

Question 5

Lab findings associated with Gastric Foreign Body…

Answer 5

Leukocytosis,
pre-renal azotemia,
hypokalemia,
hypochloremia

maybe

Question 6

How would we surgically manage congenital plyoric stenosis?

Answer 6

• *Pyloromyotomy AKA FREDET-RAMSTEDT**:
• *1-2cm** incision thru serosa and muscularis layers of long axis of pylorus
• allows the mucosal layer to bulge thru and alleviates constriction

or*

Transverse Pyloroplasty AKA Heineke-Mikulicz

3-5cm full-thickness incision; close w/appositional

Question 7

What’s a more “permanent” surgical management procedure for congenital pyloric stenosis?

Answer 7

transverse pyloroplasty (changing the orientation of pylorus)
”Heineke-Mikulicz procedure”
3-5cm full thickness incision over pylorus,
biopsy,
orient incision transversely,
close with appositional suture pattern

Question 8

How would we differentiate between congenital pyloric stenosis and CHPG?

Answer 8

CHPG: delayed gastric emptying (chronic intermittent vomiting)

Congenital: clinical signs at weaning*

Question 9

How can we surgically manage the chronic (acquired) pyloric stenosis?

Answer 9

**Y-U advancement pyloroplasty,

Heineke-Mikulicz Pyloroplasty,

Pylorectomy with Gastroduodenostomy (Bilroth I)**

choose based on most appropriate for situation

Question 10

What is the goal of a Y-U advancement pyloroplasty?

Answer 10

increase the diameter of the pylorus:
{Changing the shape and orientation}
full thickness incisions (+biopsies),
single pedicle advancement flap from antrum across pylorus

Question 11

What is a Bilroth I-Gastroduodenostomy?

Answer 11

pylorectomy-gastroduodenostomy;
removal of the thickened section of pylorus, & attachment of stomach—>duodenum
(in chronic hypertrophy - Grade 3/severe - cases)

Question 12

What small breed dogs get the chronic hypertrophic pyloric gastropathy more commonly?

Answer 12

Shih-tzu,
Lhasa-Apso,
Maltese

Question 13

Most common malignant gastric neoplasia in dogs vs. cats?

Answer 13

Dogs: adenocarcinoma

Cats: lymphoma

Question 14

Clinical signs of gastric neoplasia?

Answer 14

chronic vomiting,
anorexia,
weight loss,
hematemesis,
melena (bleeding in stomach takes awhile to get thru)

Question 15

Leiomyo-sar/comas are usually located near the ________, whereas adenocarcinomas are usually located closer to the _______.

Answer 15

Cardia of the stomach;

pyloric antrum/lesser curvature

Question 16

Describe the location typical of gastric adenocarcinomas.

Answer 16

pyloric antrum,
lesser curvature

greater met rate (70-80%)

Question 17

In treating adenocarcinoma, what should the margins be when performing aggressive surgical excision (gastrectomy)?

Answer 17

at least 5cm

*thinking about pylorus and duodenum, and where the common bile duct comes into the duodenum, we may also have other issues as far as rerouting the bile duct*
chemotherapy?

Question 18

Where does the common bile duct empty?

Answer 18

the major duodenal papilla
*important for resecting portions of the duodenum*

Question 19

What is a Bilroth II Gastroenterostomy?

Answer 19

Partial gastrectomy, removal of part of the pylorus, parts of the stomach, and also a good portion of the duodenum…
then you’re taking a portion of jejunum and anastomosing it to the stomach.

*we lose the area of the major duodenal papilla so we lose the common bile duct, so we have to reroute*—>cholecystoduodenostomy

Question 20

Regarding prognosis for leiomyosarcoma, what is the median survival time (MST)?

Answer 20

~21 months

recurrence possible - consider age when planning surgery

Question 21

Regarding prognosis, what’s the mortality rate for partial gastrectomy + splenectomy?

vs. splenectomy?
vs. partial gastrectomy?

Answer 21

55%

vs. 32%
vs. 35%