Surgery 6: SI

Question 1

What is the blood supply to the SI?

Answer 1

Cranial mesenteric

Question 2

When is dehiscence most likely?

Answer 2

2-5 days

Question 3

How long does it take to regain 80% of strength?

Answer 3

2 weeks

Question 4

What should you do if in doubt about intestinal viability?

Answer 4

Remove

Question 5

What four factors do you use to assess intestine viability?

Answer 5

Colour, thickness, blood vessels (thrombosis), peristalsis

Question 6

What does peristalsis inducate?

Answer 6

Probably viable

Question 7

In a foreign body, where is most of the bruising found

Answer 7

Proximal to the FB

Question 8

Which pattern do you suture the intestine with?

Answer 8

Simple continuous (more watertight) starting in healthy tissue

Question 9

Which material do you suture the intestine with?

Answer 9

3-0 or 4-0 PDS

Question 10

In which situations is short-acting material too short?

Answer 10

Lymphoma or damaged tissue

Question 11

What is the only holding layer in the intestines?

Answer 11

Submucosa - so need full thickness bites

Question 12

What are the indications for enterectomy?

Answer 12

Ischaemic bowel, intuss, tumour

Question 13

What margins do you need for a tumour?

Answer 13

3cm

Question 14

What is the minimum amount of healthy tissue needed?

Answer 14

A few mm

Question 15

How do you ligate the blood vessels for an enterectomy?

Answer 15

Double ligate and cut (one close to intestine, one further away)

Question 16

Which suture pattern do you use for an enterectomy?

Answer 16

Full thickness apposition pattern

Question 17

Why do you not suture an enterctomy all the way around?

Answer 17

Forms a purse string

Question 18

How do you line up an enterectomy?

Answer 18

Put two sutures at the start

Question 19

What do you do if there is a luminal size disparity?

Answer 19

Cut smaller side on diagonal or do a “fishmouth” (triangle of tissue)

Question 20

What is the indication for “serosal patching”?

Answer 20

For previous dehiscence - stitch wall of another part of intestine over the site

Question 21

What happens if you remove over 80% of the SI?

Answer 21

Small bowel syndrome - bacterial overgrowth and chronic diarrhoea

Question 22

Where are linear FBs found in cats?

Answer 22

Tongue

Question 23

Where are linear FBs found in dogs?

Answer 23

Pylorus

Question 24

Where are the perforations in a linear foreign bosy?

Answer 24

Along mesenteric border

Question 25

What can a distended SI be mistaken for on radiography?

Answer 25

Normal LI

Question 26

When should you start to feed after a GA?

Answer 26

Until fully recovered

Question 27

What should the starvation period be for LI surgery?

Answer 27

Long, with low residue diet.

Question 28

Do you do an enema for LI surgery?

Answer 28

No - solid faeces easier

Question 29

Do you give routine antibiotics for LI surgery?

Answer 29

Yes

Question 30

Why is LI healing slower?

Answer 30

More collagenase, poor blood supply, more mechanical stress

Question 31

How common is vomiting with LI issues?

Answer 31

Not

Question 32

What are more likely LI symptoms?

Answer 32

Tenesmus, dyschezia, haematochezia, diarrhoea, constipation

Question 33

Why is ultrasound less useful for the LI?

Answer 33

Gas artefacts

Question 34

What approach do you use if doing caudal surgery on the LI?

Answer 34

Pelvic symphysiotomy or osteotomy

Question 35

When is the only time you do a colotomy?

Answer 35

Biopsy

Question 36

How much of the colon can you resect?

Answer 36

All

Question 37

When might you resect the whole colon?

Answer 37

megacolon

Question 38

How can you prevent incontinence following rectal resection?

Answer 38

Save the last 1-2cm if possible, avoid damaging the nerve supply