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VETS4010 > Surgery > Flashcards

Surgery Flashcards

1
Q

Where is the stomach located in a dog lying in dorsal recumbency?

A

LHS under the rib cage. Dorsally and ventrally covered by the liver.

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2
Q

What are the 4 regions of the stomach?

A

Fundus, body, pyloric antrum, pyloric canal.

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3
Q

What section of the duodenum should you not cut out? What is located here?

A

Most proximal part of the descending duodenum (directly after pylorus).
Has bile ducts opening to the major and minor duodenal papillary ducts.

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4
Q

What techniques should you use during surgery of the GIT to reduce tissue trauma?

A

Stay sutures
Abdominal sponges - moist
Exchange instruments - sterile technique.
Atraumatic instruments - hands best.

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5
Q

Describe how to do a double layer suture of the stomach. Include suture type, and pattern

A

Absorbable - PDS, size 2-0 to 4-0
double layer; two inverting mucosa + submucosa then muscularis + serosa.
make sure there is no leakage by flushing.

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6
Q

Describe how to suture the jejunum. Include suture type, and pattern

A

Absorbable - PDS, size 2-0 to 4-0

single layer; appositional, main concern is having good apposition of the submucosal layer.

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7
Q

Procedure where you cut into the stomach lumen.

A

Gastrotomy

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8
Q

Procedure where you resect a portion of the stomach.

A

partial gastrectomy

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9
Q

Procedure where you suture the stomach to the body wall.

A

Gastropexy

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10
Q

Procedure where you remove the pylorus and anastomose the stomach to the duodenum

A

Billroth I

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11
Q

Procedure where perform a partial gastrectomy and plyorectomy then anastomose stomach to jejunum (Duodenum is still there but it a blind ending).

A

Billroth II

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12
Q

Procedure where you cut through the serosa and muscularis of the pylorus to increase the lumen diameter.

A

Pyloromyotomy

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13
Q

Procedure where you do a full thickness incision of the pylorus and reorientate the tissue to increase its diameter.

A

Pyloroplasty

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14
Q

Procedure where you create an artificial opening in the stomach

A

Gastrostomy

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15
Q

Where is the less vascular surface of the stomach?

A

Ventral surface (between the greater and lesser curvature).

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16
Q

How do you identify if tissue is viable or not?

A

Colour - dark/congested
Motility - loss in peristalsis
Thickness - Increased
Capillary perfusion - no bleeding at cut edges.

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17
Q

What is the best preventative technique for a GDV?

A

Gastropexy of the pyloric antrum to the RHS body wall

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18
Q

What is the best preventative technique for a hiatal hernia?

A

Gastropexy of the cardia to the LHS body wall.

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19
Q

What is the pathogenisity of a GDV?

A

Stomach twists –> prevents venous blood flow and trapped gas in stomach lumen. Pressure increase; intragastric and portal system –> systemic hypotension and cardiac arrest.
Also Decrease respiration due to stomach on diaphragm.

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20
Q

What are 7 predisposition of forming a GDV?

A 
Purebred giant-breed
deep thoracic cavity
Family history
Fed one large meal/day
Rapid ingestion
Exercise post eating
Male and older.
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21
Q

Surgical procedure for a GDV

A
  1. Decompress (tube > percutaneous)
  2. O2, anaesthesia, analgesia and fluids (NO ACE!)
  3. Reposition stomach + check spleen position
  4. +/- partial gastrectomy if see any non-vital tissue.
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22
Q

What is the most accepted Tx for hiatal hernia?

A

Medical Tx with PPI, H2-blockers and/or sucralphate.

Also diet change to lower fat and feed from a height.

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23
Q

What can cause a gastric ulcer?

A
  1. Renal disease (hypergastrinaemia)
  2. Hepatic disease (gastrin/histamines last longer, portal hypertension and thrombosis)
  3. NSAIDs (COX-1 inhibition –> less PGF2)
  4. Corticosteroids
  5. Neoplasia.
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24
Q

What is hypertrophic pylorogastropathy

A

Congenital = muscular hyperplasia –> obstruction
Acquired = mucosal +/- muscular hyperplasia
Both in pylorus.

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25
Q

How do you take a biopsy of the SI?

A

Dermal punch

Enterotomy (longitudinally)

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26
Q

How much SI can you remove in an enterectomy?

A

80% w/ ileocolic valve intact

50% w/out ileocolic valve.

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27
Q

What are some objective measure for SI tissue vitality

A

Fluorescein

Surface oximetry

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28
Q

How do you perform an enterectomy?

A

externalise section, pack off with laparotomy sponges (keep moist).
ligate and transect mesenteric vessels to the section of focus.
massage lumen material (unless FB) away from cut sites.
use crushing forceps at either ends of region going to cut out and atraumatic forceps/fingers on parts going to keep.
Cut out the section (arcadial pattern).

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29
Q

How do you perform an anastomosis of the SI?

A

join ends and start at the mesenteric boarder.
2nd suture at antimesenteric. Continue by the halving method to put remaining sutures in.
Check for leakage

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30
Q

What can you do if there is disparity of the lumen sizes during anastomosis?

A

Spatulation - longitudinal cut along anti-mesenteric boarder of smaller lumen. suture to other half starting at the end of the longitudinal incision.

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31
Q

What is serosal patching? What tissues are most commonly used?

A

Suturing serosal tissue to a sutured incision site to improve vasculature and security. Can use omentum or jejunum

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32
Q

What radiographic signs do you expect to see with a FB?

A

gas and fluid distention. May see the object depending on what it is made of.

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33
Q

What radiographic signs would you expect to see with a linear FB?

A

Tightly bunched up intestine into a ball with gaseous distention

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34
Q

What are four predisposing factors for intussusception?

A

Intestinal worms
Irritating material
Neoplasia
FB

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35
Q

What are the two tissue layer of an intussusception called?

A

Intussuscipien - outer layer

Intussusceptum - inner layer.

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36
Q

What is a preventative surgical procedure to reduce risk of intussusception? Why is it uncommonly done?

A

Enteroplication - suturing sections of the SI together in a mat of intestines.
Unpopular as it is difficult and high risk of fibrous adhesion.

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37
Q

What is a mesenteric volvulus?

A

Twisting of the bowel along the mesenteric axis –> strangulation, obstruction and ischaemia.

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38
Q

What is a key aspect you should remember when doing surgery on the LI?

A

Less collateral blood supply at caudal aspect (distal colon and rectum)

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39
Q

In dogs, which artery supplies the distal colon and the rectum?

A

Cranial rectal artery

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40
Q

In cats, which artery supplies the distal colon and the rectum?

A

cranial rectal a. to colon and rectum

middle and caudal rectal aa. to the more distal rectum.

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41
Q

What are the 3 major nerves that control the rectum and what are they responsible for?

A

Pudendal n - motor and sensory
Pelvic n - parasympathetic control
hypogastric - sympathetic control.

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42
Q

When does prognosis for colonic surgery greatly improve?

A

1 week post surgery.

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43
Q

How do you prep the bowel for operation?

A 
decrease content (fast)
Decrease bacteria (low residue/high calorie)
Prophylactic AM treatment 24hrs pre-op orally and 1 hour pre-op parenterally.
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44
Q

What is the procedure for caecal resection?

A

Typhylectomy

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45
Q

When performing a typhylectomy what anatomical structure do you need to make sure stays intact?

A

ileocolic junction.

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46
Q

What is the most common cause of megacolon in cats?

A

Idiopathic; gradual smooth muscle degeneration, is irreversible.

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47
Q

What are example of acquired causes of megacolon? (2)

A
  1. Hypertrophic when the lumen becomes obstructed –> muscular hypertrophy –> dilation.
  2. Neurogenic when there is damage to the spinal cord or pelvic n. (congenital in Manx cats)
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48
Q

What is the best Tx for megacolon especially if it is chronic?

A

Partial colectomy

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49
Q

What is the best treatment for neoplasia in the colon?

A

usually medical Tx as most neoplasia is malignant. Can resect after medical Tx.
Sx often only palliative care.

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50
Q

Why would you do a colopexy?

A

rectal prolapse, only if all the tissue is viable.

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51
Q

When performing an anal sacculectomy what are your major objectives? (5)

A
  1. pre-operative inflammation reduction.
  2. Don’t damage surrounding structures (sphincters, arteries and nerves)
  3. Pain relief
  4. Never operate on inflamed sacs.
  5. Don’t leave anything behind.
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52
Q

What makes an anal sacculectomy open or closed? Which one is better for larger dogs and why?

A 
Open = when making incision over the probe pushing the sac out, cut into the sac to expose its lining. remove sac and ducts
Closed = incision over pushed out probe but not into the sac. Ligate the duct and cut out the sac. Best in big dogs as their sacs go down deeply.
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53
Q

What % of oral tumours are malignant?

A

50%

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54
Q

What are the 4 most common oral tumours in dogs in order from 1st - 4th.

A

Malignant melanoma (MM)
SCC
Oral fibrosarcoma
Oral osteosarcoma (oral OSA)

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55
Q

What are common characteristics of malignant melanoma tumours in dogs?

A

Firm black mass (unless almelanomic which is more difficult to Dx).
Usually buccal, gingiva or lip mucosa.
Bone lysis
No ulceration.

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56
Q

What are some common characteristics of oral SCC in dogs?

A

Cauliflower
Ulcerated
Bone lysis

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57
Q

What location of oral SCC provides the best Px?

A

Rostral, on the mandible and in a young animal.

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58
Q

What is the most common oral neoplasia in young dogs?

A

Oral fibrosarcoma

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59
Q

What are some common characteristics of oral fibrosarcomas in dogs?

A

flat, firm, unulcerated, multilobulated and deeply attached. Bone lysis but rare met.

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60
Q

Treatment of oral fibrosarcoma

A

Sx only, Chemo and Radiation are pointless

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61
Q

What are epulides?

A

odontogenic tumours origination in te peridontal ligament.

62
Q

What are the three types of epulides?

A

Fibrous, ossifying and acanthomatous amelioblastoma.

63
Q

Best treatment for ossifying epulide

A

conservative excision, remove any associated teeth.

64
Q

Best treatment for acanthomatus amelioblastoma

A

Sx w/ 1cm margins, +/- Rx.

65
Q

What is the most common oral tumour in cats?

A

SCC

66
Q

What is the treatment protocal for a cat with oral SCC?

A

Sx and Rx.

67
Q

What oral cancer has an immunotherapy option available for treatment?

A

Malignant melanoma

68
Q

What is a primary cleft palate?

A

Only involves the lip, premaxillar and incisive alveolar ridge.

69
Q

What is the best time to Tx a primary cleft palate?

A

At 6mths or when fully grown.

70
Q

What is a secondary cleft palate?

A

Can involve the palatine, maxillary and incisive bones –> nasal and oral cavities not separate.

71
Q

How is it best to treat a secondary cleft palate?

A

recognise early so neonates do not get pneumonia.

hand feed with longer teat, and stomach tube post weaning until dog is 4-5 month.

72
Q

Surgical technique to close a soft palate celft

A

2 layer of muscle and mucosa.

73
Q

Surgical techniques to close secondary cleft palate.

A 
Surgical flaps:
Rotating
Sliding 
Over-lapping
Modified split U-flap.
74
Q

What is the best Tx for cervical mucocoeles?

A

Extraction of the mandibular and sublingual salivary glands. Remember to get both parts of the sublingual gland.

75
Q

Describe the pharyngeal mucocoele

A

Is a modified cervical mucocoele (origin from same glands). It is more serious as can cause stridor and dysphagia.

76
Q

Why does surgery of the oesophagus have higher risk than other parts of the GIT?

A
  1. Adventitia not serosa so poor healing abilities.
  2. Strong muscular contractions increasing stress on suture site
  3. Segmental blood supply not collateral
  4. Major nerves surrounding it –> increased risk of damaging them.
  5. No omentum
77
Q

What techniques can be done to increase oesophageal surgery success?

A
  1. Gentle handling
  2. Appropriate suture pattern for tension
  3. Good tissue apposition
  4. Gastrostomy tube feeding
  5. Omentum patch to heal healing
78
Q

What is the ideal suture pattern and type for oesophageal surgery?

A

1 or 2 layers appositional.
1st muc and subm layer knots left intraluminal.
2nd layer knots extraluminally.
Size = 2-0

79
Q

What is the post op treatment for oesophagotomy and oesophagectomy?

A

Oesophagotmy –> NPO for 24-48 hrs

Oesophagectomy –> NPO for 7 days (need gastrostomy tube).

80
Q

What tissues can you use for oesophageal patching?

A

Omentum, pericardium, local mucosal flap, stomach or GIT.

81
Q

How do you know when there has been an oesophageal laceration that requires surgery?

A

If can see subcut oedema/free gas in the thorax or mediastinum.

82
Q

What treatment is best for neoplasia in the oesophagus

A

Very poor Px, usually too late and surgery is pointless.

1cm excision if benign.

83
Q

What are some indications of a splenectomy?

A 
Mass
Splenitis
Extramedullary haematopoiesis
Infarction
Torsion 
Trauma
84
Q

What is the 2/3 rule in spleen tumours in dogs?

A

2/3 malignant, 2/3 of these will be HSA, LSA or histiocytic sarcoma.

85
Q

What clinical test can tell you if a ruptures spleen is acute or chronic?

A

Comparing the PCV of abdominocentesis and the blood. If RBC higher in abdomen = chronic.

86
Q

How do you stage HSA in dogs?

A 
I = In spleen only
II = Rupture +/- RLN
III = RLN inclusion and other tissues.
87
Q

What are the 2 most common tumours seen in cat spleen?

A

MCT and LSA.

88
Q

What are indications for enteral feeding?

A 
Prevent complicated starvation --> catabolism
Prevent decreased wound healing
Prevent weight-loss
Maintain immunity
Prevent malnutrition
Maintain GIT integrity
89
Q

How is the metabolic rate affected if an animal becomes severely ill?

A

Metabolism decreases

90
Q

When should you consider putting an animal onto enteric feeding?

A

Before late stage of anorexia (10% body weight loss, hypoprotein, coagulopathy)
3-5 days of anorexia,
When animal has illness or injury that will reduce its want to eat… trauma, sepsis, burns, major GI Sx.

91
Q

How should you start an enteral feeding program

A

give < recommended RER and slowly increase over 3 days.

Heat up the food before feeding.

92
Q

How frequently should you check for residual volume in CRI enteral feeding?

A

Check for residual volume every 8 hrs.

93
Q

What is the average daily feeding capacity?

A

15ml/kg.

94
Q

When should you give meds with enteral feeding?

A

always before feeding, unless it is a phosphorous binding drug, then give it during feeding.

95
Q

What are the 3 forms of cholecystitis?

A

Bacterial, necrotising and emphysematous

Transition from bacterial to emphysematous with chronicity.

96
Q

What is a risk associated with the development of necrotising cholecystitis?

A

Higher risk of rupture.

97
Q

What are some predispositions for cholelithiasis?

A 
Cholestasis
Increased mucin
Bacteria
Trauma
Haemolysis.
98
Q

What biochem and blood test finding would you expect to see with EHBO?

A

Low vitamin K and coagulopathies.

99
Q

Is it a good idea to do a cholecystocentesis?

A

There is a high risk of rupture or leakage even if it is done with U/S guidance and pass the needle through the liver.
DO NOT DO if there is a GBM.

100
Q

What should you check before performing a choleocystectomy?

A

Make sure the CBD is patent.

101
Q

What should you warn the owner before doing the operation?

A

MST ~1-2 yrs

Poorer Px = pancreatitis and biliary diversion (and GB rupture for An’s Q not Jayne’s)

102
Q

What is the best technique when performing a partial pancreatectomy?

A

Blunt dissection and ligation of the vessels

103
Q

What are some indications for partial pancreatectomy?

A

focal lesions

enucleated small tumour

104
Q

How would you perform a total pancreatectomy?

A

Bilroth II, and a cholecystojejunostomy

105
Q

What are 5 diseases that can occur in the pancreas?

A 
Abscess
Pseudocyst = blood and pancreatic juices
Insulinoma
Gastrinoma 
Pancreatic carcinoma
106
Q

How do you treat a pancreatic pseudocyst?

A

partial pancreatectomy

107
Q

What tests should you run before a liver surgery?

A

Coagulation test!

108
Q

What is the best way to suture up liver after a partial or total lobectomy?

A

Staples!

109
Q

How should you cut the liver when doing partial lobectomies?

A

Bunt dissection so can ligate and cauterise vessels and fracture parenchymal vessels (reduce bleeding).

110
Q

Should you use AMs during liver surgery? If so when is it indicated?

A

Yes! as Clostridial bacteria often resides in the liver, surgery could stimulate their proliferation.
Esp indicated in abscess, bacterial hepatitis or PSS.

111
Q

What anaesthetic factors should you consider when doing surgery on the liver?

A

It will have decreased function therefore process anaesthetic drugs slower.

112
Q

What anaesthetic drugs should you not used with liver surgery?

A

Ace and thiopental.

113
Q

What surgical technique is used to fix an extrahepatic PSS?

A

vessel attenuation
Use cellophane, ameroid, coil embolism.
Remember to measure the portal blood pressure (avoid too high hypertension).

114
Q

When is a dog considered to be experiencing dystocia?

A 
>4hrs post stage 2 (Stage 2 = water break)
>30mins strong contractions w/o pups
>2hrs btwn deliveries
Lochia post 1st pup
Significant blood loss
Shock/collapse/acute abdo pain.
115
Q

How do you check to make sure the dog is in parturition?

A

Ferguson’s reflex (vagina and uterine contractions)

U/S and rads

116
Q

suture pattern and material for cesarian (hysterotomy)

A

3-0 to 4-0.

Appositional mucosa + submuc then inverting muscularis and serosa.

117
Q

En block ovariohysterectomy

A

prep the ovarian pedicles and large vessels in the broad ligament.
Double clamp, take pups out then double ligate to take everything out.

118
Q

What is the risk of pyometra and surgical removal?

A

Uterus becomes more friable, need to be very gentle to not rupture and expose the abdomen to the purulent material –> peritonitis. lavage the abdomen and suction at the end.

119
Q

What are some vaginal operations called?

I.E. cutting into it, altering the structure.

A

episiotomy

episioplasty - what I saw at AREC.

120
Q

What are some causes of prostatic enlargement?

A

hyperplasia, neoplasia, metaplasia, abscess, cyst or inflammation.

121
Q

What causes prostatic hyperplasia?

A

excessive GnRH

122
Q

What are some common neoplasia of the testes?

A

Epithelial
smooth muscle
Adenocarcinoma
Vascular.

123
Q

What is a paraphimosis and how do you treat it?

A

inability to retract the penis.

Emergency –> castrate, amputate, phallopexy or preputiotomy.

124
Q

What is a phimosis?

A

Inability to extrude penis

125
Q

What is a hypospadias?

A

Incomplete development of the urethra and penis.

126
Q

How does a urethral prolapse occur?

A

Excessive sexual excitement, UTI

127
Q

What are the most common types of penile tumours? and what is each ones respective treatment?

A

MCT - Sx +/- Chemo/Rx
SCC - Sx +/- Chemo/Rx
TVT - vincristine.

128
Q

Where is the best place to check for haemorrhage during a OVH?

A

look in the renal gutters (use omentum to scoop the viscera and hold to one side)
If the bleeding is serious then you will see clotting.

129
Q

What is the different between open, closed and modified closed castration in dogs?

A

Open = cut open T. vaginalis
Closed = don’t open T. vaginalis, ligate spermatic cord (don’t separate the vessels and ductus deferens)
Modified closed = open T. vaginalis at spermatic cord. Double ligate separated ductus def and vessels cut testis out surrounded in T. vag.

130
Q

What is the different between open, and closed In cats?

A

Open cuts the T. vaginalis, closed doesn’t. Open separate the vessels and ductus def in the spermatic cord.

131
Q

What are some common patterns of Cryptochidism?

A

Dogs > cats
RHS > LHS
Heritable
Assoc. w/ hip dysplasia and hernias

132
Q

What are some functional markers of the liver? What direction will they go with decreased productivity?

A 
Biliruben (up)
Cholesterol (down if hepatocell orig up if cholestatic orig)
Protein (down)
Glucose (down when more severe/chronic)
Urea (down)
133
Q

What would you expect with a pre and post prandial bile acid test? why expect these results?

A

Expect it to be higher post prandial as the liver cannot break it down to recycle it, so it backs up into the blood.

134
Q

What is a contra-indication for the post prandial bile acid test?

A

Bilirubinaemia, because this is already an indicator of the pathway being slowed down/obstructed.

135
Q

What is the clinical significance of bilirubinuria in dogs and cats?

A

Dog can sometimes be insignificant

Cats it is always significant.

136
Q

What are some toxins for the liver in dogs? (6)

A 
Pb
NSAIDs
Zn
Chemo 
Cycads
Cu (usually more chronic) more in sheep
137
Q

What is cirrhosis of the liver? What concurrent problems occur due to it?

A

End stage of inflammation when it starts to fibrose and become smaller.
Blood flow more resistant therefore portal hypertension. and less functional tissue therefore altered metabolism.

138
Q

What is microvascular dysplasia? When does it need surgical attention?

A

hyperplasia of portal vein.

Only require Sx if see CSx of hepatoencephalitis.

139
Q

What is vacuolar hepatopathy?

A

Is a glycogen storage disorder, see vacuoles of glycogen in hepatocytes.

140
Q

What are common clinical signs and blood work signs of vacuolar hepatopathy?

A

Usually w/o CSx, accidental finding with blood biochem –> very high ALP.

141
Q

What % of hepatic neoplasia is malignant and what are the most common malignant and benign tumours (1 each)?

A

50% malignant
Adenocarcinoma (mal)
Adenoma (ben)

142
Q

Is 1° or 2° liver neoplasia more common in cats?

A

2° liver neoplasia infiltrative is more common in cats. (lymphoma).

143
Q

What are the 2 different types of cholangitis and cholangiohepatitis? How do they occur?

A

Supporative - bacteria –> neutrophils

non-supporative - immune –> lymphocytes

144
Q

What are some causes of hepatic lipidosis?

A

Obese cat –> starvation
IBD
DM
Pancreatitis

145
Q

What is the best treatment for hepatic lipidosis?

A

Good nutrition
Treat underlying issue
IVFT

146
Q

What are some common liver toxins in cats?

A

Paracetamol
azole antifungal
tetracyclines
diazepam

147
Q

When planning nutrition for animals that have liver issues you should decrease protein in diet by only a small amount. However this is contradicted in what pathological process?

A

If the animal has hepaticencephalopathy then you need to drop protein levels more drastically as there is too much ammonia in the blood.

148
Q

What makes a hernia a true hernia?

A

True is due to a congenital weakness and has a hernia sac.

149
Q

What are the most common locations for a traumatic diaphragmatic hernia?

A

Near caval foramen and oesophageal hiatus.

150
Q

What is a congenital diaphragmatic hernia?

A

peritoneo-pericardial hernia.

151
Q

What is a good radiographic pattern to give away there is a diaphragmatic hernia?

A

Loss of the diaphragmatic silhouette.

Poor cardiac silhouette

152
Q

What is the difference in tissue strength in a chronic or acute hernia?

A

Chronic has had time to firbrose therefore tissue is tougher

Acute hernia the tissue is weaker so need to take larger suture bites.

VETS4010 (4 decks)

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